Behavioral And Cognitive Approaches In The
Management Of Anxiety
Compare and Contrast Behavioural and Cognitive Approaches in the Management of Anxiety
The Behavioural Model sees the cause of abnormality as the learning of maladaptive habits. It aims to discover, by laboratory experiment, what aspect of the environment produced this learning, and it sees successful therapy as learning new and more adaptive ways of behaving. There are two kinds of basic learning processes that exist: Operant and Pavlovian conditioning. These have generated a set of behavioural therapies.
Pavlovian or Classical therapies begin with the assumption that emotional habits have been acquired by the contingency between a conditioned stimulus and an unconditional stimulus. The formerly neutral conditioned stimulus now produces a conditioned response, which is the acquired emotion. Two Pavlovian therapies, Systematic Desensitisation and Flooding, extinguish some maladaptive emotional habits quite successfully.
Systematic Desensitisation is a behaviour therapy primarily used to treat phobias and specific anxieties. The phobic is first given training in deep muscle relaxation and is progressively exposed to increasing anxiety-evoking situations (real or imagined). Because relaxation and fear are mutually exclusive, stimuli that formerly induced panic are now greeted calmly. A classic demonstration of this therapy was carried out by Jones (1924). She successfully treated a young boy's fear of rabbits by having him eating in the presence of a rabbit, while gradually bringing the rabbit closer to him over a number of occasions. The encourage of a pleasant response such as eating is incompatible with fear.
In Flooding the phobic is exposed to situations or objects most feared for an extended length of time without an opportunity to escape. In one study, agoraphobics went through several sessions in which they had to go out into the street and walk alone until they could no longer manage. A few such sessions led to a marked improvement as judged by both client and therapist (Emmelkamp and Wessels ,1975). In flooding, the treatment is carried out in vivo, that is, in real life. But, real-life exposure to threatening stimuli is often impossible or impractical. It's not all that easy to bring snakes and dogs into a therapist's office to do flooding therapy. Under the circumstances, the next best thing is in vitro, in a simulation, and refers to the use of imagery. One example is implosion therapy, and the patient must imagine the most terrifying situation he could possibly conceive.
Another behaviour therapy technique, Aversion therapy, tries to attach negative feelings to stimulus situations that are initially very attractive so that the patient will no longer want to approach them. The object of this endeavour is to eliminate behaviour patterns that both patient and therapist regard as undesirable. Examples are overeating, or excessive drinking.
Operant conditioning is based on three concepts: Reinforcer, operant and discriminative stimulus. Operant therapies are based on the assumption that people acquire voluntary habits by positive reinforcement and punishment. Operant therapies provide new and more adaptive repertoires of voluntary responses. Among such therapies are Selective Positive Reinforcement, Selective Punishment and Extinction. In Selective Positive Reinforcement the therapist delivers positive reinforcement contingent on the occurrence of one particular behaviour. In Selective Punishment, the therapist negatively reinforces a certain target event, causing it to decrease in probability. Extinction occurs when there is a negative contingency between the conditioned stimulus and the unconditioned stimulus. These three techniques have all been applied with success to such disorders as Anorexia Nervosa, a disorder in which the individual has an intense fear of becoming fat, eats too little to sustain herself, and has a distorted body image.
Avoidance Learning, the act of getting out of a situation that has been previously associated with an aversive event, there by preventing the aversive event, combines operant and Pavlovian theory, and helps us in the treatment of obsessive-compulsive disorders.
Cognitive school is an outgrowth and reaction to the behavioural school. In contrast to the behaviourists, the cognitive school holds that mental events are not epiphenomena, rather they cause behaviour. More particularly, disordered cognitions will alleviate and sometimes cure psychopathology. Cognitive therapy is carried out by attempting to change different sorts of mental events, which can be divided into short-term mental events and long-term mental events. Some short-term mental events consist of expectations, including outcome (a person's estimate that a given behaviour will lead to the desired outcome) and efficacy expectations (a person's belief that he can successfully execute the behaviour that will produce a desires outcome). Other short-term mental events are appraisals, or mental evaluations of our experience, and attributions, the designations of causes concerning our experience. Long-term mental events include beliefs, some of which are irrational and illogical.
The main components to cognitive therapy are education, identification of negative automatic thoughts and challenging dysfunctional schemata. In education, the individual may have little information about anxiety, or may have mistaken information such as a belief that a panic attack is the same as a heart attack. A key step in cognitive therapy is helping the individual to identify the negative automatic thoughts that are intimately connected with feelings of depression and anxiety. These may be identified in the clinical sessions themselves, for example, by asking the individual to role-play a difficult encounter, or they can be identified in homework by asking the individual to keep a diary of such thoughts in the situations in which they arise. Once identified, the individual is then encouraged to test their validity, to question them, and to check for the evidence for and against. The identification and challenging of negative thoughts leads into the final phase of cognitive therapy which is challenging the dysfunctional schemata that underlie the negative thoughts.
Many therapists practice both cognitive and behavioural therapy and are called cognitive-behavioural therapists. Multi-model therapy is an example of the use of cognitive and behavioural techniques along with techniques from the other models.
Thus, behavioural therapy is concerned with unwanted, overt behaviour rather than hypothetical underlying causes. Techniques used are derived from classical and instrumental conditioning. Cognitive therapies are for internal anxieties. The therapy is concrete and of a directive orientation , but there is no emphasis on conditioning. It tries to change the way the patient thinks about his/her situation. Other types include various attempts to advance the patients social education, using techniques such as graded task assignments, modelling and role-playing.
However, phobias and obsessive-compulsive disorders are dominated by the behavioural approach and anxiety by the cognitive approach.
Comer,R (1992) Abnormal Psychology. U.S.A.:W.H.Freeman and Company.
Emmelkamp & Wessels (1975) "Flooding in imagination vs. flooding in vivo: A comparison with agoraphobics". Behaviour research and therapy (13) 7-15.
Rosenham,D & Seligman,M (1989) Abnormal Psychology. London: W.W.Norton & Company Ltd.