Monday, March 12, 2007

Behavior Therapy

[Episode 12] In this lecture, I focus on the concepts of stimulus and response, rewards and punishments, and how these concepts make operant conditioning such a powerful approach to behavior change. Also in this lecture I touch on classical conditioning, social learning theory and cognitive behavior therapy. The role of the therapist, client, expectations for treatment, implications for multicultural treatment, and the strengths and limitations of the approach are covered.

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Hello and welcome.  You found The Social Work Podcast.  My name is Jonathan Singer and I'll be your host as we explore all things social work.

Behavior therapy has its roots in experimental psychology and as a result places a value on what's observable and measurable above all else.  In research, if you can measure something directly, it's called a manifest or observed variable.  In contrast, variables that have to be measured indirectly are called latent variables. So how do these research concepts apply to behavior therapy and therapy models that we've looked at in general?

Freud believed that therapy should focus on the unconscious which by definition is something that we cannot directly observe or measure.  Freud who is trained as a doctor and a scientist recognized the need for evidence to support his theories, so he pointed to slips of the tongue and dreams as manifestations of the unconscious.  So these were his latent variables.

Likewise, Carl Rogers believe that three unobservable qualities, unconditional positive regard, genuineness and empathy were the necessary and sufficient conditions for change.  Because we cannot see, hear, taste or touch these ideas, they too are considered latent variables.  Now in the 1940s and 50s behavior such as Wolpe in South Africa, Eysenck in England and Skinner in the USA argued that the focus of treatment should be on what we can observe and measure.

Rather than focusing on latent variables, behavior therapy focuses attention on the observable variables.  The bottom line is that if somebody wants to change his or her behavior then behavior is believed that the focus of treatment should be on behavior.  So if your client is anxious in social situations, behaviorists argued that the most ethical and expedient approach to treatment would be to reduce your client’s anxiety in social situations by addressing what was observable such as heart rate, number of interactions with others, etc. etc.

This is in contrast to what Rogers or Freud might have done which would be exploring repressed sexual content or exploring the meanings that your client gives to social situations.  Behavior therapy is based on principles of learning that are systematically applied.  For example, treatment goals are specific and measurable.  The basic goal of behavior therapy is to help people change maladaptive behaviors into adaptive behaviors.

In contrast to the psychodynamic and insight oriented therapies, behavior therapy is largely educational.  Teaching client skills of self management, the therapist is more of a coach or a teacher rather than a Sherpa guiding you through the vast unknown of your unconscious.  Now Corey talks about four aspects of behavior therapy including classical conditioning, operant conditioning, social learning theory and cognitive behavior.

We'll spend the next few minutes talking about the similarities and differences between these four aspects of behavior therapy.  The remainder of the lecture however will focus mostly on the principles derived from operant conditioning and of course we'll devote an entire lecture to cognitive behavioral therapy.

One of the most basic ideas in behavior therapy is that specific behaviors are responses to specific stimuli.  The more strictly behavioral, the more you will emphasize the importance of the stimulus and response.  Whereas the more cognitively focused behaviors will emphasize the internal processes of the organism.

Classical Conditioning:  You’ve probably heard of the famous experiment by the Russian scientist Pavlov where he rang a bell and a dog salivated.  This is a classic stimulus response experiment.  The theory behind that experiment is called classical conditioning.  Here's how it works:  As animals, we have unconditioned responses to unconditioned stimuli.

For example, when we smell food which is an unconditioned stimulus, we start to salivate and that’s the unconditioned response.  That is our bodies involuntarily prepare to consume and digest food.  If I introduced a stimulus such as the sound of a bell, you would have no innate involuntary response to that sound.  If however, I paired the unconditioned stimulus, the plate of food with the conditioned stimulus, the ringing of a bell, you’d find yourself salivating at the same time that the bell was being rung.

At first, the salivation would not be due to the bell, however over time if I were consistent in the pairing of the unconditioned stimulus, the food and the conditioned stimulus, the bell I could take away the food and make you salivate just by ringing the bell.  At that point, salivation will be considered a conditioned response because it occurred as a result of a conditioned stimulus wholly in the absence of the unconditioned stimulus.  And if you're not convinced about this, we'll revisit this idea later on in the lecture.

Operant Conditioning: Operant behavior theory is associated most closely with the work of B. F. Skinner.  In his classic 1953 text Science and Human Behavior, Skinner says that the word operant “emphasizes the fact that the behavior operates upon the environment to generate consequences.”  Whereas in classical conditioning, behavior change was brought about by modifying the stimulus, in operant conditioning behavior change is brought about by modifying the response.

Gerry Corey summarizes this point nicely when he says that if the environmental change brought about by the behavior is reinforcing, the chances are strengthened that the behavior will occur again.  If the environmental change has produced no in reinforcement, the chances are lessened that the behavior will reoccur.

Reinforcement and Punishment:  Because operant conditioning focuses on the consequences of behavior, the concepts of reinforcement and punishment are central to understanding how behavior change occurs.  Alan Kazdin in his 2004 text Parent Management Training notes that the general public uses the word punishment to mean something different than do behavior therapists.

A general definition of punishment is that it's a penalty imposed for performing a particular act.  In contrast, behaviorists see punishment as either the presentation or removal of a stimulus or event following a response and the presentation or removal decreases the likelihood of a response.  In other words, punishment has the specific function of decreasing a behavior.

Let's take a minute and look at four types of responses to behavior.  The first is positive reinforcement.  This one is pretty easily understood.  You engage in a behavior, you get something that you like in return and if that happens you're more likely to engage in that behavior in the future.  For example, you spend many hours reading the chapter and you take a quiz and you do well on the quiz, then you're more likely to put time into doing the reading in the future.

In contrast, if you're presented with an aversive event, something you don’t like say failing the quiz then you're less likely will engage in the same behavior.  In behavior theory, this is called positive punishment otherwise known as getting something that you don’t like.  Other examples of positive punishment are getting a spanking, getting a speeding ticket or getting a physical injury such as a torn ligament or shin splint as a result of not doing enough stretching.

So remember that anytime you get something in response to your behavior, it's called positive whether it encourages the continuation or the extinction of a behavior.  What happens when something is removed as a result of your behavior is called a negative response.  So the third type of response would be a punishment by removing rather than adding something.

This is called negative punishment and parents use this approach to punishment all the time when they take away a toy or a video game or send their child to bed without supper.  The idea is that if the kid knows that they will lose something they like in response to a particular behavior then they're not going to engage in that behavior anymore.

The final response to behavior is when something you don’t like removed which actually encourages more of the behavior.  This is called negative reinforcement.  An example of this is when let's say a kid hates going to school, he acts out in school and he’s suspended and has to go home.  Well, the kid prefers home to school, so the removal of school actually reinforces his behavior and therefore increases the likelihood that this problematic behavior will incur again in the future.

This is possibly one of the reasons why in-school suspension has become a popular alternative in the last 15 or 20 years.  Kazdin notes that there are many interesting combinations of positive and negative reinforcement in everyday interactions.  Consider two examples from parent-child interactions.  We begin in a supermarket where a parent is waiting in line to check out groceries.

In the checkout line with the parent is a five-year-old girl.  The child sees candy and asks the parent if she can have some.  The parent ignores this and says no.  And let us say that the child escalates a little and begins to whine, cry and tug at the parent’s clothing while saying in the most annoying and loud voice, “I want some candy”.  Suppose the parent says all right, all right, here's the candy and hands the child a candy bar from the rack.

What's the positive and what's the negative reinforcement?  The child’s behavior whining, tugging at the parent and repeatedly insisting on candy was associated with a positive consequence, getting candy.  That is positive reinforcement of the child’s behavior.  The parent’s behavior giving the candy to the child was associated with the immediate termination of an aversive event, whining.

That is negative reinforcement of the parent’s behavior.  Such combinations of positive reinforcement are common in everyday situations without the mild drama of a grocery store tantrum.  Skinner argued that reinforcement was better for behavior change than was punishment.  And there are two types of reinforcements.  And the first is continuous and this is when reinforcement occurs in response to every behavior.

This is better for establishing new behaviors.  For example, you want to reinforce your three-year-old daughter learning how to tie her own shoe.  If you give her a hug or if you compliment her every time she ties her shoe correctly then you're giving continuous reinforcement.  Let's say that you ignore her four out of five times that she correctly ties her shoes, it's less likely that she’s going to learn that new behavior because it's not being continuously reinforced.

Alternately, there is intermittent reinforcement and that’s when reinforcement occurs occasionally.  Now, intermittent reinforcement although worse for the development of new behaviors is actually a more powerful type of reinforcement when you want to maintain existing behaviors.  The classic example of intermittent reinforcement is slot machines.

Slot machines provide reinforcement on an intermittent schedule.  Sometimes putting money in is reinforced with a win and sometimes it's not.  The result is the people tend to gamble more.  The ultimate goal of any behavior modification program is to eliminate the reinforcer and maintain the new behavior.  On page 54 of his 2004 text, Parent Management Training, Alan Kazdin indentifies four types of reinforcers and discusses their strengths and limitations.

Although these reinforcers are discussed within the context of interventions with children, the general categories and their respective strengths and limitations apply to behavior modification programs for people of all ages.  The first type of reinforcer is things we consume such food or gum.  Some of the strengths are that they're immediate and they're useful in one-on-one sessions.

Kazdin notes that one of the biggest limitations is that consumables only work if the person is deprived or not satiated.  For example, food is not a strong reinforcer if someone isn't hungry.  If I don’t want the candy then having it as a reinforcer won't motivate me to change my behavior.  Another limitation is they’re often objectionable to therapists, parents and teachers and they're not feasible in group settings or everyday life on a frequent basis.

Another type of reinforcer is social reinforcers and these would be attention, praise, physical contact, etc.  One of the good things about these is that they're really easy to administer in group or individual situations and they're not as readily subject to deprivation and satiation states in the same way that food is.  Some of the limitations is there usually but not always a reinforcer.

They're not easily administered on a consistent basis if the parent, teacher, staff or somebody is not well trained or monitored.  A third type is privileges and activities.  For example, what the child does during free time when given a choice.  These are highly reinforcing and relatively easy to identify.  So if your kid loves to run off and play video games that would be a privilege and activity that would be pretty easy to identify as reinforcer.

The problem is that these reinforcers are hard to administer immediately.  They're also difficult to divide or parcel out into smaller reinforcers.  If your child does half of what he was supposed to do, it doesn’t work to reinforce that behavior with half a movie or let him play half a level in a video game.  Limitations of availability unless present in everyday life, for example watching TV, later bedtime, time with friends and finally some of these activities that could serve as a reinforcer maybe objected to by the therapists, parents and teachers, for example, violent video games or spending time in chat rooms.

And then finally tokens which could be also called points or chips or star charts and these are backed up by other reinforcers, any of the ones that we've just discussed here.  These are highly reinforcing token economies are they work really well because they're not usually dependent on any type of deprivation state and they can be used for one or more individuals.

So you can use them with your only child or you can use them with an entire floor of inpatients.  Now, the limitations of the tokens are that they require a medium of exchange.  For example, if you get five stars on a chart then you get this in exchange.  Requires backup reinforcers and anything that we've talked about thus far, food, social reinforcement, privileges and activities need to be exchanged for the tokens or the points and it requires ultimately eliminating the token so the behavior is performed without a special program.

So let's now look at social learning theory.  This is a theory that touches slightly on cognitive aspects that we're going to talk more about in the next lecture, but it's an important piece of behavior theory that we want to focus on.  Although the first fully developed social learning theory was proposed by Julian Rotter in 1954, the name and the date most closely associated with social learning theory today is Albert Bandura in 1977, the year that he wrote his text Social Learning Theory.

Bandura’s theory combined the stimulus response understanding of behaviorism with cognitive processes.  Bandura’s work argued that there is a continuous reciprocal interaction among the person, behavior and the environment.  There can be no influence without subsequent change.  As Bandura pointed out, “this conception of human functioning neither casts people in the role of powerless objects controlled by the environment nor as free agents who can become whatever they choose.”

This is a quote that directly relates to the radical behaviorism of Skinner for which there's the criticism that it leaves out the idea of free will as well as the criticism of the existentialist and the humanist, for example Carl Rogers or Rollo May for whom the extreme of their theory would suggest that people can become whatever they choose regardless of the environment.

One of the most valuable contributions of social learning theory is the concept of self-efficacy.  The basic idea behind self-efficacy is that we believe that by doing something we can change something else and if this sounds consistent with behaviorism, in a sense it is because there's that idea of stimulus response.  The cognitive piece is the piece where we believe that we can do something.

Now, there are two components to this idea.  The first is that we believe that we can do something.  Bandura called this efficacy expectation.  And the second is that we believe that the desired change will occur as a result of our actions.  And Bandura called this outcome expectation.  This concept is invaluable in understanding how someone might be fully capable of doing something like a child completing their homework on time or an adult abstaining from alcohol, but that they believe that there's no point in doing that behavior because doing that behavior they believe will not achieve the desired outcome.

And this is the point in treatment where you can intervene and say ahh, let's take a look at your self-efficacy, cognitive behavior therapy.  Now, although we're going to spend an entire lecture on CBT, it's important to know that CBT derives from behavior therapy and not the other way around.  CBT emphasizes cognitive processes and private events such as client self-talk as mediators of behavior change.

Now, a mediator is a research term and it's a variable through which an independent variable goes in order to influence the dependent variable.  For example, let's say you're working with a woman who does phone sales for a living.  In order for her to make a sale, she has to make a call.  Skinner would suggest that her likelihood of engaging in that behavior is contingent upon the reinforcement she’s received from past phone calls.

If she has called potential buyers and has been unsuccessful in making a sale, she would have gotten negative reinforcement for making phone calls and therefore be less likely to engage in that behavior.  CBT however would say that the direct relationship between the behavior and the response is mediated by a third variable and that third variable is the cognitive process.

Your client might very well be thinking you know I'm a terrible saleswoman.  No one ever buys anything from me even though 10% of her phone calls actually result in sales.  CBT would say that the likelihood of her success is due in part to the way that she thinks about herself and her job.  Therefore, it's not enough to focus on the behavior and the response alone, you also have to address the internal processes, the thoughts, the negative self-talk in this situation.

Corey has identified 10 key characteristics of behavior therapy.  The first is that it's based on a scientific method.  The second is that the focus is on current problems and factors influencing them.  Third, clients have to assume an active role.  Fourth, therapists teach client skills of self-management.  Fifth, therapists assess overt and covert behavior directly.

Again, this refers back to that idea that we're talking about in the beginning of manifest and latent variables.  If you can observe something, if you can touch, taste, smell it, if you can measure it directly then you're in line with the behaviorist ideals.  Six, behavior therapy emphasis a self-control approach in which clients learn self-management strategies.

Seven, individually tailored solutions are found to specific problems.  Eight, the relationship is collaborative.  There is a partnership between the therapist and the client.  Nine, the emphasis is really on practical applications.  There's no deep-seated personality change here.  It's all on okay, so when you go to work, how are you going to make your day better.

And then finally, there are culture-specific procedures, therapeutic goals.  The therapeutic goals include increased personal choice and to create new conditions for learning.  Assessment and treatment occur together.  There's a formal assessment that takes place prior to determining the treatment behaviors that are targets for change.  On page 234 of Corey’s text, we find Cormier and Nurius’ description of how goals are selected in a behavior therapy setting.

First, the counselor provides a rationale for goals explaining the role of goals in therapy, the purpose of goals and the client’s participation in the goal setting process.  Second, the client identifies desired outcomes by specifying the positive changes he or she wants from counseling, focuses on what the client wants to do rather than on what the client does not want to do.

Third, the client is the person seeking help and only he or she can make a change.  The counselor helps the client accept the responsibility for change rather than trying to get someone else to change.  Fourth, the cost-to-benefit effect of all identified goals are explored and the counselor and client discuss the possible advantages and disadvantages of these goals.  And finally, the client and counselor then decide to continue pursuing the selected goals to reconsider the client’s initial goals or to seek the services of another practitioner.

The therapist’s role and function:  The therapist is active and directive.  The therapist functions as a consultant and as a problem solver summarizing, reflection, clarification and use of open-ended questions are fully a part of the behavioral therapist’s toolbox.  The therapist formulates the initial treatment goals and design and implements the treatment plan.

And a key part of the therapist’s function is to evaluate the effectiveness or the progress of the treatment and that can be done using graphs or other markers that indicate the change in behavior as a result of the change of the responses.  And page 235 has an excellent description of how a behavior therapist might perform the functions I've just mentioned.

A client comes to therapy to reduce her anxiety which is preventing her from leaving the house.  The therapist is likely to begin with the specific analysis of the nature of her anxiety.  The therapist will ask how she experiences the anxiety of leaving her house including what she actually does in these situations.  Systematically, the therapist gathers information about this anxiety.

When did the problem begin?  In what situations does it arise?  What does she do with these times?  What are her feelings and thoughts in these situations?  Who’s present when she experiences the anxiety?  How do her present fears interfere with living effectively?  After this assessment, specific behavioral goals will be developed and strategies will be defined to help the client reduce her anxiety to a manageable level.

The therapist will get a commitment from her to work towards the specific goals and the two of them will evaluate her progress towards meeting these goals throughout the duration of the therapy.  Now notice that in this description the client was never asked what does she think about herself in terms of what she learned in her childhood about anxiety or what it would be like to leave the house or what the world was like or even existential questions about what does she think the purpose of living is and what it be like to leave the house.

Now, all of the questions pertain to specific measurable and observable behaviors that could be used as a baseline for understanding how to change things in the future.  The client’s experience is different somewhat in behavior therapy than it is in a number of the other therapies that we've looked at.  Similar to other therapies, the client awareness and participation is key different than a lot of the therapies.

The client is encouraged to experiment in order to increase adaptive behaviors.  That is the focus is not on insight but instead on doing something different.  Another difference is that clients are not necessarily rewarded for being able to verbalize change.  The therapist wants to see the changes actually occurred.  And finally, clients have to have a frame of reference for assessing their own progress and this goes back to the idea that clients learn how to self moderate.  They learn how to manage their own treatment.

The therapist client relationship requires having a good therapeutic relationship just like any other treatment model that we've looked at and clients make progress primarily because of specific behavioral techniques used rather than because of the relationship with the therapist.  So unlike in Rogerian therapy where the relationship between the client and the therapist was key and the attributes that the therapist brought to the treatment room were actually central in the client’s change.

In a behavioral setting, it's not really so much about the therapist or who the therapist is.  It's really about the specific techniques that the therapist is using that can help the client to engage in new and more adaptive behaviors.  Corey mentions a number of techniques that are used by behavior therapist.  He does a really nice job of describing the functional assessment model on page 239, but I wanted to take a minute and elaborate a little bit on functional assessment and talk about something that Joseph Burke described in his ’89 text Contemporary Approaches to Psychotherapy and Counseling.

And he illustrated the ABC model for identifying behavioral functioning.  The A stands for antecedents that elicit a certain behavior and B stands for that behavior and the C of course is the consequences to that behavior.  In this model, the A and the B are the S and the R, the stimulus and the response.  The consequences are rewards and punishments.  They're these consequences that indicate the likelihood that behavior is going to continue or not.

Now, what Burke noted was that the antecedents, the stimulus, they can be determined by asking clients what the problem is.  The B or the behaviors can be determined by finding out where and when the problem occurs and finally, the C is determined by finding out how the problem is maintained.  So the what, the where, the when and the how are central in doing this functional assessment.

Another technique that Corey mentions is relaxation training and this is one that I've found to be useful with every population that I've worked with and relaxation can be learned in multiple ways.  One of them is actually to pick up some of those relaxation tapes that are ubiquitous in the self help section of the library or the bookstore.  Just briefly, I'm going to do a quick relaxation technique.

So what I want you to do is to close your eyes.  I want you to take in a deep breath and I want you to imagine that you're on a grassy knoll, that the sun is warm and there's a cool breeze.  You're lying in a bed of grass and as you look up the sky is blue and there are soft clouds lazily rolling by.  The sun is out and you can feel its warmth on your skin and as you breath in you can imagine the warmth of the sun coming in through your nose and traveling down through your throat into your lungs and with every breath you feel the warmth of that sun grow and grow.

Now, imagine that that sun has a color.  Imagine that it's orange and as you breathe in the orange glow you can see as if floating above you can see yourself with that warm orange glow as it moves throughout your body.  You can feel it starting in your head down your throat.  You can feel it as it moves into your chest down your right arm into your fingers, down your left arm into your fingers as it moves into your torso, your legs and finally your feet.

As you feel this warmth, this warm orange glow you start to move your fingers, move your head back and forth.  I want you to do is I want you to open your eyes, take a deep breath and move out of this brief, brief, example of relaxation.

The next technique is called systematic desensitization and this is one of the first therapeutic techniques derived from behavioral experiments and it was developed by Joseph Wolpe.  It's an imaginal technique where increasingly anxious situations are imagined while engaging in behaviors that compete with the anxiety.  Now over time clients become desensitized to the anxious situation.

Watching horrible violence in the comfort of our own home could be considered a form of desensitization because the anxious situation, it could be watching murder on the 6:00 o’clock news, could be watching the atrocities of war, could be watching a movie where someone is violently raped that’s paired with a comfortable behavior such as eating dinner, holding the hand of your loved one etc. etc.

Exposure therapies:  In vivo desensitization is different than systematic desensitization because in vivo desensitization clients are exposed to the actual feared situation rather than simply imagining brief and graduated exposure to an actual fear situation or event is used and what that means is that you could have a brief exposure to an anxiety provoking event and that could be exposure to a rat or to a cockroach or it could be a graduated exposure in the sense that you are increasingly exposed to this anxious anxiety provoking event.

Flooding:  These are actually experiences of anxiety during the exposure, but the feared consequences do not occur and this is used when it's not ethical or possible to have a client actually experience the fear of say being on an airplane.  In flooding, clients do not have the opportunity to avoid the anxiety provoking experience.  So in this situation, the client is flooded with the anxiety provoking situation, but they do not actually experience the negative consequences that they're afraid of.

Another exposure therapy is Eye Movement Desensitization and Reprocessing.  This is an exposure-based therapy that involves imaginal flooding, cognitive restructuring and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories.  Anecdotal evidence is pretty good for EMDR.  However, the research as Corey notes is equivocal.

In a 2001 article, Allen Rubin and his colleagues did a study on EMDR and kids being treated in a child guidance center.  They found that despite the fact that the therapists argued quite strongly that in fact the kids that received the EMDR demonstrated more improvements than the kids who did not.  Statistical analysis suggested that there was no difference between children who received EMDR and those who did not. And that was an article on research and social work practice in volume 11 issue 4, pages 435 – 457. 

As we wrap up, I want to briefly take a look at the implications for multicultural counseling.  Behavior therapy really has a lot of contributions when it comes to multicultural counseling. 

First, there is a focus on environmental conditions and this can be contrasted with the existentialist therapist or even Rogers person-centered that tended to ignore environmental conditions.Behavior therapy really focuses on action plans and behavioral changes.  It's a wonderful technique if clients are looking for concrete methods of changing behaviors.  And finally, the focus is on the client’s cultural conception of problem behaviors.  One of the limitations when it comes to multicultural counseling is that behavior therapy really isn't very responsive to specific issues that are found in diverse populations such as race, gender, ethnicity, sexual orientation and some of the other critical variables that influence the process and the outcome.

In terms of contributions, behavior therapy really stresses doing rather than merely talking.  Behavior therapy is fully engrained in the medical model, geriatrics, pediatrics, rehab programs, stress management programs.  It emphasizes research and the assessment of treatment outcomes and this is found throughout evidence-based treatment and as you continue to look into evidence-based treatments you'll find that most of them have some sort of behavioral or cognitive behavioral basis.

You're not really going to find a psychodynamic best treatment and this is in part because of the way that they're structured.  They're measurable and you can determine whether or not they work.  There's also an emphasis on ethical accountability.  Is your treatment actually addressing the functional impairment that your client is coming in with?  And finally, the essential feature of behavior therapy involves the collaboration between the therapist and client and although this is not a unique contribution it's a contribution nevertheless.

Now, some of the limitations include that behavior may change, but behavior does not necessarily change feelings.  So I might be able to actually get to work every day, but I still hate my work.  So, in that sense behavior therapy might have failed a greater need that I might have.  Another limitation is that the relationship between the client and therapist is somewhat discounted in behavior therapy.

It's not again so much about developing a strong therapeutic alliance as it is in other models such as person-centered.  Behavior therapy does not provide any insight into the problem.  So, if you find yourself anxious in situations and you have no idea why then you're not going to find out the answer in a behavior therapy setting.  Behavior therapy treats symptoms rather than causes and so you know big criticism of that is that you can eliminate the symptoms, but if the cause is still there then other symptoms will take the place of the symptoms that you just eliminated and so the real problem won't actually ever get resolved.

And finally, behavior therapy involves control and manipulation by therapist.  What I'd like you to do is to take out a piece of paper and we're going to have a quiz.  Put your name on the right-hand side of the page and I'd like you to put the words behavior test in the center.

What I just did actually was a little example of classical conditioning and operant conditioning.  The operant conditioning was that when instructed, that was your stimulus, you took out a sheet of paper, that was your behavioral response.  When you realized it was going to be a quiz, probably most of you experienced some increase in heart rate, probably some increase in worry.  Perhaps your breathing increased and all of this was involuntary and that was the classical conditioning.

That meant that there was over time the conditioned stimulus, the word quiz was paired with an unconditioned response of an increased heartbeat and other physical manifestations of anxiety.  Well, the good news is there's not actually a quiz.  If there were a quiz, I'm not sure how I would administer it nor how I would grade it.  But I wanted to end this podcast with an example of how classical conditioning and operant conditioning are present in that most common of experiences, taking a test.

So, I'm Jonathan Singer.  Thanks for being with me today for this episode of The Social Work Podcast.  If you missed an episode, visit our website at  If you have suggestions for future podcasts, please email me at  And to all the social workers out there, keep up the good work.  We'll see you back here next time at The Social Work Podcast.

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Bandura, A. (1977). Social learning theory. Englewood Cliffs, N.J.: Prentice-Hall.

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th ed). Belmont, CA: Wadsworth/Thomson.

Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York: Oxford University Press.

Rubin, A., Bischofshausen, S., Conroy-Moore, K., Dennis, B., Hastie, M., Melnick, L. et al. (2001). The effectiveness of EMDR in a child guidance center. Research on Social Work Practice, 11(4), 435-457.

Rychlak, J. F. (1981). Introduction to personality and psychotherapy (2nd ed.). Boston: Houghton Mifflin Company.

Skinner, B. F. (1953). Science and human behavior. New York: Free Press.

APA (6th ed) citation for this podcast:

Singer, J. B. (Host). (2007, March 12). Behavior therapy [Episode 12]. Social Work Podcast. Podcast retrieved Month Day, Year, from

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