Experiments in Behaviour Therapy. Readings in Modern Methods of Treatment of Mental Disorders Derived from Learning Theory

545 Pages·1964·9.766 MB·English

by  H. J. Eysenck (Eds.)

EXPERIMENTS IN
BEHAVIOUR THERAPY
Readings in Modern Methods of Treatment
of Mental Disorders derived from
Learning Theory
EDITED BY
H. J. EYSENCK
PROFESSOR OF PSYCHOLOGY. UNIVERSITY OF LONDON
DIRECTOR, PSYCHOLOGICAL LABORATORIES,
INSTITUTE OF PSYCHIATRY
PSYCHOLOGIST,
MAUDSLEY AND BETHLEM ROYAL HOSPITALS
TMf QUECN'S AWARD
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Copyright © 1964
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First published 1964
Second impression 1967
Library of Congress Catalog Card No. 63-19263
Printed in Great Britain by
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08 001176 4
To J. Wölpe
FOREWORD
THIS book contains a series of reports on experiments involving the appli-
cation of modern theories of learning and conditioning to behaviour disor-
ders. Most of these disorders would be called "neuroses" by psychiatrists,
but as there is so little agreement on the definition or meaning of this term, it
might be better to use noncommittal words not carrying the implications of
"disease" or nervous dysfunctioning. Some of these behaviour disorders are
extremely serious, debilitating, and indeed tragic; others are quite trivial,
unimportant, and may even be amusing. In principle, however, they all
illustrate the same general laws of learning, and the modification in be-
haviour effected through sensitization, deconditioning, negative practice or
counterconditioning is equally dependent on knowledge of these laws; the
falling apple and the precession of the equinoxes are both explained in terms
of the same underlying theories. The psychiatrist concerned with the appli-
cation of psychological principles to his problems will probably be more
interested in the accounts of treatment applied to the more severe cases, but
it should be recognized that a paper reporting the change in behaviour of a
child with undesirable eating habits, or some other slight behavioural de-
viation, may be just as significant in suggesting methods or illustrating
principles. The possibility held out by modern psychology of altering human
behaviour in a lawful manner, and in accordance with lawful principles, is
the inspiration behind behaviour therapy, and it is the hope of the editor
that some at least of his readers will come to appreciate the tremendous
possibilities held out by these new developments — possibilities of changing
personality and behaviour in the direction of greater sanity, greater happiness,
and greater social usefulness.
It is another hope of the editor's that behaviour therapy will in time
replace the current orthodoxies in psychiatric treatment and theorizing,
orthodoxies which owe little to experimental research, patient verification,
or consistent system building. It is surely time that we abandoned the curi-
ously schizophrenic situation where behaviour disorders, which by common
consent are acquired through some form of learning or conditioning, are
treated in terms of methods and theories which take no cognizance of the
accumulated scientific information on the topics of learning and conditioning
of the last fifty years ! If the contribution of modern learning theory had been
rejected on the basis of thorough knowledge, extended trial and proved
uselessness, no complaint would be justified, but, like Christianity, behaviour
therapy has not been tried and shown to fail; it has never been tried. Its
ix
χ FOREWORD
rejection on the basis of a priori considerations by those not intimately
acquainted with its theories, experiments and applications cannot be taken
as being based on rational grounds; as the contributions to this volume will
show, behaviour therapy, in spite of its youth, has already been astonishingly
successful in practice, and current improvements in theoretical compre-
hension and in practical application bid fair to make it even more so.
Important as these practical implications are, even more important is the
insistence of behaviour therapists on experimental demonstration, theoretical
rigour, and empirical validation. This substitution of scientific methodology
for the thaumaturgical hagiolatry which pervades so much of present-day
psychiatry seems long overdue ; by their fruits shall ye know them ! Treatment
of mental disorders has for too long been frozen in antiquated postures;
a thaw is much needed.
Some of the more rational criticisms of behaviour therapy have been dealt
with in the Introduction ; others have been answered in Behaviour Therapy
and the Neuroses, the companion volume of this book, and the first set of
readings in the application of learning theory to the treatment of these be-
haviour disorders. Future work on these lines will be reported in the pages of
Behaviour Research and Therapy, a new international journal founded
especially to bring together studies of the theory and practice of behaviour
therapy. In concluding this foreword, the editor would like to pay homage to
the men whose outstanding pioneering work has determined the modern
conception of neurotic disorder and its treatment; J. B. Watson, H. O. Mow-
rer, Ν. E. Miller, J. Wölpe, and B. F. Skinner. He would also like to thank
the numerous authors who consented to have their work represented on
these pages, and who often made important alterations and additions to
earlier versions of their reports.
Institute of Psychiatry
(Maudsley Hospital) H. J. EYSENCK
University of London
NOTICE TO READERS
The text in the articles in this volume has been
set either with English or American spelling, ac-
cording to the location of the author. However,
in order to observe conformity in the layout of
the book as a whole, the page headlines have been
set consistently in English.
The Nature of Behaviour Therapy
H. J. EYSENCK
BEHAVIOUR therapy may be defined as the attempt to alter human behaviour
and emotion in a beneficial manner according to the laws of modern learning
theory. The use of the term "beneficial" distinguishes it from certain types
of manipulation, such as brain-washing, which also seek to alter behaviour,
but in the interest of the manipulator rather than the sufferer. Specious
arguments may of course be brought forward to show that really the sufferer
is mistaken, and that he will be better off after brain-washing; the Inqui-
sition was as adept as certain modern political parties in using such excuses.
We shall assume here that the term "therapy" does not easily fit such cases,
and that it should be reserved for instances where the patient voluntarily
seeks treatment. The use of the term "modern learning theory" implies a
clear distinction between the methods here advocated and those of psycho-
analytic psychotherapy; we are concerned with the application of laboratory-
based, scientific findings in the fields of learning and conditioning, rather than
with the use of Freudian principles. Lastly, the use of the term "behaviour
and emotion" implies clearly that the changes made should be capable of
being observed and studied objectively by the outside observer, rather than
being accessible, if at all, only through introspection and interpretation.
Strictly speaking " emotion " should probably be conceived of as a subclass of
"behaviour", but a distinction between skeletal and hormonal activity, or
between Central Nervous System and Autonomic Nervous System, is too
useful to be sacrificed easily (Mowrer, 1950).
The actual term "behaviour therapy" is only a few years old, but of
course the methods subsumed under that name have been in use for a much
longer period. Recent summaries by Eysenck (1960a), Bandura (1961) and
Metzner (1961) may help readers not acquainted with the history of these
techniques to obtain an overall view, and to appreciate the enormous differ-
ence between what is being attempted here, and orthodox types of treatment.
The present book has been put together to enable readers to see for them-
selves some of the most important and interesting publications in this field,
and thus receive at first-hand a glimpse of the successes and failures, the
theories and experiments, the methods and the concepts, which are at the
moment agitating behaviour therapists. The book is a successor to Behaviour
Therapy and the Neuroses (Eysenck, 1960 a), but it can be read and under-
1
2 EXPERIMENTS IN BEHAVIOUR THERAPY
stood on its own; acquaintance with the earlier volume will of course be an
advantage. It is hoped that by thus bringing together publications from a
wide range of journals unlikely to be read in their entirety even by the most
enthusiastic psychiatrist or psychologist, the book will open new doors and
vistas to many of its readers, and will encourage them to experiment with
some at least of these new methods.
There are certain objections and criticisms which experience has shown
to arise quite frequently in connexion with discussions of behaviour therapy,
and it may be useful to try and answer these as far as possible in this intro-
duction. The first objection arises from the fact that reports such as those
reprinted in Behaviour Therapy and the Neuroses, or in this book, seldom
include control groups; how, it is asked, can one evaluate the claims made
for a given type of therapy when there is no clearly demarcated base-line?
How can we demonstrate the alleged beneficial effects of behaviour therapy
when no attempt is made to exclude the effects of spontaneous remission?
Is not this reliance on single case reports a throw-back to the often criticized
clinical methods of psychoanalysis? The point is well taken, but there are
several considerations which must be borne in mind.
In the first place, attempts have in fact been made by Wölpe (1959),
Cooper (1961), Lazarus (1962), Ellis (1957), Anker and Walsh (1961),
Gwynne Jones (1960), Lovibond (1961), Lang and Lazovik (1962), and others
to provide the type of evidence requested; rudimentary as these attempts have
sometimes been, and inconclusive as they undoubtedly are when looked upon
from the point of view of pure science, they should be compared with the
complete failure of psychoanalysts even to attempt any such comparative
studies. This difference becomes even more obvious when it is realized that
psychoanalysis has many thousands of trained practitioners, has been
flourishing for half a century, has at its disposal vast sums for research, and
makes exceptionally far-reaching claims. By contrast there are probably not
more than a few dozen trained practicioners of behaviour therapy in the whole
world, having little or no access to research funds. In addition, behaviour
therapy is a very young discipline ; admittedly there are a few isolated examples
of treatment along these lines in the literature of the twenties and thirties, but
these methods were not seriously taken up until the appearance of Wolpe's
book on Psychotherapy by Reciprocal Inhibition in 1959. The critics are of
course right in demanding more and better studies of this type, but this can
hardly be interpreted as a criticism of behaviour therapy; it requires time to
perfect methods of treatment, and it requires even more time to mount and
carry out an experiment comparing the effects of different types of treatment.
If behaviour therapists allow as much time to elapse without producing any
evidence of this type as did the psychoanalysts, then such criticisms would
indeed be only too justified; considering the limited time they have had to
work out their methods and test them, their performance would seem to call
for praise rather than blame.
THE NATURE OF BEHAVIOUR THERAPY 3
Individual case studies are of course published quite frequently, but it
would not seem reasonable to condemn this practice. Not every publication
is intended to establish unequivocally an important and general scientific
truth; there is ample room for papers demonstrating techniques, illustrating
theoretical discussions, or introducing newcomers to points of detail in
treatment. Even from the most severe scientific point of view, a single case
may suffice to establish an important theoretical point—if only to disprove
a universal negative! Studies of single cases, or even of groups of such cases,
should be judged in relation to what the author claims to have established;
neither universal condemnation nor universal approbation seems appro-
priate.
This point may be carried a little farther. There are other ways of demon-
strating that one has achieved experimental control over a given phenomenon
than the use of control groups (Sidman, 1960); one such way is the clear-cut
demonstration that one can at will produce changes in the dependent variable
(which may of course be a neurotic symptom) by changing the independent
variable. Katsch (1955) has demonstrated in the treatment of a case of
asthma, where severe attacks regularly occurred when the patient retired to
bed with his wife, that these attacks ceased immediately and completely
when a large picture of the mother-in-law was removed from its place on the
wall; she had played an important role in producing the conflict hypo-
thetically underlying the asthmatic attacks. It is difficult to see how control
groups would provide better and more impressive evidence of the correctness
of the hypothesis than does the experimental control exercised by Katsch in
this case. Shapiro (1961) has discussed this point at length.
Altogether it is possible that there is here a conflict of aim between the
critics and the behaviour therapists. To the scientist, the first and most
essential aim must be to bring the phenomenon he is concerned with under
experimental control; other things, such as the improvement of a neurotic
symptom, are confidently expected to follow later once this over-riding need
has been met. An experiment such as that of Yates (1958), in which he
showed that severe tics could be manipulated at will by means of variations
in a conditioning schedule, should be interpreted as a demonstration of
experimental control ; it would be quite wrong to regard its main purpose as
the alleviation of the patient's suffering. Criticism based on such a misunder-
standing is clearly erroneous ; the author did not try to demonstrate on the
basis of a single case that the method of negative practice was an infallible
one for the cure of tics, and should not therefore be criticized as if he had in
fact had this intention. The preoccupation of many psychiatrists with curing
patients (not an unworthy one, of course) tends to blind them to the fact
that the development of rational techniques of treatment has to pass through
several stages, notall of which are directly concerned, in an immediate way,
with cures. Altogether, the actuarial counting up of "cures" is not necessarily
the best method of demonstrating the correctness of a given psychological
4 EXPERIMENTS IN BEHAVIOUR THERAPY
hypothesis, and in many instances it may in fact be most inappropriate. Such
"counts" have their place, but other methods of proof should not be neg-
lected.
Among the most important considerations in this connexion is the obser-
vation of certain consequences which follow from the theory under investi-
gation, but which may have no, or only a tangential relation to the patient's
improvement. If, as has often been contended, neurotic symptoms are
essentially conditioned autonomic responses, together with associated
skeletal ones, then such effects as stimulus generalization and extinction
should be observed; similarly, if treatment implies some form of counter-
conditioning or reciprocal inhibition, then the development of the new
responses should follow a course in line with prediction from learning
theory. Many instances will be found in the pages that follow of close
agreement between prediction and fact; such agreement lends considerable
support to the theory, without requiring a control group, and may indeed be
demonstrated to advantage even in a single case. The psychiatrist, rightly or
wrongly, concentrates entirely on the recovery of the patient; the experi-
mentally minded psychologist considers many other behavioural effects of
his experimental manipulation of the independent variables. If we already
possessed sure and certain methods of cure, experimentation of this kind
might be considered unethical; but this is not the position. As Appel et al.
(1953) have pointed out, "none of the treatments studied—including psycho-
therapy—gave recovery rates significantly greater than that reported for groups
receiving only routine hospital care". And in a similar vein, Hastings (1958),
in discussing follow-up results in psychiatric illness, says that " one is re-
luctantly forced to admit that we simply do not possess the factual knowledge
... which permits us to say that we have any treatment procedure in psy-
chiatry which promises a better outlook for a particular illness than does
nature left to her own devices". This being so, experimentation is mandatory,
and singleminded attention to the "recovery" of the patient, with complete
disregard of the importance of other variables, is not likely to lead to the
scientific break-through which is so essential if we are ever to come to grips
with the problem of neurosis.
An altogether different type of criticism is sometimes heard, to the effect
that learning theory is not sufficiently advanced to provide a safe and
satisfactory stepping-stone to such important fields as the treatment of
neurotic disorders. Are there not conflicting views about quite fundamental
points; are there not continuous disputes, sometimes quite acrimonious, be-
tween different schools? How can safe predictions be made when so much is
in doubt? Such objections may have some superficial appeal, but they are
not likely to trouble anyone unduly who is experienced in the ways of scien-
tists with theories. Consider what Sir George Thomson, F.R.S. and Nobel-
Laureate in physics, has to say on the topic: "If differences of opinion . . .
are still possible about space, time, and gravitation, this is an example of some-
THE NATURE OF BEHAVIOUR THERAPY 5
thing common in physics. Very different points of view may lead to identical
or nearly identical conclusions when translated into what can be observed.
It is the observations that are closest to reality. The more one abstracts from
them the more exciting indeed are the conclusions one draws and the more
suggestive for further advances, but the less can one be certain that some
widely different viewpoint would not do as well." (Thomson, 1961.)
The same is true of psychology. Take a practical problem, such as how
to produce conditioned response of a certain type in a dog, or how to "shape"
the behaviour of a pigeon, or how to extinguish without relapse the enuretic
behaviour of a child, and you will find considerable agreement, or even
unanimity, among behavioural scientists. Ask for theoretical justifications
for the methods advocated by them, and you will receive many alternative
hypotheses between which no rational choice may be possible at the moment.
But this great variety is no weakness, and it does not detract from the
practical value of the methods suggested for solving a given problem. To the
academic teacher and to the research worker, these different theories are
important, and much of his work is concerned with deducing consequences
which follow from one but not from the other theory, and then testing these
consequences in the laboratory. This is right and proper, even though scien-
tists so occupied may easily be accused of "ivory tower" attitudes, and of
concentrating on trivial and unimportant problems. Disagreement on the
theoretical plane, and on the borderline of knowledge, does not imply dis-
agreement with respect to established facts in well-explored areas. It is on
these facts that we must build our system of behaviour therapy, and here
there is far less disagreement, and indeed much commonality of knowledge.
Take as an example Humphrey's paradox, i.e. the well-known fact that
extinction after conditioning is prolonged after partial reinforcement, but
accelerated after 100 per cent reinforcement. There are many theories about
the reasons underlying this phenomenon, but no one doubts the accuracy
of the facts themselves. Consequently, when Lovibond (1961) tried to reduce
the relapse-rate of enuretic children treated by means of the bell-and-
blanket method, he was able to do so by changing the conditioning method
from 100 per cent reinforcement to partial reinforcement. Thus we can make
use of ascertained facts, without necessarily being in agreement about the
more far-reaching theoretical reasons behind the facts. The position is
exactly the same here as it is in physics; if we had to wait for universal theo-
retical agreement between physicists before we could make use of the dis-
coveries of physics for practical ends, we would still live in a pre-Renaissance
world. In saying this I have no wish to deny the obvious vast disproportion
between the amount of factual knowledge in physics and in psychology, or
the equally obvious superiority of the existing theoretical systems in physics
compared with those we have to work with in psychology; I merely wish to
draw attention to an essential similarity running through all the sciences,
from the most developed to the least advanced.