LEARNING THEORIES AND THEIR CLINICAL APPLICATIONS

By

Prof. B. Y. Oladimeji,

Dept of Mental Health,

College of Health Sciences,

O. A. U.,

Ile-Ife.
INTRODUCTION:
LEARNED AND UNLEARNED BEHAVIOUR

When the newborn infant starts to breathe, he is performing an act that he has
had no chance to learn. The lungs and the muscles and nerves necessary for
respiration have been developed by maturation. In the course of time, the child learns
to breathe in special ways like holding his breath at will or in blowing out a candle.
These modifications of breathing are based on the original unlearned act. Any act, even
though provided in its primitive form by maturation, is almost sure to be modified in
some ways by exercise. In virtually every activity we take part in, learning has a role to
play. Learning is not limited to any sort of activity or place.

Definition: Learning may be defined as a relatively permanent change in

behaviour that occurs as the result of prior experience or practice. This change
may not be evident until a situation arises in which the new behaviour can occur;
learning is not always immediately reflected in performance. The phrase relatively
permanent excludes those changes in behaviour that result from temporary or transient
conditions, such as fatigue or the influence of drugs. By specifying that learning is the
result of experience, we exclude changes that are due to maturation, disease, or
physical damage. Learning could be defined more simply as profiting from
experience, were it not that some learning does not profit the learner: useless and
harmful habits are learned just as useful ones are.

PRINCIPLES INVOLVED IN LEARNING

The learning process is guided by several principles. We shall discuss two
briefly, namely: association and motivation.

ASSOCIATION:
All learning involves association, learning the connection between one thing and
another. For example, if a hot stove (S1) burns our hand (2) when we touch it, an
association forms in the brain so that the thought or idea of a hot stove (1) also brings
up the thought or idea that it can burn us (S2). Alternatively, when we see someone
whose hand is burned (S2) it brings up the idea of a hot stove (S1) even if we do not
see a hot stove (S1).
There are three main forms of association involved in learning, namely Stimulus-
Response; Contiguity; and Interference.
1. Stimulus-Response: Suppose a child hears a bell (S1) and sees food (S2) both
presented almost at the same time. The child will naturally salivate (R2) to the sight
 of food (S2). But if the bell and food are presented many times together the child will
come to salivate (2) upon hearing the bell alone (S1) This association between S1
and R2 is known as conditioning, to be discussed later.

2. Contiguity: Learning involves contiguity. The stimulus and response must be close
together in time and space in order that an association can occur in our minds. Thus
contiguity also involves association.

3. Interference: Interference refers to the fact that a past association prevents us from
learning a new one. The clearest example of this is to learn the exact opposite of
what we have already learned. Interference is common in daily life - using the old
name for a street whose name was changed; continuing to write the old year during
the new years; learning more than one language at a time; and so on. In these
cases, we have two associations for the same thing (the old and new years; the old
and new street name). These are R1 and R2. However, since we cannot make both
associations to the same stimulus the stronger association wins out by interfering
with the weaker one. Interference is strongest when we first learn something and
decreases with practice.

MOTIVATION - LAW OF EFFECT:

Although learning involves contiguity, interference, and stimulus-response
association, these alone would not cause learning. We must also have a motive to
learn. A motive induces the animal to do something to satisfy its need. When an
action satisfies a need, this action tends to become associated with need reduction and
is therefore learned. Thorndike calls this the law of effect - the more often a correct
response is rewarded by need reduction the stronger the stimulus-response (S-R)
connection becomes (i.e. we learn the correct response because it keeps rewarding us
by need-reduction. If the response does not reward us, it would not be learned.
The law of effect is used to explain how we train children, animals and adults.
We reward their desirable behaviour, and punish their undesirable behaviour, until the
behaviour we want is stamped in.

THEORIES AND TYPES OF LEARNING

Psychologists have formulated a number of theories about how learning takes place
and have carried out a great deal of research with humans and animals in an attempt to
gain a better understanding of the process. Imagine a simple situation in which an
organism produces the correct or successful response for the first time in an unfamiliar,
non-routine situation. Two main questions usually arise from this observation:
1. How does this new successful response emerge for the first time in an
unfamiliar situation, when the subject has never produced just this particular
pattern of behaviour before?
 2. Once the correct response is achieved, how does it persist and reappear
when the occasion demands it? Responses do not have to be acquired over
and over again: the subject can reproduce the new trick and even modify it to
fit variations in the context. How do such modifications become semi-
permanent or permanent?

These two questions dominate investigations into the basic factors involved in
learning and the various theories that attempt to explain learning. Learning can take
place in several forms and situations, mainly through conditioning; latent, observational
and modelling.

CONDITIONED RESPONSE LEARNING

Conditioning is the simplest form of learning. It refers to the process in which an
animal makes a response to one stimulus, and then learns to make the same response
to a new stimulus. For example, Pavlov showed that dog which salivates to the sight of
food could be trained to salivate to the sound of a bell. Two major forms of conditioning
are described, namely classical and operant conditioning.

A. CLASSICAL CONDITIONING
The Russian physiologist, Pavlov (1849 - 1936) noticed that a dog salivates not only
food is in its mouth, but also to the sight of food and even to the sound of a dinner bell.
Pavlov inserted a tube in the dogs salivary gland; so that he could measure there is
response of saliva to a stimulus (food, bell, etc.) At first, the bell produced no saliva.
This was presented for several trials, each time being followed by food. Then gradually,
conditioning occurred the dog started salivating to the bell even when no food was
presented. The amount of saliva gradually kept increasing on each trial (on each
presentation of the bell alone). Pavlov also conditioned dogs to respond to light, sound,
and to different odours.
Pavlov called FOOD the UNCONDITIONED STIMULUS for salivation (i.e. FOOD
is NATURAL cause of salivation) An unconditioned stimulus that causes a response at
the start of an experiment.
An UNCONDITIONED RESPONSE (REFLEX) is the unlearned response to the
conditioned stimulus. For example, salivation was the unconditioned response to food.
The DINNER BELL is called the CONDITIONED STIMULUS. A conditioned
stimulus is a stimulus which does not cause any response at the start of an experiment;
but after being ASSOCIATED with the unconditioned stimulus it come to cause
salivation itself. When the dog learns to salivate to the conditioned stimulus (the
sound of the bell) alone, this salivation is called the CONDITIONED RESPONSE or
CONDITIONED REFLEX.
A conditioned response is a simple form of HABIT, because it is a response to a
learned stimulus, not to a natural one.
The traditional diagram of classical conditioning is as follows:

Original Situation
S1 R1
(Food) (Salivation)

Paired Stimulus Situation

S1 + S 2 R1
(Food) (Bell) (Salivation)

Post Conditioning Situation

S2 R2
(Bell) (Salivation)

S1 = Unconditioned Stimulus (UCS)

S2 = Conditioned Stimulus (CS)
R1 = Unconditioned Response (UCR)
R2 = Conditioned Response (CR)

After the bell is associated with the food long enough, the animal learns to salivate to
the bell alone. Thus, the animal learns to form an association between a response
(salivation) and a stimulus, which originally caused no response (a dinner bell)
B. INSTRUMENTAL (OPERANT) CONDITIONING

The other form of conditioning is called OPERANT CONDITIONING: Here the

organism has to do something on its own (operate) in order to get the reward. The
reward therefore reinforces the correct response.
In classical conditioning, the mere appearance of food causes a response.
However, in OPERANT conditioning the animal has to do something before food will
appear. Skinner who originated the term OPERANT, put a hungry rat in a box with a
lever (called the Skinner Box) The rat has to learn on its own that if it presses the
lever a food pellet will drop down. The rat finally does make the conditioned response
(lever pressing) on its own. It is not a response to anything the psychologist does.
By using OPERANT conditioning, the psychologist can condition almost any
response he wants. The organism is rewarded for the correct response, and this
reinforces the response. This explains how animals on TV are trained to do such
remarkable stunts. We reinforce (reward) all behaviour, which tends to go in the
direction we want. For example, if we want an animal to stand on its hind legs while
carrying a ball, we reward (reinforce) every act which gets closer and closer to the
behaviour we want; but we do not reinforce other responses. This form of OPERANT
conditioning enables us to control the behaviour of animals, infants, and even adults.

PRINCIPLES OF REINFORCEMENT
In classical conditioning, the term reinforcement refers to the paired presentation
of the unconditioned stimulus and the conditioned stimulus. In operant conditioning,
reinforcement refers to the occurrence of an event, such as giving food or water,
following the desired response. In other words, in classical conditioning, reinforcement
elicits the response, but in operant conditioning, reinforcement follows the response.
The result in both cases is an increase in the likelihood of the desired response. We
can therefore define reinforcement as any event that has an effect on the
probability of a response.

Reinforcers are classified as positive or negative according to whether their

presentation or removal strengthens the preceding response

A positive reinforcer is a stimulus that, when presented following a response,

increases the probability of the response. For example, food and water for
appropriately deprived organisms. Often the term reward is used as a synonym for
positive reinforcement.
 A Negative reinforcer is a stimulus that, when removed following a response,
decreases the probability of the response, for example, electric shock and painful noise.
Punishment, however, is not negative reinforcement. Punishment refers to a situation
where a negative reinforcer is delivered every time the organism makes a designated
response, thus decreasing the probability of that response. If an animal is given an
electric shock every time it presses a bar, the bar-press response is said to be
punished.

Primary Reinforcement refers to rewards that satisfy our biological needs (food, water,
avoiding pain, and so on).
Secondary Reinforcement refers to learned rewards. They do not satisfy our needs
directly. They are the conditioned stimuli, which came to replace the unconditioned
stimulus as a reward for making a response. A secondary reinforcer enables us to learn
something because of its association with the primary reinforcer. For example, the light
or sound that accompanies food finally arouses a response (salivation) instead of food.
This light or sound is called secondary reinforcement it acts as reward instead of food.
It is a learned reward, it is not based on biological need.
Secondary reinforcement is important because it enables us to learn more than is
possible with primary rewards alone. Human behaviour can be influenced (reinforced)
by such secondary reinforcers as money, promises of food, praise, blame, school
grades, and gestures. We would not develop the habits we need if we had to be
rewarded with food each time we made the right response.
Secondary reinforcement is sometimes an even better reinforcer than food. A
word, smile, or even the click that comes instead of food rewards us as soon as we
make the right response, that is, food takes time to be eaten before it rewards us.

Intermittent Reinforcement: In everyday life, we find that our responses are only
reinforced periodically and not every time they are made. Nevertheless, extinction does
not occur. We continue our behaviour and habits without forgetting them. This is called
intermittent or partial reinforcement. Types of periodic reinforcement include:
1) Fixed ratio: reinforcement at 3rd. Or 5th, or 10th response etc.
2) Fixed interval: reinforcement every 5 or 15 minutes, etc.
3) Variable ratio: reinforcement on the 3rd response, sometimes on the 5th, etc.
4) Variable interval: reinforcement after 4 minutes, sometimes after 10 minutes, etc.

B. F. Skinner says that variable ratio gives the highest number of responses. He
says the animal does not know when it will be paid and there keeps on responding
because it knows it will come sometime. It is the basis of gambling casinos their slot
machines work on a variable ratio in order to reinforce responses.
 Intermittent reinforcement, especially the variable ratios, causes behaviour to
persist much longer than continuous reinforcement. Here, extinction is much slower. It
is the basis of gambling and our bad habits. Most of the things we do and learn in our
daily lives occur under intermittent reinforcement, not continuous reinforcement. We
may be scolded a hundred ties for raiding the refrigerator, or for staying out late.
However, if we can get away with it just once or twice it is sufficient reinforcement for us
to keep on trying to do it.

Extinction: When we want to eliminate a conditioned response, we use experimental

extinction. We present the conditioned stimulus (the bell in Pavlovs experiment) many
times, but we do not reinforce it. This means we do not present the unconditioned
stimulus food. The result is that the dog will gradually decrease its salivation and
finally stop entirely at the sound of the bell.

Spontaneous Recovery: Experimental extinction is usually temporary. The

extinguished response returns after a period of rest. This is called spontaneous
recovery. To achieve permanent extinction of a response we have to keep on
extinguishing it each time it returns.

Generalization: An animal conditioned to one bell will also respond to a different bell,
or to any similar sound (the sound of a rattle or metronome, etc.) Similarly, when Little
Albert became conditioned to fear white rats he also became afraid of white beards and
anything resembling furry objects. This is called generalization, and it explains how we
acquire our irrational fears of things (our phobias). Generalization always exists in
conditioning, but it gives weaker responses than the original conditioned stimulus.
Pavlov could not get higher than third-order conditioning in dogs, because during
higher-order conditioning the original conditioned response (salivation) is being
extinguished. This is because no food is being presented to reinforce the response
(salivation) to the metronome. Therefore, while the metronome is being associated with
the black card, the response to the metronome is being extinguished. However, human
beings are capable of much higher levels of conditioning. In humans, it is limitless.

Discrimination: When a dog is conditioned to salivate to one sound, but also salivates
to any similar sound, we call it stimulus generalization. But suppose we only want the
dog to respond to the original sound alone? To do this, we use differential conditioning
(or conditioning discrimination). We reinforce the original response by giving food
each time the original conditioned stimulus is sounded, but we do not reinforce the
generalized response. We do not give food when other sounds are made. The animal
slowly learns to discriminate between the reinforced and non-reinforced sound, and
finally stops responding to the latter.
 Conditioned discrimination explains how children learn to discriminate between
various stimuli and thus learn more about their environment. It is in this way that the
child learns that, there are other females besides his/her mother, but only mother
satisfies its needs. Since only mother satisfies its needs, the childs responses to
mother are reinforced, and its responses to other women are extinguished, thus
resulting in a conditioned discrimination between mother and non-mother.

C. TRIAL AND ERROR OR INSIGHT LEARNING

A German psychologist, W. Kohler, who worked in America, demonstrated the
important role of non-random scheme for learning. An objection sometimes raised to
experiments like that of Skinners is that they do not allow the animal a fair chance to
show his full power of observation because the bolts, levers and other operating devices
are either concealed or meaningless to the animal. If the situation were openly
presented, the animal might show clearly that he is learning by observation of situations.
He might not see through the situation at the first glance, but at some time he would
suddenly shift from helplessness to complete grasp of the problem, and at that moment
the essential learning would occur. This would be learning by insight , that is, the new
problem is solved by combining previously learned experiences or solutions to problems
in a new way. The evidence for insight lies in the sudden transition from blind behaviour
to definite use of instruments, complete absence of trial and error at repeated trials.
Kohler arranged for a chimpanzee to be placed in a room which had a banana
suspended from the ceiling. Scattered around the room were a number of packing
boxes. The chimp normally would try to get the banana suspended from the ceiling by
leaping up, but it was too high for him. After what would appear to be useless pauses
and much fretting, the animal would suddenly act as if he realized the solution. He
would leap into action, piling the boxes one on top of the other, until the pile was high
enough to allow the chimp to climb up and get the reward.
It became clear in later studies that old responses (experience) are being applied in a
new way, through insight. Learning to solve problems by remembering and using
previous experiences in this way is very much a human method for achieving our goals
and objectives.
Insight learning occurs as a sudden solution to a problem in a way which can
readily be repeated during a similar event in the future and which has some transfer to
new situations. Trial and error might be evident in the early stages of animal
exploration, but once the animal had seen the task as a whole he could restructure or
reorganize the perceptual field in ways which afforded solutions to his problem.

D. OBSERVATIONAL AND LATENT LEARNING

Psychologists identified with the cognitive viewpoint, which argue that learning,
particularly in humans, cannot be satisfactorily explained in terms of conditioned
 associations only. They propose that the learner forms a cognitive structure in memory,
which preserves and organizes information about the various events that occur in a
learning situation. We learn many skills through observation or imitation of models

knitting, baking and so on. For examples, most young girls are not taught to use make-
up but learning through observation or imitation of older sisters or peers. Certain
characteristics of the model determine the rate of learning like the perceived
consequences of actions, actual consequences and the social status of model.
We tend to learn many simple things in our daily live although there is no reward
for it and no apparent motive. It is called latent learning or incidental learning. For
example, if we ride through a strange neighbourhood by bus, and we later drive through
it ourselves. It will tend to be more familiar to us.
Latent learning therefore seems to involve no motivation, no reward, and no
intention to learn. However, studies show that all these things are involved. Although
no physiological drive exists, other drives, such as the curiosity or exploratory drives
motivate learning, or the manipulation drives. Satisfaction of these drives reinforces the
correct responses, and thus enables learning to occur. Without motivation and
reinforcement no learning would occur.

CONCLUSION
No single theory of learning would command universal assent. Each approaches
different aspects of the learning process and types. We can summarize by saying that
our habitual patterns of behaviour are probably developed from a combination of these
different learning schemes classical conditioning, operant conditioning, insight and
observational learning.

II. APPLICATIONS INHEALTH CARE.

THE CONDITIONED RESPONSE IN HUMAN BEINGS

 The contributions of learning researchers have included practical applications of
findings to many aspects of life. The first question asked, for example, was to decide
whether experiments such as Pavlovs would succeed with human subjects. The
answer was experimentally demonstrated to be YES. Besides the salivary responses
quite a number of other findings have been demonstrated on children and adults.
Babies given the bottle a few moments after the sounding of a buzzer show signs of
conditioning after a few days of training. They stop crying at the sound of the buzzer,
open their mouths and make sucking movements.
Conditioning becomes easier as the child advances in age up to about four
years, but beyond that age the human individual seems to become progressively less
easily conditioned. Nevertheless, quite a variety of reflexes have been conditioned in
one experiment or another. Examples include hand withdrawal, the knee-jerk and even
emotional responses.

Withdrawal: One natural reaction is to pull the hand away when it receives a
strong electric shock. Bind the stimulator to the hand so that the shock cannot be
avoided, and give a flash of light as a warning signal just half a second before the
shock, repeat the combination every half minute or so for an hour and
conditioned responses are obtained, which consists of an involuntary shrinking
movement preceding the shock.

The Knee Jerk: is a quick throw of the lower leg, produced by a sudden brief
contraction of the large muscle in the front of the thigh, and elicited by a tap on
the patella tendon just below the knee. If this tap is regularly preceded by the
stroke of a bell, most adults sooner or later show some conditioned responses
consisting of a relatively slow anticipatory contraction of the thigh muscle.

Conditioned Emotional Responses: The little baby fears nothing, or almost

nothing. He makes avoiding reactions to stimuli that are directly irritating, but not
to stimuli that are simply, signs of danger. If a snake (a large but harmless snake,
carried around by the experimenter, who invites every one to feel his nice
smooth, hard skin) is tried on people of different ages, no child under 2 years
shows any fear or concern. At 3 or 4 years they begin to be somewhat wary, and
within the next few years some of them show definite avoidance behaviour.

In an experiment, a healthy boy (Little Albert), slightly under 1 year in age, who
was accustomed to playing with dogs, rabbits and white rats was conditioned against
the white rat. Somebody would hold out the white rat to the boy who will reach out for it.
At that instant a long steel bar was struck with a hammer, making a loud rasping noise
behind the child, thereby producing a momentary fright. When this procedure had been
repeated a few times, the child not only would no longer play with the rat but actually
shrank back at the sight of it. He was then tested with a dog and a rabbit and showed
fear of them too. The conditioned fear was transferred from the rat to similar objects,
evidence of generalization of conditioning discussed in the previous chapter.
Many such fears are acquired by some form of conditioning in real-life situations,
though not easily detected. Many habits have this origin in the association of a
previously neutral stimulus with an unconditioned stimulus. More complex forms of
learning appear to exhibit the patterns, which are clearly apparent for conditioning.
A very important notion for learning theory is reinforcement, which refers to the
fact that certain stimuli increase the strength and persistence of a response when
presented in close temporal conjunction with the response. This means that for the
new response to persist it must be followed immediately by the unconditioned stimulus
or else it tends to weaken towards extinction. In practical terms, this means that
association can be extinguished by reversing the procedure. If the bell in Pavlovs
experiment is sounded frequently and the food is never presented, the salivation
response will gradually diminish and eventually stop. However, the organism generally
takes longer to unlearn the response than it did to learn it.
The contributions of learning researchers have included practical applications to
many aspects of life. These include innovations such as programmed learning,
improved techniques of job and skill training, memorizing and studying. Recently, these
learning principles have been used in a major effort to develop practical techniques for
dealing with deviant behaviour, and personal problems including mental illness,
aggressiveness, criminal behaviour, fears, compulsions, obesity and smoking. The
results of these efforts are known as behaviour modification or behaviour therapy
techniques, attempts to apply learning and other experimentally derived psychological
principles to modify or change problem behaviour.

MAJOR CHARACTERISTICS OF THE BEHAVIOURAL APPROACHES

Behaviour therapy is a confluence of several relatively distinct approaches.
However, regardless of the concepts employed or procedures proposed, there are
certain commonalities:
1. Emphasis (focus) on the observable: For the purpose of diagnosis and
treatment, behaviour therapy insists on direct observation of symptoms rather
than inferred processes. A concrete description of the problem to be changed is
required. The focus is on how the patient is behaving now, in the present, not on
how the problem originated. For behaviour therapists, not all problems indicate
deep-seated disease processes or unresolved underlying conflicts. It emphasizes
the use of direct observation and measurement of observable behaviour within
the context of a given stimulus situation and is interested in its direct
manifestation, be it motoric, verbal or physiological.

2. Assessment of the behaviour that is to be altered the target behaviour:

To get a comprehensive picture of the problem, the patient is encouraged to keep
daily records, which is often summarized in graph form. This gives information about
 the frequency of occurrence of the target behaviour, time of occurrence, its
antecedent and consequences, which the patient could not provide by retrospective
reports.

3. Careful evaluation of the effect of the programme designed to change

behaviour: In line with the emphasis on controlled experimentation, behaviour
therapists often insist on securing sufficient baseline data on the target behaviour before
commencing treatment. This is necessary for objective evaluation of treatment
outcome. Data are gathered constantly while the programme is on and if it is not
working, the programme is altered. Assessment and treatment are interwoven. There
is constant feedback to the therapist and the client.

TECHNIQUES OF BEHAVIOUR THERAPY

The behaviour therapist has at his disposal a wide variety of therapeutic
techniques. Examples of behaviour therapy techniques stemming from the classical
conditioning approach to learning include systematic desensitization, flooding, aversion
therapy and punishment, assertion training. Operant (instrumental) conditioning
techniques include token economy and self-control methods.
CLASSICAL CONDITIONING TECHNIQUES
Classical conditioning techniques involve the process in which the subject makes a
response to one stimulus, and then learns to make the same response to a new
stimulus, through association. Known techniques include systematic desensitization,
flooding aversive therapy.

Systematic Desensitization:
Systematic desensitization is based on a persons inability to be both relaxed
and anxious at the same time. The autonomic effects which accompany deep relaxation
decreased pulse rate, blood pressure, and skin conductivity, slower and more regular
respiration are opposite to the autonomic effects which characterize anxiety.
According to Wolpe who developed the systematic desensitization treatment,

If a response, inhibitory to anxiety can be made to occur in the presence of

anxiety-evoking stimuli, it will weaken the connection between these stimuli and
the anxiety responses (Wolpe, 1962; pg. 562).
 This is the principle of reciprocal inhibition, in line with which systematic
desensitization attempts to substitute muscular relaxation for the tension response of
anxiety which represents the persons reaction to the phobic stimuli.
Systematic desensitization usually proceeds through a number of identifiable
stages, namely the behavioural assessment, training in deep-muscle relaxation,
desensitization sessions and homework assignments.
Therapy begins with taking the patients case history and a detailed inquiry into
the patients specific difficulties. Detailed information about duration, frequency,
pervasiveness, strength, as well as data on relevant maintaining variables are specified
during the interview. Additional assessment procedures like the Fear Survey Schedule
are often administered. Individual autonomic signs of fear are explored. Direct
observation or self-observation through record keeping for a week or two may be
required. From these different sources, the problem is formulated in behavioural terms
and an anxiety hierarchy is derived.

An anxiety hierarchy is a breakdown of anxiety-evoking situations into

sufficiently small themes, which are then arranged from the least to the most anxiety
provoking. For example, a person who is afraid of heights might come up with a list of
about 20 to 25 items which span the entire range of distress. These are ranked from
the least threatening to the most. For example, Standing on a chair, Climbing up a
six-foot ladder, and Looking down from a twelve-story building would constitute low,
middle and high items respectively on the height hierarchy.
Concurrent with construction of the anxiety hierarchy, the patient is trained in the
technique of progressive deep muscle relaxation as outlined by Jacobson (1938) or the
modified version of Benson (1974, 1975). By alternatively tensing and relaxing specific
muscle groups, patient learns to discriminate feelings of tension and relaxation in his
muscles and to relax them more deeply. He is also instructed to practice the exercises
at home.
Table 1 provides an example of a hierarchy construction for fear of water and heights.

Table 1 Hierarchy Construction (Least Anxious to Most Anxious): Fear of Water

1. Taking a bath at home.

2. Taking a shower at home.
3. Going into the shallow end of the swimming pool.
4. Starting to swim at the shallow end of the swimming pool, breaststroke only.
5. Swimming at the shallow end, doing the crawl.
6. Jumping into the swimming pool at the shallow end.
7. Jumping into the pool and then doing the crawl.
8. Swimming at the shallow end, first breaststroke, then the crawl.
9. Pushing away from the bars and causing a splash.
10. Swimming in the middle of the pool at a depth of 5 feet 3 inches.
 11. Swimming at the shallow end and then at the deep end (10 feet 3 inches).
12. Going into the deep end of the swimming pool.

PAIRING OF STIMULUS AND RELAXATION

After the relaxation has been mastered and the anxiety hierarchy constructed,
the actual desensitization begins. The patient is instructed to imagine himself/herself in
the stimulus situation, staring with stimuli which are low on the hierarchy. Relaxation
responses are used to counteract and decondition the tension responses. Once the
weakest stimulus has ceased to arouse any tension or anxiety, it will be possible to
present the next higher stimulus from the hierarchy, for it will now evoke less anxiety
than it would have done before. With successive presentations to the relaxed client, the
amount of anxiety aroused by each imagined stimulus will be brought to zero, with
further generalization to related stimulus items.
The patient is instructed to imagine himself in the situation for about 10 to 15
seconds, and then given several minutes to relax before the next presentation. In case
of excessive tension, the patient signifies by raising his/her forefinger. After several
sessions, stimuli at the highest levels of the hierarchy may be imagined without
arousing any anxiety. For the treatment to be regarded as successful, however, the
patient must be comfortable in the real phobic situation. Systematic desensitization has
proved applicable to a wide variety of other clinical problems obsessions, insomnia,
frigidity, premature ejaculation and impotence.
Manifestations of Phobic Reactions.
Certain methods of treatment have been designed to help a person overcome
fear reactions to specific objects or situations. Such stimulus-specific fears are often
called phobias to distinguish them from generalized or pervasive anxiety, which does
not appear to be related to any special circumstances. Phobias are often irrational in
that the fears are unrealistic or out of proportion to actual circumstances. There are
many different phobias as there are discrete stimuli or situation.

Table 7.1 List of Common Phobias

DIAGNOSIS MEANING
Ablutophobia Fear of Bathing
Acerophobia Fear of Small Objects.
Acrophobia Fear of Heights
Agoraphobia Fear of Open Spaces
Aikephobia Fear of Justice
Ailurophobia Fear of Cats
Alektrophobia Fear of Chickens
Amanthophobia Fear of Dust
Androphobia Fear of Men
Anginophobia Fear of Choking
Aquaphobia (Hydrophobia) Fear of Water
Arachnophobia Fear of Spiders
Aremophobia Fear of Wind
Astraphobia Fear of Thunder
Bibliophobia Fear of Books
Chrometophobia Fear of Money
Claustrophobia Fear of Closed Spaces
Coitophobia Fear of Sexual Intercourse
Coprophobia Fear of Faeces
Cynophobia Fear of Dogs
Decidophobia Fear of Making Decisions
Dendrophobia Fear of Tiles
Domotophobia Fear of Home
Doraphobia Fear of Fur
Dysmorphophobia Fear of Minor Bodily Defects.
Ecclesiaphobia Fear of Churches
Equinophobia Fear of Horses
Graphophobia Fear of Writing
Hematophobia Fear of Blood
Homophobia Fear of Homosexuals
Hypnophobia Fear of Sleep
Myctophobia Fear of Darkness
Mysophobia Fear of Dirt and Germs
Ocholophobia (Demophobia) Fear of Crowds
Odontiatophobia Fear of Dentists
Ophidophobia Fear of Snakes
Pediophobia Fear of Young Children
Phagophobia Fear of Swallowing
Phonophobia Fear of Speaking
Photophobia Fear of Light
Ptergophobia Fear of Flying
Pteronaphobia Fear of Feathers
Pyrophobia Fear of Fire
Rhypophobia Fear of Dirt
Scholionophobia Fear of School
Scopophobia Fear of Being Stared At.
Siderodromophobia Fear of Trains
Sitophobia Fear of Food
Stasiphobia Fear of Standing Upright
Venerophobia Fear of Venereal Diseases
DIAGNOSIS MEANING
Xenophobia Fear of Strangers
Zoophobia Fear of Animals
It is assumed that phobic reaction usually developed as a result of some
adverse experience with similar or related situations, in line with the principle of
stimulus generalization. For example, strict discipline by a punitive father may
lead to a fear of all authority figures.
Factor analytic studies suggest that fears tend to cluster, that is, they are
interrelated in individuals. Behaviourally, the most common response is avoidance of a
specific situation, or escape if the individual unexpectedly encounters that situation.
Physiological responses typically include increases in heart rate; increased muscle
tension, constriction of blood vessels which account for why the hands get cold, and
changes in respiration. Cognitive responses manifest in verbalizations such as Im
terrified, images of catastrophic consequences like falling off the building and so on.
Before considering systematic desensitization as the treatment of choice, it is
necessary to make sure that the feared situations were objectively harmless and
presented no demands which the client lacked the skill to handle.
FLOODING OR IMPLOSIVE THERAPY:
This is another technique of behaviour modification aimed at directly altering
undesirable behaviour. Here the patient is required to imagine himself/herself in the
most threatening situations for prolonged periods right from the start rather than working
up to them gradually. S/he is not taught relaxation responses either. The rationale for
this approach is that insistent exposure to learned anxiety-producing stimuli, in
situations where the anxiety is not reinforced by an unconditioned stimulus, eventually
results in the extinction of the response habit. Continuous exposure to the frightening
stimulus causes that stimulus eventually to lose its power to elicit anxiety.
Example: The patient was a 33-year-old woman with social fears of eating in public.
In particular, she was afraid of being observed by others when chewing and swallowing,
particularly at dinner parties. A contrived situation was arranged in which the patient
came to the session with a prepared meal and drink. She entered a conference room in
which five persons in professional attire were already seated along a table. The patient
was instructed to eat her meal in front of these individuals. Between bites, she was
instructed to look at them often, and they had been instructed to avoid staring contests.
She was not to distract herself from her anxiety symptoms. She was to eat her meal
slowly, paying attention to the behavior of the observers and to her anxiety symptoms
(e.g., dry mouth or difficulty swallowing). No conversation between the patient and
observers was permitted. The observers would look at her and observe her chewing
and swallowing behaviors, at times writing comments in a notebook. Occasionally,
observers would communicate by whispering to each other, exchanging written notes,
or giving knowing glances and smiles.

The only other communication occurred between the patient and therapist, and this was
limited to the patient providing her subjective units of distress rating. The session lasted
90 minutes. Note: this situation may seem quite traumatizing. Because the exposure
session is long and continues until ratings decline, the patient becomes desensitized

AVERSIVE (COUNTERCONDITIONING) THERAPY:

Aversion therapy is the clinical use of noxious stimulus to inhibit an undesired
approach response, by pairing the stimulus with the cues that trigger off that desired
response. Most of these responses, like drinking, smoking, were initially reinforcing.
Therapy, therefore, uses classical conditioning to create aversion to the stimulus objects
by pairing them with noxious stimuli such as emetic (nausea-inducing) drugs or electric
shock. The use of noxious stimulation is somewhat unpleasant for the therapist as well
as the client. Aversive imagery can be used instead of noxious stimulation. This
method is called covert sensitization.
The techniques have been used to treat a variety of clinical conditions like
alcoholism, drug addiction, smoking, overeating and so on. It is not uncommon,
however, to find some patients treated successfully by aversive conditioning methods
relapse within several months. Periodical supplementary sessions after basic treatment
is often necessary.

PUNISHMENT:
One form of aversion therapy focuses upon the suppression of undesired
instrumental responses through punishment. Three basic punishment methods can
provide aversive consequences:
1. A noxious stimulus can be administered directly. An example is painful spanking
when the child threw a stone at somebody.
2. Positive reinforcement can be removed response cost. A childs favourite toy
can be taken away if he uses it to beat people or he may not be allowed to go to
a film show if he does not do the homework. The person pays a price for the
behaviour. Fines, penalties and the revocation of privileges are all instances of
response cost. The frequency of thumbsucking could be decreased, for example,
while a child watched cartoons by having the picture go off every time the child
started thumbsucking. The price of thumbsucking was that there was no more
picture. As long as the child kept his thumb out of his mouth he could watch the
cartoons uninterrupted.
3. The subject can be removed calmly from all sources of reinforcement by placing
him/her in an isolated setting for a while time out.

OPERANT TECHNIQUES
Operant techniques essentially involve the use or non-use of reinforcement in the
modification of maladaptive behaviour. Instrumental behaviour is modified by controlling
its consequences. Responses are likely to increase in occurrence if they are followed by
rewards and to decrease if they are consistently unrewarded or punished. Operant
conditioning may also be used to develop new behaviours. Krasner (1971) gave a
comprehensive review of developments in the application and evaluation of operant
procedures examples of which include the token economy systems and stimulus
control.
Token Economy:
Ayllon & Azrin (1968) discussed the use of token economy systems in such
settings as residential psychiatric wards and institutions for mentally retarded children.
Tokens, such as wooden discs, are used as reinforcers. They are exchangeable for a
variety of material goods and privileges like watching the television, going for a ride etc.
the individual earns tokens for desirable behaviour like washing self, putting clothes
away, making the bed etc. token economy can be used on a wide number of people and
to modify a variety of behaviours.

Some general points need to be considered in formulating an operant treatment

approach:
It is important to be systematic and consistent in carrying out the programme of
reinforcement contingencies.

(a) It is desirable to promote generalization of conditioned behaviour to other

settings.
(b) When a behaviour pattern is being extinguished by non-reinforcement, the
behaviour occasionally gets worse before it gets better. Before one introduces
the use of extinction to eliminate undesirable behaviour, he must be sure he can
tolerate the transition period in which the behaviour may initially get worse before
it extinguishes. Bedtime crying is an example.
(c) As much as possible, reinforcements should immediately follow performance of
the desired behaviour so that the subject is certain just what behaviour is being
rewarded. Sometimes, a bridge is provided to fill the gap between a response
and a reward through the use of tokens.

Expressive Or Assertiveness Training

Assertiveness is defined as follows: Assertive behavior enables a person to act in his or
her own best interest, to stand up for herself or himself without undue anxiety, to express honest
feelings comfortably, and to exercise personal rights without denying the rights of others.
Two types of situations frequently call for assertive behaviors: (1) setting limits on pushy friends
or relatives and (2) commercial situations, such as countering a sales pitch or being persistent
when returning defective merchandise.

Early assertiveness training programs tended to define specific behaviors as assertive or

nonassertive. For example, individuals were encouraged to assert themselves if somebody got in
front of them in a supermarket checkout line. Increasing attention is now given to context, that is,
what would be assertive behavior in this situation depends on circumstances.
 Several related methods have been designed to help people become more
socially at ease and develop effective interpersonal skills. Many individuals have
difficulty expressing their thoughts and feelings in interpersonal situations like making
requests, expressing friendliness or affection, verbalization of requests or refusal of
unreasonable requests, admission of error of fault, assertion of displeasure or anger
etc. As a result, such people often fail to achieve basic social goals and experience
anxiety and low self-esteem.
In therapy appropriate expressive responses are identified. The client is
encouraged to try out mild attempts at self-assertion, for example. He thus gains a
sense of control and adequacy with increasing success. Play-acting or behavioural
rehearsal of appropriate responses are often helpful. The therapist plays the role of the
other person, while the client acts out anticipated experiences, graded in the degree to
which they require in creasing social proficiency.

Social Skills Training

The negative symptoms in patients with schizophrenia constitute behavioral deficits that go
beyond difficulties with assertiveness. These patients have inadequate expressive behaviors and
inappropriate stimulus control of their social behaviors (i.e., they do not pick up social cues).
Similarly, patients with depression often experience a lack of social reinforcement because of a
lack of social skills, and social skills training has been found to be efficacious for depression.
Patients with social phobia similarly often have not acquired adolescents' social skills. In fact,
their social defensive behaviors (e.g., avoiding eye contact, making brief statements, and
minimizing self-disclosure) increase the probability of the rejection that they fear.

Social skills training programs for patients with schizophrenia cover skills in the
following areas: conversation, conflict management, assertiveness, community living, friendship
and dating, work and vocation, and medication management. Each of these skills has several
components. For example, assertiveness skills include making requests, refusing requests,
making complaints, responding to complaints, expressing unpleasant feelings, asking for
information, making apologies, expressing fear, and refusing alcohol and street drugs. Each
component involves specific steps. For example, conflict management includes skills in
negotiating, compromising, tactful disagreeing, responding to untrue accusations, and leaving
overly stressful situations. A situation in which conflict management skills might be used is
when the patient and a friend decide to go to a movie and their choice of movie differs.

Negotiating and compromising, for example, involves the following steps:

1. Explain one's viewpoint briefly.

2. Listen to the other person's viewpoint.
3. Repeat the other person's viewpoint.
4. Suggest a compromise.
Cognitive Behaviour therapy

This new trend in behaviour therapy refers to psychological treatments intended

to change maladaptive ways of thinking. For example, certain kinds of recurrent
thoughts are frequently described by people with emotional disorders, especially
depression. Several psychological tests are used to identify the disorder, albeit
unconsciously. By giving information and questioning the basis of assertions, unjustified
generalizations are highlighted. Underlying assumptions, which lead to depression, are
also identified and modified.

Participant Modeling

In participant modeling, patients learn a new behavior by imitation, primarily by

observation, without having to perform the behavior until they feel ready. Just as
irrational fears can be acquired by learning, they can be unlearned by observing a
fearless model confront the feared object. The technique has been useful with phobic
children who are placed with other children of their own age and sex who approach the
feared object or situation. With adults, a therapist may describe the feared activity in a
calm manner that a patient can identify. Or, the therapist may act out the process of
mastering the feared activity with a patient. Sometimes, a hierarchy of activities is
established, with the least anxiety-provoking activity being dealt with first. The
participant-modeling technique has been used successfully with agoraphobia by having
a therapist accompany a patient into the feared situation. In a variant of the procedure,
called behavior rehearsal, real-life problems are acted out under a therapist's
observation or direction.

The following is a self-report by a patient with a contamination phobia, who is afraid to

touch objects for fear of being infected or contaminated. She describes her reactions.

[The therapist] started touching everything very slowly. I was told to follow behind and
touch everything she touched. It was like we were spreading the contamination. She
touched doorknobs, light switches, walls, pictures, and woodwork. She opened drawers
in each bedroom and touched the contents. She opened closets and touched clothes
hanging on the rods. She touched the towels and sheets in the linen closet. She went
through the children's rooms, touching dolls, stuffed animals, models, Star Wars figures,
Transformers, and books.
[The therapist] kept talking to me quietly and calmly all the time we went along. I had
been anxious when we started, but as we continued, my anxiety level decreased. At
one point, when I had begun to think the worst was over, she pointed to the attic door
and said we were going inside. I said, No, that's where the mice were She told me I
didn't want to have a place in my home that was off limits. I agreed but became very
anxious. It was very hard for me to go inside. I began touching the boxes too, but I was
very upset. Then, she put her hands down on the floor and wanted me to do the same. I
said, I can't. I just can't Julie said, Yes you can

[The therapist] spent several hours with me that day. Before she left, she made a list of
things for me to do by myself. Twice a day I was to go through the house touching
everything the way she had done with me. I was to invite a friend of mine who had a pet
to come and visit and also friends of my children who had pets.
Morakinyo (1983), Awaritefe (1989) and Oladimeji (1989) reviewed examples of
the use of behaviour therapy in tackling various clinical and societal problems in Nigeria.
These authors demonstrated the usefulness of the behaviour therapy techniques in
tackling a variety of clinical problems such drug abuse, nocturnal enuresis, social skills
deficiencies, depression and anxiety.

LECTURE SUMMARY:

Learning plays a role in virtually every human activity

The learning processes is guided by several principles such as association and
motivation.
Learning involved contiguity, interference and stimulus response association and
most importantly the law of effect.
Main theories proposed to explain and outline the types of learning include the
classical and operant conditioning; trial and error or insight and observational
(latent) learning.
Any event that has an effect on the probability of a response is known as
reinforcement. Reinforces are classified as positive or negative according to
whether their presentation or removal strengthens the preceding response.
Reinforcement can be primary or secondary; intermittent or continuous.
A conditioned response can be extinguished, generalized, spontaneously
recovered and discriminated.
Trial and Error or insight Learning takes place when the new problem is solved
by combining previously leaned experiences or solutions in a new way.
Observation and latent learning result from the observation or imitation of
models, sometimes without any conscious intention.
It is obvious each theory approaches different aspects of the learning process.
Our habitual patterns of behaviour are developed from a combination of these
different types classical and operant conditioning, insight and observational
learning.
 Learning researchers have demonstrated practical applications of conditioning to
many aspects of human life.
Many habits and fear are acquired by some form of conditioning on real-life
situations, Neutral stimuli are associated with unconditioned stimuli.
Behaviour modification or behaviour therapy techniques attempt to apply learning
and other experimentally derived psychological behaviour, such as phobias.
Certain commonalities of behavioural approaches include the emphasis (focus)
on the observable processes; assessment of target behaviour; careful evaluation
of treatment process and outcome, giving constant feedback.
Techniques emanating from the classical conditioning approach include
systematic desensitization, flooding or implosive therapy; aversion therapy and
punishment.
Operant techniques essentially involve the use or non-use of reinforcement in the
modification of maladaptive behaviour, namely, token economy; assertion
training.
Participant Modelling was also described.
Practitioners have demonstrated the usefulness of behaviour therapy techniques
in tackling a variety of clinical and societal problems in Nigeria. These include
problems such as drug abuse, nocturnal enuresis, social skills deficiencies,
depression and anxiety.