Psychology for Dummies (80 page)
Read Psychology for Dummies Online
Authors: Adam Cash
Tags: #Psychology, #General, #Body; Mind & Spirit, #Spirituality
There are several different types of therapy known as
exposure-based therapies
that involve “exposing” a target behavior to new conditions in order to reduce it’s occurrence.
Exposure
is another word for reassociating or relearning a target behavior with another behavior that results in the cessation of the target behavior.
Have you ever tried to smoke a cigarette while in the shower? It’s pretty hard to do. I once worked with a guy who managed to come up with a way to pull it off. (Interested? I won’t support that habit by giving you the details.) Anyway, I’m guessing that most of us find that smoking and water don’t mix. These two actions are incompatible. Finding a behavior that interferes with a target behavior is a good way to stop the target behavior from occurring.
Jacobsen and Wolpe both developed therapy techniques that made use of this incompatibility concept. When two behaviors occur at the same time, the stronger behavior prevails. Water always wins over cigarettes. The behavior-therapist jargon for this concept is
reciprocal inhibition
or
counterconditioning.
Therapy that makes use of reciprocal inhibition or counterconditioning is designed to weaken the classically conditioned, negative target behavior. When you “expose” cigarettes to water, smoking is pretty hard to pull off!
Counterconditioning
is the operative mechanism of all exposure-based therapies.
Perhaps the best way to explain how counterconditioning drives exposure therapy is to talk about one of its most popular forms of exposure therapies,
systematic desensitization (SD).
SD is most commonly used to treat phobias, like fear of public speaking, social phobia, or some other specific phobia. Therapists have also used it to successfully treat panic disorder accompanied by agoraphobia. There are several types of exposure-based therapies based on the systematic desensitization principle:
Covert sensitization (imaginal exposure):
The “learning” or associating is only occurring in the patient’s mind and not in real life.
The procedures that Wolpe and Jacobsen developed are very similar. Therapists teach patients how to enter a state of deep relaxation. Then they ask the patients to imagine themselves in the fear-producing, phobic situation, while maintaining their state of relaxation. When a patient’s anxiety level gets too high, the therapist asks the patient to let go of the image and continue to just relax.
When this process is repeated over and over again for several sessions, the fear response to the situation is diminished because the state of relaxation is competing with the original fear of the situation or object. Instead of fear, the patient now associates relaxation with the fear-inducing situation or phobic object.
Graduated-exposure therapy:
When a patient learns to perform his or her feared behavior in a real life situation, he or she is engaging
in vivo sensitization.
Usually, this form of desensitization is done gradually, and hence its name. If I’m afraid of flying, my therapist might start with me watching movies about flying. Then I’d go to the airport; then I’d sit in the terminal; then on an airplane. There’s a gradual move toward the eventual goal of flying, but not until I’ve done a lot of preparatory work and learned to relax during subsequent stages.
Flooding:
This form of therapy involves exposing a patient to his or her fear-inducing situation or object for a sustained and prolonged period of time. The patient’s anxiety goes through the roof, so this can kind of sound like torture. If you’re afraid of snakes, jump into a tank full of them. You’ll either die or get over your fear of snakes! There’s no gradual exposure here. Just jump into a pit of snakes and get over it already!
It gets better! The patient is not only exposed to his worst fears, but he’s prevented from running away, leaving, or engaging in whatever escape behavior he’s typically used in the past to avoid the fear. This is called
response prevention.
Flooding sounds horrible, but it’s actually one of the most powerful forms of behavior therapy. If a patient trusts his or her doctor, it can be a quick way to get over some powerful and debilitating phobias. It may seem cruel, but patients must consent to all treatment, and typically, people aren’t forced to go to any kind of therapy, unless it’s by the courts. (For more on the role of therapy in the criminal justice system, see Chapter 17.)
Alcoholics Anonymous uses the term “stinking thinking” to describe the kinds of thoughts that a recovering alcoholic has when he or she thinks negatively and contemplates taking a drink. The simplicity of this statement should not be mistaken for a lack of wisdom. The power of thought should never be underestimated.
Cognitive therapy
is a popular and well-researched form of psychotherapy that emphasizes the power of thought. From the perspective of cognitive therapists, psychological problems, such as interpersonal difficulties and emotional disorders, are the direct result of “stinking thinking.” In other words, maladaptive thought processes or cognitions cause these problems. “Stinking thinking” can have a tremendous impact on our psyche because we analyze and process information about every event that occurs around us and our reactions to all of these events. It can look something like this:
A (losing my job) → B (my thoughts about getting fired) → C (my emotions thought processes about the event)
Our reactions are the product of how and what we think about a situation or event. In many situations, such as the experience of loss, an insult, a failure, or encountering something scary, it’s only natural to feel some negative emotion. Negative reactions are not necessarily abnormal. It’s only when our emotional and behavioral reactions become extreme, fixed, and repetitive that we start down the path of psychological disturbance.
Sometimes our thinking can be biased or distorted, and this can get us into trouble. Cognitive therapy approaches reality from a relativistic perspective, an individual’s reality is the byproduct of how he or she perceives it. However, cognitive therapists don’t view psychopathology as simply a consequence of thinking. Instead, it’s the result of a certain kind of thinking. Specific errors in thinking produce specific problems.
Aaron Beck identified six specific cognitive distortions that lead to psychological problems:
Arbitrary inference:
This distortion occurs when someone draws a conclusion based on incomplete or inaccurate information. If a couple of scientists are asked to describe an elephant, but all they can see of the elephant is what’s visible through a small hole in a fence, each scientist’s elephant description will probably be different. One scientist looks through the hole and sees a tail. Another looks through and sees a trunk. The first scientist describes an elephant as an animal with a tail, and the other says that it’s an animal with a trunk. Neither one of them has the complete picture, but they both think that they know the truth.
Catastrophizing:
My grandmother used to refer to this distortion as “making a mountain out of a molehill.” Beck defined it as seeing something as more significant than it actually is.
Dichotomous thinking:
Most of us know that thinking only in terms of black and white, without considering the gray areas, can get us into trouble. When we categorize events or situations into one of two extremes, we’re thinking dichotomously. While working in prisons, I’ve found that inmates often separate people into two groups, — friend or foe. “If you’re not my friend, you’re my enemy.”
Overgeneralization:
“My boyfriend dumped me; no one loves me.” This is an example of overgeneralization — when someone takes one experience or rule and applies it across the board to a larger, unrelated set of circumstances.
Personalization:
One of my favorite movies is
The Tempest.
Toward the end of the movie, the main character thinks that he summoned a storm that capsized his enemies’ boat. Personalization occurs when someone thinks an event is related to him or her when it actually isn’t.
Selective abstraction:
I once knew a guy in college who believed that women always laughed at him when he walked by them on campus. Little did he know that most of the women probably didn’t notice his existence. They were most likely laughing at a joke or some other funny situation that had nothing to do with him. He arrived at a conclusion by taking their behavior out of context.
As with behavior therapy, the theory underlying cognitive therapy is beautiful in its simplicity. If psychological problems are the products of errors in thinking, therapy should seek to correct that thinking. This is sometimes easier said than done. Fortunately, cognitive therapists have a wide range of techniques and a highly systematic approach at their disposal.
The goal of cognitive therapy is to change biased thinking through the use of logical analysis and behavioral experiments designed to test dysfunctional beliefs. Many thinking errors consist of faulty assumptions about oneself, the world, and others. Cognitive therapy usually goes something like this:
1. The therapist and patient perform a thorough assessment of the patient’s faulty beliefs and assumptions and how these thoughts connect to specific dysfunctional behaviors and emotions.
Christine Padesky and Dennis Greenberger, in their book
Mind Over Mood
(Guilford Press), provide the patient with a system for identifying these thinking errors, which cognitive psychologists commonly call
automatic thoughts
— thoughts that occur automatically as a reaction to a particular situation. The patient is asked to keep track of specific situations that occur between therapy sessions and to identify and describe in detail his or her reactions to those situations.
2. The therapist and patient work together, using the automatic thought record, to identify the cognitive distortions mediating between the situations and his or her reactions.
This often-difficult process can take anywhere from several weeks to several months, but at the end of the process, the distortions have been thoroughly identified.
3. The patient and therapist work collaboratively to alter his or her distorted beliefs.
The therapist and patient collaborate in a process of logical refutation, questioning, challenging, and testing of these faulty conclusions and premises. This effort attempts to make the client a better thinker and break him or her of the habit of poor information processing.