Classical Conditioning Inspired Models of Therapy

What is Classical Conditioning Anyway?

“The emergence of behaviorism in the early twentieth century brought fresh approaches to the question, how do animals learn? (Rachlin, 1991, p. 62).”  In my old course textbook, Corsini & Wedding (2011). describe theoretical descendants of Pavlov, Wolpe & J.B. Watson’s work as a Neobehavioristic Mediational Stimulus-Response Model (p. 236).”  Overall, these approaches features the application of principles of  classical conditioning derived from the learning theories of these individuals (Corsini & Wedding, 2011). Before providing a “quick and dirty” overview of their work, there an overview of classical conditioning – in its modern format – is worth discussing.

A Core Clinical Hypothesis

I dug up another course textbook that provides an interesting perspective, titled “Clinical Case Formulations,” (Ingram, 2012).  It’s purpose is as follows. “A clinical case formulation is a ‘conceptual scheme that organizes, explains, or makes sense of large amounts of data and influences the treatment decisions’ (Ingram, 2012 p. viii).”  What I love about this book is it provides clinical hypotheses that are useful in providing “a single explanatory idea that helps us structure data about a given client (Ingram, 2012 p. 11).”  In chapter eleven of this textbook is a section titled “Behavior and Learning Models.”  In it is a clinical hypotheses based on theoretical classical conditioning insights.

“Hypothesis BL2: Conditioned Emotional Responses” (Ingram, 2012, p. 239).

The textbook notes that this hypothesis is based on the classical conditioned paradigm and implies that insights from his work are useful when a person is suffering from” high emotional distress and maladaptive avoidant behaviors, (Ingram, 2012 p. 239).”

Here is an explanation of this hypothesis, (Ingram, 2012).  
“When there is an intense emotional response that is not justified by the stimuli in the current environment, along with a lack of cognitive mediation, we can infer that prior learning involved classical conditioning. The treatment will frequently require explore to the conditioned stimuli, counter-conditioning with pleasant emotions and prevention of maladaptive avoidance responses. (Ingram, 2012, p. 239).”
Here is a clinical case example, (Ingram, (2012).
“Zac (42, White Christian), needs to overcome intense public speaking anxiety to attain an important promotion. he can recall the traumatic situation in which the conditioning response occurred. He was giving a speech in his eighth grade class when his mind went blank and he ran out of the room. Even thinking about standing in front of a group produces uncomfortable sensations, (Ingram, 2012, p. 239).”

Potential Problem Areas & Treatment Methods…

Finally, Ingram, (2012), mentions that this core hypothesis is useful with anxiety disorders, like social anxiety, panic, and OCD, as well as with trauma situations.  It is ideally useful in situations in which: (1) the emotional reaction is not contextually appropriate, and; (2) the client experiencing a functional impairment and “negative social consequences” (Ingram, 2012, p. 241). Treatment methods utilized can include exposure therapy (in vivo or via imagery) (Ingram, 2012).  Modern therapies based on Pavlov’s classical conditioning insights also utilized desensitization and flooding techniques, (discussed later).

Classical Conditioning Today…

Proponents of Behavioral therapy assert that it has grown beyond Pavlov’s dog or Watson’s Little Albert experiments.  When Pavlov began his experiments on animal behavior he was inspired by an interest in  ‘psychical activity on physiological facts, [desiring to unite]…the physiological with the psychological, the subjective with the objective (Wolpe & Plaud 1997, p. 966).”  Today rather than simply focusing on pairing a singular stimulus like a bell, with a singular response like drooling.  “Instead, correlations between entire classes of stimulus events can be learned (Corsini & Wedding, 2011, p. 247).”  The goal, however ultimately is the same” extinction or the deconditioning of an emotional / physiological response to a traumatic or anxiety producing situation or event (Corsini & Wedding 2011; Ingram, 2012).

Unique Aspects of this Behavioral Therapy Approach

Classical conditioning tends to focus on involuntary emotional and physiological responses.  In contrast, Skinner’s theory focuses on voluntary behaviors.  The extinction of a behavior for Pavlov is a triggered response that occurs by focusing on the stimulus.   Learning is then a passive process through the adjustment of expectations we develop in a situation based on previous experience.  We associate certain stimuli with an event and a response is elicited as a result.  In contrast, Skinner focuses on the consequences of our behavior, and the client’s role is an active one.   For Pavlov, behavior is more reflexive in nature and consequently they play a passive role in the learning process.

“Founding Fathers”

In this section I’m reviewing individuals reviewed in Rosenthal’s (2005) review CD for the Classical Condtioning of the NCE exam.  Included below is a “quick and dirty” overview of Pavlov, Watson, Wolpe, & Mary Covey Jones work.  

Ivan Pavlov

“While Pavlov was the director of the physiological laboratory at the Institute of Experimental Medicine in Petrograd, he noticed that dogs often would salivate at the sight of the attendant bringing them food or even at the sound of the attendant’s footsteps. Pavlov realized that the attendant was not a natural stimulus for the reflex of salivating; rather, the attendant acquired this power by being associated with food (Shunk 1991, p. 48).”

Pavlovian Conditioning

As the above quote notes, Pavlov noticed dogs salivating at the site of somebody bringing them food, or simply by hearing their footsteps.  He was interested in better understanding the stimuli that preceded these reflexive behaviors and how the to factors became connected.   In the above video is original footage from Pavlov’s classical experiment. “When meat powder was placed in a dog’s mouth, salivation takes place, (Bower & Hilgard, 1981, p. 49).”

UNCONDITIONED STIMULUS (UCS) – The meat powder in the above example is the unconditioned stimulus. It “causes a response without any learning or training, (Ingram, 2012, p. 239.”  
THE UNCONDITIONED RESPONSE (UCR) – The dog’s salivation in the above example, is the unconditioned response.  In Pavlov’s experiment it is an automatic and reflexive response.  

As stated earlier, Pavlov wanted to understand how stimuli become reflexive behaviors and cause them to happen.  In his experiments, he attempted to condition the dogs to salivate when after the presentation of a previously neutral experiment.  For example, Pavlov would ring a bell or turn on a ticking metronome prior to feeding the dogs  Eventually, they came to associate the ringing bell with food, and automatically salivate when hearing this noise….

THE CONDITIONED STIMULUS (CS) –  In this example, the bell or metronome are conditioned stimuli.  “Meaningless in themselves, these stimuli have been paired with an unconditioned stimulus (Ingram, 2012, p. 240.”
THE CONDITIONED RESPONSE (CR) – The conditioned response in Pavolv’s experiments above are conditioned responses when they occur after a previously neutral stimulus.  In the above example, when the dog salvates after the bell rings this is a conditioned response.
THE CONDITIONING PROCESS – “Palov saw conditioning as the establishment of a new reflex by the addition of a new stimulus to the group of stimuli that are capable of triggering a response. (Rachlin, 1991, p. 68).” 

Pavlov’s Hypotheses

From the above research, Pavlov learned that innate reflexive behaviors can be conditioned by establishing a connection in the brain between a conditioned stimulus and an unconditioned stimulus (Rachlin, 1991).  He conceived learning as an automatic process that occurs as a result of repeated CS-UCS pairing (Shunk, 1991). Pavlov has thwo hypotheses to explain how this happens:

STIMULUS SUBSTITUTION – Stimulus substitution occurs when the presence of a bell reminds the food for the dog.  The conditioned stimulus, (i.e. bell), is able to elicited a conditioned response through its association with the unconditioned stimulus.  This is called stimulus substitution.
PREPARATORY HYPOTHESIS – Pavlov also hypothesized that salivation occurs prior to conditioned stimuli because the dog salivation prepares the dog for eating, when food is given to him, (Rachlin, 1991).
EXPECTATIONS – Finally, Pavlov notes that expectations exists as a critical link between a conditioned and unconditioned stimulus.

Reinforcement

What Pavlov felt was crucial about the above hypotheses, is they can allow individuals to either learn new skills or extinguish maladaptive behaviors.  He uses the term reinforcement to refer to “the repeated following of the conditioned stimulus by the unconditioned stimulus and response at appropriate time intervals, (Bower & Hillgard, 1981, p. 50).”

Inhibition….

The gradual loss of a conditioned reflex is called inhibition.  Rosenthal (2005), states it is also sometimes called spontaneous.  Pavlov felt inhibition was not represent the complete removal of an original conditioned response.  Instead, the addition of an equal but opposite negative conditioning caused inhibition.  With this in mind, what follows are a few relevant terms to help understand this process:

INHIBITORY FORCE – Pavlov felt that extinction did not eliminate the original conditioned response, but added an equal opposite conditioning that prevented the emitting of a conditioned response (Rachlin, 1991).
EXTERNAL INHIBITION – “The temporary loss of a CR due to an extraneous distracting stimulus that reduces a conditioned stimulus to a light [response] (Bower & Hillgard, 1981, p. 54).” For example, a painful stimuli might cause a dog to lose it’s appetite.  
INTERNAL INHIBITION – “A learned form of inhibition that is evoked by a stimulus with nonreinforcement under circumstances when the US is otherwise expected (Bower & Hillgard, 1981, p. 54.)”  
EXTINCTION – This happens when the conditioned stimulus is no longer linked to the unconditioned stimulus.  In the above example, if you stop ringing the bell before feedings, the dog will no longer salivate when hearing a bell sound (Rosenthal, 2005).  Bower & Hillgard (1981), note extinction is a type of internal inhibition.

Generalization & Discrimination

Two final concepts are worth noting for this review.  Generalization and discrimination refer to alterations in the conditioned responses to various stimuli over time.  For example, with generalization occurs when a dog salivates with any bell-like sound, like a car horn or phone ringing.  In discrimination, when a dog responds to stimuli with greater levels of specificity.  For example, our cat used to think we were feeding it whenever we used the electric can opener.  Lately, my oldest teenager has been responsible for feeding the cat and changing the litter box.  Therefore, our cat only thinks its being fed when our son is by the can opener.

J.B. Watson

J. B. Watson (1878 – 1958) studied at the University of Chicago when the functionalist school of  “Put his name in history books by coining the term behaviorism in 1912 and is called father of behaviorism” (Rosenthal, 2005).  “The behaviorists…have in common the conviction that a science of psychology must be based upon a study of that which is observable” (Bower & Hillgard, 1981, p. 75).  As a behaviorist, Watson’s goal was to find objective laws of behavior to substitute the subjectivism that was prevalent in the emerging field of psychology.  In his work, Watson conceived feelings, and thoughts as “implicit or covert stimulus-response sequences” (Bower & Hillgard, 1981, p. 76).

The Little Albert Experiment

Inspired by Pavlov’s work, Watson used his experience as a “paradigm for learning and made the conditioned reflex the unit of habit” (Bower & Hillgard, 1981, p. 76).  In his classic “little Albert” experiment,Watson desired to replicate Pavlov’s dog experiment.   He exposed his little subject “Albert” to a loud noise whenever a white rat was present.  “After a few trials pairing rat and loud noise, Albert was afraid of the rat and stimulus generalization, causing him to be afraid of anything small and fury” (Rosenthal, 2005).  Apparently, he was unable to reverse this conditioning, and Albert lived his life in fear of any white furry animals.  While the questionable ethics pertaining to this experiment are obvious, it is frequently discussed in textbooks in relation to classical conditioning.

Insights & Observations

As a result of his “little Albert Experiment” Watson learned that frightening events can become” a conditioned stimulus that elicits a conditioned response that elicits anxiety” (Corsini & Wedding, 2011, p. 247).  Essentially, the reason this research appears repeatedly in Psychology textbooks, it is the first experimental demonstration of emotional conditioning.  In this respect, it provides the groundwork for systematic desensitization (discussed later).

Mary Cover Jones

Mary Cover Jones, (1897-1987), is a psychologist who focused on developmental psychology.  Known commonly as “the mother of behavioral therapy” (Rutherford, 2001), Mary conducted another classical conditioning experiment based on the insights of Pavlov & Watson.  However, her goals were much more noble: to extinguish a phobia in young children like Little Albert.  In her experiment, Mary utilized a young subject by the name of Peter who was about three-years-old.  She began by exposing him to something that scared him: a white rat.  She then followed this “feared object” with the presentation of food, a “craved object”.  After several repeated trials, Mary was able to eliminate Peter’s fear of rats…..

Key Insights…

Mary Cover Jones was able to prove “not only could a phobia be learned, it could be unlearned. In an article I found online, titled “The Elimination of Children’s Fears, ” she lists the results of subsequent research which builds on this insight (Jones, 1924):

“…In our study of methods for removing fear responses, we found unqualified success with only two. By the method of direct conditioning we associated the fear-object with a craving-object, and replaced the fear by a positive response. By the method of social imitation we allowed the subject to share, under controlled conditions, the social activity of a group of children especially chosen with a view to prestige effect. Verbal appeal, elimination through disuse, negative adaptation, “repression,” and “distraction” were methods which proved sometimes effective but were not to be relied upon unless used in combination with other methods, (p. 129).”

Joseph Wolpe

Based on the work of Jones & Watson, Joseph Wolpe (1915 – 1997), attempted to apply classical conditioning techniques to the therapy process. In his work “Psychotherapy by Reciprocal Inhibition”, Wolpe attempted to describe how habits could be unlearned (Corsini & Wedding, 2011).  Later, while working as an army physician in South Africa during, he described what he called “war neurosis” (now PTSD).  Wolpe felt neurosis was a byproduct of persistent anxiety that existed as a result of the autonomic nervous system and was a byproduct of classical conditioning (Corsini & Wedding, 2011).  He would eventually develop systematic desensitization as a therapeutic method to address this issue.  What follows is a description of key insights from Wolpe’s work…

What is Neurosis?

Firstly, Wolpe rejects the classical psychoanalytic view of neurosis as a byproduct of early events in one’s childhood.  Instead he felt it was a byproduct of learning processes and classical conditioning.  Neuroses consisted of persistent anxieties and maladaptive behaviors that can be unlearned.

Reciprocal Inhibition.

In his work, Wolpe, (1995 & 1997), has described the use of counterconditioning techniques to address and eliminate anxiety.  He defines reciprocal inhibition as follows:

“When a response antagonistic to anxiety can be made to occur in the presence of anxiety-evoking stimuli, and in consequence effects a complete or partial suppression of the anxiety response, the bond between…stimuli and…response is weakened (Wolpe, 1995, p. 24).”

Ideal this technique is useful for emotionally conditioned knee-jerk responses and involves some opposite action.   Engaging in an response that is contradictory to the emotions you are feeling, when presented with anxiety-producing stimuli can inhibit a maladaptive behavior.  Wolpe, (1995) notes: “Laughter is inhibited by sadness, anger or anxiety and can in turn inhibit them (p. 26).”

Systematic Desensitization

“Systematic desensitization a conditioning form of therapy for treating phobias that has four distinctive stages after you build a rapport with the client, (Rosenthal, 2005).”  These steps are described as follows:

  1. STAGE ONE – Relaxation Training.  The first step in systematic desensitization involves teaching clients relaxation techniques.  Rosenthal, (2005), notes that the Jacobson Technique is most common.
  2. STAGE TWO – Construct Hierarchy.  – Next, clients rank their list of fears in a hierarchical order so that they can be addressed gradually in therapy.  Rosenthal (2005) suggests utilizing the SUDS (Subjective Units of Distress Scale) to assure accuracy of this hierarchical scale of “feared stimuli”.
  3. STAGE THREE – Imagination.   In the interposition phase, clients utilize their imagination to think about their feared objects on their list, starting with the lowest one.  For me this would involve standing in front of a class and image giving a speech.
  4. STAGE FOUR – in vivo.  Finally, the clients gradually work their way through their feared stimuli.  This might involve co-facilitating of a group therapy class with my supervisor a few times, before running it independently.

Edwin Guthrie

“A combination of stimuli which has accomplished a movement on its recurrence tend to be followed by that movement. Stimuli patterns which are active at the time of a response tend, on being repeated, to elicit a response (Shunk 1991, p. 84).”

While not mentioned in my review CD’s by Rosenthal (2005), there is one more individual that warrants mention.  Edwin R. Guthrie (1886-1959) is a behaviorist who proposed that learning was based on an association & that reward systems were not necessary.  Two separate sources I’ve reviewed provide the above quote, which seems to indicate its important (Bower & Hilgard, 1981; Shunk, 1991).  I’m not a fan of Guthrie’s convoluted writing style.  However, it appears he is making a statement that stimuli and responses that occur together can be expected to do so in the future.  He calls this contiguity learning.  Additionally, he is noting in the above statement that there are two types of behaviors, defined below:

“Movements are discrete behaviors that result from muscle contractions…acts [are] large-scale cassess of movements that produce an outcome (Shunk, 1991, p. 84).”

Principles of Learning

In Guthrie’s writing are observations on Principles of Learning, listed below:

ASSOCIATIVE STRENGTH:  “Guthrie states that learning occurs through the pairing of a stimulus and response” (Shunk, 1991, p. 84).  The success of a learning opportunity is a function of the associative strength between a stimulus and a response.  
ALL-OR-NONE PRINCIPLE:  Guthrie rejected the notion of frequency and repetition as critical for learning (Shunk, 1991).  Instead, he believed that learning had a threshold potential.  In other words a minimal level of associative strength was required for learning.  This – he believe – was more important than repetition.
CONGITUITY: Guthrie believed that reward and punishment was not essential learning.  Instead he discussed the “mechanism of contiguity, or close pairing in time between stimulus and response” (Shunk 1991, p. 45).  
UNLEARNING: Guthrie felt, however, that rewards were helpful in preventing forgetting (or what he calls unlearning).  

How to Break Habits..

Guthrie defines habits as “learned dispositions to repeat past responses” (Shunk, 1981, p. 85).  In his theory, he provides three methods for breaking a habit.  The key underlying his methods involves associating new responses to old cues:

THRESHOLD METHOD:   Stimuli that precede a habit are introduced a a weak level below the required associative strength required for learning (Shunk, 1981).  Gradually, increase strength level, but keep the stimuli below required associative strength.  For example, I will increase the amount of time I spend doing homework with my son gradually.  However, I am also mindful of his frustration level.
FATIGUE METHOD:  Stimuli that triggers a bad habit is transformed into one that causes an individual to avoid it  (Shunk, 1981).  For example, when I become stressed I don’t respond by eating, instead I respond by exercising.
INCOMPATIBLE RESPONSE METHOD: “…the cue for the undesired behavior is paired with a response incompatible with the undesired response; that is the two responses cannot be performed simultaneously” (Shunk, 1981, p. 87).

Techniques Based on Classical Conditioning…

I am going to conclude this section with a “quick and dirty” overview of miscellaneous techniques based on classical conditioned discussed in Rosenthal’s (2005) NCE review CD’s.

Sensate Focus

“This popular technique for sexual dysfunction based on Masters & Johnson counterconditioning [is also known as behavioral sexual therapy]…Couples are told to engage in non-erotic touching while very relaxed.  They slowly work up to intercourse like systematic desensitization.” (Rosenthal, 2005).

Assertiveness Training.

Based on Wolpe’s (1995) concept of reciprocal inhibition, assertiveness training involves “overcoming interpersonal timidity.  The person is shown how to express, in all reasonable circumstances, legitimate anger, affection, and other appropriate feelings” (p. 32).  Rosenthal, (2005), notes “it has roots in the work of Andrew Salter who in 1949 wrote a book called “CONDITION REFLEX THERAPY”.  

Aversive Conditioning

Aversive conditioning is based on the classical stimulus-response model.  An unpleasant unconditioned stimulus is paired with a maladaptive behavior so that client develops an avoidance response.   An ideal example includes the pairing the antabuse and alcohol (Rosenthal, 2005).

Flooding & Implosive Therapy

Rosenthal, (2005), describes flooding as a form of exposure therapy ideal for trauma and anxiety related disorders.  It encompasses exposure to an anxiety-producing stimulus, while engaging in response prevention.  In contrast, implosive therapy is an imaginative version of flooding.  Wolpe, (1995), notes that techniques such as flooding are successful due tot their ability to induce extinction processes to occur….

Biofeedback

This high-tech form of behavioral therapy that involves being hooked up to monitors that measure your vital signs.  It is useful with anxiety and stress-related disorders, allowing clients understand the effects of stress, anxiety and relaxation exercises on the body.  Rosenthal (2005), notes that it is based on the work of Neil Miller who noted that we can control the autonomic nervous system.

Paradoxical Intention

As a fan of Viktor Frankl’s work, I will devote another post to his work.  In this post I limit my discussion of Frankl to a concept pertaining to behavioral therapy he calls “paradoxical intention”.  It is useful with anxiety disorders and in family therapy, however “should never be used with suicidal or homicidal patients” (Rosenthal, 2005).   The goal of paradoxical intention is to extinguish maladaptive behaviors.  This is done by having the client engage in a highly exaggerated and inappropriate level of a specific behavior they hope to extinguish.  Underlying this technique is an interesting observation about a vicious cycle underlying anxieties and phobias that this technique addresses through counterconditioning:

“If one wishes to understand how paradoxical intention works, he should take as a starting point the mechanism called anticipatory anxiety: A given symptom evokes, on the part of the patient, a response in terms of the fearful expectation that it might recur; fear, however, always tends to make true precisely that which one is afraid of, and by the same token, anticipatory anxiety is liable to trigger off whata the patient so fearfully expects to happen. Thus a self-sustaining vicious cycle is established: A symptom evokes phobia; the phobia evokes the symptoms…” (Frankl, 1975, 226p).

Beta Hypothesis

Knight Dunlap, another behavioral psychologist and noted a paradoxical aspect of habits similar to Viktor Frankl’s.  Essentially, repetition of a specific habit did not influence is gradual development or emergence.  Instead Dunlap (1928) noted that “importance of anticipatory ideas and desire [are] elementary factors”, (p. 361).  Therefore, Dunlap suggested that clients engage in the dysfunctional habits at times when they would not normally do so.  “Paradoxically enough, this often eliminates or reduces the frequency of the behavior” (Rosenthal, 2005).

Multimodal therapy

Arnold Lazarus (1932-1928) is a clinical psychologist born in South Africa who based a holistic model of mental health (Corsini & Wedding, 2011).  He founded a Multimodal Therapy Approach based on insights from cognitive and social learning therapies (Corsini & Wedding).  Rather than focusing on unconscious vs. unconscious aspects of the psyche, this method involves assessing a client’s needs in several key areas.  This method utilizes the acronym BASIC ID to examine several key aspects of an individual’s well-being: “Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal Relationships, and Drugs” (Rosenthal, 2005).

References

Bower, G.H. & Hilgard, E.R. (1981). Theories of Learning, 5th Ed..  Englewood Cliffs, N.J.: Prentice-Hall.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Guthrie, E.R. (1952). The psychology of learning. New York: Harper Row.
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.
Jones, M. C. (1924). The Elimination of Children’s Fears.  Retrieved from:  http://www1.appstate.edu/~kms/classes/psy5150/Documents/MCJones1924.pdf
Kazdin, A. E. (2012). Behavior modification in applied settings. Waveland Press.
Dunlap, K. (1928). A revision of the fundamental law of habit formation. Science.  Retrieved from: https://www.ganino.com/games/Science/science%20magazine%201920-1939/root/data/Science_1920-1939/pdf/1928_v067_n1736/p1736_0360.pdf
Nye, R.D. (1979). What is B.F. Skinner Really Saying?. Englewood, N.J.: Prentice-Hall.
Pierce, W. D., & Cheney, C. D. (2013). Behavior analysis and learning. Psychology Press.  Retrieved from: https://scholar.google.com/scholar?cluster=8530085740643864664&hl=en&as_sdt=0,28&as_ylo=2012
Rachlin, H. (1991). Introduction to Modern Behaviorism, 3rd. Ed. New York: Freeman & Company.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Rutherford, A. (2001). Introduction to a laboratory study in fear: The Case of Peter. Retrieved from:  http://psychclassics.yorku.ca/Jones/intro.htm
Schunk, D. H. (1991). Learning theories: An educational perspective. Retrieved from: http://s3.amazonaws.com/academia.edu.documents/44670152/_Dale_H._Schunk__Learning_Theories_An_Educational..pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1475602918&Signature=jyd3eErVXh%2F6RaD8I%2B056ea%2FlNw%3D&response-content-disposition=inline%3B%20filename%3DDale_H._Schunk_Learning_Theories_An_Edu.pdf
Frankl, V. E. (1975). Paradoxical intention and dereflection. Psychotherapy: Theory, Research & Practice12(3), 226-237. doi:10.1037/h0086434
Wolpe, J. (1995). Reciprocal inhibition: Major agent of behavior change. In W. T. O’Donohue, L. Krasner, W. T. O’Donohue, L. Krasner (Eds.) , Theories of behavior therapy: Exploring behavior change (pp. 23-57). Washington, DC, US: American Psychological Association. doi:10.1037/10169-002
Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contributions to behavior therapy: The obvious and the not so obvious. American Psychologist, 52(9), 966-972.

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