CHAPTER 39
Behaviourally-based Treatments
Behavioural methods used to be based on the notion that all behaviours
are learned, and so can be unlearned. However, a less extreme form of
behaviourism that is perhaps more acceptable states that the expression
of most behaviour is influenced by antecedent events and consequent
responses. Altering these may change the frequency of the behaviour.
Classical conditioninginvolves stimulus-contingent effects, as described by
Pavlov in 1927. A previously neutral stimulus becomes associated with
one that triggers the physiological response, and in time the new stimulus
alone (now calledconditioned) leads to a similar response. Treatments based
on this model condition new physiological responses, such as relaxation
to the stimulus. Examples that work well with children and adolescents
include systematic desensitisation for post-traumatic stress disorder and
phobias.
Operant conditioninginvolves response-contingent effects, as described by
Skinner in 1938. Responses to stimuli, or indeed behaviours of any kind,
become more frequent or stronger if they lead to rewarding consequences
(positive reinforcement), or to escape from unpleasant consequences (negative
reinforcement). Behaviours become less frequent if previously rewarding
consequences are taken away (extinction), or if they lead to unpleasant
consequences (punishment). Treatments based on this model consistently
change the contingencies that follow a behaviour. This may be to increase
desired behaviour through rewards (a star chart for clean underpants
without soiling), or to reduce undesired behaviour through punishment
(being made to clean the floor after throwing dinner on it). This approach
also includes ensuring that undesirable symptoms or behaviours are not
unintentionally rewarded, for example, ensuring that a child is not re-
warded for psychogenic abdominal pain by being allowed to miss school
andstayathome.
Social learning theory, developed by Bandura in the 1960s, led to a general
widening of the behavioural model to recognise the primacy of human re-
lationships in influencing learning. In children and adolescents, Patterson
confirmed the central role of parental attention in providing rewards, and
showed that in families where there is little positive interaction, children
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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