Abnormal Psychology

Foundations of Treatment 125

To treat compulsive behaviors, behavior therapists may use a variant of exposure

calledexposure with response prevention, whereby the patient is carefully prevented

from engaging in the usual maladaptive response after being exposed to the stimu-

lus (Foa & Goldstein, 1978). Using this technique with someone who compulsively

alphabetizes his or her canned goods, for instance, involves exposing the person to a

cupboard full of canned goods arranged randomly and then, as agreed, preventing the

typical maladaptive response of alphabetizing the cans. The person then habituates to

the ensuing anxiety. Similarly, someone with bulimia might eat a bite or two of a des-

sert and, as planned, not throw up. This technique will be described more fully when

we discuss treatments for OCD (Chapter 7) and bulimia nervosa (Chapter 10).

Treating Habitual Maladaptive BehaviorsSome disorders—substance-related

disorders, eating disorders, and sexual disorders—involve habitual maladaptive

behaviors that are elicited by certain stimuli. For instance, some people drink alcohol

to excess (habitual maladaptive behavior) only when they are in bars or clubs (the

stimulus). Others may binge (habitual maladaptive behavior) when they eat dessert

(the stimulus). Still others may become inappropriately sexually aroused (habitual

maladaptive behavior) in response to touching women’s shoes (the stimulus).

To treat such disorders, the behavior therapist may seek to limit the patient’s

contact with the stimulus. This technique, called stimulus control, involves changing

the frequency of a maladaptive conditioned response by controlling the frequency

or intensity of exposure to the stimulus that elicits the response. For example, the

person who drinks too much in bars would refrain from going to bars; the person

who binges after eating even a bit of dessert might avoid buying desserts or going

into bakeries. Stimulus control will be described more fully when we discuss treat-

ment for substance abuse (Chapter 9).

The Role of Operant Conditioning in Behavior Therapy

Whereas classical conditioning methods can be used to decrease maladaptive

behaviors related to conditioned emotional responses, operant conditioning tech-

niques can be used to modify maladaptive behaviors more generally. When operant

conditioning principles such as reinforcement and punishment are used to change

maladaptive behaviors, the process is called behavior modifi cation.

Making Use of Reinforcement and Punishment The key to successful behavior

modifi cation is setting appropriate response contingencies, which are the specifi c

consequences that follow maladaptive or desired behaviors. It is these specifi c con-

sequences (namely, reinforcement or punishment) that modify an undesired behav-

ior. The goal of behavior modifi cation is to have someone perform a desired

behaviormore often or perform an undesired behavior less often (or not at all) by

shifting the consequences of the behavior through reinforcement, removing rein-

forcement, or—less frequently—through punishment.

Some behaviors are too complex to learn or perform immediately and must

be developed gradually. Let’s consider a woman who has had the eating disorder

anorexia nervosa for a number of years. As we discuss in detail in Chapter 10, this

eating disorder involves an inadequate intake of calories, which is a consequence of

the individual’s irrational belief about being “fat.” (People with anorexia are at least

15% under their ideal weight.) When people with anorexia are in the early stages

of recovery, eating a normal quantity of food can seem impossible. They may not

be able to go from their daily intake of perhaps a serving of yogurt, a glass of milk,

an egg white and a piece of fruit to three square meals a day along with a snack or

two between meals. Sometimes the desired behavior change (in this case, resum-

ing normal eating) can only occur gradually, and reinforcement follows small and

then increasingly larger components of the desired new complex behavior. Thus, a

woman recovering from anorexia nervosa might be reinforced for increasing her

dinner from only a glass of milk and an apple to also include a small helping of fi sh.

On subsequent meals, she might be expected to eat the fi sh (without reinforcement)

and be reinforced for adding a piece of bread. This process would continue until she

ate normal meals.

Exposure with response prevention

The behavioral technique in which a patient

is carefully prevented from engaging in his or

her usual maladaptive response after being

exposed to a stimulus that usually elicits the

response.

Stimulus control

The behavioral technique for changing the

frequency of a maladaptive conditioned

response by controlling the frequency or

intensity of exposure to the stimulus that

elicits the response.

Behavior modifi cation

The use of operant conditioning principles to

change maladaptive behavior.

As part of behavioral treatment, someone with

bulimia may use stimulus control initially to limit

her intake of foods that she is likely to purge.

If she habitually purges after eating cookies,

for instance, she may want to avoid eating—or

buying—cookies. Once she is out of the habit of

purging, she may use exposure with response

prevention to learn to eat cookies without

purging.

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