3.4: Psychological Models

Learning Objectives

• Define and describe the psychodynamic model
• Describe learning.
• Outline classical conditioning and the work of Pavlov and Watson.
• Outline operant conditioning and the work of Thorndike and Skinner.
• Outline observational learning/social-learning theory and the work of Bandura.
• Evaluate the usefulness of the behavioral model.
• Define the cognitive model.
• Exemplify the effect of maladaptive cognitions on creating abnormal behavior.
• List and describe cognitive therapies.
• Evaluate the usefulness of the cognitive model.
• Describe the humanistic perspective.
• Describe the existential perspective.
• Evaluate the usefulness of the humanistic and existential perspectives.

The Psychodynamic or Psychoanalytic Model

Levels of Consciousness

To explain the concept of conscious versus unconscious experience, Sigmund Freud compared the mind to an iceberg (Figure 1). He said that only about one-tenth of our mind is conscious or self-aware, and the rest of our mind is unconscious. Our unconscious refers to mental activity (emotional reactions, motivations) of which we are unaware and are unable to access (Freud, 1923). 

Figure 1. Freud believed that we are only aware of a small amount of our mind’s activities and that most of it remains hidden from us in our unconscious. The information in our unconscious affects our behavior, although we are unaware of it.

 

According to Freud, our personality develops from a conflict between two forces: our biological aggressive and pleasure-seeking drives versus our internal (socialized) control over these drives. Our personality is the result of our efforts to balance these two competing forces. Freud suggested that we can understand this by imagining three interacting systems within our minds. He called them the id, ego, and superego (Figure 2).

 

The unconscious id contains our most primitive drives or urges and is present from birth. It directs impulses for hunger, thirst, aggression, and sex. Freud believed that the id operates on what he called the “pleasure principle,” in which the id seeks immediate gratification. Through social interactions with parents and others in a child’s environment, the ego and superego develop to help control the id. The superego develops as a child interacts with others, learning the social rules for right and wrong. The superego acts as our conscience; it is our moral compass that tells us how we should behave. It strives for perfection and judges our behavior, leading to feelings of pride or—when we fall short of the ideal—feelings of guilt. In contrast to the instinctual id and the rule-based superego, the ego is the rational part of our personality. It’s what Freud considered to be the self, and it is the part of our personality that is seen by others. Its job is to balance the demands of the id and superego in the context of reality; thus, it operates on what Freud called the “reality principle.” The ego helps the id satisfy its desires in practical and socially acceptable ways. The ego mediates between the id and the superego. 

The id and superego are in constant conflict because the id wants instant gratification regardless of the consequences, but the superego tells us that we must behave in ways that align with social and cultural expectations and demands. Thus, the ego’s job is to find the middle ground. The ego helps satisfy the id’s desires in a rational way that will not lead us to feelings of guilt. According to Freud, a person who has a strong ego, which can balance the demands of the id and the superego, has a healthy personality. Freud maintained that imbalances in the system can lead to neurosis (a tendency to experience negative emotions), anxiety disorders, or unhealthy behaviors. For example, a person who is dominated by their id might be narcissistic and impulsive. A person with a dominant superego might be controlled by feelings of guilt and deny themselves even socially acceptable pleasures; conversely, if the superego is weak or absent, a person might become a psychopath. An overly dominant superego might be seen in an over-controlled individual whose rational grasp on reality is so strong that they are unaware of their emotional needs, or, in a neurotic person who is overly defensive (overusing ego defense mechanisms).

Defense Mechanisms

Freud believed that feelings of anxiety result from the ego’s inability to mediate the conflict between the id and superego. When this happens, Freud believed that the ego seeks to restore balance by reducing anxiety through various protective measures known as defense mechanisms (Figure 3). The ego, usually conscious, resorts to these unconscious actions or behaviors to protect itself from becoming overwhelmed. Thus, when we use defense mechanisms, we are unaware that we are using them. Further, they operate in various ways that may distort reality. According to Freud, we all use ego defense mechanisms; they are a normal part of life, but defense mechanisms can also backfire if the underlying conflict is never resolved.

 

Figure 3. Defense mechanisms are unconscious, protective behaviors that work to reduce anxiety.

 

While everyone uses defense mechanisms, Freud believed that overuse of them may be problematic. For example, let’s say Aaron Snyder is a high school football player. Aaron’s id feels sexually attracted to males. His culturally shaped superego-driven conscious belief is that being gay is immoral and that if he were gay, his family would disown him and he would be ostracized by his peers. Therefore, there is a conflict between his conscious beliefs (being gay is wrong and will result in being ostracized) and his unconscious urges (attraction to males). The idea that he might be gay causes Joe to have feelings of anxiety, possibly overwhelming his ego or ability to balance this internal conflict. How can he decrease his anxiety? Joe may find himself acting very “macho,” making gay jokes, and picking on a school peer who is gay. This way, Joe’s unconscious impulses are further submerged, and his anxiety is reduced because he “fits in.”

There are several different types of defense mechanisms. For instance, in repression, anxiety-causing memories from consciousness are blocked. As an analogy, let’s say your car is making a strange noise, but because you do not have the money to get it fixed, you just turn up the radio so that you no longer hear the strange noise. Eventually you forget about it. Similarly, in the human psyche, if a memory is too overwhelming to deal with, it might be repressed and thus removed from conscious awareness (Freud, 1920). This repressed memory might cause symptoms in other areas.

Another defense mechanism is reaction formation, in which someone expresses feelings, thoughts, and behaviors opposite to their inclinations. In the above example, Aaron made fun of a homosexual peer while himself being attracted to males. In regression, an individual acts much younger than their age. For example, a four-year-old child who resents the arrival of a newborn sibling may act like a baby and revert to drinking out of a bottle. In projection, a person refuses to acknowledge her own unconscious feelings and instead sees those feelings in someone else. Other defense mechanisms include rationalization, displacement, and sublimation.

While many of Freud’s ideas have not found support in modern research, we cannot discount the contributions that Freud has made to the field of psychology. It was Freud who pointed out that a large part of our mental life is influenced by the experiences of early childhood and takes place outside of our conscious awareness; his theories paved the way for others. More modern versions of some of Freud’s ideas are described as psychodynamic theories or models while Freud’s approach and forms of treatment are described as psychoanalytic. Psychodynamic theorists and clinicians that expanded on, updated, or altered some of Freud’s basic ideas still maintain a strong focus on unconscious motivations and emotions and how they influence behavior as well as the importance of early development. Some of the founders of later psychodynamic approaches were initially followers of Freud and include Carl Jung, Melanie Klein, John Bowlby, Alfred Adler, and Mary Ainsworth.

Psychotherapy Approaches and Methods: Psychoanalysis

 

Figure 1. Unlike the famous couch in Freud’s consulting room, where patients were instructed to lie down and face away from Freud, most patients today choose to sit on a couch or chair facing a therapist, as shown in this room.

Psychoanalysis was developed by Sigmund Freud and was the first form of psychotherapy. It was the dominant therapeutic technique in the early 20th century, but it has since waned significantly in popularity. Because Freud believed most of our psychological problems are the result of repressed impulses and trauma experienced in childhood, he developed psychoanalytic methods that he thought would help uncover long-buried feelings and personality conflicts. In a psychoanalyst’s office, you might see a patient lying on a couch speaking of dreams or childhood memories, and the therapist using various Freudian methods such as free association and dream analysis (Figure 1). In free association, the patient relaxes and then says whatever comes to mind at the moment without attempting to edit or worry how the therapist might react. This enables the therapist to discern unconscious emotions, motives, and drives. Another approach is dream analysis. In Freudian theory, dreams contain not only manifest (or literal) content, but also latent (or symbolic) content. For example, someone may have a dream that his/her teeth are falling out—the manifest or actual content of the dream. However, dreaming that one’s teeth are falling out could be a reflection of the person’s unconscious concern about losing their physical attractiveness—the latent or symbolic content of the dream. It is the therapist’s job to help discover the latent content underlying the client’s manifest content through dream analysis.

Psychoanalysis is a therapy approach that typically takes years. Over the course of time, the patient reveals a great deal about themselves to the therapist. Freud suggested that during this patient-therapist relationship, the patient comes to develop strong feelings for the therapist—maybe positive feelings, maybe negative feelings. Freud called this transference: the patient transfers all the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst. For example, Crystal is seeing a psychoanalyst. During the years of therapy, she comes to see her therapist as a father figure. She transfers her feelings about her father onto her therapist, perhaps in an effort to gain the love and attention she did not receive from her own father.

Psychoanalysis was once the only type of psychotherapy available, but presently the number of therapists practicing this approach is decreasing around the world. Psychoanalysis is not appropriate for some types of patients, including those with severe psychopathology (including suicidal thinking or intention) or intellectual development disorder (intellectual disability). Further, psychoanalysis is often expensive because treatment usually lasts many years. Still, some patients and therapists find the prolonged and detailed analysis very rewarding. Perhaps the greatest disadvantage of psychoanalysis is the lack of empirical support for its effectiveness. The limited research that has been conducted on psychoanalytic treatments suggests that they do not reliably lead to better mental health outcomes for most people (e.g., Driessen et al., 2010).

The Behavioral Model

What is Learning?

The behavioral model concerns the cognitive process of learning. Simply, learning is any relatively permanent change in behavior due to experience and practice and has two main forms – associative learning and observational learning. First, associative learning is the linking together of information sensed from our environment. Conditioning, a type of associative learning, occurs which two events are linked and has two forms – classical conditioning, or linking together two types of stimuli, and operant conditioning, or linking together a response with its consequence. Second, observational learning occurs when we learn by observing the world around us.

We should also note the existence of non-associative learning or when there is no linking of information or observing the actions of others around you. Types include habituation, or when we simply stop responding to repetitive and harmless stimuli in our environment such as a fan running in your laptop as you work on a paper, and sensitization, or when our reactions are increased due to a strong stimulus, such as an individual who experienced a mugging and now experiences panic when someone walks up behind him/her on the street.

Behaviorism is the school of thought associated with learning that began in 1913 with the publication of John B. Watson’s article, “Psychology as the Behaviorist Views It,” in the journal, Psychological Review (Watson, 1913). It was Watson’s belief that the subject matter of psychology was to be observable behavior and to that end said that psychology should focus on the prediction and control of behavior. Behaviorism was dominant from 1913 to 1990 before being absorbed into mainstream psychology. It went through three major stages – behaviorism proper under Watson and lasting from 1913-1930 (discussed as respondent conditioning), neobehaviorism under Skinner and lasting from 1930-1960 (discussed as operant conditioning), and sociobehaviorism under Bandura and Rotter and lasting from 1960-1990 (discussed as social learning theory).

Classical Conditioning

You have likely heard about Pavlov and his dogs but what you may not know is that this was a discovery made accidentally. Ivan Petrovich Pavlov (1906, 1927, 1928), a Russian physiologist, was interested in studying digestive processes in dogs in response to being fed meat powder. What he discovered was the dogs would salivate even before the meat powder was presented. They would salivate at the sound of a bell, footsteps in the hall, a tuning fork, or the presence of a lab assistant. Pavlov realized there were some stimuli that automatically elicited responses (such as salivating to meat powder) and those that had to be paired with these automatic associations for the animal or person to respond to it (such as salivating to a bell). Armed with this stunning revelation, Pavlov spent the rest of his career investigating this learning phenomenon.

The important thing to understand is that not all behaviors occur due to reinforcement and punishment as operant conditioning says. In the case of classical conditioning, stimuli exert complete and automatic control over some behaviors. We see this in the case of reflexes. When a doctor strikes your knee with that little hammer it extends out automatically. You do not have to do anything but watch. Babies will root for a food source if the mother’s breast is placed near their mouth. If a nipple is placed in their mouth, they will also automatically suck, as per the sucking reflex. Humans have several of these reflexes though not as many as other animals due to our more complicated nervous system.

Classical conditioning (also called response or Pavlovian conditioning) occurs when we link a previously neutral stimulus with a stimulus that is unlearned or inborn, called an unconditioned stimulus. In respondent conditioning, learning occurs in three phases: preconditioning, conditioning, and postconditioning. See Figure 2.1 for an overview of Pavlov’s classic experiment.

Preconditioning. This stage of learning signifies is that some learning is already present. There is no need to learn it again as in the case of primary reinforcers and punishers in operant conditioning. In Panel A, food makes a dog salivate. This does not need to be learned and is the relationship of an unconditioned stimulus (UCS) yielding an unconditioned response (UCR). Unconditioned means unlearned. In Figure 2.1, we also see that a neutral stimulus (NS) yields nothing. Dogs do not enter the world knowing to respond to the ringing of a bell (which it hears).

Conditioning. Conditioning is when learning occurs. Through the pairing of a neutral stimulus and unconditioned stimulus (bell and food, respectively) the dog will learn that the bell ringing (NS) signals food coming (UCS) and salivate (UCR). The pairing must occur more than once so that needless pairings are not learned such as someone farting right before your food comes out and now you salivate whenever someone farts (…at least for a while. Eventually the fact that no food comes will extinguish this reaction but still, it will be weird for a bit).

Postconditioning. Postconditioning, or after learning has occurred, establishes a new and not naturally occurring relationship of a conditioned stimulus (CS; previously the NS) and conditioned response (CR; the same response). So the dog now reliably salivates at the sound of the bell because he expects that food will follow, and it does.

Figure \(\PageIndex{1}\): Pavlov’s Classic Experiment

One of the most famous studies in psychology was conducted by Watson and Rayner (1920). Essentially, they wanted to explore the possibility of conditioning emotional responses. The researchers ran a 9-month-old child, known as Little Albert, through a series of trials in which he was exposed to a white rat. At first, he showed no response except curiosity. Then the researchers began to make a loud sound (UCS) whenever the rat was presented. Little Albert exhibited the normal fear response to this sound. After several conditioning trials like these, Albert responded with fear to the mere presence of the white rat.

As fears can be learned, so too they can be unlearned. Considered the follow-up to Watson and Rayner (1920), Mary Cover Jones (1924) wanted to see if a child (named Peter) who learned to be afraid of white rabbits could be conditioned to become unafraid of them. Simply, she placed Peter in one end of a room and then brought in the rabbit. The rabbit was far enough away so as to not cause distress. Then, Jones gave Peter some pleasant food (i.e., something sweet such as cookies; remember the response to the food is unlearned). She continued this procedure with the rabbit being brought in a bit closer each time until eventually, Peter did not respond with distress to the rabbit. This process is called counterconditioning or extinction, or the reversal of previous learning.

Another way to unlearn a fear is called flooding or exposing the person to the maximum level of stimulus and as nothing aversive occurs, the link between CS and UCS producing the CR of fear should break, leaving the person unafraid. This type of treatment is rather extreme and is not typically practiced by psychologists.

Examples of Classical Conditioning Related to Mental Illness

Classical conditioning can occur in many regular contexts in life from food aversion (getting sick after eating something and then feeling nauseated if you see the same food later on), emotional reactions to people or places, to reactions to chemotherapy (experiencing nausea when seeing a doctor or nurse involved in the treatment even if outside of the hospital or clinic). It also can play a significant role in some forms of mental illnesses. For example, fear conditioning plays a role in creating many anxiety disorders in humans, such as phobias and panic disorders, where people associate cues (such as closed spaces, or a shopping mall) with panic or other emotional trauma (see Mineka & Zinbarg, 2006). Here, rather than a physical response (like dogs drooling), the conditioned stimulus (CS) triggers an emotional reaction. Simple examples may include a child who sees a dog (previously a neutral stimulus) and then gets bitten, increasing the chance of developing a phobia towards dogs (now a CS) or a student, who when younger, gave a presentation in class and was laughed at, contributing to social anxiety. Remember that the biopsychosocial model emphasizes multiple interactions in the development of mental illnesses, but these types of learning experiences certainly are relevant and contribute to mental illness.

Classical conditioning can also play a role in drug or alcohol addictions. When a drug is consumed, it can become paired with previously neutral cues that are present at the same time (e.g., rooms, odors, or drug paraphernalia). In this regard, if someone associates a particular smell with the high from the drug, whenever that person smells the same odor later, it may cue behavioral or emotional responses that encourage continued use. But drug cues have an even more interesting property: they can elicit physical or physiological responses that represent the body attempting to compensate for the upcoming effect of the drug (see Siegel, 1989). For example, morphine suppresses pain; however, if someone is used to taking morphine, a cue that signals the “drug is coming soon” can actually make the person more sensitive to pain. Because the person knows a pain suppressant will soon be administered, the body becomes more sensitive, anticipating that “the drug will soon take care of it.” Remarkably, such conditioned compensatory responses, in turn, decrease the impact of the drug on the body—because the body has become more sensitive to pain.

Operant Conditioning

Influential on the development of Skinner’s operant conditioning, Thorndike proposed the law of effect (Thorndike, 1905) or the idea that if our behavior produces a favorable consequence, in the future when the same stimulus is present, we will be more likely to make the response again, expecting the same favorable consequence. Likewise, if our action leads to dissatisfaction, then we will not repeat the same behavior in the future. Thorndike developed the law of effect thanks to his work with the Puzzle Box. Cats were food deprived the night before the experimental procedure was to occur. The next morning, they were placed in the puzzle box and a small amount of food was placed outside the box close enough to be smelled, but the cat could not reach the food. To get out, a series of switches, buttons, levers, etc. had to be manipulated and once done, the cat could escape the box and eat some of the food. But just some. The cat was then promptly placed back in the box to figure out how to get out again, the food being its reward for doing so. With each subsequent escape and re-insertion into the box, the cat became faster until he/she knew exactly what had to be done to escape. This is called trial and error learning, or making a response repeatedly if it leads to success. Thorndike also said that stimulus and responses were connected by the organism and this lead to learning. This approach to learning was called connectionism.

Operant conditioning is a type of associate learning which focuses on consequences that follow a response or behavior that we make (anything we do, say, or think/feel) and whether it makes a behavior more or less likely to occur. This should sound much like what you just read about in terms of Thorndike’s work. Skinner talked about contingencies or when one thing occurs due to another. Think of it as an If-Then statement. If I do X then Y will happen. For operant conditioning, this means that if I make a behavior, then a specific consequence will follow. The events (response and consequence) are linked in time.

What form do these consequences take? There are two main ways they can present themselves.

• • Reinforcement – Due to the consequence, a behavior/response is more likely to occur in the future. It is strengthened.
  • Punishment – Due to the consequence, a behavior/response is less likely to occur in the future. It is weakened.

Reinforcement and punishment can occur as two types – positive and negative. These words have no affective connotation to them meaning they do not imply good or bad. Positive means that you are giving something – good or bad. Negative means that something is being taken away – good or bad. Check out the figure below for how these contingencies are arranged.

Figure \(\PageIndex{2}\): Contingencies in Operant Conditioning

Let’s go through each:

• Positive Punishment (PP) – If something bad or aversive is given or added, then the behavior is less likely to occur in the future. If you talk back to your mother and she slaps your mouth, this is a PP. Your response of talking back led to the consequence of the aversive slap being delivered or given to your face. Ouch!!!
• Positive Reinforcement (PR) – If something good is given or added, then the behavior is more likely to occur in the future. If you study hard and earn an A on your exam, you will be more likely to study hard in the future. Similarly, your parents may give you money for your stellar performance. Cha Ching!!!
• Negative Reinforcement (NR) – This is a tough one for students to comprehend because the terms don’t seem to go together and are counterintuitive. But it is really simple and you experience NR all the time. This is when you are more likely to engage in a behavior that has resulted in the removal of something aversive in the past. For instance, what do you do if you have a headache? You likely answered take Tylenol. If you do this and the headache goes away, you will take Tylenol in the future when you have a headache. Another example is continually smoking marijuana because it temporarily decreases feelings of anxiety. The behavior of smoking marijuana is being reinforced because it reduces a negative state.
• Negative Punishment (NP) – This is when something good is taken away or subtracted making a behavior less likely in the future. If you are late to class and your professor deducts 5 points from your final grade (the points are something good and the loss is negative), you will hopefully be on time in all subsequent classes. Another example is taking away a child’s allowance when he misbehaves.

Observational Learning

There are times when we learn by simply watching others. This is called observational learning and is contrasted with enactive learning, which is learning by doing. There is no firsthand experience by the learner in observational learning. You can learn desirable behaviors such as exercising because your mother engaged in exercise every day and you can learn undesirable ones too. If your parents resort to alcohol consumption to deal with the stressors life presents, then you too might do the same. What is critical is what happens to the model in all of these cases. If my mother seems genuinely happy and pleased with herself after exercising, then I will be more likely to adopt this behavior. If my mother or father consumes alcohol to feel better when things are tough, and it works, then I might do the same. On the other hand, if we see a sibling constantly getting in trouble with the law then we may not model this behavior due to the negative consequences.

Albert Bandura conducted pivotal research on observational learning and you likely already know all about it from previous psychology courses. In Bandura’s experiment, children were first brought into a room to watch a video of an adult model playing nicely or aggressively with a Bobo doll. Next, the children were placed in a room with toys and a Bobo doll. Children who watched the aggressive model behaved aggressively with the Bobo doll while those who saw the nice model, played nice.

Figure \(\PageIndex{3}\): Bandura’s Classic Bobo Doll Experiment

Bandura said if all behaviors are learned by observing others and we model our behaviors on theirs, then undesirable behaviors can be altered or relearned in the same way. Modeling techniques are used to change behavior by having clients observe a model in a situation that usually causes them some anxiety. By seeing the model interact calmly with the fear-evoking stimulus, their fear should subside. This form of behavior therapy is widely used in clinical and classroom situations. In the classroom, we might use modeling to demonstrate to a student how to do a math problem. In fact, in many college classrooms, this is exactly what the instructor does.

But keep in mind that we do not model everything we see. Why? First, we cannot pay attention to everything going on around us. We are more likely to model behaviors by someone who commands our attention. Second, we must remember what a model does in order to imitate it. If a behavior is not memorable, it will not be imitated. Finally, we must try to convert what we see into action. If we are not motivated to perform an observed behavior, we probably will not show what we have learned.

Exposure Therapy

In order to understand the value of exposure therapy, think back to the discussion regarding extinction. Extinction is the gradual disconnection of the relationship between the unconditioned stimuli and the conditioned (learned) stimuli, or in operant conditioning, the disconnection between the operant behavior and a reinforcer (e.g., people would not go to work if they were not being paid). All forms of exposure therapy aim to reduce or eliminate the undesired behavior through these behavioral processes. Exposure therapy is especially useful in treating anxiety disorders and has been widely used in a variety of these disorders.

In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their anxiety with the idea that due to extinction they will eventually get used to it. This can be done via reality, imagination, or virtual reality. Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones worked with a three-year-old boy named Peter who was afraid of rabbits. Her goal was to replace Peter’s fear of rabbits with a conditioned response of relaxation, which is a response that is incompatible with fear. How did she do it? Jones began by placing a caged rabbit on the other side of a room with Peter while he ate his afternoon snack. Over the course of several days, Jones moved the rabbit closer and closer to where Peter was seated with his snack. After two months of being exposed to the rabbit while relaxing with his snack, Peter was able to hold the rabbit and pet it while eating (Jones, 1924; Figure 1).

 

Figure 1. Exposure therapy seeks to change the response to a conditioned stimulus (CS). An unconditioned stimulus is presented over and over just after the presentation of the conditioned stimulus. This figure shows conditioning as conducted in Mary Cover Jones’ 1924 study.

Thirty years later, Joseph Wolpe (1958) refined Jones’s techniques, giving us the behavior therapy technique of exposure therapy that is used today. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. The idea is that you can’t be nervous and relaxed at the same time. Therefore, if you can learn to relax when you are facing environmental stimuli that make you nervous or fearful, you can eventually eliminate your unwanted fear response (Wolpe, 1958; Figure 2).

 

Figure 2. This person suffers from arachnophobia (fear of spiders). Through exposure therapy, he is learning how to face his fear in a controlled, therapeutic setting. (credit: “GollyGforce – Living My Worst Nightmare”/Flickr)

How does exposure therapy work? Jayden is terrified of elevators. Nothing bad has ever happened to him on an elevator, but he’s so afraid of elevators that he will always take the stairs. That wasn’t a problem when Jayden worked on the second floor of an office building, but now he has a new job—on the 29th floor of a skyscraper in downtown Los Angeles. Jayden knows he can’t climb 29 flights of stairs in order to get to work each day, so he decided to see a behavior therapist for help. The therapist asks Jayden to first construct a hierarchy of elevator-related situations that elicit fear and anxiety. They range from situations of mild anxiety such as being nervous around the other people in the elevator, to the fear of getting an arm caught in the door, to panic-provoking situations such as getting trapped or the cable snapping. Next, the therapist uses progressive relaxation. She teaches Jayden how to relax each of his muscle groups so that he achieves a drowsy, relaxed, and comfortable state of mind. Once he’s in this state, she asks Jayden to imagine a mildly anxiety-provoking situation. Jayden is standing in front of the elevator thinking about pressing the call button.

If this scenario causes Jayden anxiety, he lifts his finger. The therapist would then tell Jayden to forget the scene and return to his relaxed state. She repeats this scenario over and over until Jayden can imagine himself pressing the call button without anxiety. Over time, the therapist and Jayden use progressive relaxation and imagination to proceed through all the situations on Jayden’s hierarchy until he becomes desensitized to each one. After this, Jayden and the therapist begin to practice what he only previously envisioned in therapy, gradually going from pressing the button to actually riding an elevator. The goal is that Jayden will soon be able to take the elevator all the way up to the 29th floor of his office without feeling any anxiety.

Sometimes, it’s too impractical, expensive, or embarrassing to re-create anxiety-producing situations, so a therapist might employ virtual reality exposure therapy by using a simulation to help conquer fears. Virtual reality exposure therapy has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD; a trauma and stressor-related disorder) (Gerardi, Cukor, Difede, Rizzo, & Rothbaum, 2010).

Evaluating the Behavioral Model

Within the context of abnormal behavior or psychopathology, the behavioral perspective is useful because it suggests that maladaptive behavior occurs when learning goes awry. The good thing is that what is learned can be unlearned or relearned using behavior modification which refers to the process of changing behavior. To begin, an applied behavior analyst will identify a target behavior, or behavior to be changed, define it, work with the client to develop goals, conduct a functional assessment to understand what the undesirable behavior is, what causes it, and what maintains it. Armed with this knowledge, a plan is developed and consists of numerous strategies to act on one or all of these elements – antecedent, behavior, and/or consequence.

The greatest strength or appeal of the behavioral model is that its tenets are easily tested in the laboratory unlike those of the psychodynamic model. Also, a large number of treatment techniques have been developed and proven to be effective over the years. For example, desensitization (Wolpe, 1997) teaches clients to respond calmly to fear-producing stimuli. It begins with the individual learning a relaxation technique such as diaphragmatic breathing. Next, a fear hierarchy, or list of feared objects and situations, is constructed in which the individual moves from least to most feared. Finally, the individual either imagines (systematic) or experiences in real life (in-vivo) each object or scenario from the hierarchy and uses the relaxation technique while doing so. This represents individual pairings of feared object or situation and relaxation and so if there are 10 objects/situations in the list, the client will experience ten such pairings and eventually be able to face each without fear. Outside of phobias, desensitization has been shown to be effective in the treatment of Obsessive Compulsive Disorder symptoms (Hakimian and D’Souza, 2016) and limitedly with the treatment of depression that is co-morbid with OCD (Masoumeh and Lancy, 2016).

Critics of the behavioral perspective point out that it oversimplifies behavior and often ignores inner determinants of behavior. Behaviorism has also been accused of being mechanistic and seeing people as machines. Watson and Skinner defined behavior as what we do or say, but later, behaviorists added what we think or feel. In terms of the latter, cognitive behavior modification procedures arose after the 1960s along with the rise of cognitive psychology. This lead to a cognitive-behavioral perspective which combines concepts from the behavioral and cognitive models, the latter is discussed in the next section.

The Cognitive Model

What is It?

As noted earlier, the idea of people being machines was a key feature of behaviorism and other schools of thought in psychology until about the 1960s or 1970s. In fact, behaviorism said psychology was to be the study of observable behavior. Any reference to cognitive processes was dismissed as this was not overt, but covert according to Watson and later Skinner. Of course, removing cognition from the study of psychology ignored an important part of what makes us human and separates us from the rest of the animal kingdom. Fortunately, the work of George Miller, Albert Ellis, Aaron Beck, and Ulrich Neisser demonstrated the importance of cognitive abilities in understanding thoughts, behaviors, and emotions, and in the case of psychopathology, they helped to show that people can create their own problems by how they come to interpret events experienced in the world around them. How so?

Maladaptive Cognitions

Irrational or dysfunctional thought patterns can be the basis of psychopathology. Throughout this book, we will discuss several treatment strategies that are used to change unwanted, maladaptive cognitions, whether they are present as an excess such as with paranoia, suicidal ideation, or feelings of worthlessness; or as a deficit such as with self-confidence and self-efficacy. More specifically, cognitive distortions/maladaptive cognitions can take the following forms:

• Overgeneralizing – You see a larger pattern of negatives based on one event.
• What if? – Asking yourself what if something happens without being satisfied by any of the answers.
• Blaming – Focusing on someone else as the source of your negative feelings and not taking any responsibility for changing yourself.
• Personalizing – Blaming yourself for negative events rather than seeing the role that others play.
• Inability to disconfirm – Ignoring any evidence that may contradict your maladaptive cognition.
• Regret orientation – Focusing on what you could have done better in the past rather than on making an improvement now.
• Dichotomous thinking – Viewing people or events in all-or-nothing terms.

For more on cognitive distortions, check out this website: http://www.goodtherapy.org/blog/20-cognitive-distortions-and-how-they-affect-your-life-0407154

Cognitive Therapies

According to the National Alliance on Mental Illness (NAMI), cognitive behavioral therapy (CBT) “focuses on exploring relationships among a person’s thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs.” CBT attempts to identify negative or false beliefs and restructure them. They add, “Oftentimes someone being treated with CBT will have homework in between sessions where they practice replacing negative thoughts with more realistic thoughts based on prior experiences or record their negative thoughts in a journal.” For more on CBT, visit: https://www.nami.org/Learn-More/Treatment/Psychotherapy. Some commonly used strategies include cognitive restructuring, cognitive coping skills training, and acceptance techniques.

First, cognitive restructuring (also called rational restructuring) involves replacing maladaptive cognitions with more adaptive ones. To do this, the client must be aware of the distressing thoughts, when they occur, and their effect on them. Next, the therapist works to help the client stop thinking these thoughts and to replace them with more rational ones. It’s a simple strategy, but an important one. Psychology Today published a great article on January 21, 2013 which described 4 ways to change your thinking through cognitive restructuring. Briefly, these included:

1. Notice when you are having a maladaptive cognition such as making “negative predictions.” They suggest you figure out what is the worst thing that could happen and what other outcomes are possible.
2. Track the accuracy of the thought. For instance, if you believe ruminating on a problem generates a solution then write down each time you ruminate and then the result. You can generate a percentage of times you ruminated to the number of successful problem-solving strategies you generated.
3. Behaviorally test your thought. As an example, if you think you don’t have time to go to the gym then figure out if you really do not have time. Record what you do each day and then look at open times of the day. Explore if you can make some minor, or major, adjustments to your schedule to free up an hour to exercise.
4. Examine the evidence both for and against your thought. If you do not believe you do anything right, list evidence of when you did not do something right and then evidence of when you did. Then write a few balanced statements such as the one the article suggests, “I’ve made some mistakes that I feel embarrassed about but a lot of the time, I make good choices.”

Link to Learning

The article also suggested a few non-cognitive restructuring techniques to include mindfulness meditation and self-compassion. For more on these visit: https://www.psychologytoday.com/blog/in-practice/201301/cognitive-restructuring

A second major strategy is to use what is called cognitive coping skills training. This strategy involves teaching social skills, communication, and assertiveness through direct instruction, role-playing, and modeling. For social skills, therapists identify appropriate social behavior such as making eye contact, saying no to a request, or starting up a conversation with a stranger and examine whether the client is inhibited from engaging in the behavior due to anxiety. For communication, the therapist can help determine if the problem is with speaking, listening, or both and then develop a plan the client can use in various interpersonal situations. Finally, assertiveness training aids the client protect their rights and obtain what they want from others. Treatment starts with determining situations in which assertiveness is lacking and generating a hierarchy of assertiveness opportunities. Least difficult situations are handled first, followed by more difficult situations, all while rehearsing and mastering all the situations present in the hierarchy. For more on these techniques, visit http://cogbtherapy.com/cognitive-behavioral-therapy-exercises/.

Finally, acceptance techniques can be used to reduce a client’s worry and anxiety. Life involves a degree of uncertainty and at times we need to just accept this uncertainty. However, many clients, especially those with anxiety, have difficulty tolerating uncertainty. Acceptance techniques might include weighing the pros of fighting uncertainty against the cons of doing so. The cons should outweigh the pros and help the client to end the struggle and accept what is unknown. Chances are the client is already accepting the unknown in some areas of life and identifying those can help them to see why it is helpful to accept uncertainty which may help them to do so in more difficult areas. Finally, the therapist may help the client to question whether uncertainty necessarily leads to a negative end. The client may think so, but reviewing the evidence for and against this statement will show them that uncertainty does not always lead to negative outcomes which can help to reduce how threatening uncertainty seems.

Evaluating the Cognitive Model

The cognitive model made up for an obvious deficit in the behavioral model – overlooking the importance of our thoughts and the role cognitive processes play in our feelings and behaviors. Right before his death, Skinner (1990) reminded psychologists that the only thing we can truly know and study is observable behavior. Cognitive processes cannot be empirically and reliably measured and so should be ignored. Is there merit to this view? Social desirability states that sometimes people do not tell us the truth about what they are thinking, feeling or doing (or have done) because they do not want us to think less of them or to judge them harshly if they are outside the social norm. In other words, they present themselves in a favorable light. If this is true, how can we really know what they are thinking? The person’s true intentions or thoughts and feelings are not readily available to us or are covert, and so do not make for good empirical data. Still, cognitive-behavioral therapies have proven their efficacy for the treatment of OCD (McKay et al., 2015); perinatal depression (Sockol, 2015); insomnia (de Bruin et al., 2015), bulimia nervosa (Poulsen et al., 2014), hypochondriasis (Olatunji et al., 2014), and social anxiety disorder (Leichsenring et al., 2014) to name a few. Other examples will be discussed throughout this book.

The Humanistic and Existential Perspectives

The Humanistic Perspective

The humanistic perspective, or third force psychology (psychoanalysis and behaviorism being the other two forces), emerged in the 1960s and 1970s as an alternative viewpoint to the largely deterministic view of personality espoused by psychoanalysis and the view of humans as machines advocated by behaviorism. Key features of the perspective include a belief in human perfectibility, personal growth and fulfillment, self-actualization, valuing self-disclosure, placing feelings over intellect, an emphasis on the present, and hedonism. Humanists believe that people are inherently good and that they are motivated to be fully functioning individuals. Its key figures were Abraham Maslow who proposed the hierarchy of needs and Carl Rogers who we will focus on here.

Rogers said that all people want to have positive regard from significant others in their life. When the individual is accepted as they are they receive unconditional positive regard and become a fully functioning person. They are open to experience, live every moment to the fullest, are creative, accept responsibility for their decisions, do not derive their sense of self from others, strive to maximize their potential, and are self-actualized. Their family and friends may disapprove of some of their actions but overall, respect and love them. They then realize their worth as a person but also that they are not perfect. Of course most people do not experience this but instead are made to feel that they can only be loved and respected if they meet certain standards, called conditions of worth. Hence, they experience conditional positive regard. According to Rogers, their self-concept is now seen as having worth only when these significant others approve and so becomes distorted, leading to a disharmonious state and psychopathology. Individuals in this situation are unsure what they feel, value, or need leading to dysfunction and the need for therapy. Rogers stated that the humanistic therapist should be warm, understanding, supportive, respectful, and accepting of his/her clients. This approach came to be called client-centered therapy. In client-centered therapy, the therapist is non-directive and the patient directs the session and the conversation. The therapist will use active listening and reflection and will urge the patient to come to their own conclusions related to their struggles. 

The Existential Perspective

This existential perspective stresses the need for people to continually re-create themselves and be self-aware, acknowledges that anxiety is a normal part of life, focuses on free will and self-determination, emphasizes that each person has a unique identity known only through relationships and the search for meaning, and finally, that we develop to our maximum potential. Abnormal behavior arises when we avoid making choices, do not take responsibility, and fail to actualize our full potential. Existential therapy is used to treat a myriad of disorders and problems including substance abuse, excessive anxiety, apathy, avoidance, despair, depression, guilt, anger, and rage. It also focuses on life-enhancing experiences such as love, caring, commitment, courage, creativity, spirituality, and acceptance, to name a few (For more information, please visit: https://www.psychologytoday.com/therapy-types/existential-therapy).

Evaluating the Humanistic and Existential Perspectives

The biggest criticism of these models is that the concepts are abstract and fuzzy and as such are very difficult to research. The exception to this was Rogers who did try to scientifically investigate his propositions, though most other humanistic-existential psychologists rejected the use of the scientific method. They also have not developed much in the way of theory and their perspectives tend to work best with people who have adjustment issues and not as well with severe mental illness. The perspectives do offer hope to people who have experienced tragedy by asserting that we control our own destiny and can make our own choices.