Conditioning and CBT Treatment

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Conditioning theories of learning posit that an organism behavior is a result of the organism’s association and response to environmental stimuli. This theory is one of the most applicable in modern psychology given its concrete operational variables, i.e. measurements of behavior. One such application of conditioning theory is cognitive-behavioral therapy (CBT), an intervention that combines the principles of cognitive and behavioral therapy to help people treat an immense range of psychological challenges from insomnia, to depression, to body dysmorphia (Sharma & Andrade, 2012; Neziroglu, Kehmlani-Patel, & Veale; 2008, Watts, Mackenzie, Thomas, Griskaitis… & Andrews, 2013). In this review, the principles that CBT uses to help recondition behavior are examined in light of their therapeutic application. 

Cognitive Behavioral Therapy

Half of cognitive-behavioral therapy (CBT) is simply behaviorism. Behaviorism holds that an individual’s behavior is a learned response to the environment, i.e. it is not so much a matter of free or innate will as it is a conditioned effect. The conditioning that shapes behavior has been narrowed to two broad categories of learning, classical conditioning, pioneered by the Russian psychologist Pavlov, and operant conditioning of the American psychologist B.F. Skinner (Dobson & Dobson, 2019). In classical conditioning, behavior is picked up through associations found within one’s environment while in operant conditioning behavior is considered a learned response to punishments and rewards. 

Even though these models of learning primarily concern behavior, cognitive-behavioral therapy took their principles and applied them to the development of an individual’s cognitive schema. In this sense, CBT drew upon cognitive theory which holds that an individual’s cognitive framing is the main driver not only in how they experience reality but also in their behavior. Behaviorism, on the other hand, offered a model for how such behaviors were learned as well as a solution for how to change them through reconditioning. In other words, because behaviorism suggests that schemas are learned through interactions with the environment, it is possible to unlearn and relearn phenomenon as well, especially when one has the assistance of a therapist trained in such a discipline. 

One hypothetical yet probably commonplace example of CBT’s application may be in the restructuring of an adult’s negative or false beliefs which have persisted since childhood. For example, a person, even as an adult may feel that they are small and incapable because that is how they authentically felt as a child. As they grew up, however, this belief was never reexamined and probably was reinforced by their behavior which stemmed from this belief. With a helpful counselor, such a belief could be identified by the individual, appraised to see if it really is still true, and replaced with a more affirmative and valid belief for where that individual is in their life (Dobson & Dobson, 2019).  Thus, a main insight of CBT is that false or negative beliefs create an inauthentic or negative experience of reality. Fortunately, with some investigation into the truth and cognitive reframing, it is possible to overcome many of the problems an individual creates for themselves whether psychological, behavioral, or even physical (Dobson & Dobson, 2019). 

Applied CBT

While the principles of CBT are insightful, its actual application in clinical contexts is where the real proof lies. Countless studies on CBT have been conducted and verified its utility as a therapeutic intervention for practically every single psychological disorder and several physical ones as well. Hoffman, Asnaani, Vonk, Sawyer, and Fang (2013), offered a comprehensive look on CBT’s use in clinical contexts with their review of CBT meta-analyses. Incredibly, the Hoffman et al. (2013) research group found and analyzed a total of 106 meta-analytic studies for CBT. In other words, this article is a meta-analysis of many meta-analyses concerning CBT. Hence, before the positive results of Hoffman et al., (2013), are shared, it is notable to observe that, given how many studies have to have been conducted for such in-depth analysis, CBT must be highly efficacious therapy. Otherwise, it would not elicit so much scholarly and clinical interest. 

Perhaps what is most notable about Hoffman et al, (2012), is just how many different treatment contexts that CBT has been applied for. Chronic pain and fatigue, distress from general medical problems, criminal behaviors, anger and aggression, general stress, personality disorders, insomnia, eating disorders, somatoform disorders, anxiety disorders, bipolar disorder, depression, schizophrenia, substance use disorder, and more (Hoffman et al., 2012). CBT has also been used within a wide range of treatment populations including both children and elderly adults. 

According to Hoffman et al., (2012), one of the most significant uses for BT is in the use of anxiety disorders, bulimia, anger control problems, general stress, and somatoform disorders. the researchers conclude that the evidence for CBT’s efficacy is very strong though even more research for CBT could be done for elderly adults and children, especially in randomized control trial form (Hoffman et al., 2012). 

One such study that may help in this regard is the Wood, Drahota, Sze, Har… and Langer (2014), an article which discusses CBT’s application in a random controlled trial for children with autism spectrum disorder with comorbid anxiety disorders, a very common condition. Using modular cognitive behavioral therapy, the researchers randomly enrolled 40 children aged 7 to 11 years old into a CBT treatment or three-month waitlist control group. In this modulated CBT, therapists emphasize parent-training, school consultation, and behavioral experimentation. Independent evaluators, who were without knowledge of what treatment groups the children were in, helped to determine that the those in the CBT group showed a drastic improvement in their behavior compared to those on the waitlist (Wood et al., 2009). 

These results are significant in several respects. One important finding is that, when this article was published, it was one of the first adaptations of CBT for children with autism spectrum disorders which have shown highly significant results (Wood et al., 2009). Also notable is the fact that treatment gains were demonstrated after just a three month follow up, a period time that would make this version of CBT useful for parents and educators alike. Given the difficulty had in relating with children with autism spectrum disorders cognitively, it is likely that this version of CBT more heavily drew upon the behavioral aspect of the theory than the cognitive one. This is interesting since it proves how, even when one side of CBT is less applicable, the other can be used in greater proportion to help balance the treatment. 

Conclusion

Conditioning theories are appealing in that they offer a concrete pattern for which behavior develops. It is this concreteness which has solidified the theory within the field of psychology as cognitive behavioral therapy. In other words, because CBT utilizes a demonstrable method for learning, rather than relying upon the somewhat murky fields of psychoanalysis, it has been applied for psychological needs as far and wide as the populations it serves. From adults to children with an autism spectrum disorder, CBT has proven its utility and, in so doing, the validity of the conditioning theory it rests upon.

References

Dobson, K. S., & Dozois, D. J. (Eds.). (2019). Handbook of cognitive-behavioral therapies. Guilford Publications.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.

Neziroglu, F., Khemlani-Patel, S., & Veale, D. (2008). Social learning theory and cognitive behavioral models of body dysmorphic disorder. Body image, 5(1), 28-38.

Sharma, M. P., & Andrade, C. (2012). Behavioral interventions for insomnia: Theory and practice. Indian journal of psychiatry, 54(4), 359.

Watts, S., Mackenzie, A., Thomas, C., Griskaitis, A., Mewton, L., Williams, A., & Andrews, G. (2013). CBT for depression: a pilot RCT comparing mobile phone vs. computer. BMC psychiatry, 13(1), 49.

Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224-234.