What is Learned Helplessness?

Introduction

Learned helplessness is behaviour exhibited by a subject after enduring repeated aversive stimuli beyond their control. It was initially thought to be caused from the subject’s acceptance of their powerlessness: discontinuing attempts to escape or avoid the aversive stimulus, even when such alternatives are unambiguously presented. Upon exhibiting such behaviour, the subject was said to have acquired learned helplessness.

Over the past few decades, neuroscience has provided insight into learned helplessness and shown that the original theory actually had it backwards: the brain’s default state is to assume that control is not present, and the presence of “helpfulness” is what is actually learned.

In humans, learned helplessness is related to the concept of self-efficacy; the individual’s belief in their innate ability to achieve goals. Learned helplessness theory is the view that clinical depression and related mental illnesses may result from such real or perceived absence of control over the outcome of a situation.

Refer to Learned Optimism.

Foundation of Research and Theory

Early Experiments

American psychologist Martin Seligman initiated research on learned helplessness in 1967 at the University of Pennsylvania as an extension of his interest in depression. This research was later expanded through experiments by Seligman and others. One of the first was an experiment by Seligman & Maier:

  • In Part 1 of this study, three groups of dogs were placed in harnesses.
    • Group 1 dogs were simply put in a harness for a period of time and were later released.
    • Groups 2 and 3 consisted of “yoked pairs”.
    • Dogs in Group 2 were given electric shocks at random times, which the dog could end by pressing a lever.
    • Each dog in Group 3 was paired with a Group 2 dog; whenever a Group 2 dog got a shock, its paired dog in Group 3 got a shock of the same intensity and duration, but its lever did not stop the shock.
    • To a dog in Group 3, it seemed that the shock ended at random, because it was their paired dog in Group 2 that was causing it to stop.
    • Thus, for Group 3 dogs, the shock was “inescapable”.
  • In Part 2 of the experiment the same three groups of dogs were tested in a shuttle-box apparatus (a chamber containing two rectangular compartments divided by a barrier a few inches high).
    • All of the dogs could escape shocks on one side of the box by jumping over a low partition to the other side.
    • The dogs in Groups 1 and 2 quickly learned this task and escaped the shock.
    • Most of the Group 3 dogs – which had previously learned that nothing they did had any effect on shocks – simply lay down passively and whined when they were shocked.

In a second experiment later that year with new groups of dogs, Overmier and Seligman ruled out the possibility that, instead of learned helplessness, the Group 3 dogs failed to avert in the second part of the test because they had learned some behaviour that interfered with “escape”. To prevent such interfering behaviour, Group 3 dogs were immobilised with a paralysing drug (curare), and underwent a procedure similar to that in Part 1 of the Seligman and Maier experiment. When tested as before in Part 2, these Group 3 dogs exhibited helplessness as before. This result serves as an indicator for the ruling out of the interference hypothesis.

From these experiments, it was thought that there was to be only one cure for helplessness. In Seligman’s hypothesis, the dogs do not try to escape because they expect that nothing they do will stop the shock. To change this expectation, experimenters physically picked up the dogs and moved their legs, replicating the actions the dogs would need to take in order to escape from the electrified grid. This had to be done at least twice before the dogs would start wilfully jumping over the barrier on their own. In contrast, threats, rewards, and observed demonstrations had no effect on the “helpless” Group 3 dogs.

Later Experiments

Later experiments have served to confirm the depressive effect of feeling a lack of control over an aversive stimulus. For example, in one experiment, humans performed mental tasks in the presence of distracting noise. Those who could use a switch to turn off the noise rarely bothered to do so, yet they performed better than those who could not turn off the noise. Simply being aware of this option was enough to substantially counteract the noise effect. In 2011, an animal study found that animals with control over stressful stimuli exhibited changes in the excitability of certain neurons in the prefrontal cortex. Animals that lacked control failed to exhibit this neural effect and showed signs consistent with learned helplessness and social anxiety.

Expanded Theories

Research has found that a human’s reaction to feeling a lack of control differs both between individuals and between situations, i.e. learned helplessness sometimes remains specific to one situation but at other times generalises across situations. Such variations are not explained by the original theory of learned helplessness, and an influential view is that such variations depend on an individual’s attributional or explanatory style. According to this view, how someone interprets or explains adverse events affects their likelihood of acquiring learned helplessness and subsequent depression. For example, people with pessimistic explanatory style tend to see negative events as permanent (“it will never change”), personal (“it’s my fault”), and pervasive (“I can’t do anything correctly”), and are likely to suffer from learned helplessness and depression.

Bernard Weiner proposed a detailed account of the attributional approach to learned helplessness. His attribution theory includes the dimensions of globality/specificity, stability/instability, and internality/externality:

  • A global attribution occurs when the individual believes that the cause of negative events is consistent across different contexts.
    • A specific attribution occurs when the individual believes that the cause of a negative event is unique to a particular situation.
  • A stable attribution occurs when the individual believes the cause to be consistent across time.
    • An unstable attribution occurs when the individual thinks that the cause is specific to one point in time.
  • An external attribution assigns causality to situational or external factors,
    • while an internal attribution assigns causality to factors within the person.

Research has shown that those with an internal, stable, and global attributional style for negative events can be more at risk for a depressive reaction to failure experiences.

Neurobiological Perspective

Research has shown that increased 5-HT (serotonin) activity in the dorsal raphe nucleus plays a critical role in learned helplessness. Other key brain regions that are involved with the expression of helpless behaviour include the basolateral amygdala, central nucleus of the amygdala and bed nucleus of the stria terminalis. Activity in medial prefrontal cortex, dorsal hippocampus, septum and hypothalamus has also been observed during states of helplessness.

In the article, “Exercise, Learned Helplessness, and the Stress-Resistant Brain”, Benjamin N. Greenwood and Monika Fleshner discuss how exercise might prevent stress-related disorders such as anxiety and depression. They show evidence that running wheel exercise prevents learned helplessness behaviours in rats. They suggest that the amount of exercise may not be as important as simply exercising at all. The article also discusses the neurocircuitry of learned helplessness, the role of serotonin (or 5-HT), and the exercise-associated neural adaptations that may contribute to the stress-resistant brain. However, the authors finally conclude that:

“The underlying neurobiological mechanisms of this effect, however, remain unknown. Identifying the mechanisms by which exercise prevents learned helplessness could shed light on the complex neurobiology of depression and anxiety and potentially lead to novel strategies for the prevention of stress-related mood disorders”.

Health Implications

People who perceive events as uncontrollable show a variety of symptoms that threaten their mental and physical well-being. They experience stress, they often show disruption of emotions demonstrating passivity or aggressiveness, and they can also have difficulty performing cognitive tasks such as problem-solving. They are less likely to change unhealthy patterns of behaviour, causing them, for example, to neglect diet, exercise, and medical treatment.

Depression

Abnormal and cognitive psychologists have found a strong correlation between depression-like symptoms and learned helplessness in laboratory animals.

Young adults and middle-aged parents with a pessimistic explanatory style often suffer from depression. They tend to be poor at problem-solving and cognitive restructuring, and also tend to demonstrate poor job satisfaction and interpersonal relationships in the workplace. Those with a pessimistic style also tend to have weakened immune systems, having not only increased vulnerability to minor ailments (e.g. cold, fever) and major illness (e.g. heart attack, cancers), but also poorer recovery from health problems.

Social Impact

Learned helplessness can be a factor in a wide range of social situations.

  • In emotionally abusive relationships, the victim often develops learned helplessness.
    • This occurs when the victim confronts or tries to leave the abuser only to have the abuser dismiss or trivialise the victim’s feelings, pretend to care but not change, or impede the victim from leaving.
  • The motivational effect of learned helplessness is often seen in the classroom.
    • Students who repeatedly fail may conclude that they are incapable of improving their performance, and this attribution keeps them from trying to succeed, which results in increased helplessness, continued failure, loss of self-esteem and other social consequences.
  • Child abuse by neglect can be a manifestation of learned helplessness.
    • For example, when parents believe they are incapable of stopping an infant’s crying, they may simply give up trying to do anything for the child.
  • Those who are extremely shy or anxious in social situations may become passive due to feelings of helplessness.
    • Gotlib and Beatty (1985) found that people who cite helplessness in social settings may be viewed poorly by others, which tends to reinforce the passivity.
  • Aging individuals may respond with helplessness to the deaths of friends and family members, the loss of jobs and income, and the development of age-related health problems.
    • This may cause them to neglect their medical care, financial affairs, and other important needs.
  • According to Cox et al., Abramson, Devine, and Hollon (2012), learned helplessness is a key factor in depression that is caused by inescapable prejudice (i.e. “deprejudice”).
    • Thus: “Helplessness born in the face of inescapable prejudice matches the helplessness born in the face of inescapable shocks.”
  • According to Ruby K. Payne’s book A Framework for Understanding Poverty, treatment of the poor can lead to a cycle of poverty, a culture of poverty, and generational poverty.
    • This type of learned helplessness is passed from parents to children.
    • People who embrace this mentality feel there is no way to escape poverty and so one must live in the moment and not plan for the future, trapping families in poverty.

Social problems resulting from learned helplessness may seem unavoidable to those entrenched. However, there are various ways to reduce or prevent it. When induced in experimental settings, learned helplessness has been shown to resolve itself with the passage of time. People can be immunized against the perception that events are uncontrollable by increasing their awareness of previous experiences, when they were able to effect a desired outcome. Cognitive therapy can be used to show people that their actions do make a difference and bolster their self-esteem.

Extensions

Cognitive scientist and usability engineer Donald Norman used learned helplessness to explain why people blame themselves when they have a difficult time using simple objects in their environment.

The UK educationalist Phil Bagge describes it as a learning avoidance strategy caused by prior failure and the positive reinforcement of avoidance such as asking teachers or peers to explain and consequently do the work. It shows itself as sweet helplessness or aggressive helplessness often seen in challenging problem solving contexts, such as learning to use a new computer programming language.

The US sociologist Harrison White has suggested in his book Identity and Control that the notion of learned helplessness can be extended beyond psychology into the realm of social action. When a culture or political identity fails to achieve desired goals, perceptions of collective ability suffer.

Emergence under Torture

Studies on learned helplessness served as the basis for developing enhanced interrogation techniques. In CIA interrogation manuals, learned helplessness is characterised as “apathy” which may result from prolonged use of coercive techniques which result in a “debility-dependency-dread” state in the subject, “If the debility-dependency-dread state is unduly prolonged, however, the arrestee may sink into a defensive apathy from which it is hard to arouse him.”

What is Motivational Interviewing?

Introduction

Motivational interviewing (MI) is a counselling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. Compared with non-directive counselling, it is more focused and goal-directed, and departs from traditional Rogerian client-centred therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counsellor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.

Core concepts evolved from experience in the treatment of problem drinkers, and MI was first described by Miller (1983) in an article published in the journal Behavioural and Cognitive Psychotherapy. Miller and Rollnick elaborated on these fundamental concepts and approaches in 1991 in a more detailed description of clinical procedures.

Overview

Motivational interviewing (MI) is a person-centred strategy. It is used to elicit patient motivation to change a specific negative behaviour. MI engages clients, elicits change talk and evokes patient motivation to make positive changes. For example, change talk can be elicited by asking the patient questions such as: “How might you like things to be different?” or “How does __ interfere with things that you would like to do?”

Unlike clinical interventions and treatment, MI is the technique where the interviewer (clinician) assists the interviewee (patient) in changing a behaviour by expressing their acceptance of the interviewee without judgement. By this, MI incorporates the idea that every single patient may be in differing stages of readiness levels and may need to act accordingly to the patient’s levels and current needs. Change may occur quickly or may take considerable time, depending on the client. Knowledge alone is usually not sufficient to motivate change within a client, and challenges in maintaining change should be thought of as the rule, not the exception. The incorporation of MI can help patients resolve their uncertainties and hesitancies that may stop them from their inherent want of change in relation to a certain behaviour or habit. At the same time, it can be seen that MI ensures that the participants are viewed more as team members to solve a problem rather than a clinician and patient. Hence, this technique can be attributed to a collaboration that respects sense of self and autonomy.

To be more successful at motivational interviewing, a clinician must have a strong sense of “purpose, clear strategies and skills for such purposes”. This ensures that the clinician knows what goals they are trying to achieve prior to entering into motivational interviewing. Additionally, clinicians need to have well-rounded and established interaction skills including asking open ended questions, reflective listening, affirming and reiterating statements back to the patient. Such skills are used in a dynamic where the clinician actively listens to the patient then repackages their statements back to them while highlighting what they have done well. In this way, it can improve their self-confidence for change.

Furthermore, at the same time the clinician needs to keep in mind the following five principles when practicing MI.

Express Empathy

This means to listen and express empathy to patients through the use of reflective listening. In this step, the clinician listens and presents ideas the patient has discussed in a different way, rather than telling the patient what to do. This hopes to ensure that the patient feels respected and that there are no judgments given when they express their thoughts, feelings and experiences but instead, shows the patient that the clinician is genuinely interested about the patient and their circumstances. This aims to strengthen the relationship between the two parties and ensures it is a collaboration, and allows the patient to feel that the clinician is supportive and therefore will be more willing to be open about their real thoughts.

Develop Discrepancy

This means to assist patients in developing discrepancies between the current self and what they want to be like in the future after a change has taken place. The main goal of this principle is to increase the patient’s awareness that there are consequences to their current behaviours. This allows the patient to realize the negatives aspects and issues the particular behaviour that MI is trying to change can cause. This realisation can help and encourage the patient towards a dedication to change as they can see the discrepancy between their current behaviour and desired behaviour. It is important that the patient be the one making the arguments for change and realise their discrepancies themselves. An effective way to do this is for the clinician to participate in active reflective listening and repacking what the patient has told them and delivering it back to them.

Avoid Arguments

During the course of MI the clinician may be inclined to argue with a patient, especially when they are ambivalent about their change and this is especially true when “resistance” is met from the patient. If the clinician tries to enforce a change, it could exacerbate the patient to become more withdrawn and can cause degeneration of what progress had been made thus far and decrease rapport with the patient. Arguments can cause the patient to become defensive and draw away from the clinician which is counterproductive and diminishes any progress that may have been made. When patients become a little defensive and argumentative, it usually is a sign to change the plan of attack. The biggest progress made towards behaviour change is when the patient makes their own arguments instead of the clinician presenting it to them.

Roll with Resistance

“Rolling with resistance” is now an outdated concept in MI; in the third edition of Miller & Rollnick’s textbook Motivational Interviewing: Helping People Change, the authors indicated that they had completely abandoned the word “resistance” as well as the term “rolling with resistance”, due to the term’s tendency to blame the client for problems in the therapy process and obscure different aspects of ambivalence. “Resistance”, as the idea was previously conceptualised before it was abandoned in MI, can come in many forms such as arguing, interrupting, denying and ignoring. Part of successful MI is to approach the “resistance” with professionalism, in a way that is non-judgmental and allows the patient to once again affirm and know that they have their autonomy and that it is their choice when it comes to their change.

Support Self-Efficacy

Strong self-efficacy can be a significant predictor of success in behaviour change. In many patients there is an issue of the lack of self-efficacy. They may have tried multiple times on their own to create a change in their behaviour (e.g. trying to cease smoking, losing weight, sleep earlier) and because they have failed it causes them to lose their confidence and hence lowers their self-efficacy. Therefore, it is clear to see how important it is for the patient to believe that they are self-efficient and it is the clinician’s role to support them by means of good MI practice and reflective listening. By reflecting on what the patient had told them, the clinician can accentuate the patient’s strengths and what they have been successful in (e.g. commending a patient who had stopped smoking for a week instead of straining on the fact they failed). By highlighting and suggesting to the patient areas in which they have been successful, this can be incorporated into future attempts and can improve their confidence and efficacy to believe that they are capable of change.

While there are as many differences in technique, the underlying spirit of the method remains the same and can be characterized in a few key points:

  • Motivation to change is elicited from the client, and is not imposed from outside forces.
  • It is the client’s task, not the counsellor’s, to articulate and resolve the client’s ambivalence.
  • Direct persuasion is not an effective method for resolving ambivalence.
  • The counselling style is generally quiet and elicits information from the client.
  • The counsellor is directive, in that they help the client to examine and resolve ambivalence.
  • Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction.
  • The therapeutic relationship resembles a partnership or companionship.

Ultimately, practitioners must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.

Four Processes

There are four steps used in motivational interviewing. These help to build trust and connection between the patient and the clinician, focus on areas that may need to be changed and find out the reasons the patient may have for changing or holding onto a behaviour. This helps the clinician to support and assist the patient in their decision to change their behaviour and plan steps to reach this behavioural change. These steps do not always happen in this order.

Engaging

In this step, the clinician gets to know the patient and understands what is going on in the patient’s life. The patient needs to feel comfortable, listened to and fully understood from their own point of view. This helps to build trust with the patient and builds a relationship where they will work together to achieve a shared goal. The clinician must listen and show empathy without trying to fix the problem or make a judgement. This allows the patient to open up about their reasons for change, hopes, expectations as well as the barriers and fears that are stopping the patient from changing. The clinician must ask open ended questions which helps the patient to give more information about their situation, so they feel in control and that they are participating in the decision-making process and the decisions are not being made for them. This creates an environment that is comfortable for the patient to talk about change. The more trust the patient has towards the clinician, the more likely it is reduce resistance, defensiveness, embarrassment or anger the patient may feel when talking about a behavioural issue. Overall, the patient is more likely to come back to follow up appointments, follow an agreed plan and get the benefit of the treatment.

Focusing

This is where the clinician helps the patient find and focus on an area that is important to them, where they are unsure or are struggling to make a change. This step is also known as the “WHAT?” of change. The goal is for the clinician to understand what is important to the patient without pushing their own ideas on the patient. The clinician needs to ask questions to understand the reasons if and why the patient would be motivated to change and choose a goal to reach together. The patient must feel that they share the control with the clinician about the direction and agree on a goal. The clinician will then aim to help the patient order the importance of their goals and point out the current behaviours that get in the way of achieving their new goal or “develop discrepancy” between their current and desired behaviours. The focus or goal can come from the patient, situation or the clinician. There are three styles of focusing; directing, where the clinician can direct the patient towards a particular area for change; following, where the clinician let the patient decide the goal and be led by the patient’s priorities, and; guiding, where the clinician leads the patient to uncover an area of importance.

Evoking

In this step the clinician asks questions to get the patient to open up about their reasons for change. This step is also known as the “WHY?” of change. Often when a patient puts this into words it reinforces their reasons to change and they find out they have more reasons to change rather than to stay the same. Usually, there is one reason that is stronger than the others to motivate the patient to change their behaviour. The clinician needs to listen and recognise “change talk”, where the patient is uncovering how they would go about change and are coming up with their own solutions to their problems. The clinician should support and encourage the patient when they talk about ways and strategies to change, as the patient is more likely to follow a plan they set for themselves. When the patient is negative or is resisting change the clinician should “roll with resistance” where they do not affirm or encourage the negative points but highlight the ways and reasons the person has come up with to change. The clinician must resist arguing or the “righting reflex” where they want to fix the problem or challenge the patient’s negative thoughts. This comes across as they are not working together and causes the patient to resist change even more. The clinician’s role is to ask questions that guide the patient to come up with their own solution to change. The best time to give advice is if the patient asks for it, if the patient is stuck with coming up with ideas, the clinician can ask permission to give advice and then give details, but only after the patient has come up with their own ideas first. If the clinician focuses more on their own reasons they believe the patient should change this would not come across as genuine to the patient and this would reduce the bond they made in the engaging process.

Planning

In this step the clinician helps the patient in planning how to change their behaviour and encourages their commitment to change. This step is also known as the “HOW?” of change. The clinician asks questions to judge how ready the patient is to change and helps to guide the patient in coming up with their own step by step action plan. They can help to strengthen the patient’s commitment to changing, by supporting and encouraging when the patient uses “commitment talk” or words that show their commitment to change. In this step the clinician can listen and recognise areas that may need more work to get to the core motivation to change or help the patient to overcome uneasiness that is still blocking their behavioural change. In doing this, they help to strengthen the patients motivation and support that they are capable of achieving this goal on their own. The clinician should help the patient to come up with SMART goals which are; Specific, Measurable, Achievable, Relevant and Time bound. This helps to set benchmarks and measure how their behaviour has changed towards their new goal.

Adaptations

Motivational Enhancement Therapy

Motivational enhancement therapy is a time-limited four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems and the Drinkers’ Check-up, which provides normative-based feedback and explores client motivation to change in light of the feedback.

Motivational interviewing is supported by over 200 randomised controlled trials across a range of target populations and behaviours including substance abuse, health-promotion behaviours, medical adherence, and mental health issues.

Motivational Interviewing Groups

MI groups are highly interactive, focused on positive change, and harness group processes for evoking and supporting positive change. They are delivered in four phases:

  1. Engaging the group.
  2. Evoking member perspectives.
  3. Broadening perspectives and building momentum for change.
  4. Moving into action.

Behaviour Change Counselling

Behaviour change counselling (BCC) is an adaptation of MI which focuses on promoting behaviour change in a healthcare setting using brief consultations. BCC’s main goal is to understand the patient’s point of view, how they’re feeling and their idea of change. It was created with a “more modest goal in mind”, as it simply aims to “help the person talk through the why and how of change” and encourage behaviour change. It focuses on patient-centred care and is based on several overlapping principles of MI, such as respect for patient choice, asking open-ended questions, empathetic listening and summarizing. Multiple behaviour change counselling tools were developed to assess and scale the effectiveness of behaviour change counselling in promoting behaviour change such as the Behaviour Change Counselling Index (BECCI) and the Behaviour Change Counselling Scale (BCCS).

Behaviour Change Counselling Scale


The Behaviour Change Counselling Scale (BCCS) is a tool used to assess lifestyle counselling using BCC, focusing on feedback on the skill achieved. “Items of BCCS were scored on 1-7 Likert scales and items were tallied into 4 sub-scales, reflecting the 3 skill-sets: MI and readiness assessment, behaviour modification, and emotion management”.

The data obtained is then presented on: item characteristics, sub-scale characteristics, interrater reliability, test-retest reliability and construct validity.

Based on a study conducted by Vallis, the results suggest that BCCS is a potentially useful tool in assessing BCC and aid to training practitioners as well as assessing training outcomes.

Behaviour Change Counselling Index

The Behaviour Change Counselling Index (BECCI) is a BCC tool that assesses general practitioner behaviour and incites behaviour change through talking about change, encouraging the patient to think about change and respecting the patient’s choices in regards to behaviour change. BECCI was developed to assess a practitioner’s competence in the use of Behaviour Change Counselling (BCC) methods to elicit behaviour change. Used primarily for the use of learning practitioners in a simulated environment to practice and learn the skills of BCC. It “provides valuable information about the standard of BCC that practitioners were trained to deliver in studies of BCC as an intervention”. Rather than the result and response from the patient, the tool emphasizes and measures the practitioner’s behaviours, skills and attitude. Results from the study show that after receiving training in BCC, practitioners show great improvement based on BECCI. However, as BECCI has only been used in a simulated clinical environment, more study is required to assess its reliability in a real patient environment. Furthermore, it focuses heavily on practitioner behaviour rather than patient behaviour. Therefore, BECCI may be useful for trainers to assess the reliability and effectiveness of BCC skills but further research and use is required, especially in a real consultation environment.

Technology Assisted Motivational Interview

Technology Assisted Motivational Interview (TAMI) is “used to define adaptations of MI delivered via technology and various types of media”. This may include technological devices and creations such as computers, mobile phones, telephones, videos and animations. A review of multiple studies shows the potential effectiveness of the use of technology in delivering motivational interviewing consultations to encourage behaviour change. However, some limitations include: the lack of empathy that may be expressed through the use of technology and the lack of face-to-face interaction may either produce a positive or negative effect on the patient. Further studies are required to determine whether face-to-face consultations to deliver MI is more effective in comparison to those delivered via technology.

Limitations

Underlying Mental Health Conditions

Patients with an underlying mental illness present one such limitation to motivational interviewing. In a case where the patient suffers from an underlying mental illness such as depression, anxiety, bipolar disease, schizophrenia or other psychosis, more intensive therapy may be required to induce a change. In these instances, the use of motivational interviewing as a technique to treat outward-facing symptoms, such as not brushing teeth, may be ineffective where the root cause of the problem stems from the mental illness. When working with these patients, it is important to recognise that only so much can be done at certain levels. The treating therapists should, therefore, ensure the patient is referred to the correct medical professional to treat the cause of the behaviour, and not simply one of the symptoms.

Pre-Contemplation

Patients in the pre-contemplation stage of the stages of change present a further limitation to the model. If the patient is in this stage, they will not consider they have a problem and therefore are unlikely to be receptive to motivational interviewing techniques. It is important that motivational interviewers are well trained in the approach to be taken when handling these patients. Well intended messages can have the opposite effect of pushing the patient away or causing them to actively rebel. In these instances discussing how the issue may be affecting the patient must be handled very delicately and introduced carefully. Suggesting less harmful ways of dealing with the client’s issue and helping them recognize danger signs may be a better approach to plant the seed aiding their progression to the contemplation stage.

Motivation

Professionals attempting to encourage people to make a behavioural change often underestimate the effect of motivation. Simply advising clients how detrimental their current behaviour is and providing advice on how to change their behaviour will not work if the client lacks motivation. Many people have full knowledge of how dangerous smoking is yet they continue the practice. Research has shown that a client’s motivation to alter behaviour is largely influenced by the way the therapist relates to them.

Therapist/Client Trust

Clients who do not like or trust their health care professionals are likely to become extremely resistant to change. In order to prevent this, the therapist must take time to foster an environment of trust. Even when the therapist can clearly identify the issues at hand it is important to have the patient feels the session is collaborative and that they are not being lectured to. Confrontational approaches by well-meaning therapists will inhibit the process.

Time Limitations

Time limits placed on therapists during consultations also have the potential to impact significantly on the quality of motivational interviewing. Appointments may be limited to a brief or single visit with a patient; for example, a client may attend the dentist with a toothache due to a cavity. The oral health practitioner or dentist may be able to broach the subject of a behaviour change, such as flossing or diet modification but the session duration may not be sufficient when coupled with other responsibilities the health practitioner has to the health and wellbeing of the patient. For many clients, changing habits may involve reinforcement and encouragement which is not possible in a single visit. Some patients, once treated, may not return for a number of years or may even change practitioners or practices, meaning the motivational interview is unlikely to have sufficient effect.

Training Deficiencies

While psychologists, mental health counsellors, and social workers are generally well trained and practiced in delivering motivational interviewing, other health-care professionals are generally provided with only a few hours of basic training. Although perhaps able to apply the underpinning principles of motivational interviewing, these professionals generally lack the training and applied skills to truly master the art of dealing with the patient’s resistant statements in a collaborative manner. It is important that therapists know their own limitations and are prepared to refer clients to other professionals when required.

Group Treatment

Although studies are somewhat limited, it appears that delivering motivational interviewing, in a group may be less effective than when delivered one-on-one. Research continues into this area however what is clear is that groups change the dynamics of a situation and the therapist needs to ensure that group control is maintained and input from group members does not derail the process for some clients.

Applications

Motivational interviewing was initially developed for the treatment of substance abuse, but MI is continuously being applied across health fields and beyond that. The following fields have used the technique of MI.

Brief Intervention

Brief intervention and MI are both techniques used to empower behavioural change within individuals. Behavioral interventions “generally refer to opportunistic interventions by non-specialists (e.g. GPs) offered to patients who may be attending for some unrelated condition”. Due to speculation in the health industry the use of brief intervention has been deemed to be used too loosely and the implementation of MI is increasing rapidly.

Classroom Management

Motivational interviewing has been incorporated into managing a classroom. Due to the nature of MI where it elicits and evokes behavioural change within an individual it has shown to be effective in a classroom especially when provoking behaviour change within an individual. In association with MI, the classroom check-up method is incorporated which is a consultation model that addresses the need for classroom level support.

Coaching

Motivational interviewing has been implemented in coaching, specifically health-based coaching to aid in a better lifestyle for individuals. A study titled “Motivational interviewing-based health coaching as a chronic care intervention” was conducted to evaluate if MI had an impact on individuals health who were assessed as chronically ill. The study’s results showed that the group that MI was applied to had “improved their self-efficacy, patient activation, lifestyle change and perceived health status”.

Environmental Sustainability

Initially motivational interviewing was implemented and formulated to elicit behavioural change in individuals suffering from substance abuse. However, MI has been reformed and has multiple uses. One of these uses include of stabilising the surrounding environment of an individual. This is completed by allowing the individual to evoke behavioural change within themselves and elicit motivation to change certain habits, for example substance abuse. By motivating the individual, it allows them to maintain the environment surrounding them to eliminate factors of temptation. However, if relapse occurs it is normal and is bound to happen.

Mental Disorders

Motivational interviewing was originally developed by William R. Miller and Stephen Rollnick in the 1980s in order to aid people with substance abuse disorders. However, it has also been implemented to help aid in established models with mental disorders such as anxiety and depression. Currently an established model known as cognitive behavioural therapy (CBT) is being implemented to aid in these issues. Research suggests that with collaborating motivational interviewing and CBT has proved to be effective as they have both shown to be effective. A study was conducted as a randomised cluster trial that suggests that when MI was implemented it “associated with improved depressive symptoms and remission rate”. There is currently insufficient research papers to prove the effect of MI in mental disorders. However, it is increasingly being applied and more research is going into it.

Dual Diagnosis

Dual diagnosis can be defined as a “term that is used to describe when a person is experiencing both mental health problems and substance misuse”. Motivational interviewing is used as a preventative measure for individuals suffering from both a mental health issue and substance misuse due to the nature of MI eliciting behavioural change in individuals.

Problem Gambling

Gambling issues are on the rise and it is becoming a struggle for therapists to maintain it. Research suggests that many individuals “even those who actively seek and start gambling treatment, do not receive the full recommended course of therapy”. Motivational interviewing has been widely used and adapted by therapists to overcome gambling issues, it is used in collaboration with cognitive behavioural therapy and self-directed treatments. The goal of using MI in an individual who is having issues with gambling is to recognize and overcome those barriers and “increase overall investment in therapy by supporting an individual’s commitment to changing problem behaviours”.

Parenting

Motivational interviewing is implemented to evoke behavioural change in an individual. Provoking behavioural change includes the recognising of the issue from an individual. A research was conducted by utilising motivational interviewing to help promote oral regime and hygiene within children under the supervision of a parent. In this research the experimental group which was parents who received MI education in the form of a “pamphlet, watched a videotape, as well as received an MI counselling session and six follow-up telephone calls”. The mothers who had received the MI counselling session showed that “children in the MI group exhibited significantly less new caries (decayed or filled surfaces)” in contrast to the children in the control group. This suggests that the application of MI with parenting can significantly impact outcomes regarding the children of the parent.

Substance Dependence

Motivational interviewing was initially developed in order to aid people with substance abuse, specifically alcohol. Due to the results it displayed MI can be implemented into any substance abuse or dependence treatment. Research that was conducted utilised MI with a cocaine-detoxification programme. This research had found that out of the 105 randomly assigned patients, the randomly assigned group that underwent MI treatment indicated that “completers who received MI increased use of behavioural coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment”. This evidence suggests that the application of MI in substance dependent individuals has a positive impact in aiding the individual to overcome this issue.

A 2016 Cochrane review focused on alcohol misuse in young adults in 84 trials found no substantive, meaningful benefits for MI for preventing alcohol misuse or alcohol-related problems.

What is Behaviourism?

Introduction

Behaviourism is a systematic approach to understanding the behaviour of humans and other animals. It assumes that behaviour is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual’s history, including especially reinforcement and punishment contingencies, together with the individual’s current motivational state and controlling stimuli. Although behaviourists generally accept the important role of heredity in determining behaviour, they focus primarily on environmental events.

It combines elements of philosophy, methodology, and theory. Behaviourism emerged in the early 1900s as a reaction to depth psychology and other traditional forms of psychology, which often had difficulty making predictions that could be tested experimentally, but derived from earlier research in the late nineteenth century, such as when Edward Thorndike pioneered the law of effect, a procedure that involved the use of consequences to strengthen or weaken behaviour.

During the first half of the twentieth century, John B. Watson devised methodological behaviourism, which rejected introspective methods and sought to understand behaviour by only measuring observable behaviours and events. It was not until the 1930s that B.F. Skinner suggested that covert behaviour – including cognition and emotions – subjects to the same controlling variables as observable behaviour, which became the basis for his philosophy called radical behaviourism. While Watson and Ivan Pavlov investigated how (conditioned) neutral stimuli elicit reflexes in respondent conditioning, Skinner assessed the reinforcement histories of the discriminative (antecedent) stimuli that emits behaviour; the technique became known as operant conditioning.

The application of radical behaviourism – known as applied behaviour analysis – is used in a variety of contexts, including, for example, applied animal behaviour and organisational behaviour management to treatment of mental disorders, such as autism and substance abuse. In addition, while behaviourism and cognitive schools of psychological thought do not agree theoretically, they have complemented each other in the cognitive-behaviour therapies, which have demonstrated utility in treating certain pathologies, including simple phobias, PTSD, and mood disorders.

Branches of Behaviourism

An outline of the various branches of behaviourism can be seen the table below.

BranchDescription
InterbehaviourismProposed by Jacob Robert Kantor before B. F. Skinner’s writings.
Methodological Behaviourism1. John B. Watson’s behaviourism states that only public events (motor behaviours of an individual) can be objectively observed.
2. Although it was still acknowledged that thoughts and feelings exist, they were not considered part of the science of behaviour.
3. It also laid the theoretical foundation for the early approach behaviour modification in the 1970s and early 1980s.
Psychological Behviourism1. As proposed by Arthur W. Staats, unlike the previous behaviourisms of Skinner, Hull, and Tolman, was based upon a program of human research involving various types of human behaviour.
2. Psychological behaviourism introduces new principles of human learning.
3. Humans learn not only by the animal learning principles but also by special human learning principles.
4. Those principles involve humans’ uniquely huge learning ability.
5. Humans learn repertoires that enable them to learn other things. Human learning is thus cumulative.
6. No other animal demonstrates that ability, making the human species unique.
Radical Behaviourism1. Skinner’s philosophy is an extension of Watson’s form of behaviourism by theorising that processes within the organism – particularly, private events, such as thoughts and feelings – are also part of the science of behaviour, and suggests that environmental variables control these internal events just as they control observable behaviours.
2. Although private events cannot be directly seen by others, they are later determined through the species’ overt behaviour.
3. Radical behaviourism forms the core philosophy behind behaviour analysis.
4. Willard Van Orman Quine used many of radical behaviourism’s ideas in his study of knowledge and language.
Teleological Behaviourism1. Proposed by Howard Rachlin, post-Skinnerian, purposive, close to microeconomics. Focuses on objective observation as opposed to cognitive processes.
Theoretical Behaviourism1. Proposed by J.E.R. Staddon, adds a concept of internal state to allow for the effects of context.
2. According to theoretical behaviourism, a state is a set of equivalent histories, i.e., past histories in which members of the same stimulus class produce members of the same response class (i.e., B.F. Skinner’s concept of the operant).
3. Conditioned stimuli are thus seen to control neither stimulus nor response but state.
4. Theoretical behaviourism is a logical extension of Skinner’s class-based (generic) definition of the operant.
Hullian & Post-Hullian1. A sub-type of theoretical behaviourism.
2. Theoretical, group data, not dynamic, physiological.
Purposive1. A sub-type of theoretical behaviourism.
2. Tolman’s behaviouristic anticipation of cognitive psychology

Modern-Day Theory: Radical Behaviourism

B.F. Skinner proposed radical behaviourism as the conceptual underpinning of the experimental analysis of behaviour. This viewpoint differs from other approaches to behavioural research in various ways, but, most notably here, it contrasts with methodological behaviourism in accepting feelings, states of mind and introspection as behaviours also subject to scientific investigation. Like methodological behaviourism, it rejects the reflex as a model of all behaviour, and it defends the science of behaviour as complementary to but independent of physiology. Radical behaviourism overlaps considerably with other western philosophical positions, such as American pragmatism.

Although John B. Watson mainly emphasized his position of methodological behaviourism throughout his career, Watson and Rosalie Rayner conducted the renowned Little Albert experiment (1920), a study in which Ivan Pavlov’s theory to respondent conditioning was first applied to eliciting a fearful reflex of crying in a human infant, and this became the launching point for understanding covert behaviour (or private events) in radical behaviourism. However, Skinner felt that aversive stimuli should only be experimented on with animals and spoke out against Watson for testing something so controversial on a human.

In 1959, Skinner observed the emotions of two pigeons by noting that they appeared angry because their feathers ruffled. The pigeons were placed together in an operant chamber, where they were aggressive as a consequence of previous reinforcement in the environment. Through stimulus control and subsequent discrimination training, whenever Skinner turned off the green light, the pigeons came to notice that the food reinforcer is discontinued following each peck and responded without aggression. Skinner concluded that humans also learn aggression and possess such emotions (as well as other private events) no differently than do nonhuman animals.

Experimental and Conceptual Innovations

This essentially philosophical position gained strength from the success of Skinner’s early experimental work with rats and pigeons, summarized in his books The Behaviour of Organisms and Schedules of Reinforcement. Of particular importance was his concept of the operant response, of which the canonical example was the rat’s lever-press. In contrast with the idea of a physiological or reflex response, an operant is a class of structurally distinct but functionally equivalent responses. For example, while a rat might press a lever with its left paw or its right paw or its tail, all of these responses operate on the world in the same way and have a common consequence. Operants are often thought of as species of responses, where the individuals differ but the class coheres in its function-shared consequences with operants and reproductive success with species. This is a clear distinction between Skinner’s theory and S-R theory.

Skinner’s empirical work expanded on earlier research on trial-and-error learning by researchers such as Thorndike and Guthrie with both conceptual reformulations – Thorndike’s notion of a stimulus-response “association” or “connection” was abandoned; and methodological ones – the use of the “free operant”, so called because the animal was now permitted to respond at its own rate rather than in a series of trials determined by the experimenter procedures. With this method, Skinner carried out substantial experimental work on the effects of different schedules and rates of reinforcement on the rates of operant responses made by rats and pigeons. He achieved remarkable success in training animals to perform unexpected responses, to emit large numbers of responses, and to demonstrate many empirical regularities at the purely behavioural level. This lent some credibility to his conceptual analysis. It is largely his conceptual analysis that made his work much more rigorous than his peers’, a point which can be seen clearly in his seminal work Are Theories of Learning Necessary? in which he criticizes what he viewed to be theoretical weaknesses then common in the study of psychology. An important descendant of the experimental analysis of behaviour is the Society for Quantitative Analysis of Behaviour.

Relation to Language

As Skinner turned from experimental work to concentrate on the philosophical underpinnings of a science of behaviour, his attention turned to human language with his 1957 book Verbal Behaviour and other language-related publications; Verbal Behaviour laid out a vocabulary and theory for functional analysis of verbal behaviour, and was strongly criticised in a review by Noam Chomsky.

Skinner did not respond in detail but claimed that Chomsky failed to understand his ideas, and the disagreements between the two and the theories involved have been further discussed. Innateness theory, which has been heavily critiqued, is opposed to behaviourist theory which claims that language is a set of habits that can be acquired by means of conditioning. According to some, the behaviourist account is a process which would be too slow to explain a phenomenon as complicated as language learning. What was important for a behaviourist’s analysis of human behaviour was not language acquisition so much as the interaction between language and overt behaviour. In an essay republished in his 1969 book Contingencies of Reinforcement, Skinner took the view that humans could construct linguistic stimuli that would then acquire control over their behaviour in the same way that external stimuli could. The possibility of such “instructional control” over behaviour meant that contingencies of reinforcement would not always produce the same effects on human behaviour as they reliably do in other animals. The focus of a radical behaviourist analysis of human behaviour therefore shifted to an attempt to understand the interaction between instructional control and contingency control, and also to understand the behavioural processes that determine what instructions are constructed and what control they acquire over behaviour. Recently, a new line of behavioural research on language was started under the name of relational frame theory.

Education

Behaviourism focuses on one particular view of learning: a change in external behaviour achieved through using reinforcement and repetition (Rote learning) to shape behaviour of learners. Skinner found that behaviours could be shaped when the use of reinforcement was implemented. Desired behaviour is rewarded, while the undesired behaviour is not rewarded. Incorporating behaviourism into the classroom allowed educators to assist their students in excelling both academically and personally. In the field of language learning, this type of teaching was called the audio-lingual method, characterised by the whole class using choral chanting of key phrases, dialogues and immediate correction.

Within the behaviourist view of learning, the “teacher” is the dominant person in the classroom and takes complete control, evaluation of learning comes from the teacher who decides what is right or wrong. The learner does not have any opportunity for evaluation or reflection within the learning process, they are simply told what is right or wrong. The conceptualisation of learning using this approach could be considered “superficial,” as the focus is on external changes in behaviour, i.e., not interested in the internal processes of learning leading to behaviour change and has no place for the emotions involved in the process.

Operant Conditioning

Operant conditioning was developed by B.F. Skinner in 1937 and deals with the management of environmental contingencies to change behaviour. In other words, behaviour is controlled by historical consequential contingencies, particularly reinforcement – a stimulus that increases the probability of performing behaviours, and punishment – a stimulus that decreases such probability. The core tools of consequences are either positive (presenting stimuli following a response), or negative (withdrawn stimuli following a response).

The following descriptions explain the concepts of four common types of consequences in operant conditioning.

TypeDescription
Positive Reinforcement1. Providing a stimulus that an individual desires to reinforce desired behaviours.
2. For example, a child loves playing video games.
3. His mother reinforced his tendency to provide a helping hands to other family members by providing more time for him to play video games.
Negative Reinforcement1. Removing a stimulus that an individual does not desire to reinforce desired behaviours.
3. For example, a child hates being nagged to clean his room.
3. His mother reinforces his room cleaning by removing the undesired stimulus of nagging after he has cleaned.
Positive Punishment1. Providing a stimulus that an individual does not desire to decrease undesired behaviours.
2. For example, a child hates to do chores.
3. His parents will try to reduce the undesired behaviour of failing a test by applying the undesired stimuli of having him do more chores around the house.
Negative Punishment1. Removing a stimulus that an individual desires in order to decrease undesired behaviours.
2. For example, a child loves playing video games.
3. His parents will try to reduce the undesired behaviour of failing an exam by removing the desired stimulus of video games.

Classical experiment in operant conditioning, for example the Skinner Box, “puzzle box” or operant conditioning chamber to test the effects of operant conditioning principles on rats, cats and other species. From the study of Skinner box, he discovered that the rats learned very effectively if they were rewarded frequently with food. Skinner also found that he could shape the rats’ behaviour through the use of rewards, which could, in turn, be applied to human learning as well.

Skinner’s model was based on the premise that reinforcement is used for the desired actions or responses while punishment was used to stop the undesired actions responses that are not. This theory proved that humans or animals will repeat any action that leads to a positive outcome, and avoiding any action that leads to a negative outcome. The experiment with the pigeons showed that a positive outcome leads to learned behaviour since the pigeon learned to peck the disc in return for the reward of food.

These historical consequential contingencies subsequently leads to (antecedent) stimulus control, but in contrast to respondent conditioning where antecedent stimuli elicits reflexive behavior, operant behavior is only emitted and therefore does not force its occurrence. It includes the following controlling stimuli:

  • Discriminative stimulus (Sd):
    • An antecedent stimulus that increases the chance of the organism engaging in a behaviour.
    • One example of this occurred in Skinner’s laboratory.
    • Whenever the green light (Sd) appeared, it signalled the pigeon to perform the behaviour of pecking because it learned in the past that each time it pecked, food was presented (the positive reinforcing stimulus).
  • Stimulus delta (S-delta):
    • An antecedent stimulus that signals the organism not to perform a behaviour since it was extinguished or punished in the past.
    • One notable instance of this occurs when a person stops their car immediately after the traffic light turns red (S-delta).
    • However, the person could decide to drive through the red light, but subsequently receive a speeding ticket (the positive punishing stimulus), so this behaviour will potentially not reoccur following the presence of the S-delta.

Respondent Conditioning

Although operant conditioning plays the largest role in discussions of behavioural mechanisms, respondent conditioning (also called Pavlovian or classical conditioning) is also an important behaviour-analytic process that need not refer to mental or other internal processes. Pavlov’s experiments with dogs provide the most familiar example of the classical conditioning procedure. At the beginning, the dog was provided a meat (unconditioned stimulus, UCS, naturally elicit a response that is not controlled) to eat, resulting in increased salivation (unconditioned response, UCR, which means that a response is naturally caused by UCS). Afterwards, a bell ring was presented together with food to the dog. Although bell ring was a neutral stimulus (NS, meaning that the stimulus did not had any effect), dog would start salivate when only hearing a bell ring after a number of pairings. Eventually, the neutral stimulus (bell ring) became conditioned. Therefore, salvation was elicited as a conditioned response (the response same as the unconditioned response), pairing up with meat – the conditioned stimulus). Although Pavlov proposed some tentative physiological processes that might be involved in classical conditioning, these have not been confirmed. The idea of classical conditioning helped behaviourist John Watson discover the key mechanism behind how humans acquire the behaviours that they do, which was to find a natural reflex that produces the response being considered.

Watson’s “Behaviourist Manifesto” has three aspects that deserve special recognition: one is that psychology should be purely objective, with any interpretation of conscious experience being removed, thus leading to psychology as the “science of behaviour”; the second one is that the goals of psychology should be to predict and control behaviour (as opposed to describe and explain conscious mental states); the third one is that there is no notable distinction between human and non-human behaviour. Following Darwin’s theory of evolution, this would simply mean that human behaviour is just a more complex version in respect to behaviour displayed by other species.

In Philosophy

Behaviourism is a psychological movement that can be contrasted with philosophy of mind. The basic premise of radical behaviourism is that the study of behaviour should be a natural science, such as chemistry or physics, without any reference to hypothetical inner states of organisms as causes for their behaviour. Behaviourism takes a functional view of behaviour. According to Edmund Fantino and colleagues: “Behaviour analysis has much to offer the study of phenomena normally dominated by cognitive and social psychologists. We hope that successful application of behavioural theory and methodology will not only shed light on central problems in judgment and choice but will also generate greater appreciation of the behavioural approach.”

Behaviourist sentiments are not uncommon within philosophy of language and analytic philosophy. It is sometimes argued that Ludwig Wittgenstein defended a logical behaviourist position (e.g. the beetle in a box argument). In logical positivism (as held, e.g. by Rudolf Carnap and Carl Hempel), the meaning of psychological statements are their verification conditions, which consist of performed overt behaviour. W.V.O. Quine made use of a type of behaviourism, influenced by some of Skinner’s ideas, in his own work on language. Quine’s work in semantics differed substantially from the empiricist semantics of Carnap which he attempted to create an alternative to, couching his semantic theory in references to physical objects rather than sensations. Gilbert Ryle defended a distinct strain of philosophical behaviourism, sketched in his book The Concept of Mind. Ryle’s central claim was that instances of dualism frequently represented “category mistakes”, and hence that they were really misunderstandings of the use of ordinary language. Daniel Dennett likewise acknowledges himself to be a type of behaviourist, though he offers extensive criticism of radical behaviourism and refutes Skinner’s rejection of the value of intentional idioms and the possibility of free will.

This is Dennett’s main point in “Skinner Skinned.” Dennett argues that there is a crucial difference between explaining and explaining away… If our explanation of apparently rational behavior turns out to be extremely simple, we may want to say that the behavior was not really rational after all. But if the explanation is very complex and intricate, we may want to say not that the behavior is not rational, but that we now have a better understanding of what rationality consists in. (Compare: if we find out how a computer program solves problems in linear algebra, we don’t say it’s not really solving them, we just say we know how it does it. On the other hand, in cases like Weizenbaum’s ELIZA program, the explanation of how the computer carries on a conversation is so simple that the right thing to say seems to be that the machine isn’t really carrying on a conversation, it’s just a trick.) (Curtis Brown, Philosophy of Mind, “Behaviorism: Skinner and Dennett”).

Law of Effect and Trace Conditioning

  • Law of Effect:
    • Although Edward Thorndike’s methodology mainly dealt with reinforcing observable behaviour, it viewed cognitive antecedents as the causes of behaviour, and was theoretically much more similar to the cognitive-behaviour therapies than classical (methodological) or modern-day (radical) behaviourism.
    • Nevertheless, Skinner’s operant conditioning was heavily influenced by the Law of Effect’s principle of reinforcement.
  • Trace conditioning:
    • Akin to B.F. Skinner’s radical behaviourism, it is a respondent conditioning technique based on Ivan Pavlov’s concept of a “memory trace” in which the observer recalls the conditioned stimulus (CS), with the memory or recall being the unconditioned response (UR).
    • There is also a time delay between the CS and unconditioned stimulus (US), causing the conditioned response (CR) – particularly the reflex – to be faded over time.

Molecular versus Molar Behaviourism

Skinner’s view of behaviour is most often characterised as a “molecular” view of behaviour; that is, behaviour can be decomposed into atomistic parts or molecules. This view is inconsistent with Skinner’s complete description of behaviour as delineated in other works, including his 1981 article “Selection by Consequences”. Skinner proposed that a complete account of behaviour requires understanding of selection history at three levels: biology (the natural selection or phylogeny of the animal); behaviour (the reinforcement history or ontogeny of the behavioual repertoire of the animal); and for some species, culture (the cultural practices of the social group to which the animal belongs). This whole organism then interacts with its environment. Molecular behaviourists use notions from melioration theory, negative power function discounting or additive versions of negative power function discounting.

Molar behaviourists, such as Howard Rachlin, Richard Herrnstein, and William Baum, argue that behaviour cannot be understood by focusing on events in the moment. That is, they argue that behaviour is best understood as the ultimate product of an organism’s history and that molecular behaviourists are committing a fallacy by inventing fictitious proximal causes for behaviour. Molar behaviourists argue that standard molecular constructs, such as “associative strength”, are better replaced by molar variables such as rate of reinforcement. Thus, a molar behaviourist would describe “loving someone” as a pattern of loving behaviour over time; there is no isolated, proximal cause of loving behaviour, only a history of behaviours (of which the current behaviour might be an example) that can be summarised as “love”.

Theoretical Behaviourism

Skinner’s radical behaviourism has been highly successful experimentally, revealing new phenomena with new methods, but Skinner’s dismissal of theory limited its development. Theoretical behaviourism recognised that a historical system, an organism, has a state as well as sensitivity to stimuli and the ability to emit responses. Indeed, Skinner himself acknowledged the possibility of what he called “latent” responses in humans, even though he neglected to extend this idea to rats and pigeons. Latent responses constitute a repertoire, from which operant reinforcement can select. Theoretical behaviourism links between the brain and the behaviour that provides a real understanding of the behaviour. Rather than a mental presumption of how brain-behaviour relates.

Behaviour Analysis and Culture

Cultural analysis has always been at the philosophical core of radical behaviourism from the early days (as seen in Skinner’s Walden Two, Science & Human Behaviour, Beyond Freedom & Dignity, and About Behaviourism).

During the 1980s, behaviour analysts, most notably Sigrid Glenn, had a productive interchange with cultural anthropologist Marvin Harris (the most notable proponent of “cultural materialism”) regarding interdisciplinary work. Very recently, behaviour analysts have produced a set of basic exploratory experiments in an effort toward this end. Behaviourism is also frequently used in game development, although this application is controversial.

Behaviour Informatics and Behaviour Computing

With the fast growth of big behavioural data and applications, behaviour analysis is ubiquitous. Understanding behaviour from the informatics and computing perspective becomes increasingly critical for in-depth understanding of what, why and how behaviours are formed, interact, evolve, change and affect business and decision. Behaviour informatics and behaviour computing deeply explore behaviour intelligence and behaviour insights from the informatics and computing perspectives.

Criticisms and Limitations

In the second half of the 20th century, behaviourism was largely eclipsed as a result of the cognitive revolution. This shift was due to radical behaviourism being highly criticised for not examining mental processes, and this led to the development of the cognitive therapy movement. In the mid-20th century, three main influences arose that would inspire and shape cognitive psychology as a formal school of thought:

  • Noam Chomsky’s 1959 critique of behaviourism, and empiricism more generally, initiated what would come to be known as the “cognitive revolution”.
  • Developments in computer science would lead to parallels being drawn between human thought and the computational functionality of computers, opening entirely new areas of psychological thought. Allen Newell and Herbert Simon spent years developing the concept of artificial intelligence (AI) and later worked with cognitive psychologists regarding the implications of AI. The effective result was more of a framework conceptualisation of mental functions with their counterparts in computers (memory, storage, retrieval, etc.)
  • Formal recognition of the field involved the establishment of research institutions such as George Mandler’s Center for Human Information Processing in 1964. Mandler described the origins of cognitive psychology in a 2002 article in the Journal of the History of the Behavioural Sciences.

In the early years of cognitive psychology, behaviourist critics held that the empiricism it pursued was incompatible with the concept of internal mental states. Cognitive neuroscience, however, continues to gather evidence of direct correlations between physiological brain activity and putative mental states, endorsing the basis for cognitive psychology.

Behaviour Therapy

Behaviour therapy is a term referring to different types of therapies that treat mental health disorders. It identifies and helps change people’s unhealthy behaviours or destructive behaviours through learning theory and conditioning. Ivan Pavlov’s classical conditioning, as well as counterconditioning are the basis for much of clinical behaviour therapy, but also includes other techniques, including operant conditioning, or contingency management, and modelling – sometimes called observational learning. A frequently noted behaviour therapy is systematic desensitisation, which was first demonstrated by Joseph Wolpe and Arnold Lazarus.

21st-Century Behaviourism (Behaviour Analysis)

Applied behaviour analysis (ABA) – also called behavioural engineering – is a scientific discipline that applies the principles of behaviour analysis to change behaviour. ABA derived from much earlier research in the Journal of the Experimental Analysis of Behaviour, which was founded by B.F. Skinner and his colleagues at Harvard University. Nearly a decade after the study “The psychiatric nurse as a behavioural engineer” (1959) was published in that journal, which demonstrated how effective the token economy was in reinforcing more adaptive behaviour for hospitalised patients with schizophrenia and intellectual disability, it led to researchers at the University of Kansas to start the Journal of Applied Behaviour Analysis in 1968.

Although ABA and behaviour modification are similar behaviour-change technologies in that the learning environment is modified through respondent and operant conditioning, behaviour modification did not initially address the causes of the behaviour (particularly, the environmental stimuli that occurred in the past), or investigate solutions that would otherwise prevent the behaviour from reoccurring. As the evolution of ABA began to unfold in the mid-1980s, functional behaviour assessments (FBAs) were developed to clarify the function of that behaviour, so that it is accurately determined which differential reinforcement contingencies will be most effective and less likely for aversive consequences to be administered. In addition, methodological behaviourism was the theory underpinning behaviour modification since private events were not conceptualised during the 1970s and early 1980s, which contrasted from the radical behaviourism of behaviour analysis. ABA – the term that replaced behaviour modification – has emerged into a thriving field.

The independent development of behaviour analysis outside the United States also continues to develop. In the US, the American Psychological Association (APA) features a subdivision for Behaviour Analysis, titled APA Division 25: Behaviour Analysis, which has been in existence since 1964, and the interests among behaviour analysts today are wide-ranging, as indicated in a review of the 30 Special Interest Groups (SIGs) within the Association for Behaviour Analysis International (ABAI). Such interests include everything from animal behaviour and environmental conservation, to classroom instruction (such as direct instruction and precision teaching), verbal behaviour, developmental disabilities and autism, clinical psychology (i.e., forensic behaviour analysis), behavioural medicine (i.e., behavioural gerontology, AIDS prevention, and fitness training), and consumer behaviour analysis.

The field of applied animal behaviour – a sub-discipline of ABA that involves training animals – is regulated by the Animal Behaviour Society, and those who practice this technique are called applied animal behaviourists. Research on applied animal behaviour has been frequently conducted in the Applied Animal Behaviour Science journal since its founding in 1974.

ABA has also been particularly well-established in the area of developmental disabilities since the 1960s, but it was not until the late 1980s that individuals diagnosed with autism spectrum disorders were beginning to grow so rapidly and groundbreaking research was being published that parent advocacy groups started demanding for services throughout the 1990s, which encouraged the formation of the Behaviour Analyst Certification Board, a credentialing program that certifies professionally trained behaviour analysts on the national level to deliver such services. Nevertheless, the certification is applicable to all human services related to the rather broad field of behaviour analysis (other than the treatment for autism), and the ABAI currently has 14 accredited MA and PhD programmes for comprehensive study in that field.

Early behavioural interventions (EBIs) based on ABA are empirically validated for teaching children with autism and has been proven as such for over the past five decades. Since the late 1990s and throughout the twenty-first century, early ABA interventions have also been identified as the treatment of choice by the US Surgeon General, American Academy of Paediatrics, and US National Research Council.

Discrete trial training – also called early intensive behavioural intervention – is the traditional EBI technique implemented for thirty to forty hours per week that instructs a child to sit in a chair, imitate fine and gross motor behaviours, as well as learn eye contact and speech, which are taught through shaping, modelling, and prompting, with such prompting being phased out as the child begins mastering each skill. When the child becomes more verbal from discrete trials, the table-based instructions are later discontinued, and another EBI procedure known as incidental teaching is introduced in the natural environment by having the child ask for desired items kept out of their direct access, as well as allowing the child to choose the play activities that will motivate them to engage with their facilitators before teaching the child how to interact with other children their own age.

A related term for incidental teaching, called pivotal response treatment (PRT), refers to EBI procedures that exclusively entail twenty-five hours per week of naturalistic teaching (without initially using discrete trials). Current research is showing that the majority of the population learn more words at a quicker pace through PRT since only a small portion of the non-verbal autistic population have lower receptive language skills – a phrase used to describe individuals who do not pay much attention to overt stimuli or others in their environment – and the latter are the children who initially require discrete trials to acquire speech.

Organizational behaviour management, which applies contingency management procedures to model and reinforce appropriate work behaviour for employees in organisations, has developed a particularly strong following within ABA, as evidenced by the formation of the OBM Network and Journal of Organisational Behaviour Management, which was rated the third highest impact journal in applied psychology by ISI JOBM rating.

Modern-day clinical behaviour analysis has also witnessed a massive resurgence in research, with the development of relational frame theory (RFT), which is described as an extension of verbal behaviour and a “post-Skinnerian account of language and cognition.” RFT also forms the empirical basis for acceptance and commitment therapy, a therapeutic approach to counselling often used to manage such conditions as anxiety and obesity that consists of acceptance and commitment, value-based living, cognitive defusion, counterconditioning (mindfulness), and contingency management (positive reinforcement). Another evidence-based counselling technique derived from RFT is the functional analytic psychotherapy known as behavioural activation that relies on the ACL model – awareness, courage, and love – to reinforce more positive moods for those struggling with depression.

Incentive-based contingency management (CM) is the standard of care for adults with substance-use disorders; it has also been shown to be highly effective for other addictions (i.e. obesity and gambling). Although it does not directly address the underlying causes of behaviour, incentive-based CM is highly behaviour analytic as it targets the function of the client’s motivational behaviour by relying on a preference assessment, which is an assessment procedure that allows the individual to select the preferred reinforcer (in this case, the monetary value of the voucher, or the use of other incentives, such as prizes). Another evidence-based CM intervention for substance abuse is community reinforcement approach and family training that uses FBAs and counterconditioning techniques – such as behavioural skills training and relapse prevention – to model and reinforce healthier lifestyle choices which promote self-management of abstinence from drugs, alcohol, or cigarette smoking during high-risk exposure when engaging with family members, friends, and co-workers.

While schoolwide positive behaviour support consists of conducting assessments and a task analysis plan to differentially reinforce curricular supports that replace students’ disruptive behaviour in the classroom, paediatric feeding therapy incorporates a liquid chaser and chin feeder to shape proper eating behaviour for children with feeding disorders. Habit reversal training, an approach firmly grounded in counterconditioning which uses contingency management procedures to reinforce alternative behaviour, is currently the only empirically validated approach for managing tic disorders.

Some studies on exposure (desensitisation) therapies – which refer to an array of interventions based on the respondent conditioning procedure known as habituation and typically infuses counterconditioning procedures, such as meditation and breathing exercises – have recently been published in behaviour analytic journals since the 1990s, as most other research are conducted from a cognitive-behaviour therapy framework. When based on a behaviour analytic research standpoint, FBAs are implemented to precisely outline how to employ the flooding form of desensitisation (also called direct exposure therapy) for those who are unsuccessful in overcoming their specific phobia through systematic desensitisation (also known as graduated exposure therapy). These studies also reveal that systematic desensitisation is more effective for children if used in conjunction with shaping, which is further termed contact desensitisation, but this comparison has yet to be substantiated with adults.

Other widely published behaviour analytic journals include Behaviour Modification, The Behaviour Analyst, Journal of Positive Behaviour Interventions, Journal of Contextual Behavioural Science, The Analysis of Verbal Behaviour, Behaviour and Philosophy, Behaviour and Social Issues, and The Psychological Record.

Cognitive Behaviour Therapy

Cognitive behaviour therapy (CBT) is a behaviour therapy discipline that often overlaps considerably with the clinical behaviour analysis subfield of ABA, but differs in that it initially incorporates cognitive restructuring and emotional regulation to alter a person’s cognition and emotions.

A popularly noted counselling intervention known as dialectical behaviour therapy (DBT) includes the use of a chain analysis, as well as cognitive restructuring, emotional regulation, distress tolerance, counterconditioning (mindfulness), and contingency management (positive reinforcement). DBT is quite similar to acceptance and commitment therapy, but contrasts in that it derives from a CBT framework. Although DBT is most widely researched for and empirically validated to reduce the risk of suicide in psychiatric patients with borderline personality disorder, it can often be applied effectively to other mental health conditions, such as substance abuse, as well as mood and eating disorders.

Most research on exposure therapies (also called desensitisation) – ranging from eye movement desensitisation and reprocessing therapy to exposure and response prevention – are conducted through a CBT framework in non-behaviour analytic journals, and these enhanced exposure therapies are well-established in the research literature for treating phobic, post-traumatic stress, and other anxiety disorders (such as obsessive compulsive disorder, or OCD).

Cognitive-based behavioural activation (BA) – the psychotherapeutic approach used for depression – is shown to be highly effective and is widely used in clinical practice. Some large randomised control trials have indicated that cognitive-based BA is as beneficial as antidepressant medications but more efficacious than traditional cognitive therapy. Other commonly used clinical treatments derived from behavioural learning principles that are often implemented through a CBT model include community reinforcement approach and family training, and habit reversal training for substance abuse and tics, respectively.

Related Therapies

  • Acceptance and commitment therapy (ACT).
  • Applied animal behaviour.
  • Behavioural activation.
  • Behaviour modification.
  • Behaviour therapy.
  • Biofeedback.
  • Clinical behaviour analysis.
  • Contingency management.
  • Desensitization.
  • Dialectical behaviour therapy.
  • Direct instruction.
  • Discrete trial training.
  • Exposure and response prevention.
  • Exposure therapy.
  • Eye movement desensitisation and reprocessing.
  • Flooding.
  • Functional analytic psychotherapy.
  • Habit reversal training.
  • Organisational behaviour management.
  • Pivotal response treatment.
  • Positive behaviour support.
  • Prolonged exposure therapy.
  • Social skills training.
  • Systematic desensitisation.

Book: Why Can’t I Stop?

Book Title:

Why Can’t I Stop?: Reclaiming Your Life from a Behavioral Addiction (A Johns Hopkins Press Health Book).

Author(s): Jon E. Grant, Brian L. Odlaug, and Samuel R. Chamberlain.

Year: 2016.

Edition: First (1st).

Publisher: John Hopkins University Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

At some point in our lives, we all engage in behaviours that are risky, irrational, or unwise. We might find it exciting and temporarily rewarding to gamble on the lottery or impulsively buy an expensive gadget. But just as substances like alcohol and narcotics have the potential to become addictive, so do certain behaviours. A person addicted to gambling, shopping, the internet, food, or picking at their skin may suffer shame in the shadows while their behaviour consumes time and energy and disrupts their life. Some people with behavioural addictions lose their family, job, savings, and home. With a physical basis in the brain, behavioural addictions are serious illnesses – but simply willing yourself to stop is usually not enough.

Why Can’t I Stop? is for anyone who has a behavioural addiction, as well as their supportive families and friends. Examining seven of the most common and serious addictions – gambling, sex, stealing, internet use, shopping and buying, hair pulling and skin picking, and food – the authors bring together cutting-edge research to describe behavioural addiction, its causes, and how it can be diagnosed and treated.

Featuring patient stories of behavioural addiction and recovery, as well as information about treatment centres, this compassionate guide will help readers better understand the complicated issues surrounding these addictions and teach family members how to help the addicted person while helping themselves.

Book: Together Apart – The Psychology of COVID-19

Book Title:

Together Apart – The Psychology of COVID-19.

Author(s): Jolanda Jetten, Stephen D. Reicher, S. Alexander Haslam, and Tegan Cruwys.

Year: 2020.

Edition: First (1st).

Publisher: SAGE Publications Ltd.

Type(s): Paperback and Kindle.

Synopsis:

Written by leading social psychologists with expertise in leadership, health and emergency behaviour – who have also played an important role in advising governments on COVID-19 – this book provides a broad but integrated analysis of the psychology of COVID-19

It explores the response to COVID-19 through the lens of social identity theory, drawing from insights provided by four decades of research. Starting from the premise that an effective response to the pandemic depends upon people coming together and supporting each other as members of a common community, the book helps us to understand emerging processes related to social (dis)connectedness, collective behaviour and the societal effects of COVID-19. In this it shows how psychological theory can help us better understand, and respond to, the events shaping the world in 2020.

Considering key topics such as:

  • Leadership.
  • Communication.
  • Risk perception.
  • Social isolation.
  • Mental health.
  • Inequality.
  • Misinformation.
  • Prejudice and racism.
  • Behaviour change.
  • Social Disorder.

This book offers the foundation on which future analysis, intervention and policy can be built.

Book: The ACT Workbook for OCD

Book Title:

The ACT Workbook for OCD: Mindfulness, Acceptance, and Exposure Skills to Live Well with Obsessive-Compulsive Disorder.

Author(s): Marisa T. Mazza.

Year: 2020.

Edition: First (1st), Workbook Edition.

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

Stand up to your OCD! The ACT Workbook for OCD combines evidence-based acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) for the most up-to-date, effective treatment for obsessive-compulsive disorder (OCD).

If you are one of the millions of people who suffer from OCD, you may experience obsessive, intrusive, or even disturbing thoughts. You may engage in compulsive or ritualistic behaviours, such as checking to make sure you have locked the front door, or endlessly washing your hands for fear of germs or contamination. And you may be tempted to give up if treatment just does not work for you.

Whether you have just received a diagnosis, or have suffered for years, this workbook can help. Using the powerful and proven-effective treatments in this guide, you will learn what type of OCD you suffer from (such as harm OCD), how to identify the underlying mechanisms of your OCD, move through triggering incidents while staying present and connected to your values, be more aware and flexible, tolerate uncertainty, and commit to behaviours that ultimately allow you to lead a full, rewarding life.

Once you realise what really matters to you, you will find the motivation needed to start on the path to psychological well-being.

If you are ready to be courageous, take a risk, and stand up to your OCD symptoms, this workbook can help guide you, every step of the way.

Addictions: Broken Brain Model vs Systems-Level Perspective

Research Paper Title

Curing the broken brain model of addiction: Neurorehabilitation from a systems perspective.

Background

The dominant biomedical perspective on addictions has been that they are chronic brain diseases.

While the authors acknowledge that the brains of people with addictions differ from those without, they argue that the “broken brain” model of addiction has important limitations. They propose that a systems-level perspective more effectively captures the integrated architecture of the embodied and situated human mind and brain in relation to the development of addictions. This more dynamic conceptualisation places addiction in the broader context of the addicted brain that drives behaviour, where the addicted brain is the substrate of the addicted mind, that in turn is situated in a physical and socio-cultural environment.

From this perspective, neurorehabilitation should shift from a “broken-brain” to a systems theoretical framework, which includes high-level concepts related to the physical and social environment, motivation, self-image, and the meaning of alternative activities, which in turn will dynamically influence subsequent brain adaptations. The authors call this integrated approach system-oriented neurorehabilitation.

They illustrate their proposal by showing the link between addiction and the architecture of the embodied brain, including a systems-level perspective on classical conditioning, which has been successfully translated into neurorehabilitation. Central to this example is the notion that the human brain makes predictions on future states as well as expected (or counterfactual) errors, in the context of its goals.

The authors advocate system-oriented neurorehabilitation of addiction where the patients’ goals are central in targeted, personalised assessment and intervention.

Reference

Wiers, R.W. & Verschure, P. (2020) Curing the broken brain model of addiction: Neurorehabilitation from a systems perspective. Addictive Behaviors. doi: 10.1016/j.addbeh.2020.106602. Online ahead of print.

On This Day … 13 September

Events

  • 1848 – Vermont railroad worker Phineas Gage survives an iron rod 1 1⁄4 inches (3.2 cm) in diameter being driven through his brain; the reported effects on his behaviour and personality stimulate discussion of the nature of the brain and its functions.

People (Deaths)

  • 1999 – Benjamin Bloom, American psychologist and academic (b. 1913).

Developing a Behavioural Health Readiness & Suicide Risk Reduction Review for Military Personnel

Research Paper Title

Development of the US Army’s Suicide Prevention Leadership Tool: The Behavioural Health Readiness and Suicide Risk Reduction Review (R4).

Background

Although numerous efforts have aimed to reduce suicides in the US Army, completion rates have remained elevated.

Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated.

The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two US Army divisions.

Methods

Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations.

In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools.

A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools.

Results

Leaders described preferences for:

  • Tool processes (e.g. incorporating engaged leadership, including multiple risk identification methods);
  • Formatting (e.g. one page);
  • Organisation (e.g. low-intermediate-high risk scoring system);
  • Content (e.g. excluding other considerations related to vehicle safety, including readiness implications); and
  • Implementation (e.g. accounting for leadership judgement, tailoring process to specific leadership echelons, consideration of institutional barriers).

Evidence-based predictors of suicide risk and practice guideline considerations (e.g. design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons.

Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership.

Conclusions

The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations.

Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (e.g. institutional factors), and empirically evaluating the implementation of those tools.

Future studies should consider utilising a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.

Reference

Curley, J.M., Penix, E.A., Srinivasan, J., Sarmiento, D.S., McFarling, L.H., Newman, J.B. & Wheeler, L.A. (2020) Development of the U.S. Army’s Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4). Military Medicine. 185(5-6), pp.e668-e677. doi: 10.1093/milmed/usz380.