Behavior therapy.
We talked a lot about behaviorism early on.
We talked about it extensively in the learning chapter and it turns out you
can apply it.
You can apply it to problems that people have and you can help people resolve
problems that they have
on a behavioral level. Sometimes our behavior is the issue,
sometimes when we correct the behavior, it makes a lot of other things better
for us in our lives.
So, behaviorism had something to say in the treatment of all kinds of disorders. In fact, all
of the
different therapies we have now, and there's well over 400 of them,
hell, there's probably 500 by now, make use of all the tags that we're talking about now in
different proportions, and different emphases, and different theoretical
frameworks. But behavior is always part of it.
There's nothing that we know about any body without some kind of behavior,
right, whether it's online behavior posting stuff
or whether it's writing something down, that's a behavior,
whether it's telling me something, whether it's nonverbal behavior.
Behavior is what we do and so understanding of it at a deeper level
is critical to any type of therapy. So we're looking now mostly at the principles
of
classical conditioning and operant conditioning. Well those things hit on
some big issues,
right? We talked about phobias, for example, anxiety disorders,
conditioned taste aversions, we also talked about sex disorders and things of that
nature, fetishism,
particularly. Social learning theory,
the models that we grew up with, the models we provide to others and how we
learn through observation,
how we learn through grasping information given to us by other people,
to reduce or eliminate maladaptive behavior. Well, maladaptive behavior
depends on your definition. Whether it's adaptive or
maladaptive depends entirely on the situation.
So we're going to talk about systematic desensitization. I won't belabor this.
This is a
behavioristic therapy. It is now
talked about in context of exposure therapy.
Exposure therapy is a therapy of choice, empirically supported therapy
for PTSD and all manner of anxiety disorders,
especially phobias, because what you do is you teach somebody
the process that we went over, if you had come to that particular
anxiety and stress seminar I gave,
we teach people how to relax, because you can't be anxious and relaxed at the same
time,
and in teaching them to become relaxed, which is something most people don't
realize
they have control over, but you can learn to have control over,
making themselves relaxed, we then would give them
either imaginal exposure, meaning they would vividly imagine stimuli that they
were fearful of,
or we would do it in actual life, where you are then
exposing them to the stimuli, previously neutral, that have come to evoke
anxiety in them to the point that you extinguish the anxiety reaction.
Assuming that nothing really bad happens in imaginally,
it won't happen, although you can go too far, too fast. You need to do it
systematically.
You can have people in a totally relaxed state
imagine levels of fearful situations, starting off on a very low level until
they're comfortable with that,
move up just a notch until that's perfectly comfortable,
and over time, several sessions perhaps, you can have it to where they can imagine
vividly
the thing that would have most scared them
before, or most anxiety provoking scene that they could have thought of.
Now you've changed something. You've fundamentally changed something
and then you take that into the real world. So if a person was totally
panicked to go into Walmart, for example,
and there are people who have that as an issue, then you could teach them
the relaxation process and you could go through an imaginal scene
where they see a TV commercial about Walmart and they relax
while they do that. And they go scene, after scene, after scene in their mind until they can
imagine themselves
in the middle of the day in the busiest possible situation in that thing
and they're calm imagining it. Then you can move them to the real-life thing
where they don't go in,
maybe they just go to the parking lot and they sit there until they're calm and relaxed.
Alright, and then maybe they go in but at night when there's few people there,
right, for five minutes, ten minutes, until they get to the point where they can
actually achieve
in life what they've achieved in mind. That works.
It works well. Token economy.
Well,
I don't know what economy is a token.
If you think about our economies and we think about money
a lot of people think money is something real.
Real value in money. But money,
it's just a piece of paper. It's cash or it's just a little piece of coin.
The coins aren't even made of precious metals anymore,
right? They're too expensive to make the coins so they're literally the kinds of tokens we
used to pop into
video games in my day. Right? You bought tokens and put the tokens in.
Now the coins, the quarters
aren't worth a quarter and pennies cost too much to make with copper
because they cost way more than a penny apiece to make. So you got these tokens
that then are used in trade. They are,
you remember, I hope, secondary reinforcers, not primary reinforcers,
but we have even beyond that now other systems.
We got pieces of plastic that are tied electronically
to little numbers in
cyberspace on people's hard drives
at different organizations. I don't see a paycheck.
Numbers appear in my online account
and then I take a piece of plastic and I swipe it and numbers disappear
from my online account. Bitcoin.
Total virtual currency. It doesn't matter whether you use shells,
right, as tokens or whether you're bartering goods and services,
what you have is essentially a scene set up in all humanity, throughout all history,
where
I can reward or reinforce a behavior
or reinforce or reward somebody providing a service
in exchange for some kind of token. Nobody really hit on this
until Nate Azrin and other people were working
in mental institutions where people were there
for long-term lockdown wards, schizophrenia was the primary issue,
and you had a lot of people, and I remember emphasizing this the other day,
we were talking about,
like, you had straight jackets, you had people tied to beds,
until you got things like thorazine, chemical straight jackets to
calm them down so they were more manageable. Well, they found that you
could actually get people to behave
in ways that were desirable by linking that
to tokens. So you want people to get up in the morning. You want them to make their bed,
and attend to their hygiene, and come out to the to the
cafeteria and eat and then go to the group room and then show up at their
therapy appointment on time, et cetera, et cetera, et cetera, et cetera.
So the ward determines what the rules are, and when people just do what they want
them to do,
they give them tokens which then can be exchanged with things that
patients wanted, like cigarettes or sodas
or privileges, going off a locked ward for maybe a little bit longer.
Little bit longer television time, whatever the case may be. The
person who is getting the tokens decided how they spent them,
and if they engaged in behavior that was counterproductive to what the ward wanted,
they would debit them. They would take away their tokens so they would lose the
opportunity
to exchange things, these tokens, for what they wanted, and what they found was
ward behavior improved dramatically without
chemicals, without straight jackets.
Just tying specific behaviors
to specific outcomes increased desirable behaviors
and decreased undesirable behaviors. Now you may say, well, I don't
plan to work in a mental institution like that but
this works for life. If you might
teach children. In
lower education, higher education, tokens work
right, not for every kid. You can't just give every kid a gold star.
Kids that don't care about gold stars won't be affected by that,
but if you say X number of gold stars equals you get to pick this, this, this, or
this,
and they like any of those things, well then they will work
to accumulate stars. People say, well that's just manipulating people.
Well hell yes it is. We do it all the time. All of us do.
Doesn't your boss manipulate you into coming into work and doing all that work
that you've got to due
so you can get some tokens at the end of the week, so that you can go get the things
you want like go to the movies
or pay the rent or eat some food?
So your just basically applying economics at the behavioral level
to any situation and you want to do it carefully and
with beneficence in mind, not to penalize people but to help them
to achieve things they might not otherwise achieve. Work situations aren't always benevolent.
But sometimes we endure them
because we can't imagine being cut off from our tokens,
because we'd go homeless if we didn't get them, so we take a lot of shit
in some jobs so we get our tokens. Don't want to interrupt the supply. We need them.
Different kinds, that's all we're talking about. Using virtual tokens
or star systems or whatever you want to do.
Aversive conditioning we've talked about a little bit.
It's what happens with conditioned taste aversion for example. When somebody
drinks way too much and starts vomiting,
the next time they smell that liquor or whatever it was that made them sick,
right, they go unh-unh. Have that little involuntary
aversive reaction and they don't want it. What if they got food poisoning?
Next time they smell that food or see that food, they go ehhh, I don't really want that.
So they become averse to it. They don't want it anymore.
Well, that very principle could be applied to help people
get over certain kinds of behaviors or fantasy desires
as it were. So you look at classical conditioning here
as a treatment where you want to pair repeatedly
whatever the undesired behavior is with a really aversive stimulus
to decrease the behavior's reward value
and increase its punishment. Thinking about it brings bad things,
you lose good things, so you're less likely to do those things.
Done correctly, punishment works.
We gave some rules for punishment before about how you want to use a lowest
desirable, lowest effective level possible
while also reinforcing desirable behaviors, also giving people clear rules
and boundaries
about when and how punishments would be enforced, et cetera, et cetera.
Those are all still standing but in these cases we have people with specialized
issues
coming in for help and Clockwork Orange is a dated movie and I used to say, you know,
you'd need to be careful because
it can be offensive, there's rape and murder in it,
they're integral to what the plot of the movie is,
however by today's standards, it's kind of passe.
Today's slasher movies and things like that make
make this look really kind of soft in comparison.
The key here is what they try to do is take behaviors into its logical
extreme.
It's a parody of behaviorism. It's looking at a guy who is a criminal.
Been a criminal since he was young and now he's committed a horrible crime
and they think they can make it such that if he even thinks about committing
a crime
he'll start retching and vomiting and he won't do it anymore and so
it's a fictionalized account of what this might do. But in reality,
you can have this stuff work. For example,
a drug called antabuse is used for people who want to quit drinking alcohol.
Now, I just saw on one of those morning shows this morning,
I think it was in Norway, somewhere in Europe,
where they're having people who are alcoholics clean up the streets,
clean up litter to get beers. And people are like, well that's ridiculous, giving them beers. Well,
they would be drinking all day theoretically if they could get the money but by
doing this they actually engage
in a proactive activity all day while they are then
monitored how much their alcohol intake is
and it helps them get off the street. It helps them get fed and you know what
happens
when you don't do this? These people are homeless any way.
They were homeless and drinking and that's how bad
alcohol got to them. Alcohol and other drugs can destroy people's lives
utterly! So, if you've got that kind of a risk,
taking some other risks to try to make that better might make some sense.
So aversive conditioning in this case, antabuse is a drug that if you take it
and you drink within the period of effectiveness of the dosage,
you will be violently ill. You will get nasty sick.
You will be retching and nauseous and vomiting.
So most people actually use it as a preventative,
meaning they know that they're taking it. And you've got to be careful because
other kinds of alcohol exist in your environment that you may not think about as
drinking like
in mouthwash, for instance, or hairspray. Transdermal
alcohol going through the skin could also cause you to retch. So people who take it have
to be very careful not to expose themselves to any kinds of
alcohol. But if you took it, it would be a pretty good disincentive
to drink because you know that there's nothing you could drink that wouldn't make
you wretch. If you were using it though
in strict classical conditioning aversive treatment paradigm,
what you would want to do though is actually drink.
You would want to drink. If your thing is brown liquor, that's what you drink,
then taking this and drinking brown liquor will make you nasty sick
such that the next time you smell it you probably won't want it, and then which case you better
do what?
Move to another kind of alcohol-based drink, right,
and another kind cause, you know from classical conditioning, it's not the
brown liquid that made you sick, it was the alcohol in the liquid
and it's dissimilar enough from say a wine cooler or wine or beer
that you won't have that retching effect and you could still consume alcohol in all those other
forms.
But if you've progressed through all of the types of alcohol, you can make it so you really,
really didn't want to drink. I used aversive conditioning
to quit smoking cigars. I quit smoking cigarettes a long time ago but there was a period
when I moved up here,
I brought my family here and I still lived in Memphis
and with nobody around, I like a good cigar every now and then and I'd smoke a cigar,
drive around in my car, listen to Ozzie Osborne,
cause that's the only CD I had in my old car. And I'd smoke my cigar, and I'd smoke my cigar
the next night, just one a night, didn't seem like a big deal,
and then I moved up here and I didn't want to smoke cigars anymore. But what I felt was a
powerful urge to go buy more cigars.
And any time I listen to that Ozzie CD, guess what? I want
to smoke a cigar. That craving comes back.
That particular CD, most just any of them. Those particular
previously neutral stimuli now cause me to go through a minor withdrawal syndrome
that makes me crave having a cigar. But what I wanted was to not be addicted to
a new tobacco product and so what I did was I went and bought me one more cigar
and I huffed it (simulates huffing)
hand so I got nicotine poisoning and about threw up,
and then I didn't want cigars anymore because I did
engage in aversive conditioning and guess what?
It works. So if you can get yourself around
that that possibility, it works because
we already know it works. You don't need to know this for your test but
before aversive conditioning, you got your nausea inducing drug, it'll cause nausea.
Now you got your previously neutral stimulus which was alcohol which caused pleasurable
effects,
plus your nausea inducing drug and you get the
unconditioned response of nausea from that nausea inducing drug.
Afterwards, drinking alcohol causes nausea such that you are less likely to want to
drink
alcohol.