This is the 2007 version. Click here for the 2017 chapter 13 table of contents.

Extinction of CERs in Therapy

At the same time behavior therapists like Ayllon were criticizing of the medical model in therapy, other behavioral psychologists were showing that behavioral techniques could be effective as therapy. One of the most effective behavior therapies was called desensitization.

What sorts of events can set up CERs that require therapy?

Desensitization is based on the insight that many severe psychological problems, such as panic attacks, are essentially conditional emotional responses (CERs). CERs are emotional responses established through Pavlovian conditioning. The type of CER that comes to the attention of therapists is usually an unpleasant one, such as fear or anxiety. The stimulus is usually one that was associated with a trauma in the past. For example, talking about a certain subject may make a person anxious, or contemplating a ride in an airplane may cause unpleasant fears.

What did Eysenck mean by saying all neuroses were CERs?

As mentioned in Chapter 5, Hans Eysenck once declared that "All neuroses are essentially conditioned emotional responses" (Cunningham, 1984). He was making the point that mental disturbances commonly involve troublesome emotional reactions to specific situations, people, or other stimuli. Therefore, Eysenck said, "all treatment must be based on Pavlovian extinction." In other words, all treatment is aimed at making the inappropriate emotional response to particular stimuli go away.

Of course, Eysenck's statement is an oversimplification, like any statement about all treatment or all therapy. Therapy can have a problem-solving function, or an exploring function, neither of which has much to do with extinguishing CERs...unless the focus of problem-solving and exploring is an emotional hurt—a complex in Jung's use of the term. Then Eysenck might have a point. A person must get over having strong negative emotions in order to think rationally about important problems.

How can airplane phobias be treated, using an extinction process?

Pavlovian extinction is the process of eliminating a conditional response by re-educating neurons. This re-education involves undoing a previously established predictive relationship between a certain stimulus and an emotional response. For example, a person who is afraid of riding in airplanes will predictably feel anxiety at the thought of boarding a plane or flying somewhere. The stimulus of taking a flight (or thinking about taking a flight) leads to an unpleasant emotional response (fear and anxiety). To treat this, one must uncouple the two. This is done by presenting the stimulus in a situation where anxiety does not occur. Originally, in the Wolpe procedure (described on the next page) this was done by teaching clients how to relax then exposing them to the fear-causing stimulus. For example, a fully-relaxed client would be introduced gradually to mental images of taking off and riding in a plane. This works, but it takes a long time to do correctly.

Another, similar approach is to expose a person to the actual stimulus, let a panic attack happen if it does (nobody dies from it), and then wait for the anxiety to burn itself out and diminish over time. It will diminish when nothing bad happens and the person remains safe. This works, too, sometimes very rapidly. It is described on the next page as in vivo therapy.

Keep in mind that in this type of therapy, people are voluntarily exposed to their fears. They remain in full control, and the therapy is provided to them because they ask for it, by clinicians who are professionally trained and licensed, not by amateurs.The optimum time of exposure for extinction of a classically conditioned emotional response is at least 20 to 30 minutes, enough time for any initial panic reaction to burn out. This requires knowledge, commitment, and preparation on the part of both a therapist and a client.

So there are two approaches. Prevent the anxiety from occurring (with relaxation training, or drugs, or CO2 inhalation) or just let the anxiety occur and flare out, which takes 20 to 30 minutes. Either approach works. Either qualifies as Pavlovian extinction.

How can other therapies be interpreted as extinction procedures?

Many therapies involve exposing people to anxiety-causing events, either in imagination (by remembering traumatic events) or in actuality (by putting people in the feared situation). Either way, the patient is encouraged to learn that no ill consequences follow from confronting his or her fears. The important part of this learning is unconscious, but the conscious self observes the improvement in ability to handle emotional situations, and this is interpreted as successful therapy, which it is. Even cathartic therapy can be viewed as an extinction procedure, because the patient is exposed to traumatic memories while in a deeply relaxed state.

Similarly, nondirective therapy and REBT can be interpreted as methods for encouraging clients to confront the very thoughts and emotions that have previously caused emotional problems, and to do so calmly without "catastrophizing" or "awfulizing." If the therapy is successful, the stimuli lose their power to cause trouble. Paradoxical therapy does the same thing by instructing a client to "make anxiety happen." This encourages a self-controlled, safe exposure to anxiety-causing thoughts. A client is essentially told to generate the internal cues that produce anxiety. But nothing harmful occurs, so the relationship between the cues and anxiety is unlearned or extinguished.

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