Counterconditioning: Therapeutic Uses Of This Technique
Counterconditioning was one of the most significant techniques in the development of psychotherapy, especially due to its pioneering use in the treatment of phobic-type anxiety. Although Mary Cover Jones was the first to use counterconditioning With this objective, it was Joseph Wolpe who popularized it within the framework of systematic desensitization.
In this article we will describe The therapeutic uses of counterconditioning in phobias and addictions ; In relation to these we will talk respectively about systematic desensitization and aversive counterconditioning. To begin, we will briefly stop at the definition of this concept and its historical journey.
Counterconditioning is a psychological technique developed from behavioral orientation that consists of delete an unwanted response and replace it with another more appropriate through the use of pleasant stimuli. It is applied with some frequency to treat irrational fears in both humans and animals, as well as addictions.
In this procedure, the person is exposed to the stimulus that they want to countercondition, and that provokes an inappropriate response, while another stimulus of the opposite sign is also present. Thus, to make a phobic object less scary it could be associated with a relaxation response, such as Jacobson’s progressive muscle relaxation.
Similarly, in many cases of alcoholism, drugs such as disulfiram are prescribed, which when combined with this drink causes nausea, tachycardia and other unpleasant sensations. This makes alcohol less palatable, so that drinking behavior becomes counterconditioned when associated with these physiological alterations.
A similar concept is extinction, which is framed in the operant conditioning paradigm. The difference is that the procedure extinction consists of eliminating a response by withdrawing reinforcement that was previously contingent on its execution, and not on replacing said behavior with another, as happens in counterconditioning.
Historical development of this technique
In the year 1924 Mary Cover Jones first used counterconditioning in the treatment of phobia in the famous case of little Peter, a boy afraid of rabbits. This researcher was the first to demonstrate the effectiveness of the technique under reliable experimental conditions.
Cover Jones used a pleasant meal for Peter as a substitute stimulus. First, the child ate in the same room where there was a rabbit, although it was a significant distance away. Gradually he brought the animal closer to little Peter; In the end the child was able to pet him without showing any anxiety response.
Little Peter’s case was a key milestone in the emergence of behavioral therapy. Subsequently Joseph Wolpe, who developed the technique of systematic desensitization In the 1950s, using counterconditioning as a basis, Mary Cover Jones would be referred to as “the mother of behavior therapy.”
Role in systematic desensitization
Systematic desensitization is a technique that aims to reduce or eliminate anxiety and avoidance responses that occur in the presence of a phobic stimulus. It is based on the execution of behaviors incompatible with anxiety in order to replace it since, in Wolpe’s own words, it is not possible to be relaxed and nervous at the same time.
In particular, Wolpe used the progressive muscle relaxation technique developed by Edmund Jacobson as an incompatible response. However, this is not a necessary component, but could be replaced by another relaxation method, such as slow, deep breathing, or any response that is not compatible with anxiety.
Although Wolpe attributed the usefulness of systematic desensitization to counterconditioning of responses opposite to those of anxiety, later authors have questioned this hypothesis. Thus, it has been proposed that the basis of this technique may be habituation, extinction, expectation or operant reinforcement of approach responses.
In any case, systematic desensitization has lost popularity in recent decades due to the improvement of live exposure techniques, which have greater empirical support and are more efficient in treating irrational fears, being based fundamentally on the contributions of scientific research.
Aversive counterconditioning
The goal of aversive conditioning is that the subject begins to associate an unwanted behavior with an unpleasant stimulus so that it loses its value as a reinforcer. In the case of aversive counterconditioning, this is achieved by pairing the behavior that is intended to be eliminated with stimuli that provoke responses opposite to those of pleasure.
The most common application of this technique is framed in the context of aversion therapy for substance addiction such as alcohol, tobacco, cannabis or cocaine. The consumption of the drug in question is identified with the unwanted behavior, while the stimuli are usually other substances that react negatively to the first.
In the case of alcohol, as we have previously said, aversive therapies are used consisting of the consumption of drugs that, when interacting with alcohol in the body, cause unpleasant physiological responses, mainly related to the digestive system. The two most used medications in this regard are naltrexone and disulfiram.
It has also been used successfully aversive electrical stimulation therapy to treat consumption tobacco, marijuana and cocaine. On the other hand, compulsive habits such as onychophagia (nail biting) or trichotillomania (hair pulling) can also be eliminated with aversive counterconditioning, although there are more tolerable procedures.
