Behaviour Therapy

Imagine walking into a pub, where you have booked a table for lunch. You see a cat curled up on the most comfortable chair in the room. How do you react?

Most people react in one of two ways. I like cats, so I would seek to make friends with it by stroking or petting it. The other common reaction would be to ignore it completely. However, a small proportion of people – my friend Rosemary is one of them – would be overwhelmed with anxiety. She would be unable to enter the room with the cat in it, much less have lunch there. Her reaction would be to leave the pub as soon as she saw the cat and send somebody in to request the landlord to remove it.

Phobias are not rational. Rosemary knows that the cat would never harm her. Even so, she cannot suppress the anxiety it evokes. Janet, a friend of my wife, has a phobia of birds. It can be triggered even by a bird motif in a stained glass window.

You probably know somebody with a phobia. But it is difficult to take their problem seriously until you see that your friend will miss lunch rather than eat when a cat is in the room, or hide their face from a stained glass window because it contains a picture of a peacock.

Behaviour therapists use discoveries from early experiments in psychology to explain and to treat phobias. In the 1920s James Watson, an American, hypothesized that humans acquire phobias by the same process that Pavlov had used to establish conditioned reflexes in dogs. The object of the phobia evokes fear because, by chance, it has been encountered at the same time as something really frightening. Just as Pavlov’s dogs came to salivate in response to the bell that had signalled food, Watson demonstrated that when he terrified a young child by making a loud noise as the child was stroking a white rat, the child soon came to fear small white furry objects of all kinds.

Avoiding the feared object helps maintain the phobia. Another psychological ‘law’, the law of effect states that behaviour that brings about pleasant consequences or avoids unpleasant ones is reinforced. So the more we avoid the object we dread, the more the avoidance is reinforced. B.F. Skinner is perhaps the most famous champion of reinforcement as a means of changing behaviour.

To treat a phobia the behaviour therapist tries to reverse these two processes. They start by making a detailed assessment of the client to try to establish as much as they can about the origin of the problem and the circumstances in which it arises.

Paul Rice, who practises in Colchester, takes four sessions to complete the assessment. This will include agreeing with the client on a goal for the therapy, and a programme to reach that goal. An appropriate goal for Rosemary might be to be able to sit calmly with a cat on her lap for 45 minutes. The programme would involve a graded series of exposures to cats such as thinking about cats, looking at pictures of cats and sitting in the same room as a cat. Each exposure would be combined with exercises to relax and to prevent anxiety.

Rosemary would do most of the exposure exercises herself, in between therapy sessions. During the sessions she would report on her progress and receive encouragement and praise – a powerful reinforcer for most of us – and training in breathing and relaxation exercises.

Behaviour therapy has been used successfully to treat phobias, social skills problems, sexual problems, obsessions and compulsive behaviour, according to Kevin Gournay of the Institute of Psychiatry in London. It is often combined with cognitive therapy, which concentrates on patterns of thinking rather than on behaviour. Gournay is sceptical about whether this offers any extra benefit. “Cognitive therapy is the new psychological religion” he says, “but behaviour therapy produces massive cognitive changes too. It may be that you can get similar effects with behaviour therapy, cognitive therapy, or even drugs” he says.

Although some psychologists doubt whether all phobias are acquired by reinforcement, there is good evidence that they can be successfully treated by behaviour therapy. Not every treatment results in a complete cure. After therapy Janet, who used to be terrified of all birds, especially chickens, can now look with equanimity at any bird up to the size of a sparrow. But she still cannot drink coffee from a mug with a picture of a hen on it!

Availability & contacts.

Behaviour therapy is available for some problems on the NHS, your GP may be able to refer you to a therapist. Treatment sessions are usually weekly and typically last 50 minutes. A typical course would be 12-15 sessions. Use an accredited therapist, and check that they are trained to treat your problem.