Chapter 1 - CBT Past and Present

Lesson 2: The History of CBT: Behaviour Therapy

• In 1920 John Watson published a report of a single case study which demonstrated how a
phobia could be conditioned in a 9 month old baby, ‘Little Albert’ (Watson & Rayner 1920).

• While Albert was playing with a white rat, Watson frightened him by positioning himself
behind the child and hitting a metal bar with a hammer. Albert had an understandable

fear response and he became afraid of white rats. This fear generalized to other furry

animals and even to a Santa Claus mask!

• This is an example of Pavlovian or classical conditioning.

• Classical conditioning usually involves taking an instinctual response (In Pavlov’s

experiments salivation and in Watson’s fear) which is evoked by an environmental stimulus

(Pavlov’s dogs – food; Little Albert – loud noise). The loud noise is the unconditional stimulus

(US) and fear is the unconditional response (UR).

• The white rat became the conditional stimulus (CS) which became associated with the noise

(US), making fear into a conditioned response (CR).

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• One of Watson’s students, Mary Cover Jones, published a paper in 1924 (Cover Jones 1924)
which described the desensitisation a child with a rabbit phobia. She achieved this by

associating the rabbit with food. This was the first case report of behaviour therapy, and

Mary Cover Jones has recently been reclaimed as the ‘Mother of Behaviour Therapy’.

• Despite this discovery of the potential therapeutic benefit of behaviour therapy, it was
another 30 years before it was applied formally in clinical practice. Joseph Wolpe

introduced Systematic Desensitisation to phobias (Wolpe 1958). He showed that by exposing

the phobic person to a feared object while they were in a state that was incompatible with

fear (a process he called reciprocal inhibition) it was possible to cure the phobia.

• In Systematic Desensitisation a patient imagines their feared object, e.g. a spider, while at
the same time practising relaxation. They create a hierarchy of the fear, beginning with

small spiders and moving up to fast-moving, large, hairy ones. Once they can imagine a

step on the hierarchy without anxiety they move up to the next step and so on until they

reach the image of their greatest fear. The person has then habituated to the feared

stimulus i.e. the spider.

• Research has shown that relaxation is not necessary for habituation to occur, and imagery
is less effective than direct exposure to the feared stimulus. Although systematic

desensitisation still practised it is time consuming and has been superseded by exposure

therapy.

• The principles of graded exposure are:

o The person is exposed to the feared stimulus until their fear reduces to a

manageable level. Then they move to the next level of the hierarchy.

o Improvement correlates with the amount of time exposed to the feared stimulus.

o In vivo exposure is more effective than exposure in imagination.

o The therapist does not have to be present. Practice without the therapist between

sessions is an important component of therapy.

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• Exposure therapy is highly effective for specific phobias and effective treatment for social

phobia and agoraphobia (Wolitzky-Taylor 2008). and obsessive compulsive disorder

(Ponniah et al 2013). There is still debate about whether cognitive behaviour therapy is

more effective than behaviour therapy alone.

• Exposure therapy is based on classical conditioning which describes how an organism

responds to its environment. Operant or Skinnerian conditioning is more concerned with

the way that the organism influences its environment to obtain rewards (Skinner 1938).

• Behaviour which elicits rewards (food, praise etc.) from the environment is more likely to
be repeated. Many of our bad habits, whether it is gambling, smoking or eating junk food

can be seen as examples of operant conditioning.

• In psychiatric practice problems such as addictions and conduct disorder in children can be

understood in operant conditioning terms. Therapy (known as behaviour modification; )

involves finding ways to break the link between stimulus, behaviour and reward by:

o Removing the trigger stimulus e.g. an alcoholic cuts off contact with heavy-drinking

friends.

o Encouraging alternative more healthy behaviours that generate rewards e.g. finding

alternative ways to self-soothe rather than self-medicate.

o Removing the rewards for the behaviour e.g. using antabuse to associate drinking

with unpleasant sensations.

• Isaac Marks is one of the pioneers of behaviour therapy (Marks 1988). I talked to him about

the early days of this therapy and its powerful effects.

• In Lesson 4 we will look at the next step in the growth of CBT: what some have termed the

cognitive revolution in psychology.

REFERENCES

 Cover Jones, M. (1924). A Laboratory Study of Fear: The Case of Peter Pedagogical
Seminary. 31: 308–315.
 Marks, I.M. (1988) Fears, phobias, and rituals: Panic, anxiety, and their disorders New York:
Oxford University Press.
 Skinner, B. F. (1938). The Behavior of organisms: An experimental analysis. New York:
Appleton-Century.
 Ponniah, K., Magiati I., & Hollon, S. D. (2013). An update on the efficacy of psychological

therapies in the treatment of obsessive-compulsive disorder in adults. Journal of Obsessive-

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 Compulsive and Related Disorders, 2(2), 207–218.
http://doi.org/10.1016/j.jocrd.2013.02.005.
 Watson, J.B.; Rayner, R. (1920) Conditioned emotional reactions. Journal of Experimental
Psychology. 3 (1): 1–14. doi:10.1037/h0069608.
 Wolitzky-Taylor et al (2008) Specific phobias – meta analysis of treatment with exposure
therapy Clinical Psychology Review, 28, 1021-1037.
 Wolpe, J. Psychotherapy by Reciprocal Inhibition. California: Stanford University Press,
1958.

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