The conceptual overlap between cognition and conditioning in clinical psychology

Conditioning and Cognitive-Behaviour Therapy

When behaviour therapy was developed in the 1950s and 1960s, it was based firmly on the experimental psychology of the time, principally learning theory. Since that time effective verbal therapies have been developed, and clinicians are faced with the difficult task of selecting among so-called behavioural and cognitive interventions based on radically different philosophies. This paper reviews developments in learning theory, particularly human learning, which suggest that conditioning is a complex cognitive process giving rise to verbally accessible expectancies and beliefs. Such a perspective provides a common theoretical framework (cf. Bandura, 1977) that allows behavioural and cognitive strategies to be coordinated to modify a particular cognitive target, such as biased expectancy of harm in anxiety. It is argued that the terms behavioural and cognitive carry unwanted connotations, and that it is preferable to specify independently the content of information to be conveyed in therapy (e.g., reduction in expectancy), and the mode by which it is conveyed — experience, observation, or language. Learning theory, in conjunction with other areas of experimental psychology, continues to provide a conceptual basis for the understanding of psychopathology and the development of new psychological interventions.

The wounded self: new approach to understanding and treating anxiety disorders

This article synthesizes the concept of "wounded self" in the understanding and psychological treatment of anxiety disorders. The focal point of this concept is the notion of self-wounds or early unresolved emotional injuries. According to this conceptualization, anxiety represents an unconscious fear of unbearable insult to the wounded self, which is protected by maladaptive conscious strategies such as avoidance, cognitive distortions, or emotional constriction. This perspective provides a theoretical basis for blending elements of psychodynamic, behavioral, cognitive, and experiential therapies in the psychological management of anxiety disorders. As cognitive hypnotherapy embodies all of these therapeutic elements, its application to anxiety disorders is described in this article. Various hypnotherapeutic techniques for symptomatic relief and for eliciting and healing the wounded self are discussed and exemplified by a case. This case illustrates that symptom-focused treatment is necessary, but not sufficient. A more durable treatment requires resolution of underlying conflicts that drive the anxiety.

Exposure versus cognitive restructuring in the treatment of panic disorder with agoraphobia

The aim of this study was to assess the rate of change on clinical, behavioral and cognitive variables during exposure therapy and cognitive restructuring in the treatment of panic disorder with agoraphobia. A total of 28 Ss who received a diagnosis of panic disorder with agoraphobia were randomly assigned to either of two treatment conditions: exposure therapy or cognitive restructuring. Treatment conditions were kept as distinct as possible from each other. Subjects were assessed on five occasions: pretreatment, after 5, 10, and 15 (posttreatment) sessions of treatment and at a 6-month follow-up. Analyses of outcome data revealed strong and significant time effects on all measures. However, no group x time interaction reached statistical significance, suggesting that both strategies operate at the same pace. Furthermore, power analyses suggest that any difference that might exist in the rate of improvement between exposure and cognitive restructuring in the treatment of panic disorder with agoraphobia is marginal.