Tuesday, September 21, 2010

Part 3 : The History of Exposure Therapy: Hans Eysenck and Learned Behavior

Learned Behaviour


Hans Eysenck was yet another British psychologist who explored behavior therapy beginning in the 1950's, and who wrote a damning article in 1952 about the ineffectiveness of psychotherapy. As Freud envisioned it, a psychotherapist could take the process of psychotherapy and deduce the facts from it, rather than studying what the facts actually were. I am staggered by the traces of this that still affect the practice of therapy in the 21st century. I have vague memories of reading about behavior therapy in social studies class, and the fear that people would be reduced to laboratory rats conditioned to do tasks for food. But there is something immensely liberating in the idea that our symptoms are in part a "learned behavior" which is unadaptive, and which can be unlearned.

It's as if we are running our own little laboratory within our own mind every time we have an obsessive thought, feel intense anxiety, and then apply a compulsion that reduces the anxiety quickly, but then rebounds in the long term.

In 1960, his article, Personality and Behaviour Therapy(Proc R Soc Med. 1960 July; 53(7): 504–508), he explores the uses of BT in "neuroses," a term not as popular as it once was. He cites the study from 1920 about "little Albert," an 11 month old boy who was conditioned to fear rats because whenever he reached for the animal, the experimenter would make a loud noise. This of course is probably where my vague uneasiness comes from, since freaking out small children is not acceptable. These early studies may be the roots of the discomfort many current therapists have about Exposure and Response Therapy, but it is worth stepping back from the old history and consider the even older history of Freudian psychoanalysis which brought a whole tradition of showing patients ink blots, asking what they saw, and building elaborate theories of their personality based on a puddle of ink.

The point that really stuck with me was Eysenck's description of avoidance--if Albert could've been exposed to a white rat for a long period of time, without the loud noise, the fear could be undone, but as he ironically puts it, "Little Albert is a free agent," and is going to avoid even the chance of encountering a white rat, thereby never getting a chance to break free of the fear. If we are willing to risk feeling the initial fear liberty is possible. I know that it feels as if we face the fear every day, we do things we don't want to do, and yet the OCD persists.

This is a frustrating and painful place to be in. I make a phone call, and it actually goes ok, but by the next time I'm anxious again as if I'd never done it before. It's taken me a long time to comprehend that I've had much more practice avoiding phone calls than making them, and what we practice tends to get better. Slogging through the anxiousness of the initial surge of fear without my compulsions sucks, but persistence in practicing strengthens the possibility of getting better.

5 comments:

  1. Another great post! Oh boy - have I ever been there.....that feeling of anxiety that you discuss when making phone calls...and yet AGAIN you feel anxious the next time! Of course that takes my OCD even deeper - "why am I still experiencing anxiety? Shouldn't my anxiety be going down with exposure? Maybe this is the wrong treatment for me" etc etc. It's true - we have to remind ourselves that this pattern of avoidance took a long time to become comfortably embedded into who we are. It will take a long time to practice "undoing" these habits.

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  2. Well said! I think it's interesting how different people experience fear in different ways and how one person might experience it differently depending on the situation causing the anxiety. It's always easy for me to see the possibility of habituation when the anxiety seems more like a biological reaction - when I can feel my heart beat faster, butterflies in my stomach, hands shaky. But more often than not, my OCD fears don't bring about that sort of visceral "anxiety" - instead it seems like it's all rumination, all in my head. I know that exposure should also work for this type of "anxiety," but sometimes it's hard to conceptualize how changing my behavior will change my opinion about the way something "has to" be done. I can see how repeated exposure can to a feared stimulus can reduce the biological responses of fear, but it is harder for me to understand how exposure will change the way I think. But I suppose it has and suppose it will continue to. I just feel like it's so much easier to confront my "regular" anxiety compared to my OCD ruminations.

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  3. Love your post - I don't believe I've seen your blog before but I appreciate your take on the different types of psychotherapy out there for OCD!

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  4. Thanks for the encouragement by commenting! Anon- I can relate to the checking to see if my anxiety has gone done after doing an exposure--obsessing about obsessing is one of my biggest challenges.

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