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FROM BEHAVIOR THEORY TO BEHAVIOR THERAPY: THE CONTRIBUTIONS OF BEHAVIORAL THEORIES AND RESEARCH TO

THE ADVANCEMENT OF BEHAVIOR THERAPY

GEORG H. EIFERT

West Virginia University

JOSEPH J. PLAUD

University of Mississippi School of Medicine

Summary - As we approach the latter years of the twentieth century, a century that witnessed the birth of the behavior therapy movement, it becomes increasingly important to understand the forces that shaped the development, advancement, and success of behavior therapy. This paper is an introduction to a series of articles analyzing how major behavioral theories and research have contributed to the advancement of behavior therapy. In view of the fact that many behavior therapists have lost touch with the relation between behavior theory and behavior therapy and the challenges of the “cognitive revolution”, we argue that the field would benefit conceptually and practically from integrating and utilizing the resources provided by recent advances in basic behavioral theory and research. The articles in this symposium attempt to build conceptual, methodological, and practical bridges to help behavior therapists recognize and utilize basic behavioral research and concepts.

The purpose of this paper is to introduce a series of articles that were presented at a symposium held at the 1992 conference of the Association for Advancement of Behavior Therapy (AABT). Each article describes how major behavioral theories and research have contributed to the advancement of behavior therapy and also includes suggestions as to how the somewhat disturbed relationship between behavior theory and behavior therapy might be restored and revitalized. Specifically, the arti- cles examine (a) recent advances in the experi- mental analysis of behavior that are of particu- lar relevance for behavior therapy, (b) paradig- matic behaviorism’s attempts to provide an integrative framework for understanding and treating abnormal behavior, and (c) an information-processing model of classical con- ditioning that shows how behavioral interven-

tions may alter the cognitive representation of emotionally relevant stimuli and responses.

The Link Between Behavior Theory and Behavior Therapy

Early behavior therapists did not question that experimentally based behavioral theories were the foundation of behavior therapy. The connection was succinctly expressed in the statement of aims and scope that appeared in the first issue of the first behavior therapy journal, Behaviour Research and Therapy, as follows:

In recent years there has been an ever-growing interest in applying modern learning theories to the improve- ment of learning efficacy The application of learning theory and the experimental method to clinical

Requests for reprints should be addressed to Georg H. Eifert. Department of Psychology. West Virginia University, Morgantown, WV 265066040, U.S.A.

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102 GEORG H. EIFERT and JOSEPH J. PLAUD

psychology also promises to carry this discipline beyond mere psychometry and close the gap between the laboratory and the clinic The main conception unifying all these different approaches has been the belief that behavioral disorders of the most divergent types are essentially learned responses, and that modern learning theory has much to teach us regarding the acquisition and extinction of such responses. This conception, cutting across many existing boundary lines which separate psychiatry, education. clinical psychol- ogy, remedial teaching, psychotherapy, social work and psychoanalysis, forms the basis for the appearance of this Journal.

In the ensuing years a number of factors have weakened the link between basic behavi- oral research and applied behavioral practice. It may have been somewhat naive to assume that merely applying these theories, without much development, to all sorts of clinical problems would automatically result in a com- prehensive range of powerful interventions. An increasing number of studies revealed some limitations of the early simple conditioning models (cf., Meichenbaum, 1977; Rachman, 1977) that were based largely on animal re- search. These models would have required systematic theory extensions to account for the emotion-eliciting, reinforcing, and behavior- directive functions of language and other sym- bolic stimuli, which are so characteristic of complex human behavior (Staats, 1972). Un- fortunately, the development of such theory extensions was neglected, and theoretical- conceptual advances, in general, lagged behind advances in the development and fine-tuning of behavioral treatments (Ross, 1985). Moreover, research studies in the field of experimental analysis of behavior focused on narrow, frequently idiosyncratic aspects of behavior. Again, many of these studies were conducted with infrahumans and, conse- quently, did not consider the important role of language in controlling maladaptive responses in humans. As a result, many behavior therap- ists began to perceive conditioning models as too mechanistic, inflexible, removed from clinical reality, and ultimately as irrelevant (Evans, Eifert, & Corrigan, 1990). Hence, a growing number of behavior therapists turned to cognitive explanations of behavior and

treatments, because such explanations appeared to be more flexible and, most impor- tantly, because cognitive explanations and techniques address areas of human experience, such as language, thought, and imagery, that were frequently given only token attention in early behavior theory and research. The rela- tive neglect of these areas of study is surprising in view of the fact that one of the earliest and most widely used behavioral interventions, systematic desensitization, incorporates imag- ery as an integral part of treatment (Wolpe, 1958).

As a result of these developments, and also because the field began to expand into many other areas and disciplines (e.g., behavioral medicine), behavior therapy came to mean different things to different people (Peterson, 1993). Yet it seems beyond question that the impressive success of behavior therapy and its subsequent expansion are attributable to the application of the experimental-empirical approach to understanding and treating abnor- mal behavior. Not all behavior therapists, however, recognized this link. For instance, as noted by Plaud & Vogeltanz (1993, this issue), behavioral scholars such as Isaac Marks have disputed that behavior therapy has grown from basic experimental psychology, arguing that behavior therapists do not read experimental journals (Marks, 1981). The history of the development of behavior therapy (e.g., Kaz- din, 1978) decisively contradicts Marks’ argu- ment. But the fact that he puts it forward is indicative of a more general problem: clini- cians frequently fail to recognize that their clinical practice is dependent on behavioral theory and research. In order to remedy this situation, researchers should constantly be aware of the ways in which their findings are relevant to and can shape the practice of behavior therapy.

The Challenge of the “Cognitive Revolution”

Over the past 15 years the field has been inundated with descriptions. analyses, and

From Behavior Theory to Behavior Therapy 103

evaluations of cognitive-behavioral concepts and technologies in specialist journals (e.g., Cognitive Therapy and Research), edited books (e.g., Kendall, 1991), and monographs (e.g., Beck & Emery, 1985). Yet, where in all these writings have the conceptual foundations of the various cognitive-behavioral theories and treatments been adequately defined and elabo- rated upon? And where is the evidence that the “cognitive revolution” has deposed the role of environmental influences and consequences in favor of hypothesized inner processes (Kras- ner, 1988)? We are concerned that the in- creased preoccupation with hypothesized inner processes will weaken the behavior therapy movement unless theories about private events are appropriately related to and integrated with basic behavioral concepts and research findings as, for instance, has been done in paradigmatic behavioral theory (Staats & Eifert, 1990) or contextual behavioral accounts of rule-governed behavior (Hayes & Hayes, 1992) - such integrative accounts might then actually strengthen the field!

A central thesis of the articles in this series is that cognitive-behavioral theorizing has obscured and/or misrepresented many of the advances made in basic research into behavior therapy. In other words, progress in the areas of the experimental analysis of behavior and paradigmatic behaviorism as well as new de- velopments in classical conditioning theories have been overlooked or not properly under- stood; in the place of such theories cognitive models have emerged as explanations of be- havior. For instance, Plaud & Vogeltanz (1991) pointed out major theoretical and methodological errors in the study of classical conditioning as a cognitive phenomenon. Moreover, Eifert (1990) has shown how the neglect of advances in understanding the verbal-symbolic control of emotional behavior has impeded the development and inclusion of verbal-symbolic techniques (derived from basic conditioning principles!) in comprehen- sive theory-based verbal-behavioral interven- tions.

We are eager to avoid any polemic and divisive arguments such as “since there is really nothing new about cognitive concepts and techniques, we should therefore not give them any special status or even discard them.” Wolpe (1990) rightly cautioned that cognitive- behavioral procedures are easily acceptable if it is realized that cognition is a category of behavior. In other words, just because the conceptual foundations of language and imagery-based interventions are currently still unsatisfactory does not necessarily make those interventions ineffective or mean that we should not engage in them. Likewise, it may be short-sighted to say that the principles under- lying cognitive-behavioral interventions can simply be adequately (re)formulated with ex- isting concepts from any of the behaviorisms in their current state of development. The huge integrative task ahead of us can only be accomplished if more attention and effort is devoted to relating concepts and research findings from different behavioral fields such as radical behaviorism, paradigmatic behavior- ism, and contextualism (Eifert & Evans, 1990; see also Plaud, 1993).

Reestablishing the Link Between Behavior Theory and Behavior Therapy

The general purpose of this series of articles is to analyze critically the contributions of the behaviorisms to the behavior therapy move- ment and to encourage the development of a more integrative and unified approach in be- havior therapy. In doing so, the articles focus on some of the more recent advances that clinicians and clinical researchers may be un- familiar with. Moreover, all three presenta- tions address recent attempts within behavioral conceptions to account for the types of learning processes that are more unique and central to human functioning (such as language, thought, and imagery). For instance, Plaud and Vogel- tanz discuss how a new behavior analytic approach to verbal (rule-governed) behavior

103 GEORG H. EIFERT and JOSEPII J. PLAUD

has led to a new behavioral treatment called Action und Commitmerlt Therupy (ACT, Hayes. 1987; Hayes & Hayes, 1902). The article by Eifert, Forsyth, and Schauss exam- ines the role of language and other symbolic stimuli in understanding and treating abnormal emotional behavior. These authors also exam- ine the potential for improving behavior ther- apy by drawing upon behavioral methods and research findings from Experimentul Cognitive Psychology. Finally, Zinbarg discusses new findings from studies examining an information-processing model of classical con- ditioning. The results of these studies suggest that the label “cognitive-behavioral” is redun- dant in that effective contemporary behavioral techniques are available to alter cognitive representations of emotionally relevant stimuli and responses.

Apart from the general significance of these conceptual developments and empirical data for behavior therapy, there is a very important and specific reason why these developments are presented in this series of articles. Therap- ists have been frustrated with radical behavior- ists’ failure to account for language and thought processes in terms that are clinically useful for them. A further source of frustration has been the radical behaviorist dictum that emotions are consequences, or at best epiphe- nomena, of behavior rather than stimuli that may control behavior (Skinner, lY74). This dictum contradicts the clinical day-to-day ex- perience of therapists and, indeed. other be- havioral research that has focused on assessing and changing maladaptive emotional responses (e.g., Eysenck, 1987; Levey Cyr Martin, lYX7; Wolpe, 19%). In any case, the reluctance by early radical behavioral researchers to deal with covert processes and private events in a manner understood by. and useful to, clini- cians has been one of the main reasons for the declining importance of ull basic experimental behavioral research in behavior therapy and why ever-increasing numbers of clinical be- havior therapists have turned their back on all basic behavioral research in favor of cognitive

concepts, explanations, and techniques. The present articles represent attempts to

remedy this situation by narrowing the enlarg- ing gap between basic behavioral research and behavior therapy. One of the major conclusions is that behavior therapists should not divorce themselves from ongoing research in basic and applied behavior analysis as well as other basic behavioral research. The question then is how behavior therapists - or clinical psychologists in general for that matter - can benefit from new developments in behavioral theories and research. We concur with Hayes (lY87) who suggested that the mutual coopera- tion model between experimental and clinical psychologists is a weak model of integration between the two disciplines. According to this model. the duty of clinical psychologists is to pass along research questions and hypotheses to experimental psychologists, who are respon- sible for testing the ideas proposed by clinical psychologists, and therefore both will share in the knowledge gained from this experimental and clinical connection. Hayes (lY87) outlines an alternative model. the mutual interest mod- ef, in which experimental psychologists and clinical psychologists can productively work together integrating experimental and clinical phenomena as long as they share a mutual interest in a specific area of psychology. As an example, Hayes discusses behavior analytic research that focuses on the role of verbal behavior in human functioning. These resear- chers want to know such things as “what happens when you talk to someone‘? and “can you talk to people in such a way that they become more or less sensitive to changes in the environment?” These questions are very simi- lar to those asked by clinical researchers in- terested in semantic therapies. It is quite possible that answers to these kinds of qucs- tions in either sub-disciplines will be of signifi- cant interest to researchers asking similar questions in the other sub-discipline. Based on this conception of a mutual interest model of basic science and clinical science integration. the present articles analyze the potential of

From Behavior Theory to Behavior Therapy 105

recent advances in behavioral theory and re- search for advancing behavior therapy and discuss how behavior therapy would be served by continued integration of clinical phenomena with basic and applied behavior research.

The behavioral movement has been one of the most successful in the history of psychologi- cal science, but our job is not finished - it has barely begun. Likewise, the behaviorisms have clearly made important contributions to the growing success of behavior therapy. We be- lieve that the field could be even more success- ful if it tapped the resources created by recent advances in basic behavioral theory and re- search. In order to utilize these resources, however, we need to build conceptual, metho- dological, and practical bridges that help behavior therapists recognize the utility and potential of these new developments. To make advances relevant for behavior therapy, new theoretical concepts and findings need to be related to existing knowledge and clinical practice. Advances in behavioral theories and research, as impressive as they may be, will have little impact on the field of basic behavior therapy unless they are made relevant and unless behavior therapists recognize them as relevant! The present articles are attempts to show that relevance for all behavior therapists. We also hope that the articles in this series, when taken as a whole, will allow behavior therapists to ponder and predict how past and recent developments will affect the future of behavior therapy as we enter into the twenty- first century.

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