Unifying the field: Developing and integrative paradigm for behavior therapy

J. Brlrav. Thrr. & Exp. t’swhrar. Vol. 24. No. 2. pp 107-118. 1993 MXlC7Y 16/Y) $b.lX) + lI.(Hl Prmted m Great Bntain. Prrgamon Press Ltd

UNIFYING THE FIELD: DEVELOPING AN INTEGRATIVE PARADIGM FOR BEHAVIOR THERAPY

GEORG H. EIFERT, JOHN P. FORSYTH and SCOTT L. SCHAUSS

West Virginia University

Summary - The limitations of early conditioning models and treatments have led many behavior therapists to abandon conditioning principles and replace them with loosely defined cognitive theories and treatments. Systematic theory extensions to human behavior, using new concepts and processes derived from and built upon the basic principles, could have prevented the divisive debates over whether psychological dysfunctions are the result of conditioning or cognition and whether they should be treated with conditioning or cognitive techniques. Behavior therapy could also benefit from recent advances in experimental cognitive psychology that provide objective behavioral methods of studying dysfunctional processes. We suggest a unifying paradigm for explaining abnormal behavior that links and integrates different fields of study and processes that are frequently believed to be incompatible or antithetical such as biological vulnerability variables, learned behavioral repertoires, and that also links historical and current antecedents of the problem. An integrative paradigmatic behavioral approach may serve a unifying function in behavior therapy (a) by promoting an understanding of the dysfunctional processes involved in different disorders and (b) by helping clinicians conduct functional analyses that lead to theory-based, individualized, and effective treatments.

Much of mainstream behavior therapy has lost its link with basic research and behavior theory. Instead the field has adopted vague notions about the so-called “cognitive control” of emotions and behavior (Eifert & Evans, 1990). Many behavior therapists now identify themselves as cognitive-behavior therapists claiming that they do both behavior and cognitive therapy. This pseudo-integration has resulted in divisive debates and confusion within behavior therapy. We will attempt to answer why this shift from conditioning to cognitive theories has occurred and concur with Staats (1990) who suggested that we need a different type of behaviorist theory rather than a replacement of behaviorism with some type of cognitivism.

The Shift from Conditioning to Cognitive Theories: Perceived and Real Inadequacies of

Simple Conditioning Models

Early behavioral research and therapy focused primarily on clinical phenomena such as phobias and fetishes that seemed to fit the classical conditioning paradigm (Eysenck, 1960; Wolpe, 1958). Over time, objections to simple conditioning interpretations began to emerge with growing evidence that seemed to indicate that the principles could not account for new data derived from laboratory investiga- tions and clinical observations (Rachman, 1977). The most common objections raised were: (a) certain phobias are more common than others, (b) not all phobias begin with

Request for reprints should be addressed to Georg H. Eifert, Department of Psychology, West Virginia University. Morgantown, WV 26506-6040, U.S.A.

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108 GEORG H. EIFERT, JOHN P. FORSYTH and SCOTT L. SCHAUSS

one or several clearly determinable traumatic experiences, and (c) conditioned fear and avoidance behavior can be highly resistant to extinction and increase over time even if the CS-CR connection is not reinforced by the UCS (for a detailed discussion of these issues, see Eifert, 1990). The conclusion that learning principles could not account for these apparent ‘anomalies’ was in fact largely the result of an inappropriately narrow understanding and application of learning principles. As will be indicated, learning principles could have accounted for these anomalies if the principles derived from animal research had been syste- matically extended to incorporate the emotion- eliciting, reinforcing, and behavior-directive functions of language and other symbolic stimuli (Staats, 1972). Indeed, no account of human behavior will be complete unless higher-order conditioning involving language and other symbolic processes - what Pavlov called the regulation of human behavior through “the second signaling system” - is an integral part of the behavior theory. In any case, several researchers (e.g., Rachman, 1980) responded to these challenges by extend- ing and modifying the basic classical conditioning position, but the more popular response, particularly in the applied arena, was to abandon conditioning concepts and behavior theory altogether (e.g., Bandura, 1978; Meichen- baum, 1977). Instead, cognitive explanations were proposed and given precedence over treatments that were originally derived from conditioning principles. Cognitive interventions were designed to target and replace maladaptive cognitions that were believed to cause emotional dysfunctions.

The other paradigm that dominated early behavior therapy, particularly in the U.S.A., was operant conditioning. Terms such as operant and reinforcement have had enormous conceptual power within behavior therapy. Adaptive and maladaptive behavior were seen as analogous, because all behavior was viewed as a function of environmental controlling variables. This notion spawned the design of

successful treatment interventions for behaviors that were previously believed imper- vious to change such as autistic and self- injurious behavior (e.g., Lovaas & Simmons, 1969). Early operant behavior modification also focused on phenomena that revealed the ubiquity of reinforcement principles. How- ever, much of basic operant research focused on infrahuman behavior and did not include the study of verbal-symbolic processes. Historically, this neglect made clinical interpretation and application of these research findings to complex human behavior difficult. Moreover, clinicians viewed operant principles as overly simplistic and mechanistic when applied to maladaptive human behavior which is so strongly influenced by verbal and other symbolic processes. Similarly, much of the classical conditioning literature continued to emphasize simple stimulus-response (S-R) notions and had not advanced to its current more sophisticated formulations (Levey Sr Martin, 1987).

Most importantly, clinicians were frustrated with radical behaviorists’ failure to account for language and thought processes in terms useful for clinicians. The situation was aggravated by the radical behaviorist dictum that emotions are consequences, or at best epiphenomena, of behavior rather than stimuli that may control behavior (Skinner, 1974). This position neither fits psychobiological research nor clinical real- ity. As a consequence. many clinicians ignored operant theories and viewed them as irrelevant for their clinical practice. Whereas numerous articulate attacks were launched against classical conditioning theories of clinical phenomena (e.g., Bandura, 1978), no similar challenges were rendered against operant conditioning. Rather, it was ignored and treated as though it has no useful application. In fact, those who abandoned classical conditioning simply dismissed operant principles at the same time (Evans, Eifert. & Corrigan, 1990).

In sum, neither classical nor operant conditioning were sufficiently developed and advanced at the critical time in the late 1970s

Integrative Behavior Therapy 109

when cognitive theories and treatments gained momentum in the behavior therapy field. Incidentally, in contrast to claims by cognitive theorists (e.g., Beck, 1976), we do not regard this momentum as a “paradigm shift.” The behavioral sciences have never had a paradigm (a universally accepted set of postulates) in the first place, although the hard-data methodology of behaviorism gives it the potential of becoming a paradigm (cf. Staats, 1983; Wolpe, 198.5). Obviously, where there is no paradigm there can be no paradigm shift. Moreover, in contrast to real paradigm shifts in other sciences, where accuracy and achievements of earlier theories are maintained and further developed in the new theory, cognitive theories largely dismissed behavioral concepts and simply replaced them with their own mentalistic terms.

Developing a Different Kind of Behaviorism. The Need for Bridging Theories to Link Fields

of Study

Theory construction in psychology has tradi- tionally been guided by the establishment of basic principles within that particular level of study followed by conjectural generalization of these principles to more advanced levels (Staats, 1983). This approach has generated many problems and schisms. Notably, these basic principles have not been extended and sufficiently developed as they have been applied to successive levels (Staats & Eifert, 1990). For example, the two-factor theory of fear and avoidance learning, based on an animal model, has subsequently been inappropriately generalized to all human fear phenomena (Mowrer, 1960). On the other hand, some clinical psychologists (e.g., Beck, 1976) have argued that verbalsognitive processes determine the type and intensity of human emotional experiences. Yet these verbal-cognitive processes have neither been related to findings from animal learning or physiological psychology nor experimental cognitive psychology for that matter. For inst-

ance, Craske and Barlow (1991) recently noted

that cognitive therapy, as currently conceptual- ized, has little to do with the cognitive phenomena that are the subject of basic cognitive science or experimental cognitive research.

Experimental study has produced important advances in our knowledge of the fundamental principles of emotion, and clinical practice has provided knowledge relating to complex human emotional behavior. When these areas are considered in isolation, our understanding is incomplete. Worse yet, when knowledge gleaned from one area is inappropriately generalized to another, misleading conceptions result. These problems highlight the need for a methodology of theory construction that relates different levels of study and psychological principles in a systematic way. In order to accomplish this, we need to develop empiric- ally derived bridging theories between different fields of study that often constitute a hierarchy of levels. Bridging theory considers knowledge from one field in a form that allows it to be related to knowledge at the next level. Principles derived from different fields also require further theory development to be suitable for use in a unified theory. Typically, this kind of theory development has not occurred. In other words, we need a common framework by which different levels of functioning and areas of knowledge relevant to behavior therapy can be productively linked and integrated. Staats and Eifert (1990) have provided such a framework for emotion - an area of central importance for behavior therapists - specifying the link between basic emotional learning, such as the direct classical conditioning of phobic fear, and other uniquely human mechanisms of learning via language and imagery.

Two-factor Theory of Fear Acquisition and Maintenance: An Example of Neglecting to Build Theory Bridges Between Fields of Study

The debate over the two-factor theory of fear and avoidance (Mowrer, 1960) illustrates

110 GEORG H. EIFERT, JOHN P. FORSYTH and SCOIT L. SCHAUSS

how inappropriate generalizations from basic infrahuman research to human clinical problems produced inconsistent findings and confusion. This influential theory states that fear results from a traumatic experience with an aversive stimulus; that is, fear is a classically conditioned response that is subsequently maintained by negative reinforcement of escape and avoidance. Behavior therapists soon discovered that not all human fears are acquired and maintained in this way (cf. Rach- man, 1977). Most importantly, fears can be acquired and maintained without direct contact with the fear stimulus [without direct exposure to an overt unconditioned stimulus (UCS)]. Rather than discarding conditioning principles because of these “inconsistencies”, paradigmatic behaviorism has extended conditioning theory to the human level by using new concepts and processes derived from, and built upon, basic conditioning principles (Staats & Eifert, 1990).

The Symbolic Function of Language and Emotional Responses

The availability and pervasiveness of language represents one of the most significant differences between animal and human learning. Language serves important symbolic functions by providing humans with emotional experiences without exposure to the actual physical stimuli or events that ordinarily elicit those responses. In order to extend principles from infrahuman learning to human behavior, we must include the study of language and semantic conditioning (Eifert, 1987; Staats, 1975) as well as stimulus equivalence (Sidman, 1986). Through classical conditioning and the learning of equivalence relations, words ac- quire emotional meaning and can come to elicit emotional responses, serve as reinforcers, and direct overt behavior. In addition, words can transfer their emotion-eliciting power to other words and to other nonverbal stimuli through higher-order classical conditioning (Staats &

Eifert, 1990) and through newly established equivalence relations not explicitly trained (Sidman, 1986).

Thus an emotional response, such as fear, can be acquired directly through aversive classical conditioning and indirectly through language-symbolic experiences and vicarious conditioning. Neither humans nor other pri- mates, such as rhesus monkeys, need experience a traumatic event to develop a phobia (Cook & Mineka, 1991; Eifert, 1987, 1990). New emotional learning can occur entirely on a verbal-symbolic basis (e.g., reading maga- zines, conversations, television, movies) and through self-talk. This may help explain the paradox of why people with no history of overt aversive conditioning may develop a phobia and maintain an anxiety disorder. Without direct reconditioning experiences patients may privately condition themselves by providing their own idiosyncratic verbal-symbolic stimuli that elicit negative responses. These theory extensions have led to new concepts and treatment strategies for anxiety that arc aimed at changing the language repertoires of phobic persons (cf. Hekmat, 1990). Such theory extensions could have also spared us some of the unproductive debates over whether phobias are learned via conditioning or some cognitive processes. As early as 1972, in an article entitled Language Behavior Therapy Staats outlined the conceptual and practical foundation for verbal cognitive and imagery- based interventions that were based upon, and derived from, both basic conditioning and human language principles. Had the field carefully considered this article rather than ignoring it, cognitive therapy would have been a revolution without a cause!

Information-Processing and Cognitive Science: The Challenge of a New Field of Study

One could argue that language conditioning


is primarily S-R conditioning. Although it extends principles from animal analogs, it is still viewed as simplistic and mechanistic by those interested in cognitive theories and information-processing research and concepts. Unlike the development of early behavior therapy techniques, which were derived from the findings of basic learning and other experimental studies, the shift in the late seventies from conditioning to cognitive theories was not inspired by developments in basic experimental cognitive psychology. Research in this area originally focused on the study of perception, attention, and memory using largely nonsense syllables and other socially and clinically irrelevant stimuli. It is therefore not surprising that even cognitive psychologists (e.g., Neisser, 1976) criticized cognitive psychology as an uninteresting specialized field with a bewilder- ing array of experimental paradigms, lacking in ecological validity, where subjects were asked to perform meaningless tasks. Similarly, Eysenck (1972) rejected the investigation of cognitive phenomena, claiming that this would lead to a reduction in scientific rigor. Like other behaviorists, he argued that cognitive events could not be studied objectively. More recently, however, methods and concepts from basic cognitive psychology research have been used to study clinically relevant processes such as recall biases (e.g., mood-state dependent retention and recall), selectivity of attention, self-focused attention, and perceptual idiosyn- crasies (Craske & Barlow, 1991; MacLeod & Mathews, 1991). Moreover, several prominent conditioning theorists (Levey & Martin, 1987; Mackintosh, 1983; Rescorla, 1988) have pointed out that conditioning and information- processing theories may not be as incompatible as has been claimed in the past (Eysenck, 1972). The challenge then is to develop theoretical and methodological bridges between behavior therapy and basic cognitive psychology so that both may benefit from methodological and epistemological advances that have been made in the two fields of study.

Methodological Bridge: Experimental Cognitive Psychology Uses Behavioral Measures to Study Dysfunctional Processes

Experimental cognitive psychology has provided a research methodology to investigate important clinical phenomena in an objective and scientifically rigorous fashion by using methods established long ago in the study of basic cognitive processes. For example, important differences between anxious and depressed persons have been demonstrated in the encoding and retrieval of information (see MacLeod & Mathews, 1991, for a summary of studies and findings). Whereas depressed subjects show an increased likelihood to attend to and recall negative rather than positive information and life events, there is little evidence for such mood-congruent retrieval in anxious subjects. On the other hand, persons with anxiety disorders show an increased sensitivity and ability to detect fear-relevant stimuli. As an example, several lines of research have demonstrated selectivity of attention for threat-related material in anxious patients compared to nonpatients; for instance, persons with panic disorder have been found to develop a perceptual hypervigilance to changes in bodily functioning as a result of repeatedly experiencing panic attacks (Craske & Barlow, 1991).

Apart from providing important insights into robust clinical phenomena, the fact that differences between clinical groups and normal persons disappear following successful treatment suggests that the research methodology and the measures used to pinpoint these differences can be used as objective behavioral measures of treatment outcome. Behaviorism developed in response to the inadequacies of introspection as an acceptable investigation procedure. Consequently, the direct observation of behavior (e.g., behavior samples and tests) were central outcome measures of early research in behavior therapy. As the field “matured” over time, a shift occurred toward a

112 GEORG H. EIFERT. JOHN P. FORSYTH and SCOTT L. SC‘FIAUSS

reliance upon nomothetic methods and self- report instruments as major outcome measures. In constrast, the majority of experimental cognitive studies have retained basic cognitive science research methods and con- tinue to use more objective, quantifiable, and observable measures such as reaction time, response latencies, and recall scores as their main source of data. These behavioral measures are useful for studying dysfunctional cognitive processes and for evaluating treatment outcome. For example, phobic persons no longer show an enhanced ability to detect fear-relevant stimuli following successful treatment (Watts, McKenna, Sharrock, 81 Trezise, 1986). It is almost ironic that experimental cognitive psychologists have provided behavior therapists with new methods to assess behavior

(e.g., Stroop-type color word tasks). Although the potential of cognitive psychol-

ogy methods for improving and widening the scope of behavioral assessment has been demonstrated, Craske and Barlow (1991) correctly point out that treatment-related research on basic cognitive processes using observable outcome measures is only just beginning in earnest. Therefore. it remains to be seen to what extent this research will improve clinical outcomes. One area of research that has already produced some treatment-relevant findings examined attentional focus and the role of distraction during exposure to feared stimuli. Foa and Kozak ( 1986) found with obsessive-compulsive patients that distraction during exposure to feared stimuli produced immediate reduction in levels of anxiety, but impeded long-term and between-session anxiety reduction. Similarly, a study by Craske, Street, and Barlow (1989) found that agoraphobic subjects who had been instructed to engage in distraction from intero- ceptive cues during in vivo exposure showed less improvement than subjects who had been instructed to focus on internal cues during exposures. Studies have also shown that distraction as a coping technique (McCaul & Haugtuedt, 1982) and attentional focus on the

emotional quality of the anxiety or pain experience (Suls & Fletcher, 19S5) appears to impede outcome compared to having patients focus their attention on the fear stimulus itself or on the “mechanical aspects of responding” (what the patients are actually doing).

In sum, research methods and findings from experimental cognitive psychology studies have the potential of providing behavior therapists with new methods for improving assessment and possibly treatment. To realize this potential, however, we also need to build conceptual bridges to link the two fields of study!

Conceptual Bridge Between Information- Processing and Conditioning: Difficult, But

Not Impossible!

Both basic cognitive and behavioral researchers rely on empirical science methodology. Therefore, it is not the methodology or scientific rigor per se that distinguishes one field of study from the other. The point of contention is the interpretation of the data. For example, cognitive researchers invoke a variety of internal hypothetical constructs (e.g., networks. nodes, and schemata) borrowed from information and computer sciences to explain their data. These constructs are troubling for the behaviorist, because they are circular and result in the reification of these hypothetical constructs. Moreover, it is the internalization of the environment - espoused by cognitivists and constructivists (e.g., Mahoney, 19X4) arguing that the human organism responds primarily to a cognitive representation of its environments rather than elements in the environments - that many behaviorists find objectionable (Zuriff, 19X5).

We believe that a functional analysis of “cognitive structures” may provide the necessary conceptual bridge to integrate the two fields of study. For instance, the observation that panic patients are hypervigilant to changes in bodily functioning does not explain the


development of this attentional bias. We need to ask questions such as: what are the contingencies that have shaped vigilance to bodily changes, and, indeed, does this selection by consequences play a role in developing hypervigilance to heart rate and other bodily changes? Does hypervigilance operate differ- entially in varying contexts? Answers to these questions may emerge if we employ knowledge from contemporary conditioning theory which recognizes the complexities and subtleties that transcend any simple classical conditioning or reinforcement mechanism. For instance, we need to examine how the principles of semantic conditioning produce differences in private events, and how such differences are related to changes in verbal-emotional repertoires and in the functional contingencies of rule-governed behavior (Hayes & Hayes, 1992).

Making Advances in Basic Research Relevant for Behavior Therapy

Such linking of new and relevant findings and theories across different fields of study has not really been attempted in behavior therapy. For instance, recent advances in the field of the experimental analysis of behavior have not been applied to improving behavior therapy (see Plaud & Vogeltanz, 1993). It has become increasingly clear to us that advancements in basic behavioral or cognitive research, as im- pressive as they may be, will have little impact on the field of behavior therapy unless they are made relevant and unless behavior therapists recognize them as relevant! In other words, advancements must be related to existing knowledge and incorporated into a unified conceptual framework that is clinically useful for both explaining and guiding the treatment of maladaptive behavior. In order to accomplish this task, we need a set of bridging principles, a guiding theoretical framework, and a methodology that fosters such integrative efforts.

Paradigmatic Behaviorism: A Unifying Framework for Behavior Therapy?

Generally, psychology and behavior therapy are fraught with disunity and divisive debates. These problems exist because of a lack of bridging theories between areas of study - areas that are considered incompatible or antithetical. We need two different, but related, types of theory-building and research to overcome some of the current divisions in behavior therapy. First, it is necessary to develop comprehensive integrative models of psychological disorders to guide the clinician toward more effective functional analyses and treatment planning. Second, treatment outcome studies should evaluate the efficacy of matching interventions to a particular client’s set of dysfunctional behaviors identified with the help of the model.

A Paradigmatic Behavioral Framework of Abnormal Behavior

Theories of abnormal behavior are often unnecessarily divisive by viewing factors such as chronic hyperarousal, conditioning, language and cognition, self control, and coping skills as independent or even in opposition to each other. They frequently focus on one set of variables and exclude others rather than attempting to develop more integrative models which would enable behavior therapists to delineate the most appropriate individualized treatment program. As already indicated for the acquisition and maintenance of phobic fear (Eifert, 1990), paradigmatic be- haviorisms’s multilevel theory (Staats & Eifert, 1990) provides a bridge between basic levels and principles of behavior (the physiological and conditioning bases of behavior) and the more advanced and specifically human levels of functioning (e.g., learning through language, thinking, and other symbolic processes). This human learning level of theory does not compete with basic conditioning principles. Rather, it integrates and builds upon them. In

114 GEORG H. EIFERT. JOHN P. FORSYTH and SCOTT L. S<‘HAUSS

addition to bridging theories between fields of study, paradigmatic behaviorism provides a conceptual structure, a framework theory, that allows us to link and relate in a systematic way several seemingly disparate factors and processes that produce abnormal behavior (see Staats, 1989, 1993).

Biological vulnerability variables. With few exceptions (Eysenck, 1967), early behavior therapy disregarded the role of biological and genetic factors in the etiology and maintenance of psychological dysfunctions. Consequently, important findings from other related fields (e.g., biological psychiatry) were not considered. This situation has changed, however, and many current models include biological and physiological variables (e.g., Barlow, 1988). Paradigmatic behavioral models (e.g., Staats. 1989, 1993; Eifert, 1992) seek to investigate and specify which physiological/ biological variables interact with the environment and contribute to the etiology and maintenance of abnormal behavior.

Learning history. Levis (1988) correctly pointed out that the neglect of the historical antecedents in some behavioral accounts has contributed to the rejection of behavioral approaches by many clinicians. This is unfor- tunate, because behavior theory predicts that early traumatic conditioning experience, inappropriate modeling, and reinforcement of inappropriate behavior may lead to behavioral, cognitive, and emotional deficits. Paradigmatic behavioral theory has developed the principle of cumulative hierarchical learning to account for idiopathic behavioral deficits and excesses that accumulate over time, where one negative experience serves as the historical foundation for more negative learning.

Psychological vulnerability variables - basic behavioral repertoires (“persorzality”). Paradig- matic behaviorism also addresses the question of how biological factors and inappropriate early learning interact to result in patterns of

abnormal behavior over time. Cumulatively and hierarchically learned deficit and excess behaviors are organized in a number of inter- related basic behavioral repertoires (Staats, 1990, 1993). The study of such personality processes as intervening variables - frequently ignored by behavior therapists because of its mentalistic connotations - could help overcome one important schism between “traditio- nal” psychology and behaviorist theories (cf. Eysenck, 1987).

Current antecedents. Finally, we need to investigate how people’s current life situation contributes to their problem. What recent or current controlling variables serve to initiate and maintain the abnormal behavior? What are the current social and environmental contingencies maintaining behavioral deficits and excesses and how do they relate to the individual learning history‘?

From Paradigmatic Behavioral Models to Paradigmatic Behavior Therapy

Paradigmatic behaviorism provides the clinician with a paradigm, that is, an integrative organizing and guiding conceptual framework for the analysis and treatment of abnormal behavior. Paradigmatic behavior therapy is the design and application of individualized treatments that are based on integrative functional models of behavioral dysfunctions (Eifert et al., 1990; Eifert. 1992; Staats, 1990). By this account, paradigmatic behaviorism may serve a unifying function for behavior therapy.

Rather than investigating the unique and idiosyncratic interactions between stimulus conditions and other parameters which maintain a problem, nosological systems tend to focus on the phenomenology of a problem for purposes of global classification. Subtypes of a clinical problem such as anxiety are differenti-

ated inappropriately at the level of symptom manifestation (e.g., the presence or absence of heart palpitations or hypervcntilatory breath- ing). Consequently, such descriptive structural labeling omits logical conceptual relations be-


tween diagnosis and treatment (Phillips, 1978). In contrast, paradigmatic behavioral models specify unique relations and causal interactions between biological variables, personality variables (emotional, cognitive, and behavioral), and environmental conditions for different manifestations and forms of anxiety in a case- by-case level. Although paradigmatic behavioral models include some factors common to the various types of anxiety, the specific processes, involved, and the interaction of these processes in different types of anxiety and in the individual case, call for idiographic specification. For instance, Staats (1989) pre- sented a paradigmatic behavioral theory of the anxiety disorders. This theory was then elaborated upon and has resulted in specific paradigmatic behavioral formulations of phobic anxiety (Eifert, 1990), agoraphobia (Eifert et al., 1990)) and heart-focused hypochon- driacal anxiety or cardiophobia (Eifert, 1992).

In the case of agoraphobia, the theory relates and integrates the basic forms of direct aversive classical conditioning (e.g., getting nauseous in a crowded stuffy bus) with the uniquely human types of learning involving language-based inappropriate reasoning (“I’m going to hurl all over the person in front of me”, “I will lose control the next time I have a panic attack”) and imagery (e.g., imagining fainting in a supermarket and being stared at and ridiculed by customers). Direct aversive conditioning and language and imagery conditioning are integrated, rather than juxtaposed, when conceptualizing problem behaviors. Several mechanisms of learning are also logically incorporated and utilized in treatment. The paradigmatic behavioral framework has been particularly useful in providing a model for conceptualizing, assessing, and treating the problem of cardiophobia (Eifert, 1992). This heart-focused anxiety disorder consists of a complex interplay of hypochon- driacal, obsessive-compulsive, and panic features and therefore does not fall squarely into any DSM-III-R category. Consequently, despite its high prevalence, cardiophobia has

not received much attention in the literature, and the rare reports of treatments (e.g., Salkovskis & Warwick, 1986) tend to concen- trate on one aspect of the problem (e.g., cardiac illness beliefs) and not address other salient features (panic symptoms or hyper- ventilation). Again, the paradigmatic behavioral model should help focus therapist attention to several functionally related aspects of the problem.

A paradigmatic behavioral framework has also been developed for the assessment and treatment of depression (Staats & Heiby, 1985; Heiby & Staats, 1990). Depression occurs as a consequence of an interaction between the individual’s environmental situation (e.g., de- creased positive emotional stimulation and/or increased negative emotional stimulation) and the individual’s learned behavioral repertoires. The theory also stipulates how biological factors (e.g., biochemical imbalances) affect the etiology of depression and how these factors may combine with psychological deficits such as low self-esteem and inadequate self- reinforcement (Heiby & Staats, 1990). Based on numerous potential etiological factors, the theory and empirical evidence (Rose & Staats, 1988) specifies different manifestations and forms of depression that have been shown to respond to different clinical treatments (Heiby, 1986). This means that clinicians should include and target only those factors that have been identified in the functional analysis as contributing to that particular client’s problem. Even though not all attempts at treatment individualization may result in superior treatment outcome (e.g., Schulte, Ktinzel, Pepping, & Schulte-Bahrenberg, 1992), we still encou- rage clinicians to individualize the framework model for a given client (see also Wolpe, 1986, 1989). Finally, Heiby’s study demonstrates the relation between advances in the knowledge and treatment of psychopathology - a relation that is possible when psychopathology is analy- zed in terms of principles that specify the interaction of particular environmental influ- ences and historically determined person vari-

116 GEORG H. EIFERT, JOHN P. FORSYTH and SCOTT I<. SCHAUSS

ables (Staats & Eifert, 1990). Finally, assessment and treatment based on

paradigmatic behavioral accounts of emotional problems do not necessarily lead to better outcomes than would be expected to result from a functional analysis; one that carefully assesses and relates all relevant factors involved in a clinical problem. Such functional analyses should be the routine of every good behavior therapist; but the fact is that only a small fraction of behavior therapists conduct such analyses (Scotti, Evans, Meyer, & Wal- ker, 1991). One reason could be that clinicians lack comprehensive, convenient, and heuristic conceptual integrative frameworks to guide their assessments and organize their findings and clinical decision making. Paradigmatic behaviorism provides a convenient framework that incorporates and relates all major relevant aspects of a problem in a systematic fashion. As a result, therapists who employ such frameworks are unlikely to adopt an atheoretical eclectic approach that is characteristic of the majority of clinical pyschologists (Garfield & Kurtz, 1976) or fall prey to the exclusionary approach (rampant not just in behavior therapy) where therapists tend to focus on one set of variables (overt behavior or cognitive processes or physiological imbalances or early learning experiences) at the expense of exclud- ing others.

Conclusion

Paradigmatic behavioral models serve as guiding frameworks for both researchers and clinicians as a means to explain behavior in a multi-factorial fashion by integrating seemingly antithetical concepts and findings from different fields of study. In turn, such models improve the efficacy of behavioral treatments by providing the tools that enable us to tailor our working model to individual client problems. We have termed this approach to treatment paradigmatic behavior rherupy (Eifert et al. 1990), because interventions are based on

integrative models of psychological dysfunctions and matched to a client’s specific dysfunctional processes.

Behavior therapy is arguably the only treatment approach derived from the empirical science of psychology, that is, the uniqueness, rapid expansion, and proliferation of behavior therapy has been largely fueled by its recipro- cal relation to psychological principles and theories. Accordingly, the strength of a paradigmatic approach to behavior therapy rests on its conceptualization of client problems within an integrative framework. This framework relates and connects the principles and levels of human behavior in an organized fashion and thereby accords biological, conditioning, language-cognitive, and personality processes their proper place in the etiology and treatment of psychological dysfunctions. Such a paradigmatic approach may prevent further separatist divisions in behavior therapy.

Paradigmatic behavioral theory is a framework in need of more specification and empirical support. Findings from related fields of study such as experimental cognitive psychology and new developments in classical conditioning as well as experimental and applied behavior analysis will require that paradigmatic behaviorism elaborate, modify, and extend its current principles and concepts. In other words, the viability and acceptance of a paradigmatic behavioral approach as a unifying paradigm for behavior therapy will depend on the model’s ability to accommodate empirical findings and theoretical arguments by other researchers who work within related, but what they consider, different models. A type of paradigmatic behaviorism that builds bridges between classical conditioning, experimental and applied behavior analysis, and basic cognitive science may provide a conceptual foundation for relating such different fields and levels of analysis in a systematic way. The signifi- cance and practical utility of a paradigmatic behavioral approach to behavior therapy is that advances in the conceptual unification of the field are likely to lead to improved clinical


interventions. We are concerned that without such conceptual advances the field could disin- tegrate further and lose more of the strength that originated from its link to basic research.

Acknowledgemenfs - The first author is grateful to Ian Evans for his contributions to the development of some of the ideas expressed in this article over several years of discussion and collaboration.

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Unifying the field: Developing and integrative paradigm for behavior therapy