Arnold A. Lazarus

Learning theory and the treatment of depression

Abstract Difficulties in defining and measuring “depression” operationally have led behavior therapists largely to ignore the subject. This paper describes several operational factors which lend themselves to more objective assessment and therapeutic maneuvers. Within this context, S-R analyses can presumably lead to effective and specific treatment procedures. Three treatment techniques are described, and one method (time projection with positive reinforcement) is described in considerable detail.

Behaviour rehearsal vs. Non-directive therapy vs. Advice in effecting behaviour change

Abstract An objective clinical appraisal of behaviour rehearsal (a systematic role-playing therapeutic procedure) is described. This approach was compared with two other techniques, direct advice and non-directive reflection-interpretation, in the management of specific interpersonal problems. Behaviour rehearsal was shown to be almost twice as effective as direct advice and the non-directive treatment procedure fared worst of all.

IN SUPPORT OF TECHNICAL ECLECTICISM

It is argued that psychotherapists who function as eclectic theorists must inevitably embrace divergent and contradictory notions. To remain theoretically consistent does not require the rejection of promising techniques culled from other theoretical orientations. Technical eclecticism can enrich the practitioners range of therapeutic effectiveness without violating his allegiance to a theoretical system which best satisfies his own subjective needs. The view upheld is that therapeutic competence depends upon an array of effective techniques rather than upon a mass of plausible theories.

On assertive behavior: A brief note

After spelling out four specific components of assertive behavior, it is emphasized that the bulk of the literature devotes undue attention to the negative aspects of anger and attacking behaviors, while ignoring the virtues of positive reinforcement in this context. The importance of training clients to emit loving and caring responses is underscored.

“Hypnosis” as a facilitator in behavior therapy

Abstract It is emphasized that people who enter therapy believing that hypnosis will facilitate their progress often possess a self-fulfilling prophecy that should be utilized in their treatment. Clients who requested hypnosis and received a standard relaxation sequence that substituted the word “hypnosis” for “relaxation” wherever possible, showed more subjective and objective improvements than those who received ordinary relaxation therapy. The main study contained 20 clients treated in a behavior therapy context. 6 additional clients who had not specifically requested either hypnosis or relaxation showed no differences when treated by either or both methods. The differences in outcome are attributed to “expectancy fulfillment.”

Why i am an eclectic (Not an integrationist)

Abstract Eclecticism is a complex set of structures and conceptions. Unsystematic eclecticism and integrationism are based mainly upon personal preference and subjective judgement, whereas systematic, prescriptive (technical) eclecticism is guided by the impact of patient qualities, clinical skills, and specific techniques. Fusionists arbitrarily blend what they consider helpful ingredients from two seemingly disparate orientations and end up in theoretical and clinical dead ends. Eventually, a unified theory is called for, together with a superordinate structure that will reconcile divergent points of view (integrationism). Nevertheless, our current pre-paradigmatic level ofunder-standing precludes such a synthesis at present. To pretend otherwise only breeds confusion worse confounded. Meanwhile, a problem-focused approach to therapy is recommended, one that eschews general labels and tries to reach consensus on the specification of goals, problems, strategies, and systematic measurements (technical ecl...

Multimodal behavioral treatment of depression

Multimodal behavior therapy emphasizes the need to pay specific and direct attention to the correction of deviant behaviors, unpleasant feelings, negative sensations, intrusive images, irrational beliefs, stressful relationships, and possible biochemical imbalance. In treating depressed persons, especially those in whom sicide is probable, it is imperative to enjoin the patient to recognize and utilize a variety of positive reinforcers. This often demands special therapeutic time and attention. Durbale results usually call for a new range of interpersonal skills, the elimination of selfdepreciation, time-projected images in which the client sees himself engaging in future rewarding activities, a “sensate focus” of enjoyable events, a repertoire of adaptive affective reactions such as self-assertive and uninhibited responses, and a behavioral pattern characterized by daily sampling of personally reinforcing activities.

A preliminary report on the use of directed muscular activity in counter-conditioning

Abstract This is a report of a specific technique intended primarily for those individuals who seem incapable of deriving benefit from relaxation or hypnotic procedures. In essence, this paper demonstrates how vigorous and well-timed muscular activity appears to be a suitable anxiety-inhibiting response in these cases.

Aversion therapy and sensory modalities: clinical impressions.

The most widely-used aversion techniques have been nausea-producing drugs, painful electric shocks, and unpleasant mental images. Over the past decade, the writer has had occasion to employ each of these procedures, usually with shortlived or unsatisfactory results. The best effects were obtained when compulsive cases (e.g., excessive handwashers), after reducing anxiety and resolving other intrapsychic conflicts, received intermittent electric shocks while engaging in their compulsive rituals. Electrical aversion therapy was far less successful with alcoholics, compulsive eaters, and cigarette smokers. In these cases, the use of unpleasant mental images (e.g., having people imagine anxiety-producing and/or nauseating scenes) was slightly more successful. Recently, it occurred to the writer to try and match the appropriate aversive stimulus to the particular sensory modality under treatment. Thus, it was hypothesized that tactile stimuli (e.g., electric shocks) would be less effective in reducing addiction to alcohol, cigarettes, food, etc., than unpleasant olfactory and gustatory stimuli. Two compulsive eaters who had each failed to reduce their over-indulgence with the aid of portable faradic shock units were given a particularly foul mixture of smelling salts and other chemicals and instructed to inhale the mixture deeply after each mouthful of forbidden food (e.g., cake, candy, ice cream, etc.) . The results were highly gratifying. On the other hand, a girl with trichotillomania (i.e., an uncontrollable impulse to pull out her hair) was unsuccessfully treated with the foul-smelling mixture but responded well to a portable faradic unit with which she could shock two fingers of her right hand. Similarly, at the writers instigation, a colleague compared white noise with faradic shock in reducing auditory hallucinations in three psychotic patients. He reported that the white noise was much more effective in each of these cases. (It should be noted that the writer never employs aversion therapy alone but feels that it may sometimes play an important role in a broad spectrum treatment regime.) The above-mentioned clinical findings suggest that the results of aversion therapy may be greatly enhanced by choosing aversive stimuli which match the modalities under treatment instead of relying on one procedure (e.g., electric shock or nausea-producing drugs) in all cases. It should be relatively simple to conduct controlled experiments to test these clinical observations. Some of these impressions are confirmed in the treatment of an obese patient by Kennedy and Foreyt ( 1968).

Between laboratory and clinic: Paving the two-way street

Banduras (1978) article “On paradigms and recycled ideologies” is criticized from several perspectives. In essence, Bandura argues that the dichotomy between laboratory treatments and clinical behavior therapy is not only false but also reflects grave ideological misconceptions. We analyze what we regard as several flaws in this argument. Banduras imputation of an implicit medical model to critics of “analogue” research seems to be ill-founded and of questionable relevance. We underscore how Bandura inadvertently argues for the very thesis that he attempts to refute—namely, that clinic patients and phobic subjects do differ in fundamental ways. In our view, when estimating the clinical significance of his research, Bandura tends to extrapolate beyond his data. Our chief objection to Banduras (1978) position is that it overlooks certain realities of clinical practice. By hypothesizing some essential differences between clinical fears and snake phobias, we hope to place laboratory research in its proper context and thus to facilitate productive dialogues between practitioners and experimenters.