Joseph Wolpe

The dichotomy between classical conditioned and cognitively learned anxiety

This paper describes how fears develop on the basis of one or other of two distinct processes--direct autonomic conditioning or the establishment of new cognitive associations to already existing fears. The dichotomy relates both to the appropriate fears of everyday life and to neurotic fears. In the case of the latter, the appropriate treatment procedure should be dictated by the fear basis that behavior analysis reveals. Failure to carry out such analysis is the reason for much confusion and inconclusiveness in therapeutic outcome studies. A retrospective survey of anxiety cases revealed that one-third of their fears were cognitively based and two-thirds due to autonomic conditioning. A study of a clinical population on the basis of a questionnaire designed to separate between cognitively based and conditioned fears has shown the expected bi-modal distribution. These findings undercut the conditioning versus cognition controversy on the causation of neurotic fears.

Inadequate behavior analysis: The achilles heel of outcome research in behavior therapy

Abstract In contrast to clinical practice, behavior analysis has figured but little in behavior therapy outcome research. Misconception-based fears have not been separated from those based on direct emotional (autonomic) conditioning, and in the latter category little attempt has been made to distinguish and separate cases with different antecedents of anxiety that might require different treatments. As a result, practically all outcome research comparisons have involved subject groupings of uncertain and non-uniform constitution, from which few valid deductions can be made.

Behavior therapy and its malcontents—II. Multimodal eclecticism, cognitive exclusivism and “exposure” empiricism

Abstract The term “malcontent” is applied to critics of behavior therapy whose criticisms are attributable to inadequacies in their understanding of it. Part I of this article discussed the malcontentedness of those who deny the bases of behavior therapy and of those who advocate a merger with psychoanalysis. Part II rebuts those who advocate the accretion of “multimodal” techniques, those who see behavior therapy as based entirely on cognitive change, and those who see it as an “exposure” technology. An important factor behind the positions taken by most malcontents is their dividing the human personality into a biological realm and a cognitive realm—Ryles “ghost in the machine”. Awareness of the unity of the organism is an essential requisite for the scientific study of the most complex levels of human behavior.

Individualization: the categorical imperative of behavior therapy practice

The fact that unadaptive neurotic anxiety response habits are learned makes it necessary for the stimulus antecedents to be accurately defined in every case in order to plan effective treatment. This requirement has been frequently neglected in recent years that have witnessed a growing tendency to apply common treatments to cases with common labels, e.g. agoraphobia. This paper argues for the desirability of accurate individual diagnosis, and illustrates its benefits in unique cases and also in respect of three common syndromes--agoraphobia, panic attacks and depression.

The experimental model and treatment of neurotic depression

Abstract Learned helplessness is at present widely accepted as a model for depression. Depression, however, is a symptom-complex that has many causes. Three general causal categories are distinguished—normal, neurotic and endogenous. Neurotic depressions comprise the main clinical category whose causation is primarily external. This paper shows that neurotic depression is evidently a function of conditioned anxiety response habits that finds a paradigm in experimental neuroses, not in learned helplessness. Both experimental and clinical neurotic depressions are overcome by deconditioning anxiety. In a sample of 25 cases treated by the deconditioning of anxiety, 22 recovered from their depressions; and the recoveries were found to have endured in the 19 of them who were followed up for at least 6 months.

Differentiation between classically conditioned and cognitively based neurotic fears: Two pilot studies

The ability of clinical trainees to learn to distinguish between classically conditioned and cognitively based neurotic fears was examined in two small-scale studies. The first study showed that they readily learned to make the distinction on the basis of transcripts of key excerpts of actual patient sessions, and that ability to do so increased with training. The second study showed a high degree of inter-rater reliability among assessor ratings of fear type on the basis of independent interviews of phobic patients.

Behavioral Formulation of Clinical Cases

The basic premise of this text is that maximally effective clinical intervention is dependent upon an accurate understanding of the factors that cause and maintain disordered behavior. Despite the presentation of this clinical position over two decades ago (Wolpe, 1958), professional obsession with treatment technology has predominated.

Self-efficacy theory and psychotherapeutic change: A square peg for a round hole

Abstract Bandura claims that treatments that succeed in eliminating neurotic fears do so not by directly weakening anxiety response habits but through the mediation of expectations of self-efficacy. Bandura came to this conclusion because of his success in treating phobic cases by methods involving modeling and, most particularly, participant modeling. However, he ignored the fact that emotional reconditioning processes were also going on during these treatments. It is argued here that the approach behavior of phobic subjects to feared objects is inhibited by their anticipation of aversive consequences in the form of the anxiety that the approaches entail, and therefore the elimination of anxiety responses is the primary therapeutic requirement. Banduras experiment purportiong to show that systematic desensitization succeeds through raising expectations of self-efficacy is shown to be unacceptable flawed. In general, the facts dispute the aptness of his theory to the therapeutic context to which he applies it.

Behavior therapy and its malcontents—I. Denial of its bases and psychodynamic fusionism

Abstract Historically, behavior therapy is the label applied to therapeutic practices based on experimentally established principles and paradigms of learning. Since the referent of the label is a synthetic construct, it is inappropriate to dispute its meaning as some are now doing. A good deal of criticism has been leveled against behavior therapy by people who are here called “malcontents” because their criticisms are attributable to inadequacies in their understanding of it. The malcontents are subdivided into five sometimes overlapping, groups: (1) those who deny the foundations of behavior therapy, (2) those who advocate some kind of merger with psychoanalysis, (3) those who advocate the accretion of “multimodal” techniques, (4) those who see behavior therapy as based entirely on cognitive change and (5) those who see it as an “exposure” technology. The untenability of the first of these positions is shown in Part I.

The effect of relaxation on the galvanic skin response to repeated phobic stimuli in ascending order

Abstract In two randomly selected groups of subjects phobic hierarchies were constructed, and from each hierarchy five evenly separated items were selected than spanned the range from least disturbing to most disturbing. One group was trained in relaxation and the other not. The five selected items from each subjects own hierarchy were presented to him, five times each in ascending order, during each of four sessions. The same schedule of scene presentations was administered to both groups. The galvanic skin response (percentage change) was recorded in respect of every presented stimulus. A consistent decreasing trend in magnitude of response was found for each of the 5 scenes across sessions for the relaxed group, and no trend for the non-relaxed group.