Behavioral Therapy & Exposure

Cognitive therapy is concerned with how your thinking affects your anxiety condition. Behavioral therapy focuses on how your anxieties and phobias have been learned through repeated actions of avoidance, approach, and reward and punishment.

You've learned that fear is a natural human emotion and follows a predictable, closed circuit biological path in the brain. Fear and anxiety are also learned responses: they happen as a consequence of natural emotional processes as well as specific scenarios in life.

Behaviorists are interested in how a person's actions in the face of a threat (or imagined threat) trains (conditions) them to react in the same predictable fashion time and again. By changing your behavior, you use psychological principles of learning to decouple your fearful or anxious reactions from a stimulus.

What is Behavioral Therapy?

Behavioral therapy is founded on the principles of biological learning. These principles are present in all aspects of human life, including the behaviors that underlie anxiety.

There are two basic ways people learn. Once is through classical conditioning, the other operant conditioning.

Classical conditioning occurs when an automatic response is triggered in the face of a certain stimulus. The classic experimental example is a drooling dog. Experimenters ring a bell and bring a dog a bowl of food. After repeatedly doing this, experimenters simply have to ring the bell and the dog begins to drool. It has learned (been conditioned) to associate the ringing of the bell (a neutral stimulus) with food, and this reaction happens automatically.

Operant conditioning is based on making new associations between cause and effect. Many psychological experiments use mice to demonstrate this concept. In their cages, mice press a lever to release food pellets. If they are positively reinforced with food every time (or more times than not), they learn that their action has a positive consequence. Likewise, negative reinforcement occurs when an action no longer happens. Mice may be in a cage whose floor shocks them whenever they stray into a certain corner. They come to learn that so long as they stay away from that corner, they will not be shocked—the consequence is taken away from the scenario.

Anxiety disorders function using both of these principles. For instance, a person who experiences a panic attack for the first time may associate the particular place they had it with the attacks themselves. They need only revisit or imagine the place to feel a wave of panic (classical conditioning).

Later on, the same person may feel that bringing a lucky rabbit's foot around with them staves off panic. They've been rewarded (positively reinforced) with a lack of panic whenever they have the rabbit's foot with them—unaware that they don't panic because they are systematically avoiding experiences where they think they will happen. The foot has nothing to do with it!

Extinction & Learned Helplessness

Phobias, anxieties, and fear responses are acquired via these two learning methods. Sometimes, more unseemly aspects of learning compound to keep an anxious person stuck in trained (conditioned) loops of fear.

For instance, learned helplessness is the state of believing that no behavior you perform can stave off a negative consequence or bring about a positive one. One famous experiment demonstrated this with dogs and electric shocks. Three groups of dogs were kept in harnesses—one group experienced no shocks, one group could stop the shocks by pressing a lever, and the last group could do nothing to stop the shocks. The first two groups eventually persisted and learned how to avoid the shocks; the third group eventually stopped trying to help their situation.

This example illustrates that when events happen to us that seem out of our control, we are more inclined to believe and behave in ways that exacerbate the problem. We learn to rely on the notion that nothing we can do can help us. A person with social anxiety, for instance, may become so debilitated by her previous experiences with social phobia that she eventually comes to expect that recovery is out of her direct control, and so stops even attempting to help herself.

Behavioral therapy helps anxious people come to terms with how learning operates and how their own behavior may be inadvertently impeding their recovery. The goal of behavioral therapy is to help clients "relearn" and make new associations between stimuli and their environments (operant conditioning) and eventually let classically conditioned responses fade away in lieu of consequences—a process called extinction.

Exposure Programs & Systematic Desensitization

To facilitate new learning and the extinction of old fear/anxiety responses, behavioral therapists work with clients to create exposure programs. In a safe and supportive setting, a person comes to "expose" themselves to a feared situation. This can be done systematically in small increments (systematic desensitization), all at once (flooding), and inside or outside of the therapist's office. Panic Disorder, Social Anxiety Disorder, and phobic responses are three states of anxiety which respond very well to the process of unlearning/re-association inherent to exposure programs and behavioral therapy.

By being routinely exposed to a feared or avoided situation or stimulus, people learn that there are no automatic negative consequences to many of the things they fear. Their automatic fears go "extinct" without classical reinforcement. They learn that the very act of avoiding or behaving in certain ways in the presence of imagined threats is what makes the situation scary and anxiety-inducing in the first place.

Behavioral therapy helps millions of people cope with and recover from anxiety and fear. Using the foundations of automatic and reinforced learning, therapists help clients make new positive connections between behaviors and consequences.