Behavioural Theory

Behavioural approaches to treatment recognise that in various ways people’s behaviour is learnt. Behaviour that is followed by pleasant experiences will occur more frequently (positive reinforcement) as will behaviour which is followed by the avoidance of something unpleasant (negative reinforcement). If aversive experiences follow our actions we are less likely to behave in that way again (punishment). These ways of understanding learning and behaviour are referred to as Operant Conditioning.

Sometimes an otherwise non-threatening experience or situation becomes associated with the experience of threat. The process by which this occurs is known as Classical Conditioning. If a frightening experience takes place in a neutral situation, that situation on its own may cause anxiety in the future, although the actual threat is absent. Any type of experience can become associated with another in this way, both positive and negative.

A further important way of understanding behaviour is that it can be learnt by social experience (social learning theory). If we see another person handling a difficult situation effectively and calmly we are likely to feel confident about handling it ourselves, and to have picked up some ideas about how to do it. We refer to this as modelling. Conversely we can learn to feel anxious about situations if we see others struggling with them.

Behavioural approaches also think of our social behaviours in terms of skills which can be learnt and improved on just as can practical skills (social skills).

Anxiety Reduction Techniques

Anxiety Management

Group work is usually used to help people learn ways in which they can minimise their anxiety experiences. The key components are:

Education

Explaining the normality of anxiety reactions, their physiology and the role the nervous system plays in causing the unpleasant symptoms. The role that thoughts can play in triggering off anxiety, and in causing it to escalate and the way in which avoidance actually makes things worse.

Relaxation

Deep muscle relaxation is taught and practised between therapy sessions, so that the skill of relaxing habitually tense muscles is learnt. Relaxation can help counter the anxiety response and the production of adrenaline. It is therefore a valuable coping strategy, and its use can boost people’s belief that they can cope.

Cognitive Aspects

People are helped to identify the automatic thoughts which influence their anxiety, to substitute helpful ways of thinking and to test these out in real life situations.

Behavioural Aspects

People are helped to identify the ways in which they avoid anxiety provoking experiences and to stop avoiding them (see graded exposure), using relaxation and cognitive strategies to help reduce the anxiety.

Systematic Desensitisation (SD) and Graded Exposure

The key aspect of anxiety reduction involves exposure to the situations that prompt anxiety. This is usually done by a gradual process, following a hierarchy of situations from the least to the most anxiety provoking for each individual. At each stage anxiety reaches a manageable level before the next stage is dealt with. In SD relaxation is used to inhibit the anxiety response, and exposure stopped as soon as anxiety is experienced. The hierarchy approach is generally preferred to ‘flooding’ in which the person would be exposed to their most anxiety provoking situation until their anxiety abated. This helps to break the association between the situation and the fear response.

Graded exposure and SD are often done with a therapist accompanying the client, and initially demonstrating how to cope, using the principle of modelling. A person’s spouse or a friend may also take this role. This support is gradually reduced until the person is going into the situations alone.

This is the approach of choice for phobic anxiety, and typical situations may be using buses, trains, flying, going in lifts, being in crowded shops, etc. The approach is effective largely because people learn that they can cope with the anxiety, that it is often less than they expected, their confidence and beliefs alter, and they are no longer afraid of being afraid.

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