Counterconditioning

An aspect of behavior therapy that involves weakening or eliminating an undesired response by introducing and strengthening a second response that is incompatible with it.

The type of counterconditioning most widely used for therapeutic purposes is systematic desensitization, which is employed to reduce or eliminate fear of a particular object, situation, or activity. An early example of systematic desensitization was an experiment that is also the first recorded use of behavior therapy with a child. In a paper published in 1924, Mary Cover Jones, a student of the pioneering American behaviorist John Watson, described her treatment of a three-year-old with a fear of rabbits. Jones countered the child's negative response to rabbits with a positive one by exposing him to a caged rabbit while he sat some distance away, eating one of his favorite foods. The boy slowly became more comfortable with the rabbit as the cage was gradually moved closer, until he was finally able to pet it and play with it without experiencing any fear.

In the 1950s South African psychiatrist Joseph Wolpe (1915- ) pioneered a prototype for systematic desensitization as it is generally practiced today. Like Cover's experiment, Wolpe's technique involved gradually increasing the intensity of exposure to a feared experience. However, instead of countering the fear with a pleasurable stimulus such as food, Wolpe countered it with deliberately induced feelings of relaxation. He had the client imagine a variety of frightening experiences and then rank them in order of intensity. The client was then trained in deep muscle relaxation and instructed to practice it as he pictured the experiences he had described, progressing gradually from the least to the most frightening. Today systemic desensitization of the type pioneered by Wolpe is widely used with both adults and children. In adults its uses range from combating phobias, such as a fear of snakes or flying, to increasing tolerance of pain from chronic illnesses or natural childbirth. In children, it is used to overcome a wide variety of fears, such as fear of certain animals or fear of the dark. The relaxation techniques most often used with children are deep breathing exercises and visual imagery (through which a calming effect is obtained by vividly imagining a peaceful or appealing scene). A typical sequence of treatment for a child afraid of dogs would be to pair the relaxation response first with very low-key exposures, such as being shown pictures of dogs, and then progressing to actual exposure to and finally interaction with them.

Another type of counterconditioning is aversive conditioning, which makes a particular behavior less appealing by pairing it with an unpleasant stimulus. Aversive conditioning has been used in adults to break addictions to substances such as tobacco and alcohol. Alcoholics are sometimes given an alcoholic drink together with a drug that induces nausea to weaken the positive feelings they associate with drinking. A common use of aversive therapy with children is the bell and pad treatment for enuresis (bedwetting), in which a wetness sensor placed in the bed activates a bell at the first sign of bedwetting.