Classical conditioning, a psychological phenomenon first discovered by Ivan Pavlov in the late 19th century, has proven to be a useful tool that has withstood the test of time (Rachman, 2009).
By using classical conditioning for phobias and anxiety disorders in modern-day treatments, individuals with intense and irrational fears may be able to find some relief.
Built upon Pavlov’s groundbreaking work, contemporary research has harnessed the power of conditioned fear extinction and reconsolidation to ease these phobic responses.
This article explores the application of classical conditioning for phobias, with techniques such as exposure therapy and systematic desensitization, in treating disorders.
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The history of classical conditioning can be traced back to the pioneering work of physiologist Ivan Pavlov (1904) in the late 19th and early 20th centuries.
Pavlov conducted a series of experiments on dogs, initially intending to study the digestive processes. However, he noticed the dogs began salivating not just in response to food but also in anticipation of the food, such as when they heard footsteps approaching or saw the experimenter.
Pavlov recognized that this salivary response was a reflexive behavior that had been conditioned through repeated pairings of neutral stimuli (such as the sound of a bell) with the presentation of food. He referred to the neutral stimulus as the conditioned stimulus and the salivation as the conditioned response (Pavlov, 1904).
Pavlov’s experiments led to the development of the concept of classical conditioning. He proposed that through repeated pairings of a neutral stimulus with a biologically significant stimulus (such as food), the neutral stimulus acquires the ability to elicit a response similar to the one elicited by the biologically significant stimulus (Pavlov, 1904).
Pavlov’s work was significant because it highlighted the role of learning in shaping behavior. He demonstrated that organisms could learn to associate stimuli in their environment and that these associations could lead to predictable behavioral responses.
Classical conditioning gained further recognition and influence through the work of psychologist John B. Watson, often considered the founder of behaviorism. Watson applied classical conditioning principles to human behavior, emphasizing the importance of environmental stimuli in shaping and modifying behaviors (Rachman, 2009).
Phobias, Fear, and Classical Conditioning
The discovery that phobias can be considered a conditioned response is attributed to Watson.
In the early 20th century, Watson conducted the infamous “Little Albert” experiment, demonstrating that fear responses could be conditioned in a young child (Watson & Rayner, 1920).
By pairing a neutral stimulus (a white rat) with a loud, sudden noise, Watson and his collaborator Rosalie Rayner successfully elicited a fear response in Little Albert whenever he encountered the rat alone.
This now-controversial experiment provided empirical evidence for the role of classical conditioning in the development of phobias. It contributed to understanding the relationship between learned associations and fear responses (Watson & Rayner, 1920).
Classical conditioning: conditioning of phobias - Sarah Bannister
Eventually, classical conditioning was incorporated into many therapeutic techniques. Often referred to as the “mother of behavior therapy,” Mary Cover Jones conducted groundbreaking work in the 1920s and 1930s on treating phobias using classical conditioning techniques.
Jones’s famous “Little Peter” experiment showed that fear responses could be gradually extinguished by pairing the feared object or situation with a pleasant stimulus, such as a treat or toy (Jones, 1991).
Joseph Wolpe (1961), a psychiatrist, developed systematic desensitization as a therapeutic technique for treating anxiety disorders. Systematic desensitization involves creating a hierarchy of feared stimuli and gradually exposing individuals to these stimuli while they engage in relaxation techniques. By repeatedly pairing relaxation with the feared stimuli, the conditioned fear response is weakened and replaced with relaxation.
Later, psychologist B. F. Skinner (1963) expanded on classical conditioning with his work on operant conditioning, which focused on the consequences of behavior rather than the association between stimuli.
In the mid-20th century, behavior therapy emerged as a distinct therapeutic approach incorporating classical conditioning principles. Prominent behavior therapists such as Joseph Wolpe (1961), Hans Eysenck (1960), and Arnold Lazarus (1974) developed and expanded upon classical conditioning techniques to treat a wide range of psychological disorders.
Over time, classical conditioning techniques found application in various therapeutic modalities, including Cognitive-Behavioral Therapy (CBT), exposure therapy, and eye movement desensitization and reprocessing (De Jongh et al., 1999).
These therapies draw on classical conditioning principles to help individuals modify their conditioned responses, reduce anxiety, alleviate phobias, treat trauma-related symptoms, and address other behavioral and emotional issues.
Conditioning can provide insights into how anxiety develops and is maintained. Anxiety can be understood as a conditioned response to certain stimuli or situations. Through classical conditioning, individuals may associate neutral or initially nonthreatening stimuli with fear or negative experiences.
Once a conditioned fear response is established, it can generalize to similar stimuli or situations. For example, if someone has a negative experience with a specific dog, they may start feeling anxious around all dogs, even if they haven’t had negative encounters with them before. The fear response generalizes from the conditioned stimulus (specific dog) to similar stimuli (other dogs).
Anxiety can also be reinforced through operant conditioning. If individuals engage in avoidance behaviors or escape responses to avoid anxiety-provoking situations, their anxiety may temporarily decrease. However, this avoidance behavior maintains and strengthens the anxiety over the long term.
By avoiding anxiety-provoking situations, individuals miss opportunities to experience corrective information and learn that their fears are unwarranted.
By understanding these processes, psychologists have developed therapeutic techniques that address and heal anxiety symptoms. One technique is systematic desensitization. This technique is often used to treat phobias, anxiety disorders, and post-traumatic stress disorder (McGlynn et al., 2004).
By gradually exposing individuals to feared stimuli or situations while pairing them with relaxation techniques, therapists aim to replace the fear or anxiety response with a relaxation response. Over time, the individual becomes desensitized to the previously feared stimuli.
Like systematic desensitization, exposure therapy exposes individuals to anxiety-provoking stimuli or situations. However, exposure therapy focuses on directly confronting the feared stimuli without relaxation techniques. Through repeated exposures, individuals learn that the feared stimuli are not as threatening as initially believed, and their conditioned fear response diminishes (Rauch et al., 2012).
Counterconditioning involves pairing the anxiety-provoking stimulus with a new, positive, or neutral response to counteract the fear response. This technique aims to establish a new conditioned response that is incompatible with anxiety. For example, a person who fears public speaking may engage in positive self-talk or visualization techniques while imagining speaking in front of an audience (Keller et al., 2020).
One fascinating way that technology has helped to assist in these processes is by using virtual reality (VR) simulations to create realistic and controlled environments to expose individuals to feared situations. By using VR, individuals can experience anxiety-provoking scenarios in a safe and controlled manner. This approach enables repeated exposure and facilitates the process of unlearning conditioned fear responses (Powers & Emmelkamp, 2008).
Obsessive-compulsive disorder
Classical and operant conditioning has also been incorporated into therapies made to treat obsessive-compulsive disorder (OCD), which is a complex set of behaviors and thoughts that can be especially debilitating to the individual.
Exposure and response prevention is a form of Cognitive-Behavioral Therapy widely considered the gold standard for treating OCD (Hezel & Simpson, 2019). It involves exposing individuals to anxiety-provoking situations or triggers (exposure) and preventing the accompanying compulsive behaviors or rituals (response prevention).
The exposure component aims to evoke anxiety or distress while allowing habituation and disconfirmation of feared consequences. Over time, this can lead to the extinction of conditioned fear responses associated with obsessive thoughts.
OCD is a complex condition, and treatment often involves a comprehensive approach. Conditioning principles, such as exposure, response prevention, ritual reversal, and aversion therapy, are integrated into a treatment protocol that may also include other evidence-based tools, counseling, and medication.
Changing Behavior Through Conditioning
While behavior therapy has now been integrated into other modalities and is rarely used as a standalone therapy, conditioning is still a valuable principle that can elicit behavior change.
Especially when considering substance and process addictions, these techniques are currently being used to help individuals reduce harmful behaviors.
How to stop smoking
Behavior therapies are very beneficial in helping individuals quit smoking and have been shown to have long-term efficacy (Vinci, 2020). These interventions are often combined with medication treatments for the highest efficacy.
The most commonly used and most successful type of psychological therapy for smoking cessation is Cognitive-Behavior Therapy (Vinci, 2020). CBT for smoking cessation usually involves cognitive restructuring beliefs about smoking, identifying triggers, and preventing relapse.
Contingency management is a behavioral intervention that provides tangible rewards or incentives for abstaining from substance use or engaging in healthy behaviors. By associating the desired behaviors with positive reinforcement, individuals are motivated to continue their recovery efforts and reduce engagement in addictive behaviors.
Contingency management has been shown to be effective in quitting smoking, drinking, and abstaining from other substances (Lamb et al., 2004).
Gambling addiction
Behavioral therapy has also been used to treat process addictions such as gambling. Gambling disorder is recognized as persistent and problematic gambling behavior that leads to increased distress and difficulties in the individual’s life.
While exposure therapy has mixed results as a treatment for substance use, it has been shown to be a good treatment for gambling (Bergeron et al., 2022).
Individuals may develop conditioned responses to gambling-related cues, like slot machine sounds or casino environments, which can elicit cravings and increase the likelihood of engaging in gambling behaviors. Treatment includes gradual exposure to either real or imagined cues, paired with response-prevention and calming techniques. Research shows a decrease in cravings and time spent gambling (Bergeron et al., 2022).
Combining conditioning approaches with other evidence-based therapies helps address the complex nature of addiction and increases the likelihood of successful recovery outcomes.
These conditioning-based techniques are often integrated into comprehensive treatment programs, including Cognitive-Behavioral Therapy, motivational interviewing, support groups, and medication management.
Does Conditioning Play a Role in Depression?
Depression is a complex mental health condition that arises from a combination of genetic, biological, environmental, and psychological factors. Conditioning is not typically considered a direct cause of depression. But conditioning processes can influence the development and maintenance of certain behavior and thought patterns contributing to depressive symptoms.
Research conducted by Martin Seligman (1972) introduced the concept of learned helplessness, which is a form of conditioning. When individuals repeatedly experience situations where they have no control over aversive events, they may develop a belief that they are helpless and unable to change their circumstances. This learned helplessness can contribute to feelings of hopelessness and helplessness that are characteristic of depression.
Individuals with depression may experience negative conditioning, where negative or aversive experiences become associated with certain stimuli, situations, or behaviors.
For example, if someone consistently receives criticism or rejection in social situations, they may develop a conditioned response of anxiety or sadness in similar situations, leading to avoidance behaviors and isolation. This negative conditioning can contribute to the maintenance of depressive symptoms.
And finally, in some cases, individuals with depression may inadvertently reinforce their depressive behaviors through negative reinforcement (Lewinsohn, 1974). For instance, withdrawal and social isolation may temporarily relieve feelings of social anxiety or stress. By engaging in these behaviors, individuals may unintentionally reinforce the cycle of depression, as avoidance and withdrawal can perpetuate negative mood states.
While conditioning processes can influence depressive symptoms, it’s clear that depression is multifaceted and caused by many underlying factors. Genetic predisposition, brain chemistry imbalances, life events, social factors, and cognitive factors all contribute to the development and experience of depression. Understanding and addressing these factors within a comprehensive treatment approach is crucial for effectively managing depression.
5 Worksheets and Games for Therapists
In order to use behavioral techniques with their clients, therapists often use worksheets to help organize the processes.
The following worksheets are useful tools.
1. Anxiety Hierarchy
This worksheet aids a client in creating a hierarchy of anxiety-provoking situations. It is a useful tool for beginning exposure therapy with a client that has an intense fear or phobia.
2. Anxiety Record
The Anxiety Record worksheet provides prompts for a client to process specific anxiety and investigate associated thoughts. This is a good worksheet to help a client reframe an unrealistic fear.
3. Imaginal Exposure
Imaginal Exposure helps the client rate their anxiety on the Subjective Units of Distress Scale before, during, and after the process.
4. Managing Panic
Sometimes clients need help identifying what behaviors, feelings, or thoughts may trigger a panic attack. Understanding their triggers may lead them to better insight and the development of coping skills to aid in treatment.
5. Fear in a Hat
Fear in a Hat is a group activity that can be used to confront fears and anxieties. Instruct every group member to write their fear or “the worst that could happen” about a particular topic on a piece of paper. Each member then places their papers into a hat or other container.
The container is passed around and group members pull out and read the fears to the group, explaining how they may feel if it were to happen. This game can help clients see that their fears may be shared by others, and they may seem less intimidating after sharing.
Resources From PositivePsychology.com
Behavior therapy is a foundational tool for clinicians to aid in relief from anxiety and related disorders, using classical conditioning for phobias.
At PositivePsychology.com, we have a range of related behavior therapy resources that you may find quite interesting.
Behavior change tools
For additional support, our tools can help incorporate behavioral techniques in other ways. Try some of these worksheets:
Here is a behavior change tool that helps clients replace maladaptive behaviors with rewarding and healthy new habits.
Graded exposure is a behavioral technique that will help clients face their fears safely. This graded exposure worksheet provides an outline and structure for the session.
Recommended reading
For additional learning, check out these other articles from our blog:
A unique form of therapy, Interoceptive Exposure uses somatic work to aid the client in working through panic and anxiety.
An exercise to help you rewrite rigid beliefs that may be keeping you from growth
A tool that will help you identify what doesn’t need to change in order to appreciate the positives in life
A writing prompt for a “wisdom letter,” written to give advice to someone who may be overcoming the same hardships that you have
17 Positive Psychology Exercises
If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.
A Take-Home Message
Classical conditioning for phobias has proven to be a valuable tool in treating anxiety disorders. Through the principles of conditioning, therapists can address the learned associations that contribute to anxiety and fear responses.
Techniques such as systematic desensitization, counterconditioning, and virtual reality exposure therapy have demonstrated effectiveness in helping individuals unlearn maladaptive fear responses and regain control over their anxiety.
Incorporating classical conditioning principles within comprehensive treatment approaches offers hope for individuals seeking relief from the burden of anxiety.
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Keller, N. E., Hennings, A. C., & Dunsmoor, J. E. (2020). Behavioral and neural processes in counterconditioning: Past and future directions. Behaviour Research and Therapy, 125.
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Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders, 22(3), 561–569.
Rachman, S. (2009). Psychological treatment of anxiety: The evolution of behavior therapy and cognitive behavior therapy. Annual Review of Clinical Psychology, 5(1), 97–119.
Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research & Development, 49(5), 679–687.
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Vinci, C. (2020). Cognitive behavioral and mindfulness-based interventions for smoking cessation: A review of the recent literature. Current Oncology Reports, 22.
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About the author
Dr. Amanda O'Bryan is a certified wellness coach and specializes in using evidence-based practices to empower her clients to shift the ways that stress and anxiety impact their lives. She also works as a freelance writer, creating psychoeducational content. Her goal with writing is to help people understand themselves better by presenting cognitive science in a fun and interesting way.
Does the name Pavlov ring a bell?
The discovery that phobias can be considered a conditioned response is attributed to Watson.
While behavior therapy has now been integrated into other modalities and is rarely used as a standalone therapy, conditioning is still a valuable principle that can elicit behavior change.
In order to use behavioral techniques with their clients, therapists often use worksheets to help organize the processes.
