The mode of action of Systematic Desensitisation is that in the early days of Systematic Desensitisation, patients would learn to confront their feared situations. They would gradually overcome their fears by learning to relax in the presence of objects or images that would normally arouse anxiety. Today, this is not the case, the therapists ask the subject to imagine the presence of the feared stimulus rather than actually presenting it.
Systematic Desensitisation typically involves steps. First, patients are taught how to relax their muscles. Then the therapist and patient construct a hierarchy, the patient gradually works their way up the hierarchy, visualising each anxiety-evoking event while engaging in the completing relaxation responses. Once one step is mastered they move to the next step, continuing up the hierarchy until they have mastered their feared situation.
Research has found that Systematic Desensitisation is successful for a range of anxiety disorders e.g. about 75% of patients with phobias responded to this method of therapy (McGrath et al, 1990). However spontaneous recovery (recovery without treatment) from phobias has been found to be as high as 50-60% (McMorran et al, 2001). This shows that Systematic Desensitisation may contribute little to recovery. Systematic Desensitisation has also been used with OCD patients. The technique of ‘exposure and response prevention’ has an effectiveness of 60-90% of adults with OCD (Albucher et al, 1998) this is where patients are exposed to the objects or situations that trigger obsessions and are then prohibited from engaging in their usual compulsive response.
All behavioural therapies have their roots in learning theory, which has its own roots in experiments with non-human animals. Wolpe’s (1958) initial research was with cats. He created a phobia by placing them in cages and administering repeated electric shocks. He could then reduce their learned anxiety response by placing food near a cage that was similar to the original. The act of eating apparently diminished the anxiety response; the cats could gradually be placed in cages more and more similar to the original cages without symptoms of anxiety.
Human anxiety may not always respond in the same way. Systematic Desensitisation did not cure the phobia of one woman treated for a fear of insects (Wolpe 1973). It turned out that her husband, with whom she had not been getting along with was nicknamed after an insect. Her fear was therefore not the result of conditioning but a means of representing her marital problems. Marital counselling was recommended to her, which succeeded where Systematic Desensitisation had failed.
One therapy that is used through Operant Conditioning is Token Economy. Operant Conditioning is making a conscious association with the consequences of a behaviour e.g. behaviour that is rewarded is more likely to be repeated.
The use of Token Economy is a behaviour modification procedure in which patients are given tokens for socially positive behaviour, these being withheld when unwanted behaviours are exhibited. The tokens can then be exchanged for desirable items and activities such as sweets. Although Token Economy programmes were widespread in the 1970s, they became largely restricted to wards being prepared for transfer into the community. A particularly widespread use of Token Economy at the time was for changing the negative symptoms of schizophrenia – poor motivation, poor attention and social withdrawal (McMonagle and Sultana, 2001). In educational setting, the Token Economy system is an important part of classroom management, where it is used to build up and maintain appropriate classroom performance and behaviour.
The mode of action of Token Economy aims to increase the frequency of a patients desirable behaviours and decrease that of the undesirably behaviours. Tokens are used to dignify reinforcement and are used as part of a reinforcement schedule. Punishment is implemented by the withdrawal of tokens. There are six main steps:
- the target behaviour is identified (reinforcement or punishment)
- the nature of the token is identified
- depending on how many tokens individual receive over the day, they will get a certain number of desired items.
- the exchange rate is determined (20 tokens for 1 chocolate bar)
- the location and time of day in which the tokens are exchanged is determined.
Allyon and Azrin (1968), pioneered the Token Economy system, found that tokens were most effective when associated with behaviours already in a patients repertoires.
O’Leary et al (1969) had no success witgh a behaviour modification programme byt found that a Token Economy system reduced disruptive behaviour in 5 out of 7 children studied.
Token Economies are important because, even though the introduction of chemotherapy in the 1950s meant that mental patients could live in community settings, this transition to community living required more than symptom reduction; living skills also had to be improved. (Lecomte et al, 2000).
Most studies do not indicate whether desirable behaviours continue when tokens stop or whether the learning that takes place is an institutional setting generalizes to other settings. Furthermore, there is the issue of cure. Behaviour may change, which helps an individual to conduct a more normal life, but the mental illness remains (Comer, 2002). The method is expensive and time consuming: maintaining it required intensive training and concentrated effort, whereas simpler behaviour modification techniques may be just as effective and easier. Finally there is the problem of establishing effective rewards. To be successful, these must be tailored to the individual.
Like behaviour modification programmes, Token Economy is manipulative; Corrigan (1995) claimed that they are also abusive and humiliating. Withholding privileges and basic rights has been rules unethical by US courts (Emmelkamp, 1994).