Counter-conditioning: therapeutic uses of this technique

Counter-conditioning was one of the most important techniques in the development of psychotherapy, especially for its pioneering use in the treatment of phobic-type anxiety. Again Mary Cover Jones was the first to use counter-conditioning to this end, it was Joseph Wolpe who popularized it as part of a systematic desensitization.

In this article we will describe the therapeutic uses of counter-conditioning to phobias and addictions; in relation to these, we will speak respectively of systematic desensitization and aversive counter-conditioning. To begin with, we will briefly focus on the definition of this concept and its historical trajectory.

    What is counter-conditioning?

    Counter-conditioning is a psychological technique developed from behavioral orientation which consists of delete an unwanted response and replace it with another more appropriate through the use of pleasant stimuli. It is applied with some frequency to treat irrational fears in humans and animals as well as addictions.

    In this procedure, the person is exposed to the stimulus to be counter-conditioned, and which elicits an inappropriate response, while another stimulus of the opposite sign is also present. So making a phobic object less frightening might be associated with a relaxation response, such as Jacobson’s progressive muscle relaxation.

    Likewise, in many cases of alcoholism, drugs such as disulfiram are prescribed, which, when combined with this drink, cause nausea, tachycardia and other unpleasant sensations. This makes alcohol less desirable, so that drinking behavior is compensated by being associated with these physiological alterations.

    A similar concept is extinction, which is framed in the operant conditioning paradigm. The difference is that the procedure of extinction is to eliminate a response by removing the reinforcement which was previously subordinate to its execution, and not to substituting this conduct for another, as in counter-conditioning.

    Historical development of this technique

    In 1924 Mary Cover Jones first used counter-conditioning in the treatment of phobia in the famous case of little Peter, a child who is afraid of rabbits. This researcher was the first to demonstrate the effectiveness of the technique under reliable experimental conditions.

    Cover Jones used a good lunch for Peter as a replacement stimulus. The child first ate in the same room where a rabbit was, although it was at a significant distance. Little by little, the animal approached little Peter; in the end, the child was able to stroke it without showing any response to the anxiety.

    The case of little Peter was a key step in the emergence of behavior therapy. later Joseph Wolpe, who developed the technique of systematic desensitization in the 1950s, using counter-conditioning as a basis, she referred to Mary Cover Jones as “the mother of behavior therapy.”

      Role in systematic desensitization

      Systematic desensitization is a technique that it aims to reduce or eliminate anxiety and avoidance responses that occur in the presence of a phobic stimulus. It relies on performing behaviors incompatible with anxiety to replace it because, in Wolpe’s own words, it is not possible to be both relaxed and nervous at the same time.

      In particular, Wolpe used the progressive muscle relaxation technique developed by Edmund Jacobson as an inconsistent response. However, this is not a necessary item, but could be replaced by another method of relaxation, such as slow, deep breathing, or any response that is not compatible with anxiety.

      Again Wolpe attributed the usefulness of systematic desensitization to counter-conditioning opposing responses to anxiety, later authors have challenged this assumption. Thus, it has been proposed that the basis of this technique could be habituation, extinction, waiting or operational reinforcement of approach responses.

      In any case, systematic desensitization has lost its popularity in recent decades due to the refinement of live exposure techniques, which enjoy greater empirical support and are more effective in treating irrational fears, while mainly based on the contributions of scientific research.

      Aversive counter-conditioning

      The purpose of aversive conditioning is that the subject associates an undesirable behavior with an unpleasant stimulus so that it loses its value as a reinforcer. In the case of aversive counter-conditioning, this is achieved by matching the behavior to be eliminated with stimuli that elicit responses opposite to those of pleasure.

      The most common application of this technique is framed in the context of drug aversion therapy like alcohol, tobacco, cannabis or cocaine. Consumption of the drug in question is identified with unwanted behavior, while stimuli are usually other substances that react negatively to the first.

      In the case of alcohol, as we have already said, aversive therapies are used, consisting in the consumption of drugs that, when interacting with alcohol in the body, cause unpleasant physiological responses, mainly related to the digestive system. The two most widely used drugs in this regard are naltrexone and disulfiram.

      The has also been used successfully aversive electrical stimulation therapy to treat consumption tobacco, marijuana and cocaine. On the other hand, compulsive habits such as onychophagia (biting nails) or trichotillomania (plucking hair) can also be eliminated with aversive counter-conditioning, although there are more tolerable procedures.

      Bibliographical references:

      • Cover Jones, M. (1924). A Laboratory Study of Fear: The Case of Peter. Educational seminar, 31: 308-315.
      • Rutherford, A. (2010). Profile of Mary Cover Jones. In A. Rutherford (Ed.), Multimedia Internet Archives of Feminist Voices in Psychology. Retrieved from http://www.feministvoices.com/mary-cover-jones/
      • Wolpe, J. (1969), The Practice of Behavioral Therapy. New York: Pergamon Press.

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