ANTECEDENTS: SELF-HELP METHODS USED
PRIOR TO THE
"TARGET" BEHAVIOR

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Using controlling or conditioned responses to change behavior

 Some of our actions are easy to control and, indeed, some desired responses are conditioned to occur automatically. For instance, if we brush our teeth after every meal or buckle our seat belts every time we get in a car, it becomes automatic. Actually, more than that, we become uncomfortable if we don't carry out these habits.

 It is reasonable to use easy-to-control behaviors to control harder-to-control behaviors. "Controlling behavior" is Skinner's term (1953) and is really another form of method #1, changing the environment. In other situations, if an activity can be gotten under stimulus control (via conditioning), and the stimulus can be maintained, then self-control is easy. This is called a "conditioned response."

Purposes

Steps

STEP ONE: Identify the "controlling" response or the controlling "conditioned" stimulus preceding the behavior to be changed.

 What response does or could facilitate or interfere with the "target" behavior? Suppose you want to discuss current events more with friends...or tell more funny stories or jokes. Obviously, "controlling" responses might be to do some reading (newspaper, joke book, etc.) and rehearsing what you could say and then saying, "Hey, I've got a joke for you."

 What very specific situations could be associated with the wanted or unwanted "target" behavior? What easily produced stimuli could be paired with desired "target" behaviors? Examples: suppose you worry a lot, you could limit your obsessing to a particular place and time (say a certain chair). Suppose you are frequently critical and suspicious and distrusting of others, either openly or secretly. To counteract this distorted and inhibiting view of others, you could condition yourself to think something positive whenever you are in a certain situation, e. g. taking a drink of any liquid. Think positive with every sip and your view of others will be conditioned to be more positive.

STEP TWO: Pair repeatedly the controllable stimulus with the "target" behavior.

 Here are some examples: Start limiting your worrying or feeling depressed to your "worry chair." Don't restrict the total time spent worrying (yet) but do restrict the worrying to that chair, as much as possible. This is conditioning the worry with the chair.

 Start pairing a positive, complimentary, trusting thought about others with some stimulus, e. g. taking a drink or seeing or thinking of a close friend. Eventually, it will become automatic but at first you will simply have to keep reminding yourself over and over...or practice by taking a sip or thinking of the friend and immediately having a positive thought. Prepare in advance a list of accurate, reassuring, caring, trusting statements to say to yourself.

 Start smoking a cigarette when a timer's bell sounds, rather than when you have the urge or see another person light up, see an ash tray, have a beer, etc. Smoke as much as usual, but get it conditioned to the bell.

STEP THREE: Start using the "controlling" response; start changing the frequency of the controlling conditioned stimulus.

 Certain controlling responses can be used immediately, such as buying only nutritional foods or learning new jokes. A particular stimulus only becomes controlling with time; it may take several days or a few weeks to condition effective study to the study chair or worry to the worry chair. In the case of studying, remember, no TV, only soft music, no talking, no daydreaming, no writing love letters, no reading Playgirl or Playboy, just concentrating on your work in the "study" chair. The same is true in the case of worry, only worry in the designated chair, later you can start decreasing the time in the chair (or move it to the basement) but only after the specific worry is conditioned to and limited to a specific chair. Otherwise, you would worry just as much, but somewhere else.

 Likewise, the timer, once it has become the conditioned stimulus for smoking, can be set for longer and longer intervals between cigarettes. In a similar way, the timer could become the stimulus for a procrastinator to begin working for a fixed period of time, say 30 minutes, without interruptions. At the end of each work period, decide to stop or to complete another 30 minute block. Use thought stopping (see method #10) to keep distractions away.

 In the example of learning to be more optimistic and trusting of others (or more self-confident or self-accepting or whatever), one may need to repeat the positive statements several times a day for several weeks (with every sip of everything you drink). Say the positive statements "with feeling" and with an earnest intention to change your own feelings. Soon you will be feeling better about people (see chapter 14).

Record and reward progress.

Time involved

 Making sure you only study or work or worry or cry in one place may not take much time; it might save time. However, establishing a conditioned stimulus-response relationship so strong that one can reduce an unwanted reaction by controlling the stimulus will take frequent attention to details over several days or, more likely, weeks. Also, remembering to pair desired thoughts or attitudes with frequently occurring stimuli, takes constant attention to the details of what is going on in your mind. Total=2 or 3 hours spread over several weeks. Yet, considering the enormous time wasted by some of the unwanted behaviors, the methods are a bargain.

Common problems with the method

 Even if it is done gradually, it isn't easy to learn to eat, smoke, worry, etc. in one place. There are so many old stimuli that are conditioned to produce the unwanted response; they are hard to break. On the other hand, pairing a desired response (study, positive beliefs) with a new stimulus or environment is not hard, but it is tedious to remember to do.

Effectiveness, advantages, and dangers

 Intuitively, the efficacy seems to depend on the problem and the method. It is effective to study or work in one place--after about a month or so of daily experience. Yet, it would take more than controlling responses in the grocery store to restrict the diet of most hungry midnight raiders (who can down a quart of low fat yogurt), but controlling responses can help. However, my experience with classes suggests that only a few people use conditioning procedures to change habits or attitudes.

Relapse prevention; temptation resistance training; cue exposure

 One of the hardest parts of self-control is stopping some unwanted, but compelling behavior. Once stopped, then there is the problem of staying in control. For this reason a section of chapter 4 was devoted to the crucial step of preventing relapses. Read that section, it is important. Coverage here will, therefore, be brief.

 The basic approach is to avoid the stimuli that produce the unwanted response (method #1) or, the opposite, to confront the tempting situation repeatedly without responding in the undesired way (methods #2 ); thus, reducing the habit's control over you.

 The drop out rate from treatment and exercise programs is high, often 50% or 60% in the first three months. The relapse from weight loss and alcohol or drug treatment programs is notorious, maybe 90% or more. Maintaining our gains in self-control is a serious problem. But we are learning much more about relapse prevention and research shows that adding these techniques to other methods, such as treatment for obsessions or compulsions, significantly improves the outcome.

Purposes

Steps

STEP ONE: Identify the high-risk conditions for you, including the external circumstances and your internal moods and thoughts. Analyze your needs and motives.

 See method #9 and relapse prevention in chapter 4. Not only do you need to know the conditions that give rise to the objectionable behavior, but you need to understand the learning principles at work and the needs being met.

 A relapse isn't an unpredictable "accident," it is somewhat predictable. High-risk as well as moderate and low-risk situations can and should be identified, so you can prepare for them or avoid them. There is evidence that many former addicts inadvertently make decisions that put them back into risky situations. Recognizing these "foolish moves" can serve as early-warning signals alerting us to denial and self-cons.

STEP TWO: Avoid the high-risk situations if you can; otherwise, learn to cope with them; meet needs; avoid self-deception.

 Methods #1,#2,#7 & #11 are relevant. Especially important here is learning to meet one's needs in an acceptable way. Find another way, instead of the compelling habit, to deal with loneliness, guilt, inferiority, stress, boredom, etc. (See chapters 5 to 9)

 You will need to carefully plan ways of avoiding high-risks. You will also need to learn skills for coping with unavoidable low and moderate-risk situations. This may involve learning from a model, self-instructions, rehearsal in fantasy, stress management skills, building your self-esteem and self-efficacy, recognizing the long-term consequences of your habit, avoiding denial of risks, stopping the obsession with the "it-will-fix-everything-if-I-relapse" thinking, and completing the advanced preparation for a possible relapse discussed in chapter 4. Constant vigilance is needed. Addiction experts speak of developing a new "life style," i.e. finding new sources of fun, new values, and life goals.

 It is also important to realize that a person with one addiction (food, alcohol, work, sex, drugs, shopping, socializing, etc.) often has others or is prone to adopt another if deprived of his/her favorite. For example, almost every drug user is a smoker or former smoker. Quitting smoking may lead to eating more. So you not only need to guard against relapse but also the development of a new addiction.

STEP THREE: Temptation resistance training; Extinguish old response.

 When we have an overpowering bad habit that runs amuck and out of control, surely it's wise to weaken if not destroy it. But, how? One way is to simply expose oneself to the situations that give rise to the urge and resist the temptation to give in. This is also called "cue exposure" (Hodgson and Miller, 1982) or going "cold turkey" or "total abstinence." For instance, a compulsive hand washer might deliberately touch a door knob, their own underclothes, someone else's underclothes, a dirty dust cloth, etc. without washing his/her hands afterwards. This is a process of extinction which eliminates the irrational reduction of distress or disgust (negative reinforcement) after touching something by washing. It also forces us to do some reality testing to find out that nothing awful happens when one doesn't wash.

 A craving or compulsion or addiction or habit often helps us immediately avoid some disagreeable feeling or situation. Negative reinforcement (reducing some unpleasant feeling) strengthens the unwanted habit. Examples: Food helps some of us forget loneliness, alcohol helps us avoid fears and feel powerful, working enables the workaholic to reduce anxiety, repetitive checking of locks reduces fear, compulsive masturbation may help us forget our troubles and self-doubts even though it may add guilt, street drugs alleviate depression or stress or boredom, cigarettes relax us, etc. None of these purposes is bad, but the long-range consequences of these stopgap "solutions" are likely to be catastrophic.

 St Augustine, an early religious leader, was, as a young man, a compulsive masturbator. He wrote that an unchecked desire produces a habit, and an unbridled habit leads to a compulsive urge. True, modern learning theory says a satisfied desire reinforces the preceding behavior. So, why aren't we all masturbating and eating compulsively? Is it because some of us try harder to restrict the behavior? Is it because more needs are met in some people than in others? We don't know. Also, unfortunately, we do not know all the feelings that were relieved by St Augustine's masturbation, almost certainly he didn't either.

 Hodgson and Miller tell of a married man who masturbated once or twice a day. He was concerned about the compulsive aspects (he couldn't stop it), the religious aspect (he often thought of the crucifixion while masturbating) and the unfaithful aspects (he also looked at pornography or at prostitutes on the streets). The therapists recommended that he expose himself to the situations that often preceded masturbating: being criticized at work, feeling depressed, being home alone, watching a sexy neighbor, and the situations mentioned above that concerned him. But he was instructed not to masturbate. At first he did this in front of the therapist, which presumably helped inhibit masturbating. Later, he did these things alone. After a year he was masturbating only once a week.

 Take the risky situations identified in step one (see Marlatt & Parks, 1982, in chapter 4) and arrange them from low-risk to high-risk. Prepare some self-instructions and behaviors for avoiding the compulsion in each situation, e.g. ask a friend to bring his/her own beer while you have only coke to drink. Expose yourself gradually from easiest to hardest to control situations. Don't give in! Take pride in your growing self-control and changing attitude. Remember the example of temptation control given in chapter 4, the beautiful hot fudge sundae that melts and gets yucky. Besides behavioral control, one learns to believe "I am strong! I can resist these silly urges!" rather than thinking, "I am helpless and weak." (See chapter 14)

STEP FOUR: Be forever on guard against the old urge.

 The life experiences of many people suggest that an old habit remains lurking in the background for a long time--maybe forever--waiting for another chance to act. People who have avoided a cigarette or alcohol for months will have an occasional urge and remember "how good it tastes." Once they give in to the old urge, it takes very little time for the habit to be re-established at full strength again. Thus, prepare in advance to curtail any relapse as soon as possible (see chapter 4). If you are in treatment but relapse, stay in treatment. After relapsing, work hard to avoid or to prepare for your next lapse. It can be done... it has been done by millions.

Time involved

 Probably several hours per week over a period of months is required if it is a well ingrained compulsive habit that requires learning new behavior and extinguishing old habits via exposure to old temptations.

Common problems with the method

 In some cases, such as alcoholism and drug abuse, it would certainly be foolish to suddenly re-expose your self to your favorite bar and drinking or drug-using buddies. Without special preparation, few people could resist. The idea is to build the skills necessary to avoid relapse. Many experts believe it is dangerous to re-expose oneself even to situations involving mild risks. Exposures, such as a former alcoholic going into a bar, are certainly not necessary; yet, other tempting situations, such as a neighbor offering you a beer on a hot summer day, are not entirely avoidable. Besides, the needs that were met by drinking, such as social needs, feeling more powerful, and having fewer worries, must now be meet in different ways. With many compulsions, there are many tempting situations that can't be avoided, e.g. those prompting eating or smoking or socializing or watching TV. If you ever gain some additional self-control, preventing a loss of that control is absolutely essential for growth.

Effectiveness, advantages, and dangers

 Rachman, Hodgson, and Marks (1973) reported 75% success rate with compulsive rituals using the cue exposure method for just three weeks. In general, studies of relapse prevention have shown it to be effective (Irvin, Bowers, Dunn & Wang, 1999).

Relapse is an ever present danger. But if successful, victory is sweet.

Additional reading


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