27 January 2017
How many different psychotherapy theories or therapies can you name? One, two, twenty? Many of them will have their own perspectives on creating and changing habits. Whether you are a student, wishing to develop helpful and positive habits or you are a therapist working with a client, addressing unwanted habits, an awareness of different perspectives can offer choice in how you approach habit work.
As creatures preferring habit, we tend to repeat the same behaviours in the same situations and contexts. Habits form as we repeat the same behaviours in given situations as it is less work for the brain to repeat a pattern, rather than working on a ‘fresh approach’ each time. Imagine how much mental effort and physical dexterity would be required to learn to tie your shoe laces every time you wanted to put them on…
There are numerous psychological perspectives on the subject of habits. From a body biology perspective, we can learn to respond in certain ways so that we can do things quicker than we could if we had to think through the individual stages (consider how you brush your teeth). Thus, we can develop physiological habits. From a psychodynamic or psychoanalytical perspective (e.g. Freud), habits are influenced by unconscious drives, urges and experiences from childhood. Thus, a client who may have seen a psychoanalyst or psychodynamic therapist, may say their smoking habit is a replacement for being weaned from breastfeeding too early as a baby. A behavioural approach considers that our external environment influences us to behave in a certain way, yet in a more ‘mechanical’ machine-like way, whereas, contrastingly, cognitivists consider behaviour is driven by our emotions and allows for the impact of free will…
A key component of behavioural work is the impact of learning. Instead of considering that we have inherited certain responses and behaviours, the behaviourists consider that we start learning from the moment we are born. Some of what we learn becomes normal, beneficial behaviour, and some can be abnormal, limiting or unhelpful. We can think of this learning as ‘conditioning’. Ivan Pavlov, with his famous salivating dogs, is recognised for the term ‘classical conditioning’ (associative learning). Pavlov’s dogs were conditioned with the ringing of a bell when food was provided, after repetitions, they began to salivate for food just at the sound of the bell, even with no food present. Associations were created between the ‘stimulus’ in their environment and a naturally occurring stimulus. Just as you can hear an ice-cream van for the first time and it means nothing, so as you become used to the musical tune and its connection with ice-cream, when you later hear the tune, so you may find yourself thinking of ice-cream. For clients, their learning happens through interactions with their environment and this directs their behaviour.
To break the simple concept down even further; an unconditioned stimulus (UCS) such as stimulus in the environment e.g. stomach flu, produces an unconditioned response (UCR), the natural response, in this case, nausea. A stimulus which usually produces no response (neutral), when associated with the UCS can create a conditioned stimulus (CS). For example, the stomach flu sufferer may associate the UCS with eating a certain food, such as pizza (CS). When the conditioned stimulus is associated with the unconditioned stimulus (UCS) it creates a new conditioned response (CR). For example, the pizza (CS) eaten before becoming sick with stomach flu (UCS) now generates a feeling of nausea just at the sight of the pizza (CR). This can then happen even without the initial UCS being present.
The behavioural theory does not take into account feelings, thoughts and emotions, just actions, with three stages to developing an association. Firstly, there is the natural response to a stimulus, such as your mouth watering when you taste lemon juice. Then, during the conditioning stage, a picture of a lemon is repeatedly shown when you taste or smell lemon juice. Finally, the mouth will water when just a picture is shown.
In therapy, a man may have a fear of spiders. He wasn’t born with one, but every time his mother saw one near him she would shriek and drag him away. After a while, when he saw a spider, he had learned to shriek and run away on his own. This can happen over time, or quite quickly. In addition to learning to respond with fear, associations can be created by any of the senses. Someone may have seafood during dinner and later vomit (unrelated to the food), they may then associate the seafood with becoming sick. We can certainly use taste aversions in the therapy room, perhaps creating an association between the desire to eat chocolate and the unpleasant image (to them) of maggots crawling out the chocolate. You can even use a planned taste aversion to prevent an unplanned one… Cancer patients may develop an aversion to food if they associate it with being sick. By deliberately giving them a strongly flavoured food, such as soup with garlic or soy, their association with that and the sickness can thereby avert an unplanned aversion to health-promoting food. When students are learning hypnotherapy, many tutors will work to give the students positive emotional experiences during their learning; if they associate negative experiences, such as humiliation, they may develop an aversion to that type of learning environment / subject.
Responses to a stimulus can be ‘infectious’. With vicarious conditioning, watching the reaction of another person can lead to a reaction themselves. For example, a queue of children waiting for a vaccination. The first child cries a little when given the vaccination, then the next one cries a little more (expectancy), and before long the children are crying before even seeing a syringe.
Hypnotherapists can use conditioning all through the therapy process. Some hypnotherapists have a ‘consultation’ chair and a ‘hypnosis’ chair; by asking the client to move into the hypnosis chair when they are about to start the hypnosis, the client becomes accustomed to going into hypnosis in that chair. You may have control over the lighting in the consulting room. Just dimming the lights prior to hypnosis can create the same expectancy or anticipatory effect. Within hypnosis, the ubiquitous ‘click’ of the fingers as a re-induction is a clear example of a conditioned response, as it the response of a client to a created cue word.
When observed, the response to a ‘click’ induction can seem to be so quick that it is beyond human consideration and almost mechanical in terms of speed of response. However, not all responses can be attributed to ‘man as machine’. As classical conditioning supports nurture over nature, it may not always fully consider the complexity of human behaviour. For example, it doesn’t allow for any input of ‘free will’.
‘Operant conditioning’ moves beyond classical conditioning and introduces the concept of rewards (strengthening a behaviour) and punishments (diminishing behaviour) as a means of directing or ‘modifying’ behaviour. If an office worker gets ‘punished’ with extra work when they return from their lunch break early, they are going to learn to get back to work just on time, or perhaps even late. With operant conditioning, initial reward of a behaviour is frequent, with it diminishing over time as the behaviour is refined or ‘shaped’. For example, if a student is too quiet in class, when they start to answer questions they are praised by their tutor for each response. Over time however, the tutor will focus towards only praising when they answer correctly and then to only praising for outstanding answers.
Whilst operant conditioning can offer answers to the hypnotherapist in relation to learning, directing behaviour and changing habits, social learning theory (Bandura) suggests that instead of personal experience, we can learn automatically, from observation. Thus, an individual can learn through observation, leading to imitation of what they have observed, and subsequent reward or punishment. This can be replicated within a hypnotherapy session using metaphor and future pacing.
The behavioural approaches outlined above do not particularly consider cognitive factors. In contrast, ‘cognitive therapy’ focuses on our thoughts, instead of our actions. Cognitivists consider the mind to be an information processor, with functions such as perception, language, memory, thinking, attention, and consciousness. Rather than the simpler ‘stimulus-response’ of behavioural approaches, with cognitive therapy, it considers stimulus leads to mental processing which then leads to a response. To understand an individual’s behaviour, there is often a need to understand these mental processes.
In reality, a habit may have been formed and maintained by a combination of factors. For example, with the habit of nail biting; a client can do it when they are anxious, bored, stressed, or irritated. Initially, from a social learning, perspective, it could have been copied from a parent or other child and could then have become an unconscious process (i.e. they are not aware they are doing it). From a behavioural perspective, an aversive substance may be used on the nails, such as bad tasting nail polish or marmite (although this approach alone is not always successful, as some clients grow accustomed to the taste and may even come to like it). From an operant conditioning perspective, reward, in terms of positive care of the nails, together with reinforcement of the behavioural aversion can be more effective. From a cognitive perspective, addressing the anxiety or other triggering emotions that cause the habitual behaviour to happen can lead to extinction of the habit as the stimulus-response cycle has then been interrupted.
Finally, there are many views on how long it takes to change a habit. The initial change can happen in a mere moment, but by repeating the new response, it can then develop into a habit. Research on habit formation (Lally, Potts & Wardle 2010), suggests that automaticity (automatic or habitual response) tends to level out at around 66 days after the first daily performance of the action. Thus, for clients who are changing their habits, it can be good to encourage repetition of the desired behaviour for around 10 weeks to enable the new behaviour to become ‘second nature’.
We hope this blog has been helpful, but if you have any more questions on habits and conditioning do get in touch because we’re always happy to help! We make a habit of it!
Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: modelling habit formation in the real world. Euro J Soc Psychol. (2010);40:998–1009.
– written by Dr Kate Beaven-Marks