Covert Extinction Therapy
learning principles in the development of alcohol dependence
Covert Extinction Therapy
Covert extinction is one of a “family” of techniques in which the reinforcing,
nonreinforcing, or punitive consequences to a behavior are imagined. Covert extinction
requires the client to imagine himself performing a problem behavior and then to imagine that
a common reinforcing stimulus does not occur. Thus, covertly, the client “performs”
behaviors in the absence of contingent reinforcement, conditions that have been shown to be
effective in promoting the extinction of overt behaviors. Covert extinction, like systematic
desensitization, implosive therapy, and other behavior therapy techniques involving the
patient's imagination, begins with the therapist's verbal descriptions of scenes to be imagined.
Initially, the client may be told the rationale behind extinction procedures, such as how his
problem behavior is maintained by reinforcement from the environment, and how treatment
will involve eliminating that reinforcement in the imagination. The client will then be given
several covert- extinction trials in the office as well as "homework" assignments, trials that he
must complete between sessions on his own.
For example,
A client who complains of stuttering in social situations may be asked first to imagine
that he is in a common situation, that he stutters, and that the stuttering evokes no response
from others: You are sitting in your school cafeteria. Choose a place in which you usually sit.
(Pause) You can hear and see students walking around, eating and talking. (Pause) You are
eating your favorite lunch. (Pause) T h e re is an empty seal near you. (Pause) A pretty blonde
girl comes over and asks you if she can sit down. (Pause) You stammer, ‘Ya..ya..va..yes.’ She
absolutely reacts in no way to your stuttering. After the client has gone through the total
scene he may be quizzed to determine if the scene was vivid and real. Then he may be asked
to imagine it on his own, without the therapist’s verbal descriptions. He is asked to signal the
therapist, for example, by raising the little finger on one hand, when the scene is finished, and
the therapist may again ask about its clarity.
Extinction is most likely to occur with a greater number of Extinction trials,
according to laboratory evidence. It is suggested that each therapy session include up to 20
imagined scenes, 10 with the therapist verbalizing the scene and 10 with the client on his
own. Furthermore, the client is required to practice the scene 10 times each night at home and
to modify the scene on some trials, to encourage extinction effects in a variety of situations.
learning principles in the development of alcohol dependence
Alcohol dependence is a complex disorder involving physical, psychological and social
aspects of the individual and having far reaching harmful effects on the family and society.
The social, familial and cultural contexts in which the problem drinking occurs are significant
factors in determining which treatment approach can be most effective with an individual.
Models such as classical conditioning, operant conditioning, drive reduction, social learning
and various others provide varying mechanisms to understand the nature of alcoholism. These
models have provided alternative approach to the traditional models in conceptualizing the
etiology of alcoholism with emphasis on the acquisition and maintenance of problem
drinking, leading to the development of appropriate intervention strategies.
The classical conditioning model postulates that contiguous pairing of a neutral stimulus with
an unconditioned stimulus leads the conditioned stimulus to elicit an anticipatory
(conditioned) response when presented alone. From the classical conditioning perspective,
dependence or craving can be explained. Presence of exteroceptive (e.g., physical setting or
drinking companions) or interoceptive (e.g., emotional states) cues associated with heavy
drinking/withdrawal leads to craving, predisposing the individual to take alcohol; this further
intensifies the craving and it leads to loss of control.
According to this model, craving occurs due to
(1) the presence of conditioned stimuli that elicit the internal state; and
(2) the convergence of certain situational factors that determine how the internal state is
labelled.
Operant conditioning
Operant conditioning is the second learning principle. The central principle of operant
behavioural psychology is that behaviour is controlled by its consequences. The operant
model explaining the acquisition, maintenance and modification of problem drinking, posits
that the problem drinking is developed through selective reinforcement of incipient
components of behaviour. When the behaviour is established by the intermittent occurrence
of reinforcement it enhances the resiliency of the behaviour. The reinforcement seeking
behaviour caused by the drug in the individual motivates him to learn compensatory
responses to ameliorate this interference. Modification of drinking behaviour caused by the
drug in the individual motivates him to learn compensatory responses to ameliorate this
interference. Modification of drinking behaviour requires removal of positive reinforcers
(i.e., extinction) and/or application of
punishment. A variety of positive (e.g., money, social interaction) and negative (e.g., electric
shock, social isolation) reinforcers have been in use within a number of operant paradigms
(e.g., punishment, escape, token economy and contingency contracting) to modify drinking
behaviour
Social learning theory
According to Bandura drinking behaviour is governed by principles of learning, cognition
and reinforcement. The social learning theory suggests that drinking as a social behaviour, is
acquired and maintained by modelling, social reinforcement, the anticipated effects of alcohol
and physical dependence. Parental norms and peer modelling of drinking behaviours also
influence the development of internalized expectancies for alcohol effects. The modelled
behaviours get translated into expectancies which in turn determine the alcohol consumption.
Certain individual factors (learned and/or inherited, biological and/or psychological)
interacting with situational or environmental demands, may overwhelm an individual's ability
to cope effectively and may lead to a decreased sense of efficacy. The individual learns that
alcohol can help to cope with the immediate situations, hence the probability of alcohol
consumption increases. Socialization deficits may also predispose an individual to heavy
drinking.
Expectancy theory
The importance of cognitive factors in the initiation and maintenance of drinking behaviours
is central to expectancy model. Individual's drinking is determined by his alcohol
expectancies rather than by its mere pharmacological effects. Individual learns to expect
short-term positive consequences of drinking as alcohol consumption leads to initial increase
in the physiological arousal. Alcohol also tends to reduce the negative affect as it blocks the
memory; alcohol reduces the past negative consequences and thereby reducing the outcome
expectation of negative consequences of excessive consumption. Accordingly, drinking tends
to transform negative feelings into positive feelings rather than reducing the negative affect.
Hence, such positive expectations of an individual about alcohol and its consumption would
interact with the degree of perceived stress and other coping responses to determine the
extent of drinking.
Tension reduction hypothesis
According to tension reduction hypothesis an increased internal tension in an individual leads
him to a heightened drive state; alcohol consumption reduces this tension by lowering the
drive-level due to its pharmacological properties; hence this drive reduction, acts as a
reinforcer and in turn, strengthens alcohol consumption. This leads an individual to habitual
drinking as alcohol consumption becomes a primary response to heightened internal tension.
This model does not adequately explain alcohol consumption as the tension reduction quality
of alcohol is a single factor explanation but alcohol has various other characteristics along
with reducing tension. It is also considered incomplete as the cognitive component is not
given importance in explaining the problem drinking its etiology and maintenance.
Motivational model of alcohol use
This model posits that such aspects as nonchemical incentives and affective changes due to
alcohol determine alcohol use, by contributing to the individual's motivation to drink, The
individual decides to drink or not to drink based on whether the expected positive affective
consequences of alcohol outweigh the expected ones due to nondrinking. Addiction occurs
when factors that contribute to the decision to drink strongly outweigh factors that contribute
to the decision not to drink. According to this model, individual's drinking depends on his
decision to drink; historical factors (e.g., personality, sociocultural environment and physical
reactivity to alcohol), his positive and negative incentives obtained from alcohol
consumption, cognitive mediating events (thoughts, perceptions and memories), and
physiological and instrumental expectancies of alcohol.
Biopsychosocial model
Mishra and Kumaraiah proposed a model in which the biopsychosocial factors are given
emphasis in the acquisition and intervention of substance abuse. According to this model
acquisition can occur at three levels: Psychological, Physiological and Social. When
acquisition occurs at a particular state of cue control (i.e., psychological, physical or social),
then the intervention should start at that level first, and subsequently all other associated
'cues' be intervened adequately. According to this model, a broad-spectrum approach for the
management and prevention is needed to combine biopsychosocial and rehabilitative efforts
in dealing with addiction. It also emphasizes on the cognitive and resocialization aspects with
additional intervention for the associated problems of alcoholics.
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