Psychological Bulletin 1966, Vol. 65, No. 3, 165-169 REPLY TO A "CRITIQUE AND REFORMULATION" OF BEHAVIOR THERAPY

S. RACHMAN AND H. J. EYSENCK Institute of Psychiatry, University of London

It is argued that Breger and McGaugh's (196S) criticisms are misguided and that they fail to mention numerous studies and arguments which support the view that behavior therapy is an encouraging development and has already achieved some therapeutic success. Attention is drawn to various "laws of learning" which have been employed in constructing treatment techniques and for generating and assessing specific hypotheses. Several doubtful assertions made by Breger and McGaugh are discussed and factual errors are corrected. Their suggested reformulation of behavior therapy is rejected as being frag- mentary, vague, and unconstructive.

This reply to the recent paper by Breger McGaugh is labelled "science issue"; they and McGaugh (196S) will confine itself to a feel that there is no such thing as "modern small number of crucial points; we will not learning theory," that there is no agreement discuss in detail, among others, two main con- on sufficient points to make testable predic- tentions put forward by those authors. One of tions and applications to the treatment of these is their "reformulation," according to neurotics, and that behavior therapists are which learning conceptions of neurosis should wrong in claiming that their procedures are make use of the "acquisition of strategies." based on scientific theories. Evaluation of this The suggestions made under this heading are point may be aided by consideration of a so fragmentary, programmatic and elusive quotation from Sir George Thomson, F.R.S. that we fail to see either their theoretical use- and Nobel-Laureate in physics. He points out fulness or any practical consequences which that might follow from them; when Breger and if differences of opinion ... are still possible about McGaugh have some actual applications to space, time, and gravitation, this is an example of report, or have at least succeeded in showing something common in physics. Very different points how the major facts of neurotic behavior can of view may lead to identical or nearly identical con- clusions when translated into what can be observed. be accounted for in terms of their scheme, It is the observations that are closest to reality. The then may be the appropriate time to take issue more one abstracts from them the more exciting in- with their "reformulation." The other conten- deed are the conclusions one draws and the more tion relates to their preference for an "Expec- suggestive for further advances, but the less can one tancy X Value" type of theory, as compared be certain that some widely different viewpoint would not do as well [1961, p. IS]. to a "Drive X Habit" type of theory, to use Atkinson's (1964) phrase. They are, of Much the same is true in psychology. Mac- course, free to make any preference choice Corquodale and Meehl (1954), Atkinson they like, even without repeating at some (1964), and many others have pointed out length arguments presented many times be- that Expectancy X Value and Drive X fore; here too, however, one would require Habit theories overlap in many ways, and some more direct evidence indicating that give rise to similar predictions, although ex- Expectancy X Value theories give rise to perimentalists may show a preference for one different and more efficient methods of treat- or the other of two ways of talking about ment than Drive X Habit theories before phenomena. But both are agreed about most entering into any formal argument. As this of these phenomena, and it is these which "are point is crucial to certain other assertions closest to reality," and which form the factual, made by Breger and McGaugh, however, it scientific basis of behavior therapy. No learn- will be referred to obliquely again below. ing theorist of any persuasion would deny The first criticism made by Breger and statements of behavioral laws of this kind: 165 166 S. RACHMAN AND H. J. EYSENCK

"Reinforced pairings of CS and UCS under the literature on the subject? If Breger and appropriate conditions produce conditioning"; McGaugh wish, in the other examples quoted, "Intermittent reinforcement slows down ex- to indicate that behavior therapists actually tinction"; "Nonreinforcement produces ex- speak to their patients and explain the ra- tinction"; "Different schedules of reinforce- tionale and nature of the treatment to them, ment produce predictably different response then their point is taken even though it does rates." It is laws of this type that are made lack novelty. Perhaps they are unaware that use of by behavior therapists, who may choose during the course of therapy, be it desensiti- to talk about them in the language of Hull, zation or any other method, the therapist also Tolman, Skinner, or any other major learning attempts to locate any sources of stress which theorist. As an example, consider the work of may be provoking or maintaining the neurotic Lovibond (1962) who made detailed predic- behavior. Where possible, these stresses are tions on the basis of the known facts of learn- eliminated or at least ameliorated. The cases ing theory for the behavior of enuretic pa- (of psychotic patients in these instances) de- tients, and showed how in doing so he could scribed by Ayllon (1963) and Ayllon and (a) accelerate recovery and (6) reduce re- Michael (1959) illustrate clearly how im- lapses; Young and Turner (196S) may fur- provements can be obtained by breaking the nish another example in the same disorder. links between stimulus and response patterns Many others are given in Eysenck (1959, as they occur in the patient's environment 1964), Ullmann and Krasner (1965), Kras- (Eysenck & Rachman, 1965). ner and Ullmann (1965), Eysenck and Rach- Breger and McGaugh's paper is also self- man (1965), Rachman (1965a), and others. contradictory. Immediately after deploring The application of scientific principles to any the emergence of a so-called dogmatic school area must be specific, and must be discussed of Behavior Therapy ("it is unfortunate that in terms of specific results; Breger and Mc- the techniques used by the Behavior Therapy Gaugh's failure to do so makes their ex group have so quickly become encapsulated in cathedra condemnation meaningless. a dogmatic 'school.'") they proceed to dis- This lack of specificity, unfortunately, runs tinguish between the "three different posi- throughout their paper. tions." They also imply that behavior therapy On the critical side, their argument primar- is oversimplified (e.g. p. 346); in other parts ily consists of doubtful assertions presented as of the paper, it is said to be cumbersome (p. if they were self-evident truths. They often 348). Behavior therapists certainly pursue contradict themselves and also distort the simplicity both in theory and in practice; nature of behavior therapy. this seems to us to be a desirable aim in itself How, for instance, are they able to conclude and a welcome contrast to the convolutions that their quotations from the three case his- of other psychotherapeutic theories. This con- tories mentioned on page 353 are representa- trast is neatly, if inaccurately, demonstrated tive ("they seem representative of the prac- by Breger and McGaugh themselves. tices of behavior therapists")? As two of the quotations were in fact taken from cases The behaviorist looks at a neurotic and sees specific symptoms and anxiety. The psychodynamicist looks reported by one of the present writers, we at the same individual and sees a complex intra- and take this opportunity to point out the follow- interpersonal mode of functioning which may or ing facts. The two sentences quoted from the may not contain certain observable fears or certain treatment of patient A. G. (Rachman, 1959) behavioral symptoms such as compulsive motor acts. When the psychodynamicist describes a neurotic, his describe one incident which occurred during referent is a cohering component of the individual's the course of 22 interviews. At no time prior functioning . . . etc. [p. 349]. to the treatment of that patient, nor in the succeeding 6 years of work in this field, has a The doubtful assertions contained in the similar incident been encountered. Is this rep- paper by Breger and McGaugh are numerous resentative of behavior therapy as Breger and and cannot be reproduced in full. The follow- McGaugh claim, or is it a distortion caused ing examples could be multiplied without ef- by ignorance of therapeutic practice and of fort. " 'What is learned,' then, is not a me- REPLY TO BEHAVIOR THERAPY 167 chanical sequence of responses but rather, drawing attention to the deficiencies of learn- what needs to be done in order to achieve ing theory; most of their criticisms, however, some final event [p. 342]." Is all learning have been stated by others before them. In really an attempt at achievement? Have any event, a detailed consideration of all neurotic patients presumably also "learned their comments would be inappropriate here. what needs to be done" in order to achieve a Their arguments about the problem of per- neurosis? A conditioned PGR is, likewise, a ceptual constancy, for example, have been doubtful achievement. The list is endless, but amply analyzed by Taylor and Papert (1956) in any event who decides "what needs to be and Taylor (1962), and the restating of their done," or what a "final event" is, or when it complex arguments and experiments would be is achieved? The phrase "some final event" is out of place. The concept of reinforcement hardly a model of precise definition. is of course replete with complexities and Another doubtful assertion is the statement seems to us to be best regarded in terms of that Harlow's experiments with monkeys pro- Mowrer's two-factor theory (1960). The dif- vide a "much better animal analogue of hu- ficulties which arise from a consideration of man neuroses than those typically cited as central activities such as thinking were dis- experimental neuroses [p. 356]." This cava- cussed in an earlier review by Metzner (1961) lier dismissal of the mass of work in the sub- —one which they appear to have missed—and ject of experimental neuroses (see Broadhurst, again 2 years later (Metzner, 1964). 1960; Massermann, 1943; Wolpe, 1952; etc.) Certainly, it would be exceedingly foolish is neither explained nor justified by Breger to regard "learning theory" as a complete, and McGaugh, Their attitude to the evidence coherent, and final account of human be- seems to stem from a belief that "saying so, havior. This does not mean, however, that makes it so." people engaged in therapy should ignore the Their assertion that the "attribution of be- established findings and the best available havior change to specific learning techniques theories. Quite the contrary. We feel that they is entirely unwarranted" is also misguided and are obliged to use these findings and ideas appears to be based on ignorance of the rele- wherever it is feasible to do so. Furthermore, vant evidence. No mention is made of the four of the main techniques used in behavior experiments of Lazarus (1961), Wolpe therapy (desensitization, aversion treatment, (1952), Eysenck (1964), King, Armitage, & operant retraining, and the "bell-and-pad" Tilton (1960), Lovibond (1962), or of the method) were derived solely or very largely studies of Ayllon and his co-workers (1959, from these findings and ideas. It is highly im- 1963). They will further be surprised by the probable that these methods would have been accumulation of recent studies which bear on developed to their present stage and form sui this point and which, with minor exceptions, generis. corroborate the viewpoint of behavior thera- Perhaps the most revealing reflection of the pists (see Eysenck, 1964; Eysenck & Rach- attitude of Breger and McGaugh to the en- man, 1965; Krasner & Ullmann, 1965; Each- tire subject of behavior modification is con- man, 1965; Ullmann & Krasner, 1965, among tained in their curiously unimaginative de- others). The currently available evidence will, scription of Skinner's work as "exercises in we feel certain, convince all but the most bi- animal training." Some notion of the wider ased workers that the methods of behavior significance of the pecking of pigeons can therapy are indeed effective in the modifica- easily be ascertained from the work of Staats tion of neurotic behavior. Not all the meth- and Staats (1964) and Krasner and Ullmann ods are successful; nor is it yet possible to (1965) among others. treat all types of disturbances successfully. Not merely doubtful, but definitely wrong, There is an immense amount of develop- is the assertion that behavior therapists mental work and experimentation which re- have partly avoided this problem [generality] by mains to be done, but a degree of optimism is focusing their attention on those neuroses that can not misplaced. be described in terms of specific symptoms (bed- Breger and McGaugh are surely correct in wetting, if this is a neurosis, tics, specific phobias, 168 S. RACHMAN AND H. J. EYSENCK etc.) and have tended to ignore those conditions view of the behavior-therapy literature. which do not fit their model, such as neurotic de- Rather, it is based on a survey of all the pressions, general unhappiness, obsessional disorders, and the kinds of persistent interpersonal entangle- studies reported in the two reviews that have ments that characterize so many neurotics [p. 348], appeared (Bandura, 1961; Grossberg, 1964)." This seems to us an inexcusable defect. Be- This is wrong factually in two respects. havior therapy may be said to have begun Firstly, a large number of patients with inter- properly around 1958-59, with the publica- personal anxiety and a moderate number of tion of the Wolpe (1958) book and Eysenck's obsessional patients have in fact been treated (1959) paper proposing the name "behavior (e.g., Lazarus, 1963; Wolpe, 19S8). Secondly, therapy" and stating in some detail its nature Wolpe (1958) and most other therapists did and purpose. Given that controlled experi- not focus their attention on anything in par- ments take several years to execute, write up, ticular other than the symptoms presented by and publish, it is clear why summaries of the their patients, who were not selected or chosen field published in 1961 or even 1964 would by the therapists. Others, like Lovibond not be adequate substantiation for such a far- (1962), Lang and Lazowik (1963), Yates reaching condemnation of a whole branch (19S8), and the present writers (Eysenck & of study. Familiarity with Behaviour Re- Rachman, 1965) have indeed experimented search and Therapy (Pergamon Press), a with specific symptoms, but not in order to journal concerned entirely with research in avoid the theoretical problem of generality— behavior therapy and nowhere referred to by the reason was simply that if specific predic- Breger and McGaugh, would have served ade- tions are to be tested, then responses must by quately to bring them up to date in this field. preference be accurately measurable. It is (It may be added that several controlled possible to count the rate at which tics occur, trials of behavior therapy are in progress, to the number of wet nights per week, or the our knowledge; three of them prospective and strength of a snake phobia; therefore, it is one retrospective, Marks and Gelder, 1965, in possible to experiment with the effect of the Maudsley Hospital alone.) Even the Ey- changing various independent variables on senck and Rachman (1965) textbook, which these dependent variables. This choice there- went to press 6 months earlier than the fore permits the testing of quite precisely the Breger and McGaugh article, is very much sort of predictions which according to Breger more up to date than their account (addi- and McGaugh cannot be made from learning tional evidence is discussed by Cooke, 1965; theory principles; it would be interesting' to Davison, 1965; Paul, 1964; Rachman, hear their explanation of just how it is that 1965a, 1965b). verification has usually followed prediction 1 We must say, indeed, that we feel quite Finally, we turn to criticisms of "claims of strongly that the burden of Breger and success." Breger and McGaugh state that "the McGaugh's criticism is entirely misplaced. most striking thing about this large body of In half a dozen years a relatively small num- studies is that they are almost all case studies. ber of behavior therapists, with little official A careful reading of the original sources re- support and often against the most hostile veals that only one study (Lang & Lazowik, opposition, have succeeded in carrying out 1963) is a controlled experiment [p. 351]." more controlled (and better controlled) This is simply not an accurate statement of studies than have hundreds of psychiatrists the position as it obtained at the time of and psychoanalysts in 60 years, with all the writing of the Breger and McGaugh review financial resources and the prestige so readily (June 1964 is the acceptance date). They do available to them. Even so, we do not con- not refer to the work of Cooper (1963), sider our studies as in any way beyond criti- Lazarus (1961), Ellis (1964), Anker and cism, nor do we feel that they go nearly far Walsh (1961), Lovibond (1962), and others, enough, or are sufficient to establish behavior and their horizon is clearly bounded, as they therapy as superior to other types of therapy themselves admit by the fact that theirs in any definitive way. We have concluded "does not purport to be a comprehensive re- in our textbook (Eysenck & Rachman, 1965) REPLY TO BEHAVIOR THERAPY 169 that "the routine use of these methods is LAZARUS, A. Group therapy of phobic disorders. undoubtedly not yet feasible; it must await Journal of Abnormal and Social Psychology, 1961, 63, 504-512. further improvement of techniques and defini- LAZARUS, A. The results of behaviour therapy in 126 tive evidence of superiority over other avail- cases of severe neurosis. Behaviour Research and able techniques [p. xji]." This is still our view, Therapy, 1963, 1, 65-78. and nothing said by Breger and McGaugh LOVIBOND, S. H. Conditioning and enuresis. Oxford: Pergamon Press, 1962. would seem to contradict this summary or MAcCoRQUODALE, R., & MEEHL, P. G. Edward C. throw doubt on its accuracy. To call views Tolman. In, Modern learning theory. New York: of this kind "dogmatic" seems a curious mis- Appleton-Century-Crofts, 1954. Pp. 177-266. understanding of the meaning of the word. MARKS, L, & GELDER, M. A controlled retrospective study of behaviour therapy in phobic patients. REFERENCES British Journal of Psychiatry, 1965, 111, 561-573. MASSERMAN, J. H. Behavior and neuroses. Chicago: ANKER, J., & WALSH, R. Group psychotherapy, a Chicago Univer. Press, 1943. special activity program and group structure in METZNER, R. Learning theory and the therapy of the the treatment of chronic schizophrenics. Journal neuroses. British Journal of Psychology Mono- of Consulting Psychology, 1961, 25, 476-481. graph Supplement, 1961, 33. ATKINSON, J. W. An introduction to motivation. METZNER, R. Re-evaluation of Wolpe and Dollard/ New York: Van Nostrand, 1964. Miller, Behaviour Research and Therapy, 1964, 1, AYI.LON, T. Intensive treatment of psychotic behav- 213-217. ior by stimulus satiation and food reinforcement. MOWRER, O. H. Learning therapy and behavior. New Behaviour Research and Therapy, 1963, 1, 47-58. York: Wiley, 1960. AYIXON, T., & MICHAEL, J. The psychiatric nurse as PAUL, G. L. Effects of insight, desensitization and a behavioral engineer. Journal of the Experimental attention-placebo treatment of anxiety. Unpub- Analysis of Behavior, 19S9, 2, 323-334. lished doctoral dissertation, University of Illinois, BREGER, L., & McGAUOH, J. Critique and reformula- 1964. tion of "learning-theory" approaches to psycho- RACHMAN, S. The treatment of anxiety and phobic therapy and neurosis. Psychological Bulletin, 1965, reactions by systematic desensitization psycho- 63, 338-3S8. therapy. Journal of Abnormal and Social Psychol- BROADHURST, P. Abnormal animal behavior. In H. ogy, 1959, 102, 421-427. J. Eysenck (Ed.), Handbook of abnormal psychol- RACHMAN, S. The current status of behavior therapy. ogy. London: Pitmans, 1960. Pp. 726-763. Archives of General Psychiatry, 1965, 13, 418-423. COOKE, G. The efficacy of two desensitization pro- (a) cedures: An analogue study. Behaviour Research RACHMAN, S. Studies in desensitization: I. The sepa- and Therapy, 1965, in press. rate effects of relaxation and desensitization. Be- COOPER, J. E. A study of behavior therapy in 30 haviour Research and Therapy, 1965, 3, 245-252. psychiatric patients. The Lancet, 1963, 1, 411-415. (b) DAVISON, G. The influence of systematic desensitiza- STAATS, A., & STAATS, C. Complex human behavior. tion, relaxation, and graded exposure to imaginal New York: Wiley, 1964. stimuli in the modification of phobic behaviour. TAYLOR, J. G. The behavioral basis of perception. Unpublished doctoral dissertation, Stanford Uni- New Haven: Yale Univer. Press, 1962. versity, 1965. TAYLOR, J. G., & PAPERT, S. A theory of perceptual ELLIS, A. Rational psychotherapy. In H. J. Eysenck constancy. British Journal of Psychology, 1956, 47, (Ed.), Experiments in behaviour therapy. Oxford: 216-224. Pergamon Press, 1964. Pp. 287-323. THOMSON, SIR G. The inspiration of science. Oxford: EYSENCK, H. J. Learning theory and behaviour University Press, 1961. therapy. Journal of Mental Science, 1959, 105, ULLMANN, L., & KRASNER, L, Case studies in behavior 61-74. modification. New York: Holt, Rinehart, & Win- EYSENCK, H. J. (Ed.) Experiments in behaviour ston, 1965. therapy. Oxford: Pergamon Press, 1964. WOLPE, J. Experimental neuroses as learned be- EYSENCK, H. J., & RACHMAN, S. The causes and haviour. British Journal of Psychology, 1952, 43, cures of neurosis. San Diego: Knapp, 1965. 243-261. KING, G. F., ARMITAOE, S., & TILTON, J. A thera- WOLPE, J. Psychotherapy by reciprocal inhibition. peutic approach to schizophrenics of extreme Stanford: Stanford Univer. Press, 1958. pathology. Journal of Abnormal and Social Psy- YATES, A. J. The application of learning theory to chology, 1960, 61, 276-286. the treatment of tics. Journal of Abnormal and KRASNER, L., & ULLMAN, L. Research in behavior Social Psychology, 1958, 56, 175-182. modification. New York: Holt, Rinehart, & Win- YOUNG, G., & TURNER, R. K. CNS stimulant drugs ston, 1965. and conditioning treatment of nocturnal enuresis. LANG, P., & LAZOWIK, R. D. The experimental Behaviour Research and Therapy, 1965, 3, 93-102. desensitization of a phobia. Journal of Abnormal and Social Psychology, 1963, 66, 519-525. (Received July 27, 1965)