DESCRIPTION OF THE STRATEGY

Counterconditioning, as a behavioral intervention for emotional or behavioral problems in

children, involves the reduction of a target behavior (CR1) through the introduction competing
response (CR2). This may be accomplished by presenting a conditioned stimulus (CS2) for the
competing response at the same time as the previously conditioned stimulus (CS1) for the
target behavior. Alternatively, the target behavior may be ignored while the competing
response is reinforced. In other words, an undesired emotional response or behavior is
reduced over time by the repeated practice of an incompatible emotion or behavior. For
example, it has been demonstrated that anger can be eliminated with the use of humor,
presumably because humor induces an incompatible emotion state to that of anger. Unwanted
behaviors can also be extinguished through the use of counter-conditioning principles. For
instance, an undesired habit such as nail biting can be eliminated with the induction of an
incompatible response (e.g., sitting on one's hands).
Historically, the term counterconditioning is derived from Pavlovian or higher-order classical
conditioning principles. In 1912, one of Ivan Pavlov's students, M. N. Erofeeva, discovered
that if a mild electric shock (CS1) was applied to one part of a dog's body in temporal
contiguity with food delivery (CS2), defensive behaviors (CR1) were eliminated and replaced
by a conditioned salivary response (CR2). This effect was termed counterconditioning and it
appeared that conditioning methods could neutralize the effects of aversive stimulation when
paired with an appetitive response. In 1942, Edwin R. Guthrie described two methods for
producing associative inhibition or counterconditioning. He first suggested that stimuli (CS1)
could be presented in a weakened form so that they did not evoke the undesired established
response (CR1), but rather elicited some alternative or antagonistic behavior (CR2). He argued
that gradually increasing the strength of the stimuli would lead to the associative inhibition of
the former response to these stimuli. Similar to other theorists, Guthrie's second proposed
method for producing counterconditioning was to deliberately elicit an antagonistic response
(CR2) for the subject in the presence of the stimulus (CS1) so that the old response (CR1) could
not be called forth.
In 1958, Joseph Wolpe used the concept of counterconditioning to rationalize the positive
effects observed from systematic desensitization. He described systematic desensitization as
the reduction of anxious responding through reciprocal inhibition whereby a response
incompatible with anxiety (e.g., deep muscle relaxation) can be made to occur in the presence
of anxiety-eliciting stimuli. As a result of this incompatible response, the bond between the
anxiety response and its eliciting stimuli is weakened or eliminated. Hence, extinction of the
fear response occurs as associative inhibition or the learning of an incompatible response
proceeds. Wolpe argued that exposure to the feared stimuli alone (i.e., without replacing the
anxious response with an incompatible response) is sometimes not an effective therapeutic
method of its own accord. Although counterconditioning techniques in behavior therapy have
been used for a variety of disorders, they are most commonly discussed in the treatment of
anxiety.
In the treatment of anxiety, counterconditioning procedures are used to extinguish anxiousover responding to a particular stimulus. For example, in the treatment of a dog phobia, the
goal is to decrease anxious responses (CR1) in the presence of dogs (CS1). To recondition or
countercondition the fear response, an incompatible response (CR2) is elicited by a new
stimulus (CS2). A relaxed state is incompatible with anxiety because it is impossible to be both
relaxed (i.e., muscles relaxed, slow heart rate) and anxious (i.e., muscles tense, fast heart rate)

at the same time. Thus, with the aim of decreasing fear to dogs, the child would first be taught
how to achieve deep relaxation. Then when in a relaxed state, the child would be exposed to
dog-related stimuli. Typically, initial exposure consists of less anxiety-provoking stimuli (e.g.,
pictures of dogs) with later exposure consisting of intensely anxiety-provoking stimuli (e.g.,
petting a large dog). As a result of repeated exposure to the previously feared stimuli (dogs;
CS1) when in a relaxed state (CR2), the original fear response (CR1) is replaced.
Counterconditioning is also discussed in the context of operant extinction. Operant extinction
is a procedure for reducing the frequency with which a target behavior occurs by consistently
withholding reinforcement following the occurrence of the target behavior. In this context,
counterconditioning is related to the procedure of differential reinforcement of incompatible
behavior (DRI). DRI refers to selectively ignoring a target behavior to produce operant
extinction while simultaneously providing reinforcement upon occurrences of an alternative
behavior. For example, unwanted stereotypic behaviors such as body rocking or hand flapping
can be eliminated by rewarding the occurrence of an alternative response (e.g., sitting still or
clasping one's hands) that is incompatible to the unwanted target behavior.

RESEARCH BASIS
Although it is unusual to see counterconditioning used as a stand-alone treatment for
psychological problems, many empirically supported treatment packages contain components
that involve counterconditioning. As noted elsewhere, the primary exception is that the
treatment of simple phobias often involves exposure to the feared stimulus paired with
alternative responses or therapist praise.
Experimental evidence has also supported the positive role of counterconditioning in operant
extinction. Studies have demonstrated that a target behavior decreases in frequency more
rapidly when an alternative behavior is simultaneously reinforced rather than solely
withholding contingent reinforcement. However, some clinic studies have suggested that
counterconditioning procedures do not increase overall therapeutic benefits up and beyond
those achieved through exposure alone.
Finally, with regard to systematic desensitization, research has demonstrated that the client
must be able to engage in some degree of vivid imagery for the procedure to be effective.
Vivid imagery is the reenactment of a scene in one's imagination with some sense of realness
and clarity. It is also important that the client be able to experience the affect that usually
accompanies these scenes in real life during vivid imagery. Research suggests that patients
who have had psychotic episodes and are in remission or who have a schizoid personality type
are less capable of vivid imagery than others.

RELEVANT TARGET POPULATIONS AND

EXCEPTIONS
Theoretically, counterconditioning procedures can be used for all populations and disorders in
which there is an unwanted classically conditioned behavior or a positively reinforced
behavior targeted for operant extinction. In the last five decades, researchers have examined
the therapeutic effects of counterconditioning procedures for a wide range of problem
behaviors and psychological disorders, including undesired habits, elimination disorders, drug
abuse, chronic pain, and self-mutilation. However, as stated above, counterconditioning

procedures are most often used in the treatment of anxiety disorders, including specific
phobias, panic disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder,
and generalized anxiety disorder.
Some recent applications of counterconditioning procedures in treatment include the
treatment of comorbid PTSD-depression as well as the treatment of behavioral distress for
invasive pediatric procedures. For comorbid PTSD-depression, in addition to the standard
well-established treatment of relaxation and exposure to feared stimuli, counterconditioning
was used wherein the client was instructed to recall past happy events during exposure to the
traumatic stimuli. Another recent application of counterconditioning procedures is in the
treatment of behavioral distress for invasive pediatric procedures. Preferred activities were
paired with medical stimuli, and differential positive reinforcement was provided contingent
on engagement with the preferred activities. As described, the counterconditioning procedures
used in these recent applications were supplemental to the already well-established treatment.

COMPLICATIONS
Although counterconditioning procedures have been found effective in the treatment of
numerous disorders, generally as part of a more comprehensive treatment package, there are
several problems or complications a therapist will want to be aware of before instituting these
procedures in treatment. One complication of counterconditioning techniques occurs when the
client is a poor reporter. In other words, if a child or his or her caregiver is unable to
accurately define what, where, and when the identified problem occurs, it is very difficult for
the therapist to assemble an appropriate and effective counterconditioning procedure.
Moreover, if the child has several diffuse problems such as multiple fears or a comorbid
problem such as depression, counterconditioning techniques may be less effective for one
specific problem.
Another complication of counterconditioning procedures is the choice of inappropriate or
inadequate replacement responses. For example, some clients may feel tense, uncomfortable,
or unnatural when relaxation is induced as a replacement response to fear. There are a number
of clients who associate becoming relaxed in front of another person with being more
vulnerable to being attacked or compromised in some way. Thus, it is important that the
therapist find an appropriate incompatible response for the client. For instance, some
researchers have found that inducing anger as opposed to relaxation can help alleviate anxious
responding.
A third complication of counterconditioning techniques is the importance of the context in
which the conditioning occurs. In other words, if treatment takes place in one specific context
such as a psychologist's office, generalization of treatment effects to other contexts may not
occur unless the therapist is careful to conduct conditioning sessions in several contexts.
Finally, although research has found that it is important to reinforce the child for employing
the incompatible response (e.g., maintaining a relaxed state when presented with a feared
stimulus), the therapist must be conscious that the child is truly reinforcing the desired
behavior. For example, a therapist may accidentally reinforce a child for not reporting distress
due to a desire to please the therapist rather than reinforce the positive performance of the
alternative behavior. New technological advancements in the measurement of physiological
states and biofeedback may help prevent this kind of false reporting. Physiological measures
such as heart rate and galvanic skin response can be used to determine whether or not

therapeutic activities effectively induce relaxation. Biofeedback-assisted relaxation training

was developed as a therapeutic technique designed to help clients become better aware of
their own arousal state as well as provide an accurate reading of the client's true arousal state
to the therapist, thus decreasing the possibility of reinforcing nonreporting.

CASE ILLUSTRATION
Dagny was a 9-year-old female from a traditional, middle-class, suburban family. Her
mother sought individual treatment for Dagny at an outpatient psychology clinic for increased
family conflict, stubborn refusal to participate in family events, and periodic bouts of temper.
Clinical assessment revealed that the family conflict was of recent onset, within 4 to 6 weeks,
and initially focused upon the relationship of Dagny with her older brother, Howard. These
problems had persisted somewhat longer than was typical when the two siblings were
fighting, and the stress was beginning to increase irritation among other family members.
Antecedent assessment found that the conflict centered on Dagny's refusal to attend Howard's
soccer games. When Dagny was required to attend the soccer games, she would refuse to get
out of the family car and throw tantrums during which she would cry, kick, and scream.
This tantrumming was viewed as embarrassing and frustrating to other family members.
Behavioral assessment with Dagny uncovered that Dagny's avoidance and agitation were
associated with a fear of bees. Dagny noted that during one of Howard's earlier soccer games,
she had witnessed multiple bees circling around a nearby garbage can. She did not report any
history of being stung by bees but noted that she experienced intense negative emotion with a
physiological reaction when she saw them. Since witnessing the bees at the soccer game,
Dagny sought to avoid further encounters with the bees by avoiding the soccer games or
refusing to leave the car at the games. Dagny's negative emotion and arousal were
conceptualized as conditioned fear responses (CR1) associated with the presence of bees (CS1)
and anything associated with bees (e.g., garbage cans on the soccer field, attending soccer
games).
Treatment for Dagny involved several components that included psychoeducation about fear
and anxiety, education about bees and their behavior, training with Dagny's parents about
strategies for managing her noncompliance while supporting her efforts to cope with her fear,
and systematic desensitization. The systematic desensitization component involved counterconditioning Dagny's fear through the use of relaxation as an alternative response (CR2).
A hierarchy of fear situations was constructed of Dagny's fears. Roughly speaking, Dagny
presented relatively little fear response to insects other than bees, wasps, and hornets, and
noted that when looking at still photographs of bees, she thought that they were gross but
did not experience fear. Videos demonstrating bees buzzing and in motion produced a stronger
sense of discomfort and gave her the creeps but did not elicit fear or behavioral avoidance.
Next in the hierarchy was watching another individual holding a jar with a live bee from a
distance, which was associated with some fear and mild efforts to escape or avoid the
situation. Even more intense fear resulted from the prospect of being in close proximity to a
bee in a jar, watching another person in a room with a bee with its stinger removed, being in a
room with a bee with its stinger removed, and being near a live bee in an uncontrolled
situation.
Once the fear hierarchy was constructed, Dagny was trained in progressive muscle relaxation.
This involved teaching Dagny to contract and relax various muscles groups and to learn to

discriminate the tense from the relaxed states. Relaxation training also involved a guided
imagery procedure to incorporate visualization skills and to condition images of situations
that Dagny found relaxing. Once Dagny demonstrated skills in relaxation, she then practiced
maintaining relaxation while she progressively imagined the increasingly arousing situations
from her fear hierarchy. Prior to proceeding to the next more distressing situation, Dagny
demonstrated the capacity to remain relaxed while imagining the fearful situation. Once
Dagny demonstrated relaxation mastery during imaginal exposure, she then practiced
remaining relaxed while she was actually exposed to the feared situations.
Dagny made considerable progress in managing her fear of bees, although she remained
apprehensive about uncontrolled situations where she was close enough to bees to hear them
buzzing or see the details of their body. The family conflict improved fairly rapidly, once her
family understood that Dagny's reaction was associated with her fear of bees, not with a
refusal to support and participate in family activities. Dagny's parents were also able to take
short-term steps to manage Dagny's potential exposure to bees (e.g., park the car a reasonable
distance from bee-infested garbage cans, watch the soccer games from a place on the field
with little bee exposure) until her fear was mastered. These steps reduced experiences of
embarrassment and direct defiance of parental authority.
Eric L. Daleiden and Charmaine K. Higa
Further Reading

Entry Citation:
Daleiden, Eric L., and Charmaine K. Higa. "Counterconditioning." Encyclopedia of Behavior
Modification and Cognitive Behavior Therapy. 2007. SAGE Publications. 15 Apr. 2008.
<http://sage-ereference.com/cbt/Article_n2036.html>.