In the introduction to this book, the history of behaviour therapy is discussed. In the following three chapters we examine the roles of reinforcement strategies and how they may be used in clinical settings. This understanding of reinforcement and its shaping of human behaviour is an important component when we examine the treatment of anxiety disorders and depression later in the book.

Reinforcement and operant conditioning

Much of this and the subsequent chapter is about techniques based on operant conditioning, a ‘sticks and carrots’ term. These principles are not always as obvious to apply as may seem on first sight. First there needs to be an understanding of reinforcement, the process of strengthening a directly measurable dimension of behaviour (the most obvious example will be covered in Chapter 6 examining exposure treatments). Anxiety is unpleasant and so when in the presence of an object or situation which provokes fear, most people will try to escape the anxiety by either running away or, in the case of OCD, by performing an anxiety-relieving compulsion. Both running away and performing an anxiolytic ritual cause the anxiety to reduce. This reduction in anxiety acts as a positive reinforcement, strengthening the likelihood of the individual escaping or ritualising in the future. By far the most common type of reinforcer to be used in clinical practice is positive reinforcement or rewarding a certain type of behaviour. The most common form of reward is social reinforcement or praise and encouragement. However, some individuals, such as people with some forms of autism, may not respond to praise and then alternative rewards need to be found. Premack's principle (1959) can be used to address this.