Adv. Behav. Res. Ther
Adv. Behav. Res. Ther
Adv. Behav. Res. Ther
00/0
@PergamonPressLtd. 1978.Printed in Great Britain.
G. Terence Wilson
Graduate Schoolof Applied and ProfessionalPsychology,RutgersUniversity,Piscataway,NJ08854.U.S.A.
(Received My 1978)
Behavior therapy was once defined as the application of “modem ‘learning theory” to
clinical disorders (Eysenck, 1959). Critics soon delighted in pointing out that there was no
single, unified learning theory; that the links between laboratory conditioning research and
clinical practice were often tenuous at best; and that the use of the terminology of
conditioning theory to describe procedures and explain causal processes was more
metaphorical than paradigmatic (e.g. Breger and McGaugh, 1965; London, 1972).
Although some defenses about behavior therapy being derived from conditioning principles
were offered (e.g. Eysenck, 1970; Wolpe, 1969), the field ‘developed and diversified to the
point where to&y simplistic definitions in terms of “learning the&y” are outdated and
widely rejected. Contemporary behavior therapy is marked by a lively diversity of views, a
broad range of heterogeneous procedures with different theoretical rationales, different
research strategies, and open debate about conceptual bases, methodological requirements
and evidence of efficacy. In short, there is no clearly agreed upon or commonly accepted
definition of behavior therapy. Broadly conceived of, the different approaches in
contemporary behavior therapy include applied behavior analysis, a neobehavioristic
mediational model, social learning theory, cognitive behavior modification, and
multimodal behavior therapy (Agras et al., 1977; Kazdin and Wilson, 1978).
In the 20 years since Eysenck (1959) and Wolpe (1958) formally derived behavior therapy
from learning theory, the field has experienced remarkable growth. Once a beleaguered
minority movement, behavior therapy has been elevated to an accepted part of the
therapeutic establishment (e.g. American Psychiatric Association, 1973; Risley, 1977).
Initially applied to a limited range of disorders, behavioral interventions have been extended
to a bewildering array of diverse psychological, psychiatric, medical, educational, industrial
and community settings (e.g. Franks and Wilson, 1973, 1976, 1977; Kazdin and Wilson,
1978; Leitenberg, 1976b; Williams and Gentry, 1977) and have shown impressive efficacy in
many of these instances (e.g. Kazdin and Wilson, 1978; Rachman and Wilson, (in press)).
This growth has been most evident in the development of new techniques and the continuing
refinement of existing strategies in the clinicalpractice and evaluation of behavior therapy
(e.g. Azrin, 1977; Goldfried and Davison, 1976). There can be little doubt that the
development of well-defined, innovative therapeutic techniques for specific problems has
contributed greatly to whatever clinical popularity behavior therapy enjoys. Methodo-
logically, .the evaluation of the outcome of behavioral methods has become increasingly
sophisticated. New applied research strategies have been pioneered (e.g. Hersen and
217
218 G. T. Wilson
Barlow, 1976; Kazdin, (in press)) while the amount of research continues to burgeon.
Behavioral research and therapy are alive and well.
But what about theory? In part because of the often justifiable criticism of narrow
conceptions of behavior therapy in terms of conditioning principles and in the course of the
technological expansion and broadening applicability of behavioral methods, the
importance of theory has often been lost sight of, ignored or even denounced as the clinically
irrelevant plaything of the ivory-tower-dwelling academic. A commitment to a squarely
pragmatic, technically eclectic therapeutic stance with little if any concern for theoretical
niceties characterizes the positions of so varied a group of influential figures in behavior
therapy as Azrin (1977), Lazarus (1977) and Marks (1976), among others. Unquestionably,
the therapeutic yield from this sort of pragmatic approach has often been rich, Given the
current incomplete state of our art, the practitioner frequently has little choice but to adopt a
flexible, pragmatic approach. However, acknowledging the exigencies of clinical practice
must not undermine a recognition of the potentially important role theory might play in
directing clinical research and in improving upon current therapeutic strategies.
*The banality of the frequently heard clinician’s retort, “I use whatever works”, should be apparent from this
circumstance.
Towards a Unifying Theory of Behavioral Change 219
Baer et al., 1968). It is doubtful, however, that methodological criteria alone can define
behavior therapy or provide a basis for the choice of therapeutic strategies in ylinical
practice. One need only examine the theoretical differences between different approaches
within the current compass of behavior therapy. Although they share common
methodological priorities and prize rigorous experimental evaluation of methods, applied
behavior analysis and social learning theory, for example, differ with respect to their
conceptualizations of a model of human nature, causal processes in psychological
functioning, and their implications for a technology of behavior change (e.g. Bandura, 1976,
1977b, (in press); Catania, 1975, 1976: Goldiamond, 1976; Mahoney, 1974). It is a fact that
theoretical issues and postures help defme behavior therapy and influence basic and applied
research. The inescapable influence of theory (explicit or otherwise) on therapy is noted by
Franks (1969): “How the behavior therapist practices (including his choice of techniques, his
approach to the problems of genera/strategy and his specific relationships with his patient) thus
depen& both upon his explicit theoretical orientation and upon his impIicit philosophical and
cultural milieu” (p. 21).
Despite what at first blush appears to be an anti-theoretical orientation, even the doctrine
of technical eclecticism is far from unfettered by implicit theoretical constraints. Thus
Lazarus (1971) has noted that the therapist’s choice of techniques is determined by “well-
conceived guiding principles and general theories of human behavior” (p. 39). The problem
with this position is that it is not always clear what these guiding principles are (cf. Franks
and Wilson, 1975,1976). Similarly, Azrin (1977), in making the case for the insufficiency of
reinforcement concepts as the basis for an outcome-oriented therapeutic approach, goes
beyond the strict operant conditioning approach in advocating the use of “emergent
principles” of behavior change. Precisely how these principles emerge from reinforcement
theory and what their boundary conditions are, among other questions, remain to be shown.
The clarification of these theoretical issues obviously has direct relevance to therapeutic
practice. With current behavioral approaches increasingly embracing what at times appear
to be divergent methods, conflicting concepts, rival rationales and apparently lacking a
uniform philosophy, one is reminded of the adage that there is nothing quite so practical as a
good theory that might bring order to what may at times appear to be confusion.
Although he accepts the scientific importance of theory in the general case, London
(1972) nevertheless advocated the end of ideology in behavior modification. His premise
was twofold: (a) current theory in behavior modification was not Very good, and (b) no
theory was useful for the development of the field at that time. In contrast to London’s
(1972) thesis the present paper proposes that Bandura’s (1977a) self-efficacy theory is an
example of the sort of theory that is (a) scientifically valuable; and (b) is extremely timely
and useful for the development of present-day behavior therapy.
Briefly, a scientific theory should (a) accommodate and integrate the currently known
facts of behavior change; (b) be stated so that it is testable - experiments can support, or
more importantly, d&confirm it; (c) it should be heuristic in stimulating novel research and
prompting therapeutic innovations; and (d) it should compare favorably with existing
theoretical alternatives. The following is a summary evaluation of Bandura’s (1977a) self-
efficacy theory in terms of each of these criteria.
The current conceptual models of behavior therapy can each 3e said to place primary
emphasis on one dimension of psychological functioning to the relative neglect of the others.
Thus applied behavior analysis focuses almost exclusively on observable, overt behavior as
typified by the Journal of Applied Behavior Analysis. In his neo-behavioristic, S-R
220 G. T. Wilson
Is it testable?
The theory generates specific predictions concerning the initiation, generalization and
maintenance of behavior change. Testing the theory requires measurement of self-efftcacy
expectations that is independent of behavioral performance. Subjects’ self-reports of
perceived efficacy define this independent measure. It is in this connection that problems in
testing the generalizability of the theory to different behaviors across different conditions
might arise. *
In testing predictions from self-efficacy theory, as Bandura (1977a) observes, it is
important that subjects have a clear understanding and full knowledge of their performance
requirements and the situational circumstances. To the extent that these are ill-defined,
discrepancies between behavior and efficacy expectations are likely to occur. The tightly
controlled laboratory conditions under which Bandura has tested the theory satisfy these
conditions of testing. Subjects knew exactly what they had to do under predictable
circumstances, i.e. they were knowledgeable about the nature of the feared object (the
snake). Even here, however, Bandura et al. (1977) note that while efficacy expectations were
accurate predictors of approach behavior, there was more of a discrepancy between
expectation and behavior during the generalization test with the “unfamiliar snake” than
the test with the familiar snake.
Interestingly, from a measurement point of view, this issue highlights the whole question
of obtaining valid self-reports, an increasingly important concern as we acknowledge the
necessity of multiple response measures instead of a narrow reliance on non-verbal overt
behavior (e.g. Rachman and Hodgson, 1974). At a minimum, accurate self-report will
depend upon a knowledge of the specific cues that govern the target behavior and the
perceived consequences that the report has on future behavior. This knowledge will
necessarily be based on exposure to the relevant cues. While this can often be accomplished
symbolically by having the person imagine the feared situation, there will be times when
only actual exposure to the feared situation will suffice. Beck (1976), for example, in
discussing what he calls the client’s “subjective estimate of the probabilities of harm”, notes
that they shift as a function of exposure to the feared situation. Under protective
circumstances removed from the threatening situation (e.g. the trusted therapist’s “safe”
offrce) the client can readily tigree that the probability of harm in approaching the feared
situation is minimal., Even imagery of experiencing the threatening situation might evoke
little or no anxiety. However, the closer the client comes to making actual contact with the
feared situation, the greater the self-reported estimates of fear.
To summarize, testing the predictions of self-efficacy theory will require specific measure
of well-defined responses in relation to particular situations. While practical difficulties
might be encountered in meeting these conditions, the task does not appear to be
insuperable. After all, this is what in principle behavioral assessment is all about.
Is it heuristic?
Self-efficacy theory has implications for broader conceptual schemes of human behavior,
basic and applied research, and clinical practice. It is in this domain of stimulating and
guiding the discovery of novel facts and treatment strategies that Bandura’s (1977a) theory
is likely to prove invaluable.
*This is not a criticism of so-called “analogue ” research, the value of which is discussed by Kazdin and Wilson
(1978). Controlled laboratory research of the sort reported by Bandura (1977a) is an appropriate means of pilot
testing and developing a new theory of behavior change.
222 G. T. Wilson
certainty of a return to uncontrollable drinking after a single drink. As a result, the often
demoralizing abruptness with which a client who has been abstinent even for a lengthy
period of time can revert to addictive drinking is explicable on grounds other than the
biological inevitability of “first drink then drunk”. Firstly, the fact that the client has been
abstinent even for a period of years does not necessarily mean that (s)he has developed a
sense of self-efficacy about alcohol. Secondly, the corollary of minimal or nonexistent
efficacy expectations is that coping behavior in the face of the inevitable difficulties the client
experiences in attempting to remain sober in the natural environment will be easily
extinguished. Finally, the outcome expectation of “first drink then drunk’* can function as a
self-fulfilling prophecy. Of course, expectations alone cannot account for the reasons for
relapse in all alcoholics, A complete social learning analysis requires consideration, among
other factors, of the individual’s incentives for sobriety and his or her requisite behavioral
skills for coping with the interpersonal difficulties of returning to continued sobriety: Given
the necessary behavioral skills and adequate incentives, however, efficacy expectations may
be a major determinant of the maintenance of treatment-produced improvement.
As for treatment, both symbolic and performance-based methods can be used to develop
realistic efficacy expectations that will minimize the likelihood of a return to addictive
drinking following the occasional “slip.” The treatment procedure would not be dissimilar
to the participant modeling or in viva exposure methods used with considerable success in
the treatment of phobics (Bandura, 1977a) and obsessive-compulsive disorders (Rachman
and Hodgson, (in press)). In this procedure the client is systematically exposed to the full
range of stimuli that elicit the problem behavior to extinguish maladaptive avoidance
responses (i.e. excessive drinking) and to substitute constructive coping behaviors. More
controversially the logic of this approach dictates what Marlatt (in press) has called a
“programmed relapse”. * With appropriate preparation and instruction, the client would
deliberately take a drink in the presence of the cues that were formerly discriminative stimuli
for alcohol abuse. The goal is to establish self-directed coping skills and efficacy
expectations that reduce the probability of any subsequent transgression serving as a
reaffirmation of a perceived inability to remain sober, a sense of helplessness and a stimulus
for further drinking.
The adequacy of the self-efficacy theory can be analyzed from several different
perspectives. For example, it can be compared with Seligman’s (1975) theory of learned
helplessness in accounting for a wide range of different behaviors. Such an extended analysis
is beyond the confines of the present paper which is addressed to the more limited question
of how well Bandura’s (1977a) theory compared to conditioning theories in explaining the
effects of specific fear reduction techniques in behavior therapy.
The neobehaviorikic S-R conditioning model. The proof of the pudding, of course, is in the
eating. Since Bandura (1977a) reports the results of only two studies that were designed to
evaluate the self-efficacy theory any conclusions about the superiority of the theory must be
regarded as tentative at best. With this reservation in mind, one can look at Bandura and
Adams’ (in press) findings indicating the superior explanatory power of the self-efficacy
theory compared to two-factor conditioning theory.? In fact, the conditioning theory on
*Marlatt (in press) has drawn upon cognitive dissonance and attribution theory in proposing a cognitive
behavioral analysis of relapse phenomena in addictive behaviors. The practical implications of Marlatt’s analysis
and that derived from efficacy expectations are essentially similar. It remains to be seen whether the self-efftcacy
analysis summarized here will confer any theoretical or therapeutic advantages over Marlatt’s cognitive
explanation.
iIn the Bandura and Adams’ (in press) study, extinction of anxiety was defined in terms of subjects’ completion
of the imaginal desensitization hierarchy. Critics might argue that extinction necessarily entails the elimination of
conditioned autonomic responsa to the fear-provoking stimuli. However, self-report of anxiety is the way in which
extinction is determined in the routine practice of systematic desensitization. Secondly, reduction of autonomic
arousal is not necessary for the extinction of avoidance behavior in animals (Rescorla and Solomon, 1967) or
phobic clients (Leitenberg, 1976). Autonomic arousal appears to be a correlated coeffect of avoidance behavior as
opposed to a direct cause as one believed.
Towards a Unifying Theory of Behavioral Change 225
which fear reduction methods such as systematic desensitization and flooding have been
based has been under fire for some time now. Thus Rachman (1977), confirming
considerable previous criticism, has detailed how the conditioning theory of fear
acquisition, a fundamental facet of behavior therapy from the start (Wolpe, 1958), is clearly
inadequate. Similarly, traditional two-factor theory faces seemingly insurmountable
problems in accounting for the maintenance and modification of neurotic anxiety
conditions (e.g. Eysenck, 1976b; Rachman, 1976b; Seligman and Johnston, 1973). A major
theoretical difficulty has been the striking resistance to extinction that phobics show despite
nonreinf’orced exposure to fear evoking stimuli.
Attempts have been made to save the theory by suggesting that the haphazard and non-
systematic exposure to feared events that phobics experience is not the stuff of which
extinction is made. Although this might be a factor, it is doubtful that it can fully explain the
persistence of neurotic behavior. Taking another tack, Borkovec (1975) has proposed a
cognitive extension of Mowrer’s (1960) two-factor theory in which mere physical exposure
to the external fear stimuli is insufficient to ensure extinction. Rather,fwrctionalexposure to
the fear stimuli may be the critical ingredient, and this can be negated or interfered with by
cognitive avoidance responses. This position is supported by data from Borkovec’s (1972,
1973) avoidance response control condition. In this condition snake phobic subjects were
imploded until they signalled anxiety, at which point they visualized an avoidance response
they might have typically made in the actual situation. In marked contrast to both the
desensitization and implosion therapy treatments in this study, the avoidance control
condition resulted in neither improvement on the behavioral avoidance test nor reductions
in heart rate during the therapy session.
Borkovec’s (1975) hypothesis merits serious consideration. Like all other versions of
conditioning theory, it attributes variability in outcome of fear reduction methods to the
quantity or overall amount of non-reinforced exposure. One of the innovative and distinctive
features of self-efficacy theory is the emphasis on the quality of the non-reinforced exposure.
The dependability of the information derived from the exposure that alters efficacy
expectations and the reliability of the cognitive processing of that information are the
critical mechanisms. This appeal to the quality as opposed to the quantity of exposure is
saved from being a post hoc tour de force by assessing quality (i.e. derivative efficacy
estimates) independently of the behavior it is said to explain.
Although non-reinforced exposure has been consistently shown to be a necessary
condition for therapeutic success (cf. Davison and Wilson, 1973; Leitenberg, 1976a;
Rachman, 1972; Wilson and Davison, 1971), the critical process mechanisms in exposure
methods have not been elucidated. In particular, the variability of performance under
similar conditions of exposure remain to be explained. In their papers on desynchrony in
fear and avoidance, Hodgson and Rachman (1974) and Rachman and Hodgson (1974)
outline several hypotheses about the observed patterns of variability in outcome of fear
reduction techniques. In one of their hypotheses, for example, they predict that the degree of
desynchrony that results from a therapeutic intervention will be a function of the particular
technique employed. Thus they suggest that in flooding, avoidance behavior will change
first with self-report and physiological arousal lagging behind. In systematic desensitization
it is suggested that behavioral change will follow reductions in subjective and affective
anxiety, whereas modeling is said to produce little desynchrony across response systems.
Hodgson and Rachman (1974) have thoughtfully set out the various clinical and
experimental observations that have been reported. However, an explicit theory to explain
the findings is still needed. Self-efficacy theory is one alternative. Instead of ordering the
desynchrony data in terms of the effects of different techniques, a finer-grained analysis
might generate predictions on the basis of the strength and generality of the efficacy
expectations induced by the different methods. Inevitably, it will require a sophisticated and
complex analysis of this sort in accounting for the highly variable patterns of behavior that
are observed in therapeutic outcomes. Among other items, this self-efficacy analysis might
explain the now familiar fact that it is not necessary to elicit maximal anxiety during
flooding in order to achieve therapeutic success (e.g. Leitenberg, 1976a; Mills et al., 1973;
Rachman, 1976b). In terms of the self-efficacy theory it is not the intensity of drive or level of
anxiety that is elicited but the informative function of the cues the client is exposed to that
determines outcome. The latter may or may not correlate highly with the former.
226 G. T. Wilson
*Social learning theory actually encompasses conditioned fear responses as a component process in the
acquisition and modification of phobic behavior. One has to ask whete the physiological arousal that serves a
source of information that affects efficacy expectations comes from. In his earlier analysis. Bandura (1969) stated
that emotional arousal is a product of two different sources of stimulation: “One is the emotional arousal serf-
generated by symbolic activities in theform of emotion-provoking thoughts aboutfrightening events. Thesecondis the
response evoked directly by conditioned aversive stimuli” (p. 364). Rachman (1977) has reached a similar conclusion
in his recent analysis of the different pathways to fear. The novel aspect of self-efftcacy theory is that it provides a
mechanism whereby emotional arousal, however it is elicited, mediates behavioral avoidance. It is the individual’s
cognitive appraisal of arousal that determines whether it motivates phobic behavior. In two-factor theory
conditioning the Eysenck’s new model of neuroses fear is directly linked to phobic behavior in a causal fashion. The
problems the desynchrony data pose for this causal sequence have already been mentioned (Bandura, 1977b;
Rachman and Hodgson, 1974).
Towards a Unifying Theory of BehavioralChange 227
view, for every generalization in which cognition is related to behavior, there must exist a
corresponding behavior-environment generalization. In this manner cognitive variables
can be overlooked without missing any lawful psychological relationships. Bandura’s
(1977a) theory challenges both these forms of behaviorism in proposing that a cognitive
variable (self-efficacy) is superior to a simple behavior-environment generalization in both
predicting and controlling behavioral outcome.
In accounting for these results, the applied behavior analyst may point out that cognitive
variables can be dispensed with in favor of the person’s past history of environmental
interaction (cf. Rachlin and Lacey, 1977). Simple performance on an item of a behavioral
avoidance hierarchy might be said to be too circumscribed a sample of “past behavior”.
Indeed, with thii view of antecedent events and a revised law of effect that is based not on
immediate or temporally contiguous consequences but an aggregate effect over time (Baum,
1973), explanation of almost any behavior change method seems possible. The more
thoughtful operant conditioner such as Rachlin (1977) will acknowledge that concepts such
as “history of environmental interaction” and a “correlation based law of effect” are
unabashedly inferential. (S)He would add, however, that they constitute inference without
mediation. Rachlin (1977) opts for inferences about past events as opposed to current
cog&ions in explaining behavior, arguing that both are speculative but the latter are at least
potentially observable and “suggest metho& of observation and modification short of
surgery” (p. 374). Yet in practice it does not appear (or at least has not yet seemed to be the
case) that the “history of environmental interaction” is any more observable than present
cognitions. Moreover, the focus on a cognitive construct such as self-efficacy demonstrably
leads to methods of indirect assessment and modification that are not surgical and, more to
the point, were not prompted by the operant conditioning model.
This is the critical point. It is suggested here that utility or heuristic value is the criterion
that provides the acid test of the relative merits of competing theories in contemporary
behavior therapy. The seminal influence of operant conditioning on the development of
behavior therapy need hardly be emphasized (e.g. Kazdin, 1975; Krasner and Ullmann,
1965; Leitenberg, 1976b; Ullmann and Krasner, 1965). It continues to direct a useful albeit
limited technology of behavior change. As mentioned earlier, however, the theoretical and
clinical potential of classical and operant conditioning learning principles appear to have
been mined to the hilt. Fresh theoretical leads are required To take a few examples, the
demonstrably successful use of vicarious observation methods, including covert, symbolic
and live modeling, were derived not from operant conditioning, but social learning theory.
The fact that some procrustean manouver may be engaged in to accommodate these
methods within the post hoc parsimony of an operant framework is less important than the
failure of this conceptual scheme to generate such techniques.
CONCLUSION
For the most part, behavior therapy has been marked by bold and imaginative
innovations, by a vigorous diversity of viewpoints and a healthy aptitude for self-criticism.
In breaking new ground that will influence theory, research and clinical practice in behavior
therapy, self-efficacy theory promises to help sustain and nourish this impetus towards a
better understanding and more effective treatment of psychological disorders. Regardless of
its ultimate fate, the heuristic value of Bandura’s (1977a) theory is bound to enrich our
knowledge.
There will be those who will complain that we can ill-afford to pursue what Grossberg
(1977) has arbitrarily rejected as “the fools’ gold of cognitive self-control constructs*‘. The
sense of the present paper can be summarized by stating that we cannot afford not to extend
the clinical and experimental foundations of behavior beyond the relatively narrow
conceptual boundaries within which we have thus far grown fat. The inferential leap must be
made and Bandura (1977a) has indicated where we might look in leaping. Extending the
analysis of self-efficacy theory to different problems beyond the comforting confines of the
research laboratory will take a combination of methodological rigor, clinical skill and a little
luck. The progress of the last 20 years suggests that this is not an unrealistic expectation.
228 G. T. Wilson
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