Typically, cognitive clinical work is identified with the cognitive restructuring proposed by Aaron Beck and carried out with techniques such as the discussion and testing of automatic thoughts or the search for alternative and rational responses.
Without a doubt, the latter constitutes one of the most prominent developments within the approach. However, there are many other procedures that can be classified as “cognitive” in their own right, such as problem-solving training, anxiety management training, self-monitoring of internal dialogue, or self-instruction training.
We choose to dedicate this small space to the so-called “covert conditioning techniques” or “covert control techniques” developed mainly by Joseph Cautela. It is a set of intervention strategies with the same denominator; In fact, in all of them the principles of classical and operant learning are applied to mental images and symbolic representations, called private events within this conceptual context.
In this way, covert conditioning techniques are a kind of hinge between behavioral and cognitive models: they apply the principles of conditioning, a field traditionally considered behavioral, to symbolic phenomena, to verbal and visual representations, elements typical of the cognitive field. We describe three of these procedures below.
Covert awareness
It consists of imagined repetitions of the problem behavior paired with aversive symbolic events. The objective is to provoke some degree of inhibition in potentially harmful behaviors that the patient does not want, such as drinking alcohol, smoking, compulsive eating or some sexual deviations such as pedophilia.
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This procedure is a kind of systematic desensitization conversely, since what is intended is for the individual to experience a certain degree of anxiety in the face of these unwanted or pathological behaviors in such a way that their occurrence is inhibited. The technique is aimed at altering the symbolic representations or mediators of the unwanted activity, in this way, its effectiveness depends on that behavior having such mediators, that is, that we are not dealing with an automatic behavior.
Generally, it is used in addictions towards the last phase of treatment, when an attempt is made for the patient to acquire self-control in the face of environments that could lead to a relapse. For example, someone who suffers from alcoholism is induced to imagine situations where there are people drinking followed by others that he experiences as aversive, that disgust him or that he greatly dislikes. In this way, the desire to consume in contexts similar to those imagined is weakened.
Covert positive reinforcement
It consists of pairing an imagined behavior with an imaginary positive reinforcer in order for that behavior to increase its probability of occurrence. As a first step, the patient is trained to imagine a pleasurable activity that will later be used as a positive reinforcer. Then, symbolic pairing is established: you are asked to imagine performing the desired behavior and immediately then switch in your mind to the reinforcing image. The complete exercise, made up of several trials, will result in an increase in the desired behavior that was previously emitted at a low frequency.
The technique is recommended to increase behaviors inhibited by anxiety, postponed due to lack of motivation or absent in the subject’s repertoire; It is also suggested to modify dysfunctional attitudes, even as a means to improve self-concept. For example, in the case of a patient who consults due to exam anxiety, it is usual to design a Systematic Desensitization with a hierarchy that gradually brings him closer to the feared situation; This way the person will be able to reduce their anxiety and will be able to perform.
Now, if this procedure is combined with the covert positive reinforcement, she will be induced to imagine a highly pleasurable situation for herself following each item in the hierarchy. In this way, we not only achieve a decrease in exam anxiety, but also link this situation with sensations of pleasure; This will help modify the negative view of it.
Covert modeling
The patient is trained in the symbolic repetition of appropriate behavior using an imagined model. Operationally, it consists of three stages. In the first, the person imagines a different model of himself in age and sex executing the target behavior. In the second, he imagines a model similar to himself in age and sex. Finally, in the third stage, he imagines himself as his own model performing the difficult behavior that he wishes to incorporate.
Since learning new habits is carried out gradually, it is usually advised that in the initial phases a management model is visualized, that is, someone who executes the behavior by making some mistakes, facing the situation with difficulties and overcoming obstacles.
On the contrary, during more advanced stages of training, the visualization of a domain model is suggested, which appears suitable and secure in its performance. For example, in animal phobias it is customary to design a treatment of combined techniques.
In short, after applying a systematic desensitization “traditional” we appeal to covert modeling, which starts with images of a person different from himself who, with hesitation and with some anxiety, manages to approach and caress, for example, a dog; This is a management model in the first phase of training. Later, the patient will visualize a subject similar to himself approaching the dog and petting it with little or no anxiety, here we see the second phase of training and with a mastery model. The last point consists of imagining yourself performing the same action without difficulties, the third phase of training and with a mastery model.
In summary, covert conditioning procedures aim at affective, cognitive and behavioral change based on the idea that our imagination is a highly powerful resource to modify behavior in reality. In fact, both the imagination and our thoughts in general are the mediators between the situations we experience every day and our behaviors; it is in this sense that they modulate our emotional reactions and our actions.
Consequently, the effectiveness of the aforementioned techniques is largely due to their power to modify or restructure our cognitions.
By: Lic. José Dahab, Lic. Carmela Rivadeneira and Lic. Ariel Minici