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When trouble arises not from relationships with people but from such fears as claustrophobia, Wolpe urges his patients to learn to relax. First, however, the patient is reassured: "You are not mentally ill, and there is no danger of your going insane." Then he is questioned about the situations that trigger his anxiety, and the triggers are ranked according to intensity. After the sufferer has been taught to relax completely—through muscular exercises —he is asked to imagine the least frightening trigger: in a person who fears death, it may be the sight of an ambulance. If he becomes frightened, he is told to let go physically, so that relaxation can in effect replace fear. If he remains unafraid, he is asked to think of the next trigger—driving past a cemetery, for example—until at last he can finally confront the idea of what terrifies him most: perhaps a corpse in a coffin.
Related techniques involve what behaviorists call reinforcement and aversion therapy (TIME, March 7, 1969; and July 11, 1969). Basically, the methods depend on the old carrot-and-stick approach, which rewards desired habits and punishes unwanted ones. Male homosexuals, for example, may be given electric shocks when they look at pictures of nude men and granted relief from the shocks when they view female figures (see cut). "What we are doing," explains Reinforcement Therapist Ogden Lindsley of the University of Kansas, "is very similar to what progressive businesses do. We constantly monitor performance. But instead of improving sales, we try to improve behavior." Such a pragmatic approach is seen as one of the major advantages of behavior therapy by its supporters. Instead of searching for the elusive causes of neurosis, as in psychoanalysis, behavior therapy deals solely with neurotic symptoms and tries only to correct disturbed behavior.
The use of physical punishment to eliminate symptoms is distasteful to some scientists, including Boston College Psychologist Joseph Cautela, who has found more subtle approaches. Recently Cautela has successfully treated obese patients by training them to imagine that they are vomiting; the idea of nausea was enough to curb their appetites. He has also taught patients to overcome intense fear of flying with a step-by-step fantasy in which the patient "travels" to an airport, rewards himself with the thought of something he likes, such as meeting a friend, then "boards" a plane, thinks of his reward again, and finally manages to take off in imagination—and eventually in reality.
Man's Freedom. To its critics, behavior therapy is shallow because it lacks a unifying theory to explain the human personality. Behaviorists are quick to reply that what counts is behavior therapy's effectiveness.