Failure of Behavior-Based Therapies

The continuing increase in mental illness on college campuses.

Posted Mar 20, 2019

Source: Pixabay

In Spring 2018 the American College Health Association (ACHA) reported that 63.4 percent of students felt overwhelming anxiety, up 13.4 percent from 2013; 41.9 percent felt so depressed it was difficult to function, up 10.6 percent from 2013; and 12.1 percent experienced serious thoughts of suicide, up 5.0 percent from 2013. What, you may ask, is going on?

While the demand for counseling services significantly increased from 2013 to 2018, and colleges hired more and more therapists, it seems that colleges, rather than being educational communities, have become therapeutic communities, dealing with all the unresolved mental issues that students bring from home.

A major problem is that most therapies are behavior-based, stemming from stimulus-response experiments with mice, popularized by B. F. Skinner in the mid-1950s. A recent article published in the Journal of Experimental Psychology: General claims that the stimulus cannot be divided from the response.

According to Dr. Warren Mansell, Manchester University, U.K., "Humans strive to get 'just right' experiences, such as keeping a comfortable temperature or keeping safe. So it's unsurprising that most of the initiatives for changing people's behavior based on removing stimuli that trigger habits like smoking, or trying to make children behave with rewards and threats, fail in the long term.” This is because psychologists favor the observer's view of behavior over the experience of the person who is performing the behavior.

Given that these two perspectives can be at odds, perception control theory (PCT) might explain the increase in student anxiety as a carryover conflict from an early childhood conflict—keeping safe versus exploring the environment. To resolve this conflict requires trial-and-error until the child strikes a balance between safety and exploring. Should an observer, most likely an overprotective parent, actively intervene and discourage exploration, the child’s control mechanism becomes thwarted, leading to the current student malaise.

The underlying premise of PCT is that we react to negative feedback to maintain an internal sense of equilibrium. Much like a thermostat control that keeps our house temperature balanced at 70 degrees, the heat turns on when below and stops when it reaches 70 degrees. If we don’t have a thermostat, we might put on a sweater to maintain our body heat. In other words, our behavior, both unconscious and conscious is performed to control our equilibrium. 

Experiencing anxiety can be seen as a result of unresolved conflict underlying one’s loss of control. PCT helps the client go up to a higher level, thereby perceiving the conflict from a different vantage point so that reorganization can restore control at a higher level. For example, suppose we are suffering from unresolved anxiety from childhood. We would first want to uncover the suppressed event that underlies the anxiety, which then automatically enables our perceptive control of the crippling event.  

Another feature of PCT is that past perceptions are stored as memories, providing a template, of sorts, for top-down recognition of patterns that can be accessed to control future conflicts, as well as plan ahead with perceptual control to deal with imagined future events. Once brought into play, going up levels may provide a greater impact on bipolar behaviors, beyond the reach of behavioral-based psychotherapies.   

Behavior-based therapies favor the observer’s view of intent, yet, we psychotherapists, like most of us, cannot always recognize other’s intentions. It’s largely a guessing game—sometime on the mark, sometimes off the mark. Mindreading what others think based on a given behavior is universally practiced, yet loaded with failings of all kinds.

For instance, when therapists focus on a desired behavioral change such as with client’s alcohol abuse or smoking, interventions almost inevitably fail. This is because these behaviors are only side effects of the client’s attempts to exert control, without addressing the root cause, which may be a lack of social confidence or possible stress.

Moving forward, until both parents and therapists overcome their penchant for behavior-based interventions, without addressing the root causes, we can expect rates of overwhelming anxiety, depression, and suicide ideation to increase among college students. 

This blog was co-published with