A person struggling with phobias reads about counterconditioning in a textbook while wearing a white sweater.

Introduction to Counterconditioning

5 min.

Many people have behaviors or reactions that hold them back, but with counterconditioning, positive change is possible.

By: Charlie Health Editorial Team

Clinically Reviewed By: Dr. Don Gasparini

June 14, 2023

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Table of Contents

What is counterconditioning?

Counterconditioning, also called stimulus substitution, is a behavioral therapy technique that aims to replace an unwanted behavior or reaction with a desired behavior or reaction. In order to do this, counterconditioning requires pairing the unwanted behavior or reaction with a positive or neutral stimulus to create a new association—sort of like a therapeutic rewiring of your brain. The goal of counterconditioning is to change how you feel or react when faced with certain things. 

What can counterconditioning help with?

Counterconditioning is commonly used as a part of treatment for phobias, anxiety disorders, obsessive-compulsive disorder (OCD), and addiction. For example, if someone wants to overcome a fear of dogs, they might use counterconditioning techniques—like gradual exposure to a well-behaved dog or two while being rewarded with ice cream— as a part of treatment. Over time, this can help the person develop a new, positive association with dogs and reduce their fear response. While this practice may seem intuitive or easy to some people, counterconditioning should be conducted under the guidance of a trained mental health professional to ensure its effectiveness and safety.

How does counterconditioning work?

Counterconditioning encompasses several different techniques, and the specific approach and strategy used in treatment will depend on someone’s needs and the behavior being treated. Here are a few examples of counterconditioning techniques: 

Systematic desensitization

This technique involves gradually exposing people to things they are afraid of while simultaneously pairing that fear with relaxation techniques. For example, someone who is afraid of flying might start by imagining being on an airplane while practicing deep breathing and progressive muscle relaxation. Over time, they would progress to more real-life exposures, such as visiting an airport or taking a short flight, while continuing to use relaxation techniques.

Aversion therapy

In aversion therapy, a negative behavior or response is linked to something undesirable. For instance, a person trying to quit smoking might undergo aversion therapy, where they receive a nauseating substance each time they smoke a cigarette. The goal is to associate the negative response (nausea) with the smoking behavior, leading to a decrease in the desire to smoke.

Exposure and response prevention (ERP)

ERP is often used in OCD treatment. It involves exposing people to situations or stimuli that trigger their obsessive thoughts or compulsive behaviors but refraining from engaging in the associated rituals or avoidance behaviors. Repeated exposure without performing the usual rituals aims to weaken the link between the triggers and the compulsions, reducing their impact over time.

Counterconditioning with positive reinforcement 

This technique pairs a feared or anxiety-provoking stimulus with a positive or enjoyable experience—the example of someone who fears dogs but spends time with a well-behaved dog while eating ice cream is counterconditioning with positive reinforcement. The aim of this technique is to create a positive association between the dog and ice cream and replace the fear response with more positive emotion.

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How long does counterconditioning take to work?

The duration of counterconditioning can vary depending on several factors, including the specific behavior being targeted, the individual’s responsiveness to the technique, and the consistency of the therapy sessions. It is important to understand that counterconditioning is a process that takes time and practice.

Some people may start to notice positive changes relatively quickly, while for others, it may take more time and effort to see significant results. The effectiveness and timeline of counterconditioning can also be influenced by the complexity and intensity of the behavior or response being addressed—if the behavior or response is deep-seated or linked to past trauma, it can take longer to address, for instance. 

Also, the frequency and duration of therapy sessions, as well as the individual’s level of motivation and engagement, can impact the speed of progress. Consistency and regular practice outside of therapy sessions can make counterconditioning more effective. 

A qualified therapist can not only provide support during counterconditioning, they can also assess your specific situation and provide you with a more accurate estimate of the timeframe for counterconditioning to yield noticeable improvements. They can also monitor progress and make necessary adjustments to the treatment plan as needed.

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What is desensitization?

Desensitization, also known as systematic desensitization, is another therapeutic technique used to reduce or eliminate a person’s anxiety or phobia associated with a specific trigger or stimulus. This technique is based on the principles of gradual exposure and relaxation—people are gradually exposed to the thing they fear in a controlled manner. 

The exposure is done incrementally, starting with situations or stimuli that elicit a relatively low level of fear or discomfort and gradually progressing to more challenging or anxiety-provoking scenarios. During the exposure, people are encouraged to practice relaxation techniques and coping strategies to manage their anxiety effectively. As people face their fears again and again, the brain learns to react differently, resulting in less fear and an increase in tolerance. 

Like counterconditioning, desensitization should be conducted under the guidance of a trained mental health professional to ensure its effectiveness and safety.

A group of people walk on a tree-lined street smiling. One with red hair carries books—she has struggled with anxiety and OCD in the past but is learning to cope with counterconditioning.

Counterconditioning vs. desensitization

Counterconditioning and desensitization are two behavioral techniques commonly used to change unwanted behaviors or emotional responses. They are both related and often used together but differ in their specific approaches. 

Counterconditioning focuses on replacing an unwanted response with a positive or neutral one by pairing the original stimulus with a new, desirable stimulus. Desensitization, on the other hand, involves gradually exposing an individual to a feared stimulus while using relaxation techniques to reduce anxiety and build tolerance. Both counterconditioning and desensitization are effective behavior modification techniques that can be used to change someone’s behaviors and emotional responses in the face of a trigger.

The choice of which technique to use depends on the specific goals and circumstances of the individual or situation. Counterconditioning is often used when there is a need to replace an undesirable response or behavior with a more desirable one. For example, if someone has a fear of public speaking, counterconditioning may involve associating public speaking with positive experiences or rewards to alleviate the fear response. Desensitization, on the other hand, is typically utilized when dealing with anxieties or phobias that can be gradually overcome through exposure and relaxation techniques in a controlled environment. It is effective for specific phobias, such as fear of heights, flying, or spiders. 

Counterconditioning and desensitization at Charlie Health

It can be overwhelming to deal with phobias and anxieties that you’d like to overcome but don’t know where to start. Anxiety disorders and phobias are manageable, especially when you have the resources and support to cope. 

Charlie Health’s personalized virtual Intensive Outpatient Program (IOP) connects each client with a licensed therapist—who can implement therapeutic techniques like counterconditioning and desensitization— to promote healing in a safe, supportive space. We also incorporate therapeutic groups into IOP, so you can see what others are doing to navigate their healing journeys. Get started today.

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