According to Pavlov, specific terms begin to be used to describe conditioning such as unconditioned response and conditioned response. Based on Ivan Pavlov’s experiment, the natural response to food for a dog is to salivate. This is called unconditioned response (UCR) to the unconditioned stimulus (UCS), which in this case is the food. Then, a neutral stimulus (NS; bell) accompanies the process. By repeating this process, there will be a conditioned response (CR) of salivating with the mere sound of the bell. This way the clicking stimulus now has become conditioned stimulus (CS), which is able to draw a conditioned response. According to Martin and Pear (2005), there are several features that increase the effectiveness of classical conditioning. One of it is that there has to be multiple pairings only between the CS and the UCS in order to increase the effectives of the CS to provoke response from the CR (highest potency). Moreover, the CS and UCS have to be stimuli that are presented in its maximum power so that the conditioning will be stronger.
Morsella (2010) explains that classical conditioning can be found around us from the time we were born. She describes that the liking we have for food that looks artificial and does not have any odour such as lollipops and certain types of candies are due to the effects of classical conditioning. Another application of classical conditioning is to treat toddlers and adults with Enuresis, and managing phobia using systemic desensitization in psychotherapy. Apart from that, classical conditioning is also applicable in the advertising sector. The application of the principles of classical conditioning in the three sectors will be further discussed in this paper.
One of the most pioneer contributions of classical conditioning in the medical setting is to treat children and adults who are suffering from enuresis. According to Gross and Dornbush (1983) one form of enuresis that is common among children who are between 5 and 14 years of age is nocturnal enuresis, affecting mostly boys than girls. They explained that nocturnal enuresis is the act of constant bed-wetting at night during sleep despite being potty trained. This behaviour is considered an enuresis if it occurs at least a few times in a month without identifiable physiological cause. It has been discussed that nocturnal enuresis causes many communal and psychological dilemmas as the children will not want to spend the night away from home due to fear of embarrassment.
Lemelin and Lemelin (1989) describes the results of using many forms of treatment in dealing with nocturnal enuresis and have identified that enuresis alarm is the best treatment available. According to Schmitt’s explanation (as cited in Lemelin & Lemelin, 1989) explained how enuresis alarm works and its association with the principles of classical conditioning. An enuresis alarm is attached to the front portion of the child’s underwear making it convenient to be carried along even during travelling. When a few urine droplets fall on the device, the two electrodes get connected triggering the alarm. The sound created awakens the child, which automatically prompts the child to control the bladder and stop the process of urinating. Then, the child can go to the toilet to complete the urination process. The effectiveness of this treatment will only be seen with multiple trials similar to the case of Ivan Pavlov’s dogs. Initial stages (several weeks), the child would only be awake once he or she has completely urinated. Several weeks after that, the child would wake up half way through the process of urinating due to the alarm, thus enabling the child to contract the bladder muscles to stop urination, and continue in the toilet. As a result of repeating this process, in the long run the child will wake up by the mere feeling of wanting to urinate rather than the sound produced by the alarm after urination. The condition improves in one month and complete cure is achieved within three to four months. However the child will have to put on the underwear with the enuresis alarm until dry nights are achieved consecutively for three weeks.
Unconditioned Stimulus (UCR)
Neutral Stimulus to Conditioned
Full bladder (need to urinate)
Many studies have found that the use of enuresis alarm has helped children suffering from any form of enuresis such as nocturnal enuresis and monosymtomatic nocturnal enuresis. Ozgur, Ozgur, Dogan and Orun (2009) has conducted a study on the effectiveness of enuresis alarm in helping 40 children ages 6 to 16 years old with monosymptomatic nocturnal enuresis to the extent of bed-wetting at least three times in a week. All the participants were told to use the alarm for 12 weeks. The parents and children were shown how the alarm reacts to urine. They only considered a person’s treatment as being successful if they managed to keep their bed dry for 14 days continously. Meanwhile, a person is said to have relapsed if they wet their bed one night or more in a week. The results after the initial 12 weeks of using the alarm showed that 27 out of 40 patients kept their beds dry successfully. During the three-month follow-up of still using the alarm at bed-time, it was found that only 9 of the initial achievers stayed dry, while 18 of them relapsed. In the subsequent three- month follow-up, 7 of the 18 relapsed participants showed successful results. Finally after another three months, out of the 7 successful participants, 4 of them achieved dry nights. In total, 13 of them stayed dry and managed to get their enuresis treated. This system works in the same way as explained by Schmitt’s explanation (as cited in Lemelin & Lemelin, 1989). The results of this study are considered to be good by Rocha, Costa and Silvares (2008). They explained that during a long-period of treatment using alarm, the family’s level of motivation, socio-economic status and circumstances at home play a huge role in keeping things consistent given that the alarm has to be used daily without fail. Enuresis can be better managed without the reliance of medication as urinating is a normal bodily function that needs to be controlled everyday during sleep and as such the use of enuresis alarm is a better long term solution as it is carried out for long period of time. Eventually the child will learn to wake up from sleep the very moment the feeling of voiding appears, which is the normal response expected from the human physiological system.
In addition to the study above, Berg, Forsythe and McGuire (1982) conducted a study on 54 children (35 boys and 9 girls) on how they responded with the pad and bell system for initially 4 weeks before extending their treatment for another five months. The pad and bell system works in the same way as the enuresis alarm where the alarm, which is the unconditioned stimulus provokes a response of waking up (unconditioned response). Over time, when full bladder (neutral stimulus) is paired with the bell sound produced by the pad and bell system, the full bladder becomes the conditioned stimulus for the conditioned response of waking up. They were also interested to study the effects of Maximum Functional Bladder Capacity (MBC) and the child’s affective issues using the Rutter A (parent) Scale to determine the outcome of the treatment for enuresis. Before the pad and bell system was introduced to the children, they were wetting their beds at nights at an average of 20 times in 28 days. However, after the pad and bell approach, on average the children were found to only wet their beds approximately 11 times in four weeks. Their treatment approach in dealing with the children’s enuresis worked for 34 out of the 54 children, which could be considered as a 63% success rate. They also found that those children who had failed in responding to the treatment had higher scores on the Rutter A Scale indicating the level of the children’s emotional instability. Therefore it could be understood that the remaining 20 children who did not respond to the treatment may be affected emotionally, thus preventing them to respond like the other children who are suffering from nocturnal enuresis. Although it has been proven that enuresis alarm has been effective for many children, the fact that every child is undergoing difference circumstances must be taken into consideration, and therefore expecting a generalised response may not be accurate. Given the right approach and environment, every child will be able to respond positively towards the treatment for enuresis using the alarm system. The parenting style is also equally important, given the role of parents in waking up the child when the alarm starts in the beginning stages. In families that practise neglectful parenting, it is unlikely for the parents to take the initiative to wake up and alert the child. As such, these factors should also be considered to assess the effectiveness of the treatment of enuresis using the alarm system.
The next area that widely uses the principles of classical conditioning is the advertising sector. Gorn (1982) conducted a study on 244 college students to understand the effects of external factors such as background music and setting to influence the marketability of a product. He explains that people tend to respond positively towards a product that is being advertised if the advertisement catches their attention and creates a pleasant feeling by way of eye-catching colours, lovely music and hilarity. Therefore, the features of the advertisement act as unconditioned stimulus, while, the product acts as a conditioned stimulus after observing them together multiple times to produce a good feeling (unconditioned and conditioned response). In his study he made sure that the information of the product is minimally exposed to the participants to ensure that the unconditioned features were the ones that captured the participants’ attention and not the information. In the experiment, there were four conditions created. The first condition involved the pairing of a piece of favoured music with a pen of light blue colour. The next condition was to match a piece of favoured music with a pen of beige colour. The third condition was to match a piece of unfavoured music with a pen of light blue colour and the forth condition was to match a piece of unfavoured music with a pen of beige colour. It was found that a majority of the participants (74%) chose the pen that was presented with their favoured music. He explained that the participants with the favoured piece of music selected the pen based on the good feeling it created.
To further support the positive outcome of classical conditioning, Tsai (2012) conducted a study on 172 undergraduates to understand the effects of classical conditioning in using movie stars to promote a product. He also mentioned that using celebrities as part of an advertisement is a popular practice in the United States and Britain. Tsai used an actor named Ethan Ruan as the celebrity to leverage on his popularity to promote an orange juice brand called GARRA. No additional information was added to the advertisement. The celebrity acts as the unconditioned stimulus that naturally draws a positive response from people (unconditioned response). The celebrity is paired five times with the conditioned stimulus, which is the virtual brand to produce a positive response to the brand (conditioned response). When respondents’ opinion on GARRA was compared between those who were put through conditioning and without conditioning, the results showed that the conditioned group (Ethan Ruan) had higher or more positive attitude towards GARRA. The attraction that people have for the actor was able to be transferred to the product or brand that the actor was promoting. Hence, after repeated exposure to the same unconditioned stimulus, GARRA (conditioned stimulus) automatically drew a positive response from consumers. Tsai also found that the appearance of celebrities in advertisements leads to a higher value in promoting a particular brand regardless whether the celebrities have done other advertisements before. While, the research involving celebrity such as Ethan Ruan was successful in this Taiwan study, the same approach might not be workable in a multi racial country like Malaysia where a celebrity who is well known to the Indian community may be completely unknown to the other races in the country. Thus, celebrity endorsement may not have a generalised outcome across the Malaysian population. Another point to note is that celebrity endorsement without a good quality product will not result in repeated purchases. If people are not satisfied with the quality of a product, they will not buy it the second time even if Brad Pitt or Jonny Depp advertised it.
The next big sector that uses the principles of classical conditioning is psychotherapy in the management of phobia. Wolpe (1958) developed a method of dealing with phobia using a behavioural approach. He explains that a person has to be conditioned to develop unnecessary fear on a particular stimulus such as cockroach, snake, heights or even social engagement. The classic experiment conducted by Watson and Rayner (1920) on a small boy known as Little Albert is a good example to explain the development of phobia. They found that loud noise produces fearful feelings. Thus, the loud noise acts as an unconditioned stimulus to provoke an unconditioned response of fear. They tested their finding by pairing a white rat (conditioned stimulus) with a loud noise that was created using a steel bar and a hammer behind Little Albert’s head multiple times, which produced fear (conditioned response; making Albert cry and move away). After multiple times of doing the same thing to Albert, he eventually developed fear (phobia) at the mere sight of a white rat. Based on this principle, Wolpe derived the idea of counteracting the phobia with a contradicting stimulus such as relaxation, which is called counterconditioning. Counterconditioning can be explained using a classic study by Jones (1924) on a child named Peter. He was afraid of rabbits (conditioned stimulus). She placed a rabbit in the same room but at the distance from Peter during the time that Peter was eating some cookies (unconditioned stimulus) which made him feel good (unconditioned response). This process was conducted multiple times resulting in Peter overcoming his phobia for rabbits. At the end of the counterconditioning period, Peter was able to have a rabbit on his lap happily (conditioned response).
Wolpe (1958) explained that the process of counterconditioning should be carried out in several stages and conducted at a slow pace and this process is known as systematic desensitization. He explained that a person is usually asked to make a list from the lowest to the highest fear causing stimuli. The process of desensitization starts from the lowest first before moving slowly to the higher level of fear. The stimulus that causes fear is put forward to the person together with relaxation to produce a good feeling either through imagination or in vivo.
To provide research evidence on the effectiveness of systematic desensitization, McCroskey, Ralph and Barrick (1970) conducted a study on 24 university students taking the public speaking class who were found to have an elevated level of anxiety to give speeches. The participants were randomly assigned to 3 groups with five members each, an hour of systematic desensitization session, for twice in a week almost three and half weeks. In the first session, the underlying principles of systematic desensitization were explained and the participants were also taught deep muscular relaxation. In the next sessions, beginning from the lower level of anxiety present in the hierarchy, the participants watched a video recorded session of public speech presentations. At any point of time when the participants displayed anxiety, they were told to raise their right index finger as that will cue the trainer to instruct all the participants within that group to stop the imagination of giving speech and focus on the deep muscular relaxation before resuming the session. The deep muscular relaxation was the unconditioned stimulus, which was paired with the speech presentation (conditioned stimulus) to eventually produce a relaxed state (unconditioned to conditioned response). For successfully completely each stage of the speech anxiety hierarchy, the participants were required to complete the first presentation of 15 seconds and second presentation of 30 seconds free from any signs of anxiety before proceeding to the next one. At the end of each session, the trainers presented the previous completed level of the speech anxiety hierarchy so that the participants’ level of anxiety is kept at a minimum level. This is done until all the stages within the hierarchy are completed. The last session ends with the repetition of the highest speech anxiety stimuli for one minute. At the end of the complete session, the participants’ level of speech anxiety was measured using Personal Report of Confidence as a Speaker (PRCS; Paul, 1966). According to the results, the groups that received systematic desensitization had a decreased level of anxiety by 54% while the control group only had a decreased level of 18%. Therefore, it can be concluded that the anxiety level for speech giving or any other phobia can be significantly reduced using the systematic desensitization method. This study is reliable given that the sessions were conducted continuously every week to ensure the effectiveness of the counterconditioning. However, the fact that it was done in a group could disrupt the flow of desensitizing an individual as each participant would have different level of phobia in terms of speech anxiety throughout each session.
To further support the effectiveness of systematic desensitization in treating phobia or high level of anxiety, Johnson and Sechrest (1968) conducted a study on 41 psychology students. They used the Alpert-Haber Achievement Anxiety Test to measure the level of test anxiety at pre and post systematic desensitization. Those who had high test anxiety and scored low (<85% in the examination) were selected as participants. The participants were randomly placed in one of the three groups (12 participants in the desensitization group, 11 participants in the relaxation group and 10 participants in the control group). The two groups' underwent many sessions while the control group was excluded. Five sessions were conducted individually for all the participants. Desensitization group learnt the relaxation technique first before proceeding to the first level on the hierarchy via imagination. The stimuli in the hierarchy included sitting for a trivial quiz, followed by preparation for a test which was due in 2 days and then shortened to a day. Moving up the hierarchy included situations of sitting for an important test where many questions were left unanswered followed by another situation of rushing to finish an important exam within limited time. During those sessions, relaxation (unconditioned stimulus) was conducted every time the person felt anxious to condition the student with test (conditioned stimulus)-relaxation pairing (as a method of counterconditioning the phobia) to produce a relax state of mind (unconditioned to conditioned response). On the other hand, the other group only received relaxation training and practised it for 15 to 20 minutes by themselves. The results in the final examination determined the positive impact of systematic desensitization on dealing with test anxiety. Only the group that received desensitization showed significant improvement in grades. Johnson and Sechrest acknowledged that when anxiety level was low, test grades improved. On the other hand, the other two groups showed no changes in the examination grades. It was important that the researchers decided to conduct the desensitization process individually as every one of the participants would have their own level of fear towards examination. This way, each participant had the privilege of undergoing systematic desensitization according to their own pace, thus the effectiveness of the desensitization will remain for a longer period of time even after the sessions have ended.
This paper discussed the use of classical conditioning in three different sectors, which are treating enuresis, advertising products and managing phobia in psychotherapy sessions. In treating enuresis, the use of classical conditioning is an ideal method as it is non-invasive and the results have been found to have a high reliability and validity value. In the advertisement sector, classical conditioning has been proven to increase the marketability of the product. It is a common practice for businesses to use celebrities to advertise their products to increase the amount of sales. Meanwhile in the psychotherapy sector, systematic desensitization is one of the most prominent methods of dealing with phobia, as it helps to deal with difficult irrational fear which has affected people for a long period of time. In a nut shell, classical conditioning is effectively used in many other sectors apart from those discussed in this paper.