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Social Work in Public Health, 26:471–481, 2011

ISSN: 1937-1918 print/1937-190X online

DOI: 10.1080/19371918.2011.591629

Social Learning Theory and Behavioral Therapy: Considering Human Behaviors

within the Social and Cultural Context of Individuals and Families

ANNIE McCULLOUGH CHAVIS

Department of Social Work, Fayetteville State University, Fayetteville,

North Carolina, USA

This article examines theoretical thoughts of social learning theory

and behavioral therapy and their influences on human behav-

ior within a social and cultural context. The article utilizes two

case illustrations with applications for consumers. It points out

the abundance of research studies concerning the effectiveness

of social learning theory, and the paucity of research studies re-

garding effectiveness and evidence-based practices with diverse

groups. Providing a social and cultural context in working with

diverse groups with reference to social learning theory adds to the

literature for more cultural considerations in adapting the theory

to women, African Americans, and diverse groups.

KEYWORDS Social learning theory, behavioral therapy, human

behavior, social context, cultural context, environment, effective-

ness, evidence-based practice, African Americans, diverse groups

INTRODUCTION

Social learning theory is one of the most recent approaches to addressing people in need and applying the theory to human problems within a social context. The utilization of the theory as an applicable approach to change human behaviors began in earnest in the 1950s. Its use in the social and behavioral sciences as a mental health intervention grew in popularity in the

Address correspondence to Annie McCullough Chavis, Fayetteville State University, Department of Social Work, 1200 Murchison Road, Fayetteville, NC 28301. E-mail: achavis@

uncfsu.edu

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472 A. McCullough Chavis

late 1950s as interest in insight-oriented approaches waned. Social learning theory is one of the most influential theories of learning and human develop- ment and is rooted in many of the basic concepts of traditional learning. The theory focuses on learning that occurs within a social context and that people learn from one another (Ormond, 1999); however, the theory adds a social element. It proposes that people can learn new information and behaviors by observing other people. Thus, the use of observational learning, imitation, or modeling explains a wide variety of human behaviors using social learning theory and approach. Behavioral therapy has its roots and basic principles within social learning theory.

Centered on principles of learned behavior that occurs within a social context, behavioral therapy focuses upon the principles of classical con- ditioning developed by Ivan Pavlov and operant conditioning developed by B. F. Skinner. Coady and Lehmann (2008) noted that Pavlov (1927) demonstrated that, through association in time and space, the sound of a bell could have the effect of cueing a dog to produce a biological reaction of salivation-classical conditioning/learning. B. F. Skinner (1953, 1974) docu- mented that when behavior occurs, whatever follows it (the consequences of behavior) can either increase or decrease the frequency, duration, or intensity of the behavior (Coady & Lehmann, 2008). Albert Bandura (1977) added to the development of the therapy by exploring the role of cognition and emphasizing that people learn vicariously. Burman (1997) stated behavior therapy is an approach to psychotherapy based on learning theory that aims to treat psychopathology through techniques designed to reinforce desired and extinguish undesired behaviors. Today, with the thrust for evidence- based practice and measurable results, behavioral therapies are widely used to change general as well as dysfunctional behaviors such as depression, anorexia, chronic distress, substance abuse, anxiety, obesity, phobia, pas- sivity, obsessive behavior, self-mutilating behavior, anger disorders, mental retardation, and alcoholism (Mehr, 2001). The explanation of these behaviors is based largely on culture. Culture is a major factor in explaining and intervening in human behaviors.

Culture shapes human behavior and the social environment. The social environment of today is one of many challenges and warrants the use of evidence-based practices that focus on culture to meet the needs of con- sumers seeking help with problem behaviors. All individuals are social beings and carry within them their cultural experiences that affect all aspects of behavior. This article focuses on two case illustrations and discusses learned behaviors: the usability of social learning theory and behavioral therapies within the social and cultural context. The cultural context refers to the environment and cultural influences but recognizes that society, community, as well as cultural heritage, values, beliefs, thinking, and traditions affect indi- viduals and families (McCullough-Chavis & Waites, 2004). For this article, the social and cultural context includes the culture, community, family, school,

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work, and all systems within the social environment of consumers. The article concludes with a discussion of the importance of social learning theory and approaches to usability with individuals from varied cultural backgrounds such as African Americans and women.

LITERATURE REVIEW

Interventions and Effectiveness

Social learning interventions and behavioral approaches to changing human behaviors are among the most studied and reported in the literature. Ac- cording to Mehr and Kanwisher (2007), persons conduct more controlled outcome research on behavioral therapies than on any other psychotherapy due to the use of scientific methods and the ability to measure outcomes us- ing evidence-based practice techniques and instruments. Behavioral therapy points toward the new emphasis in the social sciences on empiricism (ob- servable evidence) in evaluating the outcomes of intervention with children, adults, couples, and families (Mehr & Kanwisher). They stated the surge in the therapy movement toward efficiency, research-supported methods, and evaluation of outcomes, is a credit to behaviorists, and there is evidence that these approaches do change behaviors. Uses of the approaches in systems or settings include public school programs for emotionally handicapped children, residential programs for people who are mentally retarded, resi- dential and outpatient programs for children identified as mentally ill, and juvenile and adult corrections facilities (Mehr & Kanwisher). In many settings and systems, behavioral therapies are the primary approaches employed to change unacceptable learned behavior in children and adults. Therefore, the service delivery environment, with its focus on outcome indicators and evidence-based practice, owes a great debt to behaviorists who remain the most proficient group of practitioners in measuring intervention outcomes (Granvold, 1994).

Behavioral therapies are efficient therapies and several research studies document effectiveness for a wide range of behaviors. Mehr and Kanwisher (2007) postulated that the effectiveness of behavioral approaches seems well documented, particularly for consumers who have behavior problems that use behavioral approaches. Weisz, Hawley, and Doss (2004) statistically examined 236 published randomized trials on treatment for youth (age 3–18 years) spanning the years 1962 through 2002. They found that across various outcome measures, 80% of treated youngsters improved after treatment more than those not treated. Behavioral treatments proved more effective than nonbehavioral treatments regardless of client age. Mehr and Kanwisher re- ported that a major positive feature of behavioral strategies is that a majority of their proponents are thoroughly indoctrinated in the scientific method

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and extremely concerned with proving whether the techniques of behav- ioral therapy work. Therefore, many behavioral studies, and particularly controlled studies, support the claims of significant behavior evaluations, as well as evidence-based practices claims. Prochaska and Norcross (2007) described several meta-analyses conducted on adults, couples, and families concerning the effectiveness of behavioral therapy that produced similar results. For example, in a 1983 study conducted by Norcross and Wogan (cited in Prochaska & Norcross, 2007) behavior therapists reported seeing clients less frequently and for a shorter duration than psychotherapists of other persuasions; and only 7% of their clients, on average, had more than a year of treatment.

Literature documents the use of behavior approaches to deal with persons in individual, group treatment, and family settings. Mehr (2001) discussed a 1986 study, reported by Nardone, Tryon, and O’Conner on a cognitive-behavioral group treatment for reducing impulsive–aggressive behavior in adolescent boys in a residential setting for boys. During the course of the project, the frequency of impulsive–aggressive behavior on the part of the boys declined dramatically. However, during a follow-up period, the therapist discovered that the positive gains slowly eroded and disappeared within 5 weeks. With more focus on evidence-based practices, this finding clearly emphasizes the need for maintenance reinforcement programs after behavior therapy programs.

Other studies point to the use of social learning theory as a family intervention. Kilpatrick and Holland (2009) suggested that social learning theory utilization as a family intervention is particularly effective with fami- lies that have issues with internal and external environmental factors. They reported that families who experience high levels of disruptions, communi- cation problems, and families that have children who experience difficulty with social systems within the community are a few examples of intervention utilizing social learning theory. In other studies, as cited in Kilpatrick and Holland (2006, 2009); Sayger, Horne, and Glaser; Sayger, Horne, Walker, and Passmore; and Szykula, Sayger, Morris, and Sudweeks measured the effectiveness of social learning family interventions with children with be- havioral disorders and their families in a variety of settings. The results according to the authors have been remarkable, with significant decreases in negative behaviors of children in the study and subsequent increases in positive behaviors at home and in school. Sayger et al. (1988) reported the maintenance of positive behavioral changes after a 9- to 12-month follow- up. Behavioral approaches have proved to be effective with children and their families in child psychiatric outpatient treatment. Szykula et al. (1987) avowed in a comparison of strategic and behavioral family therapies in an outpatient child psychiatric facility, that 100% of the families participating in social learning theory family-intervention treatment demonstrated gains toward their treatment attainable goals and 67% of those in the strategic

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family therapy group made gains toward treatment goals. In treatment with parents, Sayger et al. (cited in Kilpatrick and Holland (2006, 2009)) found that parents participating in social learning family interventions reported significant more positive than negative side effects of their participation in treatment.

The literature review suggests social learning and behavioral interven- tions are effective in changing human behaviors across several environmental settings in treating children, adults, and families. The theory and approaches have a strong research and evidence-based background that demonstrate effectiveness within the social context of human behaviors. However, the literature does not provide sufficient information concerning effective inter- ventions with all target groups, particularly diverse groups such as women, African Americans, and people of color consumers. Today, any efforts at interventions and problem resolutions must be in tune with the distinctive culture, values, and community customs of all consumers within their social and cultural context.

Understanding theory and the impact of behaviors on human devel- opment are collectively a part of interventions in the social and behavioral sciences. For example, in social work, the influence of theory driving practice is evident, and all the social sciences expound evidence-based practices as sufficiently interrelated to outcomes pertaining to human behaviors within the social context. To illustrate the relationship concerning human behaviors, theory, and behavioral interventions, two case illustrations discuss the need for changes in human behaviors. The two cases demonstrate how to use so- cial learning theory and behavioral approaches with different individuals and families in different settings and disciplines, and particularly in social work.

CASE ILLUSTRATIONS

The case illustration of Paula demonstrates the use of behavioral therapy in a public school setting. The second case illustration of Jamaal exemplifies the use of social learning theory in a family intervention case with an emphasis on social work.1

Paula, age 10, is one of five students in an exceptional classroom. Her disruptive behavior prevents her from being in a regular classroom. Paula’s behavior disrupts the learning environment due to her hyperactivity and impulsivity. She constantly squirms in her chair, snaps her fingers, taps her feet, talks loudly to the other students during class, and gets up and moves about the classroom without permission instead of listening and following instruction from the classroom teacher or teacher assistant.

Paula is the oldest child of John and Megan Head. She has an 8-year-old brother Tim who attends the same elementary school in a regular class. The parents report no major behavioral problems with him but state that Paula

476 A. McCullough Chavis

has difficulties remaining in her seat while eating, as well as when the family watches television or engages in most family activities. They use time-out techniques when these disruptions occur. They expressed concerns about Paula’s behavior and often inquire from the school about her behavioral and educational progress.

In this case illustration modified and adapted from Mehr (2001), to help Paula change the undesirable classroom behaviors, the teacher, teacher assis- tant, school psychologist, and social worker met several times and decided to implement a behavioral treatment plan with Paula. After several discussions, they targeted two behaviors for change: talking to other students and leaving her seat without permission. The focus of intervention was observation and recording of the behaviors, verbal counseling, verbal praise, and loss of playtime because of breaking these two rules. If Paula spoke or left her seat without permission, the aide reminded her of the loss of playtime for rule breaking. If Paula behaved acceptably, she received verbal praise. The primary person responsible for the behavioral program was the teacher aide, and for a day, she observed Paula and recorded how often she disrupted the class concerning the targeted behaviors. The disrupted behaviors occurred 25 times during the one day of observation before any intervention.

The next week the teacher aide informed Paula of the program and the consequences if the two disrupted behaviors occurred. At the end of each class period when Paula did not speak out or leave her seat without permission, she earned a gold star beside her name on the board. At the end of the day, she could take a gold star home to her parents if she earned stars in more than one half of the classroom sessions. At the end of the week, Paula was down to eight disruptions a day and showed much progress as recorded by the teacher’s aide. The next week, the aide added another behavior to change and explained the addition to Paula. By the end of the second week Paula was down to four disruptions a day, and after another week, Paula took home a gold star each day. Some days there were one to no disruptions, and this change continued for the remainder of the school year. More sig- nificantly, Paula’s schoolwork improved with the improvement in behavior, and the positive changes continued until Paula did not need gold stars to maintain her behavior. Using predata and data during the intervention, the case of Paula illustrates the application of principles of learned behavior. It shows that humans can learn to change undesirable behavior with behavioral therapy and evidence-based practice within a social context.

Modified and adapted from Kilpatrick and Holland (2006), the second case illustration of Jamaal exemplifies the use of social learning theory in a family intervention case. This case illustrates the use of treatment goals consistent with the principles of the theory.

Jamaal, a 22-year-old African American male, is gay and the only child of Joe and Mary Jones. After graduating from college, he returned home to live and work as a high school teacher. Jamaal’s parents are highly religious

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and do not approve of Jamaal’s sexual orientation or his homosexual rela- tionships. They will not converse with Jamaal about his sexual orientation or relationships. They believe in intimate heterosexual relationships and that God condemns any other relationships. Jamaal is very close to his parents and expresses concern about their denial or disapproval of his relationships. He desires the acceptance of his choice of relationships and sexual orientation by his parents. Jamaal believes in God but has concerns about being gay and being accepted within his social environment. Many in his family, church, and extended family are homophobic.

Other family members suspect that Jamaal is gay but are not quite sure of his sexual orientation so he selects and guards his communication with extended family, except for his cousin, James. Although Jamaal interacts with James more than with other extended family, Jamaal has never revealed any information regarding his sexual orientation or ambivalent feelings about be- ing gay or nonacceptance by his parents to James. However, Jamaal suspects that James is aware of his sexual orientation. His parents avoid the subject and are consistent in their disapproval. Jamaal feels lonely, ashamed, angry, and isolated. Consequently, he is having considerable difficulty managing his needs for intimacy. The negative social pressure he feels from his family and social environment are burdensome and depressing.

Jamaal came to counseling seeking assistance in learning how to manage his intimacy, loneliness, shame, anger, and pain. Additionally, he needs help learning to accept his homosexuality and help with communication skills to assist in facilitating meeting other persons. There is also a need to learn new ways of conversing with his parents and family members concerning their homophobia and his sexual orientation.

In this case illustration, the focus of intervention is with Jamaal and his parents as they are experiencing difficulties with an ineffective family structure and boundaries (Kilpatrick & Holland, 2006) that could inhibit problem solving (homosexuality, intimacy, communication and feelings of shame, pain, anger, and confusion). The communication within the family as dictated by the family rules is weakened by unrealistic expectation and appears complicated by these rigid family rules and family roles. There is also confusion within the family and clearly with Jamaal. This confusion limits the family’s capacity to overcome their life challenges and feelings of insecurities, dissatisfaction, and discomfort with the level of intimacy within the family and the environment (Kilpatrick & Holland, 2006). The family operates as a closed family system concerning family rules, boundaries, and communication, and dealing with Jamaal’s sexual orientation. Also Jamaal’s communication is poor regarding his feelings, and he finds it difficult to maintain intimate relationships. Utilizing social learning theory, it would be very appropriate and useful to work with Jamaal and his family concerning the following goals as stated by Kilpatrick & Holland (2006) and modified for this case.

478 A. McCullough Chavis

1. Learn to develop coping strategies to manage fear and loss (son’s sexual orientation, family, and son’s acceptance of sexual orientation) within the social and cultural context.

2. Develop skills and knowledge concerning self-control to manage, family, life, and the social environment of extended family and religious family more effectively.

3. Help in communication skills that will permit family rules, roles, and boundaries to be more open that will allow greater means and ways of expressing feelings, meeting people, and sharing with family and friends that includes the cultural context in meeting the unique style, life experi- ences, and worldview of the family.

Social learning theory interventions are appropriate for use with Jamaal and his family. Cognitive thoughts, beliefs, and development of communica- tion skills from a cultural perspective are major focal points of intervention with Jamaal. The case also focuses on appropriate learned behaviors by normalizing the problems of the family and focusing on strengths within the social and cultural context. Social learning theory and behavioral approaches are applicable in a variety of environments and disciplines.

DISCUSSION AND IMPLICATIONS

Social learning theory offers a structured and learned approach to dealing with a variety of behavioral concerns in many different disciplines and set- tings. Although, I only discuss two case illustrations, this article presents the importance of treating and focusing on learned behaviors using theory and strategies in an effort to change behaviors from a social and cultural context. The target population of the two cases consisted of a female consumer and an African American male consumer from diverse groups. The question of the applicability of the theory and approaches with diverse groups is a major criticism and of concern to this author and others. Kilpatrick and Holland (2009) stated that in some cultural groups, the specific approaches used in social learning theory are not valued or endorsed; rather, they appear as being White, middle class, or incompatible in other ways with many cultural groups. Although behaviorists expound empowerment and concrete changes of consumers, the research rarely addresses cultural, multicultural, or African American issues, despite important theoretical contributions made by Cheek (1976) and Kantrowitz and Ballou (1992).

Cheek, a pioneer in assertive training was one of the first behaviorists to generalize behavior theory specifically to counseling with African Americans. He demonstrated the validity of behavioral concepts with African American clients and supplied a culturally relevant view to the therapy. Cheek affirmed that assertive behavior varies between African American and White cultures,

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and that both groups need to understand the frame of reference of the other (Ivey, Andrea, Ivey, & Simek-Morgan, 2002). The work by Cheek had particular implications for women.

Kantrowitz and Ballou (1992) suggested that the behavioral focus on individual skill training could neglect social issues and support dominant group values. They asserted that assertiveness training is an example of evidence-based treatment and will probably meet with the approval of the sexually harassed woman, and the social norm of women’s duty to protect themselves is not seriously questioned. The women’s distress is temporarily reduced, but the social status quo of the dominant society is also decisively protected. That is, necessary social change does not occur.

Even though the literature cites the wide use of social learning theory and behavioral therapies, a careful examination of the literature found a paucity of information to support effective and evidence-based application with women, African Americans, and diverse groups. A wide array of behav- ior therapies applying the principles is applicable for use with these groups, but what is not as clear is whether substantially conducted research studies prove efficacy and effectiveness. Empirically, behavioral therapies yielded a great deal of effective therapies, and some took into account the culture and worldview of African Americans and others, but according to Cheek (1976) behaviorists should not seek to ‘‘make African Americans White’’ or to have women think like men but to recognize the perspective and worldview of different groups. His pioneering works demonstrate how to use the approaches effectively with African American clients when modified to meet the client’s unique style, life experiences, and worldview.

The worldview and culture of African Americans and other diverse groups are uniquely different from the dominant group. Nobles (1973) argued that the African view of ‘‘self’’ is contingent upon the existence of others, oneness of being, and a balance and harmony with all things. McCullough-Chavis and Waites (2004) contended that the cultural context is an important aspect of individuals and families. Thus, a criticism of social learning theory and behavioral therapies from a cultural perspective is the somewhat exclusion of diverse cultures and an African view of ‘‘self.’’ If Cheek can demonstrate effectiveness with African American consumers when adjusted to meet the consumer’s unique linguistic style and life experiences (Ivey et. al., 2002), and Kantrowitz and Ballou (1992) with women, then behaviorists should consider these adjustment and adaptations when working with consumers from diverse groups.

CONCLUSION

This article presents two case illustrations and focuses on the importance of human behaviors within the social environment. The literature points to

480 A. McCullough Chavis

evidence-based practice and the effectiveness of the theory and approaches. However, the author believes that to make an unmitigated claim of ef- fectiveness and aggregate evidence-based practice those utilizing the the- ory and approaches must prove their effectiveness through more research with other groups as demonstrated with the dominant group. The social environment of today is a multicultural environment, which warrants the use of culturally focused evidence-based practices to meet the needs of consumers seeking assistance with problem behaviors in a variety of en- vironmental settings and disciplines. In addition, the Code of Ethics for social workers states there is a responsibility to ‘‘understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures’’ (National Association of Social Workers, 1996, p. 9). Thus, it is critical and imperative that social workers, practitioners, counselors, sociologists, psychologists, educators, and behaviorists practice more from a culturally focused perspective. To be effective, professionals must acquire further knowledge and skills about the cultures, values, beliefs, practices, and worldviews of individuals and families who come from different and varied cultural backgrounds. This article and its use of two case illustrations offer a structural and practical approach to dealing with human behaviors within the social and cultural context. It helps professionals understand and intervene appropriately and effectively with consumers from various cultural backgrounds.

NOTE

1. Please note that for this article, the names in the two case illustrations are pseudonym.

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