The possibilities of behavioural therapy in learning therapy are dealt with on the basis of specific learning problems. Hypnotherapeutic approaches within behavioural therapy are taken into account. It deals with motivation, concentration, test anxiety and the organisation of the learning process. Many examples are provided to support the understanding of the recommended methods.

Behavioural therapy concentrates on the current symptomatic behaviour and therefore does not aim to change the client’s entire personality. Even Eysenck’s classic studies on anxiety disorders show that no shifts in symptoms were observed after a phobia had been successfully overcome (as would be expected from a psychoanalytical perspective). One of the advantages of this focus on current behaviour is that help can be provided quickly. The learning therapist in particular is consulted when, for example, examinations threaten to be unsuccessful and negative consequences for the client’s life need to be averted.

• Learning therapy

• Behavioural therapy

• learning problems

• Motivation

Schuster M (2025) Learning Therapy and Behavioural Therapy. Ann Psychiatry Ment Health 13(1):1200.

Learning therapy often deals with problems of anxiety and test anxiety. However, motivation and lack of concentration when learning are also problematic.This contribution is specifically about how behavioural therapy can be adapted in these fields for the requirements of learning therapy [1]. In this brief introduction,I am focussing on a normally gifted older pupil or student. For special groups, smaller children, less gifted people [2], or clients with dyslexia, the measures described would have to be adapted in each case. Subject-specific problems could also be identified in collaboration with subject experts.

Shame and failure minimise motivation to learn in individual cases. Any preoccupation with the learning material triggers defence and reluctance. Permanent failure in learning can contribute to depressive moods on the path of ‘learnt helplessness’,which in turn makes learning more difficult in a vicious circle. So learning success is needed. This can be achieved if the learning therapist radically reduces the demands.

Example:Fritz has poor grades in Latin. He doesn’t see why he should learn it and stops doing his homework. Instead of coming up with the idea of increasing the homework hours in Latin in order to catch up, the learning therapist agreed with Fritz to translate just one (!) Latin sentence every day. Fortunately, this could be supervised by the parents, who monitored this and credited points. A reward was agreed for a certain number of points, in this case a visit to a model railway exhibition. After a few weeks,Fritz enjoyed the one sentence-which was presented like a puzzle-and his Latin grade improved.

This is where an important motivational principle of behavioural therapy comes into play: the reward. The food pill of the animal experiment cannot be realised for children (and adults), simply as a piece of chocolate. In the human realm, it is more elaborate, possibly somewhat more expensive activities that are earned through points (or ‘tokens’, as they say in the jargon). In the case of children, the parents have control over the reward and therefore ensure that the agreement is honoured. If you give yourself a reward (self-reward), you could be cheating. It would be better to involve partners or friends in the control (see ‘contracts’ below).

It is motivating just to see the success of collecting points (monitoring/self-monitoring). Points should therefore be marked in a visible calendar, e.g. as asterisks. When looking at the calendar, pride and joy can arise. It has not proved beneficial to use punishments or the removal of rewards to achieve behavioural change.

Appetence-aversion conflicts

Achievement and learning success can be associated with ambivalent feelings: on the one hand you are happy about the success-on the other hand you may be happy about the failure because, for example, you do not want to reward the parents who tried to achieve the learning success through criticism and punishment. I have experienced that siblings of disabled children are very inhibited in their striving for success because they do not want to put themselves above their sibling (or are also encouraged in their upbringing not to put themselves above them).These ambivalences need to be researched so that they can then be treated using the methods of cognitive behavioural therapy. Hypnotherapeutic methods,which are classified as behavioural therapy, can also be applied.

Systematic desensitisation

The standard method of behavioural therapy is used for anxiety:systematic desensitisation.Under deep relaxation, a series of situations are called up in the imagination in order to decouple fear and situation. The anxiety-inducing potential of the chosen imaginary situations should increase in the series. If anxiety arises during the imagination, it is stopped at this point and the less anxiety-provoking situations are started again. This method has been tried and tested many times and is also recommended here. Relaxation can also be replaced by a special eye movement (EMDR).

The stimulus hierarchy requires special attention.The most feared outcome would be failing the test. However, the imaginings should set the scene for coping with the challenge. If you had a phobia of snakes, you would not imagine that the snake would bite you. Imagining not being able to answer a difficult question is also not suitable, because this failure is then suggestively imprinted in the visual memory. When imagining a difficult question, you can cleverly incorporate a suggestion for flexible exam behaviour, for example:

‘Imagine you are asked a question that you cannot answer at first. But then you find an aspect of knowledge that fits the question and the exam goes on smoothly.’

The temporal proximity to the exam is a good dimension for increasing anxiety:

‘Imagine the exam is the next day...’

‘Imagine you’re sitting outside the exam room and it’s your turn next...’

The stimulus hierarchy can also address the physical side effects of anxiety (depending on which physical reactions the client tends to have).

‘Imagine sweating profusely (your heart is beating fast, you are trembling, etc.). However, the test now completely captures your attention, you no longer think about it and the test continues.’ Again, the instruction contains a suggestion to stop paying attention to yourself.

Problematic situations in the exam should also be framed with such a positive outcome in imagination exercises.‘Imagine you have given a wrong answer-it happens to the best candidates. Now take courage again and answer the next question correctly with a firm voice.

Autosuggestions

‘Suggestions’ have already been included in the situation descriptions above. This is an element of hypnotherapy, which uses visual suggestions to sneak past the client’s consciousness.

Autosuggestions are also helpful before the test. However, they should not be formulated in such a way that your client does not disbelieve them.

‘I will pass the test easily’ would be immediately rejected in their mind.

Better is:

‘I will do my best in the exam.’

‘I have learnt a lot and can hope to pass the exam.’

It is important that the suggestions encourage you to visualise a positive outcome.

So wrong: ‘I won’t have an exam block.’

Right:

‘I will be surprised at how easy it is for me to answer the questions.’

‘Despite a certain amount of excitement, I will remain focussed and open to the situation.’

‘I’m surprised at how little the excitement bothers me.’ (It should be explained to the client that many people have mastered the exams perfectly despite being extremely nervous).

In my experience, it has proved useful to formulate the autosuggestion together with the client and write it down so that the client can repeat it in their mind, e.g. before going to sleep. Otherwise the client may spontaneously invent unsuitable suggestions.

However, it is best not to speak any suggestions to yourself during the test.This distracts from the situation, you don’t understand the examiners’ questions and talk to yourself instead of the examiners.

But what helps during the exam? Precautionary conditioning

Memories and feelings from childhood often suddenly reappear:The smell of Christmas biscuits, the scent of candles on the Advent wreath or the sight of the Christmas tree may evoke the Christmas spirit even in older people, just as they experienced it as a child. Not only children, but also many adults take a teddy bear or a cuddly toy to bed with them and feel as safe and secure as if they were close to their protective parents. Important experiences (this applies to both positive and negative experiences), remain stored in our memories for the rest of our lives. Although we usually no longer think about them, if a certain external stimulus occurs that was once associated with the memory and the feeling, this long-forgotten memory will reappear.

It now seems plausible to harness past positive experiences and the associated feelings to cope with stressful situations.For those who have been successful in exams, appointments, speeches, job interviews, or other assessment situations, similar, new situations will involuntarily trigger memories and feelings associated with these successes.This allows one to handle such stressful situations with greater optimism, confidence,emotional calm, and focus.However, if such situations are associated with negative feelings such as fear, then retraining is appropriate.This exercise makes it possible to access feelings of competence, confidence in success, joy, and security from one’s personal store of experience “as if at the push of a button.” It is possible to engage in stressful situations without other people, such as the examiners, noticing.First, you seek out a strong sense of achievement with the client. This can be a performance situation or a situation from other areas of life, such as a sporting success. After such an episode has been selected,the client performs a relaxation procedure. The idea of success is then recalled as intensely as possible in their minds. When a strong feeling of happiness has arisen, the client is asked to place their right hand on the back of their left hand.This is repeated several times so that the feeling of happiness is conditioned to this contact of the hands.

In a critical situation, e.g. in an exam, the feeling of happiness is then intentionally recalled and has an antagonistic effect against anxiety and depression. By providing the client with a measure, the feeling of helplessness is reduced.

Example of a table tennis success

By describing the sensory impressions of the chosen moment of happiness (hearing, seeing), the memory is facilitated:

„You see the team-mate’s jersey in the memory picture.

You see the green table tennis table.

You see the yellow ball. You hear the sound of the ball hitting the table.

You hear the voice of your team-mate.

You remember the last point of the game.

The game is over and you have won the trophy. There is a roar of applause.

The feeling of success returns at this moment and becomes stronger and stronger.

While your eyes remain closed,now bring your right hand to the back of your left hand-and then after a short moment (about a minute), back to your right thigh.‘‘

When repeating this sensory impression, the moment of Success mingles with the actual feelings in the moment, eg during the exam.

Incorrect conditioning

There can also be unfavourable conditioning. Many starts and restarts with a learning material can condition fatigue attacks, even nausea, to a learning location.For example,many people experience a slight stomach ache when they re-enter their old school, their old grammar school.This needs to be recognised in relation to the current learning situation and the learning location changed if necessary.For example, you could study in the library or in another room in your flat. A new start to the learning adventure in therapy could also be supported by a new learning location. If necessary, a book can be given a different coloured dust jacket, etc.

Role play

Therapeutic role play [3], is not only suitable for the exam situation, but also for the social embedding of learning, from which fears and inhibitions have an impact on the learning process.

When playing an exam together with the therapist, you could start with questions about simple everyday knowledge to see how the client fits in socially in the situation being played out. It is clear that friendly, socially adapted examinees always get better marks [4]. What is the client’s posture like? Anxiety can also be reduced by a self-confident ‘anxiety-antagonistic’ posture. What is their voice like, where are they looking? The entire non-verbal behaviour should be observed. Later, the client could bring their index cards with them to rehearse the test on the real test items.

Special situations could be practised

For example, how to react if you can’t answer a question, or if the question seems overly trivial. (I was once present when an exam seemed to fail because of the question ‘Where does electricity come from?’.The expected answer was ‘from the socket’.The examinee was not prepared for such a trivial question). Sometimes you have to be able to switch from specialised knowledge to everyday knowledge. This can also be a way out when there is a lack of knowledge.

Another problematic situation is when the examiner talks too much and doesn’t let the candidate have their say. It would be worth practising how to get back into the examination discussion with your own knowledge.

Of course, groups are also well suited for such role plays, because you can learn skills, but also because it can be quite funny. Working groups should therefore definitely play the exam situation together. If you record such a role play with a video camera, it can be relieving for the role players to see how little of their anxious mood (which often arises during the rehearsal), can be seen on the film.

The client could choose an admired role model and then do it in the role play as the role model would do it (covert modelling).

Cognitive therapy for learning disorders

Cognitive therapy for depression is about examining self-devaluation. This may be directly transferred to learning therapy. If the client has little confidence in himself and doubts his learning success, Socratic dialogue can be used to try to find a realistic self-assessment. This depends on the therapist’s ingenuity:

Example

Therapist: ‘Do you know anyone who has passed this exam?’ Client: ‘Yes, quite a few.’ Therapist: ‘And would you say that they are all much more talented than you?’ Client (laughs): ‘No!’

A very important reason for fears of exams and learning adventures are the consequences of a negative outcome for self-esteem and reputation in the social reference group. The client should learn, for example, that assessments of exam performance always depend in a certain amount on lucky or unlucky coincidences.

There is the disorder of the ‘narcissistic’ learning disorder.The learning endeavour is not started because there is a fear that the feedback would jeopardise the inflated self-image. The therapist should then add other than ‘grandiose’ results to the horizon of expectations.

Example question

Therapist:‘Have you experienced that very talented acquaintances of yours once did quite badly?’

It can also be seen as talent and courage to carry on courageously even after failures. There are many examples of this in real life.

Example question

Therapist: ‘Have you ever heard of how often a manuscript was rejected that later became a bestseller?’ (Here I’m thinking of Rowling’s Harry Potter books, for example).

The client should learn not to see the affection of their fellow human beings in a one-dimensional way.Helpfulness, cohesion, similarities and, if necessary, appearance are dimensions of the bond.The judgement of parents, who often demand performance with merciless severity, can deteriorate. In this case, the Socratic dialogue would focus on the relevance of their judgement.

Example

Therapist: ‘The parents are getting older and frailer, they may even need your help. What role will it play then that you once messed up an exam?’

Castagna et al. [5], offer a current study on the implementation and success of cognitive therapy for learning disorders in children and adolescents.

Learning at the last minute: There are quite a few people who can only learn at the very last minute. They need the pressure that has built up until then in order to be able to learn at all. This is sometimes successful in a school context, so that it is reinforced by learning for success. The excitement then provides the necessary emotion that makes it easier to memorise. However, this strategy becomes dangerous when it comes to exams covering a wide range of material (such as in university). In a favourable case, the learning therapist has been consulted in good time, who then draws up preparation plans together with the client, which are then checked and adjusted during the therapy sessions. It also helps to discuss learning activities with the client that go beyond pure reading in order to prevent boredom during learning: e.g. writing a summary or a review of the respective textbook.

Concentration While Learning: Concentration while learning depends on many factors. Current problems can repeatedly distract one’s thoughts. Procrastination and mind-procrastination can become a disturbing habit. Underlying illnesses can also impair concentration. In depression, for example, the client is sometimes unable to even read a small section of a newspaper. There are specific learning therapy measures for at least the first two groups of causes (problems and procrastination).

When thinking about life problems, one option is to simply think the disturbing thought again in the same way. This leads to a reactive inhibition of the thought. Then the self-instruction can follow: “I’d like to return to the material now” [6], offer a mindfulness training course to reduce intrusive thoughts.

Procrastination and distraction can be avoided if there are as few distracting stimuli as possible. For example, if you study in a library instead of your own room, many alternative activities such as tidying up or cleaning shoes are not possible (stimulus reduction). Procrastination with computer games, etc., can be limited with self-instruction. Example: “Three more Clickomania games, then I’ll get back to work.”

Work schedules that are regularly adhered to and shouldn’t overwhelm the learner reduce procrastination with other activities. Examples of study plans that plan backward from the exam date can be found in Metzig and Schuster [4].

Learning Tips: Behavioral therapists are natural experts in learning processes, as behavioral therapy is based on learning theories. They should pass on this knowledge (as a basis: Metzig & Schuster 2020). If the time frame of the support allows, the learning therapist simply observes how the client accomplishes learning for a while and checks how successful their learning approach was. A learning diary, which the client keeps throughout the week, helps the therapist get an overview of the learning times.

Example:I once supervised the client’s study for the multiple choice medicine practitioner exam. It turned out that the client only learned a few of the multiple-choice alternatives and believed she could somehow deduce the rest. However, that was not the case at all. When she moved on to learning all the alternatives, she was able to pass the exam. Therefore, surprising individual errors occur during learning, which the therapist should note.

The Smallest Unit of Learning: Learning occurs through the interaction of information acquisition and retrieval, which is why self-assessment is an important part of the learning process. It would be completely wrong to think, “I’m just do the input of Information in this limited time” (information acquisition) and “the examiner will take care of the testing.”The reality is that the retrieval processes also have to be learned. If one observes the link between retrieval/self-testing and information acquisition, learning itself is somewhat assured (“The Smallest Unit of Learning,”Metzig and Schuster 2020). For example,flashcard systems ensure the link between acquisition and retrieval of the material.

Avoiding Boredom

If there is still enough time for exam preparation, it helps to present the material with various orientation tasks, e.g.,looking for applications, finding difficult exam questions yourself, and asking yourself what acquaintances and friends might find interesting about the material.

Exam Tips

Recall-induced forgetting: Experienced examiners often advise against studying the day before the exam. There’s a reason for this. Information that was reactivated shortly before the exam becomes dominant for a while and suppresses other learned information [7]. Therefore, shortly before exams-once you have learned the material you shouldn’t dwell on the exam material.

The Minutes before the Exam: Anxiety is particularly intense in the minutes before the exam. Anxiety-reducing measures are appropriate at this time to ensure that anxiety doesn’t impair your performance during the exam. On the one hand, relaxation exercises and autosuggestion can be used (see below), and on the other hand, distracting one’s thoughts is helpful.

Example: A very anxious client arrived at the exam location at a clinic. A motorcycle accident had happened by chance in front of the clinic. He helped the injured rider to the clinic. Some time passed, so he arrived just in time for the exam. To his surprise, he was almost anxiety-free at the beginning of the exam. The accident and the necessary actions to care for the accident victim had distracted him from the escalating anxious thoughts. Admittedly, such a drastic distraction cannot be organized. However, perhaps there are exciting computer games, for example, that one could play on a tablet computer while waiting for the exam.

Numerous specific applications of behavioral therapy in learning therapy cannot be carried out here.Therapy with children with learning disabilities, for example, is discussed by Bredberg & Siegel [8].

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