Operant Conditioning – Chapter 8 Some Practical Applications… Theories of Learning October 17, 2005 Class #24

Some “antismoking” ad campaigns invite children to smoke

Hook the child and you have a lifelong smoker…

Nicotine, heroin and alcohol addicts have the same relapse rate of about 80% J Clin Psychology 1971;27:455

Want To Quit Ask: smoking status is a vital sign Advice: to quit in a clear, strong and personalized way Assess: willingness to quit Assist: the patient, set a quit day, anticipate challenges, remove tobacco products Arrange follow-up or refer

Do Not Want To Quit Relevance: why quitting is important be clear, strong and relevant Risks: explain short term and long term risk Rewards: improve health, save money, feel better, look better, provide a good example Roadblocks: withdrawal symptoms, weight gain, fear of failure Repeat: every time patient returns to office

Quit recently Congratulate Reinforce: use open ended questions such as “how has stopping helped you?”

How Smokers Try To Quit American Lung Association survey 1998 73% cold turkey 44% gradual withdrawal 39% confused about medicinal help 70% believe nicotine replacement and behavior modification therapies help 35% think they need a Rx for the patch 20% think they need a Rx for the gum

Cold Turkey Cold Turkey can be be effective for some… Choose a symbolically important day for quitting Tell everybody that you are quitting and ask for help Have a non-smoking ceremony the day of quitting

Gradual withdrawal Aversive therapy Fading Behavior Modification Curtis, 1976; Barske, 1977 Rapid puffing until side effects (nausea) success rate around 20% Fading Becona & Garcia (1993) Identify and eliminate the cigarettes you can do without 57% and 41% success rate in 6 and 12 months Behavior Modification Cinciripini (1994)

Behavioral Therapies

Behavior Modification Behavior modification is more effective than group therapy, and relaxation training. Successful programs follow the rules of operant conditioning developed by BF Skinner in the 1950s

Operant conditioning rules Contract with the patient regarding what is appropriate and inappropriate behavior. Keep objective records Develop a program of positive and negative reinforcements and positive and negative punishments to strengthen and weaken appropriate and inappropriate behaviors Study results Alter the program

Objective records Food and smoking diary Activity diary Medical management diary

Diary Behavior When/How/Why Smoking, eating, medication use, relevant conduct

Activity diary Activity When/How/Why Work, bowling, watching TV, exercise

Cut the weakest link, replace, reinforce The behavioral chain Cut the weakest link, replace, reinforce Buy cigarettes cigarettes in house Watching TV Smoke Smoke Out with Smoking friends Smoke Snacking Smoke

Positive Reinforcement A method of reinforcing a behavior by rewarding such behavior Examples Deposit the money you saved by non-smoking in a vacation saving account Praise your relative for not smoking

Negative Reinforcement A method of reinforcing a behavior by removing an unpleasant stimulus Examples If you don’t smoke you give a good example to your children If you don’t smoke you feel better

Positive punishment A method to reduce a behavior by delivering an unpleasant stimulus such as: If you are going to smoke eat the butt or over-puff

Negative punishment A method of reducing a behavior by removing a pleasant stimulus: If you cannot party without smoking don’t party

Reinforcements and support Biological: Pharmacology Social: intra-treatment (group therapy) extra-treatment (internet sites, support groups) Family: other smokers in household  lower abstinence rates. Encourage significant others to quit along with patient Personal: frequent follow-up visits, telephone calls, buddy system

Extinction The weakening and eventual disappearance of a learned behavior Partial reinforcements produces behavior with greater resistance to extinction when the reinforcement is discontinued.

Example of behaviors that help to stop smoking Choose a goal: Example Exercise 5 days a week, quit smoking in 2 weeks. Keep a diary: Easier to achieve your goals if you keep a diary. Ask friends and family to help. Do not buy cigarettes. Join a smoke cessation program. Take your medications daily.

Example of behaviors that help to stop smoking 7. Avoid alcohol. 8. Ask for non-smoking tables and rooms 9. Open a no-smoking saving account. 10. Get involved in the no-smoking campaign. 11. Make a list of the benefits of smoking. 12. Make a list of the problems associated with smoking.

Be careful…

Behavior modification summary Behavior and activity diary Analysis of the behavioral chain Action Follow-up Social and psychological rewards and support

Credits: http://www.vsrc.org/Smokingcessation.ppt