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

2. Some “antismoking” ad campaigns invite children to smoke

3. Hook the child and you have a lifelong smoker…

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

6. 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

7. 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

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

9. 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

10. 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

11. 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)

12. Behavioral Therapies

13. 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

14. 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

15. Objective records Food and smoking diary Activity diary
Medical management diary

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

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

18. 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

19. 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

20. 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

21. 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

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

23. 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

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

25. 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.

26. 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.

27. Be careful…

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

31. Credits: