Transcript DISASSOCIATivE IDENTITY DISORDER

Operant Conditioning – Chapter 8
Some Practical Applications…
Theories of Learning
October 17, 2005
Class #24
Some “antismoking” ad
campaigns invite children to
smoke
If smoking
is for
adults
should I
Smoke?
and I want
to be
adult like
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
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Aversive therapy
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Fading
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Curtis, 1976; Barske, 1977
• Rapid puffing until side effects (nausea) success rate
around 20%
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


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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
Smoking, eating,
medication use,
relevant conduct
When/How/Why
Activity diary
Activity
Work, bowling,
watching TV,
exercise
When/How/Why
The behavioral chain
Cut the weakest link, replace, reinforce
Buy
cigarettes
Watching
cigarettes
in Smoke TV
house
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 nonsmoking 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) extratreatment (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
1.
2.
3.
4.
5.
6.
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
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Behavior and activity diary
Analysis of the behavioral chain
Action
Follow-up
Social and psychological rewards and support
Credits:
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http://www.vsrc.org/Smokingcessation.ppt