Learning Principles of Human Behavior

Abstract

The purpose of this chapter is to highlight key learning principles that apply to human behavior. Human behavior responds to punishment and reinforcement in predictable ways. Understanding these relationships can help physicians guide their patients to modify their behavior to achieve desirable outcomes.

A failure is not always a mistake; it may simply be the best one can do under the circumstances. The real mistake is to stop trying.

-B.F. Skinner

Appendices

Appendix A: Possible Answers to Vignettes

Vignette 4.1: Ronald

Table 4.1.1

Facts	Hypotheses	Information needed	Learning issues
58-year-old male	Given the patients extensive heavy smoking history, he will need lots of assistance to quit	Why does he want to quit now?	What is the functional relationship between the patient’s environment and his smoking?
80 pack-year smoker wants to quit		What has he tried in the past?	What are typical antecedents to smoking for this patient?
		When does he usually smoke?	What are the typical consequences of smoking for this patient?
		What is his longest period of prior abstinence?	How might motivational interviewing help guide this patient to an appropriate goal?
		How does he deal with stress?

1. RS reinforcement schedule

Table 4.1.2

Facts	Hypotheses	Information needed	Learning issues
The patient identifies the antecedents and the consequences	Changing the antecedent behavior may change the consequence	What type of follow-up plan will he need?	What are the stages of change?
			What are smoking cessation tools?

Vignette 4.2: Sally

Table 4.2.1

Facts	Hypotheses	Information needed	Learning issues
48-year-old female complains of insomnia for 3 months	Possible medical reason?	What part of sleeping does she have trouble with?	How do I take a sleep history?
	Possible stress?	What is her bedtime routine like?	What are typical antecedents for a good or poor night of sleep?
	Mood disturbance?		What are the consequences for a good or poor night of sleep?
	Substance use?

Table 4.2.2

Facts	Hypotheses	Information needed	Learning issues
Difficulty falling asleep	Changing her routine may have an impact	How does the patient’s sleep change after the intervention?	What is sleep hygiene?
Difficulty staying asleep			What are causes of insomnia?
Antecedent behaviors include exercising late
Eating late
Alcohol intake
Stays in bed and worries
Watches television in bed
Consequences include feeling fatigued the next morning and unable to concentrate at work

Vignette 4.3: Dennis

Table 4.3.1

Facts	Hypotheses	Information needed	Learning issues
Dennis is a 4-year-old boy	Parents actions are reinforcing tantrums	What type of activities lead to tantrums (antecedents)?	What are reinforcement schedules?
Parents complain of tantrums		How do the parents react to the tantrums (consequences and reinforcers)?
No problems in school
Plays well with peers

Table 4.3.2

Facts	Hypotheses	Information needed	Learning issues
Antecedents to their son’s tantrums: Dennis sees a small toy or piece of candy he wants. Dennis realizes he is in a public place that will be embarrassing for mom if he throws a fit		What happens to the behavior after implementing the intervention?	What are the reinforcement schedules that apply in this situation?
Consequences of his tantrums:	Changing the consequences may alter the behavior		What are some tools to modify behavior in children?
Mom gets embarrassed by Dennis’ tantrum
Mom gives him the toy or candy he wants, and Dennis calms down immediately

Vignette 4.4: Nana

Table 4.4.1

Facts	Hypotheses	Information needed	Learning issues
75-year-old female	Gambling may be out of control	How much does Nana actually gamble?	How do you diagnose gambling addiction?
Grandson concerned about gambling to point of exhaustion	Reinforcement schedule of slot machines makes it difficult to extinguish the gambling behavior	How much time does she devote to gambling?	Reinforcement schedules of slot machines
		Does she skip meals?
		What else does she like to do besides gambling?

Table 4.4.2

Facts	Hypotheses	Information needed	Learning issues
Twenty hours spent gambling during a 2-day trip	Using gambling as a consequence for other activities such as adequate socialization and nutrition will help her have better balance	What happens to Nana’s gambling after the intervention?	What is the Premack principle? How can it be applied in this case?
Delays meals			What are different types of reinforcement schedules?
Enjoys seeing her grandson and watching his young children play baseball			What is the neurobiology of reinforcement?
			What are the DSM 5 criteria for pathological gambling?

1. DSM 5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (APA 2013)

Vignette 4.5: Ronda

Table 4.5.1

Facts	Hypotheses	Information needed	Learning issues
The patient is a 25-year-old woman with extreme social anxiety	She is avoiding social contact due to extreme social anxiety	How many social contacts does she have in a typical day?	What is the functional analysis of this patient’s social contacts?
She makes poor eye contact		How many friends does she have?
She has few friends
She has never dated

Table 4.5.2

Facts	Hypotheses	Information needed	Learning issues
Patient only talks with her office mate rarely	Patient lacks social skills to develop social contacts	Can she have some positive experiences in interacting with others?	How can she learn conversational skills?
She has no other contacts besides her father and mother			How can she increase self-efficacy?

Appendix B: Answers to Self-Assessment Questions

• 1. C The parents are consistently and repeatedly reinforcing their baby’s crying every night.

• 2. E The impact of the model is enhanced by all of the variables except the age of the surgeon.

• 3. B It is true that the punisher may model verbal or physical aggression. All other choices are false.

• 4. D Ego functioning is a psychoanalytic concept that is unrelated to behavioral approaches to treatment.

• 5. A Negative reinforcement has to do with stopping negative stimulation to increase a behavior. Stopping anxiety reinforces driving avoidance behavior in the case example making A the correct choice.

• 6. C Functional analysis involves tracking antecedents and consequences of behavior, making option C the correct choice.

• 7. D A behavioral analysis does not rely on a diagnosis.

• 8. C Motivational interviewing helps the patient explore reasons and obstacles to change. None of the other options are reflective of motivational interviewing.

• 9. B Self-efficacy is the belief that someone has the skills to be successful. None of the other options are reflective of self-efficacy.