RCSI Building Blocks of Behaviour I – Learning PDF

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Building Blocks of Behaviour I – Learning Class FFP1, Medicine Year 1 Lecturer Ms. Luma Bashmi [email protected]...

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Building Blocks of Behaviour I – Learning Class FFP1, Medicine Year 1 Lecturer Ms. Luma Bashmi [email protected] Date September 24- 25 Enter subtitle here (24pt, Arial Regular) Enter date: 25.06.13  Learning Outcomes 1. Define learning 2. Describe, giving medically relevant examples: – Classical conditioning – Operant conditioning – Observational learning 3. Outline therapeutic methods derived from Learning Theory 2 LEARNING OUTCOME 1: Define learning 3 https://www.youtube.com/watch?v=BZUQQmcR5-g 4  Physarum polycephalum (Slime mould) https://www.youtub e.com/watch?time_ continue=112&v=ll s27hu03yw Definition of learning: A relatively durable change in behaviour or knowledge that is due to experience 5  Learning More than facts or knowledge – Behaviours – Skills e.g. social skills – Personal habits – Values – Emotional responses – Preferences Lifelong, dynamic process Enables adaptation  Think-Share As medical students, why is it important for you to understand how we learn? Why is understanding how we learn important? To better acquire the information and skills you need to become a HCP To better understand your patients (e.g., health habits, emotional responses, adjustment to illness) To better communicate and educate your patients and supervise and train junior colleagues Own life applications (e.g., problem solving, changing habits, building relationships, managing emotions…)  *** learning through direct experience - Behaviourist Learning Theories  LEARNING OUTCOME 2: Describe, giving medically relevant examples, classical conditioning 10 Classical (Pavlovian) Conditioning An initially neutral stimulus acquires the capacity to evoke a response that was originally evoked by another stimulus. Learning usually proceeds gradually but can occur rapidly Learned response = involuntary, automatic reactions (e.g. reflexes, emotional responses) 11  Classical Conditioning (NS) (UCS) (UCR) (CS) (CR) 12 Classical Conditioning NS  CS: Sound of bell CR: Summary: UCS: UCR: An originally neutral Food Salivation stimulus comes to elicit a response that it did not previously elicit 13 Everyday examples of Classical Conditioning Dogs get excited when you put on NS CS: Coat/Sound of lead your coat or pick up their lead CR: UCS: UCR: Going for a walk Excitement Cringing and/or feeling fearful when you hear the sound of a NS  CS: Sound of drill dentist’s drill CR: – Development of phobias UCS: UCR: Discomfort from drill Fear/Cringe Apply your learning NS  CS: Can you think of any other ??? CR: examples of classical UCS: UCR: conditioning? ??? ??? Everyday examples of Classical Conditioning Advertising Associate a medication with happy Campaigns to change and improved lifestyles attitudes Celebrity endorsement of Xarelto to promote Associating smoking with use over Warfarin (generic drug), to reduce death… 15 risk of blood clots Health-related examples of Classical Conditioning Form unconscious associations with healthcare experiences – e.g. Dentist drill White coat syndrome Conditioned nausea Implications – Can result in long-lasting attitudes, emotional responses and physiological responses  Applications of Classical Conditioning Prevent or change responses learned through classical conditioning e.g.… – Emotional responses e.g. prevent anxiety during medical interventions e.g. extinguish responses to phobias – Involuntary reactions e.g. overshadowing to prevent anticipatory nausea Pavlovian conditioning of nausea and vomiting. Autonomic Neuroscience, 129(1-2), 50–57. doi:10.1016/j.autneu.2006.07.012 Applications of Classical Conditioning To condition desirable responses, e.g…. – Positive attitudes/emotional responses – Physiological responses e.g., conditioning an immune response by pairing an immunosuppressant with a distinctive flavour Learned immune response: 18 www.sciencedirect.com/science/article/pii/S0889159109003948  LEARNING OUTCOME 3: Describe, giving medically relevant examples, operant conditioning 19  Operant Conditioning A form of learning in which voluntary responses/behaviours become controlled by their consequences (CC: stimuli that precede response impact that response) (CC: elicits automatic or involuntary responses) Effect on Behaviour Consequence Behaviour Rewarding Tendency to Response Stimulus tell jokes Tell Jokes Presented increases Friends Laugh 20 Operant Conditioning: Increasing Behaviour Reinforcement Occurs when an event following a response/behaviour increases the likelihood of that response/behaviour occurring again Used to promote desired behaviours http://www.youtube.com/watch?v=d3PrZeCmXd0&mode=related&search= 21 Operant Conditioning: Increasing behaviour Method Definition Example Positive Likelihood of the Studying to receive reinforce behaviour/respon praise ment se is increased Doing chores to receive because a rewarding/ rewards (e.g. money) consequence positive is Drinking alcohol to feel presented a buzz/increase confidence Negative reinforce Negative Likelihood of the Studying to remove ment reinforce behaviour/respon feelings of guilt ment aversive/ se is increased Taking pain killers to negative because an remove headache removed consequence is Putting on your seatbelt to remove the annoying warning tone in car Complaining of sickness to get the day off school 22 Operant Conditioning: Reinforcement Always involves INCREASING the response/behaviour! Positive: Adding something rewarding Negative: Removing something aversive (unpleasant) 23 Operant Conditioning: New/complex behaviours Shaping: Reinforcement of successive approximations to the desired response/behaviour – Used when no existing behaviours can be reinforced – Step by step approach is taken in order to achieve a more complex target/desired behaviour Everyday examples: – Learning complex skills e.g. training animals to do elaborate routines 24 Operant Conditioning: Decreasing behaviour Method Definition Example Non- Likelihood of the Decreasing tantrums by reinforce behaviour/respon ignoring them ment se is decreased because reinforcemen t is not presented Punishme Likelihood of the Decreasing nt behaviour/respon speeding/illegal parking se is decreased after receiving a because an aversive/ fine/clamp event is negative presented 25 Operant conditioning Negative reinforcement: Removing something aversive  increases response Punishment: Adding something aversive  decreases response 26  Applications of Operant Conditioning Quick and effective way to change behaviour! Improving knowledge and skills – Computerised tutorials with quizzes and feedback – Teaching complex skills through shaping e.g. surgery Changing behaviours – Increase adherence e.g. through positive reinforcement – Applied Behaviour Analysis (ABA) for Autism – Nursing homes & long-term care facilities – Change maladaptive pain behaviours – Drug addiction e.g. Contingency contracting Rehabilitation – Improve physical functioning following surgery e.g. shaping increasingly complex behaviours – Increase mobility in patients with chronic pain Classical vs. Operant Conditioning: Key differences Classical Operant Basic idea Learning based on Learning based on paired consequences: associations: consequences the stimuli that which precede a come after a response come behaviour come to to impact on impact that that response behaviour Type of Involuntary, Voluntary actions response/behavio automatic (learner chooses to ur reactions (learner “operate” on is passive) environment) 28  Conditioning in Action: Substance abuse “Rush” Positive STEP 1 Heroin “Buzz” reinforcement Needle, syringe, Classical tourniquet (CS) conditioning STEP 2 Withdrawal Negative symptoms Heroin reinforcement 29  Classical vs. Operant Conditioning: Shared terms Definition Classical example Operant example Generalisati Learning is applied to Little Albert’s Rat presses lever on similar situations fear (CR) of rats whenever it (greater similarity  (CS) generalised hears any music increases generalisation) to similar stimuli (e.g., dog, fur coat) Discriminati Learning is only applied Fear response Rat presses lever on in the presence of a only occurs when only for classical specific discriminative rat is presented music stimulus/context Extinction Learned Fear response Lever pressing response/behaviour decreases after decreases when decreases after the repeated reinforcement paired association (CC) exposure to rat stops or the reinforcement without loud (OC) stops noise Spontaneou Extinguished response Fear response Lever pressed s recovery starts again suddenly again when spontaneously after a triggered after a music is heard rest period period of no fear even though 30 this of rat (and no was no longer  Limitations of Behaviourist Learning Theory 1. Teacher-centred model 2. Reductionist: Ignore what goes on inside the individual 3. Focus on extrinsic rewards and incentives 4. A lot of the evidence is based on animal models 5. People’s changed behaviour can deteriorate over time  LEARNING OUTCOME 4: Describe, giving medically relevant examples, observational learning 32 Observational Learning Response is influenced by the observation of others (called models) Alfred Bandura – Importance of the social context and the learner (“human agency”) – Role models for how to think, feel and act No direct experience necessary – Vicarious reinforcement: Indirect conditioning (seeing what happens to others…) – Imitation can also occur in the absence of rewards 33  Applications of Observational Learning Influencing behaviour in healthcare setting/in response to illness – Modelling patient behaviour Children, use of patient videos – HCPs as role models Reactions to symptoms – Promote psychological adaptation/coping Support groups (model behaviour; learn from others) Buddy programmes for cancer or addiction Teaching doctors and other HCPs – Medical Teaching: “See one, do one, teach one” vs. Simulation and deliberate practice – Mentorship programmes 34 – Effective staff management  LEARNING OUTCOME 5: Outline therapeutic methods derived from Learning Theory 35  Therapies derived from Learning Theory: Behaviour Therapy: Flooding Sustained exposure to feared stimulus; fear eventually subsides: “Feel the fear & do it anyway” 36  Therapies derived from Learning Theory: Behaviour Therapy: Systematic desensitisation Step 1: Progressive muscle Anxiety relaxation Spiders Step 2: Hierarchy of fears Step 3: Imagined exposure + relaxation Relaxation Step 4: Gradual exposure + relaxation Examples: Reducing fear of withdrawal and preparing addicts to handle difficult situations during rehabilitation Teaching children with ADHD and Autism to swallow pills Drug addiction: www.tandfonline.com/doi/pdf/10.1080/02791072.2000.10400455 37 Swallowing pills: http://journals.sagepub.com/doi/pdf/10.1177/000992280504400608 Other therapeutic applications of Behavioural principles Social skills training Behaviour modification – e.g., changing maladaptive chronic pain behaviours Biofeedback Cognitive-behaviour therapy 38 Practical considerations of learning theories The context in which you deliver care is important! Recognise the role of patients’ previous learning experiences in shaping their attitudes and behaviours – Habits, culture, familiar patterns, feelings about themselves, what they value and what they perceive to be successful or rewarded in society – Relate new information to patients’ past experiences Ideal learning approach can differ between individuals – Behavioural (passive) vs. cognitive (active) approaches; effectiveness of reinforcement; and types of reinforcers that are effective varies between individuals 39  Test your understanding Based on your learning from this lecture… 1. Try to explain classical conditioning, operant conditioning, and observational learning to a friend. 2. Think of a healthcare-related example or a practical application of each that was not covered in the lecture. 40  Reading Relevant reading: – an Teijlingen E, Humphris GM. (2019) Psychology and Sociology Applied to Medicine: An Illustrated Colour Text. 4th edition. Elsevier Health Sciences, p 20 – 21. Older editon: Alder, Beth; Teijlingen, Edwin van; Porter, Michael (2011) Psychology and Sociology Applied to Medicine, 3rd edition pages 22-23; Useful resources: – Khan academy videos and knowledge check questions: https://www.khanacademy.org/test-prep/mcat/behavior/learning-slug/e/learning-questions https://www.khanacademy.org/test-prep/mcat/social-sciences-practice/social-science-practice-tut/e/ exploring-clinical-applications-of-classical-conditioning ? – Example of systematic desensitisation (feather phobia): www.youtube.com/watch?v=lMZ5o2uruXY Recommended, if interested in reading more: – Baumgart, M. & Baumgart, R. Applying Learning Theory to Healthcare Practice. Chapter 3. Health Professional as Educator: Principles of Teaching and Learning. Bastable, S. B, Gramet, P. Jacobs, K. & Sopczyk, D. L. (Eds.) 2011; Mississauga, Ontario: Jones & Bartlett Learning www.jblearning.com/samples/0763751375/chapter2.pdf – Grantcharov TP, Reznick RK. Teaching procedural skills: “see one, do one” is not the best way. BMJ 2008; 336: 1129-1131. Available from: www.bmj.com.proxy.library.rcsi.ie/content/336/7653/1129 41