Basic Behavioral Paradigms

November 7, 2007

Virtually all behavioral methods for improving patient functioning derive from two traditional behavioral paradigms. The first is called the classical or respondent model of learning, and is most associated with Ivan Pavlov, a Russian psychologist active in the 1920s. This paradigm focuses on behaviors that are largely involuntary and controlled by the body’s autonomic nervous system, Examples of such behaviors include salivation, heartrate, and emotional states.The second behavioral paradigm is called the operant model, and is usually associated with B. F. Skinner, an American psychologist active from the late 1930s to the 1980s. This paradigm focuses on behaviors that are conscious, voluntary, and purposeful, and are controlled especially by the cerebral cortex. Speech and all observable motor behaviors (except reflexes and involuntary movements) would be included.

This model reasons that all voluntary behavior is influenced by its context. That is, through experience, individuals learn that observable environ­mental conditions make it possible to guess pretty accurately whether a particular behavior by the organism will bring to it a pleasant or unpleasant consequence. This idea is summarized as “SORC,” which stands for Stimulus (also called discriminative stimulus, antecedents, cues, or prompts) Organism (the abilities and limitations created for an individual by its genetic, physiological, historical, and social characteristics) Response (the behavior itself ) Consequence (also called reinforcement, reward, punishment, and the like).

Examples of such operant learning pervade our lives. We all recognize the discriminative stimulus of a phone ring. We respond by picking up the phone and saying hello because we have so often been reinforced for such behavior by hearing the caller’s voice. Experiencing the sight, sounds, and smells (cues) of a ball game in a ballpark elicits specific behaviors (like cheering) that may be considered strange in other con­texts. Many common situations become cues for us to choose to act in specific ways, and then reward us for so acting.

Most instances of voluntary, inappropriate, learned behavior by dementia victims involve the patient responding to whatever cue is most noticeable and subjectively relevant at the moment. So, for example, seeing a door, especially a glass door or open door, will attract any patient who is restless and enjoys walking, or who feels lost and wants to go home. The door is a cue that elicits exiting behavior because, in previous experience, walking-through-door behavior has led to gratification in the form of strolling or getting home.

Learning becomes random when caregivers allow the links (also called contingencies) between desired patient behaviors and pleasant consequences to weaken or dissolve. If caregivers do not carefully insure that pleasant consequences follow most acceptable actions, random environmental events will establish haphazard, even dangerous, new rules for patients to live by. For example, when the patient’s dementia causes a decreased sense of social propriety, and caregivers do not provide the patient with structured activities, several behaviors are likely to emerge because they are available on the patient’s own body, and because they feel good. Some are often unacceptable, such as skin scratching, nose-picking, anal digging, and masturbation. Others are sometimes acceptable, unless their frequency is very high, such as patting, rubbing, rocking, walking, and tapping. These self-stimulatory behaviors are self-reinforcing, and usually indicate inadequate environmental stimulation .

Much undesired patient behavior is inadvertently reinforced by caregiver attention. Speech-such as questions, statements, or moans-that is disruptively loud or repetitive almost always results in increased caregiver attention. Contrary to common sense, waiting longer to respond to the patient for such behavior may actually strengthen, rather than weaken, the behavior. This is because it trains the patient that extensive responding is simply required to gain the attention reward.

It is crucial to realize that these two behavioral paradigms, the classical and the operant, are useful in understanding the development of both appropriate, desirable behaviors, and inappropriate, undesirable, even self-destructive behaviors. By applying these concepts to the secondary symptoms shown by dementia victims, in what is called a fimctiol1al analysis of behavior, it is possible to both understand the behavior better and design interventions that may improve the patient’s behavior.

In dementia sufferers, learning is, by definition, very inefficient. Therefore, it is vital that caregivers continually enable, prompt, and reward appropriate behavior.

Posted in Alzhemier Disease