Behavioral Medicine

Description of the Strategy

Behavioral medicine is a term that first arose in the 1960s from the ashes of the psychosomatic medicine and liaison psychiatry movements. Psychosomatic medicine and liaison psychiatry involved the application of Freudian or psychodynamic principles (i.e., psychological forces that interact within an individual and are outside of conscious awareness) to traditionally medical problems. Similarly, behavioral medicine is the application of learning theory principles (i.e., focus on overt, observable behaviors) to traditional medical disorders, such as pain, obesity, and diabetes. The influential Yale Conference on Behavioral Medicine defined behavioral medicine as “the field concerned with the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation.” It is our belief that in order to fully understand behavioral medicine, it is essential that the reader have a basic understanding of learning theory.

There are two basic types of learning, classical and operant conditioning, with the crucial thread that holds both together being the belief that behavior is lawful and observable and follows the rules of science. Classical conditioning is also referred to as “Pavlovian conditioning,” after the seminal work of the Russian scientist Pavlov in the early 20th century. Classical conditioning can be demonstrated by pairing a neutral stimulus (a conditioned stimulus, CS) in close temporal proximity with another stimulus (an unconditioned stimulus, UCS) that already elicits the desired response (the unconditioned response, UCR). In subsequent presentations of the CS, the organism will emit a new response (the conditioned response, CR) in anticipation of the UCS. For example, the UCS might be food, which elicits the UCR of salivation. The CS, the ringing of a bell, for example, is presented immediately prior to the food UCS. After repeated pairing of the ringing bell with food, the organism will come to salivate in response to the ringing bell.

Operant conditioning postulates that the consequence of a response changes the likelihood that the organism will produce that response in the future. The operant conditioning paradigm is the one most often used in behavioral medicine today. A basic proposition of operant conditioning is that if you wish a behavior to continue or increase in frequency, you reinforce (reward) that behavior. If you wish a behavior to decrease or to stop completely, you do not reinforce that behavior. Thus, within the theoretical framework of operant conditioning, the main way that you strengthen a behavior is to follow it in close temporal proximity with a reinforcer. A reinforcer is any stimulus that occurs following a response that tends to increase the likelihood that the response will be repeated. It is important that the reinforcer follow the desired behavior quickly, such that its presentation is kept to an optimally short delay. As the delay in the reinforcer increases, its effectiveness is generally decreased.

An important procedure in operant conditioning is that of shaping. Shaping refers to the learning process by which a predefined target response is achieved through gradual and systematic reinforcement. The shaping process begins with a simple, existing response and lax criteria for reinforcement and gradually moves to more stringent reinforcement criteria in order to achieve more complex responses. After a simple initial response is reliably performed, reinforcement is given contingent on the performance of more complex or difficult responses. This pattern of increasingly stringent contingent reinforcement continues until the final target response is achieved.

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