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What is Parson's sick role theory?

Definition of Sick Role Theory

Parsons saw the sick role as a form of deviance, or going against societal expectations, because an ill person has different patterns of behavior than the norm. He argued that people are generally expected to be productive members of society.

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Motivational interviewing was first described by Miller in 1983, for a study examining the treatment of alcoholism (now known as alcohol use disorder). The term has widely caught on throughout healthcare systems as a way to help the patient put into practice health promotion strategies such as nutritional recommendations for diet changes or healthier behaviours such as incorporating exercise into a daily routine, by ensuring the patient realises for themselves that they have the power to make changes, they recognise the problem, recognise how to deal with the problem, and feel motivated with a plan going forward to implement the necessary changes. Simply giving a patient advice is not enough - a strategy as to how the information is taken on and how the patient thinks, feels and behaves are integral to incorporating the necessary changes required for their health. A university lecturer, Stephen Rollnick (2010), has studied the technique and specialises in the training of others to understand how to implement it. Rollnick (2010) described that simply giving advice to patients to 'change' is not efficacious on its own.

Motivational interviewing helps to clarify the person's strengths and aspirations, inspires motivation to change and encourages independence in decision making, therefore empowering the person to feel they can take the challenge on to make change. Rollnick (2010) discusses that this style of patient engagement has been shown to promote behavioural change in various healthcare settings, and it improves relationships between clinicians and patients, while improving efficiency in achieving better health outcomes. The principles involve directing, guiding and following.

Motivational interviewing helps ensure the patient realises for themselves that they have the power to make changes

The Royal College of Nursing ( RCN, 2019) summarises the five key skills for motivational interviewing. The first skill involves an open discussion that explores why the person is fearful of change or exploring, using open questions, why the person feels low or lacks motivation recently. Reflective listening ensures the person knows they are understood by the practitioner and reinforces the interest the patient feels the practitioner has in them and their health, by the practitioner being able to reflect a summary of the issues. Clarification shows the person that they are understood. When reflecting it is important to avoid making assumptions, judgments or enforcing your own beliefs - instead focus on expressing that you are 'getting a sense' of what they have told you, then clarify the plan for moving forward. Summarise the concerns, the negative consequences identified, the plan, then elicit motivational statements such as reminding them how well they have done previously and that they can do this again, empowering them through positively appraising the plan they have made.

Tackling the obesity crisis using motivational interviewing

Exercise is found by many researchers to have a positive effect on mood, self-esteem and other aspects of mental health, as well as a high impact on physical health and therefore the risk of long-term health conditions. It is important a patient understands why exercise can help them, but also that they are motivated to change. Exercise can tackle obesity but it can also tackle depression. Pearce et al (2022) observed that exercise is a powerful tool in fighting depression by promoting positive changes in the brain, including neural growth, reduced inflammation, and new activity patterns that promote feelings of calm and well-being, while also releasing endorphins ( Pearce et al, 2022).

Wade et al (2018) studied use of the technique for encouraging weight loss, noting the significant burden obesity has on health services due to it being linked to increased risk of over 20 chronic conditions. Ensuring people are active is a public health challenge and therefore the team wanted to use a behavioural intervention that was already being used in primary care, to examine its effectiveness in encouraging a more active lifestyle for at-risk patients. The researchers looked at changes in physical activity and mental wellbeing as outcomes for examining the community-based intervention grounded in motivational interviewing.

The research took place in Essex and the project title was, 'Let's Get Moving'. Eligible participants had to be between 18 and 74 years old with a body mass index of 28-35 kg/m ². Firstly, a motivational interviewing appointment was carried out for half an hour, at the beginning of the patient's involvement. The person was then signposted to relevant activities and the data was collated. The 12-week data were collated during a face-to-face appointment, then at 6 and 12 months follow-ups were carried out over the phone. In order to measure the outcomes, the team got the participants to self-report physical activity levels using the International Physical Activity Questionnaire (IPAQ), and mental wellbeing was measured using the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Of the 2084 participants, about 60% were female and two-thirds had a disability. The sample was predominantly White or White British and therefore may not be generalisable across all ethnicities and cultures. The study found that there were significant increases in vigorous and moderate intensity physical activity, walking and mental wellbeing ( Wade et al, 2018). Therefore, the researchers concluded that physical activity intervention grounded in motivational interviewing appears to be highly effective, although bias could not be ruled out for the study ( Wade et al, 2018).
'The researchers concluded that physical activity intervention grounded in motivational interviewing appears to be highly effective.'
Motivational interviewing for newly discharged patients in the community

Brandberg et al (2021) studied the self-management challenges that exist following hospital discharge with patients with multiple conditions. The aim of their research was to describe the challenges faced over time during the four weeks following hospital discharge, as it is common for vulnerable patients to often be readmitted, and this would inevitably relate to challenges faced following leaving the hospital. Motivational interviewing was used for 16 participants, who either had heart failure or chronic obstructive pulmonary disease in combination with at least one other comorbidity. The participant then had four or five motivational interviewing sessions with a trained social worker over a period of 4 weeks, which were all digitally recorded and analysed using content analysis. The researchers noted that when people feel motivated, engaged and have a greater sense of psychological wellbeing, positive health behaviours are far more likely. They noted the importance of patient autonomy. This can be difficult when a patient is generally chronically unwell yet they face the prospect of leaving a full care environment full of practitioners to possibly living independently alone again, and this could be following months in hospital. Follow-up care would be given when required in the community but it is still a very different environment to adjust to, making the patient vulnerable and possibly overwhelmed, demotivated and anxious about their situation, leading to worse health behaviours, health outcomes and possible readmission.

The patients had their first motivational interview sessions 1-2 days following discharge to ensure first contact was established and to acknowledge any concerns or questions arising early. The patients then had sessions weekly thereafter, post-hospitalisation. These sessions helped to examine change over time post-discharge and to capture the difficulties that may lead someone back to readmission. However, due to motivational interviewing the practice enabled these difficulties to be acknowledged and managed in the community, while also observing issues that can be applied to practice for patient populations. By the fourth session, some patients stated they felt they could manage their situation and no longer required the intervention.

Brandberg et al (2021) noted the importance of motivational interviewing as it can help the patients to self-manage and therefore avoids deterioration or readmission. Brandberg et al (2021) felt the four key areas that motivational interviewing could address in order to avoid readmission and to encourage better health following discharge, were: managing medications; managing symptoms or signs or worsening illness post-discharge; acquiring knowledge of follow-up; and acquiring knowledge of and control over whom to contact for different healthcare needs. The sessions enabled the researchers to observe that self-management is a dynamic process affected by managing system-centred care along with the burden of living with multiple comorbidities. They noted that patients with multiple comorbidities need support during the first 2-weeks post-discharge and that system-centred healthcare does not necessarily suit someone with multiple chronic conditions, instead targeting a single-disease population, which in Western culture is difficult to apply given the amount of people living with multiple chronic illnesses. By adapting the process in the community following patient discharge, through empowerment and identification of changing needs using motivational interviewing, this may be a better way to encourage good health to stay on track and to avoid hospital readmission.

Brandberg et al (2021) discussed that self-management is a dynamic process that changes rapidly throughout the first weeks following hospital discharge. Patient needs shift and change during this time and if these are identified and addressed through motivational interviewing in this early post-discharge period, outcomes may be improved for both the patient and healthcare system.

There are multiple other areas that can be addressed using motivational interviewing. Addiction is an ever-increasing public health concern and also could benefit from the intervention, as found by Satre et al (2016) in their randomised controlled trial, which found cannabis use and hazardous alcohol use could be helped through the use of the intervention. Similarly, Ma et al (2014) found the intervention benefited patients with hypertension.

In fact, Ma et al (2014) found the systolic blood pressure and diastolic blood pressure of hypertensive patients significantly decreased in the participants who received motivational interviewing for 6 months. They concluded that the intervention should be used in hospitals and in primary care, and that training should be provided to nurses so they could practice this in their work with any patient.

Conclusion

In summary, the key is to ensure all staff know how to engage a patient using this method, as by motivating and empowering a patient to choose for themselves, and repeating this conversation regularly with the patient, not only can any concerns be addressed as they arise, but adherence to healthier behaviours can be increased.

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Practice Nursing - Using motivational interviewing to improve health outcomes

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Exercise is found by many researchers to have a positive effect on mood, self-esteem and other aspects of mental health, as well as a high impact on physical health and therefore the risk of long-term health conditions. It is important a patient understands why exercise can help them, but also that they are motivated to change.

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Understand different definitions of health and ill health.

1.1. Identify two contrasting definitions of health and ill health.

2. Understand different explanatory models of health and ill health.

2.1.Explain two models of health and ill health, taken from the following list - ▪ Biomedical, ▪ Sociological ▪ Holistic ▪ Personal behaviour models.

3. Understand how models of health and ill health can be applied by health professionals.

3.1.Discuss how the two models chosen could be applied by health professionals.

4. Understand the different ways in which people respond to illness.

4.1.Explain factors that affect how people react to ill health

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The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness

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The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness

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This title is directed primarily towards health care professionals outside of the United States. Nursing practice needs to be informed by an understanding of people and the societies in which they live. This introductory text has been designed specifically to discuss those aspects of sociology which are most relevant to nursing and the health care context in which it takes place.. A user-friendly introduction to a subject which students often find strange and new. Relates sociology to health and nursing to make the subject relevant to clinical practice . Key concepts and chapter summaries aid learning and revision. Case studies help relate theory to practice. Reference lists in each chapter provide the evidence base.. Biographical notes on eminent sociologists help bring the subject to life. Annotated Further Reading enables more in-depth study

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Health and high quality care for all, now and for future generations

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Fields of Medicine

Becky hurt her back. She has a number of choices regarding her treatment. She can go to her primary care physician, she can go to an orthopedist, she can see a chiropractor, an acupuncturist, a massage therapist, and the list goes on and on. Becky might choose one of these options, or combine a few. Her choices will depend on her personal preferences and what works best for her injury.

The various treatment choices represent different fields of medicine. A field of medicine is a practice of a particular medical discipline. Generally speaking, there are two main fields:

Scientific, or conventional, medicine

Holistic medicine

For the most part, holistic medicine refers to a general treatment practice that focuses on overall wellness and does not fall within the definition of conventional medicine. That's a bit circular, so let's start by examining and defining conventional, or scientific, medicine.

Scientific Medicine

Conventional medicine is science-based medicine. When you have a sore throat, and you go see your primary care physician at a doctor's office, you are partaking in scientific medicine. This type of medicine uses scientific observations in order to understand and treat the human body.

Your doctor is most likely an M.D. Professionals holding this Medical Doctor title have studied and earned a degree in science-based medicine. According to the American Medical Association, the key difference between scientific medicine and all other forms of medicine is the educational qualification of practitioners to a particular scientific standard.

So, you show up for your appointment with your sore throat. Your doctor takes a look inside your throat and swabs it in order to collect organisms. The swab will be processed in a lab. The results will let the doctor know whether or not you have an infection, like strep throat or the flu. Let's say the results show that you have strep throat. The doctor will then prescribe an antibiotic drug designed to eliminate strep infections.

This scientific process is a newer type of medicine. It was developed over the last few centuries, but only became what we now know as conventional medicine, or modern medicine, in the 19th and 20th centuries. That was due to discoveries and advances relating to germs, infectious diseases, and medicines. The first true antibiotic wasn't discovered until 1928 and wasn't widely used until the late 1940s. Other important advances include microscopes, stethoscopes, and x-ray machines.

Scientific medicine is based on documentation. Throughout the 19th century, medical researchers utilized the numerical method. This method analyzed specific treatments through statistics in order to determine effectiveness. For this reason, scientific medicine is also sometimes referred to as evidence-based medicine. Though research methods are drastically modernized, this type of clinical research is still central to scientific medicine.

Holistic Medicine

Now let's turn to holistic medicine. As you know, holistic medicine is any type of medicine that isn't science-based medicine. Specifically, holistic medicine focuses on overall wellness by treating the mind, body, and spirit. Historically, both Socrates and Plato advocated a holistic approach to medicine, though the term wasn't used until the 1920s and the concept wasn't widely accepted until the 1970s.

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scientific medicine vs. holistic medicine - video & lesson transcript | study.com

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Scientific Medicine vs. Holistic Medicine - Video & Lesson Transcript | Study.com

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Becky hurt her back. She has a number of choices regarding her treatment. She can go to her primary care physician, she can go to an orthopedist, she can see a chiropractor, an acupuncturist, a massage therapist, and the list goes on and on. Becky might choose one of these options, or combine a few.

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Fields of Medicine

Becky hurt her back. She has a number of choices regarding her treatment. She can go to her primary care physician, she can go to an orthopedist, she can see a chiropractor, an acupuncturist, a massage therapist, and the list goes on and on. Becky might choose one of these options, or combine a few. Her choices will depend on her personal preferences and what works best for her injury.

The various treatment choices represent different fields of medicine. A field of medicine is a practice of a particular medical discipline. Generally speaking, there are two main fields:

Scientific, or conventional, medicine

Holistic medicine

For the most part, holistic medicine refers to a general treatment practice that focuses on overall wellness and does not fall within the definition of conventional medicine. That's a bit circular, so let's start by examining and defining conventional, or scientific, medicine.

Scientific Medicine

Conventional medicine is science-based medicine. When you have a sore throat, and you go see your primary care physician at a doctor's office, you are partaking in scientific medicine. This type of medicine uses scientific observations in order to understand and treat the human body.

Your doctor is most likely an M.D. Professionals holding this Medical Doctor title have studied and earned a degree in science-based medicine. According to the American Medical Association, the key difference between scientific medicine and all other forms of medicine is the educational qualification of practitioners to a particular scientific standard.

So, you show up for your appointment with your sore throat. Your doctor takes a look inside your throat and swabs it in order to collect organisms. The swab will be processed in a lab. The results will let the doctor know whether or not you have an infection, like strep throat or the flu. Let's say the results show that you have strep throat. The doctor will then prescribe an antibiotic drug designed to eliminate strep infections.

This scientific process is a newer type of medicine. It was developed over the last few centuries, but only became what we now know as conventional medicine, or modern medicine, in the 19th and 20th centuries. That was due to discoveries and advances relating to germs, infectious diseases, and medicines. The first true antibiotic wasn't discovered until 1928 and wasn't widely used until the late 1940s. Other important advances include microscopes, stethoscopes, and x-ray machines.

Scientific medicine is based on documentation. Throughout the 19th century, medical researchers utilized the numerical method. This method analyzed specific treatments through statistics in order to determine effectiveness. For this reason, scientific medicine is also sometimes referred to as evidence-based medicine. Though research methods are drastically modernized, this type of clinical research is still central to scientific medicine.

Holistic Medicine

Now let's turn to holistic medicine. As you know, holistic medicine is any type of medicine that isn't science-based medicine. Specifically, holistic medicine focuses on overall wellness by treating the mind, body, and spirit. Historically, both Socrates and Plato advocated a holistic approach to medicine, though the term wasn't used until the 1920s and the concept wasn't widely accepted until the 1970s.

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scientific medicine vs. holistic medicine - video & lesson transcript | study.com

# data[].attributes.attachment_link.title
Scientific Medicine vs. Holistic Medicine - Video & Lesson Transcript | Study.com

# data[].attributes.attachment_link.description
Becky hurt her back. She has a number of choices regarding her treatment. She can go to her primary care physician, she can go to an orthopedist, she can see a chiropractor, an acupuncturist, a massage therapist, and the list goes on and on. Becky might choose one of these options, or combine a few.

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Parents

Modelling - imitating the role model's behaviour. Parent brushes teeth twice daily, the child observes. This has an effect on the child's behaviour. The child would then model the behaviour and brush their teeth twice a day.

The child observes their parent eating, the relationship with food, what food they eat. The parent also provides the food for the child. The parent communicates values about the food. This can have an effect on the child's preferences.

Vicarious Reinforcement - modelling is more likely through vicarious reinforcement. The observer witnesses the role model's behaviour being rewarded - eg a parent enjoying a chocolate bar or enjoying a particular exercise.

Peers

Schools may enlist popular children to become role models for other students, becoming 'leaders' to model healthy behaviours, reinforce positive lifestyle values. Peer groups often have the credibility that teachers or parents are unlikely to have with the other students.

Social Norms - 'desirable' or 'normal' behaviours (e.g. exercising, smoking) so other peers then imitate these behaviours.

Healthcare Professionals

Nurses are usually expected to model positive health behaviours that are targeted in health education. What if they don't? does this make health education less effective? Less credible coming from that health professional? Also they are expected to be teaching future nurses.

Celebrities

Celebrities are sometimes recruited to front media campaigns around health education. Celebrities are seen as having status, wealth and glamour that people want to emulate.

Covid vaccinations was a good example of this. Celtic Sea Salt - TikTok

Consider high media presence /social media.

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Operant conditioning, or instrumental conditioning, is a theory of learning where behavior is influenced by its consequences. Behavior that is reinforced (rewarded) will likely be repeated, and behavior that is punished will occur less frequently.

By the 1920s, John B. Watson had left academic psychology, and other behaviorists were becoming influential, proposing new forms of learning other than classical conditioning. Perhaps the most important of these was Burrhus Frederic Skinner. Although, for obvious reasons, he is more commonly known as B.F. Skinner.

Skinner's views were slightly less extreme than those of Watson (1913). Skinner believed that we do have such a thing as a mind, but that it is simply more productive to study observable behavior rather than internal mental events.

The work of Skinner was rooted in the view that classical conditioning was far too simplistic to be a complete explanation of complex human behavior. He believed that the best way to understand behavior is to look at the causes of an action and its consequences. He called this approach operant conditioning.

BF Skinner: Operant Conditioning

Skinner is regarded as the father of Operant Conditioning, but his work was based on Thorndike's (1898) law of effect. According to this principle, behavior that is followed by pleasant consequences is likely to be repeated, and behavior followed by unpleasant consequences is less likely to be repeated.

Skinner introduced a new term into the Law of Effect - Reinforcement. behavior that is reinforced tends to be repeated (i.e., strengthened); behavior that is not reinforced tends to die out or be extinguished (i.e., weakened).

Skinner (1948) studied operant conditioning by conducting experiments using animals which he placed in a " " which was similar to Thorndike's puzzle box.

A Skinner box, also known as an operant conditioning chamber, is a device used to objectively record an animal's behavior in a compressed time frame. An animal can be rewarded or punished for engaging in certain behaviors, such as lever pressing (for rats) or key pecking (for pigeons).

Skinner identified three types of responses, or operant, that can follow behavior.

Neutral operants: responses from the environment that neither increase nor decrease the probability of a behavior being repeated.

Reinforcers: Responses from the environment that increase the probability of a behavior being repeated. Reinforcers can be either positive or negative.

Punishers: Responses from the environment that decrease the likelihood of a behavior being repeated. Punishment weakens behavior.

We can all think of examples of how our own behavior has been affected by reinforcers and punishers. As a child, you probably tried out a number of behaviors and learned from their consequences.

For example, when you were younger, if you tried smoking at school, and the chief consequence was that you got in with the crowd you always wanted to hang out with, you would have been positively reinforced (i.e., rewarded) and would be likely to repeat the behavior.

If, however, the main consequence was that you were caught, caned, suspended from school and your parents became involved you would most certainly have been punished, and you would consequently be much less likely to smoke now.

Positive Reinforcement

Positive reinforcement is a term described by B. F. Skinner in his theory of operant conditioning. In positive reinforcement, a response or behavior is strengthened by rewards, leading to the repetition of desired behavior. The reward is a reinforcing stimulus.

Primary reinforcers are stimuli that are naturally reinforcing because they are not learned and directly satisfy a need, such as food or water.

Secondary reinforcers are stimuli that are reinforced through their association with a primary reinforcer, such as money, school grades. They do not directly satisfy an innate need but may be the means. So a secondary reinforcer can be just as powerful a motivator as a primary reinforcer.

Skinner showed how positive reinforcement worked by placing a hungry rat in his Skinner box. The box contained a lever on the side, and as the rat moved about the box, it would accidentally knock the lever. Immediately it did so that a food pellet would drop into a container next to the lever.

The rats quickly learned to go straight to the lever after a few times being put in the box. The consequence of receiving food, if they pressed the lever, ensured that they would repeat the action again and again.

Positive reinforcement strengthens a behavior by providing a consequence an individual finds rewarding. For example, if your teacher gives you £5 each time you complete your homework (i.e., a reward), you will be more likely to repeat this behavior in the future, thus strengthening the behavior of completing your homework.

The Premack principle is a form of positive reinforcement in operant conditioning. It suggests using a preferred activity (high-probability behavior) as a reward for completing a less preferred one (low-probability behavior).

This method incentivizes the less desirable behavior by associating it with a desirable outcome, thus strengthening the less favored behavior.

Negative Reinforcement

Negative reinforcement is the termination of an unpleasant state following a response.

This is known as negative reinforcement because it is the removal of an adverse stimulus which is 'rewarding' to the animal or person. Negative reinforcement strengthens behavior because it stops or removes an unpleasant experience.

For example, if you do not complete your homework, you give your teacher £5. You will complete your homework to avoid paying £5, thus strengthening the behavior of completing your homework.

Skinner showed how negative reinforcement worked by placing a rat in his Skinner box and then subjecting it to an unpleasant electric current which caused it some discomfort. As the rat moved about the box it would accidentally knock the lever.

Immediately it did so the electric current would be switched off. The rats quickly learned to go straight to the lever after a few times of being put in the box. The consequence of escaping the electric current ensured that they would repeat the action again and again.

In fact, Skinner even taught the rats to avoid the electric current by turning on a light just before the electric current came on. The rats soon learned to press the lever when the light came on because they knew that this would stop the electric current from being switched on.

These two learned responses are known as Escape Learning and Avoidance Learning.

Punishment (weakens behavior)

Punishment is the opposite of reinforcement since it is designed to weaken or eliminate a response rather than increase it. It is an aversive event that decreases the behavior that it follows.

Like reinforcement, punishment can work either by directly applying an unpleasant stimulus like a shock after a response or by removing a potentially rewarding stimulus, for instance, deducting someone's pocket money to punish undesirable behavior.

Note: It is not always easy to distinguish between punishment and negative reinforcement.

They are two distinct methods of punishment used to decrease the likelihood of a specific behavior occurring again, but they involve different types of consequences:

1. Positive Punishment:

Positive punishment involves adding an aversive stimulus or something unpleasant immediately following a behavior to decrease the likelihood of that behavior happening in the future.

It aims to weaken the target behavior by associating it with an undesirable consequence.

Example: A child receives a scolding (an aversive stimulus) from their parent immediately after hitting their sibling. This is intended to decrease the likelihood of the child hitting their sibling again.

2. Negative Punishment:

Negative punishment involves removing a desirable stimulus or something rewarding immediately following a behavior to decrease the likelihood of that behavior happening in the future.

It aims to weaken the target behavior by taking away something the individual values or enjoys.

Example: A teenager loses their video game privileges (a desirable stimulus) for not completing their chores. This is intended to decrease the likelihood of the teenager neglecting their chores in the future.

There are many problems with using punishment, such as:

Punished behavior is not forgotten, it's suppressed - behavior returns when punishment is no longer present.

Causes increased aggression - shows that aggression is a way to cope with problems.

Creates fear that can generalize to undesirable behaviors, e.g., fear of school.

Does not necessarily guide you toward desired behavior - reinforcement tells you what to do, and punishment only tells you what not to do.

Examples of Operant Conditioning

1. Positive Reinforcement: Suppose you are a coach and want your team to improve their passing accuracy in soccer. When the players execute accurate passes during training, you praise their technique. This positive feedback encourages them to repeat the correct passing behavior.

2. Negative Reinforcement: If you notice your team working together effectively and exhibiting excellent team spirit during a tough training session, you might end the training session earlier than planned, which the team perceives as a relief. They understand that teamwork leads to positive outcomes, reinforcing team behavior.

3. Negative Punishment: If an office worker continually arrives late, their manager might revoke the privilege of flexible working hours. This removal of a positive stimulus encourages the employee to be punctual.

4. Positive Reinforcement: Training a cat to use a litter box can be achieved by giving it a treat each time it uses it correctly. The cat will associate the behavior with the reward and will likely repeat it.

5. Negative Punishment: If teenagers stay out past their curfew, their parents might take away their gaming console for a week. This makes the teenager more likely to respect their curfew in the future to avoid losing something they value.

6. Ineffective Punishment: Your child refuses to finish their vegetables at dinner. You punish them by not allowing dessert, but the child still refuses to eat vegetables next time. The punishment seems ineffective.

7. Premack Principle Application: You could motivate your child to eat vegetables by offering an activity they love after they finish their meal. For instance, for every vegetable eaten, they get an extra five minutes of video game time. They value video game time, which might encourage them to eat vegetables.

8. Other Premack Principle Examples:

A student who dislikes history but loves art might earn extra time in the art studio for each history chapter reviewed.

For every 10 minutes a person spends on household chores, they can spend 5 minutes on a favorite hobby.

For each successful day of healthy eating, an individual allows themselves a small piece of dark chocolate at the end of the day.

A child can choose between taking out the trash or washing the dishes. Giving them the choice makes them more likely to complete the chore willingly.

Skinner's Pigeon Experiment

B.F. Skinner conducted several experiments with pigeons to demonstrate the principles of operant conditioning.

One of the most famous of these experiments is often colloquially referred to as " Superstition in the Pigeon."

This experiment was conducted to explore the effects of non-contingent reinforcement on pigeons, leading to some fascinating observations that can be likened to human superstitions.

Non-contingent reinforcement (NCR) refers to a method in which rewards (or reinforcements) are delivered independently of the individual's behavior. In other words, the reinforcement is given at set times or intervals, regardless of what the individual is doing.

The Experiment:

1. Pigeons were brought to a state of hunger, reduced to 75% of their well-fed weight.

2. They were placed in a cage with a food hopper that could be presented for five seconds at a time.

3. Instead of the food being given as a result of any specific action by the pigeon, it was presented at regular intervals, regardless of the pigeon's behavior.

Observation:

1. Over time, Skinner observed that the pigeons began to associate whatever random action they were doing when food was delivered with the delivery of the food itself.

2. This led the pigeons to repeat these actions, believing (in anthropomorphic terms) that their behavior was causing the food to appear.

Findings:

1. In most cases, pigeons developed different "superstitious" behaviors or rituals. For instance, one pigeon would turn counter-clockwise between food presentations, while another would thrust its head into a cage corner.

2. These behaviors did not appear until the food hopper was introduced and presented periodically.

3. These behaviors were not initially related to the food delivery but became linked in the pigeon's mind due to the coincidental timing of the food dispensing.

4. The behaviors seemed to be associated with the environment, suggesting the pigeons were responding to certain aspects of their surroundings.

5. The rate of reinforcement (how often the food was presented) played a significant role. Shorter intervals between food presentations led to more rapid and defined conditioning.

6. Once a behavior was established, the interval between reinforcements could be increased without diminishing the behavior.

Superstitious Behavior:

The pigeons began to act as if their behaviors had a direct effect on the presentation of food, even though there was no such connection. This is likened to human superstitions, where rituals are believed to change outcomes, even if they have no real effect.

For example, a card player might have rituals to change their luck, or a bowler might make gestures believing they can influence a ball already in motion.

Conclusion:

This experiment demonstrates that behaviors can be conditioned even without a direct cause-and-effect relationship. Just like humans, pigeons can develop "superstitious" behaviors based on coincidental occurrences.

This study not only sheds light on the intricacies of operant conditioning but also draws parallels between animal and human behaviors in the face of random reinforcements.

Schedules of Reinforcement

Imagine a rat in a "Skinner box." In operant conditioning, if no food pellet is delivered immediately after the lever is pressed then after several attempts the rat stops pressing the lever (how long would someone continue to go to work if their employer stopped paying them?). The behavior has been extinguished.

Behaviorists discovered that different patterns (or schedules) of reinforcement had different effects on the speed of learning and extinction. Ferster and Skinner (1957) devised different ways of delivering reinforcement and found that this had effects on

1. The Response Rate - The rate at which the rat pressed the lever (i.e., how hard the rat worked).

2. The Extinction Rate - The rate at which lever pressing dies out (i.e., how soon the rat gave up).

Skinner found that the type of reinforcement which produces the slowest rate of extinction (i.e., people will go on repeating the behavior for the longest time without reinforcement) is variable-ratio reinforcement. The type of reinforcement which has the quickest rate of extinction is continuous reinforcement.

(A) Continuous Reinforcement

An animal/human is positively reinforced every time a specific behavior occurs, e.g., every time a lever is pressed a pellet is delivered, and then food delivery is shut off.

Response rate is SLOW

Extinction rate is FAST

(B) Fixed Ratio Reinforcement

Behavior is reinforced only after the behavior occurs a specified number of times. e.g., one reinforcement is given after every so many correct responses, e.g., after every 5th response. For example, a child receives a star for every five words spelled correctly.

Response rate is FAST

Extinction rate is MEDIUM

(C) Fixed Interval Reinforcement

One reinforcement is given after a fixed time interval providing at least one correct response has been made. An example is being paid by the hour. Another example would be every 15 minutes (half hour, hour, etc.) a pellet is delivered (providing at least one lever press has been made) then food delivery is shut off.

Response rate is MEDIUM

Extinction rate is MEDIUM

(D) Variable Ratio Reinforcement

behavior is reinforced after an unpredictable number of times. For examples gambling or fishing.

Extinction rate is SLOW (very hard to extinguish because of unpredictability)

(E) Variable Interval Reinforcement

Providing one correct response has been made, reinforcement is given after an unpredictable amount of time has passed, e.g., on average every 5 minutes. An example is a self-employed person being paid at unpredictable times.

Response rate is FAST

Extinction rate is SLOW

Applications

1. Behavior Modification Therapy

Behavior modification is a set of therapeutic techniques based on operant conditioning (Skinner, 1938, 1953). The main principle comprises changing environmental events that are related to a person's behavior. For example, the reinforcement of desired behaviors and ignoring or punishing undesired ones.

This is not as simple as it sounds - always reinforcing desired behavior, for example, is basically bribery.

There are different types of positive reinforcements. Primary reinforcement is when a reward strengths a behavior by itself. Secondary reinforcement is when something strengthens a behavior because it leads to a primary reinforcer.

Examples of behavior modification therapy include token economy and behavior shaping.

Token Economy

Token economy is a system in which targeted behaviors are reinforced with tokens (secondary reinforcers) and later exchanged for rewards (primary reinforcers).

Tokens can be in the form of fake money, buttons, poker chips, stickers, etc. While the rewards can range anywhere from snacks to privileges or activities. For example, teachers use token economy at primary school by giving young children stickers to reward good behavior.

Token economy has been found to be very effective in managing psychiatric patients. However, the patients can become over-reliant on the tokens, making it difficult for them to adjust to society once they leave prison, hospital, etc.

Staff implementing a token economy program have a lot of power. It is important that staff do not favor or ignore certain individuals if the program is to work. Therefore, staff need to be trained to give tokens fairly and consistently even when there are shift changes such as in prisons or in a psychiatric hospital.

Behavior Shaping

A further important contribution made by Skinner (1951) is the notion of behavior shaping through successive approximation. Skinner argues that the principles of operant conditioning can be used to produce extremely complex behavior if rewards and punishments are delivered in such a way as to encourage move an organism closer and closer to the desired behavior each time.

In shaping, the form of an existing response is gradually changed across successive trials towards a desired target behavior by rewarding exact segments of behavior.

To do this, the conditions (or contingencies) required to receive the reward should shift each time the organism moves a step closer to the desired behavior.

According to Skinner, most animal and human behavior (including language) can be explained as a product of this type of successive approximation.

2. Educational Applications

In the conventional learning situation, operant conditioning applies largely to issues of class and student management, rather than to learning content. It is very relevant to shaping skill performance.

A simple way to shape behavior is to provide feedback on learner performance, e.g., compliments, approval, encouragement, and affirmation.

A variable-ratio produces the highest response rate for students learning a new task, whereby initial reinforcement (e.g., praise) occurs at frequent intervals, and as the performance improves reinforcement occurs less frequently, until eventually only exceptional outcomes are reinforced.

For example, if a teacher wanted to encourage students to answer questions in class they should praise them for every attempt (regardless of whether their answer is correct). Gradually the teacher will only praise the students when their answer is correct, and over time only exceptional answers will be praised.

Unwanted behaviors, such as tardiness and dominating class discussion can be extinguished through being ignored by the teacher (rather than being reinforced by having attention drawn to them). This is not an easy task, as the teacher may appear insincere if he/she thinks too much about the way to behave.

Knowledge of success is also important as it motivates future learning. However, it is important to vary the type of reinforcement given so that the behavior is maintained. This is not an easy task, as the teacher may appear insincere if he/she thinks too much about the way to behave.

Operant Conditioning vs. Classical Conditioning

Learning Type

While both types of conditioning involve learning, classical conditioning is passive (automatic response to stimuli), while operant conditioning is active (behavior is influenced by consequences).

Classical conditioning links an involuntary response with a stimulus. It happens passively on the part of the learner, without rewards or punishments. An example is a dog salivating at the sound of a bell associated with food.

Operant conditioning connects voluntary behavior with a consequence. Operant conditioning requires the learner to actively participate and perform some type of action to be rewarded or punished. It's active, with the learner's behavior influenced by rewards or punishments. An example is a dog sitting on command to get a treat.

Learning Process

Classical conditioning involves learning through associating stimuli resulting in involuntary responses, while operant conditioning focuses on learning through consequences, shaping voluntary behaviors.

Learning by Association (Classical Conditioning): In learning by association, a person (or animal) learns to associate two stimuli, causing a behavior change. A neutral stimulus is paired with an unconditioned stimulus that naturally triggers a response.
Over time, the person responds to the neutral stimulus as if it were the unconditioned stimulus, even when presented alone. The response is involuntary and automatic.

An example is a dog salivating (response) at the sound of a bell (neutral stimulus) after it has been repeatedly paired with food (unconditioned stimulus).

Learning by Consequences (Operant Conditioning): In learning by consequences, behavior is learned based on its outcomes or consequences. The learner is active, and the response is voluntary.
Behavior followed by pleasant consequences (rewards) is more likely to be repeated, while behavior followed by unpleasant consequences (punishments) is less likely to be repeated.

For instance, if a child gets praised (pleasant consequence) for cleaning their room (behavior), they're more likely to clean their room in the future.

Conversely, if they get scolded (unpleasant consequence) for not doing their homework, they're more likely to complete it next time to avoid the scolding.

Timing of Stimulus & Response

The timing of the response relative to the stimulus differs between classical and operant conditioning:

Classical Conditioning (response after the stimulus): In this form of conditioning, the response occurs after the stimulus. The behavior (response) is determined by what precedes it (stimulus).

For example, in Pavlov's classic experiment, the dogs started to salivate (response) after they heard the bell (stimulus) because they associated it with food.

Operant Conditioning (response before the stimulus): In this form of conditioning, the response generally occurs before the consequence (which acts as the stimulus for future behavior).
The anticipated consequence influences the behavior or what follows it. It is a more active form of learning, where behaviors are reinforced or punished, thus influencing their likelihood of repetition.

For example, a child might behave well (behavior) in anticipation of a reward (consequence), or avoid a certain behavior to prevent a potential punishment.

Summary

Looking at Skinner's classic studies on pigeons' / rat's behavior we can identify some of the major assumptions of the behaviorist approach.

* Psychology should be seen as a science, to be studied in a scientific manner. Skinner's study of behavior in rats was conducted under carefully controlled laboratory conditions.

* Behaviorism is primarily concerned with observable behavior, as opposed to internal events like thinking and emotion. Note that Skinner did not say that the rats learned to press a lever because they wanted food. He instead concentrated on describing the easily observed behavior that the rats acquired.

* The major influence on human behavior is learning from our environment. In the Skinner study, because food followed a particular behavior the rats learned to repeat that behavior, e.g., operant conditioning.

* There is little difference between the learning that takes place in humans and that in other animals. Therefore research (e.g., operant conditioning) can be carried out on animals (Rats / Pigeons) as well as on humans. Skinner proposed that the way humans learn behavior is much the same as the way the rats learned to press a lever.

So, if your layperson's idea of psychology has always been of people in laboratories wearing white coats and watching hapless rats try to negotiate mazes in order to get to their dinner, then you are probably thinking of behavioral psychology.

Behaviorism and its offshoots tend to be among the most scientific of the psychological perspectives. The emphasis of behavioral psychology is on how we learn to behave in certain ways.

We are all constantly learning new behaviors and how to modify our existing behavior. behavioral psychology is the psychological approach that focuses on how this learning takes place.

Critical Evaluation

Operant conditioning can be used to explain a wide variety of behaviors, from the process of learning, to addiction and language acquisition. It also has practical applications (such as token economy) which can be applied in classrooms, prisons and psychiatric hospitals.

Researchers have found innovative ways to apply operant conditioning principles to promote health and habit change in humans.

In a recent study, operant conditioning using virtual reality (VR) helped stroke patients use their weakened limb more often during rehabilitation. Patients shifted their weight in VR games by maneuvering a virtual object. When they increased weight on their weakened side, they received rewards like stars. This positive reinforcement conditioned greater paretic limb use (Kumar et al., 2019).

Another study utilized operant conditioning to assist smoking cessation. Participants earned vouchers exchangeable for goods and services for reducing smoking. This reward system reinforced decreasing cigarette use. Many participants achieved long-term abstinence (Dallery et al., 2017).

Through repeated reinforcement, operant conditioning can facilitate forming exercise and eating habits. A person trying to exercise more might earn TV time for every 10 minutes spent working out. An individual aiming to eat healthier may allow themselves a daily dark chocolate square for sticking to nutritious meals. Providing consistent rewards for desired actions can instill new habits (Michie et al., 2009).

Apps like Habitica apply operant conditioning by gamifying habit tracking. Users earn points and collect rewards in a fantasy game for completing real-life habits. This virtual reinforcement helps ingrain positive behaviors (Eckerstorfer et al., 2019).

Operant conditioning also shows promise for managing ADHD and OCD. Rewarding concentration and focus in ADHD children, for example, can strengthen their attention skills (Rosén et al., 2018). Similarly, reinforcing OCD patients for resisting compulsions may diminish obsessive behaviors (Twohig et al., 2018).

However, operant conditioning fails to take into account the role of inherited and cognitive factors in learning, and thus is an incomplete explanation of the learning process in humans and animals.

For example, Kohler (1924) found that primates often seem to solve problems in a flash of insight rather than be trial and error learning. Also, social learning theory (Bandura, 1977) suggests that humans can learn automatically through observation rather than through personal experience.

The use of animal research in operant conditioning studies also raises the issue of extrapolation. Some psychologists argue we cannot generalize from studies on animals to humans as their anatomy and physiology is different from humans, and they cannot think about their experiences and invoke reason, patience, memory or self-comfort.

Frequently Asked Questions

Who discovered operant conditioning?

Operant conditioning was discovered by B.F. Skinner, an American psychologist, in the mid-20th century. Skinner is often regarded as the father of operant conditioning, and his work extensively dealt with the mechanism of reward and punishment for behaviors, with the concept being that behaviors followed by positive outcomes are reinforced, while those followed by negative outcomes are discouraged.

How does operant conditioning differ from classical conditioning?

Operant conditioning differs from classical conditioning, focusing on how voluntary behavior is shaped and maintained by consequences, such as rewards and punishments.

In operant conditioning, a behavior is strengthened or weakened based on the consequences that follow it. In contrast, classical conditioning involves the association of a neutral stimulus with a natural response, creating a new learned response.

While both types of conditioning involve learning and behavior modification, operant conditioning emphasizes the role of reinforcement and punishment in shaping voluntary behavior.

How does operant conditioning relate to social learning theory?

Operant conditioning is a core component of social learning theory, which emphasizes the importance of observational learning and modeling in acquiring and modifying behavior.

Social learning theory suggests that individuals can learn new behaviors by observing others and the consequences of their actions, which is similar to the reinforcement and punishment processes in operant conditioning.

By observing and imitating models, individuals can acquire new skills and behaviors and modify their own behavior based on the outcomes they observe in others.

Overall, both operant conditioning and social learning theory highlight the importance of environmental factors in shaping behavior and learning.

What are the downsides of operant conditioning?

The downsides of using operant conditioning on individuals include the potential for unintended negative consequences, particularly with the use of punishment. Punishment may lead to increased aggression or avoidance behaviors.

Additionally, some behaviors may be difficult to shape or modify using operant conditioning techniques, particularly when they are highly ingrained or tied to complex internal states.

Furthermore, individuals may resist changing their behaviors to meet the expectations of others, particularly if they perceive the demands or consequences of the reinforcement or punishment to be undesirable or unjust.

What is an application of bf skinner's operant conditioning theory?

An application of B.F. Skinner's operant conditioning theory is seen in education and classroom management. Teachers use positive reinforcement (rewards) to encourage good behavior and academic achievement, and negative reinforcement or punishment to discourage disruptive behavior.

For example, a student may earn extra recess time (positive reinforcement) for completing homework on time, or lose the privilege to use class computers (negative punishment) for misbehavior.

Video

Further Reading

References

Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.

Dallery, J., Meredith, S., & Glenn, I. M. (2017). A deposit contract method to deliver abstinence reinforcement for cigarette smoking. Journal of Applied Behavior Analysis, 50(2), 234-248.

Eckerstorfer, L., Tanzer, N. K., Vogrincic-Haselbacher, C., Kedia, G., Brohmer, H., Dinslaken, I., & Corbasson, R. (2019). Key elements of mHealth interventions to successfully increase physical activity: Meta-regression. JMIR mHealth and uHealth, 7(11), e12100.

Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. New York: Appleton-Century-Crofts.

Kohler, W. (1924). The mentality of apes. London: Routledge & Kegan Paul.

Kumar, D., Sinha, N., Dutta, A., & Lahiri, U. (2019). Virtual reality-based balance training system augmented with operant conditioning paradigm. Biomedical Engineering Online, 18(1), 1-23.

Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: A meta-regression. Health Psychology, 28(6), 690-701.

Rosén, E., Westerlund, J., Rolseth, V., Johnson R. M., Viken Fusen, A., Årmann, E., Ommundsen, R., Lunde, L.-K., Ulleberg, P., Daae Zachrisson, H., & Jahnsen, H. (2018). Effects of QbTest-guided ADHD treatment: A randomized controlled trial. European Child & Adolescent Psychiatry, 27(4), 447-459.

Skinner, B. F. (1948). 'Superstition'in the pigeon. Journal of experimental psychology, 38(2), 168.

Schunk, D. (2016). Learning theories: An educational perspective. Pearson.

Skinner, B. F. (1938). The behavior of organisms: An experimental analysis. New York: Appleton-Century.

Skinner, B. F. (1948). Superstition" in the pigeon. Journal of Experimental Psychology, 38, 168-172.

Skinner, B. F. (1951). How to teach animals. Freeman.

Skinner, B. F. (1953). Science and human behavior. Macmillan.

Thorndike, E. L. (1898). Animal intelligence: An experimental study of the associative processes in animals. Psychological Monographs: General and Applied, 2(4), i-109.

Twohig, M. P., Whittal, M. L., Cox, J. M., & Gunter, R. (2010). An initial investigation into the processes of change in ACT, CT, and ERP for OCD. International Journal of Behavioral Consultation and Therapy, 6(2), 67-83.

Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological Review, 20, 158-177.

Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education

Associate Editor for Simply Psychology

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul Mcleod, PhD
Educator, Researcher

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, Ph.D., is a qualified psychology teacher with over 18 years experience of working in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Operant Conditioning In Psychology: B.F. Skinner Theory

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Operant conditioning is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an individual makes an association between a particular behavior and a consequence. B.F Skinner is regarded as the father of operant conditioning and introduced a new term to behavioral psychology, reinforcement.

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Barker, S (2016) Psychology for Nursing & Healthcare Professionals. Developing Compassionate Care. Sage Publishing

Marks, D.F; Murray, M., Evans, B and Estacio, E.V (2015) 4th Edition. Health Psychology Theory, Research and Practice. Sage Edge.

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Duration: 5 mins Publication Date: 8 Jun 2023 Next Review Date: 8 Jun 2026 DOI: 10.13056/acamh.13587

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Operant conditioning, sometimes called instrumental conditioning or Skinnerian conditioning, is a method of learning that uses rewards and punishment to modify behaviour. Through operant conditioning, behaviour that is rewarded is likely to be repeated, while behaviour that is punished is prone to happen less.

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Perceived seriousness - how severe are the consequences if I don't change the behaviour?

Perceived susceptibility - How likely am i to get the disease/ consequences from the behaviour?

Cost-benefit analysis - weighing up barriers and benefits (perceived).

Self-efficacy - a person's belief in their abilities

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Decision-making regarding health related choices.

self-medication - due to stress, anxiety, boredom. Short term coping strategies can have long term health consequences.

Protective behaviours - being physically active, eating a balanced diet, taking prescribed medication.

Professional biases - unconscious.

Racial and gender bias. Can lead to less accurate diagnosis, fewer treatment options, time spent with patient is shorter.

Cognitive Dissonance - a psychological discomfort when trying to make a decision that feels to have two equally attractive options/equal pros and cons to that individual. Disagreeing with yourself.

Resolving cognitive dissonance - change the behaviour or change the belief.

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