Difference between classical and operant conditioning
Classical – natural and reflexive response is elicited by a learned stimulus e.g. woman who has undergone three session of chemotherapy becomes nauseated as she enters hospital for the fourth session….Its elements include
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Unconditioned stimulus- something that produces response automatically without having to be learned e.g. odor of food.
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Unconditioned response – natural reflexive behavior that does not have to be learned e.g. salivation in response to the odor of food.
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Conditioned stimulus – Something that produces response following learning e.g. sound of the lunch bell
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Conditioned response – learned behavior e.g. salivation in response to lunch bell
Operant – Behavior is determined by its consequence for the individual…The likelihood that behavior will occur is increased by reinforcements and decreased by punishment.
Positive reinforcement- introduction of positive stimulus that result in increased behavior.
Negative reinforcement- removal of averse stimulus that results in an increase in rate of behavior.
Punishment – introduction of averse stimulus aimed at reducing unwanted behavior.
More stuff….
Classic conditioning: person is put in relaxed state then shown that phobia isn’t harmful.
Biofeedback (operant conditioning): through process of operant conditioning, the person is given ongoing physiological information (e.g. b.p measurement), which acts as reinforcement when bp drops.
Low yield facts:
Averse conditioning: Pairs maladaptive but pleasurable stimulus with an averse or painful stimulus (e.g. shock) so that the two become associated…..eg used for paedophiles
Systemic Desensitization: increasing dose of fear- provoking stimulus are paired with a relaxing stimulus to induce a relaxation response.
Flooding: The person is exposed to actual (flooding) or imagined (implosion) overwhelming dose of the feared stimulus.
LEARNING THEORY
Classical Conditioning
&
Operant (Instrumental) Conditioning
Ivan Pavlov
Classical conditioning:
-
basic form of learning in which simple responses (e.g. salivation) are associated with a new or conditioned stimulus
-
forming an association between the neutral stimuli of the waiting room and the painful stimuli of immunizations or teeth drilling
-
now it’s the neutral stimuli that triggers the fear
Basic Findings:
-
Ivan Pavlov (1849-1936)
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Unconditioned reflex: unlearned reflex, an association between the unconditioned stimulus and unconditioned response
-
Unconditioned stimulus: a stimulus that produces an unconditioned response in the absence of learning (food in mouth)
-
Unconditioned response: an unlearned response to an unconditioned stimulus (salivation)
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Conditioned stimulus: a stimulus that becomes associated through learning with the unconditioned stimulus (i.e. tone- a neutral stimulus)
-
Conditioned reflex: the new assoc between the conditioned stimulus (the tone) and the unconditioned stimulus (sight of food) causing the conditioned response (salivation)
-
Conditioned response: a response (salivation) which is produced by the conditioned stimulus after a learning process
Pavlov’s apparatus:
-Diagram of the apparatus used by Pavlov for his study of conditioning with dogs (adapted from Yerkes & Morgulis, 1909)
Operant conditioning:
-
a form of learning in which behavior is controlled by rewards or positive reinforcers or by unpleasant or aversive stimuli
-
Can you think of any examples?
B.F. Skinner (1904-1990)
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skinner believed that what we learn and how we behave in everyday life are both very heavily influenced by the conditioning experiences we have had throughout our lives
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the training of circus animals
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the treatment of PT’s suffering from various mental disorders: token economies
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biofeedback
TOKEN ECONOMIES:
-
Here Pt’s who behave in desirable ways receive tokens which can be exchanged for various rewards
-
Token economies have proved useful in the treatment of Pt’s with schizophrenia or anti-social personalities
Basic findings:
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skinner box for rates, showing chart recording of lever pressing.
Skinner: Schedules of Partial Reinforcement:
-
fixed ratio schedule
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variable ratio schedule
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fixed interval schedule
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variable interval schedule
To recap….
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learning is acquisition of new behavior pattern
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method of learning include classical and operant conditioning
-
classical and operant conditioning are the basis of behavioral techniques, such as, systematic desensitization, aversive conditioning, flooding, biofeedback, token money and cognitive therapy.
Classical (Pavlovian) Conditioning
Behaviors are linked to external stimuli, and are likely to reoccur in the presence of those stimuli
-
Ex. Pavlov’s Dog
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Ex. Fear of nurse and needles
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Ex. Fear of white beards after being assaulted by a man with a white beard
Operant (Instrumental) Conditioning – behavioral responses occur more frequently or less frequently as a function of a pleasurable or noxious consequence
-
Ex. Touching a hot stove negatively reinforced
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Ex. A man’s working out is positively reinforced by positive feedback from females
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Ex. An individual who receives secondary gain by playing the sick role is more likely to take on the sick role
Some Learning Terminology
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Reward
-
Operant
-
Superstitious conditioning;
-
Stimulus generalization
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Extinction
-
Positive reinforcement
-
Negative Reinforcement
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Systematic Desensitization
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Aversive Conditioning
-
Successive Approximations/Shaping
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Learned Helplessness
Learning Theory and Behavior
-
The principles of conditioning are clearly relevant to clinical medicine, and classical conditioning is especially important in the acquisition of physiological responses and behavioral responses
-
Behavior and physiology are intimately linked
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maladaptive responses can lead to psychosomatic disease.
CLASSICAL CONDITIONING
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A NATURAL OR REFLEXIVE RESPONSE IS ELICTED BY LEARNED STIMULUS AFTER REPEATED PAIRING OF NATURAL AND LEARNED STIMULUS
-
THE PAVLOVIAN EXPERIMENT PAIRED THE RINGING OF BELL WITH THE BRINGING OF FOOD SO THAT, EVENTUALLY, SOUND OF THE BELL ELICTED THE SALIVATORY RESPONSE, WHICH PREVIOUSLY OCCURRED ONLY AT THE SIGHT OF THE FOOD.
-
PATIENT RECEIVING CHEMOTHERAPY, WHICH INDUCES NAUSEA. EVENTUALLY, SIGHT AND SOUND OF THE HOSPITAL ALONE ELICIT NAUSEA.
-
4 ELEMENTS OF CLASSICAL CONDITIONING.
Classical Conditioning
CERTAIN FACTORS ASSOCIATED WITH CLASSICAL CONDITIONING
STIMULUS GENERALIZATION:
-
AN ORGANISM’S TENDENCY TO RESPOND TO SIMILAR STIMULI WITH SIMILAR RESPONSE.
-
A NEW STIMULUS RESEMBLING THE CONDITIONED STIMULUS CAUSES THE CONDITIONED RESPONSE
-
PATIENT ON CHEMOTHERAPY, MEETING THE PHYSICIAN OUTSIDE THE HOSPITAL CAUSES NAUSEA.
EXTINCTION
-
AFTER LEARNING HAS OCCURED , REMOVAL OF THE PAIRING BETWEEN THE UCS AND CS RESULTS IN DECREASED PROBABILITY THAT THE CONDITIONED RESPONSE WILL OCCUR
-
BREAKING THE PAIRING BETWEEN CHEMOTHERAPY AND THE HOSPITAL ANDMEDICAL SETTING BY GIVING CHEMOTHERAPY AT HOME
-
IF THE FOOD IS GIVEN WITHOUT RINGING THE BELL FOR A TIME
DISCRIMINATION:
-
THE PROCESS OF RECOGNIZING AND RESPONDING TO DIFFERENCES BETWEEN SIMILAR STIMULI
-
LEARNED OVER TIME
B. F. Skinner
OPERANT CONDITIONING
-
BEHAVIOR IS DETERMINED BY ITS CONSEQUENCES FOR THE INDIVIDUAL.
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A BEHAVIOR THAT IS NOT A PART OF INDIVIDUAL NATURAL REPERTOIRE CAN BE LEARNED THROUGH REWARD AND PUNISHMENT
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IN THE B. F. SKINNER EXPERIMENT, PRESSING THE LEVER RESULTED IN DELIVERY OF FOOD. AFTER RECEIVING FOOD, THE BAR PRESSING BEHAVIOUR INCREASED.
TYPES OF REINFORCER
A POSITIVE REINFORCER:
-
IS A STIMULUS THAT, WHEN APPLIED FOLLOWING AN OPERANT RESPONSE, STRENGTHENS THE PROBABILITY OF THAT RESPONSE OCCURING.
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INCREASED PAY RESULTS IN INCREASED WORK BY THE EMPLOYEES
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INCREASED COMPLAINING LEADS TO INCREASED ATTENTION FROM THE NURSING STAFF
A NEGATIVE REINFORCER:
-
IS THE STIMULUS THAT, WHEN REMOVED FOLLOWING A OPERANT RESPONSE, STRENGTHENS THE PROPABILITY OF RESPONSE OCCURING.
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CHILD LEARNS THAT HE CAN STOP HIS PARENT NAGGING BY CLEANING UP THE ROOM
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ACTIVE AVOIDENCE OF AN AVERSIVE STIMULI INCREASES DESIRED BEHAVIOR
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AVERSIVE STIMULI SUCH AS LOUD NOISE, BRIGHT LIGHT, SHOCK CAN OFTEN BE NEGATIVE REINFORCERS.
PUNISHMENT:
-
BEHAVIOR IS DECREASED BY SUPPRESSION
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LIKE NEGATIVE REINFORCEMENT USES A NOXIOUS STIMULI
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PHYSICAL PUNISHMENT OF CHILD WILL SUPRESS NAUGHTY BEHAVIOR
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DELIVERY OF AN AVERSIVE STIIMULUS DECREASES UNWANTED BEHAVIOR RAPIDLY BUT NOT PERMANANTLY.
EXTINCTION:
-
BEHAVIOR IS ELIMINATED BY NON REINFORCEMENT
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CHILD STOPS HIS HITING BEHAVIOR WHEN BEHAVIOR IS IGNORED BY PARENTS
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EXTICTION IS MORE EFFECTIVE THAN PUNISHMENT FOR LONG TERM REDUCTION OF UNWANTED BEHAVIOR
REINFORCEMENT SCHEDULES
CONTINOUS REINFORCEMENT:
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EVERY RESPONSE IS FOLLOWED BY REINFORCEMENT (REWARD)
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RESULTS IN FAST LEARNING
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RESULTS IN FAST EXTINCTION WHEN REINFORCEMENT IS STOPPED
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A TEENAGER RECIEVES A CANDY BAR EACH TIME SHE PUTS A DOLLAR INTO THE VENDING MACHINE. ONE TIME SHE PUT A DOLLAR IN AND NOTHING CAME OUT. SHE NEVER BUYS CANDY FROM THAT MACHINE AGAIN.
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FIXED RATIO REINFORCEMENT:
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DELIVERS REINFORCEMENT AFTER FIXED NUMBER OF RESPONCES
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PRODUCES HIGH RESPONSE RATE
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MAN IS PAID A CERTAIN AMOUNT FOR EVERY FIVE SHIRTS MADE. HE MAKES AS MANY SHIRTS AS POSSIBLE DURING HIS SHIFT
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FIXED INTERVAL REINFORCEMENT:
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DELIVERS REINFORCEMENT AFTER DESIGNATED PERIOD. IRRESPECTIVE OF AMOUNT OF WORK DONE.
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THE RESPONSE RATE INCREASES TOWARDS THE END OF EACH INTERVAL
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CRAMMING BEFORE THE EXAM OR WORKING EXTRA HARD BEFORE BONUS AT THE HOLIDAYS.
VARIABLE RATIO REINFORCEMENT:
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DELIVERS REINFORCEMENT AFTER RANDOM AND UNPREDICTABLE NUMBERS OF RESPONSES
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PRODUCES GREATEST RESISTANCE TO EXTINCTION
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GAMBLING: A LARGE NUMBER OF RESPONSES MAY BE MADE WITHOUT A REWARD. SINCE ANY RESPONSE MAY BE A LUCKY ONE, PERSON KEEPS OM TRYING SLOT MACHINES
VARIABLE INTERVAL REINFORCEMENT:
-
DELIVERS REINFORCEMENT AFTER RANDOM AND UNPREDICTABLE TIME PERIOD
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HIGH RESISTANCE TO EXTINCTION
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HIGHER STEADY RATE OF RESPONDING
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POP QUIZES OR SURPRISE BONUS AT WORK
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FISHING
MODELING & OBSERVATIONAL LEARNING
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WATCHING SOMEONE ELSE GET REINFORCED IS ENOUGH TO CHANGE BEHAVIOR
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FOLLOWS THE SAME PRINCIPLE AS OPERANT CONDITIONING
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CORRELATING THE EFFECTS OF WATCHING VIOLENCE ON TV WITH COMMITING VIOLENCE IN THE REAL WORLD STEMS FROM THIS CONCEPT
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PARTLY WHY GROUP THERAPY WORKS
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OTHER APPLICATIONS:
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ASSERTIVENESS TRAINING
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SOCIAL SKILLS TRAINING
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PREPARING CHILDRENS FOR PAINFUL SURGICAL AND MEDICAL PROCEDURE.
BEHAVIORAL THERAPIES
THERAPIES BASED ON CLASSICAL CONDITIONING
SYSTEMATIC DESENSITIZATION:
-
USED TO TREAT ANXIETY AND PHOBIAS
-
INDIVIDUAL IS EXPOSED TO FRIGHTENING STIMULI IN INCREASING DOSE IN CONJUNCTION WITH RELAXATION TECHNIQUES.
-
WORKS BY REPLACING ANXIETY WITH RELAXATION
THERAPIES BASED ON CLASSICAL CONDITIONING
EXPOSURE (flooding or implosion):
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SIMPLE PHOBIAS CAN SOMETIMES BE TREATED BY FORCED EXPOSURE TO THE FEARED OBJECT
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EXPOSURE IS MAINTAINED UNTIL THE FEAR RESPONSE IS EXTINGUISHED
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Exposed to actual (flooding) or imagined (implosion)
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FEAR OF HIEGHT TREATED BY HAVING TO RIDE UP IN THE ELEVATOR
THERAPIES BASED ON CLASSICAL CONDITIONING
AVERSIVE CONDITIONING
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OCCURS WHEN A STIMULUS THAT PRODUCES DEVIANT BEHAVIOR IS PAIRED WITH AN AVERSIVE ATIMULUS
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USED IN TREATMENT OF ALCOHOLISM AND SEXUAL DEVIANCE
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ALCOHOLICS ARE GIVEN NAUSEA INDUCING DRUG, DISULFIRAM, SO WHENEVER HE DRINKS, IT CAUSES NAUSEA, EVENTUALLY DRINKING GETS PAIRED WITH NAUSEA, AN UNPLEASENT EVENT.
-
THUMB SUCKING AND CHILLI PEPPERS
THERAPIES BASED ON OPERANT CONDITIONING
SHAPING:
-
ACHIEVES FINAL TARGET BEHAVIOR BY REINFORCING SUCCESSIVE APPROXIMATIONS OF THE DESIRED BEHAVIOR
-
REINFORCEMENT IS GRADUALLY MODIFIED TO MOVE BEHAVIORS FROM MORE GENERAL TO MORE SPECIFIC RESPONSES DESIRED.
THERAPIES BASED ON BOTH TYPES OF CONDITIONING
EXTINCTION:
-
DISCONTINUING THE REINFORCEMENT THAT IS MAINTAINING AN UNDESIRED BEHAVIOR
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IF COMPLAINING RESULTS IN PATIENT RECEIVING LOT OF ATTENTION, STOPPING THE ATTENTION WILL EVENTUALLY STOP THE UNDESIRED BEHAVIOR
-
INSTITUTING A ‘TIME OUT’ WITH CHILDREN WHO ARE ACTING INAPPROPIATELY
THERAPIES BASED ON OPERANT CONDITIONING
STIMULUS CONTROL:
-
SOMETIMES STIMULI INADVERTENTLY ACQUIRES CONTROL OVER THE BEHAVIOR. WHEN THIS IS TRUE, REMOVAL OF THAT STIMULUS CAN EXTINGUISH THE RESPONSE
-
PERSON EATING BEHAVIOR IS TIED TO WATCHING TV. REDUCING THE TIME WATCHING TV SHOULD REDUCE THE AMOUNT EATEN.
-
INSOMNIAC IS PERMITTED IN HIS BED ONLY WHEN HE IS SO TIRED THAT HE FALLS TO SLEEP ALMOST AT ONCE.
THERAPIES BASED ON OPERANT CONDITIONING
FADING:
-
GRADUALLY REMOVING THE REINFORCEMENT WITHOUT THE INDIVIDUAL DISCOVERING THE DIFFERENCE
-
PROMOTING SMOKE CESSATION BY REDUCING THE NICOTINE CONTENT OF THE CIGARETTES GRADUALLY AND SILENTLY OVER A PERIOD OF TIME
-
GRADUALLY REPLACING POSTOPERATIVE PAINKILLERS WITH THE PLACEBO
BIOFEEDBACK
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TECHNIQUE THAT ALLOWS A PERSON TO GAIN CONTROL OVER THEIR PHYSIOLOGICAL PARAMETERS SUCH AS, HEART RATE, BLOOD PRESSURE , TEMPERATURE, ETC
-
BIOFEEDBACK INVOLVES PROVIDING THE PERSON WITH THE INFORMATION ABOUT HIS INTERNAL RESPONSES TO STIMULI AND METHODS TO CONTROL OR MODIFY THEM.
BIOFEEDBACK
-
IT WORKS BY MEANS OF TRIAL AND ERROR LEARNING AND REQUIRES REPEATED PRACTICE TO BE EFFECTIVE.
-
MOST BIOFEEDBACK AFFECTS THE PARASYMPATHETIC SYSTEM
-
USES: HYPERTENSION, MIGRAINE, RAYNAUDS SYNDROME, ANXIETY, ETC.
Stanley Milgram’s Experiment: “Obedience and Individual Responsibility”: Defense based on “obedience” that they were just following orders of their superiors.
Bad Bloo: Tuskegee syphilis study: unethical
Psychoanalytic theory and ALL THE DEFENSE MECHANISMS!!!
Should be able to differentiate: some examples and asked what defense mechanism is showing:
Defense mechanism 6.2
Acting out – to get attention e.g. having multiple sexual partners after parent’s divorce.
Altruism- assisting others to avoid negative personal feelings e.g. social worker with poor self image helps out at the youth club on weekends.
Denial- not accepting aspects of reality that the person finds unbearable e.g. alcoholic insists that he’s only a social drinker
Displacement- moving emotions from a personally intolerable situation to one that is personally tolerable e.g. Surgeon mistreats female patients cos of unacknowledged anger towards his mother.
Dissociation- teenager has no memory of accident which killed his girlfriend and he was the driver.
Humor- A man concerned about his erectile dysfunction makes jokes about Viagra
Identification – a man terrorized by his gym teacher becomes a critical gym teacher.
Intellectualization – using mind’s higher function to avoid experiencing emotion e.g. medical student does extensive research on a patient’s condition before going to tell her about her illness.
Isolation- woman tells her family sad news about her cancer without showing any emotions.
Projection- a man who fancies his wife’s sister begins to accuse the wife of cheating.
Rationalization – Man looses one arm and says it was good cos it kept him from getting in trouble with the law.
Reaction formation- woman unconscious of child rearing overspends on the child
Regression – acting like a young child eg grown man asking for mummy before his operation, or 5 yr old child wets bed after mum has a new baby.
Splitting – categorizing of people or situations into fabulous or dreadful….seen in borderline personality disorder patients
Suppression – medical student studying for USMLE, mentally changes the subject when her mind wanders to the exam during a lecture.
Undoing – Believing that one can magically reverse past events caused by incorrect behavior e.g. HIV positive drug use patient stops using drugs, and starts exercise and healthful diet program.
DEFENSE MECHANISMS
• DEFENCE MECHANISMS ARE THE PRIMARY TOOL OF EGO, USED TO
MANAGE THE INTERNAL CONFLICTS BETWEEN DEMANDS OF ID AND
RESTRICTION OF SUPEREGO. THEY ARE THE MEANS BY WHICH THE EGO
WARDS OFF ANXIETY AND CONTROL INSTINCTIVE URGES AND
UNPLEASENT AFFECTS(EMOTIONS).
• ALL DEFENCES ARE UNCONCIOUS
• REPRESSION, PUSHING UNACCEPTABLE EMOTIONS INTO THE
UNCONSCIOUS, IS THE BASIC DEFENSE MECHANISM ON WHICH ALL
OTHER ARE BASED
• MAINLY DIVIDED INTO FOUR TYPES:
– NARCISSTIC
– IMMATURE
– NEUROTIC
– MATURE
NARCISSISTIC DEFENSE
MECHANISM
USED BY CHILDREN AND PSYCHOTIC
ADULTS
PROJECTION
• PERSON ATTRIBUTES HIS OWN PERSONALLY
UNACCEPTABLE FEELINGS TO OTHERS
• ASSOCIATED WITH PARANOID SYMPTOMS
AND PREJUDICE
– MAN WHO HAS COMMITED ADULTRY BECOMES
CONVINCED THAT HIS WIFE IS HAVING A AFFAIR
EVEN THOUGH THERE IS NO EVIDENCE OF THAT.
– A GIRL TALK ABOUT HER DOLL HAVING CERTAIN
FEELINGS, WHICH ARE REALLY WHAT THE GIRL
FEELS.
-a man with unconscious homosexual impulses begins to believe that his boss is homosexual
DENIAL
• NOT BELIEVING ASPECTS OF REALITY
THAT PERSON FINDS UNBEARABLE
– AFTER SURVIVING A HEART ATTACK, A
PATIENT INSISTS ON CONTINUING HIS
LIFESTYLE AS IF NOTHING HAD
HAPPENED.
– A CHILD WHO IS ABUSED INSISTS THAT
SHE HAS BEEN TREATED WELL.
-an alcoholic insists that he is only a social drinker
SPLITTING
-categorizing people or situations into categories of either “fabulous” or “dreadful” b/c of intolerance of ambiguity
• PEOPLE AND THINGS IN THE WORLD
ARE PERCIEVED AS ALL GOOD OR ALL
BAD.THE WORLD IS PICTURED IN
EXTREME TERMS.
• SEEN IN PATIENT WITH BODERLINE
PERSONALITY DISORDER
– THIS DOCTOR IS MIRACLE WORKER BUT
THAT DOCTOR IS TOTALLY INCOMPETENT
– ‘HE IS JUST SO PERFECT AND
WONDERFUL ” SAYS A TEENAGE GIRL IN
LOVE.
IMMATURE DEFENSES
USED BY ADOLESCENTS, DEPRESSIVE,
OBSESSIVE AND COMPULSIVE
INDIVIDUALS
-A patient tells the doctor that while all of the doctors in the group practice are wonderful, all of the nurses and office help are unfriendly and curt
BLOCKING
• TEMPORARY OR TRANSIENT BLOCK IN
THINKING OR INABILITY TO REMEMBER
• BLOCKING IS DISRUPTIVE AND
EMBARRASING.
– AS STUDENT IS UNABLE TO RECALL THE FACTS
NEEDED TO ANSWER THE QUESTIONS ,
ALTHOUGH HE RECALLS THEM AS HE WALKS
OUT OF THE EXAM.
– IN THE MIDDLE OF CONVERSATION, A WOMEN
PAUSES, LOOKED CONFUSED, AND ASKS ‘WHAT
WAS I JUST TALKING ABOUT”
REGRESSION
• RETURNING TO EARLY STAGE OF
DEVELOPMENT
• REGRESSION IS COMMON WHEN PEOPLE
ARE TIRED, ILL OR UNCOMFORTABLE
– A PATIENT LIES IN A BED CURLED UP IN A FETAL
POSITION
– A HUSBAND SPEAKS TO HIS WIFE IN ‘BABYTALK’
– ENURESIS IN PREVIOUSLY TOILET TRAINED
CHILD FOLLOWING BIRTH OF A SIBLING
-a 5 year old child who was previously toilet-trained begins to wet the bed when his mother has a new baby
SOMATIZATION
• PSYCHIC FEELINGS ARE CONVERTED INTO
BODILY SYMPTOMS
• EXTREME FORMS ARE SOMATIZATION ARE
DIAGNOSED AS SOMATOFORM DISORDERS
• SYMPTOMS ARE PHYSICALLY REAL AND NOT
IMAGINED
– GETTING HEADACHE WHILE TAKING EXAM
– FEELING NAUSEATED BEFORE ASKING SOMEONE
OUT ON THE DATE
INTROJECTION
(IDENTIFICATION)
• FEATURES OF EXTERNAL WORLD AND
PERSONS ARE TAKEN IN AND MADE
PART OF SELF.
• INTROJECTION IS WHY CHILDRENS
ACT LIKE THEIR PARENTS
– A RESIDENT DRESSES AND ACTS LIKE
THE ATTENDING PHYSICIAN
– A TEENAGER ADOPTS THE STYLE AND
MANNERISMS OF A ROCK STAR.
ANXIETY OR NEUROTIC DEFENSE
MECHANISMS
SEEN IN ADULTS UNDER STRESS
DISPLACEMENT:
Moving emotions from a personally intolerable situation to one that is personally tolerable
• CHANGING THE TARGET OF AN EMOTION
OR DRIVE.
• PHOBIAS ARE RESULT OF DISPLACEMENT
– A MAN WHO IS ANGRY AT HIS BOSS POUNDS ON
HIS DESK RATHER THAN TELLING HIS BOSS
HOW HE FEELS
– AN ATTENDING PHYSICIAN SCOLDS A RESIDENT
WHO LATER EXPRESSES HIS ANGER BY YELLING
AT THE MEDICAL STUDENT
-a surgeon attending with unacknowledged anger toward his mother is abrasive to the female residences on his service
REPRESSION
• AN IDEA OR FEELING IS ELIMINATED FROM
CONSCIOUSNESS.
• CONTENTS ARE USUALLY NOT
RECOVERABLE WITHOUT SOME TRAUMA OR
PSYCHOANALYSIS
– A MAN WHO SURVIVED 6 MONTHS IN
CONCENTRTION CAMP CANNOT RECALL
ANYTHING ABOUT HIS LIFE DURING THAT TIME
PERIOD
– A CHILD WHO WAS ABUSED BY HER MOTHER
AND WAS TREATED FOR ABUSE, NOW HAS NO
MEMORY OF ANY MISTREATMENT BY HER
MOTHER.
ISOLATION OF AFFECT
• REALITY IS ACCEPTED, BUT WITHOUT THE
EXPECTED HUMAN EMOTIONAL RESPONSE TO
THAT REALITY.
• THE BLAND AFFECT OF SCHIZOPHRENICS, LA
BELLE INDIFFERENCE SEEN IN CONCERSION
DISORDER IS MAINIFESTATION OF THIS
MECHANISM.
– A CHILD WHO HAS BEEN BEATEN DISCUSSES THE
BEATING WITHOUT ANY DISPLAY OF EMOTIONS
– A PATIENT WHO HAS HAD A FINGER SEVERED IN
AN ACCIDENT DESCRIBES THE INCIDENT TO HIS
PHYSICIAN WITHOUT ANY EMOTIONAL REACTION
-without showing any emotion, a woman tells her family the results of tests which indicate that her lung cancer was metastasized
INTELLECTUALIZATION
• AFFECT IS STRIPPED AWAY AND REPLACED BY AN
EXCESSIVE USE OF INTELLECTUAL PROCESS
• INTELLECT IN PLACE OF EMOTION
• OBSESSIVE COMPULSIVE ANXIETY DISORDER IS
BASED ON THIS MECHANISM
– A PHYSICIAN TELLS THE PATIENT ABOUT HIS
POOR PROGNOSIS AND TALKS A GREAT DEAL
ABOUT THE TECHNICAL ASPECTS BY WHICH
PROGNOSIS WAS DERIVED
– A SAILOR WHOSE BOAT IS ABOUT TO SINK
EXPLAINS THE TECHNICAL OF THE HULL
DAMAGE IN GREAT DETAILS TO ANOTHER CREW
MEMBERS.
ACTING OUT
• MASSIVE EMOTIONAL OR BEHAVIORAL OUTBURST
TO COVER UP UNDERLYING FEELING OR IDEA
• AVOIDING PERSONALLY UNACCEPTABLE EMOTIONS
BY BEHAVING IN ATTENTION GETTING OFTEN
SOCIALLY INAPPROPRIATE MANNER
• COMMONLY SEEN IN BODERLINE AND ANTISOCIAL
PERSONALITY
– WHISTLING IN THE DARK HIDES THE REAL UNDERLYING
FEAR
– A DEPRESSED 14 YEAR OLD GIRL WITH NO HISTORY OF
CONDUCT DISORDER HAS SEXUAL ENCOUNTERS WITH
MULTIPLE PATNERS AFTER HER PARENTS DIVORCE
RATIONALIZATION
• RATIONAL EXPLANATIONS ARE USED TO
JUSTIFY ATTITUDES, BELIEFS OR
BEHAVIORS THAT ARE UNACCEPTABLE.
• USE TO RELIEVE GUILT AND SHAME
• OFTEN ACCOMPANIES OBSESSIVE
COMPULSIVE BEHAVIOR
– YES, I BELIEVE KILLING IS WRONG BUT I KILLED
HIM BECAUSE HE DESERVED IT
– A MAN WHO IS UNFAITHFUL TO HIS WIFE
BELIEVES THAT THIS AFFAIR WILL MAKE HIM
APPRECIATE HIS WIFE MORE
-a man who loses an arm in an accident says the loss of his arm was good b/c it kept him from getting in trouble with the law
REACTION FORMATION
• AN UNACCEPTABLE INPULSE IS
TRANSFORMED INTO ITS OPPOSITE
• FIND IN MANY ANXIETY DISORDER
– A STUDENT WHO ALWAYS WANTED TO BE A
PHYSICIAN EXPRESS RELIEF AND SAYS ‘THIS IS
A BEST NEWS I EVER HEARD’, AFTER NOT BEING
ACCEPTED TO A MEDICAL SCHOOL.
– A TEENAGER BOY INTRIGUED BY ‘DIRTY
PICTURE’ ORGANIZES AN ANTIPORNOGRAPHY
COMPAIGN.
UNDOING
• ACTING OUT REVERSE OF THE
UNACCEPTABLE FEELINGS
• SEEN IN OBSESSIVE COMPULSIVE
DISORDER
– A MAN WHO IS SEXUALLY AROUSED BY A
WOMEN HE MEETS IMMEDIATELY LEAVES
AND BUYS FLOWERS FOR HIS WIFE
– SUPERSTITIONS SUCH AS ‘KNOCK ON
WOOD’ AFTER WISHING SOMEONE WELL
-a woman who is terminally ill with AIDS caused by drug abuse, stops using drugs and alcohol and starts an exercise and healthful diet program
PASSIVE AGRESSIVE
• NONPERFORMANCE OR POOR
PERFORMANCE AFTER SETTING UP THE
EXPECTATIONS OF PERFORMANCE.
• OFTEN USED BY BODERLINE PERSONALITY
DISORDER AND YOUNG CHILDRENS
– A STUDENT AGREES TO SHARE CLASS NOTES
BUT GOES HOME WITHOUT SHARING THEM
– A PHYSICIAN IGNORES OR DOES NOT ANSWER
QUESTIONS OF THE PATIENT THAT HE FINDS
ANNOYING.
• THE FEELINGS OF HOSTILITY ARE
UNCONCIOUS AND THE PERSON USING THE
DEFENCE IS GENERALLY UNAWARE OF THEM
DISSOCIATION
• SEPERATING SELF FROM ONE’S
EXPERIENCE.
• IN EXTREME FORMS , BECOMES
DISSOCIATIVE DISORDER, FUGUE STATE,
AMNESIA AND IDENTITY DISORDER.
– A WOMAN WHO WAS RAPED REPORTS THAT IT
WAS AS IF SHE WAS FLOATING ON THE CEILING
AND WATCHING IT HAPPEN
– THE SURVIVOR OF AN AUTOMOBILE ACCIDENT
TELLS OF THE FEELING THAT EVERYTHING
HAPPENED IN SLOW MOTION
MATURE DEFENSE MECHANISMS
USED BY NORMAL ADULTS
-a teenager has no memory of a car accident in which he was driving and his girlfriend was killed
ALTURISM
• ASSISTING OTHERS TO AVOID
NEGATIVE PERSONAL FEELINGS
• UNSELFISHLY ASSISTING OTHERS
• A WOMAN WHO HAS A BREAST
CANCER LEADS A SUPPORT GROUP
FOR OTHER WOMENS WITH BREAST
CANCER
-a man with a poor self-image, who is a social worker during the week, donates every other weekend to charity work
HUMER
• EXPRESSING PERSONALLY
UNCOMFORTABLE FEELINGS WITHOUT
CAUSING EMOTIONAL DISCOMFORT
– A MAN LAUGHS WHEN HE IS TOLD HE IS
GOING TO FIRED
– A TERMINALLY ILL CANCER PATIENT
MAKES FUN OF HIS CONDITION
• LAUGHTER COVERS PAIN AND
ANXIETY
SUBLIMATION
• IMPULSE GRATIFICTION IS ACHIEVED
BY CHANNELING THE UNACCEPTABLE
IMPULSES INTO SOCIALLY
ACCEPTABLE DIRECTIONS
– AN EXECUTIVE WHO IS ATTRACTED TO A
FEMALE ASSOCIATE BECOMES HER
MENTOR AND ADVISOR
– A MAN WHO GOT INTO FIGHTS
REGULARLY AS A TEENAGER, GROWS UP
TO BECOME A PROFESSIONAL FIGHTER.
SUPPRESSION
• DELIBERATELY PUSHING PERSONALLY
UNACCEPTABLE EMOTIONS OUT OF
CONSCIOUS AWARENESS
• ONLY DEFENCE MECHANISM THAT USES
SOME ASPECT OF CONSCIOUSNESS.
– A STUDENT DECIDES TO FORGET ABOUT THE
PENDING EXAM TO GO OUT AND HAVE A GOOD
TIME FOR AN EVENING
– A TERMINALLY ILL CANCER PATIENT PUTS ASIDE
HIS ANXIETY ANS ENJOY FAMILY GATHERING.
-a medical student taking a review course for the USMLE, mentally changes the subject when her mind wanders to the exam during a lecture
Sample q’s by Dr. Gall
Name Piaget’s Stages of Cognitive development?
Sensorimotor (0-2 years)
Preoperational (2-7 years)
Concrete (7-11 years)
Formal (11- End of adolescence)
What is the law of conservation and which stage is it seen?
This law states that the child becomes to the realization that changing the shape does not alter the quantity of the object: seen in CONCRETE STAGE.
In which stage is a child said to be egocentric?
Preoperational
In which tanner stage are breast buds seen?
Tanner stage 2
A midlife crisis may lead to?
A change in profession or lifestyle
Infidelity, separation, divorce
Increase use of alcohol or drugs
Depression
SAMPLE Q’S USED IN CLASS BY DR. OMAR
Topic: Defense Mechanisms
Answer Choices:
A. Undoing
B. Splitting
C. Projection
D. Denial
E. Reaction Formation
F. Isolation of Affect
G. Displacement
H. Acting Out
I. Introjection
J. Regression
Statements/Answers
1. Alcoholic claims he is simply a social drinker --> D
2. A resident begins to dress like his/her attending --> I
3. An abused child throws a temper tantrum --> H
4. Two co-workers constantly bicker, but in reality, have feelings for each other --> E
5. The day is nurse is very good, but the night nurse is horrible --> B
6. Man cheating on his wife suspects his wife is also cheating on him without any evidence --> C
7. Person angry with boss pounds his desk rather than talk to his boss --> G
8. Child pees his bed when he's ill --> J
9. A beaten child is able to discuss his experiences without any emotion --> F
Then Freud’s theory: toprogialh and
Super ego, ego: what’s the difference between superego and ego,
What the difference is between conscious, unconscious
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