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PHE1IDH NOTES
MonicaVoong
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Learning
Development
Memory&Cognition
BehaviourChange
SocialInfluences
Motivation
DependencyBehaviours
MentalHealth
ManagingEmotions
Pain
Communication
Personality
Stress
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LEARNING
Definition of Learning
• The relatively permanent change in behaviour or knowledge which results from
practise or experience
• Humans are not born with a lot of instincts, everything must be learnt
Learning and Health Related Behaviours
• Adaptive health behaviours that can be acquired through learning:
→ Healthy eating behaviours
→ Exercise behaviours
→ Social behaviours
→ Sun protective behaviours
• Maladaptive health related behaviours that can be acquired through learning:
→ Substance abuse behaviours
→ Physiological changes that can lead to illnesses
→ Avoidance behaviours (e.g. phobias)
3 Major Types of Learning
1. Classical conditioning
2. Operant conditioning
3. Social learning theory
CLASSICAL CONDITIONING
Definition of Classical Conditioning
• A learning in which an originally neutral stimulus, by repeated pairing with a stimulus
that normally produces some response, comes to produce a similar or even identical
response
Types of Stimulus & Responses
• Unconditioned Stimulus (UCS): the stimulus that elicits an unconditioned response
• Unconditioned Response (UCR): the response elicited by an unconditioned stimulus
without prior training or learning
• Conditioned Stimulus (CS): a previously neutral stimulus that comes to elicit a
conditioned response
• Conditioned Response (CR): a response elicited by some previously neutral stimulus
that occurs as a result of pairing the neutral stimulus with an unconditioned stimulus
• The CS must reliably predict the occurrence of the UCS in order for classical
conditioning to occur
Example of Classical Conditioning
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Stimulus Generalisation
• Definition: Producing a conditioned response to a stimulus that is similar but not
identical to the original conditioned stimulus
• Similar stimuli to the CS can elicit a response
• The more similar the new stimulus is to the original CS, the stronger the response
• Stimulus generalisation builds a safety factor in everyday life as stimuli rarely occur in
exactly the same form every time it is presented
• The range of learning is extended beyond the original specific experience
Stimulus Discrimination
• Process in which an organism learns to respond differently to stimuli that differ from
the conditioned stimulus on some dimension
• Discrimination training can sharpen an organism’s ability to discriminate among
similar stimuli when only one of them predicts the UCS and others are repeatedly
presented without them
• Gradually, the response to the dissimilar stimuli will weaken and the organism learns
which even-signal predicts the onset of the UGS and which signals don't
The Role of Classical Conditioning in the Development of Illness and Behaviour that is
Detrimental to Health
• Can have a detrimental effect on health if phobias develop
• Phobia: an unrealistic fear – avoidance of feared object
• Examples of Medical Phobias:
→ Dental phobias
→ Excessive fear of sharp instruments (e.g. needles)
→ Excessive fear of particular medical procedures
→ Pill swallowing phobias
How can medical conditions/health compromising behaviours be treated using
classical conditioning principles?
Extinction
• Definition: the weakening of a conditioned association in the absence of a reinforcer
or unconditioned response
• Learning is not always permanent, a conditioned response can be unlearned if the
association between the conditioned stimulus and the unconditioned stimulus is
broken
• However, sometimes the learning is so strong, the association cannot be broken
• Spontaneous Recovery: the reappearance of an extinguished conditioned response
after a rest period
Counterconditioning
• Most powerful technique for breaking learned associations
• The process in which one conditioned response is extinguished while another
response is established
• Forming a new association
Positive Counterconditioning
• Systemic Desensitisation:
→ Training the client to maintain a state of relaxation in the presence of imagined or
real anxiety-inducing objects or events
→ Forming a new association with relaxation rather than fear
→ Highly effective in treating phobias
→ Steps in Systemic Desensitisation:
1. Teach the client a relaxation technique
2. Assist the client with the construction of an anxiety hierarchy of feared
objects or situations
3. Proceed through the hierarchy using imagery
4. Invivo desensitisation – do it in real life
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→ Example:
OPERANT CONDITIONING
Definition of Operant Conditioning
• Study in the way which behaviour is modified by its consequences
• A conditioning procedure in which behaviour becomes more or less probable
depending on whether the behaviour has been reinforced or punished
Reinforcement
• Consequences that lead to increases in behaviour
• Favourable consequences: rewards, removal of unfavourable objects
• Types of Reinforcers:
→ Primary Reinforcers:
− Events that are inherently reinforcing because they satisfy biological needs
– value doesn't need to be learnt
− Example: sleep, food, love, affection
→ Secondary Reinforcers:
− Value of secondary reinforcers are learned
− Example: money, praise, attention, good marks
Delivery of Reinforcement
• Positive Reinforcement:
→ The presentation of a rewarding stimulus after a particular response to increase
the probability of the behaviour occurring again
→ Something is added
→ Everyday Examples: receiving good marks for studying hard, a child getting their
way by throwing a tantrum
→ Health Related Example: feeling more relaxed/sociable when drinking
• Negative Reinforcement:
→ The withdrawal of an unpleasant stimulus after a particular response to increase
the probability of that behaviour occurring again
→ Something is removed/taken away
→ Everyday Example: putting on sunglasses to reduce glare
→ Health Related Example: taking aspirin to stop a headache
Schedules of Reinforcement
• Continuous Schedule of Reinforcement:
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→ Delivery of reinforcement after every response
→ Advantage: good in the beginning
→ Disadvantage: prone to satiation (lose its value), easily extinguished
Partial Schedules of Reinforcement: Ratio vs. Interval
Ratio Schedules – reinforcement based on the number of responses
→ Fixed Ratio Schedule:
− Individual is rewarded after a specified number of responses
− Example: reward after every 5 times of a behaviour
→ Variable Ratio Schedule:
− An average number of responses must occur for reinforcement to occur
− Mixed up
Interval Schedules – reinforcement based on time
→ Fixed Interval Schedules:
− Individuals rewarded for the first response after a specified period of time
− Example: child rewarded with praise after every 5 minutes of performing eye
exercise
→ Variable Interval Schedule:
− An individual is rewarded for the first response after an average time
interval
What schedule produces the most stable and enduring learning?
Variable ratio and variable interval because they are the most unpredictable – much stronger
learning will result
Punishment
• Consequences that lead to decreases in behaviour
• Positive Punishment:
→ The presentation of an aversive stimulus after a particular response that
decreases the probability of the behaviour occurring again
→ Something bad is added after the behaviour
→ Everyday Examples: smacking a child for misbehaving, glare when looking at the
sun
→ Health Related Example: use of physical restraint to stop self-injury behaviour in
children
• Negative Punishment:
→ Response cost – involves the removal of a positive event after a response that
decreases the probability of the behaviour occurring again
→ Something good is taken away
→ Everyday Example: use of fines for speeding, withdrawal of affection when child
throws tantrum
→ Health Related Example: certain activities have been withheld from patients with
anorexia for not eating
What is more effective for shaping behaviour, reinforcement or punishment?
Reinforcement is more effective as it produces longer-term learning and shows what is right
to do (punishment shows what isn’t right to do)
Operant Conditioning and the Development of Illness
• Health compromising behaviours that can be developed and/or maintained through
reinforcement:
→ Consumption of fatty foods
→ Consumption of alcohol
→ Smoking behaviour
→ Illicit drug use
→ Avoidance of exercise
→ Excessive sun exposure
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Application of Operant Conditioning principles to treat illness related to behaviour and
to optimise recovery
Extinguish Unwanted Behaviours
• Example: ignore maladaptive pain behaviours
• Problems: often not effective, need to reinforce competing behaviour
Positive Reinforcement has been used in Health & Human service settings to:
• Increase cooperative behaviours
• Increase self-care behaviours
• Optimise treatment outcomes
• Example:
LIMITATIONS OF CLASSICAL & OPERANT CONDITIONING
• Learning can occur without direct experience
• They don't recognise the role of cognition in learning
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SOCIAL LEARNING THEORY
• Learning through direct experience
• Learning by observing others being reinforced/punished
• Everyday Examples: children learn a significant proportion of their behaviours
through observation
• Health Related Example: observing someone looking better and displaying more
energy after modifying their diet (health enhancing), observing friends being more
sociable after during alcohol (health compromising)
The Use of Modelling in Professional Settings
• Modelling can work in 2 major ways:
1. Improve health by motivating individuals to engage in behaviours that can aid
recovery/improve their health
2. Improvements in health by increasing self-efficacy – it can give people the
confidence that they can to perform ‘difficult’ behaviours
(People don’t change behaviour because they are not confident)
Application of Modelling
• Reduce fear/anxiety in health & human service settings
Example: preparing children for surgery, reducing fear in children recovering from
surgery
• Can be used to improve confidence of performing behaviours in all areas
Example: older person following hip replacement, improve the rate of adherence to
rehab exercises
DEVELOPM ENT
COGNITIVE DEVELOPMENT
Definition of Cognitive Development
• The study of the process and products of the mind as they emerge and change over
time
Cognitive Development
• Schemas: organised patterns of thought and action – a cognitive structure that
develops as infants and young children learn to interpret the world and adapt to their
environment
• Assimilation: how new experiences are incorporated into existing schemas
• Accommodation: how new experiences cause existing schemas to change
• Foundational Theories: a framework for initial understanding formulated by children to
explain their experiences of the world
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FOUR STAGES OF COGNITIVE DEVELOPMENT
Sensorimotor Stage
• Birth – 2 years old
• Knowledge of the world is limited to their sensory
perceptions and motor activities
• ‘Object permanency’ develops (child’s understanding
that objects exist and behave independently of their
actions/awareness)
→ 1 month – when objects are not in view, they don’t
exist
→ 3 months – will keep looking at the place even
though the object has disappeared
→ 8-12 months – will search for missing object
→ 2 years – no remaining uncertainty that ‘out of
sight’ objects continue to exist
Preoperational Stage
• 2 – 7 years old
• Improved ability to represent mentally objects that are
not physically present
• Most rapid vocabulary growth
• Children at this age cannot perform arithmetic
operations
• Symbolic thinking enables pretend play – practising a
range of emotions/activities – necessary way to learn
things
• Characterised by
→ Animism: making objects “alive”
→ Egocentrism: can’t imagine self to be in a different
position (can’t view from another perspective)
→ Irreversibility: difficult to mentally reverse an
action
→ Centration: can only focus on the single, most
important thing – attention is captured by the
striking feature of an object
Concrete Operational
• 7 – 11 years old
Stage
• Able to perform basic mental operations about tangible
(‘concrete’) objects and situations
• Actions performed in the mind give rise to logical
thinking
• Can perform what they could not in the preoperational
stage
• Acquire understanding of conservation – learn that
objects can contain the small volume despite different
shape
• Transitive inference ability develop (e.g. if A>B, B>C,
therefore A>C)
Formal Operational
• Adolescence onwards (but not always)
Stage
• Able to reason about abstract, not just concrete
situations
• Can form hypothesis and test it in a thoughtful way
*It is normal to not always have formal operational thought as adults
Example: cursing traffic light choosing to stop you – preoperational stage
Emotional state/stress/alcohol decreases formal operational thought
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Findings & Criticisms
• Findings:
→ Exhaustively researched
→ 4 stages occur in same order cross-culturally
→ Each stage must be gone through successfully in order to go to next stage
→ Skills often acquired earlier than originally suggested
• Criticisms:
→ Development in each stage is inconsistent
→ Nothing to say about adult cognitive development
→ Culture influences cognitive development
→ Cognitive development more complex and variable than theory suggests
PSYCHOSOCIAL DEVELOPMENT
Erikson’s Psychosocial Stages
• 8 stages in the life cycle
• At each stage a particular crisis comes into focus
• Each conflict never completely disappears, but it needs to be sufficiently resolved at a
give stage if an individual is to cope successfully with the conflicts of later stages
Approximate Age
Crisis
0 – 1.5 years
1.5 – 3 years
Trust vs. Mistrust
Autonomy vs. Self
Doubt
3 – 6 years
Initiative vs. Guilt
6 – puberty
Competence vs.
Inferiority
Adolescence
Identity vs. Role
Confusion
Early Adult
Intimacy vs. Isolation
Middle Adult
Generativity vs.
Stagnation
Later Adult
Ego Integrity vs.
Despair
Adequate
Resolution
Basic sense of safety
Perception of self as
agent capable of
controlling own body
and making things
happen
Confidence in
oneself as initiator,
creator
Adequacy in basic
social and intellectual
skills
Comfortable sense of
self as a person
Capacity for
closeness and
commitment to
another
Focus of concern
beyond oneself to
family, society, future
generations
Sense of wholeness,
basic satisfaction
with life
Inadequate
Resolution
Insecurity, anxiety
Feeling of
inadequacy to control
events
Feelings of lack of
self worth
Lack of self
confidence, feelings
of failure
Sense of self
fragmented, shifting,
unclear sense of self
Feeling of aloneness,
separation, denial of
need for closeness
Self indulgent
concerns, lack of
future orientation
Feelings of futility,
disappointment
Findings & Criticisms
• Findings:
→ Encompassed entire life cycle
→ Emphasised conscious processes
→ Emphasises social determinants of development (the environment)
→ No one stage needs to be ‘successfully’ resolved in order to go to the next stage
• Criticisms:
→ Crises tend to occur at particular ages but can occur at any age – sensitive
periods
→ A product of its time and individualistic culture
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→ Sexist
→ Research results equivocal
DEVELOPMENT
What is development?
• “The process of change which begins its pattern at conception and continues
throughout life” (Gething, 1995; Peterson 1996)
• Inner processes (biological/psychosocial) and external events (environment)
contribute to changes in personality throughout life
Types of influences
• Normative influences:
→ Age-related biological changes
→ Predictable social transition events
• Non-normative influences:
→ Unpredictable events
Prenatal & Perinatal Development
• Germinal Stage: first 2 weeks after contraception (zygote)
• Embryonic Stage: until end week 8 (embryo)
• Foetal Stage: week 9 until birth (foetus – once heart starts beating)
• Birth
Risks for Abnormal Development
• Genetic (inherited) factors
Example: Down Syndrome, PKU (leads to nerve damage)
• Teratogens (external factors that cause abnormal prenatal development)
Example: the environmental factors, ingested substances, infectious diseases
• Iatrogenic factors (medical procedures that cause illness)
Example: amniocentesis
• Perinatal factors
Example: hypoxia
Critical Issues in Developmental Psychology
• Nature vs. Nurture:
→ Testing through family studies, twin studies and adoption studies
→ Adoption Studies show that children are more likely to be similar to their
biological mother in religion, jobs, drug abuse and proneness to getting fat than
their adopted parents
→ Family Studies look at siblings and relatives
→ Twin Studies show that identical twins (monozygotic) are more likely to share
psychological development than non identical (dizygotic) twins
Personality tests also show that identical twins reared apart were more similar in
personality than fraternal twins reared together – personality is ~ 48% linked to
genes, 52% linked to environment
• Critical vs. Sensitive Periods:
→ Critical: has to happen at a specific period, if it doesn't, it cannot be learned at
another time
→ Sensitive: should happen at this period, but doesn't have to
• Continuity vs. Discontinuity:
→ Continuity Example: growth (height)
→ Discontinuity Example: menstruation
• Stability vs. Change:
Developmental Research Methods
• Longitudinal Design:
→ Study the same people repeatedly over time
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→ Problems: shrinkage of research population, therefore it is not necessarily
reliable
Cross-Sectional Design:
→ Compares groups of people of different ages at same point of time
→ Cohort = group of people born at the same time
→ ‘Cohort effect’
→ Benefits: no problem of dropout over time
→ Problems: different cohort will have different experiences, can’t assume that they
are the ‘same sample’
Sequential Design:
→ Combination of longitudinal and cross-sectional research designs
→ Problems: very expensive
Implications for Health Care
• People aren’t ‘stages’
• People cannot always operate at their highest level, especially under stress
• Health problems: Stage related? Age related?
• Impact of health problems multi-factorial
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