Operant Conditioning – A Different Approach to Pain Management
Operant Conditioning is a relatively lesser known form of treatment modality, which works wonders in the management of pain. While it is widely popular in medical circles, the common man has lesser exposure to this concept. At the same time, it is one of the most applied learning models focusing on behaviors learnt both automatically as well voluntarily. This article aims at demystifying the operant approach and understanding its application to pain management.
The operant approach focuses on reinforcement of behaviors through consequences. In fact, most parents quite unbeknown to them use the operant method to bring about desirable behaviors in their children by using the concepts of rewards and punishments. First extensively studied by Thorndike, he was the first to produce the animal learning curve by studying cat behavior in response to escaping from home-made box puzzles. After the initial struggle, the cats successfully escaped frequently and more quickly. This led to the psychological principle of “Law of Effect”, also proposed by Thorndike in 1898, which propagated that satisfying consequences tend to be repeated while dissatisfying consequences tend to be avoided. The concepts of “satisfying” and “dissatisfying” consequences later came to be replaced by the terms “punishing” and “reinforcing” consequences.
Almost half a century later, American psychologist and behaviorist B. F. Skinner replaced the “puzzle box” with an operant chamber or “Skinner’s box” and paved way for the operant approach, as we know it today. Skinner thought that Pavlov’s classical conditioning, a commonly known concept, is too simple to be applied to behavior.
He also rejected the concept of unobservable mental states such as satisfaction, and focused instead on observable behaviors and observable consequences, and thus came to be known as the “father of operant conditioning”.
Fordyce et al (1976) were the first to systematically apply and study the operant model to the management of chronic pain. The operant approach focuses on pain behaviors demonstrated by patients which are then reinforced through the subsequent consequences. In 2012, Gatzounis et al published a study titled “Operant Learning Theory in Pain and Chronic Pain Rehabilitation” which was a systematic study of several other studies. The findings were that learning contributes greatly to the development and maintenance of pain and that the operant approach is a very superior form of treatment with successful outcomes in pain patients. Similarly, a 2018 study titled “Learning and Unlearning of Pain” by Larissa Cordier and Martin Diers established that operant training shows promising results in pain patients by connecting pain with positive consequences or by removing negative consequences.
Pain patients more often than not display overt pain behaviors in the form of verbal responses such as moaning, sighing; non-verbal responses such as limping, bracing, grimacing; general activity level such as sitting and lying down. These behaviors unknowingly get either positively reinforced by caregivers, for example giving extra attention to verbal responses such as moaning; or they may get negatively reinforced, for example, walking with a limp to reduce pain. “Kinesiophobia” or fear of movement related to pain leads to several avoidance behaviors such as lying down, sitting etc. this avoidance can further lead to anxiety as well as reduction in activities and, eventually, possible muscular dystrophy or disability. Therapists help patients and caregivers to learn appropriate behaviors and responses; and unlearn inappropriate ones. Oftentimes patients also make inappropriate associations, for example, reserving pain medication for extreme pain, thereby affecting treatment outcomes. Psychotherapists help the patients unlearn these associations and form healthy ones.
Thus operant conditioning approach is instrumental in successful pain rehabilitation and deserves special attention from physicians and patients alike.
So, while you consider and reflect upon this article and decide when to book a therapy session, here are some quick operant tips for you to start practicing.
Identifying personal responses – Pay attention to your own set of pain responses. Focus the practices and habits you indulge in to avoid pain.
Experimenting with extinction – Once personal responses are identified, focus on overcoming those by replacing with healthy behaviors.
Practice positive self-talk – Engage in positive talk to avoid engaging in pain responses. This also gives a semblance of control over the pain.
Reestablishing activities – Any kind of pain can impact the activity level of a person, thus it is important to gradually take charge and restart activities.
Set appropriate quotas – While it is important to reestablish activities, it is important to take it easy. Setting limits and slowly increasing those works the best.
Try these easy tips. While these will help you greatly, do consider therapy! As goes a famous quote, “If you want to change attitudes, start with a change in behavior”. So do consider seeking support to better achieve behavior modification and feel free to REACH OUT!
I leave you with that thought and welcome your comments on the same.