Blok G&M 1ste Ba Medische Psychologie Hoofdstuk 2 Leren.pdf

# Introduction to learning and learning processes Learning and learning processes are fundamental to an organism's ability to survive and interact with its environment. ## 1. Introduction to learning and learning processes ### 1.1 Why consider 'learning'? Learning is essential for an organism to survive, both physically and emotionally. It enables organisms to distinguish between signals of danger and safety, thereby allowing them to predict environmental outcomes. Furthermore, learning provides the means to better understand and control one's surroundings [2](#page=2). ### 1.2 Definition of learning Learning is defined as the process through which specific experiences create new, relatively durable behaviors or attitudes, and behavioral tendencies (factual changes). Alternatively, learning can also be understood as the creation of the potential or capacity for such changes. This involves the formation of new associations, which can lead to changes in behavior even if these learned behaviors are not immediately expressed [3](#page=3). ### 1.3 Limits of learning capacity The capacity for learning is influenced by several factors: * **Genetics (Nature):** Biological predispositions impose limitations on the skills and traits that an organism can acquire [4](#page=4). * **Biological Circumstances:** Conditions before and during birth can also affect learning capabilities [4](#page=4). * **Prior Experiences (Nurture):** Previous learning experiences significantly shape how subsequent learning experiences influence an individual [4](#page=4). * **Difficulty in "Unlearning":** There is a relative impossibility of unlearning acquired skills, preferences, and aversions [4](#page=4). > **Tip:** Understanding the interplay between nature (genetics) and nurture (environment and experience) is crucial for a comprehensive view of learning limitations. > **Example:** While someone might have a genetic predisposition for musical talent, their ability to develop this talent will be heavily influenced by access to musical instruments, instruction, and practice opportunities. --- # Behavioral psychology and learning theories Behavioral psychology is synonymous with learning theory, focusing on the capacity to modify behavior based on past experiences [5](#page=5). ### 2.1 Historical context and core tenets of behaviorism Before the 1930s, psychology was largely dominated by psychoanalysis, which sought to understand patient problems through personality and internal factors. The period from 1930 to 1950 saw the rise of "behaviorism," which advocated for the study of observable behavior as the sole objective and measurable data. This approach prioritized objectivity and the testability of hypotheses, frequently employing animal experiments. Behaviorists rejected the study of the mind and mental processes, deeming them unsuitable for scientific research, although they did not deny their existence. Behaviorism posits that a person can be best described in terms of their behavior, leading to learning theory also being considered a personality theory [6](#page=6). ### 2.2 The principle of learning as the primary determinant of behavior Learning theories fundamentally operate on the principle that learning processes are the most significant determinants of behavior. The primary objective of these theories is to discover the laws that govern the acquisition or cessation of behavior, thereby enabling the prediction and stimulation of human actions [7](#page=7). ### 2.3 The Stimulus-Response-Consequence (SRC) model The essence of behavioral psychology lies in the Stimulus-Response-Consequence (SRC) model. In this model, situations (S or stimuli), also referred to as antecedent factors, elicit behavior (R or response). Following the behavior, consequent factors (C or consequents) emerge, which influence whether the exhibited behavior is maintained. This can be represented as [7](#page=7): $$ S \rightarrow R \rightarrow C $$ [7](#page=7). > **Tip:** Remember that while the process of learning itself is not directly observable, it can be inferred from observed changes in behavior [5](#page=5). > **Example:** An assertive person, in behavioral terms, is someone whose behavior patterns are consistently assertive, making learning theory a framework for understanding personality [6](#page=6). --- # Learning paradigms: non-contingent, classical, and operant conditioning, and modeling Learning paradigms describe the various processes that shape and determine behavior, explaining what is learned and how it is learned. This section will delve into four primary learning paradigms: non-contingent stimulus presentation, classical conditioning, operant conditioning, and modeling [8](#page=8). ### 3.1. Non-contingent stimulus presentation Non-contingent stimulus presentation involves repeatedly presenting the same stimulus to an individual, independent of any other events or behaviors. This is a form of non-associative learning, as the stimulus presentation is not linked to other occurrences. Two main consequences arise from this type of learning: sensitization and habituation [9](#page=9). #### 3.1.1. Sensitization Sensitization is characterized by an increased responsiveness to a stimulus following repeated exposure to it, leading to an amplification of the original reaction. This phenomenon is particularly notable when the stimulus is intense, salient, or potentially threatening. Research by Kimble on frogs demonstrated that repeated shocks, rather than leading to classical conditioning, resulted in a progressively stronger response from the frogs, indicating a reinforcement of reflex sensitivity. Physiologically, sensitization involves an increased excitability of the nervous system, often by activating arousal or stress systems, causing the organism to react more strongly, even to mild stimuli [10](#page=10) . #### 3.1.2. Habituation Habituation, conversely, is a decrease in the original response to a stimulus after repeated exposure. When an organism encounters the same stimulus repeatedly without it predicting anything significant or important, the response gradually diminishes. For instance, the initial reaction to a loud noise might be a startle response, but if the sound is regular and harmless, the startle reaction will lessen with each subsequent occurrence. This contrasts with sensitization, where unpredictable or intensely loud sounds can lead to increased sensitivity, causing the individual to startle more easily at subsequent sounds [11](#page=11). #### 3.1.3. Comparison of habituation and sensitization | Feature | Habituation | Sensitization | | :------------------ | :----------------------------------------- | :------------------------------------------------ | | Effect of repeated stimulus | Reaction decreases | Reaction increases | | Nature of stimulus | Weak, neutral, no consequence | Strong, intense, potentially threatening or unexpected | | Physiological effect | Decreased excitability of nerve cells | Increased excitability of nerve cells | | Function/meaning | Filters out irrelevant stimuli, conserves energy | Increases vigilance for potential threats, survival | | Effect on attention | Decreased attention for repeated meaningless stimuli | Increased attention for new or intense stimuli | | Example | No longer noticing the ticking of a clock | Startling more easily at each subsequent sound after a loud bang | #### 3.1.4. Negative psychological consequences of habituation and sensitization Habituation can lead to negative psychological consequences, such as learned helplessness. If an animal is repeatedly exposed to inescapable shocks, it may learn less easily to avoid similar shocks later, developing a belief that there is nothing it can do. Conversely, "pre-treatment" with intense, frequent, or prolonged shocks can make individuals less sensitive to subsequent negative experiences, such as rats becoming less responsive to swimming in very cold water. This phenomenon can manifest as emotional blunting or "compassion fatigue" in helping professions due to frequent exposure to violence and suffering [13](#page=13). #### 3.1.5. Applications in psychological interventions Habituation and sensitization principles are applied in various interventions. In sports psychology, athletes undergo strenuous training to better cope with competition demands, utilizing principles akin to habituation to discomfort. Rehabilitation programs for young people with behavioral problems may involve survival treks where they face hardships, aiming to build resilience against life's adversities [14](#page=14). #### 3.1.6. Negative psychological consequences of sensitization Sensitization, if persistent or generalized, can result in chronic overstimulation. This leads to overreacting to normal or innocuous stimuli, manifesting as a low threshold for stress responses or hypersensitivity. Pain sensitization, where the nervous system becomes oversensitive to pain stimuli (even light touch or pressure), is linked to conditions like Chronic Fatigue Syndrome (CFS), fibromyalgia, and chronic back pain through central sensitization [15](#page=15). ### 3.2. Classical conditioning Classical conditioning, pioneered by Ivan Pavlov, is a form of associative learning where a neutral stimulus becomes associated with an unconditioned stimulus that naturally elicits a response, eventually eliciting that response on its own. The famous "Pavlov's dogs" experiment demonstrated this by pairing the ringing of a bell (neutral stimulus) with the presentation of food (unconditioned stimulus), which naturally causes salivation (unconditioned response). After repeated pairings, the bell alone would elicit salivation (conditioned response) [16](#page=16) [18](#page=18). #### 3.2.1. Basic terminology * **Unconditioned Stimulus (UCS):** A stimulus that naturally and automatically triggers a response. (e.g., food ) [18](#page=18). * **Unconditioned Response (UCR):** The unlearned, naturally occurring response to the UCS. (e.g., salivation to food ) [18](#page=18). * **Conditioned Stimulus (CS):** A previously neutral stimulus that, after association with the UCS, comes to trigger a conditioned response. (e.g., the bell ) [18](#page=18). * **Conditioned Response (CR):** The learned response to the previously neutral (now conditioned) stimulus. (e.g., salivation to the bell ) [18](#page=18). > **Tip:** The key difference between UCR and CR is that the UCR is an innate reflex, while the CR is a learned association [20](#page=20) [21](#page=21). #### 3.2.2. Examples of classical conditioning * **Child's fear of the doctor's office:** A 4-year-old girl, Lies, receives an injection during her first visit to the doctor. The pain causes her to feel scared and sad (UCR to the injection - UCS). On subsequent visits, the doctor's consultation room (CS) alone elicits fear and sadness (CR) because it has become associated with the painful injection [22](#page=22) [23](#page=23). * **Aversion to cigar smell:** Mrs. S. associates the smell of cigars with her father, who used to smoke and beat her. The father and his violence were the UCS, causing her to feel distressed (UCR). Now, the smell of cigars (CS) alone evokes feelings of anxiety and distress (CR) [24](#page=24) [25](#page=25). * **Chemotherapy-induced nausea:** A 27-year-old woman undergoing chemotherapy experiences severe nausea and vomiting (UCR) triggered by the treatment (UCS). After treatment completion, the act of receiving food, including its smell and taste (CS), continues to elicit nausea and vomiting (CR), as it has become associated with the chemotherapy [26](#page=26) [27](#page=27). * **Fear of eating (swallowing phobia):** A 58-year-old woman has difficulty swallowing (CR) due to a severe choking incident (UCS) that caused intense fear and panic (UCR). The act of eating (CS) has become associated with this terrifying experience, now eliciting fear and panic [28](#page=28) [29](#page=29). #### 3.2.3. Conditions for classical conditioning Two crucial conditions must be met for a new association to form through classical conditioning: * **Contiguity:** The CS and UCS must be presented together, closely following each other in time [30](#page=30). * **Contingency:** There must be a predictive relationship between the CS and UCS, meaning the CS must be a good predictor of the UCS. A perfect contingency involves the stimuli occurring together and being absent together. Contingency cannot exist without a temporal aspect (contiguity) [30](#page=30). #### 3.2.4. Principles of classical conditioning * **Generalization vs. Discrimination:** * **Generalization:** The CR can be triggered by stimuli that resemble the original CS. The CR is strongest with the original CS but can generalize to similar stimuli (e.g., fear of specialized research leading to general fear of doctors) [31](#page=31). * **Discrimination:** The organism learns not to respond to stimuli that are similar but not identical to the original CS. Different responses are given to different CSs (e.g., fear of the dentist but not the general practitioner) [31](#page=31). * **Extinction and reinforcement:** * **Extinction:** The CR will not persist indefinitely and weakens if the UCS is not occasionally presented along with the CS [32](#page=32). * **Spontaneous recovery:** An extinguished CR can reappear after a rest period when the CS is presented again [32](#page=32). * **Reinforcement:** The contingent presentation of the UCS following the CS strengthens the association. The strength of the CR increases with the number of CS-UCS pairings [32](#page=32). * **Second-order conditioning:** Once a CS has been conditioned, it can be used to condition other stimuli. For example, a dog conditioned to salivate to a bell can also learn to salivate to a light signal if that signal is paired with the bell [33](#page=33). #### 3.2.5. Treatment based on classical conditioning Classical conditioning principles inform therapeutic techniques such as exposure and counter-conditioning [34](#page=34). * **Exposure:** This involves presenting the CS without the UCS. It is a common technique for anxiety, where patients are repeatedly and for extended periods exposed to the feared situation (internal or external) until the anxiety subsides. For example, repeatedly exposing Mrs. S. to cigar smoke (CS) without the accompanying violence (UCS) renders the smoke no longer a predictor of harm, leading to the extinction of her anxiety response (CR). The CS then reverts to being a neutral stimulus [35](#page=35). * **Counter-conditioning:** This technique involves presenting a stimulus simultaneously with the CS that elicits a response incompatible with the CR. For instance, pairing cigar smoke (CS) with a stimulus that induces a feeling of calm (incompatible with anxiety) can help re-evaluate the CS [36](#page=36). ### 3.3. Operant conditioning Operant conditioning, first described by Thorndike's "Law of Effect" and further developed by Skinner, is a form of associative learning where behaviors are learned through their consequences. Thorndike's experiments with cats in "puzzle boxes" demonstrated that actions leading to desirable outcomes are more likely to be repeated [37](#page=37) [38](#page=38) [39](#page=39). * **Puzzle box:** The environment the animal is in [37](#page=37). * **Pulling the string:** The specific behavior or response (R) [37](#page=37). * **Food:** The reinforcer (Sr) that follows the behavior [37](#page=37). The Law of Effect states that any action leading to a desirable outcome will be repeated under similar circumstances. A reinforcer (Sr) establishes an association between the response (R) and the stimuli (Sd) present when the response occurs. Behaviors followed by pleasant outcomes increase, while those followed by unpleasant outcomes decrease [38](#page=38). Skinner further elaborated on this with the "Skinner box," where an animal must perform a specific action, like pressing a lever, to receive a reward. This type of learning highlights the organism's ability to exert control over its environment [39](#page=39). #### 3.3.1. Examples of operant conditioning * A child receives a sticker for finishing their drink and will likely drink their cup fully more often in the future [41](#page=41). * If a woman complaining of headaches receives comfort from her husband, she will likely complain of pain more frequently [41](#page=41). * A teenager who learns that aggressive outbursts lead to more concessions from parents will exhibit more aggressive behavior [41](#page=41). * A person avoids flying because it confronts their fear of flying, thus not having to face their anxiety [41](#page=41). #### 3.3.2. Possible consequences/reinforcers Behaviors increase in frequency due to the following consequences: * **Positive Reinforcement (+S+):** Presenting something desirable [42](#page=42). * **Negative Reinforcement (-S-):** Removing something aversive [42](#page=42). * **Omission of the Aversive ( **Important Note:** Both "reinforcement" and "punishment" are types of "reinforcers," which are consequences that follow a behavior [42](#page=42). #### 3.3.3. Reinforcement in classical vs. operant conditioning The concept of reinforcement differs between classical and operant conditioning [43](#page=43). * In **classical conditioning**, reinforcement occurs by presenting the UCS and CS together, creating or strengthening an association between them, leading to a response to both stimuli [43](#page=43). * In **operant conditioning**, the reinforcer is administered *after* the behavior occurs. Reinforcement strengthens the preceding response, through either positive or negative means (rewarding or punishing) [43](#page=43). #### 3.3.4. Conditions for operant conditioning Similar to classical conditioning, operant conditioning also relies on specific conditions: * **Contiguity:** The temporal proximity between the response and the stimulus is crucial; the degree of operant conditioning depends on the time elapsed between the behavior and its consequence. Studies show that a longer delay between lever pressing and food delivery leads to less behavioral increase [44](#page=44). * **Contingency:** A logical relationship exists between the response and the stimulus [44](#page=44). #### 3.3.5. Flexibility of operant conditioning Operant conditioning is more flexible than classical conditioning, as learned responses can be modified when reinforcement changes. For instance, an animal can be trained to repeat a response a certain number of times before receiving reinforcement, or to perform a behavior only after a specific time has passed [45](#page=45). #### 3.3.6. Principles of operant conditioning * **Generalization:** Learned behavior occurs in contexts similar to where the behavior was initially learned [46](#page=46). * **Discrimination:** Learned behavior remains confined to a single context [46](#page=46). ### 3.4. Social learning theory (modeling) Social learning theory, proposed by Albert Bandura, posits that learning can occur through observing and imitating the behavior of others, rather than solely through direct operant or classical conditioning. This "observational learning" or "modeling" is considered a primary developmental mechanism [48](#page=48). People learn behavior patterns by observing others, and while direct rewards are not always necessary for this learning, the observer may anticipate future rewards for the new behavior. This is particularly influential in learning social behaviors, including gender roles and assertive or aggressive conduct, as children imitate parents or other role models, as famously demonstrated in Bandura's "Bobo doll" experiment [49](#page=49). #### 3.4.1. Conditions for imitation Not all observed behaviors are imitated. Bandura identified five necessary conditions for observational learning to occur [50](#page=50) [51](#page=51): 1. **Attention:** The observer must pay attention to the model and the behavior being performed [51](#page=51). 2. **Retention:** The observed behavior must be remembered and stored in memory [51](#page=51). 3. **Motor Reproduction:** The individual must possess the necessary motor skills to replicate the behavior [51](#page=51). 4. **Motivation:** The observer must be motivated to imitate the behavior. This motivation is influenced by several factors: * **Consequences:** The outcomes the model experiences for their behavior play a role [50](#page=50). * **Status:** More powerful models are more likely to be imitated [50](#page=50). > **Note:** Symbolic models, such as pop stars, can also be imitated, not just concrete individuals. Models can be categorized as **personal models** (imitated for their personal qualities) or **positional models** (imitated due to their social position or success) [50](#page=50). --- # The importance of learning processes in illness and patient care Learning processes are fundamentally intertwined with how individuals manage their health, cope with illness, and respond to medical interventions. Understanding these learned behaviors is crucial for effective patient care and improving health outcomes [53](#page=53). ### 4.1 The role of learning in illness management Individuals' responses to acute and life-threatening conditions are significantly influenced by various learning processes. These learning processes shape both efficient and inefficient learned behaviors that patients exhibit in their illness journey [53](#page=53). ### 4.2 Diagnostic and therapeutic applications of learning processes #### 4.2.1 Analyzing learned behavior for diagnosis When patients exhibit inefficient or problematic responses, a detailed analysis of their behavior is essential. Understanding the learned components of this behavior can provide valuable insights for diagnosis and comprehension of the patient's complaints and coping mechanisms [54](#page=54). > **Example:** A patient experiencing a panic reaction when blood collection is suggested might have this response rooted in learned associations and anxieties. Analyzing this learned behavior is key to understanding the underlying issue [54](#page=54). #### 4.2.2 Modifying learned behavior through treatment Therapeutic interventions can be applied to help patients unlearn problematic behaviors and acquire more adaptive responses. Techniques such as exposure therapy or counter-conditioning are designed to facilitate this process, enabling patients to replace undesirable reactions with more desired ones [54](#page=54). --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Learning | The process by which specific experiences lead to new, more or less lasting behaviors, attitudes, or behavioral tendencies, or at least create the potential for them. It involves the formation of new associations that can influence behavior. | | Nature | Refers to the genetic or biological factors that limit the skills and characteristics an individual can acquire. | | Nurture | Refers to environmental influences and experiences that shape an individual's development and learning, as opposed to genetic factors. | | Behavioral Psychology | The study of an organism's capacity to learn and adapt its behavior based on past experiences. It is often equated with learning theory. | | Stimulus (S) | An external or internal event or condition that elicits a response from an organism. | | Response (R) | The reaction of an organism to a stimulus. | | Consequent (C) | Factors that follow a behavior and influence whether that behavior will be maintained or repeated. | | Non-contingent stimulus presentation | A form of learning where stimuli are presented repeatedly, but the presentation is not dependent on other events or the organism's behavior. This can lead to sensitization or habituation. | | Sensitization | A phenomenon where repeated exposure to a stimulus leads to an increased responsiveness to that stimulus, often occurring with intense, salient, or potentially threatening stimuli. | | Habituati | A phenomenon where repeated stimulation by the same stimulus leads to a decrease in the original reaction, as the organism learns that the stimulus is not important or predictive. | | Classical Conditioning (KC) | A type of associative learning where a neutral stimulus (CS) becomes associated with an unconditioned stimulus (UCS) that naturally elicits an unconditioned response (UCR), eventually causing the CS to elicit a conditioned response (CR) similar to the UCR. | | Unconditioned Stimulus (UCS) | A stimulus that naturally and automatically triggers a response without any learning required. | | Unconditioned Response (UCR) | The unlearned, natural response to an unconditioned stimulus. | | Conditioned Stimulus (CS) | A previously neutral stimulus that, after association with an unconditioned stimulus, comes to trigger a conditioned response. | | Conditioned Response (CR) | The learned response to a previously neutral stimulus (CS) that has been associated with an unconditioned stimulus (UCS). | | Contiguity | The principle that the conditioned stimulus (CS) and unconditioned stimulus (UCS) must be presented close together in time for conditioning to occur. | | Contingency | The principle that there is a predictive relationship between the conditioned stimulus (CS) and the unconditioned stimulus (UCS); the CS must be a good predictor of the UCS. | | Generalization | In conditioning, the tendency to respond to stimuli that are similar to the conditioned stimulus (CS). | | Discrimination | In conditioning, the ability to distinguish between a conditioned stimulus (CS) and other similar stimuli, responding only to the CS. | | Extinction | The gradual weakening and disappearance of a conditioned response (CR) when the conditioned stimulus (CS) is repeatedly presented without the unconditioned stimulus (UCS). | | Spontaneous Recovery | The reappearance of an extinguished conditioned response (CR) after a period of rest, when the conditioned stimulus (CS) is presented again. | | Reinforcement (Bekrachtiging) | In operant conditioning, any event that strengthens the behavior it follows. In classical conditioning, it refers to the pairing of the CS and UCS. | | Second-order conditioning | A conditioning process where a conditioned stimulus (CS) itself becomes a signal for another stimulus, leading to a conditioned response without direct association with the original unconditioned stimulus (UCS). | | Exposure | A therapeutic technique used in treating anxiety disorders, involving prolonged and repeated exposure to a feared stimulus (CS) without the presence of the unconditioned stimulus (UCS), leading to extinction of the fear response. | | Contra-conditioning | A therapeutic technique where a stimulus that elicits an undesirable response is paired with a stimulus that elicits an incompatible, desirable response, aiming to change the association. | | Operant Conditioning (OC) | A type of learning where behavior is strengthened or weakened by the consequences that follow it (reinforcement or punishment). | | Law of Effect | Thorndike's principle that behaviors followed by satisfying outcomes will be repeated, and behaviors followed by annoying outcomes will be suppressed. | | Reinforcer (Sr) | Anything that follows a behavior and increases the likelihood of that behavior occurring again. | | Punisher (S-) | Anything that follows a behavior and decreases the likelihood of that behavior occurring again. | | Skinner Box | An experimental chamber used to study operant conditioning, typically involving a lever or button that an animal must operate to receive a reward or avoid a punishment. | | Social-cognitive learning theory | A theory that emphasizes learning through observation and imitation of others, as well as through direct experience and cognitive processes. | | Observational learning | Learning by watching the behavior of others and the consequences of their actions. | | Modeling | The process of learning new behaviors by observing and imitating others, often referred to as social learning. | | Bobo doll experiment | A famous experiment by Albert Bandura demonstrating that children learn aggressive behaviors by observing aggressive adult models. | | Learned helplessness | A psychological state where an individual feels unable to control or influence events, often resulting from repeated exposure to unavoidable aversive stimuli. |