Classical conditioning: Physicians explaining it to physicans-to-be

[sue_frantz]

In 2015, the Medical College Admission Test (MCAT) added behavioral science questions to the test. If you haven’t read the MCAT’s overview of the Psychological, Social, and Biological Foundations of Behavior Section, it’s worth a look. Two-thirds of the questions from this section are expected to come from Intro Psych. They say that this “section emphasizes concepts that tomorrow’s doctors need to know in order to serve an increasingly diverse population and have a clear understanding of the impact of behavior on health.”

As readers of this blog know, as an Intro Psych instructor deciding what should and should not be in the course, I keep my audience in mind. Many of our Intro Psych students will be pursuing careers in healthcare, and, for at least some of them, that means taking the MCAT.

Some of us think about what we cover in our courses in terms of what we want students to remember years from now. What might the physicians of tomorrow remember from their Intro Psych course of today?

I recently purchased this book written by physicians for physicians-to-be:

Boland, R. J., Verduin, M. L., Ruiz, P., Shah, A., & Sadock, B. J. (Eds.). (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

The print edition of the book comes with free (pre-purchased, really) access to the ebook. All you need to do is enter the access code, give them your name, and pick the option that best describes your role. Here are my options: medical student, nursing student, resident, fellow, practitioner, nurse, nurse practitioner, program director, program coordinator, librarian. That’s it. Not even an “other” category. Since I had to pick something to continue the registration process, I decided to throw some love to my librarian colleagues. And where do I practice my librarianship they wonder? None is an option, but if I’m going to pretend to be a librarian, I’m okay being a librarian in the U.S. At least some of their data will be meaningful.

In the chapter on anxiety disorders, they have a section on the neurobiology of these disorders with a subsection titled “Neuroimaging Studies.” For reasons that are unclear to me, within that subsection is a sub-subsection titled “Psychological Studies.” I’m guessing that this was an error, and that this sub-subsection was supposed to be a section at the same level as the neurobiology section. I logged into the ebook to see if they may have fixed it there. Nope. So, there you have it. Psychological studies are a type of neuroimaging.

That section weirdness aside, I found their description of classical conditioning fascinating.  

Behavioral scientists have helped to elucidate the psychology of fear and anxiety through both animal and human studies. A full discussion of the psychological research is well beyond the scope of this chapter, but most relevant to anxiety disorders are the work of Pavlov and later scientists on the nature of conditioning. In the classic studies, the scientist exposes an animal to an (sic) neutral stimulus, such as an auditory tone, and then presents the tone while introducing an aversive stimulus, such as an electric shock. With the repeated pairing of the two stimuli, the neutral stimulus becomes associated with the aversive one, to the point where it alone can elicit the same response even when removing the aversive stimulus. The result is that the animal has been conditioned or learned to fear the neutral stimuli. In behavioral science, the neutral stimulus is called the conditioned stimulus and the aversive one the unconditioned stimulus. If the scientist presents the conditioned stimulus without the unconditioned one and repeats this often enough, the animal will no longer associate the two stimuli; this is called extinction. How long extinction learning takes will depend on the particular stimuli and the individual animal. It also can depend on context, and a different setting can change the response. Behavioral studies suggest that the animal does not forget the conditioning. Instead, it is now competing with a new memory. Under appropriate circumstances, the pairing, and associated fear response, can be reinstated.

As humans are animals, they experience conditioning and extinction as well. The relevance to anxiety disorders, particularly phobias, should be obvious. Research in conditioning has gone well beyond this simplified description to identify and elaborate the many subtleties of conditioned learning. (Boland et al., 2022, p. 411).

Some observations. First, behavioral science and behavioral scientists have replaced psychology and psychological scientists. I knew we were doomed when behavioral economics replaced cognitive psychology, but it still pains me. I know many of you rebranded your departments of psychology as departments of psychological science. Have you rebranded again to the department of behavioral science? And is it solely behavioral science because the cognitive research has gone to economics? Identity crisis, anyone?

Second, evidently it is important for the psychiatrist-to-be who is reading this text to know the terms conditioned and unconditioned stimulus. The terms conditioned and unconditioned response, however, are not noteworthy. And that brings me back around to an earlier blog post. How important are any of these terms?

Third, extinction gets a shout-out by name and spontaneous recovery gets a shout-out by description, sort of. This sentence is a little mysterious to me: “Under appropriate circumstances, the pairing, and associated fear response, can be reinstated.” Yes, if you present the tone and shock the rat again, the fear would be reinstated. I’m not sure if that circumstance is appropriate, however. In any case, I’m just not sure what they were getting at here.

Four, even though the authors recognize that this is a “simplified description,” I would have loved to have seen generalization get a mention. Yes, your patient is afraid of the person who sexually assaulted them, but your patient is also going to show some fear of people who look like their attacker.

Of course, we cannot assume that the authors, editors, and reviewers of this text are representative of all physicians, but it does give me something to think about. Is this what our Intro Psych students remember about classical conditioning years later? Is this what we want them to remember?