Operant conditioning applied to improving health

[sue_frantz]

After covering operant conditioning, ask students to silently identify a specific behavior they would like to change. Help students understand the difference between an outcome, e.g., lose 10 pounds, get an A in this course, and a behavior, e.g., walk 30 minutes a day five days a week, study psychology one hour a day six days a week.

Ask students to raise their hands if they’ve tried to change a behavior only to have the effort peter out. All or almost all hands will go up.

“If I were to pay you each week for engaging in your behavioral change, how much money would it take for you to stick with it?” By a show of hands, “At least $25?” With their hands still up, ask “At least $50?”  With their hands still up, “At least $75?” Keep going until all hands are up.

In a recent experiment (Halpern, et.al, 2015), researchers randomly assigned participants to an incentive-based smoking cessation program. There were a few different ways they structured the incentive, but for all of them participants could earn up to $800 for being smoke-free after six months. How many were smoke-free after six months? The four incentive programs resulted in a 10% to 15% success rate. That may not sound like much, but the authors reports that “usual care” results in 6% smoke-free at six months.

Don’t be surprised if students express dismay at such an incentive program. Providing positive reinforcement for doing things that we should do anyway makes some people uncomfortable. What’s the alternative? We know that healthcare costs will be lower, overall, for people who do not smoke. The higher someone else’s healthcare costs, the higher the cost of health insurance for all of us. Framed in that light, $800 per person seems like a reasonable investment.

I don’t have someone else paying me, but I do have my own personal incentive program. When my pedometer tells me that I have reached 90,000 steps, I put $25 into a special account. It is out of this account that I pay for my Starbucks coffee, most restaurant meals, and anything else that’s considered a non-essential expense. Not only am I encouraged to walk more, but I have also reduced my spending.

Health, however, is much broader than not smoking and walking. It also includes not shooting people.

In Richmond, VA, the city council created a program designed to reduce violence. When they learned that 17 people, mostly young men, were responsible for 70% of the shootings, they knew who they needed to contact. They sent “street-savvy staff members” into the community to build relationships with these folks. With some trust established, the program coordinators invited the men to a meeting and made them an incredible offer. To paraphrase, if you stay out of trouble and attend meetings with the program’s mentors, we’ll pay you up to $1,000 per month for up to nine months. Is it working? Homicides and firearms assaults dropped by about half in just the first year of the program. Drug use among the program participants is down, employment is up, school enrollment is up. It took cash to get them started down a more productive path, but once they got going, the reinforcement came from other places. Historically we have relied on fines and jail time to try to change bad behavior. We know punishment, on the whole, is not as effective as reinforcement, so to change bad behavior why not reinforce good behavior?

Ask students to think of behaviors that are typically punished, and then in pairs or small groups, ask students to generate some ways that alternative, good behaviors could be reinforced.

Halpern, S. D., French, B., Small, D. S., Saulsgiver, K., Harhay, M. O., Audrain-Mcgovern, J., . . . Volpp, K. G. (2015). Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine N Engl J Med, 372(22), 2108-2117. doi:10.1056/nejmoa1414293