Yates: The application of Learning Theory to the treatment of tics Flashcards
Background
Examples of learned habits, little progress in this field has been reported, although their results were encouraging.
In 1932, however, Dunlap claimed that undesirable habits (including tics) could be eliminated by making the subjects repeat them voluntary and deliberately
While this technique of negative practice has been accepted, an adequate rationale and experimental confirmation of its utility are still lacking
Tics as a learned habit
It is hypothesized that some tics may be drive-reducing conditioned avoidance responses, originally evoked in a highly traumatic situation.
In this situation, intense fear is aroused and a movement of withdrawal or aggression is made.
If the movement produces or coincides with the cessation of the fear-inducing stimulus, it acquires strength through reinforcement.
Wolpe, Solomon, Wynne, and others have demonstrated that animals placed in a highly traumatic situation develop conditioned avoidance response which apparently reduce the anxiety associated with the original situation and which are highly resistant to extinction.
Second, the kind of response evoked may be determined partly at least by the mode of response characteristic of the subject in any stressful situation.
The suggested model follows closely the two-factor theory of learning expounded by Mowrer
Derivation of Method of Treatment
According to the model, the tic may be treated as a simple learned habit which has attained its maximum strength
In terms of the theory, it should be possible, therefore, to extinguish the habit by building up a negative or incompatible habit of “not performing the tic.”
With repeated massed practice, therefore, a negative habit (“not doing the tic”) will be built up, incompatible with the positive habit of doing the tic
Furthermore, the repeated voluntary evocation of the tic should not serve to increase the habit strength of the tic, since it is already asymptotic and consequently not subject to strengthening by massed practice
Subject
Female psychiatric patient, years old, who was highly cooperative and apparently had a strong desire to get well
She was of high average intelligence, and was markedly neurotic and slightly more extroverted than average
Four clear-cut tics were chosen for the experiment:
- complex stomach-contraction breathing tic
- nasal “explosion” (expiration)
- coughing tic
- eye-blink tic.
These tics appeared to have started originally following two very traumatic experiences about ten years previously when S felt that she was being suffocated while undergoing anesthesia; she said that she was terrified that she was going to die and struggled madly.
Superficially, at least, these tics seemed to be conditioned avoidance responses originally established in a traumatic situation.
She also said that she felt a need to do the tics and experienced relief when they occurred i.e., they were drive-reducing).
They varied markedly from time to time in frequency of occurrence.
It was decided to treat the four tics concurrently but independently.
Discussion
The rate of decline was most striking in that tic (nasal) which received the largest amount of massed practice.
There was no evidence of any recovery of function following prolonged rest
The data further suggest that the optimum conditions for the production of conditioned inhibition may be a period of very prolonged rest to allow for the total dissipation of reactive inhibition
There was subjective evidence suggesting that conditioned inhibition generalized beyond the test situation itself and that most generalization occurred with respect to the tic which had received most massed practice
Summary
A theoretical model was proposed to show that some tics may be conceptualized as drive-reducing conditioned avoidance responses, originally evoked in a traumatic situation.
From this model, a method of treatment was derived.
It was predicted that if the tics were evoked voluntarily under conditions of massed practice, a negative habit of “not doing the tic” should be built up, resulting ultimately in the extinction should generalized beyond the test situation.
The optimum condition for the growth of the negative habit appeared to be the combination of very prolonged massed practiced followed by prolonged rest
Subjective reports of the patient indicated considerable clinical improvement outside the immediate test situation.
Hullian Explanation
If the subject is given massed practice in the tic, then reactive inhibition (Ir) should build up rapidly
When Ir reaches a certain critical point, the patient
will be forced to “rest” or not perform the tic
This habit (sIr=conditioned inhibition) of not performing the tic will be associated with drive-reduction due to the dissipation of Ir and hence will be reinforced
