Psych · Foundations — learning theory and behavioural science
Learning theory and behavioural science
Also known as Classical conditioning · Operant conditioning · Social learning theory · Extinction learning · Inhibitory learning · Exposure mechanisms · Behavioural activation theory · Reinforcement schedules
Exam-exhaustive fellowship reference on learning theory and behavioural science for psychiatrists — classical, operant, and observational learning; reinforcement schedules; extinction and relapse phenomena; inhibitory-learning exposure; behavioural roots of CBT and BA; clinical applications across anxiety, OCD, PTSD, depression, and addiction. FRANZCP-primary, globally tagged.
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Red flags
- Elective exposure is deferred when acute suicide, violence, mania, psychosis emergency, or medical instability dominates
- Do not run intense trauma imaginal exposure without stabilisation, risk plan, and competence
- Safety behaviours left intact during exposure prevent expectancy violation and maintain threat beliefs
- Therapist drift: calling unstructured support or hierarchy-without-disconfirmation 'exposure therapy'
- Punishment-heavy contingency programmes damage alliance and drive covert avoidance
- Clinic-only extinction without multi-context generalisation predicts renewal of fear after discharge
Meet the patient
A 29-year-old nurse with contamination OCD completed twelve sessions of in-clinic exposure and response prevention. By week eight she could hold the clinic door-handle for five minutes, rated her distress at two out of ten, and ran no ritual. You discharged her feeling reasonably pleased.[15][6]
On Saturday she stood outside her local supermarket, could not bring herself to touch the trolley, went home, and washed for an hour. She told her GP the therapy "did not work". Nothing about her effort or her compliance was the problem. Why did the fear come back? The rest of this page is the consultant-level answer.[3][4][6]
References18ShowHide
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- [3]Bouton ME Context, ambiguity, and unlearning: sources of relapse after behavioral extinction Biol Psychiatry, 2002.PMID 12437938
- [4]Bouton ME Context and behavioral processes in extinction Learn Mem, 2004.PMID 15466298
- [5]Craske MG, Kircanski K, Zelikowsky M, et al. Optimizing inhibitory learning during exposure therapy Behav Res Ther, 2008.PMID 18005936
- [6]Craske MG, Treanor M, Conway CC, et al. Maximizing exposure therapy: an inhibitory learning approach Behav Res Ther, 2014.PMID 24864005
- [7]Dimidjian S, Hollon SD, Dobson KS, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression J Consult Clin Psychol, 2006.PMID 16881773
- [8]Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression J Consult Clin Psychol, 2008.PMID 18540740
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- [10]Beck AT Thinking and depression. II. Theory and therapy Arch Gen Psychiatry, 1964.PMID 14159256
- [11]Beck AT The evolution of the cognitive model of depression and its neurobiological correlates Am J Psychiatry, 2008.PMID 18628348
- [12]Butler AC, Chapman JE, Forman EM, Beck AT The empirical status of cognitive-behavioral therapy: a review of meta-analyses Clin Psychol Rev, 2006.PMID 16199119
- [13]Hofmann SG, Asnaani A, Vonk IJ, et al. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses Cognit Ther Res, 2012.PMID 23459093
- [14]Hofmann SG, Smits JA Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials J Clin Psychiatry, 2008.PMID 18363421
- [15]Foa EB, McLean CP The Efficacy of Exposure Therapy for Anxiety-Related Disorders and Its Underlying Mechanisms: The Case of OCD and PTSD Annu Rev Clin Psychol, 2016.PMID 26565122
- [16]Powers MB, Halpern JM, Ferenschak MP, et al. A meta-analytic review of prolonged exposure for posttraumatic stress disorder Clin Psychol Rev, 2010.PMID 20546985
- [17]Foa EB Prolonged exposure therapy: past, present, and future Depress Anxiety, 2011.PMID 22134957
- [18]Dimidjian S, Barrera M Jr, Martell C, et al. The origins and current status of behavioral activation treatments for depression Annu Rev Clin Psychol, 2011.PMID 21275642