Operant Principles

Historically, the application of operant-conditioning principles to chronic pain4 focused on several aspects of behavior: verbal expression of pain - including para-vocalizations, nonverbal behavior such as guarding and bracing, reduced general activity levels, and medication consumption.33 Application of operant principles requires a functional analysis of the target behavior(s) to identify the antecedents (e.g. presence of others, type of social interaction, physical setting) where the behavior is most likely to occur or where the behavior appears to be inhibited.34 Identification of the setting conditions and discriminative stimuli that appear to control the behavior is a critical component of the functional analysis. The second part of the analysis identifies current reinforcement contingencies. Two types of reinforcement maintain behavior: positive reinforcement, i.e. the contingent occurrence of an event (subjectively perceived as a pleasant event) that increases the behavior (in pain it may be the expression of concern by another) and negative reinforcement of a behavior, i.e. the removal of an event (subjectively often experienced as aversive), which similarly increases the behavior. Given that pain is inherently aversive it is easy to see that activities (or lack of activity) that reduce pain are readily negatively reinforced (i.e. the reduction of pain serves to increase the behavior that reduces pain). There are several strategies available to the therapist including the removal of the positive reinforcers (extinction), changing the antecedents, and gradually shaping new behavioral repertoires that are incompatible with pain behavior. Operant principles are often incorporated into CBT programs and used to help patients and partners change the way in which they interact.35,36[II]

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