Psychology

Hormetism is more than a scientific perspective; it also embodies a practical self-help philosophy for overcoming stress. The central idea of Hormetism is that organisms are inherently plastic and adaptable, and that the controlled application of stress can be used  to induce adaptive changes that will increase stress tolerance. This applies not only to the physical organism, but to psychology. Just as we can adapt to better handle physical stresses, we can improve our ability to overcome the emotions and physiological urges that frequently undermine our ability to handle stress.

Hormetism does this by tapping into the under-appreciated science of physiological psychology, specifically making use of some key insights about classical conditioning that emerged from the pioneering work of Ivan Pavlov in the early 20th century, and as this understanding has been updated by the emerging science of neuroplasticity.

Based on Pavlov’s work, we will find that it is not too hard to make fundamental and long-lasting changes in how we respond to stress. We can make practical use of this knowledge in the form of cue exposure therapy, a powerful tool to help us turn off cravings or negative emotions in order to lose weight, overcome addictions, or become less frustrated and angry–with the result of becoming freer and more joyful.

Pavlov’s dogs. Pavlov is best known for his studies of the behavior of dogs, for which he won the Nobel Prize in 1904. What many don’t realize is that he was a physiologist before he was a behavioral psychologist. He wanted to understand the factors that control digestive secretions in mammals, and he did his work with dogs. It is touching to note that he was a dog lover, who cared deeply for his subjects and devised careful surgical techniques that allowed him to sample digestive fluids from conscious dogs, avoiding the need to sacrifice animals.

The fascinating details of Pavlov’s investigations are brought to life  in George Johnson’s gem of a book, “The Ten Most Beautiful Experiments”, in Chapter 9, “Measuring the Immeasurable”. One of the first questions Pavlov set out to answer was why a dog would salivate even before food entered it’s mouth, rather than after the fact. “The smell, the appearance of the bowl, even the creaking of a door hinge at dinnertime might be enough to set off the reaction.” Pavlov found that digestive behavior was not an innate instinct, but was a conditioned response that could be modified. New cues, like the ringing of a bell, flashing of a light, or even an electric shock (called the Conditioned Stimulus or CS), could be presented just before the food (the Unconditioned Stimulus or US), and through association, trigger the gastric secretions (the Unconditioned Response or UR). These associations between CS and UR could be strengthened through repetition. But they were reversible. Counter-conditioning could be used to pair the stimulus with a different, incompatible response.  For example, if the bell was rung before an exercise session, that would break the association between the bell and eating. And even the unconditioned, supposedly natural associations could be reversed!  The association between the presentation of the food (US) and the physiological response (UR) could be inhibited or even”extinguished” by repeatedly presenting the food and taking it away without allowing the dog to eat it.

Fear and anxiety. A wide variety of psychological responses were found to be influenced by conditioning. J.B. Watson, another pioneer of behaviorism, did similar studies on the classical conditioning of the fear response in humans.  Others have shown similar ability to condition or decondition anxiety and other emotions, and this is the basis for successful treatments of phobias and anxieties using desensitization or “exposure” therapies, in which the subject is exposed (first in the imagination and then in reality) to a graded series of anxiety-provoking situation, in combination with a learned relaxation response.

What do these physiological studies on digestive responses and emotional reactions have to do with the psychology of humans? After all, are we not infinitely more complex than simple stimulus-response machines, with complex, active internal lives? Well, I would turn the question around: Even acknowledging our complex internal lives, are we immune to conditioning? Do we have the capacity to resist or ignore ignore the influences that have shaped us? And if we are dissatisfied with certain aspects of our behavior–with our habits or difficulty resisting temptation–what can we do to change it?

So yes, we are not simple stimulus-response machines, and we can in many cases choose to resist or overcome our conditioning, but it is not easy to do this on the basis of “sheer willpower”. Habits are very powerful reinforcers, and they not easy to change, as anyone who has attempted to lose weight, quit smoking, or stay calm when provoked. But it is precisely by studying how behaviorists have been able to change habits, that we can best learn to change our own habits. So why not take advantage of what the behaviorists have discovered, and apply these findings to help us overcome our personal challenges?

The paradox here is that Pavlovian conditioning, far from being dehumanizing as it has been portrayed in literature and film, can empower us to be freer, stronger and more in control of our lives. By understanding and applying the principles of classical conditioning, we can train ourselves to “rise above” our conditioned habits, cravings, and urges. By learning to tolerate increasing doses of stress and discomfort, we become stronger and more resistant to their calling. In so doing, we gain the freedom to chart a course of our choosing. Even dogs, with their stronger instincts and supposed lack of “free will”, can be trained to hold back from eating, from being distracted by other dogs, or from following their urges to chew, dig, or bark. If we can train dogs to be free, why can’t we train ourselves?

Conditioned responses to stress. This website is all about becoming more resistant to stress. Some stresses appear to be purely physical, like heat and cold, exercise, toxins, or infectious agents. But others involve our interpretation of events. The frustration of getting caught in traffic. Angry arguments with a friend or family member. Sudden setbacks in finances or health. Perhaps the most insidious type of stress is conditioned stress, the psychic stress that comes from triggering certain internal urges, drives or emotions. These urges and emotions may be fine in certain circumstances, but are experienced as stressful when triggered in situations or at times when they are counterproductive to our larger goals. Stressful feelings may includes basic drives like hunger or sexual desire (at times when these are not wanted), or emotions such as irritation, anger or sadness (especially when they escalate out of control). Stress may even be experienced as purely “physiological” responses, such as or headaches, itching and certain types of pain. Many of these conditioned stresses are really learned reactions to external events–events that are not in themselves stressful. Traffic and arguments are not physical stressors in the manner of hot weather or viral infections; they do not physically assault our bodies, it is rather our perception of these external events–frustration or anger–that causes the biological stress. You might agree with my comments about anger and sadness–but would you accept my claim that hunger, itching, and some types of pain are conditioned stresses?  Keep reading.

Deconditioning. It is my contention that a great many of the urges, drives, emotions and physiological irritations which we take to be biologically spontaneous and beyond our direct control, are in fact conditioned or learned responses. And if this is true, we can decondition ourselves, so that we no longer respond “on cue” to the various particular stimuli that trigger these reactions. If we can’t totally eliminate the response, generally we can at least dampen it to the point that it can be resisted or ignored, so that it is no longer experienced as stressful. We can decondition ourselves from being constantly hungry, from getting angry or irritated by certain comments, from getting sad or depressed by circumstances of health, finances, or interpersonal conflicts.

It is important to say up front what deconditioning is not. It may sound a lot like the Buddhist concept of “detachment” or the New Age ethic of just letting go and deciding not to let things bother you. This is not what I am advocating. Deconditioning is not a simple matter of just “choosing” not to respond in a certain way. It is not a sheer act of willpower, and does not necessarily arise from meditation or adopting a certain religious attitude (though it might). Nor is deconditioning the same thing as desensitization, indifference, apathy, or emotional withdrawal. It is not about becoming callous and uncaring towards others or one’s self. On the contrary, once deconditioned from the triggers of stress, one is freer to experience emotional warmth and show compassion towards others. One becomes more capable of calmly and decisively acting during challenging situations that might otherwise be paralyzing or unbearable.

Deconditioning is a systematic self-training process to free oneself from “undesirable desires”–urges and emotions that pop up when we’d prefer they didn’t, thereby making life more stressful. By training oneself to tune out undesirable or distracting desires, you become freer to make and stick with conscious decisions. You can increasingly experience the pleasures of life with a sense of freedom, and not out of compulsion.

Fortunately, the training is not that hard!  But before learning the process, it is important to understand more about how cues get associated with responses. For that, we need to return to Pavlov and his dogs.

Cues. Pavlov found that the cues and patterns that condition and reinforce a response can be quite complex and changeable. By changing the type of stimulus or timing of feeding, he found that dogs would change their response. If feeding was consistently delayed for 3 minutes, 30 minutes or an hour after a bell rang or light flashed, the dogs would learn to salivate in anticipation when the reinforced time had elapsed. In essence, the dogs could be conditioned to salivate according to just about any feeding schedule. They could also learn to discriminate between very subtle differences in the cues. For example, they could be taught to salivate when presented with an object rotating clockwise (but not counterclockwise), a metronome beating 100 times per minute (but not 96 or 104) and a C played on an organ (but not an F). Johnson even describes an amazing feat where dogs would respond to a ascending musical scale, but not the same notes played in a descending scale.

Animal trainers have long realized that by paying careful attention to small changes in animal behavior, they could shape that behavior by selectively reinforcing small changes in the animal’s behavior and gradually build up a complex routine. The amazing feats of dolphins and tigers are built up from chains of carefully reinforced behavior. This type of behavioral training is called operant conditioning. What Pavlov and Watson found earlier with their studies of physiological and psychological responses, was that even supposedly “natural” reactions to stimuli can be trained or retrained.  This modification of physiological responses (as opposed to voluntary behaviors) is called classical conditioning. (In some ways, you can think of classical conditioning as a special case of operant conditioning that deals with the “involuntary” behavior of physiological responses). Yet the patterns of reactions to cues trained by classical conditioning can be as complex and subtle as those trained with operant conditioning.

What this means is that “involuntary” responses such as hunger, panic, irritability, and anger are in many cases under the control of environment “cues”.  While we may not be free to change our responses to these cues “in the moment”, we can retrain our responses by deconditioning them.

Reinforcement. The single most effective tool we have for deconditioning or reconditioning our behavior or responses is reinforcement, especially positive reinforcement. Sometimes positive reinforcement is confused with reward, recognition or “just being positive”; these are entirely different things, and are in many cases counterproductive. It is important to be precise about the definition of reinforcement and how we use it, because it is a very sensitive and powerful tool when properly understood and used. Two of the best overviews of positive reinforcement are the books by Aubrey Daniels and Karen Pryor (See links on the Books page). Daniels is an organizational psychologist and Pryor is an animal trainer who has applies what she learned from training dolphins to innovative techniques for training pets, people and — ourselves. Daniels defines positive reinforcement as “any consequence that follows a behavior and results in an increase in that behavior.” In the behaviorist literature, sometimes a distinction is made between positive reinforcement (encouraging a behavior by giving something desireable afterwards) and negative reinforcement (encouraging a behavior by stopping something undesirable afterwards). Both are useful, but the consensus among behaviorists is that positive reinforcement works far more effectively and precisely.

What you might think to be reinforcement — money, a compliment, a reward — may in fact not be a reinforcement for a particular individual. The timing of reinforcement is crucial. The more immediate, the better. According to Daniels, “Reinforcers reinforce what is happening at the time they are given.” This is a crucial point that is often not fully appreciated. To be really effective, reinforcement needs to be almost immediate. Formal “rewards” often happen too long after an action to have much impact. And even if given right away, not all rewards have the intended effect because the subject doesn’t really want them. The best reinforcements are immediate and directly give pleasure or happiness to the recipient .It is important to pinpoint exactly what is being reinforced at the time, or you may accidentally reinforce the wrong behavior or reaction. Much of the reinforcement that we do to others (or ourselves) is inadvertent, perhaps even unconscious. Daniels tells the funny story of Henry Kissinger meeting with Richard Nixon in the Oval Office. Nixon’s new puppy was chewing on the rug.  The President tried several times to get the pup to stop chewing, shooing it away at one point. When the pup returned and started to chew again, Nixon took a treat out of his desk drawer and called the dog away.  ”Mr. President”, said Kissinger, “You have just taught the dog to chew the rug”.  You will always get more of what you reinforce and less of what you don’t.

While reinforcement is generally discussed with respect to voluntary behaviors (operant conditioning), I think it is actually more powerful and impressive in retraining involuntary physiological reactions (classical conditioning), because it is our involuntary or gut level responses that so often trip us up in our journey of overcoming stressors. Very frequently our downfall boils down to involuntary responses like appetite, addiction, anger or anxiety…these sensory and emotional reactions are typically not things we “choose” to experience! They are also not behaviors or actions. But they definitely have a strong influence on our behaviors. When you are starving, angry, fearful or depressed, that can have a big impact on your choices.

Pryor lists eight ways to decondition behavior in Chapter 4, “Untraining: Using Reinforcement to Get Rid of Behavior You Don’t Want”. Four of her techniques are based on positive reinforcement, and while she discusses them in the context of changing behavior, I believe these same techniques are equally useful in deconditioning ourselves from sensory and emotional cues. Pryor’s favored techniques are extinction, putting on cue, shaping, and counter-conditioning. In addition to these four, I would add to this list a fifth technique, derived from Pavlov’s work on classical conditioning and buttressed by some recent studies on addiction treatment:  cue exposure. I believe that these five methods can be used in combination to develop a very effective approach for controlling undesirable emotional and physiological responses. At the bottom of this page, I will present a systematic Deconditioning Protocol, which integrates these extinction strategies into an simple and effective approach for achieving weight loss, overcoming addictions, anger management, or other positive behavioral changes. Let’s take a look at how these techniques work and apply them to deconditioning.

With extinction, we just stop reinforcing the behavior. Whenever the stimulus (either unconditioned or conditioned) occurs, we remove the opportunity for the unconditioned response and reinforcement to occur. A familiar behavioral example of extinction is getting a baby to sleep through the night. There comes a time when an infant is old enough to sleep through the night without feeding, but the infant will fuss and cry until its mother or caregiver picks it up. (I’m assuming here that parent is able to establish that the the crying is psychological and not caused by physical problem or illness, which of course should not be ignored). Picking up the baby comforts and reinforces its crying when cranky, and the cessation of crying likewise reinforces the parent who picks it up. If the parent is patient and can resist picking up the baby, eventually the baby will stop crying. The crying behavior extinguishes. (And so does the picking up behavior!). What is not so widely realized is that extinction works not just to decondition behavior but also to decondition physiological responses. Extinction can even be used to extinguish hunger responses! In his book “Conditioned Reflexes”, Pavlov reports on pp. 52-53 that he was able to get a dog to stop salivating at food by presenting the food stimulus so the dog could see it and smell it, inducing a salivation response, but then taking the food away without allowing the dog to actually eat it (the reinforcement). Each time the presentation of food was not reinforced by eating (or more precisely, the physiological response of a rise in blood sugar), the salivation response became weaker and eventually disappeared.  Pavlov got his dog to completely stop salivating with as few as 6 unreinforced presentations of meat powder over a 15 minute period. He found that frequent presentations and shorter intervals resulted led to a faster extinction. After some hours passed,  salivation response might return, but it would be weaker, and it could be re-extinguished with fewer new unreinforced presentations of food.

Frequently, extinction is not so straightforward, and the behavior (or response) comes back with a vengeance, fighting for recognition, triggering what is called an extinction burst. The baby will try crying even harder, and the mistake parents often make is to then pick it up after the second, third…or tenth bout of crying.  That reaction actually reinforces the crying more strongly. (Reinforcing only every nth time or randomly is called “variable schedule” reinforcement, and explains why slot machines that pay out less often are actually more addictive to gamblers than those which always pay out). Extinction bursts are also the bane of dieters and people who want to quit smoking. The urge to eat or smoke becomes more intense, even dire. However, knowing about extinction bursts, one can prepare for them and learn to resist them by using the full set of extinction methods, as described below. Another reaction to extinction is called resurgence. In this case, the behavior (or physiological response) disappears for some period of time, but then comes back again for no apparent reason. According to Daniels, this means that the new behavior or response pattern is not getting enough reinforcement, so the old pattern comes back. Extinction bursts and resurgence are well known phenomena to behaviorists, documented across a wide range of animals, behaviors, and physiological responses. These associative learning and extinction behaviors are coded at the level of neural pathways by a process known as Hebbian learning. In 2000, the famous psychiatrist.Eric Kandel won the Nobel Prize for his work demonstrating that the biochemistry of Hebbian learning that exists in humans involves the very same excitatory and inhibitory mechanism that exist even in “unconscious” animals like sea slugs, which have simple nervous systems built from only a few neurons!

The main downside of extinction is that it is difficult in many cases to give up a behavior “cold turkey” without significant discomfort. If you are motivated, you might be able to tolerate a certain amount of discomfort, but sometimes the hunger, withdrawal, anger or  other stress reaction can be excessive and hard to bear. And even if initially successful, extinction is vulnerable to extinction bursts and resurgence. Therefore, a pure extinction strategy is difficult to implement for most people. Fortunately, there are three supplementary methods that make it much easier to decondition a habitual behavior: putting on cue, cue exposure, and counter-conditioning.

Putting on cue is a technique that Karen Pryor calls “the dolphin trainers most elegant method of getting rid of unwanted behavior.” It turns the existence of cues from an unruly nemesis into a powerful ally in your quest for taking control of your life. Our bad habits and behaviors are distressing because they are triggered by cues over which we seem to have little control – sights, sounds, smells and situations which we walk into that trigger powerful stress-response reactions. We smell delicious food and crave it. We get stuck in traffic and that makes us get angry. Walking by a casino or bar sets off a round of compulsive gambling or drinking. Since these behaviors are so readily cue-triggered, why not turn the situation to our advantage and devise alternative intentionally conditioned stimuli for these problem behaviors, just as Pavlov taught his dogs to salivate on hearing a bell, or at a specific time of day.  By selecting cues that are under our conscious control, rather than capricious environmental cues, we can control the timing and context of our response by activating the cue as often–or as seldom–as we wish.

The key principle behind “putting on cue” is a behavioral concept called “stimulus control”. If we learn to perform the behavior in response to a conditioned stimulus and only in response to it, the behavior will tend to extinguish in the absence of the cue. This may seem strange, but it has been demonstrated in countless cases, with both animals and humans. Pryor gives the example of a dolphin she was training that had a bad habit of hiding at the bottom of the pool in order to avoid training sessions. One day, she “rewarded” him when he hid by giving him a bunch of fish when he sank down in the pool — and she introduced an underwater sound cue at the same time. Then she rewarded him with fish only when he sank on cue to the sound — not when he would do it without the cue.  Soon, the dolphin stopped hiding in the absence of the cue.  After that, Pryor stopped playing the sound, and the dolphin never hid again! Pryor also describes how a dog was taught not to bark constantly bark when let outside to relieve itself. A small reversible sign with a black side and a white side was hung outside the door. The dog was only let back inside only if it barked when white side of the sign was exposed, after the owner judged that the dog had been left outside long enough to do its business.

How can you apply this technique to cut back on an excessive behavior (like eating) or totally eliminate an undesirable behavior (like biting nails)?  I think there are two basic approaches: use a sensory cue, or use timing as a cue. Let’s take eating and appetite as an example. Instead of eating whenever you are hungry, you could eat only when you are hungry and in a certain room of the house. Or only when when the table is set. You could decide that you will drink coffee only at home, but not in work, or in meetings. You can start by making the restrictions fairly small, and gradually extending them.  If you do that for a while, and you are consistent about it you’ll only be reinforcing the hunger in those specific situations, and your hunger will dissipate outside of those situations.

Another option is to use timing as a cue. You could designate certain defined meal times and stick to those. The time of day will then become the cue for appetite.  To be effective, the cue time has to be pre-selected or “scheduled” so that it cannot be seen as a response to an urge.  You can only eat within the defined window for eating — no snacking is allow at any other times. These time windows should remain constant, at least for a long enough time that you can adapt to them. As the “trainer”, you can periodically change the time windows — move them or shorten them, but as the “trained”, you must obey them. And it is best not to change them too quickly, lest they be perceived by your “trained” self as arbitrary.

The same approach can be used for a habit you want to totally extinguish. Make a rule to yourself that you can bite nails only in a certain seldom-visited room, or a certain defined time window. Then never visit that room or shorten the time to zero. The nail biting will abate.

Counter-conditioning is an additional tool you use to strengthen extinction, especially when you trying to face down strong urges. This method substitutes an incompatible response for the one you are trying to extinguish. An incompatible response is a behavior or response which is impossible to perform at the same time as the old one. A good example of this would be to engage in an alternate activity (like going for a walk or making a phone call) at the very time the stimulus (for example an urge to eat, smoke, or get angry) occurs, or immediately thereafter. It is a good idea to have the alternate activity planned ahead of time, so that it can be initiated whenever the urge or emotion resurfaces, without time to have to spontaneously think up what to do when you are suddenly stressed. If this the new activity is performed regularly enough in response to the stimulus, the old response will stop occurring. Some early research at Duke University indicates that crack addicts can be counter-conditioned to respond to specific tones to alleviate their cravings. Using virtual reality simulators to bring up images of their old crack use neighborhoods, they learn to associate the relief of their craving with a certain tone. When they later get the craving, they can play the tone to make the craving disappear.

Cue exposure can also be used to weaken the our response to powerful stimuli. Here we tap into the complexity of the cue network. In real life, each unconditioned stimulus tends to be associated not just with a single stimulus but with with a whole set of conditioned stimuli or cues, which I will call the cue network. A great example is our appetite and eating behavior. The unconditioned response of food cravings results not only from the mere presence of food, but from the whole set of sensory cues that precede it and coincide with it, and are sequenced over time. This includes the immediate flavor, the appearance, the aroma prior to eating, preparation of the food, the social situation, the time of day, etc. We will only partially succeed in extinction or counter-conditioning if we focus only on just the most obvious or immediate unconditioned stimulus, e.g. the food itself. We must also deal with all the auxiliary, contextual clues. The best way to do this is to deliberately expose ourselves to these cues without allowing any reinforcement. We should go up to the food, look at it, smell it, and spend time with the person preparing it. We can visit the bakery, walk through good restaurants and markets, all without eating. This is the opposite of the usual advice to dieters: clear your refrigerator and pantry of tempting food, or go off to a “fat farm” to lose weight without temptation. You are then failing to learn how to avoid responding to the full set of problem cues in the most realistic context that they are likely to occur.

Interestingly, there is evidence that presenting aromas (without food) or flavors (without) calories can work to decondition the association between these cues and the stimulation of appetite.  This is the basis for two effective diets that suppress appetite: the use of odor inhalers and tastants by Hirsch, and The Shangri-La Diet by Seth Roberts.  (More about these on the Diet page and the post on Flavor control diets).

Cue exposure therapy (CET) is based upon this principle. If we are fighting an addiction, we should expose ourselves to the surrounding cues–the people, the paraphernalia, the thoughts–without following through. Researchers at the University of Queensland in Australia used CET to teach moderate drinking to problem drinkers.  Using “priming doses” of alcohol. they trained participants to stop drinking after 2 to 3 drinks. This goes against much of the dogma to the effect that only total abstinence is effective, or that there must be a significant cognitive component in addiction recovery therapies. Yet, when compared with cognitive behavioral therapy over a 6 month period, CET produced significantly greater reductions in participants’ reports of frequency and total consumption of alcohol.  Cue exposure therapy for overcoming addictions is discussed in more detail in a recent post on this blog.

One could extend the use of cue exposure to other triggered behaviors, for example, anger management. To overcome anger and irritation, we could welcoming each incident of potential irritation as a “learning opportunity” to practice our new behavior of calmness in the face of provocation. And there is no reason why this skill could not be deliberately rehearsed by asking a compatriot to occasionally test you.

Shaping is one of the best known techniques of animal trainers for teaching a difficult new skill or building a complex routine. But it can also be used to eliminate a problem behavior or—I would contend—a problematic physiological reaction. Shaping is the repeated reinforcement of gradual changes towards a desireable outcome. It resembles the principle of natural selection in evolution, in the way that signficant changes can be accomplished by repeatedly applying a selection principle to a large number of very small changes to achieve an adaptive outcome.

Pryor used the technique of shaping to gradually change her elderly mother’s behavior on the phone. Their conversations used to be filled mainly with her mother’s complaints about aches, pains and loneliness. Pryor decided to respond in an engaging way when her mother would discuss other topics–news about friends, questions about her grandchildren, or reminiscences about her youth–but only with short interjections like “Hmm” and “well, well” when the conversation turned to complaints. Within the span of a few conversations, the conversations became much more upbeat and interesting. Shaping can also be applied to dampen or extinguish urges like anger or hunger. They may be  difficult to totally eliminate, but they can be gradually dampened.

One of the key principles of shaping is that you can only reinforce behavior that happens. Animal trainers understand that they must first see at least a hint of a behavior, however imperfect in order to reinforce it. From there, they can continue to reinforce the behavior only when it continues to morph in the desired direction. A dog can learn to sit by first rewarding even a transient movement toward sitting, and following up with further reinforcement only as the sitting becomes more substantial.

This same approach can be used to extinguish urges, appetite, anger, or any bad habit. The first thing to notice is that no urge or emotion is constant.  It waxes and wanes. If you were to graph it, it would not be a straight line, but a line that wiggles up and down. We can take advantage of this to reinforce a decrease in the problematic sensation or emotion whenever it occurs.

Taking itching.  You may find that you itch in different places during the day–your nose, scalp, arms, back, or whatever–and you reflexively scratch to relieve the itch “because you have to.”  We assume that itching the sensation of itching is a given, there’s nothing we can do about it.  But that’s not true.  If we ignore it, it will eventually go away. Itching is a physiological reaction based upon histamine release in the skin, and it is subject to classical conditioning. At first, the itch may seem overwhelming and at times almost excruciating. The classical symptoms of extinction bursts will occur, with the itching getting more and more intense, in waves. But by systematically ignoring the itching, it will dissipate with each cycle. However, sometimes it just seems too intense and persistent to ignore. That’s where shaping comes in handy. If you find that you cannot wait out the itch, then follow its progress up and down, and wait until the intensity subsides substantially after one of the “waves” and only then scratch very lightly and briefly. You have just reinforced the itch subsiding. If and when it returns the next time, wait again until it loses intensity, ideally becoming even more muted than before, and scratch it lightly and briefly.  After a few cycles, it should extinguish.

The same approach of shaping can be used to dampen appetite.  Never eat when you are stark raving hungry. Wait until the cravings pass, at least 15-30 minutes, and then eat. Reinforce the pattern of eating when not hungry.  This will take a lot of the “bite” out of cravings.

In a a relatively trivial training exercise like itch resistance, I find that I am also reinforced by the odd satisfaction of getting another opportunity to “test” myself, and demonstrate that I can eventually “beat” the itch. I also like thinking about how these “tests” are strengthening my overall general ability to resist urges. This thinking is buttressed by the knowledge that physiological urges like itching have correlates in neural circuits and neurotransmitter networks (histamines in the case of itching) which can be modified by classical conditioning. There are predictable, scientific principles at work.

Gradualism and Measurement. In all of the above reinforcement techniques for extinction of problem reactions, gradualism should be exercised. It is important to be aware of what we can and cannot tolerate at any given time. We can’t usually adapt to tolerate powerful stimuli all at once. One of the best chapters in Daniels book on behaviorism is Chapter 13, “Making Haste Slowly”. Daniels argues that “the smaller the change in behavior that you can observe and reinforce, the more effective you will be in changing behavior and the faster the change will occur…Perfectionists…demand too much, too soon and fail too see and reinforce small improvements.” Daniels argues for setting goals so that the probability of reaching them is high. Success builds on success. The corollary is that it is important to measure and record progress, however incremental. Break an ambitious goal down into small pieces and achieve one small goal at a time, using generous and frequent positive reinforcement.

The Premack Principle. Dr. David Premack developed a simple principle useful for reinforcing new behaviors that don’t come naturally:  ”A high-probability behavior can serve as a reinforcer for a low-probability behavior.” Postpone doing something you like to do until right after doing or experiencing something you dislike. You’ll find that you start to like, or at least tolerate better, the disfavored activity. This principle is useful, for example, in drawing up a to do list: Make a list of things you have to do and rank them from the thing you like best to do down to the thing you like least to do. Then start at the bottom of the list and work your way up. You’ll find that this reinforces doing the unpleasant things. I’ve elaborated on this in a recent post about procrastination.

The Premack Principle can also help to decondition us from stress-inducing stimuli. If you have something pleasant planned for the day, postpone it until you have successfully evaded an urge or avoided an emotional reaction–save up the more pleasurable activity for when you can use it as a reinforcer. What this really means is that we should plan for how we are going to reward ourselves for successfully evading tempting stimuli. We should not wait until the moment when temptation arises and be caught off guard without an action plan.

Let’s pull all these threads together to summarize how we can use positive reinforcement to build up our resistance to stress-inducing urges and emotions:

  1. Identify the specific responses (sensations or emotions) by which you experience external events as being stressful.  (For the dog it was hunger pangs)
  2. Identify the full set of stimuli or trigger cues (including timing) which precede or accompany these stressors (For the dog it was food appearance and aroma, maybe seeing the scientist as well)
  3. Identify your behaviors that are providing reinforcement for how you respond to these stimuli. In practice, these are the behavior which tend to reduces or eliminate the immediate emotional or physiological response. (For the dog it was eating, which eliminated its hunger)
  4. Put the response on cue, by devising a deliberate secondary cue or time window that will be required for you to continue to reinforcing the problem stimulus. To extinguish the response, reinforce only when the secondary stimulus is present.  Vary the timing and gradually reduce the frequency of the secondary stimulus to the desired frequency. (Which may be zero or some acceptable level).
  5. Use cue exposure, counter-conditioning, and shaping to weaken the response if it occurs without the secondary cue. Whenever the stimulus recurs outside of the secondary stimulus or time window (either deliberately or randomly on its own) heighten exposure to the full set of cues, including the most powerful ones, at whatever intensity can be tolerated without allowing reinforcement. Plan ahead an alternate, incompatible activity to perform whenever the cue occur without the secondary stimulus. And if the stimulus is irresistable, at least wait until its intensity has weakened and it has largely passed.
  6. Gradually increase the stress over successive exposures. Start with a stress level that is low, and conquer that before making it harder. This can be done by either (a) increasing the intensity of the unreinforced stimulus over time; or (b) decreasing the frequency or increase the interval between reinforced responses (i.e., those  with secondary stimuli).
  7. Plan ahead how you will reward yourself for successfully confronting the cues without the old response, and defer the reward until after the urge to respond has passed.

Convince yourself. Go test yourself on something small like extinguishing your itching, and then move on to something important like appetite, anger or anxiety! Be creative and use self-experimentation. There is no single one-size-all recipe for success, just the general principles of plasticity and reinforcement in physiological psychology.  These principles are scientifically verified, and that should give you confidence in your ability to adapt to become stronger and more able to rise above the distracting urges and low level desires that get between you and what you truly want.

One of the best applications of classical conditioning and cue exposure therapy is weight loss. But that is a fairly complex story, covered in the next section, on Diet.

Please leave a comment.  You can also check out (and maybe start) a discussion on the Psychology Forum linked to this blog.

21 Comments

  1. Melissa

    I basically used this system to quit smoking a few years ago. I was finding that my urge to smoke would always increase during certain situations or when I hung out with other friends who smoked. So instead of avoiding those situations I deliberately exposed myself to them. It was stressful at first, but the cravings disappeared within a few weeks.

    Reply
    • Melissa, I too used your technique with great success. In fact the failure of my previous quit, 2 years earlier, was in many ways I believe the result of my not confronting my demons. I failed earlier because of the separation anxiety I felt with my continuing to smoke friends. By now using the smell of their second hand smoke to further reinforce my own decision to quit I feel totally congruent and in charge. It is really an incredibly simple and obvious tool once you try it. I’m so glad that Mark put it here.

      Reply
  2. Is self-discipline a legitimate element in quitting marijuana? The answer’s still not known although there are lots of grass smokers that happen to be inadequate in this regard. However, the need to stop is much more important than just a deficiency of willpower.

    Reply
  3. liam

    Thanks for writing a awesome article,clearly quite a smart dude
    i have a problem with blushing and over the course of my life and have definitely had good experience with gradually increasing the stress factor of certain situations and over short periods of time i would blush less and less ,but then it would all come crashing down when i finally thought i was done with it for good.im 23 and truly believe applying the techniques you have written about is the key to mastering this problem with blushing.

    just struggling a little bit to try and figure out how to apply the techniques you outlined at the end of your article to deal with this problem of mine.If you would have any suggestions i would be eternally grateful for your time.

    thanks,liam

    Reply
    • Todd

      Hi Liam,

      I’m assuming the blushing is due to stress or embarassment, not some medical condition. Some of the advice I’ve read on the internet is to use relaxation techniques, since blushing is thought to be caused by an overactive sympathetic nervous system that allows excess capillary blood flow into the face. But that would be the normal approach, not the approach of hormesis, which emphasizes increased tolerance to stress and desensitization to emotional triggers.

      In my Psychology article, I discussed the use of desensitization techniques to combat anxiety, which may be related to your blushing triggers. This is the overview that I linked to that discussion:
      http://www.guidetopsychology.com/sysden.htm

      The methods I mention in the article relate mainly to voluntary behaviors like eating or other habits that have some voluntary component. Blushing is different in that it at least appears to be an involuntary reaction. And yet, it has been shown that classical conditioning can be used to extinguish “involuntary” reactions. In fact, that is precisely what Pavlov did in getting his dogs to stop or delay salivating — which is quite involuntary. So I think it may still be possible to apply classical conditioning techniques to extinguish blushing!

      One approach is to consider the very specific triggers that cause you to blush. Not general circumstances like being in a public place, but very specific conditions like seeing certain people, speaking at meetings, etc. Spend some time carefully noting the triggers that lead up to the blushing, as well as how it feels when you blush, how long that lasts, etc. Write this down and keep good records for a week or so.

      Now think of a “reward” you can use for successful avoidance of blushing. It must be something you can do for yourself within an hour, or at most several hours, e.g. treat yourself to a nice lunch, call a friend, buy something on-line, whatever. Make a deal with yourself that everytime you avoid or at least delay or significantly reduce the blushing in response to a trigger, you will reward yourself. The key to reward is immediacy and consistency, not necessarily how big the reward is. It could even be chewing a piece of gum or eating a small candy if that’s what you like. The key is to withhold any of these rewards from yourself except for when you succeed in not blushing or reducing blushing.

      If you do blush, don’t punish yourself, but by the same token, don’t do anything nice or special to reward yourself that day. The absence of reward is much more effective than punishment, according to the research of behaviorists.

      Another approach is the EXACT OPPOSITE of the above approach, based on a principle called “paradoxical intent”. I would use this only if you find the above conditioning approach fails to work. It is based on the idea of paradoxical intent, and it sometimes works to get rid of embarrassing reactions or reactions that get worse when you try to avoid them. What you do is to intentially try to elicit the unwanted reaction! For example, to get rid of bed wetting in small children, parents can pay them a dollar every time they wet the bed. Strangely, this often works quite well, though it is hard to explain just why. It may have to do with the fact that the reward encourages the subject to try achieve the effect rather than avoid it. This at least “avoids the attempt to avoid”, which may be the root problem. You probably don’t have to use reward on yourself. Just see if you can make yourself blush on demand. You can try this first without the normal triggers, and then try to blush deliberately when exposed to the trigger situations.

      If you find you can “blush on demand”, then you might try putting blushing under stimulus control. Try blushing only in response to very defined cues that you make up yourself. For example, do it while looking in the bathroom mirror and brushing your teeth, and only then. At that point, it will be under sufficient voluntary control that it is less likely to happen involuntarily at inconvenient times.

      These are just some suggestions. If you are up for it, I encourage you to visit the Discussion Forum (http://forum.gettingstronger.org/index.php) for this blog, where you’ll find many people like yourself posting problems or ideas in order to get suggestions from other forum members. It’s a wonderful way to get ideas and start a dialogue. So why not start a topic called “How to stop blushing” and see what people come up with?

      Todd

      Reply
      • liam

        wow thankyou so much for your time its really appreciated.
        well as of tomorrow ill start taking notes on my phone as to what the triggers are
        then follow the reward system you advised.really looking forward to trying this out
        and seeing the results,this truly is something that is having a negative effect on my life and stopping me from pursuing my goals and interests ,so the thought of finally getting it under
        control would be a huge burden of my shoulders and something id be very thankful for.
        thanks for your time again and will post a description of my problem on your forum,
        thanks again and ill let you know the results
        liam

        Reply
  4. Zeerak Zakhoyi

    This is truly an amazing article my friend. You’ve taken much beneficial knowledge from a variety of sources and condensed it for us in an easy to read format.

    Thank you

    Reply
  5. Eric

    Hi Todd,
    I am very impressed with the positive reinforcement approach. And just like with cold showers I am eager to put them into practice. But, I cannot figure out what positive reinforcement one would use on himself. I would love to try this to improve my response to depression attacks and also cultivate mental resistance to psychological stress. Could you share any specific examples of positive reinforcement in such cases? Thanks to your research I am pretty clear on all the other aspects of applying positive reinforcement.
    Thank you,
    Eric

    Reply
  6. Lizzy

    This is great. I have always struggled with depression and anxiety, and have been off and on an ssri since age 12, and off and on a couple different snri’s in between, just a month ago successfully ending a benzodiazepine addiction. My main problem is driving alone and being alone without anyone to call in case I have a panic attack. About 4 years ago I had a huge panic attack when I was by myself a couple hours from home and anyone I knew. At first I was just afraid to drive outside of my perceived range of the safety of having people I could call in case of an attack. Then as my stress levels increased from other issues in life, I became unable to drive anywhere alone, and even riding in a car was unnerving. After being back on an ssri, I’ve improved some but not back to my old self of being able to drive anywhere, in any car, in any traffic, at any time of day, in any weather, by myself, without even thinking of the possibility of a panic attack. After reading this article, I now need to figure out a way to reinforce myself when I drive, and eventually work up to driving alone. I just don’t know what to reinforce myself with. Being that I can’t drive alone, I don’t work so no money to buy things for reinforcement. The only thing I can think of that might work is to devoid myself of the internet until I’ve completed my daily exercise of driving, and setting goals of going further every day. I also fear being left alone without a close friend of family member available in case of an attack. I don’t know how to approach this one without severely inconveniencing friends and family. I desperately need to rewire my brain.

    Reply
  7. Maria

    This article is amazing. Thank you so much for sharing this information. I am a junior in college, majoring in psychology, who has been trying to lose weight for years when I realized that reinforcements and deconditioning were probably my best answer. This article really helped me formulate a plan for myself. Thank you so much!
    Maria

    Reply
  8. Tim

    Todd,

    In relation to conditioning and appetite, what do you think about performing an unpleasant activity while eating.

    Although it undoubtedly strange, I experimenter eating today while using a recumbent bike on its highest level (lactic acid burn).

    Do you expect that if this, or a similar activity, was performed at each feeding, that appetite would eventually decrease due to decreased pleasure while eating?

    Reply
    • Todd

      Tim,

      What you describe is called “aversive conditioning”. It does work, and it has been used to decondition people out of certain bad habits — like painting finger nails with bad tasting chemicals to discourage nail-biting. More controversially, it has been used to “cure” sex offenders. But do you really want aversively condition experiences that SHOULD be pleasant like eating or sex? The novel A Clockwork Orange was a sustained argument against such attempts to alter human psychology.

      I personally find it more promising (and humane to yourself) to use positive reinforcement and extinction to shape behavior. In other words, stop reinforcing the connection between certain triggers (social, sensory or timing) and when you eat. And positively reinforce alternate activities that substitute for unnecessary snacks and meals, e.g. by going for a walk, calling a friend, watching a movie or reading a book instead. You don’t want to condition yourself to hate eating; you only want to shape when, where and how much you eat — while still enjoying food. My post on the Deconditioning Diet (See the Diet page) elaborates on this a bit more.

      Todd

      Reply
      • Tim

        Todd,

        Thank you for the quick response.

        Unfortunately, at least for myself, the pleasure derived food is inverse to the pleasure derived from sex (in that I’m not getting any) as well as many other things that should be pleasurable (travelling, socializing, etc. – just about anything and everything is blunted by being overweight, at least for me). If I could press a button that forever eliminates pleasure from food, I’d happily and excitedly press it.

        I had previous read your Deconditioning Diet, and I will look for ways to incorporate those ideas, although I can’t find any obvious cues (almost always would rather eat, and eat in excess, to stave off boredom – appetite relatively agnostic to time, environment, etc.) and I have a hard time thinking of any positive reinforcements (as I’m constantly fighting boredom, any “pleasure” is very subtle, probably too subtle to reinforce in contrast to the award from food). The feeling of boredom is greatly enhanced by being overweight (activities are far more pleasurable when not overweight), so it is a bit of a downward spiral.

        I feel I need an elephant gun approach to reducing appetite, which is why I considered this. I didn’t think relatively intense exercise was too draconian/inhumane as it something good to do by itself (vs making myself sick or having someone slap me around), although I definitely don’t enjoy it, and I thought that may blunt the reward from food.

        Although, it may not be a route you would take personally, do think it may be effective in decreasing appetite/desire to eat/caloric intake over time if used consistently? Thanks.

        Reply
        • Todd

          Tim,

          Your comments above were helpful in filling in a few more details about your situation. If you are overweight, you are either insulin resistant, leptin resistant or both. (See my post “Obesity Starts in the Brain” for more details on this). Either way, normal appetite suppressing signals from eating are not reaching the satiety centers in your hypothalamus. This is a physical fact as much as it is a psychological fact. As a result, and as long as you are insensitive to insulin and leptin, you are hungry all the time. In the short term, there is nothing you can do to override this. Even aversive conditioning will at best leave you with a conflict of signals — simultaneous cravings and aversion to eating. I think you’ll agree this is a pretty awful situation.

          Conditioning by itself can help, but will not reverse this reality in the short term. Without changing your insulin or leptin resistance, your appetitive cravings will eventually overwhelm counterconditioning. So it’s necessary to re-sensitize your appetite suppression neurons and overcome transport limitations in the blood-brain barrier. This happens gradually, over a period of weeks. You really have to stick with a program of increasing the interval between meals and snacks, and curtailing the amount of carbohydrate and protein in your diet. One of the best ways to do this without getting hungry is to eat a ketogenic diet — a very high fat, low carbohydrate, moderate protein diet — as advocated by Ron Rosedale. It is important that the high fat foods have no or little carbohydrate in them, or you’ll defeat the effect entirely. You’ll find that this diet suppresses appetite amazingly well. There are certain things to look out for, e.g. if you feel light headed it means you need to add salt to your diet and drink lots of water. Check out Ron Rosedale’s blog and books for more details. Also Phinney and Volek’s book, The Art and Science of Low Carbohydrate Living. Once you are eating ketogenically, your constant cravings will die down. At that point, intermittent fasting and deconditioning become much more feasible, because you aren’t fighting these overwhelming appetite cues.

          You will also typically find such an increase in energy that you actually will not want to eat all the time, because you’ll feel stuffed even when you don’t eat. Boredom won’t inevitably lead to food.

          Try it and let me know what you think.

          Todd

          Reply
  9. Tim

    Todd,

    Thanks for the thorough response. I’ll give this a go. I’ve done low carb with varying levels of success in the past (likely in proportion to my level of adherence). Previously, I did not consider protein intake and dietary fat type.

    I’ve read Rosedale’s guidance, and I’ll attempt to execute perfectly this time. Hopefully, my appetite improves over the next few weeks. The one issue I had in the past is I would get intense carbohydrate cravings late at night. 5-HTP didn’t help, but it could have been from lack of sleep in general. I’m hoping implementing exercise, elimination of caffeine after work, and IF (eating at night) solves this.

    One thing is that is looks like Rosedale is still a proponent of small, frequent meals. I’ll ignore that part for the moment and stick with IF.

    Reply
  10. Sean

    Todd, are you familiar with the “Emotional Free Technique” or EFT: tapping on certain sensitive spots or “acupuncture points” to gradually (for some very quickly) de-condition chronic, involuntary and overwhelming stress responses?

    http://www.social-anxiety-solutions.com/how-does-eft-work/

    Reply
    • Todd

      Sean,

      I’m not familiar with EFT. I’m not doubting that it “works”, but the proposed explanations seem very speculative and unsubstantiated. Specifically, it is unclear how tapping on your head could “decondition a stress response”, other than perhaps by offering a distraction or displacement of attention. But that’s not really what this blog is about.

      Todd

      Reply
      • Dan

        I agree that the supplied EFT explanation was speculative and unsubstantiated but I can imagine that would work better on certain subsets of people who prefer speculative and unsubstantiated reasoning.

        I had bad OCD as a child and EFT seems to be based on creating the cycle of OCD sufferers (stimulus -> anxiety -> arbitrary calming ritualistic response). Ritualistic behaviors such as avoiding odd numbers or touching pressure points offer distraction and displacement and can provide significant relief if they are learned in the presence of strong feelings. For example, thinking it must work or something terrible will happen to you or a loved one if you don’t. It helps if these feelings are supported by a “reason,” since that can be used to justify the original feeling of anxiety and so re-enforce the behavior. The reason can be mystical or evidence based, but you need to believe it so you practice re-enforcement.

        Couldn’t find a decent reference off hand, but this page seems to be written by practioners and offers a more detailed overview that’s based on experience. Everybody exhibits these OCD-Style cycles but they tend to be far less strong. I would go so far as to hypothesise they are a key part of the conditioned learning process for emotional response, but obviously that is speculative (but it is used in CBT).

        http://www.ocduk.org/cognitive-behavioural-therapy

        Reply
  11. m1610

    Hello. I came across this website when listening to Gary Wilson’s radio show and as a recovering porn addict I have been employing some of your methods to great affect. One method of my own I have stumbled upon, due to my shower not being able to turn cold and seeing this as an alternative, is holding my breathe under water. I found it would have similar affect to cold showering in that I am exposing myself to something stressful and would feel great afterwards.

    I would do this after doing about 20 press ups and just before meditating for about a minute or more. Recently I started also holding my breath after meditating and quite amazingly I could reach about 80 seconds when just before it I could only reach 30.

    I do have a concern that what I’m doing could be quite dangerous though, perhaps having meditated my brain is in a state of such peace that it overrides a message from my body telling me I’m in danger, and maybe I could be often on the verge of seriously hurting myself, is this possible? Or if I was in serious danger would I still know and I’ve just made myself put off a certain amount of pain which makes it easier to get the valuable effects from such stressful situations? Thanks.

    Reply
    • Todd

      m1610

      Even if your shower can’t turn very cold, cool showers still have some value. So consider them.

      Breath holding is an interesting idea. I encourage you to read Justin Rosales’ book “Becoming the Iceman”, in which he combines the idea of cold exposure with breath holding: http://www.amazon.com/Becoming-Iceman-Wim-Hof/dp/1937600467. I blogged about the original “Iceman”, Wim Hof here:

      http://gettingstronger.org/2012/01/the-iceman/

      I can’t say for sure whether breath holding is useful or not as a type of hormetic discomfort. Is it really uncomfortable? The fact the it induces in you a state of bliss indicates that something else might be going on.

      Personally, I would be concerned about the risks of passing out or depriving your brain of oxygen for too long. So I cannot endorse it. And I think there are plenty of other uncomfortable but non-dangerous activities. But do some more research into the safety aspect and make your own judgement.

      Good luck,

      Todd

      Reply
      • Meg

        Here’s the thing about holding your breath: If you manage to hold your breath until you pass out from oxygen deprivation, you will automatically start breathing again while unconscious, before any real damage takes place. It’s a great fail-safe mechanism, unless your head happens to be underwater.

        Also, holding your breath is hormetic in that, the more you practice, the longer you can do it. Ask any snorkeler/free-diver/synchronized swimmer.

        Longer breath-hold after meditation may be due to the fact that the brain consumes the most oxygen out of any part of the body. By meditating, you reduce brain activity, and thus oxygen demand.

        I have occasionally tried to hold my breath to the point of passing out (only while lying down, to eliminate risks of falling, etc.). It’s very difficult to do, and could make a good training exercise in resisting strong urges.

        Reply

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