How behavior is rewarded offers clues to solutions

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Today, I am talking about change with a researcher who studies behavior analysis. Dr. Andy Craig is an assistant professor of pediatrics and also of neuroscience and physiology at Upstate, and he's the chair of behavioral analysis studies at the Upstate Golisano Center for Special Needs.

Welcome to "The Informed Patient," Dr. Craig.

Andy Craig, PhD: Thank you, Amber. It's such a pleasure to be here.

Host Amber Smith: Your recent paper in the Journal of the Experimental Analysis of Behavior starts with a couple of descriptions of behavior that persists even when challenged: a college student who continues studying despite invitations to go out with friends, a person at a bar who keeps drinking despite pleas from friends to stop.

So these are examples of "resistance to change," is that right?

Andy Craig, PhD: That's absolutely right, Amber. In behavioral psychology, we use the term resistance to change as a technical term to refer to how much a behavior keeps going or how much it persists despite the fact that there may be things in the environment that make it really difficult for that behavior to continue.

So we might have a college student who is vigorously working on their homework, and they have friends who are distracting them from that task. But despite those distractions, they may persist in doing their homework. They may completely stop doing their homework. They may do something in between. But how much their behavior persists is what we're talking about when we use the term resistance to change.

Host Amber Smith: So the person who's studying seems focused and unwilling to be distracted; they're engaged in what academics call a "pro-social behavior." The person at the bar is also locked into their behavior, but drinking to excess is socially undesirable. Did you choose these two examples because of those differences?

Andy Craig, PhD: I absolutely did. I think that it's important to understand that persistence in and of itself is not a good thing, and it's not a bad thing. It depends on the behavior that you're talking about, and it depends on the situation where that behavior's happening. If we are talking about, as you refer to them, pro-social behaviors or appropriate behaviors, things that are generally adaptive for an individual, like communication or engaging in academic work or living a healthy lifestyle, healthy eating, exercise. These are all behaviors that we would want to persist, or we would want to resist change whenever something in the environment otherwise disrupts them or prevents them from happening. But of course, on the other side of the coin, there are a whole host of other behaviors that we would consider maladaptive, or behaviors that may pose a risk to the individual.

As a behavioral psychologist, I intervene on these sorts of behaviors all the time, things like destructive behavior in children diagnosed with intellectual and developmental disabilities, perhaps substance-use disorders, problematic gambling. These are behaviors that throughout the course of treatment we're going to see them resist change, but our goal is to ultimately deter them from happening.

So I wanted to make sure that people who read this article and folks in the audience are aware that persistence is kind of a neutral concept. It really depends on the context in which you're talking about it.

Host Amber Smith: You say in the paper that there are a growing number of findings that challenge the basic tenets of behavioral momentum theory.

What is that theory, and what are the findings that challenge it?

Andy Craig, PhD: Behavioral momentum theory is a way that we behavioral psychologists have thought about persistence for, gee, it must be 40 years at this point. It was developed in 1983 by Tony Nevin (of the University of New Hampshire) and his colleagues. And getting into the nitty-gritty and the specifics of the theory can be challenging even for folks like myself, who have been working with the theory for quite some time.

But its broad, sweeping strokes are based on this typical finding that whenever we have a behavior that happens in two different contexts or two different settings, and those contexts or settings are associated with different conditions of reward or reinforcement, behavior is more likely to persist in a setting that is associated with more reward or more reinforcement.

So, just to bring this into a real-world example, let's say that we have a child who may transition in between classrooms as part of their academic day. In one classroom, they receive a lot of encouragement and a lot of reward and incentive for appropriate academic behavior. And in another classroom, they may receive less encouragement for appropriate academic behavior.

Now, if you were to introduce a disruptor in both of those classrooms, maybe they now have noisy classroom neighbors that prevent them from doing their schoolwork in the class. That behavior is more likely to persist in the classroom that's associated with more reinforcement. It's more likely to resist changes in that classroom.

So behavioral momentum theory argues that what makes behavior persist are the associations that we build between the context in which behavior occurs, so these classrooms, for example, and the reinforcers of the rewards that are delivered in those contexts. So in this example, the encouragement for appropriate academic behavior.

The second part of your question is also, I would say, kind of nuanced and sometimes difficult to understand even for folks who are within the field. But suffice it to say that behavioral momentum theory says that whenever you have a context that has more rewards, more reinforcers, in that context, behavior should be more persistent.

And that's simply not always the case. There are really, really specific situations where behavior may actually be less persistent in contexts that are associated with more reward. And what's surprising to me, someone who has studied this theory since I entered graduate school, is that we've known about these challenges since the development of the theory itself.

So the purpose of this paper was really to dive into and to better understand why we keep using a theory that we may understand at this point to be incorrect, or, even worse, wrong.

Host Amber Smith: Let me ask you about the reward: That's not necessarily a tangible prize, right? It could just be that you enjoy the environment you're in?

Andy Craig, PhD: Yeah, absolutely. And when you say that you enjoy the environment that you're in, there are probably components of that environment that make you enjoy it. That can be tangible things. I work in a behavior analysis clinic, and the universal tangible item for the kids that we work with is the iPad. Children nowadays love screens, right?

But it can be encouragement, it can be praise, it can be working on things that you find intrinsically reinforcing or intrinsically rewarding. Any of these outcomes that you as an individual enjoy make those contexts more rewarding.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Dr. Andy Craig from the Upstate Golisano Children's Hospital's Center for Special Needs about his research into human resistance to change.

Now, originally, I thought this was going to be about how people don't like change, but that's not really what it is. Or does it tie together to that?

Because a lot of people resist changing.

Andy Craig, PhD: That's a great question, Amber. And I think the answer to that question is that it's complicated. Unlike so many things in science and so many things when it comes to human behavior, the basic learning factors that make behavior persist will determine whether or not behavior changes.

Whenever something in the environment disrupts that behavior, and there are a whole host of other factors that may be associated with whether or not someone says that they embrace change or that they reject change. We humans are pretty risk averse. There have been behavioral economic studies that have compared an individual's choice of small certain outcomes to much larger probabilistic outcomes. So let's say a small amount of money that you get with 100% certainty and a much larger amount of money that you might get 50% of the time -- you have a 50-50 shot. That probability very strongly weighs in an individual's decision making.

Of course, there are individual differences with how strongly that association plays out.

Individuals who engage in problematic gambling, for example, are much more likely to pursue those risky options. But generally speaking, folks don't like to take risks. Folks don't like to be introduced into situations where we can't predict what happens next. And when things change in the environment, when rules change, when our jobs change or components of our jobs change, we can't really predict what's going to happen next, and that's definitely a component of whether or not someone embraces change or tries to fight against change.

Host Amber Smith: So are some people born more resistant to change than others?

Andy Craig, PhD: There are certainly subjective differences in how much of an individual's behavior will resist change.

Andy Craig, PhD: I work with both humans, in treatment populations and typically developing humans. I also work with non-human animals. I've done a lot of work with pigeons, rats, mice, and regardless of the species or the setting where I'm conducting my research, I find that some people's behavior is super-persistent, whereas other individuals' or other organisms' behavior may be much less persistent. And I think putting a finger on exactly why those individual differences exist is kind of tricky.

I don't doubt at all that there are probably some underlying genetic predispositions to make people maybe more or less sensitive to changes in their environment, more or less sensitive to reinforcers or rewards.

But it could also be learning factors. Often, whenever we are engaging in treatment with children who come into our clinic, or we're engaging in research with human populations, I have no idea what happened in an individual's history, what rewards or reinforces they may have experienced in their history that may have contributed to the extent to which their behavior persists.

But what's important is that we arrange our treatments in such a way that we are programming for those treatment effects to maintain over time. So even if someone is born more or less persistent, there's stuff that we can do now to make behavior more or less persistent in the future.

Host Amber Smith: Let me ask you, as people age or as animals age, have you noticed, is there a change in their resistance to change?

Do they become more or less resistant as they get older?

Andy Craig, PhD: That's another fantastic question, Amber, and I don't have a scientific answer for you, but I'm taking notes (laughs) for my teacher research because that could certainly be an important question to answer.

I will note that there are changes across the lifespan that lead me to believe that there could be changes in how persistent someone is or how much they persist despite disruptions to their behavior.

For example, as someone ages from childhood to adolescence, and then from adolescence to adulthood, there are changes in a construct that we refer to as executive functioning. That's an individual's ability to modify their own behavior on a moment-to-moment basis and to take into consideration different sources of information when making split-second decisions.

It's also associated with someone's impulsivity or impulsive decision making, and generally speaking, as someone ages, they become less impulsive. They become more able to exert control over those in-the-moment decisions. And those in-the-moment decisions almost certainly have some bearing on whether or not an individual persists in engaging in a behavior that might not necessarily be working for them right now.

So I wouldn't be surprised if there were those associations. We haven't studied those just yet, though.

Host Amber Smith: Well, I'd like to hear how your study of behavioral momentum theory and resistance to change applies to your work at the Upstate Golisano Children's Hospital Center for Special Needs. Do you have a goal of working with these children to make them more or less resistant to change?

Andy Craig, PhD: We sure do. The Golisano Center for Special Needs is a multidisciplinary clinic that provides support services for families of children who have specialized needs, including physical disabilities, intellectual and developmental disabilities, and behavioral concerns.

When a child presents at the center with perhaps a severe behavior disorder, meaning that they may engage in things like aggression or property destruction or self-injury, we implement treatments to reduce those behaviors.

So of course, we're butting heads with resistance to change right there because we're trying to change their behavior.

It's not something that's going to happen overnight, so their learning history will determine how quickly our treatments are able to make those modifications.

But another important component of our treatment is that it needs to maintain over time. We arrange these treatments in a clinical space. Ultimately, they need to affect the child out in the natural environment, in the school, in the home, in the community, in all aspects of their lives, if we are going to produce meaningful change for that child and their family.

So an awful lot of the research that we conduct at the center is specifically designed to evaluate how we can make our treatments better in terms of producing those great long-term outcomes, just like the really great short-term outcomes that we can produce here in the clinic.

Host Amber Smith: So how much do you depend on parents and teachers and other adults in that child's life to reinforce what you teach or work on when they're at the center?

Andy Craig, PhD: Other stakeholders in the care of our families are absolutely critical to the treatment process. What we're doing is not, it's not like a pill, right? We're not reaching into a child and clipping out parts of their behavioral repertoire that we don't want to see anymore. We're simply altering the environment to set them up for success.

We are introducing effective learning opportunities for these children that will support appropriate behavior and deter inappropriate behavior in the long term. And once the child meets their treatment goals, and we discharge, part of the process of discharge is ensuring that we train parents, we train other stakeholders in the care of these children to implement the kinds of reinforcement-based treatments that we develop here with which the children have a lot of success, so it's really a group effort.

Host Amber Smith: So do you use the same strategies if you're trying to change behavior that is something sort of small, versus something that's rather involved, or big? Is it the same strategy?

Andy Craig, PhD: Behavior analysis is a toolbox, so we have a host of different behavioral strategies that we can use to produce behavior change, whether that be a small, innocuous behavior or a really, really impactful, challenging behavior for a family.

At the very, most basic, level, we're using principles of reward to encourage good behaviors, or we withhold rewards whenever we want behaviors to go away. We teach children, we teach caregivers, to load reinforcers where you want to see behavior and to reduce reinforcers where you don't want to see behavior.

The exact treatment strategies that we arrive at are highly individually determined. We'll work with a family for several months to ensure that the treatment package that we end with is one that is exactly tailored to the needs of the specific client that we're working with.

And no two children are the same. No two behavioral concerns are the same. They might look exactly the same from the outside. We might have two different children who refuse to do schoolwork in a classroom setting, but exactly how best to arrange a treatment strategy to encourage appropriate academic work in both of those children might lead us in two very, very different directions, and those behaviors may be differentially severe. One child may be really responsive to treatment, the other child may not, but we meet the child where they are, and we arrange treatment strategies that are specifically tailored for their presentations.

Host Amber Smith: Well, Dr. Craig, thank you so much for taking time to tell us about your work.

Andy Craig, PhD: It was such a pleasure to speak with you, Amber. Thank you so much for having me.

Host Amber Smith: My guest has been Dr. Andy Craig, an assistant professor of pediatrics and also of neuroscience and physiology at Upstate, and he's the chair of behavioral analysis studies at the Upstate Golisano Center for Special Needs.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

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