Introduction

Ivan Pavlov is a 19^th century physiologist responsible for developing the classical conditioning theory. 


Terminology Used for Classical Conditioning: 
Unconditioned Stimulus (US) = Stimulus that elicits a reflex
Unconditioned Response (UR) = Reflex caused by the US
Conditioned Stimulus (CS) = Stimulus that doesn't initially elicit a reflex (neutral at first)
Conditioned Response (CR) = Action elicited by the CS (learned)

Classical conditioning, then, is “the procedure of pairing a neutral stimulus (typically referred to as the conditioned stimulus) with an unconditioned stimulus (the stimulus that elicits an unconditional response)” (Chance, 2008). 

Changes in an animal or human’s behaviour due to experience meant that ‘learning’ had occurred. Seldom do individuals in society realize that the world they live in is partially shaped by Pavlov’s classical conditioning theory. Many of the things we learn can have positive and negative impacts on a person’s psychological and physiological health, such as the acquisition and treatment of eating disorders.

Fig. 1. Anorexia (Web image). Retrieved October 16, 2012 from: http://www.thingsoftheday.com/wp-content/uploads/2011/07/Anorexia.jpg

How Classical Conditioning Applies to Eating Disorders

During classical conditioning, the neutral stimulus becomes the conditioned stimulus as it starts to evoke the natural response of the unconditioned stimulus. Conditioning is a useful tool that can be used to explain eating disorders in individuals among society because eating disorders are learned. Eating disorders are a result of behavioral conditioning, specifically, they are conditioned emotional responses in regards to eating and the body.

Using classical conditioning to explain the behavior of individuals suffering from anorexia nervosa (a condition characterized by excessive food restriction, irrational fear of weight gain and a distorted body of self-perception) and bulimia nervosa (a condition characterized by binge eating and purging of large amounts of food within a short period of time as well as partaking in extreme exercise routines) one can say that there is a learned association between eating and anxiety within anorexic individuals, and that there is a learned association between fullness and anxiety in bulimics. With anorexia and bulimia nervosa, an individual learns to associate food with the conditioned emotional response of anxiety and the fear of gaining weight. The scent, smell and sight of food would represent an unconditioned stimuli. In addition, the unappealing feeling associated with food can be used as a conditioned stimulus for anorexia nervosa and bulimia nervosa.

Fig. 2. Perfect (Web Image). Retrieved on November 30, 2012 from http://m3.img.libdd.com/farm2/168/16E1D0B7525D1B684AB1634C58AF86A8_500_200.GIF

During binge (or compulsive) overeating an individual learns to associate food with the conditioned emotional responses of comfort, happiness, and relaxation. "A conditioned response is a response elicited by a conditional stimulus" (Chance, 2008). When this person feels sad, stressed or/and anxious, they turn to food to help cope and it permits a temporary attenuation of their bad mood. Many times, people eat while doing other activities such as watching TV or socializing with friends. In classical conditioning,  this person may associate the action of eating with these other activities and so when these activities occur independently of eating,  it can also trigger a food craving.

Fig. 3. Binge (Web image). Retrieved October 17, 2012 from
http://www.fitstop.ca/images/binge.gif

Reinforcement In Regards to Anorexia Nervosa and Bulimia Nervosa

Individuals suffering from bulimia nervosa will vomit (also known as purge) after a meal to avoid the bloated, feeling associated with weight gain. Anxiety is a negative reinforcer. Negative reinforcement is "a reinforcement procedure in which a behavior is followed by the removal of or a decrease in the intensity of, a stimulus" (Chance, 2008).  So when anxiety is removed or lessened, it increases the likelihood of the continued behavior of vomiting.  By excessively vomiting, the feelings of anxiety about weight gain are reduced. Positive reinforcement is "a reinforcement procedure in which behavior is followed by the presentation of or an increase in the intensity of, a stimulus" (Chance, 2008). Individuals suffering from anorexia nervosa will perform extreme dieting rituals to remove the aversive stimulus of weight gain from their conscious mind. Positive reinforcement is also present within anorexic and bulimic subjects, that is, societal pressures act as positive reinforcers. For example, in today's society, individuals are praised for weight loss and for being thin. This in return, increases the behavior of eating less. Positive reinforcement in binge eating is the feeling of euphoria once one has devoured a large quantity of food. The feeling of content and the diminishment of anxiety reinforces the idea of binge eating and compulsive eating.

Fig. 5. Positively Skeletal (Web image). Retrieved October 17, 2012 from http://2.bp.blogspot.com/"
-5OMQdIVK-wU/T0786FEBqrI/AAAAAAAAAV0/rAkZuV5EZUs/s1600/positivelyskeletal.jpg

Punishment Regards to Eating Disorders
Punishment is a concept used in B.F Skinner’s theory of operant conditioning. The goal of punishment is to decrease the behavior that it follows. Punishment can be categorized into positive and negative. In the case of positive punishment, it involves presenting an unfavorable outcome or event following an undesirable behavior (Chance, 2008).  Disgust is "a marked aversion aroused by something highly distasteful" (Merriam-Webster, Inc., 2012). Disgust can be used to deter behaviors that are associated with eating disorders.  For example if the undesirable behavior is binge eating disgust can be used to deter that behavior. If after every time an individual binge eats they are shown pictures of critical conditions of organs resulting from consuming high fat foods. Disgust can be created in association to consuming large amounts of food and overtime the amount of food consumed will decrease eventually leading the individual to consume normal amounts of food. 

  

Fig.  4. Binge-eating (Web image). Retrieved October 17, 2012 from http://healthlob.com/wp-content/uploads/2011/07/Binge-eating.jpg

Negative punishment occurs when something desired is taken away as a consequence of a certain behavior. Over time, this can decrease the frequency of the undesired behavior (Chance, 2008). A weight watcher uses a concept that resembles negative punishment through their points system. Individuals are given a certain amount of points per day, similar to an allowance. Points are deduced based on the content of the foods consumed. High-fiber and high protein foods earn fewer points, whereas carbohydrates and fats earn more. When an individual consumes a high fat food more points are deducted which means that they have less points left over to treat themselves at the end of the week. Points are taken away as a consequence of eating high fat content food, overtime the frequency of eating high fat food decreases (Boehm Inc., 2012). The weight watchers point system is also a form of behavioral monitoring because individuals keep track of what they eat themselves and their records become visible indicators. 

Fig. 5. Freshman 15 (Web image). Retrieved November 30, 2012 from http://www.tumblr.com/tagged/freshman-fifteen?before=1344972629

Eating Disorders Acquired Through Blocking

Blocking is the “failure of a stimulus to become a conditioned stimulus when it is part of a compound stimulus, "two or more stimuli presented simultaneously, often as a conditioned stimuli" (Chance, 2008), that includes an effective conditioned stimulus. The effective conditioned stimulus is said to "block the formation of a new conditioned stimulus” (Chance, 2009). In the case of eating disorders, the initial uncontrolled stimulus is an unwanted, unappealing or stressful situation or event. The ‘bad event’ is suppose to create emotions of upset, pain or stress (all of which are uncontrolled responses). People with eating disorders try to prevent negative feelings from bad events by using a blocking mechanism. They turn to food (a new conditioned stimulus) to distract themselves from having to feel negatively (unconditioned stimulus) when something they do not like occurs. The bad event (unconditioned stimulus) then causes eating (new conditioned stimulus) which can lead to over eating (unconditioned response). Another possibility is the bad event (unconditioned stimulus) causes an obsession with weight loss (unconditioned response) where the person starves or over works their body through vigorous exercise (new conditioned stimulus) to maintain an unhealthy weight (conditioned response). In either case, blocking is used to prevent the initial emotional distress from having any effect on the person by abusing food (like abusing drugs) to make you think you are feeling better but really, you’re body is put through physical harm.

Fig. 6. Eating Disorder (Web image). Retrieved November 30, 2012 from http://24.media.tumblr.com/tumblr_me492jqMAM1rludm8o1_500.gif

Therapies for Treatment

Fig. 7. Time To Heal (Web image). Retrieved October 30, 2012 from
 http://www.websterwellnessprofessionals.com/images/time-to-heal.jpg

There are two ways to go about treating eating disorders, through pharmacotherapy, which is the treatment of disease via drugs and pharmaceuticals, and/or psychotherapy. Studies suggest that pharmacotherapy may be useful in cases where patients do not respond effectively to psychotherapy. However, psychotherapy is the primary treatment that is implemented due to its widespread success (McElroy et al, 2012). Pharmacotherapy is not considered as effective as psychotherapy because medication trials have not shown much progress. They are hindered by high placebo responses and dropout rates, short trial durations, and difficult outcome measures (Jackson et al, 2010).

Cognitive-behavioral therapy (CBT) and family therapy are the two forms of psychotherapy that may be implemented in treating any eating disorder. CBT helps individuals to understand how their negative viewpoint of their self-image directly influences their eating behaviors (Grohol, 2006). This form of therapy is time-limited and each treatment session focuses on certain goals. On the other hand, family therapy is usually done in a group setting with the patient’s family. This method allows patients to understand their dysfunctional role in their family. Also, family therapy brings awareness to the family about how it is enabling the actions of the patient (Grohol, 2006).

For anorexia nervosa, the Maudsley model is the most studied family therapy approach (Wilson et al, 2007). This method has the parents control every aspect of their anorexic child’s eating, and then gradually reduces external control as the child acts in accordance with parental authority (Wilson et al, 2007). Moreover, CBT is the most effective treatment for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Studies suggest that it may reduce the risk of relapse (Grohol, 2006). CBT treatment of bulimia nervosa focuses on breaking the binging and purging cycle by encouraging regular eating and discouraging the urge to purge (Grohol, 2006). Fluoxetine is the only drug that the Food and Drug Administration has approved for any eating disorder. It pertains to bulimia nervosa (McElroy et al, 2012). CBT for binge eating is very similar to bulimia nervosa (Grohol, 2006).

Other treatment methods include education about the risks of harmful eating habits, increasing motivation for change, learning new and healthy eating behaviors, increasing awareness of the different triggers, and promoting an active lifestyle. The concept of avoidance can be used to overcome eating disorders. For example if an individual avoids going to buffets for dinner in order to avoid overeating, they are exhibiting avoidance. By doing this they are also removing themselves from an environment where overeating is more likely to occur.   

These learned emotional eating disorders illustrate the negative impacts of learning

R       References

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Chance, P. Learning and Behaviour.

Collins, J.C., Bentz, J.E. The journal of Lancaster General hospital Behavioral and Psychological Factors in   Obesity. http://www.jlgh.org/Past-Issues/Volume-4---Issue-4/Behavioral-and-Psychological-Factors-in-Obesity.aspx- http://www.webmd.com/diet/what-is-obesity- http://www.obesite.com/comprendre/definition/quand.htm-

Grohol, John M. "Treatment of Eating Disorders." Psych Central. 25 Feb. 2006. 30 November 2012. http://psychcentral.com/disorders/eating_disorders/eating_treatment.htm

Jackson, Cherry W., Marshall Cates, and Raymond Lorenz. “Pharmacotherapy of eating disorders.” Nutrition in clinical practice 25 (2010):143-159. 30 Nov. 2012


Kern, J., Karges, C. Eating Disorders and Addiction: Why We Continue to Engage in Self-Destructive Behaviours. http://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/alcohol-substance-abuse/eating-disorders-and-addiction-why-we-continue-to-engage-in-self-destructive-behaviors

McElroy, Susan L., Anna I. Guerdjikova, Nicole Mori, and Anne M. O’Melia. “Current pharmacotherapy options for bulimia nervosa and binge eating disorder.” Expert Opin. Pharmacother 13.14 (2012):2015-2026. 16 Oct. 2012

Merriam-Webster Inc.http://www.merriam-webster.com/dictionary/disgust.

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Vanderlinden, J., Adriaensen, A., Vancampfort, D., Pieters, G., Probst, M., Vansteelandt, K. A Cognitive- Behavioral Therapeutic Program for Patients With Obesity and Binge Eating Disorder: Short- and Long- Term Follow-Up Data of a Prospective Study.
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Wilborn, C. Beckham, J., Campbell, B., Harvey, T., Galbreath, M., La Bounty, P., Nssar, E., Wismann, J., Kreider, R. Behavioral and Medical Management of Obesity. Theories, Medical Consequences, Management, and Research Directions. 2005.

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