My very very long term goal is to become a Dietician in a hospital. This probably sounds like I am trying to be ‘Dr’ Gillian Mckeith and advocating that everyone should eat their greens in order to combat the obesity epidemic. But actually the majority of my role will involve underweight patients and trying to get them to eat more food when in hospital.
The problem behaviour of under eating can be dealt with the use of Applied Behaviour Analysis (ABA). ABA involves the application of behaviour change principles (Pierce & Cheney, 2013), more specifically resolving behaviour problems (e.g. under eating) by analysing antecedents (i.e. environmental events that occur before behaviour) and/or consequences (i.e. environmental events that occur after behaviour) that change behaviour (Skinner, 1963).
When assessing the situation, eating behaviour (the target behaviour) is considered a problem because it doesn’t occur enough, and the frequency needs to be increased. Considering the antecedents, it’s likely the lack of eating is caused by feeling sick from medication and being in hospital, due to the clinical environment, and restrictions of not physically being able to swallow (i.e. dysphagia). All of these decrease a patient’s appetite. In terms of feeling sick, the reduced eating is negatively reinforced. Because eating makes the patient feel more sick, not eating food is strengthened by the worse sick feeling being avoided – so not eating reduces an aversive stimulus (Pierce & Cheney, 2013).
A method of increasing behaviour is positive reinforcement, when a favourable outcome follows eating behaviour (Pierce & Cheney, 2013). As being in a hospital can be quite lonely, a good reinforcer would be praise and social interaction that isn’t medical related. So, when a patient, who is struggling to eat, starts eating a nurse could come over and start chatting to them and praising them on eating, which would positively reinforce the eating behaviour whilst making the eating environment more pleasant.
Positive reinforcement as a tool for increasing eating behaviour has been shown to be effective with anorexic patients. Leitenberg, Agras and Thomson (1968) gave anorexic patients verbal praise for their increased eating behaviour and also offered pleasurable activities in response to their weight gain. They found greater increases in eating behaviour and weight gain with the use of positive reinforcement. Also, the positive reinforcement was found to work better than both no reinforcement and extinction.
So, positive reinforcement would be a good way to help patients in hospital gain weight and get better quicker. Cheers Behavioural Analysis!
Leitenberg, H., Agras, W. S., & Thomson, L. E. (1968). A sequential analysis of the effect of selective positive reinforcement in modifying anorexia nervosa. Behaviour Research and Therapy, 6(2), 211-218.
Pierce, W. D., & Cheney, C. D. (2013). Behavior analysis and learning. New Jersey: Lawrence Erlbaum Associates.
Skinner, B. F. (1963). Operant behavior. American Psychologist, 18, 503.