Behavioral Medicine General Principles/theory Flashcards
(110 cards)
1
Q
What is shaping?
A
the production of new forms of operant behavior by reinforcement of successive approximations to the behavior
2
Q
what are reinforcement schedules?
A
A rule that are used to present (or to remove) reinforcers (or punishers) following a specified operant behavior.
These rules are defined in terms of the time and/or the number of responses required in order to present (or to remove) a reinforcer (or a punisher).
Different schedules of reinforcement produce distinctive effects on operant behavior.
3
Q
What is positive reinforcement?
A
increases frequency of behavior when applied
4
Q
What is negative reinforcement?
A
increases the frequency of behavior when removed
5
Q
What is the impact of punishment with reinforcement schedules
A
decreases frequency of a behavior
6
Q
What is a continuous reinforcement schedule?
A
reinforcement is provided every single time after the desired behavior
7
Q
What is an interval reinforcement schedule?
A
require a min amount of time that must pass between successive reinforced responses (E.g., 5min)
Fixed time period between reinforcer (fixed interval)
Variable time period between reinforcer (variable interval)
8
Q
What is a Fixed-interval schedule?
A
An exact amount of time passes between each reinforcement
Examples:
studying for a weekly quiz
Getting your paycheck every 2 weeks
9
Q
What is a variable interval schedule?
A
A varying amount of time passes between each reinforcement
Examples:
checking email
winning a video game
10
Q
What are ratio schedules?
A
require a certain number of operant response (E.g., 10 responses) to produce the next reinforcer.
11
Q
What is a fixed-ratio schedule?
A
Reinforcement occurs after a fixed no. of responses
Examples:
Getting one free meal after purchase of 10
losing your driver’s license after 5 violations
12
Q
What is a variable-ratio schedule?
A
Reinforcement occurs after a varying no. of responses
Examples:
Playing the lottery
The no. of shots to score a goal in a soccer game
13
Q
What are partial reinforcement schedules based on?
A
Can be based on time (interval) or
Can be based on response rate (ratio)
14
Q
How is Extinction defined in classical/operant conditioning?
A
Reinforcement of a response is discontinued.
Discontinuation of reinforcement leads to the progressive decline in the occurrence of a previously reinforced response.
If the conditioned stimulus continues to appear in the absence of the unconditioned stimulus, the conditioned response becomes weaker and weaker until it disappears, which is called the extinction procedure.
Extinction inhibits the conditioned response.
It appears that extinction forms new learning separate from the original conditioned learning.
15
Q
How is spontaneous recovery defined?
A
Reappearance of the conditioned response (previously extinct conditioned response) after the unconditioned stimulus has been removed for some time
Can occur after classical or operant conditioning
16
Q
What are characteristics of classical conditioning?
A
Pavlovian conditioning, suggests that learning occurs through association
2 stimuli are linked together to produce a new learned response
Unconditioned stimulus US (e.g., physical trauma)
Unconditioned response UR (e.g., fear)
Conditioned stimulus CS (e.g., second stimulus paired with US)
Conditioned response CR (elicited by new CS)
17
Q
What 2 sleep conditions does classical conditioning play a role in?
A
Insomnia
PAP therapy
18
Q
How is conditioned insomnia defined?
A
Bed + Wake, tossing, turning, sleepless, worry, rumination = conditioned insomnia
AKA conditioned arousal
With repeated pairing of bed with wakefulness (high arousal), The bed becomes a cue for arousal and/or wakefulness, rather than sleep
19
Q
What is the rationale for stimulus control for insomnia?
A
Cues are associated emotional reactions
The bed/bedroom have become cues for distress/frustration of trying to fall asleep
Internal cues: mind racing, anticipatory anxiety, physiological arousal
External cues: bed, etc.
20
Q
How is operant conditioning defined?
A
Behavioral consequence is rewarding if the behavior preceding it increases in frequency
Consequence = reinforcer and punisher will decrease in frequency
Positive reinforcer follows the emission of a behavior
Negative reinforcer terminates the behavior
Antecedent stimuli or setting that are regularly associated with subsequent reinforcers summon operant.
21
Q
How is discriminative stimuli defined?
A
If a specified behavior is produced there is an elevated likelihood that reinforcers will follow. These are called discriminative stimuli
22
Q
What classic experiment demonstrated operant conditioning?
A
The Skinner Box by BF Skinner
Was a variation of the puzzle box created by Thorndike
The operant conditioning chamber teaches animal to perform certain actions (i.e. pressing a lever) in response to specific stimuli. When correct action is performed animal receives positive reinforcement in form of food or other reward. Chamber may deliver negative reinforcement to discourage incorrect responses.
23
Q
How do we use operant conditioning in insomnia?
A
Target behavior=falling asleep, needs to be reinforced
Cues that are associated with the onset of sleep become discriminative stimuli for the occurrence of reinforcement
Difficulty falling asleep due to inadequate stimulus control
Strong discriminative stimuli for sleep may not have been established or discriminative stimuli for activities that interfere with sleep are present
24
Q
What is the goal with stimulus control?
A
To learn the bed is a place to fall asleep more quickly
Strengthen the bed as a cue for sleeping
25
What are the rules of SCT?
Get OOB after 15-20 min if not falling asleep
Do something quiet/relaxing outside of bed/bedroom
Return to bed ONLY when sleepy
When the pt is able to return to bed & fall asleep QUICKLY, this becomes a conditioned response to the bed as a result of positive reinforcement (the act of returning to sleep)
1. Use bed/bedroom for sleep only
2. Go to bed only when sleepy
3. Get OOB when unable to sleep (i.e. 15 min)
4. Arise same time every morning
5. No napping
Created by Bootzin, Phd
26
What is Extinction?
Principle of elimination of a previously reinforced behavioral response
27
What are the different types of extinction?
Standard/unmodified extinction
Graduated extinction
Extinction with parental presence
28
What is the definition of standard/unmodified extinction?
Extinguishing infant crying at bedtime by d/cing the reinforcement of child crying via parental attention/presence
Parents have been reinforcing the child’s crying at bedtime (e.g. staying or returning to comfort the child when crying)
29
How is standard/unmodified extinction done?
Standard extinction involves putting the infant to bed while drowsy with adequate need for sleep and remotely monitoring for safety but not returning to comfort the child.
Requires parent to tolerate child crying and have strong support system (lots of wine and chocolate!)
30
What is graduated extinction?
Remove reinforcement over time
31
How is graduated extinction done?
Putting to bed when drowsy and then checking in at regular intervals (fixed or incremental scale). Not tied to whether the child is crying.
Problem as to whether you are still reinforcing in some way.
32
What is extinction with parental presence?
ignoring the child’s crying but remaining near the child (in the same room)
Also called “parental presence” or “camping out”
33
How is Extinction with parental presence done?
Parent stays in child’s room but not attending to them when crying
34
What is an extinction burst?
Reappearance of a previously extinguished behavior (crying) that should be ignored to prevent the problem from reoccurring due to parental reinforcement
35
What is the major barrier to implementing extinction treatments?
Parental resistance is the major barrier
36
What are alternatives to extinction treatments?
Positive routines
| Bedtime fading
37
what is placebo effect?
Clinically significant response to therapeutically inert substance or nonspecific treatment, deriving from recipient's expectations or beliefs regarding the intervention
38
What is the Health Belief Model?
Developed in 1950's
person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of recommended health behavior or action will predict the likelihood the person will adopt the behavior
39
what are the 2 components of health-related behavior?
1. desire to avoid illness and desire to get well if already ill
2. Belief that a specific health action will prevent or cure illness
40
What are the 6 core construct of HBM?
```
perceived susceptibility
perceived severity
perceived benefits
perceived barriers
cue to action-the stimulus needed to trigger the decision-making process to accept a recommended health action
self-efficacy
```
41
What are the limitations of HBM?
Doesn't account for person's attitudes, beliefs or other individual determinants that dictate a person's acceptance of a health behavior, habitual behaviors, non-health related reasons such as social acceptability, env factors, assumes everyone has equal access
42
What is the theory of Planned Behavior?
behavioral achievement depends on motivation (intention) and ability (behavioral control).
Distinguishes between 3 types of beliefs:
behavioral, normative, and control
43
What are the 6 constructs that collectively represent person's actual control over the behavior
attitudes
behavioral intention
subjective norms (belief of whether people approve or disapprove of the behavior)
social norms (customary codes of behavior)
perceived power
perceived behavioral control
44
what are the limitations of Theory of Planned Behavior
Assumes people are acquired opportunities and resources to be successful, regardless of intention.
Does not account for other variables that factor into intention and motivation, such as fear, threat, mood.
Doesn't take into account env or economic factors
45
What is Diffusion of Innovation Theory?
originated in communication to explain how over time an idea or product gains momentum and diffuses (or spreads) through specific population or social system.
The end result=people (as part of a social system) adopt a new behavior or product
46
What are the 5 established adopter categories?
```
Innovators
Early Adopters
Early Majority
Late Majority
Laggards
```
47
What are the characteristics of Innovators?
These are people who want to be the first to try the innovation. They are venturesome and interested in new ideas. These people are very willing to take risks, and are often the first to develop new ideas.
Very little, if anything, needs to be done to appeal to this population
48
What are the characteristics of early adopters?
These are people who represent opinion leaders. They enjoy leadership roles and embrace change opportunities. They are already aware of the need to change and are very comfortable adopting new ideas. Strategies to appeal to this population include how-to manuals and information sheets on implementation. They do not need information to convince them to change.
49
What are characteristics of early majority?
These people are rarely leaders, but they do adopt new ideas before the average person. They typically need to see evidence that the innovation works before they are willing to adopt it. Strategies to appeal to this population include success stories and evidence of the innovation's effectiveness
50
What are characteristics of the Late Majority?
These people are skeptical of change, and only will adopt an innovation after it has been tried by the majority. Strategies to appeal to this population include info on how many other people have tried the innovation and adopted it successfully.
51
What are the characteristics of the Laggards?
These people are bound by tradition and very conservative. They are very skeptical of change and are the hardest group to bring on board. Strategies to appeal to this population include statistics, fear appeals and pressure from people in the other adopter groups
52
five main factors that influence adoption of an innovation
1. Relative Advantage - The degree to which an innovation is seen as better than the idea, program, or product it replaces.
2. Compatibility - How consistent the innovation is with the values, experiences, and needs of the potential adopters.
3. Complexity - How difficult the innovation is to understand and/or use.
4. Triability - The extent to which the innovation can be tested or experimented with before a commitment to adopt is made.
5. Observability - The extent to which the innovation provides tangible results.
53
what is social cognitive theory (SCT)
posits that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behavior. It emphasizes social influence and its emphasis on external and internal social reinforcement.
54
What is Reciprocal Determinism?
This is the central concept of SCT. This refers to the dynamic and reciprocal interaction of person (individual with a set of learned experiences), environment (external social context), and behavior (responses to stimuli to achieve goals).
55
What is Behavioral Capability ?
This refers to a person's actual ability to perform a behavior through essential knowledge and skills. In order to successfully perform a behavior, a person must know what to do and how to do it. People learn from the consequences of their behavior, which also affects the environment in which they live.
56
What is Observational Learning?
- This asserts that people can witness and observe a behavior conducted by others, and then reproduce those actions. This is often exhibited through "modeling" of behaviors. If individuals see successful demonstration of a behavior, they can also complete the behavior successfully.
57
What are Reinforcements ?
This refers to the internal or external responses to a person's behavior that affect the likelihood of continuing or discontinuing the behavior. Reinforcements can be self-initiated or in the environment, and reinforcements can be positive or negative. This is the construct of SCT that most closely ties to the reciprocal relationship between behavior and environment.
58
What are Expectations ?
This refers to the anticipated consequences of a person's behavior. Outcome expectations can be health-related or not health-related. People anticipate the consequences of their actions before engaging in the behavior, and these anticipated consequences can influence successful completion of the behavior. Expectations derive largely from previous experience. While expectancies also derive from previous experience, expectancies focus on the value that is placed on the outcome and are subjective to the individual.
59
What is Self-efficacy ?
This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. Self-efficacy is unique to SCT although other theories have added this construct at later dates, such as the Theory of Planned Behavior. Self-efficacy is influenced by a person's specific capabilities and other individual factors, as well as by environmental factors (barriers and facilitators).
60
What are limitations of Social Cognitive Theory (SCT)?
assumes changes in env will automatically lead to changes in the person, loosely organized – based on interplay between person, behavior and environment; focuses heavily on processes of learning and in doing so disregards biological and hormonal predispositions that may influence behaviors, regardless of past experience and expectations; does not focus on emotion or motivation; difficult to operationalize
61
What is the Transtheoretical Model TTM (Stages of Change)?
posits that individuals move through 6 stages of change. It focuses on decision-making of intentional change. Operates under assumption that people do not change behaviors quickly and decisively.
o Prochaska and DiClemente 1970s evolved through studies examining smoking
62
What are the 6 stages of change?
```
Precontemplation
Contemplation
Preparation (determination)
Action
Maintenance
Termination
```
63
Stage of Precontemplation
- In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.
64
Stage of Contemplation
In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.
65
stage of Preparation (Determination)
In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.
66
Action stage
4. Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.
67
Maintenance Stage
In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.
68
Termination stage
In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.
69
What are the 10 processes of change?
Consciousness raising:increasing awareness about the healthy behavior.
Dramatic relief: emotional arousal about health behavior, whether + or - arousal.
Self-reevaluation: self appraisal to realize the healthy behavior is part of who they want to be
Environmental reevaluation: social reappraisal to realize how their unhealthy behavior affects others
Social liberation: environmental opportunities that exist to show society is supportive of healthy behavior.
• Self-Liberation - Commitment to change behavior based on the belief that achievement of the healthy behavior is possible.
• Helping Relationships - Finding supportive relationships that encourage the desired change.
• Counter-Conditioning - Substituting healthy behaviors and thoughts for unhealthy behaviors and thoughts.
• Reinforcement Management - Rewarding the positive behavior and reducing the rewards that come from negative behavior.
• Stimulus Control - Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior.
o Limitations: ignores social context, lines between stages are arbitrary, no clear sense of how much time is needed for each stage, assumes people make coherent and logical plans in their decision-making process
70
What is the Social Norms Theory?
aims to understand the environment and interpersonal influences (such as peers) in order to change behavior, which can be more effective than a focus on the individual to change behavior.
Peer influence, and the role it plays in individual decision-making around behaviors, is the primary focus of Social Norms Theory.
Peer influences and normative beliefs are especially important when addressing behaviors in youth.
Peer influences are affected more by perceived norms (what we view as typical or standard in a group) rather than on the actual norm (the real beliefs and actions of the group).
The gap between perceived and actual is a misperception, and this forms the foundation for the social norms approach.
71
When was Social Norms Theory first used?
First used by Perkins and Berkowitz in 1986 to address alcohol use patterns
72
What are the phases of a Social Norms media campaign?
* Assessment or collection of data to inform the message
* Selection of the normative message that will be distributed
* Testing the message with the target group to ensure it is well-received
* Selection of the mode in which the message will be delivered
* Amount, or dosage, of the message that will be delivered
* Evaluation of the effectiveness of the message
73
What groups typically fund social norms media campaigns?
currently being funded by many federal agencies, state agencies, foundation grants, and non-profit organizations. Sometimes social norms media campaigns are funded by industry. There has been a good deal of evaluations conducted on social norms campaigns.
74
What are the limitations of Social Norms Theory?
Limitations of the theory include the following: likely to question initial message; potential for unreliable sources;
dose must be enough but not too much or it becomes commonplace.
75
When should Relaxation be used and where is it most effective?
* Use with heightened somatic and/or cognitive arousal
| * More effective for sleep onset arousal
76
Benson’s relaxation response, what are the 4 elements?
yielding physiological and experiential calm
• Benson’s 4 procedural elements to focus on (Benson’s)
• Quiet environment
• Object to dwell on
• Passive attitude
• Comfortable position
77
How should relaxation exercises be prescribed?
* Prescribe two relaxation exercises a day:
* One during the day (practice for skill development)
* One at night (therapeutic dose)
* Allow for a few weeks of daytime practice before nighttime
* Relaxation should not be done while waiting to fall asleep
78
What is the Premack principle?
making more preferred activities contingent on less preferred activities (e.g., do relaxation before watching TV)
79
What are typical Relaxation activities?
* PMR
* Autogenic Training (imagine peaceful scene and repeats phrases to self)
* Meditation *yoga, mindfulness)
* Imagery
* Biofeedback
80
What is the data support for relaxation?
Support for mono therapy, CBTI and other multi component therapies
AASM supports as primary treatment for insomnia
81
What is Acceptance and Commitment Therapy? (ACT)
it is a type of therapy that aims to help patients accept what is out of their control, and commit instead to actions that enrichen their lives
a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility
82
What concept is ACT based on?
based on the concept that suffering is a natural and inevitable condition for humans. We have an instinct to control our experiences, but this instinct does not always serve us.
83
What are other ways to define ACT?
a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility”
(Hayes, founder of ACT)
The Six Core Processes of ACT
84
How does Dr. Russell Harris define ACT?
a mindfulness-based behavioral therapy that challenges the ground rules of most Western psychology.” Its unique goal is to help patients create a rich and meaningful life and develop mindfulness skills alongside the existence of pain and suffering.
(2011)
85
What are the Six core processes of ACT?
```
Acceptance
Cognitive Defusion
Being Present
Self as Context
Values
Committed Action
```
86
How is Acceptance defined in ACT?
Acceptance is an alternative to our instinct to avoid thinking about negative—or potentially negative—experiences. It is the active choice to allow unpleasant experiences to exist, without trying to deny or change them.
Acceptance is not a goal of ACT, but a method of encouraging action that will lead to positive results.
87
How is Cognitive Defusion defined in ACT?
Cognitive Defusion refers to the techniques intended to change how an individual reacts to their thoughts and feelings.
Acceptance and Commitment Therapy does not intend to limit our exposure to negative experiences, but rather to face them and come out the other side with a decreased fixation on these experiences.
88
How is “Being Present” defined in ACT?
Being Present can be understood as the practice of being aware of the present moment, without judgment the experience.
In other words, it involves experiencing what is happening without trying to predict or change the experience
89
How is “Self as Context” defined in ACT?
Self as Context is the idea that an individual is not simply the sum of their experiences, thoughts, or emotions. The “self as context” process offers the alternative concept that there is a self outside of the current experience.
We are not only what happens to us. We are the ones experiencing what happens to us.
90
How is “Values” defined in ACT?
Values in this context are the qualities we choose to work towards in any given moment. We all hold values, consciously or unconsciously, that direct our steps. In ACT, we use tools that help us live our lives in accordance with the values that we hold dear.
91
How is “Commit to actions” defined in ACT?
ACT aims to help patients commit to actions that will assist in their long-term goals and live a life consistent with their values. Positive behavior changes cannot occur without awareness of how a given behavior affects us.
92
How is ACT different from other behavioral-based therapies?
it just emphasizes acceptance instead of avoidance, and in that way, differs from many other forms of therapy.
This departure from most mainstream treatment can be traced back to the background of ACT’s founder, Stephen C. Hayes.
It emphasizes psychological flexibility
Stephen Hayes developed ACT 1986 after his own experiences with pain.
93
What other theory is ACT built on?
Acceptance and Commitment Therapy is built on the Relational Frame Theory, a theory based on the idea the human ability to relate is the foundation of language and cognition.
94
What are some aspects of mindfulness?
```
• From Buddhism: if we can take a step back and just watch things
o Thoughts are just thoughts
o They are passing states
o Impermanent nature of things
o First step in self compassion
```
95
What are some mindfulness based programs?
Mindfulness Based Stress Reduction (MBSR)- Jon Kabat-Zinn (Full Catastrophe Living)
Mindfulness Based Cognitive Therapy for depression (MBCT)
96
What are important elements of mindfulness?
o Meta-cognitive therapy (thinking about thinking)
o Shift in mental processes, not mental contents
Re-perceiving
De-centering
Positive re-appraisal
Secondary de-arousal
97
What is the metacognitive model of insomnia?
Primary arousal cognitions are:
Expectations about sleep
Consequences of sleep loss
Increased mental activity in bed
```
Secondary arousal metacognitions are:
Absorption
Rigidity
Attachment
Bias
```
Metacognitions = thinking about thinking
98
What are the elements of Mindfulness Based Treatment for insomnia (MBTI)?
o Awareness of physical and emotional states
Are you sleepy?
Are you avoiding wakefulness?
o Metacognitive shift: practice non-attachment to the need for sleep
o Adopting a mindful stance: allowing internal cues of sleep and wakefulness to regulate behavior rather than reacting to external cues
99
What are the specific sessions of MBTI?
Session 1: Intro and overview of program
Session 2: Stepping out of automatic pilot
Session 3: Paying attention to sleepiness and wakefulness
Session 4: working with sleeplessness at night (SRT, SCT)
Session 5: The territory of insomnia (daytime and nighttime symptoms)
Session 6: Acceptance and letting go
Session 7: Sleeping with the enemy, relationship with sleep
Session 8: Eating, breathing and sleeping mindfulness
100
What are typical Formal meditations in MBTI program
```
Body scan
Breathing meditation
Sitting meditation
Hatha yoga
Walking meditation
```
101
What is the typical format and structure of MBTI program?
Program format:
Experiential: 1 quiet meditation, 1 movement meditation
Discussion/inquiry: applications and challenges
Didactic and behavioral strategies: sleep consolidation (SRT), sleep re-conditioning (stimulus control)
102
What are program requirements of MBTI?
Homework: 30 min. Formal meditation practice per day, 6 days per week
Practice behavioral strategies at home (patient-centered)
103
What is a nurturing/depleting activity in MBTI?
Instructions:
List all activities in typical day
Place N next to activity that is nurturing
Place D next to activity that is depleting
Calculate totals for N activities & D activities
What is your ratio of N:D activities?
Take home points: provides log of daytime energy transactions, find ways other than sleep to restore energy
104
Meditation experience is associated with difference in default mode network activity and connectivity
If you had less activity in the default mode= you were not mind wandering as much
105
What are clinical challenges of doing MBTI program?
```
o Trying not to fix patients
o Meditation practice is the teacher
o Embodying mindfulness
Not an on/off switch
Practice, practice, patience, patience
```
106
What are qualities of good candidates for MBTI program?
Openness
Commitment
Demographic profile
107
How is the Territory of Insomnia defined?
First Disturbances in sleep physiology
Then changes in sleep behavior
Then changes in sleep cognitions
Then changes in values and metacognitions
108
Behavioral activation?
• As individuals become more depressed they engage in avoidance and isolation, which serves to worsen their symptoms.
• Work to gradually decrease avoidance and isolation and increase engagement in activities that have been shown to improve mood
109
Are anticonvulsants effective for insomnia?
Yes, especially gabapentin and lyrica
Decrease arousal
Increase SWS
Can promote good sleep quality
110
Shaping behavioral theory
This is a behavioral term that refers to gradually molding or training an organism to perform a specific response (behavior) by reinforcing any responses that are similar to the desired response. For example, a researcher can use shaping to train a rat to press a lever during an experiment (since rats are not born with the instinct to press a lever in a cage during an experiment). To start, the researcher may reward the rat when it makes any movement at all in the direction of the lever. Then, the rat has to actually take a step toward the lever to get rewarded. Then, it has to go over to the lever to get rewarded (remember, it will not receive any reward for doing the earlier behaviors now...it must make a more advanced move by going over to the lever), and so on until only pressing the lever will produce reward. The rat's behavior was "shaped" to get it to press the lever.
