Page 55 - Encyclopedia of Nursing Research

22 n BeHAvIOrAl reSeArcH

of behaviors that affect health. It has been economies, which have been used in stud-
estimated that over half of premature deaths ies on unit management with the mentally
B could be prevented if health behaviors were ill or developmentally delayed; and contin-
altered. gency management, which has been used in
Behavioral research has its roots in the promotion of treatment behaviors such as
learning theories that arose in the early part exercise.
of the 20th century. classical or respondent As the operant model has expanded over
conditioning was followed by instrumental time, self-management or self- regulation
or operant conditioning and evolved into the has evolved as a special case of contingency
cognitive–behavioral theories that dominate management. With self-management, the
the field today. In classical conditioning, an individual is responsible for establishing
unconditioned stimulus is paired with a con- intermediate goals, monitoring progress
ditioned stimulus, resulting in the develop- toward those goals, and administering self-
ment of a conditioned response. Much of the reinforcement for success. Self-management
research emphasizes conditioned physiolog- has been studied particularly for chronic,
ical responses. An example is found in the long-term regimens such as those for diabe-
study of anticipatory nausea and vomiting tes, asthma, and cardiovascular disease.
during chemotherapy. In this case, chemo- In both of these models, there is an
therapy (unconditioned stimulus) may induce emphasis on behavior rather than motivation
nausea and vomiting. After several expo- or personality or relationships, beyond that
sures to chemotherapy in a particular setting of the reinforcing behaviors of significant
(conditioned stimulus), the setting itself may others. The history of the behavior is of less
induce nausea and vomiting (conditioned interest than the factors that currently sus-
response) prior to and independent of the tain the behavior. An empirical model is used
actual administration of the chemotherapy with an assessment of the frequency or inten-
(unconditioned stimulus). Another example sity of the behavior over time, the stimulus
is reciprocal inhibition or desensitization in conditions that precede the behavior, and the
which anxiety is viewed similarly as a condi- consequent or reinforcing events that follow
tioned response to stimuli. An incompatible the behavior. Intervention is then directed
response (relaxation) is paired with progres- to the specific areas targeted by the initial
sively stronger levels of the conditioned stim- assessment. Detailed assessment continues
ulus to inhibit anxiety responses. through the course of intervention and often
With instrumental or operant condition- through a period following intervention to
ing, behavior is seen as arising from environ- assess maintenance or generalization.
mental stimuli or random exploratory actions, each of the cognitive–behavioral mod-
which are then sustained by the occurrence els identifies a cognitive feature as a major
of positive reinforcement following the motivational determinant of behavior. Self-
behavior. laws have been established that efficacy theory postulates the role of per-
address the identification of reinforcers, the ceived capability to engage in a behavior
schedules of administration of reinforcers for under various conditions. The theory of
initiation and maintenance of behavior, and reasoned action postulates that intention
the strategies for the extinction of behavior. to engage in a behavior is significant and is
In this model, motivation is seen as a state of influenced by beliefs regarding behavioral
deprivation or satiation with regard to rein- outcomes and attitudes toward the behav-
forcers. Numerous strategies have evolved ior. The health belief model postulates that
from this work, including but not limited to one’s perceptions about the illness in terms
contracting and tailoring, which have been of its threat (severity and susceptibility) as
used in studies of patient adherence; token well as the perception of the benefits and