Learning theory and behavioural science — structured clinical viva

Opening definitions

Classical conditioning: CS predicts US → CR. Operant: behaviour shaped by consequences (positive/negative reinforcement and punishment). Observational: modelling via attention, retention, reproduction, motivation; self-efficacy drives persistence under threat.[1]

Schedules (30-second version)

Continuous: fast learn, fast extinguish. Intermittent — especially variable ratio — high steady rates, extinction-resistant (gambling pearl). Fixed interval scallops; variable interval moderate steady rates. Self-efficacy still determines whether patients initiate contact with harder schedules under threat.[1]

OCD case — mechanism and ERP

Obsessions function as threat cues; washing is negatively reinforced by distress reduction. ERP arranges exposure to contamination cues without the ritual so new inhibitory learning can form that the feared outcome does not require washing. Optimise with expectancy ratings, variability, multiple contexts, and fading of subtle safety (e.g. “mental washing”). Evidence supports exposure-based treatment for OCD.[5][6][15]

Extinction teaching point

Extinction ≠ erasure. Original CS–US memory remains; inhibitory CS–noUS learning is retrieved in context. Name renewal, spontaneous recovery, reinstatement, rapid reacquisition.[3]

Depression case — BA

Low response-contingent positive reinforcement and avoidance maintain depression (Ferster line). BA: monitor activity, schedule values-based tasks, grade difficulty, problem-solve barriers. Dimidjian 2006: BA comparable to antidepressant and outperformed CT in more severe depression acutely; lineage reviewed 2011.[2][7][18]

Inhibitory learning vs habituation

Habituation model: stay until anxiety falls. Inhibitory learning: violate specific expected catastrophes; SUDS drop not required; remove safety signals; vary contexts to fight renewal.[5][6]

Safety and examiner traps

Defer exposure if acute risk/medical instability. Do not invent legal section numbers; capacity and least-restrictive care still apply. Trap answers: “extinction deletes fear forever”; “partner is fine forever as coping”; “variable ratio extinguishes fastest.” These traps reverse Bouton and Craske principles and ignore safety gates.[3][5][6]