During my recent webinar on Fear of the Veterinary Clinic, an audience member asked:
For counter-conditioning (CC) & desensitization (DS) I've always learned stimulus preceded reward as reward can become predictor of stimulus -- so they get afraid of the food. But elsewhere I believe I've seen the suggestion to start feeding before you introduce the stimulus. So, ie. feed before and during injection or palpation. Which is correct?
HA! Juicy applied behavior analysis question. :)
For counter-conditioning and desensitization - The patient should ideally never be above threshold for showing signs of negative emotional arousal (those are species specific obviously), therefore even if you were doing the food before, during, and after the food cannot become predictive of something painful or scary because it is not paired with the cue at a level that triggers those responses.
So if the patient is making an association that food=badness by definition you are not doing desensitization.
If the attempt is classical counter conditioning (without desensitization), then the stimulus (syringe) would be presented and within 1-2 seconds (ideally faster) food would be presented. But for lots of people in clinics you are working against so many triggers that in the moment providing food as a distraction AND capitalizing on it's inherent value to most patients, can help make the experience more pleasant for the patient.
DS/CC can actually be done pretty quickly with many patients right in an appointment, especially if it is combined with other distractions.
Phwew! That was a mouthful.
Here's where this goes wrong in so many clinics:
Offer unpalatable food (milk bone) one time within 2-5 seconds of a vaccination or other painful procedure. No other food is given. Patient leaves clinic still agitated. Obviously there are many steps in the middle of this, but the end result is patient leaves with elevated sympathetic nervous system tone (fight/flight/freeze). NOT AWESOME!
One trial learning could create an association where the presentation of food is associated with something painful, especially if the food isn't not palatable and where the handlers don't pony up with high frequency, potent reinforcers throughout the experience.
