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Behavior Modification Tools for Obsessions, Cravings and Addictive or Compulsive Behavior
#behaviormodification #NCMHCE #OCD

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 Review basic behavior modification interventions and their utility with addictive and compulsive behaviors
 To understand a behavior you first need to understand the
 Frequency
 Intensity
 Duration
 Vulnerabilities
 PACER proximal triggers (Discriminative stimuli)
 Compliance is enhanced with checklists
 Obsessions/cravings or compulsions/addictive behaviors that take more than 1 hour per day and/or cause clinically significant distress
 OCD: thoughts about…; Counting, checking, washing…
 Body Dysmorphic: thoughts about…; Fixing, covering up, checking
 Addictions: thoughts about…; using
 Recovery
 Sleep, exercise, nutrition, pain management; biofeedback
 Happiness promoting
 Positive thinking
Working Toward Change
 Natural consequences
 Rewards / Reinforcement (Individualized)
 Increase the likelihood of a behavior
 Positive Reinforcement
 Adding something positive
 What positive consequences exist if you change your behavior? (PACER)
 Negative Reinforcement
 Taking away something unpleasant
 What unpleasant thing will be removed if you change your behavior? (PACER)
 DEcrease the likelihood of a behavior
 Positive Punishment
 Adding something negative

Functional Analysis
 Explores the vulnerabilities and triggers for and functions of the behavior
Behavioral Alternatives
 3:1 When you remove a behavior replace with a menu of 2 or three others
 Competing Responses (Hint: Look for exceptions)
 Chew gum while cooking
 Crochet while watching television
 Journaling instead of checking
 Playing with your kids instead of smoking
 Sing when going over a bridge
 Call a friend/sponsor when triggered
 Nicotine gum
 Drinking: Antabuse
 Non-hunger eating: Only keep low preference foods available (celery, rice cakes)
 Compulsive behaviors: Pushups, squats, hold ice cubes, rubber band snap, pictures to remove the desire

Response (Delay) Prevention
 Journaling (book, online, checklist)
 What, why, alternatives
 Calling friend/sponsor
 Time delay and distress tolerance activities
 Distance
 Website firewalls and internet lockouts
 Don’t keep substance in the house

Successive Approximations
 Goal is to stop the addictive or compulsive behavior
 Reduce frequency, intensity or duration
 Smoking
 Non hunger eating
 Ruminating / “obsessing”
 Checking
 Picking / Hair pulling

 Scaffolding is similar to successive approximations, but uses a support to help you get the rest of the way to your goal
 Get as far as you can then call your sponsor/coach
 Notice
 Stop
 Choose an alternative
 Do the alternative (get into your wise mind)
 Evaluate the triggers and vulnerabilities and identify ways to prevent the problem in the future
 Behaviors are triggered by PACER discriminative stimuli
 Vulnerabilities make people more likely to be triggered by discriminative stimuli
 Behavior modification seeks to
 Implement new rewarding behaviors that are desirable and either prevent vulnerabilities or aid the person in coping with distress
 Make undesirable behaviors less rewarding

NOTE: ALL VIDEOS are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional.
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Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches including counseling techniques and skills for improving mental health and reducing mental illness.

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