304 -Behavior Modification | Journey to Recovery Series

Journey to Recovery:  Behavior Modification Basics
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Host: Counselor Toolbox
Objectives
~ Define behavior modification
~ Explore how behavior modification can be useful in practice
~ Learn basic behavior modification terms:
~ Unconditioned stimulus and response
~ Conditioned stimulus and response
~ Discriminitive stimuli
~ Learned helplessness
~ Reinforcement
~ Punishment
~ Extinction Burst
~ Premack Principle

Why Do I Care
~ Behavior modification principles will help you understand some of the reasons people act/react the way they do
~ By understanding what rewards(causes and motivates) people’s behavior or discourages (punishes/Strains) their behavior, we can better address their issues
~ The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection
How can this be useful in practice
~ Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction
~ Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their “distress” (Behaviorists would refer to excitatory response)
~ Understanding what causes feelings can also give people a greater sense of empowerment.
Example
~ Organisms learn behavior through direct and observational reinforcement and correction
~ Puppy 1 tackles puppy 2  threat
~ Puppy 2 responds by tackling puppy 1  counter threat
~ Both puppies get a surge of adrenaline
~ The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again.

~ If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave.
~ Either way, puppy 1s behavior is punished.
Example 2
~ In addition to direct and observational learning, humans learn to label certain internal experiences with feeling words (angry, scared, happy)
~ Sally goes to a pet store.
~ A puppy comes out, sits in her lap and puts is head on her leg. This contact (we know from studies) usually causes the release of dopamine and oxytocin –both reward chemicals. Sally calls this “happy”
~ If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction. Sally would label this as “fear”
Points
~ People with dysphoria or unhelpful behaviors may need to:
~ Recondition X is not actually a threat (anymore)
~ Relabel the state
~ Stressed vs. hungry vs. bored vs. tired
~ Explore the dialectics: Excitement/Fear
~ Unhook– X is causing me to have the feeling that…
Basic Terms
~ Unconditioned stimulus and response
~ Something that evokes an unconditioned/automatic response in an infant and adult
~ Loud noises
~ Pain
~ Excessive cold/heat
~ Contact
Basic Terms
~ Conditioned Stimulus
~ Something that in itself has no meaning to the person (yellow light)
~ Conditioned Response
~ The person’s reaction to the stimulus (slow down or floor it)
~ Stimuli and responses can be traced back to survival: Fight-Flee-Forget-Repeat
Basic Terms
~ Discriminitive stimulus
~ The stimulus which triggers the reaction. (Includes vulnerabilities)
~ Going to work
~ Good day
~ Bad day
~ Learned Helplessness “Damned if I do, damned if I don’t”
~ A response which occurs when people have tried and failed. Giving up.

Fight or Flee
~ Stimuli that present a threat of pain or death can trigger the excitatory fight or flight response
~ A useful intervention is to identify
~ The threat
~ If it is actually a threat
~ Break down parts of the situation into controllable and uncontrollable
Conditioning
~ Mindfulness can help people identify
~ Positive stimuli  dopamine  “happy”
~ Negative stimuli  adrenaline  fight or flee
~ Little things build up and lead to a big reaction. (Pressure cooker)
~ Stimuli that trigger a negative reaction can be reconditioned as neutral by
~ Embracing the dialectics: Find the positive (snowy day)
~ Being psychologically flexible: Not worth the energy (rainy day)
Conditioning: Repeat
~ Adding and noticing positive stimuli in the environment is vital
~ Happiness Triggers
~ Smells (pumpkin spice…lol)
~ Sights (wildlife, my kids)
~ Sounds (babbling brook)
~ Feel (crisp autumn breeze)

Putting it Together
~ How can you use discriminative stimuli to:
~ Increase a feeling of control and “self-efficacy” (Remind them to have a can-do attitude)
~ Increase “self-esteem” (Remind them they are lovable)
~ Decrease angry responses (Remind them to use coping or distress tolerance skills)

New Terms
~ Positive Reinforcement
~ Providing something positive in order to increase the likelihood a behavior will occur again
~ Examples
~ Touch
~ Gifts (Food, Money (Paycheck))
~ Words of Affirmation
~ Acts of Service
~ Power (Choosing activities, promotion)
~ Quality Time
~ What can be added that is rewarding AND helpful for the person
New Terms
~ Negative Reinforcement
~ Removing something negative in order to increase the likelihood a behavior will occur again
~ Examples
~ Reducing nagging and fighting
~ Dropping restitution or additional charges upon completion of counseling
~ Can leave the table once vegetables are eaten
~ What can be eliminated that would be considered rewarding AND helpful for the person

New Terms
~ Positive Punishment
~ Adding something negative to decrease the likelihood that a behavior will recur
~ Examples
~ Antabuse
~ Additional Chores
~ Additional sessions
~ Rubber band snaps
~ What can be added that would be considered unpleasant for the person

New Terms
~ Negative Punishment
~ Removing something positive to decrease the likelihood that a behavior will recur
~ Examples
~ Freedom/privileges
~ Money (Fines)
~ Relationship/Setting boundaries to stop a behavior
~ Control/power
~ What can be eliminated that would be considered desirable?

~ You cannot just eliminate a behavior. You must put something in its place.

Types of Rewards and Punishments
~ Rewards and Punishments can be:
~ Emotional (Happiness)
~ Mental (Improved decision making, cognitive clarity)
~ Physical (Appearance, health, pain, energy, sleep, relaxation)
~ Social (Acceptance, admiration, support)
~ Spiritual/Karmic
~ Financial
~ Environmental (freedom, pleasant conditions)

Apply It
~ The more rewards that can be gained the stronger the motivation to repeat the behavior

Apply It
~ Behavior 1: Social Withdrawal
~ Social withdrawal is rewarding mainly due to negative reinforcement (elimination of the unpleasant)

Apply It
~ Behavior 2: Emotional Eating
New Term
~ Behavior Strain
~ The point at which the reinforcement or punishment is no longer effective
~ Effected by:
~ Age
~ Cognitive development
~ Strength of the reinforcement or punishment
~ Smaller, more frequent rewards for completion of smaller goals:
~ Provide rapid benefits
~ Maintain momentum
New Term
~ Extinction Burst
~ A temporary increase in a behavior when rewards are absent or insufficient
~ Child in the store
~ Pigeon wanting food
~ “Acting Out”
~ The behavior ceases when the demands/costs of the behavior exceed the potential reward
~ What the person is doing for a promotion
~ What the person is doing to feel better/get his way
New Term
~ Premack Principle
~ Concurrently pairing something undesirable with something desirable
~ Examples
~ Laundry folding with watching television
~ Exercise with socialization/puppy time/nature
~ Studying with peer support
~ Cleaning with music/tv/aromatherapy
~ Work with coffee
New Term
~ Shaping
~ Rewarding the successive approximations of the target behavior
~ Punishing or ignoring non-target behaviors
~ Ignore if negative attention is better than no attention
~ Solidify gains
~ Withhold reward for a higher level of target behavior
~ Goal: Brewster meet me at the door quietly and sitting
~ Target behavior 1: Not jumping
~ Target behavior 2: Sitting on command
~ Target behavior 3: Sitting when I walk in without command

Apply It
~ Shaping
~ Cutting Behavior
~ Target Behavior #1: Ice cube or ink pen
~ Target Behavior #2: Alternate self-soothing behavior
~ Stress Eating
~ Target behavior #1 Fruit on a plate + mindfulness exercise (premack)
~ Target behavior #2 Drink + mindfulness exercise
~ Target behavior #3 Mindfulness exercise

New Term
~ Chaining
~ A cascade effect leading to a behavior
~ Behaviors, stimuli, reinforcements and punishments that lead up to a positive or negative result
Apply It
~ Example 1: Car problems
~ Slept well
~ Get up on time (Monday morning)
~ Get ready for work
~ Eat breakfast
~ Start driving to work and the car breaks down
~ “Get Irritated”
~ Call for assistance

~ Example 1a: Car problems (dysregulation)
~ Didn’t sleep well
~ Get up late(Monday morning)
~ Get ready for work
~ Eat breakfast and spill coffee on your shirt
~ Start driving to work and the car breaks down
~ “Get Angry”
~ Cannot think straight

Apply It
~ Example 2: Stress Eating
~ Bad day at work
~ Come home
~ Start eating
~ Feel better
~ Example 3: Panic Attack
~ Didn’t sleep well
~ Get up
~ Drink 2 cups of coffee
~ Get stuck in traffic driving to work
~ Panic attack

Summary
~ If you eliminate a behavior, you must replace it with at least one, preferably 3 new ones
~ People are “motivated” for rewards and to avoid punishment.
~ Decisional balance exercises can help people make new behaviors rewarding and old behaviors…less rewarding
~ Reinforcers must be reinforcing to the person
Summary/In Practice
~ When a client is trying to change a behavior
~ Analyze exceptions (chaining—what was different when you did not …)
~ Behavior chains can help identify antecedents/triggers and vulnerabilities
~ Remember that every behavior is maintained by rewards (getting up, going to work, eating)
~ Eliminating a behavior means
~ Making that behavior LESS rewarding than the alternative
~ Making the new behavior MORE rewarding than the alternative