Behavior Theory and Therapy Nan Van Den Bergh, PhD, LCSW Associate Clinical Professor

Basic Assumptions of Behavior Theory  Behavior is defined as what a person does, thinks or feels that can be observed  Assessment should focus on observable events with a minimum of interpretation  Behavior is amenable to change  Behavior of concern must be defined in measurable terms  People behave based on:  Learning via watching others  Environmental feedback Three major approaches to behavior therapy: –Applied behavior analysis (focuses on consequences of behavior) –Stimulus-response model (focuses on environmental factors that elicit and maintain behavior) –Social Learning theory (behavior change through modeling)

Change Through a Behavioral Perspective All behavior is influenced by learning principles of: – classical conditioning (environmental factors eliciting and maintaining behavior) – operant conditioning (consequences of behavior) – modeling No behavior is inherently healthy or unhealthy, normal or abnormal Reinforcement: environmental feedback that encourages continuation of a behavior –Consistent and immediate reinforcement produces change most frequently Punishment: environmental feedback that discourages continuation of a behavior Goal of behavioral intervention: to change behavior Clinical intervention involves the rearrangement of a client’s reinforcements so that more functional behaviors will result Behavioral change occurs when reinforcements change and are consistently applied

Change Through a Behavioral Perspective (cont.) Two primary methods of changing behavior: –Altering reinforcements –Modeling new behaviors Altering reinforcement patterns: manipulating the environment: Client helped to seek out new behaviors that offer alternative reinforcements –Ex: rather than drinking/drugging use exercise, yoga, mindfulness, singing, acting, drawing, etc. –Ex.: parents taught to reinforce pro-social behaviors and extinguish negative behaviors via ignoring or punishments Modeling: watching others engage in behaviors and observe their outcomes (being rewarded or punished) Challenge in behavior therapy is to identify the specific antecedent conditions and responses that are reinforcing to the client

BEHAVIOR THEORY Stimulus Behavior Consequence (Antecedent,(Response)Positive Reinforcement Cue) Negative Reinforcement Positive Punishment Negative Punishment

Behavior Theory Concepts: Consequences Positive reinforcement: encourages the continuation of a behavior preceding it. –Alcohol use is positively reinforced by feelings of well–being and pleasant social interaction with others, when drinking Alcohol ……Uninhibited……Alcohol Negative reinforcement: process by which an aversive event is terminated by the individual’s behavior; therefore the behavior is reinforced –Alcohol is negatively reinforcing when it leads to escape from feelings of boredom or sadness Anxiety……Alcohol……No Anxiety…..Alcohol Positive punishment: adding a consequence that eliminates a behavior (time out) Negative punishment: eliminating a reinforcer that extinguishes the behavior (removing a privilege)

Classical (Respondent) Conditioning Classical conditioning focuses on paired associations with certain aspects of a setting Conditioning: Developing patterns of behavior through responses to environmental stimuli or specific behavioral consequences –A “neutral stimulus” (bell) produces a response (salivation) after being repeatedly paired with a conditioned stimulus (food). –Pavlov: food = salivation; food plus bell = salivation; bell = salivation Behavioral intervention through principles of classical conditioning –Individual is “exposed” to stimulus (i.e. anxiety producing situation) but provided with alternatives to usual response –Examples: Attending 12 Step meetings when wanting to drink/drug, Practicing deep breathing when experiencing public speaking anxiety Practicing progressive muscle relaxation prior to stressful event Systematic desensitization for alternative to phobia or obsession/compulsions (elevators, hand washing….) **New reinforcements must be consistently supported over time by all significant persons in client’s life to maintain long term effect

Operant Conditioning Major premise: future behavior is determined by consequences of present behavior –Practitioner also pays attention to the antecedent, or prior, conditions that may trigger the behavior Two types of reinforcement: positive and negative –Both encourage the continuation of behavior Positive reinforcement: encourages the continuation of the behavior preceding it –Alcohol is positively reinforcing if it aids engaging socially with others Negative reinforcement: an aversive event is terminated by an individual’s behavior; as a result the behavior is reinforced –Alcohol is negatively reinforcing if it is an escape from anxiety Operant conditioning focus: clients are encouraged to engage in behaviors that offer alternative reinforcements so they will not be as prone to indulge in problem behaviors –Exercising rather than drinking to reduce stress –Meditating rather than taking drugs to feel calmer

Operant Conditioning: Punishments (cont.) Punishment’s purpose is to decrease behavior Positive punishment: adding a consequence that eliminates a behavior –Verbal reprimand –Corporeal punishment Negative punishment: eliminating a reinforcer that eliminates a behavior –Loss of privileges

Modeling Modeling: watching others engaging in behavior and observing reinforcement or punishment for the behavior In modeling the practitioner shows the client how to enact a new behavior –Behavioral rehearsal: client practices the new behavior Modeling is a significant way by which all people learn; particularly for youth Covert modeling: worker guides the client through a process of imagining the successful completion of an outcome (visualizataion) Rehearsal of new skills in session with the client is important for building confidence

Functional Behavioral Assessment Step One: Client's problem behavior is specified as clearly and concretely as possible Step Two: Antecedent conditions (triggers, cues) that enhance or maintain the behavior are identified Step Three: Consequences (reinforcers) of the behavior are considered Cues lead to behaviors which lead to consequences Practitioner assesses antecedent and consequence behaviors in five “domains” that may be related to the problem situation: –Environmental –Social –Physical –Emotional –Cognitive Assessment leads to planning for construction of concrete target behaviors (goals)

Functional Behavioral Analysis Questions The following are examples of questions probed during assessment: When do you experience the behavior? Where do you experience the behavior? Who are you with when the behavior occurs? How long does the behavior typically last? What happens immediately after the behavior? What do you do or what does someone else do to or with you? What bodily reactions do you experience with the behavior? How long do these reaction last? How often does the behavior typically happen?(hourly, daily, weekly) What is the typical timing of the behavior What do people around you do when the behavior is happening

FIVE “ DOMAINS” OF BEHAVIORAL ASSESSMENT Life DomainAntecedents (Triggers, Cues)Consequences (Reinforcers) SocialWith whom does the client spend most of his time? Does he have relationships with people who do not have the problem? Does he live with someone who is involved in the problem? Has his social network changed since the problem began or escalated? How have his relationships been affected? EnvironmentalWhat are the particular environmental cues for the problem? What is the level of her day-to- day exposure to these cues? Can some of these cues be avoided? What people, places, and things have been affected by the problem? Has her environment changed as a result of the problem?

FIVE “DOMAINS” OF BEHAVIORAL ASSESSMENT Life Domain Antecedents (Triggers, Cues) Consequences (Reinforcers) EmotionalWhat feeling states precede the occurrence of the problem? How does he feel afterward? How does he feel about himself? CognitiveWhat thoughts run through her mind, or what beliefs does she have about the problem? What is she thinking afterward? What does she say to herself? PhysicalWhat uncomfortable physical states precede the problem occurrence? How does he feel physically afterward? How is his physical health as a result?

Behavioral Therapy Process State problems in behavioral terms Establish clear, measurable goals and objectives Gather baseline data Specify action steps toward problem resolution Specify personal and environmental resources Identify relevant "significant others" for participation Identify possible obstacles in advance Undertake behavioral intervention (emphasize positive consequences of behavior change)

Behavioral Therapy Process (con.t) Practitioner, client or other persons collect data about the client's activities –Client's behavior changes are documented regularly Client and practitioner evaluate the intervention process regularly, comparing baseline conditions to current “counts” of desired behaviors Intervention ends after the client achieves his or her goals and demonstrates the likelihood of goal maintenance Ending intervention is a process of “fading.” –After an intervention has been underway and the client has acquired new behaviors, meetings with worker and reinforcement schedule are gradually eliminated

BEHAVIORISM AND THE SOCIAL WORKER/CLIENT RELATIONSHIP Social worker must be perceived as competent, caring and trustworthy as s/he will be asking client to undertake behaviors that will feel uncomfortable and threatening The client will be attracted to the social worker if: –interactions result in less anxiety –the practitioner is perceived as having the ability to secure rewards for the client The practitioner’s empathic understanding will facilitate these conditions The social worker must be careful not to use punishing behaviors with the client

Behaviorism and the Social Worker/Client Relationship (cont.) The social worker must be collaborative with the client –client must be behaviorally invested in change strategies Client will evaluate therapeutic relationship based on its rewards and costs relative to alternative behaviors Regular discussions about how the client is reacting to the intervention help to sustain his or her sense of reward for participation

Interviewing Skills Within Behavioral Therapy: Verbal Following and Focusing  Furthering a client’s verbal presentations (with prompts)  “ tell me more….”  “help me to understand what you mean by…”  Paraphrasing a client’s comments to add clarity (reflecting feeling and meaning)  “you felt both angry and shamed when you parent called you a “wench……”  Seeking connections among the client’s topic areas  Exploring themes related to behaviors  “ How did feeling rejected affect your binge behavior?”  Providing and maintaining a focus on topic/s  “Your recollection is intereseitng; but, I’d like to talk about that after we finish trying out ______________”

Interviewing Skills Within Behavioral Therapy: Summarizing  Highlighting key aspects of a discussion before changing Topics “ We’ve established that going to Starbucks to access WiFi can trigger your “sugar fix” behaviors….”  Making connections between different threads of a client’s communication “Whenever you are concerned that you aren’t as attractive as other women in the room, it is harder for you to engage with strangers….”  Reviewing major themes of a session  “Practicing what you want to say….writing it down and saying it out loud…has let you be more successful at _____________________”  Planning for next session,

SYSTEMATIC DESENSITIZATION Goal To reduce the client’s experience of anxiety by guiding his or her exposure to, and mastery of, situations that evoke the anxiety Prerequisites for Using the Technique Essence of the presenting problem is anxiety Anxiety-provoking stimuli can be identified and re-created The client is motivated to confront mildly anxiety-provoking situations The social worker and client can jointly plan a program of exposure Exposure to problem situations does not involve realistic danger The client is not under the influence of non-prescription drugs The client does not have a medical condition that makes the experience of moderate anxiety dangerous

Systematic Desensitization Intervention Steps Instruct the client in the technique Isolate the anxiety-evoking stimulus (i.e. elevators, public speaking, etc.) Construct a “hierarchy” of graduated tasks Teach and rehearse relaxation techniques Begin work on a task that the client selects Reassure the client (ongoing support) Give the client control of the process (the power to redirect or terminate) Initiate the exposure tasks Greatest gains occur early Visualization may be used if “in vivo” experiences are not possible Review and evaluate

STRESS MANAGEMENT / RELAXATION SKILLS DEVELOPMENT Assessment: Taking a Stress and Coping Inventory Ask the client to describe situations that cause stress Ask the client to define how s/he experiences stress: –Clarify that there are four aspects of stress: cognitive, emotional, behavioral and physiological Help the client be specific in identifying situations that create stress –Clarify incident-specific effects of the stress (in cognitive, emotional, behavioral and physiological terms) Ask the client what he or she already does to cope with stress, including actions and thoughts Provide positive feedback to the client about stress coping efforts –Point out situations where she or he dealt well with stress

STRESS MANAGEMENT / RELAXATION SKILLS DEVELOPMENT INTERVENTION  Teach new skills (via education and modeling)  Breathing (diaphramatic and belly breathing)  Progressive muscle relaxation  Visualization  Meditation  Rehearse the skills with the client “in vivo” or in session  Arrange for real-life applications

PARENTING SKILLS DEVELOPMENT An operant behavioral intervention that teaches parents to apply principles of reinforcement to change their children’s behavior. Parents learn to reinforce desirable behavior and ignore or punish negative behavior. Steps: Parents select a priority goal related to the child’s behavior Goals are broken down into smaller, observable components Tasks are specified to encourage the presence of positive behavior rather than the absence of negative behavior A baseline is determined A target goal is established The intervention is initiated Preferred reinforcement systems include social reinforcement and token economies

Parenting Skills Development: Shaping Shaping - reinforcing successive approximations (efforts) of a desired behavior to eventually meet a goal that is initially out-of-reach for the child. Command-giving should feature the following elements: –Use only commands that are necessary; too many may be counterproductive –Issue only one command at a time –Issue specific commands rather than vague warnings –Issue statements rather than questions –Phrase commands clearly as what the child should do or should not do –Keep commands brief –Praise compliance to a command

Parenting Skills Development: The Do’s and Don’ts of Praise “Do’s”: Label praise (describe specifically what a child does to deserve it) Couple verbal praise with eye contact, a smile, or physical affection Praise effort rather than just achievement Praise positive behavior immediately after it is performed “Don’ts”: Unlabeled praise (global statements such as “What a good boy!”) Coupling praise and criticism (“You did a good job washing the dishes, but why can’t you dry them right?”) Waiting too long after the behavior Taking any feelings of awkwardness as a sign to stop praising

Parenting Skills Development: Punishment and Time Out Punishment involves presenting negative events (discipline, criticism) or removing positive events (privileges) that decrease the occurrence of a response Positive reinforcements should be provided at three times the ratio of punishments Time Out is punishment that involves removing the child from a source of reinforcement for a brief period (one minute per year of the child’s age). Its purposes are: To extinguish the negative behavior Help the child calm down Help the child understand why the behavior is unacceptable The location for time out should be free from reinforcement