Operant conditioning therapies

• TYPE OF PSYCHOLOGY: Psychotherapy

Operant conditioning therapies are based on the assumption that operant behavior is shaped by its consequences; therapists use reinforcement, extinction, punishment, and discrimination training to overcome behavioral problems. Operant conditioning techniques have been applied to individual and group behavior in a variety of settings, including hospitals, prisons, schools, businesses, and homes.

Introduction

Behavior therapy uses principles of learning to modify human behavior. One orientation within behavior therapy is the operant conditioning approach, also called behavior modification. This approach modifies operant behavior by manipulating environmental consequences. The term “operant” refers to voluntary or emitted behavior that operates on the environment to produce consequences. The basic premise of operant conditioning is that operant behavior is controlled by its consequences. What happens to an individual after they perform some behavior determines the likelihood of that behavior being repeated. Pleasant or reinforcing consequences strengthen behavior, while unpleasant or punishing consequences weaken behavior.

Therapeutic Approaches

There are several characteristics that distinguish the operant approach to therapy. One is the manner in which clinical problems are conceptualized and defined. Traditional psychotherapy tends to view disturbed behavior as a symptom of an internal psychological conflict; the goal of therapy is to help the individual gain insight into this inner problem. Therapists with an operant orientation, however, view maladaptive behavior as the problem itself. They believe that just as normal or adaptive behavior is shaped by environmental consequences, so, too, is abnormal or maladaptive behavior. Therefore, by carefully arranging events in the client’s environment, it should be possible to modify maladaptive behavior and help the client learn more appropriate ways of behaving.

The behavior therapist defines problems in terms of specific behaviors that can be observed and quantified. Behavioral excesses involve too much of a specific behavior that can be specified in terms of frequency, intensity, or duration. Chain-smoking, overeating, and physically abusing another person are examples of behavioral excesses. The opposite difficulty is a behavioral deficit. In the case of a behavioral deficit, a behavior either does not occur or occurs at an extremely low rate. A man who cannot feed or dress himself and a child who rarely talks to other children exhibit behavioral deficits. Still, other behaviors are problematic because they are inappropriate when performed in a particular setting. Taking one’s clothes off in public or laughing during a solemn funeral service illustrates behavioral inappropriateness.

Behavioral monitoring is an integral component of operant conditioning therapies. The problem behavior is first observed and recorded as it naturally occurs in a variety of settings, and no attempt is made to modify the behavior. The therapist, a parent, a teacher, a spouse, a peer, or the client may conduct the observation and record the behavior. This part of the behavior modification program, which is called baseline observation, provides a record of where and when the behavior occurred as well as information about its topography or form, such as duration and intensity. Behavioral measures are often plotted on a graph to provide a visual record of behavior. The baseline data are used to define the problem or target behavior as precisely as possible. The client and therapist also define the desired changes in this target behavior and set up specific behavioral goals to be met during treatment.

Treatment Techniques

Operant techniques that are appropriate for modifying the target behavior are then selected. Therapists begin by selecting the least intrusive and restrictive procedures demonstrated to be effective for treating a specific problem. Since these techniques are based on years of experimental research and evaluation, therapists can explicitly define their methods and rationale for the client. This degree of precision, rarely found in traditional psychotherapy, makes it easier for clients and behavioral health professionals to understand and implement therapeutic procedures.

Behavioral observation continues throughout the treatment phase of the modification program. Behavior is monitored regularly, and changes from the baseline level are recorded. Examination of this ongoing record of behavioral progress allows both therapist and client to evaluate the effectiveness of the treatment throughout the treatment process. If behavior is not changing in the desired direction or pace, the treatment program can be altered or adjusted.

Behavior modifiers often include a follow-up phase as part of the modification program. After termination of treatment, the client may be contacted periodically to assess whether treatment gains are being maintained. Behavior therapists have discovered that generalizing behavior changes from the therapeutic setting to the natural environment does not occur automatically. An increasing emphasis is placed on incorporating procedures to facilitate behavior transfer into modification programs. Some therapists have reduced their reliance on tangible reinforcers, such as food or toys, and have stressed the benefits of social and intrinsic reinforcers, such as positive attention from others and personal feelings of pride and mastery. These kinds of reinforcers are likely to maintain positive behavioral changes in the client’s natural setting, allowing long-term changes. Therapists also devote attention to training individuals who will interact with the client after the termination of treatment in the effective use of operant procedures.

Ethical guidelines are followed when conducting a behavior modification program. Because behavior therapists insist on an explicit definition of problem behaviors and treatment methods, this approach facilitates public scrutiny of ethical conduct. Educating the client on the rationale and application of procedures greatly reduces the possibility that operant conditioning techniques will be used in an exploitative or harmful fashion.

Positive Reinforcement

The treatment of behavioral deficits typically involves the application of positive reinforcement techniques. Positive reinforcement increases the frequency of a response by immediately following the response with a favorable consequence. If the desired behavior does not occur, it can be developed using the procedure. In shaping, successive approximations—responses that more closely resemble the desired response—of the desired behavior are reinforced. Wayne Isaacs, James Thomas, and Israel Goldiamond provided an impressive demonstration of the use of shaping to reinstate verbal behavior in a schizophrenic patient who had been mute for nineteen years. Chewing gum was used as the positive reinforcer, and gum delivery was made contingent first on eye movements in the direction of the gum, then on lip movements, then on any vocalization, and finally on vocalizations that increasingly approximated actual words. Within six weeks, the patient was conversing with the therapist.

Positive reinforcement is also used to strengthen weak or low-frequency behaviors. Initially, the desired behavior is placed on a schedule in which each occurrence of the behavior is followed by reinforcer delivery. Gradually, an intermittent schedule can be introduced, with several responses or a time interval required between successive reinforcer deliveries.

Since people get tired of the same reinforcer and different people find different commodities and activities reinforcing, a token economy system provides another means of programming positive reinforcement. A system that delivers tokens as rewards for appropriate behaviors can be used with a single individual or a group of individuals. Tokens are stimuli such as check marks, points, stickers, or poker chips, which can be accumulated and later exchanged for commodities and activities of the individual’s choosing. Tokens can be delivered on a continuous or intermittent schedule of reinforcement and are often accompanied by praise for the desired behavior. Ultimately, the goal of the program is to fade out the use of tokens as more natural social and intrinsic reinforcers begin to maintain behavior.

Extinction and Punishment Procedures

Extinction and punishment procedures are used to treat behavioral excess. If the reinforcer that is maintaining the excessive behavior can be identified, an extinction program may be effective. Extinction is a procedure that is used to eliminate a response by withholding the reinforcer following the performance of the response. A classic demonstration of extinction is a study by Carl Williams designed to eliminate intense tantrum behavior at bedtime in a twenty-one-month-old child. Observation revealed that parental attention was reinforcing the tantrums, so the parents were instructed to put the child to bed, close the bedroom door, and not return to the child’s room for the rest of the night. This extinction procedure eliminated the tantrums in seven nights. Tantrums were then accidentally reinforced by the child’s aunt, and a second extinction procedure was instituted. Tantrums were reduced to a zero level by the ninth session, and a two-year follow-up revealed that no further tantrums had occurred.

Punishment procedures decrease the frequency of a response by removing a reinforcing or by presenting an aversive stimulus (a painful or unpleasant event) immediately following the response. Removal of a positive reinforcer contingent on the performance of the target behavior is called negative punishment or . Some token economy systems incorporate a response cost component, and clients lose tokens when specified inappropriate behaviors are performed. In another form of negative punishment, time-out or sit-out, an individual is moved from a reinforcing environment to one that is devoid of positive reinforcement for a limited amount of time. For example, a child who misbehaves during a classroom game might be seated away from the other children for a few minutes, thereby losing the opportunity to enjoy the game.

The most intrusive behavior-reduction technique is positive punishment, which involves the presentation of an aversive stimulus contingent on the performance of the undesirable behavior. This procedure is used only when other procedures have failed and the behavioral excess injures the client or others. Thomas Sajwaj and his colleagues employed a positive punishment procedure to reduce life-threatening regurgitation behavior in a six-month-old infant. Within a few minutes of being fed, the infant would begin to bring up the milk she had consumed, and regurgitation continued until all the milk was lost. Treatment consisted of filling the infant’s mouth with lemon juice immediately following mouth movements indicative of regurgitation. Regurgitation was reduced to a very low level after sixteen lemon juice presentations.

Extinction and punishment techniques can produce side effects that include aggressive behavior and fear, escape, and avoidance responses. These can be reduced by combining behavior-reduction procedures with a program of positive reinforcement for desirable alternative behaviors. In this way, the behavioral excess is weakened, and the client is simultaneously learning adaptive, socially approved behaviors.

Stimulus-Discrimination Training

Behaviors labeled as inappropriate because of their place of occurrence may be treated using stimulus-discrimination training. This involves teaching the client to express a behavior in the presence of some stimuli and not express the behavior in the presence of other stimuli. For preschoolers who take their clothes off in various public and private places, discrimination training might involve praising the child when they remove their clothes in the bedroom or the bathroom and using extinction or punishment when clothing removal occurs in other settings. Verbal explanation of the differential contingencies also helps the client learn discrimination.

Evolution of Research

Operant conditioning therapies evolved from the laboratory research of B. F. Skinner. In 1938, Skinner published The Behavior of Organisms, which outlined the basic principles of operant conditioning that he had derived from the experimental study of the effects of environmental consequences on the lever-pressing behavior of rats. This work stimulated other psychologists to analyze operant behavior in many animal species.

Most early studies with human subjects were designed to replicate and extend this animal research, and they served to demonstrate that operant techniques exerted similar control over human behavior. Literature of operant principles and theory began to accumulate, and researchers referred to this approach to learning as the experimental analysis of behavior.

Some of these human demonstrations were conducted in institutional settings with patients who had not responded well to traditional treatment approaches. The results of such studies suggested that operant procedures could have therapeutic value. In 1959, Teodoro Ayllon and Jack Michael described how staff members could use reinforcement principles to modify the maladaptive behaviors of psychiatric patients. In the 1960s, Sidney Bijou pioneered the use of operant procedures with mentally disabled children, and Ivar Lovaas developed an operant program for autistic children.

The 1960s also saw applications in noninstitutional settings. Operant techniques were introduced into school classrooms, university teaching, programs for delinquent youth, marriage counseling, and parent training. Universities began to offer coursework and graduate training programs in the application of operant principles. By the late 1960s, the operant orientation in behavior therapy became known by the terms behavior modification and applied behavior analysis.

During the 1970s, many large-scale applications were instituted. Psychiatric hospitals, schools, prisons, and business organizations began to apply operant principles systematically to improve the performances of large groups of individuals. Another important trend that began in the 1970s was an interest in the self-modification of problem behaviors. Numerous books offered self-training in operant procedures to deal with problems such as smoking, drug abuse, nervous habits, stress, sexual dysfunction, time management, and weight control.

Integration with Behavioral Medicine

Since the 1980s, operant conditioning therapies have become integral to behavioral medicine. Operant conditioning therapy comes in many forms and may be used to support treatment or as the primary treatment method for various mental health or behavioral health conditions. Reinforcement techniques have been used in the treatment of chronic pain, eating and sleeping disorders, cardiovascular disorders, and neuromuscular disorders. Applied behavioral analysis is a form of operant conditioning therapy often used for patients with autism and obsessive-compulsive disorder. Operant conditioning also has applications in educational settings for controlling classrooms, encouraging good behavior, and improving test scores. Operant procedures are also effective in teaching patients adherence to medical instructions and how to make healthy lifestyle changes.

Behavior modifiers have continued to direct attention toward public safety and improvement of the physical environment. Therapists have evaluated the effectiveness of operant procedures to combat crime, reduce traffic accidents, and increase the use of seat belts, carpools, and public transportation. Work has been done to design programs to encourage energy conservation and waste recycling.

Throughout its development, behavior modification has emphasized using operant conditioning principles to improve the quality of life for individuals and society as a whole. Behavior therapists have actively supported efforts to educate the public in the ethical use of operant techniques for social betterment.

Bibliography

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