Behavior modification

Behavior modification is a treatment approach that uses respondent and operant conditioning to change behavior. Based on methodological behaviorism,[1] overt behavior is modified with consequences, including positive and negative reinforcement contingencies to increase desirable behavior, or administering positive and negative punishment and/or extinction to reduce problematic behavior.[2][3][4] It also uses flooding desensitization to combat phobias.

For the journal, see Behavior Modification (journal).

Applied behavior analysis (ABA)—the application of behavior analysis—is a contemporary application and is based on radical behaviorism, which refers to B. F. Skinner's viewpoint that cognition and emotions are covert behavior that are to be subjected to the same conditions as overt behavior.

Description and history

The first use of the term behavior modification appears to have been by Edward Thorndike in 1911. His article Provisional Laws of Acquired Behavior or Learning makes frequent use of the term "modifying behavior".[5] Through early research in the 1940s and the 1950s the term was used by Joseph Wolpe's research group.[6] The experimental tradition in clinical psychology used it to refer to psycho-therapeutic techniques derived from empirical research.[7] In the 1960s, behavior modification operated on stimulus-response-reinforcement framework (S-R-SR), emphasizing the concept of 'transactional' explanations of behavior.[8] It has since come to refer mainly to techniques for increasing adaptive behavior through reinforcement and decreasing maladaptive behavior through extinction or punishment (with emphasis on the former).

In recent years, the concept of punishment has had many critics, though these criticisms tend not to apply to negative punishment (time-outs) and usually apply to the addition of some aversive event. The use of positive punishment by board certified behavior analysts is restricted to extreme circumstances when all other forms of treatment have failed and when the behavior to be modified is a danger to the person or to others (see professional practice of behavior analysis). In clinical settings positive punishment is usually restricted to using a spray bottle filled with water as an aversive event. When misused, more aversive punishment can lead to affective (emotional) disorders, as well as to the receiver of the punishment increasingly trying to avoid the punishment (i.e., "not get caught")..

Behavior modification relies on the following:

Areas of Effectiveness

Functional behavior assessment forms the core of applied behavior analysis. Many techniques in this therapy are specific techniques aimed at specific issues. Interventions based on behavior analytic principles have been extremely effective in developing evidence-based treatments.[9] In addition to the above, a growing list of research-based interventions from the behavioral paradigm exist.

Children with ADHD

For children with attention deficit hyperactivity disorder (ADHD), one study showed that over a several-year period, children in the behavior modification group had half the number of felony arrests as children in the medication group.[10][11] These findings have yet to be replicated, but are considered encouraging for the use of behavior modification for children with ADHD. There is strong and consistent evidence that behavioral treatments are effective for treating ADHD. A recent meta-analysis found that the use of behavior modification for ADHD resulted in effect sizes in between group studies (.83), pre-post studies (.70), within group studies (2.64), and single subject studies (3.78) indicating behavioral treatments are highly effective.[12]

Uncontrollable Diabetes Type 2

Drawing upon Bandura's self-efficacy theory, which has proven effective in programs aimed at promoting health-related behavioral modifications in adults with diabetes, various interventions have been implemented. These interventions incorporate group counseling, group discussions, and an empowerment process, all geared towards encouraging individuals to adopt healthy dietary practices, adhere to medication regimens, and engage in regular exercise, with the goal of improving glycemic levels. Notably, the outcomes of these programs have demonstrated promising advancements, with improvements observed in self-efficacy and trends towards significance in hemoglobin A1c levels.[13]

Residential Treatment

Behavior modification programs form the core of many residential treatment facility programs. They have shown success in reducing recidivism for adolescents with conduct problems and adult offenders. One particular program that is of interest is teaching-family homes (see Teaching Family Model), which is based on a social learning model that emerged from radical behaviorism. These particular homes use a family style approach to residential treatment, which has been carefully replicated over 700 times.[14] Recent efforts have seen a push for the inclusion of more behavior modification programs in residential re-entry programs in the U.S. to aid prisoners in re-adjusting after release.

Weight Loss Outcomes

Research has shown effectiveness for obese people who binge eat. One program called the Trevose Behavior Modification Program (TBMP) is an accessible self-help weight loss program that emphasizes ongoing care. TBMP, administered and directed by non-professionals, has demonstrated remarkable success in facilitating substantial and lasting weight loss. This program not only offers the advantage of being cost-effective but also provides continuous support. Notably, individuals with and without frequent binge eating have achieved significant long-term weight loss through TBMP's continuing care approach. [15]

Addictions

One area that has repeatedly shown effectiveness has been the work of behaviorists working in the area of community reinforcement for addictions.[16]

Depression

Another area of research that has been strongly supported has been behavioral activation for depression.[17]

One way of giving positive reinforcement in behavior modification is in providing compliments, approval, encouragement, and affirmation; a ratio of five compliments for every one complaint is generally seen as being effective in altering behavior in a desired manner[18] and even in producing stable marriages.[19]

Job performance

Based on the conceptual premises of classical behaviorism and reinforcement theory, the Organizational behavior management (aka OBM) represents a behavioral approach to the management of human resources in organizational settings.[20] The application of reinforcement theory to modification of behavior as it relates to job performance first requires analysis of necessary antecedents (e.g., job design, training) of the desired behavior.[20] After it has been determined that the necessary antecedents are present, managers must first identify the behaviors to change. These behaviors must be observable, measurable, task-related, and critical to the task at hand. Next, a baseline measure of the behavior must be assessed and functional consequences analyzed.[20] Now that the link between the antecedent, behavior, and contingent consequences has been established, an intervention to change the behavior can be introduced. If the intervention is successful in modifying the behavior, it must be maintained using schedules of reinforcement and must be evaluated for performance improvement.[20] The OBM has been found to have a significant positive effect on task performance globally,[20][21] with performance on average increasing 17%.[22]

A study that examined the differential effects of incentive motivators administered with the OBM on job performance found that using money as a reinforcer with OBM was more successful at increasing performance compared to routine pay for performance (i.e., money administered on performance not using OBM).[23] The authors also found that using money administered through the OBM produced stronger effects (37% performance increase), compared to social recognition (24% performance increase) and performance feedback (20% performance increase).[23]

Criticism
See also: Cognitive behavioral therapy § Criticisms, and Psychotherapy § General critiques

Behavior modification is critiqued in person-centered psychotherapeutic approaches such as Rogerian Counseling and Re-evaluation Counseling,[24] which involve "connecting with the human qualities of the person to promote healing", while behaviorism is "denigrating to the human spirit".[25] B.F. Skinner argues in Beyond Freedom and Dignity that unrestricted reinforcement is what led to the "feeling of freedom", thus removal of aversive events allows people to "feel freer".[26] Further criticism extends to the presumption that behavior increases only when it is reinforced. This premise is at odds with research conducted by Albert Bandura at Stanford University. His findings indicate that violent behavior is imitated, without being reinforced, in studies conducted with children watching films showing various individuals "beating the daylights out of Bobo". Bandura believes that human personality and learning is the result of the interaction between environment, behavior and psychological process. There is evidence, however, that imitation is a class of behavior that can be learned just like anything else. Children have been shown to imitate behavior that they have never displayed before and are never reinforced for, after being taught to imitate in general.[27]

Several people have criticized the level of training required to perform behavior modification procedures, especially those that are restrictive or use aversives, aversion therapy, or punishment protocols. Some desire to limit such restrictive procedures only to licensed psychologists or licensed counselors. Once licensed for this group, post-licensed certification in behavior modification is sought to show scope of competence in the area through groups like the World Association for Behavior Analysis.[28] Still others desire to create an independent practice of behavior analysis through licensure to offer consumers choices between proven techniques and unproven ones (see Professional practice of behavior analysis). Level of training and consumer protection remain of critical importance in applied behavior analysis and behavior modification.

See also

References
  1. Mahoney, M. J., Kazdin, A. E., & Lesswing, N. J.; Franks, C. M., Wilson, G. T. (1974). "Behavior modification: delusion or deliverance?". Annual Review of Behavior Therapy: Theory and Practice. Vol. 2. Brunner/Mazel. pp. 11–40.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. Mace, F. C. (1994). "The significance and future of functional analysis methodologies". Journal of Applied Behavior Analysis. 27 (2): 385–92. doi:10.1901/jaba.1994.27-385. PMC 1297814. PMID 16795830.
  3. Pelios, L., Morren, J., Tesch, D., and Axelrod, S. (1999). "The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior". Journal of Applied Behavior Analysis. 32 (2): 185–95. doi:10.1901/jaba.1999.32-185. PMC 1284177. PMID 10396771.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. Mace, F. C., and Critchfield, T. S. (2010). "Translational research in behavior analysis: Historical traditions and imperative for the future". J Exp Anal Behav. 93 (3): 293–312. doi:10.1901/jeab.2010.93-293. PMC 2861871. PMID 21119847.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  9. O'Donohue, W.; Ferguson, K. E. (2006). "Evidence-Based Practice in Psychology and Behavior Analysis". The Behavior Analyst Today. 7 (3): 335–52. doi:10.1037/h0100155.
  10. Satterfield, J. H.; Satterfield, B. T.; Schell, A. M. (1987). "Therapeutic interventions to prevent delinquency in hyperactive boys". Journal of the American Academy of Child and Adolescent Psychiatry. 26 (1): 56–64. doi:10.1097/00004583-198701000-00012. PMID 3584002.
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  12. Fabiano, G. A.; Pelham Jr., W. E.; Coles, E. K.; Gnagy, E. M.; Chronis-Tuscano, A.; O'Connor, B. C. (2008). "A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder". Clinical Psychology Review. 29 (2): 129–40. doi:10.1016/j.cpr.2008.11.001. PMID 19131150.
  13. Ounnapiruk, Liwan; Wirojratana, Virapun; Meehatchai, Nitaya; Turale, Sue (2014). "Effectiveness of a behavior modification program for older people with uncontrolled type 2 diabetes". Nursing & Health Sciences. 16 (2): 216-223. doi:10.1111/nhs.12089.
  14. Dean L. Fixsen, Karen A. Blasé, Gary D. Timbers and Montrose M. Wolf (2007) In Search of Program Implementation: 792 Replications of the Teaching-Family Model. Behavior Analyst Today Volume 8, No. 1, pp. 96–106 Behavior Analyst Online
  15. Delinsky, Sherrie Selwyn; Latner, Janet D.; Wilson, G. Terence (2006). "Binge Eating and Weight Loss in a Self-Help Behavior Modification Program". Obesity. 14 (7): 1244–1249. doi:10.1038/oby.2006.141. S2CID 1363953.
  16. Milford, J.L.; Austin, J.L.; Smith, J.E. (2007). Community Reinforcement and the Dissemination of Evidence-based Practice: Implications for Public Policy. IJBCT, 3(1), pp. 77–87 )
  17. Spates, R.C.; Pagoto, S.; Kalata, A. (2006). "A Qualitative and Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder". The Behavior Analyst Today. 7 (4): 508–17. doi:10.1037/h0100089. S2CID 3337916.
  18. Kirkhart, Robert; Kirkhart, Evelyn (1972). "The Bruised Self: Mending in the Early Years". In Yamamoto, Kaoru (ed.). The Child and His File: Self Concept in the Early Years. New York: Houghton Mifflin. ISBN 978-0-395-12571-7.
  19. Gottman, J.M.; Levenson, R.W. (1999). "What predicts change in marital interaction over time? A study of alternative models". Family Process. 38 (2): 143–58. doi:10.1111/j.1545-5300.1999.00143.x. PMID 10407716.
  20. Stajkovic, A. D., & Luthans, F. (1997). "A meta-analysis of the effects of organizational behavior modification on task performance, 1975-1995". The Academy of Management Journal. 40 (5): 1122–1149. doi:10.2307/256929. JSTOR 256929.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. Luthans, F., Stajkovic, A. D., Luthans, B. C., & Lutherans, K. W. (1998). "Applying Behavioral Management in Eastern Europe". European Management Journal. 16 (4): 446–475. doi:10.1016/S0263-2373(98)00023-1.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  23. Stajkovic, A. D., & Luthans, F. (2001). "Differential effects of incentive motivators on work performance". Academy of Management Journal. 4 (3): 580–590. doi:10.2307/3069372. JSTOR 3069372. Archived from the original on 2018-07-23. Retrieved 2019-07-13.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. "Re-evaluation Counseling".
  25. Holland, J.L. (1976). "A new synthesis for an old method and a new analysis of some old phenomena". The Counseling Psychologist. 6 (3): 12–15. doi:10.1177/001100007600600303. S2CID 143031073.
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  27. D. Baer, R.F.; Peterson, J.A. Sherman Psychological Modeling: Conflicting Theories, 2006
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