KeywordsAutism Spectrum Disorder Behavior Modification Aversive Stimulus Dialectical Behavioral Therapy Maladaptive Behavior
Procedure in which learning principles and procedures are systematically applied to observed behaviors and environmental conditions to increase adaptive behaviors and decrease maladaptive behaviors.
Behavior modification entails methodically applying techniques and principles of learning theory to change an individual’s observable behavior through environmental manipulation, primarily focusing on events that occur immediately before and immediately after the behavior (Martin and Pear 2015; Horrow and Gochros 1970). Behavior modification gained popularity throughout the 1950s and 1960s as an antithesis to the prevailing psychodynamic approach to the treatment of mental illness. The earliest behaviorists were interested in manipulating the stimulus-response connection in order to change a maladaptive behavior into an adaptive behavior (Bruck 1968), extending and elaborating upon Thorndike’s “law of effect” (Waters 1934). These foundational behaviorists based these techniques on learning theories, including Pavlov’s classical conditioning, Wolpe’s counterconditioning, and Skinner’s operant conditioning (Bruck 1968).
The term “behavior modification” has historically been used to describe a wide variety of procedures and applications to decrease undesirable behaviors and increase desirable behaviors (Martin and Pear 2015). In fact, the first use of the term “behavior therapy” was to describe Wolpe’s application of behavior modification techniques to the treatment of anxiety (Martin and Pear 2015). The techniques used in behavior modification are largely drawn from experimental work performed with animal subjects (Bruck 1968), especially the work of Skinner (Iverson 1992).
Principles of Behavior Modification
While behavior modification draws on several theories and types of learning, it relies significantly on the principles of operant conditioning (Kazdin 2012). This approach to learning is most concerned with behavioral contingencies – the environmental events factors that are maintaining a behavior. A behavioral contingency involves three components: (1) behaviors, (2) antecedents, and (3) consequences (Kazdin 2012). Antecedents can be defined as what occurs immediately prior to a behavior, and consequences are defined as what occurs immediately following a behavior. For example, consider a parent giving a child a command. The parent issues the command (antecedent), the child completes the command (behavior), and the child receives praise or a reward (consequence). In this example, the behavior (adhering to the command) is maintained by receiving praise or a reward.
Behavior modification focuses on modifying the antecedents and consequences of a behavior, which can lead to reinforcement of a behavior (i.e., increase the likelihood that it will occur again) or punishment of a behavior (i.e., decrease the likelihood that it will occur again; Bandura 1969). Reinforcement and punishment can be further divided into negative or positive. Positive reinforcement occurs when a behavior is followed by an advantageous consequence, increasing the probability that the behavior will occur again. Conversely, negative reinforcement involves removing an aversive stimulus immediately after a behavior, increasing the probability that the behavior will occur again. Both positive and negative reinforcement involve an increase in the likelihood that a behavior will occur again (Kazdin 2012). Conversely, punishment involves adding or removing a stimulus to decrease the probability that a behavior will occur. Positive punishment occurs when a behavior is followed by an adverse consequence, whereas negative punishment involves removing a positive stimulus immediately after a behavior (Kazdin 2012).
Behavior modification employs a variety of techniques to promote desired behaviors and suppress undesirable behaviors. For example, it is only possible to modify antecedents and consequences if an individual already has a behavior in their repertoire, which is not always the case. While it is sometimes possible to wait for a novel behavior to occur naturally, it can be helpful to use shaping, the reinforcement of “successive approximations” of the desired behavior. Another commonly implemented behavior modification technique is chaining, which involves the reinforcement of a combination or sequence of desired responses (Kazdin 2012). For example, washing one’s hands involves a series of steps, each of which is necessary before proceeding to the subsequent step.
Key Characteristics of Behavior Modification
Behavior modification involves several primary characteristics: first, behaviors that are targeted for modification should be clearly defined and measurable, so that change in the behavior can be used to indicate if progress is occurring. Additionally, the techniques used in behavior modification typically involve altering the individual’s environment to promote the target behavior and/or decrease other behaviors. In general, behavior modification has specific terminology that can be used across settings and contexts, allowing published behavior modification studies to be easily replicated by other trained professionals. Because behavior modification procedures are widely used to increase appropriate daily living skills or decrease undesirable behaviors that are interfering with functioning, using consistent terminology makes it easier for a variety of individuals to apply the same behavior modification techniques across settings (Martin and Pear 2015).
Applications of Behavior Modification
While the term behavior modification is sometimes used interchangeably with the term “applied behavior analysis,” it can be argued that behavior modification is a broader, more comprehensive term for a variety of treatments in which learning principles and procedures are systematically applied to improve overt and covert behaviors in an effort to improve daily functioning (Martin and Pear 2015). A behavior-focused therapist focuses less on modifying the client’s internal state and more on controlling environmental variables that are maintaining undesirable behaviors (Bruck 1968). However, treatments such as “cognitive behavior modification” or “cognitive behavior therapy” can fall under the purview of behavior modification, given that these treatments involve using improvement in a client’s behavior as the primary measure of therapeutic progress (Martin and Pear 2015).
Early applications of behavior modification include smoking cessation (Wagner and Bragg 1970; Gerson and Lanyon 1972), treatment of exhibitionism (Maletzky 1974), and control of juvenile delinquency (Davidson and Seidman1974). Furthermore, a variety of more recent evidence-based treatments, such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT), combine cognitive techniques with behavior modification procedures to address environmental contingencies that are maintaining maladaptive behaviors, which lead to negative thoughts and emotions (Martin and Pear 2015).
Behavior modification is a particularly advantageous approach when implementing interventions with individuals with specific psychological or neurodevelopmental concerns, as it can be effectively utilized as an intervention without requiring insight in the individual whose behaviors are being targeted. For example, behavior modification has been used to treat specific behavioral concerns in young children (e.g., treatment of encopresis; Wassom and Christophersen 2014), developmentally disabled individuals (e.g., Hanley 2012), and individuals with autism spectrum disorders (Smith 2010). Furthermore, it may be used with individuals who lack self-motivation (e.g., juvenile offenders; Davidson and Seidman 1974) or the cognitive capacity for other treatments (e.g., individuals with dementia; Kasl-Godley and Gatz 2000).
Criticisms of Behavior Modification
Behavior modification has been the subject of criticism since it was first developed. For example, a critical review of behavior modification literature and practice by Bruck (1968) pointed out that nearly all studies published at that point were case studies. Bruck’s early criticism of behavior modification also includes the assertion that behaviorists see individuals as mechanistic organisms whose “behavior may be shaped in an infinite number of ways by feeding him…a series of positive or aversive stimuli” (Bruck 1968, p. 49). This notion that behavior modification is mechanistic is based on the assumption that individuals who adhere to this approach are ignoring the thoughts, feelings, and individual differences inherent in the person they are treating (Morrow and Gochros 1970). While early proponents of behavior modification (e.g., Bandura 1969) sought to discount internal processes in favor of focusing on environmental manipulations (Bruck 1968), it can be argued that covert behaviors (i.e. thoughts and feelings) can be used to determine stimulus cues for overt actions (Morrow and Gochros 1970).
Other criticisms of behavior modification are that it can be applied unethically and manipulatively (Morrow and Gochros 1970). For example, behavior modification has been implicated in the use of aversive techniques (e.g., electroshock therapy, public shaming) with institutionalized children and adults (Morrow and Gochros 1970; Baily and Burch 2016). The efficacy of behavior modification-based practices in which physical injury is used as an aversive stimulus to decrease a maladaptive behavior has long been debated in the psychological literature (Gershoff 2002). Abuses of behavior modification procedures in the 1970s (e.g., Sunland Miami Scandal) led to the formation of laws and measures to protect developmentally disabled patients and clients. These laws and procedures included establishing standards for treatment, as well as oversight by advocacy groups and peer committees (Bailey and Burch 2016).
In summary, behavior modification can be a beneficial component of many treatments and applications when it is effectively and ethically applied. The behavior modification approach can lead to dramatic improvements in a client’s adaptive behaviors and provide a framework through which cognitive therapy can be used successfully. Lastly, behavior modification is particularly useful when working with individuals who cannot acquire the insight or internal motivation necessary to respond to some other interventions.
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