Change Through a Behavioral Perspective

• All behavior is influenced by learning principles of classical conditioning, operant condition and modeling

• No behavior is inherently healthy or unhealthy, normal or abnormal• Behavior is developed and maintained because of an individual’s

unique reinforcement schedules• Reinforcement: environmental feedback that encourages

continuation of a behavior• Punishment: environmental feedback that discourages continuation

of a behavior • Behavioral change occurs when reinforcements change and are

consistently applied• Clinical intervention involves the rearrangement of a client’s

reinforcements so that more functional behaviors will result

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 their learning, by watching others and by

environmental feedback

Intervention must focus on influencing reinforcement or punishments

Consistent and immediate reinforcement produces change most frequently

Thoughts and feelings are behaviors subject to reinforcement

principles

Change Through a Behavioral Perspective (cont.)

• Social worker helps client achieve new behaviors by:– manipulating environment to alter reinforcement patterns

– Providing new opportunities for positive modeling

• Challenge in behavior therapy is to identify the specific antecedent conditions and responses that are reinforcing to the client

Classical Conditioning

• Conditioning: Developing patterns of behavior through responses to environmental stimuli or specific behavioral consequences

– A “neutral stimulus” produces a response after being repeatedly PAIRED with a certain stimulus. Pavlov: bell, food, dog salivates

– Previously neutral cues (places, people, feelings) become associated with problem behaviors

• During behavioral intervention the principles of classical conditioning are reversed– Individual is “exposed” to stimulus but provided with alternatives to usual response – Attending 12 Step meetings when wanting to drink/drug, relaxation when experiencing public

speaking anxiety, systematic desensitization to a stimulus (i.e.. elevators)

• **New reinforcement must be consistently supported over time by all significant persons in client’s life to maintain long term effect

• Classical conditioning: paired associations with certain aspects of a setting• Systematic desensitization is an example

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 means: adding a stimulus• Negative means: removing or preventing a stimulus from occurring• Positive reinforcement: encourages the continuation of the behavior preceding it

– Earning tokens within a token economy program• 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 leads to escape from sadness

• Punishments decrease behavior, reinforcements increase behavior– Positive punishment: verbal reprimand, corporeal punishment– Negative punishment: fines, loss of privileges

Operant Conditioning Theory

Stimulus Behavior Consequence

(Antecedent, (Response) Positive Reinforcement

Cue) Negative Reinforcement

Positive Punishment

Negative Punishment

Extinction

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

• Rehearsal of new skills in session with the client is important for building confidence

• Modeling: watching others behave and receiving feedback

Behavioral Assessment

• Step One: Client's problem behavior is specified as clearly and concretely as possible

• Step Two: Environmental cures that enhance or maintain the behavior are identified

• Step Three: Consequences of the behavior are considered

• Assessment interviewing: questions are focused on environmental cues in each of five “domains” that may be related to the problem situation

FIVE “ DOMAINS” OF BEHAVIORAL ASSESSMENT

Life Domain Antecedents (Triggers, Cues) Consequences (Reinforcers)

Social With 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?

Environmental What 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)

Emotional What feeling states precede the occurrence of the problem?

How does he feel afterward?

How does he feel about himself?

Cognitive What 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?

Physical What 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)

BEHAVIORISM AND THE SOCIAL WORKER/CLIENT RELATIONSHIP

•The behavior of both the social worker and client is subject to operant conditioning principles

•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/ClientRelationship (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)

Paraphrasing a client’s comments to add clarity

Seeking connections among the client’s topic areas

Providing and maintaining a focus on:

Selecting topics

Exploring topics

Staying on topic

Interviewing Skills Within Behavioral Therapy: Summarizing

Highlighting key aspects of a discussion before changing

topics

Making connections between different threads of a client’s

communication

Reviewing major themes of a session

Planning for next session

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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 recreated

• 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

• 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 what stress means to him or her. –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 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 high-probability behaviors, social reinforcement, and token economies

Parenting Skills Development: Shaping

•Shaping - reinforcing successive approximations 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