ABSTRACT
Behavior modification is the generic term for psychological approaches to addressing maladaptive behavior. Direct learning procedures, sometimes using biologically significant appetitive and aversive stimuli as consequences, may be necessary with non-verbal populations such as autistic children. Once interfering behavioral excesses are eliminated, it becomes possible to address behavioral deficits using only appetitive consequences. The objective is to transition from direct learning to observational learning and speech. Contingency management procedures, such as the use of cash or vouchers to reward clean urine samples, have been successful in treating substance abuse. Token economies, in which generalized reinforcers backed by items of value are made 285contingent upon desired behavior, have been effective in treating a wide range of populations in a wide range of settings with a wide variety of behavioral problems. Direct procedures require a highly controlled environment where it is possible to closely monitor behavior and immediately provide consequences. In comparison, treatment of verbal individuals typically consists of weekly 1-hour conversational sessions accompanied by homework assignments. Success depends upon the client following through on suggested actions and accurately reporting what transpires.
Albert Ellis, a clinical psychologist, and Aaron Beck, a psychiatrist, independently became dissatisfied with results obtained with psychodynamic therapeutic procedures. They both argued that behavioral reactions were influenced by emotional responses to cognitive interpretations of events. They developed interventions designed to identify irrational thoughts (Ellis) and cognitive distortions (Beck), countering them with adaptive alternatives. The therapeutic process became more collaborative, with problems and progress toward desired end states defined in measurable terms. Talking therapy was no longer a mysterious process, but an objectively definable process, subject to independent verification of the fidelity of implementation, and objective assessment of its behavioral outcomes. Language-based interventions are only effective if clients experience the consequences of their acts under naturalistic circumstances (i.e., reality testing). This is consistent with an adaptive learning model of the psychotherapeutic process. Therapy is successful when individuals practice skills that are effective in increasing appetitive and decreasing aversive events.
Successful treatment must provide the necessary skills to not only cope with the current demands, but also to prepare the individual for predictable stressors and setbacks. In several instances (e.g., autism, depression, addictive disorders) successful results are not maintained. Marlatt conducted follow-up interviews to track the incidence of such relapses and found approximately 75% were precipitated by negative emotional states, social pressure, and interpersonal conflict. Relapse has been prevented by identifying personal high-risk situations and practicing coping skills.
The Good Behavior Game, Brief Alcohol Screening, and Intervention for College Students (BASICS), and Early Risers were described as highly successful examples of the application of adaptive learning principles to the prevention of behavioral problems. Multi-systemic therapy, a comprehensive approach to conduct disorder introduces evidence-based practices in the child’s home, school, and community. It has been successful in reducing fighting, destroying property, substance abuse, truancy, and running away.
Sometimes, to successfully implement behavior modification procedures, continuous monitoring of behavior is required. Helmets with pressure sensors have helped eliminate head-banging in autistic children. Surveillance technologies are making it possible to address a wide range of serious behavioral problems, including the lack of compliance with health measures, and criminal behavior. Increasingly, there is a conflict between the need for security and the right to privacy as we rely upon technology to communicate, monitor, and influence the behavior of citizens and governments.
