Module Overview
Throughout Modules 6-9 we covered upward of 30 strategies that can be used to bring about behavior change whether for yourself or another person. Do you use them all in a plan? Definitely not. The question is which of these strategies could be used. This module will help you determine this.
Module Outline
Module Learning Outcomes
- Decide how to use the results of your functional assessment to inform strategy selection.
- Choose relevant antecedent-focused strategies.
- Choose relevant behavior-focused strategies.
- Choose relevant consequence-focused strategies.
10.1. Utilizing the Results of Your Functional Assessment
Section Learning Objectives
- Review the results of the functional assessment.
One starting point when determining what strategies to use is to look at the results of the functional assessment undertaken at the end of the baseline phase and through interviews with the individual the plan is being developed for or through careful self-reflection if for yourself. This information is critical for determining what strategies to use for your plan.
For instance, if you are trying to exercise more but you find that you play your favorite game on your phone as soon as you wake up, you will want to select an antecedent manipulation such as removing the stimulus for the undesired behavior to deal with this temptation. It may also be that this game is particularly rewarding for you and so you need to modify the consequences. You could decide to go to the gym with your best friend, spouse, fraternity brother or sorority sister, teammate, child, etc., and having this workout buddy will motivate you to get up and get out the door to the gym. So, by knowing the effect of this one simple antecedent, you can use two strategies to avoid making the undesirable behavior and engaging in the correct or desired response. You might also incorporate avoidance of the game time into your token economy as an extra point.
As another example, say you are trying to lose weight and discover two things in your functional assessment. First, you LOVE pizza and eat it all the time. Fortunately, it is extremely healthy and so no issue, right? Wrong. Second, you discover you eat when out with friends whether you are hungry or not. The extra calories from both of these undesired behaviors are undermining your weight loss goals and so something needs to be done. In terms of pizza, you could reduce the positive consequences of eating it by finding out how many calories a slice from your favorite pizza place has. This may serve as an abolishing operation or reducing the reinforcing value of the undesired behavior. You could also use self-instructions to remind yourself of how bad the pizza is, social support in the form of prompts from your roommate reminding you to eat healthy, goal setting, and the token economy. That is five different strategies to just deal with the pizza issue!
In terms of your friends and eating out, you could use social support again. I know. Really? Aren’t your friends part of the problem? Well, yes, they are, but if they know what your goals are, they can help you to not eat out when you are socializing with them through prompts and once you made the right decision through praise (positive reinforcer). You can also have them engage in differential reinforcement and likely DRO in terms of reinforcing the absence of the problem behavior or eating bad when out, or DRL, and allowing yourself a little bit of food. Maybe just order a half size portion or an appetizer or share a meal with a friend who is also not really hungry and possibly trying to eat healthier too. Use self-praise once you have left the restaurant and once you have engaged in the right behavior. If you did not do well, then you can implement a punishment such as overcorrection the next day or contingent exercise. You can also use a response cost within your token economy. For the second problem behavior you have about six different strategies to use.
Again, knowing what the behavior is, the antecedents causing it, and the consequences maintaining it, will help you to create what should be a highly effective and successful plan.
10.2. Selecting Strategies
Section Learning Objectives
- Choose antecedent-focused strategies to use in your behavior modification plan.
- Choose behavior-focused strategies to use in your behavior modification plan.
- Choose consequence-focused strategies to use in your behavior modification plan.
10.2.1 Antecedent-Focused Strategies
Recall that Module 7 covered the following antecedent-focused strategies:
- Goal Setting (revisited)
- Antecedent Manipulations to include:
- Creating a Cue for the Desired Behavior
- Removing a Cue for the Undesirable Behavior
- Increasing the Energy Needed to Make a Problem Behavior
- Decreasing the Energy Needed to Engage in the Desirable Behavior
- Enhancing the Motivating Properties of the Desired Behavior through an Establishing Operation
- Decreasing the Motivating Properties of the Undesired Behavior through an Abolishing Operation
- Stimulus Discrimination and Generalization
- Prompts to include verbal, gestural, modeling, and physical
- Programming
- Self-Instructions
- Self-Praise
- Social Support
Expect that you will use quite a few of these strategies. How so?
- First, goal setting is already part of your plan as you saw in Planning Sheet 3. Be sure your goals are clearly laid out and your criterion is reasonable. If you are trying to increase exercise and have a reasonable progression of frequency and duration through your goals, but jump from working out two days to three days too quickly due to a faulty criterion, your plan could fall a part or lead to a reduction in your enthusiasm for it, especially if an injury occurs. You also don’t want to stay at the current goal level too long as you might then become bored with your plan.
- Antecedent manipulations are basically a sure thing for inclusion in your plan. In fact, you will likely use several of them and can use any strategy more than once. For instance, you might find a few different ways to present the cue for the desirable behavior in your plan. Feel free to use it more than once and each use counts as an additional strategy. Think long and hard about how you can use the two motivational strategies. They will prove to be more useful than you might realize right now if used effectively.
- Generalization – If you are trying to lose weight, you will want to make sure you engage in the desirable behavior when you are at home, out with friends, at home with family, or driving to your spring break destination.
- Prompts – Used in conjunction with social support, these are excellent reminders to make the desired behavior when you are tempted to do otherwise. They are also low cost, easy to implement, and makes your social support network stakeholder(s) in the success of your plan. Think clearly about what types of prompts these individuals might use. Is a verbal prompt enough, or will they need to physically remove the bad food from in front of you? You will probably want to avoid the latter as a prompt, but your friends could model the good behavior or gesture to you by shaking their head if you are about to make the wrong choice.
- Programming – As part of generalization of the desired response beyond training situations or familiar environments, expect to use programming in conjunction with prompts.
- Self-Instructions – These can be reminders you give yourself when at the store shopping for food or post it reminders you have on the refrigerator. They can be highly useful and should be part of your plan.
- Social Support – Already mentioned and will be part of most plans.
10.2.2 Behavior-Focused Strategies
Recall that Module 8 covered the following behavior-focused strategies:
- Shaping
- Fear and Anxiety Procedures
- Relaxation Techniques
- Desensitization
- Flooding
- Modeling
- Habit Reversal
- Cognitive Behavior Modification
- Cognitive Restructuring
- Cognitive Coping Skills Training
- Acceptance Techniques
These strategies are obviously focused on the behavior itself, but if you look closer, all but shaping are really specific to a type of behavior such as reducing fear, anxiety, a bad habit, or maladaptive thought. Unless your project concerns one of these types of behavior, you can skip these strategies. You might consider cognitive behavior modification if you are trying to lose weight or get in shape. It may be that an impediment to your success is thinking that you just cannot reach your distal goal due to something wrong with yourself. Maybe you see yourself as fat and instead of motivating you to lose weight, this cognition causes you to stay in and not risk embarrassment at the gym. You would need to change this mindset to something more positive such as thinking about how the other people at the gym would be proud of you for trying and even offer encouragement. That was my experience about 20 years ago when I embarked on a plan to lose about 75 unwanted pounds. The more encouragement I received, in the form of positive reinforcers and social support, the harder I worked out. You will need to change how you see yourself and remove the fear of embarrassment and fat shaming from your mind.
Outside of a self-modification project, if you are deciding whether to use these strategies with other people, figure out if what you are trying to reduce (cognitive excess) is fear of some person, object, or situation; a bad habit such as pacing; or a maladaptive thought such as a pervasive feeling of worthlessness. If so, then choose the right group of strategies for that issue. You will still use antecedent and consequence-focused strategies as well.
The most diverse range of strategies falls under fear and anxiety procedures. Relaxation techniques are a necessary part of the other procedures so plan to learn at least one way to relax. What you decide to use after that depends. The fear hierarchy of desensitization could be useful in flooding and modeling too. Possibly of these three strategies, modeling is the least aversive since you are only watching someone else, whether through a video or live demonstration, interact with your fear-producing stimulus. The most aversive is flooding since you are thrown into the most fear and anxiety producing situation you possibly could be placed in. Systematic would likely fall in the middle with in vivo occurring next. Both strategies use a graduated approach, moving from one fear-invoking stimulus to the next, and from last to most aversive, so the person should not be overwhelmed too fast. Again, the order for the fear and anxiety procedures from least to most aversive is:
- Modeling (least)
- Systematic desensitization
- In-vivo desensitization
- Flooding
With relaxation techniques being used in them all…
For cognitive behavior modification, the functional assessment will reveal the frequency, duration, and intensity of the maladaptive thought and what form it takes (overgeneralizing, mind reading, what if?, etc.). If you can simply replace maladaptive thoughts with adaptive ones, use cognitive restructuring (see Section 8.4.2. for suggestions). If a more hands-on approach or the teaching of specific skills such as social skills, communication, or assertiveness is needed, use cognitive coping skills training. Finally, we may not be able to change the source of the maladaptive cognition and can only accept life as it is.
Some instances of when the three could be used include:
- Feeling that you are fat and ugly – replace this cognition with positive ones such as, “I am beautiful,” or “I am moving toward my goal of being healthy” via cognitive restructuring.
- Not knowing how to talk to girls – Learning social skills via cognitive coping skills training.
- Blaming yourself for the loss of a loved one – You will need to accept that there is nothing you could have done to prevent the loss and that the person is really gone, via acceptance techniques.
Finally, if you are trying to reduce an annoying habit, use habit reversal as it is. If you are trying to develop a new behavior, shaping could work.
10.2.3. Consequence-Focused Strategies
Recall that Module 9 covered the following consequence-focused strategies:
- Token economy
- Differential Reinforcement to include:
- DRA
- DRO
- DRL
- DRI
- Self-Praise
- Punishment procedures to include:
- Time Out
- Response Cost
- Overcorrection:
- Positive Practice
- Restitution
- Physical Restraint
- Guided Compliance
- Contingent Exercise
- Social Support (again)
In the grand scheme of things, these strategies are relatively easy to use. They basically orient around reinforcement or punishment procedures, and the token economy can use both. In terms of reinforcement, differential reinforcement is useful especially if others are helping you with your plan via social support. You need to decide what type of DR procedure you will use and that depends on what the unwanted behavior is and what our end goal is. For instance:
- If you are trying to increase a desired behavior and extinguish a problem behavior at the same time, use DRA. If you are just increasing a desired behavior, you are not using DRA and standalone reinforcers will work.
- If you want to eliminate a problem behavior, use DRO.
- If you want to reduce the occurrence of a behavior, not get rid of it, use DRL.
- If you want to substitute a behavior then use DRI.
See Section 9.2.2. for more specific details about differential reinforcement.
Another reinforcement strategy is to offer self-praise. These are positive reinforcers and sort of like a self-administered pat on back. These work whether you have social support for DR or not. But if you do have others helping with your plan, use DR and self-praise in your plan. These are simple strategies than can go a long way to helping you achieve success.
Punishment, or aversive control is the other way consequence-focused strategies work. You are not required to use punishment in your plan, or in the plan you use for others, but if you do, be sure you include some type of reinforcement procedure as well. How do you know which punishment procedure to use? Much like reinforcement, it depends on the unwanted behavior and your end goal as follows:
- Time Out – When we think of time-outs, we think of young children and if you are developing a plan with a child in mind, go ahead and include a time-out, if you are trying to stop something like aggressive behavior. If you are trying to help a child with time-management, a time-out will not likely be effective when they fail to respond in the desired way such as finishing an assignment early. With adults, time-outs are used but in the form of being sent home from work for poor performance or being sent to jail for antisocial and illegal behavior.
- Response Cost – This is probably the easiest and most universal punishment procedure to use and is often used in the token economy. The response cost could be a loss in a tangible, consumable, activity, or privilege and so can affect all reinforcer classes.
- Overcorrection – This procedure is useful when a person or child acts out or destroys property. You might use it if you miss a workout day but do a longer workout the next day (positive practice) or you lose your temper and destroy your friends old tv, which you now replace with a brand spanking new 4K UHD TV (restitution).
- Physical Restraint – If the behavior the person engages in is self-injurious or destructive to other people or property, this punishment procedure may be necessary. It will not likely make it into your behavior modification plan.
- Guided Compliance – Same here. You will not likely need to be physically guided to complete some desired behavior but if you are developing a plan for a child who does not clean his room, you could added guided compliance and walk the child to the room, start manipulating him to pick up his toys, and then back off and use prompts. Upon completing the chore, give the child praise.
- Contingent Exercise – commonly used in the military, you might assign yourself jumping jacks or going for a short run if you eat something you should not have and throw off your weight loss plan. If it best that you not actually enjoy the exercise you are engaging in as it could reinforce the bad behavior and not punish it, and also be sure that you, or another person, are physically able to engage in whatever the exercise is.
Finally, I already mentioned that social support and the token economy use a combination of reinforcement and punishment. For the token economy, the system is built to deliver immediate reinforcers (the tokens) that can be cashed in later for something desired (the back-up reinforcers). You can use response costs in this system (a NP) but allow for the person to get at least some of the tokens back for making good behavior (a NR). For social support, your friends, family, roommates, professor, etc. can deliver reinforcers when you do well or deliver punishers such as guided compliance, the time-out, or physical restraint if you do not comply. They can also handle response costs too.
Module Recap
Module 10 begins the process of bringing together all that you have learned in this course. In it, we discussed how to select the strategies discussed in Modules 6-9. Though we covered about 30 strategies throughout these four modules, you will not need them all in each plan. Knowing when to use them is most of the battle. The how to use them is generally straightforward except for the token economy. We covered antecedent, behavior, and consequence-focused strategies and practical guidelines for knowing when to use them was given.
With this in mind, we now to addressing potential mistakes we might make, writing rules, and then the behavioral contract in Module 11. This will give us all we need to formulate our plan in a tangible document called the Plan Proposal.
4th edition
