Behavior Modification Basics | Counselor Education Webinar and NCE Review

Hey there everybody, and welcome to this presentation on behavior modification basics. I'm your host, Dr. Donnelly Snipes. Now, as the name implies, by the time we're finished with this hour presentation, you're certainly not going to be an expert on behavior modification, but you will have an understanding of some of the very useful and interesting tools that behavior modification contributes to our counseling toolbox. So we're going to start out by defining behavior modification and exploring how behavior modification can be useful. And then we'll go on to learning the basic behavior modification terms. Now, there's a lot of terms I'm not covering today, but I'm going to hit the highlights. So why do we care? Well, behavior modification principles will help you understand some of the reasons that people act and react the way they do. And by understanding what triggers rewards as well as discourages their behavior, we are able to create a better intervention plan and relapse prevention plan. Traditional or strict behavior modification can be quite useful in simplifying the stimulus and the reaction. You look for what triggers a behavior and the behavior that is caused. It relies on a observable behaviors and doesn't get all concerned, if you will, with the inner workings like feelings and thoughts. We're really focusing on stimulus and response. Integrating the cognitive interpretations or labels can help people in identifying and assessing what causes their distress. Behaviorist would really look at the excitatory response what triggers their HPA axis. Understanding what causes feelings and reactions can also give people a greater sense of personal empowerment. They no longer feel like these feelings or these behaviors come from out of nowhere. It's like, oh, okay, this makes sense. I may not like it, but it makes sense and I can take steps to address it. Organisms learn behavior through direct and observational reinforcement and correction. So direct reinforcement is when you do something and and there is a reward that is provided. Observational is when you see somebody else do something and they get a reward and you're like, hey, I want to do that because I want that reward. One of the easiest examples to really think about is puppies. When puppies are raised in a litter, they learn appropriate behavior, if you will. And we find that a lot of puppies that were orphaned tend to have more difficulty learning appropriate behavior, playing appropriately, not biting too hard, etc. So in this example, puppy number one tackles puppy number two. Puppy number two is like, oh, that's a threat. Even if they're playing, it's like, oh no you didn't, puppy number one. Puppy number two responds by tackling puppy number one. He comes back so there's a counter threat. So both of them have their little puppy adrenaline going right now. The puppy that dominates receives a dopamine surge that reinforces the prior behaviors. He's like, I won. I want to do that again. If puppy number one plays too rough, puppy number two will either become more aggressive or leave. Either way, puppy number one is punished. So there's a, there's that boundary, there's that line where they're playing and one wins and one loses, and it's like, okay, we'll play again. But if puppy number one just continuously plays too rough, then puppy number two ain't gonna play that. He's gonna go run and hide behind mom. And that's not rewarding for puppy number one. He wants to play. It's not that he wants to dominate. He wants to play. In addition to direct and observational learning, humans learn to label certain internal experiences with feeling words. Obviously, dogs don't, puppies don't, but humans do. So we apply labels to certain sensory states that we are experiencing, like angry or scared. So fight or flee, both of those are adrenaline HPA axis oriented survival responses. And happy feels different. I mean, think about how you feel in your body, what your symptoms are when you're angry, when you're scared, when you're happy. They are fundamentally different. So let's look at some examples. Sally goes to a pet store. A puppy comes out, sits on her lap and puts its head on her leg. This contact usually creates the release of dopamine endorphins and oxytocin, which are all reward chemicals. And Sally labels this as happy. It's like, oh, this makes me happy. But what if Sally had previously had a threatening experience with a draw a dog, when she saw it, her body would be like, responding like she was back in that situation again. It would start secreting cortisol and adrenaline and kicking off the fight orf flight reaction. Even if it is a puppy, you know, maybe she is generalized to that extent that any dog is just terrifying her. And she would label that as fear. Each day we encounter things that we label as either benign or anxiety provoking or anger provoking or, you know, something else. We have feelings we may not intentionally think about, oh, that made me feel xyz. But we're labeling it, and as we label it, it gets filed, if you will, into those particular memory banks. It's important to remember, though, that context is key. The stimuli that are involved are important. You can have an excitatory response and label it fear or anger or Exhilaration. Let's look at this. Sally goes on a roller coaster at the amusement park. If you've been on a roller coaster, you know that your innate brain, you start going down that, that hill even though you're strapped in at however fast you're going, really stinking fast, it's terrifying. But some people label that as exhilaration, other people label it as terror. But I digress. Sally, later on another day, is driving on icy roads and starts skidding out of control. Now we still have this same sort of freefall thing going on. It's a similar sort of situation. Both trigger the stress response. But on the roller coaster, Sally's getting on it and she feels safe and she feels like, okay, the tracks are there, the harness is there, the person operating this is, is trained, it's been inspected. I feel safe. So even though she has that innate stress response, when they're going down that hill or going upside down, which is not what humans are supposed to do, she doesn't feel a, a bad terror, if you will. She may feel terror, but she labels it as exhilaration. And it's hard for me to kind of explain that. But if you've been on a roller coaster, you know, it's not terror like, oh my gosh, I never want to do that again. It's like, oh, what a rush. If she is skidding out of control when she's driving, on the other hand, there are no tracks, there are no harnesses. Well, she's got that little seat belt. But you don't feel very safe when you're skidding out of control on an icy road and you feel unsafe and disempowered and out of control that she labels as terror. So it's important to recognize that both of those situations are going to trigger a very similar physiological response. But because of the stimuli involved, because the other factors, the context, one is labeled exhilaration and the other is labeled terror. So some summary points here. The HPA act axis, our stress response system, can be interpreted as euphoria or terror based on the circumstances. Stimuli associated with the situation will be encoded with that ensigned label. So think about when she's skidding on that icy road. Think about all the stimuli associated with that event she was driving. In the future after this event, she may be like, I'm not really sure I want to drive again. Or the car, maybe in a car with snow tires and four wheel drive, she feels very comfortable. But in a car that doesn't have those things, she doesn't so she learned that if you're driving on an icy road without these things dangerous, the speed. Maybe in the future when she's driving on icy roads, she ain't going to go more than 10 miles an hour or the ice. She sees ice and she thinks about having to go out driving on it and it triggers that anxiety, it triggers that fear. So all of those things are associated with that. And potentially even the place, wherever it happened, when she drives past it, that memory is going to be triggered. So we do need to recognize that there are a lot of stimuli associated with events. And those stimuli can be present in non threatening or different situations. You can have ice in other situations where it's not terrifying. But it's important to recognize all of the things that may trigger that memory to come to the forefront and go, sally, you know, you really don't want to do that again. Okay, so let's talk about some more basic terms. Stimuli and responses can be traced back to survival. The fight, flee, forget, or even repeat. And I know there's other Fs in the stress response, but what I want you to recognize is that when we have this response, it triggers a desire to survive. And if it, whatever we're doing is trying to survive, we're fighting or fleeing and it's successful, okay, that'll be rewarded. Wonderful. If what we're doing is positive and it's triggering euphoric emotions, then our brain is also going to say, hey, I want to do that again too. So repeat is the, what I call the dopamine circuit, where the body says, whatever you just did, it was beneficial. Let's do that more. In behaviorism, we also have things called unconditioned stimuli and responses. And these are stimuli and responses that are in our innate brain. They are present since birth. You'll see them in infants who've never had an experience with it, as well as potentially older people. Something that evokes an unconditioned or automatic response, like loud noises, pain, excessive cold or heat, or contact. Now some of these can be conditioned later in life, so they don't necessarily evoke the same response. But initially these things like contact, when a, when a child contacts their caregiver, it produces a rewarding sense. The child is often calmed down. The child often feels more safe. You know, think about, children tend to feel better or more secure when they're swaddled. That contact, that sense of security, is helpful. If that contact becomes associated with pain, then it's going to evoke a completely different response. But we need to recognize that some things are normal or, or what shall I say, ingrained in our psyche to elicit certain responses. Loud noises, you hear them and you're probably going to startle and you're probably going to orient towards that loud noise to go, is that a threat? Was that a threat? Now it may not terrify you, but most people when they hear a loud noise are going to be like, wonder what that was. Now conditioned stimuli are things that in and of themselves have no meaning to a person. If you show it to an infant or a 2 year old, they're just going to be like whatever. Yellow lights are examples of that. A child has no use or no understanding of stop lights or driving for that matter. So when they see a yellow light, they have no idea what that means. But as you get older, even if you're not driving, you see when there's a yellow light, your whoever's driving, your caregiver, your bus driver will slow down and come to a stop, hopefully. So that stimulus becomes conditioned. By the time you start driving, you know that yellow light means hopefully. You're supposed to slow down. And I keep saying hopefully because some people see a yellow light and they gun it. But that's a whole different issue. The conditioned response is the person's reaction to the stimulus that has been rewarded in the past. So if they've seen their caregiver see a yellow light and slow and stop and everybody was safe, and that's the thing to do well, then they're going to do that. If they've seen their caregiver see, see a yellow light and floor it so they don't have to sit at the red light and it's been successful, then they're more likely to do it. If they've been in an experience where their caregiver has run the yellow light and gotten a ticket or gotten into an accident, then that might punish that behavior and make it less likely to occur. We need to understand that stimuli end up having meanings to them even if we don't try to assign them. Discriminative stimuli are stimuli that trigger a reaction. They're things that set the occasion. Discriminative stimuli in your environment can tell you you're safe. It can trigger the relaxation response. Other stimuli, stop signs, trigger stopping bills. Most of us have a gut response when we see bills, but we also have the response of paying them. If somebody says to you we need to talk, most of us have a pretty guttural reaction there because very rarely does something positive happen. When somebody says we need to talk. And then there's particular non verbals. And I know my mother had some and I think we all have certain non verbals that telegraph what we're feeling or what we're thinking or maybe thinking. And those things can set the occasion. They can be conditioned. You, you learn. I learned from a very young age when my mother had certain looks on her face, I was in deep doo doo. And I learned that I needed to get it together and, and prepare for a talk. Other non verbals maybe. I know I have a lot of non verbals. I, I don't have a good poker face. One reason I don't play poker. But if I've done something wrong, you can read it all over my face. My boss used to say I was an open book because I'd go into his office and he could see it on my face. He's like, what did you do and how you going to fix it? But we need to recognize that those nonverbals can be generalized to other people. So when, when my husband makes the same face movements non verbals that my mother used to make when she was angry, I have that initial guttural response. He may not mean the same thing, but it's important to recognize that we may project based on our past experiences, based on our schema. When we saw that non verbal it meant this. So in the present, if we're just on autopilot and we're not considering the context and the time and the person and all that stuff, we see that non verbal, we assume that it's going to mean the same thing it meant 40 years ago. Which takes us to generalization. When people have a, an experience, whether it is extremely positive or extremely negative or painful, we tend to generalize. Instead of saying this particular situation at this particular time was unpleasant, it, it becomes much more global than that. And that is our brain's way of protecting us. Instead of saying it was this particular dog that got lost on this particular day and, and it had been beaten by its owners or something. So it already had a fear of humans. You know, that's a very specific situation. However, a lot of times we don't know what caused certain behaviors or reactions from other organisms. So we generalize because we're not sure which ones are going to respond with anger and which ones are going to respond positively. So someone may have a bad interaction with a dog and start believing all dogs are dangerous or all particular type of dog. I'm not going to name them because don't want to pathologize any particular type of dog. But all types of dogs are dangerous. And it's important for us as clinicians to help people examine that overgeneralization and say, okay, are there any exceptions to that? Have you ever met a dog that wasn't dangerous? Do you have any exceptions or examples of dogs who haven't been dangerous? So finding an exception can help address that cognitive distortion, other generalizations, or overgeneralizations. If you've been betrayed by people, one person or more, more than one person, you may start to believe that nobody can be trusted. That's an overgeneralization. So it's important to look for the exceptions. Are there examples of people who can be trusted and what is different about them compared to the people who can't be trusted? So let's look at what's similar and what's different between the two so you can start discriminating. And learned helplessness leaves a person to feel that no matter what they do, they are going to be unsafe or in pain. And a lot of people who come to counseling have gotten to that point where they're right on the verge of feeling helpless and hopeless because they feel like they've tried, quote, everything. Learned helplessness is a response that occurs when people have tried and failed. And Seligman didn't activity or experiment about this. I think it was in the early 70s, and it was a horrible, horrible, awful experiment where he had a dog, and he put the dog in this room with a divider and on. When the dog was on one side of the room or one side of the divider, he would electrify the floor, shock the dog. The dog would jump over and be like, oh, relief. Okay, it's all good. As soon as the dog would start to relax, he'd electrify the other side and shock the dog. The dog would jump back over. Eventually, he kept both sides electrified, so whichever side the dog was on, he couldn't get any relief. So the dog eventually just laid down and took it. And that is awful, that barbaric. However, think about yourself as that dog. Have you ever been in a situation where you made a change and you were. You thought it was going to work, and then it wasn't working, so you went back and that wasn't working. And no matter what you did, it didn't feel like it helped reduce your pain or your distress. So eventually you gave up. You felt powerless to change, and you just laid down. Fight or flee is. Or our stress response is part of our survival response. It's very Innate stimuli that present a threat of pain or death can trigger the excitatory fight or flight response. It's important that we help people recognize when they're in fight or flee. They're not in. Think about it, they're not in their wise mind. They're in just autopilot, get me out of here sort of mindset. It's really helpful for people in those situations to identify the threat and if it's actually a threat in that context at that time. So if something happens, it triggers their stress response. It's like, okay, am I safe? Am I, Is there an imminent threat to my health and well being? If there is, well, then get the heck out of there. If there isn't. And a lot of times the person will recognize, okay, it's not imminent, okay, so then engage in distress tolerance skills if the person is not in imminent danger, encouraging them to engage their distress tolerance skills so they can get into their wise mind, so they can think using their executive functioning, they can think more clearly about the best response to that situation at that time. And encourage them, once they're in their wise mind, instead of looking at that situation globally, explore what aspects of the situation were controllable. Maybe going into this meeting where they completely lost their temper and blew up at the boss, not a good thing. Maybe leading up to that, they hadn't, they hadn't slept well and they got up late and they skipped breakfast. So they were hungry, they were tired, they were already frazzled. So those were all vulnerabilities that they could have mitigated prior to going into that meeting, or they could have recognized going into that meeting. Hey, I've got a short fuse today. I need to figure out which tools I can use in order to keep a lid on it, if you will. Recognizing they're more. More vulnerable and taking steps and recognizing what responses they had at their disposal. Obviously blowing up at the boss was one, but what other responses did they have at their disposal? Maybe writing down their thoughts when they got angry and setting a meeting with the boss afterwards. There are a variety of different responses, but we want to encourage people to, when they're in their wise mind, to reflect on what were my options in this particular situation. That way, when they encounter that situation in the future, they feel more empowered. They feel like they've got more resources to deal with and they need to explore what parts of the situation were uncontrollable. And that's things like other people's behavior. Somebody cuts you off in traffic, what can you control? What can't you control, you can't keep them from cutting other people off. You can't control their behavior. You can control yours. Mindfulness can help people identify positive stimuli that they can add to their environment or even notice in their environment. Those positive stimuli increase dopamine, increase serotonin, increase endorphins, and that helps people feel happy or what we generally call happy negative stimuli. These are stimuli that produce a feeling of fear or disempowerment or unsafeness. And that triggers the fight or flight response. It triggers cortisol, it triggers, triggers adrenaline and that fight or flight. It's important to remember though that and, and we're going to talk about this when we get to chaining. Negative stimuli build up. They are additive. So when people have a lot of little things happen throughout the day, they can have one big explosion at the end and then they're like, that situation did not warrant that level of reaction. Where did that come from? And it was the stress of the entire day building up like a pressure cooker. And then finally the top just blew off. Stimuli that trigger a negative reaction can be reconditioned as neutral or manageable by helping people embrace their dialectics or find the positive with the negative. It's not ignoring the negative necessarily. So a snowy day. I mentioned earlier about driving on icy roads. Had some bad experiences. Don't plan to do it here in Tennessee. Thankfully we don't get snow that often. So when I see snow, it's like, okay, well I'm housebound for today, or at least until the snow clears off. But you know, I can go play in the snow, I can go watch the birds in the snow, I can take pictures because I love what the snow looks like or my favorite dog hair. We have lots of animals here on the farm. Some animals, they're supposed to be outside, come inside, it gets dirty. And it seems like it's a never ending battle against dog hair. And that drives me nuts. It drives me nuts to have dusty or not pristinely clean surfaces. But my animals mean the world to me and I would not want to not have them. They bring so much joy and meaning to my life. So I embrace the dog hair because if I didn't have the dog hair, it means I wouldn't have the dogs and that would be devastating to me. We can also encourage people to be psychologically flexible and recognize what is worth their energy. Is using my energy to get upset about this going to help me move toward my rich and meaningful life, or is it going to steal energy? I Could use to move toward my rich and meaningful life and make me actually move backwards, make me move further away from being the person I want to be. And we can encourage them to use distress tolerance skills because sometimes stimuli that trigger a negative reaction are freaking unpleasant and there's no sense sugarcoating them. Getting a shot, for example, not somebody's favorite thing to do. However, the feeling, the anxiety, the anger, whatever that feeling is, it doesn't have to feel overpowering. Using those distress tolerance skills, people can develop the sense that while it's unpleasant, those feelings are not going to destroy them. They're not going to overtake them. So it doesn't make it completely neutral, but it makes it so it doesn't feel so overwhelming and overpowering. I encourage people to add not and notice positive stimuli in the environment. This goes along with mindfulness. But when we feel safe and empowered and happy, we tend to, we tend to be a lot more buffered against stress. We're not as vulnerable to distress. So I encourage people to include in their environment safety triggers. When you look around your environment, is there anything that makes you feel unsafe? If so, what can you do to make yourself safe? Feel safe. Like at night, if it makes you feel unsafe having your blinds wide open, pull the blinds down so you're looking around. And the safety trigger is, nobody can see in here. Nobody can see me walking around. I'm safe. Empowerment triggers. I encourage people to have triggers that they can look at every day and go, you know what? I've got power. I am not powerless. A rich and meaningful life collage. And I've talked about that in other videos, but basically a collage that shows all of the things, people, experiences that are important in your rich and meaningful life that you can look at and go, yeah, I've got that, I've got that, I've got that. Still working on that. But it helps people balance the distress with the positive. Or something I call a power tree. And it is a modification of the gratitude tree. Instead of making each leaf represent something you're grateful for having, each leaf represents something that you have control or power over. And a lot of times that can help people start feeling safer in their environment. And then just plain old happiness triggers. Sights, smells, sounds and things that you can feel that make you feel happy, that trigger happy memories or that cause that rush of endorphins. Smells for me. Honeysuckle, but jasmine, pumpkin spice. I know, so cliche. But those are are pleasant smells for me. So those trigger happiness. Sights, wildlife, my kids. Sounds a babbling brook or I don't know, that's birds singing. There are a lot of different sounds that I could probably think of if I weren't on the spot right now. And then feel and I have here a crisp autumn breeze. I love the smell and the feel of the breeze. Not heavy duty wind, but the breeze in the fall. So that's one of those things. I like the feeling of sun on my skin when I walk outside and I feel the warmth of the sun. I like that feeling and it makes me happy. I like the feeling of certain types of material. So I try to look for those types of material and those textures when I shop for clothing. How can you use discriminative stimuli things in your environment to increase your feeling of control and self efficacy? How can you have clients do the same thing? Put stimuli in their environment to remind them that they're safe, that they're empowered and that they can do this. That they so they have a can do attitude. How can you use discriminative stimuli in your environment to increase self esteem, to remind you that you're lovable and to decrease angry responses? To remind you to use coping or distress tolerance skills. Maybe it's adding a poster or having something on somebody's mobile device. Something. A lot of times it's helpful if it's a visual stimulus that reminds a person to use particular tools when they are feeling distressed. If you're a caregiver, you know one of those discriminative stimuli can be a particular non verbal like if your child starts becoming extremely angry. If you have, if you raise, raise your hand up like this or number one or whatever you want to do. That is a stimulus that you can pair to trigger that person to use their distress tolerance skills. New terms. Positive reinforcement. Oh, I get so irritable when I watch tv. And they talk about reinforcement and punishment incorrectly and we'll get there in a second. Positive reinforcement means providing something positive in order to increase the likelihood a behavior will occur again. So think of positive as additive examples. Touch, giving somebody a hug or a pat on the back. Gifts like food or money. Think paycheck. Words of affirmation. Just being kind to someone or at work, giving them a promotion or giving them an award. Acts of service, doing something nice for somebody, something helpful and then quality time. So positive reinforcement, and I know this is no surprise, can be grounded in the five love languages. We want to recognize that what is reinforcing, what is rewarding to you may not be rewarding to somebody else. So we need to Recognize or. And use the reinforcers, the rewards that are reinforcing to. To that person so that person feels rewarded when. When that ha. Whenever they get the. The reinforcement. So what can be added that is rewarding and helpful for that person? So we need to think about that. I know both of my children were very, very different. And what my daughter found rewarding, my son, not so much. So it was important to tailor our rewards, our punishments, et cetera, to the particular child. Negative reinforcement, and this is the one people misuse so often. Negative reinforcement is still reinforcement. Reinforcement always increases the likelihood of a behavior. Negative thinks, subtraction. Negative reinforcement removes something unpleasant in order to increase the likelihood a behavior will occur again. So people come to therapy. Why do they do that? Well, theoretically, because they want to reduce nagging and fighting between themselves. So they come to therapy to eliminate that distressful thing. People may comply with their probation and parole requirements in order to get restitution or additional charges dropped. So if they do this, then we'll take away this other punishment. Or for children, very simply, you can leave the table and go back to playing once your vegetables are eaten, so you can remove that unpleasant thing of having to sit at the table with the family once your vegetables are eaten. So for negative reinforcement, what can be eliminated for that person that they would consider rewarding and helpful? What is it that we can take away? If you get all A's on your report card, then you don't have to do your chores for a month. There are a lot of different ways we can motivate people through positive or negative reinforcement. And generally that's preferred to punishment. Generally, we want to reward, reinforce, redirect to positive, alternative behaviors instead of just trying to eliminate a behavior, which takes us to positive punishment. Remember, positive means additive. So you're adding a punishment, you add something negative to decrease the likelihood that the behavior will reoccur. In substance abuse treatment, ant abuse. If somebody takes ant abuse when they drink, it increases the likelihood they are going to get stinking sick. And that unpleasant feeling keeps them from wanting to drink again. If children misbehave, a positive punishment is additional chores. All right, you acted out at the store with, with my son, it was always going out. We, We've always lived on a farm, going out and picking up sticks that have fallen so the mower doesn't run over them and, and mess up the mower blade. And, and my son hated that. So that was a great positive punishment for him. And, and usually was pretty effective. Additional sessions. If somebody's in court ordered treatment and they are not participating actively, then you may add additional sessions to, to their, to their treatment plan in order to ensure the proper treatment outcome. And then another one that I personally don't like, but I know a lot of people do use is rubber band snaps when somebody is having ruminations or when they are having thoughts of self harm. For example, they may snap a rubber band on their wrist and that is unpleasant. One of the reasons I don't like it is because it's really hard for us to intentionally cause harm to ourself. So people often don't snap that rubber band with enough fervor to really have a strong effect. I also don't like the like it because I just don't like causing injury, causing extreme pain. So. But that's my personal preference. Some people really like that particular intervention. So think about if somebody is making a mistake, if somebody's doing something you don't want them to do, or if they're doing something that they don't want to do. What can they add that would be considered unpleasant enough that they would think twice before engaging in the behavior? For example, if they do something that they don't want to do, they engage in a habit they don't want to engage in and they recognize it, then they have to stop and do a hundred push ups. That's pretty unpleasant. Negative punishment. And again you're like, well, all punishment is negative. What we're talking about here is taking away, subtracting. So negative punishment means taking away something positive to decrease the likelihood of behavior will reoccurring. So you can take away somebody's freedom, you can take away somebody's money, you can take away their relationship or even set boundaries to stop a behavior. You can say, all right, and this is where that tough love comes in. I love you and I want to be supportive of you. However, I will not reward that behavior. I will not rescue you and enable that behavior. I'm going to set my boundaries here. This is what I will do, this is what I won't do. And so that removes that enabling behavior and you can remove people's control or their power. And this is more, is more true with children in particular, where it's like, okay, you don't have a choice about this anymore, you have to do it. So thinking again, in terms of punishments, what could be eliminated that we would be considered unpleasant? What can, what can you eliminate that would be punishing? And, and I already covered most of them. Freedom, money, relationships, control and power. You know, when kids get Grounded. They're not allowed to use the phone. Well, you're cutting off their lifeline to. To their friends. I guess it's more complex than that now with the Internet, but I. I digress. It's also important to remember you can't just eliminate a behavior. If you just eliminate behaviors, eventually you've got this organism, child, puppy, cat, whatever. You've got this organism that's afraid to do anything. So they just sit there. They're like, I'm afraid if I do anything that I'm going to get punished. Which is why it's often better to reward and redirect. What are they going to do instead? If they're not going to drink alcohol, what are they going to do instead? If they're not going to scream and throw a temper tantrum, what are they going to do instead? The more rewards that can be gained, the stronger the motivation to repeat the behavior. And I did a video on the five different types of motivation. Physical, how does it make you feel physically better, Give you more energy, less pain? Affectively, how does it make you feel better? Emotionally, Mentally, how does it make you feel better? Cognitively, help you make better decisions? Environmentally, how does it improve whatever you're getting ready to do? How does it improve your environment? How will it make it a calmer, more relaxing, more peaceful place to be? And relationally, how does whatever you're getting ready to do improve your relationships? So when you look at those dimensions of motivation, you say, okay, let's look not just at the new behavior and try to convince ourselves why we want to do that, but let's look at the old behavior. We need to understand what was motivating and maintaining the current behavior because there were rewards. You don't do something unless it's rewarding, unless it's reinforcing. So we need to examine what was the benefit to the old behavior or the current behavior that you want to change? We need to address these things and make them less rewarding. What were the drawbacks to the current behavior? You know, why do you want to change? All right, put that in there. And then we need to look at the new behavior and then say, what are the benefits of change? What are the benefits of this new behavior? And then we need to look at the drawbacks. What might be a problem or about this new behavior, Maybe it increases your anxiety. Maybe you will experience rejection. What are some of the potential drawbacks? And we need to plan for that and minimize those drawbacks or plan on ways to deal with them if they occur. Social Withdrawal is a perfect example. We see this in a lot of different mental health diagnoses. Social withdrawal is rewarding mainly due to negative reinforcement. It eliminates the unpleasant. It eliminates the extra stress of having to be around people and try to read them and interpret what. What's going on. If I don't engage with other people, if I withdraw, then I'm not going to disappoint anybody. I'm not going to be rejected. Gives me more time with my cats, and I'm not going to burden anybody else. So these are the behaviors to social or these are the benefits to social withdrawal. The drawbacks? Well, when I'm socially withdrawn, I do feel isolated, but that feeling of ISO. Isolation and is not nearly as powerful as the fear of rejection and the. And the anxiety that goes along with being around other people. So then we move over to this new behavior. Okay, so maybe I want to get over the social withdrawal and start developing social supports that would feel. We'll just go to the drawbacks first. That may feel really terrifying. I'm afraid I'll feel needy. I'm afraid not everybody is going to understand my rejection sensitivity. And I'm afraid that I will be rejected or disappointed by some people. And guess what? That's a real possibility because ain't nobody going to be liked by everybody all the time. So in, in treatment, you know, what I would do is sit down with people and I'd say, okay, let's look at those drawbacks. Those are, you know, very realistic fears. How, what, what's your plan for how to deal with them? And we need to talk about what each one of those things mean. And then examining the benefits of the new behavior. The benefits of social support. Well, they may be able to help me buffer against stress. If I had somebody I could talk to, it may help increase positive neurotransmitters because I'm getting interaction and oxytocin and maybe it can even help me achieve my work goals because I can connect with people who can help me succeed. I don't know. Just brainstorming, but this is an activity you can do with clients to explore the benefits and drawbacks and help identify punishments and reinforcers. We want to increase those reinforcers. Identify anything that might end up being punishing or painful and figure out how to address it. We may not be able to eliminate it, but how can we address it so it's less painful, less punishing? Emotional eating. Another example benefits of emotional eating. If you love food, it can be comforting because it releases dopamine. And endorphins and serotonin. And it's easily available, it's socially accepted. You know, there's a lot of benefits, if you will, drawbacks. The person may say, well, when I emotionally eat, I gain more weight, I feel bloated, the problem is still there. Even though I may feel better for a minute, if I eat late at night, it disrupts my sleep. And then I start getting embarrassed to eat in front of other people. Okay, those are clearly drawbacks. But obviously those drawbacks again aren't powerful enough to stop the behavior right now. So we need to figure out how can we make stopping emotional eating more rewarding, more powerful new mindfulness behaviors. Well, the benefits, if I start becoming more mindful in my eating, then I will start to learn how to eat when I'm hungry. I can enjoy my food when I eat instead of just wolfing it down. I can learn how to identify the underlying problem and start to address it. And I can start to break bad habits. The drawbacks to these mindfulness behaviors, they're not as satisfying. If I really want to eat, if I really want to eat that pain, eat that emotion, then it may feel very frustrating to not be able to do that, to not allow myself to do that. So we need to explore, what are you going to do instead? You know, being mindful is one thing, but you've also got to figure out the food was helping promote feelings of positivity and relaxation. So what could you do instead of eating to promote those feelings of positivity and relaxation in addition to being mindful? Behavior strain is the point at which the reinforcement or punishment is no longer effective. This is impacted by age, cognitive development, and the strength of the reinforcement or punishment. So if you give a two year old a task and you say, if you complete that task, then at the end of the week I will give you a reward. That ain't going to cut it. Two year olds need rewards a lot more frequently. They need rewards at least daily in order to maintain that behavior because they they'll undergo behavior strain. Now, a 12 year old, on the other hand, you can say, if you do all your chores this week, then at the end of the week I will give you your allowance. That is generally a reasonable period of time. As adults we go to work and same thing for our paychecks. If we had to wait three months to get paid, we may not be real motivated to go into work. But if we know we're going to get paid every week or every other week, then that we know that reinforcement is there and we get that paycheck and we're like, all right, this is why I'm doing this. Smaller, more frequent rewards for completion of smaller goals are important. So provide rapid benefits. If you have incremental goals, baby steps, whatever you want to call them, then the person achieves that goal, gets a reward, gets a little dopamine and endorphin rush, increases the motivation. They're ready to try the next thing. Rapid cycle change. An extinction burst is a temporary increase in a behavior when rewards are absent or insufficient. So think about a child in a store that sees candy they want and they're like, oh, I want that candy. And the caregiver says, no, you can't have the candy. And the child gets louder, I want it. The caregiver says no. And the child starts throwing an all out tantrum in order to get the candy. Why I want the candy? Well, that's the extinction burst. At this point, the reward of the candy is sufficient to balance out the effort that's being exerted to get that candy. But at a certain point, the candy ain't going to be worth the effort. It's like that. Okay, fine, you win. But if you reward the extinction burst, if you, you reward the increase in behavior, then the organism, the child, learns that, hey, all I've got to do is throw a big enough tantrum and, and I'll get my own way. So the oftentimes we see an extinction burst before we start to see compliance. The behavior ceases when the demands or cost of the behavior exceed the potential reward. So if somebody is at a job and they are working their butt off because they want to get a promotion and they keep getting passed over for that promotion, at a certain point the person's not going to work as hard because it's like, well, I'm not going to get my goal, so why should I? There's no motivation. Same thing if the, whatever the person's doing to feel better or, or get their way at a certain point, the effort isn't worth it. It's like, fine, you can have your own way. It's just not worth me putting any more effort into it. The primac principle. Love this one. It means contingently pairing something undesirable with something desirable. Like folding laundry with watching television. You can't watch television unless you're folding laundry or all the laundry is done. Exercise with socialization or work with coffee. You know, you can't have the positive unless you're doing the negative. Behavior substitution or response prevention Is another key feature. If somebody is, for example, mindlessly eating, one of the interventions can be to help them do something that is incompatible with mindless eating. So if they tend to snack and munch while they're cooking or preparing food, encouraging them to chew gum, because you're generally not going to eat and chew gum at the same time, that's kind of nasty. Or if they tend to eat while they watch television, that may be one of those things where they need something to do with their hands. They can crochet, they can do a crossword puzzle, they can play a video game, whatever it is that may keep their hands busy. They can pet their cat. Smoking is another example. Keeping the cigarettes out of the house so it's harder to access. They can't just roll over to their bedside table and grab that pack of cigarettes. As soon as they wake up, it's out in the car. So they've actually got to get dressed and go outside and get it out of the car if they want the cigarette that bad. And then again, chewing gum, a lot of people are not going to chew gum and smoke at the same time. So that can also be an incompatible response. Chaining. Linehan talks a lot about chaining and, and I think it's important to think about and chaining is a cascade effect leading to a behavior. Backward chaining occurs after an event and you scratch your head and you're like, wow, how did I get here? After somebody relapses, for example, backward chaining. To look at what led up to this, it didn't come from out of the blue. What led up to this that you were not mindful of. That way people can learn and they can become more mindful and it doesn't sneak up on them. Again, forward chaining is similar, but it asks, how can I get there? I'm here, I know I want to be there, so what steps do I need to take in order to get there? Behavior, stimuli, reinforcements and punishments all can combine to lead up to a positive or negative result. So can lead up to a positive goal or removing something. Chaining to understand responses. So in example number one, car problems, you sleep well, having a great day, you get up on time, you get ready for work, eat breakfast, start driving to work, and the car breaks down, you get irritated, it's like, ah, crap. And you call for assistance. Okay, it's a Tuesday. Or same, same example, but this time you didn't sleep well, you got up late, you got ready for work, you started eating breakfast, spilled coffee on your shirt, you had to change. Now you're running late, you start driving to work and the car breaks down. Now you're already like wound up before the car even breaks down. And you dysregulate, you get infuriated and can't think straight, can't figure out, okay, how do I solve this problem? Now example number two, a panic attack. Again, you didn't sleep well, you got up, you drank two cups of coffee, you got stuck in traffic, driving to work, now you're going to be late, have a panic attack. So all of those things added up, any one of those things independently may not have caused the problem, but all of those things together added up to triggering a panic attack. Or example three, habit things on autopilot, like making coffee in the morning. Do you really think about it when you get up in the morning, you roll out of bed, you're like, okay, well should I make coffee? Or do you just kind of stagger into the kitchen and make it? That's a habit. So you want to look at, what could you do to interrupt that behavior between the time you wake up in the morning and the time you make coffee to actually start thinking mindfully about what do you want to do? Smoking is another one. And smoking is not just a habit. I'm not saying that, but there is a habitual component in that. I know my mother was a heavy smoker and she used to do that. She'd wake up, alarm would go off, she'd turn it off, she'd grab her cigarettes and light up. That's just. She didn't think, she just acted and putting space between waking up and those cigarettes. She started putting the cigarettes in the kitchen. She was. She started cutting back on how quickly she lit up her first cigarette of the day. And then eating. When you get home while watching television in the car, a lot of different environments can become associated with stimuli, can be associated with eating. And so it may be important to evaluate what things triggered my desire to eat and then try to address those triggers by either reconditioning them or eliminating them. Them we can chain to learn new behaviors like a mouse and lots of experiments with mice. When you do an experiment with animals, unfortunately they have to be hungry. And that is one of the preeminent characteristics. We don't cause them pain anymore, thankfully, or at least hopefully not. I don't want to know if we do. But you start out with an animal that's hungry, that's food motivated. So this hungry mouse is put into the maze. The mouse smells the cheese. That smell Is the stimulus. The mouse is like, oh, I'm hungry. I smell cheese. I'm all over it. So the mouse seeks out the cheese. He turns right and there's a corridor. The cheese smell gets stronger. That's rewarding where he's going. He's like, okay, it's stronger. That means I'm getting closer. I'm going to keep doing this moves toward the smell, and he keeps repeating this process until he gets the cheese. That's the big reward. And that pretty much guarantees that if you put him in that maze again, he's going to start looking for that cheese. But what if four out of five times that mouse was when he was in the maze, Four out of five times he turned left, he ran into a wall. Well, what do you think is going to happen? You're probably going to end up with a mouse that refuses to turn left. He's going to turn right and turn right again, and turn right again looking for that cheese. And we need to recognize that when people have tried therapy multiple times, for example, and it's failed, then they may not be motivated to try again. They may turn in a different direction because they're like, every time I turn towards therapy, it doesn't work. So we do need to recognize the motivations for behaviors and the reasons people may resist certain behaviors. Shaping means rewarding the successive approximations of the target behavior, punishing or ignoring non target behaviors, and ignoring if negative attention is better than no attention. So it's important to remember when we're shaping behaviors, we don't want to reward the inappropriate behavior. We want to only reward the target behavior. So if somebody engages in the inappropriate behavior, we want to ignore that instead of providing it attention. Because again, negative attention is often better than no attention. When you shape, you want to solidify gains and then increase the. Increase the challenge. So think about tying your shoes. When you're teaching a child how to tie their shoes, initially you just want them to watch. And if they watch, it's like, great, wonderful, thank you for watching. And then you want them to try to do it. And if they can get the lace is crossed, you know, that's a start. All right, good job. So we're rewarding that. And then we may have to take over. Then the next time we want them to cross the laces and tuck it under and tie it, okay, we reward that. Once they're able to regularly do that successfully, we say, okay, now what is the next thing? In order to get the reward now you've got to make the Rabbit ear. And then once they can do that reliably, now the. The rabbit has to go around the tree or whatever analogy you use. But shaping means looking for progress, scaffolding, gradual movement toward successful completion of the behavior. Maybe they can't do the thing from beginning to end all by themselves the first time, or maybe even the first 10 times, that's fine. Let them do what they can and then help them after that. And then encourage them to do a little bit more the next time and a little bit more the next time. So our dog, Brewster, he's a boxer. He's about 85 pounds. When he meets me at the door, he is so excited, and that's often not helpful. So ideally, I want him to meet me at the door quietly and sitting down. Target behavior one, If I can just get into the. Into the room, into the house without him jumping on me, you know, that would make me really happy. Once I get to that point where I can reliably get into the house and he doesn't jump on me, then I want to get into the house, him not jump on me, and he sits on command. So I walk in, I open the door, and I say, sit. And he does it. Oh, my gosh, how wonderful would that be? And Then Target Behavior 3 is sitting when I walk in without a command. So he learns eventually that when he sees me coming up the walkway, he should come to the front door. That's fine. Sit down and quietly wait for me to open the door. So that would be successive approximations. In emotional disregulation. We see a lot of people struggle with managing that, and it is not an easy issue to manage. So again, let's look at some steps that we might take. First step, new behavior one, the person dysregulates. All right, it happened later. Once they get into their wise mind, recognize the behavior, what happened. Reflect on the causes, the vulnerabilities, the triggers, and explore that using chaining, you know, what happened, what stimuli were in the environment, what happened leading up to this dysregulation. Help them understand where that came from. All right? So they're gaining an understanding. That's good. New behavior, too. Once they start to really recognize when they're dysregulating and when they might be prone to dysregulate. Encourage them to recognize the behavior in the moment. Use distress tolerance skills. Once they get into their wise mining, reflect on the causes. So now, instead of waiting until sometime later, we're encouraging them to recognize the behavior and take action. And new behavior three, Begin practicing mindfulness, noticing and responding to vulnerabilities that may make you more likely to dysregulate. So now we're not just reacting after we we dysregulate, we are trying to prevent dysregulation. So we're gradually building new skills and cutting behavior. And this is oversimplified for time. Target behavior 1 harm reduction. We don't want people engaging in self harm, so we look at giving them ice cubes to hold. Those are not pleasant, but it serves a similar purpose. Or an ink pen. I've had success with that. Where a person has been able to use an ink pen to draw on themselves, they're not actually breaking the skin, they're not actually causing physical harm to themselves. Target behavior number two, once they are reliably not injuring themselves, finding an alternate self, soothing behavior, not a replacement. So something more productive or more proactive than the ice cube or the ink pen. What can you do to self soothe to help you feel better? People with addiction or mood disorders may benefit from reconditioning stimuli, recognizing that it's not actually a threat in this context at this time and or it's more harmful than helpful in this context at this time. So sometimes things we want to recondition, it's things people are doing like drinking alcohol and they recognize, you know what, maybe that's not all it's cracked up to be. We can help people relabel the state, become more mindful and recognize the state. Instead of eating in response to stress, in response to boredom, in response to being tired before they eat, being able to recognize and relabel the states and say, okay, am I hungry, yes or no? And if no, then what am I feeling? Unhooking. Recognizing that the stimulus X is causing them to have a feeling. But that doesn't mean that it is fact. So examining is this feeling accurate in this context at this time? I'm feeling anxious. So is it accurate to say that there is a threat to me in this context at this time? And behavior substitution, it's remember, we definitely want to replace behaviors, not just eliminate them. So if somebody is not going to smoke or eat or drink or yell, what are they going to do instead? Relapse may be the result of behavior strain. Either the goal takes too long to achieve before they get a reward, or the goal doesn't have successive approximations or baby steps. It's just too overwhelming. Or the new rewards aren't sufficiently rewarding for that person. You know, it's like giving these days, giving a kid a quarter for allowance. They look at you like you lost your mind. You may have relapse as a failure to recognize all related stimuli. You're focusing two on a single moment in context instead of looking backward, chaining and looking up at what led up to it, or focusing on only a certain set of stimuli instead of everything else. If you eliminate a behavior, you must replace it with at least one, but preferably three new ones. People are motivated for rewards and to avoid punishment. Decisional balance exercises can help people make new behaviors rewarding and old behaviors, well, less rewarding. We have to remember, though, that reinforcers must be rewarding to the person, not what's rewarding to you, but what they find to be rewarding in order to be effective.