Behavioral

Psychotherapy
Course Instructor: Maha Mohsin
Case Conceptualization
Case Conceptualization
 Origins of Behavioral Psychotherapy

• It is the clinical application of behavioural principles having theoretical

and experimental roots

• Ivan Pavlov- Russia, late 1800s and early 1900s

• Physiologist; studied digestive system of dogs
• Routinely, they would present food to dogs and measure the amount of
saliva they produced
• Noticed, dogs started to salivate before food presentation
• First considered it a problem but later found out about the remarkable
phenomenon, labelled as classical conditioning
• Conditioning eventually replaced digestive research as Pavlov’s primary
interest, and using bell as the precursor to food, he conducted many
pioneering studies on the topic
• John Watson- Applied Pavlov’s idea to human behavior
• Argued psychology should refrain from focusing on the inner workings of
the mind and should instead examine ways in which conditioning shapes
behavior
• Study only overt, observable stimuli and responses
• Thorndike & Skinner- Operant conditioning
• Law of Effect- Actions followed by pleasurable consequences recur,
whereas actions followed by unpleasant consequences are less likely to
recur
• Skinner worked on law of effect
 Goals of Behavioral Psychotherapy
• Primary goal- Observable behavior change
• Aimed at modifying overt, maladaptive behaviors, as well as the cognitions,
physical changes, & emotions that accompany overt behavior
• Addresses client’s current problems by dealing with the contemporary
environmental forces, learned habits, and cognitive factors that maintain
them
• Experimental evaluation of treatment
 Defining Problems Behaviorally
Steps of the Scientific Method
1. Observing a phenomenon
2. Developing hypotheses to explain the
phenomenon
3. Testing hypotheses through
experimentation
4. Observing the outcomes of the tests
5. Revising the hypotheses
How Applied by Behavioral Therapist
• Assessing client behavior via observation, interview, or testing
• Defining a target behavior
• Establishing a baseline level of target behavior
• Functional Analysis of target behavior to determine the factors
that cause or influence it
• Establishing specific behavioural goals for treatment
• Planning interventions to alter behavior in preferred manner
• Implement interventions as planned
• Collect data on changes in the target behavior
• Compare data collected during or after treatment to baseline
data
• Compare data to goals
• Modify treatment plan as suggested by observed outcomes
• Restart scientific process with revised hypotheses
 Two Types of Conditioning
1) Classical Conditioning
• Unconditioned stimulus (Food)
• Unconditioned response (Salivation)
• Conditioned stimulus (Bell)
• Conditioned response (Salivation)
• Generalization
• Discrimination
2) Operant Conditioning
• Behavior is the function of its consequences
• Consequences shape all behavior
• Positive/Negative Reinforcement
• Positive/Negative Punishment
Techniques Based on Operant Conditioning

1) Contingency Management
• Reinforcement and Punishment
• Schedules of Reinforcement (Fixed/ Variable Ratio/Interval)
• Aversive Therapy
2) Extinction
3) Token Economy
4) Shaping
5) Behavioral Activation
6) Modelling
 What is behavior?

Anything a person does that can be observed and measured.

Behavior is anything an organism does, including those things
we can see people doing and things we cannot see people doing
(thinking and feeling).
 What is Behaviour Analysis?

• Behaviour analysis = the scientific study of behaviour

• Behaviour analysts ask "Why does behaviour change over time?"
• We seek answers by looking at the biological and environmental factors,
although we are primarily interested in the role of environment on
behaviour
 What is aba?
• ABA is the use of scientific principles of learning and motivation to teach
effectively
• The core concept is that the consequences of what we do affect what we
learn and what we will do in the future
 Characteristics of ABA:

Emphasis on function of the behavior

Emphasis on observable and measurable behavior
Requires data collection and repeated analysis
 Change environment to change behavior
 Everyone is accountable for progress
 A-B-C’s of behavior

ANTECEDENT: comes before a behavior (i.e. a trigger) A friend

walks by
BEHAVIOR: anything a person does You smile at your friend
CONSEQUENCE: occurs after the behavior (i.e. a payoff) Your
friend smiles back
 What is a Consequence?

 A consequence is what happens right after a behavior

Consequences can be both good and bad
Consequences can both increase and decrease behavior
Immediate vs. Delayed Consequences

How do you know it is a consequence?

 Consequences cont.

When we talk about increasing behavior, we’re talking about the

procedure called REINFORCEMENT
When we talk about decreasing behavior, we’re talking about the
procedure called PUNISHMENT

Reinforcement: Increase
Punishment: Decrease
 Consequences cont.

• Consequences that increase behavior are referred to as

reinforcement
• A consequence that increases behavior through the acquisition of
an item/event is referred to as Positive Reinforcement
• A consequence that increases behavior through the removal of an
item/event is referred to as Negative Reinforcement
 Why are the ABC’s important?

All behavior has a function

Identifying the function tells us
• The conditions in which the behavior may occur
• A possibly effective treatment method / how to respond to the
behavior
 What are the Functions of Behavior?

• Escape/Avoidance – escaping or avoiding a demand situation

• Often occur during work type situations
• Attention – a behavior to gain the attention of others
• This can be positive or negative attention
• Access – a behavior to gain access to an object or situation
• Food, toys, warmth
• Automatic – a behavior that “feels” good

• Self-Stimulatory or Stereotypy.
 FBA vs. BIP

• Functional Behavior Assessment (FBA) is a process which

involves the gathering of information which leads to the
development of a Behavior Intervention Plan (BIP)
• A Behavior Intervention Plan is the product that is derived from
the information gathered during the FBA process

• They are two separate entities

 Identify Challenging Behavior in Concrete & Observable Terms

General Descriptions Concrete & Observable Descriptions

Student is aggressive During lunch, when student is told “no”, he hits other children.

Student is disruptive Student continuously call out and makes inappropriate comments
during math seat work.

Student is hyperactive Student continuously moves around on seat, plays with items on desk,
and gets out of his seat w/o permission during reading activities.
 ABC Data Sheet
Date Antecedent Behavior Consequence
 Develop and implement a behavior
intervention plan
• Modifying the physical environment
• Adjusting the teaching strategy
• Changing the antecedents or consequences for the student’s
behavior
• Teaching a more acceptable replacement behavior that serves the
same function as the problem behavior.
 aba
techniques
 reinforcement

The term reinforce means to strengthen, and it refers to anything stimulus which
strengthens or increases the probability of a specific response.

There are two types of Reinforcements

• Positive Reinforcement
• Negative Reinforcement
 Positive Reinforcement
The word positive in positive reinforcement DOES NOT refer to the
pleasantness of the stimulus.
It means a stimulus is added or applied to the situation.
Any stimulus that works to increase the frequency of a behavior it follows is a
positive reinforcer, even if it does not seem like it should be rewarding.
 Negative Reinforcement

Occurs when a behavior is reinforced by removal of a stimulus.

The word negative DOES NOT mean unpleasant
It means a stimulus is removed or subtracted from the situation in order to
reinforce a behavior.
 Prompting
Prompting is the act of helping a
behavior to occur.
A stimulus introduced to control the •Cues
desired behavior during the early part •Hints
of a learning program and that is •Checklists
eliminated after the desired behavior •Hand over hand
has been strengthened.
•Scaffolding
Also Known As:
 Types of Prompts
Physical: Physically guiding the student to perform a skill

Verbal: Verbal cues which give information to help the student to respond correctly

Model: When an educator or peer demonstrates the desired skill

Gestural: Using gestures, such as pointing, to guide the student to the correct response

Visual: Visuals such as pictures, symbols and text that can assist a student to respond correctly

Positional: Placing materials in a location or sequence that ensures successful completion of an activity

(Alberto & Troutman, 2003)

 Modelling
• A form of prompting is modelling. It provides a visual
example of what is expected in a task by having students see
the task being performed. It can also help the student see the
sequence of steps in the task. For example, the student learns
the actions to a song by first watching a demonstration by an
adult.
 Shaping:
• Shaping is also known as “successive approximations” which
means successful steps towards desired goal.
• Shaping is a behavioral technique in which successive
approximations of a target behavior are reinforced.
• Shaping involves gradually modifying the existing behavior of a
child into the desired behavior.
 Example:
An example here is a young boy who only engages with the pet
dog by hitting it. Although time consuming, the parents intervene
every time he interacts with the dog, grab his hand and turn the
hit into a stroking motion. This is paired with positive
reinforcement "It's great when you are gentle with Pooch!" and
doing a favourite activity immediately afterwards as a reward.
 Example
• For example, these steps could be followed if the target
behaviour is for the student to sit with a group during story-time:
• Step 1: Reinforcement for standing near the group.
• Step 2: Reinforcement for standing closer to the group.
• Step 3: Reinforcement for standing in the group.
• Step 4: Reinforcement for sitting in the group.
 Chaining:
• Chaining refers to a method of teaching a behavior using
behavior chains. Behavior chains are sequences of individual
behaviors that when linked together form a terminal behavior.
When teaching a behavior using chaining, the first step is to
complete a task analysis.
 Task analysis
• Task analysis involves breaking tasks down into smaller,
teachable steps.
• It is important to write subtasks in terms of what the student
will do, and to record interventions or prompting that are
required for students to complete the subtasks.
 Forward Chaining
• Forward Chaining: Using forward chaining, the behavior is taught in its naturally occurring
order. Each step of the sequence is taught and reinforced when completed correctly. After the
learner completes step one with a predetermined criterion of accuracy the student is taught the
next step of the sequence with reinforcement contingent upon completion of all previous steps.
• Forward chaining is recommended if the child can successfully complete more steps at the
start of the behavior chain. Forward chaining has the advantage of using behavior momentum,
as the 1st step is often the simplest, easiest step
• For example, in learning to print his or her name, focus the student on learning to print the first
letter and print the rest of the letters for the student.
 Backward Chaining
• A method for establishing a behavioural chain in which the last step of the
chain is taught first, then the immediately preceding steps are taught and
linked together until the entire chain is acquired.
• Backward chaining is recommended if the child can successfully complete
more steps at the end of the behavior chain. Backward chaining also has
the advantage of creating a link between the most work and the biggest
reinforcer.
 Forward vs. Backward Chaining

Logical Rules can be applied in two directions

Forward chaining
• Starts from the facts
• apply rules to find all possible conclusions
• data driven
Backward chaining
• start with the desired conclusion(s)
• work backwards to find supporting facts
• goal-directed
 fading
• Fading is gradual removal of a prompt or other help or cue for responding.
• Fading is slowly diminishing an old behavior while introducing a new
stimulus as a replacement, an example might be cutting back on
cigarettes, one less per day, while adding walks when the urge to smoke
hits.
token economy:
A token economy is a form of behavior
modification designed to increase desirable
behavior and decrease undesirable behavior
with the use of tokens. Individuals receive
tokens immediately after displaying desirable
behavior. The tokens are collected and later
exchanged for a meaningful object or privilege.
 STEP OF TOKEN ECONOMY

1. Target Behaviour
2. Measurement
3. Type of Tokens
4. Backup Reinforcer
5. Reinforcement Schedule
6. Implementation
7. Response Cost
 7. RESPONSE COST:

A penalty or fine where

tokens are taken away
for engaging in
inappropriate behavior.
 Differential Reinforcement
Differential reinforcement (DR) is a special application of reinforcement
designed to reduce the occurrence of interfering behaviours
• Instead of punishing the "bad behavior" to decrease its
occurrence, get rid of it by using positive reinforcement in a
prescribed manner.

• Differential reinforcement can be used to help a child see the

difference between behavior that will be reinforced and
behavior that will not.
The goal of differential reinforcement is to increase desirable
behaviors and decrease undesirable behaviors without the
use of punishments

PUNISHMNT
 TYPES OF DR

• DRI- Differential reinforcement of incompatible behaviours.

• DRO- Differential reinforcement of other behaviours

• DRL- Differential reinforcement of low rates of behaviour

• DRH- Differential reinforcement of high rates of behaviour

 DRI
• The reinforcer is given when another behavior is used or
observed. Reinforcement is used only when the appropriate
behavior occurs.
• Removing clothes vs. keeping clothes on
• Hitting peers vs. sharing/giving items
they want

APPROPRIATE
BEHAVIOR
Example:

Danial is a boy with autistic behaviors. He self-

stimulates by mouthing his hands. Because of the
mouthing, sores are developing on his hands, and his
doctor is concerned. His instructors have taught him to
hold on to the side of his wheelchair or to play with a
preferred toy as incompatible behaviors. When he
mouths, his instructors simply take his hand out of his
mouth and do not pay attention to him.
 DRO
• The reinforcement is given in the absence of targeted behaviour

INAPPROPRIAT
E BEHAVIOR
EXAMPLE:

Bilal constantly talks out in class and disrupts the other students. The
teacher has indicated to Bilal that he needs to “not talk out” for at
least 10 minutes. If he can work quietly and not talk out, he will
receive 2 minutes of extra free time. The teacher points out that in an
hour, Bilal could earn 12 minutes of free time. During the 10 minutes
while he is quiet, the teacher makes several positive comments about
his following the rules, working quietly, and completing his work. If
Bilal does talk out, he does not receive the extra 2 minutes for the 10-
minute period and is ignored by the teacher.
 DRH
• The reinforcer is given when the behavior occurs at a higher
rate than before.

• This intervention serves to increase desirable behaviors which

decrease the amount of time available for inappropriate
behaviors.
Example:

Mrs. Sadie wants Ali to contribute more in class during

social studies. During this time, he seldom says a word. The
teacher has indicated that Ali can have 10 minutes on the
computer to play games if he will contribute at least three
times during the class discussion. Once he consistently
contributes at least three times, she increases the number of
discussion contributions one per week until he is
contributing at least five times per discussion period.
 DRL
• The reinforcer is given when the behavior occurs at a lower rate
than before.
• This intervention serves to directly decrease the rate of
inappropriate behaviors.
 EXAMPLE
Sara thinks she knows all the answers and is constantly
raising her hand in class. The instructor wants her to
contribute but does not want her to monopolize the class
discussion. She sets a limit for Sara’s contributions at five.
If Sara limits her contributions to five during the period,
she gets to be the teacher’s assistant for the next period. If
she goes above five, another student is picked to be the
assistant, and the teacher ignores her hand raises.
 DRA
This procedure entails reinforcing a behavior that serves as a
viable alternative for the problem behavior, but is not necessarily
incompatible with the problem behavior.
 EXAMPLE

Sarah engages in shouting out behavior after her teacher

poses a question to the class. Her teacher decides to use a
DRA procedure in which Sarah is only reinforced (ex.
called on) for raising her hand to answer a question. This
behavior is an alternative to shouting out, but is not
incompatible as both the problem behavior and the
alternative can occur at the same time. However, raising
her hand is a more socially acceptable alternative.
 Extinction:
• Extinction is defined as disappearance
of previously learned behavior when it
is no more reinforced or is the
reduction of response produced by
organism currently or previously.
• An association is developed between
the conditioned stimulus and the
unconditioned stimulus, which is
ended and extinction results.
Conditioned stimulus Unconditioned
stimulus REINFORCEMENT

Conditioned Unconditioned
stimulus stimulus EXTINCTION
 Punishment
• Punishment is a term used in operant conditioning to refer to any change that occurs after a
behavior that reduces the likelihood that behavior will occur again in the future.
Types of Punishment:
• Positive Punishment: This type of punishment is also known as "punishment by
application." Positive punishment involves presenting an aversive stimulus after a behavior as
occurred. For e.g Challan
• Negative Punishment: This type of punishment is also known as "punishment by removal."
Negative punishment involves taking away a desirable stimulus after a behavior as occurred.
 Specific Types of punishers
 Physical punisher
 Reprimands
 Contingent Exercise
 Overcorrection
 Positive Practice
 Negative Practice
 Timeout
 Response cost
 Physical
( aversive ) punishers
Behavior that activates pain receptors that typically evoke feelings of
discomfort
Aversive stimuli or aversive punishers
Example
Spanking, Pinching.
 Reprimands
 A simple word or statement are used to get a child stop doing the
behavior.
 Strong negative verbal stimuli
Example : “no, that was bad”, “ stop”
 Effectiveness of reprimands could be increased by pairing them with
other punishers.
 Contingent Exercise
• Contingent exercise is a positive punishment procedure sometimes used
to decrease problem behaviors that requires a person to engage in physical
activity or exercise that is unrelated to the problem behavior.
• For e.g.: required standing up and sitting on the floor five to ten times on
an inappropriate behavior.
 Overcorrection

Overcorrection procedures involve having the student engage in repetitive

behavior as a penalty for having displayed an inappropriate action.
 There are two different types of overcorrection procedures:
1) Restitution
2) Positive practice
 Restitution
The student must return the environment to the previous condition (before the
display of the "bad" behavior and make it even better.
Example
A student uses a marking pens to write his name on a desk
The student must clean his/her name off from the desk (perhaps with a spray
designed to remove paint/magic marker) and all the other words/designs written in
ink on that surface. We might even have him/her clean all the other desks in the
classroom
 Positive practice
Upon having committed a problematic behavior, the student must repeatedly practice
the correct behavior for that situation. Consider what you might require of the student.
Example
Making a mistake during the playing of a Piano piece
The student is required to correctly re-play (many times) the section of the piece in
which the mistake was made.

Misspell APPLE now the kid is asked to write 100 time.

 Negative practice
• When a person engages in an inappropriate behavior, he/she will be
required to engage in an inappropriate behavior repeatedly.

• Example of Ice Cream.

 Response cost
Removal of specified amount of reinforcer following a particular behavior.

Example
 Library fines
 Traffic tickets
 Time out
 Transferring an individual from a more reinforcing to a less reinforcing
situation following a particular behavior.
 Two types of timeout
a) Exclusionary
b) Non-exclusionary
 Exclusionary timeout
Removing individual from the situation in which reinforcement is occurring
for short time

Example
Detention in timeout room for 5 minutes
 Non exclusionary timeout
Introducing into the situation a stimulus associated with less reinforcement.

Example
Children wearing a ribbon will participate in activity
Ribbon removed for short time
Child not allowed to participate in an activity without ribbon
Techniques Based on Classical Conditioning

1) Exposure Therapy
• Imaginal exposure
• In-vivo exposure
• Graded exposure
• Flooding
• Exposure & response prevention
2) Systematic Desensitization
• Counterconditioning
• Relaxation training

3) Assertive Training
• Targets client’s social anxieties
1) Teach clients how to express themselves appropriately
2) Eliminate cognitive obstacles to clear self-expression