Behavioral Modification (b-mod) is a common intervention utilized to treat a range of behavioral issues exhibited by children in home and school settings, as well as to shape maladaptive behaviors in adults. The foundation of b-mod is based on utilizing positive reinforcement (i.e., earn a reward) and negative reinforcement (i.e., avoid/eliminate negative outcome or experience) to increase specific behavioral actions, as well as positive punishment (i.e., incur a negative outcome or experience) and negative punishment (i.e., loss of a desired outcome or experience) which serves to decrease undesired or maladaptive behaviors. In essence, individuals learn how to intentionally choose a response (i.e., behavior) based on the anticipated consequence or outcome. Below is a list of suggestions that can make behavioral planning and intervention more effective overall, as well as increasing awareness and understanding of choices and the functional/contextual factors contributing to both desired and undesired responses.
Behavioral Modification “Do’s”:
- Hold individuals accountable for their actions: Provide patients with adequate psychoeducation regarding the function and learning of behaviors so that shame and blame can immediately be removed from the picture at the onset. Reminding patients that “everything we do is for good reason” is a quick and easy way to do this and incorporates empathy into behavioral interventions. Reframe consequences in an empowering way such as, “If you choose to respond like this, then that will happen” (i.e., contingency). This can foster an increased locus of control and power by emphasizing the ability to choose an intentional response in any given situation. B-mod interventions can be very empowering, especially for children who tend to feel an inherent lack of power in controlling their day to day lives.
- Use both reinforcement and punishment: Many clinicians steer away from using punishments to shape behaviors, because they can be unpleasant and upsetting to the patient, or they can evoke unhelpful negative emotions which can create conflict. However, punishments are just as important as reinforcers when using b-mod in treatment. We want to model natural consequences in b-mod as much as possible, in order to prepare patients for real-life experiences. Punishment (e.g., losing some type of privilege, missing out on a positive or desired experience or outcome, etc.) happens often in life, and we want our patients to learn how to tolerate and adapt to these experiences effectively. In addition, there is an opportunity to increase understanding and learning about what choices and responses they can control which lead to the life outcomes and experiences they are seeking. Again, this boosts overall empowerment and locus of control.
Behavioral Modification “Don’ts”:
- Don’t excessively compromise on reinforcers/punishments: B-mod is often frowned upon by some clinicians, parents, and patients because the process can easily become manipulative and overly focused on rewards and negotiation. The goal is not to teach individuals and children how to manipulate situations to get what they want from others, but to learn the value in making intentional behavioral choices that will lead to positive and healthy outcomes in many facets of their lives; in addition to increasing self-control, problem-solving skills, and overall self-esteem. Again, focusing on natural consequences and balancing reinforcement with punishment, can help eliminate this common pitfall. Also, trialing an agreed upon behavioral plan with contingencies for a minimum of 2 weeks before considering making any changes, is a suggested approach. Shaping behaviors and understanding what contingencies work vs. what doesn’t work takes time; as well as helping patients learn to tolerate the consequences incurred by their behavioral choices.
- Try not to focus on too many problem behaviors at once: In order for b-mod strategies to be effective, there needs to be clear and concise consequences in place that will also have a high likelihood of being followed through by the person shaping the behavior. Especially when working with children, it is very important that parents feel confident in following through with agreed upon contingencies. It is also important that all consequences are realistic and reasonable. With that said, it is best to focus on 1-3 target behaviors at a time and select behaviors of focus based on priority and/or those most interfering with daily life. This allows the patient, therapist, and/or parent to clearly understand the plan, expectations, and contingencies. It also allows for adequate time to be spent on coaching and addressing obstacles to plan implementation as needed; in addition to setting patients and/or parents up for success by developing attainable goals.