Week 5: Behavioural Psychotherapy: US Tradition of Behavioural Psychotherapy

Question 1

US Tradition of Behavioural Psychotherapy

Answer 1

• Primary Influence: B.F. Skinner
• Methods: Operant Conditioning, Reinforcement
• AKA: Behaviour Modification
• Settings: Psychiatric and other long-stay institutions
• Targets: Reduction in challenging behaviours and encouraging desired behaviours

Question 2

Challenging Behaviours

Answer 2

Self-injury/self-harm or eating non-food objects, aggression that might harm others, or behaviour that was seen as disruptive, such as soiling, refusal to wear
clothes, and prolonged screaming/shouting

Question 3

Three-Term or ABC Contingency

Answer 3

Antecedent: The event that precedes a behavior (Discriminative Stimulus)
Behavior: The action itself (Response)
Consequence: The outcome of the behavior (Reinforcer)

Question 4

Functional

Answer 4

Term used because we assume that the behaviour in question has a specific function or purpose for that individual, to either gain a positive outcome or avoid a negative one.

Question 5

Functional Analysis / Applied Behavioural Analysis / Functional Assessment

Answer 5

This approach focuses on identifying the function of a behavior that tends to fall into two broad categories, either to obtain or access something positive for the individual or to escape or avoid
something negative.

Question 6

Function of Behaviour to Obtain Something Positive

Answer 6

Attention-seeking: Behavior that elicits attention from others.
Tangible rewards: Behavior that leads to tangible items (e.g., food).
Sensory stimulation: Behavior that provides sensory input (i.e., rocking, shouting, self-harm)

Question 7

Function of Behaviour to Avoid/Escape Something Negative

Answer 7

Escape from demands: Behavior that allows avoidance of unpleasant tasks or situations (i.e., chores)
Avoidance of social situations: Behavior that prevents interaction with others.

Question 8

FAST (Functional Assessment Screening Tool)

Answer 8

16-item questionnaire developed by Brian Iwata and colleagues at the University of Florida for use with children with autism in the home, school, or other settings.

It provides an easy means of doing a preliminary, indirect
analysis, based on reports of informants, rather than direct observation.

Question 9

Full Behavioural or Functional Analysis

Answer 9

A systematic approach that is typically based on:
- careful, direct observation over a period of time
- record-keeping using ABC charts.
- careful training to use such tools accurately and reliably

Question 10

ABC Model of Behaviour Modification

Answer 10

Antecedent-based interventions: Modify the environment to reduce triggers for the unwanted behavior.
Behavior-based interventions: Teach new skills to provide alternative ways to achieve the same goal.
Consequence-based interventions: Change the outcomes of the behavior to reduce its reinforcement.

Question 11

Antecedent-based (stimulus) interventions

Answer 11

• Reduce individual’s exposure to trigger
• If a reduction in unwanted behaviour is observed, intervention = successful
• Simpler and easier to implement

Question 12

Behavior-based (skill) interventions

Answer 12

• Provide new effective skills or new tools to deal with situations
• Costly in time + effort to implement

Question 13

Consequence-based (outcome) interventions

Answer 13

• Behaviour will eventually stop if attention is no longer given
• Hard to apply and neglects the underlying purpose of the behaviour

Question 14

Extinction

Answer 14

Removing the reinforcement that maintains an unwanted behavior. Over time, the behavior will decrease in frequency and eventually stop altogether.

Challenge: Behaviour may increase initially before it subsides. It’s important to be consistent with extinction for it to be effective.

Question 15

Extinction Bursts

Answer 15

A temporary increase in the frequency, intensity, or duration of behavior when reinforcement is withheld.

Question 16

Partial Reinforcement Schedule

Answer 16

If a person’s gets reinforced every nth time that they behave in a certain way

Question 17

Continuous Reinforcement
Schedule

Answer 17

Give the reinforcement immediately and consistently every time the behaviour happens for a period, before we remove the reinforcement completely.

Leads to the fastest extinction.

Question 18

Non-contingent Reinforcement

Answer 18

Reward is given regardless of the behavior.
Weakens association between behaviors and unwanted outcomes.
Practical alternative to extinction.

Question 19

Agitation in Dementia

Answer 19

E.g., aggression, swearing, screaming, refusal to take food or liquids.

The onset of persistent agitation is often the trigger that causes some family carers to place their relative in a formal care setting.

Question 20

Treatment Routes for Exploring
Agitation (TREA) programme

Answer 20

A tool kit has developed by the American psychiatrist Jessica Cohen-Mansfield. This forms part of a comprehensive assessment and management programme, involving individualised
ABC assessments and individualised treatment.

Question 21

Treatment Routes for Exploring
Agitation (TREA)

Answer 21

• Identifying potential antecedents: Pinpointing common situations that trigger agitation, such as pain, loneliness, or boredom.
• Implementing targeted interventions: Addressing the identified antecedents through strategies like pain management, social interaction, or stimulating activities.
• Evaluation: Assessing the effectiveness of the intervention in reducing agitation.

Question 22

Cluster Randomised Trial

Answer 22

A type of research design where groups of individuals, rather than individuals themselves, are randomly assigned to different treatment conditions.

Question 23

Challenge in Behaviour Modification

Answer 23

When there does not seem to be an
effective reinforcer that can be applied, the person may refuse typical reinforcers or, if accepted, they may be ineffective, because they are not valued.

Question 24

Premack’s Principle (David Premack)

Answer 24

Addresses a challenge in behaviour modification: Ineffective reinforcers. A high-probability behavior (something the individual likes to do: eat desserts) can be used as a reinforcer for a low-probability behavior (something the individual doesn’t like to do: eat vegetables).

Question 25

Effective Reinforcers

Answer 25

Reinforcers can only be considered such if behaviour changes as a result of their pairing with a particular response.

Question 26

Primary Reinforcers

Answer 26

These are stimuli that are inherently reinforcing because they satisfy biological needs (i.e., Food, Water, Sleep, Sex, Relief from pain)

Question 27

Secondary Reinforcers

Answer 27

These are stimuli that acquire reinforcing properties through their association with primary reinforcers. They are learned, not innate (ex. money buys food, praise is associated with positive attention, grades lead to rewards, and tokens can be exchanged for primary reinforcers)

Question 28

Token Economy Method

Answer 28

This is a form of contingency management based on the principle
of secondary reinforcement.

Is a behavior modification technique where individuals earn tokens for desired behaviors. These tokens can then be exchanged for privileges or tangible rewards.

Question 29

Advantages of Token Economy

Answer 29

1. Controllability: Tokens are easily managed and dispensed.
2. Scalability: Token value can be adjusted to match behavior improvement.
3. Delay of reinforcement: Bridges the gap between behavior and reward.
4. Resistance to satiety: Tokens maintain their reinforcing value.
5. Flexibility: Tokens can be both earned and removed (response cost).

Question 30

5 Basic Components of Token Economies

Answer 30

1. Clear Definition: the nature and value of the token must be explicit and understood.
2. Tracking: an accurate and transparent means of recording tokens earned, spent, or removed.
3. Reinforcers: there must be clear and valued actual reinforces that can be acquired through accumulated tokens. 4. 4. Rules: the rules governing the earning of tokens and possibly losing them must be clear.
4. Consistent Implementation: particularly not allowing access to the tangible reinforcer other than through the tokens.

Question 31

Token Economy in Mental Health

Answer 31

• Gained popularity from the 1970s
• Learning disabilities
• Neurodevelopmental disorders
• Addiction & substance misuse
• Long stay psychiatric hospitals
• Generally successful in increasing adaptive behavior