Module-2 Behavior Therapy- II

I. Difference between Operant and Respondent Conditioning

CLASSICAL CONDITIONING :- Classical conditioning is a type of learning when an unconditioned

stimulus (UCS) such as food produces an unconditioned response (UCR) such as salivation. If a neutral
stimulus such as a bell is then paired with the UCS to get the UCR and this is repeated, the neutral
stimulus will create the response of salivation. The neutral stimulus is now the conditioned stimulus (CS)
and the response is a conditioned response (CR).

OPERANT CONDITIONING :- Operant Conditioning (or instrumental learning) is the process whereby
learned responses are controlled by the consequences (Weiten, 2007). There are two main processes
involved in operant conditioning:

1) Reinforcement occurs when a response is strengthened by an outcome. There are two types of
reinforcement, negative and positive reinforcement. Positive reinforcement occurs when a behavior is
strengthened by a positive reward. For example, a child behaves well at the shops so is given a chocolate
as a reward. This reinforces the good behavior at the shops. Negative reinforcement occurs when
behavior is strengthened by the removal of a negative stimulus. For example, doing a relaxation exercise
when stressed. The relaxation exercise (response) reinforces this behavior as the stress (aversive
stimulus) has been removed.

2) Punishment occurs when a response to behavior decreases the likelihood of the behavior reoccurring
(Weiten, 2007). There are also two types of punishment, negative and positive punishment. Positive
punishment occurs when an aversive response to behavior is used and therefore the behavior is less
likely to occur For example, a child is given chores when he or she has been naughty. The child
therefore, has been given a punishment to reduce the likelihood of the bad behavior continuing. Negative
punishment occurs when something is taken away and therefore decreases the likelihood of the behavior
reoccurring. For example, a person fails to secure a bike and this leads to the theft of the bike. This
therefore decreases the likelihood of the person leaving property unsecured in the future.

Differences

Classical conditioning Operant conditioning

1. First described by Ivan Pavlov, Russian BF skinner, an American psychologist
psychologist
2. It focuses on elicited behaviors: the It focuses on emitted behaviors: in a given
conditioned response (eg; salivation) is situation, the organism generates responses (eg;
triggered involuntarily, almost like a reflex, pressing a lever) that are under its physical control.
by the conditioned stimulus (eg; a tone)
3. In CC, learning occurs through CS-UCS In OC, behavior changes when responses made by
pairings. In other words, one stimulus (eg; the organism (eg; pressing a lever) become
a tone) becomes associated with another associated with certain consequences (eg;
 stimulus (eg; food). receiving food).
4. In CC, the CS (eg; tone) occurs before the In OC, the reinforcing or punishing consequences
CR (eg; salivation) and triggers it. occur after a response is made.
5. Focuses on involuntary, automatic Focuses on strengthening and weakening of
behaviors. voluntary behaviors.
6. Strength of conditioning is measured by Strength of conditioning is measured by Rate of
speed or amount of response. production of behavior
7. The determinants: 1 Reinforcer, i.e. the consequence
1 Time relations between stimuli. 2 Nature of response or behaviour
2 Type of unconditioned stimuli, i.e. 3 Time interval between the occurrence of
aversive or appetitive. response and reinforcement.
3 Intensity of conditioned stimuli.

II. Extinction

Classical conditioning: Extinction in context to CC, is the process in which the CS is presented
repeatedly in the absence of the UCS, causing the CR to weaken and eventually disappear. Each
occurrence of the CS without the UCS is called an extinction trial.

Occasional re-pairings of the CS (eg; a tone) and the UCS (eg; food) are usually required to maintain a
CR.

Eg; the tone is repeatedly presented without the food, eventually the dog will stop salivating to the tone.

Operant conditioning: Extinction is the weakening and eventual disappearance of a response because
it is no longer reinforced. When previously reinforced behaviors no longer pay off, we are likely to
abandon and replace them with more successful ones. If pressing a lever no longer results in food pellets,
the rat will eventually stop making this response.

The degree to which nonreinforced responses persist is called resistance to extinction.

1. ASSOCIATED PSYCHOPATHOLOGY
a. Many anxiety disorders such as posttraumatic stress disorder are believed to reflect, at
least in part, a failure to extinguish conditioned fear.
2. APPLICATION
a. Behavioral extinction procedures have been utilized to manage gross pathological
behavior, like violence and destructive tantrums in psychotic autistic children, especially
when coupled with differential reinforcement of constructive behavior. Such behavioral
gains are consolidated when management techniques are taught to parents or other
adults with whom the patient lives

III. Differential Reinforcement (picture sent by mam)

 1. MEANING
a. Differential Reinforcement is the implementation of reinforcing only the appropriate
response (or behavior you wish to increase) and applying extinction to all other
responses.  Extinction is the discontinuing of a reinforcement of a previously reinforced
behavior.   
2. BASIC PRINCIPLE
a. A basic principle of differential reinforcement is the concept of
discrimination.  Discrimination is developed through differential reinforcement by
determining when reinforcement is and is not received.  An example of differential
reinforcement is rewarding a child for brushing their teeth before bedtime and withholding
the reward when the child does not brush their teeth before bedtime. 

IV. Antecedent Control Procedures

1. MEANING
a. In these procedures, antecedent stimuli are manipulated to evoke desirable behaviors, so
that they can be differentially reinforced, and to decrease undesirable behaviors that
interfere with the desirable behaviors.

There are six different antecedent control procedures. The following three are Antecedent Manipulations
that Evoke a Desired Response:

Presenting the Discriminative Stimulus (Sd) or Cues for the Desired Behavior.

-When the S^D is present, the behavior is more likely

-Cues serve as prompt or reminders
-Seating arrangement to facilitate conversation in a nursing home
-Reminder to floss on the bathroom mirror
-Fruit in the fridge
-Going to the library to study
-Activity placemats at restaurants

Arranging Establishing Operations for the Desirable Behavior.

An establishing operation is an environmental event or biological condition that changes the value of a
stimulus as a reinforcer. (i.e. running 5 miles and sweating a lot is an establishing operation that makes
water more reinforcing).

-An EO makes the reinforcer for the desirable behavior more potent 

Examples: Presenting EOs

-No snacks before meal time

-Arrange a contract for getting work done
-No naps to make sleeping more likely at night
-Pictures of rotten teeth to make flossing more likely

Decreasing Response Effort for the Desirable Behavior.

-A behavior is more probable when it requires less response effort than does a concurrent operant
-Response effort may be decreased through environmental manipulation
Examples: decreasing response effort

-Recycling bin next to desk

-Healthy foods in easy reach
-Easy to use car seats
-Coffee shop on every corner
Removing the Discriminative Stimulus or Cues for Undesirable Behaviors.
If the Sd or cues for an undesirable behavior are not present, it is less likely that the person will engage in
the behavior.
Examples:
-Get junk food out of the house
-Keep partying friends out of your place at study time
-Don't drive past McDonalds after school
-Keep TV off

Removing Establishing Operations for Undesirable Behaviors.

If you can make the outcome of the undesirable behavior less reinforcing, you will be less likely to engage
in the behavior and, therefore, more likely to engage in the desirable behavior (i.e. Cal eating a meal and
having a full stomach before going shopping so that he is not tempted to buy junk food).

Eliminate EOs (present AO) for competing behavior

Increasing the Response Effort for Undesirable Behaviors.

If the competing behaviors take more effort, they are less likely to interfere with the desirable behavior
-Response effort is increased through environmental manipulation
-No change in pocket/purse for candy machines
-No junk food in the house
-Seat aggressive person away from victim
-Keep trash can away from desk (recycle bin on desk)

-Antecedent control procedures address the antecedents (A's in the A-B-C model)
-Differential reinforcement and extinction address the consequences (C's in the A-B-C model)

V. Punishment Techniques (picture sent by mam)

The goal of reinforcement is to increase target behavior, but the goal of punishment is to decrease target
behavior. Miltenberger (2008) describes two kinds of punishment that may occur as a consequence of
behavior: positive punishment and negative punishment.

Aversive punishment (positive punishment)

It involves applying aversive stimuli, such as painful slaps, electric shock, and verbal reprimands. A
response is weakened by the subsequent presentation of a stimulus. A high school student wears a new
blouse, her friends facial expressions say: urghh and she tosses the blouse into the back of her closet.

Response cost (negative punishment)

Loss of privileges, groundings and monetary fines represent another approach to modifying behavior.
They take away something that an individual finds satisfying. A response is weakened by the subsequent
removal of a stimulus. (i.e. it will cost you). A child who misbehaves may be punished with a timeout in
which he or she has to sit quietly for a period of time (temporarily removes oppurtunities to play)
VI. Self Management
 Defining Self-Management
a. “Behave today, to manage behavior tomorrow.” “Take action now, to prevent problems
later.” “A little effort now, for a larger gain later.”
Components:
b. Self-management involves a controlling behavior and a controlled behavior
c. Controlling behavior what the person does now. Managing antecedents and
consequences.
d. Controlled behavior refers to the behavior the person wants to manage in the future.
Learning new behaviors.
Self-Management Strategies Seven steps are involved:
e. 1.Goal setting.
i. Set goals that are: achievable. especially true early in change program. Goal
achievement=conditioned reinforce.
f. Self-monitoring.
i. Observing one’s own behavior. Often combined with goal setting. Produces
reactivity effects.
g. Antecedent manipulations.
i. Involved in all self-management interventions. Six strategies.
ii. Three strategies for increasing desirable behavior: Presenting SD. Arranging
EOs. Decreasing response effort.
iii. Three strategies for decreasing undesirable behavior: Removing SD. Removing
EOs. Increasing response effort. 10/15/14 14
h. Behavioral contracting.
i. A written document that: specifies the target behavior arranges contingent
consequences in a specified time period.
ii. A contract can be written and implemented by: oneself, or a contract manager.
Reinforce the manager’s behavior!
i. Using consequences (reinforcers & punishers).
i. Contingency management sans the contract.
ii. Positive/negative reinforcement.
iii. Positive/negative punishment.
j. Social support.
i. Occurs when significant others provide: the context (SDs) for the behavior; the
consequences for the behavior.
ii. Useful in preventing short-circuiting.
k. Self-instructions and self-praise.
i. Self-instructions involve instructing/telling oneself what to do and how to do it.
ii. Self-praise involves positive evaluations of one’s desirable performance.
Devising A Self- Management Plan
l. Deciding to use self-management.
m. Defining the target and competing behaviors.
n. Functional assessment.
o. Selecting the appropriate strategy.
p. Evaluating the change.
q. Re-evaluating self-management strategies.
r. Maintenance strategies.
VII. Habit Reversal
Habit behaviors generally fall into one of three categories: nervous habits (e.g., nail biting,
skin picking, hair pulling, teeth grinding, mouth biting), motor or vocal tics, and stuttering
(Adams, Adams, & Miltenberger, 2003;
 VIII. Token Economy

Token economies are in which desirable behaviors are reinforced with tokens (eg; points, gold stars) that
are later turned in for other reinforcers (eg; prizes, recreation time ). They are based on the principles of
applied behavior analysis (ABA) and emphasize the use of positive reinforcement to target behavior
change. Token economies help students to visualize progress, accept and work for delayed
reinforcement, learn to self-monitor, and learn to regulate behavior.

In the early stages of teaching the token economy, pair social praise with the tokens by giving a high five,
a pat on the back, or tickles while at the same time labeling the behavior with “good sitting!” or “awesome
reading!” School staff and family members working with the student may share the responsibility of
distributing tokens but as stated previously, they should be consistent in their distribution of tokens and
exchanges of the back-up reinforcer. Flood the student with tokens in the beginning so that access to the
back-up reinforcer is frequent.

The goal of the token economy is to teach appropriate behaviors that will generalize to use in the natural
environment. Therefore, it is necessary to have a plan for fading the token economy to prevent the
student from developing a dependence on it. As the student becomes increasingly successful in response
to the token economy, increasing appropriate behavior and decreasing inappropriate behavior, you can
begin fading the token system. Keep in mind that even after a token economy has been successfully
faded, there may be a time in the future when the student will again benefit from use. A token economy
can be faded by dispensing tokens in an increasingly random and intermittent fashion and requiring more
tokens to access the back-up reinforcers. Additionally, the use of tangible reinforcers can be faded and
replaced with reinforcers that are more readily available in the natural environment.

IX. Fear and Anxiety Reduction Techniques

Exposure therapies are used to treat anxiety, fear and other intense negative emotional reactions (anger)
by exposing clients under carefully controlled and safe conditions to the situations or events that create
the negative emotions.

The are two basic models of exposure therapy- brief/graduated and prolonged/intense.

Brief/Graduated Prolonged/Intense
1. It exposes the client to a threatening event It exposes the client to the threatening event for a
for a short period (few seconds to few minutes) lengthy period (10 to 15 minutes at a minimum and
sometimes more than an hour)
2. incrementally, beginning with aspects of And from the outset, the client is exposed to
the event the produce minimal anxiety and aspects of the event that elicit intense
progressing to more anxiety-evoking anxiety.
aspects.
Mode of exposure can occur in four basic ways-

verbal & visual

In-vivo depictions

virtual -reality In-vitro

In-vivo-actually encountering the event

Virtual-reality-through computer-simulations that appear almost real.

Verbal & visual depictions- clients can listen to verbal depictions or view visual

depictions.

In-vitro-imaginary exposure

A. Standard systematic desensitization

It was developed by Joseph Wolpe and considered the first major behavior therapy. The client imagines
successively more anxiety-arousing situations while engaging in a behavior that competes with anxiety
(muscle-relaxation). The client gradually becomes less sensitive (desensitized) to the situations. Therapy
involves three steps-

 The therapist teaches the client a response that competes with anxiety (like muscle-relaxation).
 The specific events that cause anxiety are ordered in terms of the amount of anxiety they
evoke (descending order).
 The client repeatedly visualizes the anxiety evoking events, in order of increasing anxiety,
while performing the competing response.

Muscle –relaxation as a competing response to Anxiety- it counters some of the physiological

components of anxiety, including increased muscle-tension, heart-rate, blood-pressure and
breathing. Training in progressive relaxation involves relaxing various skeletal muscle groups:
arms, face, neck, shoulders, chest, abdomen and legs.

Constructing an Anxiety Hierarchy- it is a list of the events that elicit anxiety, ordered in terms
of increasing anxiety. When clients are not clear about what is making them anxious, they may
complete a self-report inventory known as “FEAR-SURVEY-SCHEDULE”, which provides a list of
stimuli that evoke anxiety in many adults.
The desensitization process- desensitizing anxiety-evoking events begins as soon as the client
has learned progressive relaxation (or other competing response) and has constructed as anxiety
hierarchy.

The anxiety-evoking events are ordered from least to most anxiety-evoking. This process often
uses the “SUBJECTIVE UNITS OF DISCOMFORT SCALE.” The units of this scale, called SUDs,
range from 0 to 100 (sometimes 0 to 10). Zero represents no anxiety, 100 represents the highest
level of anxiety that the client can imagine. As the term subjective implies, SUDs are specific to
individual. However same person’s SUDs can be compared at various times and in different
situations. Eg. If a client reported experiencing 60 SUDs last week and 40 SUDs today in the
same situations, then it is safe to conclude that the client is less anxious today. Comparisons of a
client’s SUDs levels often are used as measures of change in therapy. The therapist instructs the
client, who is seated or reclining comfortably, to relax all of his or her muscles. Then therapist
describes the scenes from the anxiety hierarchy for the client to imagine, starting with the lowest
item on the hierarchy. The scenes are described in detail and are specific to the client.

Essential & facilitating components of systematic desensitization- the essential component is the
repeated exposure to anxiety-evoking situations without the client experiencing any negative
consequences.

The facilitating components-gradual exposure and a competing response-are more likely to be

beneficial when the client’s anxiety is severe.

B. In-vivo Exposure Therapy

In it the client is exposed to the actual feared event (rather than imagining it). The exposure is
brief and gradual and the client has the option to terminate the exposure, if it becomes too
uncomfortable. Muscle –relaxation is often used to compete with the anxiety, although complete
deep muscle-relaxation is not possible because the client is using a variety of muscles during in-
vivo exposure. This procedure is used as differential relaxation (standing requires some tension
in the neck, back and leg muscles, but facial, arm, chest and abdominal muscles so not have to
be tensed.

Why does brief/graduated exposure therapy works-

1. Counter-conditioning- an adaptive response ( feeling relaxed) is substituted for

a maladaptive response (anxiety) to a threatening stimulus. Anxiety develops
through classical conditioning. This therapy counters this conditioning by
associating anxiety-evoking event with relaxation.
 2. Reciprocal inhibition-our physical emotional responses associated with anxiety
(increased heart rate and sweating) are largely controlled by the autonomic
nervous system which has two divisions- sympathetic and parasympathetic. The
physical symptoms of anxiety are primarily sympathetic functions, whereas
relaxation generally is associated with parasympathetic division. Thus the client’s
anxiety is inhibited by a reciprocal or opposite physiological response, relaxation.
This process is known as reciprocal inhibition.
3. Extinction-extinction involves terminating reinforcement. Facing the fear and
nothing unusual happens.
4. In-vivo flooding- involves prolonged/intense actual exposure to actual anxiety-
evoking stimuli. It often involves response-prevention, in which clients are
specifically prevented from engaging in their typical maladaptive anxiety-reducing
response.
5. Imaginal flooding- follows the same basic principles and procedures used in-
vivo except that exposure is imaginary. In-vivo exposure to the actual traumatic
events (rape etc) generally not possible due to ethical reasons. It is well-suited
for re-creating the circumstances of the trauma safely –without the actual
adverse consequences. It was first used to treat posttraumatic stress disorder in
Vietnam War Veterans.
6. Implosion therapy-is an imaginal prolonged/intense exposure therapy
developed by Thomas Stampfl & Donald Levis. It is different from flooding –
The use of hypothesized anxiety-provoking cues
Exaggeration of scenes to heighten anxiety, sometimes with fantasy like details
The elaboration of the scenes as they are presented.
C. Eye Movement Desensitization & Reprocessing
 A relatively new & controversial exposure based treatment, developed by
Francine Shapiro to treat upsetting memories & thoughts about traumatic
experiences (sexual assault, robbery at gun point & combat-related trauma).
 It is a hybrid imaginal exposure therapy in that it does not fit cleanly into either
the prolonged/intense or the brief/graduated model. Although clients visualize
anxiety-evoking scenes for relatively brief periods, the scenes often engender
intense anxiety.
 The treatment often consists of 3 important aspects-
1. Assessment & preparation
2. Imaginal flooding
3. Cognitive restructuring
The therapy has 8 phases-
1. History & Treatment Planning-in the first sessions, client’s history & an overall
treatment plan are discussed.
During this process the therapist identifies potential targets for EMDR. Targets refer
to a disturbing issue, event, feeling or memory for use as an initial focus for EMDR.
Maladaptive beliefs are also identified (eg. I can’t trust people or I can’t trust myself).
2. Preparation- the client identifies a “safe-place”-an image or memory that elicits
comfortable feelings and a positive sense of self. This safe place can be used later to
bring closure to an incomplete session or to help a client tolerate a particularly
upsetting session.
3. Assessment –involves
a. Identifying a traumatic image (memory) that results in anxiety or distress.
b. Identifying the bodily sensations associated with anxiety (tension in the chest).
c. Assess the level of anxiety they are experiencing, using 0 to 10 Subjective Units
of Discomfort Scale
d. Identifying a maladaptive belief (negative cognition-NC) that is strongly
associated with the event (in case of rape victim-“I should have run-away” or “I
am totally powerless”)
e. Thinking of an adaptive belief (positive cognition-PC) that would alleviate the
distress associated with the traumatic event (“I did the best I could”) and rate how
personally believable the adaptive belief is on a 1 to 7 scale.
4. Desensitization phase/ Imaginal flooding-the client visualizes the traumatic event
while verbalizing the negative cognition/maladaptive belief and concentrating on
her/ his bodily sensations associated with the trauma. During this process, the client
is asked to visually track the therapist’s index finger, as it is moved rapidly and
rhythmically back & forth across the client’s line of vision (left to right twice per
second, 12 to 24 times).
Shapiro theorizes that the eye movements produce a neurological effect-similar to
rapid eye movements associated with intense dreaming-that facilitates the
processing of emotionally charged, stress-related material.
After the eye-movements, the client is instructed to
(1) Block out the experience momentarily and take a deep breath
(2) To report what he or she is imagining, thinking and feeling and rate the
experience using SUDs.
When the client’s SUDs rating has been reduced to 0 or 1, the client is ready
for the phase of the installation.
5. Installation Phase- it essentially involves cognitive-restructuring. The client is again
asked to imagine the traumatic scene but with the adaptive belief (Positive-cognition).
 The aim is to associate traumatic image with the adaptive belief so that the image no
longer results in tension & maladaptive thinking. The believability of the adaptive
belief on the validity of Cognition Scale is assessed.
6. The Body Scan- client’s anxiety level is assessed, by asking him or her if anywhere
in in the body client is experiencing pain, stress or discomfort.
If the client generally accepts the positive cognition as valid and experiences little
anxiety, therapist progress towards the nest phase.
7. Debriefing- the therapist gives the information to client about his or her condition.
8. Re-evaluation-At the beginning of a new Session, the client reviews the week,
discussing any new sensations. The level of disturbance arising from the experiences
targeted in the previous session is also assessed.