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Home Mental Health

Therapy 101 – Behavior Modification and Dealing with Triggers

Anthony HeardbyAnthony Heard
April 7, 2019
in Mental Health, Social Work
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Imagine for a second you really want a chocolate bar. You have been thinking about it all day. You have been trying to give up chocolate because you’re concerned about your bone density, and you’ve heard it can contribute to lower bone density. You also tend to eat (what you feel like is) too much of it in a single sitting once you’ve had one. You think about the pros and the cons, and decide to eat the chocolate bar. You think that you’re about to eat dinner so you won’t eat more than one, you haven’t had one in a week, and it would really make you feel better after a long, difficult day. You walk slowly across the room, peel back the wrapper and… SOMEONE SLAPS YOUR HAND HARD AND YELLS “NOOOOO! THAT’S BAAAAD!”

What next? Give up on chocolate? Probably not. This ridiculous example illustrates several of the difficulties with using punishment alone when working with children on behavior modification. It’s an often repeated mistake and if you work with families, the odds are high you have heard someone talk about the benefits of punishment. Many parents have a story about a time they were punished, perhaps even severely, that really “set [them] straight.”

You may have also heard positive reinforcement or any reinforcement dismissed as “coddling” or unrealistic. As a social worker, you may already be familiar with the actual research on both and you may already know the research on corporal punishment, which does not suggest a hard yes or no, but does recommend specific situations where it’s best not done and does not specifically recommend it either. You may even already be familiar with the basics of operant conditioning like “reward desired behavior as soon after they occur as possible” and “use punishment or aversive conditions consistently and proportionately”. But what do you tell the parent who is really struggling?

All forms of behavior modification are effective when used appropriately. Reinforcement is used to increase a behavior, and punishment is used to decrease it. Even corporal punishment when used appropriately can be effective in the correct context and applied appropriately. It’s useless to argue with a parent who is insistent that corporal punishment was important in their upbringing, or caused them to make a big, important change for them. Instead, acknowledge it and use those types of statements as an opportunity to explore their own experience with punishment further and how it is or is not working with their child. If it was used appropriately in their recollection, highlight how it was.

The important thing to communicate about punishment, corporal or not, is that it is only used to reduce a behavior. A child will not suddenly start doing something new, or at least not necessarily the behavior you want to see increase, because they were discouraged from another behavior. For this reason, punishment should always be coupled with a form of reinforcement, even if it’s not in the immediate moment. Plus it’s always easier to add a new behavior than to extinguish an old one.

Just remove the trigger or opportunity for the undesired behavior. If it can be done, this is even easier than reinforcement to implement, though with limited, lasting effect. Don’t want a child to have chocolate bars? Parents can decide to not buy them, keep them up high in the cabinet if their children are small enough, or lock them up if they’re not. Would they rather their child not drive the car unless they’ve given specific permission? Don’t leave multiple spare sets of car keys around the house in places they can easily get them. The only downside to removing the opportunity alone is that it may have no long-term impact, and depends on the parent to maintain the lack of access. Especially for risky behaviors you’re trying to extinguish using other means, but need to have practically cease as soon as possible, it can be a good, quick fix while you implement a plan of appropriate reinforcement and punishment.

Reinforcement can be harder to implement in the beginning, but more effective long-term and less work overall. Punishment tends to ironically reinforce the parent using it, because it tends to have an immediate response, but that doesn’t necessarily mean it’s more effective. As soon as the aversive stimulus is removed, a child may repeat the discouraged behavior if they found something sufficiently reinforcing about it. A child who really, really loves chocolate bars may avoid taking the chocolate bar while their parent who last punished them is in immediate line of sight. It doesn’t make them want chocolate any less, however. Especially if you haven’t replaced the unsanctioned chocolate eating with something else like structured chocolate eating (perhaps as reinforcement for another desired behavior even), another snack, an activity, or whatever else depending on what the child finds similarly rewarding.

Reinforcement tends to be more effective when done intermittently, or not every time the desired behavior occurs, while punishment tends to be most effective when used every single time the undesired behavior occurs. If someone is motivated by something they were previously punished for seeking, they may still try again if the punishment doesn’t happen every time because the anticipated reward or reinforcement outweighs the anticipation of the aversive condition which may or may not happen.

If a behavior is reinforced intermittently, it‘s more likely to increase because each time a child is repeating the same behavior with the hopes that this time it will occur, the fact that it could happen the next time is all that is needed to make the behavior occur again, and not receiving the reward behavior isn’t particularly aversive on its own. Basically, reinforcement doesn’t come with an aversive condition if the desired reward isn’t received when completing the desired behavior, but punishment doesn’t decrease the anticipated reward if you do the undesired behavior again. The net effect is that reinforcement tends to be more effective long term.

Be as specific as possible. An adult or older child may be able to figure out from context why their hand was being slapped. Many younger children might as well. It is not a given unless you make sure it’s clear, however. Was a hand being slapped because of how you were walking across the room? Because you spent so much time thinking about the chocolate bar? Because you waited too long before you ate it? Because of the random bone density thing? These may seem like ridiculous examples, but for many parents trying to use punishment exclusively to modify problem behavior in younger children particularly, they’re the entire problem.

Even adults are not particularly rewarded by non-specific praise, and are not dissuaded from doing things they enjoy by one person giving them a hard time about it. Why would a child understand you generally labeling their behavior bad when they just did five different things in the space of time immediately preceding when you yelled at or punished them? Yelling can be effectively used to draw immediate attention or immediately stop a problem behavior in progress, but should be used sparingly and followed with clear instructions and replacement behavior, especially with younger children.

There’s always a reason for the unwanted behavior: Address it. The motivation for a chocolate bar is not terribly complex if you feel motivated by it. It tastes good and you feel good when you consume it. Many other unwanted behaviors that children display may require a little more digging however. If your child is old enough you can ask them directly what they liked about the thing you’re telling them not to do and solicit input on what other, more acceptable behaviors can replace it, though you may not need to do this.

If a child fights with siblings over tablet, you can institute a tablet schedule to remove the cause for argument. We now know whose turn it is. If a child willingly hands over the tablet to a sibling, reinforce this behavior with simple but specific verbal praise. If both children refuse to give way in their argument over the tablet, institute specific, negative punishment by removing the desired tablet for a period of time. An additional tablet can be considered as a long-term reward for doing really, consistently well on something else with which the child is struggling. Maybe the same task can completed on the family computer, the smartphone of a family member who doesn’t mind loaning it?

Think bigger picture. In the example above, whoever slapped the hand didn’t know what preceded the single, “bad” action. They didn’t know that they would associate the hand slapping with the chocolate, or if the chocolate eater would feel resentful because they put all this work into it and you disrupted their plan to reduce your chocolate intake by eating just that one bar at that one particular time. In many cases it’s just as effective to simply remove access to the item since, as noted in the instance above, occasionally it’s completely unclear why the punishment is occurring, which makes it useless at decreasing that behavior in the future.

Model the recommendations. Positively reinforce a parent making progress with verbal praise. Verbally redirect the child while in session, and reinforce them when they stop displaying the unwanted behavior. Be as specific as possible when reinforcing the child and the parent’s behavior. Ask a parent what they were thinking and feeling when they used a behavior to respond to their child’s behavior they previously said they were not going to use. Acknowledge that behavioral change is difficult, and single failures to meet goals do not equal total failure. Refrain from punishment unless needed, and demonstrate reinforcement techniques including redirection whenever possible.

So what about that chocolate bar? Going back to opening, ludicrous example with all its twists and turns, imagine you are the supervising parent who slapped a hand and yelled. What options does the parent have before that occurs?

  • Remove the opportunity: don’t leave chocolate bars out
  • Provide alternative behaviors or activities that similarly motivate
  • Structure access to the chocolate bar: Chocolate bars are given out when other desired behaviors or tasks are completed, or at certain times of the day or week.
  • Reinforce instances when your child does something else when they would normally go for the chocolate bar.
  • Do research and observe the child’s behavior as it pertains to the undesired behavior: When do ask about chocolate bars? When do they take them without asking? What are they thinking about? How do they feel afterwards? What are things can similarly motivate them?

And now that it’s happened?

  • A parent can certainly yell and slap the hand as the example parent did, though they probably don’t have to do both if they’re consistently applying the punishment, and it’s extremely important that they make it clear why the punishment was administered
  • Redirect to another activity they know will similarly motivate their child
  • Clearly direct them to drop the chocolate bar and maybe reinforce if they comply
  • Let this one go (especially as they really have been cutting back), specifically note that as the reason they’re letting it go, and plan for next time by referring to the “before” steps above

It’s always okay to ask questions and do additional research to ensure the prescribed plan for behavior modification is most effective, even if it slightly delays the impact of a specific type of modification. As noted above, punishment is most effective when implemented consistently and reliably each time the undesired behavior occurs, but it can be okay to not punish one time in an effort to learn what made them break the rule, or how they feel about the behavior they previously was instructed not to do. For example, “You know you’re not supposed to have chocolate bars right now. Why did you take the one I just saw you take?” Taking the extra time to sincerely ask children questions about why they do what we don’t want them to do can also make it feel safer for them to talk to more about their behaviors.

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Anthony Heard

Anthony Heard

Anthony Heard, MSW, LCSW is a pediatric social worker at the University of Illinois Hospital in Chicago with experience in trauma-informed care, child protection, and healthcare. His interests range from these areas to health psychology and chronic disease to evaluation capacity building and implementation in social service programs.

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