Clinical Applications

CLINICAL APPLICATIONSJustin Daigle, MA, BCBA, LBAProgram Director

INTRODUCTION• Focus of internship has been

using behavior analysis in traditional Autism Treatment

• It has been hinted that behavior analysis can have additional applications:

• Animal Training• Pizza Delivery Article

• Acceptance and Commitment Therapy

INTRODUCTION• Here are some areas we will

discuss today:• Sleep• Drug Addiction• Gambling• Phobia• Public Safety• Organizational Behavior

Management (OBM)• There are other areas that will

not be covered

SLEEP“We may conveniently regard sleep as a special form of behavior.”

- B.F. Skinner (1953)

SLEEP• Skinner never defined “special

behavior”.• Researchers (Blumberg & Lucas,

1996; Thoman, 1990) suggest that conceptualizing sleep as a “state” is more constructive.

• “Being alert” is a state, that requires many behaviors leading up to it.

• “Being pregnant” is a state, that requires many behavior leading up to it.

CONCEPTUAL

Can sleep be reinforced?

SLEEP• If sleep is not a behavior, why is

behavior analysis interested in it?

• How do we work around the biological factors of sleep?

• “Sleep” may be a state, but it takes several behaviors to achieve this state.

SLEEP“Falling asleep is conceptualized as an instrumental act (i.e., it is not a reflex response) emitted to produce reinforcement (i.e., sleep).

Thus, stimuli associated with sleep become discriminative stimuli for the occurrence of reinforcement. Difficulty in falling asleep, then, may be due to inadequate stimulus control.”

- Bootzin (1977)

SLEEPLet’s conceptualize sleep in the

3-Term Contingency:

Stimulus Response Postcedant

FallingAsleep

State of Sleep

Biological (tired) and

Environmental

SLEEPWe cannot systematically

manipulate the response nor the postcedant.

Stimulus Response Postcedant

FallingAsleep

State of Sleep

Biological (tired) and

Environmental

SLEEPSome stimulus control suggestions:1. Lie down to go to sleep only

when you are sleepy.2. Do not use your bed for anything

except sleep and sexual activity.3. If you can’t fall asleep, get up,

and go to another room. Repeat as necessary.

4. Get up at the same time no matter what.

5. Do not nap during the day.

SLEEP• Every human HAS to sleep. • The behavior will occur (though

the individual may not like the process).

• The goal becomes to place “falling asleep” behavior under stimulus control (when in the bedroom and lying in bed).

• Several complex interventions which will not be discussed in this presentation.

SLEEP STUDY• Kaston Anderson• Sleep Apnea• C-PAP Compliance• Token Economy and Sleep Journal• Very effective, but generalization

was not observed.

DRUGS“Almost 18% of the U.S. population will experience an [Substance use disorder] at some point in their lifetime.”

- Galanter & Kleber, (2008)

DRUGSLet’s conceptualize drug use in the

3-Term Contingency:

Stimulus Response Postcedant

Taking Drug

Biology and Social

Private Events (sad)

andEnvironment

al

DRUGSLet’s highlight what we CANNOT

systematically manipulate in Purple:

Stimulus Response Postcedant

Taking Drug

Biology and

Social

Private Events

(sad) andEnvironment

al

DRUGSLet’s highlight what we CAN

systematically manipulate in Red:

Stimulus Response Postcedant

Taking Drug

Biology and

Social

Private Events

(sad) andEnvironme

ntal

DRUGS• This leaves us at a disadvantage. • We can use a Stimulus Control

Intervention.• We can use a Social Intervention

(often times causing the power of the social reinforcer to diminish in favor of just the biological reinforcer – ‘social isolation’).

DRUGS• Or, we have to get creative

• Aversion Therapy• Reinforcement of Alternative

Behaviors• Non-Contingent Reinforcement

(NCR)

STIM. CONTROL1. Identify the discriminative stimuli (location, time of day, social situation, etc).2. Systematically break the association between the stimulus and the behavior (diminish stimulus control).

STIM. CONTROLExample:

Timmy smokes when the follow SDs are presented:1)Lunch Break2)In a Bar3)When Stressed4)At a party

How do we break these associations?

AVERSION• Usually an in-patient procedure.• Usually as a “last resort”• Usually under the supervision of a

physician.• Drug of choice is presented laced

with an emetic• Soon the drug becomes paired with

the state of sickness. • (Can be overcome by common use

of the drug with no continued treatment).

REINFORCE• Reinforcement is provided for an

alternative behavior either in situation (i.e., free sodas for designated drivers) or on a modified DRO schedule.

• It is difficult because you have to find a reinforcer that is powerful enough to combat with the biological reinforcement of the drug.

• Often use a token economy with a menu of reinforcers.

NCR• Constant biological reinforcement

breaks the association between the stimuli and the need for the drug.

• “The patch”

GAMBLING

GAMBLING• Gambling treatment is becoming

more behavioral.• Gambling is now treated like an

addiction, because it has the same characteristics of a drug addition when put into the 3-term contingency.

• Treatment is similar to drug treatments

• Stimulus Control• Reinforcement of Alternative

Behaviors

GAMBLING• Slot machines tend to be the worst.• They are on a variable response

schedule (designed like that).• XXXXXXXXXXXXWXXXXXXXXXXXXX

XXXXWXXXXXXXXXXXXXXXXXXXXXXXXXXXW.

• It will keep the player waiting for the “big win” which often times will not come before the player runs out of money.

PHOBIA

PHOBIAThe most common

treatment for phobia is called Systematic Desensitization.

PUBLIC SAFETY

SAFETY• Dr. Van Houtten• Crosswalk Safety• “Pizza Delivery Driver”

OBM

OBM• Skinner first outlined the concept

of using behavior modification in the workplace in his 1953 book “Science and human behavior”.

• Since then, OBM has become a growing field alongside Autism treatment.

• It is the second most popular use of behavioral principles in an applied setting.

OBM• The use of behavioral principles in a

office or business setting.• In a workplace, results should be

measured• Reinforcement and punishment can be

used• Feedback is key.• Amounts should be predetermined

• Not “let’s see who can sell the most”, but rather “your personal goal is 5

cars”.

SOURCESBlumberg, M.S., & Lucas, D.E. (1996). A developmental and component analysis of active sleep. Developmental Psychology, 29, 1-22.

Bootzin, R. (1977). Stimulus control treatment for insomnia. In R. Stuart (Ed.), Behavioral self-management strategies and outcomes (pp. 176-195). New York, NY: Brunner-Mazel.

SOURCESGalanter, M., & Kleber, H.D. (Eds.). (2008). Textbook of substance abuse treatment (4th ed.) Washington, DC: American Psychiatric Press.

SOURCESSkinner, B.F. (1953). Science and human behavior. New York, NY: Macmillan.

Thoman, E.B. (1990). Sleeping and waking states in infants: A functional perspective. Neuroscience and Biobehavioral Reviews, 14, 93-107.