Behavior modification

Transcription

1 Behavior modification Principles, issues, and applications W. Edward Craighead Alan E. Kazdin Michael J. Mahoney The Pennsylvania State University Houghton Mifflin Company Boston Atlanta Dallas Geneva, Illinois Hopewell, New Jersey Palo Alto London

2 Contents Preface xv Part I Conceptual foundations of behavior modification 1 1 Behavior modification; An overview 4 Definition of behavior modification 5 The history of behavior modification 6 Behavior modification and "mental health" professions 9 Behavior modification at work 11 Behavior as subject matter 12 Choice of methodology 14 Drawing conclusions 16 Ethical issues 17 The relevance of behavior modification 18 Summary 19 Suggested readings 20 2 The scientific emphasis in behavior modification 21 The goals of a scientific approach 21 Truth, certainty, and probable inference 23 Criteria in science 25 Testability 25 Objectivity and operationism 26

3 Scientific subject matter versus scientific methodology 29 Causation, correlation, and determinism 30 The limitations of science 32 Summary 34 Suggested readings 35 3 The role of inferred variables 36 Intervening variables and hypothetical constructs 36 Mentalism versus behaviorism 38 Mentalism 38 B ehaviorism 41 A final note 46 Inferred variables in behavior modification 46 Summary 50 Suggested readings 50 4 Data collection and research design 51 Data collection 52 Classes of behavioral data 52 Methods of data collection 53 Data collection formats 55 Summary 55 Research design 55 The experimental design 56 The case study 56 Intrasubject experimental designs 58 Intersubject experimental designs 67 Summary 72 Suggested readings 72 5 Data analysis and interpretation 74 N on statistical data analysis 75 Criteria for nonstatistical method 75 Possible shortcomings 78 Statistical data analysis 79 Basic statistical method 79 Possible shortcomings 82 The approaches compared 85 Interpretation of data 85 Summary 86 Suggested readings 87

4 Part II Empirical foundations of behavior modification 89 6 Models of behavior change 93 The medical model 93 Intrapsychic or quasi-medical models 95 Psychoanalytic theory 95 Other intrapsychic approaches 97 Implications of intrapsychic models 97 Criticisms of the intrapsychic model 101 The behavioral approach 102 The behavioral model and learning 104 Implications of the behavioral view 108 Summary 110 Suggested readings Principles of operaet conditioning 111 Reinforcement 113 Positive reinforcement 113 Negative reinforcement 117 Punishment 118 Operant extinction 120 Reinforcement schedules 121 Shaping 125 Chaining 126 Prompts 128 Discrimination and stimulus control 129 Generalization 130 Stimulus generalization 130 Response generalization 131 Summary 132 Suggested readings Cognitive influences in behavior modification 134 Cognitive processes and environmental events 135 Contributions of cognitive psychology 137 Attribution 137 Placebo reaction and demand characteristics 139 Problem solving 141 Verbal mediators of behavior 145 Imaginal mediators of behavior 149 Summary 151 Suggested readings 152

5 9 Assessment and treatment strategies 153 Experimental/clinical model 155 Clinical assessment 156 Model for assessment 156 Areas of assessment 157 Treatment strategies 162 Examples of experimental/clinical approaches 163 A final note 169 Summary 169 Suggested readings Ethical issues 171 Free will, determinism, and responsibility 171 Behavior control and countercontrol 174 Behavioral freedom and humanistic issues 177 Summary 178 Suggested readings 179 Part III Applications of behavior modification Anxiety management 183 Definition and measurement of anxiety 184 Nature and development of anxiety as a clinical problem 187 Targets of anxiety management 189 Behavioral approaches to anxiety management 191 Systematic desensiuzation 191 Modeling 195 Flooding and implosion 197 Some concluding comments Behavioral formulations of depression 200 Definitions of depression 201 Measurement of depression 203 The experimental/clinical approach to depression 204 Socio-environmental model 205 Development of depression 206 Treatment strategies 209 Learned helplessness model 215 Cognitive model 216 Development of depression 216 Treatment strategies 218 Self-reinforcement model 219 Development of depression 219

6 Treatment strategies 220 An integrative model 222 IS Behavior modification in the classroom 227 Praise and ignore technique 228 With individual children 228 With entire class 229 Back-up reinforcers: The token economy 231 Program with individual contingencies 234 Program with group contingencies 235 Punishment in the classroom 236 Response cost 236 Time out from positive reinforcement 237 Verbal reprimands 238 Current topics of research 239 Peers as behavior modifiers 239 Self-control 240 Sociometric behavior 240 Generalization 241 Concluding comments Treating the hospitalized person 243 Questions about mental hospitals 244 Who goes there? 244 Are admissions rates decreasing? 245 What are the costs? 246 Treatment in the hospital setting 247 Psychotherapy and drugs 247 Family therapy 248 Individually tailored behavioral programs 248 Token economy programs 249 Comprehensive behavioral or psychiatric rehabilitation 252 Why a comprehensive program? 252 Areas for rehabilitation 254 Example of a comprehensive program 255 Recent and future directions Behavior management in medical and nursing practice 260 Relationship of medical and behavioral treatments 263 The bio-behavioral model 264 Behavioral intervention 265 Behavior management and the somatic systems 266 Cardiovascular system 266

7 Respiratory system 269 Derwmtological system 272 Gastrointestinal system 274 Gynecological system 277 Neurological systems 277 Musculoskeletal system 280 Genitourinary system 282 A final note 283 Patient self-management through behavioral technology 283 Self-medication 284 Self-prevention 284 Behavioral self-examination for health professionals 284 Measurement and monitoring 285 Emerging themes in behavioral health care 286 The future Behavioral principles and experimental communities 289 Can a science of behavior help solve the problems of experimental communities? 290 The University of Kansas Experimental Living Project 293 The worksharing system 294 Conceptual analysis 294 Behavioral solution 296 The coordinating system 299 Conceptual analysis 299 Behavioral solution 300 The governance system 303 Conceptual analysis 303 Behavioral solution 304 An overview 307 A peek at the future The teaching-family model of group home treatment 310 Description of the program 312 Evaluation of the program Behavior modification in prisons 321 Development of the controversy 322 Three examples of behavioral prison programs 324 Patuxent Institution 324 START 327 The Rehabilitation Research Foundation 331 Implementing the behavioral model in prisons 333

8 Problems stemming from conflicting roles of a prison 333 Steps for implementing a behavioral model 335 Ethical issues Sexual deviation 341 Development of behavioral approaches 342 Aversion therapy 342 Expanding the approach 344 Assessment of patterns of sexual arousal 346 Verbal report 346 Attitudinal measures 346 Physiological measures of sexual arousal 347 New developments in treatment of sexual deviation 352 Development of alternative treatments 352 Example of behavioral treatment 353 A concluding note Social skills training 361 Social skills and behavior disorders 363 Historical antecedents 363 Assertive training 364 Social skills and treatment of depression 365 Social skills and treatment of minimal dating 367 Assessment and treatment 368 Measurement of social skills deficits 368 Current treatment procedures 371 Generalization and maintenance of therapeutic gains 373 A concluding note Alcohol and drug abuse 376 Definition of abuse 378 Etiology of drug abuse 378 Sociological factors 3 78 Physiological factors 3 79 Psychological factors 380 Specific maintaining factors 381 Traditional treatment approaches 383 Assessment techniques 383 Self-report measures 383 Physiological measures 383 Behavioral measures 384 A model behavioral treatment program 385 Decreasing drug-taking behavior 385

9 Teaching incompatible behaviors 388 Rearranging environmental contingencies 390 Community self-help groups 392 Overview Behavioral management of obesity 394 Behavior modification principles used 396 Consequent control of behavior 396 Antecedent stimulus control 398 Additional procedures 399 Research issues 400 Attrition rate 401 Standardized improvement criteria 401 Intermediate and long-term followups 401 Research strategies and significance 402 Reinforce the reporting of individual differences 402 A comprehensive behavioral program 402 Assessment stage 405 Treatment program stage 409 Maintenance followup stage 412 Human factors Quitting smoking 414 Development and maintenance of motivation to quit smoking 416 Motivational impediment 416 Behavioral treatments 417 Withdrawal symptoms 418 Addiction or habituation? 418 Physical symptoms 418 Behavioral treatments 419 Habit in smoking 420 Extent of the habit 420 Behavioral treatments 421 The needs filled by smoking 426 Reasons for smoking 426 Behavioral treatments 428 A concluding note Behavioral treatment of marital problems 431 Marital relationships 432 Behavioral view of marriage and its problems 434 Intervention procedures 436 Pinpointing and discrimination training 436

10 Communication skills training 440 Problem solving and negotiation training 442 Contingency contracting 443 A concluding note The future of behavior modification 447 Behavior modification 450 Reinforcement mechanisms 452 Aggression and altruism 454 Group processes and behavior change 454 Taxonomy and diagnosis 455 Social systems analysis 456 Reactance and countercontrol 458 Self-regulation and self-control 459 Control of physiological responses 460 Language and thinking 461 Summary and conclusion 461 References 463 Author index 527 Subject index 540