 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. Welcome everybody to happiness isn't brain surgery behavior modification basics part three. In the last two segments, we really talked about conditioned and unconditioned stimuli and reinforcement and punishment and all those basic terms. Now we're going to start looking at how do you put it all together in order to help a client? I mean, obviously we know that when we're working with clients to increase their motivation, we want to make whatever behavior they're working toward or whatever behavior they're trying to learn more rewarding or more reinforcing than the alternative. So we talked about that in terms of using the decisional balance exercise in section two of this particular series, but now we're going to move on to two really useful concepts and I'm going to hit them on a very basic basic level today. So you can understand them if you want to learn more about shaping and chaining. Obviously, there's a lot that you can read on it, but in an hour, I wanted to just try to make it as useful as possible. So we're going to continue to explore the usefulness of behavior modification. It's not for everybody. However, everything we do, every choice we make is really behavior modification. Whether you want to call it that or not, whether you want to get into analyzing it like that or not, we're trying to increase the rewards. We're trying to do something that makes us happier. So our first new term is shaping. We're rewarding what we call successive approximations of the target behavior and that's a lot of garbledygook to mean we're going to reward baby steps. We don't want to give attention to or reward non-target behavior. Sometimes negative attention is better than no attention at all. So if there's a behavior that occurs that is not the one that you want, you don't want to reward it and then you solidify gains. So once you get them making that baby step, you reward that for a little while until you're sure that's going to occur 100% of the time and then you say, okay, we're going to make it a little bit more difficult now. So an example would be for my dog Brewster. Brewster blesses heart. He is a boxer and he's just so excited to see me every time I walk in the door and I could just be like coming out of the bathroom. It's not like I have to be gone for a long time, but he's a little high strung. So the first thing I wanted him to do was not jump. And so when I would walk in, I would wait for him to not jump before I would give him praise. And sometimes I had to turn around and a few circles so he couldn't get pause on me and he would figure out that he was not going to get my attention until he didn't jump. And, you know, at that point sitting was not even a concept. His little brain was still shut off and I mean his butt was just wagging back and forth. We got to the point where I could walk in and he wouldn't jump and I was like, okay, that's good. Now when I walk in, not only do I want you to not jump, but before you get my attention, before I pat him on the head and ask him how his day was. I know he can't respond, but you know, he's my baby. He has to sit so I walk in the door. He doesn't jump. I give him the sit command and when he sits and only when he sits, does he get the feedback that he finds rewarding? Eventually, I hope to get to the point where I don't have to give him that command. I can walk in, set my purse down on the foyer table and he will sit and wait for me to acknowledge him. We're not there yet, but it's a slow process. It's not something that happens overnight. Other examples of shaping would be for people who want to run a marathon and they've never worked out before. The first thing they're going to do is get to the point where they can walk a mile without being in pain. And once they can regularly walk a mile and it's not exhausting, it's not painful, then they're going to maybe walk two miles or maybe they'll jog for one minute and then walk for two minutes. They'll do that until it gets to the point where it seems easy and they're like, Hey, I got this and they will make it a little bit more difficult before there's a reward. Some more practical examples of that cutting behavior. If we have a client who comes in and is involved in some sort of self-injurious behavior, the first thing that we can do and we don't want them causing tissue damage. We don't want them hurting themselves. To that degree. So the first thing that I talk with my clients about is, you know, maybe hold an ice cube because that is not pleasant. If you hold an ice cube in both hands for long enough, you will have to really focus on controlling your reaction to that pain, which is really what the cutting behavior is about. It's not in most cases, it's not as much about a suicide attempt. And when you look at a lot of the places people cut, it's not necessarily even as a demonstrative thing to say, see what you made me do. It's a distraction. It's something that they can focus on something that they control can control, whereas what's going on in their head is uncontrollable. A lot of people cut when they cut, they do it high up on their arm, high up on their thigh somewhere where the average person's not going to see it. So I want to get to the point and hopefully rapidly. Where the person that I'm working with instead of causing self injury uses an ice cube and holds that or some people prefer to use an ink pen. And if they typically would cut on their thighs or cut on their on their wrists or whatever, they would use an ink pen and draw ink pens are not that it doesn't feel pleasant if you push hard enough, but it's not going to cause permanent tissue damage. Is this ideal? Of course not. This is not ideal, but we're not going to get somebody to go from cutting to all of a sudden not cutting a hundred percent of the time. So what kind of interim behavior can we give them as an alternative if they get get to the point where they have to and I use quotes for that where they have to cut. So the ice cube in the ink pen. This is a way of they still feel a little bit of pain. They still have some control until that they can tolerate or until that emotion passes until they get to the point where they've sort of ridden the wave. Then we want to move on and say, okay, once you get that under control and you're not having to cut anymore, let's see if we can up the ante and choose a different self soothing behavior instead of something that's quite so destructive. Let's look at what this holding the ice cube or using the ink pen does for you. And what are some other behaviors or other things you could do? We're also going to be looking at vulnerabilities and other things, but in terms of shaping what you're doing is progressively moving them closer to whatever you want them to ultimately do. Stress eating target behavior the first time or the first step might be instead of gorging on a pint of hog and does put some fruit, which is still sweet on a plate. So you're not just walking around eating and shoving any fruit into your face and do a mindfulness exercise. Now at first the mindfulness exercise might follow eating the fruit, but right kind of in the same area. Ideally we get to the point where the person is getting some fruit, putting it on a plate and doing a mindfulness exercise. If they don't like doing the mindfulness exercise because you know they have to stop and be aware and be present with their feelings, which is kind of overwhelming for some people. I pair it together. Remember we talked about the premack principle pairing something that you like or something that's helpful with something that you don't really want to do doing it that at the same time makes it a little bit more tolerable. So once they get to the point where they're doing that with regularity instead of coming in and just putting down their their briefcase and grazing for the rest of the night, they come in, put the fruit on the plate, do a mindfulness exercise, figure out where they are and then they can make decisions. Then we want to move on to instead of eating, why don't you get a drink of some sort? Not an alcoholic one. I'm not saying, you know, get that kind of a drink. Get a soda, get some water, get something that you like to drink. Most people are not going to come in and go, oh, yeah, I can't wait to drink ice water. Some people will, but whatever it is that they choose to drink that is somewhat rewarding and again, preferably not alcoholic, preferably not caffeinated, but you know, I'm not going to split hairs there and do their mindful next exercise. What's the difference here? Now we're not having that sugar rush. If we take away the fruit, then you're not going to have the sugar rush that you normally get when you start stress eating, eating a high carbohydrate foods. You're still doing that hand to mouth thing. So that behavior is still there and the person is potentially getting hydrated. Once they get that down and they do that with regularity instead of coming home and grazing. Then we move on to target number three and that's just come home, set your stuff down, go sit in a quiet area and do a mindfulness exercise or do the mindfulness exercise on the way home. When I used to work in community mental health, I would call my husband and I'd be like, this is how my day went and I would decompress on the 20 minute drive home. Now that I don't work in community mental health and I live like three minutes from the house. It's a little bit or three minutes from the office. That's not as effective, but you can do it in your car. You can do mindfulness exercises to go. Okay, how did my day go? How am I feeling? What stressors? How can I deal with this so you can leave it all basically in the car and then when you go in the house, you can have a different mindset. So shaping is again where we want to get someone it's these baby steps. If you think of infants, first they roll over, then they scoot, then they crawl, then they walk holding on to furniture, then they start walking and each one of those in the child's mind provides some sort of reward or reinforcement. Mainly they can get to stuff that they couldn't get to before. So think of it in terms of that. What is the first incremental step to getting someone to where you want them to be? Now chaining is something that they talk about some in dialectical behavior therapy. A chain is basically a series of behaviors or a cascade of effect leading to an ultimate behavior. What we're looking at is behavior, stimuli, reinforcements and punishments that lead up to a positive or negative result. So what do I mean? You wake up in the morning and the alarm goes off. It goes off on time. You get up, you look outside. It's a nice sunny day outside. You're like, okay, it's a nice sunny day. Traffic's probably not going to be a big deal. You get dressed and you head into the office. Now you engaged in all kinds of behaviors leading up to that point. What is your mood like at this point? The other example would be, you get up in the morning. Your alarm clock didn't go off. You forgot to set it. So you get up late. You look outside and it's raining and it's nasty and you're getting ready for work and you get dressed and you're eating, you're rushing and you spill coffee on yourself and all of a sudden it's like the end of the world. So there are a lot of behaviors that led up to that. If you would have been having a good day leading up to spilling coffee on yourself, it probably wouldn't have been as catastrophic. So let's think about this with a mouse. When we talk about one behavior leading to another. There's a lot of times in behavior modification we start out with mice or pigeons. So little mousey is put into the maze and if you've ever read who moved my cheese, it's really hard to get that story out of your head when you're going through this scenario. But try to stay with me. The mouse is put into the maze. The mouse smells the cheese. That's a behavior. He smells and he registers that. The reward and consequence, you know, old Pavlovian thing. He's like, oh, that's cheese. I'm wanting some of that. So the mouse seeks out the cheese. The mouse starts running around trying to find the cheese. The mouse turns left and there's a wall. So turning left behavior was the behavior and the punishment was the wall. He's like, oh crap, I can't go this way. He tries to climb over the wall and fails. Again, climbing, punished. He turns right and there was a corridor and the cheese smell gets stronger. He's like, I'm on the right track now. You like how the mice think and talk in English, don't you? Anyway. So the mouse happens along another crossroad after he ran down that corridor towards the cheese smell and it got stronger. Which way is he going to turn now? Chances are his first choice is going to be to the right because the last time when he turned left and when he tried to climb over the wall, he failed. So mice tend to learn pretty darn quickly, especially when cheese is involved. So he turns right. He goes down the corridor. The process repeats until the mouse gets to the cheese and this is the big reward. When he gets to the cheese, his brain releases the dopamine. So the brain is going, this is exactly what I want. You need to remember what you did. Another example, you get up in the morning, Monday morning. You get ready for work, eat breakfast, start driving to work and the car breaks down. You get irritated and you call for assistance. You know, it's, it happens. It's probably happened to most of us at one time or another. The other alternative, you get up late. You get ready for work. You spill coffee on your shirt. I use that example a lot because it happens to me a lot. I don't wear white anymore. Anyway, you start driving to work and the car breaks down, then you get angry. Can't think straight. Can't even think about what to do next. It's like, this is going to be the absolute worst day in the absolute worst world. It leads to an overreaction. So why is this important? When clients have a upsetting or a distressful situation, we want to ask them, you know, what made it distressful? What made it problematic? Have there been other times where you haven't reacted to the same degree? And if so, what was different? If they say no, then you say, was it worth acting to this degree? Was it worth getting this upset over it? Was it worth this amount of energy? And if the answer is no, then we want to look and say, okay, what led up to this that we could look at changing? So you didn't have so much stress going into things so that you had a little bit more reserve on hand. A lot of my clients are really bad with time management, partly because many of them don't like their jobs. Those are two stressors that are facing people as soon as they get up in the morning. So if they don't like their jobs, they're not motivated to get out of bed. They may hit that snooze button three, four, 17 times. Then they start their press for time getting to work. They're going to be late. They're running a little bit behind or just on time and then they get behind a slow driver. They can't get around them and all of these little things start building up because way back in that chain, they didn't get up on time. So as therapists, we can say, well, how can we relieve some of that stress? The two most obvious things obviously are to get up on time. So we want to look at why they're not getting up on time and part of it could be not going to sleep at a reasonable hour. Part of it could be poor sleep habits and part of it could be guess what not liking that job. So then we want to look at the job. What positive things are you getting out of it right now? How can we make this job more rewarding? And at the same time, you know, maybe this isn't the job that you're going to be at forever. So what can you do to provide some light at the end of the tunnel? Chaining really helps us identify where those vulnerabilities are that add stress to people's life. These little stressors that kind of make people irritable that drain a little bit of energy that cause some negative thinking. So when something happens, it ends up being catastrophic. Stress eating. Another example, somebody has a bad day at work. They come home. They start eating and they start to feel better. Now, why is it that they start to feel better? Well, they're focusing on what they're eating instead of what happened during the day. They're not at work anymore. And when you eat, your body releases certain rewarding chemicals, your serotonin, your dopamine, and you start to relax a little bit. There could also be other things going on in the environment that are helping the person to relax. So there's a lot going on there. But what we want to look at is example 2A. Were there days that you came home that you didn't stress eat? You came home and did something else. So you have a good day at work. You come home, change clothes, and you feel better. No eating involved. So the obvious in this particular scenario, the person had a good day versus a bad day. So then we want to talk about what makes a good day versus a bad day. Evaluate the cognitions and go, okay. A bad day at work was still a day at work. So you're still getting the bills paid. You're still doing what you have to do. Let's look at what made it a bad day. We also want to ask them if there were certain times that they've had a bad day at work that they came home and they didn't start stress eating. Maybe they came home and their roommate was there and they started automatically talking to their roommate about what happened and venting and just kind of getting it out there. So they didn't feel the need to eat or maybe they went to the gym right after work and got out some of that stress and when they came home, they took a shower because they were gross and by that point they weren't wanting to stress eat as much. So we want to look at what changes in that chain of events that leads to either the positive or the negative outcome panic attacks. If somebody didn't sleep well and they get up and they drink two cups of coffee and they get stuck in traffic driving to work and that caffeine kicks in all of a sudden and the heart rate goes up. It may not be a lot but a little bit and then the person registers. Oh, my heart rate went up for no reason. That must mean I've got a panic attack coming on. They start focusing on all their physiological symptoms. They get freaked out that they might be getting ready to have a panic attack inadvertently causing their own panic attack. The other alternative, they didn't sleep well. They got up. They drank two cups of decaf coffee and the same thing happens but they didn't have a panic attack because there wasn't a cue to the body that there was something to be concerned about. Remember our brain and our body are really smart and really dumb at the same time. The really smart part is the part that says we want to survive and I'm going to find workarounds and I'm going to try to protect you. The really dumb part is the part that reacts to certain stressors or certain stimuli and says this could be a crisis and then we have to use our higher order thinking to go no this is just the caffeine kicking in or you know this is just me focusing on things that are getting me upset or whatever the case may be. Higher order thinking is really useful. So when a client is trying to change a behavior what we want to do is analyze the exceptions. We want to ask them in the past when this whole when you've had this outcome or when you've had this experience what was different when you didn't get upset? What was different when you didn't engage in the behavior that you don't want to do? So then we're identifying their strengths we're identifying exceptions and we can start highlighting those. We can also again look at when it does happen what's going on and how can we minimize those vulnerabilities highlight exceptions minimize vulnerabilities. The behavior chains can also help identify antecedents and triggers and vulnerabilities. If someone knows that they tend to be more reactive when they haven't had a good night's sleep or if they're on cold medication or you know we all have our own little idiosyncrasies that we just know that today would be a good day for people to give us a wide berth. If they're aware of that then they can act in a certain way to protect themselves to reserve their energy maybe not start volunteering for extra committee meetings and what have you. We can also look in the environment if we look at just the basic chain of events and we're like I don't know why this was so stressful today when a week ago it wasn't as stressful. We also want to start looking at triggers in the environment what else was going on what else was present. Why was it this particular time was there something different environmentally socially did the person start having negative cognitions about something. People who have PTSD who have issues with flashbacks may be able to identify certain things that happen or certain things they do or certain conditions that make them more vulnerable to flashbacks so they can avoid those while enhancing other things. A friend of mine is a 20-some-odd year military veteran and he's got PTSD to beat the band and there are certain movies he will not watch because he knows that's going to trigger some of his flashbacks. Likewise when the commercials for certain video games and for those same movies come on he leaves the room. He knows that that's not something he wants to be exposed to because it will increase the chance that he's going to have night terrors or flashbacks. It's important that we remember that every behavior is maintained by rewards. So why do you get up in the morning? And I'm asking you to think about for you personally why do you get up in the morning? I wake up in the morning and I'm laying there in bed and the bed is all nice and warm and toasty and comfortable. I get up for coffee. Actually I get up because the chickens have to be let out and I need to get ready for work and get ready for the gym. Work and the gym are rewarding for me. So those are things that make it, I don't want to say exciting to get out of bed but worthwhile to get out of bed. They're things I look forward to doing. So why do you get out of bed in the morning and how can you make it more positive to get out of bed? You know, I don't really want to make it negative to stay in bed. If you remember the old Jetsons cartoons, if George didn't get up by a certain time the bed would dump him out and dump him into the shower. You know, I don't want to go that far but I have before with my children when they haven't wanted to get out of bed, open the door and let the dogs go in and jump on them and start licking them in the face and that generally gets him up. Not in a good mood but it gets them up. We want to increase rewards for some of these behaviors. Going to work, not every day is going to be a good day at the office. I don't care who you are or where you work. So how can you make it rewarding to get up and go to work? Maybe you've got a project you're working on right now that really is not something that you want to do or again, when I worked in community mental health it was like every other month we had an audit of some sort. Now thankfully I really enjoyed audits because it was a time for me to be able to let my staff shine and I'm a little bit rigid about policies and procedures. So I didn't have a whole lot of concerns. My staff on the other hand would get all freaked out and I couldn't understand why. And one of the things we would talk about in staff meeting was it's the auditor's job to find problems. It's the auditor's job to find issues to help us get better, to help us improve. However, it's also important for you to remember if you did what you needed to do to in the best interest of the client and you did your best to document it and all that kind of stuff, you know, we're going to be good. So as a supervisor, my goal was always to try to make people look forward or at least not dread coming to work even on audit days. Why do we eat? Well, sometimes it's yummy and we like food. I love food. Some food sometimes you don't want to eat. When you don't want to eat, what's the reward in not eating? You know, pretty much the only time I don't want to eat is if I've got the flu and I'm not going to go into details about why I don't want to eat then, but you can see there's a punishment reward thing going there too. Everything we do is involved in punishments and rewards. Sometimes those rewards are not immediate though, like going to work. Some people may not love what they do every day, but they really like that paycheck. So that may be enough of a reward. Eliminating a behavior means making that behavior less rewarding than the alternative. You've always got at least one competing response. You can get up or you can stay in bed. The third option is to do nothing at all. But in this particular case, that's staying in bed. When you're at a job, you can either stay at the job and choose to enjoy it. You can stay at the job and hate every day and just be a big ol' grump. Or you can quit the job and find something else. You know, three choices there. So what we want to encourage clients to do is look at the alternatives, look at the options that they have and make sure that they're making choices that are getting them toward where they want to be and they're using their energy, that amount of energy that they have. It doesn't, it runs out at a certain point. Use that energy to get them where they want to be. And we want to make the new behavior more rewarding than the alternative. And you've got to remember any time you're learning something new, it's not going to be effective or not as rewarding or it's going to be harder than the old behaviors because you haven't learned it yet. So it's important to incorporate a lot of rewards to make the new behavior more rewarding. Decisional balance exercises help people understand that rewards are maintaining their behavior and shaping can help make new behaviors more rewarding. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com providing 24 seven multimedia continuing education and pre-certification training to counselors, therapists and nurses since 2006. Use coupon code counselor toolbox to get a 20% discount off your order this month.