 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 today's presentation. Happiness isn't brain surgery, but behavior modification basics part two. Last time we talked about basically what behavior modification can do for you in a clinical situation. And we also started to identify conditioned and unconditioned stimuli and conditioned and unconditioned responses. So in this presentation we're going to continue to explore the usefulness of behavior modification. Review those terms that we talked about and learn additional modification terms such as reinforcement, punishment, extinction burst and pre-mech principle. So again, why do we care? Because this is one of the principles for adult learning is you always need to bring it back to why is this important to me? How can this benefit either me or my clients? Change means doing something different or modifying a response. While stimuli prompts a behavior, reinforcement and punishment are associated with motivation. Now remember last time we talked about how strict behaviors don't like those internal terms called motivation and desire. Because you can't label those. You can't or you can't see them. You can't touch them. You can't quantify them. So we're going to be a little bit loosey-goosey in how we talk about things today. But basically I want you to think about it in terms of, you know, if you've been around a little kid or even for yourself if you tried to set a New Year's resolution. You tried to convince yourself to do things by putting discriminative stimuli in the environment. Maybe you put your gym bag by the door. So that would remind you that you were going to the gym after work. And maybe you also provided reinforcement. If you went so many days a week, then there was a reward at the end of the week. Whatever the case was, you were trying to increase your motivation to go to the gym. You were trying to make it more pleasurable. You were trying to make your body say, yeah, this is worth the effort. Understanding these principles are going to help you elicit a behavior. Get somebody to come to counseling. Get somebody to complete counseling. Get somebody to achieve their goals. And it will increase the likelihood that whatever the behavior is will happen again. We want to make sure that we reward things in a manner that's going to be substantial enough to make the behavior happen again. My kids are teenagers. If they do something really well and I give them a nickel, they're going to look at me like I'm crazy. And like, my, we can get more than that out of the couch cushions. So make it worth my while. And we can also decrease the likelihood of unwanted behaviors. And I talked a little bit last time about you don't want to just eliminate behaviors. Otherwise you've got a person who doesn't have any behaviors to do. They just kind of sit there and they're like, I don't have any other options. You told me everything I tried was wrong. So we want to make sure that if we're decreasing a behavior, we're also increasing another one. For example, think about smoking. One of the behaviors people have with smoking is that hand to mouth when they start to get stressed. When they stop smoking, a lot of people start doing the same hand to mouth with candy or with food and they gain a lot of weight. Now, this is not just the over simplistic explanation, but I want you to see where this behavior kind of gets transferred. So we've got to not only decrease the frequency of this hand to mouth behavior, but we've got to give the hand something else to do. If they're not going to the mouth, what are they doing? Crocheting, crossword puzzles, maybe you're going out and playing tennis. I don't know, playing ball with the dog. So brief review. Unconditioned stimulus and response means the same thing to an adult as it does to a child, an infant. A loud noise, no matter what your age, is going to cause you to startle. A bright light, you look up at the sun, you're going to squint. That's a natural response. You don't have to be taught that the sun is bright. So if you look at it, then you need to squint. These are things that just happen. Condition stimuli and responses are those things that you don't really know. An infant doesn't know what it means. And I was reminded the other day, I love the Beverly Hills billies. I was watching that the other day. And somebody came to the mansion and rang the doorbell. And they were going all around looking for where that music was coming from. Because a doorbell is a conditioned stimulus. It has no meaning until you learn that, oh, that means somebody's at the door. A yellow light, like we talked about in the other session. For some people, it means slow down. For other people, it means gun it. Whatever your learning happens to be. One of the cool things with humans, we have our higher order cognition. So some of these unconditioned stimuli, we can counter condition or decondition a little bit. So we don't startle as much with certain loud noises. We can say, oh, okay, that wasn't a big deal. And you can also get used to it. You can desensitize to it. If you happen to work in a kitchen somewhere where there's always things banging and going. Or if you work in a kennel where there's always dogs barking, you may desensitize to certain loud noises. How does that help us as clinicians? It helps us because we can take some things that are very natural, survival based unconditioned stimuli and say, okay, this is adding to your stress. We need to figure out how to reduce its impact on your stress level if it's not really a threat. And we also want to look at some of these unconditioned stimuli like cold and hot in terms of vulnerabilities. If there is something that is stimulating the person to shiver, to sweat, to be cranky because they're uncomfortable, that's one of our vulnerabilities. And it's going to make it harder to deal with stress because our body is already trying to deal with not being at the right temperature. Discriminative stimuli are one of my favorite things to talk about. And one of my favorite things to do because you can use discriminative stimuli to identify what triggers a behavior like smoking or using drugs or freaking out. If you have small kids and you go down the candy aisle, that's a discriminative stimuli. If they go down the dairy aisle, they're not going to be going, oh, can I please have the mozzarella? Well, most of them won't, but if they go down the candy aisle, it's all over because candy elicits a very different response than mozzarella cheese. So discriminative stimuli can trigger an unpleasant behavior, but it can also trigger a positive behavior. If you have discriminative stimuli in the environment that reminds you to be happy, that reminds you to be grateful, that reminds you of why you're doing whatever you're doing. Maybe you're at a job right now that's not your favorite in the world, but it is a stepping stone to get to where you want to be. You know, you can remind yourself of that. If you are on a diet, there are going to be some days where those Oreos are really calling your name. If you have a picture of whatever resort you're going to on vacation on the refrigerator, it may remind you that you may want to stick to your diet a little bit more or not. Learned helplessness, again, oh, and alarms. Alarms are some of the most basic discriminative stimuli. My kids have alarms that remind them to do different chores at different times of day, get started on their lessons, take the dogs out, lunch break, take the dogs out, put the chickens up. It tells them what to do. Now, the interesting thing with there are other stimuli like daylight. For chickens, for example, chickens go to bed as soon as it gets dusky. They'll go into the barn kind of by themselves. You just have to shut the door and lock them in. And those are discriminative stimuli for animals. So we want to pay attention to that. It's also a discriminative stimuli for us because we've talked about circadian rhythms. When the light level starts to go down, our body says, oh, it's time to go to sleep. And then learned helplessness is a lack of responsiveness to a stimulus when all options have been exhausted. You're damned if you do, you're damned if you don't. So why should you even try? And a lot of our clients, unfortunately, by the time they come to us, this is where they're at. They're like, I've tried everything and nothing has worked. And, you know, I point out that they're in our office. That's really awesome. That's a step in the right direction because there's some hope somewhere that there's something that may work. You just haven't found it yet. This is where I want them to be because they've got hope. It's the people who don't come to treatment because they don't think there's any hope or they quit trying different medications because they don't think there's any hope. That's the learned helplessness and we don't want people to get there. One of the things that we can do with clients is if they're not progressing, we don't want them to get to this stage so we can say, OK, hold up for a second. We see that we're trying these things and they're not being really effective for you. So, let's brainstorm why they're not effective for you and maybe change courses instead of putting it on the client and going, well, I guess you're just not treatable or if you would have done something differently, it would have gotten better. We want to help them feel empowered. We want to help them feel like detectives to try to figure out what's going to work and what's not going to work. So, our new terms. And remember you can shoot questions to me in the chat room anytime if you have questions. Positive reinforcement. This is the one we really like. This is somebody giving us something to make us happy and it provides something positive in order to increase the likelihood a behavior will occur again. This can be food, you know, sometimes food works. If you are stuffed giving somebody more food probably isn't going to be a huge reinforcement. Money. Sometimes people can get money, they can get vouchers, they can get movie tickets. There's a lot of different forms that money or currency can take. But again, if you're somebody like Donald Trump and you have more money than you know what to do with, you know, getting a check for 25 bucks probably isn't going to be very rewarding. Validation. Telling somebody they did a really good job. Even sticky notes on their monitors or on their door. Mentioning them in a staff meeting. Something it doesn't have to be huge. But a lot of people really respond well to validation. This can be true if even if you're doing like group counseling or even individual counseling. If you comment on the progress someone has made. And then maybe review specifically the progress that they have made. But highlight the fact that you're noticing how much better that they're doing and how hard they're working. A promotion at work or a promotion to a higher level or lower level of treatment. Closer to graduating is always beneficial because somebody goes, I'm doing it. This might actually work this time. And power. Power can take a lot of different forms depending on the setting, depending on the person. At our house, my kids whoever ends up with the most points at the end of the week gets to choose what we do for our family activity on the weekend. So that gives them power to decide if they want to watch a movie or want to go to a museum or whatever they want to do. And they get to decide which day they want to do it on and for how long. So, you know, if they're not feeling it, it can be 30 minutes one day. Or if they really want to do it, it can be like a whole day activity for my kids. This happens to be something that's rewarding may not be rewarding for everybody's kids. Other things you can do in group. If everybody comes to group for the entire week, then on Friday, we will do a recreational therapy activity and you guys can choose which one of those we do. It still has to be therapeutic, but it can be something of a diversion from the norm. Basically what you want to ask your clients is what can be added that's rewarding and helpful for the person. Now, I said helpful. That's a key thing here. If you're dealing with somebody with an eating disorder, they may crave, you know, if you're dealing with somebody who's bulimic, you know, they really like chocolate. Chocolate is not, you know, something that they hate. They hate what it does. They hate how it makes them feel and there's all kinds of therapeutic issues there. So, you're not going to take somebody who has an eating disorder and give them a gift certificate for dinner out at such-and-such restaurant. That's probably not going to be overly rewarding. So, you want to make sure that it's rewarding and helpful. It's going to get them towards their goals, not undermine them. Likewise, you wouldn't want to take someone who is recovering from gambling addiction and go, here, here's $50. Do with it whatever you want and it's, you know, untracked money because while it may be rewarding to them and they're like, woohoo, I can go gamble. The downside is probably going to undermine their treatment. So, make sure the interventions are rewarding and helpful, moving them towards where they want to be ultimately. Negative reinforcement. Now, this is a concept that some people kind of struggle with. Reinforcement always, always, always means increasing the likelihood of a behavior. Negative reinforcement means taking away something unpleasant, reducing mandatory counseling sessions. When I worked in probation and parole, some of my clients would come in and they're like, I've been through this before. I don't want to go through it again and I'm like, well, the judge says you have to. However, I have some discretion. If you come to the first eight sessions, you test clean for every single one of those sessions and you participate in group, then I can let you graduate at that point. So, I give them conditions and behaviors that I want them to exhibit, but they have this carrot of negative reinforcement. That is, they don't have to come see me anymore. Some courts will drop restitution payments or additional charges if somebody completes treatment. When you're talking about kids, you can say, you know what? If you want to get up and go back to your video games, you've got to eat your vegetables. As soon as you eat your vegetables, you can leave the table. So, think about negative reinforcement as taking away something that's unpleasant. What can be eliminated that the person would consider rewarding? They're like, woohoo, I don't have to do that anymore and helpful. Again, if the person was going to benefit from counseling and I really felt that there was a need for it, we might look at alternatives instead of saying, okay, after eight sessions, I'm going to kick you to the curb. But likely, they'll want to stay on if it is beneficial for them at that point. Always rewarding plus beneficial. Positive punishment. Add something negative to decrease the likelihood that a behavior will occur. Punishment always reduces the likelihood of a behavior. So, antibuse is a perfect example. When somebody drinks, you know, they may have a hangover afterwards, but if somebody drinks while they're taking antibuse, they have a really negative, violent reaction, or they can. So, positive punishment would be the sickness associated with the reaction to the antibuse if somebody drank. That would punish that behavior. They're going to look at it and go, alcohol's not worth the effort. Not that I believe in it, but spanking. You know, in the olden days, if somebody was thinking about doing something, they're like, well, am I going to get in trouble? Am I going to get a weapon for it? That deterred a lot of people. Additional sessions and counseling. If you relapse or if you fail to come, if you have three unexcused absences, we're going to tack on a certain number of additional sessions. Not only does that cost people money, it costs them time, and they may not want to be there. So, that's three reasons that they might do it. Another example that I don't necessarily agree with, but is used a lot, rubber band snaps. If somebody has a rubber band on their wrist and when they have a negative thought, they snap it. It hurts. If they don't want it to hurt, then they don't have the negative thoughts is the theory. In any event, positive punishment is not my favorite thing because I would really rather reward alternate behaviors. Then add something that's really unpleasant, but that's my personal opinion. Negative punishment means taking away something they want. When you ground your kids, that's negative punishment. You're taking away their electronics. You're taking away their freedom. When people have to pay money or fines for things, you're taking away their money. When they go to jail, you're taking away their freedom. Now, here's an interesting one. Relationship setting and boundaries is a punishment. How is that? For some people, especially people with active addictions, they are so needing of and desiring of being in control of other people and manipulating other people in order to protect their own addiction. They want to be around people who do what they say and don't have boundaries. If someone else sets boundaries and says, I'm not going to tolerate that kind of behavior in my house or around me or whatever, the person with the addiction, that's pretty negative. A support system is withdrawing from them. Control and power. If you take away somebody's control or take away somebody's power, it's negative punishment. You're taking something away. As severe as restraints, I know in the facilities I worked at, we rarely used them except for over in the crisis stabilization unit. Even then, it was rare because that is an extremely devastating negative punishment for a lot of people. We want to look again at what can be eliminated that would be considered undesirable but also not harmful. Above all, do no harm. When we talk about restraints, if you're going to put someone in restraints, you really got away their own safety right then and there versus what is going to be the lasting effect of restraining them, physically restraining them. It's always a judgment call and your rewards and punishments are going to differ for every single different person behavior because each behavior requires its own amount of reinforcement. Some behaviors you don't mind doing so you're going to do them. Other behaviors like paying bills or something may take a little bit more to get you motivated to do them. Rewards and punishments can be emotional. Now emotional simple, it's going to make you happier or a punishment is going to make you sad or angry. Mental, mental rewards improve decision making, cognitive clarity, you don't have to think about it anymore. Balance a little bit more esoteric. Physical rewards, it's going to improve your appearance, your health, your pain levels, your energy levels, your ability to sleep throughout the night or your relaxation. All of those are pretty big rewards for a lot of people. Social rewards to consider, peer acceptance, family acceptance, admiration or validation by peers as well as people who are in a power position and support. Social rewards can come just from having the support of other people and not feeling like they are an island unto themselves. Spiritual or karmic punishments and rewards. Now I put karmic there because not everybody likes the term spiritual but some people believe that when they do things they're kind of paying it forward and that's enough of a reward that internal feeling of I did something good and eventually it'll come back to me. Is enough for some people for some behaviors. Financial rewards, if financial rewards are big enough to be rewarding to that person, you know, if somebody makes 10 million dollars per football game then you're going to have to probably exceed that to make something rewarding to them. And environmental rewards, freedom. People like having freedom. If you're in a treatment center where you've got IOP and residential, maybe allowing people the freedom to choose to go off on a furlough. Our clients after they'd been in treatment for 28 days were able to apply for a furlough and then the counselors would staff it based on their behaviors in treatment and how much progress that they made and how much risk we assessed that they would experience going out unsupervised. And then generally just pleasant conditions. If you work in an environment where I used to work, it was a community mental health facility. We were cramped for space so we all shared offices. The less senior you were, the more people were in your office. So you could have five clinicians in an office which made doing sessions, assessments, progress notes a little bit more chaotic because we didn't have individual treatment rooms. So you'd have, you know, lots of people in there talking. When you were there and you had a little bit more seniority or if you got promoted, then you would have your own office, which tended to be a little bit more pleasant. But definitely the ability to choose an environment that's more conducive to what is rewarding for the person can be rewarding in and of itself. You know, even moving to a different neighborhood, maybe once they graduate from school, which is, you know, a behavior, then the reward from that is they get to move out of mom and dad's house and into their own apartment. Woo-hoo, some kids, that's plenty to get them to graduate. So the more rewards that can be gained, the stronger the motivation to repeat the behavior. What do I mean by that? I mean, if it's just a positive, a single positive reward, you know, you're going to get a voucher, that's rewarding. And if it's a big voucher, then it could be really rewarding. But if you combine that with other things like dopamine and positive reinforcement and negative reinforcement, you're going to have a bigger bang for your buck. Drugs pack a double whammy or any addictive behaviors for that matter because you have the release of dopamine, which the brain goes, ooh, I want to do that again. And then you have negative reinforcement because whatever you're doing is helping you escape from the emotional or physical pain. So it's eliminating that pain. So you've got positive and negative reinforcement and your body is going, yeah, that's really positive. I'm going to put that over there to do soon. Self-injury. Now, this is one that you're kind of looking at me going, hmm, how can that have positive consequences? When people cut, the body releases endogenous opioids in addition to dopamine in order to help them tolerate and or numb the pain. And a lot of people report when they self-injure, they have a feeling of control. They can't control anything out there, but they can control how much pain they're experiencing and what they're doing. So those are both positive reinforcements. Negative reinforcement, it's the numbing of whatever pain they're trying to escape from because they're focused on the physical pain. It's not to say when they cut, it hurts. They're not different than the rest of us. They're not going, oh, this doesn't hurt at all. It hurts, but they're focusing on that physical pain that's controllable instead of the emotional pain that seems like it's oppressive. So that one has three rewards to it. New term, behavior strain. The point at which the reinforcement or punishment is no longer effective. So if somebody tells you to go to work and you are going to work at this job, which, you know, is okay, but you're only going to get paid once every three months. How motivated do you think you are going to be to go every single day unless that paycheck at the end of the three months is really big? You know, if it's just an average paycheck, but you only get paid quarterly, there's going to be too much behavior strain. When we're working with younger people, little kids, their concept of time is so different than ours because they've only been alive for like six years. So proportionally, a day is a really long time to a six year old, whereas to us where we're 36, 46 years old, a day, that's a drop in the bucket. So age, cognitive development and the strength of the reinforcement or punishment are going to affect how strong the reward has to be or how big the reward has to be and how frequent it has to be. So even if it's a big reward, it's probably going to be more effective with younger children to have it more frequently. You know, at the end of every day, review the star chart and then at the end of the week, they can cash in their stars. You know, one of the token economies or something that that can work for most elementary age children for most adults, we can go, you know, a week or two. But after about two weeks, we need some sort of reward of some sort. Making sure people are identifying what rewards they're getting and making sure they're getting those rewards in the intensity that they hoped. If somebody goes, they decide they're going to try to lose weight and they want to lose a pound and a half a week. It's a reasonable goal. And they start working out and after two weeks, they get on the scale and they've lost weight, but it's only half a pound. They've still lost weight, which, yeah, woohoo, but it is not nearly as rewarding because they were trying to have lost three pounds by then. So we need to make sure the intensity is there to maintain the motivation. Smaller, more frequent rewards for completion of smaller goals. So instead of waiting two weeks and hoping for three pounds, let's look at smaller goals like just going to the gym, burning 600 calories or however many is reasonable for that person. For our clients, if you're working with addictions clients, going through the day without using, you know, 24 hours, great. Let's provide some positive reinforcement. Remember the reward from the drugs, you know, if you're working with addictions clients, that's a really powerful reward. So you're working against the pull of that reward and they're going, oh, I really want to use. So we need to have frequent and as intensive rewards as possible in order to maintain momentum. Here's an interesting concept, the extinction burst. If you've ever decided to go on a diet or quit smoking, you know, I know a lot of people make those resolutions and they're going to start on Monday. And the prior Friday, Saturday and Sunday is kind of a free for all because they know they're not going to get it anymore, which is one of the reasons I have an issue with completely eliminating anything, but I digress. With an extinction burst, there's a temporary increase in the behavior when the rewards are absent or insufficient. So children in the store, perfect example, child goes into the store and he says, I want a cookie. And mom says, no, he gets a little bit louder. He says, I want a cookie. Mom says, no, and I'm not going to keep getting louder because I don't want to blow your eardrums out. But eventually he gets to the point where he's being pretty darn obnoxious and the mother says, no, you're not getting a cookie. And the child stops because at that point, the effort to continue this argument isn't worth the cookie. It's like fine, whatever, cookie ain't worth it. The other thing that you've really got to pay attention to is if mom would have given in when junior was screaming, what does that teach junior? Then junior learns, oh, I'm not even going to start out with asking nicely. I'm just going to start with the screaming. I want a cookie. And mom will do it because she doesn't want to be embarrassed. So juniors manipulating her reinforcements and punishments. So extinction burst, we see it in a lot of behaviors. The desire, the cravings, the desire to engage in a particular behavior when you're trying to not do it is going to go up before it goes down because the body's going to go, come on, come on, come on, please. And eventually somewhere in your head, you're going to go, this just isn't worth the effort or you're going to find something else to do. When I was in college, I minored in behavior modification and we had a pigeon and we spent an entire semester teaching our little pigeon how to hokey pokey. And you're going to learn about shaping next session. Basically, when our pigeon wanted food, it would do what it knew how to do to get food, which was peck a lever. But if it pecked a lever and it didn't get food, it would be very, and this is a feeling word, confused, and it would peck the lever again. Then it would start to get very animated and it would peck the lever again. And eventually we would reward whatever behavior we were hoping that it would do. Any form of acting out is generally sort of some level of an extinction burst. It started out small and it's been rewarded to this point. I see it in my kids martial arts classes. There's a younger kids class that's there beforehand. And some kids come out of class and they demand things from their parents and they're just like, we're going to go over to Dunkin Donuts and get a donut right now. And the parent goes, okay, I'm like, really? Okay. Because that's been rewarded in that particular child. The behavior ceases when the demands or costs of the behavior exceed the potential reward. Think about behaviors you've tried to do, starting an exercise program. You're doing it, you're feeling good, but you're starting to hurt a little bit. You start to have other priorities come up that, you know, have to get done. So it becomes less of a priority, which means it's adding stress and it's less rewarding. And on top of that, you're just starting to feel tired. So the rewards of going to the gym, unless you've implemented some, are starting to fade. Which is why a lot of people fade on their New Year's resolutions because they don't keep those rewards going strong and remind themselves of what they want to do. And yes, we're adults, but we also need rewards. I mean, if we're going to stay motivated. Promotion can be one way to keep people motivated and treatment. So if you've got somebody who's in treatment and they're starting to kind of flounder, we need to say, what can we do to present a more viable or a more rewarding reward to you? Why is this unpleasant to you right now? What is more rewarding? And finally, the premac principle. Concurrently pairing something undesirable with something desirable. Now, if you do something undesirable and then you do something positive, like you pay the bills and then you go out to dinner, that's a reward. The premac principle says you do them at the same time. Doing laundry while watching television. These are some of mine. I don't like folding laundry. I don't mind washing it, but I don't really like folding it. But if I watch television at the same time, it takes my mind off of it. Exercise gives people some socialization opportunities. So positive socialization, not so happy exercise sometimes. Or you can exercise with your dog. Or it gives you time to be out in nature when I go trail running. Some days I just am not wanting to go to the gym. And the trail runs I can at least do and hope I see a bunny rabbit. Studying, for me, studying at home was just not rewarding at all. But when I would go to the library, there was sort of this peer pressure because everybody was studying. And it was also rewarding just to be in an environment where there was some movement and I wasn't feeling totally isolated because that's the extrovert in me. Cleaning with music, you know, put on your headphones, rock out while you're cleaning. Or watch TV. Aromatherapy, if you clean with essential oils, it can also boost your mood. Depends on what works for you. Going to work if there's something you really don't want to do at work. And, you know, I like my coffee. Even though it's decaf now, I like my coffee. So if I've got to do a task that I really don't want to do, I make sure I have a good cup of coffee. Some of our clients don't like going to meetings. You know, 12-step meetings, smart recovery meetings, celebrate recovery meetings, whatever kind of support group meetings they need to go to. Sometimes they don't like going to group. But let's say whatever it is you don't want to go to. I ask my clients, I'm like, well, you got to go because the court says so or it's in your treatment plan or generally you enjoy doing it. So on those days that you don't want to go, ask yourself when you're walking out or when you're in the meeting, what parts of this are beneficial to me right now? What parts of this can I relate to? What parts of this are useful? And then write them down when you're done. Some people, my daughter, tends to focus better and I do the same thing. So I know she's telling the truth when she doodles. And when I teach them, we're going through a lesson on marketing right now. And when I'm talking to them, she's sitting there doodling. She's hearing everything I'm saying, but it makes her able to focus a lot more. She's got something to do with her hands. So that's another example of the premac principle. If I made her just sit there and stare at me, she'd be ready to pull her hair out. So we're going to apply it on a couple of things. What you're seeing right now, you probably recognize as a decisional balance exercise. In general, you want to look at the benefits of the old behavior. These are the reasons the old behavior was rewarding and the person was motivated to engage in it. So whatever the alternative is, has to meet that same need to that same degree. I always tell people when you are doing something, it's always in competition with something else. So if you're going to go on a diet, you don't want to say, well, I'm craving chocolate so I'm going to eat celery. That's probably not going to work. Let's try a banana. If you are used to be a couch potato and you're going to go out and exercise, maybe the gym's not for you. Maybe you would prefer to go on a bike ride. So something that has some rewarding capacity to it. Drawbacks. Drawbacks to the old behavior are the reasons the old behavior is punishing. These need to be strengthened and highlighted and additional punishments may be considered. These are the reasons the person wants to change. So we need to highlight these and go, remember, walk it through. If you want to take a drink, just one drink. How's that worked for you before? It's just one drink is turned into just six drinks and then you don't make it home. And then you and your wife end up in an argument and you get kicked out of the house and then you get a DUI. Yeah, when you play the story all the way through, it doesn't sound so good. So making sure the person remembers the drawbacks to the old behavior. I have them write them down in a journal to review if they start going, you know, maybe my drinking wasn't so bad. Well, let's look at that journal there. The benefit to the new behavior. These are the reasons the new behaviors rewarding and need to be strengthened. If we're going to say, all right, we don't want you to do drugs anymore. What are we going to do instead that helps the person escape from whatever the pain is and is rewarding enough that they're going to choose it over the drugs. Now you have the combination there because, you know, generally the person has had some negative experiences or consequences of the drugs. So they don't want to lose their kids. They don't want to go back to jail. And they do want to figure out how to make that pain go away, not just stop using, but they want to figure out how to make the pain go away. So that's good. We can put that in the benefits to the new behavior. And finally, the one that almost nobody considers is the reasons the new behavior is punishing. Why don't I want to do it? These are drains on people's energy. It's like, oh, I don't want to do it today. You can address this with the premac principle, just as if people are going to meetings and they don't want to go. What else can you get out of it? Socialization. It's time where you're in a safe environment where you're not using. It is meeting your criteria for your court mandated X and so. So you can look at some benefits to the behavior, but you do want to identify all the reasons. The person may not really want to do this behavior. Some of them we can fix. And some of them we've got to decide if they're going to live with or not going back to my daughter. Like I said, if I made her sit there and listen to me lecture, she's 12. She's not a college student. She's not into lectures when I lecture all the time because I'm her mother. But if I want her to hear what I'm saying, letting her doodle is a way to make it more pleasant for her. Now, she's not necessarily doodling about anything that I'm saying. So I don't know if it is really opening up any other learning pathways, but it definitely keeps her more engaged in what's going on. Social withdrawal. A lot of our clients, if they've got depression, anxiety disorders or addictions, you know, this is a common behavior that we want to identify. Social withdrawal is rewarding mainly due to negative reinforcement. They're eliminating unpleasant things. So the benefits of social withdrawal, they avoid extra stress. You know, at a certain point, you're just like, you don't even want to get on Facebook. You don't want to turn on the news. You don't want to open the curtains. You just can't take any more input. They don't have to worry about disappointing anyone. Social withdrawal may increase depression a little bit, but it's better than being overwhelmed and exhausted all the time. Benefit of social withdrawal? More time with my cats. You know, I'm home. I've got the windows closed. Nobody's coming over, not answering the phone. I can spend more time with Fluffy or my dogs or my parents or whatever it is. And I won't burden anyone else. A lot of our clients with addictive or mental health issues feel like reaching out to other people burdens them. So social withdrawal makes them not feel guilty. It makes them not feel overwhelmed. It doesn't fix anything, but it doesn't add any extra stress. What's the drawback to social withdrawal? It's not a whole lot of drawbacks except for it doesn't help. It just kind of leaves them stuck in this point. And again, it may increase depression a little bit. So what do we want to do? We want to look at how to address some of the benefits of social withdrawal. Like it helps them avoid extra stress. Okay. How can you engage with others in a way that is not going to cause extra stress? Facebook may not be it. Getting online may not be it. Going to a meeting may be helpful. There may be one or two people that you know you can engage with and it's not going to end up being an exhausting mess. So what can we do there? Won't disappoint anyone. So that's an issue we can address. It's a therapeutic issue about who are you disappointing? And in what way are you disappointing them? How can you address that? And do you really care? You know, if someone is being judgmental or if they think that you are a disappointment, let's talk about that relationship and is there something you can do about it? How can we deal with it? Maybe the person loves spending time with their cats. You know, I like my cats. They're cute. I enjoy spending time with them. So if they start socializing, they need to spend time with people who aren't allergic to cats. And then, again, the burdening anyone else is a therapeutic issue that you would need to work through with the person. So they're not constantly fearful of engaging with others because they don't want to burden them. How you do that is going to be up to you and the client and what works for them. So the drawbacks, it doesn't help. We want to keep going back to that if the person continues to stay withdrawn. We want to point out the logic of you're continuing to stay withdrawn and you seem to feel stuck. So let's look at some new behaviors. Maybe we haven't found the right one yet. So a new behavior would be social support. It's a good buffer against stress, but you've got to find the right social support system. Not one that's going to drain you. You don't want to go back to those old people places and things. Social support can increase positive neurotransmitters like serotonin and oxytocin. Oxytocin is kind of your bonding neurotransmitter. And when you're around other people, you can laugh. Some ways to start integrating this is to have a person have people try it in small doses or have them do things like go to a safe place when they are trying out, reaching out and being more social. One of the IOPs that I worked with had sort of a clubhouse room, if you want to call it that, where people could come when it wasn't group time or if it was group time, they could come obviously if they weren't in that group and hang out. It was a safe place. It had safe internet access. There were no drugs. There was staff around that could interface with them and they wouldn't feel as isolated. But it also wasn't a situation where they were having to put on a happy face and try to be something for somebody. Drawbacks to these behaviors. Some people will disappoint you. Even if you're in the safest situation, sometimes it's going to be disappointing and it happens. Not everyone will understand how you feel or what's going on with you. That's true. And sometimes you may feel needy at first. All three of these are really issues that we can address in counseling about disappointments and looking at the frequency. Yes, this person disappointed you this time or didn't respond the way you wanted. How frequent is that? Is that like all the time or did they just, you know, they were off that day? So we can address these issues. We want to eliminate as much as we can the drawbacks to the new behaviors. We want to enhance the likelihood that the new behavior is going to be rewarding. So we want to enhance these benefits. We want to help them see how it can buffer against stress. Therapeutic recreation is an awesome activity and an awesome way to help people learn how to have fun when they're clean and sober. A lot of my clients had never actually played volleyball or watched a football game or done anything like that sober, or at least it had been decades. So when they came and they were in treatment, we got them playing card games. We got them playing chess and checkers and doing arts and crafts and then going outside. We had a ropes course. We had a cornhole. We had different activities that they could do and hang out and talk to one another. And it wasn't like they were talking about stuff or issues. They were just hanging out and they learned how to have fun and being less self-conscious in that environment. Explosive anger. Benefits. It gives people power. It pushes away the threat and the person gets their own way. So we want to look at how can we reduce the benefits when somebody explodes. Make sure they don't get their own way. Try to help them look at whether they wanted to push away the threat and examine the type of power that they're actually getting. Drawbacks to explosive anger. It's exhausting. You know, if you have these blow-ups all the time, it's exhausting. It alienates people, which takes away your social support, which is a buffer, makes it difficult to get genuine feedback. If you're working for somebody who explodes all the time and they ask you for your feedback, are you really going to give them 100% honest feedback? Are you going to tell them what you think they want to hear to prevent the explosion? So explosive anger is something that people need to deal with. In addiction, a lot of clients, when they are not able to get their addiction, their addictive substance or engage in their addictive behavior, will become somewhat volatile. So it's important to understand the motivations behind the behavior, what they're trying to do. They're trying to bully me into letting them get to their addiction of choice. We want to look at the benefits and reinforce these. It gives people time to get past the adrenaline surge and think clearly. Well, that's all well and good. You know, we can look at it in retrospect and go, yeah, it was probably a better decision. It doesn't feel so good in the moment. So encouraging people to journal after they call a friend, take a walk or journal about how it felt to react differently is going to go a long way towards helping them realize that there are alternate behaviors that can be less exhausting and less alienating. It enables people to make better long-term decisions because they're not acting in that adrenaline haze. So have them replay the scenarios. If you would have exploded, what would have been the outcome? Since you decided to go on a walk and then come back and handle the situation, how was the outcome different? And it enhances teamwork and communication. It's really hard to communicate or to negotiate with someone who has to have absolute power all the time. The downsides, they can feel vulnerable because they're not in that power position and they're asking for help or they're asking for input. And somebody may tell them exactly what they think and they may be taken advantage of. It happens. So how do they deal with these things? We need to make sure to head these two things off at the pass. So enhancing whatever they're doing instead of exploding has to have some calming features to it. And help them ultimately get the power or the resolution that is doable. It may not be the one they necessarily wanted, but it's the resolution that's going to get them towards their goals for where they want to be. And I keep saying towards their goals if you took the acceptance and commitment therapy class with me, you know that people have a decision to make whenever they're getting ready to engage in a behavior. Is that behavior or is that reaction moving them closer to their goals or further away? And so that's an easy way to bring it back to clients all the time that they can do on the fly and say, is this getting me closer to? And emotional eating. People love food. Food's good. I love food. It's comforting. It releases dopamine and serotonin and it's easily available. So I can see where it's an easy go to. Drawbacks for people. Weight gain. Feel bloated. Some people feel weak if they eat too much. The problem's still there. If you eat too late at night, it can disrupt your sleep. And some people become embarrassed to eat in front of other people because when they start eating, they don't feel like they can stop. So we want to highlight these and say, OK, these are the reasons you want to change this behavior. So let's look at the coping behaviors. What are you going to do instead? And the person's going to have to choose something. And I always say choose three alternate behaviors. But these coping behaviors can help the person eat when they're hungry instead of when they're stressed out and in their kind of zone, if you will. They're kind of in an adrenaline haze. They'll be able to enjoy the food that they're eating because they're actually eating because they're hungry. They're going to taste it instead of just kind of trying to numb the pain and get as much stimulus as possible to not focus on whatever they're trying to avoid focusing on. And the coping behaviors by their very nature assist in addressing the problem. Kind of like the open wound on the arm. If you keep putting a band-aid on it, you're going to keep covering it up and yeah, you may not notice it. But until you address the problem, whatever caused the oozing wound in the first place, it's probably not going to get better. So you're going to be stuck in this loop. The drawbacks, compulsions are hard to overcome and coping behaviors are not as satisfying most of the time. So we need to figure out a way to look at the drawbacks to the old behavior plus the benefits to the new behavior in order to make it worth the person's effort, which is what we call motivation. So motivational interviewing really plays on a lot of punishment and reinforcement concepts. If you eliminate a behavior, you have to replace it with at least one, preferably three new ones. People are motivated for rewards and to avoid punishment. I don't like pain. Now there are some things that I have to do because ultimately there's a reward out there or I'm avoiding punishment. I don't like paying bills. You know, I find it tedious. But if I don't, I'd get my lights turned off and my credit score would go into the toilet. So there are outstanding rewards there. Decisional balance exercises can help people make new behaviors rewarding and old behaviors less rewarding. Reinforcers must be reinforcing to the person. A person who has a history of being in and out of jail and they feel pretty comfortable in there and they know all the corrections officers, avoiding being in jail may not be a real big reward for them. And you know, it isn't for some people. Or the example I gave earlier, giving 25 bucks to Donald Trump, he's going to look at you like whatever. So the reinforcer must be reinforcing to the person. And likewise, punishments must be unpleasant to the person. I love spinach, you know, so making me eat spinach in the big deal, making my kids eat spinach, you would think I was making them drink castor oil. Rewards and punishments can be emotional, mental, physical, social, spiritual, financial, environmental and I probably forgot some. So if clients are having difficulty finding rewards, not only rewards for their new behavior, but identifying what's maintaining their old behavior, have them look through each one of these areas and they'll probably get some greater clarity. 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. 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