Clinical Applications
description
Transcript of Clinical Applications
![Page 1: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/1.jpg)
CLINICAL APPLICATIONSJustin Daigle, MA, BCBA, LBAProgram Director
![Page 2: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/2.jpg)
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
![Page 3: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/3.jpg)
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
![Page 4: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/4.jpg)
SLEEP“We may conveniently regard sleep as a special form of behavior.”
- B.F. Skinner (1953)
![Page 5: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/5.jpg)
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.
![Page 6: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/6.jpg)
CONCEPTUAL
Can sleep be reinforced?
![Page 7: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/7.jpg)
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.
![Page 8: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/8.jpg)
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)
![Page 9: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/9.jpg)
SLEEPLet’s conceptualize sleep in the
3-Term Contingency:
Stimulus Response Postcedant
FallingAsleep
State of Sleep
Biological (tired) and
Environmental
![Page 10: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/10.jpg)
SLEEPWe cannot systematically
manipulate the response nor the postcedant.
Stimulus Response Postcedant
FallingAsleep
State of Sleep
Biological (tired) and
Environmental
![Page 11: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/11.jpg)
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.
![Page 12: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/12.jpg)
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.
![Page 13: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/13.jpg)
SLEEP STUDY• Kaston Anderson• Sleep Apnea• C-PAP Compliance• Token Economy and Sleep Journal• Very effective, but generalization
was not observed.
![Page 14: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/14.jpg)
DRUGS“Almost 18% of the U.S. population will experience an [Substance use disorder] at some point in their lifetime.”
- Galanter & Kleber, (2008)
![Page 15: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/15.jpg)
DRUGSLet’s conceptualize drug use in the
3-Term Contingency:
Stimulus Response Postcedant
Taking Drug
Biology and Social
Private Events (sad)
andEnvironment
al
![Page 16: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/16.jpg)
DRUGSLet’s highlight what we CANNOT
systematically manipulate in Purple:
Stimulus Response Postcedant
Taking Drug
Biology and
Social
Private Events
(sad) andEnvironment
al
![Page 17: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/17.jpg)
DRUGSLet’s highlight what we CAN
systematically manipulate in Red:
Stimulus Response Postcedant
Taking Drug
Biology and
Social
Private Events
(sad) andEnvironme
ntal
![Page 18: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/18.jpg)
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’).
![Page 19: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/19.jpg)
DRUGS• Or, we have to get creative
• Aversion Therapy• Reinforcement of Alternative
Behaviors• Non-Contingent Reinforcement
(NCR)
![Page 20: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/20.jpg)
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).
![Page 21: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/21.jpg)
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?
![Page 22: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/22.jpg)
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).
![Page 23: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/23.jpg)
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.
![Page 24: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/24.jpg)
NCR• Constant biological reinforcement
breaks the association between the stimuli and the need for the drug.
• “The patch”
![Page 25: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/25.jpg)
GAMBLING
![Page 26: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/26.jpg)
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
![Page 27: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/27.jpg)
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.
![Page 28: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/28.jpg)
PHOBIA
![Page 29: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/29.jpg)
PHOBIAThe most common
treatment for phobia is called Systematic Desensitization.
![Page 30: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/30.jpg)
PUBLIC SAFETY
![Page 31: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/31.jpg)
SAFETY• Dr. Van Houtten• Crosswalk Safety• “Pizza Delivery Driver”
![Page 32: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/32.jpg)
OBM
![Page 33: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/33.jpg)
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.
![Page 34: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/34.jpg)
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”.
![Page 35: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/35.jpg)
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.
![Page 36: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/36.jpg)
SOURCESGalanter, M., & Kleber, H.D. (Eds.). (2008). Textbook of substance abuse treatment (4th ed.) Washington, DC: American Psychiatric Press.
![Page 37: Clinical Applications](https://reader036.fdocuments.in/reader036/viewer/2022062500/56815787550346895dc51c29/html5/thumbnails/37.jpg)
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.