“Behaviour Management Plan (BMP) as a learning tool”

Luis Gustavo Vechi, PhD

10 September 2015

Learning goal

Review the behaviour learning principles and its importance for devising a BMP.

From a psychological perspective is a BMP is…

1. A learning/a rehabilitation tool (not a punishing or a controlling one).

2. A structured opportunity for client to decrease maladaptive behaviours and to increase adaptive ones.

3. An avenue for staff to identify what needs to be modified in the ward environment and in the interactions with client.

SO…

Improving our ability to use a BMP as a learning tool requires

“Revisiting the behaviour learning principles”

The A-B-C learning paradigm

AStimulus (trigger)

Example:Carol’s walking

leaves were turned town

B (Behaviour, Thoughts, Feelings)

Example:Carol feels angry and withdraws

in her room.

C (Consequence

+ or -)Example:

Carol receives extra attention

from staff

Learning Procedures

TARGETING A SPECIFIC BEHAVIOUR TO BE CHANGED.

MANIPULATING TRIGGERS (A) and CONSEQUENCES (C) TO CHANGE/INCREASE ABEHAVIOUR.

Learning Procedures – manipulating consequences

1. SHAPING: Positive and negative reinforcement -> AIM: to start/increase behaviour

2. EXTINCTION: Stop positive and negative reinforcement -> AIM: to weaken a behaviour

3. PUNISHMENT: Aversive consequence -> AIM: to stop a behaviour.

1. SHAPING

You have to use:

POSITIVE OR NEGATIVE REINFORCEMENT - A consequence of behaviour that starts or increases frequency of behaviour.

1. SHAPING

Positive reinforcement: “a reward” = consequences a person wants, likes or will behave to get.

A positive reinforcement will increase a targeted behaviour.

POSITIVE REINFORCEMENT EXAMPLE

AStimulus (trigger)

Example:You ask your

client to clean his room.

B (Behaviour, Thoughts, Feelings)

Example:Your client

cleans the room.

C (Consequence

+ or -)Example:

You smile and praise the client for having done

this.

1. SHAPING

A negative reinforcement = “a relief” = consequences that stop or reduce something negative.

A negative reinforcement will increase a targeted behaviour.

NEGATIVE REINFORCEMENT EXAMPLE

AStimulus (trigger)

Example:You nag about your client’s untidy room.

B (Behaviour, Thoughts, Feelings)

Example:He cleans the

room

C (Consequence

+ or -)Example:

You stop nagging about this.

1. SHAPING - SUMMARYTO START or INCREASE BEHAVIOUR . Positive or negative reinforcement.

. Reinforcement in small steps.

. Reinforce immediately after it occurs. (“timing counts”)

. A new behaviour stabilizes and requires a little bit more before reinforcing this.

. Continue reinforcement until your client produces the targeted behaviour.

. To keep a behaviour from resurfacing, reinforce an alternative behaviour.

. Keep in mind the risk of satiation.

2. EXTINCTION

TO WEAKEN A BEHAVIOUR

. Remove positive or negative consequences.

. If you intermittently reinforce. (will never stop the behaviour)

EXTINCTION EXAMPLE

AStimulus (trigger)

Example:You want the client to be quiet in the

group.

B (Behaviour, Thoughts, Feelings)

Example:Your client

expects you to tell him off.

C (Consequence

+ or -)Example:

The client does not have your

attention.

3. PUNISHMENT

You have to use:

Aversive consequences: Consequence of ones behaviour that is disliked by the person.

An aversive consequence will decrease a targeted behaviour.

AVERSIVE CONSEQUENCE EXAMPLE

AStimulus (trigger)

Example:You nag about your client’s untidy room.

B (Behaviour, Thoughts, Feelings)

Example:Your client does

not clean the room.

C (Consequence

+ or -)Example:

The client loses his walks.

PUNISHMENT - SUMMARY PUNISHMENT = DECREASE A BEHAVIOUR

. works only when the punisher is (or is likely to be) present.

. Be sure that the punishment is specific, is time-limited, and fits the “crime”.

. leads to emotional side-effects, such as avoidance of the person that is punishing and may lead to self-punishment.

. punishment happens when it doesn’t teach our clients what went or what to do next time.

Is this a negative reinforcement or punishment?

A client usually runs late for whakamoemiti and, as a consequence of that, staff tell him off. Within two weeks, the client started showing up on time.

PUNISHMENT x NEGATIVE REINFORCEMENT

Punishment weakens the targeted behaviour by introducing an aversive consequence.

while

Negative reinforcement strengthens the targeted behaviour by taking something away after the response.

A Behaviour Management Plan as a learning tool should include…

1. an expiring date.

2. Include client’s values and his treatment goals in order to motivate the client to comply with the plan.

3. Mention the targeted behaviour to be decreased and increased.

4. Identify the consequences that will be given (rewards, punishment, etc) when targeted behaviour are produced. The client should have a say.

5. The magnitude and frequency of consequences should be observed.

6. The budget should also be observed mainly regarding rewards. (artificial life/institutionalization)

7. A description of procedure/how the plan is going to be applied, identifying procedures and persons involved.

8. Compliance controls.

Behaviour Management Plan as a learning tool…

• Requires allocated daily time with the client to remind him of the wanted and unwanted behaviours e.g., “prepare for the day” and to “feedback on the day”.

• Requires availability to sit with the client when he does not comply with the plan in order to identify the A-B-C and new course of appropriate action for the client e.g., “Chain Analysis”.

Psychological Learning Principles

Tips:• To change a person’s behaviour ask what

consequence he/she would work to get (reinforcement) or work to avoid (punishment).

• Observe changes in behaviour when a consequence is applied.

• Behaviour learned in one situation may not happen in another situation.

Psychological Learning PrinciplesSummary:To increase behaviour, use reinforcement = add negative/positive reinforcement and/or remove aversive consequence.

To weaken behaviour, use extinction = remove negative/positive reinforcement and/or provide relief before unwanted behaviour.

To suppress behaviour, use punishment = add aversive consequence and/or remove positive/negative reinforcement.

Exercise

Reference

Linehan, M. M. (2015) DBT Skills training manual. 2nd ed. USA: The Guilford Press.

Linehan, M. M. (2015) DBT Skills training handouts and worksheets. 2nd ed. USA: The Guilford Press.

THANK YOU!