2. Before we start, be aware that…
A) the content of this presentation is important but
may be boring.
B) don’t concentrate on details, but try to get a
general picture of this presentation.
C) Some of the content may be shared and used
with your client to facilitate the learning process in
his/her rehabilitation.
3. Learning goal
Improve the ability to apply to increase
client’s wanted behaviours and to
decrease client’s unwanted ones while
using a BMP.
6. A BMP is…
1. A rehabilitation tool (not a punishing or a
controlling one).
2. A structured opportunity for client to decrease
maladaptive voluntary behaviours and to
increase adaptive voluntary ones.
3. An avenue for staff to identify what needs to be
modified in the ward environment and in the
interactions with client.
7. BMP as a learning tool
BMP is a learning tool that may support clients
to develop their WISE MIND and to deal with
their EMOTION MIND and the RATIONAL MIND.
‰‰
9. Psychological Learning Principles
To start or increase a voluntary/deliberate
behaviour, a reinforcer should be used.
REINFORCER: a consequence that increases
frequency of behaviour
11. Psychological Learning Principles
To start or increase a behaviour
Positive reinforcement = consequences a
person wants, likes or will behave to get.
A reward=praise, a compliment, a smile, a raise
at work, food, money, leaves)
13. Psychological Learning Principles
To start or increase a behaviour
Negative reinforcement = consequences that
stop or reduce something negative.
A relief e.g., cleaning your room to stop
someone from nagging about it)
16. Psychological Learning Principles
To start or increase a behaviour
SHAPING
1. Reinforce small steps that lead toward the goal.
2. As new behaviour stabilizes, require a little bit
more before reinforcing.
3. Continue until you reach the goal behaviour.
17. Psychological Learning Principles
To start or increase a behaviour
Timing counts
1. Reinforce behaviour immediately after it occurs.
2. When shaping new behaviour, at first reinforce
every instance of the behaviour.
3. Once behaviour is established, gradually start to
reinforce only some of the time.
19. Psychological Learning Principles
To stop or decrease unwanted behaviours
Satiation = providing relief or what is wanted
before the behaviour occurs.
20. Psychological Learning Principles
To stop or decrease unwanted behaviours
Punishment = an aversive consequence that
decreases a behaviour.
Aversive consequence = the person dislikes or
will work to avoid.
23. Difference between Punishment and
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.
24. Is this punishment or negative
reinforcement?
A student thinks that it is ok to run late for his
classes. However when his new teacher realised
this, she started pausing, frowning, and then
continued with the class. The teacher gave this
student who was late instant negative
reinforcement for his bad behaviour. Within two
weeks, this student was showing up on time.
25. Difference between Punishment and
Negative Reinforcement
Punishment weakens the targeted behaviour by
introducing an aversive consequence.
while
Extinction weakens the targeted behaviour by
stopping reinforcement (positive=reward or
negative=relief).
26. Difference between Punishment and
Negative Reinforcement
While driving, you’ve probably encountered a
situation in which, regardless of your speed, the
person behind you wants to go even faster. He
may have communicated this by tailgating
which is a deliberate behaviour.
27. Difference between Punishment and
Negative Reinforcement
How would you discourage/decrease his/her
behaviour of tailgating?
28. Difference between Punishment and
Negative Reinforcement
Extinction would involve not reinforcing the
behaviour e.g., not speeding up when the man
tailgates.
Punishment would be stepping on the brakes,
which also would cause your brake lights to turn
on, thereby causing the tailgater to step on his
brakes too.
29. Psychological Learning Principles
a. Be sure to reinforce the wanted behaviour to
replace behaviour you want stopped.
b. Extinction and punishment weaken or
suppress behaviour, but do not eliminate it.
c. Extinction and punishment do not teach new
behaviour.
30. Psychological Learning Principles
d. To keep a behaviour from resurfacing,
reinforce an alternative behaviour.
e. Punishment works only when the punisher is
(or is likely to be) present.
f. Punishment leads to avoidance of the person
punishing.(emotional side-effects)
31. Psychological Learning Principles
Tips:
• One person’s poison can be another person’s
passion.
• Context counts. A reinforcer in one situation can
be punishment in another.
• Quantity counts. If a reinforcer is too little or too
much, it will not work.
• Natural consequences work best. Let them do
the work when possible.
32. 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.
33. Psychological Learning Principles
Summary:
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.
34. The Environment role in the
Learning Process
An invalidating environment:
• see client’s experience/emotions are seen as invalid, weird,
wrong, or bad. e.g., “don’t tell me that you are angry
again”, “don’t come with this endless request list”, “you
should not feel like this”.
• ignores client’s emotional reactions and does nothing to
help him/her.
• triggers client’s impulsive behaviours because they are
prone to experience emotion deregulation.
36. A Behaviour Management Plan as a
learning tool should include…
1. an expiring date.
2. client’s values and his treatment goals.
3. the targeted behaviour to be decreased and increased.
4. the consequences that will be given (rewards, punishment, etc) when
targeted behaviour are produced.
5. a description of procedure/how the plan is going to be applied,
identifying procedures and persons involved.
6. forms that capture the BMP process and make this explicit to other staff
i.e., Maladaptive targeted behaviours form on file front page.
37. Before using the BMP as a learning tool…
• Make sure that you have already bought into the
idea of doing this as a learning tool.
• Motivate your client to do so, by:
a) Introducing the idea of a Wise Mind.(use the picture)
b) Filling the “Pros” and “Cons” Form.
c) Showing how the BMP may be positive for the
client’s goals/values/learning
process/opportunity to be rewarded.
40. “PROS” AND “CONS” Exercise
Enables the client to see a BMP as a tool that can support
him/her to do the following:
• Pursue his/her treatment goals.
• Learn new behaviours.
• Cope with the old unwanted behaviours.
• Commit himself to his/her values.
• Be entitled to have rewards.
41. Analysing behaviour:
applying learning principles to BMP
To figure out behaviours causes and plan for problem
solving.
Tools:
Chain Analysis: when client engage in ineffective
behaviour.
Missing Link Analysis: when client fail to engage in
effective behaviour.
42. Chain Analysis
• Examine the chain of events that leads to
ineffective behaviours.
• Examine the consequences of those
behaviours that may be making it hard to
change them.
• Helps to figure out how to repair the damage
(problem-solve).
45. Supporting your client to
understand his unwanted behaviour and change this
Open your booklet on page 16 – Chain Analysis
Worksheet.
46. Missing link analysis
• Helps you identify what got in the way of
doing things you needed or hoped to do,
things you agreed to do, or things others
expected you to do.
• It also helps you problem-solve for the future.
47. Supporting your client to
overcome barriers preventing him from doing
new/wanted behaviours
Open your booklet on page 16 – Chain Analysis
Worksheet.
48. Wrapping up…
• To use a BMP as a learning tool (and not only a
control one), you should buy into this proposal.
• Remember that rewards are required to learn
new/wanted behaviours.
• Remember that punishment causes side-effects
and is not an avenue to learn wanted behaviours.
49. Wrapping up…
• Introduce a BMP to your client, using the
concept of WISE MIND.
• Explain to your client that a BMP may be an
opportunity to learn, to be rewarded and to
work towards his/her goals.
• Using “PROS” and “CONS” form may help you
to motivate your client.
50. Wrapping up…
• The worksheets and some of the information
presented in the booklet may be shared with
your client.
51. 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.
A voluntary behaviour is called an operant behaviour
The wise mind concept may be seen as a metaphor that defines the ultimate goal of our interventions with our clients to support their growth and their evolvement as persons.
Ask for an example
Ask for an example
Ask for an example
Ask for an example
Ask for an example
When you vary reinforcement – reinforce intermittently - behaviour becomes very hard to stop.
For example
This leads to a burst of behaviour, and then to a decrease in behaviour.
Satiation reduces motivation for behaviour and thus decreases its frequency.
Behaviour is decreased
by consequences the person dislikes or will work to avoid.
by consequences that stop or reduce something positive.
Be sure that the punishment is specific, is time-limited, and fits the “crime”.
Avoid a punitive tone (threaten the client/to be the punishment); let the consequence do the work.
Be mindful of ineffective punishment happens when it doesn’t teach our clients what went or what to do next time. May lead to self punishment.
The word “positive” in positive punishment refers to the fact that the stimulus is presented after the operant response rather than removed after the response. It should be obvious that, in this case, the word “positive” does not mean that the stimulus was something that the person enjoyed: it is hard to imagine that anyone, even those suffering from sexual masochism, would find severe pain to be enjoyable.
Let’s say that a teenager has a very messy bedroom, with clothes and other objects thrown all around, and his mother wants him to clean it up. If she asks him to clean the room and he answers, “no, it’s my bedroom and I like the way it looks!” she probably will not like this answer. If she is determined to get him to clean his room, she might use a positive reinforcement, such as offering him money if he does as she asks. But she also might decide to punish him for refusing to clean his room. Positive punishment would be something like yelling at him after he says, “no.” On the other hand, many parents decide to punish by taking away something that the child or adolescent likes. In this case, the mother might take away his cell phone so that it is harder for him to talk to and text his friends. The mother is trying to weaken the operant response of saying, “no” (and thereby refusing to clean his room) by removing a stimulus (the phone) that is very important to him. This type of punishment is called negative punishment, and is defined as a stimulus that weakens an operant response when it is taken away after the response
The term negative reinforcement in the quoted passage is incorrect: the correct term for what the business owner and others were doing is punishment. It was punishment because, by pausing and frowning, the teacher was trying to weaken the behaviour of being late, not strengthen it. It is important for you to remember that a negative reinforcement strengthens a behaviour by taking something away after the response.
Both punishment and extinction reduce the strength of (weaken) operant responses, but they do so in different ways. In order to understand the distinction, let’s look at an example
How to discourage/decrease his/her behaviour of tailgating?
Reinforcing his/her behaviour is to speed up and let him/her keep the speed.
Extinction is the slower way of decreasing the tailgating behaviour. Extinction requires many trials — many presentations of the tailgating behaviour followed by no reinforcement.
Extinction would stop him straightaway, but probably if you want this person to reduce tailgating into the future, then multiple punishment times may be necessary.
Be sure that the punishment is specific, is time-limited, and fits the “crime”.
Avoid a punitive tone (threaten the client/to be the punishment); let the consequence do the work.
Be mindful of ineffective punishment happens when it doesn’t teach our clients what went or what to do next time. May lead to self punishment.
An invalidating social environment can be a barrier to learn wanted behaviours and to decrease unwanted ones, because:
Sometimes sStaff may be afraid that if they validate your emotions, you will get more emotional, not less.
Staff may be under high stress or time pressure, or they may have too few resources themselves.
Motivating you client to use a BMP as a learning tool means to meet him 1:1 in order to discuss the BMP.
Explain that BMP is a learning tool to support/speed up your client’s learning process/recovery.
Use the concept of WISE to explain the rationale for using a BMP. State that BMP is a learning tool to develop WISE MIND. Make connections between WISE MIND and recovery and your clients ability to move forward on his journey.
Fill the PROS and CONS Form.
You may be able to do this with you client using this form or just talking about this, depending on your client’s cognitive/emotional ability to do so. You can always adapt this exercise considering your client’s abilities to understand and to follow you.
Fill this in with the client and discuss it connecting the PROS and CONS with clients values and treatment goals. Ask question rather than making assumptions or telling your client what to do. This is your client “buying into” moment.
For example:
If you are an animal lover, would you be able to lead your life based on this value here, on the unit, or in the community? Probably speeding up your recovery by using a BMP would allow you to lead a life based on this value?
If you don’t discuss your behaviours, will you develop your social skills? Develop your social skills is one of your treatment goals.
a) Don’t thinking about your behaviours, will help you to learn how to manage your anger? So if you don’t think about your behaviours, you may overlook one of your treatment goals.
You like to go to Burger King and not using the BMP, you may not be entitled to have this extra reward.
OR b) You said that loyalty to your friends and family is an important value for you. You also said that
