5. Clinical Application of Reinforcement Procedures

A field of experimental endeavor in which Skinner’s work has yielded a vast and ever-expanding wealth of empirical research is the application of operant reinforcement theory in the clinical modification of behaviors.  Fuller (1949) was probably the first to report systematic investigation in this area.  Fuller (1949) used warm sugar-milk to shape, by successive approximation, the right-arm movement of an institutionalized, 18-year-old “vegetable idiot.”  Upon the removal of the reinforcer, the shaped response was extinguished.

Subsequent studies in the operant conditioning of human behavior in clinical settings have been reported by Lindsley and Skinner (1954), Lindsley (1956, 1960), Tilton (1956), King et al. (1960), and by Ferster and DeMyer (1961).  As an illustration, Lindsley (1956) used a prosthetic environment—a human-sized version of “Skinner’s box”—to study the effects of the application of different reinforcers, contingency schedules, and discriminative stimuli on the rate of lever pulling in chronic schizophrenics.  King et al. (1960) positively reinforced and shaped operant responses of severe chronic schizophrenics with cigarettes, candy, and colored slides.  King et al. (1960) reported that this procedure promoted clinical improvement more effectively than the verbal or recreational therapy given to control groups, as evaluated by behavioral observations and interviews.

Other areas of clinical research in the application of operant conditioning technology to the modification of behavior include: token economies (Ayllon & Azrin, 1965, 1968); reinstatement of verbal behavior in psychotics (Isaacs et al., 1960); modification of delinquent behavior (Burchard & Tyler, 1965); the therapeutic process and verbal conditioning (Sigal, 1967); toilet training and bed wetting (Azrin & Foxx, 1971, 1974; Azrin, Sneed, & Foxx, 1973; Foxx & Azrin, 1973); deviant behavior in children (Blackwood, 1971; Ora & Burgess, 1971); self-injurious behavior in retarded children (Lovaas & Simmons, 1969; Peterson & Peterson, 1968); and the operant approach in behavior therapy (Krasner, 1971).  As an example, Isaacs et al. (1960) reinstated verbal behavior in two persons exhibiting psychotic behavior.  The procedure they used was successive approximation (shaping), with chewing gum as the reinforcer.  These two institutionalized individuals had been mute for a number of years.  After the intervention procedure, one of the two individuals only maintained the verbal behavior in the presence of the therapist in the experimental situation.  The other person spoke both in the experimental situation and in the ward, but only to the therapist.  This second individual’s verbal behavior was later generalized to another person who was brought into the experimental situation.

In another study, Burchard and Tyler (1965) modified the behavior of an institutionalized 13-year-old boy.  The deviant behaviors that led to the institutionalization of this boy 4 years earlier included stealing, fire-setting, bed wetting, and cruelty to animals and small children.  During the year prior to the application of the contingency management procedure, this boy had spent a total of 200 days in isolation for various offenses such as stealing, breaking and entering, and smearing the walls of his room with paint.

The program to modify the boy’s behavior consisted of training the institution’s staff in using a 3-hr isolation procedure every time the boy produced any deviant behavior.  Other contingencies were also applied, such as adding 1 hour in isolation if the deviant behavior persisted during isolation.  In addition, this boy was also given tokens for every hour of the day that he was not in isolation, as well as for other activities.  The tokens thus received could be exchanged for different articles such as cigarettes and sodas, or for privileges such as going to a movie and taking a trip to town.  The shaping of the boy’s behavior required him to produce improved behavior in order for him to earn his tokens.  During the 5 months of the operant conditioning intervention, this boy was also taken off all medication and other forms of therapy.  The reported findings indicated that there was a 33% decrease in the use of the isolation procedure, in the 5-month period, from 18 instances in the first month to 12 instances in the last month.  In addition, the offenses for which the isolation procedure was used became increasingly less serious.

In the following section, the technique of behavioral contingency management has been selected for review on the basis of its relative importance to the research procedure used in this investigation.

© 1976 Angel Enrique Pacheco, Ph.D., C.Psych.  All Rights Reserved.

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