Behavioral Techniques for

the Healthcare Setting

 Dealing with non-compliance
• Power of negative reinforcement  ESCAPE from aversive stimulation
• Stimulus removal following behavior
• Increases future frequency of that behavior

Antecedent: See aversive stimulus/shot Behavior: Escape by flailing, kicking Consequence: No pain; happy child for now
at least
 Avoiding or decreasing non-compliance
Positive reinforcement
• Stimulus presentation following behavior
• Increases future frequency of that behavior

Always praise good behavior

Use potent reinforcers and avoid bootleg reinforcers
Use a rich schedule of reinforcement; response-independent (NCR)
 Avoiding or decreasing non-compliance
Differential reinforcement
• Reinforce some responses but not others
• Shape successive approximations to a target behavior

Reinforcing alternative behavior (such as request a break) may reduce anxiety

 Avoiding or decreasing non-compliance
Antecedent manipulation
• Altering the environment [e.g., reducing sensory stimulation]
• Use of discriminative stimuli (see Derrickson et al., 1993)
• Motivating operations
 Avoiding or decreasing non-compliance
Antecedent manipulation
• Preparation
• Gradual exposure
• Rehearsal with task analysis
• Breaking a behavior or sequence into component parts
• Rules in a sequential order
• Presented one step at a time
• Modeling
 Gradual exposure (ex.)
John has one painful spinal tap procedure and then becomes highly anxious
and fearful any time someone brings any kind of needle in the room. John’s
nurses first begin just showing him needles, then bringing them closer to his
skin without actually poking him. They also supervise him while he uses
needles to make a needlepoint art project, which he highly enjoys. After a week,
John no longer becomes anxious when staff bring a needle in the room for
basic procedures.
 Avoiding or decreasing non-compliance
Counterconditioning
• Used to “reverse” anxiety that occurs in the presence of a particular stimulus
that has been conditioned through history to be aversive
• Syringe, other medical equipment, treatment rooms, smell of alcohol wipes
• Gradual exposure to feared stimulus + paired with new pleasurable stimuli
 Counterconditioning (ex.)
Doug previously had an aversive experience getting his blood drawn and now
he is afraid of syringes. The nurses start a new procedure for Doug in which
syringes are repeatedly presented without drawing blood, and instead show
them to Doug while playing his favorite music, over an extended period of
time. Doug then no longer finds syringes to be scary.
 Avoiding or decreasing non-compliance
High probability request sequence
• Identify behaviors with history of compliance (high probability behaviors)
• Rapid request of high-probability behaviors
• Intersperse target behaviors with history of lower compliance
• Reinforcement for compliant behavior
 High-p RS (ex.)
Adam needs to sit very still to get his port accessed. Just prior to getting his
port accessed, the CLS plays a game with Adam, quickly shouting activities for
him to do:
“Clap your hands real fast for 10 seconds!”
“Stomp your feet for 10 seconds!”
“Lift your hands up for 5 seconds!”
“Sit real still for 10 seconds!”
 Readings Partner Work
Hankinson & Slifer (2013)
1. What behavioral techniques had been successfully used in prior studies?
2. What are some variables that typically contribute to non-adherence?
3. List the components of the intervention package.
Derrickson et al. (1993)
1. Describe the procedures.
2. What were the results?
3. What explains the positive effect in the infant?
 H & S (2013)
What behavioral techniques had been successfully used in prior studies?
• Stimulus fading
• Shaping/differential reinforcement
• Practice sessions with “pills” of increasing size
 What behavioral techniques had been
successfully used in prior studies? (cont.)
• Modeling of pill swallowing skills
• Task analysis
 What are some variables that typically
contribute to non-adherence?
• Negative mood (depression or issues with executive functioning)
• Sleep difficulties
• Chronic illness
 List the components of the intervention
package.
• Pill swallowing training
• Verbal + visual instruction; modeling; DR of swallowing mock and then real pills
• Mock: Stimulus fading to next size after 2 successful swallows; first cake decorations, then
placebo capsules
• Medication tracking sheet for adherence at home; SR+ for filling out and bringing back
• Parent training
• CBT Skills Training
• Relaxation training: deep breathing, visual imagery
• Positive activity scheduling
• Cognitive restructuring
 Derrickson et al. (1993)

Describe the procedures.

• ABAB design
• Signal present vs. signal absent
• Signal present: Box with push button attached to crib, emitted low buzz + red light
• Signal turned on immediately before an invasive procedure, and turned off as soon as it was
over
 What were the results?

• More positive behavior and less negative behaviors

• During periods of no invasive events
• During signal-present conditions across all events
 What explains the positive effect in the infant?

• Conditional discrimination
• Help the infant distinguish between aversive and “safe” periods