Applied Behavioural Analysis in Therapy

On leaving university, I am aiming to pursue a career in clinical psychology. Despite it not being one of my main interests, applied behaviour analysis could be a strategy that I could adopt in therapy sessions in order to help treat people with eating disorders such as anorexia nervosa.

Applied behaviour analysis involves understanding how we can use environmental events to influence behaviour in desirable ways. When treating a client with anorexia, extinction could be used to remove the reinforcers that are helping to maintain the target behaviour (not eating). After defining the target behaviour (not eating), reinforcers that maintain this target behaviour should be identified. Examples of these could include attention provided by the family when the client complains about pain, references to not eating or weight. Withholding all reinforcement of the target behaviour, by ignoring the client’s complaints and by informing the family to continue to ignore these behaviours when the client is in their home environment, will help to discourage behaviours associated with not eating. Leitenber, Agras and Thomson (1968) found that physical complaints were eliminated when they were ignored.

Leitenber et al. (1968) also found that a normal eating pattern was not restored by an extinction procedure. Positive reinforcement could, therefore, be introduced to increase the frequency of the new target behaviour (eating). Once this is defined, appropriate reinforcers should be identified. Leitenber et al. (1968) used verbal praise such as ‘you gained nicely today,’ provided the patient with certain privileges such as ‘would you like to watch TV for an hour tonight?’ and enthusiastically praised any statements the patient made towards eating and health. Natural reinforcers could also be used. For example, the therapist could tell the client to think about how much better they feel after eating food.

However, the more time that there is between the behaviour and the reinforcement, the more likely it is that a different behaviour will be reinforced instead. Delayed reinforcement, therefore, could have negative consequences. In order to prevent this, reinforcers should be made immediate and the family of the client should be told to continue this style of reinforcement at home. The reinforcement should also be consistent, otherwise the client may become confused and the reinforcers may not be effective.

Studies have shown that positive reinforcement is effective in encouraging weight gain and food intake in anorexic patients (Leitenber et al., 1968; Agras, Barlow, Chapin, Abel, & Leitenberg, 1974; Monti, McCrady, & Barlow, 1977). This suggests that applied behaviour analysis may be an effective way of treating individuals with anorexia that I could implement in my future career.

Alexandra Hampstead

References

Agras, W. S., Barlow, D. H. Chapin, H. N., Abel, G. G., & Leitenberg, H. (1974). Behaviour modification of anorexia nervosa. Archives of General Psychiatry, 30, 279-286.

Leitenberg, H., Agras, W. S., & Thomson, L. E. (1968). A sequential analysis of the effect of selective positive reinforcement in modifying anorexia nervosa. Behaviour Research and Therapy, 6, 211-218.

Monti, P. M., McCrady, B. S., & Barlow, D. H. (1977). Effect of positive reinforcement, informational feedback, and contingency contracting on a bulimic anorexic female. Behaviour Therapy, 8, 258-263.