Consider the following small sample of problems that psychologists, teachers, parents, and other change agents
must deal with: What are effective ways of helping a person control or eliminate unwanted emotions such as some
anxiety, anger, jealousy, aggression, and racial prejudice? What basic approaches are available to us to facilitate
the reduction of nervous habits, epileptic seizures, stealing, and littering? What concrete things can be done when a
person wishes to reduce overeating, smoking, or the consumption of alcohol or other drugs? How does one deal
with insomnia and nightmares? If a client has a sexual dysfunction or is only sexually aroused by “inappropriate”
objects, what can be done to eliminate the problem and facilitate desired sexual behavior? How can a person
increase motivation in himself, a prison, a ward in a mental hospital, or a work Organization? What are effective
ways for a person to learn to relax, quiet his mind, and control unwanted thoughts? What constructive things can we
tell a parent about child rearing, toilet training, and bedwetting? In school classrooms, what are effective ways of
motivating the students, dealing with disruptive behavior, and individualizing instruction as much as possible? Given
the enormous number of people seeking clinical and counseling help and the relatively small number of highly
trained practitioners, how can we most effectively and efficiently help these people while maximizing the use of
available human resources?
This book describes one approach, behavior modification, which deals with the above problems, among many
others. The reason behavior modification can deal with such a wide range of problems, with varying degrees of
effectiveness, is because the approach draws on several basic principles of human behavior that cut across many
different problem areas and situations. Experimental studies are the main ways we refine our understanding of
human behavior and evaluate and evolve our behavior modification practice.
BEHAVIOR MODIFICATION
Behavior modification is the application of experimentally established principles of behavior to problems of behavior.
Currently, it draws most heavily from studies, not theories, in the areas of learning and motivation, although
behavior modification is not restricted to these areas. When used in settings that are primarily seen as clinical,
behavior modification is often called behavior therapy or conditioning therapy. Behavior modification is sometimes
equated with applied operant conditioning, which is just a part of behavior modification and more accurately called
experimental analysis of behavior.
In the last few years some writers have used the term behavior modification to refer to almost any practice that alters
human behavior. But this is not the case. More specifically, behavior modification is not brainwashing or mind
control, and behavior modifiers do not use psychosurgery or electroshock therapy and only occasionally use drugs
as a temporary adjunct to a change procedure. Rather, behavior modification is structured learning in which new
skills and other behaviors are learned, undesired reactions and habits are reduced, and the client becomes more
motivated for the desired changes.
Behavior modification is experimentally based. The assumption of psychology is that there is a set of laws that
describes factors which affect a person’s behavior. If a person’s behavior is changed, regardless of what the
procedure is called (e.g., behavior modification, analysis, influence, non- directive counseling), the change must be
based on these laws. And the closer the treatment procedure comes to using these laws, the more effective it is. It is
not known exactly what these basic laws are, but the experimental psychologist believes that the information from
experimental studies is the best approximation we have at present. The practice of behavior modification includes
the technology of applying these principles to human problems. (Note that behavior modification is more a
technology than a philosophy of the nature of human beings.) As various change procedures are developed, they
too are experimentally studied in terms of such questions as how effective are different-approaches for diff rent
problems and how can a specific procedure be improved. Therefore, behavior modification is continually evolving
and improving. This book is intended to give the reader a brief conceptual overview of the whole field of behavior
modification. Therefore, it is not possible or desirable to review all the related experimental research. However, I
have included many references so the readers may be directed to that research literature they wish to inspect in
more detail.
LEARNING AND MOTIVATION
Among the many factors that influence human behavior are genetic variables, physiological abnormalities, nutrition,
and electromagnetic radiation. Treatment of some problems may thus involve changing the person’s diet or
removing a brain tumor. Other physiological factors such as genetic predispositions for some forms of
schizophrenia, abnormally reactive nervous systems, biochemical imbalances in the brain, and mental retardation
generally cannot be directly treated at present. Hence they must be considered part of the “personality” of the
person (see Mikulas, 1974b, chap. 7) and seen as givens or constraints for whatever change procedures are
applicable. Behavior modification may not be able to eliminate the retardation, but it can help the retarded person
lead the most fulfilling life possible. Similarly, many problems that before were primarily treated by purely medical
approaches are now seen to be best treated by coupling the medical approach with behavior modification (Katz &
Zlutnick, 1974; Knapp & Peterson, 1976; LeBow, 1976).
began smoking cigarettes as teenagers for social approval may find several years later that they have learned a
complex smoking habit which is difficult to eliminate for more than a short period of time.
On the other hand, many problems involve behaviors that the person has not learned, but needs to learn, such as
how to study, relax, handle anxiety, or be more assertive. Behavior modification then draws strongly on learning and
motivation, and much of the practice consists of helping people reduce undesired learned behaviors and learn new
desired behaviors. Throughout this book I will be conceptualizing behavior from a learning-motivation position. But
psychology is overflowing with personality theories and clinical approaches that offer alternative ways of
conceptualizing behavior. What are the relationships between these various models and why choose one over
another? To some extent it is a matter of translation: How do the constructs and approaches of model A translate
into the constructs and approaches of model B? Are the “strokes” of transactional analysis the same as
“reinforcement” in behavior modification? In this context, many writers (Dollard & Miller, 1950; French, 1933; Kimble,
1961, chap. 14; Krasner, 1962; Sargant, 1959; Shoben, 1949; Truax, 1966) have attempted to show that what takes
place in various forms of therapy and counseling can be explained from a learning orientation. However, the issue is
much more than one of translation, for the various models often contain assumptions that lead to incompatibilities. In
Chapter 10, after the reader has a better understanding of behavior modification, I will raise this issue again and
suggest some relationships between behavior modification and other models.
There are a number of advantages to a learning-motivation based model. One is that the constructs are relatively
“clean”; they are well defined with a minimum of excess meaning and associations. This facilitates an objective
understanding of behavior. A second advantage is that learning and motivation, perhaps more than any other
model, suggest complex interrelationships of the various constructs in a way useful in understanding and treating
human problems that involve complex interweaving of many behaviors.
THE MEDICAL MODEL
From about the time of Freud until fairly recently the predominant way of thinking about and treating psychological
problems has been the medical model. The assumption of this approach is that abnormal behaviors are products of
more basic underlying causes within the psychological system, such as a subconscious conflict based on early
childhood experiences. If a person reports a fear of snakes, this is merely a symptom of an underlying cause. In this
case, the snake is usually seen as a sexual symbol; and the fear of snakes is based on sexual anxiety or castration
fears. Similarly, one theory of alcoholism is that the drinking behavior is a result of a more basic cause of latent
homosexuality. The medical model has so infused our culture that many people automatically assume it must be
true. A disadvantage of this way of thinking is that undesired behaviors are often seen as a product of a basic
pathology or psychological disease, an attitude which may lead to clients feeling more helpless or worse about
themselves. A common early step in behavior therapy is reducing the client’s beliefs and fears about being diseased
or mentally ill in some sense.Treatment based on the medical model requires procedures—such as psychoanalysis--
aimed at the underlying cause, not the behavioral symptom. This usually involves the client gaining insight into the
underlying cause and/or reliving and dealing with early experiences, often of a psychosexual nature. Psychology as
a science is very young, most of the information having been acquired in the last 30 years. Thus around the turn of
the century, psychology was basically a subset of philosophy. Freud then built his medical model based on his
medical training, his experiences with hysterical and neurotic clients, and his work with hypnosis. He and other
medical model theorists generated a large number of creative and important ideas about human behavior, many of
which have been refined and incorporated into the experimental literature and many of which have not held up and
have been significantly altered or rejected.
Over time, many psychologists became dissatisfied with the medical model. One reason is that many of the basic
concepts of the different theories (e.g., ego, id, power-striving, inferiority complex) were not defined so they could be
adequately measured. Without adequate measures it is always questionable whether a construct is applicable to an
individual or whether purported changes in a construct have taken place. This led to many different theories, all of
which could explain people’s behavior within their own theoretical constructs. But without better measures of the
constructs it is difficult to choose between alternative explanations or alternative approaches to change procedures.
Behavior modification defines its constructs in as measurable a way as possible.
A second question about the medical model concerns the idea of an underlying cause. Is a person’s fear of snakes
actually based on something like sexual anxiety? Medical models assume yes; learning-based models assume no.
From a learning approach a person acquired a fear of snakes through some combination of experiences such as
actual bad experiences with snakes; bad associations to snakes via stories, cartoons, religious tales, and the like
(our culture is extreme in its bad treatment of snakes); and/or acquiring the fear from someone else, often a parent,
who has the same fear (see Chapter 8). It is also likely that humans as a species have a predisposition to acquiring
a fear of snakes (Seligman, 1971) or perhaps even some degree of an innate fear that is coupled with learning
(Gray, 1971, p. 1 5).
This issue of the underlying cause is raised again below in the discussion of symptom substitution and again in
Chapter 1 0 when considering the relationships between behavior modification and psychoanalysis. But if, in fact,
there is no reason or need to trace an underlying cause, then one’s treatment program can generally proceed
significantly faster.
A major problem for all change agents, which is related to medical model types of conceptualization, is the tendency
to explain behavior problems in terms of some characteristic of the person, rather than a functional understanding of
the behaviors. A teacher might explain why a student misbehaves in class in terms of the student being a slow
learner, or being from a broken home, or from a minority group. A foreman might account for a worker’s poor work
performance in terms of the worker being a loner or not identifying with the company. Behavior modifiers look at
behavior more functionally—what are the conditions supporting this behavior? Being from a broken home does not
make a child misbehave in class. Rather, when we functionally examine the behavior, we will probably discover
something like the fact that the child gets peer approval for his misbehavior and has not learned other ways to get
this attention. (Perhaps being from a broken home impaired his learning alternative behaviors.) We can easily help
the child learn more acceptable and useful ways of gaining social approval; we cannot easily change the fact he is
from a broken home. Similarly, by systematically studying the worker with poor work performance, we may find that
he needs skill training related to his job or that the union would punish him for working harder.
BEHAVIORISM
Behavior modification then, as the name implies, is concerned with behavior, what does the person do. Behavior
here is meant in the broadest sense, including overt behavior that is readily observable, covert behavior such as
thoughts that are generally inferred from what the person tells us, various emotions, and subtle activity of the
nervous system. In all cases we define the behaviors as objectively as possible within the confines of the practicality
of the situation and the limits of our technology.
Behavior modification arose from the school of psychology called behaviorism, an approach that suggests the study
of psychology should emphasize the understanding, prediction, and control of behavior. The first major statement of
a behaviorist position was that of Watson in 1 91 3. Watson’s approach was a variation of methodological
behaviorism, which argues that mental events cannot be scientifically studied since you cannot get agreement about
what goes on in the mind. Watson held an extreme point of view in that he only considered the study of overt
behavior as scientifically valid and attempted to reduce thinking to movements of the vocal cords and tongue. He
emphasized the necessity for objective study of overt behavior, although he allowed for covert behavior. Many critics
of modern behav iorism and behavior modification use Watson’s form of behaviorism as a straw man. They suggest
behavior modification disregards people’s thoughts and feelings, treating them as empty organisms or white rats. In
reality, although these criticisms may apply to some practitioners of many orientations, the field of behavior
modification is not at all like that. Since its beginnings, behavior modification has been concerned with people’s
feelings, particularly anxiety. And Chapter 9 discusses the relationship of mental events to behavior and the
application of behavior modification to thoughts.
Similarly, Skinner (1974) is the foremost spokesman for behaviorism today. He suggests a form of behaviorism
called radical behaviorism, which recognizes and studies mental events as internal behaviors. Skinner’s views and
approach to behaviorism are not the same as all behaviorists practicing behavior modification. However, Skinner is
important reading for students of behavior modification.
The type of behaviorism being suggested here is not an attempt to reduce all human behavior to a few simple
reflexes or stimulus-response associations. Rather, it is an appreciation of the enormous complexity of human
behavior and an attempt to understand this complexity in terms of interrelationships of component behaviors.
Breaking behavior down into its components need not detract from an understanding of the person as a whole;
instead it facilitates developing an effective change program. The component behaviors are not conceptualized as
specific responses being learned to specific stimuli, but rather are classes of behaviors learned to classes of
situations.
By focusing on behaviors, behavior modification provides practical information about what to do in real situations.
While in school the student of clinical psychology may explore and debate various psychological- philosophical
models of human behavior; but when sitting down with a client who is a sexually impotent alcoholic reporting general
feelings of depression, what is the practitioner going to do? This client wants concrete, practical help now! A new
teacher may have many creative ideas for educating fifth graders and individualizing instruction. But when he gets
his first class he finds thirty different students with a wide range of academic backgrounds and behavior problems.
He is spending much of his time as a Policeman rather than an innovative educator. What is he to do?
Sometimes understanding a problem or seeing why he acts in some way may help a person deal with a problem.
Perhaps the person has the skills to overcome a problem once the problem is understood. But usually this is
insufficient Thus behavior modification does not depend on understanding, insight, or being able to interpret
behavior from some theoretical model as sufficient for behavior change. Rather, people may need help in learning
alternative behaviors or skills that are not in their repertoire. A woman in a Consciousness-raising group may
discover she needs to be more assertive with her husband. But this knowledge does not teach her to be
appropriately assertive without, for example, becoming too aggressive. In behavior modification we have specific
ways of helping a person learn appropriate assertive behaviors (see Chapter 8). Or consider fears. Probably just
about everyone reading this book has some type of undesired fear or source of anxiety, such as fear of spiders,
fear of snakes, fear of heights, test anxiety, or anxiety about speaking before a particular group of people. Does
your knowledge of this fear, your feeling the fear is irrational, or your ability to interpret the fear in terms of some
theory eliminate the fear? Probably not. Behavior modification provides specific ways of helping people handle
anxiety and eliminate fears.
This does not mean that understanding or insight is not present in behavior modification, only that it is often
insufficient. In fact, behavior modification practices often encourage clients to observe and understand the causes
of their behavior. This type of awareness or discrimination learning is often necessary for a thorough assessment
and often is the first step in helping the person develop self-control of some behaviors. The relationship between
understanding and behavior change will be covered in a little more detail in Chapter 9.
Working with behavior problems often involves a variety of different components. In some cases, there is a need for
education or clearing up misconceptions. This is common in the treatment of sexual problems. Sometimes the client
needs encouragement, permission, or a good listener. Sometimes the client needs medical aid, vocational training,
driving lessons, or a new set of teeth. But beyond all of this the behavior modifier has a practical approach of what
to do to deal with a range of behaviors that need to be increased or decreased.
SYMPTOM SUBSTITUTION
A concern of people from the medical model orientation is that behavior modification only treats the symptoms
without getting at the underlying cause. If the underlying cause is not treated, it may simply manifest itself in terms of
some other symptoms, a phenomenon called symptom substitution. This type of reasoning causes some people to
reject a behavioral approach as only tinkering with symptoms.
The issue, however, is not as clear as it first seems. Symptoms and underlying causes have not been well defined. It
is not clear exactly what constitutes a symptom, when substitution should occur, or when you have reached an
underlying cause. It is not clear why one must make the assumption of symptom substitution; such an assumption is
compatible, but unnecessary, from even a medical model or psychodynamic approach (Weitzman, 1967). Freud
allowed this as just one possibility. The issue becomes an empirical one: Does something such as symptom
substitution follow treatment of behaviors? The answer appears to be no. A large number of studies (e.g., Baker,
1969; Lazarus, 1963; Nolan et al., 1970; Paul, 1967, 1968; Wolpe, 1961; Yates, 1958) has shown that if the
treatment of the behaviors is adequately carried out, seldom does anything that resembles symptom substitution
occur. The key word is “adequately,” for if the practitioner does not treat all the relevant behaviors, then the
untreated behaviors, or behaviors resulting from them, might be interpreted as symptom substitution (Cahoon,
1968). Some examples of this follow.
Many behaviors are maintained by anxiety. Consider, for example, a person who feels anxious in social situations
and has adopted smoking as a means to reduce anxiety. If the behaviorist merely stopped the smoking behavior,
the person might turn to some other anxiety-reducing behavior, for example, excessive drinking. Superficially, it
would appear that symptom substitution had occurred. However, if the behaviorist treated the behavior of feeling
anxious, as well as the smoking behavior, then there should not be a substitute symptom. Now the reader may wish
to think of anxiety as some type of underlying cause in this case, and this is fine. But this is not how most medical
model theorists would think of an underlying cause. And the anxiety in this situation is readily reduced from a
behavioral position, as will be discussed in Chapter 3.
For treatment purposes, many people are taken from one environment and placed in another: A child is removed
from a public school and placed in a special training school, an adult is taken from his home and institutionalized, or
a drug addict is removed from society and placed in a treatment center. If, after treatment, clients are returned to
their original environment, the old surroundings and friends may trigger some of the old behaviors, which may then
be strengthened. A followup study might report relapse or symptom substitution, when in fact return of the undesired
behavior was because of the environment the clients were returned to. This underscores the importance for all
practitioners to systematically investigate and, if possible, alter any environments in which they place their clients.
The issue of symptom substitution was raised often in the early days of behavior modification, in the late 1950s and
early 1960s. But it is not mentioned much anymore in the professional literature, primarily because of lack of
empirical support. However, I still encounter it often when talking with lay people and undergraduates. It is an
interesting example of the extent to which medical model assumptions have been accepted into large parts of our
culture.
PROPERTIES OF BEHAVIOR MODIFICATION
1. Behavior modification is ahistorical. It does not matter how the individuals got where they are or acquired certain
problems. The question is What do we do here and now? What currently elicits and maintains undesirable
behaviors? What behavioral deficits currently exist? This does not mean we disregard historical information, for it is
often useful. But historical information is used to help determine current variables affecting behavior. Sometimes
historical information is unnecessary. If we had a case of a student with test anxiety, it might take a long time to
determine the events of the past that led to test anxiety. Fortunately, we can probably adequately reduce the anxiety
in a few hours without knowing the genesis. Also, the genesis of some current problem may be another earlier
problem that might now be resolved and need not be brought up again. Being ahistorical, behavior modification is
often faster than approaches that require tracing down historical causes.
2. Behavior modification avoids labeling and categorizing people and the use of words such as “abnormal.”
Classification systems may be useful for some administrative and communication purposes and may suggest some
variables to look at during assessment. But a label or category usually adds little to a functional analysis of the
behaviors. On the other hand, labeling the person may be detrimental to the person (as will be discussed in the next
chapter) or may cause the practitioner to overlook behaviors unique to that person.
Adjectives such as “abnormal,” “deviant,” and “mentally ill” are often used to describe people and behaviors. But
these are basically social- political constructs by which people in a particular culture at a particular time define
acceptable and unacceptable behaviors. Homosexuality in our culture is generally considered deviant. But this
attitude has been changing in our culture; and in some cultures, such as some early Greek cultures, homosexuality
was considered superior to heterosexuality. Similarly, some creative people and great leaders show behaviors that
are infrequent (not normal) in our culture, but does this make them deviant or abnormal? Such terms are too poorly
defined to be of much use. Behavior, regardless of how it is classified (e.g., normal versus abnormal), is acquired
and can be modified by the same principles of learning and motivation. Whether the behavior is acceptable or not to
some people or cultures is a separate ethical issue.
3. Behavior modification is sensible. The reasoning of behavior modification or some specific program can often be
explained to clients, teachers, parents, ward attendants, and others in a way that “makes sense” to them. They
need not accept some theoretical model or learn specialized terminology. When working with a client you can both
know where you are going and why. When working with ward attendants in a mental hospital you get better results
and cooperation when you reason with them. If you point out how one patient throws food in the cafeteria because it
results in the nurse going and sitting with him, then it is possible to suggest reasonable ways to reduce the food
throwing. On the other hand, if you describe the patient in nonsensical ways to the ward attendant, you should not
expect much help from the attendant in your treatment program. If parents go to a child psychologist, they usually
want some reasonable and specific suggestions for specific problems. They are probably not interested in
psychological-philosophizing or categorizing the child’s behavior or developmental stage.
4. One of the greatest advantages of behavior modification is that it does not require a one-to-one relationship
between the behavior modifier, who establishes and supervises the programs, and the clients. Thus the behavior
modifier can train teachers to carry out programs in classrooms (Doerr, 1 975) and parents to carry out programs
with children (Berkowitz & Graziano, 1972; O’Dell, 1974; Sloop, 1975). This is more effective and efficient than trying
to deal with all the individual children, particularly when the parents and teachers are often unknowingly responsible
for the misbehavior they wish to change. In this context, numerous behavior modification books have been written
specifically for teachers and parents (see Chapter 11). Similarly, ward attendants can learn to implement programs
in mental hospitals (e.g., the token economies of Chapter 7). In one program working with juveniles, the psychologist
supervises the behavior analysts who supervise the mediators who work with the youth (Tharp & Wetzel, 1969). And
others are investigating how behavior modification procedures can be used in the training of people to carry out
behavior modification (e.g., Loeber & Weisman, 1975). The importance of such programs is that more people and
paraprofessionals can be effectively used in the treatment program, more people can be directly helped, and the
behavior modifier can spend more of his time on general programs and specialized problems. In addition, some
behavior modification programs can be carried out with groups of people at a time. And in many situations,
automation can do many of the tasks for people (Butterfield, 1974; Elwood, 1975; Schwitzgebel & Schwitzgebel,
1973). For all these reasons, plus the emphasis on self- control mentioned next, more people can be treated more
efficiently and cheaper than approaches requiring a one-to-one relationship between the client and a highly trained
practitioner.
5. Finally, a large part of behavior modification is concerned with self-control, approaches geared toward teaching
people how to carry out change programs on themselves (see Chapter 11). This has many advantages, including
freeing the practitioner’s time and hence less expense to clients, greater attitude and behavior changes if clients
attribute the changes to themselves, the clients learning general strategies that they can apply in a variety of
situations, and the possibility of catching problems early or even Preventing them from occurring. People may learn
these self-control skills and programs from popularized magazine articles or books (e.g., Alberti & Emmons, 1975;
Fensterheim & Baer, 1975; Robbins & Fisher, 1973), selfcontrol clinics, television shows on self-control (Mikulas,
1976a), or individual counseling and training. In addition, several written self-control programs are being developed
to help people learn by themselves such things as how to improve study habits (Beneke & Harris, 1 972); lose
weight (Hagen, 1974; Hanson et al., 1976); and control premature ejaculation, the tendency of a male to ejaculate
too quickly in intercourse situations (Lowe & Mikulas, 1975). Thus more and more behavior modification information
is being distributed to people at large, so people can better understand, control, and direct their own behavior.
Overall then, behavior modification is a relatively new, evolving field that already contains a fast, efficient, and
powerful technology for behavior change. It is an important literature for all change agents and people who wish to
understand their own behavior, regardless of how they wish to incorporate this information into their own models.
SUMMARY
From experimental studies of behavior, including studies of learning and motivation, psychology is evolving an
understanding of basic principles of behavior that may be seen in a wide range of situations. Behavior modification
is the technology of applying these principles to problems of behavior, reducing undesired behaviors and teaching
desired behaviors, while continually experimentally evaluating and improving the various approaches. As much as
possible, the constructs of behavior modification are defined in ways that are readily measurable. The emphasis is
on behavior, what does the person do, including overt and covert behaviors. The practitioner focuses on the
complex interrelationships of current behaviors rather than on the historical causes or development of these
behaviors. Behavior modification does not require a one-to-one relationship between practitioner and client. People
can learn self-control skills and carry out programs on themselves; parents, teachers, and paraprofessionals can
learn how to help implement programs with others; groups of people can often be treated at one time; and many
aspects of different programs can be automated.
must deal with: What are effective ways of helping a person control or eliminate unwanted emotions such as some
anxiety, anger, jealousy, aggression, and racial prejudice? What basic approaches are available to us to facilitate
the reduction of nervous habits, epileptic seizures, stealing, and littering? What concrete things can be done when a
person wishes to reduce overeating, smoking, or the consumption of alcohol or other drugs? How does one deal
with insomnia and nightmares? If a client has a sexual dysfunction or is only sexually aroused by “inappropriate”
objects, what can be done to eliminate the problem and facilitate desired sexual behavior? How can a person
increase motivation in himself, a prison, a ward in a mental hospital, or a work Organization? What are effective
ways for a person to learn to relax, quiet his mind, and control unwanted thoughts? What constructive things can we
tell a parent about child rearing, toilet training, and bedwetting? In school classrooms, what are effective ways of
motivating the students, dealing with disruptive behavior, and individualizing instruction as much as possible? Given
the enormous number of people seeking clinical and counseling help and the relatively small number of highly
trained practitioners, how can we most effectively and efficiently help these people while maximizing the use of
available human resources?
This book describes one approach, behavior modification, which deals with the above problems, among many
others. The reason behavior modification can deal with such a wide range of problems, with varying degrees of
effectiveness, is because the approach draws on several basic principles of human behavior that cut across many
different problem areas and situations. Experimental studies are the main ways we refine our understanding of
human behavior and evaluate and evolve our behavior modification practice.
BEHAVIOR MODIFICATION
Behavior modification is the application of experimentally established principles of behavior to problems of behavior.
Currently, it draws most heavily from studies, not theories, in the areas of learning and motivation, although
behavior modification is not restricted to these areas. When used in settings that are primarily seen as clinical,
behavior modification is often called behavior therapy or conditioning therapy. Behavior modification is sometimes
equated with applied operant conditioning, which is just a part of behavior modification and more accurately called
experimental analysis of behavior.
In the last few years some writers have used the term behavior modification to refer to almost any practice that alters
human behavior. But this is not the case. More specifically, behavior modification is not brainwashing or mind
control, and behavior modifiers do not use psychosurgery or electroshock therapy and only occasionally use drugs
as a temporary adjunct to a change procedure. Rather, behavior modification is structured learning in which new
skills and other behaviors are learned, undesired reactions and habits are reduced, and the client becomes more
motivated for the desired changes.
Behavior modification is experimentally based. The assumption of psychology is that there is a set of laws that
describes factors which affect a person’s behavior. If a person’s behavior is changed, regardless of what the
procedure is called (e.g., behavior modification, analysis, influence, non- directive counseling), the change must be
based on these laws. And the closer the treatment procedure comes to using these laws, the more effective it is. It is
not known exactly what these basic laws are, but the experimental psychologist believes that the information from
experimental studies is the best approximation we have at present. The practice of behavior modification includes
the technology of applying these principles to human problems. (Note that behavior modification is more a
technology than a philosophy of the nature of human beings.) As various change procedures are developed, they
too are experimentally studied in terms of such questions as how effective are different-approaches for diff rent
problems and how can a specific procedure be improved. Therefore, behavior modification is continually evolving
and improving. This book is intended to give the reader a brief conceptual overview of the whole field of behavior
modification. Therefore, it is not possible or desirable to review all the related experimental research. However, I
have included many references so the readers may be directed to that research literature they wish to inspect in
more detail.
LEARNING AND MOTIVATION
Among the many factors that influence human behavior are genetic variables, physiological abnormalities, nutrition,
and electromagnetic radiation. Treatment of some problems may thus involve changing the person’s diet or
removing a brain tumor. Other physiological factors such as genetic predispositions for some forms of
schizophrenia, abnormally reactive nervous systems, biochemical imbalances in the brain, and mental retardation
generally cannot be directly treated at present. Hence they must be considered part of the “personality” of the
person (see Mikulas, 1974b, chap. 7) and seen as givens or constraints for whatever change procedures are
applicable. Behavior modification may not be able to eliminate the retardation, but it can help the retarded person
lead the most fulfilling life possible. Similarly, many problems that before were primarily treated by purely medical
approaches are now seen to be best treated by coupling the medical approach with behavior modification (Katz &
Zlutnick, 1974; Knapp & Peterson, 1976; LeBow, 1976).
began smoking cigarettes as teenagers for social approval may find several years later that they have learned a
complex smoking habit which is difficult to eliminate for more than a short period of time.
On the other hand, many problems involve behaviors that the person has not learned, but needs to learn, such as
how to study, relax, handle anxiety, or be more assertive. Behavior modification then draws strongly on learning and
motivation, and much of the practice consists of helping people reduce undesired learned behaviors and learn new
desired behaviors. Throughout this book I will be conceptualizing behavior from a learning-motivation position. But
psychology is overflowing with personality theories and clinical approaches that offer alternative ways of
conceptualizing behavior. What are the relationships between these various models and why choose one over
another? To some extent it is a matter of translation: How do the constructs and approaches of model A translate
into the constructs and approaches of model B? Are the “strokes” of transactional analysis the same as
“reinforcement” in behavior modification? In this context, many writers (Dollard & Miller, 1950; French, 1933; Kimble,
1961, chap. 14; Krasner, 1962; Sargant, 1959; Shoben, 1949; Truax, 1966) have attempted to show that what takes
place in various forms of therapy and counseling can be explained from a learning orientation. However, the issue is
much more than one of translation, for the various models often contain assumptions that lead to incompatibilities. In
Chapter 10, after the reader has a better understanding of behavior modification, I will raise this issue again and
suggest some relationships between behavior modification and other models.
There are a number of advantages to a learning-motivation based model. One is that the constructs are relatively
“clean”; they are well defined with a minimum of excess meaning and associations. This facilitates an objective
understanding of behavior. A second advantage is that learning and motivation, perhaps more than any other
model, suggest complex interrelationships of the various constructs in a way useful in understanding and treating
human problems that involve complex interweaving of many behaviors.
THE MEDICAL MODEL
From about the time of Freud until fairly recently the predominant way of thinking about and treating psychological
problems has been the medical model. The assumption of this approach is that abnormal behaviors are products of
more basic underlying causes within the psychological system, such as a subconscious conflict based on early
childhood experiences. If a person reports a fear of snakes, this is merely a symptom of an underlying cause. In this
case, the snake is usually seen as a sexual symbol; and the fear of snakes is based on sexual anxiety or castration
fears. Similarly, one theory of alcoholism is that the drinking behavior is a result of a more basic cause of latent
homosexuality. The medical model has so infused our culture that many people automatically assume it must be
true. A disadvantage of this way of thinking is that undesired behaviors are often seen as a product of a basic
pathology or psychological disease, an attitude which may lead to clients feeling more helpless or worse about
themselves. A common early step in behavior therapy is reducing the client’s beliefs and fears about being diseased
or mentally ill in some sense.Treatment based on the medical model requires procedures—such as psychoanalysis--
aimed at the underlying cause, not the behavioral symptom. This usually involves the client gaining insight into the
underlying cause and/or reliving and dealing with early experiences, often of a psychosexual nature. Psychology as
a science is very young, most of the information having been acquired in the last 30 years. Thus around the turn of
the century, psychology was basically a subset of philosophy. Freud then built his medical model based on his
medical training, his experiences with hysterical and neurotic clients, and his work with hypnosis. He and other
medical model theorists generated a large number of creative and important ideas about human behavior, many of
which have been refined and incorporated into the experimental literature and many of which have not held up and
have been significantly altered or rejected.
Over time, many psychologists became dissatisfied with the medical model. One reason is that many of the basic
concepts of the different theories (e.g., ego, id, power-striving, inferiority complex) were not defined so they could be
adequately measured. Without adequate measures it is always questionable whether a construct is applicable to an
individual or whether purported changes in a construct have taken place. This led to many different theories, all of
which could explain people’s behavior within their own theoretical constructs. But without better measures of the
constructs it is difficult to choose between alternative explanations or alternative approaches to change procedures.
Behavior modification defines its constructs in as measurable a way as possible.
A second question about the medical model concerns the idea of an underlying cause. Is a person’s fear of snakes
actually based on something like sexual anxiety? Medical models assume yes; learning-based models assume no.
From a learning approach a person acquired a fear of snakes through some combination of experiences such as
actual bad experiences with snakes; bad associations to snakes via stories, cartoons, religious tales, and the like
(our culture is extreme in its bad treatment of snakes); and/or acquiring the fear from someone else, often a parent,
who has the same fear (see Chapter 8). It is also likely that humans as a species have a predisposition to acquiring
a fear of snakes (Seligman, 1971) or perhaps even some degree of an innate fear that is coupled with learning
(Gray, 1971, p. 1 5).
This issue of the underlying cause is raised again below in the discussion of symptom substitution and again in
Chapter 1 0 when considering the relationships between behavior modification and psychoanalysis. But if, in fact,
there is no reason or need to trace an underlying cause, then one’s treatment program can generally proceed
significantly faster.
A major problem for all change agents, which is related to medical model types of conceptualization, is the tendency
to explain behavior problems in terms of some characteristic of the person, rather than a functional understanding of
the behaviors. A teacher might explain why a student misbehaves in class in terms of the student being a slow
learner, or being from a broken home, or from a minority group. A foreman might account for a worker’s poor work
performance in terms of the worker being a loner or not identifying with the company. Behavior modifiers look at
behavior more functionally—what are the conditions supporting this behavior? Being from a broken home does not
make a child misbehave in class. Rather, when we functionally examine the behavior, we will probably discover
something like the fact that the child gets peer approval for his misbehavior and has not learned other ways to get
this attention. (Perhaps being from a broken home impaired his learning alternative behaviors.) We can easily help
the child learn more acceptable and useful ways of gaining social approval; we cannot easily change the fact he is
from a broken home. Similarly, by systematically studying the worker with poor work performance, we may find that
he needs skill training related to his job or that the union would punish him for working harder.
BEHAVIORISM
Behavior modification then, as the name implies, is concerned with behavior, what does the person do. Behavior
here is meant in the broadest sense, including overt behavior that is readily observable, covert behavior such as
thoughts that are generally inferred from what the person tells us, various emotions, and subtle activity of the
nervous system. In all cases we define the behaviors as objectively as possible within the confines of the practicality
of the situation and the limits of our technology.
Behavior modification arose from the school of psychology called behaviorism, an approach that suggests the study
of psychology should emphasize the understanding, prediction, and control of behavior. The first major statement of
a behaviorist position was that of Watson in 1 91 3. Watson’s approach was a variation of methodological
behaviorism, which argues that mental events cannot be scientifically studied since you cannot get agreement about
what goes on in the mind. Watson held an extreme point of view in that he only considered the study of overt
behavior as scientifically valid and attempted to reduce thinking to movements of the vocal cords and tongue. He
emphasized the necessity for objective study of overt behavior, although he allowed for covert behavior. Many critics
of modern behav iorism and behavior modification use Watson’s form of behaviorism as a straw man. They suggest
behavior modification disregards people’s thoughts and feelings, treating them as empty organisms or white rats. In
reality, although these criticisms may apply to some practitioners of many orientations, the field of behavior
modification is not at all like that. Since its beginnings, behavior modification has been concerned with people’s
feelings, particularly anxiety. And Chapter 9 discusses the relationship of mental events to behavior and the
application of behavior modification to thoughts.
Similarly, Skinner (1974) is the foremost spokesman for behaviorism today. He suggests a form of behaviorism
called radical behaviorism, which recognizes and studies mental events as internal behaviors. Skinner’s views and
approach to behaviorism are not the same as all behaviorists practicing behavior modification. However, Skinner is
important reading for students of behavior modification.
The type of behaviorism being suggested here is not an attempt to reduce all human behavior to a few simple
reflexes or stimulus-response associations. Rather, it is an appreciation of the enormous complexity of human
behavior and an attempt to understand this complexity in terms of interrelationships of component behaviors.
Breaking behavior down into its components need not detract from an understanding of the person as a whole;
instead it facilitates developing an effective change program. The component behaviors are not conceptualized as
specific responses being learned to specific stimuli, but rather are classes of behaviors learned to classes of
situations.
By focusing on behaviors, behavior modification provides practical information about what to do in real situations.
While in school the student of clinical psychology may explore and debate various psychological- philosophical
models of human behavior; but when sitting down with a client who is a sexually impotent alcoholic reporting general
feelings of depression, what is the practitioner going to do? This client wants concrete, practical help now! A new
teacher may have many creative ideas for educating fifth graders and individualizing instruction. But when he gets
his first class he finds thirty different students with a wide range of academic backgrounds and behavior problems.
He is spending much of his time as a Policeman rather than an innovative educator. What is he to do?
Sometimes understanding a problem or seeing why he acts in some way may help a person deal with a problem.
Perhaps the person has the skills to overcome a problem once the problem is understood. But usually this is
insufficient Thus behavior modification does not depend on understanding, insight, or being able to interpret
behavior from some theoretical model as sufficient for behavior change. Rather, people may need help in learning
alternative behaviors or skills that are not in their repertoire. A woman in a Consciousness-raising group may
discover she needs to be more assertive with her husband. But this knowledge does not teach her to be
appropriately assertive without, for example, becoming too aggressive. In behavior modification we have specific
ways of helping a person learn appropriate assertive behaviors (see Chapter 8). Or consider fears. Probably just
about everyone reading this book has some type of undesired fear or source of anxiety, such as fear of spiders,
fear of snakes, fear of heights, test anxiety, or anxiety about speaking before a particular group of people. Does
your knowledge of this fear, your feeling the fear is irrational, or your ability to interpret the fear in terms of some
theory eliminate the fear? Probably not. Behavior modification provides specific ways of helping people handle
anxiety and eliminate fears.
This does not mean that understanding or insight is not present in behavior modification, only that it is often
insufficient. In fact, behavior modification practices often encourage clients to observe and understand the causes
of their behavior. This type of awareness or discrimination learning is often necessary for a thorough assessment
and often is the first step in helping the person develop self-control of some behaviors. The relationship between
understanding and behavior change will be covered in a little more detail in Chapter 9.
Working with behavior problems often involves a variety of different components. In some cases, there is a need for
education or clearing up misconceptions. This is common in the treatment of sexual problems. Sometimes the client
needs encouragement, permission, or a good listener. Sometimes the client needs medical aid, vocational training,
driving lessons, or a new set of teeth. But beyond all of this the behavior modifier has a practical approach of what
to do to deal with a range of behaviors that need to be increased or decreased.
SYMPTOM SUBSTITUTION
A concern of people from the medical model orientation is that behavior modification only treats the symptoms
without getting at the underlying cause. If the underlying cause is not treated, it may simply manifest itself in terms of
some other symptoms, a phenomenon called symptom substitution. This type of reasoning causes some people to
reject a behavioral approach as only tinkering with symptoms.
The issue, however, is not as clear as it first seems. Symptoms and underlying causes have not been well defined. It
is not clear exactly what constitutes a symptom, when substitution should occur, or when you have reached an
underlying cause. It is not clear why one must make the assumption of symptom substitution; such an assumption is
compatible, but unnecessary, from even a medical model or psychodynamic approach (Weitzman, 1967). Freud
allowed this as just one possibility. The issue becomes an empirical one: Does something such as symptom
substitution follow treatment of behaviors? The answer appears to be no. A large number of studies (e.g., Baker,
1969; Lazarus, 1963; Nolan et al., 1970; Paul, 1967, 1968; Wolpe, 1961; Yates, 1958) has shown that if the
treatment of the behaviors is adequately carried out, seldom does anything that resembles symptom substitution
occur. The key word is “adequately,” for if the practitioner does not treat all the relevant behaviors, then the
untreated behaviors, or behaviors resulting from them, might be interpreted as symptom substitution (Cahoon,
1968). Some examples of this follow.
Many behaviors are maintained by anxiety. Consider, for example, a person who feels anxious in social situations
and has adopted smoking as a means to reduce anxiety. If the behaviorist merely stopped the smoking behavior,
the person might turn to some other anxiety-reducing behavior, for example, excessive drinking. Superficially, it
would appear that symptom substitution had occurred. However, if the behaviorist treated the behavior of feeling
anxious, as well as the smoking behavior, then there should not be a substitute symptom. Now the reader may wish
to think of anxiety as some type of underlying cause in this case, and this is fine. But this is not how most medical
model theorists would think of an underlying cause. And the anxiety in this situation is readily reduced from a
behavioral position, as will be discussed in Chapter 3.
For treatment purposes, many people are taken from one environment and placed in another: A child is removed
from a public school and placed in a special training school, an adult is taken from his home and institutionalized, or
a drug addict is removed from society and placed in a treatment center. If, after treatment, clients are returned to
their original environment, the old surroundings and friends may trigger some of the old behaviors, which may then
be strengthened. A followup study might report relapse or symptom substitution, when in fact return of the undesired
behavior was because of the environment the clients were returned to. This underscores the importance for all
practitioners to systematically investigate and, if possible, alter any environments in which they place their clients.
The issue of symptom substitution was raised often in the early days of behavior modification, in the late 1950s and
early 1960s. But it is not mentioned much anymore in the professional literature, primarily because of lack of
empirical support. However, I still encounter it often when talking with lay people and undergraduates. It is an
interesting example of the extent to which medical model assumptions have been accepted into large parts of our
culture.
PROPERTIES OF BEHAVIOR MODIFICATION
1. Behavior modification is ahistorical. It does not matter how the individuals got where they are or acquired certain
problems. The question is What do we do here and now? What currently elicits and maintains undesirable
behaviors? What behavioral deficits currently exist? This does not mean we disregard historical information, for it is
often useful. But historical information is used to help determine current variables affecting behavior. Sometimes
historical information is unnecessary. If we had a case of a student with test anxiety, it might take a long time to
determine the events of the past that led to test anxiety. Fortunately, we can probably adequately reduce the anxiety
in a few hours without knowing the genesis. Also, the genesis of some current problem may be another earlier
problem that might now be resolved and need not be brought up again. Being ahistorical, behavior modification is
often faster than approaches that require tracing down historical causes.
2. Behavior modification avoids labeling and categorizing people and the use of words such as “abnormal.”
Classification systems may be useful for some administrative and communication purposes and may suggest some
variables to look at during assessment. But a label or category usually adds little to a functional analysis of the
behaviors. On the other hand, labeling the person may be detrimental to the person (as will be discussed in the next
chapter) or may cause the practitioner to overlook behaviors unique to that person.
Adjectives such as “abnormal,” “deviant,” and “mentally ill” are often used to describe people and behaviors. But
these are basically social- political constructs by which people in a particular culture at a particular time define
acceptable and unacceptable behaviors. Homosexuality in our culture is generally considered deviant. But this
attitude has been changing in our culture; and in some cultures, such as some early Greek cultures, homosexuality
was considered superior to heterosexuality. Similarly, some creative people and great leaders show behaviors that
are infrequent (not normal) in our culture, but does this make them deviant or abnormal? Such terms are too poorly
defined to be of much use. Behavior, regardless of how it is classified (e.g., normal versus abnormal), is acquired
and can be modified by the same principles of learning and motivation. Whether the behavior is acceptable or not to
some people or cultures is a separate ethical issue.
3. Behavior modification is sensible. The reasoning of behavior modification or some specific program can often be
explained to clients, teachers, parents, ward attendants, and others in a way that “makes sense” to them. They
need not accept some theoretical model or learn specialized terminology. When working with a client you can both
know where you are going and why. When working with ward attendants in a mental hospital you get better results
and cooperation when you reason with them. If you point out how one patient throws food in the cafeteria because it
results in the nurse going and sitting with him, then it is possible to suggest reasonable ways to reduce the food
throwing. On the other hand, if you describe the patient in nonsensical ways to the ward attendant, you should not
expect much help from the attendant in your treatment program. If parents go to a child psychologist, they usually
want some reasonable and specific suggestions for specific problems. They are probably not interested in
psychological-philosophizing or categorizing the child’s behavior or developmental stage.
4. One of the greatest advantages of behavior modification is that it does not require a one-to-one relationship
between the behavior modifier, who establishes and supervises the programs, and the clients. Thus the behavior
modifier can train teachers to carry out programs in classrooms (Doerr, 1 975) and parents to carry out programs
with children (Berkowitz & Graziano, 1972; O’Dell, 1974; Sloop, 1975). This is more effective and efficient than trying
to deal with all the individual children, particularly when the parents and teachers are often unknowingly responsible
for the misbehavior they wish to change. In this context, numerous behavior modification books have been written
specifically for teachers and parents (see Chapter 11). Similarly, ward attendants can learn to implement programs
in mental hospitals (e.g., the token economies of Chapter 7). In one program working with juveniles, the psychologist
supervises the behavior analysts who supervise the mediators who work with the youth (Tharp & Wetzel, 1969). And
others are investigating how behavior modification procedures can be used in the training of people to carry out
behavior modification (e.g., Loeber & Weisman, 1975). The importance of such programs is that more people and
paraprofessionals can be effectively used in the treatment program, more people can be directly helped, and the
behavior modifier can spend more of his time on general programs and specialized problems. In addition, some
behavior modification programs can be carried out with groups of people at a time. And in many situations,
automation can do many of the tasks for people (Butterfield, 1974; Elwood, 1975; Schwitzgebel & Schwitzgebel,
1973). For all these reasons, plus the emphasis on self- control mentioned next, more people can be treated more
efficiently and cheaper than approaches requiring a one-to-one relationship between the client and a highly trained
practitioner.
5. Finally, a large part of behavior modification is concerned with self-control, approaches geared toward teaching
people how to carry out change programs on themselves (see Chapter 11). This has many advantages, including
freeing the practitioner’s time and hence less expense to clients, greater attitude and behavior changes if clients
attribute the changes to themselves, the clients learning general strategies that they can apply in a variety of
situations, and the possibility of catching problems early or even Preventing them from occurring. People may learn
these self-control skills and programs from popularized magazine articles or books (e.g., Alberti & Emmons, 1975;
Fensterheim & Baer, 1975; Robbins & Fisher, 1973), selfcontrol clinics, television shows on self-control (Mikulas,
1976a), or individual counseling and training. In addition, several written self-control programs are being developed
to help people learn by themselves such things as how to improve study habits (Beneke & Harris, 1 972); lose
weight (Hagen, 1974; Hanson et al., 1976); and control premature ejaculation, the tendency of a male to ejaculate
too quickly in intercourse situations (Lowe & Mikulas, 1975). Thus more and more behavior modification information
is being distributed to people at large, so people can better understand, control, and direct their own behavior.
Overall then, behavior modification is a relatively new, evolving field that already contains a fast, efficient, and
powerful technology for behavior change. It is an important literature for all change agents and people who wish to
understand their own behavior, regardless of how they wish to incorporate this information into their own models.
SUMMARY
From experimental studies of behavior, including studies of learning and motivation, psychology is evolving an
understanding of basic principles of behavior that may be seen in a wide range of situations. Behavior modification
is the technology of applying these principles to problems of behavior, reducing undesired behaviors and teaching
desired behaviors, while continually experimentally evaluating and improving the various approaches. As much as
possible, the constructs of behavior modification are defined in ways that are readily measurable. The emphasis is
on behavior, what does the person do, including overt and covert behaviors. The practitioner focuses on the
complex interrelationships of current behaviors rather than on the historical causes or development of these
behaviors. Behavior modification does not require a one-to-one relationship between practitioner and client. People
can learn self-control skills and carry out programs on themselves; parents, teachers, and paraprofessionals can
learn how to help implement programs with others; groups of people can often be treated at one time; and many
aspects of different programs can be automated.
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