Within the scope of psychotherapy, therapists employ many different approaches to handling the client’s issues. A popular approach used in trying to handle problematic behaviours that may be presented is through the use of behaviour therapy. According to Archer and McCarthy (2007), behaviour therapy (behaviourism) gathered momentum in the 1960’s and has since become one of the many influential perspectives used to combat problematic issues. According to this approach, the behaviour of individuals is determined by social learning and therefore; stimuli that are presented to us on a daily basis affect what we learn and consequently manipulate our behaviours (Westen, Burton & Kowalski, 2006).
One of the major contributions this approach is the use of operant conditioning, envisaged by Burrhus Frederic Skinner in 1937 (Archer & McCarthy, 2007). Staddon and Cerutti (2002) comment that under operant conditioning, the rate at which a particular behaviour is repeated is dependent upon whether; the behaviour is reinforced (behaviour increased) or punished (behaviour decreased). They further state that for this reason, Skinner referred to this process as being behaviours which are “controlled” by their outcomes.
Archer and McCarthy (2007), further state that operant conditioning is further divided as being positive or negative reinforcement, while punishment is also divided into positive and negative punishment. In each subclass, “positive” should be interpreted as being something that is introduced into the situation, while “negative” means to take away something from the situation. Therefore in each subclass something can either be introduced or taken away to increase the behaviour (positive/negative reinforcement) or something can either be introduced or taken away to decrease the behaviour (positive/negative punishment).
Time to talk about water
A common addition to reinforcement is the implementation of a reward system, which is given in order to applaud and reinforce a desired behaviour change. According to Fulton (2010) rewards are best described as the receiving of a valuable incentive by a person that would promote them to repeat a pre-performed action. Such was a case studied by Azerrad and Stafford (1969) who tested the use of a positive reward system (tokens) to initiate a desired behaviour change in a patient diagnosed with anorexia nervosa. The patient displayed behaviours of not eating properly and hoarding food in her room that she hid from the dinner table. In the study the patient was hospitalised for a period of time in order to help increase the patients’ weight and change her behaviour towards eating.
Therapist implemented different stages of reward system reinforcements to help coax the patient towards the desired behaviour. The patient was given tokens for 3 different types of achievements over the span of her hospitalised time. For a period of one week she received immediate tokens for any increased weight gain from the prior day. The second phase which was carried out over a four week period was the use of a delayed rewarding system that was dependent upon the amount of food ate. The last phase implemented an immediate reward system whereby a reward was offered for the type of food chosen.
Results indicated that although initially the reward system was dishonestly being manipulated by the patient, upon proper supervision of desired behaviours, results indicated that the patients’ weight had significantly increased over the hospitalised time frame. The study results indicated that the patient was physically eating more food and no longer trying to hide food in her room. Azerrad and Stafford further stated that immediate reward system had a more beneficial reinforcement than a delayed system. However a problem they did note was that the patients’ eating rate did in fact drop once she was discharged and no longer receiving the rewards.
Similarly a study by Sorensen et al. (2007) found similar reinforcement results when they tested a reward system for HIV- drug abuse subjects. When given the option for positive treatment, many subject rejected following medical advice. Therefore the study implemented a continuous reinforcement schedule of using money to coax the correct behaviour of taking appropriate medication. Results indicated that when compared to a control group, the subjects being tested were more cooperative in following medical direction given when reinforced with a monetary reinforcer. However just like the study by Azerrad and Stafford; results found that once reinforcement was ceased, adherence to the behaviour also decreased. They further hypothesised that the reinforcement did not show any evidence of long lasting effects once the reward system was stopped.
An important area that this report will follow on is the adequate behaviour of drinking sufficient water to maintain healthy living. According to Juan and Basiotis (2004) having a routine in place in terms of drinking water is very important. Medical professional recommend that in daily life we should on average drink at least 8 glasses of water a day with the reason being that through our bodies natural functions we lose approximately 1 – 3litres of water a day. The water stored in the body help us function daily in terms of support blood vessels in the body from dying out, helping kidney function eliminate waste and more importantly regulate a healthy body temperature. Considering that the body is made up of 50 – 70% water keeping rehydrated would be an advisable behaviour to maintain throughout life. (Barnard, 2009; Juan & Basiotis, 2004).
Taking these facts on board, this study analysed a subjects’ water drinking behaviour in order to increase the behaviour and promote good health. Using a continuous positive reinforcement schedule incorporating a reward system, it is hypothesised that the behaviour of drinking water will increase due to the intervention that has been implemented.
The subject monitored in this case study was a 30 year old male student. The subject is considered to be outside of normal health with medical staff diagnosing him with diabetes. For this reason he was recommended to decrease his level of sugary drinks and increase his level of water consumption. The subject had also decided that a $1.00 coin would not make an impact for reinforcement purposes, however a $2.00 coin would
Materials and Design
Materials incorporated in the experiment included a 250ml marked drinking glass, normal tap or unflavoured bottled water, stationery and a narrative sheet for tallying the desired behaviour as shown in appendix A. The narrative sheet was also used for noting down any thoughts and feeling that the subject experienced while performing the monitored behaviour. For purposes of the reinforcement schedule, $2.00 coins were also utilised.
Self-monitoring method. The experiment was segmented into two monitored periods and used an event recording procedure whereby each occurrence of the behaviour is scored. Total time frame incorporated a baseline period and an intervention period; with each period consisting of seven days of monitoring. In each phase the subject will also have to use the narrative sheet to write any thoughts or emotions he had just prior to drinking a glass of water.
Baseline phase. During the baseline period a tally was kept of the number of glasses of water that was consumed in a day under normal circumstances. Each time the subject drank a complete 250ml glass of water, the behaviour was scored on the narrative sheet. After seven days of monitoring, the scores were accumulated and averaged out over the seven days resulting in what was termed the “baseline rate”.
Intervention phase. During the intervention period, after each complete glass of water was drunk and scored on the narrative sheet, the subject was rewarded with a $2.00 coin that was deposited into a collection tin. The use of the $2.00 coin is aimed at being a continued reinforcer for the desired behaviour. It was not necessary for each glass of water to be consumed at once; however the complete 250ml in the glass had to be consumed before the reward was given. After seven days of monitoring the intervention period, the scores of the intervention period were tallied and averaged, resulting in what is termed “actual intervention behaviour rate”.
Functional analysis of behaviour. As show in appendix B the pre-intervention behaviour is best analysed using a SORCK analysis. The analysis reveals that the current behaviour historically started due to the subjects’ preference of always drinking soft drink through previous years. A direct link has been established that the subjects’ preference to drink soft drink rather than water has carried over through the years and well into present times. Another influential factor for the behaviour could also be explained by the subjects’ disclosure that the water lacks any taste to his liking.
Contextually the presence of a corner shop near the subjects’ residence has indirectly reinforced his behaviour of drinking soft drink rather than water. This is because the subject has stated that, automatically buying a soft drink from the shop was an unconscious act that he performed whenever he got thirsty. When the subject had the notion of drinking something he portrayed physical characteristics of a dry mouth and dry throat; however, an immediate cognition of there being a bland taste to water always hindered the decision to drink water. Therefore based on this information an organismic analysis reveals that this cognition is also maintaining the minimal water consumption behaviour.
The subject revealed that the immediate consequences of drinking water allowed an initial outcome of quenching the thirst, while a delayed consequence was the benefit of being rehydrated. However even with these benefits, based on the estimated glasses of water the subject has stated, the study analysis has labelled the initial behaviour as being a deficit in water consumption. Contingencies which seem to maintain the behaviour presently can be identified as being negative punishment. This is because the removal of any taste from the water consumed, is punishing (decreasing) the water consuming behaviour.
Intervention. The intervention contingency employed was a positive reinforcement schedule; specifically the subject will be rewarded using a positive reward system. During the intervention phase the subject will receive a $2.00 coin each time the subject drinks a 250ml glass of water. The use of the $2.00 coin as a reinforcer is appropriate because it’s something tangible that the subject will receive and hence can be accumulated and used at a later date. The reinforcement will follow a continuous reinforcement schedule whereby each time the behaviour is completed, the reward will be delivered. This form of reinforcement is the best in this situation because it offers (maybe look up article) an immediate reinforcement for each desired behaviour performed. Another benefit of the continuous reinforcement approach is that it does not allow for a relapse towards old behaviour which may be a problem if not continuously reinforced.
As shown in figure 1; according to Bloom’s single case design, the number of glasses consumed significantly increased from pre- intervention to post-intervention due to the positive reinforcement schedule implemented. Pre-intervention results indicated that the number of glasses consumed during the baseline period ranged from 1 to 6 glasses with a mean of 3.14 glasses whilst Post-intervention results indicated that the number of glasses consumed ranged from 6 to 9 glasses with a mean of 7.57 glasses.
Figure 1. Glasses of water consumed pre and post intervention phase.
According to Fulton (2010) the experiences we have to certain actions can strongly reflect in whether we reproduce the certain action or try and avoid it in our next contact. Going by this interpretation Fulton suggest that it’s these immediate consequences that have the most powerful influence rather the acts themselves that orientate our future behaviours. This was the case highlighted in the earlier study by Azerrad and Stafford.
What would it be like in long run
Would I continue trend if contingency stopped