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454 – Behavior Modification, Goal Setting and Avoiding Common Traps
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Host: Counselor Toolbox

A direct link to the CEU course is
~ Define behavior modification
~ Explore how behavior modification can be useful in practice
~ Learn basic behavior modification terms:
~ Unconditioned stimulus and response
~ Conditioned stimulus and response
~ Discriminitive stimuli
~ Learned helplessness

Why Do I Care
~ Change means doing something different or modifying a response
~ That response can be a neurochemical one (stress response) or an overt behavioral one (smoking)
~ Behavior modification principles will help you understand some of the reasons people act/react the way they do
~ By understanding what causes and motivates people’s behavior we can better address their issues
~ The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection
~ Behavior modification in its truest form is concerned only with observable, measurable behaviors, stimuli and reinforcement
~ Emotions, interpretations and mental processes have no bearing

How can this be useful in practice
~ Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction
~ Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their “distress” (Behaviorists would refer to excitatory response)
~ Understanding what causes feelings can also give people a greater sense of empowerment.
~ Puppies learn appropriate behavior through reinforcement and correction
~ Puppy 1 tackles puppy 2  threat
~ Puppy 2 responds by tackling puppy 1  counter threat
~ Both puppies get a surge of adrenaline
~ The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again.

~ If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave.
~ Either way, puppy 1s behavior is punished.
Example 2
~ Humans have learned to label certain internal experiences with feeling words (angry, scared, happy)
~ Sally goes to a pet store
~ A puppy comes out, sits in her lap and puts is head on her leg
~ This contact (we know from studies) usually causes the release of dopamine and oxytocin –both reward chemicals
~ Sally calls this “happy”

~ If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction. Sally would label this as “fear”
~ The brain receives signals and, based on prior learning (conditioning), responds with either:
~ Fight/Anger or Flee/Fear (adrenaline/norepinepherine)
~ No reaction/neutral
~ Pleasure/Happy/Do this again (Dopamine/norepinephrine/Serotonin/GABA/Oxytocin?)
~ Humans label these different chemical responses with feeling words.
~ The same response can be labeled differently by two different people (fear vs. exhilaration)
~ People with anxiety, anger or resultant depression may need to:
~ Recondition X is not actually a threat (anymore)
~ Relabel
~ Excited vs. terrified
~ Stressed vs. hungry
~ Helpless/anxious vs. fat
~ ACT approach– X is causing me to have the feeling that…
~ In American culture we often use nonfeeling words to describe emotional states.
~ Part of recovery is identifying the physiological response to the stimulus and labeling it with a feeling word
Basic Terms
~ Unconditioned stimulus and response
~ Something that evokes an unconditioned/automatic response in an infant and adult
~ Loud noises
~ Pain
~ Excessive cold/heat
~ Contact
Basic Terms
~ Conditioned Stimulus
~ Something that in itself has no meaning to the person (yellow light)
~ Conditioned Response
~ The person’s reaction to the stimulus (slow down or floor it)
~ Conditioned stimuli and responses can be traced back to survival Fight-Flee-Forget-Repeat
Basic Terms
~ Discriminitive stimulus
~ All things being equal, the stimulus which triggers the reaction. (Includes vulnerabilities)
~ Going to work
~ Good day
~ Bad day
~ Learned Helplessness
~ A response which occurs when people have tried and failed to either fight or flee. Giving up.

Measurable Responses  Basic Feelings
~ Excitatory (Adrenaline, norepinephrine, Glutamate)
~ Fight  Anger, rage, resentment, jealousy, envy, regret, stress
~ Flee  Fear, anxious, nervous, apprehensive, timid
~ Neutral
~ Learned Helplessness  Depression
~ Inhibitory (Serotonin, GABA, Dopamine)
~ Repeat  Happy, elated, victorious, successful, competent

Fight or Flee
~ Stimuli that present a threat of pain or death can trigger the excitatory fight or flight response
~ Through experiences (conditioning) people learn what threats
~ They can defeat (fight/anger)
~ Will defeat them (flee/anxiety)
~ A useful intervention is to identify
~ The threat
~ Why is was labeled fight/anger/controllable or flee/fear/uncontrollable
~ Break down parts of the situation into controllable and uncontrollable
A Note About Threats
~ Fight or Flee (survival)
~ Basic Fears
~ Loss of Control
~ Underscores most fears
~ Fighting or fleeing provides control
~ Isolation & rejection
~ Primitive: Death/inability to procreate
~ Can be examined and counter conditioned
~ Is this really going to kill you?
~ Examine the exceptions
~ Examine alternate explanations

A Note About Threats
~ Fight or Flee (survival)
~ Basic Fears
~ The unknown
~ Primitive: Death/pain
~ Can be examined or counter conditioned
~ What is the probability this will end in death or pain?
~ How many other times have you confronted an unknown and the outcome was positive or neutral?

A Note About Threats
~ Fight or Flee (survival)
~ Basic Fears
~ Failure
~ Primitive: Death/pain
~ Can be examined or counter conditioned
~ What is the probability that if I fail it will result in death or pain?
~ If I fail, is that pain related to fear of rejection and/or loss of control?
~ How many other times have you tried and failed and the outcome was at least neutral?
~ How can you make failure into a positive or neutral (Hint: Learning experience)

~ Some stimuli elicit little or no response and are often ignored
~ MindLESSness can cause people to fail to identify
~ Positive stimuli  dopamine  “happy”
~ Negative stimuli  adrenaline  fight or flee
~ Little things build up and lead to a big reaction. (Water and the dam)
~ Negative stimuli can be reconditioned as neutral
~ Find the positive (snowy day)
~ Not worth the energy (rainy day)
~ Adding and noticing positive stimuli in the environment is vital
~ Grouchy day
~ Happy day
~ Positive stimuli in the environment can include
~ Smells (pumpkin spice…lol)
~ Sights (wildlife, my kids)
~ Sounds (babbling brook)
~ Feel (crisp autumn breeze)

Putting It Together
~ Humans label physiological reactions with feeling words.
~ What do you experience when you are scared?
~ What do you experience when you are angry?
~ How do you differentiate? (Hint: Prior experience)
~ What do you experience when you are happy?

Putting it Together
~ How can you use discriminative stimuli to
~ Increase happy responses
~ Increase a feeling of control and “self-efficacy”
~ Loss of control
~ The Unknown
~ Increase “self-esteem”
~ Rejection
~ Isolation
~ Increase feelings of “competence”
~ Failure

Putting it Together
~ How can you use discriminative stimuli to:
~ Decrease angry responses
~ Decrease anxious/fearful responses
~ Decrease learned helplessness

~ Behavior modification is concerned with the stimuli in the environment that evoke a response
~ Unconditioned stimuli evoke a response based upon survival needs
~ Conditioned stimuli have no meaning to the person, but, through experience, become associated with pleasure or pain/threat
~ The excitatory responses, anger and fear serve to protect the person from what they have in the past experienced as producing pain/being threatening.

~ Stimuli can be reconditioned in order to change the biochemical response (feeling)
~ People with a logical/experimental mindset often respond well to behavior modification techniques
~ It is imperative to include alternate responses.
~ In the next segment we will discuss
~ Reinforcement
~ Punishment

Nashville Counseling Un-Conference
A grass-roots conference put together by clinicians for clinicians.
Up to 20 CEUs from a NAADAC approved provider are available for addiction and mental health counselors and people seeking certification as addiction counselors
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~ WHEN: February 23-25, 2018
~ WHERE: Nashville Metro (exact site TBD)
~ The main speaker each hour will also be simulcast online. Virtual attendance is possible for those who do not need “face-to-face” hours.
~ Whole conference (20 CEUs): $99 in advance; $149 at the door
~ One Day (8 CEUs): $45 in advance; $65 at the door
~ Registration will open in October 2017
Nashville Counseling Un-Conference
Call for Papers

~ Theme: Addressing the Growing Problem of Co-Occurring Disorders.
~ Suggested Topics:
~ Techniques and Effectiveness of Technology Assisted Therapy (e-therapy, text-based coaching, apps, online support and educational programs etc.)
~ Special Needs of Rural Populations
~ Transdiagnostic Approaches to Treatment
~ Relapse Prevention for Co-Occurring Disorders
~ Multidisciplinary Approaches to Treatment
~ Prevention and Early Intervention Strategies for Co-Occurring Disorders
~ Developing Self-Esteem and Emotion Regulation Skills in Youth
~ Case Management is not a counselor's job, but…It is
~ Exploring pharmacotherapy in the treatment of co-occurring disorders (SSRIs and their impact on compulsive behaviors for example)
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