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Introduction

Positive behavior support (PBS) is a combination of evidence based practices, intended to increase individuals quality of life while decreasing problem behaviors. The principles of PBS include lifestyle enhancement, a partnership between individual and caregivers to ensure carryover, assessing across environments, function-based interventions, intervention in the natural environment, and empowerment of caregivers to implement interventions (Hieneman, 2015). Positive behavior support can help individuals with a variety of mental health disorders (Van Wynsberghe, 2012).

Theory

Applied Behavior Analysis (ABA) is recognized for altering negative behaviors using a form of reinforcement by challenging the behavior with positive rewards or negative responses. The prime focus of ABA, focuses on human behavior, specifically, socially important behaviors (Bailey & Burch, 2002, p. 23). The main goal with ABA is to create procedures that can thoroughly produce significant positive behavior changes (Bailey & Burch, 2002, p. 15). There is extensive literature devoted to this particular topic including its well known contributions to fields such as, rehabilitation, delinquency, mental health, education and more (Bailey & Burch, 2002, p. 2).

Evidence

The use of positive reinforcement among individuals with eating disorders may promote increased caloric intake and overall body weight. According to a study conducted by Leitenberg, Agras and Thomson (1968), once positive reinforcement has demonstrated a desired change, healthier eating habits were not disrupted by the withdrawal of behavioral modifications. Such modern approaches to psychotherapy have indicated to be more effective than traditional methods to address disturbed behaviors, including eating disorders. Individuals with eating disorders, specifically obesity, have responded well to positive reinforcement and other behavioral modifications, and there have been several developments of programs dedicated to this specific discipline (Leitenberg, Agras & Thomson, 1968).

Case Study

Lola is 18 years old and has bulimia nervosa. Whether it’s breakfast, lunch, or dinner, Lola purges after each meal. She is underweight and her mother is concerned about her health. Lola wants to attend prom and would like to have her nails and hair done for the special event. She feels she is overweight and will not fit in any dress for prom. Lola understands the risk she is putting herself in by engaging in purging behaviors and feels it consumes her time when she can be hanging out with friends. Lola wants to stop the behaviors so she can participate in social events.

Intervention Plan

Problem Statement
Due to negative body image, client is unable to engage in social events.

Long Term Goals

• Client will decrease the frequency of purging behaviors by calling a friend when purging thoughts occur to participate in social events by 2 weeks.
• Lola will have a full course meal at prom, without purging, to engage in social events by discharge.

Short Term Goals

• Lola will identify two trigger events that provoke her purging behaviors to participate in social gatherings within two therapy sessions.
• Lola will identify 3 replacement behaviors when purging thoughts occur in order to participate in social events by discharge.
• Client will be able to have breakfast without demonstrating any purging behavior in order to participate in social events in 2 weeks.

Intervention Format
Individual

Setting
Client will meet with therapist in clinic for 30 minutes once a week for 6 weeks.

Supplies
None

Agenda
Interview- Build rapport with client (5 minutes)
Identify/ describe problem behaviors
Educate Lola’s mother on positive reinforcement (10 minutes)
Every time client eats a meal without purging, Lola’s mother will give Lola a token. After receiving 15 tokens (3 per day, for a 5 day work week), client will receive a manicure/pedicure.
Educate Lola on positive replacement behaviors (10 minutes
Identify different replacement behaviors
Summary (5 minutes)

Documentation
S: “ I would like to have more time to spend with my friends”
O: Therapist interviewed Lola to determine her unhealthy behaviors. Client was able to identify trigger events that elicit purging behaviors. Lola recognizes the risk of purging behaviors and its’ effects on her leisure time with friends. Lola was also educated on positive replacement behaviors. Client thought about calling a friend as a replacement behavior. Client said she can call her friend when she feels like purging. Lola’s mother was educated on positive reinforcement and when it is appropriate to give a token.
A: Client is able to recognize the risks and effects caused by her actions which indicates further awareness into her illness. Client’s ability to identify trigger events demonstrates she is prepared to change her maladaptive behaviors to positive behaviors. Client was only able to come up with one replacement behavior showing she will benefit from more time and assistance in changing her behaviors. Mom’s willingness to help with this process, gives opportunities for better outcomes.
P: Next session, client will continue identifying additional replacement behaviors. Client will also continue working on replacing her purging behavior for positive ones.

References

Bailey, J. S., & Burch, M. R. (2002). Research Methods in Applied Behavior Analysis (pp. 2-23). SAGE.

Hieneman, M. (2015). Positive Behavior Support for Individuals with Behavior Challenges. Behavior Analysis in Practice, 8(1), 101–108. http://doi.org/10.1007/s40617-015-0051-6

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(2), 211-218.

Van Wynsberghe, A. (2012). The Benefits of Positive Behavior Support. Psych Central. Retrieved on March 7, 2018, from https://psychcentral.com/blog/the-benefits-of-positive-behavior-support/