AVERSION THERAPY

PRESENTED BY
ANKITA PAUL
CLINICAL PSYCHOLOGY (2016-18)

SUPERVISED BY
LEKSHMI S.
ASSISTANT PROFESSOR
CLINICAL PSYCHOLOGY
INTRODUCTION
• In Behavior therapy, punishment refers to those
consequences of behavior that reduce the future probability
of its occurrence (Azrin & Holz, 1966).
• 2 types of punishment: 1) Punishment by withdrawal and 2)
Punishment by application.
• Punishment by application (Positive Punishment) suppresses
a response by contingent application of certain aversive
events; eg: reprimand, warning or aversive stimulation)
• Punishment by withdrawal (Negative Punishment) involves
contingent withdrawal of certain rewarding consequences.
E.g: in token economy programme, when token earned for
good behavior are withdrawn for undesirable behavior, the
technique is called response cost.
• Aversion Therapy is an attempt to establish a
durable association between an undesirable
behavior and an unpleasant stimulation.
• Aversion therapy is used to refer to the clinical
application of aversive stimuli for treatment of
behavior disorders.
• Aversion Therapy may follow either a classical
conditioning paradigm simple association by
contiguity — or an operant conditioning
paradigm.
THEORIES…..
 SINGLE-FACTOR THEORY OR NEGATIVE
LAW OF EFFECT

• In classical conditioning, punishment is used as an

unconditional stimulus. Repeated pairing of aversive
stimuli with an undesirable behaviour reduces the
occurrence of that behaviour.
• As a result of this pairing, the responses are
unlearned. The character of aversive stimulus is such
that they cause either pain or discomfort to the
individual. Being associated with certain responses
consistently, these aversive stimuli weaken their
strength.
• This theory explains response decrement as a direct
function of punishment often called single-factor
theory or negative law of effect.
 AVOIDANCE THEORY OF PUNISHMENT
• Dinsmoor (1954, 1955, and 1977) proposed an
avoidance theory of punishment. He stated that every
response consists of a chain of behaviour. When the
terminal response is punished, the earlier behaviour in
this chain begins to generate fear. In order to avoid
fear the organism disrupts this chain and engages in
other behaviour.
• A response decreases simply because it produces a
punisher almost all the time it occurs in a laboratory or
natural setting. Consequently, the client actively
engages in that behaviour, which help in avoiding
aversive consequences of another response.
• This is a ‘response-dependent’ active process and not
simply a ‘stimulus- dependent’ event.
 COMPARISON:

Avoidance theory does not explain elimination of the

punished behaviour, although it explains why one engages in
other behaviour. Thus the function of punishment is to
increase other behaviour; whereas Single-factor theory
considers that reinforcement and punishment are direct
opposites. Covert, visceral and cognitive responses do
occur in the presence of stimuli that elicit deviant response.
Therefore, pairing them with shock prevents the response to
occur.
APPLICATION OF AVERSIVE ACTIVITIES
1. Overcorrection- Positive practice and restitution - In
overcorrection, by Foxx and Azrin (1972, 1973) the
client is required to engage in an effortful behavior for an
extended period contingent on each instance of the
problem behavior.
• There are two forms of overcorrection: positive
practice and restitution.
1. a) Positive Practice - : The client has to engage in
correct forms of relevant behavior contingent on an
instance of the problem behavior.
• The client engages in the correct behavior, with physical
guidance if necessary, for an extended period (say, 5–15
minutes) or until the correct behavior has been repeated
a number of times.
E.g: Assume that a grade school student makes numerous
spelling errors on the written assignments that she hands in
to her teacher. She makes errors because she rushes
through the assignment and does not check her work. How
could the teacher implement positive practice overcorrection
to decrease spelling errors from this student? The teacher
could mark each misspelled word on her assignment, give
the assignment back to the student, and tell her to write the
correct spelling of each word ten times. The repeated
practice in correct spelling is an example of positive practice.
Because this aversive activity is contingent on misspelling,
the misspelling should decrease in future assignments.
 THERE ARE TWO FORMS OF OVERCORRECTION:
POSITIVE PRACTICE AND RESTITUTION.

1. b) Restitution: Is a procedure in which,

contingent on each instance of the problem
behavior, the client must correct the
environmental effects of the problem behavior
and restore the environment to a condition
better than that which existed before the
problem behavior.
• Physical guidance is used as needed to get the
client to engage in the restitutional activities.
• The client overcorrects the environmental effects
of the problem behavior.
E.g: Consider an example in which a student with a behavioral
disorder has an outburst in the classroom and knocks over a
desk during a detention period when no other students are in the
classroom. Describe how the teacher would implement a
restitution procedure with this student. The teacher would have
the student pick up the desk and put it back in place in its row. In
addition, the teacher might have the student go up each row of
desks in the classroom and straighten all the desks so that they
are perfectly in line in the rows. In this way, the student would
correct the problem he caused and would restore the classroom
environment to a condition better than that which existed before
the problem behavior.
CONTINGENT EXERCISE

• In the contingent exercise procedure, the client

is made to engage in some form of physical
exercise contingent on an instance of the
problem behavior (Luce, Delquadri, & Hall, 1980;
Luce & Hall, 1981). The result is a decrease in
the future probability of the problem behavior.
E.g: Johnny had started swearing around his younger
brothers, and this concerned his parents. They asked him
not to swear and, in particular, not to swear around his
brothers. Johnny agreed to comply with his parents’ request,
but one day his father caught him swearing again. His father
had Johnny immediately stop what he was doing, gave him a
rag and a bottle of window cleaner, and told him to wash
windows in the house for the next 10 minutes. Johnny
grudgingly washed the windows under his father’s
supervision. When Johnny was done, his father said that he
would do the same each time he caught Johnny swearing.
Johnny’s swearing around his family stopped almost
immediately once his father implemented this contingent
exercise procedure (adapted from Fisher & Neys, 1978).
GUIDED COMPLIANCE
• When a person is engaging in a problem behavior in a
compliance situation (the person is instructed or asked to
engage in an activity), guided compliance can be used as a
positive punishment procedure to decrease the problem
behavior.
• In a guided compliance procedure, the person is guided
physically through the requested activity (such as an
educational task) contingent on the occurrence of the
problem behavior.
• For most people, physical guidance in a noncompliance
situation is an aversive event. Because physical guidance
of the requested activity occurs contingent on the problem
behavior, it acts as a punisher for the problem behavior.
Eg: Consider the following example. Lindsey, an 8-year-old girl, is
watching a TV show when her parents ask her to pick her toys up off
the floor before guests arrive for the evening. In response to the
request, Lindsey whines and argues with her parents and continues
to watch TV. Her father walks up to Lindsey and calmly repeats the
request to pick up her toys. As he does so, he physically guides
Lindsey over to the area where her toys are spread across the floor
and uses handover- hand guidance to make her pick up the toys. He
ignores Lindsey’s complaints but, as soon as she starts to pick up
toys without his physical guidance, he releases her hand and lets her
continue to pick up the toys on her own. Once she has finished
picking up her toys, her father thanks her and lets her go back to
what she was doing. If the parents use this procedure each time
Lindsey is noncompliant, Lindsey is less likely to engage in problem
behaviors when they make requests and more likely to comply with
their requests.
 
 PHYSICAL RESTRAINT
• Physical restraint is a punishment procedure in which,
contingent on a problem behavior, the change agent
holds immobile the part of the client’s body that is
involved in the behavior.
• As a consequence, the client is physically restrained
from continuing to engage in the problem behavior.
• For example, when a student with intellectual disability
engages in aggressive behavior (by slapping students
sitting nearby), the teacher might respond by holding
the student’s arms down for 1 minute. While being
physically restrained, the student cannot engage in the
problem behavior or any other behavior. The teacher
does not interact with the student while applying the
physical restraint.
• One variation of physical restraint involves response blocking, in
which the change agent prevents the occurrence of a problem
behavior by physically blocking the response
• As soon as the client initiates the problem behavior, the change
agent blocks it so that the client cannot complete the response.
• Response blocking can also be used with brief restraint; in this case,
the change agent blocks the response and then uses physical
restraint for a brief period
• For example, suppose that a student with intellectual disability
engages in hand-mouthing behavior; that is, the student puts his
hand in his mouth, in an action similar to thumb-sucking. Response
blocking in that case would mean that as soon as he brings his hand
up to his mouth, the teacher puts his or her hand in front of the
student’s mouth to prevent the student from inserting his hand (Reid,
Parsons, Phillips, & Green, 1993). Response blocking can also be
used with brief restraint; in this case, the change agent blocks the
response and then uses physical restraint for a brief period (Rapp et
al., 2000).
 
•
 APPLICATION OF AVERSIVE STIMULATION
FARADIC AVERSION
• Electric shock is used as a punisher in many behaviour
modification programs. It can be measured accurately and can be
presented at low levels without causing damage to the tissue.
• Electric shocks are administered in association with the stimulus
that triggers a deviant response.
• Electric shocks are response interfering; therefore the limbs used
by the client for executing an escape or avoidance response
should not be shocked.
• For example- if the hand or palm has to be used, shock may be
administered on the thighs. Marshall (1985) suggested that in order
to avoid possible tissue damage due to inadvertent administration
of high amperage shock, number 6 ignition batteries might also be
used. The advantage is that, it permits an increase in the shock
intensity (voltage) while holding the amplitude constant at a
negligible level.
SELF-ADMINISTERED SHOCK TREATMENT
• McGuire and Vallance (1964) used a technique of self-
administered shock with smokers, alcoholics and
sexual perverts.
• Here the clients themselves determined the shock level
and administered it on themselves. This was also
adjusted during the session.
• The client was instructed to administer the electric
shock whenever the craving arose.
LEMON JUICE
A 6-month-old child is admitted to the hospital because she is
underweight and malnourished. The infant engages in a life-threatening
behavior called rumination in which, immediately after she eats, she
regurgitates the food back into her mouth. The rumination continues for
20–40 minutes after each feeding until the infant loses most or all of the
food she has just eaten. If she continues this behavior without medical
intervention, she will die. A psychologist at the hospital implements a
punishment procedure in which he instructs the nurse to squirt a small
amount of concentrated lemon juice into the infant’s mouth each time
she starts to ruminate. The infant makes a face and smacks her lips and
tongue when the sour lemon juice enters her mouth, and she stops the
rumination. If she starts ruminating again, the nurse squirts another
small amount of lemon juice into her mouth. This punishment
procedure is implemented after each feeding when the infant ruminates,
and the life-threatening rumination is eliminated. The child gains weight
steadily while she is in the hospital and is discharged after a couple of
months (Sajwaj, Libet, & Agras, 1974).
AROMATIC AMMONIA
• Aromatic ammonia has been used to decrease behavior
problems such as selfinjurious (Tanner & Zeiler, 1975) and
aggressive behavior (Doke, Wolery, & Sumberg, 1983).
• Contingent on the problem behavior, the change agent
breaks open an ammonia capsule and waves the capsule
under the client’s nose.
• The smell of the ammonia is an aversive stimulus that
decreases the problem behavior it follows.
• The ammonia capsule is the same as the smelling salts
used to arouse an unconscious boxer or football player.
SPRAY MIST
• In the punishment procedure involving spray mist, the
person who engages in the severe problem behavior is
given a brief spray in the face from a water bottle
contingent on an instance of the problem behavior.
• The spray mist is always clear water and causes no harm
to the person.
• Dorsey, Iwata, Ong, and McSween (1980) used the spray
mist procedure to decrease self-injurious behavior in nine
children and adults with profound intellectual disabilities.
FACIAL SCREENING
• Facial screening is a punishment procedure in which the
client’s face is covered briefly with a bib or with the
change agent’s hand.
• For example, facial screening was evaluated in a study by
Singh, Watson, and Winton (1986). They worked with three
institutionalized girls with intellectual disability who
engaged in self-injurious behavior involving hitting or
rubbing their heads and faces. Each girl wore a terry cloth
bib and, when the self-injury occurred, the experimenter
took the bib and pulled it up over the girl’s face for 5
seconds. The procedure was not painful and the girls
could still breathe easily. This procedure reduced the self-
injury to zero or almost zero for all three girls.
NOISE
• Recent research has shown that noise, similar to the sound
of an alarm buzzer, may function as a punisher for hair-
pulling and thumb-sucking when it is delivered contingent on
the behavior (Ellingson, Miltenberger, Stricker, Garlinghouse,
et al., 2000; Rapp, Miltenberger, & Long, 1998; Stricker et al.,
2001, 2003).
• Rapp, Miltenberger, and Long (1998) developed a treatment
device with two parts, one worn on the wrist and one worn on
the collar of a shirt. A woman who engaged in severe hair-
pulling (she had pulled out half the hair on her head) wore the
device; when she raised her hand to pull her hair, the device
sounded an alarm. The noise of the alarm did not stop until
she lowered her hand away from her head. The woman’s hair-
pulling decreased to zero when she wore the device.
REPRIMANDS, SCOLDING, WARNINGS

• Van Houten and his colleagues’ research evaluated the

effectiveness of reprimands as punishers (Van Houten,
Nau, MacKenzie-Keating, Sameoto, & Colavecchia, 1982).
• They found that reprimands were effective as punishers
with elementary school students when the reprimand
instructed the student to stop a specific misbehavior and
was delivered with eye contact and a firm grasp of the
student’s shoulder.
• Reprimands also decreased the problem behaviors of
students who observed the reprimands but did not receive
reprimands themselves.
ANXIETY RELIEF PROCEDURE

• Anxiety relief conditioning was first described by Wolpe

(1958) as a means of countering anxiety.
• The original procedure arranged for the client to receive an
uncomfortable faradic shock, which was terminated
immediately after he emitted the word "calm." The
termination of shock was followed by a period of relief, and
the concomitants of this relief phase were hypothesized to be
incompatible with anxiety and similar emotional discomforts.
• It was believed that after several repetitions of this
procedure, the relief responses would become conditioned to
the word "calm," and the client could then sub vocally utter
the word when he found himself in anxiety-provoking
situations, and, thereby, inhibit anxiety.
• Several years after Wolpe introduced anxiety relief conditioning,
Wolpe and Lazarus (1966) described several variations within the
basic paradigm.
• These variations concerned the manner in which faradic aversive
stimulation was applied, and included: (a) steady-shock escape;
(b) increasing-shock escape; and (c) shock avoidance.
• In the steady-shock escape condition, the client receives a
steady, uncomfortable, but not unbearable shock. After enduring
this shock for a period sufficient to make shock-cessation
definitely desirable, the client utters the word "calm" and the
shock ceases.
• In the increasing-shock escape condition, the only variation is
the manner in which a strong desire for shock cessation is
approached. Instead of beginning with a high intensity shock, the
level is initially low, and is steadily increased to the point where
the client feels the "desire" to say "calm." The shock is then
terminated.
• Because some clients experienced mere sensory
discomfort as opposed to emotional discomfort when
subjected to the steady or increasing-shock escape
conditions, the shock cessation produced only sensory
relief, not the emotional relief considered necessary for the
development of a relief phase and effective anxiety relief
conditioning.
• Therefore, a third condition was established in which the
client received a powerful current until he uttered the word
"calm," at which time the shock ceased. Shortly thereafter,
a second, more powerful current was delivered until the
word "calm" was uttered. The client was then informed that
the therapist would say "shock," and those ten seconds
later an even more powerful current would be delivered.
The client was told to anticipate the shock for at least five
seconds, and if he then uttered the word "calm," the shock
would be avoided.
AVERSION RELIEF PROCEDURE
• Solyom and Miller (1967) used anxiety relief conditioning in a
much more specific manner with phobic clients, although
under the rubric, "aversion relief," instead of anxiety relief.
• Their procedure required each client to prepare several
written accounts of past and future (anticipated) anxiety-
provoking episodes and to record these episodes on tape in
narrative form.
• Clients were also required to obtain anxiety-provoking
pictures relevant to their particular phobia. In the treatment
situation, the client heard the tape-recorded phobic
narrations played through earphones.
• Within each tape, lapses of silence were strategically placed
so that a silence of about thirty seconds duration was
terminated immediately prior to the description of an
especially anxiety-provoking scene.
• Just prior to hearing the anxiety-provoking scene, the
client received a faradic shock to his finger which he
could terminate by pressing an escape button.
Immediately following the shock termination, the client
heard the phobic narration through the earphones.
• The phobic stimuli were contiguous with the relief phase
which succeeded faradic shock termination, and the
phobic stimuli were consequently paired with the relief
responses.
• Similarly, anxiety-provoking pictures were presented to
the client during the relief phase, which also provided for
counterconditioning to be affected.
• In this manner, the anxiety responses typically associated
with the anxiety stimuli were presumably inhibited by the
incompatible feelings of relief and comfort generated by
faradic shock termination.
• A distinction will be drawn at this point between the
aversion relief paradigm employed by Thorpe et al. (1964),
Solyom and Miller (1965) and Gaupp et al. (1972), and the
anxiety relief paradigm employed by Solyom and Miller
(1967). In the latter paradigm there was no aversion
stimulus signalling the onset of faradic shock. That is, the
Solyom and Miller (1967) paradigm was identical to
Wolpe's (1958) anxiety relief conditioning paradigm, and
was predicated on the assumption that anxiety provoking
stimuli associated with aversion relief will acquire new
conditioned responses due to the operation of reciprocal
inhibition.
• In the Solyom and Miller (1967) procedure, the faradic
shock was delivered during a lapse of silence, and its
onset was not paired with aversion (inappropriate) stimuli.
• The second component of the paradigm, phobic stimuli
contiguous with faradic shock termination, was identical in
both procedures.
Aversion relief:
Aversion stimulus-------- shock/termination-----------relief stimulus
(e.g., nude male) (e.g., nude female)

Anxiety relief:
-------------------------------shock/termination----------relief stimulus
(e.g., snake slide)

Fig. 1— A diagrammatic distinction between aversion and anxiety

relief conditioning procedures.
COVERT SENSITIZATION

• Covert sensitization is a form of aversive

counterconditioning developed by Joseph Cautela in
which the client imagines an unpleasant event following
the undesired stimulus response complex rather than
experiencing overt aversive stimulation.
• For example, persons may imagine taking a large bite of
hot fudge sundae topped with whipped cream and nuts,
then imagine becoming grossly fat, unable to fit into their
clothes, and socially ostracized. In the avoidance phase,
they imagine becoming increasingly anxious as they
approach the ice cream shop. They then imagine turning
away and experiencing immediate relief.
Covert sensitization has four advantages over other aversion
therapies:
1. No equipment, such as a shock apparatus, is needed;
2. Unlike some drug-induced aversion, covert sensitization can be
safely carried out without medical supervision;
3. With an aversive image, clients can easily Self-administer
covert sensitization in vivo; and
4. Clients may consider it more acceptable, which is an important
consideration because of the high dropout rate with aversion
therapy.
• Covert sensitization most frequently has been used to treat
paraphilias, overeating, alcohol abuse, and smoking, and it is
used almost exclusively with adults.
• Support for the effectiveness of covert sensitization is tenuous,
however. Most of the research has been case studies, and some
of the few controlled studies have yielded equivocal findings.
EFFECTS OF POSITIVE PUNISHMENT

The discussion is focused on the controlled clinical use of

punishment. Most laboratory studies have indicated that
punishment helps in securing short-term immediate
compliance (Newsom, Flavell and Rincover 1983). Whereas
it’s long term objective is to initiate discipline and promote
development of internal control. Punishment helps in moral
internalization as the individual learn to take over the values
and attitudes of the society as one’s own.
1. CONDITIONED EMOTIONAL RESPONSE

Negative side effect of punishment increase with its intensity.

Conditioned emotional response is one of the principal side
effects of punishment. When a neutral stimulus is associated with
punishment, it acquires the ability to elicit conditioned fear, which
in turn functions to suppress the ongoing behavior. Severe
punishment may cause extensive behavioral inhibition of
responses, both preceding and following the critical response.
Due to punishment, the next inappropriate behaviour in the
hierarchy may appear (Rimm and Masters 1979). Bandura (1969)
also pointed out the punishment may result in maladaptive
conditioned anxiety, leading to a generalized suppression of
socially desirable patterns of behaviour and avoidance of the
punishing agents or the situation in which punishment occurred.
For instance, severe punishment for poor scholastic performance
may cause school avoidance (truancy) among children.
2. AGGRESSION
One who administers punishment acts as a role model of
aggressive behaviour too. This may be imitated by the client
who receives the punishment. Aversive stimulation causes
counter aggression. It may lead to aggressive acting-out,
temper tantrums, an attack on the less powerful victims or
property destruction. A child severely punished by an adult
may not react against the adult directly, but may displace his
anger by attacking a child younger to him or a peer. Thus,
punishment predicts and promotes aggressive behaviour
(Aronfreed 1969; bandura and walters 1959 et al.) use of
punishment early in life legitimizes many forms of violence in
later life (White and Straus 1981). Attribution theorist
explained that punishment promotes hostile attribution,
making the client hyper – vigilant to aggressive cues.
Consequently, it produces violent behaviour.
3. HABITUATION
Habituation is considered as one of the worst negative side effects of
punishment. Due to repeated presentation of aversive stimulus, not only
the associated situations and people acquire secondary aversive
qualities, but also the suppressive effect of the aversive stimulus
habituates in due course of time. The client requires higher degree of
punishment to have the same suppressive effect. The avoidance reaction
declines with exposure to punishment. The individual becomes ‘thick-
skinned’ or less responsive to punishment. For example, a dehumanised
prison system, implementing unreasonable punishment, may become the
breeding grounds for hardened criminals; school administration imposing
frequent punishment, may become ineffective in shaping discipline.
Therefore, the therapist who has already used punishment earlier is more
likely to use it again and there is high chance of generalizing such
practice to other unacceptable behaviors. Thus, it should be used as a
last-resort method; only when other alternatives methods fail to change
the behaviour. In order to avoid or at least minimize the negative effects,
punishment should be used as an adjunct to other reinforcement methods
THE ETHICS OF PUNISHMENT

The decision to use a punishment procedure should be made

carefully after alternative treatments have been considered.
Because punishment involves the loss of reinforces, forced
activity, restriction of movement, or delivery of aversive
stimulation, its use can result in the restriction of the client’s
rights. As a result, punishment procedures often are called
restrictive procedures. In addition, misusing or overusing
punishment procedures can harm the recipient (Gershoff, 2002).
Finally, some individuals and organizations believe that the
application of aversive stimulation is not humane and is not
justified for any reason (LaVigna & Donnellan, 1986; The
Association for Persons with Sever Handicaps, 1987). For these
reasons, you should always consider the following ethical
issues before deciding to implement a punishment procedure.
1. INFORMED CONSENT
A person must fully understand the punishment procedure,
the rationale for its use, how and when it will be used, its
intended effects and side effects, and possible treatment
alternatives. The person must be fully informed and must
willingly agree to be the recipient of the procedure before it
is used. Only adults can give informed consent. Therefore,
before a punishment procedure is used with a minor or an
adult who cannot give consent (e.g., some people with
intellectual disabilities or psychiatric disorders), a legal
guardian or legal representative must give consent on the
person’s behalf.
2. ALTERNATIVE TREATMENTS

As discussed in preceding sections, a punishment procedure

will not be the first choice of treatment in most cases.
Functional treatments that are less restrictive and
nonaversive are used before punishment is considered. In
many cases, severe problem behaviors can be eliminated
with nonaversive functional treatment procedures developed
from a functional assessment of the problem. If punishment
is to be used, less restrictive punishment procedures should
be implemented, if possible, before the most restrictive
punishment procedures are used. In addition, reinforcement
procedures are always used in conjunction with punishment
procedures.
3. RECIPIENT SAFETY
A punishment procedure should never result in harm to the
client. If physical guidance is used in the application of
aversive activities, the change agent must not harm the
client in the process of physically guiding the behavior. An
aversive stimulus must never be used if it causes physical
injury to the client.
4. PROBLEM SEVERITY
Punishment procedures should be reserved for more severe
problem behaviors. The delivery of a painful, unpleasant, or
annoying stimulus can be justified only if the problem
behavior presents a threat to the person’s well-being or harm
to other people.
5. IMPLEMENTATION GUIDELINES
If a punishment procedure is to be implemented, there must
be strict written guidelines for using the procedure. With
written guidelines, there can be no ambiguity about how the
procedure is conducted, when and where it is to be
conducted, and by whom. In fact, there should be written
guidelines for the use of any behavior modification
procedures.
 
6. TRAINING AND SUPERVISION

In addition to written guidelines explaining the use of the

punishment procedure, all staff, teachers, or other personnel
who implement the procedure will must receive behavioral
skills training in the correct use of the procedure. This involves
instructions, modeling, the opportunity for rehearsal, feedback,
and continued rehearsal until the procedure is implemented
without errors. Personnel implement the procedure only after
they have demonstrated competence in its use. Once a
punishment procedure is in use, there must be ongoing
supervision of the personnel performing the procedure to
ensure that they continue to implement it correctly. Again,
these training procedures should be used with any behavior
modification procedures.
 
7. PEER REVIEW
The punishment procedure must be written into a detailed
program, and the written program must be reviewed by a
panel of peers, which should include professionals in
behavior analysis and behavior modification. The peer review
panel will evaluate the punishment program and approve the
procedure if it is well-designed and justified for use in the
particular case. Peer review ensures professional evaluation
of the chosen procedure and prevents the misuse of
punishment.
 8. ACCOUNTABILITY: PREVENTING
MISUSE AND OVERUSE

Because the use of punishment may be negatively reinforced by

the termination of the problem behavior, there is always the risk
that punishment may be misused or overused. Therefore, it is
important that each person who implements the punishment
procedure be held accountable for its correct implementation and
the avoidance of misuse or overuse. Implementation guidelines,
training, and supervision contribute to accountability. Frequent
review of data on the problem behavior and use of the punishment
procedure also contributes to accountability.
Foxx, McMorrow, Bittle, and Bechtel (1986) have
recommended the following steps to ensure accountability of
a program involving the use of electric shock:
“(a) testing everyone before they were allowed to use the
program;
(b) having each person who conducted the program
experience the shock prior to using it;
(c) assigning a specific individual to be responsible for
implementing the program each shift or school day; and
(d) requiring accurate record keeping that was verified each
shift or school day by the staffs supervisor and one of the
primary treatment personnel”. Although these steps were
developed for the use of a shock procedure they are relevant
for the use of any punishment procedure involving the
application of aversive stimulation.
THANK YOU