Reinforced Practice

Reinforced practice is one of several different types of “exposure” procedures that are used in the treatment of fears and phobias. Exposure-based treatments for fears and phobias typically involve requiring the individual to confront, for prolonged periods, a real or imagined version of the feared object or situation. Reinforced practice, in particular, involves rewarding an individual for remaining in the presence of a feared stimulus for progressively longer periods of time. Initially, the individual remains in the presence of the feared object for short, “tolerable” periods. Gradually, the expectations are [Page 981]increased, and rewards are only delivered for increasingly longer periods of time in the presence of that object or situation. Important elements of reinforced practiced include (a) gradual and repeated practice in approaching the object of fear or anxiety, (b) providing rewards for gains in the length of time exposed, and (c) providing feedback to the individual about measurable progress. Early uses of reinforced practice tended to rely solely on the praise of the therapist as a reward for treatment gains. However, praise alone may not be sufficient as a reward for many individuals, and more recent approaches to reinforced practice have emphasized the use of tangible rewards (i.e., treats, prizes, activities).

Numerous studies over the past 30 years have been conducted on the use of exposure-based treatments in general, demonstrating effectiveness in reducing fears and anxieties. Specific studies of reinforced practice have demonstrated its effectiveness with adults and children alike. Reports suggest effectiveness with children as young a 4 years of age. A wide variety of fears and anxieties have been treated, including fear of heights, fear of the darkness, fear of snakes, fear of storms, fear of open spaces, fear of closed spaces, fear of dental procedures, and fear of people.

Using reinforced practice can present some challenges, depending upon the nature of the fear or phobia. Although some forms of exposure therapy involve the individual simply imagining the distressing situation, reinforced practice requires the use of the actual feared object or situation. This can present a difficult obstacle in some cases. In addition, some fears and phobias can be especially challenging to solve due to wellestablished and long-standing avoidance behaviors that are resistant to treatment. Thus, reinforced practice, by itself, may not be adequate to address some complicated fears and phobia. Indeed, reinforced practice is often used in combination with other treatments such as relaxation. Finally, children are not always good reporters of their own thoughts and feelings, making it difficult to determine how much they can tolerate in establishing the criteria for rewards.