I have previously written how you can make exposures fun and use rewards to help your child engage in treatment with greater motivation. Now I want to write a brief follow-up about something I touched upon in those articles.
What Happens When your Child Doesn’t do the Exposure?
First off, it’s ok! You don’t need to get angry or frustrated with your child. You don’t have to beg them or negotiate with them. Making someone complete exposures when they are not willing to is rarely, if ever, effective. Instead, you’ll want to ignore that they didn’t complete it and make sure that you withhold the reward until they do so. This is very powerful for motivating behavior.
We have a saying in psychology that goes as follows: “Let contingencies do the work.” What this means is that you can let the rewards (e.g. ice-cream) be the motivator to complete the exposure, rather than you having to do all the work to get them to do it. As long as the reward is powerful enough this will almost certainly help the child try the exposure. For example, look at that ice-cream in the picture. I think I’d do anything to earn that!
Why Isn’t My Child Doing The Exposure?
If your child continues to not complete the exposure then it’s most likely that the reward system you have in place needs to change. For example, let’s say little Derek, your 10 year old, can earn15 minutes of extra screen time per day for completing his exposure of touching a contaminated object and then not washing his hands. Except he doesn’t. It’s like that 15 minutes of extra screen time is not worth it. In these cases, take a step back and try to look at the bigger picture. For example, if he already gets an hour of screens per day, then one could see that extra 15 minutes of extra time just isn’t worth it. You have to change the system so that the reward is more valuable. Maybe he needs only 15 minutes of screen time per day and he can unlock another hour by completing the exposure. I’m confident that for many situations like this you should reevaluate your reward system and you’ll be much more successful.
Another reason could be that the exposure is too difficult. It’s important to remember that the exposure target should be one that you have set together. This makes the expectation predictable because it has already been negotiated.
What can sometimes happen when your child does not earn his/her reward is that they can become quite upset. They may yell at you, throw things, or in extreme cases even hurt themselves. We call this an extinction burst, which is an escalation of behavior. When you see escalation of behavior for not earning their reward, NEVER give in and give the reward. Instead, for most situations you want to ignore whatever they are doing and only give the reward once they have completed the target behavior.
- Follow through and withhold the reward until they complete the target behavior
- Try to negotiate or persuade them to do the exposure in the middle of an extinction burst
Here’s an example:
Imagine your child is at the supermarket and wants candy. When you say no they start crying loudly, drawing others’ attention. You ignore and start to walk away, trying to not pay attention to this behavior. They then start to cry really loudly and now everyone is looking at you. If you give candy after this, guess what? Your child has just learned how to push your buttons and get candy.
Here’s another example that I see commonly come up regarding exposure treatment:
Jenny didn’t do whatever exposure she was supposed to do with you today. She refused. You then follow your contingency management plan and withhold her screen time until she completes it. Good job! However, Jenny then gets quite upset. She starts trying to negotiate, begging you for just 15 minutes of screens as she has worked so hard this week. You ignore, stating only that she can earn screens for completing her exposure. She then gets really frustrated and starts negotiating harder, saying she needs 15 minutes of screen time before she can do her exposure. You really want her to complete the exposure, so what do you do?
Don’t give in! If you give in, you’re actually reinforcing Jenny’s escalating and negotiating behavior. She is learning that rather than do what she is supposed to do for screen access she can simply negotiate her way to it instead.
If you don’t give in, she learns that escalating her behavior won’t work, and that the only way to get her desired screen time is to complete the exposure.
Sometimes children and youth can escalate strongly, to the point that they cause themselves or others harm, or damage property. These are things that are nearly impossible to ignore, so what I described above won’t necessarily apply. If you have one of these situations, I’d suggest seeing a psychologist to get guidance, as there are other strategies that I won’t go into that you can use.
If you follow these steps you’ll know how to handle extinction bursts around treatment so that you can help your child complete their exposures and earn their rewards. Remember, let the contingencies do the work. You are a team with your child. You are working together to help them master their anxiety and get rewarded for doing so. If you give rewards when the requirement hasn’t been met then it may feel kind but it’s actually a disservice to you and your child and it will hinder future exposures.
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