Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


50th Annual Convention; Philadelphia, PA; 2024

Event Details

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Symposium #409
CE Offered: BACB
Is There an Alternative to Escape Extinction and Differential Reinforcement of Other Behavior (DRO): The Promise of Constructional Exposure Therapy
Monday, May 27, 2024
12:00 PM–12:50 PM
Convention Center, 100 Level, 113 C
Area: AUT/CBM; Domain: Applied Research
Chair: Leah Herzog (Morningside Academy / PEER International)
Discussant: Richard T. Codd (Refresh Mental Health)
CE Instructor: Awab Abdel-Jalil, M.S.

This symposium consists of two presentations. The first will present a systematic review of the literature on exposure therapies, including systematic desensitization, applied to a wide range of medical procedures. Several findings from reviewing 62 articles across 715 participants and 11 medical procedures will be shared. Following the review, a recent approach to addressing phobias and highly reactive patterns, Constructional Exposure Therapy, will be introduced and contrasted with traditional methods. The second presentation will introduce three case studies where Constructional Exposure Therapy was implemented to treat a vacuum phobia with an adult diagnosed with ASD, and extreme refusal of eye-drops and ear-drops in a typically-developing child and a child diagnosed with ASD. The presentation will detail the procedures, and present the associated data. These cases show an alternative to escape extinction, DRO, and related decelerating procedures. A discussion will follow to address CET, the emerging data, and future directions in the area of exposure.

Instruction Level: Intermediate
Keyword(s): Constructional, Desensitization, Exposure, Shaping
Target Audience:


Learning Objectives: 1. Describe the respondent conditioning underpinnings of systematic desensitization. 2. Describe the operant conditioning variables involved in systematic desensitization. 3. Describe how one could shape appropriate behavior with negative reinforcement ethically.
Past, Present, and Future of Exposure Therapy: A Literature Review and Future Directions
AWAB ABDEL-JALIL (Upstate Caring Partners & Endicott College), Jillian Baldwin (Endicott College)
Abstract: Findings from a systematic literature review on the application of exposure therapies including systematic desensitization to address phobias and highly reactive patterns associated with a wide range of medical procedures will be presented. Sixty-two articles were identified spanning the years 1968 to 2021, encompassing a total of 715 participants and 11 medical procedures. Several findings from this literature review will be shared and discussed. Following the review, a new approach for addressing phobias and highly reactive patterns will be introduced: Constructional Exposure Therapy. This approach emphasizes the operant contingencies associated with reactive patterns, and aims to shape the needed repertoires utilizing the already present negative reinforcement contingency without the use of extinction or other extraneous consequences. That is, the removal of the aversive stimulus follows approximations to a targeted repertoire. It will be shown how Constructional Exposure Therapy empowers participants, rather than them playing a passive role in most exposure therapies.
Constructional Exposure Therapy: The Emerging Data
ANDREW MILLER (Conestoga Behavioral Services, LLC)
Abstract: Three recently completed cases of Constructional Exposure Therapy will be reviewed during this presentation. The first case involved the acceptance of eye-drops by a typically developing 3-year-old who displayed extreme refusal at first. The second case involved the acceptance of ear-drops by a 9-year-old diagnoses with ASD who was also extremely reactive at first. Finally, the third involved the acceptance of a vacuum cleaner by a 19-year-old with autism who had a long-standing history of phobic behavior around vacuums and the sounds they produce. Each Constructional Exposure Therapy program was nearly errorless in nature, and was also completed without the use of escape extinction or arbitrary reinforcers. Progress in each program was successfully extended to relevant caregivers within the initial treatment session and was maintained thereafter without difficulty. The procedures will be clearly outlined, and the data will be presented and analyzed. A discussion will follow to address CET, the emerging data, and future directions in the area of exposure.



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