Commentary: Interventions based on learning principles can supplant seclusion and restraint

Regulatory and administrative imperatives, when paired with staff training in humanistic, verbally mediated interventions can reduce the frequency of seclusion and restraint but can be associated with increases in the frequency and severity of staff injury, with concomitant tension and apprehension in the treatment setting. Even when educational programs for staff are made available for patient-centered, therapeutic, and persuasion-based modes of de-escalation, aggression, destructiveness and self-injury may continue to occur or even increase. Administrative contingencies can lead to less reporting of such incidents by staff with consequential, adverse effects on their morale and the unit milieu. Given the neurocognitive deficits, learning disabilities and lengthy histories of inadvertent reinforcement of provocative and aggressive behavior among persons with developmental and serious psychiatric disorders, basic principles of learning are needed to teach alternatives for belligerent behavior. Examples of behavior therapies that have been documented as effective in reducing aggression and self-injury include differential reinforcement of other behavior, social skills training, teaching interaction, social learning modalities, and time out from reinforcement. These evidence-based behavioral interventions must be superimposed on optimal, diagnostically driven, and monitored pharmacotherapy. When evidence-based, person-centered, and recovery-oriented biobehavioral interventions are made available to inpatient units, favorable clinical outcomes with reductions in the use of seclusion and restraint are likely.