Behavioral treatment of violent psychiatric patients

This article reviewed major accelerative and decelerative behavioral treatments for aggressive and destructive behavior in psychiatric patients. Accelerative procedures supplant antagonistic behavior by teaching adaptive skills, and by strengthening competing responses; they are realized in token economies, social skills training, differential reinforcement of other behavior, and activity programming. Current decelerative procedures reduce violent behavior by decreasing reinforcement accessible to the patient following violent acts; they are exemplified by social extinction, response cost, time out from reinforcement, overcorrection, and contingent restraint. All behavioral interventions are applied within a philosophic framework that emphasizes observable behavior, measurement of treatment effects, and restructure of the social and physical environment to improve patients' response patterns. This approach extends beyond a problem-oriented model and presents proven techniques for developing and maintaining patients' adaptive functioning.