What is Contingency Management?

Contingency management is a type of therapy defined by the systematic reinforcement of positive behaviors and, to a lesser extent, the punishment of negative ones. It is most often used in mental health treatment, substance abuse treatment, and in children with behavioral problems. Studies have shown significant success rates with this type of mental health intervention.

The roots of modern contingency management can be found in two schools of mental health treatment: behavior therapy and applied behavior analysis. Behavior therapy is the treatment of psychological issues through modification of behavior, achieved by various means of reinforcing good behavior and eradicating unhelpful behavior. In applied behavior analysis, behavior is regulated and predicted by the connection between the environment and an individual's response to the environment. The key aspects of these two fields work in conjunction to create contingency management.

The first breakthroughs in contingency management were witnessed during preliminary research on animals. Researchers found that monkeys and rats, when left to their own devices, would ingest massive amounts of drugs and alcohol. The animals would then engage in challenging tasks in the hopes of obtaining more of the illicit substances. This finding set a precedence for the scientific basis of addiction and its neurobiological ties. As a result, a need was created for a system of therapy that would work effectively with an individual's biological makeup to alter behavior by a reward/punishment system.

For individuals receiving mental health or substance abuse treatment, contingency management has been shown to be exceptionally effective. A patient receives a reward for behavior deemed positive and healthy. This reward is typically given for following program rules or treatment plan adherence. The payoff is traditionally small, but it is sufficient enough to plant the desire to continue conducting oneself in such a manner.

Conversely, an individual will receive consequences for any negative behavior he or she may undertake. The "punishment" aspect of contingency management is not extreme by any means; it could be as simple as assigning the patient a menial chore. But, like the reward, the mild punishment is important enough in the mind of the individual to make an impression on the appropriateness of his or her behavior.

Contingency management is also used as conduct disorder treatment in children. This mode of educational intervention is commonly known as a token system. Under a token system, a child is given a token for good behavior. The tokens can be amassed and traded in at a later time for perks, treats, and special privileges. If the child misbehaves, a token is confiscated. There has, however, been a fair amount of criticism aimed at this mode of contingency management when it is applied to especially young children.