In recent years, the concept of punishment has had many critics, though these critiques tend not to apply to negative punishment (time-outs) and usually apply to the addition of some aversive event. The use of positive punishment by board-certified behavior analysts is restricted to extreme circumstances when all other forms of treatment have failed and when the behavior to be modified is a danger to the person or to others (see professional practice of behavior analysis). In clinical settings positive punishment is usually restricted using a spray bottle filled with water as an aversive event. When mis-used, extreme punishment can lead to affective (emotional) disorders, as well as to the target of the punishment eventually focusing only on avoiding punishment (i.e., "not getting caught") rather than improving behavior.
Pear and Martin indicate that there are seven characteristics to behavior modification, They are:
Behavior modifiers like to employ a variety of evidenced-based techniques. These techniques intervene at all levels of context. For example, given specific setting events for a behavior, a behavior modifier may develop a neutralizing routine to eliminate that setting. If a behavior pattern has a specific antecedent of trigger, then an antecedent control strategy can be developed to train new behavior in the presence of the trigger. If a problem behavior readily occurs because it achieves some function, then an alternative behavior can be instructed and trained to occur in the context of the trigger. If a behavior is particularly complex it may be task-analyzed and broken into its component parts to be taught through chaining. While all these methods are effective, when the behavior problem gets difficult or when all else fails many turn to contingency management systems. Complex and comprehensive contingency management systems have been developed and represent effective ways to eliminate many problem behaviors (see applied behavior analysis and positive behavior support). Collabortive goal setting with the client enhances treatment effects.
In addition to the above, a growing list of researched-based interventions from the behavioral paradigm exists. With children with attention deficit hyperactivity disorder, one study showed that over a several year period, children in the behavior modification group had half the number of felony arrests as children in the medication group. These findings remain to be replicated but are considered encouraging for the use of behavior modification for children with attention deficit hyperactivity disorder.
Behavior modification programs form the core of many residential treatment facility programs. (In Wikipedia these link under Behavior Modification Facility.) They have shown success in reducing recidivism for adolescents with conduct problems and adult offenders. One particular program that is of interest is 'teaching-family homes', which is based on a social learning model that emerged from radical behaviorism. These particular homes use a family style approach to residential treatment, which has been carefully replicated over 700 times.. Recent efforts have seen a push for the inclusion of more behavior modification programs in residential re-entry programs in the U.S. to aid prisoners in re-adjusting after release.
One area that has repeatedly shown effectiveness has been the work of behaviorists working in the area of community reinforcement for addictions. Another area of research that has been strongly supported has been behavioral activation for depression.
One way of giving positive reinforcement in behavior modification is in providing compliments, approval, encouragement, and affirmation; a ratio of five compliments for every one complaint is generally seen as being effective in altering behavior in a desired manner and even producing a stable marriage.
Of notable interest is that the right behavioral intervention can have profound system effects. For example, Forgatch and DeGarmo (2007) found that with mothers who were recently divorced, a standard round of parent management training (a program based on social learning principles that teaches rewarding good behavior and punishing bad behavior combined with communication skills) could help elevate the divorced mother out of poverty. In addition, parent management training programs sometimes referred to as behavioral parent training programs have shown relative cost effectiveness for their efforts for the treatment of conduct disorder. Thus, such intervention can have profound effects on socializing the child in a relatively cost effective fashion and help elevate the parent from poverty. This level of effect is often looked for and valued by those who practice behavioral engineering and results of this type have caused the Association for Behavior Analysis International to take a position that those receiving treatment have a right to effective treatment ABA:I and a right to effective education. ABA:I
Several people have criticized the level of training required to perform behavior modification procedures, especially those which are restrictive or use aversives, aversion therapy or punishment protocals. Some desire to limit such restrictive procedures only to licensed psychologist or licensed counselors. Still others desire to create an independent practice of behavior analysis through licensure to offer consumers choices between proven techniques and unproven ones (see Professional practice of behavior analysis). Level of training and consumer protection remain of critical importance in applied behavior analysis and behavior modification.