Effectiveness of Differential Reinforcement of Other Behaviors in Reducing Non-suicidal Self-Injurious Behaviors in Adolescents


Behavior therapy
Problem behavior
Self-injurious behavior
Token economy

How to Cite

Nosrati, F., Massah Bavani, A., & Ghobari Bonab, B. (2021). Effectiveness of Differential Reinforcement of Other Behaviors in Reducing Non-suicidal Self-Injurious Behaviors in Adolescents. Iranian Red Crescent Medical Journal, 23(10). https://doi.org/10.32592/ircmj.2021.23.10.872


Background: Non-suicidal self-injury is a prevalent phenomenon, especially among adolescents, with substantial personal and social consequences. To reduce such behaviors, differential reinforcement of other behaviors has gained substantial empirical support. However, previous investigations on the efficacy of this approach have mostly focused on individuals with developmental disorders, and it is still unknown whether such an approach is a viable treatment option for typically developed individuals.

Objectives: This study aimed to investigate the effectiveness of differential reinforcement of other behaviors in reducing non-suicidal self-injury behaviors in typically developed adolescents.

Methods: A single-subject A-B-A-B design was used in this study. The statistical population included male adolescents with self-injurious behaviors, the families of whom were seeking treatment for these behaviors. In total, four adolescents were recruited from a psychology clinic in Tehran, Iran, using convenience sampling. Participants were observed at 6, 8, 10, and 12 sessions at baseline phases of A1 and A2, followed by 12 intervention sessions after each baseline phase. The intervention included differential reinforcement of other behaviors. If the participants showed no self-injury behavior within a specific time duration, a reward was provided. Non-suicidal self-injury behaviors included self-harm, hair pulling, severe itching, pinching, wound manipulation, and hand biting. The frequency of these behaviors was assessed during each session. Visual analysis of graphed data, percentage of non-overlapping data, and mean percentage improvement were used for data analysis. 

Results: The results showed a fairly reliable effect for the intervention on reducing the target behavior, as indicated by a frequency reduction from phase A1 to B1 and A2 to B2 and by a frequency elevation by the intervention withdrawal from B1 to A2. The average percentage reduction across participants was obtained at 56%. However, a low rate of self-injury remained consistent for the participants.

Conclusion: The results provided further evidence on the effectiveness of differential reinforcement of other behaviors in reducing self-injury behaviors. Although the intervention could reduce self-injury substantially, it seemed that it could not eliminate the behavior.




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