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JOURNAL
OF
APPLIED
BEHAVIOR
ANALYSIS
THE
NEGATIVE
SIDE
EFFECTS
OF
REWARD
PETER
D.
BALSAM
AND
ANDREW
S.
BONDY
BARNARD
COLLEGE
AND
RUTGERS
UNIVERSITY
The
negative
side
effects
of
aversive
control
have
been
extensively
discussed
in
clinical
literature
and
textbooks.
The
symmetry
between
aversive
and
appetitive
control
in
basic
experimental
research
implies
that
parallel
negative
side
effects
of
reward
exist.
These
negative
side
effects
are
described
and
their
implications
for
clinical
practice
and
research
are
discussed.
DESCRIPTORS:
reinforcement,
punishment,
iatrogenic
illness,
symptom
substitution,
generalization
A
behavioral
psychologist,
Dr.
B,
once
had
a
student,
N,
who
was
quiet
and
withdrawn.
He
decided
to
try
to
encourage
N
to
participate
in
research
discussions.
He
consulted
all
of
the
latest
behavior
therapy
textbooks
and
de-
signed
an
intervention
program.
Each
time
N
spoke
of
research,
Dr.
B
said
enthusiasti-
cally
how
nice
it
was
to
hear
N's
opinion
and
what
good
points
N
was
making
(all
of
which
were
true).
Soon
N's
rate
of
verbal
behavior
had
increased
enormously.
Unfortunately,
N
also
began
talking
about
topics
other
than
re-
search.
In
fact,
N's
major
topics
of
discussion
were
about
the
relative
merits
of
different
kinds
of
dog
food
and
which
city
had
the
best
mass
transportation
system.
N
spent
several
hours
each
day
seeking
out
Dr.
B
at
the
office,
the
lab,
and
on
the
phone.
N
spent
so
much
time
looking
for
and
talking
to
Dr.
B
that
N's
interaction
with
other
students
was
virtually
eliminated.
Dr.
B's
life
became
miserable.
This
time
Dr.
B
consulted
a
clinically
oriented
col-
league
who
suggested
that
he
punish
N
for
all
of
the
excessive
verbal
behavior.
Dr.
B,
of
course,
abhorred
the
use
of
this
method
for
The
order
of
authorship
was
determined
by
a
ran-
dom
process.
We
thank
A.
Brownstein,
J.
Doron,
S.
O'Leary,
E.
Segal,
and
H.
Terrace
for
helpful
com-
ments
on
an
earlier
draft
of
this
paper
and
E.
Balsam
for
some
of
the
examples.
Reprints
may
be
obtained
from
Peter
Balsam,
Department
of
Psychology,
Bar-
nard
College,
Columbia
University,
New
York,
New
York.
10027
or
from
Andrew
Bondy,
Department
of
Psychology,
Rutgers
University,
Camden,
New
Jersey
08102.
fear
that
the
well-known
negative
side
effects
of
punishment
would
be
too
devastating
to
N.
Like
Dr.
B,
a
number
of
other
psychologists
have
been
concerned
with
the
iatrogenic
prob-
lems
associated
with
psychotherapy
(Goldia-
mond,
1974;
Stuart,
1970).
This
concern
with
negative
side
effects
of
therapy
is
reflected
in
the
literature
on
"symptom
substitution"
and
in
more
recent
behavior
therapy
literature
on
nega-
tive
side
effects
of
various
therapeutic
proce-
dures.
Although
some
very
recent
attention
has
been
paid
to
potential
negative
side
effects
of
reward
(Kazdin,
1982;
Lepper
&
Greene,
1978),
the
behavior
therapy
literature
has
focused
pri-
marily
on
the
negative
side
effects
of
treatments
that
use
aversive
control
techniques
(i.e.,
pun-
ishment,
aversion
therapy,
overcorrection).
From
their
inception,
only
qualified
acceptance
has
been
given
to
averesive
control
procedures
be-
cause
of
the
widespread
belief
in
these
side
ef-
fects.
In
this
paper
we
focus
attention
on
the
less
acknowledged
negative
side
effects
of
re-
ward
procedures.
In
the
first
part
of
the
paper,
we
review
the
negative
side
effects
of
aversive
control
and
the
extent
to
which
these
effects
are
emphasized
in
current
clinical
training.
In
the
second
section,
we
establish
the
symmetry
of
reinforcement
and
punishment
and
suggest
historical
reasons
for
the
failure
of
psychologists
to
a4dress
the
nega-
tive
side
effects
of
reward.
In
the
third
section
283
1983,
16,
283-296
NUMBER
3
(FALL
1983)
PETER
D.
BALSAM
and
ANDREW
S.
BONDY
of
the
paper,
we
argue
that
the
symmetry
be-
tween
appetitive
and
aversive
procedures
in-
cludes
negative
side
effects
and
document
our
arguments
with
clinical
and
experimental
evi-
dence.
In
the
fourth
and
final
section,
we
discuss
the
implications
of
our
arguments
for
therapy
and
the
training
of
psychotherapists.
NEGATIVE
SIDE
EFFECTS
OF
AVERSIVE
CONTROL
Negative
by-products
of
aversive
control
are
widely
acknowledged
in
the
behavior
therapy
literature.
Table
1
shows
that
most
classic
and
current
textbooks
in
behavior
therapy
do
cau-
tion
students
and
practitioners
about
a
variety
of
problems
associated
with
the
use
of
punish-
ment
and
avoidance
contingencies.
In
general,
these
texts
develop
such
statements
about
the
negative
side
effects
of
aversive
control
by
either
referring
to
basic
experimental
research
on
pun-
ishment
and
avoidance
with
animals
or
by
pro-
viding
case
study
exemplars.
In
fact,
with
few
exceptions
(cf.
Bellack
&
Hersen,
1977;
Kanfer
&
Phillips,
1970;
Kazdin,
1980),
these
texts
do
not
refer
to
the
clinical
documentation
of
nega-
tive
side
effects,
and
only
one
(Kazdin,
1980)
does
so
in
a
systematic
fashion.
There
have,
how-
ever,
been
over
30
clinical
articles
published
that
document
the
occurrence
of
these
effects,
the
great
majority
of
which
have
been
published
in
the
past
decade
(see
Bitgood,
Crowe,
Suarez,
&
Peters,
1980;
Kazdin,
1980,
1982).
This
grow-
ing
empirical
literature
on
negative
side
effects
and
the
widespread
belief
in
their
existence
are
the
impetus
for
examining
in
detail
potential
side
effects
in
both
aversive
and
appetitive
con-
ditioning.
The
potential
negative
side
effects
of
aversive
conditioning
that
have
been
described
in
the
behavior
therapy
literature
are
presented
below.
Elicited
or
Emotional
Effects
The
mere
presentation
of
an
aversive
stimu-
lus
or
the
contingency
between
conditioned
and
unconditioned
stimuli
may
induce
behavior
that
can
be
therapeutically
inappropriate.
This
be-
havior
may
be
inappropriate
because
it
is
itself
problematic
or
because
it
interferes
with
the
successful
implementation
of
the
therapeutic
program.
There
seem
to
be
four
general
classes
of
problems
that
appear
to
be
potentially
in-
duced
by
the
use
of
aversive
control
techniques:
Anger
and
aggression.
Column
1
of
Table
1
indicates
that
many
authors
caution
that
ag-
gressive
responses
may
be
elicited
by
aversive
stimuli.
Aggression
may
be
directed
toward
the
punishing
agent
or
toward
another
individual.
In
clinical
cases,
a
child
whose
behavior
has
been
punished
may
start
to
fight
with
siblings,
peers,
or
other
"safe"
targets.
Anger
may
be
displayed
by
yelling
o