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What is Contingency Management?
While you may not be familiar with the official term, most of us know the concept of contingency management from our own lives. Growing up you might have made your bed to earn an allowance and continue to make your bed as an adult. You might get your annual flu shot because you get yourself a sweet treat afterward. You might excel at work because you have a bonus on the line. All of these scenarios are based on contingency management. It’s almost as basic as your ABCs. Antecedent, behavior, and consequence, with the “consequence” itself being a reward to celebrate!
In short, contingency management is a therapeutic approach that uses incentives/rewards to reinforce positive behaviors. It’s widely researched but still somewhat underutilized in certain practices, despite its proven effectiveness, notably in substance use disorder treatment.
How it Works: The Science Behind Contingency Management
Contingency management is grounded in behavioral psychology, particularly in principles of positive reinforcement. We reward desirable behaviors to increase the likelihood of them being repeated. This strategy leverages the brain’s reward system which is central to learning and motivation and is highly influenced by neurotransmitters like dopamine, which creates feelings of pleasure and satisfaction.
The Role of Neurotransmitters and Dopamine
As mentioned above, contingency management is based on operant conditioning. Operant conditioning shows that behavior can be modified by changing the consequences following an action. As mentioned above, this sequence shows us that behavior change is a matter of what I call the ABCs. An antecedent that triggers a behavior that results in a consequence. ABC.
In contingency management, we use positive consequences (like rewards) that follow positive behaviors (e.g., abstaining from drug use). These rewards encourage the person to keep repeating those behaviors because they get a rush of dopamine from receiving the reward. For most people who have struggled with substance use disorder, the sought-after dopamine “hit” was dependent on taking the drug. Contingency management essentially tries to mimic the dopamine hit with something much more adaptive, like a reward for pro-social behavior.
When a reward is given immediately after a desired behavior, the brain associates that behavior with a positive outcome, strengthening the likelihood of repeating it. This is effective because it helps override negative behaviors (like substance use) by shifting the person’s focus toward attainable rewards for healthy choices. When a person receives a reward, dopamine is released, especially in areas like the nucleus accumbens, a brain region crucial to motivation and pleasure. This release reinforces the behavior because the person feels rewarded. Other neurotransmitters, such as serotonin (related to mood) and endorphins (linked to pleasure and pain relief), may also play supportive roles in the reinforcement process, though dopamine is the most directly tied to reward-driven behaviors.
Contingency Management in Therapy and Treatment
Let’s illustrate contingency management in practice. Lauren, a 32-year-old woman was referred to us for behavioral counseling. She presented for her first appointment reluctant and unwilling to participate. In her mind, therapy was a waste of time. She believed she was “fine” and resented the idea of being told what to do. She was present for the session only to check the boxes to prove compliance with the plan her case manager set.
While her participation was lacking and her frustration was apparent, we rewarded her for “showing up” by adding a nominal amount of money to her Holon Health “account.” She liked getting the reward for her actions. While she initially showed up just to get rewards, within 6 weeks she found she actually liked talking with her counselor. It made her stress level more manageable and she looked forward to the visits. At that time, it became the visits that brought her dopamine more than the reward. This is the goal of contingency management.
Common Rewards and Incentives
Contingency Management has been previously referred to as Voucher-Based Reinforcement Therapy or VBRT. In VBRT, the reward could be a raffle entry, a gift, a piece of candy, or anything that is positively reinforcing to the client.
Here’s an example of a reward. When my son was young, he earned 10 minutes of Xbox time after school for certain morning routine behaviors, like brushing his teeth or making his bed. While I could not give him the Xbox time immediately, I gave him a “voucher” for each 10 minutes earned. He kept the “voucher” in his pocket all day as a reminder. (I realize now what having me as his behavior specialist mother might have been like!)
When he was no longer motivated by the Xbox, I had to find a new incentive to reinforce behaviors. And, he was getting pretty good with the teeth brushing and morning routine. So, contingency management must be flexible and fluid. When the behavior becomes rote, it has to be adapted to new behaviors that need encouragement just as when the reinforcement is no longer exciting or interesting, a new reward must be offered.
Get Motivated and Rewarded to Improve Your Health
If traditional treatment approaches aren’t working for you, utilizing contingency management could help you improve your health and wellness. At Holon Health, we provide healthcare and substance use disorder treatment that includes contingency management, primary care, recovery coaching, and more.
So, you cash rewards for completing short therapeutic lessons on our app, Holon Vibe, or reaching your goals. Ready to improve your health? Sign up today!
Want to learn more? Email partnerships@holonhealth.com.