This paper discusses the role of automatic negative reinforcement in the maintenance of clinical problems. Following a brief introduction to the functional conceptualization of clinical problems and discussion of four classes of reinforcement maintaining clinical problems, the paper suggests that automatic negative reinforcement is an understudied function of problem behaviors. The role of automatic negative reinforcement is then discussed in the context of three clinical problems, binge eating, hair pulling, and compulsive buying. Finally, treatment for problem behaviors maintained by automatic negative reinforcement is briefly reviewed.