Clinical behavior analysis

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Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is the clinical application of behavior analysis (ABA). [1] CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism and the use of functional analytic models of verbal behavior—particularly, relational frame theory (RFT).

Contents

Current Models

Clinical behavior analysis (CBA) therapies include acceptance and commitment therapy (ACT), behavioral medicine (such as behavioral gerontology and pediatric feeding therapy), community reinforcement approach and family training (CRAFT), exposure therapies/desensitization (such as systematic desensitization), functional analytic psychotherapy (FAP, such as behavioral activation (BA) and integrative behavioral couples therapy), and voucher-based contingency management.

Acceptance and Commitment Therapy

Acceptance and commitment therapy is probably the most well-researched of all the third-generation behavior therapy models.[ citation needed ] Its development co-occurred with that of relational frame theory, with several researchers such as Steven C Hayes being involved with both. ACT has been argued to be based on relational frame theory. [2] Although this is a matter of some debate within the community, [3] Originally, this approach was referred to as comprehensive distancing. [4] Every practitioner mixes acceptance with a commitment to one's values. These ingredients become enmeshed into the treatment in different ways which leads to ACT being either more on the mindfulness side, or more on the behavior-changing side. [5] ACT has, as of May 2022, been evaluated in over 900 randomized clinical trials for a variety of client problems. [6] Overall, when compared to other active treatments designed or known to be helpful, the effect size for ACT is a Cohen's d of around 0.6, [7] [8] which is considered a medium effect size.

Behavioral Activation

Behavioral activation emerged from a component analysis of cognitive behavior therapy. Cognitive behavior therapy focuses on trying to reverse those negative thoughts that contribute to emotional difficulties such as depression and anxiety. This research found no additive effect for the cognitive component. [9] Behavioral activation is based on a matching law model of reinforcement. [10] A recent review of the research supports the notion that the use of behavioral activation is clinically important for the treatment of depression. [11]

Community Reinforcement Approach and Family Training

Community reinforcement approach and family training (CRAFT) is a model developed by Robert Meyer and based on the community reinforcement approach (CRA) first developed by Nathan Azrin and Hunt. The model focuses on the use of functional behavioral assessment to reduce drinking behavior. CRAFT combines CRA with family therapy.

Functional Analytic Psychotherapy

Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship. [12] It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement. [13] The basic FAP analysis utilizes what is called the clinically relevant behavior (CRB1), which is the client's presenting problem as presented in-session. Client in-session actions that improve their CRB1s are referred to as CRB2s. Client statements, or verbal behavior, about CRBs are referred to as CRB3s. In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change. [14]

Integrative Behavioral Couples Therapy

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule-governed behavior. [15] It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness. [16]

Clinical Formulation

As with all behavior therapy, clinical behavior analysis relies on a functional analysis of problem behavior. Depending on the clinical model this analysis draws on B.F Skinner's model of Verbal Behavior or relational frame theory.

Professional Organizations

The Association for Behavior Analysis International has a special interest group in clinical behavior analysis ABA:I. [17] ABA:I serves as the core intellectual home for behavior analysts. [18] [19]

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis.

The Association for Contextual Behavioral Science is devoted to third-generation therapies and basic research on derived relational responding and relational frame theory. [20]

The Behavior Analyst Certification Board (in partnership with subject matter experts) has produced a "Clinical Behavior Analysis" fact sheet. [21]

See also

Related Research Articles

Behaviorism is a systematic approach to understand the behavior of humans and other animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual's history, including especially reinforcement and punishment contingencies, together with the individual's current motivational state and controlling stimuli. Although behaviorists generally accept the important role of heredity in determining behavior, they focus primarily on environmental events. The cognitive revolution of the late 20th century largely replaced behaviorism as an explanatory theory with cognitive psychology, which unlike behaviorism examines internal mental states.

A behavior modification facility is a residential educational and treatment institution enrolling adolescents who are perceived as displaying antisocial behavior, in an attempt to alter their conduct.

Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

Relational frame theory (RFT) is a psychological theory of human language, cognition, and behaviour. It was developed originally by Steven C. Hayes of University of Nevada, Reno and has been extended in research, notably by Dermot Barnes-Holmes and colleagues of Ghent University.

Behavior modification is a treatment approach that uses respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior is modified with (antecedent) stimulus control and consequences, including positive and negative reinforcement contingencies to increase desirable behavior, or administering positive and negative punishment and/or extinction to reduce problematic behavior. It also uses systematic desensitization and flooding to combat phobias.

Acceptance and commitment therapy is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility.

Steven C. Hayes is an American clinical psychologist and Nevada Foundation Professor at the University of Nevada, Reno Department of Psychology, where he is a faculty member in their Ph.D. program in behavior analysis. He is known for developing relational frame theory, an account of human higher cognition. He is the co-developer of acceptance and commitment therapy (ACT), a popular evidence-based form of psychotherapy that uses mindfulness, acceptance, and values-based methods, and is the co-developer of process-based therapy (PBT), a new approach to evidence-based therapies more generally. He also coined the term clinical behavior analysis.

Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.

Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

The professional practice of behavior analysis is a domain of behavior analysis, the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both experimental and applied behavior analysis. Professional practice seeks to change specific behavior through the implementation of these principles. In many states, practicing behavior analysts hold a license, certificate, or registration. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as behavior analysts are becoming more and more common.

Behavioral activation (BA) is a third-generation behavior therapy for treating mood disorders. Behavioral activation primarily emphasizes engaging in positive and enjoyable activities to enhance one's mood.

The behavioral analysis of child development originates from John B. Watson's behaviorism.

Behavioral theories of depression explain the etiology of depression based on the behavioural sciences, and they form the basis for behavioral therapies for depression.

A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and is deemed to be a core component of that profession. Mental health nurses, social workers, and some psychiatrists may also use formulations.

A licensed behavior analyst is a type of behavioral health professional in the United States. They have at least a master's degree, and sometimes a doctorate, in behavior analysis or a related field. Behavior analysts apply radical behaviorism, or applied behavior analysis, to people.

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences — even when doing so creates harm in the long run. The process of EA is thought to be maintained through negative reinforcement — that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behavior will persist. Importantly, the current conceptualization of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings is thought to be linked to a wide range of problems.

<span class="mw-page-title-main">Association for Contextual Behavioral Science</span> Professional association for ACT, RFT, and behavior analysis

The Association for Contextual Behavioral Science (ACBS) is a worldwide nonprofit professional membership organization associated with acceptance and commitment therapy (ACT), and relational frame theory (RFT) among other topics. The term "contextual behavioral science" refers to the application of functional contextualism to human behavior, including contextual forms of applied behavior analysis, cognitive behavioral therapy, and evolution science. In the applied area Acceptance and Commitment Therapy is perhaps the best known wing of contextual behavioral science, and is an emphasis of ACBS, along with other types of contextual CBT, and efforts in education, organizational behavior, and other areas. ACT is considered an empirically validated treatment by the American Psychological Association, with the status of "Modest Research Support" in depression, Obsessive Compulsive Disorder, mixed anxiety disorders, and psychosis, and "Strong Research Support" in chronic pain. ACT is also listed as evidence-based by the Substance Abuse and Mental Health Services Administration of the United States federal government which has examined randomized trials for ACT in the areas of psychosis, work site stress, and obsessive compulsive disorder, including depression outcomes. In the basic area, Relational Frame Theory is a research program in language and cognition that is considered part of contextual behavioral science, and is a focus of ACBS. Unlike the better known behavioral approach proposed by B.F. Skinner in his book Verbal Behavior, experimental RFT research has emerged in a number of areas traditionally thought to be beyond behavioral perspectives, such as grammar, metaphor, perspective taking, implicit cognition and reasoning.

Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.

References

  1. ↑ Kohlenberg, R. J.; Bolling, M. Y.; Kanter, J. W.; Parker, C. R. (2002). "Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright" (PDF). The Behavior Analyst Today. 3 (3): 248–53. doi:10.1037/h0099988. ISSN   1539-4352. Archived from the original (PDF) on October 8, 2011. Retrieved May 23, 2010.
  2. ↑ Blackledge, J.T. (2003). "An Introduction to Relational Frame Theory: Basics and Applications" (PDF). The Behavior Analyst Today. 3 (4): 421–42. doi:10.1037/h0099997. Archived from the original (PDF) on April 13, 2016. Retrieved August 19, 2016.
  3. ↑ Zettle, Robert D; Hayes, Steven C; Barnes-Holmes, Dermot; Biglan, Anthony, eds. (2015). The Wiley Handbook of Contextual Behavioral Science - Wiley Online Library. doi:10.1002/9781118489857. ISBN   9781118489857. S2CID   147707892.
  4. ↑ Zettle, R.D. (2005). "The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT". International Journal of Behavioral Consultation and Therapy. 1 (2): 77–89. doi:10.1037/h0100736. S2CID   4835864.
  5. ↑ Hayes, Steven. "Acceptance & Commitment Therapy (ACT)". ContextualPsychology.org.
  6. ↑ "State of the ACT Evidence | Association for Contextual Behavioral Science". contextualscience.org. Retrieved December 5, 2016.
  7. ↑ Lappalainen, R.; Lehtonen, T.; Skarp, E.; Taubert, E.; Ojanen, M. & Hayes, S.C. (2007). "The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial". Behavior Modification. 31 (4): 488–511. doi:10.1177/0145445506298436. PMID   17548542. S2CID   21133628.
  8. ↑ Zettle, R.D. & Rains, J.C. (1989). "Group cognitive and contextual therapies in treatment of depression". Journal of Clinical Psychology. 45 (3): 438–45. doi:10.1002/1097-4679(198905)45:3<436::aid-jclp2270450314>3.0.co;2-l. PMID   2745733.
  9. ↑ Jacobson, N.S.; Martell, C.R. & Dimidjian, S. (2001). "Behavioral activation treatment for depression: Returning to contextual roots" (PDF). Clinical Psychology: Science and Practice. 8 (3): 255–70. doi:10.1093/clipsy.8.3.255.
  10. ↑ Cullen, J.M.; Spates, C.R.; Pagoto, S. & Doran, N. (2006). "Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation". The Behavior Analyst Today. 7 (1): 151–64. doi:10.1037/h0100150. S2CID   41079284.
  11. ↑ Spates, C.R.; Pagoto, S. & Kalata, A. (2006). "A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder". The Behavior Analyst Today. 7 (4): 508–12. doi:10.1037/h0100089. S2CID   3337916.
  12. ↑ Kohlenberg, R.J.; Tsai, M. (1991). Functional Analytic Psychotherapy. New York: Plenum.
  13. ↑ Wulfert (2002). "Can Contextual Therapies Save Clinical Behavior Analysis?". The Behavior Analyst Today. 3 (3): 254. doi:10.1037/h0099984.
  14. ↑ Cautilli, J.T.; Riley-Tillman, C.; Axelrod, S. & Hineline, P. (2005). "The Role of Verbal Conditioning in Third Generation Behavior Therapy". The Behavior Analyst Today. 6 (2): 138–57. doi:10.1037/h0100152.
  15. ↑ Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.
  16. ↑ Cordova, J.; Cautilli, J.D.; Simon, C. & Axelrod-Sabtig, R. (2006). "Behavior Analysis of Forgiveness in Couples Therapy" (PDF). International Journal of Behavioral Consultation and Therapy. 2 (2): 192–213. CiteSeerX   10.1.1.507.7911 . doi:10.1037/h0100776.
  17. ↑ ABA:I
  18. ↑ Twyman, J.S. (2007). "A new era of science and practice in behavior analysis". Association for Behavior Analysis International: Newsletter. 30 (3): 1–4.
  19. ↑ Hassert, D.L.; Kelly, A.N.; Pritchard, J.K. & Cautilli, J.D. (2008). "The Licensing of Behavior Analysts: Protecting the profession and the public". Journal of Early and Intensive Behavior Intervention. 5 (2): 8–19. doi:10.1037/h0100415. S2CID   145406830.
  20. ↑ Association for Contextual Behavioral Science
  21. ↑ "Clinical Behavior Analysis". Behavior Analyst Certification Board. Retrieved September 14, 2022.
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