Get into groups of 4

Workshop Preparation

Workshop 74The Basic Behavior Analytic Principles of Psychotherapy

William C. Follette, Ph.D.Glenn M. Callaghan, Ph.D.

Sabrina M. Darrow, M.A.Jordan T. Bonow, M.A.

Get into groups of 4 Pick an active, difficult client General guidelines

Workshop Preparation

1. Introduction

2. Basics Principles

[Short Break]

3. Therapist Repertoires◦ Noticing (Assessment)◦ Responding (Intervention)

Outline

Introduction

1. Learn the basic principles of behavior analysis as they operate in psychotherapy

2. Learn how to develop a client case conceptualization focusing on behavioral processes

3. Learn how to develop intervention strategies based on a case conceptualization and behavioral processes

Learning Objectives

• “The application of the assumptions, principles, and methods of modern functional contextual behavior analysis to ‘traditional clinical issues’” (Dougher & Hayes, 1999; p. 11)

• Modalities in CBA– Acceptance and Commitment Therapy (ACT)– Behavioral Activation (BA)– Functional Analytic Psychotherapy (FAP)

Clinical Behavior Analysis (CBA)

• Targets behavioral repertoires– Establishing repertoires– Shaping more effective behavior from existing

repertoires– Maintaining effective repertoires– Training discrimination of when to behave

• The client is not the target– The cause of behavior is in the environment– People do what they do because it works– Do not blame person for what they have learned– We do not reinforce or punish clients

CBA is All About Behavior

Basic CBA Model

Problematic Behavioral Repertoires

Problems in Broad

Functioning

Improved Behavioral Repertoires

Improvements in Broad

Functioning

In-Vivo Intervention

1. Establish therapist as an important stimulus for client

2. Assess the variables influencing client behavior

3. Change client’s environment in order to change client’s behavior

4. Promote continued behavior change outside the therapy environment

5. Assess for changes in client functioning

Broad Tasks of Therapy

The Basics

Behavior in context The ABCs

◦ Antecedent (A)◦ Behavior (B)◦ Consequence (C)

The Behavioral Unit of Analysis

• More technically a “response”• Relatively self-explanatory• Any activity of an organism

– Physical movement– Talking– Thinking– Feeling

• Can be measured in multiple ways

Behavior (B)

What happens in the environment following behavior of interest

An event temporally following behavior (immediately)

Consequences change and maintain behavior

Consequence (C)

Reinforcer- A consequence that increases the probability of the behavior occurring in the future

Punisher- A consequence that decreases the probability of the behavior occurring in the future

Consequences can be “natural” or “arbitrary”

Two Types of Consequences

• Condition in the environment that occurs before the behavior of interest– Another person’s behavior– Our own behavior, including thoughts and feelings– Motivational states: being hungry or tired– Temperature, noise level, location, etc.

• Antecedents are the setting factors; they set the stage for behavior to occur – Signal the availability of reinforcement (technically referred

to as a discriminative stimulus)– Directly elicit behavior (technically referred to as a

conditioned stimulus)– Create motivation (technically referred to as establishing

operations)

Antecedent (A)

Remember this is a unit Referred to as a contingency (dependence) In this situation/context (A) if I do (B), (C)

will happen

Problems can occur at any point (A, B, or C)

How the ABC’s Go Together

A B C.

Video 1-Behavioral Chains

• Behaviors should be grouped by function (i.e., those that demonstrate the same ABC contingency)

• Some common basic functions– Attention– Escape/avoidance– Sensory/Automatic– Tangibles/Preferred activities

• Behavior can be, and is, multiply controlled

Functional Classes

Topography can be both helpful and misleading

The same topographical behavior can be maintained by different functional consequences

Widely different topographical behaviors can be part of the same functional class

Function and Topography

Video 2- A Functional Class

Extinction Shaping Differential reinforcement Schedule thinning Generalization Rule governance

Important Processes to Consider

The failure of the environment to present a functional reinforcer◦ The ABC contingency is broken◦ Eventually results in elimination of the behavior

within a context Also leads to “extinction bursts” in the

shorter term

Extinction

Focus on building on a person’s existing repertoire◦ Different strategy than punishment or extinction

Differential reinforcement◦ Works particularly well when the behaviors are

incompatible

Constructional Approach

A completely generative strategy The systematic building of a particular

repertoire Relies on the reinforcement of “successive

approximations”

Shaping

A strategy for maintaining a behavior Involves fading out presentation of

reinforcement (particularly from an FR1 schedule)

There is a fine balance between thinning and extinction

Reinforcement Thinning

Behaving with respect to a stimulus as if it were an established A

Can result from◦ Topographical similarity◦ Arbitrary verbal relations

Stimulus Discrimination◦ the opposite process ◦ constricting the stimuli that will function as As

Stimulus Generalization

The functioning of verbal stimuli as As◦ Can be used to promote discrimination or

generalization Complete rules identify the As, Bs, and Cs An individual does not need to be verbally

aware of the ABCs in order for contingencies to influence his or her behavior

Rule Governance

The ABCs are a molecular, focused approach

Molar functional relations involve patterns of behavior occurring over time◦ Aggregates of multiple ABC instantiations over

time The unit of analysis is flexible

Molar Functional Relations

• The time spent engaging in a particular behavior (relative to other behavior) matches the rate of reinforcement for that activity (relative to the rate of reinforcement for other behavior)

Matching

SR+ for

SR+ for all activities

Implications◦ Have client monitor his or her behavior◦ Decrease reinforcement for the target behavior◦ Increase reinforcement for alternative behavior◦ Noncontingent reinforcement

Potential issues◦ Difficulty in overcoming the strong reinforcers

maintaining the target behavior◦ Client skills deficits in alternative behavior◦ Client’s inaccurate labeling of potential reinforcers

and alternative activities

Matching (cont.)

Focuses on choice alternatives Refers to the decrease in the value of a

reinforcer resulting from some inconvenience◦ Delay◦ Risk◦ Cost

A way to characterize impulsivity

Discounting

Implications◦ Increase the reinforcing function of the stimulus

maintaining a desired behavior◦ Shape approximations of the desired behavior ◦ Establish rules that can occasion behavior◦ Decrease the punishing function of the

inconvenience variable

Discounting (cont.)

A behavior’s persistence despite challenging circumstances

Determined by◦ Past levels of reinforcement for a behavior◦ Level of reinforcement currently provided

Reinforcement of the behavior Reinforcement for other behavior

Momentum

Implications◦ Identify the reinforcers for a target behavior

Social community Internalized rules

◦ Importance of replicating outside contexts within therapy

◦ Attend to response rate and rate of reinforcement Fluency training Differential reinforcement rather than simple

noncontingent reinforcement

Momentum (cont.)

Continuum of complete stereotypy to complete randomness

Functionality of variability is related to the context

Variability can be shaped

Variability

Implications◦ Watch for excesses and deficits in variability◦ Train variability directly after establishing a

repertoire (but not too long after)◦ Vary your eliciting and responding behavior to

increase client variability

Variability (cont.)

Break Time

1. Identify characteristics of client via assessment

2. Organize these characteristics into an analysis of the client’s problems in terms of behavioral principles

3. Devise an intervention based on assessment4. Implement intervention5. Assess outcome

Successful- Assessment and intervention completeUnsuccessful- Reformulate functional case

conceptualization

Steps of Therapy

1. Noticing2. Responding

Therapist Repertoires

Noticing (Assessment)

Therapy should target variables that are:◦ Causal- Actually influence client behavior◦ Controllable- Can be manipulated effectively◦ Important- Meaningful to client broad functioning

Assessment◦ Identifies these variables◦ Determines if their manipulation was successful

Appropriate Therapy Targets(Haynes & O’Brien, 1990)

Fundamental to doing CBA Contains

◦ Conceptualization of both strengths and weaknesses

◦ Behavioral deficits and excesses◦ Examination of contingencies of client’s behavior

Functions◦ Helps guide therapy in the moment and over time◦ Allows measurement of targeted variables

The Case Conceptualization

Broad understanding of this client and his or her life

Understanding his or her goals for treatment Understanding this session or series of

sessions with focused goals Understanding this interaction now and its

impact on therapist

Layers of Conceptualization

All of these tie to each other◦ How does this strategy I am attempting now tie

into my goals for this session given my intervention in the context of this client’s life?

The conceptualization applied to these levels will tell the therapist what to do next

Layers of Conceptualization (cont.)

Layers of Conceptualization (cont.)

Layers of Conceptualization (cont.)

Context of Client’s Life

Goals of Therapy

Goals of Session

NOW

Tests competing hypotheses Uses flexible analytic units

The Behavioral Approach is Pragmatic and Empirical

Your first idea may not always be correct Always generate alternative hypotheses Conduct critical tests Methods for testing

◦ Observation of ABCs over time◦ Mini functional analyses

Testing Competing Hypotheses

Analytic unit becomes wider as therapy progresses◦ ABCs◦ Molar relations

Therapist may be involved in the unit

Using Flexible Analytic Units

What are you noticing? What do you want to know? Why do you want to know that?

Video Exercises: Assessment

Video 3

Possible case conceptualizations◦ Client engages in avoidance of his trauma history◦ Client has skills deficit in talking about trauma

history◦ Client does not feel safe with therapist

Video 3

Video 4

Possible case conceptualizations◦ Client is avoiding her social anxiety◦ Client has competing activities/positive

reinforcers

Video 4

Responding (Intervention)

Responding◦ According to a behavioral case conceptualization◦ Strategy based on behavioral principles

Are there right and wrong responses◦ Yes◦ But…

This is determined by case conceptualization (and ultimately function)

There is room to be wrong and repair

Putting It All Together

Can you anticipate hard cases given your repertoire/history?

Are there repertoires on which you might rely too strongly?

What are your strengths? How can you make this an in-vivo learning

opportunity?

Responding: Individual Strengths and Weaknesses

What is your response? What is the logic underlying your response

(based on the case conceptualization)? What would make you change your

response? Keep in mind your strengths and

weaknesses

Responses

Case conceptualization◦ Client’s excessive emotional expressivity prevents

effective communication and intimacy building

Video 5

Video 5

Case conceptualization◦ Client has difficulty asking others for assistance

Video 6

Video 6

Case conceptualization◦ Client frequently neglects the needs/wants of

others

Video 6 (Round 2)

Video 6 (Round 2)

Case conceptualization◦ Client engages in experiential avoidance

Video 7

Video 7

Case conceptualization◦ Client fails to identify important therapy targets◦ Client talks about specific events in isolation

How do you interpret the client’s behavior so as to guide you on how to respond?

Video 8

Video 8

Case conceptualization◦ Client frequently refuses therapist’s suggestions◦ Client often avoids talking about things that are

important to her

Note: Therapeutic relationship has been established (~session 12)

Video 9

Video 9

1. What are the basic principles of behavior analysis?

2. What are some methods one can use to develop and test a case conceptualization?

3. What are some strategies for effecting change in a client within the context of a therapeutic relationship?

Post-Test Questions

Follette, W. C., Naugle, A. E., & Linnerooth, P. J. N. (2000). Functional alternatives to traditional assessment and diagnosis. In M. J. Dougher (Ed.), Clinical behavior analysis (pp. 99-125). Reno, NV: Context Press.

Ramnero, J., & Torneke, N. (2008). The ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: New Harbinger Publications, Inc.

Waltz, T. J., & Follette, W. C. (2009). Molar functional relations and clinical behavior analysis: Implications for assessment and treatment. The Behavior Analyst, 32, 51-68.

Farmer, R.F., & Nelson-Gray, R.O. (2005). Personality-guided behavior therapy. Washington, D.C.: American Psychological Association.

For Further Reading

Contact:Jordan T. Bonow

jtbonow@yahoo.com