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Workshop Preparation. Get into groups of 4. Workshop 74 The 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. Workshop Preparation. Get into groups of 4 Pick an active, difficult client

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Workshop preparation

Workshop Preparation

  • Get into groups of 4


Workshop 74 the basic behavior analytic principles of psychotherapy

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.


Workshop preparation1

Workshop Preparation

  • Get into groups of 4

  • Pick an active, difficult client

  • General guidelines


Outline

Outline

  • Introduction

  • Basics Principles

    [Short Break]

  • Therapist Repertoires

    • Noticing (Assessment)

    • Responding (Intervention)


Introduction

Introduction


Learning objectives

Learning Objectives

  • 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


Clinical behavior analysis cba

Clinical Behavior Analysis (CBA)

  • “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)


Cba is all about behavior

CBA is All About Behavior

  • 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


Basic cba model

Basic CBA Model

In-Vivo Intervention

Problematic Behavioral Repertoires

Improved Behavioral Repertoires

Problems in Broad Functioning

Improvements in Broad Functioning


Broad tasks of therapy

Broad Tasks of Therapy

  • Establish therapist as an important stimulus for client

  • Assess the variables influencing client behavior

  • Change client’s environment in order to change client’s behavior

  • Promote continued behavior change outside the therapy environment

  • Assess for changes in client functioning


The basics

The Basics


The behavioral unit of analysis

The Behavioral Unit of Analysis

  • Behavior in context

  • The ABCs

    • Antecedent (A)

    • Behavior (B)

    • Consequence (C)


Behavior b

Behavior (B)

  • More technically a “response”

  • Relatively self-explanatory

  • Any activity of an organism

    • Physical movement

    • Talking

    • Thinking

    • Feeling

  • Can be measured in multiple ways


Consequence c

Consequence (C)

  • What happens in the environment following behavior of interest

  • An event temporally following behavior (immediately)

  • Consequences change and maintain behavior


Two types of consequences

Two Types of Consequences

  • 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”


Antecedent a

Antecedent (A)

  • 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)


How the abc s go together

How the ABC’s Go Together

  • 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)

.

B

C

A


Video 1 behavioral chains

Video 1-Behavioral Chains


Functional classes

Functional Classes

  • 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


Function and topography

Function and Topography

  • 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


Video 2 a functional class

Video 2- A Functional Class


Important processes to consider

Important Processes to Consider

  • Extinction

  • Shaping

  • Differential reinforcement

  • Schedule thinning

  • Generalization

  • Rule governance


Extinction

Extinction

  • 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


Constructional approach

Constructional Approach

  • 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


Shaping

Shaping

  • A completely generative strategy

  • The systematic building of a particular repertoire

  • Relies on the reinforcement of “successive approximations”


Reinforcement thinning

Reinforcement Thinning

  • 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


Stimulus generalization

Stimulus Generalization

  • 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


Rule governance

Rule Governance

  • 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


Molar functional relations

Molar Functional Relations

  • 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


Matching

Matching

  • 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)

SR+ for

SR+ for all activities


Matching cont

Matching (cont.)

  • 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


Discounting

Discounting

  • 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 cont

Discounting (cont.)

  • 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


Momentum

Momentum

  • 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 cont

Momentum (cont.)

  • 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


Variability

Variability

  • Continuum of complete stereotypy to complete randomness

  • Functionality of variability is related to the context

  • Variability can be shaped


Variability cont

Variability (cont.)

  • 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


Break time

Break Time


Steps of therapy

Steps of Therapy

  • Identify characteristics of client via assessment

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

  • Devise an intervention based on assessment

  • Implement intervention

  • Assess outcome

    Successful- Assessment and intervention complete

    Unsuccessful- Reformulate functional case conceptualization


Therapist repertoires

Therapist Repertoires

  • Noticing

  • Responding


Noticing assessment

Noticing (Assessment)


Appropriate therapy targets haynes o brien 1990

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

  • 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


The case conceptualization

The Case Conceptualization

  • 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


Layers of conceptualization

Layers of 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 cont

Layers of Conceptualization (cont.)

  • 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 cont1

Layers of Conceptualization (cont.)

CONTEXT


Layers of conceptualization cont2

Layers of Conceptualization (cont.)

Context of Client’s Life

Goals of Therapy

Goals of Session

NOW


The behavioral approach is pragmatic and empirical

The Behavioral Approach is Pragmatic and Empirical

  • Tests competing hypotheses

  • Uses flexible analytic units


Testing competing hypotheses

Testing Competing Hypotheses

  • 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


Using flexible analytic units

Using Flexible Analytic Units

  • Analytic unit becomes wider as therapy progresses

    • ABCs

    • Molar relations

  • Therapist may be involved in the unit


Video exercises assessment

Video Exercises: Assessment

  • What are you noticing?

  • What do you want to know?

  • Why do you want to know that?


Video 3

Video 3


Video 31

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 4

Video 4


Video 41

Video 4

  • Possible case conceptualizations

    • Client is avoiding her social anxiety

    • Client has competing activities/positive reinforcers


Responding intervention

Responding (Intervention)


Putting it all together

Putting It All Together

  • 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


Responding individual strengths and weaknesses

Responding: Individual Strengths and Weaknesses

  • 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?


Responses

Responses

  • 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


Video 5

Video 5

  • Case conceptualization

    • Client’s excessive emotional expressivity prevents effective communication and intimacy building


Video 51

Video 5


Video 6

Video 6

  • Case conceptualization

    • Client has difficulty asking others for assistance


Video 61

Video 6


Video 6 round 2

Video 6 (Round 2)

  • Case conceptualization

    • Client frequently neglects the needs/wants of others


Video 6 round 21

Video 6 (Round 2)


Video 7

Video 7

  • Case conceptualization

    • Client engages in experiential avoidance


Video 71

Video 7


Video 8

Video 8

  • 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 81

Video 8


Video 9

Video 9

  • 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 91

Video 9


Post test questions

Post-Test Questions

  • 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?


For further reading

For Further Reading

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.


Contact jordan t bonow jtbonow@yahoo com

Contact:Jordan T. Bonow [email protected]


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