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Get into groups of 4
William C. Follette, Ph.D.
Glenn M. Callaghan, Ph.D.
Sabrina M. Darrow, M.A.
Jordan T. Bonow, M.A.
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Get into groups of 4
Pick an active, difficult client
General guidelines
1.
Introduction
2.
Basics Principles
[Short Break]
3.
Therapist Repertoires
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◦
Noticing (Assessment)
Responding (Intervention)
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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
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“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)
•
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
In-Vivo
Intervention
Problematic
Behavioral
Repertoires
Improved
Behavioral
Repertoires
Problems in
Broad
Functioning
Improvements
in Broad
Functioning
1.
2.
3.
4.
5.
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
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Behavior in context
The ABCs
◦ Antecedent (A)
◦ Behavior (B)
◦ Consequence (C)
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More technically a “response”
Relatively self-explanatory
Any activity of an organism
– Physical movement
– Talking
– Thinking
– Feeling
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Can be measured in multiple ways
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What happens in the environment following
behavior of interest
An event temporally following behavior
(immediately)
Consequences change and maintain behavior
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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”
•
Condition in the environment that occurs before the
behavior of interest
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–
–
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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)
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Remember this is a unit
Referred to as a contingency (dependence)
In this situation/context (A) if I do (B), (C) will
happen
.
A
B
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C
Problems can occur at any point (A, B, or C)
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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
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Behavior can be, and is, multiply controlled
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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
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Extinction
Shaping
Differential reinforcement
Schedule thinning
Generalization
Rule governance
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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
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Also leads to “extinction bursts” in the
shorter term
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Focus on building on a person’s existing
repertoire
◦ Different strategy than punishment or extinction
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Differential reinforcement
◦ Works particularly well when the behaviors are
incompatible
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A completely generative strategy
The systematic building of a particular
repertoire
Relies on the reinforcement of “successive
approximations”
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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
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Behaving with respect to a stimulus as if it
were an established A
Can result from
◦ Topographical similarity
◦ Arbitrary verbal relations
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Stimulus Discrimination
◦ the opposite process
◦ constricting the stimuli that will function as As
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The functioning of verbal stimuli as As
◦ Can be used to promote discrimination or
generalization
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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
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The ABCs are a molecular, focused approach
Molar functional relations involve patterns of
behavior occurring over time
◦ Aggregates of multiple ABC instantiations over time
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The unit of analysis is flexible
•
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
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Implications
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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
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Focuses on choice alternatives
Refers to the decrease in the value of a
reinforcer resulting from some inconvenience
◦ Delay
◦ Risk
◦ Cost
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A way to characterize impulsivity
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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
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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
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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
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Continuum of complete stereotypy to
complete randomness
Functionality of variability is related to the
context
Variability can be shaped
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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
1.
2.
3.
4.
5.
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
1.
2.
Noticing
Responding
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Therapy should target variables that are:
◦ Causal- Actually influence client behavior
◦ Controllable- Can be manipulated effectively
◦ Important- Meaningful to client broad functioning
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Assessment
◦ Identifies these variables
◦ Determines if their manipulation was successful
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Fundamental to doing CBA
Contains
◦ Conceptualization of both strengths and
weaknesses
◦ Behavioral deficits and excesses
◦ Examination of contingencies of client’s behavior
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Functions
◦ Helps guide therapy in the moment and over time
◦ Allows measurement of targeted variables
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
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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?
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The conceptualization applied to these
levels will tell the therapist what to do
next
Context of Client’s Life
Goals of Therapy
Goals of Session
NOW
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Tests competing hypotheses
Uses flexible analytic units
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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
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Analytic unit becomes wider as therapy
progresses
◦ ABCs
◦ Molar relations
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Therapist may be involved in the unit
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What are you noticing?
What do you want to know?
Why do you want to know that?
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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
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Possible case conceptualizations
◦ Client is avoiding her social anxiety
◦ Client has competing activities/positive reinforcers
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Responding
◦ According to a behavioral case conceptualization
◦ Strategy based on behavioral principles
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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
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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?
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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
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Case conceptualization
◦ Client’s excessive emotional expressivity prevents
effective communication and intimacy building
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Case conceptualization
◦ Client has difficulty asking others for assistance
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Case conceptualization
◦ Client frequently neglects the needs/wants of
others
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Case conceptualization
◦ Client engages in experiential avoidance
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Case conceptualization
◦ Client fails to identify important therapy targets
◦ Client talks about specific events in isolation
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How do you interpret the client’s behavior so
as to guide you on how to respond?
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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)
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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?
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). Personalityguided behavior therapy. Washington, D.C.: American
Psychological Association.