get into groups of 4. william c. follette, ph.d. glenn m. callaghan, ph.d. sabrina m. darrow, m.a....
TRANSCRIPT
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Get into groups of 4
Workshop Preparation
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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.
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Get into groups of 4 Pick an active, difficult client General guidelines
Workshop Preparation
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1. Introduction
2. Basics Principles
[Short Break]
3. Therapist Repertoires◦ Noticing (Assessment)◦ Responding (Intervention)
Outline
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Introduction
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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
Learning Objectives
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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)
Clinical Behavior Analysis (CBA)
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• 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
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Basic CBA Model
Problematic Behavioral Repertoires
Problems in Broad
Functioning
Improved Behavioral Repertoires
Improvements in Broad
Functioning
In-Vivo Intervention
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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
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The Basics
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Behavior in context The ABCs
◦ Antecedent (A)◦ Behavior (B)◦ Consequence (C)
The Behavioral Unit of Analysis
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• 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)
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What happens in the environment following behavior of interest
An event temporally following behavior (immediately)
Consequences change and maintain behavior
Consequence (C)
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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”
Two Types of Consequences
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• 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)
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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
Problems can occur at any point (A, B, or C)
How the ABC’s Go Together
A B C.
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Video 1-Behavioral Chains
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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
• Behavior can be, and is, multiply controlled
Functional Classes
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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
Function and Topography
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Video 2- A Functional Class
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Extinction Shaping Differential reinforcement Schedule thinning Generalization Rule governance
Important Processes to Consider
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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 Also leads to “extinction bursts” in the
shorter term
Extinction
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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
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A completely generative strategy The systematic building of a particular
repertoire Relies on the reinforcement of “successive
approximations”
Shaping
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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
Reinforcement Thinning
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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
Stimulus Discrimination◦ the opposite process ◦ constricting the stimuli that will function as As
Stimulus Generalization
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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
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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 The unit of analysis is flexible
Molar Functional Relations
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• 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
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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.)
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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
A way to characterize impulsivity
Discounting
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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
Discounting (cont.)
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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
Momentum
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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
Momentum (cont.)
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Continuum of complete stereotypy to complete randomness
Functionality of variability is related to the context
Variability can be shaped
Variability
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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
Variability (cont.)
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Break Time
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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
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1. Noticing2. Responding
Therapist Repertoires
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Noticing (Assessment)
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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
Assessment◦ Identifies these variables◦ Determines if their manipulation was successful
Appropriate Therapy Targets(Haynes & O’Brien, 1990)
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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
Functions◦ Helps guide therapy in the moment and over time◦ Allows measurement of targeted variables
The Case Conceptualization
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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
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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?
The conceptualization applied to these levels will tell the therapist what to do next
Layers of Conceptualization (cont.)
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Layers of Conceptualization (cont.)
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Layers of Conceptualization (cont.)
Context of Client’s Life
Goals of Therapy
Goals of Session
NOW
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Tests competing hypotheses Uses flexible analytic units
The Behavioral Approach is Pragmatic and Empirical
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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
Testing Competing Hypotheses
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Analytic unit becomes wider as therapy progresses◦ ABCs◦ Molar relations
Therapist may be involved in the unit
Using Flexible Analytic Units
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What are you noticing? What do you want to know? Why do you want to know that?
Video Exercises: Assessment
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Video 3
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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
Video 3
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Video 4
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Possible case conceptualizations◦ Client is avoiding her social anxiety◦ Client has competing activities/positive
reinforcers
Video 4
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Responding (Intervention)
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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
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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?
Responding: Individual Strengths and Weaknesses
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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
Responses
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Case conceptualization◦ Client’s excessive emotional expressivity prevents
effective communication and intimacy building
Video 5
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Video 5
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Case conceptualization◦ Client has difficulty asking others for assistance
Video 6
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Video 6
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Case conceptualization◦ Client frequently neglects the needs/wants of
others
Video 6 (Round 2)
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Video 6 (Round 2)
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Case conceptualization◦ Client engages in experiential avoidance
Video 7
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Video 7
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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
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Video 8
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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)
Video 9
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Video 9
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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?
Post-Test Questions
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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