1.  Get into groups of 4

2. William C. Follette, Ph.D. Glenn M. Callaghan, Ph.D. Sabrina M. Darrow, M.A. Jordan T. Bonow, M.A.

3.  Get into groups of 4  Pick an active, difficult client  General guidelines Workshop Preparation

4. 1. Introduction 2. Basics Principles [Short Break] 3. Therapist Repertoires ◦ Noticing (Assessment) ◦ Responding (Intervention)

6.  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

7. “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)

8. 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

9. Basic CBA Model Basic CBA Model Problematic Behavioral Repertoires Problems in Broad Functioning Improved Behavioral Repertoires Improvements in Broad Functioning In-Vivo Intervention

10. 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

12.  Behavior in context  The ABCs ◦ Antecedent (A) ◦ Behavior (B) ◦ Consequence (C)

13. More technically a “response” Relatively self-explanatory Any activity of an organism – Physical movement – Talking – Thinking – Feeling Can be measured in multiple ways

14.  What happens in the environment following behavior of interest  An event temporally following behavior (immediately)  Consequences change and maintain behavior

15.  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”

16. 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)

17.  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) A B C.

19. 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

20.  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

22.  Extinction  Shaping  Differential reinforcement  Schedule thinning  Generalization  Rule governance

23.  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

24.  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

25.  A completely generative strategy  The systematic building of a particular repertoire  Relies on the reinforcement of “successive approximations”

26.  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

27.  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

28.  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

29.  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

30. 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) S R+ for S R+ for all activities

31.  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

32.  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

33.  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

34.  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

35.  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

36.  Continuum of complete stereotypy to complete randomness  Functionality of variability is related to the context  Variability can be shaped

37.  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

39. 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 assessment 4. Implement intervention 5. Assess outcome Successful- Assessment and intervention complete Unsuccessful- Reformulate functional case conceptualization

40. 1. Noticing 2. Responding

42.  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

43.  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

44.  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

45.  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

47. Context of Client’s Life Goals of Therapy Goals of Session NOW

48.  Tests competing hypotheses  Uses flexible analytic units

49.  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

50.  Analytic unit becomes wider as therapy progresses ◦ ABCs ◦ Molar relations  Therapist may be involved in the unit

51.  What are you noticing?  What do you want to know?  Why do you want to know that?

53.  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

55.  Possible case conceptualizations ◦ Client is avoiding her social anxiety ◦ Client has competing activities/positive reinforcers

57.  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

58.  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?

59.  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

60.  Case conceptualization ◦ Client’s excessive emotional expressivity prevents effective communication and intimacy building

62.  Case conceptualization ◦ Client has difficulty asking others for assistance

64.  Case conceptualization ◦ Client frequently neglects the needs/wants of others

66.  Case conceptualization ◦ Client engages in experiential avoidance

68.  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?

70.  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)

72.  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?

73. 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.