clinical behavior analysis

Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is the clinical application of behavior analysis (ABA).{{Cite journal |volume=3 |issue=3 |pages=248–53 |last1=Kohlenberg |first1=R. J. |last2=Bolling |first2=M. Y. |last3=Kanter |first3=J. W. |last4=Parker |first4=C. R. |title=Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright |journal=The Behavior Analyst Today |year=2002 |issn=1539-4352 |url=https://pantherfile.uwm.edu/jkanter/www/pdf/publication/behavioranalysis.pdf |doi=10.1037/h0099988 |access-date=2010-05-23 |archive-url=https://web.archive.org/web/20111008194237/https://pantherfile.uwm.edu/jkanter/www/pdf/publication/behavioranalysis.pdf |archive-date=2011-10-08 |url-status=dead }} CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism and the use of functional analytic models of verbal behavior—particularly, relational frame theory (RFT).

Current models

Clinical behavior analysis (CBA) therapies include acceptance and commitment therapy (ACT), behavioral medicine (such as behavioral gerontology and pediatric feeding therapy), community reinforcement approach and family training (CRAFT), exposure therapies/desensitization (such as systematic desensitization), functional analytic psychotherapy (FAP, such as behavioral activation (BA) and integrative behavioral couples therapy), and voucher-based contingency management.

=Acceptance and commitment therapy=

Acceptance and commitment therapy is probably the most well-researched of all the third-generation behavior therapy models.{{Citation needed|date=July 2021}} Its development co-occurred with that of relational frame theory, with several researchers such as Steven C Hayes being involved with both. ACT has been argued to be based on relational frame theory.{{cite journal|year=2003|title=An Introduction to Relational Frame Theory: Basics and Applications|url=http://facts4u.com/free/rft_blackledge.pdf|journal=The Behavior Analyst Today|volume=3|issue=4|pages=421–42|author=Blackledge, J.T.|doi=10.1037/h0099997|access-date=2016-08-19|archive-url=https://web.archive.org/web/20160413165349/http://facts4u.com/free/rft_blackledge.pdf|archive-date=2016-04-13|url-status=dead}} Although this is a matter of some debate within the community,{{Cite book|title=The Wiley Handbook of Contextual Behavioral Science - Wiley Online Library|doi=10.1002/9781118489857|year = 2015|isbn = 9781118489857|editor1-last=Zettle|editor1-first=Robert D|editor2-last=Hayes|editor2-first=Steven C|editor3-last=Barnes-Holmes|editor3-first=Dermot|editor4-last=Biglan|editor4-first=Anthony|s2cid=147707892}} Originally, this approach was referred to as comprehensive distancing.{{cite journal|author=Zettle, R.D.|s2cid=4835864|year=2005|title= The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT|journal=International Journal of Behavioral Consultation and Therapy|volume=1|issue=2|pages=77–89|doi=10.1037/h0100736}} Every practitioner mixes acceptance with a commitment to one's values. These ingredients become enmeshed into the treatment in different ways which leads to ACT being either more on the mindfulness side, or more on the behavior-changing side.{{cite web |last=Hayes |first=Steven |author-link=Steven C. Hayes |title=Acceptance & Commitment Therapy (ACT) |url=http://www.contextualpsychology.org/act |publisher= ContextualPsychology.org}} ACT has, as of May 2022, been evaluated in over 900 randomized clinical trials for a variety of client problems.{{Cite web|url=https://contextualscience.org/state_of_the_act_evidence|title=State of the ACT Evidence {{!}} Association for Contextual Behavioral Science|website=contextualscience.org|access-date=2016-12-05}} Overall, when compared to other active treatments designed or known to be helpful, the effect size for ACT is a Cohen's d of around 0.6,{{cite journal|author1=Lappalainen, R.|author2= Lehtonen, T.|author3= Skarp, E.|author4= Taubert, E.|author5=Ojanen, M. |author6= Hayes, S.C.|name-list-style=amp|year=2007|title=The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial|journal=Behavior Modification|volume=31|issue=4|pages=488–511|pmid=17548542|doi=10.1177/0145445506298436|s2cid= 21133628|url=https://www.researchgate.net/publication/6287169}}{{cite journal|author1=Zettle, R.D.|author2=Rains, J.C.|name-list-style=amp|year=1989|title= Group cognitive and contextual therapies in treatment of depression|journal=Journal of Clinical Psychology|volume=45|issue=3|pages=438–45|pmid=2745733|doi=10.1002/1097-4679(198905)45:3<436::aid-jclp2270450314>3.0.co;2-l|url=https://www.researchgate.net/publication/20409969}} which is considered a medium effect size.

=Behavioral activation=

Behavioral activation emerged from a component analysis of cognitive behavior therapy. Cognitive behavior therapy focuses on trying to reverse those negative thoughts that contribute to emotional difficulties such as depression and anxiety. This research found no additive effect for the cognitive component.{{cite journal|author1=Jacobson, N.S.|author2=Martell, C.R.|author3=Dimidjian, S.|name-list-style=amp|year=2001|title= Behavioral activation treatment for depression: Returning to contextual roots|journal=Clinical Psychology: Science and Practice|volume=8|issue=3|pages=255–70|doi=10.1093/clipsy.8.3.255|url=http://www.personal.kent.edu/~dfresco/CBT_Readings/CPSP_Jacobson_et_al_BA.pdf}} Behavioral activation is based on a matching law model of reinforcement.{{cite journal|author1=Cullen, J.M.|author2=Spates, C.R.|author3=Pagoto, S. |author4= Doran, N.|name-list-style=amp|year=2006|title= Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation|journal=The Behavior Analyst Today|volume=7|issue=1|pages=151–64|doi=10.1037/h0100150|s2cid=41079284 |url=https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1107&context=prevbeh_pp}} A recent review of the research supports the notion that the use of behavioral activation is clinically important for the treatment of depression.{{cite journal|author1=Spates, C.R.|author2=Pagoto, S.|author3=Kalata, A.|name-list-style=amp|year=2006|title= A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder|journal=The Behavior Analyst Today|volume=7|issue=4|pages=508–12 |doi=10.1037/h0100089|s2cid=3337916 |url=https://escholarship.umassmed.edu/prevbeh_pp/113}}

=Community reinforcement approach and family training=

Community reinforcement approach and family training (CRAFT) is a model developed by Robert Meyer and based on the community reinforcement approach (CRA) first developed by Nathan Azrin and Hunt. The model focuses on the use of functional behavioral assessment to reduce drinking behavior. CRAFT combines CRA with family therapy.

=Functional analytic psychotherapy=

Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship.{{cite book|author=Kohlenberg, R.J.|author2=Tsai, M.|year=1991|title=Functional Analytic Psychotherapy|location=New York|publisher=Plenum}} It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement.{{cite journal|last=Wulfert|year=2002|title=Can Contextual Therapies Save Clinical Behavior Analysis? |journal=The Behavior Analyst Today|volume=3|issue=3|page= 254 |doi=10.1037/h0099984}} The basic FAP analysis utilizes what is called the clinically relevant behavior (CRB1), which is the client's presenting problem as presented in-session. Client in-session actions that improve their CRB1s are referred to as CRB2s. Client statements, or verbal behavior, about CRBs are referred to as CRB3s. In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change.{{Cite journal|author1=Cautilli, J.T.|author2= Riley-Tillman, C.|author3= Axelrod, S. |author4=Hineline, P.|name-list-style=amp|year=2005|title=The Role of Verbal Conditioning in Third Generation Behavior Therapy|journal=The Behavior Analyst Today|volume=6|issue=2|pages= 138–57|doi=10.1037/h0100152}}

=Integrative behavioral couples therapy=

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule-governed behavior.{{cite book|author=Skinner, B.F.|year=1969|title=Contingencies of Reinforcement: A Theoretical Analysis|location=New York|publisher=Meredith Corporation}} It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness.{{cite journal|author1=Cordova, J.|author2=Cautilli, J.D.|author3=Simon, C.|author4=Axelrod-Sabtig, R.|name-list-style=amp|year=2006|title=Behavior Analysis of Forgiveness in Couples Therapy|journal=International Journal of Behavioral Consultation and Therapy|volume=2|issue=2|pages=192–213|url=http://files.eric.ed.gov/fulltext/EJ804016.pdf|doi=10.1037/h0100776|citeseerx=10.1.1.507.7911}}

Clinical formulation

As with all behavior therapy, clinical behavior analysis relies on a functional analysis of problem behavior. Depending on the clinical model this analysis draws on B. F. Skinner's model of verbal behavior or relational frame theory.

Professional organizations

The Association for Behavior Analysis International (ABAI) has a special interest group in clinical behavior analysis ABA:I.[http://www.abainternational.org/ ABA:I] ABA:I serves as the core intellectual home for behavior analysts.{{cite journal|author=Twyman, J.S.|year=2007|title=A new era of science and practice in behavior analysis|journal=Association for Behavior Analysis International: Newsletter|volume=30|issue=3|pages=1–4}}{{cite journal|author1=Hassert, D.L.|author2=Kelly, A.N.|author3=Pritchard, J.K.|author4=Cautilli, J.D.|s2cid=145406830|name-list-style=amp|year=2008|title=The Licensing of Behavior Analysts: Protecting the profession and the public|journal=Journal of Early and Intensive Behavior Intervention|volume=5|issue=2|pages=8–19|doi=10.1037/h0100415}}

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis.

The Association for Contextual Behavioral Science (ACBS) is devoted to third-generation therapies and basic research on derived relational responding and relational frame theory.[http://www.contextualpsychology.org Association for Contextual Behavioral Science]

The Behavior Analyst Certification Board (BACB), in partnership with subject-matter experts, has produced a "Clinical Behavior Analysis" fact sheet.{{Cite web |title=Clinical Behavior Analysis |url=https://www.bacb.com/about-behavior-analysis/clinical-ba/ |access-date=2022-09-14 |website=Behavior Analyst Certification Board |language=en-US}}

References

Category:Behavior therapy

Category:Behaviorism