What is Clinical Behaviour Analysis?

Introduction

Clinical behaviour analysis (CBA; a third-generation behaviour therapy) is the clinical application of behaviour analysis (ABA). CBA represents a movement in behaviour therapy away from methodological behaviourism and back toward radical behaviourism and the use of functional analytic models of verbal behaviour – particularly, relational frame theory (RFT).

Current Models

CBA therapies include acceptance and commitment therapy (ACT), behavioural medicine (such as behavioural gerontology and paediatric feeding therapy), community reinforcement approach and family training (CRAFT), exposure therapies/desensitisation (such as systematic desensitisation), functional analytic psychotherapy (FAP, such as behavioural activation (BA) and integrative behavioural 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 behaviour therapy models. 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, although this is a matter of some debate within the community. Originally this approach was referred to as comprehensive distancing. 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 behaviour-changing side. ACT has, as of May 2021, been evaluated in over 600 randomised clinical trials for a variety of client problems. 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, which is considered a medium effect size.

Behavioural Activation

Behavioural activation emerged from a component analysis of cognitive behaviour therapy. This research found no additive effect for the cognitive component. Behavioural activation is based on a matching law model of reinforcement. A recent review of the research supports the notion that the use of behavioural activation is clinically important for the treatment of depression.

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 behavioural assessment to reduce drinking behaviour. CRAFT combines CRA with family therapy.

Functional Analytic Psychotherapy

Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship. It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement. The basic FAP analysis utilises what is called the clinically relevant behaviour (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 behaviour, about CRBs are referred to as CRB3s. In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.

Integrative Behavioural Couples Therapy

Integrative behavioural couples therapy developed from dissatisfaction with traditional behavioural couples therapy. Integrative behavioural couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule-governed behaviour. It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.

Clinical Formulation

As with all behaviour therapy, clinical behaviour analysis relies on a functional analysis of problem behaviour. Depending on the clinical model this analysis draws on B.F Skinner’s model of Verbal Behaviour or relational frame theory.

Professional Organisations

The Association for Behaviour Analysis International has a special interest group in clinical behaviour analysis ABA:I. ABA:I serves as the core intellectual home for behaviour analysts.

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

The Association for Contextual Behavioural Science is devoted to third-generation therapies and basic research on derived relational responding and relational frame theory.

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