Caproxamine is a drug which was patented as an antidepressant.
Caproxamine is 2-aminoethyl-oxime derivative patented by pharmaceutical company N. V. Philips’ Gloeilampenfabrieken as the compound with pronounced action on the central nervous system in doses of 10-500 mg/day for adults.
Campaign Against Living Miserably, or CALM, is a registered charity based in England.
CALM run a free, confidential and anonymous helpline as well as a webchat service, offering help, advice and information to anyone who is struggling or in crisis.
CALM was initially a Department of Health pilot project launched late in 1997 in Manchester with the help of Tony Wilson, and then rolled out to Merseyside in 2000. It was a helpline targeted specifically at young men who were unlikely to contact mainstream services and who were at greater risk of suicide. Jane Powell was commissioned to launch the project and ran it until 2000. When funding for the pilot project ceased in 2004/2005, Powell relaunched the pilot as a registered charity in 2006 working with some of the pilot’s original commissioners and with Tony Wilson as a founding Trustee.
In 2015 rapper and singer-songwriter Professor Green was named as CALM’s patron, and the campaign’s Trustees Board includes health professionals and leading figures from the worlds of music, advertising, and management, as well as relatives of men who have taken their own lives. Robin Millar and David Baddiel are former patrons.
The campaign has brought in significant pro bono advertising support from agencies such as Ogilvy Advertising, Tullo Marshall Warren, MTV, and Metro, and most recently Topman and BMB. This has brought CALM a significant amount of advertisements on billboards, on TV, in the underground and on radio.
In November 2018, CALM partnered with UKTV channel Dave to create a campaign called “Be The Mate You’d Want”. This started with a 3-minute ad break, voiced by comedian James Acaster, encouraging the viewer to text, chat or tweet someone who needs support. It occurred again in July 2019, this time with a “comedy festival in an ad break” which featured comedians Ahir Shah, Alex Horne, Dane Baptiste, Darren Harriott, David Mumeni, Ed Gamble, Elf Lyons, Jamali Maddix, Jessie Cave, Lou Sanders, Maisie Adam, Natasia Demetriou, Phil Wang, Pierre Novelli, Sindhu Vee, Stevie Martin and Zoe Lyons, with Jessica Knappett providing intro and outro voiceover.
In 2018, the charity commissioned the artists Mark Jenkins and Sandra Fernandez to create Project84, an art installation in London, England. The work was sponsored by Harry’s and designed to raise awareness of adult male suicide.
In May 2019 CALM announced a partnership with Dave for a podcast called Conversations Against Living Miserably hosted by Lauren Pattison and Aaron Gillies talking to comedians about their mental health.
James Kennedy (born 05 November 1950) is an American social psychologist, best known as an originator and researcher of particle swarm optimisation. The first papers on the topic, by Kennedy and Russell C. Eberhart, were presented in 1995; since then tens of thousands of papers have been published on particle swarms. The Academic Press / Morgan Kaufmann book, Swarm Intelligence, by Kennedy and Eberhart with Yuhui Shi, was published in 2001.
The particle swarm paradigm draws on social-psychological simulation research in which Kennedy had participated at the University of North Carolina, integrated with evolutionary computation methods that Eberhart had been working with in the 1990s. The result was a problem-solving or optimisation algorithm based on the principles of human social interaction. Individuals begin the programme with random guesses at the problem solution. As the program runs, the “particles” share their successes with their topological neighbours; each particle is both teacher and learner. Over time, the population converges reliably on optimal vectors.
While there has been a trend in the research literature toward a “Gbest” or centralised particle network, Blackwell and Kennedy (2018) demonstrated the importance of a distributed population topology in solving more complex problems.
A recent paper discusses the possible contribution of human female orgasm to the species’ prosociality.
Kennedy has been an active combatant in the controversy over sex education in Montgomery County, Maryland, supporting the public schools’ efforts to develop a comprehensive and inclusive programme. He also worked to support a gender identity non-discrimination law in Montgomery County that came under attack from conservatives, and has maintained an online progressive presence.
He also worked as a professional musician for fifty years and currently plays in a rockabilly band called The Colliders, which released albums in 2011 and 2015. In 2018 Kennedy released a DIY album, The Life of Mischief, and is currently organizing live performance of that material.
Kennedy worked in survey methods for the US government, and has conducted basic and applied research into social effects on cognition and attitude. He served as Director of the Office of Analysis and Research Services at the US International Trade Commission until his retirement in 2017. He has worked with particle swarms since 1994, with research publications in fields related and unrelated to swarms and surveys.
Beck Institute for Cognitive Behaviour Therapy, a non-profit organisation located in suburban Philadelphia, is an international cognitive behaviour therapy (CBT) training and resource centre.
It was founded in 1994 by Aaron T. Beck and his daughter Judith S. Beck. Beck Institute offers training in CBT in a variety of forms. Its mission is “improving lives worldwide through excellence in cognitive behaviour therapy.”
Aaron T. Beck is currently Beck Institute’s President Emeritus. He is recognised as the founder of cognitive therapy, one of the elements from which cognitive behaviour therapy developed. His daughter, Judith Beck, is Beck Institute’s current President. Aaron Beck is University Professor Emeritus of Psychiatry at the University of Pennsylvania and continues to do research there, while Judith Beck is a Clinical Professor of Psychology in Psychiatry at the same university. Lisa Pote is Beck Institute’s Executive Director, and Allen R. Miller is CBT Programme Director.
Among Beck Institute’s training programmes are Philadelphia Workshops held at the Beck Institute, On the Road Workshops held throughout the US, the Beck Institute Supervision programme, and Training for Organisations in which Beck faculty travel around the world to teach. Beck Institute’s workshops cover a variety of topics, including CBT for Depression, Anxiety, Personality Disorders, Youth, PTSD, Schizophrenia, and more. Beck Institute offers scholarships for therapists working with active duty military and veterans through their Soldier Suicide Prevention initiative and holds an annual scholarship competition for graduate students and faculty.
Beck Institute also runs a clinic at its location in suburban Philadelphia.
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).
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 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 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 (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 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 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.
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.
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.
Behavioural activation (BA) is a third generation behaviour therapy for treating depression.
It is one functional analytic psychotherapy which are based on a Skinnerian psychological model of behaviour change, generally referred to as applied behaviour analysis. This area is also a part of what is called clinical behaviour analysis (CBA) and makes up one of the most effective practices in the professional practice of behaviour analysis. The technique can also be used from a cognitive-behaviour therapy (CBT) framework.
The Beck Institute describes BA as “getting clients more active and involved in life by scheduling activities that have the potential to improve their mood.”
Behavioural activation emerged from a component analysis of cognitive behavioural therapy. This analysis found that any cognitive component added little to the overall treatment of depression. The behavioural component had existed as a stand-alone treatment in the early work of Peter Lewinsohn and thus a group of behaviourists decided that it might be more efficient to pursue a purer behavioural treatment for the disorder. The theory holds that not enough environmental reinforcement or too much environmental punishment can contribute to depression. The goal of the intervention is to increase environmental reinforcement and reduce punishment.
The theoretical underpinnings of behavioural activation for depression is Charles Ferster’s functional analysis of depression. Ferster’s basic model has been strengthened by further development in the study of reinforcement principles which led to the matching law and continuing theoretical advances in the possible functions of depression, as well as a look at behaviour analysis of child development in order to determine long-term patterns which may lead to dysthymia.
One behavioural activation approach to depression was as follows: participants were asked to create a hierarchy of reinforcing activities which were then rank-ordered by difficulty; participants tracked their own goals along with clinicians who used a token economy to reinforce success in moving through the hierarchy of activities; participants were measured before and after by the Beck Depression Inventory (BDI) and a great effect on their depression was found as a result of their treatment. This was then compared to a control group who did not receive the same treatment. The results of those who received behavioural activation treatment were markedly superior to those of the persons in the control group. Multiple clinics have since piloted and developed the treatment.
Another behavioural activation approach utilised a different methodology: clients are asked to develop an understanding of the relationship between actions and emotions, with actions being seen as the cause of emotions. An hourly self-monitoring chart is created to track activities and the impact on the mood they create for a full week. A rating scale from 1 to 10 is used for each mood change per hour. The goal is to identify depression loops. A depression loop is when a temporary coping method reduces the overall depression, such as the temporary relief provided by alcohol or other drugs, escape or avoidance or rumination. When patterns of dysfunctional responding, or loops, are identified alternative coping responses are attempted to break the loop. This method is described with the acronym “TRAP” (Trigger, Response, Avoidance Pattern) which is to be replaced with a “TRAC” (Trigger, Response, Alternate Coping response). Particular attention is given to rumination, which is provided with its own acronym RCA (Rumination Cues Action). Rumination is identified as a particularly common avoidance behaviour which worsens mood. The client is to evaluate the rumination in terms of it having improved the thing being ruminated about, providing understanding, and its emotional effects on the client. Attending to experience is suggested as an alternative to rumination as well as other possible distracting or mood improving actions.
The general program is described with the acronym ACTION (Assess behaviour/mood, Choose alternate responses, Try out those alternate responses, Integrate these alternatives, Observe results and (Now) evaluate). The goal being the understanding of the relationship between actions and emotional consequences and a systematic replacement of dysfunctional patterns with adaptive ones. Additionally, focus is given to quality sleep, and improving social functioning.
Reviews of behavioural activation studies for depression found that it has a robust effect and that policy makers should consider it an effective treatment. A large-scale treatment study found behavioural activation to be more effective than cognitive therapy and on par with medication for treating depression. A meta-analysis study comprising 34 Randomised Control Trials found that while Behavioural Activation treatment of adults with depression showed significantly greater beneficial effect compared with control participants, compared to participants treated with CT/CBT, at post treatment there were no statistically significant differences between treatment groups. A 2009 meta-analysis showed a medium post-treatment effect size compared to psychotherapy and other treatments.
A 2006 study of behavioural activation being applied to anxiety appeared to give promising results. One study found it to be effective with fibromyalgia-related pain anxiety.
Behavioural activation comes under the heading clinical behaviour analysis or what is often termed third generation behaviour therapy. Other behaviour therapies are acceptance and commitment therapy (ACT), as well as dialectical behaviour therapy (DBT) and functional analytic psychotherapy (FAP). Behavioural activation owes its basis to Charles Ferster’s Functional Analysis of Depression (1973) which developed B.F. Skinner’s idea of depression, within his analysis of motivation, as a lack of reinforcement.
The Association for Behaviour Analysis International has a special interest group for practitioner issues, behavioural counselling, and clinical behaviour analysis. The association has larger special interest groups for behavioural medicine. It also 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.
Doctoral level behaviour analysts who are psychologists belong to the American Psychological Association’s division 25 -Behaviour analysis. APA offers a diplomate in behavioural psychology.
Due to a lack of access to trained providers, physical constraints or financial reasons, many patients are not able to attend BA therapy. Researchers are trying to overcome these challenges by providing BA via Virtual Reality. The idea of the concept is to enable especially elderly adults to participate in engaging activities that they would not attend it without VR. Possibly, the so-called “BA-inspired VR protocols” will mitigate the lower mood, life satisfaction, and likelihood of depressions.
Applied behaviour analysis (ABA), also called behavioural engineering, is a scientific technique concerned with applying empirical approaches based upon the principles of respondent and operant conditioning to change behaviour of social significance. It is the applied form of behaviour analysis; the other two forms are radical behaviourism (or the philosophy of the science) and the experimental analysis of behaviour (or basic experimental research).
The name applied behaviour analysis has replaced behaviour modification because the latter approach suggested attempting to change behaviour without clarifying the relevant behaviour-environment interactions. In contrast, ABA changes behaviour by first assessing the functional relationship between a targeted behaviour and the environment. Further, the approach often seeks to develop socially acceptable alternatives for aberrant behaviours.
ABA has been utilised in a range of areas, including applied animal behaviour, schoolwide positive behaviour support, classroom instruction, structured and naturalistic early behavioural interventions for autism, paediatric feeding therapy, rehabilitation of brain injury, dementia, fitness training, substance abuse, phobias, tics, and organisational behaviour management.
ABA is considered to be controversial by some within the autism rights movement due to a perception that it emphasizes indistinguishability instead of acceptance and a history of, in some embodiments of ABA and its predecessors, the use of aversives such as electric shocks.
ABA is an applied science devoted to developing procedures which will produce observable changes in behaviour. It is to be distinguished from the experimental analysis of behaviour, which focuses on basic experimental research, but it uses principles developed by such research, in particular operant conditioning and classical conditioning. Behaviour analysis adopts the viewpoint of radical behaviourism, treating thoughts, emotions, and other covert activity as behaviour that is subject to the same rules as overt responses. This represents a shift away from methodological behaviourism, which restricts behaviour-change procedures to behaviours that are overt, and was the conceptual underpinning of behaviour modification.
Behaviour analysts also emphasize that the science of behaviour must be a natural science as opposed to a social science. As such, behaviour analysts focus on the observable relationship of behaviour with the environment, including antecedents and consequences, without resort to “hypothetical constructs”.
The beginnings of ABA can be traced back to Teodoro Ayllon and Jack Michael’s study “The psychiatric nurse as a behavioural engineer” (1959) that they published in the Journal of the Experimental Analysis of Behaviour (JEAB). Ayllon and Michael were training the staff and nurses at a psychiatric hospital how to use a token economy based on the principles of operant conditioning for patients with schizophrenia and intellectual disability, which led to researchers at the University of Kansas to start the Journal of Applied Behaviour Analysis (JABA) in 1968.
A group of faculty and researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf, applied the principles of behaviour analysis to instruct developmentally disabled children, manage the behaviour of children and adolescents in juvenile detention centres, and organise employees who required proper structure and management in businesses, among other situations. In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behaviour Analysis.
Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas. Lovaas established the UCLA Young Autism Project while teaching at the University of California, Los Angeles. In 1965, Lovaas published a series of articles that outlined his system for coding observed behaviours, described a pioneering investigation of the antecedents and consequences that maintained a problem behaviour, and relied upon the methods of errorless learning that was initially devised by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury.
In 1987, Lovaas published the study, “Behavioural treatment and normal educational and intellectual functioning in young autistic children”. The experimental group in this study received an average of 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training (DTT). The treatment is done at home with parents involved in every aspect of treatment, and the curriculum is highly individualised with a heavy emphasis on teaching eye contact, fine and gross motor imitation, and language. The use of aversives and reinforcement, were used to motivate learning and reduce non-desired behaviours. The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typical adolescent peers. This included passing regular education without assistance and making and maintaining friends. These gains were maintained as reported in the 1993 study, “Long-term outcome for children with autism who received early intensive behavioural treatment”. Lovaas’ work went on to be recognised by the US Surgeon General in 1999, and his research were replicated in university and private settings. The “Lovaas Method” went on to become known as early intensive behavioural intervention (EIBI), or 30 to 40 hours per week of DTT.
The original Lovaas method focused heavily on the use of aversives; utilising shocks, beating children, ignoring children, withholding food, etc. Using shocks, ignoring children, withholding food and toys, and spraying children with water are still used today and considered ethical by the Behaviour Analyst Certification Board (BACB). Another criticism of the Lovaas Method is Lovaas’s connection with gay conversion therapy, using his own behaviour modification techniques seen in ABA in The Feminine Boy project. Similarities in gay conversion therapy to making boys indistinguishable from their heterosexual peers have been drawn with Lovaas’ belief that ABA makes “autistic children indistinguishable from their normal friends.” He infamously said “‘[Y]ou start pretty much from scratch when you work with an autistic child…they are not people in the psychological sense”.
Over the years, “behaviour analysis” gradually superseded “behaviour modification”; that is, from simply trying to alter problematic behaviour, behaviour analysts sought to understand the function of that behaviour, what antecedents promote and maintain it, and how it can be replaced by successful behaviour. This analysis is based on careful initial assessment of a behaviour’s function and a testing of methods that produce changes in behaviour.
While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other situations. Recent notable areas of research in JABA include autism, classroom instruction with typically developing students, paediatric feeding therapy, and substance-use disorders. Other applications of ABA include applied animal behaviour, consumer behaviour analysis, behavioural medicine, behavioural neuroscience, clinical behaviour analysis, forensic behaviour analysis, increasing job safety and performance, schoolwide positive behaviour support, and contact desensitisation for phobias.
Baer, Wolf, and Risley’s 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA.
In 2005, Heward et al. suggested that the following five characteristics should be added:
Behaviour refers to the movement of some part of an organism that changes some aspect of the environment. Often, the term behaviour refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behaviour. If a group of responses have the same function, this group may be called a response class. Repertoire refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do.
Operant behaviour is the so-called “voluntary” behaviour that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control, in particular an antecedent contingency called the discriminative stimulus (SD) that influences the strengthening or weakening of behaviour through such consequences as reinforcement or punishment. The term is used quite generally, from reaching for a candy bar, to turning up the heat to escape an aversive chill, to studying for an exam to get good grades.
Respondent (classical) conditioning is based on innate stimulus-response relationships called reflexes. In his famous experiments with dogs, Pavlov usually used the salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning, the response does not produce a reinforcer or punisher (e.g. the dog does not get food because it salivates).
Reinforcement is the key element in operant conditioning and in most behaviour change programmes. It is the process by which behaviour is strengthened. If a behaviour is followed closely in time by a stimulus and this results in an increase in the future frequency of that behaviour, then the stimulus is a positive reinforcer. If the removal of an event serves as a reinforcer, this is termed negative reinforcement. There are multiple schedules of reinforcement that affect the future probability of behaviour.
Punishment is a process by which a consequence immediately follows a behaviour which decreases the future frequency of that behaviour. As with reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g. pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a ‘time out’). Punishment in practice can often result in unwanted side effects. Some other potential unwanted effects include resentment over being punished, attempts to escape the punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it.
Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behaviour, resulting in the decrease of that behaviour. The behaviour is then set to be extinguished (Cooper et al.). Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst is the temporary increase in the frequency, intensity, and/or duration of the behaviour targeted for extinction. Other characteristics of an extinction burst include an extinction-produced aggression – the occurrence of an emotional response to an extinction procedure often manifested as aggression; and b) extinction-induced response variability – the occurrence of novel behaviours that did not typically occur prior to the extinction procedure. These novel behaviours are a core component of shaping procedures.
In addition to a relation being made between behaviour and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviours. This differs from the S-R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between a behaviour (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts. This antecedent-behaviour-consequence contingency is termed the three-term contingency. A behaviour which occurs more frequently in the presence of an antecedent condition than in its absence is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (SD). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control. More recently behaviour analysts have been focusing on conditions that occur prior to the circumstances for the current behaviour of concern that increased the likelihood of the behaviour occurring or not occurring. These conditions have been referred to variously as “Setting Event”, “Establishing Operations”, and “Motivating Operations” by various researchers in their publications.
B.F. Skinner’s classification system of behaviour analysis has been applied to treatment of a host of communication disorders. Skinner’s system includes:
Skinner’s use of behavioural techniques was famously critiqued by the linguist Noam Chomsky through an extensive breakdown of how Skinner’s view of language as behavioural simply can not explain the complexity of human language. This suggests that while behaviourist techniques can teach language, it is a very poor measure to explain language fundamentals. Considering Chomsky’s critiques, it may be more appropriate to teach language through a Speech language pathologist instead of a behaviourist.
For an assessment of verbal behaviour from Skinner’s system, refer to Assessment of Basic Language and Learning Skills.
When measuring behaviour, there are both dimensions of behaviour and quantifiable measures of behaviour. In applied behaviour analysis, the quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus.
Response classes occur repeatedly throughout time – i.e. how many times the behaviour occurs.
This dimension indicates that each instance of behaviour occupies some amount of time – i.e. how long the behaviour occurs.
Each instance of behaviour occurs at a specific point in time – i.e. when the behaviour occurs.
Derivative measures are unrelated to specific dimensions:
In applied behaviour analysis, all experiments should include the following:
Task analysis is a process in which a task is analysed into its component parts so that those parts can be taught through the use of chaining: forward chaining, backward chaining and total task presentation. Task analysis has been used in organizational behaviour management, a behaviour analytic approach to changing the behaviours of members of an organization (e.g. factories, offices, or hospitals). Behavioural scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioural consultation relationship and Thomas Kratochwill developed a training program based on teaching Bergan’s skills. A similar approach was used for the development of microskills training for counsellors. Ivey would later call this “behaviourist” phase a very productive one and the skills-based approach came to dominate counselor training during 1970-1990. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of the methods to design the Direct Instruction curriculum.
The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once they have learned this, the next step may be squeezing the tube, etc.
For problem behaviour, chains can also be analysed and the chain can be disrupted to prevent the problem behaviour. Some behaviour therapies, such as dialectical behaviour therapy, make extensive use of behaviour chain analysis, but is not philosophically behaviour analytic.
A prompt is a cue that is used to encourage a desired response from an individual. Prompts are often categorised into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g. verbal). In order to minimise errors and ensure a high level of success during learning, prompts are given in a most-to-least sequence and faded systematically. During this process, prompts are faded as quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting.
Types of prompts Prompters might use any or all of the following to suggest the desired response:
This is not an exhaustive list of prompts; the nature, number, and order of prompts are chosen to be the most effective for a particular individual.
The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at a particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behaviour or skill.
Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements. Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (refer to professional practice of behaviour analysis).
Generalisation is the expansion of a student’s performance ability beyond the initial conditions set for acquisition of a skill. Generalisation can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if a student has successfully mastered learning colours at the table, the teacher may take the student around the house or school and generalise the skill in these more natural environments with other materials. Behaviour analysts have spent considerable amount of time studying factors that lead to generalisation.
Shaping involves gradually modifying the existing behaviour into the desired behaviour. If the student engages with a dog by hitting it, then they could have their behaviour shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behaviour with patting or other gentler behaviour. Shaping is based on a behaviour analyst’s thorough knowledge of operant conditioning principles and extinction. Recent efforts to teach shaping have used simulated computer tasks.
One teaching technique found to be effective with some students, particularly children, is the use of video modelling (the use of taped sequences as exemplars of behaviour). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behaviour.
Critical to behaviour analytic interventions is the concept of a systematic behavioural case formulation with a functional behavioural assessment or analysis at the core. This approach should apply a behaviour analytic theory of change (see Behavioural change theories). This formulation should include a thorough functional assessment, a skills assessment, a sequential analysis (behaviour chain analysis), an ecological assessment, a look at existing evidenced-based behavioural models for the problem behaviour (such as Fordyce’s model of chronic pain) and then a treatment plan based on how environmental factors influence behaviour. Some argue that behaviour analytic case formulation can be improved with an assessment of rules and rule-governed behaviour. Some of the interventions that result from this type of conceptualisation involve training specific communication skills to replace the problem behaviours as well as specific setting, antecedent, behaviour, and consequence strategies.
ABA-based techniques are often used to teach adaptive behaviours or to diminish behaviours associated with autism, so much that ABA itself is often mistakenly considered to be synonymous with therapy for autism. According to a paper from 2007, it was considered to be an effective “intervention for challenging behaviours” by the American Academy of Paediatrics. A 2018 Cochrane review of five studies that compared treatment vs. control showed that ABA may be effective for some autistic children. However, the quality of the evidence was weak; the number of subjects in the studies was small, and only one study randomised subjects into control and treatment groups. ABA for autism may be limited by diagnostic severity and IQ.
Recent reviews of the efficacy of ABA-based techniques in autism include:
The value of eliminating autistic behaviours is disputed by proponents of neurodiversity, who claim that it forces autistics to mask their true personalities on behalf of a narrow conception of normality. Autism advocates contend that it is cruel to try to make autistic people “normal” without consideration for how this may affect their well-being. Instead, these critics advocate for increased social acceptance of harmless autistic traits and therapies focused on improving quality of life. Julia Bascom of the Autistic Self Advocacy Network (ASAN) has said, “ASAN’s objection is fundamentally an ethical one. The stated end goal of ABA is an autistic child who is ‘indistinguishable from their peers’ – an autistic child who can pass as neurotypical. We don’t think that’s an acceptable goal. The end goal of all services, supports, interventions, and therapies an autistic child receives should be to support them in growing up into an autistic adult who is happy, healthy, and living a self-determined life.” A recent study examined perspectives of autistic adults that received ABA as children and found that the overwhelming majority reported that “behaviourist methods create painful lived experiences”, that ABA led to the “erosion of the true actualising self”, and that they felt they had a “lack of self-agency within interpersonal experiences.”
Professionals against ABA have voiced concerns over it’s evolution from Radical behaviourism. Radical behaviourism when applied views the individual as nothing more than a stimulus-response, that all of their experience can be reduced to a set of behavioural functions and manipulated through operant conditioning which only addresses “the surface level” and may only temporarily subdue aggressive behaviour under the guise that it is addressed because the subject appears content. Other concerns have focused on the “ideological zealotry” surrounding it, where ABA journals and websites have claimed that it “cures” autism and is “the only evidence based autism therapy” which has restricted access to other therapies that are also evidence based like TEACCH. The rhetoric surrounding the virtues of ABA has concerning effects including parents and professionals that claim that ABA “cured” their child’s autism, like one parent who “…claims that ABA had saved her children’s lives, likening it to chemotherapy as a treatment for cancer.”
Researchers have critiqued the leniency of the ABA ethical code, discussing how it does not restrict or clarify the “appropriate use of aversives”, it does not require competency so ABA therapists are “not required to take even a single class on autism, brain function or child development” , and its view of the client as the parent so requiring “client consent” only requires parental consent, not the person receiving services. Similarly, because the parent is seen as the client, the goals that are set under the ethical code are according to the client’s needs, which means focusing on changing autistic behaviours for the benefit of the parent and not the child is considered ethical.
Besides ethics, scientists also have concerns over the methodological issues rampant through the evidence that ABA claims supports the therapy. Early ABA research regularly employed poor methodology, including the initial study by Lovaas that supposedly supported the use of the therapy. The study by Lovaas used a self-selected sample of autistic children with high IQ and many early and present studies also employed this poor sampling with a lack of randomization, researcher-selected samples, samples pulled from researchers’ own clinics, and funding by ABA organizations with a clear conflict of interest for proving ABA is effective. Another concern is that ABA research only measures behaviour as a means of success, which has led to a lack of qualitative research about autistic experiences of ABA, a lack of research examining the internal effects of ABA and a lack of research for autistic children who are non-speaking or have comorbid intellectual disabilities (which is concerning considering this is one of the major populations that intensive ABA focuses on). Research is also lacking about whether ABA is effective long-term and very little longitudinal outcomes have been studied.
Some embodiments of applied behaviour analysis as devised by Ole Ivar Lovaas used aversives such as electric shocks to modify undesirable behaviour in their initial use in the 1970s, as well as slapping and shouting in the landmark 1987 study. Over time the use of aversives lessened and in 2012 their use was described as being inconsistent with contemporary practice. However, aversives have continued to be used in some ABA programs. In comments made in 2014 to the US Food and Drug Administration (FDA), a clinician who previously worked at the Judge Rotenberg Educational Centre claimed that “all textbooks used for thorough training of applied behaviour analysts include an overview of the principles of punishment, including the use of electrical stimulation.” In 2020, the FDA banned the use of electrical stimulation devices used for self-injurious or aggressive behaviour and asserted that “Evidence indicates a number of significant psychological and physical risks are associated with the use of these devices, including worsening of underlying symptoms, depression, anxiety, posttraumatic stress disorder, pain, burns and tissue damage.”
Applied behaviour analysts publish in many journals. Some examples of “core” behaviour analytic journals are:
Agomelatine is an atypical antidepressant used to treat major depressive disorder.
One review found that it is as effective as other antidepressants with similar discontinuation rates overall but less discontinuations due to side effects. Another review also found it was similarly effective to many other antidepressants.
Common side effects include weight gain, fatigue, liver problems, nausea, headaches, and anxiety. Due to potential liver problems ongoing blood tests are recommended. Its use is not recommended in people with dementia or over the age of 75. There is tentative evidence that it may have fewer side effects than some other antidepressants. It works by stimulating melatonin receptors and blocking serotonin receptors.
Agomelatine was approved for medical use in Europe in 2009 and Australia in 2010. Its use is not approved in the United States and efforts to get approval were ended in 2011. It was developed by the pharmaceutical company Servier.
Agomelatine was discovered and developed by the European pharmaceutical company Servier Laboratories Ltd. Servier continued to develop the drug and conduct phase III trials in the European Union.
In March 2005, Servier submitted agomelatine to the European Medicines Agency (EMA) under the trade names Valdoxan and Thymanax. On 27 July 2006, the Committee for Medical Products for Human Use (CHMP) of the EMA recommended a refusal of the marketing authorisation. The major concern was that efficacy had not been sufficiently shown, while there were no special concerns about side effects. In September 2007, Servier submitted a new marketing application to the EMA.
In March 2006, Servier announced it had sold the rights to market agomelatine in the United States to Novartis. It was undergoing several phase III clinical trials in the US, and until October 2011 Novartis listed the drug as scheduled for submission to the FDA no earlier than 2012. However, the development for the US market was discontinued in October 2011, when the results from the last of those trials became available.
It received approval from the European Medicines Agency (EMA) for marketing in the European Union in February 2009 and approval from the Therapeutic Goods Administration (TGA) for marketing in Australia in August 2010.
Agomelatine is used for the treatment of major depressive episodes in adults in Europe. Ten placebo controlled trials have been performed to investigate the short term efficacy of agomelatine in major depressive disorder. At the end of treatment, significant efficacy was demonstrated in six of the ten short-term double-blind placebo-controlled studies. Two were considered “failed” trials, as comparators of established efficacy failed to differentiate from placebo. Efficacy was also observed in more severely depressed patients in all positive placebo-controlled studies. The maintenance of antidepressant efficacy was demonstrated in a relapse prevention study. One meta-analysis found agomelatine to be as effective as standard antidepressants.
A meta-analysis found that agomelatine is effective in treating severe depression. Its antidepressant effect is greater for more severe depression. In people with a greater baseline score (>30 on HAMD17 scale), the agomelatine-placebo difference was of 4.53 points. Controlled studies in humans have shown that agomelatine is at least as effective as the SSRI antidepressants paroxetine, sertraline, escitalopram, and fluoxetine in the treatment of major depression. A 2018 meta-study comparing 21 antidepressants found agomelatine was one of the more tolerable, yet effective antidepressants.
However, the body of research on agomelatine has been substantially affected by publication bias, prompting analyses which take into account both published and unpublished studies. These have confirmed that agomelatine is approximately as effective as more commonly used antidepressants (e.g. SSRIs), but some qualified this as “marginally clinically relevant”, being only slightly above placebo. According to a 2013 review, agomelatine did not seem to provide an advantage in efficacy over other antidepressants for the acute-phase treatment of major depression.
It is not recommended in Europe for use in children and adolescents below 18 years of age due to a lack of data on safety and efficacy. However, a study reported in September, 2020, showed greater efficacy vs. placebo for agomelatine 25mg per day in youth age 7-18 years. Only limited data is available on use in elderly people ≥ 75 years old with major depressive episodes.
It is not recommended during pregnancy or breastfeeding.
Agomelatine is contraindicated in patients with kidney or liver impairment. According to information disclosed by Servier in 2012, guidelines for the follow-up of patients treated with Valdoxan have been modified in concert with the European Medicines Agency. As some patients may experience increased levels of liver enzymes in their blood during treatment with Valdoxan, doctors have to run laboratory tests to check that the liver is working properly at the initiation of the treatment and then periodically during treatment, and subsequently decide whether to pursue the treatment or not. No relevant modification in agomelatine pharmacokinetic parameters in patients with severe renal impairment has been observed. However, only limited clinical data on its use in depressed patients with severe or moderate renal impairment with major depressive episodes is available. Therefore, caution should be exercised when prescribing agomelatine to these patients.
Agomelatine does not alter daytime vigilance and memory in healthy volunteers. In depressed patients, treatment with the drug increased slow wave sleep without modification of REM (Rapid Eye Movement) sleep amount or REM latency. Agomelatine also induced an advance of the time of sleep onset and of minimum heart rate. From the first week of treatment, onset of sleep and the quality of sleep were significantly improved without daytime clumsiness as assessed by patients.
Agomelatine appears to cause fewer sexual side effects and discontinuation effects than paroxetine.
No dosage tapering is needed on treatment discontinuation. Agomelatine has no abuse potential as measured in healthy volunteer studies.
Agomelatine is expected to be relatively safe in overdose.
Agomelatine is a substrate of CYP1A2, CYP2C9 and CYP2C19. Inhibitors of these enzymes, e.g. the SSRI antidepressant fluvoxamine, reduce its clearance and can therefore lead to an increase in agomelatine exposure. There is also the potential for agomelatine to interact with alcohol to increase the risk of hepatotoxicity.
Agomelatine is a melatonin receptor agonist (MT1 (Ki 0.1 nM) and MT2 (Ki = 0.12 nM)) and serotonin 5-HT2C (Ki = 631 nM) and 5-HT2B receptor (Ki = 660 nM) antagonist. Binding studies indicate that it has no effect on monoamine uptake and no affinity for adrenergic, histamine, cholinergic, dopamine, and benzodiazepine receptors, nor other serotonin receptors.
Agomelatine resynchronizes circadian rhythms in animal models of delayed sleep phase syndrome. By antagonising 5-HT2C, it disinhibits/increases noradrenaline and dopamine release specifically in the frontal cortex. Therefore, it is sometimes classified as a norepinephrine-dopamine disinhibitor. It has no influence on the extracellular levels of serotonin. Agomelatine has shown an antidepressant-like effect in animal models of depression (learned helplessness test, despair test, chronic mild stress) as well as in models with circadian rhythm desynchronisation and in models related to stress and anxiety. In humans, agomelatine has positive phase shifting properties; it induces a phase advance of sleep, body temperature decline and melatonin onset.
Antagonism of 5-HT2B is an antidepressant property agomelatine shares with several atypical antipsychotics, such as aripiprazole, which are themselves used as atypical antidepressants. 5-HT2B antagonists are currently being investigated for their usefulness in reducing cardiotoxicity of drugs as well as being effective in reducing headache. Hence this particular receptor antagonism of agomelatine is useful for its antidepressant effectiveness as well as reducing the drug’s adverse effects.
The chemical structure of agomelatine is very similar to that of melatonin. Where melatonin has an indole ring system, agomelatine has a naphthalene bioisostere instead.
Agomelatine is under development by Servier for the treatment of generalised anxiety disorder and has reached phase III clinical trials for this indication, but in August 2017, Servier communicated that development for this indication is suspended.
Agomelatine is also studied for its effects on sleep regulation. Studies report various improvements in general quality of sleep metrics, as well as benefits in circadian rhythm disorders. It has been found more effective than placebo in the treatment of generalised anxiety disorder. A 2019 review suggested no recommendations of agomelatine in support of, or against, its use to treat individuals with seasonal affective disorder.
The affective spectrum is a spectrum of affective disorders (mood disorders).
It is a grouping of related psychiatric and medical disorders which may accompany bipolar, unipolar, and schizoaffective disorders at statistically higher rates than would normally be expected.
These disorders are identified by a common positive response to the same types of pharmacologic treatments.
They also aggregate strongly in families and may therefore share common heritable underlying physiologic anomalies.
Affective spectrum disorders include:
The following may also be present as co-morbidities for affective mood disorders:
Also, there are now studies linking heart disease.
Many of the terms above overlap. The American Psychiatric Association’s definitions of these terms can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Wilhelm Reich (24 March 1897 to 03 November 1957) was an Austrian doctor of medicine and a psychoanalyst, along with being a member of the second generation of analysts after Sigmund Freud.
The author of several influential books, most notably The Impulsive Character (1925), Character Analysis (1933), and The Mass Psychology of Fascism (1933), he became known as one of the most radical figures in the history of psychiatry.
Reich’s work on character contributed to the development of Anna Freud’s The Ego and the Mechanisms of Defence (1936), and his idea of muscular armour – the expression of the personality in the way the body moves – shaped innovations such as body psychotherapy, Gestalt therapy, bioenergetic analysis and primal therapy. His writing influenced generations of intellectuals; he coined the phrase “the sexual revolution” and according to one historian acted as its midwife. During the 1968 student uprisings in Paris and Berlin, students scrawled his name on walls and threw copies of The Mass Psychology of Fascism at police.
After graduating in medicine from the University of Vienna in 1922, Reich became deputy director of Freud’s outpatient clinic, the Vienna Ambulatorium. During the 1930s, he was part of a general trend among younger analysts and Frankfurt sociologists that tried to reconcile psychoanalysis with Marxism. He is credited for establishing the first sexual advisory clinics in Vienna, along with Marie Frischauf. He said he wanted to “attack the neurosis by its prevention rather than treatment”.
He moved to New York in 1939, after having accepted a position as Assistant Professor at the New School of Social Research. During his five years in Oslo, he had coined the term “orgone energy” – from “orgasm” and “organism”—for the notion of life energy. In 1940 he started building orgone accumulators, modified Faraday cages that he claimed were beneficial for cancer patients. He claimed that his laboratory cancer mice had had remarkable positive effects from being kept in a Faraday cage, so he built human-size versions, where one could sit inside. This led to newspaper stories about “sex boxes” that cured cancer.
Following two critical articles about him in The New Republic and Harper’s in 1947, the US Food and Drug Administration obtained an injunction against the interstate shipment of orgone accumulators and associated literature, believing they were dealing with a “fraud of the first magnitude”. Charged with contempt in 1956 for having violated the injunction, Reich was sentenced to two years imprisonment, and that summer over six tons of his publications were burned by order of the court. He died in prison of heart failure just over a year later, days before he was due to apply for parole.
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