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What is Behaviourism?

Introduction

Behaviourism is a systematic approach to understanding the behaviour of humans and other animals. It assumes that behaviour is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual’s history, including especially reinforcement and punishment contingencies, together with the individual’s current motivational state and controlling stimuli. Although behaviourists generally accept the important role of heredity in determining behaviour, they focus primarily on environmental events.

It combines elements of philosophy, methodology, and theory. Behaviourism emerged in the early 1900s as a reaction to depth psychology and other traditional forms of psychology, which often had difficulty making predictions that could be tested experimentally, but derived from earlier research in the late nineteenth century, such as when Edward Thorndike pioneered the law of effect, a procedure that involved the use of consequences to strengthen or weaken behaviour.

During the first half of the twentieth century, John B. Watson devised methodological behaviourism, which rejected introspective methods and sought to understand behaviour by only measuring observable behaviours and events. It was not until the 1930s that B.F. Skinner suggested that covert behaviour – including cognition and emotions – subjects to the same controlling variables as observable behaviour, which became the basis for his philosophy called radical behaviourism. While Watson and Ivan Pavlov investigated how (conditioned) neutral stimuli elicit reflexes in respondent conditioning, Skinner assessed the reinforcement histories of the discriminative (antecedent) stimuli that emits behaviour; the technique became known as operant conditioning.

The application of radical behaviourism – known as applied behaviour analysis – is used in a variety of contexts, including, for example, applied animal behaviour and organisational behaviour management to treatment of mental disorders, such as autism and substance abuse. In addition, while behaviourism and cognitive schools of psychological thought do not agree theoretically, they have complemented each other in the cognitive-behaviour therapies, which have demonstrated utility in treating certain pathologies, including simple phobias, PTSD, and mood disorders.

Branches of Behaviourism

An outline of the various branches of behaviourism can be seen the table below.

BranchDescription
InterbehaviourismProposed by Jacob Robert Kantor before B. F. Skinner’s writings.
Methodological Behaviourism1. John B. Watson’s behaviourism states that only public events (motor behaviours of an individual) can be objectively observed.
2. Although it was still acknowledged that thoughts and feelings exist, they were not considered part of the science of behaviour.
3. It also laid the theoretical foundation for the early approach behaviour modification in the 1970s and early 1980s.
Psychological Behviourism1. As proposed by Arthur W. Staats, unlike the previous behaviourisms of Skinner, Hull, and Tolman, was based upon a program of human research involving various types of human behaviour.
2. Psychological behaviourism introduces new principles of human learning.
3. Humans learn not only by the animal learning principles but also by special human learning principles.
4. Those principles involve humans’ uniquely huge learning ability.
5. Humans learn repertoires that enable them to learn other things. Human learning is thus cumulative.
6. No other animal demonstrates that ability, making the human species unique.
Radical Behaviourism1. Skinner’s philosophy is an extension of Watson’s form of behaviourism by theorising that processes within the organism – particularly, private events, such as thoughts and feelings – are also part of the science of behaviour, and suggests that environmental variables control these internal events just as they control observable behaviours.
2. Although private events cannot be directly seen by others, they are later determined through the species’ overt behaviour.
3. Radical behaviourism forms the core philosophy behind behaviour analysis.
4. Willard Van Orman Quine used many of radical behaviourism’s ideas in his study of knowledge and language.
Teleological Behaviourism1. Proposed by Howard Rachlin, post-Skinnerian, purposive, close to microeconomics. Focuses on objective observation as opposed to cognitive processes.
Theoretical Behaviourism1. Proposed by J.E.R. Staddon, adds a concept of internal state to allow for the effects of context.
2. According to theoretical behaviourism, a state is a set of equivalent histories, i.e., past histories in which members of the same stimulus class produce members of the same response class (i.e., B.F. Skinner’s concept of the operant).
3. Conditioned stimuli are thus seen to control neither stimulus nor response but state.
4. Theoretical behaviourism is a logical extension of Skinner’s class-based (generic) definition of the operant.
Hullian & Post-Hullian1. A sub-type of theoretical behaviourism.
2. Theoretical, group data, not dynamic, physiological.
Purposive1. A sub-type of theoretical behaviourism.
2. Tolman’s behaviouristic anticipation of cognitive psychology

Modern-Day Theory: Radical Behaviourism

B.F. Skinner proposed radical behaviourism as the conceptual underpinning of the experimental analysis of behaviour. This viewpoint differs from other approaches to behavioural research in various ways, but, most notably here, it contrasts with methodological behaviourism in accepting feelings, states of mind and introspection as behaviours also subject to scientific investigation. Like methodological behaviourism, it rejects the reflex as a model of all behaviour, and it defends the science of behaviour as complementary to but independent of physiology. Radical behaviourism overlaps considerably with other western philosophical positions, such as American pragmatism.

Although John B. Watson mainly emphasized his position of methodological behaviourism throughout his career, Watson and Rosalie Rayner conducted the renowned Little Albert experiment (1920), a study in which Ivan Pavlov’s theory to respondent conditioning was first applied to eliciting a fearful reflex of crying in a human infant, and this became the launching point for understanding covert behaviour (or private events) in radical behaviourism. However, Skinner felt that aversive stimuli should only be experimented on with animals and spoke out against Watson for testing something so controversial on a human.

In 1959, Skinner observed the emotions of two pigeons by noting that they appeared angry because their feathers ruffled. The pigeons were placed together in an operant chamber, where they were aggressive as a consequence of previous reinforcement in the environment. Through stimulus control and subsequent discrimination training, whenever Skinner turned off the green light, the pigeons came to notice that the food reinforcer is discontinued following each peck and responded without aggression. Skinner concluded that humans also learn aggression and possess such emotions (as well as other private events) no differently than do nonhuman animals.

Experimental and Conceptual Innovations

This essentially philosophical position gained strength from the success of Skinner’s early experimental work with rats and pigeons, summarized in his books The Behaviour of Organisms and Schedules of Reinforcement. Of particular importance was his concept of the operant response, of which the canonical example was the rat’s lever-press. In contrast with the idea of a physiological or reflex response, an operant is a class of structurally distinct but functionally equivalent responses. For example, while a rat might press a lever with its left paw or its right paw or its tail, all of these responses operate on the world in the same way and have a common consequence. Operants are often thought of as species of responses, where the individuals differ but the class coheres in its function-shared consequences with operants and reproductive success with species. This is a clear distinction between Skinner’s theory and S-R theory.

Skinner’s empirical work expanded on earlier research on trial-and-error learning by researchers such as Thorndike and Guthrie with both conceptual reformulations – Thorndike’s notion of a stimulus-response “association” or “connection” was abandoned; and methodological ones – the use of the “free operant”, so called because the animal was now permitted to respond at its own rate rather than in a series of trials determined by the experimenter procedures. With this method, Skinner carried out substantial experimental work on the effects of different schedules and rates of reinforcement on the rates of operant responses made by rats and pigeons. He achieved remarkable success in training animals to perform unexpected responses, to emit large numbers of responses, and to demonstrate many empirical regularities at the purely behavioural level. This lent some credibility to his conceptual analysis. It is largely his conceptual analysis that made his work much more rigorous than his peers’, a point which can be seen clearly in his seminal work Are Theories of Learning Necessary? in which he criticizes what he viewed to be theoretical weaknesses then common in the study of psychology. An important descendant of the experimental analysis of behaviour is the Society for Quantitative Analysis of Behaviour.

Relation to Language

As Skinner turned from experimental work to concentrate on the philosophical underpinnings of a science of behaviour, his attention turned to human language with his 1957 book Verbal Behaviour and other language-related publications; Verbal Behaviour laid out a vocabulary and theory for functional analysis of verbal behaviour, and was strongly criticised in a review by Noam Chomsky.

Skinner did not respond in detail but claimed that Chomsky failed to understand his ideas, and the disagreements between the two and the theories involved have been further discussed. Innateness theory, which has been heavily critiqued, is opposed to behaviourist theory which claims that language is a set of habits that can be acquired by means of conditioning. According to some, the behaviourist account is a process which would be too slow to explain a phenomenon as complicated as language learning. What was important for a behaviourist’s analysis of human behaviour was not language acquisition so much as the interaction between language and overt behaviour. In an essay republished in his 1969 book Contingencies of Reinforcement, Skinner took the view that humans could construct linguistic stimuli that would then acquire control over their behaviour in the same way that external stimuli could. The possibility of such “instructional control” over behaviour meant that contingencies of reinforcement would not always produce the same effects on human behaviour as they reliably do in other animals. The focus of a radical behaviourist analysis of human behaviour therefore shifted to an attempt to understand the interaction between instructional control and contingency control, and also to understand the behavioural processes that determine what instructions are constructed and what control they acquire over behaviour. Recently, a new line of behavioural research on language was started under the name of relational frame theory.

Education

Behaviourism focuses on one particular view of learning: a change in external behaviour achieved through using reinforcement and repetition (Rote learning) to shape behaviour of learners. Skinner found that behaviours could be shaped when the use of reinforcement was implemented. Desired behaviour is rewarded, while the undesired behaviour is not rewarded. Incorporating behaviourism into the classroom allowed educators to assist their students in excelling both academically and personally. In the field of language learning, this type of teaching was called the audio-lingual method, characterised by the whole class using choral chanting of key phrases, dialogues and immediate correction.

Within the behaviourist view of learning, the “teacher” is the dominant person in the classroom and takes complete control, evaluation of learning comes from the teacher who decides what is right or wrong. The learner does not have any opportunity for evaluation or reflection within the learning process, they are simply told what is right or wrong. The conceptualisation of learning using this approach could be considered “superficial,” as the focus is on external changes in behaviour, i.e., not interested in the internal processes of learning leading to behaviour change and has no place for the emotions involved in the process.

Operant Conditioning

Operant conditioning was developed by B.F. Skinner in 1937 and deals with the management of environmental contingencies to change behaviour. In other words, behaviour is controlled by historical consequential contingencies, particularly reinforcement – a stimulus that increases the probability of performing behaviours, and punishment – a stimulus that decreases such probability. The core tools of consequences are either positive (presenting stimuli following a response), or negative (withdrawn stimuli following a response).

The following descriptions explain the concepts of four common types of consequences in operant conditioning.

TypeDescription
Positive Reinforcement1. Providing a stimulus that an individual desires to reinforce desired behaviours.
2. For example, a child loves playing video games.
3. His mother reinforced his tendency to provide a helping hands to other family members by providing more time for him to play video games.
Negative Reinforcement1. Removing a stimulus that an individual does not desire to reinforce desired behaviours.
3. For example, a child hates being nagged to clean his room.
3. His mother reinforces his room cleaning by removing the undesired stimulus of nagging after he has cleaned.
Positive Punishment1. Providing a stimulus that an individual does not desire to decrease undesired behaviours.
2. For example, a child hates to do chores.
3. His parents will try to reduce the undesired behaviour of failing a test by applying the undesired stimuli of having him do more chores around the house.
Negative Punishment1. Removing a stimulus that an individual desires in order to decrease undesired behaviours.
2. For example, a child loves playing video games.
3. His parents will try to reduce the undesired behaviour of failing an exam by removing the desired stimulus of video games.

Classical experiment in operant conditioning, for example the Skinner Box, “puzzle box” or operant conditioning chamber to test the effects of operant conditioning principles on rats, cats and other species. From the study of Skinner box, he discovered that the rats learned very effectively if they were rewarded frequently with food. Skinner also found that he could shape the rats’ behaviour through the use of rewards, which could, in turn, be applied to human learning as well.

Skinner’s model was based on the premise that reinforcement is used for the desired actions or responses while punishment was used to stop the undesired actions responses that are not. This theory proved that humans or animals will repeat any action that leads to a positive outcome, and avoiding any action that leads to a negative outcome. The experiment with the pigeons showed that a positive outcome leads to learned behaviour since the pigeon learned to peck the disc in return for the reward of food.

These historical consequential contingencies subsequently leads to (antecedent) stimulus control, but in contrast to respondent conditioning where antecedent stimuli elicits reflexive behavior, operant behavior is only emitted and therefore does not force its occurrence. It includes the following controlling stimuli:

  • Discriminative stimulus (Sd):
    • An antecedent stimulus that increases the chance of the organism engaging in a behaviour.
    • One example of this occurred in Skinner’s laboratory.
    • Whenever the green light (Sd) appeared, it signalled the pigeon to perform the behaviour of pecking because it learned in the past that each time it pecked, food was presented (the positive reinforcing stimulus).
  • Stimulus delta (S-delta):
    • An antecedent stimulus that signals the organism not to perform a behaviour since it was extinguished or punished in the past.
    • One notable instance of this occurs when a person stops their car immediately after the traffic light turns red (S-delta).
    • However, the person could decide to drive through the red light, but subsequently receive a speeding ticket (the positive punishing stimulus), so this behaviour will potentially not reoccur following the presence of the S-delta.

Respondent Conditioning

Although operant conditioning plays the largest role in discussions of behavioural mechanisms, respondent conditioning (also called Pavlovian or classical conditioning) is also an important behaviour-analytic process that need not refer to mental or other internal processes. Pavlov’s experiments with dogs provide the most familiar example of the classical conditioning procedure. At the beginning, the dog was provided a meat (unconditioned stimulus, UCS, naturally elicit a response that is not controlled) to eat, resulting in increased salivation (unconditioned response, UCR, which means that a response is naturally caused by UCS). Afterwards, a bell ring was presented together with food to the dog. Although bell ring was a neutral stimulus (NS, meaning that the stimulus did not had any effect), dog would start salivate when only hearing a bell ring after a number of pairings. Eventually, the neutral stimulus (bell ring) became conditioned. Therefore, salvation was elicited as a conditioned response (the response same as the unconditioned response), pairing up with meat – the conditioned stimulus). Although Pavlov proposed some tentative physiological processes that might be involved in classical conditioning, these have not been confirmed. The idea of classical conditioning helped behaviourist John Watson discover the key mechanism behind how humans acquire the behaviours that they do, which was to find a natural reflex that produces the response being considered.

Watson’s “Behaviourist Manifesto” has three aspects that deserve special recognition: one is that psychology should be purely objective, with any interpretation of conscious experience being removed, thus leading to psychology as the “science of behaviour”; the second one is that the goals of psychology should be to predict and control behaviour (as opposed to describe and explain conscious mental states); the third one is that there is no notable distinction between human and non-human behaviour. Following Darwin’s theory of evolution, this would simply mean that human behaviour is just a more complex version in respect to behaviour displayed by other species.

In Philosophy

Behaviourism is a psychological movement that can be contrasted with philosophy of mind. The basic premise of radical behaviourism is that the study of behaviour should be a natural science, such as chemistry or physics, without any reference to hypothetical inner states of organisms as causes for their behaviour. Behaviourism takes a functional view of behaviour. According to Edmund Fantino and colleagues: “Behaviour analysis has much to offer the study of phenomena normally dominated by cognitive and social psychologists. We hope that successful application of behavioural theory and methodology will not only shed light on central problems in judgment and choice but will also generate greater appreciation of the behavioural approach.”

Behaviourist sentiments are not uncommon within philosophy of language and analytic philosophy. It is sometimes argued that Ludwig Wittgenstein defended a logical behaviourist position (e.g. the beetle in a box argument). In logical positivism (as held, e.g. by Rudolf Carnap and Carl Hempel), the meaning of psychological statements are their verification conditions, which consist of performed overt behaviour. W.V.O. Quine made use of a type of behaviourism, influenced by some of Skinner’s ideas, in his own work on language. Quine’s work in semantics differed substantially from the empiricist semantics of Carnap which he attempted to create an alternative to, couching his semantic theory in references to physical objects rather than sensations. Gilbert Ryle defended a distinct strain of philosophical behaviourism, sketched in his book The Concept of Mind. Ryle’s central claim was that instances of dualism frequently represented “category mistakes”, and hence that they were really misunderstandings of the use of ordinary language. Daniel Dennett likewise acknowledges himself to be a type of behaviourist, though he offers extensive criticism of radical behaviourism and refutes Skinner’s rejection of the value of intentional idioms and the possibility of free will.

This is Dennett’s main point in “Skinner Skinned.” Dennett argues that there is a crucial difference between explaining and explaining away… If our explanation of apparently rational behavior turns out to be extremely simple, we may want to say that the behavior was not really rational after all. But if the explanation is very complex and intricate, we may want to say not that the behavior is not rational, but that we now have a better understanding of what rationality consists in. (Compare: if we find out how a computer program solves problems in linear algebra, we don’t say it’s not really solving them, we just say we know how it does it. On the other hand, in cases like Weizenbaum’s ELIZA program, the explanation of how the computer carries on a conversation is so simple that the right thing to say seems to be that the machine isn’t really carrying on a conversation, it’s just a trick.) (Curtis Brown, Philosophy of Mind, “Behaviorism: Skinner and Dennett”).

Law of Effect and Trace Conditioning

  • Law of Effect:
    • Although Edward Thorndike’s methodology mainly dealt with reinforcing observable behaviour, it viewed cognitive antecedents as the causes of behaviour, and was theoretically much more similar to the cognitive-behaviour therapies than classical (methodological) or modern-day (radical) behaviourism.
    • Nevertheless, Skinner’s operant conditioning was heavily influenced by the Law of Effect’s principle of reinforcement.
  • Trace conditioning:
    • Akin to B.F. Skinner’s radical behaviourism, it is a respondent conditioning technique based on Ivan Pavlov’s concept of a “memory trace” in which the observer recalls the conditioned stimulus (CS), with the memory or recall being the unconditioned response (UR).
    • There is also a time delay between the CS and unconditioned stimulus (US), causing the conditioned response (CR) – particularly the reflex – to be faded over time.

Molecular versus Molar Behaviourism

Skinner’s view of behaviour is most often characterised as a “molecular” view of behaviour; that is, behaviour can be decomposed into atomistic parts or molecules. This view is inconsistent with Skinner’s complete description of behaviour as delineated in other works, including his 1981 article “Selection by Consequences”. Skinner proposed that a complete account of behaviour requires understanding of selection history at three levels: biology (the natural selection or phylogeny of the animal); behaviour (the reinforcement history or ontogeny of the behavioual repertoire of the animal); and for some species, culture (the cultural practices of the social group to which the animal belongs). This whole organism then interacts with its environment. Molecular behaviourists use notions from melioration theory, negative power function discounting or additive versions of negative power function discounting.

Molar behaviourists, such as Howard Rachlin, Richard Herrnstein, and William Baum, argue that behaviour cannot be understood by focusing on events in the moment. That is, they argue that behaviour is best understood as the ultimate product of an organism’s history and that molecular behaviourists are committing a fallacy by inventing fictitious proximal causes for behaviour. Molar behaviourists argue that standard molecular constructs, such as “associative strength”, are better replaced by molar variables such as rate of reinforcement. Thus, a molar behaviourist would describe “loving someone” as a pattern of loving behaviour over time; there is no isolated, proximal cause of loving behaviour, only a history of behaviours (of which the current behaviour might be an example) that can be summarised as “love”.

Theoretical Behaviourism

Skinner’s radical behaviourism has been highly successful experimentally, revealing new phenomena with new methods, but Skinner’s dismissal of theory limited its development. Theoretical behaviourism recognised that a historical system, an organism, has a state as well as sensitivity to stimuli and the ability to emit responses. Indeed, Skinner himself acknowledged the possibility of what he called “latent” responses in humans, even though he neglected to extend this idea to rats and pigeons. Latent responses constitute a repertoire, from which operant reinforcement can select. Theoretical behaviourism links between the brain and the behaviour that provides a real understanding of the behaviour. Rather than a mental presumption of how brain-behaviour relates.

Behaviour Analysis and Culture

Cultural analysis has always been at the philosophical core of radical behaviourism from the early days (as seen in Skinner’s Walden Two, Science & Human Behaviour, Beyond Freedom & Dignity, and About Behaviourism).

During the 1980s, behaviour analysts, most notably Sigrid Glenn, had a productive interchange with cultural anthropologist Marvin Harris (the most notable proponent of “cultural materialism”) regarding interdisciplinary work. Very recently, behaviour analysts have produced a set of basic exploratory experiments in an effort toward this end. Behaviourism is also frequently used in game development, although this application is controversial.

Behaviour Informatics and Behaviour Computing

With the fast growth of big behavioural data and applications, behaviour analysis is ubiquitous. Understanding behaviour from the informatics and computing perspective becomes increasingly critical for in-depth understanding of what, why and how behaviours are formed, interact, evolve, change and affect business and decision. Behaviour informatics and behaviour computing deeply explore behaviour intelligence and behaviour insights from the informatics and computing perspectives.

Criticisms and Limitations

In the second half of the 20th century, behaviourism was largely eclipsed as a result of the cognitive revolution. This shift was due to radical behaviourism being highly criticised for not examining mental processes, and this led to the development of the cognitive therapy movement. In the mid-20th century, three main influences arose that would inspire and shape cognitive psychology as a formal school of thought:

  • Noam Chomsky’s 1959 critique of behaviourism, and empiricism more generally, initiated what would come to be known as the “cognitive revolution”.
  • Developments in computer science would lead to parallels being drawn between human thought and the computational functionality of computers, opening entirely new areas of psychological thought. Allen Newell and Herbert Simon spent years developing the concept of artificial intelligence (AI) and later worked with cognitive psychologists regarding the implications of AI. The effective result was more of a framework conceptualisation of mental functions with their counterparts in computers (memory, storage, retrieval, etc.)
  • Formal recognition of the field involved the establishment of research institutions such as George Mandler’s Center for Human Information Processing in 1964. Mandler described the origins of cognitive psychology in a 2002 article in the Journal of the History of the Behavioural Sciences.

In the early years of cognitive psychology, behaviourist critics held that the empiricism it pursued was incompatible with the concept of internal mental states. Cognitive neuroscience, however, continues to gather evidence of direct correlations between physiological brain activity and putative mental states, endorsing the basis for cognitive psychology.

Behaviour Therapy

Behaviour therapy is a term referring to different types of therapies that treat mental health disorders. It identifies and helps change people’s unhealthy behaviours or destructive behaviours through learning theory and conditioning. Ivan Pavlov’s classical conditioning, as well as counterconditioning are the basis for much of clinical behaviour therapy, but also includes other techniques, including operant conditioning, or contingency management, and modelling – sometimes called observational learning. A frequently noted behaviour therapy is systematic desensitisation, which was first demonstrated by Joseph Wolpe and Arnold Lazarus.

21st-Century Behaviourism (Behaviour Analysis)

Applied behaviour analysis (ABA) – also called behavioural engineering – is a scientific discipline that applies the principles of behaviour analysis to change behaviour. ABA derived from much earlier research in the Journal of the Experimental Analysis of Behaviour, which was founded by B.F. Skinner and his colleagues at Harvard University. Nearly a decade after the study “The psychiatric nurse as a behavioural engineer” (1959) was published in that journal, which demonstrated how effective the token economy was in reinforcing more adaptive behaviour for hospitalised patients with schizophrenia and intellectual disability, it led to researchers at the University of Kansas to start the Journal of Applied Behaviour Analysis in 1968.

Although ABA and behaviour modification are similar behaviour-change technologies in that the learning environment is modified through respondent and operant conditioning, behaviour modification did not initially address the causes of the behaviour (particularly, the environmental stimuli that occurred in the past), or investigate solutions that would otherwise prevent the behaviour from reoccurring. As the evolution of ABA began to unfold in the mid-1980s, functional behaviour assessments (FBAs) were developed to clarify the function of that behaviour, so that it is accurately determined which differential reinforcement contingencies will be most effective and less likely for aversive consequences to be administered. In addition, methodological behaviourism was the theory underpinning behaviour modification since private events were not conceptualised during the 1970s and early 1980s, which contrasted from the radical behaviourism of behaviour analysis. ABA – the term that replaced behaviour modification – has emerged into a thriving field.

The independent development of behaviour analysis outside the United States also continues to develop. In the US, the American Psychological Association (APA) features a subdivision for Behaviour Analysis, titled APA Division 25: Behaviour Analysis, which has been in existence since 1964, and the interests among behaviour analysts today are wide-ranging, as indicated in a review of the 30 Special Interest Groups (SIGs) within the Association for Behaviour Analysis International (ABAI). Such interests include everything from animal behaviour and environmental conservation, to classroom instruction (such as direct instruction and precision teaching), verbal behaviour, developmental disabilities and autism, clinical psychology (i.e., forensic behaviour analysis), behavioural medicine (i.e., behavioural gerontology, AIDS prevention, and fitness training), and consumer behaviour analysis.

The field of applied animal behaviour – a sub-discipline of ABA that involves training animals – is regulated by the Animal Behaviour Society, and those who practice this technique are called applied animal behaviourists. Research on applied animal behaviour has been frequently conducted in the Applied Animal Behaviour Science journal since its founding in 1974.

ABA has also been particularly well-established in the area of developmental disabilities since the 1960s, but it was not until the late 1980s that individuals diagnosed with autism spectrum disorders were beginning to grow so rapidly and groundbreaking research was being published that parent advocacy groups started demanding for services throughout the 1990s, which encouraged the formation of the Behaviour Analyst Certification Board, a credentialing program that certifies professionally trained behaviour analysts on the national level to deliver such services. Nevertheless, the certification is applicable to all human services related to the rather broad field of behaviour analysis (other than the treatment for autism), and the ABAI currently has 14 accredited MA and PhD programmes for comprehensive study in that field.

Early behavioural interventions (EBIs) based on ABA are empirically validated for teaching children with autism and has been proven as such for over the past five decades. Since the late 1990s and throughout the twenty-first century, early ABA interventions have also been identified as the treatment of choice by the US Surgeon General, American Academy of Paediatrics, and US National Research Council.

Discrete trial training – also called early intensive behavioural intervention – is the traditional EBI technique implemented for thirty to forty hours per week that instructs a child to sit in a chair, imitate fine and gross motor behaviours, as well as learn eye contact and speech, which are taught through shaping, modelling, and prompting, with such prompting being phased out as the child begins mastering each skill. When the child becomes more verbal from discrete trials, the table-based instructions are later discontinued, and another EBI procedure known as incidental teaching is introduced in the natural environment by having the child ask for desired items kept out of their direct access, as well as allowing the child to choose the play activities that will motivate them to engage with their facilitators before teaching the child how to interact with other children their own age.

A related term for incidental teaching, called pivotal response treatment (PRT), refers to EBI procedures that exclusively entail twenty-five hours per week of naturalistic teaching (without initially using discrete trials). Current research is showing that the majority of the population learn more words at a quicker pace through PRT since only a small portion of the non-verbal autistic population have lower receptive language skills – a phrase used to describe individuals who do not pay much attention to overt stimuli or others in their environment – and the latter are the children who initially require discrete trials to acquire speech.

Organizational behaviour management, which applies contingency management procedures to model and reinforce appropriate work behaviour for employees in organisations, has developed a particularly strong following within ABA, as evidenced by the formation of the OBM Network and Journal of Organisational Behaviour Management, which was rated the third highest impact journal in applied psychology by ISI JOBM rating.

Modern-day clinical behaviour analysis has also witnessed a massive resurgence in research, with the development of relational frame theory (RFT), which is described as an extension of verbal behaviour and a “post-Skinnerian account of language and cognition.” RFT also forms the empirical basis for acceptance and commitment therapy, a therapeutic approach to counselling often used to manage such conditions as anxiety and obesity that consists of acceptance and commitment, value-based living, cognitive defusion, counterconditioning (mindfulness), and contingency management (positive reinforcement). Another evidence-based counselling technique derived from RFT is the functional analytic psychotherapy known as behavioural activation that relies on the ACL model – awareness, courage, and love – to reinforce more positive moods for those struggling with depression.

Incentive-based contingency management (CM) is the standard of care for adults with substance-use disorders; it has also been shown to be highly effective for other addictions (i.e. obesity and gambling). Although it does not directly address the underlying causes of behaviour, incentive-based CM is highly behaviour analytic as it targets the function of the client’s motivational behaviour by relying on a preference assessment, which is an assessment procedure that allows the individual to select the preferred reinforcer (in this case, the monetary value of the voucher, or the use of other incentives, such as prizes). Another evidence-based CM intervention for substance abuse is community reinforcement approach and family training that uses FBAs and counterconditioning techniques – such as behavioural skills training and relapse prevention – to model and reinforce healthier lifestyle choices which promote self-management of abstinence from drugs, alcohol, or cigarette smoking during high-risk exposure when engaging with family members, friends, and co-workers.

While schoolwide positive behaviour support consists of conducting assessments and a task analysis plan to differentially reinforce curricular supports that replace students’ disruptive behaviour in the classroom, paediatric feeding therapy incorporates a liquid chaser and chin feeder to shape proper eating behaviour for children with feeding disorders. Habit reversal training, an approach firmly grounded in counterconditioning which uses contingency management procedures to reinforce alternative behaviour, is currently the only empirically validated approach for managing tic disorders.

Some studies on exposure (desensitisation) therapies – which refer to an array of interventions based on the respondent conditioning procedure known as habituation and typically infuses counterconditioning procedures, such as meditation and breathing exercises – have recently been published in behaviour analytic journals since the 1990s, as most other research are conducted from a cognitive-behaviour therapy framework. When based on a behaviour analytic research standpoint, FBAs are implemented to precisely outline how to employ the flooding form of desensitisation (also called direct exposure therapy) for those who are unsuccessful in overcoming their specific phobia through systematic desensitisation (also known as graduated exposure therapy). These studies also reveal that systematic desensitisation is more effective for children if used in conjunction with shaping, which is further termed contact desensitisation, but this comparison has yet to be substantiated with adults.

Other widely published behaviour analytic journals include Behaviour Modification, The Behaviour Analyst, Journal of Positive Behaviour Interventions, Journal of Contextual Behavioural Science, The Analysis of Verbal Behaviour, Behaviour and Philosophy, Behaviour and Social Issues, and The Psychological Record.

Cognitive Behaviour Therapy

Cognitive behaviour therapy (CBT) is a behaviour therapy discipline that often overlaps considerably with the clinical behaviour analysis subfield of ABA, but differs in that it initially incorporates cognitive restructuring and emotional regulation to alter a person’s cognition and emotions.

A popularly noted counselling intervention known as dialectical behaviour therapy (DBT) includes the use of a chain analysis, as well as cognitive restructuring, emotional regulation, distress tolerance, counterconditioning (mindfulness), and contingency management (positive reinforcement). DBT is quite similar to acceptance and commitment therapy, but contrasts in that it derives from a CBT framework. Although DBT is most widely researched for and empirically validated to reduce the risk of suicide in psychiatric patients with borderline personality disorder, it can often be applied effectively to other mental health conditions, such as substance abuse, as well as mood and eating disorders.

Most research on exposure therapies (also called desensitisation) – ranging from eye movement desensitisation and reprocessing therapy to exposure and response prevention – are conducted through a CBT framework in non-behaviour analytic journals, and these enhanced exposure therapies are well-established in the research literature for treating phobic, post-traumatic stress, and other anxiety disorders (such as obsessive compulsive disorder, or OCD).

Cognitive-based behavioural activation (BA) – the psychotherapeutic approach used for depression – is shown to be highly effective and is widely used in clinical practice. Some large randomised control trials have indicated that cognitive-based BA is as beneficial as antidepressant medications but more efficacious than traditional cognitive therapy. Other commonly used clinical treatments derived from behavioural learning principles that are often implemented through a CBT model include community reinforcement approach and family training, and habit reversal training for substance abuse and tics, respectively.

Related Therapies

  • Acceptance and commitment therapy (ACT).
  • Applied animal behaviour.
  • Behavioural activation.
  • Behaviour modification.
  • Behaviour therapy.
  • Biofeedback.
  • Clinical behaviour analysis.
  • Contingency management.
  • Desensitization.
  • Dialectical behaviour therapy.
  • Direct instruction.
  • Discrete trial training.
  • Exposure and response prevention.
  • Exposure therapy.
  • Eye movement desensitisation and reprocessing.
  • Flooding.
  • Functional analytic psychotherapy.
  • Habit reversal training.
  • Organisational behaviour management.
  • Pivotal response treatment.
  • Positive behaviour support.
  • Prolonged exposure therapy.
  • Social skills training.
  • Systematic desensitisation.

Does the Ability to Maintain An Exercise Routine during The Pandemic Help Support Maternal Mental Health?

Research Paper Title

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States.

Background

The COVID-19 pandemic has negatively affected physical and mental health worldwide. Pregnant women already exhibit an elevated risk for depression compared to the general public, a pattern expected to be exacerbated by the pandemic. Certain lifestyle factors, including moderate exercise, may help support mental health during pregnancy, but it is unclear how the pandemic may impact these associations across different locations. Here, the researchers test whether:

  • Reported exercise routine alterations during the pandemic are associated with depression scores; and
  • The likelihood of reporting pandemic-related exercise changes varies between women living in metro areas and those in non-metro areas.

Methods

This cross-sectional study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant women in the United States. Participants were recruited April-June 2020 (n = 1,856). Linear regression analyses assessed whether reported COVID-19-related exercise change was associated with depression score as measured by the Edinburgh Postnatal Depression Survey. Logistic regression analyses tested whether a participant’s Rural-Urban Continuum Code classification of “metro” was linked with higher odds of reporting exercise changes compared to a “non-metro” classification.

Results

Women who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Moreover, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas.

Conclusions

These results suggest that the ability to maintain an exercise routine during the pandemic may help support maternal mental health. It may therefore be prudent for providers to explicitly ask patients how the pandemic has impacted their exercise routines and consider altered exercise routines a potential risk factor for depression. An effort should also be made to recommend exercises that are tailored to individual space restrictions and physical health.

Reference

Gildner, T.E., Laugier, E.J. & Thayer, Z.M. (2020) Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States. PLoS One. 15(12), pp.e0243188. doi: 10.1371/journal.pone.0243188. eCollection 2020.

On This Day .. 11 January

People (Births)

  • 1842 – William James, American psychologist and philosopher (d. 1910).
  • 1867 – Edward B. Titchener, English psychologist and academic (d. 1927).

People (Deaths)

  • 2007 – Robert Anton Wilson, American psychologist, author, poet, and playwright (b. 1932).

William James

William James (11 January 1842 to 26 August 1910) was an American philosopher and psychologist, and the first educator to offer a psychology course in the United States. James is considered to be a leading thinker of the late nineteenth century, one of the most influential philosophers of the United States, and the “Father of American psychology”.

Along with Charles Sanders Peirce, James established the philosophical school known as pragmatism, and is also cited as one of the founders of functional psychology. A Review of General Psychology analysis, published in 2002, ranked James as the 14th most eminent psychologist of the 20th century. A survey published in American Psychologist in 1991 ranked James’s reputation in second place, after Wilhelm Wundt, who is widely regarded as the founder of experimental psychology. James also developed the philosophical perspective known as radical empiricism. James’s work has influenced philosophers and academics such as Émile Durkheim, W.E.B. Du Bois, Edmund Husserl, Bertrand Russell, Ludwig Wittgenstein, Hilary Putnam, Richard Rorty, and Marilynne Robinson.

Born into a wealthy family, James was the son of the Swedenborgian theologian Henry James Sr. and the brother of both the prominent novelist Henry James and the diarist Alice James. James trained as a physician and taught anatomy at Harvard, but never practiced medicine. Instead he pursued his interests in psychology and then philosophy. James wrote widely on many topics, including epistemology, education, metaphysics, psychology, religion, and mysticism. Among his most influential books are The Principles of Psychology, a ground-breaking text in the field of psychology; Essays in Radical Empiricism, an important text in philosophy; and The Varieties of Religious Experience, an investigation of different forms of religious experience, including theories on mind-cure.

Edward B. Titchener

Edward Bradford Titchener (11 January 1867 to 03 August 1927) was an English psychologist who studied under Wilhelm Wundt for several years. Titchener is best known for creating his version of psychology that described the structure of the mind: structuralism. He created the largest doctoral program in the United States (at the time) after becoming a professor at Cornell University, and his first graduate student, Margaret Floy Washburn, became the first woman to be granted a PhD in psychology (1894).

Robert Anton Wilson

Robert Anton Wilson (born Robert Edward Wilson; 18 January 1932 to 11 January 2007) was an American author, futurist and self-described agnostic mystic. Recognised by Discordianism as a Pope and saint, Wilson helped publicise the group through his writings and interviews.

Wilson described his work as an “attempt to break down conditioned associations, to look at the world in a new way, with many models recognised as models or maps, and no one model elevated to the truth”. His goal being “to try to get people into a state of generalised agnosticism, not agnosticism about God alone but agnosticism about everything.”

Following a journalistic career, Wilson emerged as a major countercultural figure in the mid-1970s, comparable to one of his co-authors, Timothy Leary, as well as Terence McKenna.

He received a B.A., M.A. (1978) and Ph.D. (1981) in psychology from Paideia University, an unaccredited institution that has since closed. Wilson reworked his dissertation, and it found publication in 1983 as Prometheus Rising.

On This Day … 09 January

People (Births)

  • 1879 – John B. Watson, American psychologist and academic (d. 1958).

People (Deaths)

  • 2012 – William G. Roll, German-American psychologist and parapsychologist (b. 1926).

John B. Watson

John Broadus Watson (09 January 1878 to 25 September 1958) was an American psychologist who popularized the scientific theory of behaviourism, establishing it as a psychological school. Watson advanced this change in the psychological discipline through his 1913 address at Columbia University, titled Psychology as the Behaviourist Views It. Through his behaviourist approach, Watson conducted research on animal behaviour, child rearing, and advertising, as well as conducting the controversial “Little Albert” experiment and the Kerplunk experiment. He was also the editor of Psychological Review from 1910 to 1915. A Review of General Psychology survey, published in 2002, ranked Watson as the 17th most cited psychologist of the 20th century.

William G. Roll

William G. Roll (03 July 1926 to 09 January 2012) was an American psychologist and parapsychologist on the faculty of the Psychology Department of the University of West Georgia in Carrollton, Georgia. Roll is most notable for his belief in poltergeist activity. He coined the term “recurrent spontaneous psychokinesis” (RSPK) to explain poltergeist cases. However, RSPK was never accepted by mainstream science and sceptics have described Roll as a credulous investigator.

The Real Fear of Phobia

For many years psychologists have been aware that our minds are more than capable of producing a real biological reaction to any given situation.

And, so as long as the phobic person ‘believes’ that the object or situation they fear represents danger to them, then they will experience real fear.

The majority of people who do suffer with a phobia understand that their fear is ‘irrational’ but continue to experience it regardless of this knowledge. This is why simply being told to “snap out of it” rarely produces a solution!

What is Bathmophobia?

Introduction

Bathmophobia, or the fear of slopes or stairs, is a somewhat complicated phobia.

It is quite similar to climacophobia, or the fear of climbing stairs, except in its specific focus. If you have bathmophobia, you might panic when simply observing a steep slope, while people with climacophobia typically experience symptoms only when expected to actually climb or descend. The difference is subtle but important, and can only be accurately diagnosed by a trained clinician.

Definition

Bathmophobia is a specific phobia. The word itself defines what it means:

  • ‘Bathmo’ means step in Greek; and
  • ‘Phobia’ means fear in Greek.

Therefore, we have the meaning, which is a fear of steps.

Prevalence

According to the National Institute of Mental Health, approximately 12.5 % of the American population will experience a phobia at some point in their life. Bathmophobia is a specific phobia.

Symptoms

The symptoms of Bathmophobia are very similar to other specific phobias and will often include:

  • Feelings of Panic, Dread or Terror.
  • Inability to Relax.
  • An Impending Sense of Dread.
  • Problems Concentrating.
  • Being quick tempered.
  • Feelings of dizziness.
  • Difficulties in becoming motivated.
  • Prickly sensations like pins and needles.
  • Palpitations.
  • Aches & Pains.
  • Fatigued Muscles.
  • Dry and Sticky mouth.
  • Sweating Excessively.
  • Breathlessness.
  • Migraines and Headaches.
  • Poor Quality of Sleep.

Bathmophobia Symptoms are generally automatic and uncontrollable and can seem to take over a person’s thoughts which frequently leads to extreme measures being taken to avoid the feared object or situation, what are known as ‘safety’ or ‘avoidance’ behaviours. Unfortunately, for the sufferer, these safety behaviours have a paradoxical effect and actually reinforce the phobia rather than solve it!

Bathmophobia may be the result of negative emotional experiences that can be either directly or indirectly linked to the object or situational fear. Over time, the symptoms often become ‘normalised’ and ‘accepted’ as a limiting belief in that person’s life – “I’ve learnt to live with it.”’ In just as many cases, Bathmophobia may have become worse over time as more and more sophisticated safety behaviours and routines are developed.

Causes

Bathmophobia may be caused by a wide range of factors. A particularly common cause is an early negative experience with stairs or a steep hill. If you slipped or fell on steep stairs or watched someone else struggle with shortness of breath while climbing, you may be at a greater risk of developing bathmophobia.

Particularly in children, bathmophobia can also be triggered by negotiating or even just contemplating a particularly scary looking set of stairs. One example is a child involved in a local community theater with stairs leading to the backstage costume loft. The stairs were steep and open at the back so you could see down as you climbed them, and the child could imagine slipping through them, even though they did not ever climb them themself.

Memories of those stairs played into dreams that included struggling to cross a sloped floor that would tilt to near-vertical as they neared their destination in the dreams. They may continue to feel apprehension when confronted with a sloped floor or a tricky set of stairs.

Diagnosis

If your child has a fear of stairs or slopes, keep in mind that fears are a normal part of development. Bathmophobia, as with other phobias, is generally not diagnosed in children or adults unless it persists for more than six months.

Differential Diagnosis

In addition to the above-mentioned climacophobia, bathmophobia may be related to other disorders. Acrophobia, or the fear of heights, is exceptionally common. What appears to be a fear of stairs may, in fact, be a fear of the height that the stairs achieve. Illygnophobia, or the fear of vertigo, can also cause symptoms similar to those of bathmophobia.

Medical causes must also be considered. True vertigo is a medical disorder of the balance system that causes a feeling of spinning or dizziness. The term is also applied medically to similar symptoms that are not caused by a balance disorder. Both types can be worsened by even minor changes in height. By definition, a fear that is reasonable due to an existing medical condition cannot be called a phobia.

Treatment

The good news is that the vast majority of people who suffer from Bathmophobia will find a course of psychotherapy helps enormously. Almost every phobia responds well to psychological interventions.

If your clinician determines that your symptoms are caused by bathmophobia, you are likely to receive cognitive behavioural therapy (CBT). The goal of this type of therapy is to help you replace your fearful thoughts and behaviours with more rational alternatives. You will be taught relaxation exercises to help you remain calm, and slowly introduced to the object of your fear through a process known as systematic desensitisation.

Although it takes time, therapy has an excellent success rate in treating this type of phobia. Choosing a therapist that you trust is an essential component in working through your fear.

Did You Know?

  • Bathmophobia can be seen in both children and adults.
  • If you have medical vertigo, fearing that stairs and slopes may trigger your symptoms does not mean that you also have bathmophobia.
  • It is also fairly common among animals, particularly household pets.
  • Dogs trained as service animals may be rejected because of their fear of stairs.
  • Donald Trump has a fear of stairs.

Further Reading

What is the Prevalence of Psychological Disorders in the COVID-19 Epidemic in China?

Research Paper Title

Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study.

Background

This study aimed to explore the prevalence of psychological disorders and associated factors at different stages of the COVID-19 epidemic in China.

Methods

The mental health status of respondents was assessed via the Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI) and the Generalised Anxiety Disorder 7 (GAD-7) scale.

Results

5,657 individuals participated in this study. History of chronic disease was a common risk factor for severe present depression (OR 2.2, 95% confidence interval [CI], 1.82-2.66, p < 0.001), anxiety (OR 2.41, 95% CI, 1.97-2.95, p < 0.001), and insomnia (OR 2.33, 95% CI, 1.83-2.95, p < 0.001) in the survey population. Female respondents had a higher risk of depression (OR 1.61, 95% CI, 1.39-1.87, p < 0.001) and anxiety (OR 1.35, 95% CI, 1.15-1.57, p < 0.001) than males. Among the medical workers, confirmed or suspected positive COVID-19 infection as associated with higher scores for depression (confirmed, OR 1.87; suspected, OR 4.13), anxiety (confirmed, OR 3.05; suspected, OR 3.07), and insomnia (confirmed, OR 3.46; suspected, OR 4.71).

Limitations

The cross-sectional design of present study presents inference about causality. The present psychological assessment was based on an online survey and on self-report tools, albeit using established instruments. The researchers cannot estimate the participation rate, since they cannot know how many potential subjects received and opened the link for the survey.

Conclusions

Females, non-medical workers and those with a history of chronic diseases have had higher risks for depression, insomnia, and anxiety. Positive COVID-19 infection status was associated with higher risk of depression, insomnia, and anxiety in medical workers.

Reference

Wang, M., Zhao, Q., Hu, C., Wang, Y., Cao, J., Huang, S., Li, J., Huang, Y., Liang, Q., Guo, Z., Wang, L., Ma, L., Zhang, S., Wang, H., Ahu, C., Luo, W., Guo, C., Chen, C., Chen, Y., Xu, K., Yang, H., Ye, L., Wang, Q., Zhan, P., Li, G., Yang, M.J., Fang, Y., Zhu, S. & Yang, Y. (2020) Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study. Journal of Affective Disorders. 281, pp.312-320. doi: 10.1016/j.jad.2020.11.118. Online ahead of print.

What is a Community Mental Health Service?

Introduction

Centre for Mental Health Services, also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided. It refers to a system of care in which the patient’s community, not a specific facility such as a hospital, is the primary provider of care for people with a mental illness. The goal of community mental health services often includes much more than simply providing outpatient psychiatric treatment.

Community services include supported housing with full or partial supervision (including halfway houses), psychiatric wards of general hospitals (including partial hospitalisation), local primary care medical services, day centres or clubhouses, community mental health centres, and self-help groups for mental health.

The services may be provided by government organisations and mental health professionals, including specialised teams providing services across a geographical area, such as assertive community treatment and early psychosis teams. They may also be provided by private or charitable organisations. They may be based on peer support and the consumer/survivor/ex-patient movement.

The World Health Organisation (WHO) states that community mental health services are more accessible and effective, lessen social exclusion, and are likely to have fewer possibilities for the neglect and violations of human rights that were often encountered in mental hospitals. However, WHO notes that in many countries, the closing of mental hospitals has not been accompanied by the development of community services, leaving a service vacuum with far too many not receiving any care.

New legal powers have developed in some countries, such as the United States, to supervise and ensure compliance with treatment of individuals living in the community, known as outpatient commitment or assisted outpatient treatment or community treatment orders.

Brief History

Origins

Community mental health services began as an effort to contain those who were “mad” or considered “lunatics”. Understanding the history of mental disorders is crucial in understanding the development of community mental health services. As medical psychology developed as a science and shifted toward the treatment of the mentally ill, psychiatric institutions began to develop around the world, and laid the groundwork for modern day community mental health services.

Pre-Deinstitutionalisation

On 03 July 1946, US President Harry Truman signed the National Mental Health Act which, for the first time in the history of the United States, generated a large amount of federal funding for both psychiatric education and research. The passing of this Act eventually led to the founding of the National Institute of Mental Health (NIMH) in 1949. At the end of the 1940s and moving into the beginning of the 1950s, the governor of Minnesota Luther Youngdahl initiated the development of numerous community-based mental health services. He also advocated for the humane treatment of people in state institutions.

Deinstitutionalisation

Philippe Pinel played a large role in the ethical and humane treatment of patients and greatly influenced Dorothea Dix. Dix advocated the expansion of state psychiatric hospitals for patients who were at the time being housed in jails and poor houses. Despite her good intentions, rapid urbanisation and increased immigration led to a gross overwhelming of the state’s mental health systems and because of this, as the 19th century ended and the 20th century began, a shift in focus from treatment to custodial care was seen. As quality of care declined and psychotropic drugs were introduced, those with mental illnesses were reintroduced to the community, where community mental health services were designated as primary care providers.

Mental Health Movements

Reform MovementEraSettingFocus of Reform
Moral Treatment1800-1850AsylumHumane, restorative treatment
Mental Hygiene1890-1920Mental hospital or clinicPrevention, scientific orientation
Community Mental Health1955-1970Community mental health centreDeinstitutionalisation, social integration
Community Support1975-PresentCommunitiesMental illness as a social welfare problem (e.g. treatment housing, employment, etc.)

Post-Deinstitutionalisation

Following deinstitutionalisation, many of the mentally ill ended up in jails, nursing homes, and on the streets as homeless individuals. It was at this point in history that modern community mental health services started to grow and become influential. In 1955, following a major period of deinstitutionalisation, the Mental Health Study Act was passed. With the passing of this Act, the US Congress called for “an objective, thorough, nationwide analysis and re-evaluation of the human and economic problems of mental health.” Following Congress’ mandate, the Joint Commission on Mental Illness conducted numerous studies. For the next four years this Commission made recommendations to establish community mental health centres across the country. In 1963, the Community Mental Health Centres Act was passed, essentially kick-starting the community mental health revolution. This Act contributed further to deinstitutionalisation by moving mental patients into their “least restrictive” environments. The Community Mental Health Centres Act funded three main initiatives:

  • Professional training for those working in community mental health centres;
  • Improvement of research in the methodology utilised by community mental health centres; and
  • Improving the quality of care of existing programmes until newer community mental health centres could be developed.

That same year the Mental Retardation Facilities and Community Mental Health Centres Construction Act was passed. President John F. Kennedy ran part of his campaign on a platform strongly supporting community mental health in the United States. Kennedy’s ultimate goal was to reduce custodial care of mental health patients by 50% in ten to twenty years. In 1965, the Community Mental Health Act was amended to ensure a long list of provisions. First, construction and staffing grants were extended to include centres that served patients with substance abuse disorders. Secondly, grants were provided to bolster the initiation and progression of community mental health services in low-SES areas. Lastly, new grants were established to support mental health services aimed at helping children. As the 20th century progressed, even more political influence was exerted on community mental health. In 1965, with the passing of Medicare and Medicaid, there was an intense growth of skilled nursing homes and intermediate-care facilities that alleviated the burden felt by the large-scale public psychiatric hospitals.

20th Century

From 1965 to 1969, $260 million was authorised for community mental health centres. Compared to other government organisations and programmes, this number is strikingly low. The funding drops even further under Richard Nixon from 1970-1973 with a total of $50.3 million authorised. Even though the funding for community mental health centres was on a steady decline, deinstitutionalisation continued into the 1960s and 1970s. The number of state and county mental hospital resident patients in 1950 was 512,501 and by 1989 had decreased to 101,402. This continuing process of deinstitutionalisation without adequate alternative resources led the mentally ill into homelessness, jails, and self-medication through the use of drugs or alcohol. In 1975, Congress passed an Act requiring community mental health centres to provide aftercare services to all patients in the hopes of improving recovery rates. In 1980, just five years later, Congress passed the Mental Health Systems Act of 1980, which provided federal funding for ongoing support and development of community mental health programmes. This Act strengthened the connection between federal, state, and local governments with regards to funding for community mental health services. It was the final result of a long series of recommendations by Jimmy Carter’s Mental Health Commission. Despite this apparent progress, just a year after the Mental Health Systems Act was passed, the Omnibus Budget Reconciliation Act of 1981 was passed. The Omnibus Act was passed by the efforts of the Reagan administration as an effort to reduce domestic spending. The Act rescinded a large amount of the legislation just passed, and the legislation that was not rescinded was almost entirely revamped. It effectively ended federal funding of community treatment for the mentally ill, shifting the burden entirely to individual state governments. Federal funding was now replaced by granting smaller amounts of money to the individual states. In 1977, the National Institute of Mental Health (NIMH) initiated its Community Support Program (C.S.P.). The C.S.P.’s goal was to shift the focus from psychiatric institutions and the services they offer to networks of support for individual clients. The C.S.P. established the ten elements of a community support system listed below:

  • Responsible team.
  • Residential care.
  • Emergency care.
  • Medicare care.
  • Halfway house.
  • Supervised (supported) apartments.
  • Outpatient therapy.
  • Vocational training and opportunities.
  • Social and recreational opportunities.
  • Family and network attention.

This conceptualisation of what makes a good community programme has come to serve as a theoretical guideline for community mental health service development throughout the modern-day United States psychological community. In 1986, Congress passed the Mental Health Planning Act of 1986, which was a Federal law requiring that at the state government level, all states must have plans for establishing case management under Medicaid, improving mental health coverage of community mental health services, adding rehabilitative services, and expanding clinical services to the homeless population. More specifically, community mental health providers could now receive reimbursement for services from Medicare and Medicaid, which allowed for many of the centres to expand their range of treatment options and services. As the 1990s began, many positive changes occurred for people with mental illnesses through the development of larger networks of community-based providers and added innovations with regards to payment options from Medicare and Medicaid. Despite these advancements, there were many issues associated with the increasing cost of health care. Community mental health services moved toward a system more similar to managed care as the 1990s progressed. Managed care as a system focuses on limiting costs by one of two means: either keeping the total number of patients using services low or reducing the cost of the service itself. Despite the drive for community mental health, many physicians, mental health specialists, and even patients have come to question its effectiveness as a treatment. The underlying assumptions of community mental health require that patients who are treated within a community have a place to live, a caring family, or supportive social circle that does not inhibit their rehabilitation. These assumptions are in fact often wrong. Many people with mental illnesses, upon discharge, have no family to return to and end up homeless. While there is much to be said for the benefits that community mental health offers, many communities as a whole often harbour negative attitudes toward those with mental illnesses. Historically, people with mental illnesses have been portrayed as violent or criminal and because of this, “many American jails have become housing for persons with severe mental illnesses arrested for various crimes.” In 1999 the Supreme Court ruled on the case Olmstead v. L.C. The Court ruled that it was a violation of the Americans with Disabilities Act of 1990 to keep an individual in a more restrictive inpatient setting, such as a hospital, when a more appropriate and less restrictive community service was available to the individual.

21st Century and Modern Trends

In 2002, President George W. Bush increased funding for community health centres. The funding aided in the construction of additional centres and increased the number of services offered at these centres, which included healthcare benefits. In 2003, the New Freedom Commission on Mental Health, established by President Bush, issued a report. The report was in place to “conduct a comprehensive study of the United States mental health delivery system…” Its objectives included assessing the efficiency and quality of both public and private mental health providers and identifying possible new technologies that could aid in treatment. As the 20th century came to a close and the 21st century began, the number of patients diagnosed with a mental health or substance abuse disorder receiving services at community mental health centres grew from 210,000 to approximately 800,000. This nearly four-fold increase shows just how important community mental health centres are becoming to the general population’s wellbeing. Unfortunately, this drastic rise in the number of patients was not mirrored by a concomitant rise in the number of clinicians serving this population. The staggering new numbers of patients then are being forced to seek specialised treatment from their primary care providers or hospital emergency rooms. The unfortunate result of this trend is that when a patient is working with their primary care provider, they are more likely for a number of reasons to receive less care than with a specialised clinician. Politics and funding have always been and continue to be a topic of contention when it comes to funding of community health centres. Political views aside, it is clear that these community mental health centres exist largely to aid areas painfully under resourced with psychiatric care. In 2008, over 17 million people utilised community mental health centres with 35% being insured through Medicaid, and 38% being uninsured. As the 2000s continued, the rate of increase of patients receiving mental health treatment in community mental health centres stayed steady.

Purpose and Examples

Cultural knowledge and attitude is passed from generation to generation. For example, the stigma with therapy may be passed from mother to daughter. San Diego county has a diverse range of ethnicities. Thus, the population diversity in San Diego include many groups with historical trauma and trans-generational trauma within those populations. For example, witnesses of war can pass down certain actions and patterns of survival mechanism to generations. Refugee groups have trans-generational trauma around war and PTSD. Providing services and therapy to these communities is important because it affects their day-to-day lives, where their experiences lead to trauma or the experiences are traumatic themselves. Knowledge and access to mental health resources are limited in these multicultural communities. Government agencies fund community groups that provide services to these communities. Therefore, this creates a power hierarchy. If their missions do not align with each other, it will be hard to provide benefits for the community, even though the services are imperative to the wellbeing of its residents.

The combination of a mental illness as a clinical diagnosis, functional impairment with one or more major life activities, and distress is highest in ages 18-25 years old. Despite the research showing the necessity of therapy for this age group, only one fifth of emerging adults receive treatment. Psychosocial interventions that encourage self-exploration and self-awareness, such as acceptance and mindfulness-based therapies, is useful in preventing and treating mental health concerns. At the Centre for Community Counselling and Engagement, 39% of their clients are ages 1-25 years old and 40% are in ages 26-40 years old as well as historically underrepresented people of colour. The centre serves a wide range of ethnicities and socio-economic statuses in the City Heights community with counsellors who are graduate student therapists getting their Master’s in Marriage and Family Therapy or Community Counselling from San Diego State University, as well as post-graduate interns with their master’s degree, who are preparing to be licensed by the state of California. Counselling fees are based on household incomes, which 69% of the client’s annual income is $1-$25,000 essentially meeting the community’s needs. Taking into account of San Diego’s population, the clinic serves as an example of how resources can be helpful for multicultural communities that have a lot of trauma in their populations.

Future

On one hand, despite the field’s movement toward community mental health services, currently “insufficient empirical research exists regarding the effectiveness of community treatment programmes, and the evidence that does exist does not generalise to all types of community treatment.” In addition to the fact that community mental health’s overall success must be further evaluated, in the times when it has proved effective, very little research exists to help in understanding what exact aspects make it effective. Effective and insightful research will be crucial in not only evaluating, but also improving the techniques community mental health utilises. On the other hand, the demand for and necessity of community mental health is driving it into the future. With this seemingly unrelenting increase in the number of people experiencing mental health illnesses and the number of people reporting these problems, the question becomes what role community mental health services will play. In 2007, almost 5% of adults in the United States reported at least one unmet need for mental health care. Funding has historically been and continues to be an issue for both the organisations attempting to provide mental health services to a community and the citizens of the community who are so desperately in need of treatment. The community mental health system’s goal is an extremely difficult one and it continues to struggle against changing social priorities, funding deficits, and increasing need. Community mental health services would ideally provide quality care at a low cost to those who need it most. In the case of deinstitutionalisation, as the number of patients treated increased, the quality and availability of care went down. With the case of small, private treatment homes, as the quality of the care went up their ability to handle large numbers of patients decreased. This unending battle for the middle ground is a difficult one but there seems to be hope. For example, the 2009 Federal Stimulus Package and Health Reform Act have increased the funding for community health centres substantially. Undoubtedly as community mental health moves forward, there will continue to be a juggling act between clinical needs and standards, political agendas, and funding.

Can a COVID-19 Contact Tracing App Improve Psychological Distress?

Research Paper Title

Downloading a government-issued COVID-19 contact tracing app may improve psychological distress in the outbreak among employed adults: a prospective study.

Background

Downloading of a COVID-19 contact tracing app may be effective in reducing anxiety about COVID-19 and psychological distress of users.

Therefore, the objective of this 2.5-month prospective study aimed to investigate the association of downloading of a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government with fear and worry about COVID-19 and psychological distress in a sample of employed adults of Japan.

Methods

A total of 996 full-time employed respondents to an online survey on 22 to 26 May 2020 (baseline) were invited to participate in a follow-up survey on 07 to 12 August 2020 (follow-up). High level of worrying about COVID-19 and high psychological distress were defined by scores on a single-item scale and the K6 scale, respectively, both at baseline and follow-up. The app was released between the two surveys on 17 June. Participants were asked at follow-up if they downloaded the app.

Results

A total of 902 (90.6%) out of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress, but not with fear and worry about COVID-19, at follow-up after controlling for baseline variables.

Conclusions

The study provided first evidence that a COVID-19 contact tracing app may be beneficial for the mental health of employed adults using a government-issued tracing app under the COVID-19 outbreak.

Reference

Kawakami, N., Sasaki, N., Kuroda, R., Tsuno, K. & Imamura, K. (2020) Downloading a government-issued COVID-19 contact tracing app may improve psychological distress in the outbreak among employed adults: a prospective study. JMIR Mental Health. doi: 10.2196/23699. Online ahead of print.

On This Day … 08 January

People (Births)

  • 1902 – Carl Rogers, American psychologist and academic (d. 1987).

Carl Rogers

Carl Ransom Rogers (08 January 1902 to 04 February 1987) was an American psychologist and among the founders of the humanistic approach (or client-centred approach) to psychology. Rogers is widely considered to be one of the founding fathers of psychotherapy research and was honoured for his pioneering research with the Award for Distinguished Scientific Contributions by the American Psychological Association (APA) in 1956.

The person-centred approach, his own unique approach to understanding personality and human relationships, found wide application in various domains such as psychotherapy and counselling (client-centred therapy), education (student-centred learning), organisations, and other group settings. For his professional work he was bestowed the Award for Distinguished Professional Contributions to Psychology by the APA in 1972. In a study by Steven J. Haggbloom and colleagues using six criteria such as citations and recognition, Rogers was found to be the sixth most eminent psychologist of the 20th century and second, among clinicians, only to Sigmund Freud. Based on a 1982 survey among 422 respondents of US and Canadian psychologists, he was considered the first most influential psychotherapist in history (Sigmund Freud was ranked third).