Covert conditioning is an approach to mental health treatment that utilises the principles of applied behaviour analysis, or cognitive-behaviour therapies (CBTs) to help individuals improve their behaviour or inner experience. This method relies on the individual’s ability to use imagery for purposes such as mental rehearsal. In some populations, it has been found that an imaginary reward can be as effective as a real one. The effectiveness of covert conditioning is believed to depend on the careful application of behavioural treatment principles, including a comprehensive behavioural analysis.
Some clinicians include the mind’s ability to spontaneously generate imagery that can provide intuitive solutions or even reprocessing that improves people’s typical reactions to situations or inner material. However, this goes beyond the behaviouristic principles on which covert conditioning is based.
Therapies and self-help methods have aspects of covert conditioning. This can be seen in focusing, some neuro-linguistic programming methods such as future pacing, and various visualisation or imaginal processes used in behaviour therapies, such as CBTs or clinical behaviour analysis.
Therapeutic Interventions
“Systematic desensitisation” associates an aversive stimulus with a behaviour that the client wishes to reduce or eliminate. This is achieved by imagining the target behaviour followed by imagining an aversive consequence. “Covert extinction” attempts to reduce a behaviour by imagining the target behaviour while imagining that the reinforcer does not occur. “Covert response cost” seeks to reduce a behaviour by associating the loss of a reinforcer with the target behaviour that is to be decreased.
“Contact desensitisation” intends to increase a behaviour by imagining a reinforcing experience in connection with modelling the correct behaviour. “Covert negative reinforcement” attempts to increase a behaviour by connecting the termination of an aversive stimulus with increased production of a target behaviour.
“Dialectical behaviour therapy” (DBT) and “Acceptance and commitment therapy” (ACT) uses positive reinforcement and covert conditioning through mindfulness.
Effectiveness
Previous research in the early 1990s has shown covert conditioning to be effective with sex offenders as part of a behaviour modification treatment package. Clinical studies continue to find it effective with some generalisation from office to natural environment with this population.
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Behaviour management, similar to behaviour modification, is a less-intensive form of behaviour therapy. Unlike behaviour modification, which focuses on changing behaviour, behaviour management focuses on maintaining positive habits and behaviours and reducing negative ones. Behaviour management skills are especially useful for teachers and educators, healthcare workers, and those working in supported living communities. This form of management aims to help professionals oversee and guide behaviour management in individuals and groups toward fulfilling, productive, and socially acceptable behaviours. Behaviour management can be accomplished through modelling, rewards, or punishment.
Research
Influential behaviour management researchers B.F. Skinner and Carl Rogers both take different approaches to managing behavio.
Skinner claimed that anyone can manipulate behaviour by identifying what a person finds rewarding. Once the rewards are known, they can be given in exchange for good behaviour. Skinner called this “Positive Reinforcement Psychology.”
Rogers proposed that the desire to behave appropriately must come before addressing behavioural problems. This is accomplished by teaching the individual about morality, including why one should do what is right. Rogers held that a person must have an internal awareness of right and wrong.
Many principles and techniques are the same as in behaviour modification. However, they are considerably different and administered less often.
In the Classroom
Behaviour management is often applied by a classroom teacher as a form of behavioural engineering, in order to raise students’ retention of material and produce higher yields of student work completion. This also helps to reduce classroom disruption and places more focus on building self-control and self-regulating a calm emotional state.
American education psychologist, Brophy (1986, p.191) writes:
Contemporary behavior modification approaches involve students more actively in planning and shaping their own behavior through participation in the negotiation of contracts with their teachers and through exposure to training designed to help them to monitor and evaluate their behavior more actively, to learn techniques of self-control and problem solving, and to set goals and reinforce themselves for meeting these meetings.
In general, behaviour management strategies are effective at reducing classroom disruption. Recent efforts have focused on incorporating principles of functional assessment.
Such strategies can come from a variety of behavioural change theories, although the most common practices rely on using applied behaviour analysis principles such as positive reinforcement and mild punishments (like response cost and child time-out). Behavioural practices like differential reinforcement are often used. These may be delivered in a token economy or a level system. In general, the reward component is considered effective. For example, Cotton (1988) reviewed 37 studies on tokens, praise, and other reward systems and found them to be effective in managing student classroom behaviour. A comprehensive review of token procedures to match children’s level of behavioural severity is found in Walker’s text “The Acting Out Child.”
Behaviour management systems have three main parts:
Whole group;
Table group; and
Individual.
Examples may include marble jars for the class, prize charts for tables, and a grid chart with 25 spaces for individual students. Many types of charts can be found to use in each situation.
Effective behaviour management depends on using tools that are appropriate to each situation. One effective tool is the High Card/Low Card system. To use a high card, the educator or instructor uses strong intervention to address the issue. Some examples of High Cards are:
Sending a student to the office.
Keeping a student after school hours.
Calling home to the student’s parent.
A Low Card approach is a less invasive way to address a behavioural issue and may include:
Speaking to a student privately.
Making eye contact during the issue.
Changing the seating arrangement.
Some student behaviours must be addressed immediately and could cause a teacher to interrupt teaching in order to resolve the issue. This is known as a direct cost situation. This typically arises in extreme behaviour situations like physical disputes between students, loud outbursts in class, or disrupting the class disrespectfully.
Purkey proposed a visualisation way to keep track of the methods used to manage student behaviour. He called it the “Blue-card, orange-card theory”. Blue cards help reinforce good behaviour and ways to encourage a student. Orange cards, in contrast, are things that may be critical, discouraging, or demeaning. Some examples of blue cards might be bringing up the good things a student has done before focusing on the behaviour that needs to change, therefore reminding the student that they have worth and causing them to feel encouraged. An orange card could list ways to critique a student’s work in front of the class, which would lower their feelings of self-worth, providing an example of what to avoid. Teachers can be aware and provide students with required critique and feedback, while reinforcing their self-image. Purkey’s theory helps teachers understand how they can edit behavioural management specifically in the classroom.
In Supported Living
When bringing behavioural management in relation with supported living the purpose of this is to keep a person’s dignity. Most of the time, residents have some behaviour that is meant to be improved in order for them to live a more normal life. Our main goal of the behavioural management is to help them become as independent as possible. Of course, it is important to recognise that not every resident will be back to being completely independent.
There are a lot of ways to help residents be more independent and we will look at some of those here.
It is important we first take a look at each resident’s history. Many of them will have gone through an experience that may have started the behaviour change in the first place. Some examples of these are child abuse, trauma, anxiety, depression, etc.
Once a person is in the behaviour management process, we have to consider their behaviour daily. We should also be meeting with them regularly in order to keep accurate data of their behaviour. In this way we can look back and make modifications to what they need during the behaviour management process.
Each resident will be different and need a variety of attention. But it is important to consider what will be needed in order to get to their success. The main goal of the behaviour management is to address the behaviour issue in order to keep them independent.
When with a resident there are a variety of behaviours you may come into contact with. You will not only need to know what to do in each situation but also how to act. Your behaviour is crucial to the progress of their behaviour. There may be situations when yourself can not handle the behaviour and will need to lead to a bigger solution. Redirecting them to a psychologist, psychiatrist, hospital, or a behaviour management centre may be beneficial.
Building Prosocial Behaviour
Behavioural management principles have used reinforcement, modelling, and punishment to foster prosocial behaviour. This is sometimes referred to as behavioural development, a sub-category of which is behaviour analysis of child development. The “token economy” is an example of behavioural management approach that seeks to develop prosocial behaviour. In this model, socially appropriate behaviours are encouraged and reinforced since these are equivalent to points that can be exchanged for rewards. Examples of situations and behaviours where tokens can be earned include attending groups, taking medication, and refraining from aggressive behaviours, among others.
Several studies have been done in this area to discover effective methods of building prosocial behaviour. Midlarsky and colleagues (1973) used a combination of modelling and reinforcement to build altruistic behaviour. Two studies exist in which modelling by itself did not increase prosocial behaviour; however, modelling is much more effective than instruction-giving (such as “preaching”). The role of rewards has been implicated in the building of self-control and empathy. Cooperation seems particularly susceptible to rewards. Sharing is another prosocial behaviour influenced by reinforcement. In a Harvard study, it was proven that acts of kindness and expressing gratitude in the classroom can cause better behaviour and increased mood overall.
Reinforcement is particularly effective in the learning environment if context conditions are similar. Recent research indicates that behavioural interventions produce the most valuable results when applied during early childhood and early adolescence. Positive reinforcement motivates better than punishment. Motivation to behaviour change is also less damaging to the relationship.
More controversy has arisen concerning behaviour management due to the role of punishment in forming prosocial behaviour. However, one study found that sharing rates of children could be increased by removing factors that caused a failure to share. The socialisation process continues by peers with reinforcement and punishment playing major roles. Peers are more likely to punish cross-gender play and reinforce play specifically to gender.
Positive reinforcement, negative reinforcement, positive punishment, and negative punishment are all forms of operant conditioning. Reinforcements are an attempt to change behaviour, either positively or negatively. Positive reinforcement attempts to increase a behaviour by adding something the target wants (e.g. awarding good behaviour with a treat). Negative reinforcement is attempting to increase behaviour by removing something unwanted from the target. (e.g. a child’s room is messy and their mother nags them to clean it up, they will eventually try to keep it clean to stop the mother from nagging them). Punishment is trying to decrease behaviour, either by using negative or positive stimuli. Positive punishment is when one adds an unwanted stimulus to decrease the target’s behaviour (e.g. spanking a child when they behave badly). Here, spanking is being added to decrease undesired behaviour. Negative punishment is when one removes something the target enjoys or likes to decrease their undesired behaviour. (e.g. a child comes home past curfew every weekend, so if their mother bans them from watching TV when they are past curfew, the child will eventually try to come home on time). This is negative punishment because the child likes to watch TV, so when the mother takes that away from them, they dislike the consequence. Thus, they will be more likely to come home in time to avoid having that privilege taken away.
Abraham Maslow is a very well-known humanist psychologist, known for his work on the hierarchy of needs, in which he states that humans must have one level of needs satisfied before attaining the next level. There are five needs that are being satisfied in sequence: physiological, safety, social, esteem, and self-actualisation. Maslow also claims that humans’ needs are never completely fulfilled and that this affects how people behave (e.g. if a person’s needs are never fully satisfied, then they might not always behave well, even if they do receive a treat for good behaviour). A related concept, the “Hawthorne Effect”, involves the manipulation of behaviour of somebody being observed. For example, if someone is being studied in an experiment, that person might perform better or work harder because they are aware of the attention they are receiving. It is this effect of observation that is called the “Hawthorne Effect”. This is interesting because if a child who is behaving very poorly, no matter what, is put in an experiment, they might increase their good behaviour. After all, they are receiving attention from the researcher. The point of operant conditioning in behaviour modification is to regulate the behaviour. This method uses different techniques and ties them all together to monitor behaviour. It can lead to problems, however, when talking about Maslow’s Hierarchy of needs because in this model Maslow goes on to explain how no one’s needs are fully met. The highest point on Maslow’s pyramid is self-actualisation which Maslow argues is the goal in which we do not reach. This can pose a problem when it comes to behaviour modification because one might think if that individual can not reach that ultimate goal, why try at all. Self-actualisation is the goal in which humans have this sense of belonging or accomplishment. Humans have an inherent need to achieve goals and attain self-satisfaction; when we do not attain those goals and needs, we feel dissatisfied. When a person does not meet that top goal, that person might feel a void, discouraged because they cannot seem to reach that ultimate step. Using these behavioural modifications or techniques, people can teach themselves how to better attain these goals.
Managing Defensive Behaviour
Understanding and dealing with defensiveness is an important personal skill. Following are some of the strategies:
Recognize that defensive behaviour is normal, as “defensive behaviours are intended to reduce a perceive threat or avoid an unwanted threat,” It is normal for one to be defensive when they feel that something is their fault. These actions are attempted in order to avoid blame or change of action.
Never attack a person’s defences. Do not try to “explain someone” to themselves by saying things like, “you know the real reason you are using that excuse is that you cannot bear to be blamed for anything.” Instead, try to concentrate on the act itself rather than on the person.
Postpone action. Sometimes it is best to do nothing at all. People frequently react to sudden threats by instinctively closing off and hiding their feelings. When given time the person will be able to give a more composed reaction or answer. These feelings often come from being overloaded, especially in the workplace where overload can have a taxing effect on a person’s ability to meet task expectations.
Recognize human limitations. Do not expect to be able to solve every problem that comes up, especially the human ones. More importantly, remember that a layman should not try to be a psychologist. Offering employees understanding is one thing; trying to deal with deep psychological problems is another matter entirely.
Knowing personal limits and expectations is important in helping others with defensive behaviour. Being able to have effective self-observation is important because if there is no solid idea of one’s feelings, then trying to help others will come across as too aggressive or too reserved. A smart way to start this change is by asking oneself a couple of different questions, such as “what am I feeling”, “what am I thinking”, “how else can I think about that,” etc. Then proceed to automatically notice if the feelings are winding up or down to act accordingly.
An effective strategy to dealing with defensiveness is the SCARF model which was developed by an Australian neuroscientist named David Rock. The five letters stand for status, certainty, autonomy, relatedness, and fairness. Understanding each domain will help explain the fight or flight response when someone is faced with a stressful situation; and focus on each individuals’ skills.
Status threats relate to how important the threat is to others and ourselves, looking at how the situation will help lift or put down the other people involved and forget about ego(s).
Certainty threats deal with predicting the future such as when someone says “I never get told anything in this company.” It is actually them asking to be kept in the loop about decisions that are being made.
Autonomy threats are based on the control throughout a situation; if someone is having this threat they will feel like they have not had any say or input and become frustrated as a result. In these situations, giving that person a choice is the best option.
Relatedness threats deal with how comfortable someone feels around other people. In this case, the leader of the group needs to make sure that everyone is feeling included and important. Making sure that everyone’s voice is heard and they are important individuals.
Finally, the fairness threat is the perception of both parties that the exchange of content and relation is fair and equal. No one wants to feel like they are putting in 80 percent while the other side is only putting in 20%.
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Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people’s mental states, influences those behaviours, and consists of techniques based on behaviourism’s theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person’s psychological problems.
Behavioural psychotherapy is sometimes juxtaposed with cognitive psychotherapy. While cognitive behavioural therapy integrates aspects of both approaches, such as cognitive restructuring, positive reinforcement, habituation (or desensitisation), counterconditioning, and modelling.
Applied behaviour analysis (ABA) is the application of behaviour analysis that focuses on functionally assessing how behaviour is influenced by the observable learning environment and how to change such behaviour through contingency management or exposure therapies, which are used throughout clinical behaviour analysis therapies or other interventions based on the same learning principles.
Cognitive-behavioural therapy views cognition and emotions as preceding overt behaviour and implements treatment plans in psychotherapy to lessen the issue by managing competing thoughts and emotions, often in conjunction with behavioural learning principles.
A 2013 Cochrane review comparing behaviour therapies to psychological therapies found them to be equally effective, although at the time the evidence base that evaluates the benefits and harms of behaviour therapies was weak.
Brief History
Precursors of certain fundamental aspects of behaviour therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Wolpe and Lazarus wrote,
While the modern behavior therapist deliberately applies principles of learning to this therapeutic operations, empirical behavior therapy is probably as old as civilization – if we consider civilization as having started when man first did things to further the well-being of other men. From the time that this became a feature of human life there must have been occasions when a man complained of his ills to another who advised or persuaded him of a course of action. In a broad sense, this could be called behavior therapy whenever the behavior itself was conceived as the therapeutic agent. Ancient writings contain innumerable behavioral prescriptions that accord with this broad conception of behavior therapy.
The first use of the term behaviour modification appears to have been by Edward Thorndike in 1911. His article Provisional Laws of Acquired Behaviour or Learning makes frequent use of the term “modifying behavior”. Through early research in the 1940s and the 1950s the term was used by Joseph Wolpe’s research group. The experimental tradition in clinical psychology used it to refer to psycho-therapeutic techniques derived from empirical research. It has since come to refer mainly to techniques for increasing adaptive behaviour through reinforcement and decreasing maladaptive behaviour through extinction or punishment (with emphasis on the former). Two related terms are behaviour therapy and applied behaviour analysis. Since techniques derived from behavioural psychology tend to be the most effective in altering behaviour, most practitioners consider behaviour modification along with behaviour therapy and applied behaviour analysis to be founded in behaviourism. While behaviour modification and applied behaviour analysis typically uses interventions based on the same behavioural principles, many behaviour modifiers who are not applied behaviour analysts tend to use packages of interventions and do not conduct functional assessments before intervening.
Possibly the first occurrence of the term “behavior therapy” was in a 1953 research project by B.F. Skinner, Ogden Lindsley, Nathan Azrin and Harry C. Solomon. The paper talked about operant conditioning and how it could be used to help improve the functioning of people who were diagnosed with chronic schizophrenia. Early pioneers in behaviour therapy include Joseph Wolpe and Hans Eysenck.
In general, behaviour therapy is seen as having three distinct points of origin: South Africa (Wolpe’s group), the United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behaviour problems. Eysenck in particular viewed behaviour problems as an interplay between personality characteristics, environment, and behaviour. Skinner’s group in the United States took more of an operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on contingency management such as the token economy and behavioural activation. Skinner’s student Ogden Lindsley is credited with forming a movement called precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualising of programs for improved learning in those with or without disabilities and worked with Fred S. Keller to develop programmed instruction. Programmed instruction had some clinical success in aphasia rehabilitation. Gerald Patterson used programme instruction to develop his parenting text for children with conduct problems. (see Parent management training.) With age, respondent conditioning appears to slow but operant conditioning remains relatively stable. While the concept had its share of advocates and critics in the west, its introduction in the Asian setting, particularly in India in the early 1970s and its grand success were testament to the famous Indian psychologist H. Narayan Murthy’s enduring commitment to the principles of behavioural therapy and biofeedback.
While many behaviour therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behaviour therapy with the cognitive therapy, of Aaron Beck, Albert Ellis, and Donald Meichenbaum to form cognitive behaviour therapy. In some areas the cognitive component had an additive effect (for example, evidence suggests that cognitive interventions improve the result of social phobia treatment.) but in other areas it did not enhance the treatment, which led to the pursuit of third generation behaviour therapies. Third generation behaviour therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a clinical formulation/case conceptualisation of verbal behaviour more inline with view of the behaviour analysts. Some research supports these therapies as being more effective in some cases than cognitive therapy, but overall the question is still in need of answers.
Theoretical Basis
The behavioural approach to therapy assumes that behaviour that is associated with psychological problems develops through the same processes of learning that affects the development of other behaviours. Therefore, behaviourists see personality problems in the way that personality was developed. They do not look at behaviour disorders as something a person has, but consider that it reflects how learning has influenced certain people to behave in a certain way in certain situations.
Behaviour therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. Classical conditioning happens when a neutral stimulus comes right before another stimulus that triggers a reflexive response. The idea is that if the neutral stimulus and whatever other stimulus that triggers a response is paired together often enough that the neutral stimulus will produce the reflexive response. Operant conditioning has to do with rewards and punishments and how they can either increase or decrease certain behaviours.
Contingency management programs are a direct product of research from operant conditioning.
Current Forms
Behavioural therapy based on operant and respondent principles has considerable evidence base to support its usage. This approach remains a vital area of clinical psychology and is often termed clinical behaviour analysis. Behavioural psychotherapy has become increasingly contextual in recent years. Behavioural psychotherapy has developed greater interest in recent years in personality disorders as well as a greater focus on acceptance and complex case conceptualisations.
Functional Analytic Psychotherapy
One current form of behavioural psychotherapy is functional analytic psychotherapy. Functional analytic psychotherapy is a longer duration behaviour therapy. Functional analytic therapy focuses on in-session use of reinforcement and is primarily a relationally-based therapy. As with most of the behavioural psychotherapies, functional analytic psychotherapy is contextual in its origins and nature. and draws heavily on radical behaviourism and functional contextualism.
Functional analytic psychotherapy holds to a process model of research, which makes it unique compared to traditional behaviour therapy and cognitive behavioural therapy.
Functional analytic psychotherapy has a strong research support. Recent functional analytic psychotherapy research efforts are focusing on management of aggressive inpatients.
Assessment
Behaviour therapists complete a functional analysis or a functional assessment that looks at four important areas: stimulus, organism, response and consequences. The stimulus is the condition or environmental trigger that causes behaviour. An organism involves the internal responses of a person, like physiological responses, emotions and cognition. A response is the behaviour that a person exhibits and the consequences are the result of the behaviour. These four things are incorporated into an assessment done by the behaviour therapist.
Most behaviour therapists use objective assessment methods like structured interviews, objective psychological tests or different behavioural rating forms. These types of assessments are used so that the behaviour therapist can determine exactly what a client’s problem may be and establish a baseline for any maladaptive responses that the client may have. By having this baseline, as therapy continues this same measure can be used to check a client’s progress, which can help determine if the therapy is working. Behaviour therapists do not typically ask the why questions but tend to be more focused on the how, when, where and what questions. Tests such as the Rorschach inkblot test or personality tests like the MMPI (Minnesota Multiphasic Personality Inventory) are not commonly used for behavioural assessment because they are based on personality trait theory assuming that a person’s answer to these methods can predict behaviour. Behaviour assessment is more focused on the observations of a person’s behaviour in their natural environment.
Behavioural assessment specifically attempts to find out what the environmental and self-imposed variables are. These variables are the things that are allowing a person to maintain their maladaptive feelings, thoughts and behaviours. In a behavioural assessment “person variables” are also considered. These “person variables” come from a person’s social learning history and they affect the way in which the environment affects that person’s behaviour. An example of a person variable would be behavioural competence. Behavioural competence looks at whether a person has the appropriate skills and behaviours that are necessary when performing a specific response to a certain situation or stimuli.
When making a behavioural assessment the behaviour therapist wants to answer two questions: (1) what are the different factors (environmental or psychological) that are maintaining the maladaptive behaviour and (2) what type of behaviour therapy or technique that can help the individual improve most effectively. The first question involves looking at all aspects of a person, which can be summed up by the acronym BASIC ID. This acronym stands for behaviour, affective responses, sensory reactions, imagery, cognitive processes, interpersonal relationships and drug use.
Clinical Applications
Behaviour therapy based its core interventions on functional analysis. Just a few of the many problems that behaviour therapy have functionally analysed include intimacy in couples relationships, forgiveness in couples, chronic pain, stress-related behaviour problems of being an adult child of a person with an alcohol use disorder, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia and obesity.
Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, partially engaged clients and involuntary clients. Applications to these problems have left clinicians with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reinforcement or operant conditioning. Although behaviour therapy is based on the general learning model, it can be applied in a lot of different treatment packages that can be specifically developed to deal with problematic behaviours. Some of the more well known types of treatments are: Relaxation training, systematic desensitization, virtual reality exposure, exposure and response prevention techniques, social skills training, modelling, behavioural rehearsal and homework, and aversion therapy and punishment.
Relaxation training involves clients learning to lower arousal to reduce their stress by tensing and releasing certain muscle groups throughout their body. Systematic desensitisation is a treatment in which the client slowly substitutes a new learned response for a maladaptive response by moving up a hierarchy of situations involving fear. Systematic desensitization is based in part on counter conditioning. Counter conditioning is learning new ways to change one response for another and in the case of desensitisation it is substituting that maladaptive behaviour for a more relaxing behaviour. Exposure and response prevention techniques (also known as flooding and response prevention) is the general technique in which a therapist exposes an individual to anxiety-provoking stimuli while keeping them from having any avoidance responses.
Virtual reality therapy provides realistic, computer-based simulations of troublesome situations. The modelling process involves a person being subjected to watching other individuals who demonstrate behaviour that is considered adaptive and that should be adopted by the client. This exposure involves not only the cues of the “model person” as well as the situations of a certain behaviour that way the relationship can be seen between the appropriateness of a certain behaviour and situation in which that behaviour occurs is demonstrated. With the behavioural rehearsal and homework treatment a client gets a desired behaviour during a therapy session and then they practice and record that behaviour between their sessions. Aversion therapy and punishment is a technique in which an aversive (painful or unpleasant) stimulus is used to decrease unwanted behaviours from occurring. It is concerned with two procedures: 1) the procedures are used to decrease the likelihood of the frequency of a certain behaviour and 2) procedures that will reduce the attractiveness of certain behaviours and the stimuli that elicit them. The punishment side of aversion therapy is when an aversive stimulus is presented at the same time that a negative stimulus and then they are stopped at the same time when a positive stimulus or response is presented. Examples of the type of negative stimulus or punishment that can be used is shock therapy treatments, aversive drug treatments as well as response cost contingent punishment which involves taking away a reward.
Applied behaviour analysis is using behavioural methods to modify certain behaviours that are seen as being important socially or personally. There are four main characteristics of applied behaviour analysis. First behaviour analysis is focused mainly on overt behaviours in an applied setting. Treatments are developed as a way to alter the relationship between those overt behaviours and their consequences.
Another characteristic of applied behaviour analysis is how it (behaviour analysis) goes about evaluating treatment effects. The individual subject is where the focus of study is on, the investigation is centred on the one individual being treated. A third characteristic is that it focuses on what the environment does to cause significant behaviour changes. Finally the last characteristic of applied behaviour analysis is the use of those techniques that stem from operant and classical conditioning such as providing reinforcement, punishment, stimulus control and any other learning principles that may apply.
Social skills training teaches clients skills to access reinforcers and lessen life punishment. Operant conditioning procedures in meta-analysis had the largest effect size for training social skills, followed by modelling, coaching, and social cognitive techniques in that order. Social skills training has some empirical support particularly for schizophrenia. However, with schizophrenia, behavioural programs have generally lost favour.
Some other techniques that have been used in behaviour therapy are contingency contracting, response costs, token economies, biofeedback, and using shaping and grading task assignments.
Shaping and graded task assignments are used when behaviour that needs to be learned is complex. The complex behaviours that need to be learned are broken down into simpler steps where the person can achieve small things gradually building up to the more complex behaviour. Each step approximates the eventual goal and helps the person to expand their activities in a gradual way. This behaviour is used when a person feels that something in their lives can not be changed and life’s tasks appear to be overwhelming.
Another technique of behaviour therapy involves holding a client or patient accountable of their behaviours in an effort to change them. This is called a contingency contract, which is a formal written contract between two or more people that defines the specific expected behaviours that you wish to change and the rewards and punishments that go along with that behaviour. In order for a contingency contract to be official it needs to have five elements. First it must state what each person will get if they successfully complete the desired behaviour. Secondly those people involved have to monitor the behaviours. Third, if the desired behaviour is not being performed in the way that was agreed upon in the contract the punishments that were defined in the contract must be done. Fourth if the persons involved are complying with the contract they must receive bonuses. The last element involves documenting the compliance and noncompliance while using this treatment in order to give the persons involved consistent feedback about the target behaviour and the provision of reinforcers.
Token economies is a behaviour therapy technique where clients are reinforced with tokens that are considered a type of currency that can be used to purchase desired rewards, like being able to watch television or getting a snack that they want when they perform designated behaviours. Token economies are mainly used in institutional and therapeutic settings. In order for a token economy to be effective there must be consistency in administering the program by the entire staff. Procedures must be clearly defined so that there is no confusion among the clients. Instead of looking for ways to punish the patients or to deny them of rewards, the staff has to reinforce the positive behaviours so that the clients will increase the occurrence of the desired behaviour. Over time the tokens need to be replaced with less tangible rewards such as compliments so that the client will be prepared when they leave the institution and won’t expect to get something every time they perform a desired behaviour.
Closely related to token economies is a technique called response costs. This technique can either be used with or without token economies. Response costs is the punishment side of token economies where there is a loss of a reward or privilege after someone performs an undesirable behaviour. Like token economies this technique is used mainly in institutional and therapeutic settings.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy, habit reversal training, has been found to be highly effective for treating tics.
In Rehabilitation
Currently, there is a greater call for behavioural psychologists to be involved in rehabilitation efforts.
Treatment of Mental Disorders
Two large studies done by the Faculty of Health Sciences at Simon Fraser University indicate that both behaviour therapy and cognitive-behavioural therapy (CBT) are equally effective for OCD. CBT is typically considered the “first-line” treatment for OCD. CBT has also been shown to perform slightly better at treating co-occurring depression.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy (habit reversal training) has been found to be highly effective for treating tics.
There has been a development towards combining techniques to treat psychiatric disorders. Cognitive interventions are used to enhance the effects of more established behavioural interventions based on operant and classical conditioning. An increased effort has also been placed to address the interpersonal context of behaviour.
Behaviour therapy can be applied to a number of mental disorders and in many cases is more effective for specific disorders as compared to others. Behaviour therapy techniques can be used to deal with any phobias that a person may have. Desensitisation has also been successfully applied to other issues such as dealing with anger, if a person has trouble sleeping and certain speech disorders. Desensitisation does not occur over night, there is a process of treatment. Desensitisation is done on a hierarchy and happens over a number of sessions. The hierarchy goes from situations that make a person less anxious or nervous up to things that are considered to be extreme for the patient.
Modelling has been used in dealing with fears and phobias. Fears are thought to develop through observational learning, and so positive modelling, when a person’s behaviour is imitated, can used to counter these effects. In a systematic review of 1,677 papers, positive modelling was found to lower fear levels. Modelling has been used in the treatment of fear of snakes as well as a fear of water.
Aversive therapy techniques have been used to treat sexual deviations, as well as alcohol use disorder.
Exposure and prevention procedure techniques can be used to treat people who have anxiety problems as well as any fears or phobias. These procedures have also been used to help people dealing with any anger issues as well as pathological grievers (people who have distressing thoughts about a deceased person).
Virtual reality therapy deals with fear of heights, fear of flying, and a variety of other anxiety disorders. VRT has also been applied to help people with substance abuse problems reduce their responsiveness to certain cues that trigger their need to use drugs.
Shaping and graded task assignments has been used in dealing with suicide and depressed or inhibited individuals. This is used when a patient feel hopeless and they have no way of changing their lives. This hopelessness involves how the person reacts and responds to someone else and certain situations and their perceived powerlessness to change that situation that adds to the hopelessness. For a person with suicidal ideation, it is important to start with small steps. Because that person may perceive everything as being a big step, the smaller you start the easier it will be for the person to master each step. This technique has also been applied to people dealing with agoraphobia, or fear of being in public places or doing something embarrassing.
Contingency contracting has been used to effectively deal with behaviour problems in delinquents and when dealing with on task behaviours in students.
Token economies are used in controlled environments and are found mostly in psychiatric hospitals. They can be used to help patients with different mental illnesses but it does not focus on the treatment of the mental illness but instead on the behavioural aspects of a patient. The response cost technique has been used to successfully address a variety of behaviours such as smoking, overeating, stuttering, and psychotic talk.
Treatment Outcomes
Systematic desensitisation has been shown to successfully treat phobias about heights, driving, insects as well as any anxiety that a person may have. Anxiety can include social anxiety, anxiety about public speaking as well as test anxiety. It has been shown that the use of systematic desensitisation is an effective technique that can be applied to a number of problems that a person may have.
When using modelling procedures this technique is often compared to another behavioural therapy technique. When compared to desensitisation, the modelling technique does appear to be less effective. However it is clear that the greater the interaction between the patient and the subject he is modelling the greater the effectiveness of the treatment.
While undergoing exposure therapy, a person typically needs five sessions to assess the treatment’s effectiveness. After five sessions, exposure treatment has been shown to provide benefit to the patient. However, it is still recommended treatment continue beyond the initial five sessions.
Virtual reality therapy (VRT) has shown to be effective for a fear of heights. It has also been shown to help with the treatment of a variety of anxiety disorders. Due to the costs associated with VRT in 2007, therapists were still awaiting results of controlled trials investigating VRT, to assess which applications demonstrate the best results.
For those with suicidal ideation, treatment depends on how severe the person’s depression and sense of hopelessness is. If these things are severe, the person’s response to completing small steps will not be of importance to them, because they do not consider the success an accomplishment. Generally, in those without severe depression or fear, this technique has been successful, as completion of simpler activities builds their confidences and allows them to progress to more complex situations.
Contingency contracts have been seen to be effective in changing any undesired behaviours of individuals. It has been seen to be effective in treating behaviour problems in delinquents regardless of the specific characteristics of the contract.
Token economies have been shown to be effective when treating patients in psychiatric wards who had chronic schizophrenia. The results showed that the contingent tokens were controlling the behaviour of the patients.
Response costs has been shown to work in suppressing a variety of behaviours such as smoking, overeating or stuttering with a diverse group of clinical populations ranging from sociopaths to school children. These behaviours that have been suppressed using this technique often do not recover when the punishment contingency is withdrawn. Also undesirable side effects that are usually seen with punishment are not typically found when using the response cost technique.
“Third Generation”
Since the 1980s, a series of new behavioural therapies have been developed. These have been later labelled by Steven C. Hayes as “the third-generation” of behavioural therapy. Under this classification, the first generation of behavioural therapy is that independently developed in the 1950s by Joseph Wolpe, Ogden Lindsley and Hans Eysenck, while the second generation is the cognitive therapy developed by Aaron Beck in the 1970s.
Other authors object to the term “third generation” or “third wave” and incorporate many of the “third wave” therapeutic techniques under the general umbrella term of modern cognitive behavioural therapies.
This “third wave” of behavioural therapy has sometimes been called clinical behaviour analysis because it has been claimed that it represents a movement away from cognitivism and back toward radical behaviourism and other forms of behaviourism, in particular functional analysis and behavioural models of verbal behaviour. This area includes acceptance and commitment therapy (ACT), cognitive behavioural analysis system of psychotherapy (CBASP) (McCullough, 2000), behavioural activation (BA), dialectical behaviour therapy, functional analytic psychotherapy (FAP), integrative behavioural couples therapy, metacognitive therapy and metacognitive training. These approaches are squarely within the applied behaviour analysis tradition of behaviour therapy.
Acceptance and Commitment Therapy (ACT) may be the most well-researched of all the third-generation behaviour therapy models. It is based on relational frame theory. As of March 2022, there are over 900 randomised trials of Acceptance and Commitment Therapy and 60 mediational studies of the ACT literature. ACT has been included in over 275 meta-analyses and systematic reviews. As the result of multiple randomised trials of ACT by the World Health Organisation (WHO) now distribute ACT-based self-help for “anyone who experiences stress, wherever they live, and whatever their circumstances.” As of March 2022, a number of different organizations have stated that Acceptance and Commitment Therapy is empirically supported in certain areas or as a whole according to their standards. These include: American Psychological Association, Society of Clinical Psychology (Div. 12), The WHO, The United Kingdom National Institute for Health and Care Excellence (NICE), Australian Psychological Society, Netherlands Institute of Psychologists: Sections of Neuropsychology and Rehabilitation, Sweden Association of Physiotherapists, SAMHSA’s National Registry of Evidence-based Programs and Practices, California Evidence-Based Clearinghouse for Child Welfare, and the US Veterans Affairs/Department of Defence.
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. In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.
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 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.
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 couple’s relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.
A review study published in 2008, concluded that at the time, third-generation behavioural psychotherapies did not meet the criteria for empirically supported treatments.
Organisations
Many organisations exist for behaviour therapists around the world. In the United States, the American Psychological Association’s Division 25 is the division for behaviour analysis. The Association for Contextual Behavioural Science is another professional organisation. ACBS is home to many clinicians with specific interest in third generation behaviour therapy. Doctoral-level behaviour analysts who are psychologists belong to American Psychological Association’s Division 25 – behaviour analysis. APA offers a diploma in behavioural psychology.
The Association for Behavioural and Cognitive Therapies (formerly the Association for the Advancement of Behaviour Therapy) is for those with a more cognitive orientation. The ABCT also has an interest group in behaviour analysis, which focuses on clinical behaviour analysis. In addition, the Association for Behavioural and Cognitive Therapies has a special interest group on addictions.
Characteristics
By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable), monistic (rejecting mind–body dualism and treating the person as a unit), and relational (analysing bidirectional interactions).
Behavioural therapy develops, adds and provides behavioural intervention strategies and programs for clients, and training to people who care to facilitate successful lives in various communities.
Training
Recent efforts in behavioural psychotherapy have focused on the supervision process. A key point of behavioural models of supervision is that the supervisory process parallels the behavioural psychotherapy provided.
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Flooding, in psychology terms, sometimes referred to as in vivo exposure therapy, is a form of behaviour therapy and desensitisation — or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder (PTSD). It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It is still used in behaviour therapy today.
Flooding is a psychotherapeutic method for overcoming phobias. In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia. Under controlled conditions and using psychologically-proven relaxation techniques, the subject attempts to replace their fear with relaxation. The experience can often be traumatic for a person, but may be necessary if the phobia is causing them significant life disturbances. The advantage to flooding is that it is quick and usually effective. There is, however, a possibility that a fear may spontaneously recur. This can be made less likely with systematic desensitisation, another form of a classical condition procedure for the elimination of phobias.
How it Works
“Flooding” works on the principles of classical conditioning or respondent conditioning—a form of Pavlov’s classical conditioning—where patients change their behaviours to avoid negative stimuli. According to Pavlov, people can learn through associations, so if one has a phobia, it is because one associates the feared stimulus with a negative outcome.
Flooding uses a technique based on Pavlov’s classical conditioning that uses exposure. There are different forms of exposure, such as imaginal exposure, virtual reality exposure, and in vivo exposure. While systematic desensitisation may use these other types of exposure, flooding uses in vivo exposure, actual exposure to the feared stimulus. A patient is confronted with a situation in which the stimulus that provoked the original trauma is present. The psychologist there usually offers very little assistance or reassurance other than to help the patient to use relaxation techniques in order to calm themselves. Relaxation techniques such as progressive muscle relaxation are common in these kinds of classical conditioning procedures. The theory is that the adrenaline and fear response has a time limit, so a person should eventually have to calm down and realize that their phobia is unwarranted. Flooding can be done through the use of virtual reality and has been shown to be fairly effective in patients with flight phobia.
Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who was scared of cars, and drove her around for hours. Initially the girl was panicky but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars. Psychologist Aletha Solter used flooding successfully with a 5-month-old infant who showed symptoms of post-traumatic stress following surgery.
Flooding therapy is not for every individual, and the therapist will discuss with the patient the levels of anxiety they are prepared to endure during the session. It may also be true that exposure is not for every therapist and therapists seem to shy away from use of the technique.
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Systematic desensitisation, or graduated exposure therapy, is a behaviour therapy developed by the psychiatristJoseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioural therapy and applied behaviour analysis. When used in applied behaviour analysis, it is based on radical behaviourism as it incorporates counterconditioning principles. These include meditation (a private behaviour or covert conditioning) and breathing (a public behaviour or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behaviour, so it initially uses cognitive restructuring.
The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitisation occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.
In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov’s work on artificial neuroses and the research done on elimination of children’s fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.
Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.
Three steps of desensitisation
There are three main steps that Wolpe identified to successfully desensitize an individual.
Establish anxiety stimulus hierarchy
1. The individual should first identify the items that are causing the anxiety problems. 2. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. 3. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately. 4. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
Learn the mechanism response
1. Relaxation training, such as meditation, is one type of best coping strategies. 2. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time. 3. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity. 4. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels. 5. Only a few sessions are needed for a patient to learn appropriate coping mechanisms. 6.Additional coping strategies include anti-anxiety medicine and breathing exercises. 7. Another example of relaxation is cognitive reappraisal of imagined outcomes. 8. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
Connect stimulus to the incompatible response or coping method by counter conditioning
1. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias. 2. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented. 3. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all. 4. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped. 5. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.
Example
A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitisation:
Establish anxiety stimulus hierarchy
1. A therapist may begin by asking the patient to identify a fear hierarchy. 2. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake. 3. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
Learn coping mechanisms or incompatible responses
1. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
Connect the stimulus to the incompatible response or coping method
1. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilising the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned. 2. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc. 3. At each step in the imagined progression, the patient is desensitised to the phobia through exposure to the stimulus while in a state of relaxation. 4. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.
Uses
Specific Phobias
Specific phobias are one class of mental disorder often treated via systematic desensitisation. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients’ avoidance behaviours can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitisation is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. Wolpe found that systematic desensitisation was successful 90% of the time when treating phobias.
Test Anxiety
Between 25 and 40 percent of students experience test anxiety. Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety. The principles of systematic desensitisation can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitisation can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counsellors or school psychologists could instruct children on the methods of systematic desensitisation.
Recent Use
Desensitisation is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitisation has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitisation has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitisation has also declined since 1980. Those clinicians that continue to regularly use systematic desensitisation were trained before 1986. It is believed that the decrease of systematic desensitisation by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modelling.
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Joseph Wolpe (20 April 1915 to 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behaviour therapy.
Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.
In 1956, Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Center for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.
In 1965, Wolpe accepted a position at Temple University.
One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy. A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.
Reciprocal Inhibition
In Wolpe’s search for a more effective way in treating anxiety he developed different reciprocal inhibition techniques, utilising assertiveness training. Reciprocal inhibition can be defined as anxiety being inhibited by a feeling or response that is not compatible with the feeling of anxiety. Wolpe first started using eating as a response to inhibited anxiety in the laboratory cats. He would offer them food while presenting a conditioned fear stimulus. After his experiments in the laboratory he applied reciprocal inhibition to his clients in the form of assertiveness training. The idea behind assertiveness training was that you could not be angry or aggressive while simultaneously assertive at same time. Importantly, Wolpe believed that these techniques would lessen the anxiety producing association. Assertiveness training proved especially useful for clients who had anxiety about social situations. However, assertiveness training did have a potential flaw in the sense that it could not be applied to other kinds of phobias. Wolpe’s use of reciprocal inhibition led to his discovery of systematic desensitisation. He believed that facing your fears did not always result in overcoming them but rather lead to frustration. According to Wolpe, the key to overcoming fears was “by degrees”.
Systematic Desensitisation
Systematic desensitisation is what Wolpe is most famous for. Systematic desensitisation is when the client is exposed to the anxiety-producing stimulus at a low level, and once no anxiety is present a stronger version of the anxiety-producing stimulus is given. This continues until the individual client no longer feels any anxiety towards the stimulus. There are three main steps in using systematic desensitization, following development of a proper case formulation or what Wolpe originally called, “behaviour analysis“. The first step is to teach the client relaxation techniques.
Wolpe received the idea of relaxation from Edmund Jacobson, modifying his muscle relaxation techniques to take less time. Wolpe’s rationale was that one cannot be both relaxed and anxious at the same time. The second step is for the client and the therapist to create a hierarchy of anxieties. The therapist normally has the client make a list of all the things that produce anxiety in all its different forms. Then together, with the therapist, the client makes a hierarchy, starting with what produces the lowest level of anxiety to what produces the most anxiety. Next is to have the client be fully relaxed while imaging the anxiety producing stimulus. Depending on what their reaction is, whether they feel no anxiety or a great amount of anxiety, the stimulus will then be changed to a stronger or weaker one. Systematic desensitisation, though successful, has flaws as well. The patient may give misleading hierarchies, have trouble relaxing, or not be able to adequately imagine the scenarios. Despite this possible flaw, it seems to be most successful.
Achievements
Wolpe’s effect on behavioural therapy is long-lasting and extensive. He received many awards for his work in behavioural science. His awards included the American Psychological Associations Distinguished Scientific Award, the Psi Chi Distinguished Member Award, and the Lifetime Achievement Award from the Association for the Advancement of Behaviour Therapy, where he was the second president. In addition to these awards, Wolpe’s alma mater, University of Witwatersrand, awarded him an honorary doctor of science degree in 1986. Furthermore, Wolpe was a prolific writer, some of his most famous books include, The Practice of Behaviour Therapy and Psychotherapy by Reciprocal Inhibition. Joseph Wolpe’s dedication to psychology is clear in his involvement in the psychology community, a month before his death he was attending conferences and giving lectures at Pepperdine University even though he was retired. Moreover, his theories have lasted well beyond his death.
Wolpe developed the Subjective Units of Disturbance Scale (SUDS) for assessing the level of subjective discomfort or psychological pain. He also created the Subjective Anxiety Scale (SAS) and the Fear Survey Plan that are used in behaviour research and therapy.
Functional analysis in behavioural psychology is the application of the laws of operant and respondent conditioning to establish the relationships between stimuli and responses.
To establish the function of operant behaviour, one typically examines the “four-term contingency”: first by identifying the motivating operations (EO or AO), then identifying the antecedent or trigger of the behaviour, identifying the behaviour itself as it has been operationalised, and identifying the consequence of the behaviour which continues to maintain it.
Functional assessment in behaviour analysis employs principles derived from the natural science of behaviour analysis to determine the “reason”, purpose, or motivation for a behaviour. The most robust form of functional assessment is functional analysis, which involves the direct manipulation, using some experimental design (e.g. a multielement design or a reversal design) of various antecedent and consequent events and measurement of their effects on the behaviour of interest; this is the only method of functional assessment that allows for demonstration of clear cause of behaviour.
Applications in Clinical Psychology
Functional analysis and consequence analysis are commonly used in certain types of psychotherapy to better understand, and in some cases change, behaviour. It is particularly common in behavioural therapies such as behavioural activation, although it is also part of Aaron Beck’s cognitive therapy. In addition, functional analysis modified into a behaviour chain analysis is often used in dialectical behaviour therapy.
There are several advantages to using functional analysis over traditional assessment methods. Firstly, behavioural observation is more reliable than traditional self-report methods. This is because observing the individual from an objective stand point in their regular environment allows the observer to observe both the antecedent and the consequence of the problem behaviour. Secondly, functional analysis is advantageous as it allows for the development of behavioural interventions, either antecedent control or consequence control, specifically designed to reduce a problem behaviour. Thirdly, functional analysis is advantageous for interventions for young children or developmentally delayed children with problem behaviours, who may not be able to answer self-report questions about the reasons for their actions.
Despite these benefits, functional analysis also has some disadvantages. The first that no standard methods for determining function have been determined and meta-analysis shows that different methodologies appear to bias results toward particular functions as well as not effective in improving outcomes. Second, Gresham and colleagues (2004) in a meta-analytic review of JABA articles found that functional assessment did not produce greater effect sizes compared to simple contingency management programmes. However, Gresham et al. combined the three types of functional assessment, of which descriptive assessment and indirect assessment have been reliably found to produce results with limited validity Third, although functional assessment has been conducted with a variety host of populations much of the current functional assessment research has been limited to children with developmental disabilities.
Professional Organisations
The Association for Behavioural and Cognitive Therapies (ABCT) also has an interest group in behaviour analysis, which focuses on the use of behaviour analysis in the school setting including functional 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 and school psychology both of which focus on the use of functional analysis in the school setting.
The World Association for Behaviour Analysis offers a certification for clinical behaviour therapy and behavioural consultation, which covers functional analysis.
The UK Society for Behaviour Analysis also provides a forum for behaviour analysts for accreditation, professional development, continuing education and networking, and serves as an advocate body in public debate on issues relating to behaviour analysis. The UK-SBA promotes the ethical and effective application of the principles of behaviour and learning to a wide range of areas including education, rehabilitation and health care, business and the community and is committed to maintaining the availability of high-quality evidence-based professional behaviour analysis practice in the UK. The society also promotes and supports the academic field of behaviour analysis with in the UK both in terms of university-based training and research, and theoretical develop.
The Association for Behavioural and Cognitive Therapies (ABCT) was founded in 1966.
Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therapists, nurses, and other mental-health practitioners and students. These members support, use, and/or disseminate behavioural and cognitive approaches.
Brief History
ABCT was founded in 1966 under the name Association for Advancement of Behavioural Therapies (AABT) by 10 behaviourists who were dissatisfied with the prevailing Freudian/psychoanalytic model (Its founding members include: John Paul Brady, Joseph Cautela, Edward Dengrove, Cyril Franks, Martin Gittelman, Leonard Krasner, Arnold Lazarus, Andrew Salter, Dorothy Susskind, and Joseph Wolpe). The Freudian/psychoanalytic model refers to the Id, Ego, and Superego within each individual as they interpret and interact with the world and those around them. Although the ABCT was not established until 1966, its history begins in the early 1900s with the birth of the behaviourist movement, which was brought about by Pavlov, Watson, Skinner, Thorndike, Hull, Mowrer, and others – scientists who, concerned primarily with observable behaviour, were beginning to experiment with conditioning and learning theory. By the 1950s, two entities – Hans Eysenck’s research group (which included one of AABT’s founders Cyril Franks) at the University of London Institute of Psychiatry, and Joseph Wolpe’s research group (which included another of AABT’s founders, Arnold Lazarus) in South Africa – were conducting important studies that would establish behaviour therapy as a science based on principles of learning. In complete opposition to the psychoanalytic model, “The seminal significance of behaviour therapy was the commitment to apply the principles and procedures of experimental psychology to clinical problems, to rigorously evaluate the effects of therapy, and to ensure that clinical practice was guided by such objective evaluation”.
The first president of the association was Cyril Franks, who also founded the organisation’s flagship journal Behaviour Therapy and was the first editor of the Association for Advancement of Behavioural Therapies Newsletter. The first annual meeting of the association took place in 1967, in Washington, DC, concurrent with the American Psychological Association’s meeting.
An article in the November 1967 issue of the Newsletter, entitled “Behaviour Therapy and Not Behaviour Therapies” (Wilson & Evans, 1967), influenced the association’s first name change from Association for Advancement of Behavioural Therapies to Association for Advancement of Behaviour Therapy because, as the authors argued, “the various techniques of behaviour therapy all derive from learning theory and should not be misinterpreted as different kinds of behaviour therapy…”. This issue remains a debate in the field and within the organization, particularly with the emergence of the term “cognitive behavioural therapies.” This resulted in yet another name change in 2005 to the Association for Behavioural and Cognitive Therapies.
The Association for Advancement of Behavioural Therapies/Association for Behavioural and Cognitive Therapies has been at the forefront of the professional, legal, social, and ethical controversies and dissemination efforts that have accompanied the field’s evolution. The 1970s was perhaps the most “explosive” and controversial decade for the field of behaviour therapy, as it suffered from an overall negative public image and received numerous attacks from the press regarding behaviour modification and its possible unethical uses. In Gerald Davison’s (AABT’s 8th president) public “Statement on Behaviour Modification from the AABT”, he asserted that “it is a serious mistake … to equate behaviour therapy with the use of electric shocks applied to the extremities…” and “a major contribution of behaviour therapy has been a profound commitment to full description of procedures and careful evaluation of their effects”. From this point, AABT became instrumental in enacting legislative guidelines that protected human research subjects, and they also became active in efforts to educate the public.
Mission Statement
The ABCT is an interdisciplinary organisation committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioural, cognitive, prevention, and treatment. While primarily an interest group, ABCT is also active in:
Encouraging the development, study, and dissemination of scientific approaches to behavioural health.
Promoting the utilisation, expansion, and dissemination of behavioural, cognitive, and other empirically derived practices.
Facilitating professional development, interaction, and networking among members.
Professional Activities
Through its membership, publications, convention and education committees, the ABCT conducts a variety of activities to support and disseminate the behavioural and cognitive therapies. The organization produces two quarterly journals, Behaviour Therapy (research-based) and Cognitive and Behavioural Practice (treatment focused), as well as its house periodical, the Behaviour Therapist (eight times per year). The association’s convention is held annually in November. ABCT also produces fact sheets, an assessment series, and training and archival videotapes. The association maintains a website on which can be found a “Find-a-Therapist” search engine and information about behavioural and cognitive therapies. The organisation provides its members with an online clinical directory, over 30 special interest groups, a list serve, a job bank, and an awards and recognition programme. Other offerings available on the website include sample course syllabi, listings of grants available, and a broad range of offerings of interest to mental health researchers.
Mental Health Professionals
The training of mental health professionals has also been a significant priority for the association. Along with its annual meeting, AABT created an “ad hoc review mechanism” in the 1970s through the 1980s whereby a state could receive a review of a behaviour therapy programme. This led to the yearly publication of a widely used resource, “The Directory of Training Programmes”. With growing concerns over quality control and standardisation of practice, the certification of behaviour therapists also became an issue in the 1970s. This debate led to the development of a Diplomate in behaviour therapy at APA and for those behavioural therapy practices from a more radical behavioural perspective, the development of certification in behaviour analysis at the master level.
An ongoing debate within the association concerns what many consider to be a movement away from basic behavioural science as the field has attempted to advance and integrate more and more “new” therapies/specialisations, particularly the addition of cognitive theory and its variety of techniques. John Forsyth, in his special issue of Behaviour Therapy] entitled “Thirty Years of Behaviour Therapy: Promises Kept, Promises Unfulfilled”, summarised this opposition as follows:
“(a) cognition is not behaviour, (b) behaviour principles and theory cannot account for events occurring within the skin, and most important, (c) we therefore need a unique conceptual system to account for how thinking, feeling, and other private events relate to overt human action”.
The field’s desire to maintain its scientific foundations and yet continue to advance and grow, was reflected in its most recent discussion about adding the word “cognitive” to the name of the association.
Many notable scholars have served as president of the association, including Joseph Wolpe, Arnold Lazarus, Nathan Azrin, Steven C. Hayes, and David Barlow. The current executive director of the ABCT is Mary Jane Eimer, CAE. For a wealth of historical specifics (governing bodies, lists of editors, past presidents, award winners, SIGs, and conventions from the past 40 years) see ABCT’s 40th anniversary issue of the Behaviour Therapist.
About Behavioural and Cognitive Therapies
Cognitive and behavioural therapists help people learn to actively cope with, confront, reformulate, and/or change the maladaptive cognitions, behaviours, and symptoms that limit their ability to function, cause emotional distress, and accompany the wide range of mental health disorders. Goal-oriented, time-limited, research-based, and focused on the present, the cognitive and behavioural approach is collaborative. This approach values feedback from the client, and encourages the client to play an active role in setting goals and the overall course and pace of treatment. Importantly, behavioural interventions are characterized by a “direct focus on observable behaviour”. Practitioners teach clients concrete skills and exercises – from breathing retraining, to keeping thought records to behavioural rehearsal – to practice at home and in sessions, with the overall goal of optimal functioning and the ability to engage in life fully.
Because cognitive behavioural therapy (CBT) is based on broad principles of human learning and adaptation, it can be used to accomplish a wide variety of goals. CBT has been applied to issues ranging from depression and anxiety, to the improvement of the quality of parenting, relationships, and personal effectiveness.
Numerous scientific studies and research have documented the helpfulness of CBT programmes for a wide range of concerns throughout the lifespan. These concerns include children’s behaviour problems, health promotion, weight management, pain management, sexual dysfunction, stress, violence and victimisation, serious mental illness, relationship issues, academic problems, substance abuse, bipolar disorder, developmental disabilities, autism spectrum disorders, social phobia, school refusal and school phobia, hair pulling (trichotillomania) and much more. Cognitive-behavioural treatments are subject randomised controlled trials and “have been subjected to more rigorous evaluation using randomised controlled trials than any of the other psychological therapies”. There is discussion of using technology to determine diagnosis and host interventions according to research done by W. Edward Craighead. This would be done using “genetic analysis” and “neuroimaging” to create more individualised treatment plans.
Special Interest Groups
The ABCT has more than 40 special interest groups for its members. These include groups for issues involving African-Americans, Asian-Americans, Hispanics and other ethnic groups such as children and adolescents; couples; gay, lesbian, bisexual and transgender people; students; military personnel; and the criminal justice system. The ABCT works within these groups to overcome addictive behaviours and mental illnesses that may cause negativity in these groups life. A group that the ABCT has supported well is the special interest group of the criminal justice system. The ABCT helps provide the prison system with knowledge of how to more humanely treat those who committed crimes and give people the proper care and attention to become great citizens.
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.”
Theoretical Underpinnings
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.
Methods
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.
Research Support
Depression
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.
Anxiety
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.
In the Context of Third Generation Behaviour Therapies
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.
Professional Organisations
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.
BA in Virtual Reality
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.
Definition
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”.
Brief History
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.
Characteristics
Baer, Wolf, and Risley’s 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA.
Applied: ABA focuses on the social significance of the behaviour studied. For example, a non-applied researcher may study eating behaviour because this research helps to clarify metabolic processes, whereas the applied researcher may study eating behaviour in individuals who eat too little or too much, trying to change such behaviour so that it is more acceptable to the persons involved.
Behavioural: ABA is pragmatic; it asks how it is possible to get an individual to do something effectively. To answer this question, the behaviour itself must be objectively measured. Verbal descriptions are treated as behaviour in themselves, and not as substitutes for the behaviour described.
Analytic: Behaviour analysis is successful when the analyst understands and can manipulate the events that control a target behaviour. This may be relatively easy to do in the lab, where a researcher is able to arrange the relevant events, but it is not always easy, or ethical, in an applied situation. Baer et al. outline two methods that may be used in applied settings to demonstrate control while maintaining ethical standards. These are the reversal design and the multiple baseline design. In the reversal design, the experimenter first measures the behaviour of choice, introduces an intervention, and then measures the behaviour again. Then, the intervention is removed, or reduced, and the behaviour is measured yet again. The intervention is effective to the extent that the behaviour changes and then changes back in response to these manipulations. The multiple baseline method may be used for behaviours that seem irreversible. Here, several behaviours are measured and then the intervention is applied to each in turn. The effectiveness of the intervention is revealed by changes in just the behaviour to which the intervention is being applied.
Technological: The description of analytic research must be clear and detailed, so that any competent researcher can repeat it accurately. Cooper et al. describe a good way to check this: Have a person trained in applied behaviour analysis read the description and then act out the procedure in detail. If the person makes any mistakes or has to ask any questions then the description needs improvement.
Conceptually Systematic: Behaviour analysis should not simply produce a list of effective interventions. Rather, to the extent possible, these methods should be grounded in behavioural principles. This is aided by the use of theoretically meaningful terms, such as “secondary reinforcement” or “errorless discrimination” where appropriate.
Effective: Though analytic methods should be theoretically grounded, they must be effective. If an intervention does not produce a large enough effect for practical use, then the analysis has failed
Generality: Behaviour analysts should aim for interventions that are generally applicable; the methods should work in different environments, apply to more than one specific behaviour, and have long-lasting effects.
Other proposed Characteristics
In 2005, Heward et al. suggested that the following five characteristics should be added:
Accountable: To be accountable means that ABA must be able to demonstrate that its methods are effective. This requires the repeatedly measuring the effect of interventions (success, failure or no effect at all), and, if necessary, making changes that improve their effectiveness.
Public: The methods, results, and theoretical analyses of ABA must be published and open to scrutiny. There are no hidden treatments or mystical, metaphysical explanations.
Doable: To be generally useful, interventions should be available to a variety of individuals, who might be teachers, parents, therapists, or even those who wish to modify their own behaviour. With proper planning and training, many interventions can be applied by almost anyone willing to invest the effort.
Empowering: ABA provides tools that give the practitioner feedback on the results of interventions. These allow clinicians to assess their skill level and build confidence in their effectiveness.
Optimistic: According to several leading authors, behaviour analysts have cause to be optimistic that their efforts are socially worthwhile, for the following reasons:
The behaviours impacted by behaviour analysis are largely determined by learning and controlled by manipulable aspects of the environment.
Practitioners can improve performance by direct and continuous measurements.
As a practitioner uses behavioural techniques with positive outcomes, they become more confident of future success.
The literature provides many examples of success in teaching individuals considered previously unteachable.
Concepts
Behaviour
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 Conditioning
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
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
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
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
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.
Discriminated Operant and Three-Term Contingency
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.
Verbal Behaviour
B.F. Skinner’s classification system of behaviour analysis has been applied to treatment of a host of communication disorders. Skinner’s system includes:
Tact: A verbal response evoked by a non-verbal antecedent and maintained by generalised conditioned reinforcement.
Mand: Behaviour under control of motivating operations maintained by a characteristic reinforcer.
Intraverbals: Verbal behaviour for which the relevant antecedent stimulus was other verbal behaviour, but which does not share the response topography of that prior verbal stimulus (e.g. responding to another speaker’s question).
Autoclitic: Secondary verbal behaviour which alters the effect of primary verbal behaviour on the listener. Examples involve quantification, grammar, and qualifying statements (e.g. the differential effects of “I think…” vs. “I know…”)
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.
Measuring Behaviour
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.
Repeatability
Response classes occur repeatedly throughout time – i.e. how many times the behaviour occurs.
Count is the number of occurrences in behaviour.
Rate/frequency is the number of instances of behaviour per unit of time.
Celeration is the measure of how the rate changes over time.
Temporal Extent
This dimension indicates that each instance of behaviour occupies some amount of time – i.e. how long the behaviour occurs.
Duration is the period of time over which the behaviour occurs.
Temporal Locus
Each instance of behaviour occurs at a specific point in time – i.e. when the behaviour occurs.
Response latency is the measure of elapsed time between the onset of a stimulus and the initiation of the response.
Inter-response time is the amount of time that occurs between two consecutive instances of a response class.
Derivative Measures
Derivative measures are unrelated to specific dimensions:
Percentage is the ratio formed by combining the same dimensional quantities.
Trials-to-criterion are the number of response opportunities needed to achieve a predetermined level of performance.
Analysing Behaviour Change
Experimental Control
In applied behaviour analysis, all experiments should include the following:
At least one participant.
At least one behaviour (dependent variable).
At least one setting.
A system for measuring the behaviour and ongoing visual analysis of data.
At least one treatment or intervention condition.
Manipulations of the independent variable so that its effects on the dependent variable may be quantitatively or qualitatively analysed.
An intervention that will benefit the participant in some way.
Methodologies Developed through ABA Research
Task Analysis
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.
Chaining
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.
Prompting
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:
Vocal prompts: Words or other vocalisations.
Visual prompts: A visual cue or picture.
Gestural prompts: A physical gesture.
Positional prompt: e.g. the target item is placed close to the individual.
Modelling: Modelling the desired response. This type of prompt is best suited for individuals who learn through imitation and can attend to a model.
Physical prompts: Physically manipulating the individual to produce the desired response. There are many degrees of physical prompts, from quite intrusive (e.g. the teacher places a hand on the learner’s hand) to minimally intrusive (e.g. a slight tap).
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.
Fading
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 a Reinforcement Schedule
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
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
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.
Interventions Based on an FBA
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.
Use in the Treatment of Autism Spectrum Disorders
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.
Efficacy
Recent reviews of the efficacy of ABA-based techniques in autism include:
A 2007 clinical report of the American Academy of Paediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorders (ASDs) “has been well documented” and that “children who receive early intensive behavioural treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behaviour as well as some measures of social behaviour”.
Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches in 2008. On the basis of “the strength of the findings from the four best-designed, controlled studies”, they were of the opinion that one ABA-based approach (the Lovaas technique created by Ole Ivar Løvaas) is “well-established” for improving intellectual performance of young children with ASD.
A 2009 review of psycho-educational interventions for children with autism whose mean age was six years or less at intake found that five high-quality (“Level 1” or “Level 2”) studies assessed ABA-based treatments. On the basis of these and other studies, the author concluded that ABA is “well-established” and is “demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists”. However, the review committee also concluded that “there is a great need for more knowledge about which interventions are most effective”.
A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987 to 2007 of early intensive behavioural intervention (EIBI, a form of ABA-based treatment with origins in the Lovaas technique) for autism. It determined that EIBI’s effect sizes were “generally positive” for IQ, adaptive behaviour, expressive language, and receptive language. The paper did note limitations of its findings including the lack of published comparisons between EIBI and other “empirically validated treatment programmes”.
In a 2009 systematic review of 11 studies published from 1987 to 2007, the researchers wrote “there is strong evidence that EIBI is effective for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment”. Furthermore, any improvements are likely to be greatest in the first year of intervention.
A 2009 meta-analysis of nine studies published from 1987 to 2007 concluded that EIBI has a “large” effect on full-scale intelligence and a “moderate” effect on adaptive behaviour in autistic children.
A 2009 systematic review and meta-analysis by Spreckley and Boyd of four small-n 2000-2007 studies (involving a total of 76 children) came to different conclusions than the aforementioned reviews. Spreckley and Boyd reported that applied behaviour intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behaviour. In a letter to the editor, however, authors of the four studies meta-analysed claimed that Spreckley and Boyd had misinterpreted one study comparing two forms of ABI with each other as a comparison of ABI with standard care, which erroneously decreased the observed efficacy of ABI. Furthermore, the four studies’ authors raised the possibility that Spreckley and Boyd had excluded some other studies unnecessarily, and that including such studies could have led to a more favourable evaluation of ABI. Spreckley, Boyd, and the four studies’ authors did agree that large multi-site randomised trials are needed to improve the understanding of ABA’s efficacy in autism.
In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model (the latter developed by Sally Rogers and Geraldine Dawson). They concluded that “both approaches were associated with … improvements in cognitive performance, language skills, and adaptive behaviour skills”. However, they also concluded that “the strength of evidence … is low”, “many children continue to display prominent areas of impairment”, “subgroups may account for a majority of the change”, there is “little evidence of practical effectiveness or feasibility beyond research studies”, and the published studies “used small samples, different treatment approaches and duration, and different outcome measurements”.
A 2019 review article concluded ABA proponents have utilised predominantly non-verbal and neurologically different, children who are not recognised under this paradigm to have their own thought processes, basic needs, preferences, style of learning, and psychological and emotional needs, for their experiment. This also indicates a missing voice of children and nonverbal people who cannot express their view on ABA.
A preliminary study indicates that there might be a publication bias against single-subject research studies that show that ABA is ineffective. Publication bias could lead to exaggerated estimates of intervention effects observed by single-subject studies.
Opposition to the Use in Treatment of Autism Spectrum Disorder
The Autistic Community
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.”
Professional Concerns
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.
Use of Aversives
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.”
Major Journals
Applied behaviour analysts publish in many journals. Some examples of “core” behaviour analytic journals are:
Journal of Applied Behaviour Analysis.
Journal of the Experimental Analysis of Behaviour.
Behaviour Analysis: Research and Practice.
The Behaviour Analyst Today.
Perspectives on Behaviour Science (formerly The Behaviour Analyst until 2018).
The Psychological Record.
The Journal of Speech-Language Pathology and Applied Behaviour Analysis.
Journal of Early and Intensive Behaviour Interventions.
The International Journal of Behavioural Consultation and Therapy.
The Journal of Behavioural Assessment and Intervention in Children.
The Behavioural Development Bulletin.
Behaviour and Social Issues.
Journal of Behaviour Analysis of Sports, Health, Fitness, and Behavioural Medicine.
Journal of Behaviour Analysis of Offender and Victim: Treatment and Prevention.
Mental Health Matters 
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