What is the Mood & Feelings Questionnaire?

Introduction

The Mood and Feelings Questionnaire (MFQ) is a survey that measures depressive symptoms in children and young adults.

Background

It was developed by Adrian Angold and Elizabeth J. Costello in 1987, and validity data were gathered as part of the Great Smokey Mountain epidemiological study in Western North Carolina.

The questionnaire consists of a variety of statements describing feelings or behaviours that may manifest as depressive symptoms in children between the ages of 6 and 17. The subject is asked to indicate how much each statement applies to their recent experiences. The Mood and Feelings Questionnaire has six versions, short (13 item) and long (33 item) forms of each of the following:

  • A youth self-report;
  • A version that a parent would complete; and
  • A self-report version for adults.

Several peer-reviewed studies have found the Mood and Feelings Questionnaire to be a reliable and valid measure of depression in children. Compared to many other depression scales for youth, it has more extensive coverage of symptoms and more age-appropriate wording and content.

Scoring and Interpretation

The MFQ has several tests, one short and one long, with the short questionnaire including 13 questions and the long questionnaire consisting of 33 questions. Scoring of the MFQ works by summing the point values allocated to each question. The responses and their allocated point values are as follows:

  • “not true” = 0 points.
  • “somewhat true” = 1 point.
  • “true” = 2 points.

Scores on the short MFQ range from 0 to 26, whereas scores on the long version range from 0 to 66. Higher score are indicative of increased depressive symptom severity. Scores larger than 12 on the short version or larger than 27 on the long version are suggestive of likely depression and warrant further clinical assessment.

Validity

The Mood and Feelings Questionnaire, along with the Short Mood and Feelings Questionnaire, shows reasonable psychometric properties for identifying children in early adolescence with a depressive disorder. Secondly, the MFQ does not significantly differentiate between children with depression versus children with anxiety disorders. Finally, the MFQ has been translated into Arabic, Spanish and Norwegian, but testing of these versions is more limited.

Limitations

Questionnaires like the Mood and Feelings Questionnaire should not act as a substitute for thorough clinical evaluations for both the child and parent.

What is Catatonia?

Introduction

Catatonia is a neuropsychiatric behavioural syndrome that is characterised by abnormal movements, immobility, abnormal behaviours, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. There are several subtypes of catatonia: akinetic catatonia, excited catatonia, malignant catatonia, and other forms.

Although catatonia has historically been related to schizophrenia (catatonic schizophrenia), catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurologic, and medical conditions. Catatonia is not a stand-alone diagnosis (although some experts disagree), and the term is used to describe a feature of the underlying disorder.

Recognising and treating catatonia is very important as failure to do this can lead to poor outcomes and can be potentially fatal. Treatment with benzodiazepines or ECT can lead to remission of catatonia. There is growing evidence of the effectiveness of the NMDA receptor antagonists amantadine and memantine for benzodiazepine-resistant catatonia. Antipsychotics are sometimes employed, but they can worsen symptoms and have serious adverse effects.

Brief History

It was first described in 1874 by Karl Ludwig Kahlbaum as Die Katatonie oder das Spannungsirresein (Catatonia or Tension Insanity).

Aetiology/Causes

Catatonia is almost always secondary to another underlying illness, often a psychiatric disorder. Mood disorders such as a bipolar disorder and depression are the most common aetiologies to progress to catatonia. Other psychiatric associations include schizophrenia and other primary psychotic disorders. It also is related to autism spectrum disorders.

Catatonia is also seen in many medical disorders, including infections (such as encephalitis), autoimmune disorders, meningitis, focal neurological lesions (including strokes), alcohol withdrawal, abrupt or overly rapid benzodiazepine withdrawal, cerebrovascular disease, neoplasms, head injury, and some metabolic conditions (homocystinuria, diabetic ketoacidosis, hepatic encephalopathy, and hypercalcaemia).

Epidemiology

Catatonia has been mostly studied in acutely ill psychiatric patients. Catatonia frequently goes unrecognised, leading to the belief that the syndrome is rare, however, this is not true and prevalence has been reported to be as high as 10% in patients with acute psychiatric illnesses. 21-46% of all catatonia cases can be attributed to a general medical condition.

Pathogenesis/Mechanism

The pathophysiology that leads to catatonia is still poorly understood and a definite mechanism remains unknown. Neurologic studies have implicated several pathways, however, it remains unclear whether these findings are the cause or the consequence of the disorder.

Abnormalities in GABA, glutamate signalling, serotonin, and dopamine transmission are believed to be implicated in catatonia.

Furthermore, it has also been hypothesized that pathways that connect the basal ganglia with the cortex and thalamus is involved in the development of catatonia.

Signs and Symptoms

The presentation of a patient with catatonia varies greatly depending on the subtype, underlying cause and it can be acute or subtle.

Because most patients with catatonia have an underlying psychiatric illness, the majority will present with worsening depression, mania, or psychosis followed by catatonia symptoms. Catatonia presents as a motor disturbance in which patients will display marked reduction in movement, marked agitation, or a mixture of both despite having the physical capacity to move normally. These patients may be unable to start an action or stop one. Movements and mannerisms may be repetitive, or purposeless.

The most common signs of catatonia are immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing (rigidity), rigidity, waxy flexibility/catalepsy, stereotypy (purposeless, repetitive movements), echolalia or echopraxia, verbigeration (repeat meaningless phrases). It should not be assumed that patients presenting with catatonia are unaware of their surroundings as some patients can recall in detail their catatonic state and their actions.

There are several subtypes of catatonia and they are characterised by the specific movement disturbance and associated features. Although catatonia can be divided into various subtypes, the natural history of catatonia is often fluctuant and different states can exist within the same individual.

Subtypes

  • Retarded/Withdrawn Catatonia:
    • This form of catatonia is characterised by decreased response to external stimuli, immobility or inhibited movement, mutism, staring, posturing, and negativism.
    • Patients may sit or stand in the same position for hours, may hold odd positions, and may resist movement of their extremities.
  • Excited Catatonia:
    • Excited catatonia is characterised by odd mannerisms/gestures, performing purposeless or inappropriate actions, excessive motor activity restlessness, stereotypy, impulsivity, agitation, combativeness.
    • Speech and actions may be repetitive or mimic another person’s.
    • People in this state are extremely hyperactive and may have delusions and hallucinations.
    • Catatonic excitement is commonly cited as one of the most dangerous mental states in psychiatry.
  • Malignant Catatonia:
    • Malignant catatonia is a life-threatening condition that may progress rapidly within a few days. It is characterised by fever, abnormalities in blood pressure, heart rate, respiratory rate, diaphoresis (sweating), and delirium.
    • Certain lab findings are common with this presentation, however, they are nonspecific which means that they are also present in other conditions and do not diagnose catatonia.
    • These lab findings include: leukocytosis, elevated creatine kinase, low serum iron.
    • The signs and symptoms of malignant catatonia overlap significantly with neuroleptic malignant syndrome (NMS) and so a careful history, review of medications, and physical exam are critical to properly differentiate these conditions.
    • For example, if the patient has waxy flexibility and holds a position against gravity when passively moved into that position, then it is likely catatonia.
    • If the patient has a “lead-pipe rigidity” then NMS should be the prime suspect.

Diagnosis

There is not yet a definitive consensus regarding diagnostic criteria of catatonia. In the American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the World Health Organisation’s eleventh edition of the International Classification of Disease (ICD-11) the classification is more homogeneous than in earlier editions. Prominent researchers in the field have other suggestions for diagnostic criteria.

DSM-5 Classification

The DSM-5 does not classify catatonia as an independent disorder, but rather it classifies it as catatonia associated with another mental disorder, due to another medical condition, or as unspecified catatonia. Catatonia is diagnosed by the presence of three or more of the following 12 psychomotor symptoms in association with the above mentioned mental disorder, medical condition, or unspecified.

  • Stupor: no psycho-motor activity; not actively relating to environment.
  • Catalepsy: passive induction of a posture held against gravity.
  • Waxy flexibility: allowing positioning by examiner and maintaining that position.
  • Mutism: no, or very little, verbal response (exclude if known aphasia).
  • Negativism: opposition or no response to instructions or external stimuli.
  • Posturing: spontaneous and active maintenance of a posture against gravity.
  • Mannerisms that are odd, circumstantial caricatures of normal actions.
  • Stereotypy: repetitive, abnormally frequent, non-goal-directed movements.
  • Agitation, not influenced by external stimuli.
  • Grimacing: keeping a fixed facial expression.
  • Echolalia: mimicking another’s speech.
  • Echopraxia: mimicking another’s movements.

Other disorders (additional code 293.89 [F06.1] to indicate the presence of the co-morbid catatonia):

  • Catatonia associated with autism spectrum disorder.
  • Catatonia associated with schizophrenia spectrum and other psychotic disorders.
  • Catatonia associated with brief psychotic disorder.
  • Catatonia associated with schizophreniform disorder.
  • Catatonia associated with schizoaffective disorder.
  • Catatonia associated with substance-induced psychotic disorder.
  • Catatonia associated with bipolar and related disorders.
  • Catatonia associated with major depressive disorder.
  • Catatonic disorder due to another medical condition.
  • If catatonic symptoms are present but do not form the catatonic syndrome, a medication- or substance-induced aetiology should first be considered.

ICD-11 Classification

In ICD-11 catatonia is defined as a syndrome of primarily psychomotor disturbances that is characterised by the simultaneous occurrence of several symptoms such as stupor; catalepsy; waxy flexibility; mutism; negativism; posturing; mannerisms; stereotypies; psychomotor agitation; grimacing; echolalia and echopraxia. Catatonia may occur in the context of specific mental disorders, including mood disorders, schizophrenia or other primary psychotic disorders, and Neurodevelopmental disorders, and may be induced by psychoactive substances, including medications. Catatonia may also be caused by a medical condition not classified under mental, behavioural, or neurodevelopmental disorders.

Assessment/Physical

Catatonia is often overlooked and under-diagnosed. Patients with catatonia most commonly have an underlying psychiatric disorder, for this reason, physicians may overlook signs of catatonia due to the severity of the psychosis the patient is presenting with. Furthermore, the patient may not be presenting with the common signs of catatonia such as mutism and posturing. Additionally, the motor abnormalities seen in catatonia are also present in psychiatric disorders. For example, a patient with mania will show increased motor activity that may progress to excited catatonia. One way in which physicians can differentiate between the two is to observe the motor abnormality. Patients with mania present with increased goal-directed activity. On the other hand, the increased activity in catatonia is not goal-directed and often repetitive.

Catatonia is a clinical diagnosis and there is no specific laboratory test to diagnose it. However, certain testing can help determine what is causing the catatonia. An EEG will likely show diffuse slowing. If a seizure activity is driving the syndrome, then an EEG would also be helpful in detecting this. CT or MRI will not show catatonia; however, they might reveal abnormalities that might be leading to the syndrome. Metabolic screens, inflammatory markers, or autoantibodies may reveal reversible medical causes of catatonia.

Vital signs should be frequently monitored as catatonia can progress to malignant catatonia which is life-threatening. Malignant catatonia is characterised by fever, hypertension, tachycardia, and tachypnoea.

Rating Scale

Various rating scales for catatonia have been developed, however, their utility for clinical care has not been well established. The most commonly used scale is the Bush-Francis Catatonia Rating Scale (BFCRS) (downloadable PDF). The scale is composed of 23 items with the first 14 items being used as the screening tool. If 2 of the 14 are positive, this prompts for further evaluation and completion of the remaining 9 items.

A diagnosis can be supported by the lorazepam challenge or the zolpidem challenge. While proven useful in the past, barbiturates are no longer commonly used in psychiatry; thus the option of either benzodiazepines or ECT.

Differential Diagnosis

The differential diagnosis of catatonia is extensive as signs and symptoms of catatonia may overlap significantly with those of other conditions. Therefore, a careful and detailed history, medication review, and physical exam are key to diagnosing catatonia and differentiating it from other conditions. Furthermore, some of these conditions can themselves lead to catatonia. The differential diagnosis is as follows:

  • Neuroleptic malignant syndrome (NMS):
    • Malignant catatonia and NMS are both life-threatening conditions that share many of the same characteristics including fever, autonomic instability, rigidity, and delirium.
    • Lab values of low serum iron, elevated creatine kinase, and white blood cell count are also shared by the two disorders further complicating the diagnosis.
    • Some experts consider NMS a drug-induced form of catatonia, however, it has not been established as a subtype.
    • There are features of malignant catatonia (posturing, impulsivity, etc) that are absent from NSM and the lab results are not as consistent in malignant catatonia as they are in NMS.
    • NMS is a drug-induced condition associated with antipsychotics, particularly, first generation antipsychotics.
    • Therefore, discontinuing antipsychotics and starting benzodiazepines is a treatment for this condition, and similarly it is helpful in catatonia as well.
  • Anti-NMDA receptor encephalitis:
    • Anti-NMDA receptor encephalitis is an autoimmune disorder characterised by neuropsychiatric features and the presence of IgG antibodies.
    • The presentation of anti-NMDAR encephalitis has been categorized into 5 phases: prodromal phase, psychotic phase, unresponsive phase, hyperkinetic phase, and recovery phase.
    • The psychotic phase progresses into the unresponsive phase characterized by mutism, decreased motor activity, and catatonia.
  • Serotonin syndrome:
    • Both serotonin syndrome and malignant catatonia may present with signs and symptoms of delirium, autonomic instability, hyperthermia, and rigidity.
    • Again, similar to the presentation in NSM. However, patients with Serotonin syndrome have a history of ingestion of serotonergic drugs (Ex: SSRI).
    • These patients will also present with hyperreflexia, myoclonus, nausea, vomiting, and diarrhoea.
  • Malignant hyperthermia:
    • Malignant hyperthermia and malignant catatonia share features of autonomic instability, hyperthermia, and rigidity.
    • However, malignant hyperthermia is a hereditary disorder of skeletal muscle that makes these patients susceptible to exposure to halogenated anaesthetics and/or depolarising muscle relaxants like succinylcholine.
    • Malignant hyperthermia most commonly occurs in the intraoperative or postoperative periods. Other signs and symptoms of malignant hyperthermia include metabolic and respiratory acidosis, hyperkalaemia, and cardiac arrhythmias.
  • Akinetic mutism:
    • Akinetic mutism is a neurological disorder characterised by a decrease in goal-directed behaviour and motivation, however, the patient has an intact level of consciousness.
    • Patients may present with apathy, and may seem indifferent to pain, hunger, or thirst.
    • Akinetic mutism has been associated with structural damage in a variety of brain areas.
    • Akinetic mutism and catatonia may both manifest with immobility, mutism, and waxy flexibility.
    • Differentiating both disorders is the fact that akinetic mutism does not present with echolalia, echopraxia, or posturing.
    • Furthermore, it is not responsive to benzodiazepines as is the case for catatonia.
  • Elective mutism:
    • Elective mutism has an anxious aetiology but has also been associated with personality disorders.
    • Patients with this disorder fail to speak with some individuals but will speak with others.
    • Likewise, they may refuse to speak in certain situations, for example, a child who refuses to speak at school but is conversational at home.
    • This disorder is distinguished from catatonia by the absence of any other signs/symptoms.
  • Non-convulsive status epilepticus:
    • Non-convulsive status epilepticus is seizure activity with no accompanying tonic-clonic movements.
    • It can present with stupor, similar to catatonia, and they both respond to benzodiazepines.
    • Non-convulsive status epilepticus is diagnosed by the presence of seizure activity seen on electroencephalogram (EEG).
    • Catatonia on the other hand, is associated with normal EEG or diffuse slowing.
  • Delirium:
    • Delirium is characterised by fluctuating disturbed perception and consciousness in the ill individual.
    • It has hypoactive and hyperactive or mixed forms. People with hyperactive delirium present similarly to those with excited catatonia and have symptoms of restlessness, agitation and aggression.
    • Those with hypoactive delirium present with similarly to retarded catatonia, withdrawn and quiet.
    • However, catatonia also includes other distinguishing features including posturing and rigidity as well as a positive response to benzodiazepines.
  • Locked-in syndrome:
    • Patients with locked-in syndrome present with immobility and mutism, however, unlike patients with catatonia who are unmotivated to communicate, patients with locked-in syndrome try to communicate with eye movements and blinking.
    • Furthermore, locked-in syndrome is caused by damage to the brainstem.
  • Stiff-person syndrome:
    • Catatonia and stiff-person syndrome are similar in that they may both present with rigidity, autonomic instability and a positive response to benzodiazepines.
    • However, stiff-person syndrome may be associated with anti-glutamic acid decarboxylase (anti-GAD) antibodies and other catatonic signs such as mutism and posturing are not part of the syndrome.
  • Parkinson’s disease:
    • Untreated late-stage Parkinson’s disease may present similarly to retarded catatonia with symptoms of immobility, rigidity, and difficulty speaking.
    • Further complicating the diagnosis is the fact that many patients with Parkinson’s disease will have major depressive disorder which may be the underlying cause of catatonia.
    • Parkinson’s disease can be distinguished from catatonia by a positive response to levodopa.
    • Catatonia on the other hand will show a positive response to benzodiazepines.

Treatment

The initial treatment of catatonia is to stop medication that could be potentially leading to the syndrome. These may include steroids, stimulants, anticonvulsants, neuroleptics, dopamine blockers, etc. The next step is to provide a “lorazepam challenge,” in which patients are given 2 mg of IV lorazepam (or another benzodiazepine). Most patients with catatonia will respond significantly to this within the first 15-30 minutes. If no change is observed during the first dose, then a second dose is given and the patient is re-examined. If the patient responds to the lorazepam challenge, then lorazepam can be scheduled at interval doses until the catatonia resolves. The lorazepam must be tapered slowly, otherwise, the catatonia symptoms may return. The underlying cause of the catatonia should also be treated during this time. If within a week the catatonia is not resolved, then ECT can be used to reverse the symptoms. ECT in combination with benzodiazepines is used to treat malignant catatonia. In France, zolpidem has also been used in diagnosis, and response may occur within the same time period. Ultimately the underlying cause needs to be treated.

Electroconvulsive therapy (ECT) is an effective treatment for catatonia that is well acknowledged. ECT has also shown favourable outcomes in patients with chronic catatonia. However, it has been pointed out that further high quality randomised controlled trials are needed to evaluate the efficacy, tolerance, and protocols of ECT in catatonia.

Antipsychotics should be used with care as they can worsen catatonia and are the cause of neuroleptic malignant syndrome, a dangerous condition that can mimic catatonia and requires immediate discontinuation of the antipsychotic.

Excessive glutamate activity is believed to be involved in catatonia; when first-line treatment options fail, NMDA antagonists such as amantadine or memantine may be used. Amantadine may have an increased incidence of tolerance with prolonged use and can cause psychosis, due to its additional effects on the dopamine system. Memantine has a more targeted pharmacological profile for the glutamate system, reduced incidence of psychosis and may therefore be preferred for individuals who cannot tolerate amantadine. Topiramate is another treatment option for resistant catatonia; it produces its therapeutic effects by producing glutamate antagonism via modulation of AMPA receptors.

Complications, Outcomes, and Recurrence

Patients may suffer several complications from being in a catatonic state. The nature of these complications will depend on the type of catatonia being experienced by the patient. For example, patients presenting with retarded catatonia may have refusal to eat which will in turn lead to malnutrition and dehydration. Furthermore, if immobility is a symptom the patient is presenting with, then they may develop pressure ulcers, muscle contractions, and are at risk of developing deep vein thrombosis (DVT) and pulmonary embolus (PE). Patients with excited catatonia may be aggressive and violent, and physical trauma may result from this. Catatonia may progress to the malignant type which will present with autonomic instability and may be life threatening. Other complications also include the development of pneumonia and neuroleptic malignant syndrome.[2]

Patients who experience an episode of catatonia are more likely to suffer recurrence. Treatment response for patients with catatonia is 50-70% and these patients have a good prognosis. However, failure to respond to medication is a very poor prognosis. Many of these patients will require long-term and continuous mental health care. For patients with catatonia with underlying schizophrenia, the prognosis is much poorer.

What is Behaviour Therapy?

Introduction

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 learning theory, such as 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 felt to be 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 behaviour”. 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 “behaviour 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 programme 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. 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 (CBT). 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 strengthen or weaken certain behaviours.

Contingency management programmes 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 persons 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 desensitisation, 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 desensitisation 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 programmes 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 indicates that both behaviour therapy and cognitive-behavioural therapy (CBT) are equally effective for OCD. CBT has 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 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. 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 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 doesn’t 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 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, therapists are 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 don’t consider the success an accomplishment. Generally, in those not suffering from 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

The third-generation behaviour therapy movement has been called clinical behaviour analysis because 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), behavioural activation (BA), dialectical behavioural 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.

ACT may be the most well-researched of all the third-generation behaviour therapy models. It is based on relational frame theory. 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.

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 (1969) 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.

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 Behaviour Therapy 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 an 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 the 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.

Methods

  • Behaviour management.
  • Behaviour modification.
  • Clinical behaviour analysis.
  • Contingency management.
  • Covert conditioning.
  • Decoupling.
  • Exposure and response prevention.
  • Flooding.
  • Habit reversal training.
  • Matching law.
  • Modelling.
  • Observational learning.
  • Operant conditioning.
  • Professional practice of behaviour analysis.
  • Respondent conditioning.
  • Stimulus control.
  • Systematic desensitisation.

Reference

Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.

What is a Licensed Behaviour Analyst?

Introduction

A licensed behaviour analyst is a type of behavioural health professional in the United States.

They have at least a master’s degree, and sometimes a doctorate, in behaviour analysis or a related field.

Behaviour analysts apply radical behaviourism, or applied behaviour analysis, to people.

Defining the Scope of Practice

The Behaviour Analyst Certification Board (BACB) defines behaviour analysis as follows:

“The analysis. The experimental analysis of behavior (EAB) is the basic science of this field and has over many decades accumulated a substantial and well-respected research literature. This literature provides the scientific foundation for applied behavior analysis (ABA), which is both an applied science that develops methods of changing behavior and a profession that provides services to meet diverse behavioral needs. Briefly, professionals in applied behavior analysis engage in the specific and comprehensive use of principles of learning, including operant and respondent learning, in order to address behavioral needs of widely varying individuals in diverse settings. Examples of these applications include: building the skills and achievements of children in school settings; enhancing the development, abilities, and choices of children and adults with different kinds of disabilities; and augmenting the performance and satisfaction of employees in organizations and businesses.”

As the above suggests, behaviour analysis is based on the principles of operant and respondent conditioning. This places behaviour analysis as one of the dominant models of behaviour management, behavioural engineering and behaviour therapy. Behaviour analysis is an active, environmental based approach and some behaviour analytic procedures are considered highly restrictive (see least restrictive environment). For example, these service may make access to preferred items contingent on performance. This has led to abuses in the past, in particular where punishment programmes have been involved. In addition, failure to be an independent profession often leads behaviour analysts and other behaviour modifiers to have their ethical codes supplanted by those of other professions. For example, a behaviour analyst working in the hospital setting might design a token economy, a form of contingency management. He may desire to meet his ethical obligation to make the program habilitative and in the clients’ best long-term interest. The physicians and nurses in the hospital who supervise him may decide that the token economy should instead create order in the nursing routines so clients get their medication quickly and efficiently. Instead of the ethical code of the BACB and the Association for Behaviour Analysis International’s position that those receiving treatment have a right to effective treatment and a right to effective education. In addition, failure on the part of a behaviour analyst to adequately supervise his or her workers could lead to abuse. Finally, misrepresentations of the field and historical problems between academics has led to frequent calls to professionalise behaviour analysis.

In general, there is wide support within the profession for licensure.

Range of Populations Worked With

The professional practice of behaviour analysis ranges from treatment of individuals with autism and developmental disabilities to behavioural coaching and behavioural psychotherapy. In addition to treatment of mental health problems and corrections, the professional practice of behaviour analysis includes organisational behavioural management, behavioural safety and even maintaining the behavioural health of astronauts while within and beyond earth’s orbit.

Certification

The BACB offers a technical certificate in behaviour analysis. This certification is internationally recognised. This certification states the level of training and requires an exam to show a minimum level of competence to call oneself a board certified behaviour analyst (BCBA). Certification came about because of many ethical issues with behavioural interventions being delivered including the use of aversive and humiliating treatments in the name of behaviour modification. The American Psychological Association offers a diplomate (post Ph.D. and licensed certification) in behavioural psychology.

The Meaning of Certification

BACB is a private non-profit organisation without governmental powers to regulate behaviour analytic practice. While the BACB certification means that candidates have satisfied entry-level requirements in behaviour analytic training, certificants may require a government license for independent practice when treating behavioural health or medical problems. Licensed certificants must operate within the scope of their license and must practice within their areas of expertise. Where the government regulates behavior analytic services unlicensed certificants must be supervised by a licensed professional and operate within the scope of their supervisor’s license when treating disorders. Unlicensed certificants who provide behaviour analytic training for educational or optimal performance purposes do not require licensed supervision. Where the government does not regulate the treatment of medical or psychological disorders certificants should practice in accord with the laws of their state, province, or country. All certificants must practice within their personal areas of expertise.

Licensure

Recently, a move has occurred to license behaviour analysts. Licensure’s purpose is to protect the public from employing unqualified practitioners.

The model licensing act states that a person is a behaviour analyst by training and experience. The person seeking licensure must have mastered behaviour analysis by achieving a master’s degree in behaviour analysis or related subject matter. Like all other master level licensed professions the model act sets the standard for a master’s degree. This requirement states that the person has achieved textbook knowledge of behaviour analysis which can be then tested through the exam offered by the BACB or the one offered by the World Centre for Behaviour Analysis. It also requires an internship in which a behaviour analysts works under another master or Ph.D. level behaviour analyst for a period of one year (750 hours) with at least two hours/week of supervision. Finally, those 750 hours are considered tutelage time. After that, the behaviour analyst must engage in supervised practice under a behaviour analyst for a period of another 2 years (2,000 hours).

Once this process is complete, the person applies to a state board who ensures that he or she has indeed met the above conditions. Once the person is licensed public protection is still monitored by the licensing board, which makes sure that the person receives sufficient ongoing education, and the licensing board investigates ethical complaints. A licensed behaviour analyst would have equal training, knowledge, skills and abilities in their discipline as would a mental health counsellor or marriage and family therapist in their discipline. In February 2008, Indiana, Arizona, Massachusetts, Vermont, Oklahoma and other states now have legislation pending to create licensure for behaviour analysts. Pennsylvania was the first state in 2008 to license “behaviour specialists” to cover behaviour analysts. Arizona, less than three weeks later, became the first state to license “behaviour analysts.” Other states such as New York, Nevada and Wisconsin also have passed behaviour analytic licensure.

Professional Organisations

The Association for Behaviour Analysis International has a special interest group for practitioner issues, which focuses on key issues related to licensing behaviour analysts. In addition, they have a practice board and a policy board to handle legislative issues ABA:I. Finally, the association has recently put out its own model licensing act for behaviour analysts.

Association for behaviour analysis international serves as the core intellectual home for behaviour analysts. The Association for Behaviour Analysis International sponsors 2 conferences per year – one in the US and one international.

What is Fundamental Attribution Error?

Introduction

In social psychology, fundamental attribution error (FAE), also known as correspondence bias or attribution effect, is the tendency for people to under-emphasize situational explanations for an individual’s observed behaviour while over-emphasizing dispositional and personality-based explanations for their behaviour.

This effect has been described as “the tendency to believe that what people do reflects who they are”, that is, to overattribute their behaviours (what they do or say) to their personality and under-attribute them to the situation or context.

Background

The phrase was coined by Lee Ross some years after a classic experiment by Edward E. Jones and Victor Harris (1967). Ross argued in a popular paper that the fundamental attribution error forms the conceptual bedrock for the field of social psychology. Jones wrote that he found Ross’s phrase “overly provocative and somewhat misleading”, and also joked: “Furthermore, I’m angry that I didn’t think of it first.” Some psychologists, including Daniel Gilbert, have used the phrase “correspondence bias” for the fundamental attribution error. Other psychologists have argued that the fundamental attribution error and correspondence bias are related but independent phenomena, with the former being a common explanation for the latter.

As a simple example of the behaviour which attribution error theory seeks to explain, consider the situation where Alice, a driver, is cut off in traffic by Bob. Alice attributes Bob’s behaviour to his fundamental personality, e.g. he thinks only of himself, he is selfish, he is a jerk, he is an unskilled driver; she does not think it is situational, e.g. he is going to miss his flight, his wife is giving birth at the hospital, his daughter is convulsing at school. Alice might well make the opposite mistake and excuse herself by saying she was influenced by situational causes, e.g. I am late for my job interview, I must pick up my son for his dental appointment, rather than thinking she has a character flaw, e.g. I am such a jerk, I treat others in contempt, I am bad at driving.

Classic Demonstration Study: Jones and Harris (1967)

Jones and Harris hypothesized, based on the correspondent inference theory, that people would attribute apparently freely chosen behaviours to disposition and apparently chance-directed behaviours to situation. The hypothesis was confounded by the fundamental attribution error.

Subjects in an experiment read essays for and against Fidel Castro. Then they were asked to rate the pro-Castro attitudes of the writers. When the subjects believed that the writers freely chose positions for or against Castro, they would normally rate the people who liked Castro as having a more positive attitude towards Castro. However, contradicting Jones and Harris’ initial hypothesis, when the subjects were told that the writers’ positions were determined by a coin toss, they still rated writers who spoke in favour of Castro as having, on average, a more positive attitude towards Castro than those who spoke against him. In other words, the subjects were unable to properly see the influence of the situational constraints placed upon the writers; they could not refrain from attributing sincere belief to the writers. The experimental group provided more internal attributions towards the writer.

Criticism

The hypothesis that people systematically tend to overattribute behaviour to traits (at least for other people’s behaviour) is contested. Epstein and Teraspulsky tested whether subjects over-, under-, or correctly estimate the empirical correlation among behaviours (These behavioural consistencies are what “traits” describe). They found that estimates of correlations among behaviours correlated strongly with empirically observed correlations among these behaviours. Subjects were sensitive to even very small correlations, and their confidence in the association tracked how far they were discrepant (i.e. if they knew when they did not know), and was higher for the strongest relations. Subjects also showed awareness of the effect of aggregation over occasions and used reasonable strategies to arrive at decisions. Epstein concluded that “Far from being inveterate trait believers, as has been previously suggested, [subjects’] intuitions paralleled psychometric principles in several important respects when assessing relations between real-life behaviours.”

While described as “robust, firmly established, and pervasive”, meta-analysis of the 173 qualified studies of the actor-observer asymmetry available by 2005 established, surprisingly, an effect size of near zero. These analyses allowed a systematic review of where, if at all, the effect holds. These analyses showed that the asymmetry was found only when:

  1. The other person was portrayed as being very unusual;
  2. When hypothetical (rather than real) events were explained;
  3. When people were intimate (knew each other well); or
  4. When researcher degrees of freedom were high.

It appeared that in these circumstances two asymmetries were observed: negative events were asymmetrically attributed to traits in others, but the reverse held for positive events, supporting a self-serving bias rather than an actor–observer asymmetry. See also the 2006 meta-analysis by Malle.

Explanations

Several theories predict the fundamental attribution error, and thus both compete to explain it, and can be falsified if it does not occur. Leading examples include:

  • Just-world fallacy:
    • The belief that people get what they deserve and deserve what they get, the concept of which was first theorized by Melvin J. Lerner (1977).
    • Attributing failures to dispositional causes rather than situational causes – which are unchangeable and uncontrollable – satisfies our need to believe that the world is fair and that we have control over our lives.
    • We are motivated to see a just world because this reduces our perceived threats, gives us a sense of security, helps us find meaning in difficult and unsettling circumstances, and benefits us psychologically.
    • Unfortunately, the just-world hypothesis also results in a tendency for people to blame and disparage victims of an accident or a tragedy, such as rape and domestic abuse, to reassure themselves of their insusceptibility to such events.
    • People may even blame the victim’s faults in a “past life” to pursue justification for their bad outcome.
  • Salience of the actor:
    • We tend to attribute an observed effect to potential causes that capture our attention.
    • When we observe other people, the person is the primary reference point while the situation is overlooked as if it is nothing but mere background.
    • As such, attributions for others’ behaviour are more likely to focus on the person we see, not the situational forces acting upon that person that we may not be aware of.
    • When we observe ourselves, we are more aware of the forces acting upon us.
    • Such a differential inward versus outward orientation accounts for the actor-observer bias.
  • Lack of effortful adjustment:
    • Sometimes, even though we are aware that the person’s behaviour is constrained by situational factors, we still commit the fundamental attribution error.
    • This is because we do not take into account behavioural and situational information simultaneously to characterise the dispositions of the actor.
    • Initially, we use the observed behaviour to characterise the person by automaticity.
    • We need to make deliberate and conscious effort to adjust our inference by considering the situational constraints.
    • Therefore, when situational information is not sufficiently taken into account for adjustment, the uncorrected dispositional inference creates the fundamental attribution error.
    • This would also explain why people commit the fundamental attribution error to a greater degree when they are under cognitive load; i.e. when they have less motivation or energy for processing the situational information.
  • Culture:
    • It has been suggested cultural differences occur in attribution error: people from individualistic (Western) cultures are reportedly more prone to the error while people from collectivistic cultures are less prone.
    • Based on cartoon-figure presentations to Japanese and American subjects, it has been suggested that collectivist subjects may be more influenced by information from context (for instance being influenced more by surrounding faces in judging facial expressions).
    • Alternatively, individualist subjects may favour processing of focal objects, rather than contexts.
    • Others suggest Western individualism is associated with viewing both oneself and others as independent agents, therefore focusing more on individuals rather than contextual details.

Versus Correspondence Bias

The fundamental attribution error is commonly used interchangeably with “correspondence bias” (sometimes called “correspondence inference”), although this phrase refers to a judgment which does not necessarily constitute a bias, which arises when the inference drawn is incorrect, e.g. dispositional inference when the actual cause is situational). However, there has been debate about whether the two terms should be distinguished from each other. Three main differences between these two judgmental processes have been argued:

  • They seem to be elicited under different circumstances, as both correspondent dispositional inferences and situational inferences can be elicited spontaneously.
    • Attributional processing, however, seems to only occur when the event is unexpected or conflicting with prior expectations.
    • This notion is supported by a study conducted by Semin and Marsman (1994), which found that different types of verbs invited different inferences and attributions.
    • Correspondence inferences were invited to a greater degree by interpretative action verbs (such as “to help”) than state action or state verbs, thus suggesting that the two are produced under different circumstances.
  • Correspondence inferences and causal attributions also differ in automaticity.
    • Inferences can occur spontaneously if the behaviour implies a situational or dispositional inference, while causal attributions occur much more slowly (e.g. Smith & Miller, 1983).
  • It has also been suggested that correspondence inferences and causal attributions are elicited by different mechanisms.
    • It is generally agreed that correspondence inferences are formed by going through several stages.
    • Firstly, the person must interpret the behaviour, and then, if there is enough information to do so, add situational information and revise their inference.
    • They may then further adjust their inferences by taking into account dispositional information as well.
    • Causal attributions however seem to be formed either by processing visual information using perceptual mechanisms, or by activating knowledge structures (e.g. schemas) or by systematic data analysis and processing.
    • Hence, due to the difference in theoretical structures, correspondence inferences are more strongly related to behavioural interpretation than causal attributions.

Based on the preceding differences between causal attribution and correspondence inference, some researchers argue that the fundamental attribution error should be considered as the tendency to make dispositional rather than situational explanations for behaviour, whereas the correspondence bias should be considered as the tendency to draw correspondent dispositional inferences from behaviour. With such distinct definitions between the two, some cross-cultural studies also found that cultural differences of correspondence bias are not equivalent to those of fundamental attribution error. While the latter has been found to be more prevalent in individualistic cultures than collectivistic cultures, correspondence bias occurs across cultures, suggesting differences between the two phrases.

What is Learned Helplessness?

Introduction

Learned helplessness is behaviour exhibited by a subject after enduring repeated aversive stimuli beyond their control. It was initially thought to be caused from the subject’s acceptance of their powerlessness: discontinuing attempts to escape or avoid the aversive stimulus, even when such alternatives are unambiguously presented. Upon exhibiting such behaviour, the subject was said to have acquired learned helplessness.

Over the past few decades, neuroscience has provided insight into learned helplessness and shown that the original theory actually had it backwards: the brain’s default state is to assume that control is not present, and the presence of “helpfulness” is what is actually learned.

In humans, learned helplessness is related to the concept of self-efficacy; the individual’s belief in their innate ability to achieve goals. Learned helplessness theory is the view that clinical depression and related mental illnesses may result from such real or perceived absence of control over the outcome of a situation.

Refer to Learned Optimism.

Foundation of Research and Theory

Early Experiments

American psychologist Martin Seligman initiated research on learned helplessness in 1967 at the University of Pennsylvania as an extension of his interest in depression. This research was later expanded through experiments by Seligman and others. One of the first was an experiment by Seligman & Maier:

  • In Part 1 of this study, three groups of dogs were placed in harnesses.
    • Group 1 dogs were simply put in a harness for a period of time and were later released.
    • Groups 2 and 3 consisted of “yoked pairs”.
    • Dogs in Group 2 were given electric shocks at random times, which the dog could end by pressing a lever.
    • Each dog in Group 3 was paired with a Group 2 dog; whenever a Group 2 dog got a shock, its paired dog in Group 3 got a shock of the same intensity and duration, but its lever did not stop the shock.
    • To a dog in Group 3, it seemed that the shock ended at random, because it was their paired dog in Group 2 that was causing it to stop.
    • Thus, for Group 3 dogs, the shock was “inescapable”.
  • In Part 2 of the experiment the same three groups of dogs were tested in a shuttle-box apparatus (a chamber containing two rectangular compartments divided by a barrier a few inches high).
    • All of the dogs could escape shocks on one side of the box by jumping over a low partition to the other side.
    • The dogs in Groups 1 and 2 quickly learned this task and escaped the shock.
    • Most of the Group 3 dogs – which had previously learned that nothing they did had any effect on shocks – simply lay down passively and whined when they were shocked.

In a second experiment later that year with new groups of dogs, Overmier and Seligman ruled out the possibility that, instead of learned helplessness, the Group 3 dogs failed to avert in the second part of the test because they had learned some behaviour that interfered with “escape”. To prevent such interfering behaviour, Group 3 dogs were immobilised with a paralysing drug (curare), and underwent a procedure similar to that in Part 1 of the Seligman and Maier experiment. When tested as before in Part 2, these Group 3 dogs exhibited helplessness as before. This result serves as an indicator for the ruling out of the interference hypothesis.

From these experiments, it was thought that there was to be only one cure for helplessness. In Seligman’s hypothesis, the dogs do not try to escape because they expect that nothing they do will stop the shock. To change this expectation, experimenters physically picked up the dogs and moved their legs, replicating the actions the dogs would need to take in order to escape from the electrified grid. This had to be done at least twice before the dogs would start wilfully jumping over the barrier on their own. In contrast, threats, rewards, and observed demonstrations had no effect on the “helpless” Group 3 dogs.

Later Experiments

Later experiments have served to confirm the depressive effect of feeling a lack of control over an aversive stimulus. For example, in one experiment, humans performed mental tasks in the presence of distracting noise. Those who could use a switch to turn off the noise rarely bothered to do so, yet they performed better than those who could not turn off the noise. Simply being aware of this option was enough to substantially counteract the noise effect. In 2011, an animal study found that animals with control over stressful stimuli exhibited changes in the excitability of certain neurons in the prefrontal cortex. Animals that lacked control failed to exhibit this neural effect and showed signs consistent with learned helplessness and social anxiety.

Expanded Theories

Research has found that a human’s reaction to feeling a lack of control differs both between individuals and between situations, i.e. learned helplessness sometimes remains specific to one situation but at other times generalises across situations. Such variations are not explained by the original theory of learned helplessness, and an influential view is that such variations depend on an individual’s attributional or explanatory style. According to this view, how someone interprets or explains adverse events affects their likelihood of acquiring learned helplessness and subsequent depression. For example, people with pessimistic explanatory style tend to see negative events as permanent (“it will never change”), personal (“it’s my fault”), and pervasive (“I can’t do anything correctly”), and are likely to suffer from learned helplessness and depression.

Bernard Weiner proposed a detailed account of the attributional approach to learned helplessness. His attribution theory includes the dimensions of globality/specificity, stability/instability, and internality/externality:

  • A global attribution occurs when the individual believes that the cause of negative events is consistent across different contexts.
    • A specific attribution occurs when the individual believes that the cause of a negative event is unique to a particular situation.
  • A stable attribution occurs when the individual believes the cause to be consistent across time.
    • An unstable attribution occurs when the individual thinks that the cause is specific to one point in time.
  • An external attribution assigns causality to situational or external factors,
    • while an internal attribution assigns causality to factors within the person.

Research has shown that those with an internal, stable, and global attributional style for negative events can be more at risk for a depressive reaction to failure experiences.

Neurobiological Perspective

Research has shown that increased 5-HT (serotonin) activity in the dorsal raphe nucleus plays a critical role in learned helplessness. Other key brain regions that are involved with the expression of helpless behaviour include the basolateral amygdala, central nucleus of the amygdala and bed nucleus of the stria terminalis. Activity in medial prefrontal cortex, dorsal hippocampus, septum and hypothalamus has also been observed during states of helplessness.

In the article, “Exercise, Learned Helplessness, and the Stress-Resistant Brain”, Benjamin N. Greenwood and Monika Fleshner discuss how exercise might prevent stress-related disorders such as anxiety and depression. They show evidence that running wheel exercise prevents learned helplessness behaviours in rats. They suggest that the amount of exercise may not be as important as simply exercising at all. The article also discusses the neurocircuitry of learned helplessness, the role of serotonin (or 5-HT), and the exercise-associated neural adaptations that may contribute to the stress-resistant brain. However, the authors finally conclude that:

“The underlying neurobiological mechanisms of this effect, however, remain unknown. Identifying the mechanisms by which exercise prevents learned helplessness could shed light on the complex neurobiology of depression and anxiety and potentially lead to novel strategies for the prevention of stress-related mood disorders”.

Health Implications

People who perceive events as uncontrollable show a variety of symptoms that threaten their mental and physical well-being. They experience stress, they often show disruption of emotions demonstrating passivity or aggressiveness, and they can also have difficulty performing cognitive tasks such as problem-solving. They are less likely to change unhealthy patterns of behaviour, causing them, for example, to neglect diet, exercise, and medical treatment.

Depression

Abnormal and cognitive psychologists have found a strong correlation between depression-like symptoms and learned helplessness in laboratory animals.

Young adults and middle-aged parents with a pessimistic explanatory style often suffer from depression. They tend to be poor at problem-solving and cognitive restructuring, and also tend to demonstrate poor job satisfaction and interpersonal relationships in the workplace. Those with a pessimistic style also tend to have weakened immune systems, having not only increased vulnerability to minor ailments (e.g. cold, fever) and major illness (e.g. heart attack, cancers), but also poorer recovery from health problems.

Social Impact

Learned helplessness can be a factor in a wide range of social situations.

  • In emotionally abusive relationships, the victim often develops learned helplessness.
    • This occurs when the victim confronts or tries to leave the abuser only to have the abuser dismiss or trivialise the victim’s feelings, pretend to care but not change, or impede the victim from leaving.
  • The motivational effect of learned helplessness is often seen in the classroom.
    • Students who repeatedly fail may conclude that they are incapable of improving their performance, and this attribution keeps them from trying to succeed, which results in increased helplessness, continued failure, loss of self-esteem and other social consequences.
  • Child abuse by neglect can be a manifestation of learned helplessness.
    • For example, when parents believe they are incapable of stopping an infant’s crying, they may simply give up trying to do anything for the child.
  • Those who are extremely shy or anxious in social situations may become passive due to feelings of helplessness.
    • Gotlib and Beatty (1985) found that people who cite helplessness in social settings may be viewed poorly by others, which tends to reinforce the passivity.
  • Aging individuals may respond with helplessness to the deaths of friends and family members, the loss of jobs and income, and the development of age-related health problems.
    • This may cause them to neglect their medical care, financial affairs, and other important needs.
  • According to Cox et al., Abramson, Devine, and Hollon (2012), learned helplessness is a key factor in depression that is caused by inescapable prejudice (i.e. “deprejudice”).
    • Thus: “Helplessness born in the face of inescapable prejudice matches the helplessness born in the face of inescapable shocks.”
  • According to Ruby K. Payne’s book A Framework for Understanding Poverty, treatment of the poor can lead to a cycle of poverty, a culture of poverty, and generational poverty.
    • This type of learned helplessness is passed from parents to children.
    • People who embrace this mentality feel there is no way to escape poverty and so one must live in the moment and not plan for the future, trapping families in poverty.

Social problems resulting from learned helplessness may seem unavoidable to those entrenched. However, there are various ways to reduce or prevent it. When induced in experimental settings, learned helplessness has been shown to resolve itself with the passage of time. People can be immunized against the perception that events are uncontrollable by increasing their awareness of previous experiences, when they were able to effect a desired outcome. Cognitive therapy can be used to show people that their actions do make a difference and bolster their self-esteem.

Extensions

Cognitive scientist and usability engineer Donald Norman used learned helplessness to explain why people blame themselves when they have a difficult time using simple objects in their environment.

The UK educationalist Phil Bagge describes it as a learning avoidance strategy caused by prior failure and the positive reinforcement of avoidance such as asking teachers or peers to explain and consequently do the work. It shows itself as sweet helplessness or aggressive helplessness often seen in challenging problem solving contexts, such as learning to use a new computer programming language.

The US sociologist Harrison White has suggested in his book Identity and Control that the notion of learned helplessness can be extended beyond psychology into the realm of social action. When a culture or political identity fails to achieve desired goals, perceptions of collective ability suffer.

Emergence under Torture

Studies on learned helplessness served as the basis for developing enhanced interrogation techniques. In CIA interrogation manuals, learned helplessness is characterised as “apathy” which may result from prolonged use of coercive techniques which result in a “debility-dependency-dread” state in the subject, “If the debility-dependency-dread state is unduly prolonged, however, the arrestee may sink into a defensive apathy from which it is hard to arouse him.”

On This Day … 27 January

People (Births)

  • 1904 – James J. Gibson, American psychologist and academic (d. 1979).

James J. Gibson

James Jerome Gibson (27 January 1904 to 11 December 1979), was an American psychologist and one of the most important contributors to the field of visual perception.

Gibson challenged the idea that the nervous system actively constructs conscious visual perception, and instead promoted ecological psychology, in which the mind directly perceives environmental stimuli without additional cognitive construction or processing. A Review of General Psychology survey, published in 2002, ranked him as the 88th most cited psychologist of the 20th century, tied with John Garcia, David Rumelhart, Louis Leon Thurstone, Margaret Floy Washburn, and Robert S. Woodworth.

Education and Career

Gibson began his undergraduate career at Northwestern University, but transferred after his freshman year to Princeton University, where he majored in philosophy. While enrolled at Princeton, Gibson had many influential professors including Edwin B. Holt who advocated new realism, and Herbert S. Langfeld who had taught Gibson’s experimental psychology course. After taking Langfeld’s course, Gibson decided to stay at Princeton as a graduate student and pursued his Ph.D. in psychology with Langfeld serving as his doctoral adviser. His doctoral dissertation focused on memory of visual forms, and he received his Ph.D. in 1928.

E.B. Holt, who was taught by William James, inspired Gibson to be a radical empiricist. Holt was a mentor to Gibson. While Gibson may not have directly read William James’ work, E.B. Holt was the connecting factor between the two. Holt’s theory of molar behaviourism brought James philosophy of radical empiricism into psychology. Heft argues that Gibson’s work was an application of William James’. Gibson believed that perception is direct and meaningful. He discussed the meaning of perception through his theory of affordances. Gibson also was influenced by James’ neutral monism, nothing is solely mental or physical.

Gibson started his career at Smith College where he taught psychology. While at Smith, Gibson encountered two influential figures in his life, one of which was the Gestalt psychologist Kurt Koffka. Although Gibson did not agree with Gestalt psychology, he nevertheless agreed with Koffka’s belief that the primary investigations of psychology should be problems related to perception. The other important figure Gibson met during his time at Smith College was his wife, Eleanor Jack, who became a prominent psychologist known for her investigations such as the “visual cliff.” The two were married on 17 September 1932, and later had two children, James Jerome Jr. in 1940 and Jean Grier in 1943.

In 1941, Gibson entered the US Army, where he became the director of a unit for the Army Air Forces’ Aviation Psychology Programme during World War II. Of particular interest to him was the effect flying an aircraft had on visual perception. He used his findings to help develop visual aptitude tests for screening out pilot applicants. He was promoted to the rank of lieutenant colonel in 1946. After the war ended, he returned to Smith College for a short period during which he began writing his first book, The Perception of the Visual World, in which he discussed visual phenomena such as retinal texture gradient and retinal motion gradient. Before the book was published in 1950, Gibson moved to Cornell University where he continued to teach and conduct research for the rest of his life.

What is the Impact of Shame in Body-Focused Repetitive Behaviours & Binge Eating?

Research Paper Title

“Shame on you”: The impact of shame in body-focused repetitive behaviours and binge eating.

Background

Body-focused repetitive behaviours (BFRBs), such as hair-pulling, skin-picking, and nail-biting, have been associated with difficulties in emotion regulation.

Studies have suggested that aversive emotions are important triggers for impulsive behaviours such as BFRBs and binge eating.

In particular, shame has been hypothesized to be a key emotion before and after these behaviours, but no experimental studies yet have investigated its impact on BFRBs.

The researchers aimed to evaluate the role of shame in BFRB and binge eating episodes and the presence of shame following these behaviours.

Methods

Eighteen women with BFRBs, 18 with binge eating, and 18 community controls participated in the study.

Results

Results showed that an experimental shame condition triggered more shame in the binge eating and BFRB groups than in the control group.

In addition, the shame induced condition increased the urge to engage in BFRBs, but not in binge eating.

Conclusions

Results showed that participants from the BFRB and the binge eating groups reported more shame after engaging in their pathological behaviours compared to following the neutral condition.

Future studies should replicate these findings with larger samples and different shame-inducing conditions.

Reference

Houazene, S., Leclerc, J.B., O’Connor, K. & Aardema, F. (2021) “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behaviour Research and Therapy. doi: 10.1016/j.brat.2021.103804. Online ahead of print.

Young People & Impulsivity in the Short-Term Build up to Self-Harm

Research Paper Title

What young people say about impulsivity in the short-term build up to self-harm: A qualitative study using card-sort tasks.

Background

Youth who self-harm report high levels of trait impulsivity and identify impulsive behaviour as a proximal factor directly preceding a self-harm act. Yet, impulsivity is a multidimensional construct and distinct impulsivity-related facets relate differentially to self-harm outcomes.

Studies have yet to examine if and how a multidimensional account of impulsivity is meaningful to individual experiences and understandings of self-harm in youth.

The researchers explored the salience and context of multidimensional impulsivity within narratives of self-harm, and specifically in relation to the short-term build-up to a self-harm episode.

Methods

Fifteen community-based adolescents (aged 16-22 years) attending Further Education (FE) colleges in the UK took part in individual face-to-face sessions (involving exploratory card-sort tasks and semi-structured interviews) which explored factors relating to self-harm, impulsivity and the broader emotional, developmental and cognitive context. Session data were analysed thematically.

Results

Two overarching themes, and associated subthemes, were identified:

  1. ‘How I respond to strong negative emotions’; and
  2. ‘Impulse versus deliberation – How much I think through what I’m doing before I do it’.

Self-harm was typically a quick, impulsive act in the context of overwhelming emotion, underpinned by cognitive processing deficits. The dynamic tension between emotion-based impulsivity and controlled deliberation was articulated in the immediate moments before self-harm. However, impulsive responses were perceived as modifiable. Where self-harm patterns were established, these related to habitual behaviour and quick go-to responses. Young people identified with a multidimensional conception of impulsivity and described the impulsive context of a self-harm act as dynamic, contextual, and developmentally charged.

Conclusions

Findings have implications for youth-focused work. Card-task frameworks are recommended to scaffold and facilitate discussion with young people, particularly where topics are sensitive, complex and multifactorial.

Reference

Lockwood, J., Townsend, E., Allen, H., Daley, D. & Sayal, K. (2020) What young people say about impulsivity in the short-term build up to self-harm: A qualitative study using card-sort tasks. PLoS One. 15(12), pp.e0244319. doi: 10.1371/journal.pone.0244319. eCollection 2020.

What is Behaviourism?

Introduction

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

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

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

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

Branches of Behaviourism

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

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

Modern-Day Theory: Radical Behaviourism

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

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

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

Experimental and Conceptual Innovations

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

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

Relation to Language

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

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

Education

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

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

Operant Conditioning

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

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

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

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

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

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

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

Respondent Conditioning

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

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

In Philosophy

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

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

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

Law of Effect and Trace Conditioning

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

Molecular versus Molar Behaviourism

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

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

Theoretical Behaviourism

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

Behaviour Analysis and Culture

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

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

Behaviour Informatics and Behaviour Computing

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

Criticisms and Limitations

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

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

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

Behaviour Therapy

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

21st-Century Behaviourism (Behaviour Analysis)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cognitive Behaviour Therapy

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

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

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

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

Related Therapies

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