Tag: Behaviour

What is Displacement Activity?

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Introduction

Displacement activities occur when an animal experiences high motivation for two or more conflicting behaviours: the resulting displacement activity is usually unrelated to the competing motivations.

Background

Displacement head-scratching occurs when humans do not know which of two options to choose.

Birds, for example, may peck at grass when uncertain whether to attack or flee from an opponent; similarly, a human may scratch their head when they do not know which of two options to choose. Displacement activities may also occur when animals are prevented from performing a single behaviour for which they are highly motivated. Displacement activities often involve actions which bring comfort to the animal such as scratching, preening, drinking or feeding.

In the assessment of animal welfare, displacement activities are sometimes used as evidence that an animal is highly motivated to perform a behaviour that the environment prevents. One example is that when hungry hens are trained to eat from a particular food dispenser and then find the dispenser blocked, they often begin to pace and preen themselves vigorously. These actions have been interpreted as displacement activities, and similar pacing and preening can be used as evidence of frustration in other situations.

Psychiatrist and primatologist Alfonso Troisi proposed that displacement activities can be used as non-invasive measures of stress in primates. He noted that various non-human primates perform self-directed activities such as grooming and scratching in situations likely to involve anxiety and uncertainty, and that these behaviours are increased by anxiogenic (anxiety-producing) drugs and reduced by anxiolytic (anxiety-reducing) drugs. In humans, he noted that similar self-directed behaviour, together with aimless manipulation of objects (chewing pens, twisting rings), can be used as indicators of “stressful stimuli and may reflect an emotional condition of negative affect”.

More recently the term ‘displacement activity’ has been widely adopted to describe a form of procrastination. It is commonly used in the context of what someone does intentionally to keep themselves busy whilst, at the same time, avoiding doing something else that would be a better use of their time.

Brief History

The subsequent development of research on displacement activities was a direct consequence of Konrad Lorenz’s works on instincts. However, the first mentions of the phenomenon came in 1940 by the two Dutch researchers Nikolaas Tinbergen and Adriaan Kortlandt.

Tinbergen in 1952 noted, for example, that “two skylarks engaged in furious combat [may] suddenly peck at the ground as if they were feeding”, or birds on the point of mating may suddenly begin to preen themselves. Tinbergen adopted the term “displacement activities” because the behaviour appeared to be displaced from one behavioural system into another.

In 1902, in The Little White Bird, J.M. Barrie refers to sheep in Kensington Gardens nibbling the grass in nervous agitation immediately after being shorn, and to Solomon, the wise crow, drinking water when he was frustrated and outwitted in an argument with other birds. Another bird encourages him to drink in order to compose himself. These references to displacement activities in a work of literature indicate that the phenomenon was well recognised at the turn of the twentieth century. A further early description of a displacement activity (though not the use of the term) is by Julian Huxley in 1914.

What is Denialism?

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Introduction

In the psychology of human behaviour, denialism is a person’s choice to deny reality as a way to avoid a psychologically uncomfortable truth.

Denialism is an essentially irrational action that withholds the validation of a historical experience or event, when a person refuses to accept an empirically verifiable reality.

In the sciences, denialism is the rejection of basic facts and concepts that are undisputed, well-supported parts of the scientific consensus on a subject, in favour of ideas that are radical, controversial, or fabricated. The terms Holocaust denial and AIDS denialism describe the denial of the facts and the reality of the subject matters, and the term climate change denial describes denial of the scientific consensus that the climate change of planet Earth is a real and occurring event primarily caused in geologically recent times by human activity. The forms of denialism present the common feature of the person rejecting overwhelming evidence and trying to generate political controversy in attempts to deny the existence of consensus.

The motivations and causes of denialism include religion, self-interest (economic, political, or financial), and defence mechanisms meant to protect the psyche of the denialist against mentally disturbing facts and ideas; such disturbance is called cognitive dissonance in psychology terms.

Definition and Tactics

Anthropologist Didier Fassin distinguishes between denial, defined as “the empirical observation that reality and truth are being denied”, and denialism, which he defines as “an ideological position whereby one systematically reacts by refusing reality and truth”. Persons and social groups who reject propositions on which there exists a mainstream and scientific consensus engage in denialism when they use rhetorical tactics to give the appearance of argument and legitimate debate, when there is none. It is a process that operates by employing one or more of the following five tactics in order to maintain the appearance of legitimate controversy:

  • Conspiracy theories: Dismissing the data or observation by suggesting opponents are involved in “a conspiracy to suppress the truth”.
  • Cherry picking: Selecting an anomalous critical paper supporting their idea, or using outdated, flawed, and discredited papers in order to make their opponents look as though they base their ideas on weak research. Diethelm and McKee (2009) note, “Denialists are usually not deterred by the extreme isolation of their theories, but rather see it as an indication of their intellectual courage against the dominant orthodoxy and the accompanying political correctness.”
  • False experts: Paying an expert in the field, or another field, to lend supporting evidence or credibility. This goes hand-in-hand with the marginalization of real experts and researchers.
  • Moving the goalposts: Dismissing evidence presented in response to a specific claim by continually demanding some other (often unfulfillable) piece of evidence (aka Shifting baseline).
  • Other logical fallacies: Usually one or more of false analogy, appeal to consequences, straw man, or red herring.

Common tactics to different types of denialism include misrepresenting evidence, false equivalence, half-truths, and outright fabrication. South African judge Edwin Cameron notes that a common tactic used by denialists is to “make great play of the inescapable indeterminacy of figures and statistics”. Historian Taner Akçam states that denialism is commonly believed to be negation of facts, but in fact “it is in that nebulous territory between facts and truth where such denialism germinates. Denialism marshals its own facts and it has its own truth.”

Focusing on the rhetorical tactics through which denialism is achieved in language, Alex Gillespie (2020) of the London School of Economics has reviewed the linguistic and practical defensive tactics for denying disruptive information. These tactics are conceptualised in terms of three layers of defence:

  • Avoiding: The first line of defence against disruptive information is to avoid it.
  • Delegitimising: The second line of defence is to attack the messenger, by undermining the credibility of the source.
  • Limiting: The final line of defence, if disruptive information cannot be avoided or delegitimised, is to rationalise and limit the impact of the disruptive ideas.

In 2009 author Michael Specter defined group denialism as “when an entire segment of society, often struggling with the trauma of change, turns away from reality in favor of a more comfortable lie”.

Prescriptive and Polemic Perspectives

If one party to a debate accuses the other of denialism they are framing the debate. This is because an accusation of denialism is both prescriptive and polemic: prescriptive because it carries implications that there is truth to the denied claim; polemic since the accuser implies that continued denial in the light of presented evidence raises questions about the other’s motives. Edward Skidelsky, a lecturer in philosophy at Exeter University writes that “An accusation of ‘denial’ is serious, suggesting either deliberate dishonesty or self-deception. The thing being denied is, by implication, so obviously true that the denier must be driven by perversity, malice or wilful blindness.” He suggests that, by the introduction of the word denier into further areas of historical and scientific debate, “One of the great achievements of The Enlightenment—the liberation of historical and scientific enquiry from dogma—is quietly being reversed”.

Some people have suggested that because denial of the Holocaust is well known, advocates who use the term denialist in other areas of debate may intentionally or unintentionally imply that their opponents are little better than Holocaust deniers. However, Robert Gallo and colleagues defended this latter comparison, stating that AIDS denialism is similar to Holocaust denial since it is a form of pseudoscience that “contradicts an immense body of research”.

Current Examples

HIV/AIDS

AIDS denialism is the denial that the human immunodeficiency virus (HIV) is the cause of acquired immune deficiency syndrome (AIDS). AIDS denialism has been described as being “among the most vocal anti-science denial movements”. Some denialists reject the existence of HIV, while others accept that the virus exists but say that it is a harmless passenger virus and not the cause of AIDS. Insofar as denialists acknowledge AIDS as a real disease, they attribute it to some combination of recreational drug use, malnutrition, poor sanitation, and side effects of antiretroviral medication, rather than infection with HIV. However, the evidence that HIV causes AIDS is scientifically conclusive and the scientific community rejects and ignores AIDS-denialist claims as based on faulty reasoning, cherry picking, and misrepresentation of mainly outdated scientific data. With the rejection of these arguments by the scientific community, AIDS-denialist material is now spread mainly through the Internet.

Thabo Mbeki, former president of South Africa, embraced AIDS denialism, proclaiming that AIDS was primarily caused by poverty. About 365,000 people died from AIDS during his presidency; it is estimated that around 343,000 premature deaths could have been prevented if proper treatment had been available.

Climate Change

Some international corporations, such as ExxonMobil, have contributed to “fake citizens’ groups and bogus scientific bodies” that claim that the science of global warming is inconclusive, according to a criticism by George Monbiot. ExxonMobil did not deny making the financial contributions, but its spokesman stated that the company’s financial support for scientific reports did not mean it influenced the outcome of those studies. Newsweek and Mother Jones have published articles stating corporations are funding the “denial industry”.

In the context of consumer protection, denialism has been defined as “the use of rhetorical techniques and predictable tactics to erect barriers to debate and consideration of any type of reform, regardless of the facts.” The Bush Administration’s replacement of previous science advisers with industry experts or scientists tied to industry, and its refusal to submit the Kyoto Protocol for ratification due to uncertainties they asserted were present in the climate change issue, have been cited by the press as examples of politically motivated denialism.

COVID-19

The term “COVID-19 denialism” or merely “COVID denialism” refers to the thinking of those who deny the reality of the COVID-19 pandemic. or, at the very least, deny that deaths are happening in the manner or proportions scientifically recognised by the World Health Organisation. The claims that the COVID-19 pandemic has been faked, exaggerated, or mischaracterised are pseudoscience. Some famous people who have engaged in COVID-19 denialism include Elon Musk, President Donald Trump, and Brazilian President Bolsonaro.

Evolution

Religious beliefs may prompt an individual to deny the validity of the scientific theory of evolution. Evolution is considered an undisputed fact within the scientific community and in academia, where the level of support for evolution is essentially universal, yet this view is often met with opposition by biblical literalists. The alternative view is often presented as a literal interpretation of the Book of Genesis’s creation myth. Many fundamentalist Christians teach creationism as if it were fact under the banners of creation science and intelligent design. Beliefs that typically coincide with creationism include the belief in the global flood myth, geocentrism, and the belief that the Earth is only 6,000-10,000 years old. These beliefs are viewed as pseudoscience in the scientific community and are widely regarded as erroneous.

Flat Earth

The superseded belief that the Earth is flat, and denial of all of the overwhelming evidence that supports an approximately spherical Earth that rotates around its axis and orbits the Sun, persists into the 21st century. Modern proponents of flat-Earth cosmology (or flat-Earthers) refuse to accept any kind of contrary evidence, dismissing all spaceflights and images from space as hoaxes and accusing all organizations and even private citizens of conspiring to “hide the truth”. They also claim that no actual satellites are orbiting the Earth, that the International Space Station is fake, and that these are lies from all governments involved in this grand cover-up.

Adherents of the modern flat-Earth model propose that a dome-shaped firmament encloses a disk-shaped Earth. They may also claim, after Samuel Rowbotham, that the Sun is only 3,000 miles above the Earth and that the Moon and the Sun orbit above the Earth rather than around it. Modern flat-Earthers believe that Antarctica is not a continent but a massive ice flow, with a wall 150 feet or higher, which circles the perimeter of the Earth and keeps everything (including all the oceans’ water) from falling off the edge.

Flat-Earthers also assert that no one is allowed to fly over or explore Antarctica, despite contrary evidence. According to them, all photos and videos of ships sinking under the horizon and of the bottoms of city skylines and clouds below the horizon, revealing the curvature of the Earth, have been manipulated, computer-generated, or somehow faked. Therefore, regardless of any scientific or empirical evidence provided, flat-Earthers conclude that it is fabricated or altered in some way.

When linked to other observed phenomena such as gravity, sunsets, tides, eclipses, distances and other measurements that challenge the flat earth model, claimants replace commonly-accepted explanations with piecemeal models that distort or over-simplify how perspective, mass, buoyancy, light or other physical systems work. These piecemeal replacements rarely conform with each other, finally leaving many flat-Earth claimants to agree that such phenomena remain “mysteries” and more investigation is to be done. In this conclusion, adherents remain open to all explanations except the commonly accepted globular Earth model, shifting the debate from ignorance to denialism.

Genetically Modified Foods

There is a scientific consensus that currently available food derived from GM crops poses no greater risk to human health than conventional food, but that each GM food needs to be tested on a case-by-case basis before introduction. Nonetheless, members of the public are much less likely than scientists to perceive GM foods as safe. The legal and regulatory status of GM foods varies by country, with some nations banning or restricting them, and others permitting them with widely differing degrees of regulation.

However, opponents have objected to GM foods on grounds including safety. Psychological analyses indicate that over 70% of GM food opponents in the US are “absolute” in their opposition, experience disgust at the thought of eating GM foods, and are “evidence insensitive”.

Statins

Statin denialism is a rejection of the medical worth of statins. Cardiologist Steven Nissen at Cleveland Clinic has commented “We are losing the battle for the hearts and minds of our patients to Web sites…” promoting unproven medical therapies. Harriet Hall sees a spectrum of “statin denialism” ranging from pseudoscientific claims to the understatement of benefits and overstatement of side effects, all of which is contrary to the scientific evidence.

Mental Illness Denial

Refer to Mental Illness Denial.

Mental illness denial or mental disorder denial where a person denies the existence of mental disorders. Both serious analysts, as well as pseudoscientific movements question the existence of certain disorders. A minority of professional researchers see disorders such as depression from a sociocultural perspective and argue that the solution to it is fixing a dysfunction in the society not in the person’s brain. Certain analysts argue this denialism is usually fuelled by narcissistic injury. Anti-psychiatry movements such as Scientology promote mental illness denial by having alternative practices to psychiatry.

Historical Examples

Historical negationism, also called denialism, is falsification or distortion of the historical record. It should not be conflated with historical revisionism, a broader term that extends to newly evidenced, fairly reasoned academic reinterpretations of history. In attempting to revise the past, illegitimate historical revisionism may use techniques inadmissible in proper historical discourse, such as presenting known forged documents as genuine, inventing ingenious but implausible reasons for distrusting genuine documents, attributing conclusions to books and sources that report the opposite, manipulating statistical series to support the given point of view, and deliberately mistranslating texts.

Some countries, such as Germany, have criminalized the negationist revision of certain historical events, while others take a more cautious position for various reasons, such as protection of free speech; others mandate negationist views, such as California and Japan, where schoolchildren are explicitly prevented from learning about the California genocide and Japanese war crimes, respectively. Notable examples of negationism include Holocaust denial, Armenian genocide denial, the Lost Cause of the Confederacy, the myth of the clean Wehrmacht, Japanese history textbook controversies, and historiography in the Soviet Union during the Stalin era. Some notable historical negationists include Arthur Butz, David Irving, and Shinzo Abe. In literature, the consequences of historical negationism have been imaginatively depicted in some works of fiction, such as Nineteen Eighty-Four, by George Orwell. In modern times, negationism may spread via new media, such as the Internet.

Armenian Genocide Denialism

Armenian genocide denial is the claim that the Ottoman Empire and its ruling party, the Committee of Union and Progress (CUP), did not commit genocide against its Armenian citizens during World War I – a crime documented in a large body of evidence and affirmed by the vast majority of scholars. The perpetrators denied the genocide as they carried it out, claiming Armenians were resettled for military reasons, not exterminated. In the genocide’s aftermath, incriminating documents were systematically destroyed, and denial has been the policy of every government of the Republic of Turkey, as of 2022.

Borrowing the arguments used by the CUP to justify its actions, denial rests on the assumption that the “relocation” of Armenians was a legitimate state action in response to a real or perceived Armenian uprising that threatened the existence of the empire during wartime. Deniers assert the CUP intended to resettle Armenians rather than kill them. They claim the death toll is exaggerated or attribute the deaths to other factors, such as a purported civil war, disease, bad weather, rogue local officials, or bands of Kurds and outlaws. Historian Ronald Grigor Suny states that the main argument is “There was no genocide, and the Armenians were to blame for it.” Denial is usually accompanied by “rhetoric of Armenian treachery, aggression, criminality, and territorial ambition.”

One of the most important reasons for this denial is that the genocide enabled the establishment of a Turkish nation-state. Recognition would contradict Turkey’s founding myths. Since the 1920s, Turkey has worked to prevent official recognition or even mention of the genocide in other countries; these efforts have included millions of dollars spent on lobbying, the creation of research institutes, and intimidation and threats. Denial also affects Turkey’s domestic policies and is taught in Turkish schools; some Turkish citizens who acknowledge the genocide have faced prosecution for “insulting Turkishness”. The century-long effort by the Turkish state to deny the genocide sets it apart from other cases of genocide in history. Azerbaijan also denies the genocide and campaigns against its recognition internationally. Most Turkish citizens and political parties in Turkey support the state’s denial policy. The denial of the genocide contributes to the Nagorno-Karabakh conflict as well as ongoing violence against Kurds in Turkey.

Holocaust Denial

Holocaust denial refers to denial of the murder of 5 to 6 million Jews by the Nazis in Europe during World War 2. It is an essentially irrational action that withholds validation of a historical experience or event.” In this context, the term is a subset of the more accurate genocide denial, which is a form of politically motivated denialism.

Srebrenica Massacre Denialism

Sonja Biserko, president of the Helsinki Committee for Human Rights in Serbia, and Edina Bečirević, the Faculty of Criminalistics, Criminology and Security Studies of the University of Sarajevo have pointed to a culture of denial of the Srebrenica massacre in Serbian society, taking many forms and present in particular in political discourse, the media, the law and the educational system.

What is Relapse Prevention?

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Introduction

Relapse prevention (RP) is a cognitive-behavioural approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behaviour, sexual offending, obesity, and depression.

It is an important component in the treatment process for alcohol use disorder, or alcohol dependence.

Underlying Assumptions

Relapse is seen as both an outcome and a transgression in the process of behaviour change. An initial setback or lapse may translate into either a return to the previous problematic behaviour, known as relapse, or the individual turning again towards positive change, called prolapse. A relapse often occurs in the following stages: emotional relapse, mental relapse, and finally, physical relapse. Each stage is characterised by feelings, thoughts, and actions that ultimately lead to the individual’s returning to their old behaviour.

Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. In particular, high self-efficacy, negative outcome expectancies, potent availability of coping skills following treatment, positive affect, and functional social support are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor of relapse.

Efficacy and Effectiveness

Carroll et al. conducted a review of 24 other trials and concluded that RP was more effective than no treatment and was equally effective as other active treatments such as supportive psychotherapy and interpersonal therapy in improving substance use outcomes. Irvin and colleagues also conducted a meta-analysis of RP techniques in the treatment of alcohol, tobacco, cocaine, and polysubstance use, and upon reviewing 26 studies, concluded that RP was successful in reducing substance use and improving psychosocial adjustment. RP seemed to be most effective for individuals with alcohol problems, suggesting that certain characteristics of alcohol use are amenable to the RP. Miller et al. (1996) found the GORSKI/CENAPS relapse warning signs to be a good predictor of the occurrence of relapse on the AWARE scale (r = .42, p < .001).

Prevention Approaches

General Prevention Theories

Some theorists, including Katie Witkiewitz and G. Alan Marlatt, borrowing ideas from systems theory, conceptualize relapse as a multidimensional, complex system. Such a nonlinear dynamical system is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organisation, feedback loops, timing/context effects, and the interplay between tonic and phasic processes.

Rami Jumnoodoo and Dr. Patrick Coyne, in London UK, have been working with National Health Service users and carers over the past ten years to transfer RP theory into the field of adult mental health. The uniqueness of the model is the sustainment of change by developing service users and carers as ‘experts’ – following RP as an educational process and graduating as Relapse Prevention Practitioners. The work has won many national awards, been presented at many conferences, and has resulted in many publications.

Terence Gorski MA has developed the CENAPS (Centre for Applied Science) model for relapse prevention including Relapse Prevention Counselling (Gorski, Counselling For Relapse Prevention, 1983) and a system for certification of Relapse Prevention Specialists (CRPS).

Depression

For the prevention of relapse in Major Depressive Disorder (MDD), several approaches and intervention programmes have been proposed. Mindfulness-based Cognitive Therapy is commonly used and was found to be effective in preventing relapse especially in patients with more pronounced residual symptoms. Another approach often used in patients who wish to taper down antidepressant medication is Preventive Cognitive Therapy, an 8-weeks lasting psychological intervention programme delivered in individual or group sessions that focuses on changing dysfunctional attitudes, enhancing memories of positive experiences and helping patients to develop personal relapse prevention strategies. Preventive Cognitive Therapy has been found to be equally effective in preventing a return of depressive symptoms as antidepressant medication use alone in the long-term treatment of MDD. In combination with pharmaceuticals, it was found to be even more effective than antidepressant use alone.

What is the Obsessive-Compulsive Spectrum?

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Introduction

The obsessive-compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive-compulsive disorder (OCD).

Refer to An Overview of the Biology of Obsessive-Compulsive Disorder.

“The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks.”

OCD is a mental disorder characterised by obsessions and/or compulsions. An obsession is defined as “a recurring thought, image, or urge that the individual cannot control”. Compulsion can be described as a “ritualistic behaviour that the person feels compelled to perform”. The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive-compulsive spectrum disorders.

Conditions

The following conditions have been hypothesized by various researchers as existing on the spectrum:

However, recently there is a growing support for proposals to narrow down this spectrum to only include body dysmorphic disorder, hypochondriasis, tic disorders, and trichotillomania.

Body Dysmorphic Disorder

Refer to Body Dysmorphic Disorder.

Body dysmorphic disorder is defined by an obsession with an imagined defect in physical appearance, and compulsive rituals in an attempt to conceal the perceived defect. Typical complaints include perceived facial flaws, perceived deformities of body parts and body size abnormalities. Some compulsive behaviours observed include mirror checking, ritualised application of makeup to hide the perceived flaw, excessive hair combing or cutting, excessive physician visits and plastic surgery. Body dysmorphic disorder is not gender specific and onset usually occurs in teens and young adults.

Hypochondriasis

Hypochondriasis is excessive preoccupancy or worry about having a serious illness. These thoughts cause a person a great deal of anxiety and stress. The prevalence of this disorder is the same for men and women. Hypochondriasis is normally recognised in early adult age. Those that suffer with hypochondriasis are constantly thinking of their body functions, minor bumps and bruises as well as body images. Hypochondriacs go to numerous outpatient facilities for confirmation of their own diagnosis. Hypochondriasis is the belief that something is wrong but it is not known to be a delusion.

Tic Disorders

Tourette’s syndrome is a neurological disorder characterised by recurrent involuntary movements (motor tics) and involuntary noises (vocal tics). The reason Tourette’s syndrome and other tic disorders are being considered for placement in the obsessive compulsive spectrum is because of the phenomenology and co-morbidity of the disorders with obsessive compulsive disorder. Within the population of patients with OCD up to 40% have a history of a tic disorder and 60% of people with Tourette’s syndrome have obsessions and/or compulsions. Plus 30% of people with Tourette’s syndrome have clinically diagnosable OCD. Course of illness is another factor that suggests correlation because it has been found that tics displayed in childhood are a predictor of obsessive and compulsive symptoms in late adolescence and early adulthood. However, the association of Tourette’s and tic disorders with OCD is challenged by neuropsychology and pharmaceutical treatment. Whereas OCD is treated with SSRI, tics are treated with dopamine blockers and alpha-2 agonists.

Trichotillomania

Refer to Trichotillomania.

Trichotillomania is an impulse control disorder which causes an individual to pull out their hair from various parts of their body without a purpose. The cause for trichotillomania remains unknown. Like OCD, trichotillomania isn’t a nervous condition but stress can trigger this habit. For some people pulling their hair out of boredom is normal, but that isn’t the case for someone that is dealing with trichotillomania. Emotions do not affect the behaviour but these behaviours are more prevalent in those that suffer with depression. Review articles recommend behavioural interventions such as habit reversal training and decoupling.

What is Nefazodone?

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Introduction

Nefazodone, sold formerly under the brand names Serzone, Dutonin, and Nefadar among others, is an atypical antidepressant which was first marketed by Bristol-Myers Squibb (BMS) in 1994 but has since largely been discontinued.

BMS withdrew it from the market by 2004 due to decreasing sales due to the rare incidence of severe liver damage and the onset of generic competition. The incidence of severe liver damage is approximately 1 in every 250,000 to 300,000 patient-years. Generic versions were introduced in 2003.

Nefazodone is a phenylpiperazine compound and is related to trazodone. It has been described as a serotonin antagonist and reuptake inhibitor (SARI) due to its combined actions as a potent serotonin 5-HT2A receptor and 5-HT2C receptor antagonist and weak serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI).

Brief History

Nefazodone was discovered by scientists at Bristol-Myers Squibb (BMS) who were seeking to improve on trazodone by reducing its sedating qualities.

BMS obtained marketing approvals worldwide for nefazodone in 1994. It was marketed in the US under the brand name Serzone and in Europe under the brand name Dutonin.

In 2002, the US Food and Drug Administration (FDA) obligated BMS to add a black box warning about potential fatal liver toxicity to the drug label. Worldwide sales in 2002 were $409 million.

In 2003 Public Citizen filed a citizen petition asking the FDA to withdraw the marketing authorisation in the US, and in early 2004 the organisation sued the FDA to attempt to force withdrawal of the drug. The FDA issued a response to the petition in June 2004 and filed a motion to dismiss, and Public Citizen withdrew the suit.

Generic versions were introduced in the US in 2003 and Health Canada withdrew the marketing authorization that year.

Sales of nefazodone were about $100 million in 2003. By that time it was also being marketed under the additional brand names Serzonil, Nefadar, and Rulivan.

In April 2004, BMS announced that it was going discontinue the sale of Serzone in the US in June 2004 and said that this was due to declining sales. By that time BMS had already withdrawn the drug from the market in Europe, Australia, New Zealand and Canada.

As of 2012 generic nefazodone was available in the US.

Medical Uses

Nefazodone is used to treat major depressive disorder, aggressive behaviour, and panic disorder.

Available Forms

Nefazodone is available as 50 mg, 100 mg, 150 mg, 200 mg, and 250 mg tablets for oral ingestion.

Side Effects

Nefazodone can cause severe liver damage, leading to a need for liver transplant, and death. The incidence of severe liver damage is approximately 1 in every 250,000 to 300,000 patient-years. By the time that it started to be withdrawn in 2003, nefazodone had been associated with at least 53 cases of liver injury, with 11 deaths, in the United States, and 51 cases of liver toxicity, with 2 cases of liver transplantation, in Canada. In a Canadian study which found 32 cases in 2002, it was noted that databases like that used in the study tended to include only a small proportion of suspected drug reactions.

Common and mild side effects of nefazodone reported in clinical trials more often than placebo include dry mouth (25%), sleepiness (25%), nausea (22%), dizziness (17%), blurred vision (16%), weakness (11%), lightheadedness (10%), confusion (7%), and orthostatic hypotension (5%). Rare and serious adverse reactions may include allergic reactions, fainting, painful/prolonged erection, and jaundice.

Nefazodone is not especially associated with increased appetite and weight gain.

Interactions

Nefazodone is a potent inhibitor of CYP3A4, and may interact adversely with many commonly used medications that are metabolized by CYP3A4.

Pharmacology

Pharmacodynamics

Nefazodone acts primarily as a potent antagonist of the serotonin 5-HT2A receptor and to a lesser extent of the serotonin 5-HT2C receptor. It also has high affinity for the α1-adrenergic receptor and serotonin 5-HT1A receptor, and relatively lower affinity for the α2-adrenergic receptor and dopamine D2 receptor. Nefazodone has low but significant affinity for the serotonin, norepinephrine, and dopamine transporters as well, and therefore acts as a weak serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI). It has low but potentially significant affinity for the histamine H1 receptor, where it is an antagonist, and hence may have some antihistamine activity. Nefazodone has negligible activity at muscarinic acetylcholine receptors, and accordingly, has no anticholinergic effects.

Pharmacokinetics

The bioavailability of nefazodone is low and variable, about 20%. Its plasma protein binding is approximately 99%, but it is bound loosely.

Nefazodone is metabolized in the liver, with the main enzyme involved thought to be CYP3A4. The drug has at least four active metabolites, which include hydroxynefazodone, para-hydroxynefazodone, triazoledione, and meta-chlorophenylpiperazine. Nefazodone has a short elimination half-life of about 2 to 4 hours. Its metabolite hydroxynefazodone similarly has an elimination half-life of about 1.5 to 4 hours, whereas the elimination half-lives of triazoledione and mCPP are longer at around 18 hours and 4 to 8 hours, respectively. Due to its long elimination half-life, triazole is the major metabolite and predominates in the circulation during nefazodone treatment, with plasma levels that are 4 to 10 times higher than those of nefazodone itself. Conversely, hydroxynefazodone levels are about 40% of those of nefazodone at steady state. Plasma levels of mCPP are very low at about 7% of those of nefazodone; hence, mCPP is only a minor metabolite. mCPP is thought to be formed from nefazodone specifically by CYP2D6.

The ratios of brain-to-plasma concentrations of mCPP to nefazodone are 47:1 in mice and 10:1 in rats, suggesting that brain exposure to mCPP may be much higher than plasma exposure. Conversely, hydroxynefazodone levels in the brain are 10% of those in plasma in rats. As such, in spite of its relatively low plasma concentrations, brain exposure to mCPP may be substantial, whereas that of hydroxynefazodone may be minimal.

Chemistry

Nefazodone is a phenylpiperazine; it is an alpha-phenoxyl derivative of etoperidone which in turn was a derivative of trazodone.

Society and Culture

Generic Names

Nefazodone is the generic name of the drug and its INN and BAN, while néfazodone is its DCF and nefazodone hydrochloride is its USAN and USP.

Brand Names

Nefazodone has been marketed under a number of brand names including Dutonin (AT, ES, IE, UK), Menfazona (ES), Nefadar (CH, DE, NO, SE), Nefazodone BMS (AT), Nefazodone Hydrochloride Teva (US), Reseril (IT), Rulivan (ES), and Serzone (AU, CA, US). As of 2017, it remains available only on a limited basis as Nefazodone Hydrochloride Teva in the United States.

Research

The use of nefazodone to prevent migraine has been studied, due to its antagonistic effects on the 5-HT2A and 5-HT2C receptors.

What is Hostile Attribution Bias?

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Introduction

Hostile attribution bias, or hostile attribution of intent, is the tendency to interpret others’ behaviours as having hostile intent, even when the behaviour is ambiguous or benign.

For example, a person with high levels of hostile attribution bias might see two people laughing and immediately interpret this behaviour as two people laughing about them, even though the behaviour was ambiguous and may have been benign.

The term “hostile attribution bias” was first coined in 1980 by Nasby, Hayden, and DePaulo who noticed, along with several other key pioneers in this research area (e.g. Kenneth A. Dodge), that a subgroup of children tend to attribute hostile intent to ambiguous social situations more often than other children. Since then, hostile attribution bias has been conceptualized as a bias of social information processing (similar to other attribution biases), including the way individuals perceive, interpret, and select responses to situations. While occasional hostile attribution bias is normative (particularly for younger children), researchers have found that individuals who exhibit consistent and high levels of hostile attribution bias across development are much more likely to engage in aggressive behaviour (e.g. hitting/fighting, reacting violently, verbal or relational aggression) toward others.

In addition, hostile attribution bias is hypothesized to be one important pathway through which other risk factors, such as peer rejection or harsh parenting behaviour, lead to aggression. For example, children exposed to peer teasing at school or child abuse at home are much more likely to develop high levels of hostile attribution bias, which then lead them to behave aggressively at school and/or at home. Thus, in addition to partially explaining one way aggression develops, hostile attribution bias also represents a target for the intervention and prevention of aggressive behaviours.

Brief History

The term hostile attribution bias first emerged in 1980 when researchers began noticing that some children, particularly aggressive and/or rejected children, tended to interpret social situations differently compared to other children. For example, Nasby and colleagues presented photographs of people to a group of aggressive adolescent boys (aged 10-16) and observed that a subgroup of these youth exhibited a consistent tendency to attribute hostile intent to the photographs, even when the cues were ambiguous or benign. Similarly, Kenneth A. Dodge and colleagues conducted a study on a sample of school-aged children between 3rd-5th grade and found that children who were rejected were much more likely than other children to exhibit hostile attributions of intent to ambiguous social situations (e.g. when a behaviour could have been either accidental or intentional). Furthermore, Dodge and colleagues found that children with high hostile attribution bias then went on to exhibit the most aggressive behaviours later on.

Early studies investigating links between hostile attribution bias and aggression were somewhat mixed, with some studies reporting no significant effects or small effects and other studies reporting large effects. Since then, over 100 studies and a meta-analysis have documented a robust association between hostile attribution bias and aggressive behaviour across various samples ranging in age, gender, race, countries, and clinical populations.

Theoretical Formulation

Hostile attribution bias is typically conceptualised within a social information processing framework, in which social information (e.g. during an interaction) is processed in a series of steps that leads to a behavioural reaction. Accurate social information processing requires a person to engage in six steps that occur in order.

Step
1Accurately encode information in the brain and store it in short-term memory. During this step, an individual will pay attention to and code specific stimuli/cues in their environment, including external factors (e.g. someone bumping into you; other people’s reactions to the situation) and internal factors (e.g. your affective reaction to the situation).
2Accurately interpret or give meaning to encoded information. During this step, an individual may decide if a behaviour or situation was meant to be hostile or benign.
3Decide a goal for the interaction.
4Generate potential responses.
5Evaluate potential responses and select the “optimal” response.
6Enact chosen response.

Hostile attribution bias is theorised to result from deviations in any of these steps, including paying attention to and encoding biased information (e.g. only paying attention to cues suggestive of hostility), biases toward negative interpretations of social interactions (e.g. more likely to interpret situation as hostile), limited ability to generate a broad range of potential responses, and difficulty appropriately evaluating responses and selecting an optimal response. Furthermore, biases in any of the steps affect the rest of the steps. Hostile attribution bias has been particularly linked to step 2 of social information processing (i.e. interpretation of information), but is linked to impairments in other steps as well, including inaccurate perception/encoding of social situations and problems with generating a broad range of potential behavioural responses. For example, a child with high levels of hostile attribution bias may generate fewer potential responses than other children, and these responses may be limited to hostile or ineffective responses to a situation.

Dodge theorised that hostile attribution bias arises from an individual’s hostile schemas about the world that are formed through an interaction between a child’s neural dispositions and his/her early exposures to hostile socialisation experiences. These experiences may include disrupted parental attachment, child abuse, exposure to family violence, peer rejection or victimization, and community violence.

Measurement

In research settings, hostile attribution bias is typically measured with a laboratory task, in which participants are presented with staged interaction (live actors), video, picture, audio, or written presentations of ambiguous social situations. For example, an ambiguous social situation presented might be a video of a child opening a door, causing the door to knock over a tower of toys that another child was building. After the stimulus is presented, participants would be asked to make attributions about the intent of the actor (i.e. hostile vs. benign). (For example: “Do you think the girl who opened the door was trying to be mean, nice, or could have been mean or nice?”).

Multiple trials are administered with various ambiguous scenarios, and these attributions are then used by the researchers to determine the level of the child’s hostile attribution bias. Careful selection of stimuli and comparison of stimuli across mediums is helpful for accurately assessing an individual’s level of hostile attribution bias. A meta-analysis investigating the link between hostile attribution bias and aggressive behaviour found that the strongest effect sizes were linked with actual staging of social interactions, followed by audio presentation of stimuli, then video and picture presentation.

Implications

Aggression

Substantial literature has documented a robust association between hostile attribution bias and aggression in youth. Hostile attribution bias is traditionally associated with overt physical aggression (e.g. hitting, fighting), such that higher levels of hostile attribution bias predict more aggressive behaviour. In particular, much evidence suggests that hostile attribution bias is especially linked to “reactive aggression” (i.e. impulsive and “hot-blooded” aggression that reflects an angry retaliation to perceived provocation) rather than “proactive aggression” (i.e. unprovoked, planned/instrumental, or “cold-blooded” aggression). Beyond physical aggression, elevated hostile attribution bias is also associated with increased use of relational aggression (e.g. gossip, spreading rumours, social exclusion). This is particularly the case when youth attribute hostile intent to ambiguous relational situations (e.g. not receiving an invitation to a party or not receiving a response to a text).

Negative Adult Outcomes

Hostile attribution bias has also been documented in adult populations, and adults with high levels of hostile attribution bias are over 4 times more likely to die by the age of 50 than adults with low levels of hostile attribution bias. Hostile attribution bias is particularly linked to relational problems in adulthood, including marital conflict/violence and marital/relationship dissatisfaction. Finally, parents with high levels of hostile attribution bias are also much more likely to use harsh discipline and aggressive parenting, which may further contribute to the intergenerational continuity in hostile attribution bias and aggression across time.

Clinical Implications for Intervention

Hostile attribution bias has been tested as a malleable target for intervention for aggressive behaviours in youth, including in cognitive interventions designed to increase accurate identification of others’ intentions and attribution of benign intentions. Relative success has been documented from these interventions in changing levels of hostile attribution bias, although actual enduring changes in aggressive behaviour have been modest.

What is ‘Honne’ and ‘Tatemae’?

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Introduction

In Japan, “honne” refers to a person’s true feelings and desires (本音, hon’ne, “true sound”), and “tatemae” refers contrastingly to the behaviour and opinions one displays in public (建前, tatemae, “built in front”, “façade”). This distinction began to be made in the post-war era.

A person’s honne may be contrary to what is expected by society or what is required according to one’s position and circumstances, and they are often kept hidden, except with one’s closest friends. Tatemae is what is expected by society and required according to one’s position and circumstances, and these may or may not match one’s honne. In many cases, tatemae leads to outright telling of lies in order to avoid exposing the true inward feelings.

The honne-tatemae divide is considered by some to be of paramount importance in Japanese culture.

Refer to Smile Mask Syndrome.

Causes

In Japanese culture, public failure and the disapproval of others are seen as particular sources of shame and reduced social standing, so it is common to avoid direct confrontation or disagreement in most social contexts. Traditionally, social norms dictate that one should attempt to minimise discord; failure to do so might be seen as insulting or aggressive. For this reason, the Japanese tend to go to great lengths to avoid conflict, especially within the context of large groups. By upholding this social norm, one is socially protected from such transgressions by others.

The conflict between honne and giri (social obligations) is one of the main topics of Japanese drama throughout the ages. For example, the protagonist would have to choose between carrying out his obligations to his family/feudal lord or pursuing a clandestine love affair.

The same concept in Chinese culture is called “inside face” and “outside face”, and these two aspects also frequently come into conflict.

Effects

Contemporary phenomena such as hikikomori seclusion and parasite singles are seen as examples of late Japanese culture’s growing problem of the new generation growing up unable to deal with the complexities of honne-tatemae and pressure of an increasingly consumerist society.

Though tatemae and honne are not a uniquely Japanese phenomenon, some Japanese feel that it is unique to Japan; especially among those Japanese who feel their culture is unique in having the concepts of “private mind” and “public mind”. Although there might not be direct single word translations for honne and tatemae in some languages, they do have two-word descriptions; for example in English, “private mind” and “public mind”.

Some researchers suggest that the need for explicit words for tatemae and honne in Japanese culture is evidence that the concept is relatively new to Japan, whereas the unspoken understanding in many other cultures indicates a deeper internalisation of the concepts. In any case, all cultures have conventions that help to determine appropriate communication and behaviour in various social contexts which are implicitly understood without an explicit name for the social mores on which the conventions are based.

A similar discord of Japanese true own feeling and the pretension before public is observed in yase-gaman, a phrase whose meaning literally translates as “starving to [one’s] skeleton”, referring to being content or pretending to be so. Nowadays, the phrase is used for two different meanings, expressing the samurai virtue of self-discipline, silent moral heroism, or ridiculing stubbornness, face-savingness.

What is Body-Focused Repetitive Behaviour?

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Introduction

Body-focused repetitive behaviour (BFRB) is an umbrella name for impulse control behaviours involving compulsively damaging one’s physical appearance or causing physical injury.

Body-focused repetitive behaviour disorders (BFRBDs) in ICD-11 is in development.

BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum.

Cause(s)

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.

Research has suggested that the urge to repetitive self-injury is similar to a BFRB but others have argued that for some the condition is more akin to a substance abuse disorder.

Researchers are investigating a possible genetic component.

Onset

BFRBs most often begin in late childhood or in the early teens.

Diagnosis

Types

The main BFRB disorders are:

  • Skin:
    • Dermatillomania (excoriation disorder), skin picking.
    • Dermatophagia, skin nibbling.
  • Mouth:
    • Morsicatio buccarum, cheek biting.
    • Morsicatio labiorum, inner lip biting.
    • Morsicatio linguarum, tongue biting.
  • Hands:
    • Onychophagia, nail biting.
    • Onychotillomania, nail picking.
  • Nose:
    • Rhinotillexomania, compulsive nose picking.
  • Hair:
    • Trichophagia, hair nibbling.
    • Trichotemnomania, hair cutting.
    • Trichotillomania, hair pulling.
  • Eyes:
    • Mucus fishing syndrome – compulsion to remove or “fish” strands of mucus from the eye.

Treatment

Psychotherapy

Treatment can include behaviour modification therapy, medication, and family therapy. The evidence base criteria for BFRBs is strict and methodical. Individual behavioural therapy has been shown as a “probably effective” evidence-based therapy to help with thumb sucking, and possibly nail biting. Cognitive behavioural therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting; a systematic review found best evidence for habit reversal training and decoupling. Another form of treatment that focuses on mindfulness, stimuli and rewards has proven effective in some people. However, no treatment was deemed well-established to treat any form of BFRBs.

Pharmacotherapy

Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders. BFRBs may affect at least 1 out of 20 people. These collections of symptoms have been known for a number of years, but only recently have appeared in widespread medical literature. Trichotillomania alone is believed to affect 10 million people in the United States.

What is Decoupling for Body-Focused Repetitive Behaviours?

Published on by Andrew Marshall3 Comments

Introduction

Decoupling is a behavioural self-help intervention developed for body-focused and related behaviours (DSM-5) such as trichotillomania, onychophagia (nail biting), skin picking and lip-cheek biting (Mortiz & Rufer, 2011).

Background

The user is instructed to modify the original dysfunctional behavioural path by performing a counter-movement shortly before completing the self-injurious behaviour (e.g. biting nails, picking skin, pulling hair). This is intended to trigger an irritation, which enables the person to detect and stop the compulsive behaviour at an early stage. A systematic review from 2012 showed the efficacy of decoupling, which was corroborated by Lee and colleagues in 2019. Whether or not the technique is superior to other behavioural interventions such as habit reversal training awaits to be tested.

Reference

Lee, M.T., Mpavaenda, D.N. & Fineberg, N.A. (2019) Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. Frontiers in Behavioral Neuroscience. 13:79. doi:10.3389/fnbeh.2019.00079.

Moritz, S. & Rufer, M. (2011) Movement Decoupling: A Self-Help Intervention for the Treatment of Trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry. 42(1), pp.74-80. doi:10.1016/j.jbtep.2010.07.001.

Further Reading

What is the Association for Behavioural and Cognitive Therapies?

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Introduction

The Association for Behavioural and Cognitive Therapies (ABCT) was founded in 1966.

Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therapists, nurses, and other mental-health practitioners and students. These members support, use, and/or disseminate behavioural and cognitive approaches.

Brief History

ABCT was founded in 1966 under the name Association for Advancement of Behavioural Therapies (AABT) by 10 behaviourists who were dissatisfied with the prevailing Freudian/psychoanalytic model (Its founding members include: John Paul Brady, Joseph Cautela, Edward Dengrove, Cyril Franks, Martin Gittelman, Leonard Krasner, Arnold Lazarus, Andrew Salter, Dorothy Susskind, and Joseph Wolpe). The Freudian/psychoanalytic model refers to the Id, Ego, and Superego within each individual as they interpret and interact with the world and those around them. Although the ABCT was not established until 1966, its history begins in the early 1900s with the birth of the behaviourist movement, which was brought about by Pavlov, Watson, Skinner, Thorndike, Hull, Mowrer, and others – scientists who, concerned primarily with observable behaviour, were beginning to experiment with conditioning and learning theory. By the 1950s, two entities – Hans Eysenck’s research group (which included one of AABT’s founders Cyril Franks) at the University of London Institute of Psychiatry, and Joseph Wolpe’s research group (which included another of AABT’s founders, Arnold Lazarus) in South Africa – were conducting important studies that would establish behaviour therapy as a science based on principles of learning. In complete opposition to the psychoanalytic model, “The seminal significance of behaviour therapy was the commitment to apply the principles and procedures of experimental psychology to clinical problems, to rigorously evaluate the effects of therapy, and to ensure that clinical practice was guided by such objective evaluation”.

The first president of the association was Cyril Franks, who also founded the organisation’s flagship journal Behaviour Therapy and was the first editor of the Association for Advancement of Behavioural Therapies Newsletter. The first annual meeting of the association took place in 1967, in Washington, DC, concurrent with the American Psychological Association’s meeting.

An article in the November 1967 issue of the Newsletter, entitled “Behaviour Therapy and Not Behaviour Therapies” (Wilson & Evans, 1967), influenced the association’s first name change from Association for Advancement of Behavioural Therapies to Association for Advancement of Behaviour Therapy because, as the authors argued, “the various techniques of behaviour therapy all derive from learning theory and should not be misinterpreted as different kinds of behaviour therapy…”. This issue remains a debate in the field and within the organization, particularly with the emergence of the term “cognitive behavioural therapies.” This resulted in yet another name change in 2005 to the Association for Behavioural and Cognitive Therapies.

The Association for Advancement of Behavioural Therapies/Association for Behavioural and Cognitive Therapies has been at the forefront of the professional, legal, social, and ethical controversies and dissemination efforts that have accompanied the field’s evolution. The 1970s was perhaps the most “explosive” and controversial decade for the field of behaviour therapy, as it suffered from an overall negative public image and received numerous attacks from the press regarding behaviour modification and its possible unethical uses. In Gerald Davison’s (AABT’s 8th president) public “Statement on Behaviour Modification from the AABT”, he asserted that “it is a serious mistake … to equate behaviour therapy with the use of electric shocks applied to the extremities…” and “a major contribution of behaviour therapy has been a profound commitment to full description of procedures and careful evaluation of their effects”. From this point, AABT became instrumental in enacting legislative guidelines that protected human research subjects, and they also became active in efforts to educate the public.

Mission Statement

The ABCT is an interdisciplinary organisation committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioural, cognitive, prevention, and treatment. While primarily an interest group, ABCT is also active in:

  • Encouraging the development, study, and dissemination of scientific approaches to behavioural health.
  • Promoting the utilisation, expansion, and dissemination of behavioural, cognitive, and other empirically derived practices.
  • Facilitating professional development, interaction, and networking among members.

Professional Activities

Through its membership, publications, convention and education committees, the ABCT conducts a variety of activities to support and disseminate the behavioural and cognitive therapies. The organization produces two quarterly journals, Behaviour Therapy (research-based) and Cognitive and Behavioural Practice (treatment focused), as well as its house periodical, the Behaviour Therapist (eight times per year). The association’s convention is held annually in November. ABCT also produces fact sheets, an assessment series, and training and archival videotapes. The association maintains a website on which can be found a “Find-a-Therapist” search engine and information about behavioural and cognitive therapies. The organisation provides its members with an online clinical directory, over 30 special interest groups, a list serve, a job bank, and an awards and recognition programme. Other offerings available on the website include sample course syllabi, listings of grants available, and a broad range of offerings of interest to mental health researchers.

Mental Health Professionals

The training of mental health professionals has also been a significant priority for the association. Along with its annual meeting, AABT created an “ad hoc review mechanism” in the 1970s through the 1980s whereby a state could receive a review of a behaviour therapy programme. This led to the yearly publication of a widely used resource, “The Directory of Training Programmes”. With growing concerns over quality control and standardisation of practice, the certification of behaviour therapists also became an issue in the 1970s. This debate led to the development of a Diplomate in behaviour therapy at APA and for those behavioural therapy practices from a more radical behavioural perspective, the development of certification in behaviour analysis at the master level.

An ongoing debate within the association concerns what many consider to be a movement away from basic behavioural science as the field has attempted to advance and integrate more and more “new” therapies/specialisations, particularly the addition of cognitive theory and its variety of techniques. John Forsyth, in his special issue of Behaviour Therapy] entitled “Thirty Years of Behaviour Therapy: Promises Kept, Promises Unfulfilled”, summarised this opposition as follows:

“(a) cognition is not behaviour, (b) behaviour principles and theory cannot account for events occurring within the skin, and most important, (c) we therefore need a unique conceptual system to account for how thinking, feeling, and other private events relate to overt human action”.

The field’s desire to maintain its scientific foundations and yet continue to advance and grow, was reflected in its most recent discussion about adding the word “cognitive” to the name of the association.

Many notable scholars have served as president of the association, including Joseph Wolpe, Arnold Lazarus, Nathan Azrin, Steven C. Hayes, and David Barlow. The current executive director of the ABCT is Mary Jane Eimer, CAE. For a wealth of historical specifics (governing bodies, lists of editors, past presidents, award winners, SIGs, and conventions from the past 40 years) see ABCT’s 40th anniversary issue of the Behaviour Therapist.

About Behavioural and Cognitive Therapies

Cognitive and behavioural therapists help people learn to actively cope with, confront, reformulate, and/or change the maladaptive cognitions, behaviours, and symptoms that limit their ability to function, cause emotional distress, and accompany the wide range of mental health disorders. Goal-oriented, time-limited, research-based, and focused on the present, the cognitive and behavioural approach is collaborative. This approach values feedback from the client, and encourages the client to play an active role in setting goals and the overall course and pace of treatment. Importantly, behavioural interventions are characterized by a “direct focus on observable behaviour”. Practitioners teach clients concrete skills and exercises – from breathing retraining, to keeping thought records to behavioural rehearsal – to practice at home and in sessions, with the overall goal of optimal functioning and the ability to engage in life fully.

Because cognitive behavioural therapy (CBT) is based on broad principles of human learning and adaptation, it can be used to accomplish a wide variety of goals. CBT has been applied to issues ranging from depression and anxiety, to the improvement of the quality of parenting, relationships, and personal effectiveness.

Numerous scientific studies and research have documented the helpfulness of CBT programmes for a wide range of concerns throughout the lifespan. These concerns include children’s behaviour problems, health promotion, weight management, pain management, sexual dysfunction, stress, violence and victimisation, serious mental illness, relationship issues, academic problems, substance abuse, bipolar disorder, developmental disabilities, autism spectrum disorders, social phobia, school refusal and school phobia, hair pulling (trichotillomania) and much more. Cognitive-behavioural treatments are subject randomised controlled trials and “have been subjected to more rigorous evaluation using randomised controlled trials than any of the other psychological therapies”. There is discussion of using technology to determine diagnosis and host interventions according to research done by W. Edward Craighead. This would be done using “genetic analysis” and “neuroimaging” to create more individualised treatment plans.

Special Interest Groups

The ABCT has more than 40 special interest groups for its members. These include groups for issues involving African-Americans, Asian-Americans, Hispanics and other ethnic groups such as children and adolescents; couples; gay, lesbian, bisexual and transgender people; students; military personnel; and the criminal justice system. The ABCT works within these groups to overcome addictive behaviours and mental illnesses that may cause negativity in these groups life. A group that the ABCT has supported well is the special interest group of the criminal justice system. The ABCT helps provide the prison system with knowledge of how to more humanely treat those who committed crimes and give people the proper care and attention to become great citizens.