Clinical Behavior Analysis , livre ebook

Dedication To Megan and Tim


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Copyright © 2004 Context Press
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PDF ISBN: 978-1-62625-414-5
The Library of Congress has cataloged the original print edition as:
Clinical Behavior Analysis / edited by Michael J. Dougher
p. 306 cm.
Includes bibliographical references
ISBN 1-878978-38-1
1. Behavioral assessment. 2. Behavior therapy. 3. Cognitive therapy.
I. Dougher, Michael J. 1950-
RC473.B43C58 1999
616.89--dc21 99-43532 CIP


Contents
Foreword
Chapter 1. Clinical Behavior Analysis
Chapter 2. Recent Developments in the Behavioral Analysis of Language: Making Sense of Clinical Phenomena
Chapter 3. A Behavior-Analytic Approach to Some of the Problems of Self: A Relational Frame Analysis
Chapter 4. Long-Term Correlates of Childhood Sexual Abuse: A Behavior Analytic Perspective
Chapter 5. Functional Alternatives to Traditional Assessment and Diagnosis
Chapter 6. Behavior Analysis and Depression
Chapter 7. A Process-Oriented Behavioral Approach to the Etiology, Maintenance, and Treatment of Anxiety-Related Disorders
Chapter 8. Marital Problems
Chapter 9. CRA: The Community Reinforcement Approach for Treating Alcohol Problems
Chapter 10. An Acceptance-Based Performance Enhancement Intervention for Collegiate Athletes
Chapter 11. Decreasing the Prevalence of Marital Conflict: A Public Health Perspective for Clinical Research
Chapter 12. Emotion and The Relationship in Psychotherapy: A Behavior Analytic Perspective
Chapter 13. Interpretation in Clinical Behavior Analysis
Foreword
Clinical behavior analysis is a relatively recent and rapidly growing branch of applied behavior analysis. Although they share many of the same philosophical assumptions, the two fields differ in terms of the types of interventions, clinical disorders, and treatment settings that characterize them. Applied behavior analysis focuses on the use of contingency management procedures to treat severely impaired populations such as autistic, brain injured, and developmentally delayed children and adults in residential treatment settings, special schools and hospitals. Clinical behavior analysis focuses on the use of verbally based interventions to treat verbally competent clients who seek outpatient treatment. The types of disorders treated by clinical behavior analysts include anxiety, depression, personality disorders, substance abuse, stress disorders, and relationship difficulties. While applied behavior analysis has flourished since its beginning in the early 1960s, it is only recently that behavior analysts have more fully addressed the issues faced by verbally competent clients seeking therapeutic assistance.
Because of the substantive differences between the two fields, the applied behavior analysis literature has been of only limited use to those working in the emerging field of clinical behavior analysis. Although the mainstream clinical literature, is concerned with the same substantive issues, the philosophical assumptions, theories, underlying principles, objectives, and methods of clinical behavior analysis are so fundamentally different from those of other clinical approaches, including behavior therapy, that these literatures have also been of limited use to clinical behavior analysts. In the end, clinical behavior analysts have had to develop their own literature.
The seeds of clinical behavior analysis were planted years ago in the writings of Skinner (1953; 1957; 1974), Ferster (1972a; 1972b; 1973;), Goldiamond (1974), and Hawkins (1986). Since then, an increasing number of behavior analysts have turned their attention to clinically relevant behavioral phenomena. Two sets of events have been particularly important to the development of the field. First is the relatively recent and rapid increase in basic research on verbal behavior. The research on rule-governance, stimulus equivalence, derived stimulus relations and the transformation of stimulus functions has been particularly relevant. This work, much of which has been conducted by clinical behavior analysts themselves, has led to an enhanced understanding of complex human behavior and provided the empirical foundation upon which the unique contributions made by behavior analysts to clinical contexts are based.
The second set of events that significantly affected the growth and direction of clinical behavior analysis was the development of Kohlenberg and Tsai’s Functional Analytic Psychotherapy (FAP, 1994) and Hayes’ Acceptance and Commitment Therapy (ACT, Hayes & Wilson, 1994; Hayes, Stosahl, & Wilson, 1999). To a large extent, FAP relies on direct contingency shaping of clinically relevant behaviors. However, it incorporates a basic premise of psychodynamic therapies that the best place to observe and modify these behaviors is within the therapeutic session. Moreover, FAP actively seeks to establish intense, curative, emotional reactions within the therapeutic relationship. ACT, on the other hand, stems directly from a radical behavioral perspective on private experience and recent research on derived stimulus relations. Its aim is to help clients openly experience both private and public events as they are and without distortion. Perhaps surprisingly, its objectives and some of its techniques are similar to those advocated by Buddhism, Gestalt therapies and existential therapies.
Although they differ in their objectives and in the types and focus of the interventions they employ, FAP and ACT represent the first fully articulated, verbally based, comprehensive, outpatient oriented treatment approaches based upon behavior analytic principles. By demonstrating the unique contributions that behavior analysis can make to the clinical context, these two therapies have provided tremendous impetus to the development of the field. Acceptance based procedures, in particular, have recently proliferated and have been applied to the treatment of a wide-variety of disorders (see Hayes, Jacobson, Follette, & Dougher, 1994).
In the past decade, an increasing number of scholar/practitioners have contributed to the developing field of clinical behavior analysis. These writers have drawn upon long-standing behavior analytic principles and recent advances in verbal behavior research to explain the development of a variety of clinical disorders, advocate alternative approaches to clinical assessment and classification, develop new therapeutic interventions, and suggest new treatment goals. The field has grown enormously and it is fair to say at this point that clinical behavior analysis has made some unique contributions to the fields of psychopathology, clinical assessment and psychotherapy. The purpose of this book is to bring together in a single place a sampling of the work that constitutes the growing field of clinical behavior analysis.
The first four chapters of the book focus on the distinguishing characteristics of behavior analysis and the recent research on language and verbal behavior upon which much of the field is based. In Chapter 1, Michael Dougher and Steven Hayes provide an historical perspective on the development of clinical behavior analysis and lay out the underlying philosophical and theoretical assumptions that distinguish it from other clinical approaches, including behavior therapy and cognitive behavior therapy. In Chapter 2, Kelly Wilson and John Blackledge discuss the clinical relevance of recent behavior analytic research on language and verbal behavior. These authors make the argument that recent data draw into question Skinner’s definition of verbal behavior, and they offer an alternative definition, which they suggest provides a better framework for understanding important clinical phenomena. In the next chapter, Dermot Barnes, Ian Stewart, Simon Dymond, and Bryan Roche attempt to bring some clarity to the term “self,” one of the most frequently used but poorly understood terms in psychology. These authors rely on recent developments in Relational Frame Theory to provide an account of the development of the concept of self and related clinical disorders. In Chapter 4, Jacqueline Pistorello, Victoria Follette, and Steven Hayes describe the long-term effects of childhood sexual abuse and attempt to explain these effects by appeal to the concept of derived stimulus relations
The next five chapters focus more directly on the assessment and treatment of specific disorders. In Chapter 5, William Follette, Amy Naugle and Peter Linnerooth distinguish between functional (behavioral) and more traditional approaches to clinical assessment and diagnosis. They go on to describe the basic assumptions, principles, processes, and objectives of functional assessment, and suggest how this approach can enhance treatment utility and bring some clarity to the difficult issue of psychological health. In Chapter 6, Madelon Bolling, Robert Kohlenberg, and Chauncey Parker provide a behavior analytic account of some basic cognitive therapy terms and then describe how FAP can enhance cognitive therapies for depression. In the next chapter, John Forsyth relies on recent developments in verbal research to elucidate the core processes and functional similarities among the various anxiety dis