This document discusses various anxiety disorders and how applied behavioural analysis (ABA) can be used as a treatment approach. It provides information on specific anxiety disorders like social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder and explains how ABA techniques like exposure therapy, reinforcement, and extinction can be applied to reduce anxiety symptoms by targeting behaviours maintained by avoidance. The length of ABA intervention depends on the type and severity of the anxiety disorder.

1. ANXIETY DIOSRDERS & ABA

2. • As the name implies it is applied and therefore is based
on practice rather than theory and focuses on changing
the observable behaviour of the individual and how it
affects a particular situation. ABA is a form of almost
pure behaviourism.
• Applied behaviour analysis (ABA) is the application of
the principles of operant learning theory to socially-
significant behaviours.
APPLIED BEHAVIOURAL ANALYSIS

3. • Anxiety is the most common psychological
condition displayed in children and adolescents.
There are a variety of specific anxiety disorders
that may be present in children. The predominant
theme of all the anxiety disorders is “uncontrollable
worry”.
ANXIETY DISORDER

4. • Applied Behavioral Treatment (ABT) involves systematic and structured
attempts to increase the level of meaningful activity in a person’s everyday
life, thereby helping clients to contact sources of positive reinforcement for
behaviors that correspond with clinical improvements
• ABA techniques are applied in order to reduce anxiety by increasing positive
reinforcement.
• It is application of principles of operant psychology including positive and
negative reinforcement.
APPLIED BEHAVIOURAL TREATMENT

5. • The anxiety disorders differ considerably, so
techniques should be tailored to your specific
symptoms and concerns.
• The length of intervention will also depend on the
type and severity of anxiety disorder. However, many
anxiety therapies are relatively short-term. According
to the American Psychological Association, many
people improve significantly within 8 to 10 therapy
sessions.

7. 1 Separation Anxiety
Disorder
Overwhelming fear of harm or loss significant figure.
2 Selective Mutism persistent failure to speak in public situations where speaking is
expected, despite speaking in other situations
3 Social phobia Marked and consistent fear of performing publicly
4 Specific Phobia Intense fear of a particular object or situation
5 Generalized Anxiety
Disorder
Excessive worry and anxiety about a number of events and
activities
5 Agoraphobia Intense fear of being in public places where escape might be
difficult.
7 Panic Disorder Uncontrollable panic attacks with significant fear about future
attacks

8. • Comprehensive ABA Interventions are aimed at producing changes in specific
skills that impact global measures of functioning including IQ, adaptive skills,
and social functioning in children with autism.
• Typically, such treatment is provided for an extended period (often spanning
several years) and is often a home- or center-based program (sometimes in
an educational setting).
• These programs rely on the use of clear instructions, reinforcement, teaching
small units of behaviour, and repeated trials to maximize learning
opportunities.

9. • Focused ABA Interventions are generally more time-limited in nature because
they are designed to address specific behaviour deceleration concerns
including aggression, self-injury, disruptive behaviour, pica, and other
challenging behaviours.
• Focused interventions can also address other concerns such as anxiety and
skills deficits (i.e., social skills and self-care deficits).

10. • Anxiety shares functional similarities with depression because (anxious)
individuals who report high levels of anxiety respond to a relatively high
frequency of negative reinforcement where avoidance behavior is
commonplace.
• Avoidance is a key feature of the diagnostic criteria for an anxiety-related
disorder (American Psychiatric Association (APA), 2000).
ANXIETY DISORDER & ABA

11. • Increased access to response-contingent positive reinforcement for
approach behavior with concurrent decreases in negative
reinforcement for avoidance behavior could lead to greater
engagement in activities that have anxiolytic functions, with a gradual
extinction of anxious responses.

12. SEPARATION ANXIETY DISORDER
The (DSM-V) identifies Separation Anxiety
Disorder as a “developmentally
inappropriate and excessive fear or anxiety
concerning separation from home or from
those to whom the individual is attached”
Children exhibiting SAD symptoms
become significantly distressed
when separated from their home
or attachment figure (usually a
parent) and will often take
measures to avoid separation.

13. This fear is exhibited
through disproportionate
and persistent worry
about separation,
including apprehension
about harm befalling a
parent or the child when
they are not together, as
well as fear that the
parent will leave and
never return.
Avoidance behaviors
commonly associated
with SAD include
clinging to parents,
crying or tantruming,
and refusal to participate
in activities that require
separation (e.g., play
dates, camp, sleepovers).

14. When confronted with situations that require separation, such
as bedtime or school attendance, a child with SAD may tantrum
or refuse to comply with parents’ instructions. Oppositional
behavior in the course of SAD often arises from the inadvertent
reinforcement of the child’s avoidance behaviors and
misconduct.
For instance, when a child tantrums or “causes a scene,”
parents may remove the child from the anxiety-provoking
situation. As a result, these actions may reinforce the
disruptive, inappropriate behavior.

15. Emotional Security
• The “cure” for separation anxiety is emotional security that is allowed to
grow over an extended period of time. But emotional security may be
elusive for a child with chronic, severe anxiety. In many cases, this
emotional security can be done by parents through social reinforcement,
habit repetition and schedules of reinforcement.Extinction
• Extinction occurs when you withhold or remove the CSE that is
reinforcing the client’s maladaptive behavior.

16. SOCIAL ANXIETY DISORDER
Social Anxiety Disorder, also called
social phobia, in which a person
has an excessive and unreasonable
fear of social situations. Anxiety
(intense nervousness) and self-
consciousness arise from a fear of
being closely watched, judged, and
criticized by others.
A person with social anxiety disorder is
afraid that he or she will make mistakes,
look bad, and be embarrassed or
humiliated in front of others. The fear
may be made worse by a lack of social
skills or experience in social situations.

17. • Various forms of exposure (imaginal, in vivo), social-
skills training, or combinations of these can be used.
• Behavioral approaches emphasize prolonged exposure
to social stimuli both within and between sessions via
homework assignments (e.g., Newman,
Hofmann,Werner, Roth, & Taylor, 1994).
SOCIAL ANXIETY DISORDER

18. Fading
Fading involves taking a behavior that occurs in one situation and
getting it to occur in second situation by gradually changing the first
situation into the second.
Exposure therapy
Exposure therapy involves a controlled environment in which patients
are gradually exposed to situations that would normally cause anxiety
in them. The purpose is to slowly desensitize them to those triggering
situations until those triggers become manageable, or completely
eliminated. As a result, the patient has less panic or fewer anxiety
attacks over time.

19. • Agoraphobia is an intense fear of being in public places where
you feel escape might be difficult.
Entering shops, crowds, and public places.
Travelling in trains, buses, or planes.
Being on a bridge or lift.
Being in a cinema, restaurant, etc, where there is no easy exit.
Being anywhere far from your home.
• They all stem from one underlying fear. That is, a fear of being in
a place where help will not be available, so you tend to avoid
public places, and may not even venture out from home.
AGORAPHOBIA

20. • Behavioural therapy aims to change any behaviours which are harmful or not helpful.
• For example, with phobias your behaviour (your response to the feared object) is
harmful, and the therapist aims to help you to change this.
• Various techniques are used, depending on the condition and circumstances. For
example, in agoraphobia, the therapist will usually help you to face up to feared
situations, a little bit at a time.
• A first step may be to go for a very short walk from your home with the therapist
who gives support and advice. Over time, a longer walk may be possible, then a
walk to the shops, and then a trip on a bus, etc. The therapist teaches you how to
control anxiety when you face up to the feared situations and places. For example,
by using deep breathing techniques.
TREATMENT THROUGH ABA

21. • Mostly positive reinforcement is used in combination with exposure therapy.
• Behavioural treatments (e.g., exposure in vivo) similarly have been shown
effective when compared to other psychological interventions. Clum, Clum, and
Surls (1993) reported.
• In vivo exposure refers to the direct confrontation of feared objects, activities, or
situations by a patient.

22. • Panic disorder is a condition where you have recurring panic attacks.
• A panic attack is a severe attack of anxiety and fear which occurs suddenly, often
without warning, and for no apparent reason. In addition to the anxiety, various other
symptoms may also occur during a panic attack. These include one or more of the
following:
 A thumping heart (palpitations).
 Sweating and trembling, Dry mouth.
 Hot flushes or chills, Fear of dying or going crazy.
 Feeling short of breath, sometimes with choking sensations.
 Chest pains., Feeling sick (nauseated), dizzy, or faint.
 Feelings of unreality, or being detached from yourself.
PANIC DISORDER

23. • Behavioral theories of anxiety disorders (e.g., Mowrer, 1960) posit that
pathological fears are acquired through classical conditioning processes and
maintained through operant conditioning (i.e., reinforcement) of avoidance
behavior.
• With repeated and prolonged exposure, anxiety responses gradually
diminish, a process known as habituation (Wolpe, 1958).
• Other theorists (e.g., Foa & Kozak, 1986) have postulated that exposure
procedures work by providing the patient with corrective information about
the dangerousness of feared situations.
TREATMENT TROUGH ABA (PANIC
DISORDER)

24. • Exposure to feared bodily sensations (i.e., interoceptive exposure), is used to
treat panic disorder
• Specifically, interoceptive exposure is designed to help individuals directly
confront feared bodily symptoms often associated with anxiety, such as an
increased heart rate and shortness of breath.
• The therapist may assist this by having the client (in a controlled and safe
manner) hyperventilate for a brief period of time, exercise, or hold his breath.

25. • Selective mutism refers to a persistent failure to speak in
public situations where speaking is expected, despite speaking
in other situations (American Psychiatric Association, 2000).
• Children with selective mutism commonly fail to speak in
situations outside their home and especially in places such as
school, restaurants, stores, and recreational settings. From a
diagnostic perspective, selective mutism must last at least one
month.
SELECTIVE MUTISM

26. • Behavioral strategies: refers to coming up with a step-by-step plan where the
child gradually does more and more difficult speaking-type behaviors, as well
as coming up with a system of positive reinforcement whenever the child is
able to accomplish those behaviors.
• Contingency management involves positive reinforcement of (or rewarding
for) verbal behavior with initial reinforcement of nonverbal communication
like pointing and whispering
• Shaping reinforcement is provided for approximations of the target verbal
behaviors (e.g., mouthing words, whispering, talking on the telephone) and
later for normal speech. A reinforcement menu (what types of rewards the
child wants to earn and for what behaviors) is first developed in collaboration
with the child.
TREATMENT TROUGH ABA
(SELECTIVE MUTISM)

27. • Stimulus fading interventions build on the success of contingency management and
shaping by gradually increasing the number of people and places in which speech is
rewarded. For example, the child may first be rewarded for speaking to a classmate to
whom s/he already speaks outside of school. Gradually, other students are introduced
into the group until the child is able to speak in the presence of a large group of
peers. Stimulus fading can also be used in problematic situations that occur outside
of school (e.g., talking to grandparents, ordering in fast food restaurants).
• Systematic desensitization traditionally involves the use of relaxation skills along with
gradual exposure to successively more anxiety-provoking situations. In this type of
intervention a hierarchy of feared speaking events is constructed and therapy consists
of a series of imaginal and in vivo (real-life) exposures to feared situations

28. • Social skills training may also be used to reduce anxiety and facilitate speech
with peers and involves learning what to say to initiate conversations, how to
take turns, making eye contact, and learning how to understand another
person’s nonverbal behavior.
• (self-) Modeling involves making video and/or audiotapes that have been
edited to depict the child speaking in settings in which he or she has
previously remained mute. The tapes are played repeatedly throughout the
intervention, with the expectation that the child will become accustomed to
hearing him- or herself speaking in these settings and will begin to believe in
his or her ability to do so.

29. • A single-case within-subject experimental (A/B/C) design was used for
evaluating treatment effects on the reported anxiety levels of each
participant. The A phase was baseline; B phase was treatment; and C phase
was maintenance/follow-up. Standardised repeated measures of anxiety were
collected during each phase and the participants were required to self-
monitor their anxiety-related behaviours daily.
• During baseline, each participant was required to complete daily self-
monitoring of anxiety and activity levels using diaries developed for this
study.
• The duration of phase B (treatment) was 84 days for all participants.
STUDY WITH ANXIETY PATIENTS
EXPERIMENTAL DESIGN

30. • The aim of study was to increase the amount of approach-oriented, socially
important behaviors in the participant’s daily life (positive reinforcement)
while decreasing the frequency of habitual avoidance behaviours (negative
reinforcement).
• This was achieved by helping participants bring their overt behaviors more
under the control of life goals and related scheduled daily-activities.
• The duration of phase C for each participant was 84 days (3 months) and the
phase commenced immediately after the completion of the treatment phase
B. The aim was to observe participant behaviour independent of the
structural variables inherent in the earlier baseline and treatment phases.

31. • Frank’ was a 51-year-old male reporting a history of chronic anxiety with
repeating periods of abdominal discomfort, tightness in the throat area, hot
flushes, sweating, rapid breathing, and intense worry occurring since
adolescence.
• He reported that he often engaged in worry about his relationships, work, his
long-term life direction, and anxiety itself.
• Frank met DSM-IV (APA, 2000) criteria for Social Anxiety Disorder (SAD;
generalised) and Generalised Anxiety Disorder (GAD).
CASE 1: GAD
(GENERALIZED ANXIETY DISORDER)

33. • “Mary” was a 62-year-old female who reported strong anxiety in relation to
road- and vehicle - related activity. She stated that she had never driven
independently, did not have a driving licence, had “always been nervous”
when travelling in cars and buses, and experienced fear when walking
adjacent to or crossing highly-populated roads and traffic intersections.
• She reported that she had been fearful of cars and car -travel since she was a
child although she couldn’t explain why.
• Mary met DSM-IV (APA, 2000) criteria for Specific Phobia (situational) and
Generalised Anxiety Disorder (GAD).
CASE 2: SPECIFIC PHOBIA

35. • Decreased scores in self-reported anxiety were obtained in each case and the
improvements were maintained during a 3-month no treatment maintenance
phase.
• Compared to baseline, each participant also recorded increases in activity
levels in some key life areas during the treatment phase.
• These preliminary findings suggest that increased activation in functionally
positive areas is associated with reported decreases in anxiety
• positive reinforcement and negative reinforcement could be an effective
stand-alone treatment for anxiety in adults.

36. THANK YOU!!!