Behaviorism as a Theoretical and Applied Framework for Cognitive-Behavioral Therapy; Clinical Applications of Applied Behavior Analysis

1. Basics of Cognitive-
BehavioralTherapy
Clinical Applications of ABA

2. Presenter:
Kevin D. Arnold, PhD, ABPP
• PsychologistOhio andWisconsin
• Board Certified in Behavioral and
Cognitive Psychology
• Advanced Certificates in CBT
from Atlanta Center for Cognitive
Therapy and the Center for
CognitiveTherapy of NewYork
• Vice-President,American Board
of Behavioral and Cognitive
Psychology
• Past-President of Ohio
Psychological Association and the
Ohio Board of Psychology
• Approved ABA Supervisor by the
Behavior Analyst Certification
Board
• President of the Council of
Specialties in Professional
Psychology and the Behavioral and
Cognitive Psychology Specialty
Council

3. Conducting Reliable Direct Observations
• Operational Definitions
• Define Most Functional Unit of Measure
– Duration
– Frequency Count
– Total
– Ratios (and denominator)
• Standardize Measurement Procedure (beep,
watch, recording)
• Objective Measurement (Verification Methods
and Reliability—Inter-rater Agreement, Inter-
rater Correlation, Kappa Coefficient)

4. Types of Behavioral Data
• Time Sampling
• Counting Frequency vs. Occurrence
• Duration withinTime Samples
• Ratios of Duration withinTime Samples
• Ratings
– SUDS, Mastery, Pleasure
• Ratios of Counts withinTime Sampling
• Ratios of Occurrence per Opportunity (later the
role of Sds or S-deltas)

5. Application to Clinical Practice:Teaching
Self-Monitoring to Patients
• Teaching Data Collection to Patients and Parents
• Self-Monitoring of Self vs. Child
• Objective Anchors for Ratings
• Empowerment of Self-Monitoring
• Use ofThird-Party toVerify Self-Monitoring Counts
• Commonly UsedTypes
– Daily Activity Record
– Pleasure/Mastery Ratings
– Mood Records
– Extinction Charts and OCD/PTSD
– Ratings of Likelihood or Believability (DTR, Barlow)

6. Graphing and Analyzing Behavioral Data
• Basic Graph Set –up:Time on the X-axis, Data
on theY-axis
– Days, hours, events on X
– SUDS, P/M, Duration, Counts, %s onY
• Phase Lines
– Very useful for motivation
• Using “Research” Phase Lines to Educate
Patient

7. Graphing and Analyzing Behavioral Data
0
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
M Mastery
M Pleasure
T Mastery
T Pleasure
W Mastery
W Pleasure
Tr Mastery
Tr Pleasure
F Mastery
F Pleasure
Sat Mastery
Sat Pleasure
Sun Mastery
Sun Pleasure

8. Graphing and Analyzing Behavioral Data
0
10
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30
40
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70
80
90
Time 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7

9. Graphing and Analyzing Behavioral Data
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Time
Sample
1 2 3 4 5 6 7 8 9 10 11
Baseline
Intervention
Withdrawl

10. Explaining Behavioral Data to Patients
• Behavior Defined
– SUDS, M/P, Emotional Ratings, Behavioral Counts
• Use of Behavior to Increase Motivation
• Correction of Mis-use of SUDS, MP, etc.
• Increases, Decreases, Causes

11. How-tos of Functional Behavioral Analysis
Experiments
• SDs and MOs as Core Concepts (more to
come)
• A-B-C
• Deriving SDs and Mos
• Vary one of Four Motivators
– Attention
– Escape
– Stimulation
– Objects

12. How-tos of Functional Behavioral Analysis
Experiments
• Using Mini-Experiments
• Design with Data Collection andVariability
from Hypothesized Motivators
• Vary SDs through Contexts (person, place,
things, time of day, internal states, sleep, etc.)
• Analyze the data on a graph
• See which Factors Affect the Behaviors

13. Use of Functional Assessment for Parents
in FamilyTherapy
• PMT backdrop
• Parents use of Aversive Attention
• Use ofWithholdingAttention or Modifying
Delivery (DRAs)
• Modifying Parent’s SDs and S-Rs through
Practice
• Finding the Parental Motivator (Positive kid
attention, peace-quiet: escape, etc.)

14. Using FunctionalAnalysis as a Self-
Determination Strategy for Patients
• Application of Premack Principle
• Development of Self-Assessment Skills for
SDs, S-deltas, and MOs
• Creation of ALT-R and DRI interventions
– Self-conducted research
– Applications
• HRT, Substance Use Cessation
• Behavioral Activation

15. Prompts and Rewards: Keys to Behavioral
Control
• Prompts: Rely on associational learning with
language, gestures, or stimuli in environment
– “Get your shoes”
– Pointing to get something
– Red light/green light
• Rewards
– Positive—delivery of something with a motivating
potential
– Negative—removal of something aversive
• Motivating Operants
– Est. Operant (EO)—changing the strength of a reward to
create greater reinforcing qualities (withhold candy)
– Abolishing Operant (AO)—changing the strength of a
reward to create less reinforcing qualities (satiate)

16. Parenting Intervention for Prompts and
Rewards
• Teach parent effective prompting
– Clear and concise
– Polite but direct
– Rule of two prompts
– Proximity and assurance of prompt reception
• When prompts reinforce non-compliance
• Rewards
– Attention and the structure of praise
– Contingencies and use of tokens
– Associational learning for tokens
– Non-contingency and praise

17. Self-Control Strategies that Rely on Self-
Prompting and Self-Reward Management
• Self-Control and Internal Linguistic Rules
• Use of Self-designed Stimulus Control
– Community Referenced interventions
– Self-Time-Out
• Self-Reward
– Overcoming Reward Erosion
– Self-Care as Self-Reward
– Delayed Gratification—Premack
– Use of DARs toTeach Reward Potentials
– MOs vs. Learned Helplessness

18. Extinction in Clinical Settings
• Extinction is not Habituation
– Habituation is a part of counter-conditioning
– Extinction is the elimination of negative
reinforcement
• Application to OCD
• Application to GAD
• Application to Depression (behavioral
activation)
• Application to PTSD
• Application to ADHD/ODD

19. Differential Rewards and Maintaining
Extinction Gains
• What are Alt-R, DRI, and DRO
• Use of Rewards and Extinction to Maintain
Gains
• Design of Generalization
– Use of in vivo
– Use of in vitro
– Use of imaginal
– Modification of Social System Responsibility

20. Application of Extinction, DR and Inhibitory
Conditioning to Parenting and Self-Control
• Planning the inhibitory conditioning based on
environments
• Modification of parental expectations
(internal language as an SD for poor
parenting)
• Practice with collaborative praise and image
based success
• Use of child attention as DR for positive
parenting

21. Associational Learning and Sd/S-delta
• Summary Slide
• Classical Conditioning-What is that Pavlov
Thing—Woof!
• Sd/S-delta as behavioral controllers (the
joystick of life)
• Managing the power of SDs and S-Deltas:
systematic planning and practice
• Praise must be delivered for the SD to have
adequate power of control

22. What are Motivating Operants and How-to Use
Them
• Summary Slide
• MOs (EOs and AOs) are manipulations
– Increase hunger, withhold desired object
– Satiate physical state, random delivery of rewards
• Manipulation takes “nerves of steel” for either
parenting or self-reward programs
• A donut for 5 pounds and the rule of self-
control

23. Application of Sd/S-delta and Motivating
Operants to Parenting and Self-Control
• The Rule-Governed Nature of Behavior
– Rules of Reward and SD/S-Delta
– Linguistic Rules (Associational Learning)
• Helping Folks Look under the Hood
• Adopting a Self-control Belief System (control
exists, but do you want to control or let other
factors control you?)
• Use of ACT’sWhat Matters Most Rule
– Review of Internal Language to Create new Rules for
Governing Behaviors
– Executive Functioning and Internal Praise
• What do you want your Obit to say?

24. Questions