Van, a 7-year-old boy, developed severe germ phobia and compulsive behaviors like spending 20-30 minutes cleaning himself after using the bathroom. His parents were under stress due to his mother's chronic illness and their poor relationship. ABA treatment for Van's OCD included identifying antecedents like his mother's illness and consequences like relief from obsessive thoughts. Treatment methods included escape extinction to reduce hand washing, contingent reinforcement for avoiding the behavior, and behavior shaping to gradually reduce cleaning time. Research shows ABA interventions using functional analysis and differential reinforcement can effectively reduce compulsive behaviors. While effective, ABA may not fully address unconscious causes of OCD.

1. Applied
Behavioral
Analysis
Dealing with OCD
BY:
HIBA ASHFAQ
SARA ISMAIL
ZAHYREEN KOUSAR
ZAHRA NAYYAR

2. Content
– Case of OCD
– Rationale behind ABA Case Conceptualization
– Case Conceptualization of OCD Using ABA (Functional
Analysis)
– ABA Based Treatment Methods of OCD
– Evidences for Efficacy of Applied Behavioral Interventions
with OCD
– Conclusion

3. Case of OCD
– Van, a seven-year-old first grader, developed a severe germ phobia
and extremely compulsive behaviors. After going to the bathroom
he would regularly spend twenty minutes to a half an hour
cleaning himself. At school he would not open or close any doors
without first covering his hand with his sweater to protect himself
from germs. He limited his play with his friends because of his fear
of being contaminated by germs. His compulsive behaviors
increased and required larger amounts of time. The only anger Van
manifested was when his parents tried to shorten the time he
spent in compulsive behaviors.

4. – Initially, Van had no awareness of any difficulties which preceded the
development of his symptoms. However, when his parents were seen alone,
they related numerous stresses in their relationship. His mother had been sick
over the previous two years with severe chronic fatigue and numerous vague
health problems which resulted in prolonged bed rest. She had had a very
stressful relationship with her mother as a child and had difficulty in trusting
her husband. Also, even though Van's parents rarely quarreled, there was very
little affection in the marital relationship. Although each was dissatisfied with
the marriage, they were not considering separation or divorce; neither were
they working to improve their marital relationship.

5. – Van denied having any fear that his parents might separate or divorce although
he had been informed by them that there was considerable stress in the
marriage. He, in fact, called their relationship good. When asked about his
mother who had been in bed for almost two years, he insisted, I'm not worried
about her. She'll be fine. It was suggested to Van that he might have developed
a fear of something bad happening to him as a result of his mothers illness and
of the stress in his parents marriage. It was explained to him that these fears
might have been too frightening to face, so instead of addressing them, he
acquired the fear that he might contract a serious illness from germs.

6. Rationale For ABA Case
Conceptualization
– The behavior analytic model focuses on operationally defined specific behaviors
that may be exhibited by an individual with Obsessive compulsive disorder.
– That is, as opposed to assessing the presence or absence of the disorder, the
behavior analytic model focuses on specific behaviors exhibited by the
individual.
– Assessment involves determination of the antecedent and consequential
environmental events that influence these behaviors. Once the variables
controlling the target behaviors have been identified, an intervention that is
designed to address the variables responsible for maintenance of each behavior
is implemented.

7. – Although the behavior analytic model does not make use of biological
explanations, the model does not deny that such variables are important.
However, instead of focusing on a biological cause and corresponding
intervention, the model analyzes the environmental events that may occasion
and/or maintain each specific behavior that makes up the individual’s diagnosis
(Wilder and Wong, 2007).

8. – In a behavior analytic account, abnormal behavior stems from an individual’s
genetic history, his current biological condition, his history of interaction in and
with the world around him (i.e., the environment) and immediate
environmental events (or immediate contingencies). Of these variables,
immediate environmental contingencies are most amenable to manipulation.
– Thus, these are the focus of behavior analytic assessment and treatment

9. Defining The Disorder
– Individuals with a diagnosis of a Clinical disorder typically exhibit behavioral
excesses as well as skill deficits.
– Behavioral excesses are responses occurring at unusually high rates that disrupt
social relations, or activities of daily living, or both.
– Behavioral deficits are responses occurring at unusually low rates that are
insufficient to maintain independent living.

10. Case Conceptualization of OCD Using ABA (Functional Analysis)
– Functional Analysis is predicated on the assumption that maladaptive behavior
is caused by inappropriate consequences and/or antecedents. But, human
behavior is more complex than that.
– NO EMPHASIS ON PERSONAL VARIABLES

11. ANTECEDENTS
– Mother’s illness for 2 years_______ Negative punishment______ taking away
mother’s attention from child
– Vicarious learning _____ fear of having illness because of the observation of
problems mother faced during her illness.
– Mother’s relationship with the child’s father _______ Negative
punishment______ taking away comfort of family environment from child.

12. BEHAVIOR
– Regularly spend twenty minutes to a half an hour cleaning himself.
– Would not open or close any doors without first covering his hand with his
sweater.
– limited his play with his friends.

13. CONSEQUENCES
– Excessive cleanliness measures _______ Negative Reinforcement ______
adding satisfaction in child’s life as he has re-directed his attention towards
germ preventive measures.
– Avoiding/limiting play with friends because of fear of contamination
__________ Negative reinforcement for him as he would be least exposed to
the social surroundings.

14. ABA Based Treatment Methods
– Functional Analysis
– The first step is to identify the problem behavior and observing those
antecedents and consequences that maintain that behavior
– In Van’s case the observable behavior is washing hands up to to half an hour
after each visit to the restroom .
– What actually precedes this behavior is distressing thought that something bad
is going to happen if he doesn’t wash his hands a certain duration of time or
number of times
– And as a consequence when he washes his hands he is able to neutralize those
negative thoughts in his mind- in short his hand washing behavior is his coping
mechanism .

15. ABA Based Treatment Methods of OCD
– Escape- Extinction
– In Van’s case the first step of intervention would be to withhold the
reinforcement that he receives from the constant washing of hands .
– He has to be encouraged to withhold himself from washing his hands for long
periods of time .
– The downside of extinction is that when it is implement it can result in
extinction burst or “pop up” behaviors that are alternate behaviors that
provide the client the same reinforcement but with a different behavior .
– In this situation contingent reinforcement will be used .

16. – Contingent Reinforcement
– Contingent mean “based upon”
– So every time the behavior of washing hands is avoided so he is rewarded for
avoiding the behavior but the moment he engages in it he will not be rewarded
.
– Token Economy
– Activities that would be given as a reward would be such that are activities that
he likes to do but with his parents so that he can further get social
reinforcement from being with them and that will also help to reduce his fear of
being apart from them.

17. – Behavior Shaping
– Rewarding behaviors that lead to the desired behaviors
– In Van’s case, a condition will be set for acceptable behavior such as initially he
would be rewarded for washing his hands 15 times instead of the usual 20 times
each time he visits the rest room .
– A series of graduated tasks will be decided and as he masters one task he will
be informed that now the criteria for receiving a reward has changed and he
will be rewarded accordingly up until he is able to complete eliminate the act of
washing his hands

18. Efficacy of Applied Behavioral Interventions with OCD
– A corresponding function-based treatment plan incorporated antecedent
strategies and differential reinforcement (Deitz, 1977; Lindberg, Iwata, Kahng,
and DeLeon, 1999; Reynolds, 1961).
– Have resulted in reductions in problem behaviour were evidenced through use
of a multiple baseline across behaviours design.
– Research studies have supported socially mediated positive reinforcement.
– treatment results of previous literature indicates the need to match extinction
procedures to the function of problem behavior; a task which would be less
probable and more susceptible to errors had functional analysis not initially
been conducted.

19. – Researches suggest the consequences effectively competed with the positive
reinforcement potentially obtained by the compulsions (i.e., tokens and back-up
rein forcers competed with stimulation).
– The decision to utilize extinction rather than exposure and response prevention
(ERP), a procedure included in customary CBT treatments for OCD (March & Mulle,
1998), is considered to have been integral in creating treatment efficacy. While ERP
involves exposing the individual to specific environmental variables (imagined or in
vivo) and preventing associated compulsive behaviours thereby allowing
habituation to anxiety to occur (March & Mulle, 1998), extinction does not prohibit
aberrant behaviour from taking place. This difference was deemed significant.
– The shaping Behaviour technique will help the child to have less anxiety and would
be able to mentally relax and come back to having a less impaired social life

20. Limitations:
– Emotional and the cause of unconscious disturbance was not literally addressed
. Rather was not put forward and this ABA indicates something wrong at the
outside.
– Hence – Cognitive and Psychoanalytic approach would also be useful along with
this therapy.

21. Conclusion
– Fictional explanations of behaviour, including compulsive behaviours categorized as OCD, have
been erroneously generated within .
– Concluding that behaviour occurs because of a 'need' or 'drive' is fictional and explains
nothing (Wyatt, 2001).
– Instead, empirical investigation would explain better of the effectiveness for behaviour
occurrence: "the best way to dispose of any explanatory fiction is to examine the facts upon
which it is based. These usually prove to be, or suggest, variables which are acceptable from
the point of view of scientific method" (Skinner, 1953, p. 285).
– As Mace et al. (1988) assert: "without an empirical understanding of the variables controlling
aberrant behavior, the researcher/clinician is faced with selecting treatments on the basis of a
subjective analysis, or combining several intervention elements that have a history of
effectiveness with similar problems"