CBT

Getting a Behavior Analyst House-Call

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

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Behavior Analysis is different from other psychological therapies. First, it is considered a natural science, meaning that its interventions rely in manipulation of real world variables that can be observed. This removes some of the stereotypical therapeutic long talks on a couch for viable behavior analytic therapy, but don’t sell behavior analysis short just yet.

The best evidence based practices in applied behavior analysis can be found in the natural environment, both studying participants behavior across those environments. It looks at the patterns of either prosocial behavior that can be therapeutically reinforced , and identification and reduction of maladaptive behaviors which get in the way of a fulfilling life.

One of the founding psychologists of behavior analysis, B.F Skinner, wrote in “Science and Human Behavior” (1951) about both the experimental setting for behavior analysis, and the paramount importance of seeing behavior in the environment in which it behaves. Doing tests in a lab may be helpful to get behavior analysts some solid and clinically controlled data sets, but it could never tell them if those skills or patterns would generalize a certain way in the world outside. There’s an importance to that. One of the founding dimensions of behavioral analytic science demands that the products have Generality meaning that the effects of therapy occur across environments and time. The benefits of therapy must outlast the clinical visits. This is helpful to the clients and consumers of behavior analytic therapy (ABA) for obvious reasons; you want the therapy to work in the places you need it most.

ABA practitioners use two broad tools to shape the direction of therapy a Behavior Plan to identify maintaining factors for maladaptive behaviors, and a Skill Acquisition Plan to build up the better patterns, skills, and coping behaviors to replace them. It is all about identifying the problems fast, and implementing actionable change. To that end, they need all the information they can get. Location matters.

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When it comes to the location of services, both for client/consumers, or perhaps the children of client/consumers, age becomes a factor in where this therapy takes place. In many cases this could happen in a school setting, or clinical center setting. This is a practical and commonplace service location for clients of therapy of younger ages. The school setting does have naturalistic opportunities that the clinical setting does not, and having the opportunity to receive therapy in both has its benefits. Clinical settings can focus on the skills that can be practiced with controllable conditions and stimuli that do not have the scheduling drawbacks of an academic setting. School settings have the benefit of natural peer environments, and natural contingencies for task demands if behaviors are dependent on those factors. What is often overlooked, however, is the home setting. I practiced as a School Counselor, and although certain types of therapy worked in the school setting and helped the students, once they walked out the door, the practitioner had no idea. It was all self-report from homes, and those can be misleading.

The benefits of having a house call from a behavior analyst (BCBA), and getting ABA therapy at a residence, is that the practitioner can see the conditions outside of the clinical and academic sphere that may be relevant to either stifling patterns of prosocial behavior, or feeding into the maladaptive behaviors. Sometimes the home environment is rich in information and reinforcement history that an analyst can work with. Routines, schedules, and practice can all be built into a home visit to work on the things that need the most work. Sometimes the privacy and comfort of the home also helps with going through dry runs of new skills without the social pressure of the outside world. When a Behavior Analyst comes in through the front door they are interested in getting to the bottom of the problem behaviors, teach socially relevant alternatives, and most of all, to help. I’ve seen first hand how just a change to familiar scenery can open up dialogue and planning for therapy directions that might be uncomfortable, or even embarrassing elsewhere, so never underestimate the power of an environment change on behavior.

Some Practitioners might not be able to deliver consistent services in the home, but even one occasional house call, one single visit, could open the lens on new conceptualizations on the therapeutic framework. I’ve experienced this countless times. As a practitioner, you think you know what’s going on, and then you’re in the client’s place of residence and a big piece of the puzzle falls into place. This is advice to any behavior analytic practitioner; if you have the opportunity to make that house call, don’t wait. It could change your entire idea of what is going on and save hours on dead end functional analysis hypotheses. House calls can also get the broader family involved with services that they might have otherwise been unfamiliar with. This opens up dialogue, and questions, which could lead to greater support both inside and outside of the home. There is a well known tenant in behavior analysis called dissemination. That means, this natural science works best when people know about it and understand it. Spreading the word, and being correct in the delivery of what ABA therapy is, is important. There is no short supply of misinformation out there. A home visit with the family, willing to participate, can break down the barriers of hesitancy, and show just how effective and useful this therapy can be.

So potential clients and consumers? If you can swing it, call for a home visit.

Behavior Analysts and ABA practitioners? Don’t be afraid of house-calls. You’ll be kicking yourself for not doing it sooner.

Questions? Comments? Thoughts? Leave them below.

Interest in ABA therapy for resources in getting services, or practicing? Feel free to email the address below.

References:

Cooper, John O, Heron Timothy E.. Heward, William L.. (2018). APPLIED BEHAVIOR ANALYSIS. S.l.: PEARSON.

Skinner, B. F., & Skinner, B. F. (1951). Science And Human Behavior. Riverside: Free Press

Photo Credits: http://www.Pexels.com

Overcoming the Fear of Failure

/ Chris Sawyer, M.Ed.,BCBA / 1 Comment

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This is a topic I see very often in clinical practice. Not only that, but it affects everyone at one point in their lives. When I am working on skills with my clients who are able to vocalize and express these fears, I see a pattern inherent to everyone who has ever encountered something new. In Applied Behavior Analytic research, sometimes we like to operationalize this phenomenon as “aversion”, or “presentation of an aversive novel stimulus”. Whatever we call it, it is the same thing. Engaging in something new and uncomfortable in a goal directed way is a challenge that we have to confront. Clinically, I prefer to have the individual guide their own process and become aware of their own specific aversions and behaviors. It makes the practice of confronting these stimuli as self-initiated, and self-guided as possible.

I prefer the word confront because it has a better ring to it than “desensitization”. When it comes to coming face to face with a stimulus or situation where we have to either perform or adapt, confront just seems to carry the operant theme more than the passive “desensitizing”. Failure is a scary and aversive thing.  We can define it as a condition where our operant behaviors are unsuccessful. Efforts which are not reinforced. It’s perfectly natural to want to avoid a contingency with no reinforcement. When we face something we are afraid of, or a new situation where we might not be sure we can succeed; we are facing that fear of failure. Maybe it is a fear of not being able to complete a required activity of success, or putting yourself out there socially and being received amiably. There is something universally human to that kind of hesitation. In ABA we call that an “escape-maintained” behavior, and when the behavior serves no real purpose to protect us, it tends to hold us back. When failure is that fear, then we tend not to even try.

In clinical practice, be it Applied Behavior Analysis (ABA) or any other Cognitive Behavior Therapy (CBT) the advice is all the same; it takes presentation (and sometimes repeated presentation) of that stimulus in a controlled situation until that aversive situation becomes neutral. This is called controlled exposure. That is where the real progress happens. When someone meets that situation, faces it, and can come through the other side fearing it less (or finding it less aversive), it is a step in the right direction. You may also hear the term “graduated exposure”, which denotes the concept of fading in stimuli or related stimuli in from least to most in order to acclimate in steps. A common example is if someone is scared of spiders or animals, they would be shown a picture first across the room, and gradually get closer to the picture before moving on to any examples of the real deal. Habituation is the term commonly used for becoming used to something, to the point where the stimulus becomes tolerable, if not neutral.

These same principles can be used when actively trying to overcome a fear of failure too. Generally, we come across things that are new to us. These can be either unconditioned stimuli (things we are “naturally” fearful of) and conditioned stimuli (things we have learned to be fearful of). Public speaking in front of large groups is an example of an unconditioned stimulus (for some, but it can be conditioned for others) while taking tests is a common example of a conditioned stimulus. Both present a challenge that we have to act on (engage in operant behavior) in order to be reinforced. Be it someone you are helping in clinical practice, or yourself, you can use these same foundational principles of graduated exposure. If the situation is not reinforcing in itself, keep in mind that you can always improvise your own reinforcement (reward) in order to make adapting easier. Using reinforcement alongside challenging situations can make them less aversive through a process called conditioning. The act of practicing this process on yourself is called self-management.

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Consider these steps when trying to formulate your own graduated exposure:

  1. Find the situation which you feel is important to engage in or achieve (Target).
  2. Break it down into it’s smallest components (Task Analysis). 
  3. Pinpoint which part, exactly, is causing the most aversion or fear (Aversive Stimulus). 
  4. Document, to the best of your ability, the behaviors you engage in along the way (Data Recording/Self-Monitoring). Do these behaviors help, or do they hinder? 
  5. Practice engaging with a facsimile or similar situation where the stimulus or stakes are not so high (ie. If public speaking is the target try practicing a speech in front of 1 person first). 
  6. Reinforce (reward) any toleration or approximation of success! This is the most important step. 
  7. Gradually shape these practice simulations to simulate the “real” objective as closely as possible. 
  8. Do not rush it. Challenge yourself, but be mindful that this is a process, not a race.

Take it slow. Document everything you can. Learn. Improve. The process is where the fear of failure is overcome. Often it takes more than one contact with the situation to get accustomed. I’ve used this process on myself more times than I can count. As a person who has found large exams, public speaking to crowds, public competition, and even engagement in new and unfamiliar situations; the end-goal is all the same. It is something that is worth facing because the outcome is a socially important, or beneficial to us. The aversion, or fear, is not helpful or adaptive. Facing these situations and designing the process oneself is empowering.

Self-Management is one of the greatest strategies in ABA. If someone can find a way to manage their own behavior successfully then it is the ideal situation. Self-monitoring and self-management also have the unique bonus of being able to handle what Behaviorists call “covert behaviors” (thoughts, etc). Covert behaviors are things that are not visible to outside observers but are still able to be tracked and recorded by the person experiencing them. Accuracy and specificity is important here, and can vastly improve a personal insight into their own patterns of behavior. This doesn’t have to be a single person job either! Even though someone can monitor their own behavior, they can also bring trusted friends/family/cooperators into the process of reinforcement and help to keep them on track.

Independence, and knowledge about yourself, while overcoming a challenge.

What could be better?

 

Comments? Questions? Leave them below!

 

References:

  1. Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Columbus: Merrill Pub. Co.
  2. Wood, S. E., Wood, E. R., & Wood, E. R. (1996). The world of psychology. Boston: Allyn and Bacon.

Photo Credits:

  1. pexels.com Pexels Stock Photos