Basics of Cognitive-Behavioral Therapy

Clinical Applications of ABA

Presenter: Kevin D. Arnold, PhD, ABPP

• Psychologist Ohio and Wisconsin• Board Certified in Behavioral and

Cognitive Psychology• Advanced Certificates in CBT

from Atlanta Center for Cognitive Therapy and the Center for Cognitive Therapy of New York

• 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

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)

Types of Behavioral Data• Time Sampling• Counting Frequency vs. Occurrence• Duration within Time Samples• Ratios of Duration within Time Samples• Ratings – SUDS, Mastery, Pleasure

• Ratios of Counts within Time Sampling• Ratios of Occurrence per Opportunity

(later the role of Sds or S-deltas)

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 of Third-Party to Verify Self-Monitoring Counts• Commonly Used Types

– Daily Activity Record– Pleasure/Mastery Ratings– Mood Records– Extinction Charts and OCD/PTSD– Ratings of Likelihood or Believability (DTR, Barlow)

Graphing and Analyzing Behavioral Data

• Basic Graph Set –up: Time on the X-axis, Data on the Y-axis– Days, hours, events on X– SUDS, P/M, Duration, Counts, %s on Y

• Phase Lines– Very useful for motivation

• Using “Research” Phase Lines to Educate Patient

Graphing and Analyzing Behavioral Data

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Graphing and Analyzing Behavioral Data

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Graphing and Analyzing Behavioral Data

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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

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

How-tos of Functional Behavioral Analysis Experiments

• Using Mini-Experiments• Design with Data Collection and

Variability 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

Use of Functional Assessment for Parents in Family Therapy

• PMT backdrop• Parents use of Aversive Attention• Use of Withholding Attention or

Modifying Delivery (DRAs)• Modifying Parent’s SDs and S-Rs

through Practice• Finding the Parental Motivator

(Positive kid attention, peace-quiet: escape, etc.)

Using Functional Analysis 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

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)

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

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 to Teach Reward Potentials–MOs vs. Learned Helplessness

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

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

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

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

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

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’s What 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?

Questions