Behavioural Principles and Methods

1. Behavioural Principles and Methods Michael Worrell

2. “As far as I am concerned, cognitive science is the creationism of psychology” (B.F. Skinner, 1990)

3. The cognitive approach says… • There are underlying structures that have become dysfunctional and create problems when triggered by an environmental event. • So…we need to change the dysfunctional belief structures. • Behaviour change is a means to an end. • The ‘real’ goal is to test and shift beliefs.

4. “What matters most is how you see yourself”

5. The behavioural approach says… • Behaviour is ‘lawful’. • The function of specifiable antecedents and consequences. • Change involves ‘manipulating’ variables with the most controlling influence. • Overt behaviour change is the major criterion for evaluating intervention.

6. “…there is only one constant. One universal. It is the only real truth. Causality. Action, reaction. Cause and effect…We are all victims of causality (Matrix Reloaded).

7. Current debates: Is cognitive determinism misplaced? • The “zeitgeist of internal causation”. • Treatment effectiveness tells us nothing about the validity of the underlying theory. • Component analysis studies question whether cognitive interventions are necessary (Longmore and Worrell, 2007). • Have we paid sufficient attention to the contextual aspects of clients’ concerns?

8. What does a contemporary behavioural philosophy offer? • A general orientation that follows the experimental approach to the study of human behaviour. • A means of combining an experimental approach with an individualised treatment plan. • Enables the environment and the person to be seen as one context. • Analysis may not lead to therapy but to changing environmental factors that maintain the behaviour.

9. Broad aims of Behavioural Activation • To teach the client about the functional aspects of their behaviour. • To help the client become an ‘expert observer’ on how current behaviour is and isn’t working for them. • To help the client engage with activities that will be positively reinforced in their environment. • To help them act according to their goals rather than their feelings.

10. The treatment rationale in BA (Lejuez, Hopko & Hopko, 2001)Increased healthy behaviour Positive Improved thoughts experiences and moodDecreased depressed behaviour

11. Key Components of BA • Idiographic case formulation. • Functional analysis of the contingencies that maintain the depression. • Activity monitoring and scheduling. • Emphasis on avoidance patterns. • Emphasis on routine regulation. • Behavioural strategies for targeting rumination.

12. Revisiting reinforcement • Positive reinforcement • Negative reinforcement • Punishment • Reinforcement on a fixed/variable ratio • Reinforcement on a fixed/variable interval • Plus complex schedules based on combinations of the above

13. “I am a Failure”

14. Context Focused Questions (Martell, 2008) • What is the client doing more or less of since becoming depressed? • How narrow or broad is the client’s repertoire? • What would the client be doing more/less of if not depressed? • What is the relationship between specific activities and mood, and specific life contexts and mood?

15. Context Focused Questions (Martell, 2008) • What environmental factors are involved in how the client is feeling right now? • How is the client responding to these that might maintain low mood? • In what ways is avoidance maintaining the depression? • Are there routine disruptions? • Where has contact with positive reinforcers been lost? • Are there deficits in coping skills?

16. Questions to Guide Client Review • What were you doing when you began to think/feel that way? • Where does the belief/feeling/action tend to occur? • Where does it tend not to occur? • What do you do next when you think/feel that? • What are the consequences of acting in this way? • What is getting in the way of you enjoying/engaging with life? • What behaviours are good candidates for maximising change?

17. Clive: a 49 year old man diagnosed with depression • Circumstances: business in trouble, change in financial circumstances, relationship conflict. • Main symptoms: sadness; tearfulness; hopelessness; irritation; anxiety; fatigue; problems concentrating; rumination. • Additional problems: reduced activity + bursts of over-working; increased drinking; social withdrawal; sleep excessively; procrastination.

18. What we set out to discover… • How it might be possible to modify his behaviour to increase contact with sources of +ve reinforcement. • The function of his avoidance and how we could modify it. • What alternative coping behaviours might be available to him – were any new skills necessary? • What routines had been disrupted by his depression and how could these be re-established?

19. Reinforcement Patterns Loss of positive reinforcement (e.g. sense of satisfaction; customer interaction; dates); increased punishment (from partner) Escape/Avoidance (work + socially) Life events Business in trouble, Disruption in routine, Financial difficulty, Relationship conflict Symptoms Sadness; tearfulness; hopelessness; irritation; anxiety; fatigue; problems concentrating Secondary Problems Reduced functional activity; increased drinking social withdrawal; sleep excessively; rumination; diminished problem solving ability Formulation of Clive’s Depression

20. The ‘TRAP’ and ‘TRAC’ Tools

21. A ‘TRAP’ for Clive (and his ‘TRAC’ response)

22. ACTION Strategy (Martell, 2008)

23. Clive’s Action Strategy

24. Methods Frequently Used in Behavioural Activation • Mastery-Pleasure tasks • Graded tasks • Verbal rehearsal of assigned tasks • Managing situational contingencies • Role-playing behavioural assignments • Therapist modelling • ‘Acting toward a goal’ • Problem solving • Addressing skill deficits through skills coaching

25. Unanswered Questions • To what extent can a purely behavioural rationale account for the changes we see in our clients? • In using behavioural methods, when should we aim for behavioural or cognitive change? • To what extent is BA (and the philosophy that underpins it) relevant to other clinical presentations? • What are the practical and economic implications of our choice?

26. Some hints on using a behavioural approach • Behavioural approaches are more complex than they look: use with care. • Be clear about your goals. • Be clear about your conceptual framework. • Consider the client’s problem, as defined by the formulation (inc. possibilities and constraints afforded by physical and social environment).