Clinical Behavior Analysis and Behavioral Health

Descriptions of Processes and Therapy

What is Behavior Analysis?
Behavior analysis (formally Applied Behavior Analysis) is a distinct behavioral health profession with national and international standards for education, training, ethics, and clinical practice. It is a specialty science in the field of mental health that focuses specifically on a person’s behavior, rather than their mental fitness and thought processes.

What is clinical behavior analysis?
Clinical behavior analysis is the application of the conceptual and methodological tools of behavior analysis to treat challenging behavior health problems that have traditionally been characterized as mental health disorders. Clinical behavior analysts work in universities, hospitals, outpatient clinics, and schools … as well as in residential settings such as family homes, group homes, clinical offices, and primary care facilities. Common problems addressed through clinical behavior analysis include behavioral outbursts, aggression, depression, anxiety, stress, relationship discord, social communication deficits, disruptive behavior, impulsivity, inattention, tic and self-injury disorders, sleep disturbance, chronic pain, substance misuse, among others. Interventions involve understanding our client’s and patient’s private events including thoughts, feelings, and actions, all of which are viewed as behavior, that must be understood in context. We use a process called descriptive functional analyses to identify environmental antecedents or triggers of behavior (distal and proximate, verbal and nonverbal) and consequences that follow behavior and often reinforce it (immediate and delayed, verbal and nonverbal). Common forms of clinical behavior analysis include acceptance and commitment therapy, behavioral activation, behavioral parent training, community reinforcement, comprehensive behavioral intervention for tics, contingency management interventions, dialectical behavior therapy, functional analytic psychotherapy, integrative behavioral couples therapy, stimulus control therapy for insomnia and Eye Movement Desensitization and Reprocessing (EMDR) to treat post-traumatic stress disorder (PTSD) to alleviate the distress associated with traumatic memories.

What is a Functional Behavioral Assessment?
A Board Certified Behavior Analyst first competes a functional behavioral assessment (FBA). The assessment will gather information through indirect methods, such as patient, family, caregiver or other provider interviews and physician, PT, OT or SLP records review, along with ecological and behavioral assessments, a Quality of Life questionnaire, etc. Additionally, the behavior analyst will make direct observations of the patient in the setting(s) in which the behavior is reported to occur including the home, school and community. The behavior analyst will also look at evidence that is referred to as ‘permanent products,’ such as self-inflicted wounds, damaged property, and other physical outcomes of behavior. Frequency, duration, intensity, and other forms of behavioral baseline data is collected to help determine what the function of behavior is (what maintains it). The assessment also seeks to identify the reinforcers that the patient most prefers, and the reinforcers that are currently provided when the behavior targeted for reduction happens.

What is a Behavior Intervention Plan?
Upon completion of the assessment, the behavior analyst will write a behavior intervention plan (sometimes called a behavior support plan). The behavior plan is, among other things, a road map for changing the environment around the individual as it relates to reinforcement. It includes procedures for what parents, teachers or other caregivers or providers should do (and not do) before and after target behavior occurs. The behavior plan is intended to replace dysfunctional or maladaptive behavior with more functional and socially-appropriate behavior that is healthy and safe. If a skills deficit is identified, such as behavioral self-regulation and self-monitoring (sometimes referred to as Anger Management by mental health professionals) or if a deficit in functional communication is identified, such as tantrum behavior, arguing or defiance, the behavior analyst may complete a task analysis and develop a step-by step training program intended to educate the person on how to advance and improve the skills necessary to improve overall quality of life. Family, teacher, or other caregiver or provider training is also provided so that everyone is on the same page with implementing the behavior intervention plan.

How does behavior analysis differ from mental health counseling?
Mental health counselors help patients work through personal issues like anger management, depression, suicidal thoughts, aging, parenting, self-image, relational problems, stress, or addiction. They provide psychotherapy, assessment, diagnosis, substance abuse treatment, and crisis management. These counselors may diagnose, as well as treat, mental illness. The work of the counselor is usually intended to change the way a person thinks, reasons and perceives their environment, which may then cause change in the patient’s behavior. While counseling results in positive outcomes for many individuals, it may not be the best option for others, especially young children or young adults that present maladaptive behavior who have not yet fully developed their cognitive or ‘thinking and reasoning’ abilities; or children and adults with intellectual or developmental disabilities. In some cases, behavior analysts will coordinate therapeutic services with the mental health counselor, the clinical social worker, the physician or other healthcare providers by providing behavioral data and anecdotal information about treatment protocols and outcomes. If during treatment the behavioral data indicates that an intervention is not working, modifications to the plan are made by the behavior analyst on a week-by-week basis until predetermined desired behavioral outcomes are achieved.

What Is Acceptance and Commitment Therapy?
Acceptance and commitment therapy (ACT) is a type of psychotherapy that emphasizes acceptance as a way to deal with negative thoughts, feelings, symptoms, or circumstances. It also encourages increased commitment to healthy, constructive activities that uphold your values or goals. ACT therapists operate under a theory that suggests that increasing acceptance can lead to increased psychological flexibility. This approach carries a host of benefits and can often help people to stop habitually avoiding certain thoughts or emotional experiences, which can lead to further behavioral and quality of life problems. the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsetting cognitive distortions, emotions, or urges. Rather, the goal is to reduce your struggle to control or eliminate these experiences while simultaneously increasing your involvement in meaningful life activities, i.e., those activities that are consistent with your personal values.

This process involves six components:

Acceptance: This means allowing your inner thoughts and feelings to occur without trying to change them or ignore them. Acceptance is an active process.
Cognitive defusion: Cognitive defusion is the process of separating yourself from your inner experiences. This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them.
Self as context: This involves learning to see your thoughts about yourself as separate from your actions.
Being present: ACT encourages you to stay mindful of your surroundings and learn to shift your attention away from internal thoughts and feelings.
Values: These are the areas of your life that are important enough to you to motivate action.
Commitment: This process involves changing your behavior based on principles covered in therapy.

During ACT, your therapist will help you learn how to apply these concepts to your life. They may teach you how to practice acceptance and cognitive defusion, or they may help you develop a different sense of yourself that’s distinct from your thoughts and feelings. Sessions can also include mindfulness exercises designed to foster nonjudgmental, healthy awareness of thoughts, feelings, sensations, and memories that you have otherwise avoided. Your therapist may also help highlight moments when your actions didn’t fit your values while helping you understand which behaviors would fit. Your therapist may assign homework to practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.