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| The Impact of Behavior Analysis on Mental Health Services – Then and Now |
| Saturday, May 25, 2024 |
| 3:00 PM–4:50 PM |
| Marriott Downtown, Level 4, Franklin Hall 12-13 |
| Area: CBM/PCH; Domain: Translational |
| Chair: Thomas J. Waltz (Eastern Michigan University) |
| Discussant: Amanda M Muñoz-Martinez (Universidad de Los Andes, Colombia) |
| CE Instructor: Amanda M Muñoz-Martinez, Ph.D. |
| Abstract: In line with this year’s conference theme, this symposium highlights the history and future of behavioral analysis applied to mental health services through multiple lenses. We begin with the history and current status of functional analysis in clinical case formulations for mental and behavioral health presentations illustrating strategies that increase a clinician’s abilities to contextualize client presenting concerns. This will be followed by two presentations that focus on the evolution of behavior analytic conceptualizations of depression and anxiety from the early work by Skinner and Ferster to present day. The depression and anxiety presentations are also accompanied by case illustrations. Our fourth presentation focuses on the ethical issues of assent when working with vulnerable populations and the enduring relevance of Goldiamond’s work in guiding ethical clinical practice. Finally, we have an international expert on Functional Analytic Psychotherapy (FAP), a radical behavioral approach to interpersonal therapy, provide commentary on the history and future of clinical behavior analysis. |
| Instruction Level: Intermediate |
| Keyword(s): case formulation, clinical, mental health |
| Target Audience: Individuals with advanced graduate degrees that target the application of behavioral principles. |
| Learning Objectives: (1) At the conclusion of the presentation, participants will be able to use structured clinical case formulation tools to improve the individual tailoring of their client treatment plans. (2) At the conclusion of the presentation, participants will be able to use descriptive functional analysis to link interpersonal components of depressed and suicidal clinical case presentations to evidence-based interventions. (3) At the conclusion of the presentation, participants will be able to incorporate a broad range of behavioral principles into client-specific case formulations involving safety behaviors. (4) At the conclusion of the presentation, participants will be able to describe how individual, local community, and system-level assumptions underlying problem definitions impact treatment planning. |
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| Functional Analysis in Clinical Case Formulations – History and Current Status |
| (Theory) |
| CRYSTAL YUET WEN LIM (Eastern Michigan University), Thomas J. Waltz (Eastern Michigan University), Claudia Drossel (Eastern Michigan University) |
| Abstract: Already in 1974, Kanfer and Saslow pointed out shortcomings of the current diagnostic system, which bases diagnoses on the classification and clustering of presenting problems viewed topographically. They introduced functional analysis as a powerful tool and suggested that behavioral health problems could be viewed as (a) behavioral deficits, (b) behavioral excesses, (c) inappropriate stimulus control, (d) inappropriate self-management, and (e) inappropriate reinforcement contingencies. Later developments by Haynes and colleagues (2011) focused on a collaborative approach by which clients are actively engaged in generating functional analytical clinical case diagrams (FACCD) to be tested. These comprehensive diagrams extend Kanfer and Saslow’s work and capture historical and current factors that may be influencing the presenting problem, including strengths (and not only weaknesses), medical conditions, relationship characteristics, and other social patterns. With the FACCD, collaborative treatment planning results in examining the effects of different variables during treatment. This presentation will explore the connection between the functional analytical approach FACCD, focusing on social determinants of behavior change. |
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| The Interpersonal Contexts of Depression and Suicidal Behavior |
| (Theory) |
| PEIQI LU (Eastern Michigan University), Claudia Drossel (Eastern Michigan University) |
| Abstract: Depressed behavior is characterized by a loss of access to reinforcers, and suicidal behavior (e.g., thoughts, feelings of hopelessness, planning, or intent) sometimes accompanies such loss. Behavior analysis has a long history of addressing depressed and suicidal behavior, starting with Ferster’s work in 1973 that outlined potential contextual factors. Ferster focused on ineffective social interactions, marked by magical mands and coercion, that contribute to an absence of reinforceable responses and the emergence of extreme behavior. Later, interpersonal theories of depression (for a review, see Van Orden et al., 2010) picked up the circumstance that individuals with depressed behavior often meet with social dislike or rejection. This presentation will discuss how functional analysis conceptualizes and targets depressed and suicidal behaviors from an interpersonal perspective, illustrated with case examples. Functional analysis allows for the design of individualized treatments by understanding idiosyncratic contextual factors that maintain target behaviors. Emphasis will be placed on linking assessment to current empirically supported intervention packages (e.g., behavioral activation, acceptance and commitment therapy, problem-solving therapy, interpersonal therapy). |
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| Behavior Analysis of Anxiety and Phobia - From Conditioned Emotional Responses to Safety Behaviors |
| (Theory) |
| STEPHANIE LIN (University of Hawaii-Manoa ), Thomas J. Waltz (Eastern Michigan University), Claudia Drossel (Eastern Michigan University) |
| Abstract: Early behavioral conceptualizations of anxiety and phobia involved a mixture of operant and respondent conditioning formulations. For example, conditioned emotional responses (CERs) reflected how conditioned stimuli (CS) paired with aversive stimuli could disrupt operant behavior (Estes & Skinner, 1941). As learning theories were used to develop behavior therapies for anxiety and phobia interventions focused on extinction, competing responses, and stimulus control interventions. Goldfried and Davison (1976/1994) noted that in addition to CER, anxiety often characterizes clinical situations where skills deficits are present, clients experience competing or untenable contingencies, and where rule or other verbally-governed behavior negatively impact performance. Subsequent research has looked at the plausible roles of somatic alarm conditioning and relational operants. A contemporary contextual behavior analytic approach incorporates an even broader analysis of complex life circumstances that impact these clinical presentations including the role of health, the social community, and safety behaviors. A contemporary update of a behavior analytic account of anxiety and phobia will be presented along with an illustrative case presentation. |
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| The Relevance of Goldiamond’s Work to Advocacy and Social Change |
| (Theory) |
| CLAUDIA DROSSEL (Eastern Michigan University), Lindsey Bookman (Eastern Michigan University) |
| Abstract: Society at large defines the circumstances under which specific behavioral patterns count as “problematic” and “intervenable.” In the 1970s, Goldiamond pointed out that behavioral health providers – as members of the culture – often uncritically accept the given social definitions of behaviors needing intervention. Consequently, behavioral health providers may rely on behavior reduction programs and adapt client behavior to systems (e.g., educational, care, or familial) that are inadequate, ineffective, discriminatory, oppressive, and in need of reform. He outlined steps to safeguard providers from participating in questionable social or institutional practices. The current presentation will review the problem with “problem definitions” and Goldiamond’s proposed solutions. We will especially consider caregiving/parenting and surrogate consent situations. Working with individuals who have difficulties expressing their preferences requires a careful analysis of the interests of the individual, their local community, and the systems in which they participate. Finally, we will discuss expanding the roles of behavioral health providers to include advocacy and the facilitation of social change. |
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