INTRODUCTIONTOTHESPECIALSECTIONON - PDF document

1 INTRODUCTIONTOTHESPECIALSECTIONON CLINIC
INTRODUCTIONTOTHESPECIALSECTIONON CLINICALBEHAVIORANALYSIS D OUGLAS W.W OODS UNIVERSITYOFWISCONSIN–MILWAUKEE R AYMOND G.M ILTENBERGER UNIVERSITYOFSOUTHFLORIDA AND J AMES E.C ARR WESTERNMICHIGANUNIVERSITY














































































Sinceitsinception,appliedbehavioranalysis hasfocusedonanalyzinganddeveloping effectiveinterventionsforavarietyofbehavior problemsseenindiversepopulationsand settings.Infact,the JournalofAppliedBehavior Analysis ( JABA )mastheadstatesthatthepurpose ofthejournalistopublish‘‘reportsof experimentalresearchinvolvingapplicationsof theexperimentalanalysisofbehaviortoprob- lemsofsocialimportance.’’Thereareavariety ofmethodstodeterminewhethersomethingis sociallyimportant,buttheprimaryarchitectsof appliedbehavioranalysisbelievedthattarget behaviorsshouldbechosen‘‘becauseoftheir importancetoman(sic)andsociety,ratherthan theirimportancetotheory’’(Baer,Wolf,& Risley,1968,p.92).Thisinitialemphasison sociallyimportanttargetsforinterventionasan essentialfeatureofappliedbehavioranalysishas beenreaffirmedseveraltimessinceitsannounce- mentin1968(e.g.,Baer,Wolf&Risley,1987; Wolf,1978).Fromtheirdescriptivepapers,as wellastheextraordinarybodyoftheirpublished research,itisclearthatBaeretal.(1968,1987) stronglybelievedthatappliedbehavior-analytic researchshouldfocusontopicsofdemonstrable socialimportance.Wesharetheirbeliefthat suchafocusnotonlyextendsthescienceof behavioranalysisandenlargesitsinfluenceby demonstratingitsappliedimplicationsbutalso benefitsthehumancondition. Forsomespecificpopulationsandtarget behaviors(e.g.,self-injuryofindividualswith developmentaldisabilities,pediatricfeedingdis- orders,teachingskillstochildrenwithautism), JABA hasbeentruetoitsoriginalmandate. However,overthecourseof JABA ’shistory, concernhasbeenexpressedthatthejournal’s scopemaybetoonarrow(Kunkel,1987).One areainwhich JABA hasnotpublishedasub- stantialamountofresearchisinthedomainof clinicalpsychology,clearlythelargestapplied areainpsychology(AmericanPsychological Association[APA]ResearchOffice,2000).In fact,62%ofallmembersoftheAPAareclinical orcounselingpsychologists(APAResearch Office).Althoughthesedisciplinesworkwith awidearrayofpopulat

2 ionsandproblems,they mostfrequentlyseekt
ionsandproblems,they mostfrequentlyseektounderstandandtreat typicallydevelopingchildrenandadultswith functionallyimpairingbehavioralexcessesor deficits.Theproblembehaviorsexhibitedby thesepopulationsarecommonanddiverse.For example,intheNationalComorbidityStudy (Kessler,Berglund,Demler,Jin,&Walters, 2005),thelifetimeprevalenceofmooddisorders wasfoundtobe20.8%;anxietydisorders, 28.8%;impulsecontroldisorders,24.8%;and substanceusedisorders,14.6%.Inaddition,the AddresscorrespondencetoDouglasW.Woods,De- partmentofPsychology,UniversityofWisconsin– Milwaukee,Box413,Milwaukee,Wisconsin53201(e- mail:dwoods@uwm.edu). doi:10.1901/jaba.2006.intro JOURNALOFAPPLIEDBEHAVIORANALYSIS 2006, 39, 407–411 NUMBER 4( WINTER 2006) 407 financialandfunctionalimpactofthesedisorders suggeststhattheyareofprofoundsocial importance. Althoughtheseandotherclinicaldisorders arenotproblembehaviorsastypicallyaddressed byappliedbehavioranalysts,eachdisorderis comprisedofbehaviorsthatmaybetargetedfor intervention.AsnotedbyBaeretal.(1987), Themostfruitfultask(inbehavioranalysis)…isto recognizethateachofthoselabels(anxiety,atten- tion,intelligence,andmanyotherslikethem)often representssomebehavioralrealitynotyetanalyzedas such.Thepointisthatthesebehavioralrealitiesare notlikelytobeanalyzedassuchwithintheirparent disciplines,andthuswillneverbecometruly applicablethere,yetmightwellbeanalyzedbehavior analytically,perhapswithgreatprofittousandthose disciplines,andthustoourroleswithinthose disciplines.(p.315) Given JABA ’smandateforaddressingsocially importanttopics,onemightexpectthatit wouldplayamajorroleinanalyzingand developinginterventionsfortheseclinical problems.However,thisdoesnotseemtobe thecase.Ourownexaminationofrecent JABA contentindicatesaconcentrationonindividuals withdevelopmentaldisabilities(i.e.,60%of data-basedarticlesfrom2001to2005),with relativelylittleattentiontoproblemscommonly encounteredbymainstreamclinicalpsycholo- gists.Collectively,11%ofdata-basedarticles from2001to2005targetedbehaviorsassociat- edwithoneofthefollowingclinicalproblems: sleepdisorders,incontinence,psychoticdisor- ders,anxietydisorders,mooddisorders,impulse controldisorders,substanceabuse,attention deficithyperactivitydisorder,obesity,andtic disordersorstuttering. Otherevidencethat JABA maynotbe addressingthemostcommonclinicalproblems comesfromstudiesshowingthat JABA has asmallimpactonjournalsinwhichmainstream clinicalissuesarediscussedbutalargeimpact onjournalsthatad

3 dressissuesrelevanttothe studyofdevelopm
dressissuesrelevanttothe studyofdevelopmentaldisabilities(Critchfield, 2002).Perhapsthemostdisconcertingevidence that JABA isnotaddressingproblemsencoun- teredbymainstreamclinicalpsychologyisthe factthat,basedonitsmostrecentInstitutefor ScientificInformationimpactfactor(.875asof May2005),itisoneofthe10lowestimpact journals(outof30)inbehavioralclinical psychology(Taylor,Abramowitz,McKay, Stewart,&Asmundson,2006).Thisispartic- ularlytroublingbecausethelowrankingis withinthebehaviortherapybranchofclinical psychology,arguablythebranchwiththeclosest theoreticalalliancetoappliedbehavioranalysis. Itisnotentirelyclearwhyresearchin JABA hasnotfocusedmoreonmoremainstream clinicallyrelevantproblems,butweoffertwo plausiblespeculations.First,appliedbehavior analysisandbyextension, JABA ,didnotdevelop outofclinicalpsychology.Itdevelopedoutof experimentalpsychologylaboratories,andfrom settingstowhichthisearlylaboratoryworkwas firstextendedforappliedpurposes.These settingswereofteninstitutionsorothersettings thatprovidedtheopportunityforrelativelytight environmentalcontrol.Second,certainaspectsof traditionallyaccepted JABA methodologymay notbebestsuitedforresearchwithclinical populations.Oneofthehallmarkfeaturesof JABA hasbeentherelianceondirectobservation ofbehaviorbyindependentobservers(Baeretal., 1968,1987).Unfortunately,manyofthetarget behaviorsexhibitedbymainstreamclinical populationsincludeprivatedimensions(e.g., aversivefeelingsinthecaseofdepression, worryinginapersonwithgeneralizedanxiety disorder,orhearingvoicesinthecaseofparanoid schizophrenia)orbehaviorthatisdifficultto observedirectly.Forexample,theescapeor avoidancefunctionof‘‘anxious’’behaviorcanbe quiteeasilymeasured,butitwouldbeextremely impracticalandexpensivetocloselyfollowan individualdiagnosedwithsocialphobiafor extendedperiodstodeterminewhensocial situationsareavoidedorescaped.Articlesthat employstrategiesotherthandirectobservation (e.g.,self-monitoring),however,areoftenviewed withsuspicionbyeditorialstaff,andresearch 408 DOUGLASW.WOODSetal. relyingonthemhashistoricallyhadanunlikely futurein JABA . Itisunclearhowthissituationcanbereversed togetmoreclinicalbehavior-analyticresearch publishedin JABA ,buthereweofferafew suggestions.First, JABA anditseditorialstaff wouldhavetoclearlycommunicateinterestin publishingpapersonmainstreamclinicalprob- lems(i.e.,clinicalbehavioranalysis).Thisspecial sectiononclinicalbehavioranalysisisastepin thatdirection.Second,therewo

4 uldneedtobe increasedrecognitionthatthep
uldneedtobe increasedrecognitionthatthepracticalcon- straintsofconductingresearchwithmany clinicalpopulationsmaynecessitateabroader approachtomethodologythanistypically reportedin JABA .Althoughpapersonclinical topicsmaybephilosophicallybehavioral,certain methodologicalpracticesmaybenecessarygiven researchoncertaintopics.Similarly,when appropriate(e.g.,actuarialquestionsaboutthe broadefficacyofabehavioraltreatmentor assessmentprocedure), JABA shouldconsider publishinggroupstudiesasawaytoreach abroaderclinicalaudiencewhoseclinical epistemologyisgovernedmorebyquantitative thanbysingle-subjectresearchmethods. Althoughitmightbeappropriateinitiallyto haveslightlydifferentmethodologicalexpecta- tionsforclinicalpaperssubmittedto JABA ,we wouldexpectclinicalbehavior-analyticresearch- ers(a)tocollectdirectobservationdatawhenever possible,(b)toreportindividualdataalongwith aggregatebehavioranalysesingroup-design research,(c)tocollectmultiplemeasureswhen possibleassupportingevidenceforbehavior change,(d)toinvestigatenewandinnovative waystoimproveassessmentofclinicallyrelevant behaviors,(e)toidentifymethodologicallimita- tionsintheirresearchandsuggestwaysfor researcherstoovercometheselimitations,and(f) toincludeaconceptualanalysisofbehavior changeemployingbasicbehavioralprinciples. Inthesectionthatfollows,wehaveassem- bledadiversecollectionofarticlesfromthearea ofclinicalbehavioranalysis.Thearticleby Kanterandcolleaguesdescribesabehavior- analyticapproachtothetreatmentofdepressive behaviorinmainstreampopulations.Function- alanalytictherapywasimplementedfollowing standardcognitivetherapy.Althoughresults weremixed,thearticleconfirmsthatbehavior analysiscancontributetothetreatmentof majordepression.Thearticlealsohighlightsthe challengesbehavioranalystsfacewhenworking withthispopulation. ThearticlebyDixonandcolleaguesrepre- sentsabehavior-analyticexaminationofthe environmentalvariablesthatinfluencepatho- logicalgamblingbehavior.Theauthorsdem- onstratedthatpathologicalgamblersdiscounted delayedhypotheticalmonetaryrewardsto agreaterextentinagamblingsettingthanin anongamblingsetting.Thisarticleisnotewor- thyinthatitrepresentsastyleofclinically relevantresearchthatisparticularlysuitablefor behavior-analyticresearchers:identifyingthe controllingvariablesofpathologicalbehavior. Oneofthemostsubstantialcontributionsof behavioranalysiswithinmainstreamclinical domainshasbeeninthetreatmentofticsand otherhabitdisorders.ThearticlebyThompson a

5 ndcolleaguesextendstheliteratureonthe tr
ndcolleaguesextendstheliteratureonthe treatmentofchronicskinpickingbydemon- stratingtheutilityofantecedentmanipulations. Althoughthisstrategyhasbeenusedclinicallyfor sometime,untilrecentlytherehasbeenlittle publishedempiricalevidencetosupportitsuse. ThearticlebyWetterneckandWoodsdescribes theuseofexposureandresponsepreventionto treatrepetitivebehaviorsassociatedwithTour- ette’ssyndrome.Thearticlecouldbeof particularinteresttothosewhoworkinthe areasofTourette’ssyndromeandobsessive- compulsivedisorder,becausetherepetitive behaviorstreatedinthisstudyarethoughtto befunctionallyrelatedtoboth.Thefinalarticle inthisareasoughttofurtherevaluatetheutility ofdirectobservationmethodsintheassessment ofchildrenwithticdisorders.Inthispaper, Himleandcolleaguesprovidedatathatdirect CLINICALBEHAVIORANALYSIS 409 observationprocedurescanbeefficient,reliable, andgeneralizableacrosssettings,butatthesame timeencouragebehavioranalyststomove beyondfrequencycounts,withthegoalof developingassessmentstrategiestomeasureall relevantdimensionsoftics. ThearticlebyFreemandemonstratedthe utilityofanextinction-basedprocedurewith auniquecomponent(i.e.,bedtimepass)for treatmentofbedtimeresistanceexhibitedby typicallydevelopingchildren.Thisstudyhasat leasttwonoteworthyfeatures.First,thein- terventiondidnotproduceextinctionbursts, whichlikelyenhancesthesocialvalidityofthis behavioralapproachtoaproblemcommonly experiencedbyfamilies.Second,thestudy demonstratestheutilityofbehavioralinterven- tionsforcommonplaceproblemswithtypically developingchildren.Thisrepresentsapotential growthareaforappliedbehavioranalysis. ThearticlebyShabaniandFisherdescribes areinforcement-basedintervention(withstim- ulusfading)fortreatingneedlephobiainachild withautism.Thisisaparticularlyimportant goalbecauseneedlephobiascaninhibitthe adequatedeliveryofphysicalhealthcare,andby reducingthisphobicbehaviorphysicalhealth canbeimproved.Similarly,thearticleby Ricciardiandcolleaguesdemonstratestheuse ofareinforcement-basedprocedure(without escapeextinction)totreatthephobiaofachild withautism.Bothofthesearticlesmake importantcontributionstotheliterature,be- causethereisarelativelackofinformationon treatinganxietyproblemsinindividualswith developmentaldisabilities. ThearticlebyBakerandcolleaguesillustrates thesuccessfuluseofafunctionalanalysisand subsequentfunction-basedtreatmentforun- derstandingandreducingtheaggressionofan elderwithdementia.Thisarticledemonstrates howwelltechnologydeve

6 lopedforindividuals withdevelopmentaldis
lopedforindividuals withdevelopmentaldisabilitiescantransferto otherdependentpopulations.Suchapplications ofbehavioranalysistotheproblemsofelders (i.e.,behavioralgerontology)couldbecome increasinglyvaluableastheprevalenceofelders intheU.S.increases.Inanothersystematic replicationthatillustratesthetransferof technologydevelopedforindividualswithde- velopmentaldisabilities,Rasmussenand O’Neillemployedfixed-timereinforcementto successfullyreduceproblembehaviorexhibited bychildrenwithemotionalandbehavioral disorders.Furthermore,thisstudyextendsthe literatureonfixed-timereinforcementbyim- plementingtreatmentinthenaturalenviron- ment. Thepresenceofthisspecialsectionon clinicalbehavioranalysisin JABA isaninitial attempttoincreasethevisibilityofclinical behavioranalysisandincreasethenumberof relatedpaperssubmittedto JABA .Thesuccess ofthiseffortwillrestonwhetherresearch submittedto JABA ismethodologicallysound, clinicallyrelevant,andconceptuallyinteresting to JABA readers.Thehistoricalrecordclearly showsthatbehavioranalystshavesuccessfully metthesechallengeswiththemanypopulations andclustersofproblemstheyhavefaceduntil now.Webelievethetimehascomeforsimilar successestobeproducedwithmainstream clinicalpopulationsandproblems. REFERENCES AmericanPsychologicalAssociationResearchOffice. (2002). APAdirectorysurvey .Washington,DC:Author. Baer,D.M.,Wolf,M.M.,&Risley,T.R.(1968).Some currentdimensionsofappliedbehavioranalysis. JournalofAppliedBehaviorAnalysis , 1 ,91–97. Baer,D.M.,Wolf,M.M.,&Risley,T.R.(1987).Some still-currentdimensionsofappliedbehavioranalysis. JournalofAppliedBehaviorAnalysis , 20 ,313–327. Critchfield,T.S.(2002).Evaluatingthefunctionof appliedbehavioranalysis:Abibliometricanalysis. JournalofAppliedBehaviorAnalysis , 35 ,423–426. Kessler,R.C.,Berglund,P.,Demler,O.,Jin,R.,& Walters,E.E.(2005).Lifetimeprevalenceandage-of- onsetdistributionsofDSM-IVdisordersinthe nationalcomorbiditysurveyreplication. Archivesof GeneralPsychiatry , 62 ,593–602. Kunkel,J.H.(1987).Thefutureof JABA :Acomment. JournalofAppliedBehaviorAnalysis , 20 ,329–333. 410 DOUGLASW.WOODSetal. Taylor,S.,Abramowitz,J.S.,McKay,D.,Stewart,S.H., &Asmundson,G.J.G.(2006).Publishwithout perishing,Part2:Moresuggestionsforstudentsand newfaculty. TheBehaviorTherapist , 29 ,21–26. Wolf,M.M.(1978).Socialvalidity:Thecasefor subjectivemeasurementorhowappliedbehavior analysisisfindingitsheart. JournalofAppliedBehavior Analysis , 11 ,203–214. CLINICALBEHAVIORANALYSI