Clinical behavior analysis

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Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is a clinical application of behavior analysis (ABA) that encompasses behavioral medicine and cognitive-behavior therapy.[1] CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism, in particular functional analysis and cognitive models of verbal behavior—in particular, relational frame theory (RFT).

Current models in clinical behavior analysis

Cognitive-behavioral therapies (CBTs) include acceptance and commitment therapy (ACT), community reinforcement approach and family training (CRAFT), behavioral activation (BA), functional analytic psychotherapy (FAP), integrative behavioral couples therapy, dialectical behavioral therapy (DBT), systematic desensitization, and contingency management (CM). Behavioral medicine includes health psychology (which also overlaps with CBTs), behavioral pharmacology, behavioral pediatrics, and behavioral gerontology.

Acceptance and commitment therapy

Acceptance and commitment therapy is probably the most well-researched of all the third-generation behavior therapy models. It is based on relational frame theory.[2] Originally this approach was referred to as comprehensive distancing.[3] Every practitioner mixes acceptance with a commitment to one's values. These ingredients become emeshed into the treatment in different ways which leads to ACT being either more on the mindfulness side or more on the behavior-changing side.[4] ACT has, as of October 2006, been evaluated in over 30 randomized clinical trials for a variety of client problems.[5] Overall, when compared to other active treatments designed or known to be helpful, the effect size for ACT is a Cohen's d of around 0.6,[6][7] which is considered a medium effect size.

Functional analytic psychotherapy

Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship.[8] It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement.[9] The basic FAP analysis utilizes what is called the clinically relevant behavior (CRB1), which is the client's presenting problem as presented in-session. Client in-session actions that improve their CRB1s are referred to as CRB2s. Client statements, or verbal behavior, about CRBs are referred to as CRB3s. In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change.[10]

Behavioral activation

Behavioral activation emerged from a component analysis of cognitive behavior therapy. This research found no additive effect for the cognitive component.[11] Behavioral activation is based on a matching law model of reinforcement.[12] A recent review of the research supports the notion that the use of behavioral activation is clinically important for the treatment of depression.[13]

Integrative behavioral couples therapy

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule-governed behavior.[14] It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness.[15]

Community reinforcement approach and family training

Community reinforcement approach and family training is a model first developed by Nathan H. Azrin and Hunt. The model focuses on the use of functional behavioral assessment to reduce drinking behavior.

Dialectical behavioral therapy

Dialectical behavioral therapy was created by Marsha Linehan. The model attempts to balance acceptance and change. It focuses on the use of behavior chain analysis, which combines the process of functional analysis with a greater focus on each element in the behavior stream. DBT uses groups to train specific social skills and other behavioral skills. DBT is a well-established treatment for borderline personality disorder.

Clinical formulation

As with all behavior therapy, clinical behavior analysis relies on a functional analysis of problem behavior. Depending on the clinical model this analysis draws on B.F Skinner's model of Verbal Behavior or relational frame theory.

Professional organizations

The Association for Behavior Analysis International has a special interest group in clinical behavior analysis ABA:I. ABA:I serves as the core intellectual home for behavior analysts.[16][17]

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis

The Association for Contextual Behavioral Science is devoted to third-generation therapies [1].

The World Association for Behavior Analysis offers certification in clinical behavior therapy [2].

See also


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  2. Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3(4), 421–42 BAO
  3. Zettle, R.D. (2005). The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT. IJBCT, 1(2), pp. 77–89 BAO
  4. Hayes, Steven. "Acceptance & Commitment Therapy (ACT)".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  5. Hayes, S.C.; Luoma, J.; Bond, F.; Masuda, A. & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25.
  6. Lappalainen, R.; Lehtonen, T.; Skarp, E.; Taubert, E.; Ojanen, M. & Hayes, S.C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31, 488–511.
  7. Zettle, R.D. & Rains, J.C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438–45.
  8. Kohlenberg, R.J. & Tsai, M. (1991) Functional Analytic Psychotherapy. New York: Plenum
  9. Wulfert (2002) Can Contextual Therapies Save Clinical Behavior Analysis? The Behavior Analyst Today, 3(3), 254 BAO
  10. Cautilli, J.T.; Riley-Tillman, C.; Axelrod, S. & Hineline, P. (2005). The Role of Verbal Conditioning in Third Generation Behavior Therapy. The Behavior Analyst Today, 6(2), 138–57 BAO
  11. Jacobson, N.S.; Martell, C.R. & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255–70.
  12. Cullen, J.M.; Spates, C.R.; Pagoto, S. & Doran, N. (2006). Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation. The Behavior Analyst Today, 7(1), 151–64.
  13. Spates, C.R.; Pagoto, S. & Kalata, A. (2006). A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder. The Behavior Analyst Today, 7(4), 508–12 BAO
  14. Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.
  15. Cordova, J.; Cautilli, J.D.; Simon, C. & Axelrod-Sabtig, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. IJBCT, 2(2), 192–213 BAO
  16. Twyman, J.S. (2007). A new era of science and practice inbehavior analysis. Association for Behavior Analysis International: Newsletter, 30(3), 1–4.
  17. Hassert, D.L.; Kelly, A.N.; Pritchard, J.K. & Cautilli, J.D. (2008). The Licensing of Behavior Analysts: Protecting the profession and the public. Journal of Early and Intensive Behavior Intervention, 5(2), 8–19 BAO