Beyond Autism Treatment: The Application of Applied Behavior Analysis in the Treatment of Emotional and Psychological Disorders
Ross, Robert K., The International Journal of Behavioral Consultation and Therapy
Over the course of the past decade, the field of Applied Behavior Analysis (ABA) has become synonymous in the eyes of many parents, teachers and clinicians from other disciplines with treatment of autism. Many professionals in ABA do not fully welcome a narrow view of this applied science. However, it can be argued that this is partially a very good thing for our field. The perception of ABA as the most effective treatment for children with Autism Spectrum Disorders has come about as a result of the demonstrated effectiveness of the application of the principles and procedures consistent with the science of ABA (Lovaas, 1987; NYS DPH EIP, 1999: NRC, 2001). The lack of the identification of ABA as the most empirically effective treatment for other areas (e.g., psychological and emotional disorders), for which is it often applied, may stem from an absence of such data and formal application of our technology. Rather than lament the over identification of ABA with autism treatment, the more adaptive response would be to conduct the kind of empirical studies in the areas of psychological and emotional disorders that has served to bring ABA prominence in autism treatment.
A major impediment to accomplishing this goal, in my view, is the lack of careful application of some of the tenets of applied behavior analysis to areas that are typically described as "psychological" or "emotional" rather than "behavioral". This needs to be addressed directly. As behavior analysts, we must be willing to use terms outside of our discipline, but insist on operational definitions for these terms when we use them. For example, a behavior analyst can treat a child who presents with a "mood disorder" by specifying the behavioral evidence of the disorder. Is it that the child is often happy, but becomes enraged when told "no" or when there is a change in their schedule? Is it that they describe high levels of variability in their mood and would like to describe more stable levels?, or it is that the child behaves in certain ways more often than we would like (hitting, yelling, inactivity,) and describe this as evidence of a mood disorder? We can, if we choose to, make specific and measureable the evidence for the disorder/diagnosis, and then apply treatment. Subsequent evaluation of levels of the symptoms can enable us to determine empirically if treatment has reduced, increased or had no effect on these symptoms.
Descriptive Differences between Behavior Analytic and Non- Behavior Analytic Approaches
To understand why ABA based approaches to treatment of psychological and emotional issues are less well accepted, we need to describe how behavior analytic and non-behavior analytic approaches fundamentally differ in terms of how professionals talk about (describe) and treat these issues. Before doing that we must confront the elephant in the room. What is a "psychological" or "emotional" issue? This argument can be phrased as "are we treating the "emotion/psyche" or are we treating "behavior"? If we step back just a little from this question we may be able to see that the treatment goal for both perspectives is to have treatment change behavior. Unfortunately, for behavior analysts the descriptions of treatment from a non-behavior analytic framework involves the use of descriptions of hypothesized mental processes. One of the fundamental tenets of our science is that we do not embrace such hypothetical entities such as "mind" and "will", these terms "refer to a possibly existing, but at the moment unobserved process or entity" (Moore, 1995, p.36).
While that may be how the question is correctly answered on the Behavior Analyst Certification Board exam, it is simply not what most psychologists believe and often not what some behavior analysts believe as well. Additionally the field of behavior analysis requires precise definitions and objective measurable outcomes (BACB, 2005). The treatment goal for many clinicians treating "emotional" and "psychological" issues may be that the patient self-reports to "feel better" as evidence of an improved condition. …