ABA Interventions With Depressed Clients

Functional Behavioral Assessment

Identify the variables controlling problem behavior (i.e., the cause of the behavior)

Involve altering the environment to minimize problem behavior,

Analysis of behavior-environment relations

Reinforcing adaptive behaviors, &

Withholding reinforcement for problem behavior/negative punishment

Reinforcement LossReductions in reinforcement rates will produce

reductions in responding. This certainly is the case when reinforces have

been lost completely.

Examples

Death of or divorce from a spouse, Loss of a job or relocation to a new

environment, Loss of physical or cognitive activity due to

aging or injury.

Skills DeficitsIndividual must have skills necessary to

obtain social reinforcement; if these skills are deficient, rates of social reinforcement will be reduced and depression will result (Lewinsohn, 1974, 1975).

In fact, some research found that social skills deficits are a consequence, not a cause, of depression (Cole & Milstead, 1989).

On the other hand, it is quite clear that disturbances in interpersonal functioning, which may be a product of social skills deficits or other factors, are both cause and consequences of depression (Barnett & Gotlib, 1988).

In addition to social skills, active problem solving skills and emotion regulation skills have been considered important coping skills relevant to depression (Linehan, 1993) .

Too Much PunishmentIt is well known that stressful life experiences

produce depression in adults (Kessler, 1997).

In addition, several researches suggest that risk for depression is a function of negative reinforcement and punishment for children and adolescents.

Children who display academic difficulty often experience high rates of depressive behavior (Cole, 1990).

In addition, adolescents in less supportive and more aversive environments experience higher rates of depressive behaviors (Sheeber & Sorensen, 1998).

Loss of Effective Operant BehaviorGeneralized punishment should be of

particular importance, and it is common for clients with chronic depression.

Experiments shows that failure to display effective operant behavior over time leads to the extinction of entire operant classes of behavior.

Examples Roth and Kubal (1975) showed that

participants presented unsolvable problems later failed to solve problems that were solvable.

Klein and Seligman (1976) showed that participants exposed to inescapable noise were subsequently slower to escape the noise when it was escapable.

Removal of Positive Reinforcement / Negative Punishment

May be seen as a class of behaviors historically reinforced by the verbal-social community

Complaining = Reason-giving, in turn, is highly reinforced by the verbal-social community (Hayes & Hayes, 1989; Baum, 1994)

Victim role

Reassurance seekers = elicit social support from their environment, i.e. family and friends (Coyne, 1976)

Reassurance may become frustrated = make themselves less available,

leading to decreased and intermittent reinforcement direct or indirect, can concomitantly exasperate

depression Research has supported the notion that this vicious

cycle strengthens a depressed mood (Joiner & Metalsky, 2001).

Intermittent Reinforcement

Removal of Negative ReinforcementSeveral depressive behaviors served avoidance or escape

functions (Ferster, 1973) Avoiding contact with the social community, Excessive sleeping, help to avoid exposure to environmental

stimuli that elicit aversive thoughts or feelings, thus maintaining depressive behaviors and reducing contact

with potential reinforcers (Martell, Addis, & Jacobson, 2001) complaining, or crying may function to avoid aversive

conditions, such as silence, inactivity, or other anxiety-producing

activities.

Biglan, Hops, and Sherman (1987) showed that depressive behaviors = suppress partner aggressive behavior.

Using direct observation Hops and colleagues (1987), showed that depressed mothers emitted dysphoric affect, which suppressed husband hostility more often than non-depressed mothers.

The reverse is also true that aggressive statements made by family members often reduce mother depressive statements (Hops et al., 1987).

Thus, depression can come to be a coercive response to an aggressive partner. And the

partner’s increased aggressive behavior can be seen as a method to decrease the

depressive behavior.

Shaping

A women who recently got divorced and now is unable to do her daily chores and office work,

where previously she was a good and hard working employee.

Breaking a task(inherently reinforcing)

Step 1 – just think about going to office and work.

Step2 – plan out mentally how you are going to do your pending project/work.

Step 3 – witting the plan on the paper.Step 4 – looking through/viewing the files and

previously done work.Step 5 – going to office and just visiting her

office. Step 6 – going to office and doing some work..

References http://www.kennedykrieger.org/patient-care/

patient-care-programs/inpatient-programs/neurobehavioral-unit-nbu/applied-behavior-analysis

https://pantherfile.uwm.edu/jkanter/www/pdf/publication/5factors.pdf

Case Studies

CASE STUDYWhite female20 years oldInpatient since 6 years

General procedure:Value of token:

Sleeping facilities Access to television Off-grounds trips

Smiling response:Opening of the lipsAn upward turn on the corners of the mouthProtrusion of the skin covering the

cheekbones.

Crying response:Inarticulate sounds accompanied by tears.Crying period ranged from 5 to 30 minutes.

Responses recorded for 3 times everyday.Rating interval 2 hours maximum.

Baseline: introduction of how token economy would work.

Positive reinforcement and response cost.Extinction: determine the effects of prior

experimental treatment.ReversalPositive reinforcement and response cost: social

reinforcement component. Fading:

Patient was nearing discharge status,Ensure maintenance of established behavior.

Baseline measures: zero frequency of smile responses and 28 to 30 crying spells in the first two weeks.

Token reinforcement: 27 smiles in the final week.

Extinction: smiling decreased to 11 smiles in the final week.

Crying spells increased.Reinstatement: 23 times smiled and cried 2

times.Crying was extinguished by withdrawal of aid

attention.

CASE STUDY

Control of environment.Escape from instructional demands.Reinforcement of compliance and quiet-hand procedure

contingency.Negative affects when left alone. 10 minutes session.Padded room with one-way mirror.Observation: SIB and 10 minutes interval of positive

and negative affects.Enriched environment: tape player, stacking clowns,

tool catalog, Legos, plastic tools, stuffed octopus, pom-pom.

Baseline: empty room.Enriched environment: negative affect

decreased, positive affect increased. No SIB in enriched environment.Addition of simple stimuli can be sufficient.

ReferencesLindauer, S. E., DeLeon, I. G., & Fisher, W. W.

(1999). Decreasing signs of negative affect and correlated self-injury in an individual with mental retardation and mood disturbances. Journal of Applied Behavior Analysis, 32(1), 103–106. http://doi.org/10.1901/jaba.1999.32-103

Reisinger, J. J. (1972). The treatment of “anxiety-depression” via positive reinforcement and response cost. Journal of Applied Behavior Analysis, 5(2), 125–130. http://doi.org/10.1901/jaba.1972.5-125

STRENGTHS

1. Setting goals to replace negative patterns of behavior with positive ones, addressing bad habits.

2. Participating positively in a variety of activities.

3. No “typical” program.

4. Emphasis on “here and now” in the client’s life, rather than the, “there and then”.

5. Rewards can be effective.

6. Its scientific methodology.

7. Relatively brief period of time.

8. Ethical accountability.

WEAKNESSES

1) Time.

2) Require a high degree of self-honesty.

3) Does not change feelings.

4) Does not provide insight.

5) Treats symptoms rather than causes.

6) Long-term dependency.