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The behavior which leads to a person’s admission to a mental hospital often involves danger to himself or others, withdrawal from normal social functions, or a dramatic change from his usual mode of behaving. The professional staff of the psychiatric hospital directs its major efforts toward the discovery of the flaw in the patient’s mental apparatus which presumably underlies his disturbing and dangerous behavior. Following the medical paradigm, it is presumed that once the basic disfunction has been properly identified the appropriate treatment will be undertaken and the various manifestations of the disfunction will disappear.

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The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the “common cold” of outpatient populations. Two treatments for depression have emerged: acceptance and commitment therapy (ACT) and behavioral activation (BA). At times ACT and BA may suggest largely redundant intervention strategies. However, at other times the two treatments differ dramatically and may present opposing conceptualizations. This paper will compare and contrast these two important treatment approaches. Then, the relevant data will be presented and discussed. We will end with some thoughts on how and when ACT or BA should be employed clinically in the treatment of depression.

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An approach to a functional analysis of delusional speech and hallucinatory behavior is described and discussed using concepts found in Goldiamond’s (1975a and 1984) nonlinear contingency analysis and Skinner’s Verbal Behavior (1957). This synthesis draws upon and concords with research from the animal laboratory, with the extensive experimental literatures on stimulus control and signal detection theory, and with our own clinical experiences. In this formulation, delusional speech and hallucinatory behavior are viewed as successful operants. Accordingly, we argue that such behaviors can be considered adaptive and rational, rather than maladaptive and irrational, when analyzed within a model of consequential governance that includes alternative sets of contingencies. Several clinical examples are offered to illustrate both analytic procedures and the design of systemic treatment programs based upon a behavioral contingency analysis derived from a natural science of behavior. Throughout, we emphasize the consequential governance of these clinically important classes of behavior, in contrast to other approaches which suggest formal similarities to operant verbal behavior but largely ignore the role of consequential contingencies.

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This paper has two purposes; the first is to reintroduce Goldiamond’s constructional approach to clinical behavior analysis and to the field of behavior analysis as a whole, which, unfortunately, remains largely unaware of his nonlinear functional analysis and its implications. The approach is not simply a set of clinical techniques; instead it describes how basic, applied, and formal analyses may intersect to provide behavior-analytic solutions where the emphasis is on consequential selection. The paper takes the reader through a cumulative series of explorations, discoveries, and insights that hopefully brings the reader into contact with the power and comprehensiveness of Goldiamond’s approach, and leads to an investigation of the original works cited. The second purpose is to provide the context of a life of scientific discovery that attempts to elucidate the variables and events that informed one of the most extraordinary scientific journeys in the history of behavior analysis, and expose the reader (especially young ones) to the exciting process of discovery followed by one of the field’s most brilliant thinkers. One may perhaps consider this article a tribute to Goldiamond and his work, but the tribute is really to the process of scientific discovery over a professional lifetime.

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Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable. replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders.

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Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a behavior-analytic
model of intervention and behavior change. ACT is grounded in a post Skinnerian account of language and cognition, relational frame theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001), that codeveloped with ACT. ACT and RFT are linked to an elaboration and extension of the traditional behavioranalytic model of how best to build and extend psychological knowledge, which we have termed a contextual behavioral science (CBS) approach (Hayes, Levin, Plumb, Boulanger, & Pistorello, in press; Vilardaga, Hayes, Levin, & Muto, 2009). In this chapter, we describe the ACT model and enough of the underlying theoretical underpinnings and scientific strategy to place data on its impact and change process in the proper context. We link CBS to the challenges faced by an inductive approach in translation and system building.

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Acceptance and commitment therapy (ACT) is a modern form of cognitive behavioral therapy based on a distinct philosophy (functional contextualism) and basic science of cognition (relational frame theory). This article reviews the core features of ACT’s theoretical model of psychopathology and treatment as well as its therapeutic approach. It then provides a systematic review of randomized controlled trials (RCTs) evaluating ACT for depression and anxiety disorders. Summarizing across a total of 36 RCTs, ACT appears to be more efficacious than waitlist conditions and treatment-as-usual, with largely equivalent effects relative to traditional
cognitive behavioral therapy. Evidence from several trials also indicate that ACT treatment outcomes are mediated through increases in psychological flexibility, its theorized process of change.

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The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional CBT. There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data seem promising.

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Dialectical-behavioral therapy (DBT) has been developed as a treatment for borderline personality disorder (BPD), a disorder that afflicts approximately 10% of the outpatient population and up to 20% of inpatients. DBT conceptualizes BPD as a pervasive disorder of the emotion regulation system that arises from the
transaction of a biologic predisposition to emotional vulnerability and emotional learning within an invalidating environment. As a result, individuals with BPD
experience tremendous problems including interpersonal difficulties, self-injurious behaviors, and suicidal behaviors. DBT incorporates the principles of dialectical philosophy, Zen, and behavior therapy to treat these problems. DBT utilizes several modes of therapy and teaches skills in several areas to help patients who
experience a tremendous amount of suffering to build a life worth living.

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Presents a behavioral analysis of depression which includes a discussion of avoidance, escape, and reinforcement parameters. The decreased frequency of many kinds of positively reinforced activity is seen as the common denominator among depressed persons. Basic behavioral processes which contribute to or reduce the frequency of a person’s conduct are discussed, including changes in the environment, schedules of reinforcement, and suppressed anger. Implications of a behavioral analysis for research and verbal interaction with the therapist are discussed. It is concluded that behavioral and clinical concepts can be combined as a method of uncovering the actual events of psychopathology and therapy.

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In most talk therapies for outpatient adults, the therapist has no control over the client’s daily life or contingencies outside the treatment session. The fundamental theoretical issue facing the behavior analyst is, “How can the talking that goes on during the session help the client with problems that occur outside the session in the client’s daily life?” An historical analysis and the application ofverbal behavior principles are used to answer the question and form the basis of clinical behavior analysis (CBA). The implications of CBA range from providing a theoretical base for psychotherapy to suggesting new forms of treatment. Key words: clinical behavior analysis, psychotherapy, verbal behavior, behavior therapy

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In this article we discuss the traditional behavioral models of depression and some of the challenges analyzing a phenomenon with such complex and varied features. We present the traditional model and suggest that it does not capture the complexity of the phenomenon, nor do syndromal models of depression that dominate the mainstream conceptualization of depression. Instead, we emphasize ideographic analysis and present depression as a maladaptive dysregulation of an ultimately adaptive elicited emotional response. We emphasize environmental factors, specifically aversive control and private verbal events, in terms of relational frame theory, that may transform an adaptive response into a maladaptive disorder. We consider the role of negative thought processes and rumination, common and debilitating aspects of depression that have traditionally been neglected by behavior analysts.

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Behavioral Activation (BA) for depression is an empirically supported psychotherapy with a long history dating back to the 1970s. To date there have been no systematic reviews of how BA treatment packages and their accompanying components have evolved over the years. This review sought to identify and describe the specific treatment components of BA based on the descriptions of techniques provided in empirical articles on BA and referenced treatment manuals when available. The following component techniques were identified: activity monitoring, assessment of life goals and values, activity scheduling, skills training, relaxation training, contingency management, procedures targeting verbal behavior, and procedures targeting avoidance. The implementation of these techniques is reviewed, along with their empirical support both as stand-alone components and as components of larger treatment packages. Whereas activity scheduling, relaxation, and skills training interventions have received empirical support on their own, other procedures have shown effectiveness as parts of larger treatment packages. Although BA interventions differed in tools used, activity monitoring and scheduling were shown to be constant components across interventions. Possible directions for the future evolution of BA are discussed.

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Two new systems of adult outpatient psychotherapy based on Skinner’s radical behaviorism are described. They do not resemble traditional behavior therapy. Functional analytic psychotherapy (FAP) relies on an involved, emotional, nonmanipulative client-therapist relationship as the vehicle of change. Acceptance and commitment therapy (ACT) gives the client a counterintuitive method of accepting, rather than changing or eliminating, troublesome thoughts and feelings. The descriptions of these therapies are offered (a) to illustrate how intensive, in-depth psychotherapies can be derived from radical behaviorism, and (b) to circumvent the frequent misunderstandings that characterize the discussions between behavior analysts and their critics. The nature of ACT and FAP methods appears to dispel many common myths about contemporary behavior analysis.

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