INTRODUCTION TO THE SPECIAL SECTION ON CLINICAL BEHAVIOR ANALYSIS DOUGLAS W. WOODS JAMES E. CARR

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1 JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2006, 39, NUMBER 4(WINTER 2006) INTRODUCTION TO THE SPECIAL SECTION ON CLINICAL BEHAVIOR ANALYSIS DOUGLAS W. WOODS UNIVERSITY OF WISCONSIN MILWAUKEE RAYMOND G. MILTENBERGER UNIVERSITY OF SOUTH FLORIDA AND JAMES E. CARR WESTERN MICHIGAN UNIVERSITY Since its inception, applied behavior analysis has focused on analyzing and developing effective interventions for a variety of behavior problems seen in diverse populations and settings. In fact, the Journal of Applied Behavior Analysis (JABA) masthead states that the purpose of the journal is to publish reports of experimental research involving applications of the experimental analysis of behavior to problems of social importance. There are a variety of methods to determine whether something is socially important, but the primary architects of applied behavior analysis believed that target behaviors should be chosen because of their importance to man (sic) and society, rather than their importance to theory (Baer, Wolf, & Risley, 1968, p. 92). This initial emphasis on socially important targets for intervention as an essential feature of applied behavior analysis has been reaffirmed several times since its announcement in 1968 (e.g., Baer, Wolf & Risley, 1987; Wolf, 1978). From their descriptive papers, as well as the extraordinary body of their published research, it is clear that Baer et al. (1968, 1987) strongly believed that applied behavior-analytic research should focus on topics of demonstrable social importance. We share their belief that Address correspondence to Douglas W. Woods, Department of Psychology, University of Wisconsin Milwaukee, Box 413, Milwaukee, Wisconsin ( dwoods@uwm.edu). doi: /jaba.2006.intro such a focus not only extends the science of behavior analysis and enlarges its influence by demonstrating its applied implications but also benefits the human condition. For some specific populations and target behaviors (e.g., self-injury of individuals with developmental disabilities, pediatric feeding disorders, teaching skills to children with autism), JABA has been true to its original mandate. However, over the course of JABA s history, concern has been expressed that the journal s scope may be too narrow (Kunkel, 1987). One area in which JABA has not published a substantial amount of research is in the domain of clinical psychology, clearly the largest applied area in psychology (American Psychological Association [APA] Research Office, 2000). In fact, 62% of all members of the APA are clinical or counseling psychologists (APA Research Office). Although these disciplines work with a wide array of populations and problems, they most frequently seek to understand and treat typically developing children and adults with functionally impairing behavioral excesses or deficits. The problem behaviors exhibited by these populations are common and diverse. For example, in the National Comorbidity Study (Kessler, Berglund, Demler, Jin, & Walters, 2005), the lifetime prevalence of mood disorders was found to be 20.8%; anxiety disorders, 28.8%; impulse control disorders, 24.8%; and substance use disorders, 14.6%. In addition, the 407

2 408 DOUGLAS W. WOODS et al. financial and functional impact of these disorders suggests that they are of profound social importance. Although these and other clinical disorders are not problem behaviors as typically addressed by applied behavior analysts, each disorder is comprised of behaviors that may be targeted for intervention. As noted by Baer et al. (1987), The most fruitful task (in behavior analysis) is to recognize that each of those labels (anxiety, attention, intelligence, and many others like them) often represents some behavioral reality not yet analyzed as such. The point is that these behavioral realities are not likely to be analyzed as such within their parent disciplines, and thus will never become truly applicable there, yet might well be analyzed behavior analytically, perhaps with great profit to us and those disciplines, and thus to our roles within those disciplines. (p. 315) Given JABA s mandate for addressing socially important topics, one might expect that it would play a major role in analyzing and developing interventions for these clinical problems. However, this does not seem to be the case. Our own examination of recent JABA content indicates a concentration on individuals with developmental disabilities (i.e., 60% of data-based articles from 2001 to 2005), with relatively little attention to problems commonly encountered by mainstream clinical psychologists. Collectively, 11% of data-based articles from 2001 to 2005 targeted behaviors associated with one of the following clinical problems: sleep disorders, incontinence, psychotic disorders, anxiety disorders, mood disorders, impulse control disorders, substance abuse, attention deficit hyperactivity disorder, obesity, and tic disorders or stuttering. Other evidence that JABA may not be addressing the most common clinical problems comes from studies showing that JABA has a small impact on journals in which mainstream clinical issues are discussed but a large impact on journals that address issues relevant to the study of developmental disabilities (Critchfield, 2002). Perhaps the most disconcerting evidence that JABA is not addressing problems encountered by mainstream clinical psychology is the fact that, based on its most recent Institute for Scientific Information impact factor (.875 as of May 2005), it is one of the 10 lowest impact journals (out of 30) in behavioral clinical psychology (Taylor, Abramowitz, McKay, Stewart, & Asmundson, 2006). This is particularly troubling because the low ranking is within the behavior therapy branch of clinical psychology, arguably the branch with the closest theoretical alliance to applied behavior analysis. It is not entirely clear why research in JABA has not focused more on more mainstream clinically relevant problems, but we offer two plausible speculations. First, applied behavior analysis and by extension, JABA, did not develop out of clinical psychology. It developed out of experimental psychology laboratories, and from settings to which this early laboratory work was first extended for applied purposes. These settings were often institutions or other settings that provided the opportunity for relatively tight environmental control. Second, certain aspects of traditionally accepted JABA methodology may not be best suited for research with clinical populations. One of the hallmark features of JABA has been the reliance on direct observation of behavior by independent observers (Baer et al., 1968, 1987). Unfortunately, many of the target behaviors exhibited by mainstream clinical populations include private dimensions (e.g., aversive feelings in the case of depression, worrying in a person with generalized anxiety disorder, or hearing voices in the case of paranoid schizophrenia) or behavior that is difficult to observe directly. For example, the escape or avoidance function of anxious behavior can be quite easily measured, but it would be extremely impractical and expensive to closely follow an individual diagnosed with social phobia for extended periods to determine when social situations are avoided or escaped. Articles that employ strategies other than direct observation (e.g., self-monitoring), however, are often viewed with suspicion by editorial staff, and research

3 CLINICAL BEHAVIOR ANALYSIS 409 relying on them has historically had an unlikely future in JABA. It is unclear how this situation can be reversed to get more clinical behavior-analytic research published in JABA, but here we offer a few suggestions. First, JABA and its editorial staff would have to clearly communicate interest in publishing papers on mainstream clinical problems (i.e., clinical behavior analysis). This special section on clinical behavior analysis is a step in that direction. Second, there would need to be increased recognition that the practical constraints of conducting research with many clinical populations may necessitate a broader approach to methodology than is typically reported in JABA. Although papers on clinical topics may be philosophically behavioral, certain methodological practices may be necessary given research on certain topics. Similarly, when appropriate (e.g., actuarial questions about the broad efficacy of a behavioral treatment or assessment procedure), JABA should consider publishing group studies as a way to reach a broader clinical audience whose clinical epistemology is governed more by quantitative than by single-subject research methods. Although it might be appropriate initially to have slightly different methodological expectations for clinical papers submitted to JABA, we would expect clinical behavior-analytic researchers (a) to collect direct observation data whenever possible, (b) to report individual data along with aggregate behavior analyses in group-design research, (c) to collect multiple measures when possible as supporting evidence for behavior change, (d) to investigate new and innovative ways to improve assessment of clinically relevant behaviors, (e) to identify methodological limitations in their research and suggest ways for researchers to overcome these limitations, and (f) to include a conceptual analysis of behavior change employing basic behavioral principles. In the section that follows, we have assembled a diverse collection of articles from the area of clinical behavior analysis. The article by Kanter and colleagues describes a behavioranalytic approach to the treatment of depressive behavior in mainstream populations. Functional analytic therapy was implemented following standard cognitive therapy. Although results were mixed, the article confirms that behavior analysis can contribute to the treatment of major depression. The article also highlights the challenges behavior analysts face when working with this population. The article by Dixon and colleagues represents a behavior-analytic examination of the environmental variables that influence pathological gambling behavior. The authors demonstrated that pathological gamblers discounted delayed hypothetical monetary rewards to a greater extent in a gambling setting than in a nongambling setting. This article is noteworthy in that it represents a style of clinically relevant research that is particularly suitable for behavior-analytic researchers: identifying the controlling variables of pathological behavior. One of the most substantial contributions of behavior analysis within mainstream clinical domains has been in the treatment of tics and other habit disorders. The article by Thompson and colleagues extends the literature on the treatment of chronic skin picking by demonstrating the utility of antecedent manipulations. Although this strategy has been used clinically for some time, until recently there has been little published empirical evidence to support its use. The article by Wetterneck and Woods describes the use of exposure and response prevention to treat repetitive behaviors associated with Tourette s syndrome. The article could be of particular interest to those who work in the areas of Tourette s syndrome and obsessivecompulsive disorder, because the repetitive behaviors treated in this study are thought to be functionally related to both. The final article in this area sought to further evaluate the utility of direct observation methods in the assessment of children with tic disorders. In this paper, Himle and colleagues provide data that direct

4 410 DOUGLAS W. WOODS et al. observation procedures can be efficient, reliable, and generalizable across settings, but at the same time encourage behavior analysts to move beyond frequency counts, with the goal of developing assessment strategies to measure all relevant dimensions of tics. The article by Freeman demonstrated the utility of an extinction-based procedure with a unique component (i.e., bedtime pass) for treatment of bedtime resistance exhibited by typically developing children. This study has at least two noteworthy features. First, the intervention did not produce extinction bursts, which likely enhances the social validity of this behavioral approach to a problem commonly experienced by families. Second, the study demonstrates the utility of behavioral interventions for commonplace problems with typically developing children. This represents a potential growth area for applied behavior analysis. The article by Shabani and Fisher describes a reinforcement-based intervention (with stimulus fading) for treating needle phobia in a child with autism. This is a particularly important goal because needle phobias can inhibit the adequate delivery of physical health care, and by reducing this phobic behavior physical health can be improved. Similarly, the article by Ricciardi and colleagues demonstrates the use of a reinforcement-based procedure (without escape extinction) to treat the phobia of a child with autism. Both of these articles make important contributions to the literature, because there is a relative lack of information on treating anxiety problems in individuals with developmental disabilities. The article by Baker and colleagues illustrates the successful use of a functional analysis and subsequent function-based treatment for understanding and reducing the aggression of an elder with dementia. This article demonstrates how well technology developed for individuals with developmental disabilities can transfer to other dependent populations. Such applications of behavior analysis to the problems of elders (i.e., behavioral gerontology) could become increasingly valuable as the prevalence of elders in the U.S. increases. In another systematic replication that illustrates the transfer of technology developed for individuals with developmental disabilities, Rasmussen and O Neill employed fixed-time reinforcement to successfully reduce problem behavior exhibited by children with emotional and behavioral disorders. Furthermore, this study extends the literature on fixed-time reinforcement by implementing treatment in the natural environment. The presence of this special section on clinical behavior analysis in JABA is an initial attempt to increase the visibility of clinical behavior analysis and increase the number of related papers submitted to JABA. The success of this effort will rest on whether research submitted to JABA is methodologically sound, clinically relevant, and conceptually interesting to JABA readers. The historical record clearly shows that behavior analysts have successfully met these challenges with the many populations and clusters of problems they have faced until now. We believe the time has come for similar successes to be produced with mainstream clinical populations and problems. REFERENCES American Psychological Association Research Office. (2002). APA directory survey.washington,dc:author. Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20, Critchfield, T. S. (2002). Evaluating the function of applied behavior analysis: A bibliometric analysis. Journal of Applied Behavior Analysis, 35, Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, Kunkel, J. H. (1987). The future of JABA: A comment. Journal of Applied Behavior Analysis, 20,

5 CLINICAL BEHAVIOR ANALYSIS 411 Taylor, S., Abramowitz, J. S., McKay, D., Stewart, S. H., & Asmundson, G. J. G. (2006). Publish without perishing, Part 2: More suggestions for students and new faculty. The Behavior Therapist, 29, Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11,