Clinical behaviour analysis

Domain II · Behavioural & cognitive · Kohlenberg, Tsai, Dougher · 1993

What it is

CBA is a framework, not a single therapy. It is the application of behaviour-analytic concepts and methods to problems usually classed as mental disorders, treating thoughts, feelings and actions alike as behaviour to be understood in context. It has no single founder or manual; its named clinical…

Format

• CBA has no fixed session schedule. The sources describe a functional-analytic cycle rather than numbered phases; the phases below organise that cycle. The phase labels and transition criteria are my synthesis unless a source is tagged.
• Phase A: Assessment and descriptive functional analysis (typically 3 to 5 sessions).

Who practises it, and how they are trained or regulated

• Goal: change the maintaining variables: shape alternatives in session (FAP), change out-of-session contingencies (BA, exposure, CM, behaviour exchange), and change verbal regulation (ACT processes, rule analysis).
• CBA is a framework, not a single therapy. It is the application of behaviour-analytic concepts and methods to problems usually classed as mental disorders, treating thoughts, feelings and actions alike as behaviour to be understood in context. It has no single founder or manual; its named clinical forms include ACT, FAP, BA, IBCT, community reinforcement, contingency management, behavioural parent training, CBIT for…
• How change happens. With outpatient adults the therapist cannot control the client's daily environment, so the core question is how in-session talk can change out-of-session behaviour. CBA gives two answers: (a) the therapy relationship is itself a real environment in which the client's problem behaviours occur and can be shaped directly by the therapist's natural responses (the FAP route); and (b) verbal behaviour…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• sliding back into blame; slow down and return to description.
• demand effects on self-report; triangulate with in-session CRB change.
• values that are really rules for approval; values the therapist prefers.
• acceptance used as a new control strategy ("I'll accept it so it goes away").
• goals set too large; commitment as a promise to you rather than to the value.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.