Clinical behaviour analysis

1. Introduction

Version followed: clinical behaviour analysis (CBA) as defined by Kohlenberg, Tsai and Dougher (1993) and the BACB fact sheet (version 03/2023), with procedures taken from functional analytic psychotherapy (FAP) as set out in Kohlenberg and Tsai (1991; five rules) and Tsai, Callaghan and Kohlenberg (2013; four guidelines), the rule-governed-behaviour analysis of Törneke, Luciano and Valdivia Salas (2008), and the signature procedures of ACT, behavioural activation (BA; Martell, Dimidjian and Herman-Dunn, 2nd ed. 2021) and IBCT (Christensen, Doss and Jacobson, 2nd ed. 2020).

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 [source: BACB fact sheet]. 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 tics, DBT and stimulus control therapy for insomnia [source: BACB fact sheet; Wikipedia CBA]. What unites them is a shared method: a descriptive functional analysis of the client's behaviour, followed by interventions chosen to change the variables that maintain it [source: BACB fact sheet].

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 [source: Kohlenberg, Tsai & Dougher 1993, abstract]. 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) [source: Kanter et al. 2017; Tsai et al. 2013]; and (b) verbal behaviour (rules, self-descriptions, values) alters the functions of events outside the room, so changing how the client's behaviour is regulated by language changes how they act (the ACT/RFT route) [source: Törneke et al. 2008]. Out-of-session contingencies are also changed directly through scheduling, exposure and contingency arrangements (the BA/CM route) [source: BACB fact sheet; Martell 2018].

This guide gives the shared CBA procedures in full and the signature procedures of the member therapies as they are used inside a CBA case formulation. Each member therapy has its own manual; consult it before delivering that therapy as a stand-alone protocol [synthesis].

2. Framework

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 [synthesis].

Phase A: Assessment and descriptive functional analysis (typically 3 to 5 sessions).

Goal: identify problem and target behaviours by function, their antecedents (distal and proximal, verbal and non-verbal) and consequences (immediate and delayed, verbal and non-verbal) [source: BACB fact sheet].
Format: collaborative, unstructured or semi-structured interview, guided by a template such as the Functional Idiographic Assessment Template (FIAT; Callaghan 2006) or the FAP Case Conceptualization Form (Tsai et al. 2009) [source: Kanter et al. 2006; Tsai et al. 2013]. In two published FAP cases, assessment took 5 and 3 sessions [source: Kanter et al. 2006].
Move on when: you can state, for each main problem, a plausible maintaining contingency and a functionally equivalent alternative behaviour, the client recognises the pattern in their own examples, and daily self-monitoring has started [synthesis].

Phase B: Formulation feedback and target selection (1 session).

Goal: give the client the functional analysis in plain words, agree idiographic targets anchored in behavioural examples, set up diary cards or other tracking [source: Kanter et al. 2006]. In IBCT this is the formal feedback session after the DEEP assessment [source: TPC review of Christensen et al. 2020].
Move on when: targets are agreed and measurable, and the client accepts the rationale for working on them (including in-session work if FAP is used) [synthesis].

Phase C: Function-based intervention (bulk of therapy; length set by the member protocol).

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).
Typical counts where a protocol exists: BA in the COBRA trial allowed up to 20 sessions over 16 weeks plus up to 4 boosters, in three phases (assessment and activation; rumination and optional modules; relapse prevention) [source: Martell 2018 workshop slides]. FAP has no fixed length; it is often added to another therapy [source: Kanter et al. 2017]. IBCT: not established from the sources [uncertain].
Review every session against diary data. Re-formulate when a target has not moved after about 3 to 4 sessions of a well-delivered intervention, or when new functions emerge [synthesis].

Phase D: Generalisation, maintenance and ending.

Goal: make sure in-session and in-therapy gains occur in daily life and persist: functional interpretations linking session and life, homework that takes new behaviour "on the road", self-planning, trigger identification, relapse-prevention review [source: Tsai et al. 2013; Martell 2018].
End or taper when out-of-session targets are stable on the client's own tracking for several weeks and the client can describe their own patterns functionally (CRB3) and plan responses without the therapist [synthesis].

3. Guiding principles

Function over form. Behaviours that look different can serve one function, and the same act can serve different functions; group problems by what they do for the client, not how they look. In practice: ask "what does this get or avoid?" before deciding what to change [source: Kanter et al. 2017; Virués Ortega et al. 2003; Tsai et al. 2013].
All of it is behaviour in context. Thoughts, feelings and actions are all behaviour, explained by their history and current context [source: BACB fact sheet]. In practice: treat a thought as something the client does in a situation, not as a cause sitting inside them.
Idiographic, not syndromal. Targets are defined for this client from their own examples; diagnosis does not set the treatment [source: Tsai et al. 2013; Kanter et al. 2006]. In practice: write targets in the client's words with a concrete example of each.
The session is a real environment. The client's interpersonal problems will show up with you; that is an opportunity, not an interference [source: Kohlenberg et al. 1993 abstract; Tsai et al. 2013]. In practice: when the pattern appears in the room, work on it there.
Natural, not arbitrary, reinforcement. Respond as a caring person in the client's life would ideally respond; avoid contrived praise or tokens in adult outpatient work [source: Kanter et al. 2017, citing Ferster 1967; Virués Ortega et al. 2003]. In practice: show real interest, closeness or relief rather than saying "good job".
Reinforcement is defined by its effect. A response is reinforcing only if the behaviour it follows becomes more likely [source: Tsai et al. 2013]. In practice: watch whether the client does more of the target after your response; adjust if not.
Immediacy. The closer your response is in time and place to the behaviour, the stronger its effect [source: Tsai et al. 2013]. In practice: respond in the moment rather than at the end of the session.
Shape within the current repertoire. Ask for steps the client can achieve now, neither too much nor too little [source: Tsai et al. 2013; Martell 2018 (start small)]. In practice: accept partial improvements and raise the criterion gradually.
Rules can make behaviour insensitive to consequences. Rule-governed behaviour adapts more slowly when contingencies change; problems often arise from generalised pliance, inaccurate tracking and augmentals that inflate the aversiveness of private events [source: Törneke et al. 2008]. In practice: listen for the rule behind rigid behaviour and test it against what actually happens.
Experiential avoidance is a common maintaining function. Efforts to avoid thoughts, feelings and memories give short-term relief, strengthen the avoidance and narrow life [source: Törneke et al. 2008; ACBS]. In practice: check whether a problem behaviour functions to escape a private event.
Workability, not truth, is the criterion. Judge a thought or strategy by whether acting on it serves the client's values [source: ACBS six core processes]. In practice: ask "where has following this got you?" rather than disputing the thought.
The therapist is part of the client's environment. Your reactions, avoidances and reinforcing effects are data and must be monitored, ideally with peer supervision or recordings [source: Tsai et al. 2013; Virués Ortega et al. 2003]. In practice: notice what you avoid with this client and how it shapes the session.
Awareness, courage and therapeutic love. Notice CRBs as they happen, be willing to take interpersonal risks to evoke them, and respond with care that is contingent on improvement [source: Tsai et al. 2013]. In practice: positive regard alone is not enough; it must follow improved behaviour.
Generalisation must be worked for. Link session events to daily life in both directions and set out-of-session tests [source: Tsai et al. 2013; Kanter et al. 2017]. In practice: end each in-session improvement with "where else could you do this?"
Measure continuously. Track idiographic targets daily and review weekly; let data, not impressions, guide changes [source: Kanter et al. 2006]. In practice: review the diary card at the start of every session.
Collaborative coach stance. In BA terms: set an agenda, nurture activation, learn together, be non-judgemental, validate, encourage and show natural warmth (ENLIVEN) [source: Martell 2018]. In practice: you and the client are co-investigators of what works.
Treatment utility of assessment. Assessment is worth doing to the extent it improves treatment decisions [source: attributed to Hayes, Nelson & Jarrett 1987] [uncertain]. In practice: stop gathering detail that will not change what you do.

4. Intervention inventory

Grouped as A: assessment and formulation; B: in-session contingency work (FAP); C: changing out-of-session contingencies; D: changing verbal regulation (ACT/RFT-derived); E: couples (IBCT); F: evaluation and maintenance. All example language is illustrative wording of my own unless quoted and cited. Where a member therapy has its own manual, these entries describe its use inside a CBA formulation, not the full protocol.

A1. Descriptive functional analysis interview

Purpose / when: the core CBA procedure, used at intake and whenever a problem is not changing [source: BACB fact sheet].
Steps:
1. Ask for a recent, specific episode of the problem (not a summary). Get the setting, time, who was present.
2. Define the behaviour operationally: what exactly the client did, said, thought or felt, so that two people could agree it happened.
3. Map antecedents on two time scales: proximal (what happened just before, including thoughts and bodily states) and distal (history, recent losses, sleep, stress) [source: BACB fact sheet].
4. Map consequences: immediate and delayed, verbal and non-verbal (what stopped, what started, what others did, what the client told themselves) [source: BACB fact sheet].
5. Add motivating operations: conditions that make a consequence more or less valuable (fatigue, pain, deprivation, satiation) [source: Wikipedia functional analysis; Virués-Ortega & Froján-Parga 2014].
6. Repeat with 2 to 4 more episodes and look for the common function (escape, access to attention or closeness, relief from a private event, rule-following for approval).
7. Ask what the client does when things go better: this identifies functionally equivalent alternatives already in repertoire.
Example language (illustrative): "Take me to the last time this happened. Where were you, and what was the very first thing you noticed?" / "And right after you left the room, what changed for you, even for a moment?"
Watch for: summaries and explanations ("I just always do that") instead of episodes; return to a specific moment. The analysis is a working hypothesis; descriptive and indirect methods have limited validity, so test it through the intervention [source: Wikipedia functional analysis].

A2. Grouping problems into functional response classes (idiographic case conceptualisation)

Purpose / when: after A1, to organise many complaints into a few classes that share a function and can each be targeted [source: Tsai et al. 2013; Virués Ortega et al. 2003].
Steps:
1. List problem behaviours from A1 and the client's history.
2. Sort them by function, using the domains in a template such as FIAT (Callaghan 2006: for example, how the client asserts needs, handles conflict, discloses, experiences closeness) or the FAP Case Conceptualization Form [source: Tsai et al. 2013; Kanter et al. 2006]. Do not reproduce the template items; use its domains as headings.
3. For each class, write: the problem form (to decrease), the improvement form (to increase), the likely maintaining contingency, and the historical context (for example, rigid self-protective rules learned in earlier relationships) [source: Tsai et al. 2013].
4. Ask: how might this class show up with me in the room? Write your prediction [source: Tsai et al. 2013].
Example language (illustrative): "Withdrawing at work, not answering your sister, going quiet with your partner: they look different, but they all seem to get you out of a moment where someone might be disappointed in you. Does that fit?"
Watch for: classes defined by topography ("crying") rather than function; ask what the crying does in each context.

A3. Self-monitoring with diary cards

Purpose / when: from the end of assessment onwards, to track out-of-session targets that you cannot observe [source: Kanter et al. 2006].
Steps:
1. Put each agreed target (problem and improvement form) on a simple daily card in the client's words.
2. Ask for a daily yes/no or frequency rating, plus a brief note of one episode.
3. Review the card at the start of every session; teach accurate reporting by checking vague entries against specific episodes [source: Kanter et al. 2006].
4. Use the card to choose the session agenda and to test whether interventions move targets.
Example language (illustrative): "This card is how we will know if what we do in here is changing anything out there. Rough and honest beats perfect."
Watch for: non-completion (see Section 5); reactivity (monitoring alone may change behaviour, which is fine).

A4. In-session observation of clinically relevant behaviour (FAP Rule 1: awareness)

Purpose / when: throughout therapy, to notice CRB1 (in-session instances of the problem) and CRB2 (in-session improvements) as they happen [source: Kanter et al. 2017; Tsai et al. 2013].
Steps:
1. Before each session, review the predicted in-session forms from A2.
2. During the session, watch for those forms: for example, avoidance of closeness may appear as joking, lateness, silence or excessive crying at close moments; identify the form case by case [source: Tsai et al. 2013].
3. Use your own reactions (feeling pulled away, impatient, moved) as a possible marker, but check them: ask the client whether significant others react the same way, since your reaction is only valid to the extent it matches theirs [source: Tsai et al. 2013].
4. Note client reports of outside behaviour separately from CRBs (outside problems and goals) [source: Paidéia 2017 FAPRS study].
Example language (illustrative): "Something just shifted. You were telling me about your father, and then we were suddenly talking about the parking. Did you notice that?"
Watch for: mistaking your idiosyncratic reactions for CRBs; missing CRB2s because they are small.

A5. Rule analysis (pliance, tracking, augmenting)

Purpose / when: when behaviour stays rigid despite clearly unhelpful results, suggesting it is governed by a verbal rule rather than by its consequences [source: Törneke et al. 2008].
Steps:
1. Elicit the rule: "what do you tell yourself you have to do here?"
2. Classify its function: pliance (followed for others' approval or to avoid their disapproval; counter-pliance is a form of pliance), tracking (followed because it seems to describe how the world works), augmenting (makes a consequence more or less valuable, often abstract, such as being a good person or being right) [source: Törneke et al. 2008].
3. Check accuracy: does following the rule produce what it predicts in the client's experience? Inaccurate tracking can form loops where short-term relief strengthens long-term harm [source: Törneke et al. 2008].
4. If a rule is understood but not followed, check the four reasons the source gives: response not in repertoire, source not credible, no reinforcement for following, or the rule is incoherent [source: Törneke et al. 2008].
5. Feed the findings into D-interventions.
Example language (illustrative): "When you say you must never let anyone down, who are you doing that for? And when you have followed that rule, what has actually happened?"
Watch for: turning rule analysis into debate (which itself invites pliance or counter-pliance); keep it experiential.

A6. Formulation feedback and target agreement

Purpose / when: end of assessment, and again at any re-formulation [source: Kanter et al. 2006; Christensen et al. 2020 via TPC review].
Steps:
1. Present 2 to 4 functional classes using the client's own episodes.
2. For each, state the short-term pay-off and the long-term cost.
3. Agree targets with a behavioural example of the problem and the improvement [source: Kanter et al. 2006].
4. If FAP will be used, explain that the patterns will probably appear between you and that you will work on them there.
5. Invite correction; a disputed formulation is data.
Example language (illustrative): "Here is my best guess at what keeps this going. Tell me where I have it wrong."
Watch for: client agreement that sounds compliant rather than recognising (pliance). Ask for a new example that fits.

B1. Structuring the environment and giving the FAP rationale (FAP Rule 2, part 1)

Purpose / when: from first contact, to make in-session work on interpersonal behaviour expected and safe [source: Tsai et al. 2013].
Steps:
1. Describe therapy as evocative and in vivo: what happens between you is part of the work.
2. Invite the client to say what they think, feel and want with you, including about you, even when it feels risky [source: Tsai et al. 2013].
3. Get explicit consent to point out moments when the pattern seems to be happening.
Example language (illustrative): "The ways you relate to people out there will probably show up with me too. If it is OK with you, I will point that out when I see it, and we can try something different right here."
Watch for: the rationale being heard as criticism; normalise and emphasise that you will also notice improvements.

B2. Evoking CRBs (FAP Rule 2: courage)

Purpose / when: when the targeted classes are not occurring in session, or to create opportunities to practise improvements [source: Tsai et al. 2013; Kanter et al. 2017].
Steps:
1. Choose an evocative method suited to this client. The source lists empty chair work, free association, writing exercises, dream work, mindfulness, acceptance exercises, cognitive restructuring, bodily focus and hypnotherapy; the criterion is whether it evokes this client's CRBs, not your theoretical orientation [source: Tsai et al. 2013].
2. Use yourself: ask about the client's experience of you, of the session, of ending; name moments of closeness or distance.
3. Use strategic self-disclosure to deepen the relationship, normalise, model or balance power, always judged by its likely effect on CRBs; it is not unlimited [source: Tsai et al. 2013].
Example language (illustrative): "What is it like to be telling me this right now?" / "What would you want from me in this moment, if you could ask?"
Watch for: evoking more than the client can handle (see Section 5, overwhelm); your own avoidance of evocative moments.

B3. Natural reinforcement of improvements (FAP Rule 3: therapeutic love)

Purpose / when: whenever a CRB2 occurs; single-case studies suggest this is the active ingredient [source: Kanter et al. 2017].
Steps:
1. Notice the CRB2 (A4).
2. Respond at once, in a way a caring person in the client's ideal relationships would respond: express genuine interest, closeness, appreciation or your honest positive reaction [source: Tsai et al. 2013; Kanter et al. 2017].
3. Size the response to the client's repertoire; for a very small step, a small natural response is enough.
4. Where useful, name the improvement and its effect on you.
Example language: "Can you see that in my eyes?" (verbatim therapist question to a client who saw himself as unlovable, after the therapist expressed care) [source: Tsai et al. 2013]. Illustrative: "You just told me you were annoyed with me. I am glad you did; it makes me feel more connected to you, not less."
Watch for: contrived praise; reinforcing content you like rather than the targeted function; therapist responses that are warm regardless of what the client does.

B4. Responding to and blocking problem behaviour (CRB1)

Purpose / when: when a CRB1 occurs; aim to prompt a better alternative, with reinforcement of CRB2 clearly predominating [source: Virués Ortega et al. 2003; Tsai et al. 2013].
Steps: choose one, gently:
1. Ignore the CRB1 and wait for or prompt an alternative you can reinforce.
2. Block escape or avoidance using one of four ways studied in an FAPRS study: restate your question after the client's pause; restate it while interrupting the shift; describe the effect of the client's behaviour on you; ask the client to describe what they just did [source: Paidéia 2017 FAPRS study].
3. Invite an immediate alternative: "I want you to try something different with me right now" [source: Tsai et al. 2013 (verbatim)].
4. When the client tries, reinforce (B3).
Example language (illustrative): "When you changed the subject just then, I felt a bit shut out. Can we go back to what you were about to say?"
Watch for: blocking can be aversive and raise CRB1 in the short term (it rose in the blocking phase of the cited study), and may contribute to dropout [source: Paidéia 2017; Kanter et al. 2006]. Keep blocking brief and follow it quickly with an opportunity for reinforcement.

B5. Observing your reinforcing effects (FAP Rule 4)

Purpose / when: after every contingent response, and in supervision [source: Kanter et al. 2017; Tsai et al. 2013].
Steps:
1. After reinforcing a CRB2, watch whether the client does more of it later in the session and in following sessions.
2. Ask directly how your response landed.
3. If the behaviour did not increase, change the form, timing or size of your response.
4. In supervision or with recordings: what do you avoid with this client, how does it affect the work, and what skill do you need to build? [source: Tsai et al. 2013].
Example language (illustrative): "When I said that, how was it for you?"
Watch for: clients who say a response was fine while withdrawing; trust what they do next.

B6. Functional interpretation and generalisation (FAP Rule 5)

Purpose / when: after work on a CRB, and at the end of sessions, to help the client describe their own patterns (CRB3) and transfer gains [source: Kanter et al. 2017; Tsai et al. 2013].
Steps:
1. Draw parallels in both directions: how the session moment resembles outside situations, and how an outside report may be happening in the room [source: Tsai et al. 2013].
2. Help the client state the pattern in their own words: situation, what they did, what it got them, what the alternative produced.
3. After a CRB2, assign taking that behaviour "on the road" with a named person [source: Tsai et al. 2013].
4. Review the outcome next session and repeat.
Example language (illustrative): "You just asked me directly for what you needed. Who out there could you try that with this week?"
Watch for: in controlled single-case work, interpretation alone did not change behaviour; it should follow, not replace, contingent responding [source: Kanter et al. 2017].

C1. Activity monitoring (BA)

Purpose / when: when the formulation points to low response-contingent positive reinforcement or avoidance, as in depression [source: Martell 2018; BACB fact sheet].
Steps:
1. Ask the client to record, hour by hour or in blocks, what they did and their mood during it.
2. Review together: which activities came with better or worse mood, what was avoided, what routines have broken down.
3. Draw out the link between mood and behaviour [source: Martell 2018].
Example language (illustrative): "Let's be detectives about your week. Where was mood a little better, and what were you doing then?"
Watch for: blank records (often avoidance of the task itself; see Section 5); global ratings with no specifics.

C2. TRAP/TRAC analysis (BA)

Purpose / when: to show the client how short-term coping maintains depression, and to choose alternatives [source: Martell 2018].
Steps:
1. Take a recent episode: Trigger, Response (feeling), Avoidance Pattern (what they did to cope, for example brooding in bed).
2. Ask what the avoidance led to in the short and longer term.
3. Build the alternative: same Trigger and Response, then Alternative Coping (for example calling a friend) [source: Martell 2018].
4. Plan when the next trigger is likely and rehearse the alternative.
Example language (illustrative): "Staying in bed made sense in the moment. What did it cost you by the evening?"
Watch for: the client hearing the analysis as blame; validate the short-term function first.

C3. Activity scheduling and graded activation (BA)

Purpose / when: after C1/C2, to increase contact with natural reinforcers and counter avoidance [source: Martell 2018].
Steps:
1. Choose activities linked to the formulation and the client's values, favouring those likely to be naturally reinforcing [source: Martell 2018].
2. Act according to a plan, not mood [source: Martell 2018].
3. Make each task small, specific and doable: what, when, where, with whom. Start small; break large tasks into steps [source: Martell 2018].
4. Ask what might get in the way and plan for it; ask what the client expects to happen [source: Martell 2018].
5. Have the client rate mood during the activity; review next session and adjust.
6. Restore disrupted routines (sleep, meals, work rhythms) [source: Martell 2018].
Example language (illustrative): "What is the smallest version of this you could do on Tuesday, even if you feel exactly as you do now?"
Watch for: tasks that are too big; activities chosen for the therapist or out of duty (pliance) rather than for their effect.

C4. Targeting rumination as avoidance (BA)

Purpose / when: when brooding functions to avoid action or difficult experience [source: Martell 2018].
Steps:
1. Help the client notice brooding and its consequences (TRAP).
2. Apply the two-minute rule: if no solution has emerged after two minutes of thinking, it is probably brooding [source: Martell 2018].
3. Either switch to problem solving (define the problem behaviourally, brainstorm, evaluate, commit to one option, check the outcome) or redirect attention to direct experience of the current activity [source: Martell 2018].
Example language (illustrative): "Has going over it produced a next step, or is it going round? If round, what is in front of you right now?"
Watch for: reflective problem-solving being labelled as rumination; check function, not form.

C5. Exposure and response prevention as a function-based intervention

Purpose / when: when the formulation shows escape or avoidance of feared situations or private events maintaining anxiety or related problems; exposure and desensitisation are listed among CBA therapies [source: Wikipedia CBA]. Use the specific manual for the disorder; this entry gives only the CBA framing [synthesis].
Steps (CBA framing) [synthesis]:
1. Confirm the function (escape or avoidance) through A1 and diary data.
2. Obtain informed consent: explain that the aim is to stay in contact with what has been avoided until avoidance stops controlling behaviour, that discomfort will rise before it falls or becomes more tolerable, and that the client controls pace and can stop.
3. Screen for contraindications: acute suicidality, current danger (for example ongoing violence), active psychosis or mania, intoxication, unstable medical conditions or pregnancy where arousal carries medical risk; obtain medical advice where relevant.
4. Build a graded list with the client, agree the first step, and agree to drop safety behaviours (response prevention) at each step.
5. Pair with acceptance and values work (D1, D5) so that the reason for approaching is the client's own.
Example language (illustrative): "You decide how fast we go. The aim is not to feel nothing, but to be able to do this while feeling what you feel."
Watch for: subtle avoidance (distraction, reassurance seeking); exposure that is coerced (pliance) rather than chosen.

C6. Contingency management and community reinforcement

Purpose / when: for substance misuse and similar problems where competing reinforcers maintain use; voucher-based contingency management and CRA/CRAFT are named CBA applications [source: Wikipedia CBA; BACB fact sheet]. Their primary manuals are not drawn on; follow them for steps [uncertain].
Steps (general behaviour-analytic outline) [synthesis]: verify the target objectively (for example by testing where that is part of the programme); deliver the agreed reinforcer immediately after verified abstinence or target behaviour; increase alternative reinforcers in the client's life (work, relationships, leisure) so use competes with more; in CRAFT, a family member is coached to reinforce sober behaviour and allow natural consequences of use.
Example language (illustrative): "What in your week could compete with drinking for your Friday evening?"
Watch for: reinforcers delivered late or inconsistently; plans that rely on the therapist alone.

D1. Workability analysis (examining the results of control efforts)

Purpose / when: when the client is caught in efforts to control or avoid private events; the source describes helping the client experience the results of unsuccessful control efforts in relation to their values [source: Törneke et al. 2008].
Steps:
1. List what the client has tried to get rid of the unwanted feeling or thought.
2. For each: did it work short term? Long term? What did it cost in terms of what matters to them?
3. Let the client draw the conclusion; do not argue it.
Example language (illustrative): "You have worked hard to make the anxiety go away. In your experience, has it gone, and what has the effort cost you?"
Watch for: the client agreeing to please you (pliance); you being invested in the conclusion.

D2. Acceptance (willingness)

Purpose / when: when experiential avoidance is the maintaining function [source: ACBS six core processes; Törneke et al. 2008].
Steps: invite the client to feel the emotion or sensation fully, as it is, without defending against it; describe its location, shape, movement; practise staying with it for short periods in session; link willingness to a valued action [source: ACBS].
Example language (illustrative): "Can you let that tightness be there for a moment, without trying to change it, and just describe it to me?"
Watch for: acceptance used as a new control strategy ("I'll accept it so it goes away").

D3. Cognitive defusion

Purpose / when: when the literal content of thoughts is controlling behaviour (fusion) [source: ACBS].
Steps: use one or more of the techniques the ACBS lists: watch thoughts without reacting; repeat a word aloud until it loses its meaning; label thinking (prefix the thought with "I am having the thought that"); treat a thought as an object with physical features (size, colour, speed) [source: ACBS]. Then ask what the client would do if the thought were just a thought.
Example language (illustrative): "Say it again, but this time start with 'I'm having the thought that'. What changes?"
Watch for: defusion used to dismiss or ridicule the client's experience; check it is received as freeing, not invalidating.

D4. Present-moment contact and self-as-context

Purpose / when: when attention is dominated by past or future, or when the client is fused with self-descriptions [source: ACBS; Törneke et al. 2008].
Steps: brief mindfulness exercises noticing sounds, breath or sensations with description rather than judgement; experiential exercises that help the client notice the perspective from which experiences are observed, the I located here and now, as distinct from the thoughts and feelings themselves [source: ACBS; Törneke et al. 2008].
Example language (illustrative): "Notice the thought. Now notice who is noticing it."
Watch for: exercises that evoke dissociation in trauma survivors; keep eyes-open options and grounding available [synthesis].

D5. Values clarification (building augmentals)

Purpose / when: to give the client chosen consequences that can motivate approach behaviour and support more accurate long-term tracking [source: Törneke et al. 2008; ACBS].
Steps: explore directions in life domains such as family, work, friendship, health, spirituality; distinguish values (ongoing qualities of action, never completed) from goals; check whether a stated value is driven by "should" or others' expectations (pliance) [source: ACBS].
Example language (illustrative): "If no one would ever know, what would you want your life to be about here?"
Watch for: values that are really rules for approval; values the therapist prefers [source: Martell 2018 (client values may differ from the therapist's)].

D6. Committed action

Purpose / when: to build patterns of values-linked behaviour using standard behaviour-change methods (exposure, skills training, goal setting) [source: ACBS].
Steps: set short, medium and long-term goals linked to a value; schedule specific actions; address obstacles with acceptance and defusion; review and adjust [source: ACBS].
Example language (illustrative): "What is one action this week that would move you towards being the parent you want to be, with the anxiety coming along?"
Watch for: goals set too large; commitment as a promise to you rather than to the value.

D7. Undermining pliance and building tracking

Purpose / when: when generalised pliance (or counter-pliance) is blocking contact with direct consequences [source: Törneke et al. 2008, analysis]. The steps are my derivation [synthesis].
Steps [synthesis]:
1. Avoid giving rules the client can follow just to please you; ask questions that direct attention to consequences.
2. Set small behavioural experiments and ask the client to notice what actually happened, not whether they did it right.
3. Reinforce accurate reports of consequences, including when the client's experiment failed or contradicted you.
4. In session, notice compliant agreement as a possible CRB1 and evoke disagreement or a personal preference as a CRB2 (B2, B3).
Example language (illustrative): "Forget what I think. What did you notice happened when you did it?"
Watch for: doing all this to please you, which is still pliance; track whether behaviour changes with consequences over time.

E1. DEEP assessment and feedback session (IBCT)

Purpose / when: couples work; assessment begins with a joint session followed by individual sessions, leading to a formulation and a feedback session [source: TPC review of Christensen et al. 2020].
Steps: assess Differences between partners, Emotional sensitivities, External stressors and the Pattern of communication; present this formulation in a feedback session and describe the planned intervention [source: TPC review]. Session numbers for the assessment were not confirmed [uncertain].
Example language (illustrative): "You two differ in how much closeness you need, and each of you is sensitive to something that the other's way of coping touches."
Watch for: one partner using the individual session to recruit you; keep the formulation non-blaming.

E2. Empathic joining (IBCT acceptance)

Purpose / when: to build compassion between partners around their recurring conflict [source: TPC review].
Steps: shift each partner from analysing the other's actions to describing their own reactions; reflect and summarise the softer, less visible emotions under the harder ones [source: TPC review].
Example language (illustrative): "Under the anger, it sounds like there was something more like fear that you did not matter to her."
Watch for: the other partner's response; reinforce any softening immediately (B3 logic).

E3. Unified detachment (IBCT acceptance)

Purpose / when: to reduce negative affect by discussing a salient incident non-judgementally, as a shared pattern "out there" [source: TPC review].
Steps: pick a recent incident; describe the sequence step by step as a joint pattern rather than either partner's fault; give the pattern a neutral name the couple can use [synthesis on naming].
Example language (illustrative): "Let's look at Tuesday as if we were watching it on film. What happened first?"
Watch for: sliding back into blame; slow down and return to description.

E4. Tolerance building and change interventions (IBCT)

Purpose / when: tolerance building aims to reduce the impact of behaviour that is unlikely to change; change interventions are dyadic behavioural activation (behaviour exchange), communication training and problem-solving training [source: TPC review]. The source names these without detailing steps; follow the IBCT manual [uncertain].
Watch for: introducing change skills before acceptance work has reduced the hostility that would block them [synthesis].

F1. Ongoing evaluation and phase-change logic

Purpose / when: throughout, to test the formulation [source: Kanter et al. 2006].
Steps: keep a stable baseline of diary data where possible; introduce one main change at a time; compare target levels before and after; if no change, re-run A1 and check delivery (for example, were you actually responding contingently?) [source: Kanter et al. 2006 used A/A+B designs]. The decision rules are my synthesis [synthesis].
Watch for: demand effects on self-report; triangulate with in-session CRB change [source: Kanter et al. 2006].

F2. Maintenance and relapse prevention

Purpose / when: final phase [source: Martell 2018].
Steps: review the client's functional patterns and what worked; identify likely triggers; have the client plan their own activation and responses (self-planning); review goals; offer booster sessions where available [source: Martell 2018]. Ask the client to state their patterns functionally (CRB3) as evidence of readiness [synthesis].
Example language (illustrative): "If this started creeping back in six months, what would be the first sign, and what would you do?"

5. Handling problems

The sources say little about troubleshooting. Each entry is marked by where the guidance comes from. In CBA the general rule is to treat any difficulty as behaviour with a function: analyse it (A1) before responding [synthesis, consistent with BACB fact sheet].

Stuck client (targets not moving). Check delivery first: are you actually responding contingently, or mostly talking about outside life? In single-case work, change appeared only in phases that included contingent reinforcement [source: Kanter et al. 2017]. Then re-run A1: the formulation may have the wrong function (for example, activity scheduled for pleasure when the problem is escape). Check motivating operations (sleep, pain, substance use) that weaken reinforcers [source: Virués-Ortega & Froján-Parga 2014]. Check whether a rule is overriding consequences (A5) [source: Törneke et al. 2008]. If still stuck, change one variable at a time and track [synthesis].
"Resistance". Do not treat it as a trait. Common functions: avoiding an aversive topic, counter-pliance (doing the opposite of what is asked as a way of following others' control), or a CRB1 of the relationship class you are treating [source: Törneke et al. 2008 for counter-pliance; Kanter et al. 2006 for avoidance paralleling outside avoidance]. Responses: name the pattern gently and ask about it; reduce directives and use questions about consequences (D7); reinforce any direct expression of disagreement as a possible CRB2 [synthesis].
Overwhelm during evocation, blocking or acceptance work. Requests must fit the client's current repertoire [source: Tsai et al. 2013]. Step back to a smaller request; ground the client in the present (D4); reinforce the step they did manage; afterwards ask what was too much and agree a signal they can use to slow you down [synthesis]. With trauma histories, keep exercises brief and eyes-open and check for dissociation [synthesis].
Non-adherence (diary cards, homework, scheduled activities). Analyse the specific episode of not doing it: antecedent, what happened instead, consequence. Typical findings and responses [synthesis, using Martell 2018 for small, specific, barrier-planned tasks and Kanter et al. 2006 for teaching accurate reporting]: task too big (shrink it); task done for you rather than chosen (link it to the client's own value, or let the client design it); punishment at review (respond to partial or failed attempts with interest, not disappointment); avoidance of the material on the card (treat as a CRB and work on it in session). Complete the card together in session if needed.
Ruptures in the relationship. In CBA a rupture is often the target class appearing with you. Responses: notice your own reactions and check whether they match how others react to the client [source: Tsai et al. 2013]; describe the moment and its effect on you without blame; invite the client to say what they need from you, and reinforce that request (B3, B4); acknowledge your part. If evocation or blocking was too aversive, say so and slow down [source: Paidéia 2017 found blocking increased CRB1; Kanter et al. 2006 reported a client who dropped out after the therapist pointed out disclosure avoidance, and speculated this was aversive]. The repair itself is a chance to reinforce new relating [synthesis].
Dropout risk early in FAP work. The published case of dropout suggests that pointing out parallels between avoidance with the therapist and outside avoidance can be aversive early on [source: Kanter et al. 2006]. Build a relationship with a high rate of reinforcement before blocking or interpreting, and keep explicit consent for in-room work (B1) [synthesis].
Therapist's own avoidance (modality-specific). FAP asks therapists to examine what they avoid with clients and in their own lives, and to use supervision or recordings to check their effects [source: Tsai et al. 2013; Virués Ortega et al. 2003]. Signs include steering away from in-room material, over-disclosing, or reinforcing CRB1s because they are comfortable for you (for example, flattering compliance) [synthesis].
Self-disclosure and boundaries (modality-specific). Disclosure must be strategic and judged by its effect on CRBs; the source states the approach is not a licence for unlimited disclosure [source: Tsai et al. 2013]. Never disclose to meet your own needs; avoid any physical or out-of-therapy relationship content; discuss borderline cases in supervision [synthesis].
Your reactions are idiosyncratic, not representative. If others in the client's life would not react as you do, your reaction is not a valid CRB marker [source: Tsai et al. 2013]. Check by asking the client, and in supervision [source: Tsai et al. 2013].
Compliant "good client" behaviour (modality-specific). Rapid improvement in self-report may be shaped by demand rather than real change [source: Kanter et al. 2006 noted this risk]. Look for consistency between self-report, in-session behaviour and specific episodes; reinforce honest reports of no change (D7) [synthesis].
Couples: one partner disengaged or recruiting the therapist. Return to the DEEP formulation and to unified detachment, describing the pattern as shared [source: TPC review for the interventions]; the application to this problem is my synthesis [synthesis].
Risk: suicidal ideation or self-harm. Not addressed in the opened CBA sources [uncertain]. Use current standard practice: ask directly about thoughts, intent, plans, preparatory behaviour and history; assess protective factors; make a collaborative safety plan; do lethal-means counselling (agree safe storage or removal of means with the client and, with consent, family); increase contact or refer to crisis services as indicated [synthesis]. Within CBA, include self-harm in the functional analysis (often escape from intolerable private events or access to care), but do not delay safety steps for analysis; and avoid arranging contingencies that withdraw care after self-harm [synthesis].
When CBA is not the right frame. If problems neither occur in the session nor can be evoked there, FAP is less suited; it fits best when problems occur or can be evoked in session, the therapist can discriminate CRBs and can model the target behaviour [source: Virués Ortega et al. 2003, citing Hayes, Kohlenberg and Melancon]. Use out-of-session contingency methods (C-interventions) or refer [synthesis].

Sources

Sources:

Clinical behavior analysis (Wikipedia)
BACB fact sheet: Clinical Behavior Analysis
Kohlenberg, Tsai & Dougher (1993) The dimensions of clinical behavior analysis, PMC record and abstract (full text not drawn on)
Kohlenberg & Tsai (1994) Improving cognitive therapy for depression with FAP, PMC record and abstract
Dougher (Ed.) (2000) Clinical Behavior Analysis, ACBS record
Tsai, Callaghan & Kohlenberg (2013) Awareness, courage, therapeutic love and behavioral interpretation in FAP
Kanter et al. (2017) A comprehensive review of research on FAP
Kanter et al. (2006) Contingent reinforcement in outpatient psychotherapy for depression: two FAP cases
FAP Rating Scale blocking study (Paidéia, 2017)
Virués Ortega, Descalzo Quero & Venceslá Martínez (2003) Aspectos funcionales de la psicoterapia analítico funcional
Virués-Ortega & Froján-Parga (2014) A translational approach to the functional analysis of language in psychotherapy
Virués-Ortega & Haynes (2005) Functional analysis in behavior therapy, repository record (abstract only)
Functional analysis (psychology) (Wikipedia)
Törneke, Luciano & Valdivia Salas (2008) Rule-governed behavior and psychological problems
ACBS: The six core processes of ACT
[Martell (2018) Getting the essentials in place: a structured BA protocol, ACBS workshop slides](https://contextualscience.org/files/50. Getting the Essentials in Place Using a Structured BA Protocol to Gain Proficiency.pdf)
Guilford: Behavioral Activation for Depression, 2nd ed.
The Professional Counselor review of Christensen, Doss & Jacobson, IBCT 2nd ed.
Ramnerö & Törneke, The ABCs of Human Behavior: table of contents and ACBS record