What is ABA? An in-depth explanation

[Tristus]

I wanted to know my understanding of ABA was correct so I spoke with an associate of my husband who is a BCBA. I thought this was extremely enlightening and could be of some value here:

Good morning,

Sorry about the delay in response.

It is difficult to respond to your question as you didn't really discuss ABA as a therapy or the behavioral perspective very much. With regard to the meltdown/tantrum issue, neither is an ABA technical term. What you seem to be alluding to is that the FUNCTION of the person's response is tied to history, environment, and biological issues. I think that is fair although it is unclear to me what all the causal factors may or may not be (I do not have the data to make such a decisions; at the end I address "cause" and I hope that is of some use).

In general, you seem to be speaking as if you understand the function of his behavior in a very clear sense. Again, I have no data that would let me know if that is true or not. Regardless, I would suggest caution on using such a definitive tone unless you have a ton of data supporting your claims. For example, you said "The difference is you aren't doing it because you are spoiled but because you are stressed." Often it would be advisable to phrase such things like "Perhaps you were doing such things because that is how you have best learned to deal with these things in the past (instead of invoking spoiled). Perhaps it was due to being stressed due to being overloaded with sensory information. Perhaps it was something else or a combination of things. But the good thing is that we are trying to figure out how to work through these issues so you can be the kind of person you really want to be!" This avoids potential misattribution, empowers the client, and helps them become aware of the possible factors that may be involved in such events.

Correct me if I am wrong, but that part of the e-mail FEELS like you are "just" trying to make him feel better. That is understandable but the data on such actions shows it is more harmful than helpful. First, it can be seen as very invalidating to many. Second, it can cause the person to "explain away" the emotions (rather than process them fully). There are some nice ways to be validating ("wow you were really upset. What did that feel like to you" that allow contact with and process that "negative" emotion. Further, once they tell the story, you can say things like "So you felt overwhelmed because of all the noise and you responded in the way you knew how. That is understandable. It is so brave of you to discuss this. Now that I know exactly what you are going through, we can work on this together to find ways where you can react in a way that you find more useful in your life!" Again, as the context above is not clear, I am unsure if this applies. These are just some thoughts that jumped to mind while reading this.

Toward the end of the below, I include some points that address your "This is my point" comment. But before I get to that, I think it might be useful to discuss some key things that may delineate key concepts underlying ABA and broad psychological science.

The overarching ABA POV is in many ways, very simple yet has VERY broad ramifications. A narrow behavioral view focuses on ABA procedures (a.k.a. methodological behaviorism). People in this camp stress overt behavior for at least two reasons: the only thing we can measure easily in vivo is overt behavior and the only thing we can be relatively sure of when working with someone is what they do (including verbal behavior). It is a practical, but much less nuanced view of human functioning than radical behaviorism (more below). In essence, their work would look very similar to the work done by radical behaviorists (see below) but they are more "toolbox" therapists who are not very interested in "internal states". Such states are more or less "ignored" by these people because they are too difficult to attack from an empirical science POV. methodological behaviorists still rely in functional analyses (seeing how environment affects behavior and vice versa), and that is VERY important...it is the core of all behavior analysis. However, in my opinion, they are a bit too rigid at points. I would conjecture that most ABA therapists are trained closer to a methodological than radical POV. This has a huge plus (so few service providers exist and this method is much easier to teach...and these people do a LOT of good) and minus (they do not understand the broader underlying science and often are too arrogant/off-putting...thus hurting ABA public relations).

A second, broader view (my camp), is that everything is behavior: overt (moving hands, feet, mouth, etc.), cognition (thinking, images, sounds, etc. "in your mind"), and emotions (which, if you want to get really biological, are respondent behaviors). Further, these things are, hypothetically, amenable to empirical research from this POV. This is called Radical Behaviorism; radical means we approach everything as a behavior and that all overt and covert human experiences are governed by behavioral laws. This is the "real" split between radical behaviorists and pretty much everyone else (this is not correct, but it is pretty close).

Really, behaviorism is a split from Cartesian dualism (i.e., that there is a mind and a body). We threw out dualistic mind as there is no evidence that mind (as a concrete thing) exists. Further, even if it did, it may be impossible to work with it. Methodological behaviorists tend to not worry about "internal" issues radical behaviorists find interest in. Radical behaviorists acknowledge the importance of internal issues but do not give them a concrete container (mind) in which they live...they treat them as dynamic behaviors.

Some key things to mention here: Brain is not equivalent to mind for a radical behaviorist. Mind tends to be primarily conceptualized as a object where thoughts/emotions/etc. occur, like a container. This type of thinking subverts the key issue: what is one doing/thinking/feeling matters...that is our focus...not on some possibly mythical container. Focus on working with some mythical container, rather than the key content (what one does/thinks/feels) does not make sense to us...where is this container and how do you work with it?

If one REALLY wants to dig in to understanding psychology, it is key to understand philosophy of science. I find most people in psychology, behavior analysis, biology...pretty much every science...and pretty much all humans...are clueless on the nuance afforded by taking the time to understand philosophy of science. Things have depth...I care very much about that depth. I pasted an old study guide question on Descartes (i.e., Cartesian dualism) at the bottom. It is important history to know. Despite no evidence in the past 300 or so years, dualism is STILL pushed at a societal level which filters down to all sciences in a way that is imperceptible unless you REALLY look for it (BECAUSE it is woven into us by society at birth...it is taken as a given!).

Focus on what people do rather than the "mythical container" irritated many people. People began saying brain was mind...which is a tad odd. The brain is important, but every effort to understand brain as cause of behavior has failed. Now, to say that brain and behavior do not interact is patently silly. BUT what we have found is that environmental procedures can change fundamentally every key aspect in your biology: gene expression, epigenetics, brain chemistry...essentially everything (although not all at once and not necessarily in a comprehensive manner). Overall, we are given a genetic brain (which can be affected by literally an infinite amount of things in the world) and there has been little we can do about the genes that created it. BUT we can affect gene expression which changes protein production (and other things). This interaction (brain needed to behave...behaving changes environment...environment changes brain) is dynamic and complex. Below I discuss causation and that will be useful to understand this paragraph more fully.

Further, the exact tiology of essentially every "psychological disorder" is unclear. The biological aspects have very little support. The APA (who creates the book on mental disorders, the DSM) has said such for 99+% of the disorders (I made that number up, but it is VERY close). Thus, we MUST ask, "why approach working with people's brain in a direct manner when we know of environmental procedures that affect the brain and greatly enhance quality of life?" Again, this does not discount biological factors on behavior...but it does question ideas of cause (see below - kindergarten causation).

This does NOT mean that large differences in brain wiring/structural formation do not matter. Further, base genetic things COULD be the cause of many issues (Down's Syndrome is a good example of this). But the facts of the matter are that we do not know the WAY such things specifically affect behavior and how to attack those things outside of an environmental approach. Further, environmental effects at a point in history can and do affect the brain in ways that are either permanent (or hard-to-overcome) and can affect the way we "process" the world. Thus, it is key to remember that the stance of (radical) Behavior Analysis should incorporate such understandings. AND, it is key to remember that there is little we can do to "fix" such "problems" with the structure of the brain in a direct sort of fashion.

Drugs are the current attempt at this in many areas of psych and, time after time, they have been shown to be broadly more harmful than helpful. More and more data is/should be digging the grave for the current panoply of drug therapies (see Mad in America and The Anatomy of an Epidemic). At times drug therapy can be very useful (e.g., SSRIs are quite effective for those with SEVERE depression for a short period of time) but, en masse, study after study has shown that therapy is just as or more effective short term and has much longer lasting effects. Further, you do not get the massive and terrible side effects of many of these drugs, you do not have to take a drug forever, and you do not get the massive relapse you get when taken off of these drugs.

Now, how does this relate to ABA? The key from the above is that biological effects matter, we cannot currently attack them directly, and, even if we could, is it unclear if it is ethical to do so. Environment/ behavior interaction does affect biology and, even if it does not "cure" the problems, we do not really care. Many of my fellow ABA therapists are not interested in creating a certain "type" of person. I just want my clients to have accesses to choices. However, when dealing with many behavioral deficits, people are faced with living in a world they cannot easily navigate. How can these people make choices if they cannot navigate the complex world in which we live? My goal has always been to help people navigate the world to make choices that matter to them. To me, THAT is ABA; building repertoires to replace and augment a person's ability to have a life about which they care. ABA is the most effective therapy for this. Its key drawback is the expense (time and money).

Of course, I cannot claim to speak for every ABA therapist. In fact, I am a bit of an oddball (e.g., not a pure Autism expert, interested in ACT/RFT, etc.). And many people get training nowhere near to the depth I have received (I have attended 3 universities with world-leading behavior analysts and worked for another such university). I have seen narrow views that I believe are not beneficial for "public relations (i.e., methodological behaviorism). However, I think these people are still doing MUCH more harm than good. AND ABA is the only empirically validated treatment for Autism. I wish methodological behaviorists had the nuanced understanding of the radical behaviorism Skinner outlined. Skinner was very interested in covert behavior such as thoughts and emotions but, as a scientist, he realized that was REALLY hard content with which to work (see the Skinner 1945 on operationalizing terminology). Thus, Skinner did the "responsible" thing and conducted inductive, natural science like chemists and physicists (whereas, most every other area jumped the gun and tried to understand "mental" stuff in the fashion of dualists). I think of it like building a house. Skinner said, "Man, I better build a foundation" whereas others tried seemed to try and start by building a roof. Considering this happened so long ago, Skinner's approach seems freaking amazingly advanced. There is a reason he was the APA's most influential psychologist of the 20th century.

Quick note: There are many ABA people who are bad at explaining the behavior analytic POV. This is probably due to the fact that there are few training programs that provide excellent training in the nuances of ABA. Thus, if you are struggling with ABA issues, keep that in mind.

I cannot speak for my field, but the comment you made above has many interesting things in it that would be useful to address. You said "This is my point. Trying to gain new skills without alleviating the inside symptoms which the therapist or BRCA or whoever can’t see or personally experience may inadvertently add stigma to the patient while they are simultaneously improving their behaviors." This point of view places causation of behavior from the "inside out". It entails that thoughts and emotions cause behavior. This is NOT false...but it does not catch the nuance that ABA, ACT, and much of CBT addresses. The key thing is that thoughts, emotions, behavior, and environment (and history of all of these things) all interact in a VERY dynamic way. Here is an example.

In society, people say things like "She hit her sister because she was angry". AND if you chased it a bit, the little girl might admit she was angry. The question is, did the anger cause the strike? If you want to really chase this issue, ask the little girl why she was angry. You might then find that her sister stole her ball.

Now, what caused the strike: the stealing or the anger? This is a poor question as both would be involved. Saying ONE was the cause is simplistic.However, in society, emotion is given the priority. I often talk to my classes about "kindergarten logic" and this is an example of it. This is a complex interaction between environment, covert responses, and learning history. MANY factors matter.

ABA would focus on social skills and ways to deal with anger responses as those things we could SEE as important due to the interaction. Other therapies may focus on "anger issues" and never address skill training. The key here is that saying anger causes anything is only part of the story and, yet, THAT gets all the focus in many cases. It is simplistic and usually not a USEFUL stance. ABA is a functional approach.

Because of the above, a criticism leveled at ABA is that it does not address the "underlying core" of the issue. This has been shown to be false. One of the best clinical examples is Behavioral Activation for depression. People often say "once feel better, I can start doing more". Behv activation takes the opposite approach, "do more and you will feel better" (simplified). It is arguably the best depression therapy. The reason it works (probably...as we can probably never know for sure) is that thoughts, emotions, and behaviors ALL affect each other in complex ways. Therefore, leveraging the more observable behaviors is often easier AND results in emo/thought changes. The interaction of all of these important things is broadly missed because people are so fused to their thoughts and emotions. Thus, behavioral approach many seem cold but, to me, are actually the most CARING because they leverage science toward the betterment of behaviors, thoughts, and emotions. A good ABA therapist can make this clear (I have seen some REAL good ones). The bad ones say "CHANGE LIKE THIS CAUSE I AM AN EXPERT". This second type really hurts ABA.

Further, if you take out the "pure" behavioral parts of other therapies for depression, they usually do not work anywhere near as well. THAT said, some of those other therapies DO work; this again exemplifies that thought, emotion, behavior interact....change one and you can affect the others. The data supports behavioral change to push emo/thought change is the key thing to pull here.

Thus, the criticism leveled at ABA is often made out of ignorance of the data and philosophy of science. People will believe what they are told and ignore data. Kindergarten logic is much more palatable than the time and effort it takes to understand the nuance of how these things all work together.

In the above, there is no way to succinctly cover every piece of information needed to delineate all the important pieces that make up this puzzle...and they are not all known. It is commendable you are trying to search out how all these things interact. Further, many people in ABA may have too narrow of a view at times...they are people. Yet, ABA overall is very rich in that all of these issues are important to it.

Let me know how you react to this. It was hard to come at your original question due to the point I made at the outset, but I think this all relates in an important overarching sense

Cheers,

See below...

2. Descartes struggled to resolve his faith in the teachings of the church with his scientific convictions. What philosophical move did he make to resolve this conflict between vitalism and mechanism? What were the ramifications of that philosophical move for the development of psychology?

· Descartes was (supposedly) a Catholic who held many mechanistic beliefs

o Posited human body was a machine and behaves in mechanical ways much like animals

o Thought reflexive behavior was driven in a hydraulic fashion

o Like water gardens in St. Germain (France)

· But if true, where would the soul fit in

o Catholicism is a vitalist stance (soul as source of what we do)

o A mechanical stance would make him look as if he were denying the existence of a soul

o May make others see him as a heretic (and he may suffer persecution)

o So how could he juxtapose his mechanistic and vitalistic beliefs?

· To resolve the conflict, Descartes took a mentalistic stance regarding human behavior

o Proposed Humans, unlike other animals, possessed a rational soul: the cogito

§ Cogito = the thinking thing. The soul. Pure thought. Point-like and matter-less.

§ It resides in the body viewing the world as if on a screen: the Cartesian theater

· The cogito did not interact with the world directly

· It interacts via secondary sense properties

§ Argued the cogito received sensations and commanded the body to act (Mind and body affect each other)

§ Proposed that interaction occurs in the pineal gland

o Overall, the body is mechanistic AND controlled by the soul

o Thus avoided persecution by taking a mentalistic/dualistic stance

· Effects on development of psychology

o Descartes defined psychology as the study of consciousness

§ Descartes claimed this occurred in the IMMATERIAL cogito

§ Thus, this could only be studied using rational thinking

§ Method of choice = INTROSPECTION.

§ Thus he left psychology with

· The task of studying something (mind/cogito) that is no-thing (Immaterial)

· Introspection as a key method to study behavior

o Further, Descartes never answered how the point-like, matter-less cogito (which is essentially No-Thing/nothing) could affect the material world (something/Some-Things, in this case, the body)

§ Thus, psychology was left with the task of explaining this interaction as well

o It should be noted that some have posited he did not hold vitalistic beliefs and the whole system above was to avoid persecution: The interplay created here is interesting

§ Psych left with the problems (delineated above)

§ BUT the dualistic stance was probably responsible for scientists being able to do work in this area (i.e., science)

§ Thus he could be credited with finding a way for scientists to study behavior without being persecuted (as Le Mettrie was when he did away with the cogito in his writings)



*******. ********, MS, BCBA
********** ***********
Clinical Psychology Doctoral Student


On Sun, Mar 13, 2016 at 11:35 PM, ******** wrote:

*****,

********* suggested I get a few things straight about ABA as it pertains to Autism. My personal views aren’t correct and I realize that. As I’m coordinating with a local non-profit to start an adult social/support group for Autism I should take him up on getting information from someone that isn’t him.

I actually just gave some information to Joseph (a guy with Aspergers from a forum I just posted to) and talked over things with ******* who straightened me out on a few things. However ********* pointed out this isn’t his area of interest, and he wouldn't be the best person to speak on behalf of ABA. What I was thinking is you could look at this message I sent to Joseph and tell me what I got right, what I got wrong and elaborate on important points I should know. What is in bold is what I added after speaking with ********. I wanted to send the whole message as I've noticed a few things in reading up on ABA which don't directly have to do with ABA but often come up when talking about autism. Following is the original message to Joseph [from the "Autism sucks" thread] :

“Joseph, what you are describing is not a tantrum. It is a meltdown. The difference is you aren't doing it because you are spoiled but because you are stressed. You feel guilty afterwards and shame for having acted out. That is the key difference visible to others that you are having a meltdown (embarrassment and shame rather than defiance). You have sensory issues that others don't deal with. I like to tell people its like turning up the volume on the television all the way and then trying to talk to people as if you are the only one who can hear it.

You know why you are tired after going out? Well, anyone given enough stimuli will be equally exhausted. I don't know if you've ever been to Disney but people come back from there so tired and it isn’t just from walking. The whole park is set to stimulate all your senses (we actually have about 20, not 5). For you the whole world is set to Disney level stimulus. The lights hum, people sneeze, textures are painful, showers are like needles...there are so many issues you deal with that others don't. Most people can filter information but people with Autism have trouble doing that, unless you are hyper focusing (an autistic superpower). I watched a documentary last night where a Professor claimed 90% of all the inventions since the industrial age have been created by people on the spectrum because we have the ability to become experts on unique things which seems too good to be true but is pretty cool.

What I'm saying is that you aren't giving yourself enough credit. Anyone who is so overwhelmed by this constant stream of information is going to have a hard time fitting into social society. People do not give those on the spectrum enough credit for what they deal with. It's not just sensory issues but motor functioning, communication, working memory...the list goes on and on. Don't let anyone push you around and tell you that you aren't trying. I'm gonna make an unpopular confession here but my husband is a Psych. Major who's planning on going clinical with a focus on ABA to help veterans with PTSD [he informed me he actually has more of an interest in ACT]. This is our main point of contention. In his mind it's less important to focus on sensory issues because his job is to get people prepared to be accepted by society [Isaiah corrected me here. He talked about the behaviors being visible and since he can’t see the sensory issues ABA focuses on behaviors]. My point of view is that places extra guilt and pressure on someone on the spectrum to perform while also dealing with so much more than the average person. He counters that with the fact that life isn't fair and some people have to work harder and rather than go down the whole debate I'll just tell you this. You don't have to feel guilty for being born the way you were born. If you feel someone is pushing you in a way that makes you feel shame for being on the spectrum that person is wrong, not you (even your therapist). That doesn't mean they are a bad person, or that they don't care but that they are wrong as we are all apt to be about some things. It won't help you to be accepting of yourself if you focus on what you can't do or to think you aren't trying hard enough. The thing is everyone knows this. Parents know this, doctors know this, peers know it too. That is the very nature of a disability. You have every right to be angry and frustrated and depressed because you are dealing with a lot.

So far as I know Autism is one of the few disorders where it's acceptable to focus on your deficits and in my opinion that sucks [I think ****** was surprised I saw it that way He doesn’t see ABA as focusing on deficits so I asked him how ABA focuses on a person’s strengths and I’m not sure he answered so if you could clarify]. That's personally offensive to me, like bigotry level offensive. If it were up to me we'd focus a lot on Autism superpowers [yep, I get that self-harming behaviors need to stop and people need to be able to communicate with each other]. When I was diagnosed the first thing I was told was that it was okay because I could try harder and not be Autistic any more. What?! You can learn to pretend really well (for example, I'm currently in a gestalt therapy group to learn social skills because I’m awkward in person) but you still have all the neurological differences that make you Autistic or at least an outlier so far as how your brain is wired (more white matter, think of it as having a LOT of hard drive space but not enough RAM) [This is where ****** pointed out something very important. What if I had an fMRI and I don’t actually have more white matter? My response is this: Exactly! I was diagnosed without actually ever looking at my brain and now I associate myself as on the spectrum so I want a brain scan. First, I’m endlessly curious but more importantly it would be difficult to learn at a later date that I’m not on the spectrum. The thing ****** seemed to find curious is that I would be glad for a diagnosis. What he doesn’t seem to get is the level of guilt and shame comes with being on the spectrum and not knowing it. The diagnosis works to relieve a lot of that self-blame. Yes, it can also lead to leaning on the diagnosis as an excuse not to try as hard so I guess it’s a cost/benefit scenario. Frankly, it's a relief not to put so much pressure on myself to do better. Friday night we discussed a similar scenario for ADHD where a Yale professor suggested it’s impossible to do certain things without medication. My response to this was, “Yes! Vindicated!” ****** gave me a curious look, “You want to be told it’s impossible for you gain executive functioning?” Of course not. What I felt in that moment was immense relief that I hadn’t just been lazy or selfish all these years. That is as helpful as gaining new skills, if not more important to my mental wellbeing.]

I have a book suggestion. My husband has been learning about ACT and its very helpful. It's under the umbrella of ABA. I have a hard time reading books so I download them from Audible (not an intentional plug). There is a great book titled, "The Happiness Trap" but it's not on Audible so I downloaded a similar book called, "The Confidence Gap." Also, everyone who has a connection to Autism should read, "Neurotribes." That is on Audible too. We are part of this cool neurodiverse world and every day we are getting closer to being allowed to wave our freak flag high. Soon enough we won't have to worry about being fired or not hired because of our awkwardness. More and more people are understanding. How can they not be? Almost everyone knows someone Autistic.

I forgot to mention that you can learn to pretend but when you get stressed and overwhelmed that mask you are keeping up (which comes naturally to most everyone else) is going to come down. Think of it like being in a play but you are the only actor. If you have a trauma or a series of smaller problems that lead to overwhelming stress you are going to drop the act as anyone would. So with every meltdown you have it would be more logical to assess what thing or things are making you feel overwhelmed and minimize the damage by making your environment more inviting (dim the lights, wear soft clothes, keep the air comfortable et. cetera). If you are in a place where that isn't possible at least you have the comfort of knowing what is really going on so you don't feel so much shame or guilt. My main objective is less on how you perform in public and more on minimizing the negative emotions that are so common in ASD's.

People don't think about it but suicide is extremely common for Autism. I read a peer-reviewed article written a few years ago (Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study) for Aspergers which 35% of the hundreds studied had plans or had attempted suicide. I would be in that 35%, myself. I can only speculate its similar everywhere on the spectrum. So please please treat yourself well. In fact, I'm trying to take my own advice. I realized I was making plans with all the shit I was trying to hide in an effort to appear "normal." It's a lot to do and the better you are at it the more people assume it's easier rather than seeing all the effort it takes to spend time in public. [This is my point. Trying to gain new skills without alleviating the inside symptoms which the therapist or BRCA or whoever can’t see or personally experience may inadvertently add stigma to the patient while they are simultaneously improving their behaviors. ] I know my brother has been/is suicidal and he's still a teenager. My family refuses to keep firearms on the property for this reason. I can see my husband's point of view but I also don't think his view is helping to minimize the suicide rate that comes with trying so hard to mold yourself to society in order to be accepted. There is a reason 60% of Aspies are unemployed even though they are smart and capable. He thinks society won't change [or that it’s easier to mold the person to society rather than to change society] but I think it will (I'm an Anthropology Major - kinda comes with the territory, especially with my interest in Cultural Anthro). I want to teach Autism acceptance. There are many hurtles and I'm not sure of the correct path or the best answers but that is my lofty goal.


Aside from the corrections ****** made would this be a fair assessment of ABA?