Psychotherapy’s Taxonomy Problem

Advances in Measurement, Citable Commentary, Clinical Behavior Analysis, Clinical Behavior Analysis: In Practice, Contextual Behavioral Science, The Future of Psychology

Psychotherapy’s Taxonomy Problem

Why We Keep Arguing About Mythical Animals Instead of Studying Behavior

Imagine walking into a county fair where the grand prize is about to be awarded for Best Animal. One contestant is an elephant with zebra legs, butterfly wings, peacock feathers, and octopus tentacles. The next is a giraffe with the body of a bear, tiger paws, and the tail of a fish.The judges are having an intense argument.

Which creature is more authentic? Which one has the better anatomy? Which one deserves the blue ribbon for Effective Treatment?

No one stops to ask a more fundamental question.

When did we stop studying animals and start arguing about mythical ones?

Sometimes I wonder whether psychotherapy has wandered into the same county fair.

Every generation of researchers tries to build a better way of understanding human suffering. That’s exactly what science should do. New theories propose new mechanisms. New measures. New therapeutic languages. New ways of organizing behavior.

Over time, though, something subtle happens.

We stop treating those theories as useful maps and begin treating them as though they were different species inhabiting nature.

ACT becomes one animal.

CBT becomes another.

Psychodynamic therapy, DBT, Process-Based Therapy, Unified Protocols—they each develop their own anatomy, their own vocabulary, and their own criteria for what healthy functioning looks like.

Then the debates begin.

One of the most common arguments is that comparing therapies like ACT and CBT is like comparing apples and oranges.

I think we’ve accepted the wrong conclusion.

Apples and oranges are remarkably easy to compare.

We compare them by properties they both possess: acidity, water content, sugar, fiber, weight, shelf life.

What we don’t do is ask whether the orange became a better apple.

Yet that’s surprisingly close to how psychotherapy research often operates.

Each theory develops its own mechanisms.

Its own process measures.

Its own language.

Its own explanations.

Then we ask whether each therapy became a better version of itself.

The more our theories evolve, the stranger the animals become.

New mechanisms are added.

Old concepts are borrowed.

Measures are refined.

Constructs multiply.

Eventually we’re no longer comparing elephants and giraffes.

We’re comparing beautifully assembled mythical creatures built from decades of accumulated assumptions.

Then we race them.

We hand out blue ribbons.

And we argue endlessly about which mythical animal won.

I don’t think this is because psychotherapy research is failing.

I think it’s because our theories have become more sophisticated than the way we measure them.

Karl Popper reminded scientists that observations are never interpreted in isolation. Every scientific test rests on a network of assumptions connecting theory to observation. The challenge is not pretending those assumptions don’t exist; it’s remembering that they’re there.

Perhaps psychotherapy has become so successful at building increasingly sophisticated theories that we’ve started mistaking the theories for the thing they were created to explain.

The thing we were trying to understand was never ACT.

Or CBT.

Or any other named therapy.

It was human behavior.

Maybe the next step in psychotherapy isn’t inventing another mythical animal.

Maybe it’s learning how to measure the behavioral dimensions that all of them have in common.

Because mature sciences don’t advance by becoming more loyal to their taxonomies.

They advance by discovering ways to build knowledge across them.

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.

What is ‘clinically relevant behavior’: Sign or sample

Advances in Measurement, Citable Commentary, Clinical Behavior Analysis, Clinical Behavior Analysis: In Practice, Contextual Behavioral Science

By, Angela Coreil, PhD, LP, BCBA

As discussed by Ollendick et al. (2004), abnormal and clinically-relevant behavior can be viewed as either a “sample” or as a “sign.” To what extent does this difference, in turn, make a difference in the assumed temporal and situational consistency of such behavior?

Whether you view abnormal and clinically-relevant behavior as a “sample” or a “sign” makes a significant difference in whether you consider such behavior to be consistent over time and in various situations. If a behavior is seen as only a “sample” of a person’s behavior then there is no expectation that this behavior will be consistent over time or in different situations. When behavior is only said to be only a “sample” the implication is that you expect variation in the behavior. If the behavior is thought of as a “sign”, however, the implication is that the behavior is only an indication of an underlying trait or pathology which implies that the behavior should be more constant through time and situations. From this view as long as the underlying pathology, trait, etc. is present then behavioral “signs” of the underlying construct should also be present. In the relation to psychological problems this “sign” conceptualization, however, is most often a circular or reifying argument. A “sign” behavior indicates a “disorder” when a “disorder” only indicates a collection of symptoms. This conceptualization provides no particular “cause” for the behavior other than itself. This conceptualization is an artifact of using the methods of physicians to understand physical disease to understand human behavior.

The understanding of behavior as a “sample” vs a “sign” also impacts how problem behavior is conceptualized and in turn how assessment is conducted. If the behavior is only a “sample” of a person’s behavior at a certain time in a certain situation than an assessment of the person’s behavior in other situations is likely to be important. If the behavior is a “sign” then assessment over one time period in one situation is more acceptable because the behavior is assumed to be stable as long the “disorder” is constant. Assessment of “sample” behavior may also involve a less predetermined route than assessment of “sign” behavior. As behavior seen as a “sample” implies that there may be a wide variety of other problem behaviors that may exist with the target behavior. Thus, assessment may include any route of questioning, observing etc. that helps the clinician learn about all problem behavior and any possible relationships between the environment and problem behaviors. Because the behavior is expected to vary by situation, factors related to the situation may more likely be considered part of the conceptualization of the problem and should be assessed. If behavior is conceptualized as an “sign”, however, the behavior is related to internal factors and assessment is more likely to focus on assessing for other problem behaviors that are understood to cluster to indicate the underlying pathology. Assessment of environmental/situational factors is also less important if the behavior is understood to indicate pathology as the person’s behavior should continue to indicate the pathology across situations. In other words, assessment from a “sample” behavior perspective is more likely to be all-inclusive in assessing what other behaviors are present and what factors may be causing the problem behavior. Assessment from behavior as a “sign” perspective is more likely to be limiting in the sense that the clinician begins by looking specifically for behaviors that indicate a disorder and is more likely to ignore situational factors in the behavior and understand the “disorder” indicated the cause of the problem behavior.

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.

A Beginner’s Guide to Clinical Behavior Analysis (CBA) and Related Treatments (ACT, DBT, FAP)

Clinical Behavior Analysis, Clinical Behavior Analysis: In Practice, Contextual Behavioral Science

A Beginner’s Guide to Clinical Behavior Analysis
If you’re interested in studying how to treat ‘mental health’ issues, as a behavior analyst, Clinical Behavior Analysis (CBA) is the pathway you should be looking into.

Clinical Behavior Analysis (CBA) is not a new area for behavior analysis, in fact, behavior analysts treating “mental health” issues pre-dates the refocusing of the field to the treatment of Autism. Clinical Behavior Analysis involves using learning principles to help people who often identify as having “mental health” challenges change their behavior and improve their functioning.

What is Clinical Behavior Analysis?
Clinical Behavior Analysis (CBA) is at the intersection of behavior analysis and psychology. It is the application of behavioral principles to changing behaviors previously considered to fit in within the are of ‘mental health’. Clinical Behavior Analysis focuses on changing behavior through functional analysis and reinforcement of more adaptive behaviors. CBA requires evaluating the impact of multiple levels of contingencies on the client and determining which level(s) of contingencies to intervene on to create the most impact in changing the client’s behavior. Changing the client’s behavior – also tends to change the client’s experience. Application of behavioral principles to ‘mental health’ has existed since Skinner’s time; however, much of CBA fell out of popularity during the Cognitive Revolution within psychology. Now, with ‘psychology’ in a replication crisis born of the constructs and methods that allowed for rapid growth and division from behavior analysis – CBA is rising again in popularity.

History of Clinical Behavior Analysis
Clinical behavior analysis was developed during a time of rapid growth and change in scientific psychology. With a strong interest in data-driven treatment, John B. Watson and other early behaviorists began researching methods that could be scientifically verified. They turned away from early clinical work with mental health issues—and techniques that couldn’t be measured or observed—and toward controlled experiments. They laid down a foundation for understanding how different operant and classical conditioning might be used to treat behaviors considered “mental illness.”

During the Cognitive Revolution, Clinical Behavior Analysis as a clear arm of behavior analysis fell out of focus; however, treatments based on behavior analytic principles grew within realms of “psychotherapy” traditions. These treatments are now often confused as themselves being CBA. Examples of these treatments that fall into this category include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Functional Analytic Psychotherapy (FAP). To be clear – ACT, DBT, and Functional Analytic Psychotherapy may be performed in ways that are CBA – but they are not by default CBA. It is entirely possible to do ‘canned ACT’ or to otherwise do what people recognize as one of these treatments without using functional analysis to guide treatment. In those cases, these treatments are not CBA.

Acceptance and Commitment Therapy as Clinical Behavior Analysis
Acceptance and Commitment Therapy (ACT) has become very popular with behavior analysts, particularly as Relational Frame Theory (RFT) and as a clinical behavior analysis recently. There is much current debate over whether “ACT” is clinical behavior analysis. This debate is well warranted as ACT though grown out of Relational Frame Theory and explicitly behavior analytic principles diverged to compete with cognitive-behavioral treatment packages. This necessarily led to a language that would fit training a multitude of clinicians (mid-level terms) and result in higher inter-rater reliability in Randomized Controlled Trials (RCTs) against Cognitive Behavioral Therapy (CBT). Most would say “ACT” accomplished its goals here and now is recognized as a treatment efficacious for the treatment of a wide variety of “psychological” problems right alongside its former chief competitor, Beckian CBT. Now – the issue becomes that most of the existing training on ACT follows the patterns set during this period. These trainings are meant for psychotherapists, use imprecise mid-level terms that tend to confuse behavior analysts, and do not well prepare behavior analysts for utilizing ACT in ways consistent with behavior analytic scope and practice.

Functional Analytic Psychotherapy as Clinical Behavior Analysis
Functional Analytic Psychotherapy has its foundation behavior analytic principles as a way of improving in-session behavioral repertoires. The clinician then seeks to generalize these in-session improvements to the client’s outside-of-session life. In recent years, this treatment has also begun to go the way that ACT did to become better recognized as an effective psychological treatment. This has included, again, developing standardized terminology and even beginning to focus on a more specific set of clinical problems. This again – is well suited for the treatment becoming a competitor in “psychotherapy” according to standards of Randomized Controlled Trials (RCTs) but does not bode well for the training of behavior analysts in this treatment according to their scope and capabilities.

Dialectical Behavior Therapy as Clinical Behavior Analysis
Dialectical behavior therapy (DBT) is a form of therapy developed by Marsha Linehan, Ph.D., that emphasizes chain analysis, fading, and reinforcement of less dangerous behaviors in its population of interest. This approach has been shown effective in treating people who suffer from intense suicidal urges or self-harming behaviors like cutting or drug addiction. Despite how DBT has held to its roots somewhat more effectively than it would seem ACT and Functional Analytic Psychotherapy have – it is also in this writer’s opinion likely the most out-of-scope for behavior analysts simply due to the typical target applications of the overall treatment package. There are many places where topography can be picked up under supervision for behavior analysts and treatment methods may be taught consistent with behavioral principles and behavior analysts’ scope of practice. DBT applied to “borderline personality disorder” is well appreciated for its difficulty and danger in application. True “DBT” is performed with a team of clinicians, with a great deal of support, and is not for behavior analysts beginning to develop skills in Clinical Behavior Analysis.

Clinical Behavior Analysis as Clinical Behavior Analysis
It’s because of the incompatibilities in how some of these treatments are now taught that I prefer to refer to Clinical Behavior Analysis as “Clinical Behavior Analysis.” If we are clear in labeling it differently, it will be easier for behavior analysts wanting training in ACT or other treatment techniques to find clinicians able to train them in ways consistent with their scope and behavioral principles. This does not again mean that one cannot learn the techniques used in “ACT” but that one will likely be learning them without the use of mid-level terms and with more precise and clear linking to behavior principles.

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.

Finding Clinical Behavior Analysis: Part I

Clinical Behavior Analysis, Clinical Behavior Analysis: In Practice, Contextual Behavioral Science

by Angela Coreil, PhD

In my recent invited talk at CalABA on Clinical Behavior Analysis as a way of unifying the behavioral sciences, I alluded to a series of painful learning experiences that brought me to Clinical Behavior Analysis.

My training path has been long and winding – all with the intention of finding ways to improve clinical treatment. You see, I grew up with a close family member experiencing a great deal of impairment, emotional pain, and later addiction. I was present for years of this family member seeking treatment and even as a child seeing failures in the systems meant to help her. I watched her go through the revolving door of inpatient units, which became like brief vacations to her. I watched as therapists seemed helpless to soothe her pain. And, I watched as she was prescribed pill after pill to ease her pain. I was at an early age effectively an involuntary ‘mental health’ crisis worker.

This led to a passion for understanding human behavior and a desire to find better ways to address human suffering. I believed that I could best influence treatment by becoming a process and outcomes researcher and set upon a long path to become this. I spent a number of years gaining experience on process and outcomes studies at a number of major research institutions in Houston, Texas where I lived. Then I happened upon on a job as a Research Coordinator for a project called “Opportunity Houston.” This was a large grant focused on treating dual diagnosis (mental health + addiction) homeless individuals. The study focused in some respects on enriching the environments of those experiencing addiction by providing housing and work, contingent on improving maintenance of sobriety. I later learned this was a study in part of Kelly Wilson’s design, an ACT founder. At the time, I would not have known who he was but the William “Dub” Norwood was my advisor there and he was an early ACT devotee.

It was through him that I began to be exposed to ACT and then entered the University of Houston – Clear Lake for my master’s in Clinical Psychology. Following this, I started my doctorate in Clinical Psychology under Rob Zettle, Steve Hayes’ first student who played a strong role in developing ACT back when it was called “Comprehensive Distancing.” Throughout my master’s I found myself drawn to ACT, in its stance that human suffering was a natural part of the human experience and often an extension of otherwise adaptive behavior. In my early exposures to Beckian Cognitive Behavior Therapy, I was often presented with a list of ‘cognitive distortions’ and told that treatment would in part be helping clients recognize their ‘cognitive distortions.’ At the time, I found this conceptualization offensive and insensitive. I could not imagine myself telling other humans experiencing pain that their painful thoughts were ‘distortions’ of reality.

I would say that the way that clinical psychology training is currently structured – learning deeply the key elements of treatment is not an easy experience. We are typically taught behavioral principles but soon after we begin to divide off into camps to learn the particular language ways of our chosen orientations. I broke from this tradition repeatedly because beyond my allegiance to “ACT” was the guiding rule that my mission was to find ways to understand and improve treatment as a process researcher. I became more fluid in ACT treatment and began to depart from “canned ACT” in the early years of my doctorate. I had early experiences of clients with Obsessive-Compulsive Disorder” finding ways to “compulse” (momentarily avoid or reduce their anxiety) with the very ACT exercises I provided them. One client taught mindfulness, returned the next week to tell me how effective mindfulness had been in reducing their anxiety. I asked what had occurred and the client recounted engaging in mindfulness ‘instead of’ compulsions each time they became anxious.

I went back to Rob and told him what had occurred and in his monotone way of beating a dead horse for my benefit he said ‘Yes, of course.’ And, then followed it with the ‘Hole in the Field’ metaphor to illustrate how I’d simply given the client a new shovel. Now, I would need to again – get them to drop their new improved ‘shovel.’ This was all in the context of learning Exposure and Response Prevention (ERP) also known within the behavior analytic community still as desensitization.

It was working in OCD and specializing in a particular technique that was widely endorsed across theoretical orientations as the ‘gold standard’ (i.e., ERP) for treating anxiety and related disorders that allowed me, I believe, to be able to track more about the differences in models as a I learned. After learning this technique well embedded in ACT, I sought out an Advanced Assistantship with the closest highly regarded research and treatment specialty center in Kansas. My clinical supervisor was widely regarded as a highly-skilled Beckian Cognitive Behavioral Therapy clinician and researcher. My initial learning experiences here were somewhat disorienting; however, as I went in with experience and skill validated by ACT experts. Fairly quickly into my training at this center, it became clear that ACT was not particularly favored by my supervisor and to treat clients under her supervision using similar language was quick to elicit punishment.

I remember writing back to my lab at that time and questioning whether I was actually proficient in ERP and ACT. The response I received was telling – but for years I did not fully understand the impact of what I was told in the full context of my academic experience. Rob told me that my ACT and ERP was fine and that I would simply have to ‘learn their language.’ He mentioned that as Steve Hayes’ first student he was also sent to work under the competing theoretical model for his internship year – under Aaron Beck. Though he never disclosed much about this experience directly it often seemed apparent that his internship year had probably not been easy on him.

I’d like to say that I won this particular CBT expert over; in fact, I learned the language and got out as soon as possible. I seemed to be fighting a battle far bigger than myself with zero footing as a new mother of a 4-month old just pre-internship. From here, I moved onto working at Rogers Memorial Hospital under Brad Reimann and running the day-to-day clinical management of an adult Intensive Outpatient Program for OCD in Oconomowoc, Wisconsin. By that time, I had mastered the CBT language and found myself commended and promoted for my treatment skill.

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.

Notes from CalABA 2022: A field ready for change.

Clinical Behavior Analysis, Contextual Behavioral Science, The Future of Psychology

by Angela Coreil, PhD

Fields Ready for Change: Notes from CalABA 2022

As I sit here today, recalling my experience of CalABA and the responses to talks, including but not limited to my own talk on unifying the sciences, it is clear that change is both needed and wanted. We find ourselves in a world where COVID has altered how we operate in our lives and in our world. We have found ourselves in the ‘Great Resignation’ of people leaving their positions and rethinking their priorities out of necessity.

I too have been on this journey. Long before 2020, I found myself embedded in a system of seemingly unworkable contingencies. This led to several years of inventing and reinventing myself and my career – and finally to freedom from the system that had held me down for a decade. It is from this perspective and with this experience that I find myself advocating for the field to be better, not because I am the right person to do so, but because I built myself a system that allows me to speak up more freely than most.

At CalABA 2022, I was able to speak at my first in-person conference since freeing myself from academia. I found myself re-invigorated by the presence, energy, and curiosity of those who attended my talk: Clinical Behavior Analysis: Unifying the Behavioral Sciences. It was inspiring to see how many people were already thinking about how to find a common language between behavior analysis and psychology and how many people were working in positions where they both needed and wanted more guidance on how to navigate the intersection between our fields.

There were a number of patterns that were evident in the responses of attendees. First, many were unaware that Clinical Behavior Analysis has existed since the 1950s. Second, the pervading thought was that additional degrees would help broach this gap – yet, those with multiple degrees broaching both fields still had the same questions. “Which hat am I operating under?”, “How do I know if I am still in scope?”, “Where does ‘ACT’ begin and end in relation to RFT and to the clinical situation I find myself in on a daily basis?” Many were struggling with how to speak to colleagues and stakeholders about the areas where our fields meet and divide. And, as I presented regarding the bubble forming as more behavior analysts enter the field and nearly all enter the Autism treatment area – there was recognition of how this affects the perception of behavior analysis, drives the narrowing of treatment programs, and ultimately will leave behavior analysts vulnerable to changes that are not under their control (e.g., changes in the DSM, etc).

Sign up for our mailing list or check out our continuing education if you’d like to learn more about clinical behavior analysis or rule-governed behavior!

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.

Measurement: Why we get no R.E.S.P.E.C.T.

Advances in Measurement, Citable Commentary, Clinical Behavior Analysis, Contextual Behavioral Science

Original post by Angela Coreil (JULY 2, 2016)“MEASUREMENT: WHY WE GET NO R.E.S.P.E.C.T.”
Editor’s Note (2026): This article was originally published on AngelaCathey.com in 2016. It is reproduced here with only minor grammatical edits for readability. Some resources and terminology have evolved since its original publication, but the conceptual discussion is presented largely as it appeared at that time.

Psychologists, therapists, and researchers in mental health:

How many times have you been at a party and told someone you’re a psychologist only to hear, “So, you can read my mind?”… or, “Can you analyze my dreams for me?”

Why does this happen?

The public has no idea what we do. At best, we’re often perceived as paid friends or mistaken for psychiatrists.

And, maybe we can live with this but it isn’t just the public.

The National Institute of Mental Health (NIMH) is a major funder of our research… or it used to be. The recent move towards Research Domain Criteria Initiative (RDoC) for NIH funding means that obtaining a grant for an RCT from the NIH requires that you heavily integrate investigation of possible biological factors in your study to obtain funding. This has occurred despite the fact that most of the field (psychology) agrees that biological components aren’t driving contributors in most maladaptive behavior. In fact, years of searching for specific biological profiles for diagnoses has turned up little useful information. Still we’re on the search for the right blood test, fMRI, EEG, or otherwise, that will diagnose people, why?

Because – it makes what we do ‘real’ for them.

So, what are the consequences of this search for ‘real’… thing-y-ness in mental health?

If you’re a clinician, not seeking research funding, you may not immediately contact what this means for you. So, here’s my take: If you’re using Beckian-CBT or even ACT, you’re probably fine. We’ve already got loads of RCTs to show these ‘work’. This means you can probably count on insurance companies giving you less of a hassle for treatment reimbursement.

If, by chance, you are using anything else that has had few RCTs you might have problems eventually. If we can’t get said treatment determined an ‘Empirically Supported Treatment’ through the current standard of massive and repeated RCTs. (Eh hem.. FAP. One of the most behavior analytic in-the-moment treatments struggles with RCTs because they are based on our most effective tool (functional analysis). Functional analysis is ideographic and doesn’t easily conform to RCT methodology. This is part of the reason for the build out of the ACL model… a need to standardize functional analysis. )

Well, I’m sorry but if we have to alter a treatment that is driven by a tool we all respect then our overall measurement/methodology strategy sucks. In fact, psychoanalysts were saying this about RCTs from the beginning but when we were in a foot race with them it was a little hard to hear the truth in it.

So, what I’m getting at here is several levels of pervasive problems related to our field… but thankfully, they’re related.

Some of you may not like what I say here. I fully expect to get a few angry emails (Save it, prove me wrong with data.).

So, here’s my analysis of what’s causing these problems:

In a word: Measurement!

In a few words: Reifying rigidity! Constructs! and lack of integration!

Okay, so I’m probably at a level of geekery here that few will understand. So, this is what I’m talking about.

Too many of our measures of process and outcomes are based on pure constructs.
Measurement and methods issues abound.
- See (Nature: Over half of psychology studies fail reproducibility test)
- And then, comically enough, a failure to reproduce on the failure to reproduce. (Nature: Psychology’s reproducibility problem is exaggerated say psychologists)
And, as a whole, we seem to be so used to understanding methodology and measurement in certain ways that we continue to attempt to refine the methods that aren’t working, even when refining them makes the problems worse. (See: The Chronicle of Higher Education: The flaw at the heart of psychological research )

So, why am I picking on constructs?

We all use constructs. We have to so we can get through the day. Clinicians can’t walk around explaining to each other from the ground-up what “psychological flexibility”, “response flexibility”, “borderline”, “depression”, or anything means. That’s impractical but we do need to continually contact the effect of this on our methods and the perception of the world. Then we need to choose our level of analysis appropriately.

If we assess only at the level of constructs without awareness of the consequences then we’re essentially shooting ourselves in the foot.

We’ve measured mostly in constructs because measuring real behavior was HARD. We know that behavior and report of behavior vary by context (e.g., mood state bias, retrospective report bias, rule-governed behavior, and the list goes on…) so we’ve tried to standardize the heck out of measures. We’ve measured mid-level concepts that attempt to represent whole clusters of supposedly important relationships. Then, because the public wouldn’t understand this… we have to integrate symptom inventories to give it some ‘realness’. It’s a chain reaction.

When we measure constructs we need them to hold still and mean something so we apply psychometric rules that assume thing-y-ness and stability to these airy clouds of invention. Then we make it ‘real’ with symptom inventories that use diagnostic labels that the public gets, but which we know have poor as hell diagnostic reliability (not surprising since they are essentially Chinese menu style creations. Congrats! pick 5 out of 7 and ooo. la. la. you’re depressed.)

Before you get ‘depressed’ reading this let’s take a ‘beginner’s mind’ to assessment (as Todd Kashdan suggests) and look at how we can fix these problems.

Let’s build from the ground up.

Let’s understand our assumptions and what works. Let’s start by measuring behavior, in context, across contexts.

Contextual Behavioral Science has been moving towards this for years. Some of our brightest minds in theory, philosophy of science, treatment, and methodology have been telling us to go there for years (e.g., Roger Vilardaga, Kelly Koerner, Todd Kashdan, Kelly Wilson, and many others.)

For the interested, here are a few citations:

Wilson, Hayes, Gregg, & Zettle (2001). Psychopathology and Psychotherapy (Chapter in Big Purple).

Wilson (2001). Some notes on constructs: Types and validation from a contextual behavioral perspective

Hughes, Barnes-Holmes, & Vahey (2012). Holding onto our functional roots while exploring new intellectual islands: A voyage through implicit cognition research ***The Relational Elaboration Coherence model and RFT based assessment***

Vilardaga, Bricker, & McDonell (2014). The promise of mobile technologies and single case study designs for the study of individuals in their natural environments.

Iwata, DeLeon, & Roscoe (2013) The FAST. Functional Analysis Screening Tool

Hurl, Wrightman, Hayes, & Virues-Ortega (2016). Does a pre-intervention functional assessment increase intervention effectiveness? A meta-analysis of within-subject interrupted time-series studies. (**Spoiler alert: Yes, it does.**)

Since you probably didn’t click on any of those:

We have better methods now. We can use technology to assess behavior (across contexts), to intervene, and to rapidly and cheaply assess behavior. Take a moment: Look at your iPhone… That thing ‘knows’ more about you than your best friend or your spouse.

So, why aren’t we using these methods? Well, I hear you. Most of us weren’t taught to create Apps in grad school, to deal with data flow that exceeds the capability of SPSS, or to understand the intersection between technology and confidentiality. For most of us, even though we let Target (who lost tons of credit card numbers. yikes!), Apple, Best Buy, Netflix, and many others track our every move we’re not utilizing this technology well in the behavioral sciences.

Essentially: Who has time to learn entire new areas of science (App design, UX, Data Science, Python, R, etc.) in order to have better and cheaper assessment?

It’s not that people aren’t trying. I certainly heard a lot of interest in Ecological Momentary Assessment (EMA), Ecological Momentary Intervention (EMI), Relational Frame Theory, and links from basic to applied at the CBS conference this year but these things aren’t exactly user- friendly straight out the ‘box.’

Notably: There have been some valiant efforts to create systems of assessment and data tracking that ‘work’ for clinicians and researchers.

See:

Learn2ACT an integrated system of Acceptance and Commitment Therapy (ACT) driven mobile client-client centered data collection and intervention. It tracks and logs data for multiple clients and displays it for clinicians. Big props to Ellen & Bart for taking this on from programming to testing. Release of this product is currently scheduled for some time in Fall (so show them some love and for doing all this work for us)!

Other systems in development include Matrix (ACT-driven) Apps out of Mike Levin and Beniji Schoendorff’s groups. Roger Vilardarga and Jonathan Bricker and others also have out Apps that are a bit more target specific (e.g., ACT driven for psychosis, smoking cessation, etc.) – (Forward me links to anything else that is evidence-based or getting that way and I’ll consider listing them too.)

The process of gaining an evidence base for this technology (Mental Health Smart Phone Apps: Review and evidence-based recommendations for the future development), while mastering all this tech, and paying attention to user experience (UX) AND getting people aware of these technologies is a difficult one. So, as a community I think we need to support efforts to develop technologies that make it easier for clinicians and researchers to use functional contextual behavioral assessment.

I’m working on an integrated functional analysis driven assessment platform and I need your feedback.

My concept is a bit different but also includes EMA/EMI, as this is our best CBS consistent context sensitive assessment effort thus far.

Stay with me here:

I propose that we also go from basic research and theory and build a system that integrates what we know to the best of our ability. One that is functional analysis driven, contextually-sensitive, rapid, and user-friendly. Then we make this available such that we can funnel meta data (read de-identified behavioral data on relations) to basic and applied researchers from clinicians. After all, those RCTs aren’t even touching how to treat complicated multi-problem clients.

Such a system would involve:

Contextualized behavioral assessment (EMA/EMI and passive assessment of biometrics. Hey, we’re not going to bowl the NIH and RDOC over all at once.)
Assessment of verbal/symbolic related behavior (aka… integrating what we know from RFT into understanding contextualized functional analysis driven assessment.

Note: You won’t have to go read Big Purple to use this system. We’re planning to present relations in pretty visual analytics that even clients can make sense of. We’d like to make explaining relationships (between verbal behavior and verbal behavior or verbal behavior and EMA/EMI passive behavioral data ) functional. Wouldn’t it be nice if you could such demonstrate your outcomes in forms that show you make ‘real’ change in the lives of your clients?

See previous post on RFT: Relational Frame Theory (RFT)- What’s the big deal? And, Hayes & Berens (2004) Why Relational Frame Theory alters the relationship between basic and applied behavioral psychology for why RFT is important to this. If, your mind just squealed… “but relating and frames are just constructs!” See future post on empirical logic and the difference between reifying constructs and properties.

Essentially, we need to add in RFT because we know that verbal/symbolic relations can more powerfully influence behavior in the moment than the actual contingencies. Additionally, integrating RFT allows us to step back and forth from behavior, to intervention, to level of appropriate measurement across diagnoses and therapy orientation – so maximum flexibility and applicability.

I understand that many of you may be thinking at the point… so, are we talking assessing the content of language? Word counts?

Well, no and yes… we do look at the verbal content but we can look at functional relations indicated between verbal relating and verbal relating, or between this and other behavioral measures. I’ll save that for another post.

For now, here’s some ground work within CBS that supports the use of attempting to assess verbal/symbolic relating through language:

Atkins & Styles (2016). Measuring self and rules in what people say: Exploring whether self-discrimination predicts long-term well-being (ACBS membership needed to view).

Collins, Chawla…Marlatt (2009). Language-based measures of mindfulness: Initial validity and utility

If you’re interested in learning more about clinical behavior analysis, RFT, and advanced measurement methods – let us know in the comments below! We also have some online, on-demand training events on a variety of topics that may interest you.

Angela Coreil, PhD, BCBA

Clinical Behavior Analyst, Methodologist & Trainer

Angela J. Coreil, PhD, is a professor at the University of Louisiana at Lafayette, clinical behavior analyst, and methodologist. Formerly director of an OCD and anxiety IOP/PHP, she integrates behavior analysis, ACT, Interpersonal Behavior Therapy, CBT, and exposure-based treatment. Her work develops practical improvements in behavioral science, and she provides consultation, professional training, workshops, and continuing education across disciplines.

Views expressed are those of Dr. Coreil or the explicitly named author, not the University of Louisiana at Lafayette.