Changing thoughts, feelings and urges · • Beck Depression Inventory (BDI; Beck & Steer ,1993) administered at nine specific points in study (every major phase change). – 21 questions

Changing thoughts,Changing thoughts,feelings and urgesfeelings and urges

Abigail B. Abigail B. CalkinCalkin, Ph.D. , Ph.D. Private Practice & ConsultingPrivate Practice & Consulting

Gustavus, AlaskaGustavus, Alaskawww.abigailbcalkin.comwww.abigailbcalkin.com

Emma F. Emma F. CobaneCobane, Ph.D., Ph.D.TreeHouse SchoolTreeHouse SchoolLondon, EnglandLondon, England

http://www.abigailbcalkin.com/

"Observations of the objective world "Observations of the objective world depend on an experience which is just depend on an experience which is just as private as the soas private as the so--called subjective called subjective experiences. The public status of an experiences. The public status of an observation is given by symbolic observation is given by symbolic communication between observerscommunication between observers……through the medium of language. By through the medium of language. By means of the same communication, means of the same communication, our inner or subjective experiences can our inner or subjective experiences can likewise achieve a public status."likewise achieve a public status."

John Eccles, 1970John Eccles, 1970Facing RealityFacing Reality

"For surely it is time that the effect "For surely it is time that the effect of discouragement upon the mind of of discouragement upon the mind of the artist should be measured, as I the artist should be measured, as I have seen a dairy company measure have seen a dairy company measure the effect of ordinary milk and Grade the effect of ordinary milk and Grade A milk upon the body of a rat."A milk upon the body of a rat."

Virginia Woolf, 1929Virginia Woolf, 1929A Room of One's OwnA Room of One's Own

““ManMan’’s capable of understandings capable of understanding……how ether vibrates and whathow ether vibrates and what’’s s going on in the sungoing on in the sun——but how any but how any other man can blow his nose other man can blow his nose differently from him, that hedifferently from him, that he’’s s incapable of understanding.incapable of understanding.””

Turgenev, 1862Turgenev, 1862

Fathers and SonsFathers and Sons

““Until you can express what you Until you can express what you are talking about in numbers and are talking about in numbers and can measure it, your knowledge is can measure it, your knowledge is meager and unsatisfactory.meager and unsatisfactory.””

Lord Kelvin (1824Lord Kelvin (1824--1907)1907)ScientistScientist

University of GlasgowUniversity of Glasgow

Respondent BehaviorRespondent BehaviorThe actual respondent behavior is typically The actual respondent behavior is typically

executed by glands that behave automatically in executed by glands that behave automatically in response to environmental stimuli by excreting response to environmental stimuli by excreting

chemicals into the bloodstream. The systemic afterchemicals into the bloodstream. The systemic after--effect of that chemical infusion is then detected in effect of that chemical infusion is then detected in the form of feelingsthe form of feelings——mostly aversive in the case of mostly aversive in the case of bereavement. Apart from being felt, such changes bereavement. Apart from being felt, such changes to the body result in differences in the capacity of to the body result in differences in the capacity of the body to execute certain operant behaviorsthe body to execute certain operant behaviors……..

Technically, the personTechnically, the person’’s operant behavior is being s operant behavior is being executed by a body that is temporarily changed by executed by a body that is temporarily changed by

the chemical afterthe chemical after--effects of the respondent effects of the respondent behavior that was executed by one or more glands.behavior that was executed by one or more glands.

Lawrence Fraley, 2001, p. 143Lawrence Fraley, 2001, p. 143

Inner Behaviour DefinedInner Behaviour Defined

•• Covert behaviors triggered by certain stimuli Covert behaviors triggered by certain stimuli accessible to the individual aloneaccessible to the individual alone

•• Stimuli Stimuli –– private in the sense that they are not private in the sense that they are not available to others, occurring within the individualavailable to others, occurring within the individual

•• Responses to these stimuli may themselves be public Responses to these stimuli may themselves be public or privateor private

•• Two classes of private stimuli that can trigger inner Two classes of private stimuli that can trigger inner behaviour (Moore, 1995):behaviour (Moore, 1995):-- internal sensations (e.g., hunger, pain)internal sensations (e.g., hunger, pain)-- covert behaviour covert behaviour (e.g., problem(e.g., problem--solving, imagery, solving, imagery, thinking, urges, attitudes, visualizations)thinking, urges, attitudes, visualizations)

•• Contact with such private phenomena constitutes a Contact with such private phenomena constitutes a ‘‘private eventprivate event’’

DefinitionsDefinitions

Thought Thought -- an ideaan idea

Feeling Feeling -- an idea with a mild an idea with a mild physiological componentphysiological component

Urge Urge -- a a mandmand

Depression Depression -- a decrease in the a decrease in the frequency of behaviorfrequency of behavior

““A small part of the universe is contained within A small part of the universe is contained within the skin of each of us. . . . No very good account the skin of each of us. . . . No very good account is available, however, and it therefore seems all is available, however, and it therefore seems all the more important that we should be in touch the more important that we should be in touch with it in other ways. We feel it and in some with it in other ways. We feel it and in some

sense observe it, and it would seem foolish to sense observe it, and it would seem foolish to neglect this source of information just because no neglect this source of information just because no more than one person can make contact with one more than one person can make contact with one

inner world. Nevertheless, our behaviour in inner world. Nevertheless, our behaviour in making that contact needs to be examined.making that contact needs to be examined.””

Skinner, 1974, p. 21Skinner, 1974, p. 21

Radical behaviourism & innersRadical behaviourism & inners

•• BehaviorBehavior -- all observable human actionall observable human action, not all , not all publicly observable human actionpublicly observable human action

•• ““[Radical [Radical behaviorismbehaviorism] does not insist upon truth ] does not insist upon truth by agreement and can therefore consider events by agreement and can therefore consider events taking place in the private world within the skin. taking place in the private world within the skin. It does not call these events unobservable, It does not call these events unobservable, and it does not dismiss them as subjectiveand it does not dismiss them as subjective””(Skinner, 1974, p. 16)(Skinner, 1974, p. 16)

•• Private and public Private and public behaviorsbehaviors operate in the same operate in the same manner and, as such, are subject to the same laws.manner and, as such, are subject to the same laws.

Importance ofImportance ofinner behaviour researchinner behaviour research

Inner behaviours are equally important in:Inner behaviours are equally important in:

–– developing our understanding of learningdeveloping our understanding of learning

–– a more comprehensive science of a more comprehensive science of behaviour, a science behaviour, a science ““more advanced in more advanced in its understanding of and ability to its understanding of and ability to influence human behaviourinfluence human behaviour””..

(Anderson, Hawkins, Freeman & Scotti, 2000, p. 9)(Anderson, Hawkins, Freeman & Scotti, 2000, p. 9)

Inner Inner behaviorbehavior researchresearch

•• Positive and negative thoughts Positive and negative thoughts and feelingsand feelings

•• Aggressive thoughts and feelingsAggressive thoughts and feelings

•• Substance abuseSubstance abuse

•• Bereavement behavioursBereavement behaviours

Positive and negativePositive and negativeinners researchinners research

•• Behavioural selfBehavioural self--management using Precision management using Precision TeachingTeaching--directed behavioural techniquesdirected behavioural techniques

•• Increasing our awareness of positive and Increasing our awareness of positive and negative thoughts and feelings, thereby negative thoughts and feelings, thereby promoting general mental wellpromoting general mental well--beingbeing

Frequency VariabilityFrequency Variability

COCO COUNTERCOUNTER INDEPENDENTINDEPENDENT

Academic (1999)Academic (1999)

BD (n = 1035)BD (n = 1035) 313 (30%)313 (30%) 476 (46%) 476 (46%) 246 (24%)246 (24%)

Regular Ed Regular Ed (1883)(1883)

644 (34%)644 (34%) 654 (35%)654 (35%) 585 (31%)585 (31%)

Learning CenterLearning Center(172)(172)

54 (31.3%)54 (31.3%) 59 (34.3%)59 (34.3%) 59 (34.3%)59 (34.3%)

Behavior (1999)Behavior (1999)

BD (168)BD (168) 54 (32%)54 (32%) 73 (44%)73 (44%) 41 (24%)41 (24%)

Inner Behavior Inner Behavior (1992) (1992)

1343 (38,5%)1343 (38,5%) 1118 (32%)1118 (32%) 1025 (29.5%)1025 (29.5%)

‘‘KathyKathy’’ss’’ inner inner behaviorbehavior chartscharts

Aims of selfAims of self--management exercise:management exercise:

•• Establish selfEstablish self--management of positive and management of positive and negative inners using Precision Teachingnegative inners using Precision Teaching--directed directed behavioural strategiesbehavioural strategies

•• Examine and evaluate techniquesExamine and evaluate techniques’’ effectiveness effectiveness in terms of frequency of positive and negative in terms of frequency of positive and negative inners recorded (increase positive inners & inners recorded (increase positive inners & reduce negative inners)reduce negative inners)

•• Prevent depressive symptomsPrevent depressive symptoms

Definition of target Definition of target behavioursbehaviours

Reported positive and negative inner behaviours, Reported positive and negative inner behaviours, namely thoughts and feelingsnamely thoughts and feelings

Positive thoughtsPositive thoughts = positive self= positive self--observed ideas not observed ideas not accompanied by a physical sensation as to suggest accompanied by a physical sensation as to suggest individualindividual’’s own conviction in thoughts own conviction in thought

Positive feelingsPositive feelings = pleasant emotional states, often = pleasant emotional states, often accompanied by a physical sensation related to feelingaccompanied by a physical sensation related to feeling

Negative thoughts and feelingsNegative thoughts and feelings = inverse of the above= inverse of the above

Exploring inner behaviour Exploring inner behaviour amongst older people amongst older people

using precision teaching using precision teaching and basic tenets of applied and basic tenets of applied

behaviour analysisbehaviour analysis

Volunteer & procedure detailsVolunteer & procedure details

•• 5 adults (two male and three female) aged 52 5 adults (two male and three female) aged 52 -- 78 years78 years

–– SH & JR SH & JR -- residential homeresidential home

–– DC & MM DC & MM -- sheltered accommodationsheltered accommodation

–– MK MK -- independently in the communityindependently in the community•• Beck Depression Inventory Beck Depression Inventory (BDI; Beck & Steer ,1993)(BDI; Beck & Steer ,1993) administered at administered at

nine specific points in study (every major phase change).nine specific points in study (every major phase change).–– 21 questions consisting of 4 statements rated 021 questions consisting of 4 statements rated 0--3. Scores aggregated, 3. Scores aggregated,

giving BDI score. When compared with the cutgiving BDI score. When compared with the cut--off scores, depression off scores, depression severity is determined, the guidelines for which are as follows:severity is determined, the guidelines for which are as follows:

•• 00--99 = minimal depression= minimal depression•• 1010--1616 = mild depression= mild depression•• 1717--2929 = moderate depression= moderate depression•• 3030--6363 = severe depression= severe depression

BDI: Question examplesBDI: Question examples

00 I do not feel sad.I do not feel sad.11 I feel sad.I feel sad.22 I am sad all the time and I canI am sad all the time and I can’’t snap out of it.t snap out of it.33 I am so sad or unhappy that I canI am so sad or unhappy that I can’’t stand it.t stand it.

00 I am not particularly discouraged about the future.I am not particularly discouraged about the future.11 I feel discouraged about the future.I feel discouraged about the future.22 I feel I have nothing to look forward to.I feel I have nothing to look forward to.33 I feel that the future is hopeless and that things cannot improvI feel that the future is hopeless and that things cannot improve.e.

00 I do not feel like a failure.I do not feel like a failure.11 I feel I have failed more than the average person.I feel I have failed more than the average person.22 As I look back on my life, all I can see is a lot of failures.As I look back on my life, all I can see is a lot of failures.33 I feel I am a complete failure as a person.I feel I am a complete failure as a person.

00 I get as much satisfaction out of things as I used to.I get as much satisfaction out of things as I used to.11 I donI don’’t enjoy things the way I used to.t enjoy things the way I used to.22 I donI don’’t get real satisfaction out of anything anymore.t get real satisfaction out of anything anymore.33 I am dissatisfied or bored with everything.I am dissatisfied or bored with everything.

Condition A4

Baselineconditions

Condition A1

Baseline measurement of positive and negative inners each day (16 hrs)

Condition B1

Intervention – Counting periods of positive inners

SAFMEDS worksheets

Condition A2

Baselineconditions

Condition A3

Baselineconditions

Condition B2A – JR & SHIntervention reintroduced with token economy and extrinsic reinforcers to meet aims set

Condition B2B – DC, MM & MKIntervention reintroduced

with setting of small aims to meet aims set

Condition A5

Baselineconditions

Experiment 2.1: Experiment 2.1: ProcedureProcedure

See/say SAFMEDS worksheet

6/9

6/2

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Successive Calendar Days (by weeks)

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Behaver: JRTarget: Positive & negative inners

A1 A2B1 A3

13 17 23 9

156 day break before A4

(see Chart ?.?)

KEY: = Positive inners x = Negative inners = Daily 1-minute timings Bold Nos. = BDI scores


3/9

3/2

2/23

2/9

03/1

6/03

02/1

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0

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Behaver: JRTarget: Positive & negative inners

A4 B2

25 19 15 23 18

A5


See/say SAFMEDS worksheetSee/silent read SAFMEDS worksheet

6/9

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Behaver: SHTarget: Positive & negative inners

A1 A2

B1

14 25


10/2

7

10/2

0

10/1

3

9/29

11/0

3/02

10/0

6/02

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4/02

7/21

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1/02

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7/28

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9/15

9/22

6"

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0 7 14 21 28 35 42 49 56 63 70 77 84 91 98 105 112 119 126 133 140


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A3

10 21 18

A4


See/silent read SAFMEDS worksheet

3/16

3/9

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2/16

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3/03

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3/02

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0

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B2

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4

A1 B1 A2 A3

4 5 3


4/20

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18

A1 B1 A2 A3

12 14 7

See/say SAFMEDS worksheet See/silent read SAFMEDS worksheet

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A5


Chart findings . . .Chart findings . . .

•• Aim setting most effective in increasing the frequency of recordAim setting most effective in increasing the frequency of recorded ed positive inners during both 1positive inners during both 1--minute counting periods and minute counting periods and throughout the day whilst reducing the reporting of negative innthroughout the day whilst reducing the reporting of negative inners ers (supporting literature to date).(supporting literature to date).

•• Use of token economy systems and provision of extrinsic Use of token economy systems and provision of extrinsic reinforcement for meeting aims produced greater accelerations inreinforcement for meeting aims produced greater accelerations inthe reporting of positive inners during the day for two of the fthe reporting of positive inners during the day for two of the five ive participants, perhaps suggesting need for some individuals, participants, perhaps suggesting need for some individuals, particularly those receiving antiparticularly those receiving anti--depressive medication and whose depressive medication and whose opportunities for social interaction and reinforcement are limitopportunities for social interaction and reinforcement are limited, to ed, to receive extra reinforcement in achieving aim and receive extra reinforcement in achieving aim and behaviorbehavior retention.retention.

•• Such extrinsic reinforcement should only be resorted to as a lasSuch extrinsic reinforcement should only be resorted to as a last t resort in the pursuit of inner behaviour change and retention resort in the pursuit of inner behaviour change and retention ((LindsleyLindsley, 1972)., 1972).

Assessing the effects of Assessing the effects of improving inner improving inner behaviours onbehaviours on

‘‘depresseddepressed’’ observable observable behavioursbehaviours

AimsAims

•• Address issues concerning the relation between covert and Address issues concerning the relation between covert and overt responding.overt responding.

•• Extend knowledge regarding link between private and Extend knowledge regarding link between private and public behaviour.public behaviour.

•• Assess the effect of increasing the reported frequency of Assess the effect of increasing the reported frequency of inner behaviours using the 1inner behaviours using the 1--minute timing of positive minute timing of positive affirmation SAFMEDS upon affirmation SAFMEDS upon ‘‘depresseddepressed’’ publicly observable publicly observable behaviours (i.e., visible behaviours no longer occurring at a behaviours (i.e., visible behaviours no longer occurring at a high rate).high rate).

•• 11--minute timing of positive affirmations was an assessment minute timing of positive affirmations was an assessment of the effect of verbal reporting on the frequency and of the effect of verbal reporting on the frequency and fluency of both private and public behaviours.fluency of both private and public behaviours.

Reducing bereavementReducing bereavement--related behaviours related behaviours

through the through the selfself--management of management of

inner behavioursinner behaviours

Bereavement definedBereavement defined

•• The deprivation created by bereavement The deprivation created by bereavement leads to leads to ““the multiplicity of interrelated the multiplicity of interrelated private and public behaviours that are private and public behaviours that are observed following the death of a loved observed following the death of a loved oneone”” ((DillenburgerDillenburger & Keenan, 2001)& Keenan, 2001)

•• Of these reactions to death, many of which Of these reactions to death, many of which increase in frequency (i.e., crying, talking increase in frequency (i.e., crying, talking and thinking about the dead person, anger, and thinking about the dead person, anger, worrying about the future), depression is worrying about the future), depression is distinct since it results in both an increase distinct since it results in both an increase and decrease of normal functioning.and decrease of normal functioning.

Observable effects of Observable effects of bereavementbereavement--related depressionrelated depression

•• Many observable behaviours normally in bereaved Many observable behaviours normally in bereaved persons repertoire also become persons repertoire also become ‘‘depresseddepressed’’..

•• Interests previously engaged in on a regular basis Interests previously engaged in on a regular basis no longer take precedence and sometimes no longer take precedence and sometimes disappear completely (disappear completely (CalkinCalkin, 1990)., 1990).

•• In severe cases, symptoms can include disruption In severe cases, symptoms can include disruption of eating and sleeping patterns, decreased of eating and sleeping patterns, decreased energy, change in weight, difficulty concentrating, energy, change in weight, difficulty concentrating, and suicidal thoughts (APA, 1994)and suicidal thoughts (APA, 1994)

BehavioralBehavioral definitionsdefinitionsof depressionof depression

•• FersterFerster (1973) (1973) -- the reduced frequency of the reduced frequency of adjustiveadjustive behaviorbehavior, high frequency of escape , high frequency of escape and avoidance, and passive activity.and avoidance, and passive activity.

•• Hayes, Hayes, StrosahlStrosahl and Wilson (1999) and Wilson (1999) ––‘‘destructive normalitydestructive normality’’, highlighting the fact , highlighting the fact that such feelings are and should be that such feelings are and should be accepted as the norm in our society.accepted as the norm in our society.

•• When these When these behaviorsbehaviors begin to impact begin to impact adversely upon normal everyday functioning adversely upon normal everyday functioning appropriate interventions are usually sought.appropriate interventions are usually sought.

Interventions availableInterventions available

•• MedicationMedication•• Psychological interventionsPsychological interventions

–– CounsellingCounselling–– PsychotherapyPsychotherapy–– CognitiveCognitive--behaviorbehavior therapytherapy

•• Guerin (2001) highlights research Guerin (2001) highlights research suggesting that the cathartic nature of suggesting that the cathartic nature of many therapies may actually prove more many therapies may actually prove more damaging than healingdamaging than healing(Bracken, 2001; Bracken, (Bracken, 2001; Bracken, GillerGiller & Summerfield, 1995, 1997; & Summerfield, 1995, 1997;

Raphael & Wilson, 2000; Summerfield, 1999; Watters, 2001).Raphael & Wilson, 2000; Summerfield, 1999; Watters, 2001).

BehaviorBehavior analysis & analysis & bereavementbereavement

•• Relatively little Relatively little behavioralbehavioral research research related to bereavement and its related to bereavement and its treatment of related depression treatment of related depression ((CalkinCalkin, 1990, , 1990, DillenburgerDillenburger & Keenan, 1994, 2001; & Keenan, 1994, 2001; SulzerSulzer--AzaroffAzaroff, 1999; European Journal of , 1999; European Journal of BehaviorBehavior Analysis Analysis –– Special Special Section: Bereavement and Grief, 2001).Section: Bereavement and Grief, 2001).

•• Proactive research needed to address Proactive research needed to address this knowledge gap this knowledge gap ((DillenburgerDillenburger & Keenan, 2001)& Keenan, 2001)

Why the dearth ofWhy the dearth ofbehavioural research?behavioural research?

•• Investigating private Investigating private behaviorbehavior often seen as often seen as a distinct challenge.a distinct challenge.

•• Skinner (1957) Skinner (1957) ““the investigator cannot the investigator cannot readily point to the stimuli to which he must readily point to the stimuli to which he must appeal in predicting and controlling appeal in predicting and controlling behaviourbehaviour”” (p. 130).(p. 130).

•• However, people are capable of recording However, people are capable of recording their own their own behaviorsbehaviors, both overt and covert. , both overt and covert. The growth of the inner The growth of the inner behaviorbehavior literature literature is testament to this.is testament to this.

The role ofThe role ofPrecision TeachingPrecision Teaching

•• SelfSelf--monitoring and the utilisation of precision monitoring and the utilisation of precision teaching based technologies has been teaching based technologies has been demonstrated as a viable way forward.demonstrated as a viable way forward.

•• Promotion of selfPromotion of self--management of behaviour management of behaviour using empowering, clientusing empowering, client--centred approaches.centred approaches.

•• European Journal of European Journal of BehaviorBehavior Analysis (2001) Analysis (2001) --more scientific research, particularly that which more scientific research, particularly that which focuses upon the use of 1focuses upon the use of 1--minute timings of minute timings of positive thoughts and feelings positive thoughts and feelings ((DillenburgerDillenburger & Keenan, 2001).& Keenan, 2001).

Definition ofDefinition oftarget behaviourstarget behaviours

1.1. Reported positive and negative inner Reported positive and negative inner behaviours, namely thoughts and feelingsbehaviours, namely thoughts and feelings

2.2. ‘‘DepressedDepressed’’ observable behaviour observable behaviour ––number of words written per day number of words written per day (PhD thesis)(PhD thesis)

Measurement & ProcedureMeasurement & Procedure

•• Reported frequency of positive and negative Reported frequency of positive and negative thoughts and feelings throughout waking hoursthoughts and feelings throughout waking hours–– Free/Tally learning channel using wrist counterFree/Tally learning channel using wrist counter–– 11--minute counting periods minute counting periods –– See/Say SAFMEDS w/sSee/Say SAFMEDS w/s

•• Number of words written per dayNumber of words written per day•• Beck Depression Inventory (BDI) completed Beck Depression Inventory (BDI) completed

throughout investigationthroughout investigation•• Daily Intensity Scale Daily Intensity Scale –– 1 = 1 = ‘‘awfulawful’’ and and

10 = 10 = ‘‘excellentexcellent’’•• All data presented on Standard All data presented on Standard CelerationCeleration ChartChart•• ABAB Single subject designABAB Single subject design

The way forward . . .The way forward . . .

““Charting may be one of the few sensitive Charting may be one of the few sensitive techniques that we have to keep track of . . . techniques that we have to keep track of . . . inner thoughts, feelings, and urges. It could inner thoughts, feelings, and urges. It could be that precision teaching will ultimately be that precision teaching will ultimately provide man with the most good and the provide man with the most good and the most help by being applied to his inner most help by being applied to his inner behaviour. It is one of the few ways to chart behaviour. It is one of the few ways to chart and change inner behaviours.and change inner behaviours.””

LindsleyLindsley, 1971, pp. 117, 1971, pp. 117--118118

Documents

Changing thoughts, feelings and urges · • Beck Depression Inventory (BDI; Beck & Steer ,1993) administered at nine specific points in study (every major phase change). – 21 questions