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HAYNES 509 CONCEPTUAL FOUNDATIONS OF BEHAVIORAL ASSESSMENT 510 CURRENT STATUS AND APPLICATIONS OF BEHAVIORAL ASSESSMENT 512 GOALS AND APPLICATIONS OF BEHAVIORAL ASSESSMENT 513 Topographical Analysis: The Operationalization and Quantification of Target Behaviors and Contextual Variables 514 Identification of Functional Relationships and the Functional Analysis of Behavior 515 BEHAVIORAL ASSESSMENT METHODS: SAMPLING, DATA COLLECTION, AND DATA EVALUATION TECHNIQUES 517 Sampling 518 Assessment Methods 519 Methods Used to Identify Causal Functional Relationships 521 Methods Used to Estimate the Magnitude of Causal Functional Relationships 523 SUMMARYAND CONCLUSIONS 525 REFERENCES 526 Imagine the following: You are intensely worried. You cannot sleep well, you feel fatigued, and you have a near-constant hollow feeling in the pit of your stomach. At the moment, you are convinced that you have cancer because a cough has per- sisted for several days. You’ve been touching your chest, taking test breaths in order to determine whether there is some abnormality in your lungs. Although you would like to schedule an appointment with your physician, you’ve avoided making the call because you feel certain that either the news will be grim or he will dismiss your concerns as irrational. In an effort to combat your worries about the cancer, you’ve been repeatedly telling yourself that you’re probably fine, given your health habits and medical history. You also know that on many previous occasions, you developed intense worries about health, finances, and career that eventually turned out to be false alarms. This pattern of repeatedly developing intense and irrational fears is creating a new and disturbing feeling of depressed mood as you realize that you have been consumed by worry about one thing or another for much of your adult life. Furthermore, between the major episodes of worry, there are only fleeting moments of relief. At times, you wonder whether you will ever escape from the worry. Your friends have noticed a change in your behavior, and you have become increasingly withdrawn. Work performance is declining, and you are certain that you will be fired if you do not improve soon. You feel that you must act to seek professional help, and you have asked some close friends about therapists. No one has any strong recommendations, but you have learned of a few possible professionals. You scan the telephone book, eventually settle on a therapist, and after several rehearsals of what you will say, you pick up the phone. Now, consider the following: If you were to contact a cognitive-behaviorally oriented therapist, what assessment methods would be used to evaluate your condition? What model of behavior problems would be used to guide the focus of assessment, and how would this model differ from ones generated by nonbehavioral therapists? What methods would be used to assess your difficulties? What sort of information would be yielded by these methods? How would the therapist evaluate the information, and how valid would his or her conclusions be? How would the information be used? These and other important questions related to behavioral assessment are discussed in this chapter. Rather than empha- size applications of behavioral assessment to research questions and formal hypotheses testing, we concentrate on how behavioral assessment methods are operationalized and exe- cuted in typical clinical settings. The initial section of this chapter examines the conceptual foundations of behavioral assessment and how these foundations differ from other 510 Assessment of Psychopathology With Behavioral Approaches approaches to assessment. Then we present information about the extent to which behavioral assessment methods are being used by behavior therapists and in treatment-outcome studies. Specific procedures used in behavioral assessment are described next; here, our emphasis is on reviewing bene- fits and limitations of particular assessment strategies and data evaluation approaches. Finally, the ways in which assessment information can be organized and integrated into a comprehensive clinical model known as the functional analysis are presented. CONCEPTUAL FOUNDATIONS OF BEHAVIORALASSESSMENT Two fundamental assumptions underlie behavioral assessment and differentiate it from other theoretical approaches. One of these assumptions is environmental determinism. This assumption states that behavior is functional—it is emitted in response to changing environmental events (Grant & Evans, 1994; S. C. Hayes & Toarmino, 1999; O’Donahue, 1998; Pierce, 1999; Shapiro & Kratochwill, 1988). It is further assumed that learning principles provide a sound conceptual framework for understanding these behavior-environment relationships. Thus, in behavioral assessment, problem behaviors are interpreted as coherent responses to environmental events that precede, co-occur, or follow the behaviors’ occurrence. The measurement of behavior without simulta- neous evaluation of critical environmental events would be anathema. A second key assumption of the behavioral paradigm is that behavior can be most effectively understood when assessment procedures adhere to an empirical approach. Thus, behavioral assessment methods are often designed to yield quantitative measures of minimally inferential and precisely defined behaviors, environmental events, and the relationships among them (Haynes & O’Brien, 2000). The empirical assumption underlies the tendency for behavior therapists to prefer the use of measurement procedures that rely on systematic observation (e.g., Barlow & Hersen, 1984; Cone, 1988; Goldfried & Kent, 1972). It also underlies the strong endorsement of empirical validation as the most appropriate means of evaluating the efficacy and effectiveness of interventions (Nathan & Gorman, 1998). Emerging out of environmental determinism and empiri- cism are a number of corollary assumptions about behavior and the most effective waysto evaluate it. These additional assumptions characterize the evolution of thought in behavioral assessment and its openness to change, given emerging trends in learning theory, behavioral research, and psychometrics (Haynes & O’Brien, 2000). The first of these corollary assumptions is an endorsement of the position that hypothetico- deductive methods of inquiry are the preferred strategy for identifying the causes and correlates of problem behavior. Using this method of scientific inquiry, a behavior therapist will often design an assessment strategy whereby client behavior is measured under different conditions so that one or more hypotheses about its function can be tested. Two excel- lent examples of this methodology are the functional analytic experimental procedures developed by Iwata and colleagues for the assessment and treatment of self-injurious behavior (Iwata et al., 1994) and the functional analytic psychotherapy approach developed by Kohlenberg for assessment and treatment of adult psychological disorders such asborderline spec- trum behaviors (Kohlenberg & Tsai, 1991). A second corollary assumption, contextualism, asserts that the cause-effect relationships between environmental events and behavior are often mediated by individual differences (e.g., Dougher, 2000; Evans, 1985; Hawkins, 1986; Russo & Budd, 1987). This assumption supports the expectation that behaviors can vary greatly according to the many unique interactions that can occur among individual characteristics and contextual events (Wahler & Fox, 1981). Thus, in contemporary behavioral assessment approaches, the therapist may be apt to measure individual difference variables (e.g., physiological activation patterns, self-statements) in order to evaluate how these variables may be interacting with environmental events. A third corollary assumption is behavioral plasticity (O’Brien & Haynes, 1995). This assumption is represented in the behavioral assessment position that many problem behaviors that were historically viewed as untreatable (e.g., psychotic behavior, aggressive behavior among individuals with developmental disabilities, psychophysiological disorders) can be changed if the correct configuration of learning principles and environmental events is built into an intervention and applied consistently. This assumption supports per- sistence and optimism with difficult-to-treat problems. It may also underlie the willingness of behavior therapists to work with clients who are eschewed by nonbehavioral practitioners because they were historically deemed untreatable (e.g., persons with mental retardation, schizophrenia, autism, psychosis). A fourth assumption, multivariate multidimensionalism, posits that problem behaviors and environmental events are often molar constructs that are comprised of many specific and qualitatively distinct modes of responding and dimensions by which they can be measured. Thus, there are many ways in which a single behavior, environmental event, or both can be operationalized. The multidimensional assumption is Conceptual Foundations of Behavioral Assessment 511 reflected in an endorsement of multimethod and multifaceted assessment strategies (Cone, 1988; Haynes, 2000; Morris, 1988). Reciprocal causation is a fifth assumption that character- izes behavioral assessment. The essential position articulated in reciprocal causation is that situational events that influence a problem behavior can in turn be affected by that same behavior (Bandura, 1981). An example of reciprocal causation can be found in patterns of behavior observed among persons with headaches. Specifically, the headache patient may ver- balize headache complaints, solicit behaviors from a spouse, and exhibit headache behaviors such as pained facial expres- sions. These pain behaviors may then evoke supportive or helping responses from a spouse (e.g., turning down the radio, darkening the room, providing medications, offering consolation). In turn, the supportive behavior provided by the spouse may act as a reinforcer and increase the likelihood that the pain behaviors will be expressed in the future. Hence, the pain behaviors may trigger reinforcing consequences, and the reinforcing consequences may then act as an important determinant of future pain behavior (O’Brien & Haynes, 1995). A sixth assumption, temporal variability, is that relationships among causal events and problem behaviors often change over time (Haynes, 1992). Consequently, it is possible that the initiating cause of a problem behavior differs from the factors maintaining the behavior after it is estab- lished. Health promotion behaviors illustrate this point. Specifically, factors that promote the initiation of a preven- tive health regimen (e.g., cues, perceptions of susceptibility) may be quite different from factors that support the maintenance of the behavior (Prochaska, 1994). The aforementioned conceptual foundations have a number of implications for therapists who use behavioral assessment techniques. First, it is imperative that persons who endorse a behavioral approach to assessment be familiar with learning principles and how these principles apply to behavior problems observed in clinical settings. Familiarity with learning principles in turn permit the behavior therapist to better understand complex and clinically relevant context- behavior processes that govern environmental determinism. For example, we have noted how virtually any graduate stu- dent or behavior therapist can describe classical conditioning as it applies to dogs salivating in response to a bell that was previously paired with meat powder or how Little Albert developed a rabbit phobia. These same persons, however, often have difficulty describing how anticipatory nausea and vomiting in cancer patients, cardiovascular hyperreactivity to stress, social phobia, and panic attacks may arise from classical conditioning. Similarly, most clinicians can describe how operant conditioning may affect the behavior of rats and pi- geons under various conditions of antecedent and consequen- tial stimuli. However, they often have a limited capacity for applying these principles to important clinical phenomena such as client resistance to therapy directives, client transfer- ence, therapist countertransference, and how various therapy techniques (e.g., cognitive restructuring, graded exposure with response prevention) promote behavior change. In addition to being well-versed in learning theory, behavior therapists must also learn to carefully operationalize constructs so that unambiguous measures of problem behavior can be either created or appropriately selected from the corpus of measures that have been developed by other researchers. This task requires a deliberate and scholarly approach to assessment as well as facility with research methods aimed at construct development and measurement (cf. Cook & Campbell, 1979; Kazdin, 1998). Finally, behavior therapists must know how to create and implement assessment methods that permit reasonable identification and measurement of complex relationships among behaviors and contextual variables. Imagine once again that you are the client described in the beginning of the chapter. The assumptions guiding the behavior therapist’s assessment would affect his or her model of the your problem behavior and the selection of assessment methods. Specifically, guided by the empirical and multivariate assumptions, the behavior therapist would be apt to use methods that promote the development of unambiguous measures of the problem behavior. Thus, he or she would work with you to develop clear descriptions of the key presenting problems (insomnia, fatigue, a feeling in the pit of the stomach, chronic worry, touching chest and taking test breaths, negative expectations about prognosis, use of reassuring self- statements). Furthermore, guided by environmental determinism and contextualism, the behavior therapist would encourage you to identify specific persons, places, times, and prior learning experiences that may account for variation in problem behavior (e.g., do the various problem behaviors differ when you are alone relative to when you are with others, is your worry greater at work versus home, etc.). Finally, guided by assumptions regarding reciprocal causation and temporal variability, the behavior therapist would allow for the possibility that the factors controlling your problem behaviors at the present time may be different from initiating factors. Thus, although it may be the case that your worries were initiated by a persistent cough, the maintenance of the worry may be related to a number of current causal factors such as your negative expectations about cancer prognosis and your efforts to allay worry by using checking behaviors (e.g., test breaths, chest touching) and avoidance (not obtaining a medical evaluation). 512 Assessment of Psychopathology With Behavioral Approaches In the following sections, we review procedures used by behavioral assessors to operationalize, measure, and evaluate problem behavior and situational events. As part of the review, we highlight research findings and decisional processes that guide the enactment of these procedures. Prior to presenting this information, however, we summarize the current status of behavioral assessment in clinical settings and research applications. CURRENT STATUS AND APPLICATIONS OF BEHAVIORALASSESSMENT One indicator of the status and utility of an assessment method is the extent to which it is used among practitioners and researchers. Frequency of use among practitioners and researchers represents a combination of influences, including the training background of the practitioner, the treatment-utility of information provided by the method (i.e., the extent to which information can guide treatment formulation and implementation), and the extent to which the method conforms to the demands of a contemporary clinical settings. Frequency of use also represents the extent to which the method yields information that is reliable, valid, and sensitive to variation in contextual factors (e.g., treatment effects, variation in contextual factors, and experimental manipulations). An examination of the behavioral assessment practices of behaviorally oriented clinicians was conducted to determine their status and utility among those who endorse a cognitive- behavioral perspective. Five hundred members of the Associ- ation for Advancement of Behavior Therapy (AABT) were surveyed (Mettee-Carter et al., 1999). The survey contained a number of items that were used in prior investigations of assessment practices (Elliott, Miltenberger, Kastar-Bundgaard, & Lumley, 1996; Swan & MacDonald, 1978). Several additional items were included so that we could learn about strategies used to evaluate assessment data and the accuracy of these data analytic techniques. The results of the survey regarding assessment practices are presented in this section. Survey results that pertain to the accuracy of data evaluation techniques are presented later in this chapter in the section addressing methods used to evaluate assessment data. A total of 156 completed surveys were returned by respondents (31%). This response rate was comparable to that obtained by Elliott et al. (1996), who reported that 334 of 964 (35%) surveys were returned in their study. The majority of respondents (91%) held a PhD in psychology, with 4% reporting master’s level training, 2% reporting attainment of a medical degree, and 1% reporting PsyD training. A large proportion of respondents reported that they were engaged in clinical practice in either a private setting (40%), medical center or medical school (16%), or hospital (9%). Thirty percent reported their primary employment setting was an academic department. As would be expected, most respondents reported their primary orientation to assessment was cognitive-behavioral (73%). Less frequently endorsed orientations included applied behavior analysis (10%) and social learning (8%). Re- gardless of orientation, behavioral assessment was reported to be very important in treatment formulation (mean rating of importance = 5.93,SD=1.17, on a Likert scale that ranged from 1 = not at all importantto 7 = extremely important). Furthermore, they reported that they typically devoted four sessions to develop an adequate conceptualization of a client’s problem behavior and the factors that control it. The more commonly reported assessment methods used by behavior therapistsin thisstudy aresummarized inTable 22.1. For comparison purposes, we included data reported by Elliot et al. (1996), who presented results separately for academic psychologists and practitioners. As is readily evident in Table 22.1, our data are quite similar to those reported by Elliott et al. Additionally, like Elliott et al., we observed that interviewing (with the client, a significant other, or another professional) is clearly the most commonly used assessment method. The administration of self-report inventories is the next most commonly used assessment method, followed by behavioral observation and self-monitoring. It is important to note that these latter two methods are more uniquely aligned with a behavioral orientation to assessment than are interviewing and questionnaire administration. TABLE 22.1 Results of 1998 Survey Investigating Assessment Methods Used by Members of the Association for the Advancement of Behavior Therapy Percent of Clients Assessed with this Method Assessment Method Current Study Elliot et al. (1996) Interview with client 92 93–94 Direct behavioral observation 55 52 Behavior rating scales and 49 44–67 questionnaires Self-monitoring 44 44–48 Interview with significant others 42 42–46 Interview other professionals 37 38–42 Mental status exam 32 27–36 Structured diagnostic interview 31 23–29 Personality inventory 16 15–20 Role play 15 19–25 Intellectual assessment 11 16–20 Analog functional analysis 10 10–16 Projective testing 3 3–5 Goals and Applications of Behavioral Assessment 513 In order to evaluate the extent to which the various assessment methods were associated with assessment orientation, we regressed values from an item that assessed self-reported degree of behavioral orientation (rated on a 7-point Likert scale) onto the 13 assessment method items. Results indicated thatuseofanalogfunctionalanalysis(␤ = .23,t = 2.8, p < .01),interviewingwithclient(␤ = – .22,t = – 2.75, p < .01),andprojectivetesting(␤ = – .18,t = 2.21,p < .05) accounted for significant proportions of variance in the degree of behavioral orientation rating. The direction of association in this analysis indicated that persons who described them- selves as more behaviorally oriented were more likely to use analog functional analysis as an assessment method and less likely to use interviewing and projective assessment methods. In addition to the methods reported by therapists in surveys, another indicator of status and applicability of behavioral assessment is in clinical research. Haynes and O’Brien (2000) evaluated data on the types of assessment methods used in treatment outcome studies published in the Journal of Clinical and Consulting Psychology (JCCP) from 1968 through 1996. JCCP was chosen because it is a highly selec- tive, nonspecialty journal that publishes state-of-the-art research in clinical psychology. Articles published in 2000 were added to these data; the results are summarized in Table 22.2. Table 22.2 illustrates several important points about the relative status and applicability of behavioral assessment. First, it is apparent that self-report questionnaire administration has grown to be the dominant assessment method. Although it is not specifically reflected in the table, most of these questionnaires used in these treatment outcome studies assessed specific problem behaviors rather than broad personality constructs. Thus, their use is quite consistent with the behavioral approach to assessment, which supports the use of focused and carefully designed indicators of problem behavior. Second, the prototypical behavioral assessment methods—behavioral observation and self-monitoring—are maintaining their status as useful measures for evaluating treatment outcomes, and psychophysiological measurement appears to be increasingly used. Returning once again to your experiences as the hypothetical client with chronic worries, we would argue that in addition to encountering a behavior therapist who tends to endorse certain assumptions regarding behavior and who would seek careful operationalization of behavior and contexts, you would also be evaluated using a number of methods, including a clinical interview, questionnaire administration, self-monitoring, and direct observation. Alternatively, it is unlikely that you would undergo projective testing or complete a personality inventory. GOALS AND APPLICATIONS OF BEHAVIORALASSESSMENT The primary goal of behavioral assessment is to improve clinical decision making by obtaining reliable and valid information about the nature of problem behavior and the factors that control it (Haynes, 2000). This primary goal is realized through two broad classes of subordinate goals of behavioral assessment: (a) to objectively measure behavior and (b) to identify and evaluate relationships among problem behaviors and causal factors. In turn, when these subordinate goals are realized, the behavior therapist is better able to make valid decisions regarding treatment design, treatment selection, treatment outcome evaluation, treatment process evaluation, and identification of factors that mediate response to treatment (Haynes & O’Brien, 2000). To attain the two subordinate goals, a behavior therapist must generate detailed operational definitions of problem behaviors and potential causal factors. After this step, strategies for collecting empirical data about relationships among problem behaviors and casual factors must be developed and enacted. Finally, after data collection, proper evaluation TABLE 22.2 Assessment Methods Used in Treatment Outcome Studies Published in the Journal of Consulting and Clinical Psychology Treatment Self-Report Behavioral Psychophysiological Projective Publication Outcome Studies Questionnaire Observation Self-Monitoring Assessment Testing Year (N) (Percent) (Percent) (Percent) (Percent) (Percent) 1968 9 33 56 33 0 0 1972 23 48 35 22 0 0 1976 34 50 44 9 18 4 1980 21 62 33 29 14 9 1984 37 51 16 32 16 0 1988 21 81 24 38 10 0 1992 21 81 33 14 9 0 1996 28 86 7 25 25 0 2000 42 98 17 17 33 0 514 Assessment of Psychopathology With Behavioral Approaches procedures must be used to quantify the magnitude of causal effects. In the following sections, the assessment processes and the decisions associated with these processes are reviewed. Topographical Analysis: The Operationalization and Quantification of Target Behaviors and Contextual Variables Target Behavior Operationalization and Quantification In consonance with the empirical assumption, an important goal of behavioral assessment is to accurately characterize problem behaviors. To accomplish this goal, the behavior therapist must initially determine which behaviors emitted by the client are to be the focus of the assessment and subse- quent intervention. These selected behaviors are commonly referred to as target behaviors. After a target behavior has been identified, the behavior therapist must determine what constitutes the essential characteristics of the behavior. Operational definitions are used to capture the precise, unambiguous, and observable qualities of the target behavior. When developing an operational definition, the clinician often strives to maximize content validity (i.e., the extent to which the operational definition captures the essential elements of the target behavior), and—consistent with the multidimensional assumption—it is accepted that a client’s problem behavior will need to be operationalized in a number of different ways. In order to simplify the operationalization decisions, behavioral assessment writers have recommended that complex behaviors be partitioned into at least three inter- related modes of responding: verbal-cognitive behaviors, physiological-affective behaviors, and overt-motor behaviors (cf. Hollandsworth, 1986; Spiegler & Guevremont, 1998). The verbal-cognitive mode subsumes spoken words as well as cognitive experiences such as self-statements, images, irrational beliefs, attitudes, and the like. The physiological- affective mode subsumes physiological responses, physical sensations, and felt emotional states. Finally, the overt-motor mode subsumes observable responses that represent skeletal- nervous system activation and are typically under voluntary control. The process of operationally defining a target behavior can be deceptively complex.For example,a clientwho reports that she is depressed may be presenting with myriad of cognitive, emotional, and overt-motor behaviors, including negative ex- pectancies for the future, persistent thoughts of guilt and pun- ishment, anhedonia, fatigue, sadness, social withdrawal, and slowed motor movements. However, another client who reports that he is depressed may present with a very different configuration of verbal-cognitive, physiological-affective, and overt-motor behaviors. It is important to note that these different modes of responding that are all subsumed within the construct of depression may be differentially responsiveto intervention techniques. Thus, if the assessor measures a very restricted number of response modes (e.g., a measure only of feeling states),the validity of criticaldecisions about intervention design, intervention evaluation, and intervention process evaluation may be adversely affected. After a target behavior has been operationalized in terms of modes, appropriate measurement dimensions must be selected. The most commonly used measurement dimensions used in clinical settings are frequency, duration, and intensity. Frequency refers to how often the behavior occurs across a given time frame (e.g., number per day, per hour, per minute). Duration provides information about the amount of time that elapses between behavior initiation and completion. Intensity provides information about the force or salience of the behavior in relation to other responses emitted by the client. Although all of the aforementioned modes and dimensions of behavior can be operationalized and incorporated into an assessment, varying combinations will be evaluated in any given case. For example, Durand and Carr (1991) evaluated three children who were referred for assessment and treatment of self-injurious and disruptive behaviors. Their operationalization was limited to frequency counts of overt-motor responses. Similarly, Miller’s (1991) topographical description of a veteran with posttraumatic stress disorder and an airplane phobia quantified self-reported anxiety, an affective-physiological response, using only a measure of intensity (i.e., subjective units of distress). In contrast, Levey, Aldaz, Watts, and Coyle (1991) generated a more comprehensive topographical description of a client with sleep onset and maintenance problems. Their topographical analysis em- phasized the temporal characteristics (frequency and duration of nighttime awakenings, rate of change from an awake state to sleep, and interresponse time—the time that elapsed between awakenings) and variability (variation in sleep onset latencies) of overt-motor (e.g., physical activity), affective- physiological (e.g., subjective distress), and cognitive-verbal (i.e., uncontrollable presleep cognitions) target behaviors. Contextual Variable Operationalization and Quantification After operationally defining target behaviors, the behavior therapist needs to construct operational definitions of key contextual variables. Contextual variables are environmental events and characteristics of the person that surround the target behavior and exert nontrivial effects upon it. Contextual factors can be sorted into two broad modes: social-environmental Goals and Applications of Behavioral Assessment 515 factors and intrapersonal factors (O’Brien & Haynes, 1997). Social-environmental factors subsume interactions with other people or groups of people as well as the physical characteristics of an environment such as temperature, noise levels, light- ing levels, food, and room design. Intrapersonal factors include verbal-cognitive, affective-physiological, and overt- motor behaviors that may exert significant effects on the target behavior. The contextual factor measurement dimensions are similar to those used with target behaviors. Specifically, frequency, duration, and intensity of contextual factor occurrence are most often measured. For example, the intensity and duration of exposure to adult attention, demanding tasks, or both can be reliably measured and has been shown to have a significant impact on the frequency and magnitude of self-injurious behavior among some clients (Derby et al., 1992; Durand & Carr, 1991; Durand & Crimmins, 1988; Taylor & Carr, 1992a, 1992b). Similarly, the magnitude, frequency, and duration of exposure to hospital cues among chemotherapy patients with anticipatory nausea and vomiting have been shown to exert a significant impact on symptom severity (Burish, Carey, Krozely, & Greco, 1987; Carey & Burish, 1988). In summary, careful operationalization of behavior and contextual variables is one of the primary goals of behavioral assessment. Target behaviors are typically partitioned into modes, and within each mode, several dimensions of measurement may be used. Similarly, contextual variables can be partitioned into types and dimensions. Applied to the hypothetical client with chronic worry regarding cancer, we can develop a preliminary topographical analysis. Specifically, negative expectations about prognosis, disturbing mental images, and reassuring self-statements would fall into the cognitive-verbal mode of responding. The affective-physiological mode would subsume feelings of fatigue, sleeplessness, sad mood, the sen- sation in the pit of your stomach, and specific physical symptoms associated with worry (e.g., increased heart rate, trembling, muscle tension, etc.). Finally, the overt-motor mode would include social withdrawal, checking behaviors, and avoidance behaviors. Each of the behaviors could also be measured along a number of different dimensions such as frequency, intensity (e.g., degree of belief in negative or reassuring self-statements, vividness of mental images, degree of heart rate elevation), duration, or any combination of these. The contextual variables could also be identified and operationalized for this case. Specifically, the behavior therapist would seek to identify important social-environmental and interpersonal variables that may plausibly promote changes in target behavior occurrence. For example, what is the nature of current family and work environments, and have there been substantial changes in them (e.g., have increased stres- sors been experienced)? What sorts of social and situational contexts are associated with target behavior intensification and target behavior improvement? Applications of the Topographical Analysis of Behavior and Contexts The operationalization and quantification of target behavior and contextual factors can serve important functions in behavioral assessment. First, operational definitions can help the client and the behavior therapist think carefully and objectively about the nature of the target behaviors and the contexts within which they occur. This type of consideration can guard against oversimplified, biased, and nonscientific descriptions of target behaviors and settings. Second, operational definitions and quantification allow the clinician to evaluate the social significance of the target behavior or the stimulus characteristics of a particular context relative to relevant comparison groups or comparison contexts. Finally, operationalization of target behaviors is a critical step in de- termining whether behavioral criteria are met for establishing a psychiatric diagnosis using the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV; American Psychiatric Association, 1994) or the ninth edition of the International Classification of Diseases (ICD-9; American Medical Association). This latter process of rendering a diagnosis is not without controversy in the behavioral assessment literature. However, it is the case that with the increasing development of effective diagnosis-specific treatment protocols, the rendering of a diagnosis can be a critical element of pretreatment assessment and intervention design. For example, the pattern of behaviors experienced by the hypothetical client with cancer worries would conform to a diagnosis of generalized anxiety disorder, and it would be reasonable to use the empirically supported treatment proto- col for this disorder that was developed by Craske, Barlow, and O’Leary (1992). Identification of Functional Relationships and the Functional Analysis of Behavior After target behaviors and contextual factors have been identified and operationalized, the therapist will often wish to develop a model of the relationships among these variables. This model of causal variable-target behavior interrela- tionships is the functional analysis. As is apparent in the preceding discussion of target and causalvariable operationalization, a wide range of variables will need to be incorporated into any reasonably complete functional analysis. As a result, [...]... (Acklin, 199 9; Holzman et al., 197 4; Kleiger, 199 9; Perry & Braff, 199 4; Perry, Geyer, & Braff, 199 9; Perry, Viglione, & Braff, 199 2; Viglione, 199 9; Weiner, 196 6) Projective tests collect standardized samples of real-life behavior—the problem-solving of the personality operations in real life This view of personality would incorporate thought organization and disorder as the problem-solving of the personality... Lauterbach, W ( 199 0) Situation-response questions for identifying the function of problem behavior: The example of thumb sucking British Journal of Clinical Psychology, 29, 51–57 Levey, A B., Aldaz, J A., Watts, F N., & Coyle, K ( 199 1) Articulatory suppression and the treatment of insomnia Behavior Research and Therapy, 29, 85– 89 Matyas, T A., & Greenwood, K M ( 199 0) Visual analysis of single-case time... identified (cf Einhorn, 198 8; Elstein, 198 8; Garb, 199 8; Kanfer & Schefft, 198 8; Kleinmuntz, 199 0; also see the chapter by Weiner in this volume) A particularly troubling finding, however, is that a clinician’s confidence in his or her judgments of covariation and causality increase with experience, but accuracy remains relatively unchanged (Arkes, 198 1; Garb, 198 9, 199 8) In summary, intuitive data evaluation... Horner, Albin, Storey, & Sprague, 199 0; Sturmey, 199 6) In terms of clinical utility, a number of authors have argued that an incorrect or incomplete functional analysis can produce ineffective behavioral interventions (e.g., Axelrod, 198 7; Evans, 198 5; S L Hayes, Nelson, & Jarret, 198 7; Haynes & O’Brien, 199 0, 2000; Iwata, Kahng, Wallace, & Lindberg, 2000; Nelson & Hayes, 198 6) Despite the fact that the... ed.) New York: Guilford Press Sturmey, P ( 199 6) Functional analysis in clinical psychology New York: Wiley Suen, H K., & Ary, D ( 198 9) Analyzing quantitative behavioral data Hillsdale, NJ: Erlbaum Swan, G E., & MacDonald, M L ( 197 8) Behavior therapy in practice: A national survey of behavior therapists Behavior Therapy, 9, 799 –801 Taylor, J C., & Carr, E G ( 199 2a) Severe problem behaviors related to... is considered to be a critical component of assessment, the term has been used to characterize a diverse set of clinical activities, including (a) the operationalization of target behavior (e.g., Bernstein, Borkovec, & Coles, 198 6; Craighead, Kazdin, & Mahoney, 198 1), (b) the operationalization of situational factors (Derby et al., 199 2; Taylor & Carr, 199 2a, 199 2b), (c) single subject experimental procedures... Kanfer, F H., & Phillips, J (l970) Learning foundations of behavior therapy New York: Wiley Kanfer, F H., & Schefft, B K ( 198 8) Guiding the process of therapeutic change Champaign: Research Press Kazdin, A E ( 199 8) Research design in clinical psychology (3rd ed.) Boston: Allyn and Bacon Kearney, C A., & Silverman, W K ( 199 0) A preliminary analysis of a functional model of assessment and treatment for... Wiley Garb, H N ( 198 9) Clinical judgment, clinical training, and professional experience Psychological Bulletin, 105, 387– 396 Garb, H N ( 199 8) Studying the clinician: Judgment research and psychological assessment Washington, DC: American Psychological Association Gaynor, S T., Baird, S C., & Nelson-Gray, R O ( 199 9) Application of time-series (single subject) designs in clinical psychology In P C Kendall,... Wryobeck, J., & O’Brien, W ( 199 9, November) Estimation of functional relationships by AABT members: A comparison of tabular and graphic self-monitoring data Poster presented at the 33rd Annual Convention of the Association for the Advancement of Behavior Therapy, Toronto, Canada Miller, D J ( 199 1) Simple phobia as a symptom of posttraumatic stress disorder in a former prisoner of war Behavior Modification,... & Nelson, R O ( 197 9) The reliability of problem identification in the behavioral interview Behavioral Assessment, 1, 107–118 Hayes, S C., & Follette, W C ( 199 2) Can functional analysis provide a substitute for syndromal classification? Behavioral Assessment, 14, 345–365 Hayes, S C., & Toarmino, D ( 199 9) The rise of clinical behavior analysis Psychologist, 12, 505–5 09 528 Assessment of Psychopathology . (Percent) 196 8 9 33 56 33 0 0 197 2 23 48 35 22 0 0 197 6 34 50 44 9 18 4 198 0 21 62 33 29 14 9 198 4 37 51 16 32 16 0 198 8 21 81 24 38 10 0 199 2 21 81 33 14 9 0 199 6 28 86 7 25 25 0 2000 42 98 17 17. changing environmental events (Grant & Evans, 199 4; S. C. Hayes & Toarmino, 199 9; O’Donahue, 199 8; Pierce, 199 9; Shapiro & Kratochwill, 198 8). It is further assumed that learning principles. frequency and magnitude of self-injurious behavior among some clients (Derby et al., 199 2; Durand & Carr, 199 1; Durand & Crimmins, 198 8; Taylor & Carr, 199 2a, 199 2b). Similarly, the

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