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Contextual Behavior Therapy

Traditional cognitive behavioral therapy emphasizes change and control of thoughts and emotions. It views irrational thoughts as the primary factor in creating and maintaining distress. Treatment comprises identifying and evaluating irrational thoughts, then developing challenges to them. Outcome effectiveness is measured by the degree to which one is successful at replacing irrational thoughts with rational thoughts, which is assumed to alleviate distress.

Recent studies have identified contradictions and pitfalls with this perspective. Several studies suggest that the mechanisms of action outlined by the traditional cognitive behavioral approach (i.e., cognitive restructuring) may not be the active ingredient of the therapy. For example, in one study, improvement appeared to occur before the cognitive change strategies were applied (Ilardi & Craighead, 1994), and in a component analysis of cognitive behavioral therapy, improvement was evident without ever engaging clients in cognitive change strategies (Jacobson, Dodson, Koerner, Gollan etc, 1996).

A contextual behavior approach is grounded in understanding behaviors—including emotions and thoughts—in the situations in which they occur. In fact, it is only in examining them in the context in which they occur that a person’s behavior makes any sense. For example, if you were to observe two films—in each is a close up of a person crying as they walk. In both films, the crying and walking behavior looks very similar but we have no sense of the meaning of these behaviors until the camera zooms out and we see that one person is walking up an aisle to the platform at an awards ceremony and in the other film the person is walking out of an office after receiving a pink slip from his boss. The meaning implied by the behaviors look the same, but the implications become meaningful only as we seen them in context.

We cannot determine if a behavior, thought, or emotion is irrational unless we observe it in context. Thus, we do not look to thoughts or feelings in a person’s head to make sense of their behavior or experience. Rather, their thoughts and feelings are aspects of their experience. Thoughts and feelings are reactions to things happening in any given moment. (Even persons who disagree with this last statement must admit that their disagreement is a reaction to what is happening right now—that is, a reaction to reading the previous sentence).

From a contextual perspective, we do not appeal to unapparent responses or private experiences (e.g., thoughts or emotions) or any other mental construct (e.g. schemas, self, other or object representations) to explain behavior and experience. For example, often people attempt to explain their yelling, or slamming of a door as caused by a feeling of anger. From the contextual perspective, the anger is not a cause of the behavior but one in a set of reactions in a chain of events. Ultimately, this chain of events only makes sense in the context in which it occurred. Anger was a reaction to something someone in a real life situation did or said. Anger does not inevitability lead to one particular behavior—therefore feeling anger is not sufficient to explain the behavior of yelling or slamming doors.

From a contextual perspective, rather than looking for causes (behavior is much more complex than this), we attempt to identify the multiple variables associated with the behavior. In this sense a particular response is an emergent phenomenon associated witha person's current context, physiological state(s), and their learning history.

The ultimate goal of most people who seek therapy is to promote change in their life. A contextual perspective will attempt to identify factors in a person’s life that can be influenced— that is changed. In the language of science, we look to control an independent variable and measure the impact this change has on the dependent variables.

From this perspective, you and I have thoughts and feelings, and they are dependent variables that we cannot directly change. Sure, you and I can use thoughts to think through a problem (i.e., 2+2=4; given where the sun is, it must be about 4:00 PM) but these are not the type of thoughts that are associated with our distress. The thoughts and emotions associated with distress are impossible to control. Thus, part of the problem is that people attempt to change and control their thoughts, which only exacerbates the problem. That is, the tendency to react to experience by judging and avoiding aversive thoughts and emotions are the source of most distress. So rather than evaluate thoughts and emotions as rational or irrational, a contextual behavior perspective will examine the function of having “these reactions” in “those situations.”

Therefore, treatment emphasizes mindfulness and acceptance of current experiences with the thoughts and emotions that accompany them, rather than change and control of troubling thoughts and painful emotions. Outcome effectiveness is measured by the effectiveness of behaviors ("these reactions") in present contexts ("those situations")-- i.e. "workability." While problem-solving is focused on workability and not alleviating distress, it is not unusual for clients to experience a reduction in distressing thoughts or emotions as a by-product of the therapy. Basically we are attempting to teach client the difference between evaluating your experience and living your experience. Basically, many therapies encourage persons to get further and further into their head, whereas this approach attempts to assist people in getting out of their head and into their direct experience.

 
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