Functional analytic rehabilitation: A contextual behavioral approach to chronic distress.

Abstract

The many consumers experience may be a result of perpetuating factors associated with lifestyle rather than with the signs and symptoms associated with a formal diagnosis. Frequently, these individuals require a highly structured treatment environment to maximize contact with the contingencies associated with effective illness management and social skills. Functional Analytic Rehabilitation (FAR) is a behavioral approach which keeps consumers in contact with relevant contextual factors as they participate in traditional curriculum-based interventions (e.g., UCLA and DBT skills training). Thus, the program is organized with the goal of creating a functional similarity with real-life environments. As a result, behavioral momentum is developed to maintain social effectiveness and to overcome the numerous disincentives to participating in community-based activities. ********** The present paper outlines a treatment approach, Functional Analytic Rehabilitation (FAR), which creates a treatment context in which persons who experience learn to cope more efficiently in social settings. The term chronic distress refers to a state in which individuals, in response to psychiatric symptoms, create lifestyles that inadvertently perpetuate and even amplify their problems. These persons often develop an inflexible and ineffective interpersonal style, marked by the avoidance of aversive emotional states, which they apply across multiple social roles and situations. The short-term relief from aversive emotional states via experiential avoidance (Hayes, Strosahl, & Wilson, 1999; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996) obscures the aversive but slow and cumulative consequences. Individuals experiencing can be found across numerous diagnostic categories. In fact, this condition is better understood from the contextual perspective than that of a formal psychiatric diagnosis (Hayes & Follette, 1992). Traditional day-treatment approaches to rehabilitation tend to have limited benefits for persons experiencing (e.g., Linehan, 1993). Most such programs tend to focus on manualized topographical skills training and less so on the contextual factors associated with the expression of a particular illness. Despite efforts to promote the generalization of newly acquired skills via the use of homework exercises and joint planning with ancillary workers and/or family members, minimal direct intervention occurs within relevant contexts (e.g., in the residential facility, home; Heinssen, Liberman,& Kopelowicz, 2000). Manual-based treatments generally follow a specified sequential outline in order to increase treatment fidelity. In contrast, principle-based interventions have more flexibility because they are able to respond to particular consumer needs in the moment (Miller & Rathus, 2000). FAR takes into account the contextual factors (i.e., discriminative, eliciting and reinforcing stimuli) relevant to skills acquisition and generalization, combining the strengths of both manual-based and principle-based interventions in order to promote effective living for multi-problem, treatment-refractory consumers. It thus attempts to provide a functionally relevant context for optimizing manual-based therapies (e.g., UCLA skills training modules) using principle-based interventions. FAR draws heavily upon radical behavioral assumptions and in particular, applies principles of Functional Analytical Psychotherapy (FAP; Kohlenberg, Hayes & Tsai, 1993; Kohlenberg and Tsai, 1991; Hayes, Kohlenberg, & Melancon, 1989) to the broader context of the rehabilitation treatment milieu. FAR has been extended to conditions as diverse as schizophrenia, borderline personality disorder, and recurrent major depression. THEORETICAL ASSUMPTIONS Fundamental Components of FAP A brief overview of FAP will serve to familiarize the reader with concepts used in FAR. …