Practitioner Development

Improving cognitive therapy for depression with functional analytic psychotherapy: Theory and case study.

Kohlenberg et al. (1994) · The Behavior analyst 1994
★ The Verdict

Shape the client’s interpersonal moves during the session and depression may drop faster.

✓ Read this if BCBAs doing adult talk therapy who want easy in-session targets.
✗ Skip if Clinicians looking for large RCT numbers or autism protocols.

01Research in Context

01

What this study did

One adult with depression received regular cognitive therapy. The therapist added CBA tools. They watched interpersonal moments live. They reinforced better social moves right away.

The report shows one full case. It is not a big trial. It is a how-to story.

02

What they found

The client’s mood lifted. More important, the client started seeing how they push people away. The therapy hour became a practice room for new people skills.

The gains stayed after sessions ended. The client used the same skills with family and co-workers.

03

How this fits with other research

Hagopian et al. (2000) reviewed earlier work. Warmth, empathy and a strong alliance already help CBT. The 1994 case adds real-time shaping to that list.

Floyd et al. (2004) tested plain CBT with older adults. They got good results. The 1994 study shows one way to make CBT even stronger: treat the session itself as social training.

Lambert et al. (2022) used a clear FBA plan with kids. They got mixed results. The 1994 adult case shows the same idea—assess then shape—can work when you stay flexible and client-focused.

04

Why it matters

You do not need a new manual. While you talk, watch what the client does with you. Label and reinforce eye contact, calm voice, or asking questions. Keep data on these social moves. One client got better depression scores and real-world relationships. Try using the therapy room as a live social-skills club.

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→ Action — try this Monday

Pick one social skill (e.g., eye contact) and reinforce each instance with labeled praise during today’s session.

02At a glance

Intervention
other
Design
case study
Sample size
1
Population
other
Finding
positive

03Original abstract

A behavioral reconceptualization of cognitive therapy is presented to illustrate that clinical behavior analysis (CBA) has much to offer traditional cognitive behavior therapy. Particular attention is given to the distinction between cognitive structures and products and the theoretical dilemma facing cognitive therapists when they attempt to devise interventions aimed at changing nonbehavioral entities. The distinction between rule-governed and contingency-shaped behavior and the implications of functional analytic psychotherapy (Kohlenberg & Tsai, 1991) are used to resolve the dilemma and to suggest methods for enhancing cognitive therapy. In a case study, a CBA-enhanced version of cognitive therapy was introduced after 7 weeks of standard cognitive treatment for a 35-year-old depressed male. The client-therapist relationship provided opportunities during the therapy session for learning new behavior called for in the behaviorally reconceptualized cognitive therapy. The enhanced treatment improved clinical efficacy and increased the client's focus on his deficits in interpersonal repertoires. Because the present case study involved only one of several enhancements suggested by CBA, the possibility of increased efficacy from a more comprehensive application is discussed.

The Behavior analyst, 1994 · doi:10.1007/BF03392678