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INTERACTIONS OF RESPONSE PATTERNS AND THEIR IMPLICATIONS FOR BEHAVIOR THERAPY

DENNIS J. DELPRATO

Eastern Michigan University, Ypsilanti

and

F. DUDLEY McGLYNN

University of Missouri, Kansas City

Summary - Basic and clinical behavioral research reveals that actions of the organism fre- quently are organized to form concurrent and sequential response patterns. The former are nonrandom interrelationships among two or more responses that are measured over the same time period. Sequential response patterns are nonrandom relationships between responses when measured over time. This paper addresses some implications of response patterns for assessment and intervention in behavior therapy.

Behavioral scientists must agree that behav- ior is organized lawfully. The elementaristic/ mechanistic tradition handed down that there are elemental responses or response classes, that they are independent of one another, and that lawful organization of behavior results from factors that are external to the responses themselves, e.g. brain events, mental forces, environmental features. The elementaristic/ mechanistic tradition thus set the stage for the first scientific psychologists to study one response or response class at a time. Accord- ingly, single-response methodology was in- corporated into the psychology of learning (e.g. Pavlov, 1927; Skinner, 1938) and, in turn, became a prominent feature of behavior modification (e.g. Ullmann and Krasner, 1965). However, behavioral scientists have suggested occasionally that responses them- selves participate alongside organismic and set- ting factors to govern behavioral organization (e.g. Honig, 1959; Ray and Brown, 1975). And, recently, behavior therapists have begun thinking similarly by using concepts such as re-

sponse structure (Evans, 1986; Wahler and Fox, 1982), response covariation (Kazdin, 1982), and behavioral covariation (Burgio et al., 1985). Delprato (1986) has used the term “response pattern” to denote how responses participate in behavioral organization and has shown, in some detail, how a response-pattern approach is compatible with modern reform- ulations of the conditioning paradigms on which orthodox behavior therapy is based (e.g. Henton and Iversen, 1978; Ray and Brown, 1975). The purpose of this paper is to highlight a few of the ways in which response-pattern thinking calls for reformulation in behavior therapy itself.

CONCURRENT AND SEQUENTIAL RESPONSE PATTERNS

Response-pattern analysis begins with de- fining two classes of response patterns. Con- current response patterns are nonrandom interrelationships involving two or more re-

Requests for reprints’should be addressed to Dennis J. Delprato. Department of Psychology, Eastern Michigan Univer- sity, Ypsilanti, MI 48197, U.S.A.

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200 DENNIS J. DELPRATO and F. DUDLEY McGLYNN

sponses that are measured over the same time period. Sequential response patterns are non- random interrelationships involving responses that are measured over different time periods. Clearly, the distinction between concurrent and sequential response patterns is somewhat arbitrary because the designation of a given pattern as concurrent or sequential will depend on actual data-analytic methodology and on variables such as the durations of individual responses vis-h-vis the durations of measure- ment intervals. Nonetheless, the terminology is of value insofar as it allows for describing and predicting behavioral interrelationships while avoiding the elementaristic/mechanistic con- notations of terms such as response class and response chain and, to some extent, terms such as behavioral covariation.

Examples of concurrent patterning are easily found in the behavior modification literature. Rachman and Hodgson (1974) described vari- able concordance-discordance in concurrent measures of fear and avoidance. Nordquist (1971) reported covariation nocturnal enuresis and oppositional behavior. Rojahn er al. (1978) described predictable variation across three topographically distinct self-injurious behaviors.

Examples of sequential patterns are easily found as well. Rachman and Hodgson (1974) described variable synchrony-desynchrony in sequential measures of fear and avoidance. Baumeister et al. (1980) used sequential analyses to describe serial dependencies be- tween behaviors such as hand-flapping and head-shaking among developmentally delayed individuals. Zlutnick et al. (1975) used sequen- tial multiple-response analysis to describe a recurring series of posturing, arm, hand and head activities that preceded major seizure behavior. If the distinction between concurrent and sequential patterns is not at issue, then the token economy literature provides numerous examples of patterning phenomena described, for example, as the effects of reward on un- targeted or collateral behaviors (e.g. Winkler, 1983). [For further examples see related re-

views by Kazdin (1982), Voeltz and Evans (1982). and Wahler and Fox (1982).]

SOME IMPLICATIONS FOR ASSESSMENT

Multiple-response recording The most straightforward implication of

response-pattern thinking is that behavior therapy should move toward routinely assess- ing multiple responses over time. Repeated multiple-response assessment before interven- tion can influence choice of target behaviors (below). Repeated multiple-response assess- ment during and after intervention can identify unanticipated (including undesirable) interven- tion effects.

One might argue that multiple-response assessment is routinely practiced in behavior therapy already. Clinicians who treat anxiety, for example, routinely evaluate self-reported, physiological-arousal and overt responses (e.g. Bellack and Lombardo, 1984). Clinicians who treat depression, for another example, usually assess appetitive and sleep behaviors, rates of activity and of negative self-reference cogni- tions, and the like. In cases such as these, however, narrow-band assessment of multiple responses simply reflects the efforts of thera- pists to translate traditional psychiatric con- cepts into more concrete events. Repeated multiple-response assessment on the order prompted by response-pattern theory would subsume more diverse behaviors and would be guided by likelihood judgments about reveal- ing clinically useful patterning that includes but is not restricted to response referents of pre- senting complaints. The practical details of repeated multiple-response assessment will depend on several circumstances, i.e. the response repertoires that are possible in a given set of patient-environment transactions, inpatient vs outpatient assessment contexts, and the availability of time and instrumenta- tion. In general, however, work along these lines can begin with appropriately structured interviewing (e.g. Wahler and Cormier, 1970)

and will continue with frequent recording of diverse behaviors including cognitive and physiological responses. There is a need for new and convenient devices for time-based, multiple-response record keeping such as the ambulatory psychophysiological recording in- struments that are becoming increasingly available.

INTERACTIONS OF RESPONSE PATTERNS AND BEHAVIOR THERAPY 101

friendly software for pattern analysis will probably be available by the time techniques for clinically feasible multiple-response assess- ment are developed.

Puttern assessment in multiple settings

Pattern assessment A major implication of response-pattern

thinking is that subtle response patterning occurs and behavior therapists should move toward describing and making use of it. Ad- mittedly, little is known about the organization of response patterns within the domains of interest to behavior therapists. However, some assessment systems are formulated grossly in these terms (e.g. Achenbach and Edelbrock, 1978; American Psychiatric Association, 1980), and preliminary and heuristic concep- tualizations of clinically relevant response patterns are available elsewhere in the litera- ture, for example, in behavioral medicine (Obrist. 1981), in dual task motor performance (Heuer and Wing, 1984), and in time allocation choice (Dunham et al., 1986) paradigms. In addition, suitable methodologies are being developed. In the case of concurrent pattern- ing, for example, investigators have used conditional probability analysis (Bakeman, 1978), factor analysis and cluster analyses (Kara and Wahler, 1977). In the case of sequential patterns, methods such as auto- correlational analysis (e.g. Gottman, 1981), spectral analysis (Gottman, 1981), and lag sequential analysis (Bakeman and Gottman, 1986) have been used. A good deal of work remains before time-based multiple-response assessment in clinical work will be of sufficient resolution to bring these techniques to bear routinely on clinically relevant pattern assess- ment. Nonetheless, pattern assessment follows directly from multiple-response recording and is seen as important to the future of behavior therapy as a modern scientific enterprise. User

The notion that behavior is situation specific has already prompted behavior therapists to assess target behaviors in different settings (e.g. Kazdin, 1979). However, across-setting assessment usually has focussed on one tar- geted response class at a time and frequently has sought to discover only its momentary antecedents and consequences. A response- pattern view on the other hand, prompts multiple-response measurement and pattern assessment across the various settings and diverse setting events of clinical interest. Empirical support for such an approach exists. Hodgson and Rachman (1974) showed that concordance in measures of fear and avoidance differed as a function of setting-demand condi- tions. Wahler (1975) showed that entirely dif- ferent patterns of behavioral covariation existed at home and at school for two troubled boys. In general, settings change at slower rates than do responses. In addition, settings do not control responses. Rather they partici- pate along with responses (and organismic factors) in regulating behavioral organization. Hence, current guidelines for conducting across-setting assessment (e.g. those guided by the goal of representative stimulus sampling) are incomplete.

SOME IMPLICATIONS FOR INTERVENTION

Indirect therapeutic tactics In the early days of the behavior-therapy

movement, we criticized our psychodynamic opponents for treating behaviors that seemed far removed from those involved in the pre- senting complaint and voiced our intention to modify problematical conduct directly (cf.

s Ullmann and Krasner, 1965). An interesting

201 DENNIS J. DELPRATO and F. DUDLEY M&LYNN

implication of response patterning is that it moves us back toward indirect behavior- change thinking, albeit for dramatically dif- ferent reasons. If we know that two responses covary then we should be able to influence one by influencing the other. One approach to indirect intervention takes advantage of con- current response patterning. Nordquist (1971)) for example, observed concurrent variations between compliance, noncompliance and noc- turnal enuresis; when he targeted only the former two, the enuresis was modified. Another approach to indirect intervention takes advantage of sequential response pat- terning. Burgio et al. (1985), for example, observed that delusional verbalization pre- ceded virtually all other anomolous behavior of a 23-year-old retarded and psychotic female. Targeted deceleration of delusional speech alone was accompanied by decreased scream- ing, disruption and out-of-seat behavior. A major advantage of indirect interventions is that target behaviors can be chosen by their accessibility, duration and convenience rather than by their direct contributions to adjustive impairment (Kara and Wahler, 1977). In prin- ciple, inaccessible behaviors such as halluci- nating can be influenced by virtue of their concurrent and/or sequential patterning with accessible responses. [For other examples of indirect intervention tactics based on observed response patterning see Becker et al. (1978), Mulick et al. (1978), Russo et al. (1981).]

Predicting “side effects” In the early days of the behavior-therapy

movement we criticized our psychodynamic opponents also for predicting symptom sub- stitution. According to the then emerging be- havioral view, events interpretable as symptom substitution would not likely occur and, if they did, they would reflect completely the influ- ence of new learning. Reflecting thinking very close to that of the behavioral systems perspec- tive that underlies response pattern theory, Kazdin (1982) and Voeltz and Evans (1982)

recognized that side effects and symptom sub- stitution can be formulated within a behavioral interrelationships framework. A clear implica- tion of response patterning over time is that it moves us back toward concern about predict- ing response substitution. For example, when a response is deleted from the flow of behavior it might be replaced by response patterns that are detrimental to the patient. Basic research (Dunham et al., 1986; Henton and Iversen, 1978) suggests that, eventually, research utiliz- ing multiple-response methodology will yield means of predicting the likely behavioral consequences of therapeutic response deletion in individual cases. Some tentative guidelines already exist. For example, one might predict that a deleted response will be replaced by the next response down on a time allocation hier- archy (Dunham ef al., 1986). Similar con- siderations arise, of course, when the result of therapy is an added response or repertoire.

Conceptual renovation As noted already, the most influential con-

cepts in behavior therapy are rooted in the elementaristic single-response learning theory tradition. The notion of positive reinforce- ment, for example, directs our attention to the details of change in one instrumentally defined class of behaviors at a time (e.g. Ferster and Skinner, 1957). Granted we sometimes study concurrent operants and granted we sometimes admit that reinforcement of one response has profound effects on other responses; however, we still are working with a single-response con- cept, viz. reinforcement of an operant. The advent of multiple-response recording and pattern assessment methodologies gives us an opportunity to immediately renovate our con- ceptions of what we are doing. For example reinforcement of a response results in altered behavioral flow characterized by new con- current and sequential pattern organization. We could, at least for the time being, retain our procedural concepts, e.g. reward training, punishment training, but modify our functional

INTERACTIONS OF RESPONSE PATTERNS AND BEHAVIOR THERAPY 203

concepts, e.g. concurrent pattern change by response addition, sequential pattern change by response deletion. The potential value of this sort of conceptual overhaul can be seen in the work of Zlutnick et al. (1975) who deleted a sequentially organized preseizure response in order to produce decrements in seizure fre- quency (see also Lang and Melamed, 1969; Kohlenberg, 1970).

Ultimately the methods of multiple-element behavioral systems science, e.g. structural analysis, functional analysis and operational analysis could yield entirely new ways of con- ceptualizing the events of behavior therapy. For example, the concept of “kinematic velo- city” or rate of element transition might be applied to the behavioral details of those phe- nomena we now refer to as depression and agitation. Our therapeutic efforts could be directed toward normalizing kinematic velocity in both cases. This reflects response-pattern thinking ideally because one numerical value will denote kinematic velocity and both con- current and sequential-pattern data will con- tribute to that value. [For an overview of behavioral systems methodology see Ray and Delprato (in press).]

Constructional tactics Goldiamond (1974) distinguished between

eliminative and constructional models of be- havior therapy. The goal of eliminative pro- cedures is the direct elimination of problem- atical behaviors. The goal of constructional approaches is the development of adaptive responses or repertoires that sometimes serve to replace maladaptive activities (see also Delprato, 1981). It is axiomatic that if some responses are eliminated, then other responses will replace them through time. It is clear likewise, that if some response is gradually eliminated, then replacement responses are beginning to appear before the reference response is completely eliminated. From the response patterns perspective these new re- sponses are themselves important factors in

target-response elimination as soon as they begin to appear. Hence a complete account of response elimination requires the study of multiple responses and an ideal intervention makes use of those competing activities that are seen to emerge. In brief, the present per- spective calls for constructional thinking even when the clinician’s goal is to eliminate some target response of interest.

Consider for example, the elimination of phobic anxiety by exposure techniques. A view that is currently in favor is that exposure treat- ments represent state-of-the-art technology for anxiety disorders (Barlow and Wolfe, 1981; Marks, 1975). The reasoning underlying ex- posure treatment ignores completely the rule of response replacement, insofar as the conten- tion is that prolonged exposure to feared stimuli is sufficient for therapeutic success. On the other hand, according to the response- pattern approach, diminutions in anxiety re- sponding can only occur in conjunction with increments in alternative responses. There- fore, therapy should progress most effectively when the therapist arranges anxiety-competing responses to replace anxiety responses. Wolpe (1981a, 1981b, 1982) has been the most ada- mant of those supporting the importance of specifically arranged alternative responses in the treatment of anxiety. He argued that when exposure therapy is effective, this is correlated with unplanned and usually unassessed in- crements in alternative responding (often, but not uniformly, relaxation responses).

It is not possible at the present time to re- solve conclusively the exposure vs response- pattern interpretations of anxiety treatment; however, McGlynn et al. (1981) reviewed the relevant literature and concluded that ex- posure to aversive stimuli is sufficient provided that the exposure is nonanxious. In other words, the patient must be doing something other than behaving anxiously during ex- posure. This conclusion accords with Wolpe’s thesis and highlights the congruity of the response-pattern approach with the body of behavioral knowledge concerning response de-

20-l DENNIS J. DELPRATO and F. DUDLEY McGLYNN

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