S03E05 – Behaviourism And Mental Health – The Basics – Nokhez & Yola

00:00
Nokhez
You. Welcome back to Mental Health Ae, where we talk about everything mental health. And we go from discussions about what you can do to improve your gut health all the way down to what and where can you find the right kind of help. So you all probably know me, Nihaza Sama. I’ve done a couple of podcasts where I’ve talked about everything NeuroHealth, behavioral neuro functioning. And I’m also a behavioral therapist here in Dubai. And rather than the typical format where we have Ali talk away about all the XYZ different things that he likes, you have to deal with me. And today, I have a very special guest, someone that I look up to in my own professional development. She is director of Slukiat Center, Miss Yolo.

00:48
Yola
Hello.

00:49
Nokhez
Hi. How are you doing?

00:50
Yola
I’m good, fine. And it’s happening.

00:54
Nokhez
Thank you for taking the time to prepare everything. And also, we’re going to have a lot to discuss about today in terms of behavioral analysis, some new terminology. We’re going to discuss also the importance of behavioral analysis in the grand scheme of things, especially mental health. So I would love for you to introduce yourself, the kind of work that you’ve done, and we’ll dive right into it then.

01:17
Yola
Sure. So. My name is Yola Hasani. I’m board certified behavior analyst, licensed special educator, co founder of the Lebanese Association for Behavior Analysis, co founder of Surukiat Center. It’s a center that provides therapeutic services for children with determination or children with special needs. I’m also animal lover advocate, and I’m a mother of four cats.

01:44
Nokhez
Allah, that’s great. I feel like you’re doing a lot. Doing a lot. And I think it’s a balancing act to get everything going and keeping your head open and all that. So I’m really excited to see your perspective. I’m really excited to see your perspectives and sort of understand a little bit more about behavioral analysis, because, as you said, you’re a board certified behavioral analyst. So I imagine that you have insight and not just from your education, but also from experience that I think people should be aware of as well. And I’d like to start off by just asking you, what are some typical differences in the field of psychology and behavioral analysis?

02:20
Yola
So the main difference is that psychology studies mental processes, and it studies the mind as such. Also in the approach, it uses mentalism as its main approach of study. Behavior analysis studies the science of behavior, and the approach is completely different. So behavior analysis provides a complete, rigorous system scientific, that is with the principles of behavior that also includes proven studies, proven techniques that change, eliminate, and replace behaviors. So if you want to think of it this way, behavior analysis is the science of behavior. And wherever you need a behavior change is where you need a behavior analyst.

03:20
Nokhez
I remember even in my college, we understood that behavior change comes from learning and unlearning and as we all know, it comes with the formation of reinforcements, punishments and extinction. And that is how you see the change in behavior over time. So I agree we have to have people who are specialized in behaviorism, sorry, not behaviorism, but behavioral analysis, behaviourismaudio, who understand how a behavior is almost constructed. So I clearly see the difference here between a behaviorist or a behaviorist.

03:55
Yola
Behavior analysis, sorry, behavior analysis is a better way of describing it. It’s a more accurate way.

04:02
Nokhez
Okay.

04:02
Yola
Because behavioral analysis is you’re using a behavioral way of analyzing things. Well, when you say behavior analysis, you are analyzing the behavior. So changes the meaning as well. To add to that, I think we should kind of also define what science is as well, because we hear the world, the word science, we hear the word science and people kind of use it lightly. You hear lots of things out there, be it approaches, be it, you know, recommended therapy that they say it’s scientific where it’s not scientific. So when we say the word science, we have to apply the scientific characteristics which can be in terms of science, you need to have a science that follows certain law, what we call determinism and science, you have to follow a certain law. There has to be an order of a law there. The studies has to be replicated.

05:15
Yola
Studies have to be replicated. You have to have empiricism in terms of your open for testing, for validating your suggested experiments as well. It is highly experimental. This is a very important note of science as well. And it should be simple.

05:37
Nokhez
Yeah, I think that’s also the one thing to highlight is simplicity is also what helps science keep going is because you can add the information over time. If I think the system is too complex and it’s too difficult to understand, then you can’t replicate it. And reliability is then immediately compromised if you are unable to replicate something. And reliability helps with standardizing something over time. And I think it’s important to understand what science means. And behavioral, the science behind behaviourismaudio, the science behind psychology as well, and they’re all very different, but at the same time they’re very interlinked. And I think this takes us to the next part where we want to talk about sort of like how does this sort of behavioral science come it how does it bring itself to mental health?

06:26
Yola
So I’ll talk about my own experience with regards to that. Throughout my work, I’ve seen the wonder, the magic of behavior analysis as an effective treatment, as a science that uses evidence based practices. When we say evidence based practices, it’s a way of you’re analyzing, you’re collecting, you’re translating the latest evidences and you are combining the client’s preferences, latest research, clinical experiments and experiences and you are putting all of this in the service of helping, supporting your client. So I’ve seen all of this. I’ve seen behavior analysis doing, bringing about positive changes and not simple changes in the lives of people who are diagnosed with autism, which is a complex developmental delay. I mean, I’ve also seen how their families struggle whenever there’s a diagnosis of certain developmental delay, the effect of that on mental health basically. And so I was thinking about approaching mental health, what’s happening there, what’s happening in this area?

07:51
Yola
And I would say the Pandemic was a turning point for me in my life because I was also diagnosed with moderate anxiety and depression. And when I sought therapy, I was surprised to see how much psychology as an approach is failing short in terms of having the same effectiveness that I’ve seen in behavior analysis with clients and also with the Pandemic. It did increase the mental health around the world with individuals. So yeah, this is basically what kind of make me think, okay, time to see what’s happening in psychology with regards to mental health.

08:47
Nokhez
No, I agree. I think it’s also I heard a lot of the times from a lot of my friends as well where they say that they’ve been to therapy but they feel like they’ve just talked and there hasn’t been a greater change. And talking obviously does help, seeking out help in different forms can help people in different ways. But I think that the part where you talked about effectiveness is sometimes more prevalent and more pronounced in behavioral analysis or behavioral work with when individuals work with a behavioral analyst, the effectiveness of the outcome of their treatment is so much greater. And I want to ask you more about that. So why do you think that there is a difference of the effectiveness there? Is it because of the evidence based strategies that are used in behavioral analysis or what’s your take on that?

09:35
Yola
So when we say effectiveness is, again, I’m seeing changes, I’m seeing positive changes and you are able to some extent to phase out therapy and fade it eventually. And when we talk about effectiveness, of course, when it comes to evidence based practices, whenever you say evidence based practice, you know that the practice itself will yield positive results. But then you also see what’s happening with people kind of taking psychology therapy as it is. And here I want to highlight the immense efforts made by psychologists to bring about the awareness needed for people to seek mental health. So there is really a massive kind of improvement as such in terms of people, they’re not shy or they’re not ashamed of talking, being vocal about their mental health issues and now more than other people are seeking therapy. But in terms of what you also notice is that lots of people are dropping therapy, psychological therapy as is and they’re going for kind of alternative solutions that might end up putting them a bit off the healing path.

11:06
Yola
So if you are not getting the results that you want and you’re not getting the results immediate. You’re noticing something immediate happening. This is where we say therapy is not effective.

11:17
Nokhez
But I feel like it also goes both ways. There’s this misconception in the social media and unpopular accounts where therapy will solve all your problems. And I feel like it’s that misconception of if you go to someone and talk to them, your problems are solved. But the magic is really behind the evidence based strategies. If you place the strategies, you’re able to track behaviors, change behaviors, learn from these behaviors and that change takes time. And I feel like there’s no shame. Like I’m not trying to shame psychology or anything, but I think the collaboration of the two of behavioral analysis with psychology, if we’re able to track the changes and help understand and also maintain changes overall would really add to the value that most people would seek or what value people are trying to seek in therapy. So I feel like the collaboration is very important between the two and I feel like it takes us to the conversation of how can behavioral analysis aid mental health services and programs and management of interventions.

12:26
Yola
I mean, I do believe that I’ve looked up research supporting this as well that started dated in 1953 when there was actual collaboration happening between behavior analysis and psychology. And I guess the reason why there’s lack of or there was no continuity of such collaboration. It could because of the high demand on behavior analysts to be involved in developmental delays and working with children or people with determination or people who have developmental delay. And there is a few number of board certified behavior analysts out there. So this can be one of the reasons if we take it from behavior analysis perspective and also if we want to take it from the psychologist perspective, is that I believe that sometimes there’s a lack of actual knowledge of what behavior analysis can actually provide and behavior analysis actually, if there’s collaboration between behavior analysts and psychologists, this will be a game changer in terms of addressing mental health as such.

13:49
Yola
So to give specific examples, this all starts with the journey of the patient. In terms of the journey always starts with diagnosis, right? Usually the typical or the classic diagnosis is always like the patient goes, the psychologist asks question and concludes the diagnosis as such if you include behavior analysts or during this phase. So the behavior analysts will collect comprehensive data, will collect data about what’s actually happening with the client, their daily routine, their lives, their interests, will collect data which are so needed about the duration and the rate of episodes of anxiety and depression. Because that’s your baseline. I mean, what are the healing metrics that you’re using if you don’t have baseline? Saying this person engages in episodes of anxiety, episodes with this number, with this frequency and here’s the data. And now putting to test later on if interventions are working. Besides, of course, then the client saying, I think I’m feeling better because we have lots of either placebo effects going on there or sometimes the client wishes to feel better, basically.

15:13
Yola
So this will be basically an objective way of starting to diagnose. And there’s something else also with diagnosis is that you get to know a lot about and you heard these diagnosis no, House, I mean, my diagnosis moderate, severe. What does this even mean for a patient? What does it mean? Who puts the magnitude of the diagnosis? This is where we say and you know, like as behavior analysts, you are not kind of validating the diagnosis. You are just putting metrics to study the baseline to say, okay, here we are. And now after we put the intervention, let’s measure later the results. So this is as a start of diagnosis, if you want to call it the first initial phase in therapeutic journey.

16:18
Nokhez
I think what also would be substantial to mention is that even in the diagnosis phase, the behavioral analyst would also collect data as to what are the triggering points, what causes this. And I feel like sometimes, especially for traditional psychopathology, it’s very difficult to underline exactly what’s causing what. And if over time, a behavior analyst can capture the different points, then we can also see trends, for example, of like, what kind of issues are causing or what kind of triggers are causing an attack in the middle of the night, what’s causing in the morning. And it can provide you more insight to more unique and specific data for your patient. I feel like that’s where the personalization of the treatment plan really comes in. And that’s where I really see that click between both fields collaborating to figure out how can we best manage the intervention.

17:08
Nokhez
And I think that also leads us to the next part, is I think it’s the intervention management and the planning of the intervention. Then on both on select for a psychologist, right?

17:16
Yola
Absolutely. And I just want to add another point to data collection, as you’re mentioning it, because it’s very important. So with regards to data collection, like you said, nohaj, this is a science of specifics. So you are going because specifics are needed here.

17:31
Nokhez
Absolutely.

17:31
Yola
You need to know the triggers, you need to write them down. And if you are helping a patient to become aware of their feelings and most importantly, to manage. Right. So data collection helps also in teaching patients to have self management skills. You cannot have self management skills if you don’t collect data.

17:55
Nokhez
Okay, so you don’t know what to even manage.

17:58
Yola
Exactly. So data collection and of course, add to it that some kind of data collection acts as a reward by itself. Like, for example, checklists.

18:09
Nokhez
Absolutely.

18:09
Yola
The moment you think that something is done, you get instant reward. Although maybe and we’ll talk about rewards maybe you have kind of an intention to watch a movie after you finish engaging in a specific behavior that will bring about this positive income. The moment you tick that checklist, that by itself is providing you the very first reinforcer that you need.

18:33
Nokhez
Absolutely.

18:35
Yola
I just wanted to kind of add that behavior analysis and after diagnosis is also being able like, just imagine psychologist, behavior analyst and the patient called the client sitting together and mapping out, as you said, the plan put forth. Like, if the psychologists say, okay, we have six important targets, how do we prioritize these targets? Which is something you don’t unfortunately kind of hear in therapy sessions. So say, for example, you have a patient that’s not happy about their body image and it’s causing them los an. So you have a target of having them go to gym, having exercising and things like that. And also it happens that patient suffers from insomnia. So for example, this is where a behavior analyst would prioritize insomnia because this will lead into the client sleeping and later on will lead into the client being able to actually go to the gym and exercise.

19:43
Yola
So prioritizing this behavior. You’re putting lots of principles out there, what we call anticipate intervention. You’re putting lots of training. So prioritizing targets. As such, there has to be collaboration between the three parties. And I want to also add the goal itself. The goal, I can’t overemphasize on that. The goals. Like we need to have goals. The patient cannot feel stuck. They come to the psychologist because they already feel stuck. This is what depression is about, right? It’s about feeling stuck somewhere they cannot go and be in that endless loop, endless maze of I don’t know, where am I at? I don’t know if I’m heading towards healing. Which phase am I at? What am I targeting? What is my goal? What is the behavior change? What is my part? What am I supposed to be doing? This is where the behavior analysts would come in and say, okay, so you want to change this for the patient to feel X, Y and Z.

20:57
Yola
Okay, then let’s establish what we call operationally defined target. I put a target and the goal should be very specific, should be about the person engaging in specific behavior, specific times, specific place. There should be do’s and don’ts of a behavior so there’s no misunderstanding as such. So we can add a lot to the targets there.

21:25
Nokhez
But maybe I think that brings in a really interesting perspective because, for example, for individuals who have depression, giving them specific achievable, not achievable measurable. And if you’re giving them specific targets, it also motivates them. If you tell someone who is suffering with depression or anxiety, one of the biggest symptoms that they also feel is Rumination. Is this sense of this loss of purpose or loss of directionality that does come with rumination and constantly thinking about the negative biases that they’re experiencing. So if you’re able to give them a very specific goal like, hey, for this week we’re going to work on this. And then also being able to measure if that intervention or the behavioral change that we’re trying to facilitate is actually changing over time, they will feel more empowered in their mental health because they feel a sense of purpose. Like okay, things are actually improving.

22:21
Nokhez
It is not just I go to this person talk and then I come out and I’m like, hello, I feel a little bit better right now. That’s not the point of therapy. The therapy is to have a specific goal to work on, no matter how incremental or small it is. But is that a small change will always result in a bigger, more cascading effect, especially with mental health. And I think that this is a very great perspective that being able to manage those specific targets, giving them targets feasible and measurable ideas of like, this is what we could work on this week and this will add into this and it’s like the snowball effect will kick in almost. I think it gives also the speed and the momentum that behavior change needs. And I know that even from practicing as a behavioral therapist, speed is a very big thing, is being able to find those moments off where the sweet moment or the hotspot of where an intervention will be effective.

23:15
Nokhez
And I feel like this is where behavioral analysts can really collaborate with the psychologist and be like, okay, we’re entering this phase now. Let’s try to work on this target and let’s see how far this also carries on. And then it’s not just for something like depression, but also more severe symptoms. I know that anorexia and addiction models also really prefer behavioral change outcomes rather than just talk therapy because like eating disorders and addiction behaviors, they are largely associated to a reward system. So most disorders are also most disorders that are associated to reward systems will definitely benefit from behavior analysis from a behavioral analyst being present in their team for mental health support.

23:57
Yola
Absolutely. I mean, there has been also no have studies about what they found in common between people who struggle with depression is that those people didn’t contact lots of reinforcers, they weren’t in contact with lots of enjoyable activities. And this is again back to what you mentioned, which is super important, is I’m breaking the target down. I’m breaking it until it becomes achievable, giving that sense of, as you said, that I’ve done it. And there’s a way also of doing that is I make the very first target. I associate them with less efforts. I make something. It can be as easily as getting rid of items that you’re hoarding or things that you can feel instantly. So you are in touch with that reinforcer and you can repeat that behavior. And again, if we want to compare to the classic way of how things are being done?

25:03
Yola
Who is collecting data about the patient’s? Hobbies? Yeah, this is an important thing. How can I provide alternative behavior if I don’t know what the client likes, what he doesn’t like, what they can do, what they cannot do? How can I provide a plan for that?

25:19
Nokhez
Also, I feel like what is a really important aspect is to also consider their home and their work environments. How do the different factors in those different places also impact mental health? Is it that they’re sitting away from direct sunlight and they are maybe someone who really likes sunlight? Is it that the house environment is very toxic, very heavy? How can we also engage with that? Because I think one thing that people also need to understand that you can go to therapy and everything, but also you need to change your environment sometimes not completely change. And I’m not saying, like, move to a different country, go on a fancy holiday. Just adjust. Yeah, exactly. Adjust and make the small changes. You need to feel that change. I got new pillow covers and a little fancy carpet, and I suddenly feel like, okay, my room’s a little open, and I feel a bit more like I can almost breathe a little bit more.

26:13
Nokhez
And that helps with anxiety. And I imagine if a behavior analyst was also sitting with me, they’d take these notes and be like, okay, this is something she’s struggling with. What are the measures that we can take to make her feel like she can breathe more? What else can she do? Can she exercise? What kind of exercises? And like this you do almost construct a very nice map of different interventions in different places. And that brings us to the importance of generalization in therapy is immensely important. I feel like maintenance is one thing, but generalization, it’s sometimes I think classical therapy of just talking to someone is too restricted to the clinical setting. What about being able to test it with friends or family? Can those same habits be retained and maintained over time or not? Is a person deviating into maladaptive behaviors in a different setting?

27:03
Nokhez
If so, what kind of behaviors? What are the settings that are causing that? So I feel like behavioral analysis really captures that perfectly and brings in the evidence almost to therapy that, okay, this is what we could do next or change for next time.

27:19
Yola
Absolutely. I mean, you mentioned key points there. For example, changing environment. This is very important. And that’s why, again, that collaboration is needed because psychologists can work. They’re working on the target. And then the behavior analyst is visiting home, visiting the natural environment, of course, with the patient’s consent and approval. And they are building new habits. They’re making changes in the home itself. You’re also investigating, like, for example, sometimes some people reported they feel lonely and the advice would be just kind of get support, as vague as that. Get support where the person doesn’t know sometimes or they have sometimes social phobia. So I have to target removing the barrier before I say this is too vague and it’s unreachable.

28:18
Nokhez
Go out and have fun.

28:20
Yola
So looking where does the person live? You are there to help with depression. You visit the person and you discover that they hoard lots of items like the house is cluttered with things that unneeded. So for example, this shifts the focus of therapy immediately. So changing the environment generalization, as you said, we cannot expect people to know what they don’t know. This is very important in therapy. When I help someone make change, the best way to do it is I do it in their natural environment because this makes it easier to change in other environments.

29:05
Nokhez
It also helps with familiarization to an extent. And it’s also if you’re only talking about specific behaviors in a clinical setting, if that same behavior occurs differently in a different kind of frequency or intensity, you’re not familiar with it in a different setting. So that sort of difference in it, you almost are blindsided by it and you feel like you’re not making any improvement because you maybe dwell into the same bad behaviors or you do something that makes you realize oh, I did it all over again. And I feel like if you’re able to take it out and give them perspective and insight on how their behavior can manifest over time due to certain different kinds of triggers and really map out everything for them, you are giving them the agency that they need in their behavior to also be able to change what they can change.

29:53
Nokhez
Because it’s like as you said, it’s like we can’t expect them to change something that they don’t know that they need to change.

30:00
Yola
Exactly. We can talk. Maybe we’ll have more episodes about techniques such as extinction recovery. Like for example, you change something and then you go back to the same setting or environment where the behavior sees the last time you made that change. It is expected, for example, that the behavior to reoccur and that’s predictable. So who tells the patient that don’t panic, this is to happen. You’ve been doing great. Now you went back to visit a place that reminds you of certain things. Expect what we call extinction recovery doesn’t mean this will last. And that’s what the things that I.

30:41
Nokhez
Feel like if that was a message I was giving to people in therapy, they just feel a little bit more calm because that’s also the fear in so many individuals that go to therapy. It’s slight slip and they’re like my whole world is coming down. I feel like I’ve made no improvement. And if just someone could tell them you will feel this, it will come and it will pass. That sort of, I don’t know, almost like grounding the feeling of someone grounding you a little bit in times of recovery and healing is very necessary. And I think that collaborative effort of not just a psychologist but a behavioral analyst and a psychiatrist and whoever a neurologist, whoever is in the mix of this, the collaboration makes it a lot more holistic and wholesome for the patient. And I think some of the interesting things that I’ve read online is that mental health needs to be considered as a more holistic, wide approach rather than just something of, oh, I’m struggling with how I’m feeling.

31:35
Nokhez
It’s something that impacts a day to day routine and if we are able to manage it, not just categorically, but also look at the subcategories and look at how the things are being impacted. And through that develop the right kind of interventions, the right plans, the right behavioral portfolios, whatever you want to call it.

31:52
Yola
Clarity, I would call it. The patient has the right to have clarity about what to expect.

32:00
Nokhez
It brings you peace.

32:01
Yola
It brings you also a sense of control that you lose when you face depression. It gives you actual hope, not false hope, real hope, which is really needed.

32:12
Nokhez
And measurable hope.

32:13
Yola
Measurable hope. I like that.

32:17
Nokhez
What are some messages you would want to share with the community, with the listeners especially, who are listening to this podcast and are now they’re getting familiar with the term of behavior analysis. What is the message that you can also put out for psychologists in terms of collaboration?

32:37
Yola
I would first address the patients, people who are seeking support in mental health, to kind of ask them to seek that psychologist that does this collaboration, to know that they have the right of effective treatment and most importantly, not to give up and to change completely to alternatives. We’re seeing lots of alternatives out there that are very harmful in nature, relying on pseudoscience and just with social media alternatives that are just trendy, but actually they’re harmful for the psychologist. I mean, I would definitely say be that psychologist that brings about that change. Be that distinguished psychologist. The thing is, when patients improve, the psychologist practice will improve and vice versa. You cannot expect to advance in your therapy and your research and your career if your patients are stuck.

33:44
Nokhez
Yeah, absolutely.

33:46
Yola
And I mean, there’s a nice saying by Donald Burr that there could be a science of behavior, of what we are and what we can do. How could you resist that? This is, in a nutshell, what behavior analysis is.

34:04
Nokhez
Well, I think that really perfectly ends our episode for today then. Thank you so much. Yola. I think this was a very insightful discussion, a discussion I feel like a lot of people are going to learn something from. And also that there’s a good big takeaway here is that small wins are still wins in mental health and that sometimes you need someone extra on your team. Who knows how to make that little goal for you. Give that goal so you can measure it and whether that be serial, behavioral analyst or a psychologist, the importance of evidence based strategies intervention planning is very important, especially at the critical stage where there’s a higher prevalence of anxiety, depression, more severe mental health illnesses in the society. So, yes, thanks a lot.

34:51
Yola
Nohaz and Ali, thank you for providing this beautiful platform of collaboration and sharing ideas. Thank you for doing app.

35:00
Nokhez
Thank you. And thank you so much, listeners. We will be back with something.