BCBAs Need to Breathe: Using Mindfulness Techniques to Feel Less Anxious and More Effective in ABA Practice

By: Brian Brutzman, Ph.D., BCBA, LBA 

During a recent conversation, my colleague and I were talking about how BCBAs might incorporate mindfulness into their practice. “So, are you good at mindfulness?” she asked. We both chuckled. For the record, I don’t consider myself “good” at mindfulness, but I know just enough to be in on the joke. I might feel a similar sense of humorous discomfort if someone asked me if I am “good” at ABA. I have been practicing ABA for a long time. I work at it almost every day in one way or another. But am I “good” at it? I hope my clients think so. However, I have to acknowledge that both my ABA journey and my journey with mindfulness are ongoing. There is always more to learn. Here, at the paradoxical crossroads of being “good” at something while acknowledging we can always be better is where I’d like to discuss what mindfulness is, how it relates to ABA, and how mindful practices can make BCBAs calmer, more attuned to the environment, and ultimately more effective.

What is mindfulness? Rooted in Eastern spiritual traditions, mindfulness involves an ongoing commitment to focus ourselves on the present moment. We fulfill this commitment and hone this focus through structured meditative practice. In behavior analytic terms, this might be compared to the empirical observation of our own private events. We sit quietly, observe our thoughts with curiosity, and rather than getting overly involved in our private events, we practice simply letting them go. Similar to the skills taught in ABA, the point of meditation is for this conscious awareness of the present moment to generalize beyond the quiet sitting to the entire rest of our lives. 

“When all is said and done, mindfulness is really a way of being—a way of being in relationship to experience. By its very nature, it requires ongoing cultivation and nurturance by us as individuals if we care about living our lives fully and freely, and ultimately, as supportive and nurturing communities and societies” (Kabat-Zinn, 2021, p. 1557).

What do ABA and mindfulness have in common? To outsiders unfamiliar with the practice of ABA and/or mindfulness, the concepts can be confusing. It is fairly easy to project expectations and biases on each. ABA and mindfulness often ask people to do counterintuitive things, and in some cases, this can be downright paradoxical. In behavior analysis, if a child is struggling with temper tantrums, our prescription is often to suggest that the parent or the teacher should behave differently in order to achieve a different outcome with the child. A casual observer might be confused about that. Why aren’t we focused on changing the child’s behavior directly? Mindful meditation nudges us to let go of our attachment to outcomes altogether. But wait a second: how can I let go of my attachment to outcomes when I am meditating precisely to be less stressed, lower my blood pressure, be nicer to my kids, etc.?

If we dig a bit deeper into each of these practices, the picture becomes clearer. ABA and mindfulness are at some level meant to achieve beneficial, pro-social outcomes, and we get better at them through deliberate practice. But to succeed at either, we probably need to be less preoccupied with future outcomes and more attuned to the present moment. ABA and mindfulness both emphasize an interconnectedness of environmental variables. In ABA we might use the language of synthesized contingencies, generalization across environments, or functional response classes (e.g., Hanley et al., 2014; Sprague & Horner, 1992; Stokes & Baer, 1977). ABA teaches us to analyze and change the environment. Mindfulness challenges us to observe our own experience and acknowledge our contribution to that environment. To drill down on this further, what follows is an example of how a behavior analyst’s private events and behavior can contribute to a client’s challenging behavior and how we might incorporate ideas from the mindfulness literature to alter our perspective and facilitate behavioral success.

The Anxious BCBA

“The anxious BCBA” is someone who gets overwhelmed by worry in any of the anxiety-provoking professional scenarios we might find ourselves in (i.e., me and maybe even you!). Anxious thoughts and feelings creep in and make our admittedly hard job even harder. At best, anxiety clouds judgement and diverts attention. At worst, it can dictate our behavior as clinicians. The DSM-5 discusses anxiety as an apprehensive expectation that is difficult to control and involves private events such as restlessness, fatigue, and difficulty concentrating, as well as outwardly observable behavior such as muscle tension, sleep disturbance, and irritability (American Psychiatric Association, 2013). Stakeholder anxiety during behavioral challenges, whether it is coming from teachers, parents, or you as the BCBA can wreak havoc on assessment fidelity and treatment integrity. But how often do we really address it? Not often enough. Anxiety often causes adults to behave in ways that are antithetical to the hypothesized function of problem behavior. It also tends to spiral. For example, if a student is having a difficult time behaviorally and I am anxious about “fixing it” and doing so as quickly as possible, I might behave in a way that violates best practices. I might inadvertently reinforce challenging behavior rather than use extinction. I might also get more anxious when I realize I did something wrong, which will lead to more hasty and ill-advised behavior, and yet more anxiety about what might happen next. 

To counteract the toxic effect of anxiety in ourselves or our clients, we can look to the seven attitudes of mindfulness laid out by Kabat-Zinn & Hanh (2009) and apply them to our practice. Here, it should be noted that my intention is not to strip out the experiential and deeply spiritual aspect of mindful meditative practice. Rather, it is to serve as a primer for how BCBAs might apply these ideas right away and delve deeper if they so choose. Also, it should be noted that these attitudes are not presented in a particular order. They constitute a holistic approach toward challenging behavior.

Non-judging. We need to stop judging ourselves and others harshly. We as practitioners are under an immense amount of pressure to “fix the problem” and do it quickly. I typically get called into a situation far later than I would prefer. By then, things have often already reached a boiling point. This makes me feel anxious, but how I react to that anxiety is a choice. Instead of letting anxiety dictate my behavior, I can utilize the mindful approach as an antecedent strategy. If I feel the anxiety creeping in, I privately acknowledge anxious thoughts before they get out of hand and engage in an incompatible replacement behavior instead. For example, if I am worried about saying the wrong thing in the moment, deep breaths are a covert way to pause and prevent that from happening. I might also focus attention on my breath (e.g., rhythm of the breath, counting breaths, focusing on the physical sensation of breathing). This pause typically allows my anxiety to subside, but it also provides time to hone my non-judgemental approach. I resolve to NOT judge all the other adults for letting a behavioral challenge reach the point of crisis. I also resolve to not waste time judging myself. “Am I going to be able to solve this quickly enough?” “Did I say all the right things in that meeting?” None of that is helpful. My focus has to be on the present moment. Better questions are “what do I see happening right now?” and “what can I do in this moment to be impactful?”

Patience. If you’re a behavior analyst, you’ve probably had to exercise a fair bit of patience to get where you are already. However, is there a particular behavioral topography that tests your patience? Working for a long time with clients who exhibit intense challenging behavior, most of the unsavory stuff doesn’t get to me anymore. However, bullying really tests my patience. It is hard for me to keep it together when I perceive a student getting bullied by their peers. Chances are you have a trigger as well. My advice is to identify it and sit in that discomfort for a moment or two before you decide to march across the school yard and make a scene. How about a particular colleague, parent, or teacher? People who get on our nerves are a fact of life. Resolve ahead of time to be patient when they inevitably start pushing buttons and prepare to sit in that discomfort quietly before you react.

Beginner’s mind. Please be forewarned: this idea might cause you as a BCBA to recoil a little bit. Why? You’ve got a bunch of degrees, you’ve passed a big test, you’ve got experience, credentials, expertise, etc. What if I told you that none of it matters, at least not in the moment? Beginner’s mind challenges us to put all of our experiences and accomplishments aside, be completely present, and observe each behavioral phenomenon with fresh eyes. You are a beginner. You have not seen this client before or anyone like them. You don’t know anything about them or why they do what they do. I can say with confidence that this attitude will make you more effective for several reasons. First, you will be open to all functional possibilities and start looking for evidence in places you hadn’t considered. This is critical when you are trying to unpack intense and complex behavioral phenomena. Second, you will be open to the opinions of others in ways you might not have been before. This dovetails with the third advantage: beginner’s mind will get you off your high horse and down into the trenches with everybody else. What is the number one stereotype I hear from people who don’t want to collaborate with BCBAs? We are haughty know-it-alls who are difficult to be around, let alone work with. Beginner’s mind will make you a better listener and collaborator. In turn, the people around you will be more likely to listen to you, take your advice, and change their behavior. This is often the difference between interventions that work and ones that don’t. 

Trust. We need to trust ourselves and our colleagues. We also need to trust the process of assessment and intervention. In the throes of a behavioral challenge, the “I alone can fix it” mentality might creep in. We have to trust in our own abilities, but we also have to trust the people we work with, the people we have trained, and the people who might know the learner better than we do. Similarly, we might feel the pressure to fast forward to a certain part in the assessment process. However, this once again connotes a preoccupation with the future. Faith in the process itself dictates that we carry it out with fidelity moment to moment in order to put forward the most sound interventions possible. Interventions will then need to be implemented in a similarly methodical way. Trust is critical at every step.

Non-striving. This is an admittedly tricky one, because behavior analysts are strivers. We strive for the best in all we do and we push ourselves to maximize our impact for clients. However, contentment in the present moment is extremely useful and preoccupation with changing the present moment is not. Here is an example of how this might look in practice: when I meet with the RBTs I supervise, I make it a point to periodically review progress graphs with them. At some point in my career, I realized that I have the advantage of seeing progress week to week, month to month. However, the RBTs who are grinding it out with the learner day in and day out often do not. When the progress they see is so incremental that it can be hard to notice, it is easy to get dejected and wish that things were different in the present. So, wherever appropriate, I try to show them how incremental gains compound over time and emphasize how satisfied I am with current progress given the starting point. This satisfaction tends to be contagious, especially when it is delivered in the form of verbal praise. 

Acceptance. This is another one which can feel a bit paradoxical. However, I believe that it is possible to accept things the way they are and simultaneously work toward a brighter future. I might even argue that acceptance is a critical first step in that direction. Here is a sensitive example: we as behavior analysts often work with clients who have profound developmental disabilities. At several points in my career, I have been asked by a client’s loved ones if their child will ever be “normal,” if they will ever be “just like everybody else,” or if they will get to go to the prom, get to go to college, be gainfully employed, and so on. These are heartbreaking moments to work through with people because in many cases, they betray a lack of acceptance that their child’s future might not align with their hopes and expectations. In these moments, compassion is critical, but so is acceptance. I typically start off by summarizing the profound nature of the disability. If they use the word “normal,” I might also gently push back on the concept itself. What is “normal”? Is it helpful to think in those terms? Then I usually talk a bit about criterion-referenced assessments vs. norm-referenced assessments. You might have already guessed that I have a pretty strong preference for the former. Once loved ones understand that I seek to measure their child’s progress against their own individual yard stick of potential rather than an average of same-aged peer performance, things tend to open up even more. From criterion-referenced assessment we might infer that a molehill for one of those other children might look a little bit more like a mountain for our client. Climbing a mountain is hard. It takes time and a lot of sustained effort. However, if we are ever going to climb it, we have to acknowledge and accept that it is indeed a mountain. And when the client reaches their summit, we rejoice for them because we understand the relative magnitude of the challenge they overcame.

Letting go. This attitude represents a pretty logical next step from the last one. After a decade of behavior analytic practice, I look back and see that at the beginning I was doing a lot. I was likely doing too much. Maybe I was inserting myself unnecessarily into crisis situations. Maybe I thought that the answer to a behavioral challenge was for a client to have more contact with me. I might have pushed too hard or tried to control things too tightly. The phrase “doing the most” comes to mind. If you have ever heard that expression before, you probably know that the connotation isn’t good. Over the years I have found that knowing when to let go is an incredibly useful skill in behavior analytic practice. I now acknowledge that the answer to every challenge is not more of me. Maybe it is less me. Maybe letting go is offering a client more choices, more space, or more free time. We as behavior analysts often want to control the environment like we would an experiment. What if we acknowledged that this control we seek is illusory? I have found that when I do not seek to control the environment in an unrealistic, ham-fisted way, I paradoxically exert a lot more influence within it. People listen to me more. They are happier to see me. It is easier to connect with me because I have integrated more seamlessly into their natural environment.

In closing, behavior analysis and mindfulness look a bit different on the surface but they are more compatible than they seem. If you want to get started on your own mindfulness journey, you can download a guided meditation app on your phone and give it a try. Start small with the number of minutes in meditation and work your way up. Consistency is probably more important than duration in the beginning, so you might want to carve out a few minutes around the same time every day. I typically like to meditate right after I exercise in the morning, which is reinforcing for me. You can also reflect on what aspect of your ABA practice makes you most anxious and implement an antecedent intervention for when worried thoughts creep in. Don’t forget to reinforce your own appropriate behavior when you successfully manage to mitigate anxiety or stick to your meditation schedule. With practice, you can integrate ABA and mindfulness to become a calmer, more confident, and more effective behavior analyst, setting an example that will ripple outward in beneficial ways. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47(1), 16-36.

Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta.

Kabat-Zinn, J. (2021). The liberative potential of mindfulness. Mindfulness, 12(6), 1555-1563.

Sprague, J. R., & Horner, R. H. (1992). Covariation within functional response classes: Implications for treatment of severe problem behavior. Journal of Applied Behavior Analysis, 25(3), 735-745.

Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization 1. Journal of applied behavior analysis, 10(2), 349-367.