Meditation, Yoga and Behavior Science: Some Sarcasm and Science on "Behavioral Xanax"
“Inhale, raise your right leg high….” Why aren’t we studying this empirically? “Exhale, right leg comes through, low lunge….” I mean, this is good stuff. “Inhale to Crescent Lunge…” I’m not even thinking about that terrifying public speaking event. Well, now I am, but… “Exhale, Warrior Two.”
Ahhhhhh… (hour of clarity and peace ensues).
As a behavior science professional for 17 years and a yoga practitioner for nearly as long, I’ve often fantasized about the day when the scientist and yogini within me might exist in the same room. The day I wouldn’t cringe when I heard the words “energy lines”, which I couldn’t observe much less quantify. The day when I might use the words “awareness” or “mindfulness” without feeling a little bit of school-induced guilt. The day when I wouldn’t add mental air quotes when people talked about the “thoughts” in their “mind”.
Interestingly, those days may be approaching more quickly than expected. The behavior analysts of yesterday have grown up to be entrepreneurs, innovators and curious scientists who challenge themselves to create models and birth ideas that aim to serve a larger demographic: Everyone.
In that spirit, a giant, nagging question has developed over my last few years of practicing behavior analysis, yoga, and, most recently, meditation: “How can we expand our lens and use these practices to serve others?” After all, there’s a reason yoga and meditation have become a growing trend- the reinforcement system is off the hook (is that how the kids say it?). My rigorous N=1 study (that’s me) has confirmed and replicated the same findings several times each week: yoga and meditation are critical to our stress response, focus and overall sense of wellbeing. But we are still, at our core, scientists. We must not dare rely on the millions of people trekking to yoga and meditation studios in the rain and snow to get a dose of automatic reinforcement (or is it escape-maintained?). Just kidding. Yes we can. But wouldn’t it be great to have the data, operational definitions, a conceptually systematic approach anyway?
With the help of some data, I chose a population of people who might benefit from marrying behavior analysis and the mindfulness strategies we’ve all heard of (if not experienced ourselves). According to a 2009 study in The Behavior Analyst (Dymond & Roche), prevalence rates of anxiety disorders are between 10.6% and 28.8%. That sounded like a good place to start.
After a few hours of research, three things stood out:
The behavioral research on anxiety is nearly non-existent (Dymond & Roche, 2009), potentially due to challenges in defining criteria (Friman, Hayes & Wilson, 1998) and other empirically unattractive components.
We as behaviorists can, however, approach anxiety in terms of avoidance responses in the presence of a conditioned stimulus and an avoidance- or escape-maintained reinforcement system (2009).
The stigma of mental health and therapy is one of the reasons, if not the primary reason, individuals neglect to seek support. Given this stigma, individuals with anxiety avoid treatment in favor of substances like alcohol or pharmaceuticals which may come with harmful side effects and risk for dependency.
Hi, Behavior Analysis? It’s me, Social Validity. We’ve worked together before. Let me conference in Data and Non-Stigmatizing Treatment Possibilities, I think we have something for you!
Below I include some ways we can start to change the lens on meditation and yoga- low-risk practices entering their own empirical era- to support those who experience workplace anxiety, stagnation in productivity or daily movement, or who would benefit from a full behavior analytic plan for a clinical diagnosis. The repercussions of using and studying behavior analytic meditation and yoga may influence a substantial and socially-significant impact, improve the quality of life for millions of individuals and families, encourage a more productive, engaged workplace and may even, according to the World Health Organization, have a positive impact on economies. Being a sojourner in the nascent marriage of meditation, yoga and behavior analysis, I offer these concepts as a starting point.
Meditation, yoga and breathing techniques are teachable skills that can interrupt the stimulus-response contingency and verbal behavior chains that occur when people experience interfering or disruptive thoughts (although meditation has been found to be more effective in reducing anxiety than breathing techniques in studies with subjective measures like patient surveys).
As anxiety is categorized by a combination of challenging-to-define physical and mental (private state) behaviors, meditation and yoga may be helpful in regulating these behaviors that serve as either a discriminative stimulus or a precursor for general avoidance or anxiety attacks (i.e., controlling a racing heartbeat or identifying an external stimulus may slow or redirect escalation and intrusive verbal behavior chains). Extra points go to the behavior analysts, who are skilled in defining the historically abstract.
Once we teach and train a person to identify, redirect and effectively manage specific behaviors unique to their anxiety, it may be possible to create a learning history that teaches and reinforces appropriate replacement behaviors. This could mean engaging in more objective, data-based and useful verbal behavior (“I have no evidence that this talk will go poorly, I only have evidence of past public speaking engagements going well”) or, ideally, learning new skills to eventually evoke approach behaviors instead of avoidance, prompting a new learning history through replacement behaviors and strong reinforcement under the guidance of a behavior analyst.
Private events matter. Anyone who has ever been fearful, in love, angry, or straight up “hangry" can tell you that their internal states are controlling variables to behavior in some cases. So although it’s difficult to tackle, it’s not impossible.
Although IOA, validity and reliability are important, we underestimate and disempower individuals by not affording them the education and opportunity to identify and track their own feelings and internal states. Other therapeutic interventions do this often, although I would argue that actual training in data collection by a behavioral professional would make a client’s data exponentially more accurate and thus useful in determining antecedent stimuli, frequency, etc.
Sustainability (maintenance), generalization, motivation and reinforcement are elements crucial for effective change; these topics shine in behavior analysis like nowhere else. Teaching others to analyze and manage their own behavior using ABA strategies and other supports like yoga and meditation puts clients ahead of the game by systematically introducing them to non-stigmatizing (and even quite cool) strategies. For example, we know we feel anxious even when someone observing us doesn’t. If a person can take data on a measurable, primarily controlling dimension of their anxiety, that can be used to aid the behavior analyst and, more importantly, set the individual up with a lifelong skill in sustainability by learning to recognize and manage their own internal states (primary tenets in meditation and yoga as well as Acceptance and Commitment Therapy).
If we are bound to facilitating socially-meaningful changes as part of our BCBA ethos, the above points deserve our overly-detailed, analytical attention. We as behaviorists are uniquely equipped to address difficult challenges and therefore positioned to expand our practice to those who need it. After all, who loves torturing themselves for months on end to solve complex problems more than we do? Fortunately, trends and behavioral momentum are on our side. Meditation-goers have grown companies like MNDFL, a New York-based meditation center, into a rapidly expanding businesses with a strong following. Meditation apps have seen a significant increase in the last year. Aetna, a healthcare company with a corporate mindfulness program, estimates $2,000 per employee in healthcare savings and $3,000 in increased productivity. Health and wellness has never been more popular of a topic now that organizations and individuals have the technology and platforms to analyze and disseminate information.
So what if we tackled the air quotes around “meditation” and “yoga” and recognized them as possible, more sustainable parts of a behavior plan or company-wide productivity project? Will we one day be discussing Behavioral Xanax? Yogaceuticals? Meditation Medication? Or, for the nerds (me), “building fluency in the skills necessary to redirect covert behavior chains and regulate physiological actions in order to allow the opportunity for sustainable access to reinforcement through a more appropriate replacement behavior”.
Some critics accuse Skinner of being overly inflammatory and optimistic about the possibilities of behavior analysis, but I disagree. We have not done nearly enough empirical research in other applications of our science to confirm or deny his hopes. As behavioral science grows to be more sophisticated, and as more applied behaviorists are chomping at the bit to serve larger demographics, we will experience growing pains. But given our current technological and innovative climate, I truly believe behavioral science has only begun to explore it’s applications.
“It is not a question of starting. The start has been made. It's a question of what's to be done from now on.”
Dymond, S., & Roche, B. (2009) A Contemporary Behavior Analysis of Anxiety and Avoidance The Behavior Analyst, 32, 7-27
Frieman, P.C., Hayes, S.C., & Wilson, K.G. (1998). Why behavior analysts should study emotion:The example of anxiety. Journal of Applied Behavior Analysis, 31, 137-156