An EST for IP: 
Behavior Experiments

by Rocky Garrison, Ph.D.

Behavior experiments (BE) are “… planned experiential activities, based on experimentation or observation, which are undertaken by patients in or between cognitive therapy sessions…” with three purposes: (1) test the validity of the patients’ existing beliefs about themselves, others, and the world, (2) construct and/or test new, more adaptive beliefs, (3) contribute to the development and verification of the cognitive formulation (Bennett-Levy, et al., 2004, p. 8).  They are a specific type of homework that is included in many CBT treatments, but, like thought records, there is little research on their efficacy as a standalone treatment.  Two studies compared the therapeutic impact of BEs with thought records, finding that BEs are slightly more effective at changing beliefs (McManus, Van Doorn, & Yiend, 2011) and that BEs are perceived by clients as more powerful than TRs (Bennet-Levy, 2003).

The EST.  The foundation for a BE is a prediction that is inherent in a mistaken belief or private logic.  Listening for these predictions and reframing mistaken beliefs into predictions are essential skills in using BE.  Once a mistaken belief and related prediction are collaboratively defined, the BE intervention begins with an orientation of the client to the treatment, providing a description of the process and the treatment rationale, and obtaining their informed consent.  The collaborative definition of the BE includes specifying (1) the target cognition, (2) an alternative perspective, and (3) the prediction, as illustrated in this case:

Problem.  Frank thought he had a defective memory and therefore had to keep checking doors, switches, etc.  He reasoned that even slight uncertainty meant that there was a risk that the action had been left undone and that the consequences could be catastrophic.  He believed everyone else would always be 100% sure of having done such actions.

Target cognition.  I must be able to remember with absolute certainty that I have locked the door; if I cannot remember it, I probably have not done it (belief rating 100%).

Alternative perspective.   It is normal to be unable to remember doing such everyday actions.

Prediction.  Everyone else will be able to remember actions such as locking the door or turning off taps.  Bennett-Levy, et al., 2004, p. 114)

This prediction led to an experiment in which Frank and the therapist each surveyed 12 people, asking if they could remember locking their door when they left home.  The results helped Frank realize his memory was not defective and became a cornerstone for disputing other instances of Frank’s intolerance of uncertainty private logic.

There are a variety of types of BEs, limited only by the creativity of the therapist.  One typology identifies two designs: (1) hypothesis-testing experiments and (2) discovery experiments, and several types: (1) in-vivo, (2) simulated (e.g., role play), (3) direct observation, (4) surveys, and (5) information gathering from other sources (Bennett-Levy, et al., 2004).  

Most CBT treatments are designed to treat a cluster of symptoms, usually defined by DSM 5 (American Psychiatric Association, 2022), but the BE focus on a mistaken belief allows an Individual Psychology practitioner to respect the uniqueness of their client.  My experience has been that the process of specifying a mistaken belief and then disputing it in an overt style with data creates an anchor point to refer to as more instances of the mistaken belief in action emerge.  The experiment becomes a condensed reminder of the disputation: “Remember the surveys we did?”

REFERENCES

American Psychiatric Association (Ed.).  (2022).  Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision).  American Psychiatric Association. Publishing.

Bennett-Levy, J. (2003).  Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experiments.  Behavioural and Cognitive Psychotherapy, 31(3), 261-277.

Bennett-Levy, J. E., Butler, G., Fennell, M., Hackman, A., Mueller, M., & Westbrook, D. (Eds.) (2004), Oxford guide to behavioural experiments in cognitive therapy.  Oxford University Press.

McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of behavior therapy and experimental psychiatry, 43(1), 540-547.