A Winding Road: Reconciling What Seemed Incompatible

3

Dear blog reader,

Our next contributor is a brilliant and creative behavior scientist based in Ireland, Dr Michelle Kelly. Dr Kelly’s research story is another great example of the message we are trying to promote during this series – the benefits of cooperation and collaboration, and of breaking out of our silos. We hope you have been getting a sense from the fantastic stories of the contributors to this series so far just how much more we have to learn and offer together than we do apart. Dr Kelly is one more excellent example of this effort and of the kind of people in our field doing amazing and impactful work across disciplines, but with firm behavior-analytic roots.

Much out of my own ignorance (Colin’s ignorance that is, not Dermot’s!), before knowing Michelle, I did not have much exposure to, or even think much of, how behavior analysis could be applied to the area of cognitive decline and dementia. And indeed, as readers of this blog series likely firmly agree, behavior analysis has much to offer all corners of the human behavioral experience. So it will come as no surprise that the work Michelle is doing in this domain is having an impact. Of course, she is not the only person doing this work, but she is one phenomenal example. Perhaps Michelle and her story will inspire many of you who, like me, did not give much thought before to the possibilities behavior analysis has to offer this domain, nor to how both behavior analysts and cognitive psychologists may jointly positively contribute to this effort. You will quickly see from Michelle’s story just how important varied perspectives can be, particularly when working in applied contexts. As Michelle says herself, diversity is our greatest asset.

Well, enough out of us, check it out for yourself!

Colin and Dermot

Author bio:

Dr Michelle Kelly graduated from Maynooth University with a BA Hons degree in Psychology in 2006; and with a doctorate in Psychological Science (Applied Behaviour Analysis and Therapy) in 2011. She completed a postdoc with the NEIL Programme in Trinity College’s Institute of Neuroscience (TCIN) and the Alzheimer Society of Ireland (2011-2014), where she was responsible for the research and development of evidence-based brain health interventions for older adults and people with dementia. Michelle took up a lecturing post in psychology and behaviour analysis in Maynooth University from 2014-2017, before subsequently moving to the National College of Ireland (NCI). Michelle is an Associate Professor in the Psychology Department in NCI and co-directs the ProBrain Research Lab. She is a PI on research projects funded by the Irish Research Council (IRC) and the Alzheimer’s Society of Ireland, and contributes to research and clinical placement supervision in Trinity College Dublin, Galway University, Maynooth University, and the International CST Centre in University College London. Michelle is the Chair of the NCI Psychology Ethics Subcommittee, Chair of the Psychological Society of Ireland’s (PSI) Division of Behaviour Analysis (DBA), a member of the PSI Undergraduate and Postgraduate Accreditation Committees, and an editorial board member for Behaviour Analysis in Practice.

A Winding Road: Reconciling What Seemed Incompatible

There is such value in varying perspectives, interests and approaches. For a long time, I thought that I was doing something wrong by deviating from the more obvious or traditional academic endeavours of a behaviour analyst, and I was conscious that a quick glance at my list of publications would easily expose me! Now, maybe because there is a certain comfort that comes with experience, I embrace that difference.

Michelle and her twin sister Amanda

I grew up in a rural part of the midlands in Ireland with my parents and my identical twin sister. My sister and I have always been very close and very competitive. We did everything together so it seemed natural that we would pursue the same degree and doctorate. I realise now that was somewhat unusual but our competitive spirit meant we constantly motivated each other, so we worked hard and efficiently, which gave us an edge in our academic endeavours. Work always interested us; we picked up odd jobs from age 12 and were waiting tables by age 15. Even with that, I don’t know how our parents managed the financial burden of putting us through college. Maynooth was the perfect campus because it was near home and quite rural. At the time I didn’t understand or appreciate how lucky we were, not only to be in college and living on campus, but also to be in a department with such world-renowned behaviour analysts. Like most young people, that appreciation only comes later.

Prof Dermot-Barnes Holmes (founding professor and Chair of the department) and Dr Yvonne Barnes-Holmes were both teaching on the undergrad course in Maynooth then, and their lectures had a profound impact on my academic journey. Yvonne’s classes captivated me. She told us stories about her clinical work and how behaviour analytic techniques could be used to support young students with learning disabilities. She taught us about Acceptance and Commitment Therapy (ACT) through practical demonstrations akin to group therapy sessions. I was hooked. Dermot’s classes focused on experimental behaviour analysis and relational frame theory (RFT). As a young undergrad, I found those classes more difficult to grasp. He seemed to be speaking another language, one that I didn’t quite understand but I knew I wanted to become fluent in. I completed my undergraduate dissertation under Yvonne’s supervision and doctoral dissertation under Dermot’s supervision. For undergrad, I contributed to early research efforts examining the fake-ability of the Implicit Relational Assessment Procedure (IRAP; Barnes-Holmes et al., 2006), and for the doctorate, I used the IRAP to compare mainstream and behaviourally-trained teachers’ relational responses in the context of words describing ‘good’ and ‘bad’ behaviours (Kelly & Barnes-Holmes, 2015).

Michelle amongst the rest of her cohort graduating with her doctorate in Psychological Science (Behaviour Analysis and Therapy) in 2011. On the far left of the photo is Dr Carol Murphy, while on the far right are Drs Yvonne and Dermot Barnes-Holmes.

The doctorate in Psychological Science (Behaviour Analysis and Therapy) in Maynooth allowed me to focus wholly on behavioural science, and to apply the skills learned in the classroom in an applied setting. I worked with autistic children in a special school for four days per week and attended college on the other day. The doctorate was developed and run by Dermot and Yvonne, with the support of Dr Carol Murphy who later took over as course director. Again, I was steeped in luck. Carol has an incredible intellectual mind and her work with ‘the little ones’ (as she affectionately called the autistic learners she supported) was inspiring to say the least. Above everything else, Carol taught me how to be an ethical practitioner. She was also very supportive and encouraged me to ‘think big’ when considering the next steps for my career. I recall asking Dermot at the end of the doctorate what he thought I should do next. I was more than a little uncertain and valued my mentors’ opinions. He suggested that a career in academia would be a good option. I had wanted to be a lecturer from the moment I started college so that was music to my ears.

By this point I was fluent in the language of behaviour analysis and RFT. I would get so deep in thought contemplating how RFT could explain language and thinking, and how the IRAP could give us a snapshot of how our verbal learning histories influenced those in-the-moment responses. The more I knew about RFT and the IRAP the more I began to see every interaction, thought, and conversation in terms of relational responding. Once you start seeing the world like that you can’t un-see it! This made me appreciate the complexity of language acquisition so much. I was in awe of my sons language development; demonstrating mutual or combinatorial entailment, moving from non-arbitrary to arbitrarily applicable relational responding (AARRing), and advancing down the levels of complexity in relational responding from basic relational framing to relating-relational networks  (and finally being able to tell a decent joke!). These everyday situations still fascinate me. I otherwise might take them for granted.

Michelle and her sister Amanda either side of Dermot Barnes-Holmes on the day of their PhD graduation ceremony. Yvonne Barnes-Holmes can be seen on the far left.

A few months after graduating from the doctorate (2011), I secured a postdoc position with the Alzheimer’s Society of Ireland and the Institute of Neuroscience in Trinity College Dublin (TCD). I wanted to use behaviour analysis in different ways with diverse populations, and this was my chance. What a change this was. I entered a world of cognitive ageing and neuropsychology and I began to learn everything I could about dementia. The experience the postdoc afforded me was incredible and I quickly realised that research on brain health and dementia was what I wanted for my career. Although I loved the role of Early Intervention Coordinator, it took me a long time to understand how behaviour analysis fit in that bigger picture. I doubted myself and my suitability for the job. Perhaps others did too. A senior academic in the Institute once suggested that I apply for a PhD in cognitive psychology despite knowing I had just completed a doctorate in behaviour analysis and therapy. I didn’t have the time, money or energy to consider that at the time, but I also didn’t think it was necessary. Still though, the already looming imposter syndrome seriously ramped up and the old saying “jack of all trades but master of none” frequently came to mind.

My perspective is very different now. I am certain that there is great value in understanding both cognitive and behavioural psychology, especially in my line of work with people with dementia. This shift in perspective happened gradually. Initially I was inspired by Barbara Wilson’s work; she is a behaviourally trained clinical neuropsychologist who has written often about importance of behavioural and functional approaches in neuropsychological rehabilitation (e.g., Wilson, 2014). I knew of other clinical colleagues with behavioural training working in brain injury also, so I thought the dementia rehabilitation route was at least worth a shot. I read everything I could about behavioural gerontology (e.g., LeBlanc et al., 2011; Moniz-Cook et al., 2012; Trahan et al., 2011) and was intrigued by descriptions of how behaviour analysis supported positive outcomes for the aging population. On that note, I highly recommend Skinner’s book on ageing entitled “Enjoy Old Age: A Practical Guide”; it’s a light-hearted and enjoyable read. In 2014, I returned to Maynooth for a lecturing position and spent hours talking with Carol and Dermot about behaviour analysis, cognition and ageing. I was also lucky to have maintained a network of wonderfully supportive colleagues working in cognitive disciplines. All of these experiences afforded me a certain comfort with my ‘identity’ as a behavioural gerontologist specialising in brain health and dementia.

Behavioural gerontology literature tends to focus on interventions for moderate to later stage dementia, when responsive behaviours or communication difficulties are more common. I believe that behaviour analysis can offer so much more in terms of rehabilitation for those with mild cognitive impairment or early stage dementia. Understanding basic and advanced levels of AARRing provides important insights into complex language and cognitive abilities, but the development of the multi-dimensional, multi-level (MDML) framework (Barnes-Holmes et al., 2017) and then the hyper dimensional multi-level framework (HDML; Barnes-Holmes et al., 2020) has advanced this much further. This work provides a roadmap for assessment and intervention of complex higher-order cognitive processes. I have already written about this at length (Kelly, 2020) so I’ll keep it brief here, but basically when we consider core executive functions in terms of complex and flexible AARRing, we have a specific and measurable way of intervening to support positive outcomes for people experiencing difficulties with everyday functional tasks (e.g., in early stage dementia). Aside from this, behavioural strategies like task analysis, shaping, chaining, discrimination training, multiple exemplar training, reinforcement… (I could go on) are hugely beneficial approaches in cognitive rehabilitation interventions (e.g., see Kelly et al., 2017, Table 1 for an example). Behavioural psychologists have appropriate skills to deliver these types of rehabilitative interventions but might naturally shy away from this type of work as it is less common in our field. In an exciting new project funded by The Alzheimer Society of Ireland, we[1] are recruiting MSc students studying ABA in Trinity College and the University of Galway to complete placements delivering cognitive rehabilitation to people attending the memory clinic in Tallaght University Hospital.  The hope is to continue advancing this work to include more complex cognitive-training-type interventions that build on recent developments with the HDML.

Michelle pictured with Dr Caoimhe Hannigan (left), co-director of the ProBrain Research lab, and Dr Conor Nolan (right), assistant  professor in Psychology at NCI.

These days, I am an associate professor at the National College of Ireland (NCI), and with my close friend and colleague from my time at TCD, Dr Caoimhe Hannigan (now also at NCI), we co-direct the ProBrain Research Lab where behavioural psychology and cognitive aging/neuropsychology come together in meaningful and productive ways. Well, we think so anyway! One of the undergrad modules I teach is cognitive psychology, which is somewhat ironic but I enjoy it. The students get a well-rounded perspective at least! One thing that bothers me is when mainstream psychology textbooks describe the cognitive revolution as ‘the end of behaviourism’ and don’t elaborate any further (e.g., Miller, 2003 states that “Behaviorism was an exciting adventure for experimental psychology but by the mid-1950s it had become apparent that it could not succeed”). Undergraduate psychology students are often left with the impression that behaviourism died, never to be seen again. As recognised by this blog series, that kind of “we’re-right-and-they’re-wrong” mind set in any discipline is problematic and promotes the idea that we should be researching and practising in silos. In my classes, students instead learn about how advances in behaviourism continue to provide comprehensive and widely accepted behavioural accounts of language and thought. We discuss how complementary these approaches can be and how important varied perspectives are for working in applied contexts. If I have learned anything from my academic journey so far, it’s that the road less travelled is often the most interesting and that diversity is our greatest asset.

[1] The ProBrain Lab in the Psychology Department of the National College of Ireland in collaboration with research partners in Tallaght University Hospital

References

Barnes-Holmes, D., Barnes-Holmes, Y., and McEnteggart, C. (2020). Updating RFT (more field than frame) and its implications for process-based therapy. Psychol. Record 2020, 1–20. doi: 10.1007/s40732-019-00372-3

Barnes-Holmes, D., Barnes-Holmes, Y., Luciano, C., and McEnteggart, C. (2017). From the IRAP and REC model to a multi-dimensional multi-level framework for analyzing the dynamics of arbitrarily applicable relational responding. J. Context. Behav. Sci. 6, 434–445. doi: 10.1016/j.jcbs.2017.08.001

Wilson, Barbara A. Thinking about Neuropsychological Rehabilitation: An Interview with Barbara Wilson Revista Chilena de Neuropsicología, vol. 9, núm. 1, 2014, pp. 4-7

LeBlanc, L. A., Raetz, P. B., & Feliciano, L. (2011). Behavioral gerontology. In W. W. Fisher, C. C. Piazza, & H. S. Roane (Eds.), Handbook of applied behavior analysis (pp. 472–486). The Guilford Press.

Trahan MA, Kahng S, Fisher AB, Hausman NL. Behavior-analytic research on dementia in older adults. J Appl Behav Anal. 2011 Fall;44(3):687-91. doi: 10.1901/jaba.2011.44-687. PMID: 21941406; PMCID: PMC3177357.

Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis‐based interventions for challenging behaviour in dementia. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD006929. DOI: 10.1002/14651858.CD006929.pub2. Accessed 19 February 2024.