The efficacy of Focused Acceptance and Commitment Therapy in VA primary care.

Focused Acceptance & Commitment Therapy (FACT) is a brief intervention based on traditional Acceptance and Commitment Therapy (ACT). Although there is a growing body of research on the efficacy of ACT for a variety of populations and disorders, there is little research to date on the use of FACT in group settings. This project is 1 of the first of its kind, as it examines data on psychological flexibility, health and mental health status, and symptom reduction from a 4-week FACT group. Participants in this study were 51 patients who attended this group as part of routine clinical care in a VA integrated primary care and mental health setting. They completed pre- and posttreatment measures of well-being, depression, anxiety, stress, psychological flexibility, and perceptions of physical and mental health functioning. Pre- to posttreatment analyses of variance demonstrated large effects for quality of life, F(1, 51) = 21.29, p < .001, η2 = 0.30, moderate effects for depressive symptoms, F(1, 51) = 11.47, p < .001, η2 = 0.08, and perceptions of mental health functioning (MCS scale), F(1, 51) = 9.67, p = .003, η2 = 0.11, and small effects for perceptions of perceived stress, F(1, 51) = 4.08, p = .04, η2 = 0.03, and physical health functioning (PCS scale), F(1, 51) = 6.60, p = .01, η2 = 0.08. There was a statistical trend for reductions in anxiety, F(1, 51) = 3.29, p = .07, η2 = 0.01, and a nonsignificant effect for psychological flexibility, F(1, 51) = 2.05, p = .16, η2 = 0.04. These data provide initial support for the implementation of a group-based FACT protocol within a VA primary care setting and help to lay a foundation for further, more controlled studies on Group FACT in future research. (PsycINFO Database Record

The Functional Idiographic Assessment Template-Questionnaire (FIAT-Q): Initial Psychometric Properties.

The evidence based assessment (EBA) movement stresses the importance of psychological measures with strong psychometric properties and clinical utility. The Functional Idiographic Assessment Template system (FIAT; Callaghan, 2006) is a functional analytic behavioral approach to the assessment of interpersonal functioning for use with therapies like Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991). While research has begun to demonstrate the clinical utility of the FIAT, its psychometric properties have not been explored. The present study examines the Functional Idiographic Assessment Template-Questionnaire (FIAT-Q), a self-report measure contained in the FIAT. Two different approaches are used to explore the psychometric properties and structure of the FIAT-Q, and test-retest reliability is examined. These methods are discussed along with the use of the FIAT-Q as an alternative to nosological assessment of client behaviors.

Translating the theoretical into practical: a logical framework of functional analytic psychotherapy interactions for research, training, and clinical purposes.

Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement of a client's effective behavior, should be a powerful mechanism of change. However, much of the previous literature on FAP has been theoretical, broadly defining FAP techniques rather than explicating them with the precision necessary for replication and training. In this article, the authors explicate a logical framework for turn-by-turn interactions between the client and therapist that may guide research, training, and dissemination of FAP. This molecular behavioral description of the events of the proposed logical interaction lends itself to microprocess research methodology, and a discussion of potential hypotheses to explore follows. Prescriptive, direct guidance for the application of FAP for training and dissemination purposes is given.

Beyond values clarification: addressing client values in clinical behavior analysis.

Ethical principles of psychology, as exemplified in the American Psychological Association (APA) Code of Ethics (2002), provide impractical advice for addressing client values during psychotherapy. These principles seem to argue that each client's values should be respected and protected at all times, except in cases in which this would result in harm to the client or the general public. Although the code is appropriately designed as a defense against potential and actual abuses of professional power, this general proscription against directly targeting client values for change is based on an understanding of values that grants them special ontological status and has resulted in limited clinical interventions focusing solely on "values clarification." With its strong foundation in a unified philosophical system, clinical behavior analysis offers a sophisticated alternative approach to values that both defines what they are and identifies when they can be ethically targeted to improve the lives of clients.

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy.

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.