A Preliminary Analysis of the Effects of Clicker Training and Verbal Instructions on the Acquisition of Relationship-Building Skills in Two Applied Behavior Analysis Practitioners.

Recent research has emphasized the need for training and competency beyond the standard technical skills acquired by applied behavior analysis (ABA) practitioners, including essential relationship-building and compassionate care skills (Taylor et al., 2019). Clicker training is a well-established behavior-analytic method for improving performance via immediate feedback in the form of an audible "click." The effectiveness of clicker training has not yet been evaluated as a technique for shaping complex clinical repertoires. This study evaluated the effects of verbal instructions, clicker training, and role-play on the acquisition of therapeutic relationship skills in ABA practitioners. Data were obtained as part of a training program conducted within an ABA agency, and the acquisition of target skills was evaluated using a multiple-baseline design across behaviors for two participants. During baseline, participants rarely demonstrated target skills. During training, the procedure resulted in increased engagement in all three target skills for both participants. Skill generalization with respect to untrained and novel scenarios was observed but at levels below mastery. Findings have potential implications for trainers and supervisors seeking efficient, nonintrusive, socially acceptable methods of improving practitioner performance.

Efficacy of a Digital Acceptance and Commitment Therapy Intervention for the Improvement of Self-management Behaviors and Psychological Flexibility in Adults With Cardiac Disease: Protocol for a Single Case Experimental Design.

BACKGROUND: Research indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease. OBJECTIVE: The objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions. METHODS: The digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants' experiences with using the intervention and what factors contribute to or impede successful outcomes. RESULTS: Participant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022. CONCLUSIONS: The findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33783.

Ongoing, Explicit, and Direct Functional Assessment is a Necessary Component of ACT as Behavior Analysis: A Response to Tarbox et al. (2020).

Tarbox et al. (2020) offered preliminary functional analyses and practical guidelines for incorporating acceptance and commitment therapy (ACT) within the scope of practice of applied behavior analysis (ABA). Although we agree that this is a needed goal, the approach taken by the authors gives rise to important conceptual, ethical, and practical concerns that warrant further discussion. In particular, we propose that explicit functional assessment of behavior (FA) is necessary in any intervention said to be ABA, and we wonder about the apparent omission of explicit FA throughout the article. We question what we read as the authors' tacit assertion that the functions of verbal stimuli can be inferred based on behavioral topography, that the function of verbal behavior can likewise be inferred based on form, and that behavior-behavior relations are both causal and predictive of behavior, irrespective of context. Furthermore, we consider whether a number of procedures for functional assessment presented in the article under consideration are consistent with established ABA best practices. Finally, we discuss the extent to which ACT interventions absent explicit FA in ABA interventions introduces the possibility that the interventions may do harm, arguing that further discussion around competence and scope of ethical practice for behavior analysts who wish to incorporate ACT into their work is needed.

Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment.

The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents' autistic children's behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents' ratings of their children's challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children's behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.

First Things First: Parent Psychological Flexibility and Self-Compassion During COVID-19.

The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health. For parents, shaping these processes may help promote family nurturance, support children's prosocial behavior, and provide effective and consistent use of evidence-based parenting "kernels." The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.

An Invitation to Act on the Value of Self-Care: Being a Whole Person in All That You Do.

The emergence of COVID-19 resulted in a sudden, unprecedented change in context that impacted the way behavior analysts live and work worldwide. Any rapidly shifting context requires behavioral flexibility, in addition to the acquisition of new skills and access to resources that foster resilience in the face of practical challenges and uncertainty about the future. Behavior analysts (particularly novice practitioners) may already be vulnerable to burnout (Plantiveau, Dounavi, & Virués-Ortega, 2018) and in need of greater support to adopt protective self-care practices. Such practices will enable them to continue providing effective services to distressed families, while navigating their own challenges. This article seeks to offer behavior analysts some tools and practices drawn from the work of contextual behavior scientists that can promote well-being and resilience. This includes strategies for clarifying and committing to an overarching value of self-care, acting congruently with personal and professional values across many domains of living, and practicing self-compassion in the process.