How to Build and How not to Build an Implicit Measure in Behavior Analysis: A case Study Using the Function Acquisition Speed Test.

This article provides a comprehensive overview of the development of a behavior-analytic alternative to the popular implicit association test (IAT), namely, the function acquisition speed test (FAST). The IAT appears, prima facia, to indirectly assess participants' learning histories with regard to the categorization of stimuli. However, its origin within cognitive psychology has rendered it replete with mentalism, conceptual ambiguity, statistical arbitrariness, and confounding procedural artifacts. The most popular behavioral alternative to the IAT, the widely used implicit relational assessment procedure (IRAP), has inherited many of these concerning artifacts. In this article, we present a behavior-analytic critique of both the IAT and IRAP, and argue that a behavior-analytic approach to implicit measures must have stimulus control front and center in its analysis. We then outline a series of early research studies that provided the basis for a potentially superior procedure within our field. We go on to outline how this early research was harnessed in stepwise research, guided by a strict adherence to traditional behavior-analytic methods for the analysis of stimulus relations, to increasingly modify a test format fit for the behavior analyst interested in assessing stimulus relatedness.

A Process-Based Analysis of Cognitive Defusion in Acceptance and Commitment Therapy.

Cognitive defusion is among the main components of Acceptance and Commitment Therapy (ACT), a contextual behavioral approach to psychotherapy. Defusion serves as a middle-level term, and, as such, may be useful for applying and disseminating behavior science, despite its lower precision. However, some authors argue that for middle-level terms in psychotherapy to be useful to clinicians, they need to be clearly linked to basic behavioral concepts, with higher precision; and that this is not currently the case with defusion. Our objective is to increase the pragmatic utility of the concept of "cognitive defusion" by providing a more nuanced, multifaceted and process-based definition of the term. In order to do this, we surveyed the ACT literature regarding defusion and critically examined it through the lens of conceptual analysis. This culminated in a revised and updated conceptualization of defusion in terms of its relationship to basic behavioral concepts, in which defusion is an outcome that may be achieved through different processes.

ACT: A Process-Based Therapy in Search of a Process.

A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.

Strengthening Mental Abilities with Relational Training (SMART) in multiple sclerosis (MS): study protocol for a feasibility randomised controlled trial.

BACKGROUND: Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions-such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need-and recognised research priority-for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS-requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing-and examining the feasibility of trialling-a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning. METHODS: The primary objective of this study aims to conduct a feasibility study to inform the development of a definitive trial of SMART for improving cognitive functioning in people with MS. The secondary objective is to develop the framework for a cost-effectiveness analysis alongside a definitive trial, and the exploratory objective is to assess the signal of efficacy. DISCUSSION: As a feasibility trial, outcomes are unlikely to immediately effect changes to NHS practice. However, this is a necessary step towards developing a definitive trial-and will give us a signal of efficacy, a prerequisite for progression to a definitive trial. If found to be clinically and cost-effective, the latter trial could create a step-change in MS cognitive rehabilitation-improving service delivery and optimising support with limited additional resources. TRIAL REGISTRATION: Registration ID: ClnicalTrials.gov: NCT04975685-registered on July 23rd, 2021. PROTOCOL VERSION: 2.0, 25 November 2021.

Usability and acceptability of a cognitive training intervention (SMART) for people with multiple sclerosis (MS): A prefeasibility formative evaluation.

Background: Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. Methods: This study aimed to test the usability and acceptability of a computerised cognitive training intervention-Strengthening Mental Abilities Through Relational Training (SMART) -for people with MS, through a mostly qualitative prefeasibility design ( n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol ( n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement ( n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results: Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. Conclusions: This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis.

AIMS: We are developing a new 'brain training' treatment to help people with multiple sclerosis (MS) who have problems with thinking skills ( e.g., problem-solving, attention, and memory). This study aimed to test whether the training (called 'Strengthening Mental Abilities Through Relational Training' ['SMART']) is suitable for people with MS. Specifically, we assessed whether SMART was easy to use and acceptable for use in their everyday lives. BACKGROUND: MS is a long-term condition that affects the nervous system, with the number of cases increasing in both developed and developing countries. MS affects an individual's thinking skills, which can affect their ability to go about their everyday lives. Brain training has potential for improving thinking skills in people with MS, provided ease of use and factors impacting willingness to use the training are explored. Design and methods used: This study used a mix of methods, such as scores from objective tests and verbal feedback, to explore whether SMART is easy to use and acceptable for people with MS. The study had two phases: think-aloud interviews (participants provided feedback on whether the training interface and guidance were easy to use) and then the alpha-testing phase (participants tested the training over time, and then gave feedback on acceptability). Common and salient themes were identified in both phases. RESULTS: Participants found SMART to be suitably easy to use and acceptable for use by people with MS. Participants thought that the interface was visually appealing, and easy to operate and navigate. Participants made minor suggestions for improving the intervention, but feedback was generally positive, despite demands on time and energy. DISCUSSION: SMART appears to be suitable for people with MS. We conclude that we can go ahead with the next phase of testing SMART, as a possible treatment for improving thinking skills in people with MS.

Transitions from avoidance: Reinforcing competing behaviours reduces generalised avoidance in new contexts.

Generalised avoidance behaviours are a common diagnostic feature of anxiety-related disorders and a barrier to affecting changes in anxiety during therapy. However, strategies to mitigate generalised avoidance are under-investigated. Even less attention is given to reducing the category-based generalisation of avoidance. We therefore investigated the potential of an operant-based approach. Specifically, it was examined whether reinforcing competing (non-avoidance) behaviours to threat-predictive cues would interfere with the expression of generalised avoidance. Using a matching-to-sample task, artificial stimulus categories were established using physically dissimilar nonsense shapes. A member of one category (conditioned stimulus; CS1) was then associated with an aversive outcome in an Acquisition context, unless an avoidance response was made. Next, competing behaviours were reinforced in response to the CS1 in new contexts. Finally, we tested for the generalisation of avoidance to another member of the stimulus category (generalisation stimulus; GS1) in both a Novel context and the Acquisition context. The selective generalisation of avoidance to GS1 was observed, but only in the Acquisition context. In the Novel context, the generalisation of avoidance to GSs was significantly reduced. A comparison group (Experiment 2), which did not learn any competing behaviours, avoided GS1 in both contexts. These findings suggest that reinforcing competing behavioural responses to threat-predictive cues can lead to reductions in generalised avoidance. This study is among the first study to demonstrate sustained reductions in generalised avoidance resulting from operant-based protocols, and the clinical and research implications are discussed.

Measuring differential nodal distance using the function acquisition speed test.

Increasing evidence suggests that the relatedness of stimuli within the Function Acquisition Speed Test (FAST) methodology is sensitive to the learning histories of participants. For example, this method is sensitive to differences in the amount of baseline training provided to establish stimulus equivalence relations using arbitrary stimuli (Cummins et al., 2018a). However, it has not yet been investigated whether the relatedness of stimuli within the FAST varies based on differential nodal distances between stimuli within stimulus classes. If so, the FAST could serve an important adjunct assessment procedure for researchers who wish not only to assess the formation of stimulus classes using traditional methods, such as matching-to-sample, but also the relative relatedness of stimuli within complex stimulus classes (i.e., nodal distance). The current study sought to investigate this possibility. Participants (n = 16) were trained in the formation of two 4-member equivalence classes consisting of arbitrary nonsense syllables. Following this, participants completed three FAST assessments, each of which probed for the relatedness of stimulus pairs of differing nodal distance. Group- and individual-level analyses broadly demonstrated that relatedness varied as a function of nodal distances in pre-trained stimulus classes. However, results also highlighted some limitations of the FAST at the individual level.

The Relational Abilities Index+: Initial Validation of a Functionally Understood Proxy Measure for Intelligence.

The Relational Abilities Index (RAI) has shown considerable utility as a functional proxy measurement of intellectual performance by providing a metric of an important skill set known as relational skills, which are proposed to underlie much of what we conceive of as intellectual behavior. The Relational Abilities Index+ (RAI+) assesses performance across an extended range of relational skills (Same/Opposite, More/Less, Same/Different, Before/After, and Analogy), and has been designed to provide a more comprehensive and nuanced assessment of relational skills. The current study aims to investigate the validity and utility of the RAI+ by assessing its degree of correlation with well-established assessments of intelligence (WASI), numeracy (WAIS: Arithmetic), and educational attainment (WIAT-T-II). Results indicate that the RAI+ displays considerable efficacy in predicting intellectual performance and numeracy, but not educational attainment.

MINDflex Training for Cognitive Flexibility in Chronic Pain: A Randomized, Controlled Cross-Over Trial.

Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training (CCT) program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted.

Profiles of Psychological Flexibility: A Latent Class Analysis of the Acceptance and Commitment Therapy Model.

There exists uncertainty for clinicians over how the separate subcomponent processes of psychological flexibility, a core construct of the Acceptance and Commitment Therapy model, interact and influence distress experienced. The present study (N = 567) employed latent class analysis to (a) identify potential classes (i.e., subgroups) of psychological flexibility based on responses on measures of key subcomponent process and (b) examine whether such classes could reliably differentiate levels of self-reported psychological distress and positive and negative emotionality. We found three distinct classes: (a) High Psychological Flexibility, (b) Moderate Psychological Flexibility, and (c) Low Psychological Flexibility. Those in the Low Psychology Flexibility class reported highest levels of psychological distress, whereas those in the High Psychological Flexibility class reported lowest levels of psychological distress. This study provides a clearer view to clinicians of the profile of the broader spectrum of the psychological flexibility model to facilitate change in clients.

The relationship between differential stimulus relatedness and implicit measure effect sizes.

Implicit measures have been hypothesized to allow researchers to ascertain the existence and strength of relations between stimuli, often in the context of research on attitudes. However, little controlled behavioral research has focused on whether stimulus relations, and the degree of relatedness within such relations, are indexed by implicit measures. The current study examined this issue using a behavior-analytic implicit-style stimulus relation indexing procedure known as the Function Acquisition Speed Test (FAST). Using a matching-to-sample (MTS) procedure to train stimulus equivalence relations between nonsense syllables, the number of iterations of the procedure was varied across groups of participants, hence controlling stimulus relatedness in the resulting equivalence relations. Following final exposure to the MTS procedure, participants completed a FAST. Another group of participants was exposed to a FAST procedure with word pairs of known relatedness. Results showed that increasing relatedness resulted in a linear increase in FAST effect size. These results provide the first direct empirical support for a key process-level assumption of the implicit literature, and offer a behavior-analytic paradigm within which to understand these effects. These results also suggest that the FAST may be a viable procedure for the quantification of emergent stimulus relations in stimulus equivalence training.

Related to Anxiety: Arbitrarily Applicable Relational Responding and Experimental Psychopathology Research on Fear and Avoidance.

Humans have an unparalleled ability to engage in arbitrarily applicable relational responding (AARR). One of the consequences of this ability to spontaneously combine and relate events from the past, present, and future may, in fact, be a propensity to suffer. For instance, maladaptive fear and avoidance of remote or derived threats may actually perpetuate anxiety. In this narrative review, we consider contemporary AARR research on fear and avoidance as it relates to anxiety. We first describe laboratory-based research on the emergent spread of fear- and avoidance-eliciting functions in humans. Next, we consider the validity of AARR research on fear and avoidance and address the therapeutic implications of the work. Finally, we outline challenges and opportunities for a greater synthesis between behavior analysis research on AARR and experimental psychopathology.

Transforming valences through transitive inference: How are faces emotionally dissonant?

Information that is emotionally incongruous with self-concepts can produce feelings of unease. This implies that embedding incongruous information in newly formed relational structures would have little effect on their previous emotive properties. Alternatively, Relational Frame Theory highlights the importance of contextualized stimulus-stimulus relations, where the structure of a relational series is key in determining the function of its elements. To see whether series membership can mitigate 'dissonance' when a salient element is employed, the present investigation trained and tested a seven-term relational series (X>A>B>C>D>E>Y) using blurred faces as stimuli. Specifically, Stimuli X, A, B, D, E and Y were blurred unfamiliar faces and Stimulus C constituted of the participant's own blurred face, assumed to be more salient than the former. To assess how the valences of the related stimuli were transformed by relational series membership, self-report ratings and electroencephalographic (EEG) recordings were collected before and after training the X>A>B>C>D>E>Y series. These pre vs. post contrasts revealed that, for unfamiliar faces, stimulus valence transformed as a function of relational structure. Conversely, the lack of difference in pre vs. post contrasts of Stimulus C, which maintained a high valence, suggest that relational series membership may not suffice to mitigate emotionally dissonant information.

Generalisation of fear and avoidance along a semantic continuum.

Directly conditioned fear and avoidance readily generalises to dissimilar but conceptually related stimuli. Here, for the first time, we examined the conceptual/semantic generalisation of both fear and avoidance using real words (synonyms). Participants were first exposed to a differential fear conditioning procedure in which one word (e.g., "broth"; CS+) was followed with brief electric shock [unconditioned stimulus (US)] and another was not (e.g., "assist"; CS-). Next, an instrumental conditioning phase taught avoidance in the presence the CS+ but not the CS-. During generalisation testing, synonyms of the CS+ (e.g., "soup"; GCS+) and CS- (e.g., "help"; GCS-) were presented in the absence of shock. Conditioned fear and avoidance, measured via skin conductance responses, behavioural avoidance and US expectancy ratings, generalised to the semantically related, but not to the semantically unrelated, synonyms. Findings have implications for how natural language categories and concepts mediate the expansion of fear and avoidance repertoires in clinical contexts.

Learned, instructed and observed pathways to fear and avoidance.

BACKGROUND AND OBJECTIVES: Conditioned fear may emerge in the absence of directly experienced conditioned stimulus (CS)--unconditioned stimulus (US) pairings. Here, we compared three pathways by which avoidance of the US may be acquired both directly (i.e., through trial-and-error instrumental learning) and indirectly (i.e., via verbal instructions and social observation). METHODS: Following fear conditioning in which CS+ was paired with shock and CS- was unpaired, three separate groups of participants learned by direct experience (Instrumental-learning), were instructed about (Instructed-learning), or observed (Observational-learning) a demonstrator performing an avoidance response that canceled upcoming US (shock) presentations. Groups were then tested in extinction with presentations of the directly experienced CS+ and CS-, and either a novel CS (Instrumental and observational groups) or an instructed CS (instructed-group). RESULTS: Similar to instrumental learning, results demonstrate that avoidance may be acquired via instructions and social observation in the absence of directly learning that an avoidance response prevents the US. Retrospective US expectancy ratings were modulated by the assumed presence or absence of avoidance. Overall, these findings suggest that instrumental-, instructed-, and observational-learning pathways to avoidance in humans are similar. LIMITATIONS: Alternative experimental designs would permit direct comparison between the pathways for stimuli with no prior experience of fear conditioning, and trial-by-trial US expectancy ratings would help track the modulation of fear by avoidance pathway. CONCLUSIONS: Instrumental-, instructed-, and observational-learning pathways of avoidance are similar. Findings may have implications for understanding the etiology of clinical avoidance in anxiety.

A derived transformation of emotional functions using self-reports, implicit association tests, and frontal alpha asymmetries.

Research on the derived transformation of stimulus functions (ToF) typically employs single dependent measures for assessing the stimulus functions after derived relations have been established. For the first time, we examined ToF using three dependent measures both prior to and after relational training and testing. Specifically, we employed self-reports, implicit association tests, and frontal alpha asymmetry as pre versus post measures for assessing ToF. First, we trained two abstract shapes as contextual cues for happier-than and unhappier-than relations, respectively. Next, four conditional discriminations (A+/B-, B+/C-, C+/D-, and D+/E-) were trained in the presence of the happier-than cue only, where A, B, C, D, and E were blurred faces. This was followed by tests for contextually controlled transitive inference (TI) in the presence of both the happier-than and unhappier-than cues. For the participants who demonstrated TI, performance across all three measures following relational training and testing indicated that the "happiness" functions of the A/B stimuli were greater than those of the D/E stimuli. This constitutes the first known demonstration of emotional ToF along explicit, implicit, and neurophysiological measures concurrently.

Fear Generalization in Humans: Systematic Review and Implications for Anxiety Disorder Research.

Fear generalization, in which conditioned fear responses generalize or spread to related stimuli, is a defining feature of anxiety disorders. The behavioral consequences of maladaptive fear generalization are that aversive experiences with one stimulus or event may lead one to regard other cues or situations as potential threats that should be avoided, despite variations in physical form. Theoretical and empirical interest in the generalization of conditioned learning dates to the earliest research on classical conditioning in nonhumans. Recently, there has been renewed focus on fear generalization in humans due in part to its explanatory power in characterizing disorders of fear and anxiety. Here, we review existing behavioral and neuroimaging empirical research on the perceptual and non-perceptual (conceptual and symbolic) generalization of fear and avoidance in healthy humans and patients with anxiety disorders. The clinical implications of this research for understanding the etiology and treatment of anxiety is considered and directions for future research described.

Acquired equivalence and generalized suppression in a virtual reality environment.

Acquired equivalence was investigated using a virtual reality conditioned suppression task administered in a first-person-shooter game. Two visual cues, A1 and B1, were followed by a tone (O1), and another two cues, A2 and B2, were followed by another tone (O2). During differential Pavlovian conditioning, A1 was paired with an instructed unconditioned stimulus (US) consisting of a flashing white screen, whereas A2 was not. All cues and outcomes were then presented at test, in the absence of the US, and suppression ratios were calculated for multiple response topographies (shots, hits, and breaks). Clear evidence of the suppression of shots was seen for A1 and B1, with no suppression being seen for either A2 or B2. Presentations of O1 and O2 resulted in significant suppression of shots and hits, whereas only O1 led to the suppression of breaks. The US expectancy ratings were consistent with these behavioral results. The findings are discussed in the light of differing accounts of acquired equivalence.

The spread of fear: symbolic generalization mediates graded threat-avoidance in specific phobia.

Overgeneralization of fear and threat-avoidance represents a formidable barrier to successful clinical treatment of anxiety disorders. While stimulus generalization along quantifiable physical dimensions has been studied extensively, less consideration has been given to symbolic generalization, in which stimuli are indirectly and arbitrarily related. The present study examined whether the magnitude and extent of symbolic generalization of threat-avoidance and threat-beliefs differed between spider-phobic and nonphobic individuals. Initially, participants learned two sets of stimulus equivalence relations (A1 = B1 = C1; A2 = B2 = C2). Next, one cue (B1) was established as a conditioned stimulus (CS + ; threat) that signalled onset of spider images and prompted avoidance, and another cue (B2) was established as a CS- (safety cue) that signalled the absence of such images. Subsequent testing showed that phobics compared to nonphobics exhibited greater symbolic generalization of threat-avoidance to threat cues A1 and C1 (indirect CS+ threat cues related via symmetry and equivalence, respectively), while all individuals showed nonavoidance to indirect safety cues A2 and C2. The enhanced symbolic generalization of threat-beliefs and avoidance behaviour observed in spider phobics warrants further investigation.