Functional Analytic Psychotherapy Enhanced Behavioral Activation for Depression: A Concurrent and Non-Concurrent Between-Participants Study

Abstract

Functional analytic psychotherapy enhanced behavioral activation (FEBA) is a therapeutic approach that combines strategies from behavioral activation and functional analytic psychotherapy to improve therapeutic outcomes in clients who lack stable sources of reinforcement in their natural environments. In FEBA, therapists modify clients’ behaviors within the therapeutic session and simultaneously change clients’ environmental conditions in their natural contexts. A concurrent and nonconcurrent multiple-baseline design between participants was conducted. Four participants—2 men and 2 women—who reported depressive symptoms were independently treated in a psychological services center by 2 male therapists. FEBA increased the frequency of healthy behaviors (e.g., engaging in meaningful conversations with friends) in session and out of session. However, depressive behaviors in therapeutic and natural settings did not show stable changes. The implications for implementing some of the results of this study with clients with depression are discussed. Methodological recommendations for using FEBA with specific populations and in other contexts are also presented.

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References

  1. American Psychological Association (2002). Ethical principles of psychologists and code of conduct.Retrieved from http:// www.apa.org/ethics.

  2. American Psychological Association (2015). Psychological treatments.Retrieved from https://www.div12.org/psychological-treatments/treatments/.

  3. Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2011). Improvement in symptoms versus functioning: How do our best treatments measure up? Administration and Policy in Mental Health and Mental Health Services Research, 38, 440–458.

    Article  PubMed  Google Scholar 

  4. Bianchi, J. M., & Muñoz-Martínez, A. M. (2014). Activaciónconductual: Revisiónhistórica, conceptual y empírica. Psychologia: Avances de la disciplina, 8, 83–93. https://doi.org/10.21500/19002386.1223.

    Article  Google Scholar 

  5. Callaghan, G. M., Follette, W. C., Ruckstuhl Jr., L. E., & Linnerooth, P. J. (2008). The Functional Analytic Psychotherapy Rating Scale (FAPRS): A behavioral psychotherapy coding system. The Behavior Analyst Today, 9, 98–116.

    Article  Google Scholar 

  6. Campo-Arias, A., Díaz-Martínez, L. A., Rueda-Jaimes, G. E., & Barros-Bermúdez, J. A. (2005). Validación de la escala de Zung para depresiónenuniversitarias de Bucaramanga, Colombia. RevistaColombiana de Psiquiatría, 34, 54–62.

    Google Scholar 

  7. Carr, J. E. (2005). Recommendations for reporting multiple-baseline designs across participants. Behavioral Interventions, 20, 219–224.

    Article  Google Scholar 

  8. Carrascoso, F., & Valdivia, S. (2007). Towards alternative criteria for the validation of psychological treatments. International Journal of Psychology and Psychological Therapy, 7, 347–363.

    Google Scholar 

  9. Cooper, J., Heron, T., & Heward, W. (2007). Applied behavior analysis (2nd ed.). London: Pearson.

    Google Scholar 

  10. David, D., & Montgomery, G. H. (2011). The scientific status of psychotherapies: A new evaluative framework for evidence-based psychosocial interventions. Clinical Psychology: Science and Practice, 18, 89–98.

    Google Scholar 

  11. Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression: An update of meta-analysis of effectiveness and sub group analysis. PLoS One, 9. https://doi.org/10.1371/journal.pone.0100100.

  12. Fernández Parra, A., & Ferro García, R. (2006). Psicoterapiaanalíticofuncional: Una aproximación contextual funcional al tratamientopsicológico. EduPsykhé, 5, 203–229.

    Google Scholar 

  13. Follette, W. C., Naugle, A. E., & Callaghan, G. M. (1996). A radical behavioral understanding of the therapeutic relationship in effecting change. Behavior Therapy, 27, 623–641.

    Article  Google Scholar 

  14. Grosscup, S. J., & Lewinsohn, P. M. (1980). Unpleasant and pleasant events, and mood. Journal of Clinical Psychology, 36, 252–259.

    Article  PubMed  Google Scholar 

  15. Hayes, S., Strosahl, K., & Wilson, K. (1999a). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  16. Hayes, S. C., Barlow, D., & Nelson-Gray, R. (1999b). The scientist practitioner: Research and accountability in the age of managed care. Needham Heights: Allyn & Bacon.

    Google Scholar 

  17. Hayes, S. C., Nelson, R. O., & Jarrett, R. B. (1987). The treatment utility of assessment: A functional approach to evaluating assessment quality. American Psychologist, 42, 963–974.

    Article  PubMed  Google Scholar 

  18. Hurl, K., Wightman, J., Virues-Ortega, J., & Haynes, S. N. (2016). Does a pre-intervention functional assessment increase intervention effectiveness? A meta-analysis of within-subject interrupted time-series studies. Clinical Psychology Review, 47, 71–84.

    Article  PubMed  Google Scholar 

  19. Kanter, J. W., Busch, A. M., & Rusch, L. C. (2009). Behavioral activation: Distinctive features. New York: Routledge.

    Google Scholar 

  20. Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation? A review of the empirical literature. Clinical Psychology Review, 30, 608–620.

    Article  PubMed  Google Scholar 

  21. Kanter, J. W., Manos, R. C., Busch, A. M., & Rusch, L. C. (2008). Making behavioral activation more behavioral. Behavior Modification, 32, 780–803.

    Article  PubMed  Google Scholar 

  22. Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: A guide for creating intense and curative therapeutic relationships. New York: Plenum Press.

    Google Scholar 

  23. Lewinsohn, P. M. (1974). A behavioral approach to the treatment of depression. In R. M. Freidman & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research (pp. 157–185). New York: Wiley.

    Google Scholar 

  24. Manos, R. C., Kanter, J. W., & Busch, A. M. (2010). A critical review of assessment strategies to measure the behavioral activation model of depression. Clinical Psychology Review, 30, 547–561.

    Article  PubMed  Google Scholar 

  25. Manos, R. C., Kanter, J. W., Rusch, L. C., Turner, L. B., Roberts, N. A., & Busch, A. M. (2009). Integrating functional analytic psychotherapy and behavioral activation for the treatment of relationship distress. Clinical Case Studies, 8, 122–138.

    Article  Google Scholar 

  26. Martell, C., Dimidjian, S., & Hernan-Dunn, R. (2010). Behavioral activation for depression: A clinician’s guide. New York: Guilford Press.

    Google Scholar 

  27. Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: Norton.

    Google Scholar 

  28. Muñoz, R., Le, H., Clarke, G., Barrera, A., & Torres, L. (2009). Preventing first onset and recurrence of major depressive episodes. In I. Gotlib & C. Hammen (Eds.), Handbook of depression (pp. 533–553). New York: Guilford Press.

    Google Scholar 

  29. Muñoz-Martínez, A., & Novoa-Gómez, M. (2011). Confiabilidad y validación de unmodelo de formulaciónclínicaconductual. UniversitasPsychologica, 10, 501–519. https://doi.org/10.4067/S0718-48082012000100003.

    Google Scholar 

  30. Muñoz-Martínez, A. M., & Coletti, J. P. (2015). Psicoterapiaanalíticafuncional: Aproximaciones y alcances de unaterapiabasadaenloscambiosen el contextoterapéutico. Vertex, 26, 43–48.

    PubMed  Google Scholar 

  31. Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40, 357–367.

    Article  PubMed  Google Scholar 

  32. Perkins, R. (2001). What constitutes success? The British Journal of Psychiatry, 179, 9–10.

    Article  PubMed  Google Scholar 

  33. Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22, 317–338.

    Google Scholar 

  34. World Health Organization (2012). 10 facts about mental health.Retrieved from http://www.who.int/features/factfiles/mental_health/mental_health_facts/es/index1.html.

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Correspondence to Marcos A. Montenegro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Montaño, O.M., Montenegro, M.A. & Muñoz-Martínez, A.M. Functional Analytic Psychotherapy Enhanced Behavioral Activation for Depression: A Concurrent and Non-Concurrent Between-Participants Study. Psychol Rec 68, 27–37 (2018). https://doi.org/10.1007/s40732-018-0263-6

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Keywords

  • Functional analytic psychotherapy enhanced behavioral activation
  • Depressive behaviors
  • Healthy behaviors
  • Clinically relevant behaviors