Abstract
Research on functional analytic psychotherapy's (FAP) proposed process of change has focused on the turn-by-turn coding of FAP. In these studies, FAP-consistent therapeutic techniques result in decreased idiographically defined problem behavior in session. The decreased in-session problem behavior generalizes and reduces the problem behaviors outside of session. Although theoretically consistent and methodologically rigorous, this turn-by-turn coding approach has yet to be explicitly linked to a process of change that can be assessed via questionnaires. In the current study, three participants were treated in a multiple baseline design study that compared an interaction without personal detail exchange, reading plays, to FAP as implemented using the awareness, courage, and love model, a popular treatment dissemination strategy that identifies treatment targets as midlevel terms. Data presented explore the implementation of FAP on a turn-by-turn basis, the resulting change in treatment targets via questionnaires (in and out-of-session relating), and the treatment's impact on reported symptoms of psychopathology. Findings provide additional, yet still inconclusive, support for FAP's proposed process of change. The current results call into question the effects of treatment implementation using the awareness, courage, and love model in place of traditional implementation anchored in operant conditioning.
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All data is available at the following link: https://osf.io/7qps8/?view_only=640d71ecbbef4964b07379466a89ead5.
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References
Broadhead, W. E., Gehlbach, S. H., DeGruy, F. V., & Kaplan, B. H. (1989). Functional versus structural social support and health care utilization in a family medicine outpatient practice. Medical Care, 27(3), 221–233. https://doi.org/10.1097/00005650-198903000-00001
Busch, A. M., Callaghan, G. M., Kanter, J. W., Baruch, D. E., & Weeks, C. (2010). The functional analytic psychotherapy rating scale: A replication and extension. Journal of Contemporary Psychotherapy, 40(1), 11–19. https://doi.org/10.1007/s10879-009-9122-8
Busch, A. M., Kanter, J. W., Callaghan, G. M., Baruch, D. E., Weeks, C. E., & Berlin, K. S. (2009). A micro-process analysis of functional analytic psychotherapy's mechanism of change. Behavior Therapy, 40(3), 280–290. https://doi.org/10.1016/j.beth.2008.07.003
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: Clinical import and interventions. Perspectives on Psychological Science, 10(2), 238–249. https://doi.org/10.1177/1745691615570616
Callaghan, G. M., & Follette, W. C. (2008). FAPRS manual: Manual for the functional analytic psychotherapy rating scale. The Behavior Analyst Today, 9(1), 57–97. https://doi.org/10.1037/h0100649
Callaghan, G. M., & Follette, W. C. (2020). Interpersonal behavior therapy (IBT), functional assessment, and the value of principle-driven behavioral case conceptualizations. The Psychological Record, 70(4), 625–635. https://doi.org/10.1007/s40732-020-00395-1
Callaghan, G. M., Follette, W. C., Ruckstuhl, L. E., & Linnerooth, P. J. (2008). The functional analytic psychotherapy rating scale (FAPRS): A behavioral psychotherapy coding system. The Behavior Analyst Today, 9(1), 98. https://doi.org/10.1037/h0100648
Callaghan, G. M., Summers, C. J., & Weidman, M. (2003). The treatment of histrionic and narcissistic personality disorder behaviors: A single-subject demonstration of clinical improvement using functional analytic psychotherapy. Journal of Contemporary Psychotherapy, 33(4), 321–339. https://doi.org/10.1023/B:JOCP.0000004502.55597.81
Cordova, J. V., & Scott, R. L. (2001). Intimacy: A behavioral interpretation. The Behavior Analyst, 24(1), 75–86. https://doi.org/10.1007/BF03392020
Descutner, C. J., & Thelen, M. H. (1991). Development and validation of a fear-of-intimacy scale. Psychological Assessment: A Journal of Consulting & Clinical Psychology, 3(2), 218–215. https://doi.org/10.1037/1040-3590.3.2.218
Ferster, C. B. (1967). Arbitrary and natural reinforcement. Psychological Record, 17(3), 341–347.
Hare, R. D., Harpur, T. J., Hakstian, A. R., Forth, A. E., Hart, S. D., & Newman, J. P. (1990). The revised psychopathy checklist: Reliability and factor structure. Psychological Assessment: A Journal of Consulting & Clinical Psychology, 2(3), 338–341. https://doi.org/10.1037/1040-3590.2.3.338
Harrington, M., & Velicer, W. F. (2015). Comparing visual and statistical analysis in single-case studies using published studies. Multivariate Behavioral Research, 50(2), 162–183. https://doi.org/10.1080/00273171.2014.973989
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working Alliance inventory. Psychotherapy Research, 16(1), 12–25. https://doi.org/10.1080/10503300500352500
Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting & Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006X.59.1.12
Kanter, J. W., Kuczynski, A. M., Manbeck, K. E., Corey, M. D., & Wallace, E. C. (2020). An integrative contextual behavioral model of intimate relations. Journal of Contextual Behavioral Science, 18, 75–91. https://doi.org/10.1016/j.jcbs.2020.09.001
Kanter, J. W., Landes, S. J., Busch, A. M., Rusch, L. C., Brown, K. R., Baruch, D. E., & Holman, G. I. (2006). The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: A successful and unsuccessful case using functional analytic psychotherapy. Journal of Applied Behavior Analysis, 39(4), 463–467. https://doi.org/10.1901/jaba.2006.21-06
Kanter, J. W., Manbeck, K. E., Kuczynski, A. M., Maitland, D. W. M., Villas-Bôas, A., & Ortega, M. A. R. (2017). A comprehensive review of research on functional analytic psychotherapy. Clinical Psychology Review, 58, 141–156. https://doi.org/10.1016/j.cpr.2017.09.010
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432
Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: A guide for creating intense and curative therapeutic relationships. Plenum https://doi.org/10.1007/978-0-387-70855-3
Kupfer, D. J., First, M. B., & Regier, D. A. (Eds.). (2008). A research agenda for DSM V. American Psychiatric Publishing.
Landes, S. J., Kanter, J. W., Weeks, C. E., & Busch, A. M. (2013). The impact of the active components of functional analytic psychotherapy on idiographic target behaviors. Journal of Contextual Behavioral Science, 2(1), 49–57. https://doi.org/10.1016/j.jcbs.2013.03.004
Maitland, D. W. M. (2020). Experiential avoidance and fear of intimacy: A contextual behavioral account of loneliness and resulting psychopathology symptoms. Journal of Contextual Behavioral Science, 18, 193–200. https://doi.org/10.1016/j.jcbs.2020.10.002
Maitland, D. W. M., & Gaynor, S. T. (2012). Promoting efficacy research on functional analytic psychotherapy. International Journal of Behavioral Consultation & Therapy, 7(2–3), 63–71. https://doi.org/10.1037/h0100939
Maitland, D. W. M., & Gaynor, S. T. (2016). Functional analytic psychotherapy compared with supportive listening: An alternating treatments design examining distinctiveness, session evaluations, and interpersonal functioning. Behavior Analysis: Research & Practice, 16(2), 52–64. https://doi.org/10.1037/bar0000037
Maitland, D. W. M., Kanter, J. W., Manbeck, K. E., & Kuczynski, A. M. (2017). Relationship science informed clinically relevant behaviors in functional analytic psychotherapy: The awareness, courage, and love model. Journal of Contextual Behavioral Science, 6(4), 347–359. https://doi.org/10.1016/j.jcbs.2017.07.002
Maitland, D. W. M., Kanter, J. W., Tsai, M., Kuczynski, A. M., Manbeck, K. E., & Kohlenberg, R. J. (2016b). Preliminary findings on the effects of online functional analytic psychotherapy training on therapist competency. The Psychological Record, 66(4), 627–637. https://doi.org/10.1007/s40732-016-0198-8
Maitland, D. W. M., Petts, R. A., Knott, L. E., Briggs, C. A., Moore, J. A., & Gaynor, S. T. (2016a). A randomized controlled trial of functional analytic psychotherapy versus watchful waiting: Enhancing social connectedness and reducing anxiety and avoidance. Behavior Analysis: Research & Practice, 16(3), 103–122. https://doi.org/10.1037/bar0000051
Russell, D. W. (1996). UCLA loneliness scale (version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40. https://doi.org/10.1207/s15327752jpa6601_2
Singh, R. S., & O'Brien, W. H. (2018). A quantitative synthesis of functional analytic psychotherapy single-subject research. Journal of Contextual Behavioral Science, 7, 35–46. https://doi.org/10.1016/j.jcbs.2017.11.004
Tarlow, K. R. (2017). An improved rank correlation effect size statistic for single-case designs: Base-line corrected tau. Behavior Modification, 41, 427–467. https://doi.org/10.1177/0145445516676750
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363.
Wilkins, W. (1986). Therapy–therapist confounds in psychotherapy research. Cognitive Therapy & Research, 10(1), 3–11. https://doi.org/10.1007/BF01173378
Zimmerman, M., & Mattia, J. (1999). The reliability and validity of a screening questionnaire for 13 DSM-IV Axis I disorders (the psychiatric diagnostic screening questionnaire) in psychiatric outpatients. Journal of Clinical Psychiatry, 60(10), 677–683. https://doi.org/10.4088/JCP.v60n1006
Acknowledgment
I would like to thank Dr. Rachel Petts and Dr. Lindsey Knott for their tireless efforts in providing FAPRS coding.
Funding
Our work was funded via a 2017 Charles J. Gelso, PhD, Psychotherapy Research Grant. The current manuscript was prepared with grant support from NIGMS 8P20GM103436, KY INBRE.
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Written informed consent for publication of their clinical details and/or clinical images was obtained from all participants who participated in the presented study.
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Maitland, D.W.M., Lewis, J.A. Creating Connection and Reducing Distress: the Effects of Functional Analytic Psychotherapy on Measures of Social Connection across Levels of Analysis. Psychol Rec 72, 727–744 (2022). https://doi.org/10.1007/s40732-022-00526-w
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DOI: https://doi.org/10.1007/s40732-022-00526-w