Assessing the Mechanism of Change of Functional Analytic Psychotherapy: An Analysis of a Process-Driven Behavioral Intervention
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 3
- 试验地点
- 2
- 主要终点
- Functional Idiographic Assessment Template-Questionnaire Short Form (FIAT-Q-SF)
研究概览
简要总结
This study seeks to assess the mechanisms of change of Functional Analytic Psychotherapy (FAP). FAP is a process-outcome psychotherapy that focuses on the therapeutic relationship, providing services to participants presenting with difficulties in their social interactions and relationships. A multiple baseline design between four participants who report interpersonal relating difficulties and psychological distress will be conducted. Therapists will provide contingent reinforcement to clients' behavior in session with the aim of:
- Examining the mechanisms of change of FAP via contingent responding to participants' interpersonal difficulties.
- Determining the effectiveness of FAP on the interpersonal functioning of verbally able adults.
- Establishing the relationship between the amount of contingent reinforcement and the changes in clients' interpersonal repertoires (proportion).
Four hypotheses will be explored in this study: (1) contingent reinforcement functions as the mechanism of change in FAP, (2) FAP implementation decreases the frequency of interpersonal problems in and out of session, (3) FAP implementation increases the frequency of interpersonal functioning in and out of session, and (4) a higher proportion of reinforcement delivered by therapist enhances clients' alternative behaviors.
详细描述
The interest for supporting process-outcome psychotherapies has increased in recent years. With the aim of finding parsimonious and precise interventions for specific populations under particular circumstances, clinical researchers have supported the development of principle-driven research. Studies discussed the importance of conducting translational research to identify psychotherapy mechanisms of change in order to match those interventions with psychological problems maintained by similar variables. In the long term, it is expected that process-outcome psychotherapies will reduce the burden produced by the overload of psychological interventions that share similar mechanisms of change but have been treated as independent therapeutic packages. Likewise, it is anticipated that process-outcome psychotherapies will reduce relapse frequency by targeting specific mechanisms of change. They would also enhance efficiency since they will reduce the use of therapeutic procedures that do not target the most important variables in producing therapeutic change.
Functional Analytic Psychotherapy (FAP) is a process-outcome psychotherapy that produces changes in interpersonal relating behaviors by modifying the contingencies of reinforcement of clients' behavior. Reinforcement, as a behavioral mechanism of change, explains the increment on the probability of occurrence of the behavior and its maintenance. FAP focuses on improving the effectiveness of clients' interpersonal behaviors by providing social contingencies of reinforcement to clients' responses within the therapeutic setting. Though there are several studies and reports that support the effectiveness of FAP, few studies have explored the specific mechanisms of change. Some studies have explored the effects of therapists' contingent responding to clients' ineffective behavior. However, they have lacked analyses of conditional relationships between clients and therapists' responses. This research, therefore, will provide information about the mechanism of change underlying FAP by studying the conditional relations of contingencies of reinforcement and clients' behaviors in the context of a meaningful therapeutic relationship.
Method
Study aims:
- To examine the mechanisms of change of Functional Analytic Psychotherapy (FAP) via contingent responding to participants' interpersonal difficulties
- To determine the effectiveness of FAP on the interpersonal functioning of verbally able adults.
- To establish the relation between the amount of contingent reinforcement and the changes in clients' interpersonal repertoires.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Basic Science
- 盲法
- None
盲法说明
An independent blind Research Assistant (RA) will score and record the data from questionnaires administered before and after therapeutic sessions.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Interpersonal Difficulties: participants who endorse high scores in the Functional Idiographic Assessment Template-Questionnaire Short Form (Darrow et al., 2014) and report interpersonal dysfunction in a clinical interview based on the Functional Idiographic Assessment Template (Callaghan, 2001)
- •Psychological Distress: participants who endorse indicators of depression, anxiety, stress, or general psychological distress based on the DASS-42 (Crawford & Henry, 2003) and report psychological distress in a clinical interview.
- •Participants who Identify themselves as needing psychological services.
排除标准
- •Current substance abuse.
- •Current suicidal plan.
- •Past suicidal attempts.
- •History of psychotic or bipolar disorders.
- •Participants who are taking psychiatric medication for less than six weeks.
研究组 & 干预措施
Functional Analytic Psychotherapy
Within the baseline (A), Supportive Listening (SL) will be provided, which has been widely utilized in randomized control trials (Cuijpers et al., 2012), including the only Randomized Control Trial (RCT) conducted in FAP (Maitland & Gaynor, 2016), as a control condition. SL is defined as "a psychological treatment in which therapists do not engage in any therapeutic strategies other than active listening and offering support, focusing on participants' problems and concerns" (Cuijpers et al., 2012, p. 281). In this therapy, the therapist reflects on clients' experiences and encourage them to share emotional experiences. Therapists are prohibited from giving advice, making interpretations, and providing feedback to clients (Cuijpers et al., 2012).
FAP will be introduced at phase B, where contingent reinforcement will be administered for increasing clients' alternative behaviors (CRB2) and differential reinforcement will be utilized to reduce clients' problem behaviors (CRB1).
干预措施: Functional Analytic Psychotherapy (Behavioral)
结局指标
主要结局
Functional Idiographic Assessment Template-Questionnaire Short Form (FIAT-Q-SF)
时间窗: Through study completion, an average of 1 year
FIAT-Q-SF is a 32-items self-report in a 6-point liker scale (from -3 to +3) based on a functional analytic approach of interpersonal functioning. Items are contained in six interpersonal factors that have moderate and good reliability using Cronbach's alpha: (a) avoidance of interpersonal intimacy (α= 0.82), (b) argumentativeness or disagreement (α= 0.74), (c) connection and reciprocity (α= 0.64), (d) conflict aversion (α= 0.72), (e) emotional experience and expression (α= 0.75), and (f) excessive expressivity (α= 0.77). Total score of FIAT-Q-SF had mean -16.56 and a standard deviation (SD) of 18.31 in its validation study. Values 1-SD above the mean are considered worse interpersonal functioning while scores 1-SD below of the mean are considered improvements in social functioning.
Depression Anxiety Stress Scale (DASS-42)
时间窗: Through study completion, an average of 1 year
DASS is a 42-items self-report scale developed to measure emotional states of depression, anxiety, and stress over the past week. The sum of DASS-42 scales provides an estimate of psychological distress. DASS has shown a consistent three-factorial structure, as well as convergent and discriminant validity. DASS total score and their sub-scales have found a good reliability using the Cronbach's alpha: depression α=0.947, anxiety α=0.897, stress α=0.933, and total score α=0.96. The following cutt-off points for each category of the DASS based on normative percentiles: (a) normal (0-78 percentile), (b) mild (78-87 percentile), (c) moderate (87-95 percentile), (d) severe (95-98 percentile), and (e) extremely severe (98-100 percentile). Scores above 78 percentile in one or more of DASS sub-scales are indicative of psychological distress.
Changes in clients Behaviors and therapists responses in session
时间窗: Through study completion, an average of 1 year
Frequency of clients and therapists' behaviors in session will be assessed coding therapeutic interactions. Functional Analytic Psychotherapy Rating Scale (FAPRS) is a coding system designed for assessing behaviors within the clinical setting based on behavior analytic principles. Trained coders will rate the presence or absence of FAPRS codes on a turn-by-turn basis. This allows researchers to evaluate the mechanisms of change of FAP and therapists' adherence to FAP procedures (providing contingencies of reinforcement).
次要结局
- Working Alliance Inventory-Short Revised (WAI-SF)(Through study completion, an average of 1 year)
- The Functional Analytic Psychotherapy-Intimacy Scale (FAP-IS)(Through study completion, an average of 1 year)