Functional Analytic Psychotherapy Research Articles

Assessing the Psychometric Properties of the Functional Analytic Psychotherapy Intimacy Scale (FAPIS) in a Spanish-Speaking Population

AbstractIntimacy is an interpersonal repertoire related to physical and behavioral health indicators. Functional analytic psychotherapy (FAP) is a behavioral intervention that has demonstrated utility in improving intimacy repertoires, particularly in experimental single-case designs. The FAP Intimacy Scale (FAPIS) was developed with the aim of using a theoretically sound measure to evaluate FAP effects on a large scale. This study sought to culturally adapt and validate the FAPIS for Spanish-speaking populations. A total sample of 509 Spanish-speaking participants completed the survey. Exploratory and confirmatory factor analyses were conducted to examine FAPIS psychometric properties. A network analysis was also performed to assess the relation among scale factors. As expected, the FAPIS Spanish version demonstrated a good fit, meeting the same three-factor structure as the original version. Network loading along three factors was also found, and item 3 was identified as the most central item in the scale. Low and negative correlations among FAPIS, experiential avoidance, emotional sensitivity, and social impact were found. Findings showed that FAPIS is a valid and reliable measure for assessing intimacy in Spanish-speaking populations.

The extended evolutionary meta-model and process-based therapy: Contemporary lenses for understanding functional analytic psychotherapy

Functional Analytic Psychotherapy (FAP) is a type of psychotherapy often described as "process-based" because treatment targets are idiographically defined, and intervention strategies are specified in behavioral principles. Recently, refinements have been made to the idea of process-based therapy (PBT) that incorporates an extended evolutionary meta-model (EEMM). The present discussion articulates how FAP fits into current conceptualizations of engaging in PBT. I argue that embracing a PBT approach to treatment can enhance therapeutic outcomes by expanding the conceptualization of clinically relevant behaviors to be viewed as a series of interrelated processes. EEMM dimensions are explored as clinically relevant behaviors, and established FAP intervention strategies for some of these dimensions are discussed. This expanded conceptualization of FAP is applied to a case example before future directions for FAP are discussed in the context of a process based approach to treatment.

The illusion of inclusion: contextual behavioral science and the Black community.

Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.

Validity of the Jordanian Version of the Life Snapshot Inventory

Functional Analytic Psychotherapy (FAP) and the Life Snapshot Inventory (LSI) agree with a contextual, behavioral, relational approach to psychotherapy in which therapists focus on what happens in a session between the client and therapist to shape the interpersonal behaviors, emotional awareness, and self-expression necessary for clients to create and maintain close relationships and to live meaningful lives. This study aimed to test the reliability and the convergent validity of the (LSI) as a self-report instrument to measure meaningful personal and social factors. It was created in Functional Analytic Psychotherapy for use in various areas of life (e.g., family, work, love, spirituality, sexuality, health, etc.). This study involved 393 Jordanian participants (M = 49 years) in the sample. The examined questionnaire was compared with the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the Rosenberg Self-Esteem Scale (RSES) to examine its validity. The results demonstrated a high internal consistency (α = 0.92) of the LSI, with a correlation ranging between 0.74 and 0.87, both of which were statistically significant. Further, the factorial analysis identified only one factor (45.31% variance). Additionally, the results showed that both the DASS-21 and treatment options had an effect on the total scores of the LSI and the RSES. The LSI was introduced as the predictor and the variable related to depression, anxiety, stress, and the RSES as the dependent variables. The scale in total explained −31% of the variance in depression, −30% of the variance in anxiety, −22% of the variance in stress, and 46% of the variance in RSES. However, the results did not show any effects on the variables of gender, employment, and qualification. The examined questionnaire would be a helpful measure for use in healthcare, diagnosis, and clinical contexts in Jordanian society.

Respiratory Sinus Arrhythmia as a Therapy Measurement Strategy: The Example of Functional Analytic Psychotherapy

Introduction: Respiratory sinus arrhythmia (RSA) may be a psychophysiological measure that can gauge change processes in psychotherapy. RSA is a cardiovascular marker of nervous system functioning and has been proposed as an index of social engagement. Given the emphasis on social relationships in Functional Analytic Psychotherapy (FAP), RSA may be useful for understanding the process of change in FAP. The current study details the logic of using RSA as a measurement tool and provides data to establish proof of concept. Methods: RSA data were collected from three participants in a multiple baseline experiment which involved a control condition of reading two-person plays and a FAP condition. Sessions were coded using the FAP Rating Scale. RSA was calculated for each session and each client-therapist interaction. Results: RSA higher during FAP sessions (P1Mean = 6.60, P2Mean = 6.41, P3Mean = 6.32) than the control condition (P1Mean = 6.29, P2Mean = 5.79, P3Mean = 5.96). Conclusions: Data are consistent with outcomes that might be anticipated during therapy and suggest RSA could improve as a function of treatment. RSA was able to be isolated for therapeutic moves when coded at the turn-by-turn level. Thus, data suggest RSA’s utility for measuring therapy processes and outcomes.

Robert J. Kohlenberg (1937-2021).

Memorializes Robert (Bob) Kohlenberg (1937-2021). A preeminent clinical psychologist, Bob retired as a professor of psychology from the University of Washington (UW) in 2020 after a half century of service. From 1997 to 2004, Bob served as director of clinical training, a period during which the program received the Distinguished Program Award from the Association of Behavioral and Cognitive Therapies. Influenced by Ivar Lovaas and Irving Maltzman at UCLA, Bob's theoretical orientation was strongly behavioristic, and he remained a devoted Skinnerian during his entire career. In the mid-1980s, Bob's attention turned to the enterprise of psychotherapy. Based on the principle that client behaviors that occur in their "real world" interpersonal relationships will occur in the therapeutic relationship as well, Bob and his spouse, Mavis Tsai, developed a new operant-based treatment approach, functional analytic psychotherapy (FAP), which focused on genuine in-the-moment interactions between therapist and client. The publication of their seminal 1991 book, Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships, heralded a major new phase in Bob's career trajectory. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Creating Connection and Reducing Distress: the Effects of Functional Analytic Psychotherapy on Measures of Social Connection across Levels of Analysis

Creating Connection and Reducing Distress: the Effects of Functional Analytic Psychotherapy on Measures of Social Connection across Levels of Analysis

Acceptance and Commitment Therapy and its Application in Women Living under a Situation of Intimate Partner Violence

The objective of the study was to describe whether Acceptance and Commitment Therapy (ACT) was effective for the care of women living in a situation of intimate partner violence. A search was made in virtual libraries: Google Scholar, Redalyc, Scielo, Dialnet. The inclusion criteria focused on research on Acceptance and Commitment Therapy (ACT) addressing victims of intimate partner violence in the last ten years. Protocols and interventions on women who experience intimate partner violence and men who generate it, treated from Acceptance and Commitment Therapy in conjunction with other models such as Mindfulness, Cognitive Behavioral Therapy (CBT), Behavioral Activation (BA) and Functional Analytical Psychotherapy (FAP) were found. It was concluded that although there is little evidence of the results, Acceptance and Commitment Therapy has been shown to be effective in reducing symptoms of postraumatic stress disorder (PTSD), depression and anxiety.

Enhancing students' well-being with a unified approach based on contextual behavioural science: A randomised experimental school-based intervention.

A new generation of interventions has begun to move towards principles of acceptance that deal with the context and function of psychological events. The aim of this paper is to analyse the effectiveness of a brief contextual behavioural intervention to improve the psychological well-being of secondary school students. This intervention represents a unified model with key processes based on contextual behavioural science, including Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP). We conducted an intervention with 94 students (age range 17-19 years), randomly assigned to an experimental group (n = 50) or control group (n = 44). Participants took a pretest and post-test of distress, life satisfaction, psychological flexibility and mindfulness. The intervention consisted of three sessions of 1 h each. The results showed significant differences between the groups in distress and significant differences for the interaction (group × pre-post) in all the other variables. The intervention had greater benefits for girls than for boys. These results may provide a breakthrough, thus leading to a process of evidence-based therapies, which would be responsible for inducing psychological improvements in brief periods, in a population with an increasing risk of distress.

Linking process to outcome in Functional Analytic Psychotherapy: Evaluating the behavioral mechanism of change of a process-based therapy

Process-based therapy has received attention in recent years and seeks to advance our understanding of mechanisms of change in behavioral health interventions. A process-to-outcome research approach was employed to examine the mechanism of change and treatment effects of Functional Analytic Psychotherapy (FAP). A non-concurrent multiple baseline design was conducted with three clients who endorsed psychological distress and interpersonal difficulties. FAP's mechanism of change was tested with a lag sequential analysis. Statistical analysis for single-case designs was performed to assess between and within-participant treatment outcomes. High contingent and consistent reinforcement were associated with clinical changes in treatment outcomes. Therapeutic relationship factors such as therapeutic alliance and therapeutic relationship intimacy did not show moderation effects on treatment variables. Limitations and recommendations for improving reliability are discussed. The relations of treatment outcomes and FAP implementation are summarized. Finally, we discuss the relevance of process-to-outcome research for improving clinical science.

Testing Functional Analytic Psychotherapy's mediational model of change in social connectedness for people with fear of intimacy

In efforts to decrease psychological distress, psychotherapy frequently focuses on a client's intimate relationships and connectedness with others. One contextual-behavioral approach, Functional Analytic Psychotherapy (FAP), aims to do so by employing the therapeutic relationship to shape improvements in the clients' in-session interpersonal behaviors. In a recent randomized trial of a FAP intervention for dyads who wanted to improve their relationships (Kanter et al., 2018), clients who presented with fear of intimacy were specifically taught in-session interpersonal skills to improve intimate behaviors and connectedness within dyads and reduce related fears. The current study employed a secondary analysis of those data and tested a mediational model in which decreases in fear of intimacy from pre-treatment to post-treatment for these participants would be associated with increases in social connectedness, and this association would be mediated by increases in self-reported intimacy-related behaviors. Results indicated that as fear of intimacy decreased, social connectedness increased, and this association was partially mediated by self-reported improvements in the intimacy-related behaviors targeted by the intervention. Thus, findings support a model in which fear of intimacy is associated with avoidance of intimacy-related behaviors which in turn decreases social connectedness; when these behaviors are targeted and improved, fear of intimacy may decrease and social connectedness may increase.

Application of FACT in the academic context to improve the health in high school students

There is growing evidence showing the efficacy of contextual or third-generation therapies in various contexts and clinical conditions. In large groups of first- and second-year high school students (n= 112), the present study compares the efficacy of applying a program based on Acceptance and Commitment Therapy (ACT) versus a combined program using strategies from Functional-Analytical Psychotherapy (FAP), resulting in a so-called FACT approach. The purpose of this intervention was to extract the most relevant processes underpinning clinical changes to design training programs based on contextual behavioral science to improve students' health. The results indicated that both interventions produced statistically significant improvement in the health of the students. The program combined with FACT was superior in the self-concept variable. The implications of both brief programs to improve students' health in short periods are discussed on the basis of a behavioral methodology adapted to the academic context.

Enhancing Interpersonal Intimacy in Colombian Gay Men Using Functional Analytic Psychotherapy: An Experimental Nonconcurrent Multiple Baseline Design

A growing body of research suggests that rejection sensitivity, a form of interpersonal guardedness associated with familial rejection and societal bias, is a transdiagnostic risk factor for anxiety and mood disorders in gay men. From a behavioral perspective, rejection sensitivity is conceptualized as avoidance of intimacy as the result of systematic social punishment of vulnerable behaviors. Despite the implications of rejection sensitivity for psychological well-being, clinical psychology lacks specific behavioral interventions for emotional intimacy at the level of the individual. Functional Analytic Psychotherapy (FAP) is a therapeutic approach developed to enhance interpersonal behaviors that promote intimacy and closeness through identification of, and contingent responding to, clinically relevant behaviors.A nonconcurrent between-participants design examined the effectiveness of 4 to 8 sessions of FAP on reducing intimacy-avoiding behaviors and increasing intimacy-promoting behaviors in three Colombian gay men.FAP implementation yielded significant increases in intimacy promoting behaviors (β = 65.65, S.E. = 11.48, p = .0004) with a large effect size calculated by the between-case standardized mean difference (BC-SMD (17.01) = 1.66, CI [0.69–2.73]). The increase in intimacy-promoting behaviors occurred without evidence for reduction or elimination of intimacy-avoiding behaviors.Recommendations for future research include (1) the implementation of longitudinal intensive studies to capture participants' out-of-session behavioral changes and (2) further research to determine FAP’s effectiveness for increasing intimacy-promoting behaviors among other sexual or gender minority individuals.

Importance of the Therapeutic Relationship: Efficacy of Functional Analytic Psychotherapy with Different Problems

Functional Analytical Psychotherapy (FAP) is a third generation and contextual therapy. It is based on therapeutic interaction, verbal and emotional client-therapist relationships. It also uses functional analysis of behaviour, and live on-going modification of clinical problem behaviours. The aim of this research was to study the efficacy of FAP with different types of psychological problems (anxiety, depression, obsession, sexual, personality, emotional control). An intra-group design (10 participants, 36 years old average) was used with pre-post and follow-up measurements. Different questionnaires have been used as common assessment tools for all clinical cases. The results showed a statistically significant change in all the standardised questionnaires, with a considerable size effect (d from -2.01 to -3.80) and maintained one year later. Also, as clinical change, the participants had improved in their daily lives. We conclude on the efficacy of FAP, focusing on the therapeutic relationship, regardless of diagnostic categories.

Is "Self-Experience" Really a Transdiagnostic Concept? Preliminary Evidence in Favor of the Transdiagnostic Conception of Functional Analytic Psychotherapy.

Functional Analytic Psychotherapy (FAP) offers a radically behavioral and transdiagnostic conception of the formation of the “self” and the appearance of a diversity of psychological problems. This study examined the extent to which a wide variety of psychological disorders (somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility/aggressiveness, phobic anxiety, paranoid ideation, and psychoticism) and a global index of psychopathological severity may in fact be linked to problems of the “self” according to the FAP conception. Two questionnaires, one related to self-experience according to FAP and the other to find the scores on several different psychopathology scales, were administered to 280 adult Spaniards for this purpose. The results confirmed the transdiagnostic nature of the “self”-experience. There are significant and strong correlations between all the psychopathology scales studied and self-experience. Linear regression analyses also show that, along with age and gender, in some cases, the score on self-experience predicts each and every one of the psychopathological variables studied, in addition to the Global Severity Index. These results are discussed and related to the transdiagnostic approach to psychopathology.

Spanish adaptation of the Awareness, Courage and Responsiveness Scale: Preliminary psychometric properties in non-clinical samples

The Awareness, Courage, and Responsiveness Scale (ACRS) is the first measure created to assess a contextual-behavioral model of Intimacy, rooted in the Functional Analytic Psychotherapy. The objectives of this study were to adapt to Spanish the ACRS and to analyze its psychometric properties in non-clinical samples from Spain. The scale adaptation was carried out using three independent forward and backward translations. Data was collected from two sub-samples of participants: college students (n = 254) and health professionals (n = 120). A part of the students (n = 93) responded to the ACRS in a reevaluation phase to assess its stability over time. Reliability was assessed with Cronbach's alphas, Intraclass Correlation Coefficients, and Pearson's correlations. Construct dimensional structure was tested with Confirmatory Factor Analysis (CFA). Convergent validity was evaluated by Pearson's correlations between ACRS and other theoretically related constructs. Results for internal consistency, time stability, and convergent validity were adequate. With some re-specifications, the original five-factor hierarchical model, with Self-awareness, Others-awareness, Courage, and Responsiveness as lower-order factors, and Intimacy as a higher-order factor, seems valid for Spain's population. Errors correlations, low items loadings, and lower temporal stability of the Awareness scales are some of the limitations.

The Effectiveness of Functional Analytical Therapy on Controlling, Expressing and Internalizing Anger in Patients with a Borderline Personality Disorder

Introduction : Borderline personality disorder affects many cognitive, behavioral, and even emotional domains of individuals. This study aimed to evaluate the effectiveness of functional analytical therapy on controlling, expressing, and internalizing anger in patients with a borderline personality disorder. Methods : The research method was a quasi-experimental pre-test-post-test with experimental and control groups. The statistical population of this study included all 43 women referred to Asal Psychological Clinic in Karaj city in 2020. Out of 33 patients with moderate borderline personality disorder, 24 were selected by simple random sampling method and were randomly assigned to two groups of 12 (experimental and control groups). The functional analytical psychotherapy package of Tsai, Kohlenberg, Kanter & Waltz (2010) was performed on the experimental group in 10 sessions of 45 minutes. For experimental and control groups in pre-test and post-test Anger Questionnaire of Spielberg (1988) was used. Data were analyzed using analysis of covariance mixed with SPSS18 software. Results: The results showed that functional analytical therapy has a significant effect on improving controlling, expressing, and internalizing anger in patients with borderline personality disorder (Pvalue≤0.001). Conclusions: These results emphasize the level of performance of functional analytical psychotherapy in different areas of cognitive, behavioral, and emotional in the treatment of people with a borderline personality disorder. Keywords: Functional therapy, Anger, Borderline personality disorder.

Ketamine-Assisted Psychotherapy for PTSD Related to Racial Discrimination

Current research suggests that ketamine-assisted psychotherapy has benefit for the treatment of mental disorders. We report on the results of ketamine-assisted intensive outpatient psychotherapeutic treatment of a client with treatment-resistant, posttraumatic stress disorder (PTSD) as a result of experiences of racism and childhood sexual abuse. The client’s presenting symptoms included hypervigilance, social avoidance, feelings of hopelessness, and intense recollections. These symptoms impacted all areas of daily functioning. Psychoeducation was provided on how untreated intergenerational trauma, compounded by additional traumatic experiences, potentiated the client’s experience of PTSD and subsequent maladaptive coping mechanisms. Ketamine was administered four times over a 13-day span as an off-label, adjunct to psychotherapy. Therapeutic interventions and orientations utilized were mindfulness-based cognitive therapy (MBCT) and functional analytic psychotherapy (FAP). New skills were obtained in helping the client respond effectively to negative self-talk, catastrophic thinking, and feelings of helplessness. Treatment led to a significant reduction in symptoms after completion of the program, with gains maintained 4 months post-treatment. This case study demonstrates the effective use of ketamine as an adjunct to psychotherapy in treatment-resistant PTSD.

Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

AbstractPsychedelic medicine is an emerging field of research and practice that examines the psychotherapeutic effects of substances classified as hallucinogens on the human mind, body, and spirit. Current research explores the safety and efficacy of these substances for mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although current studies explore psychotherapeutic effects from a biomedical perspective, gaps in awareness around cultural issues in the therapeutic process are prominent. African Americans have been absent from psychedelic research as both participants and researchers, and little attention has been paid to the potential of psychedelics to address traumas caused by racialization. This paper examines cultural themes and clinical applications from the one-time use of 3,4-methylenedioxymethamphetamine (MDMA) as part of an US Food and Drug Administration (FDA)-approved clinical trial and training exercise for three African American female therapists. The primary themes that emerged across the varied experiences centered on strength, safety, connection, and managing oppression/racialization. The participants' experiences were found to be personally meaningful and instructive for how Western models of psychedelic-assisted psychotherapy could be more effective and accessible to the Black community. Included is a discussion of the importance of facilitator training to make best use of emerging material when it includes cultural, racial, and spiritual themes. A lack of knowledge and epistemic humility can create barriers to treatment for underserved populations. Implications for future research and practice for marginalized cultural groups are also discussed, including consideration of Functional Analytic Psychotherapy (FAP) as an adjunct to the psychedelic-therapy approaches currently advanced. As women of color are among the most stigmatized groups of people, it is essential to incorporate their perspectives into the literature to expand conversations about health equity.

Ensuring the psychedelic renaissance and radical healing reach the Black community: Commentary on Culture and Psychedelic Psychotherapy

AbstractSimilar to much of the mental health field, psychedelic-assisted psychotherapy has failed to center the needs of people of color. Monnica Williams and colleagues demonstrate the harm faced by Black women and other people of color when working with psychedelic-assisted psychotherapists that are unaware of and ill-equipped to address sensitive topics related to race. Here I discuss the benefits and limitations of Functional Analytic Psychotherapy training for therapists that have not engaged in deep and reflective processes to understand their personal engagement in racism, privilege, and oppression. I call on leaders in the field of psychedelic-assisted psychotherapy to adhere to a new standard of intersectional cultural humility for anyone preparing to provide these services. Finally, I highlight the need to significantly increase the number of therapists of color trained to offer psychedelic-assisted psychotherapy to begin to address racial disparities to access to these radical treatments for trauma.