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Here's a long response detailing some of my thoughts on potential research ideas. Read at your leisure. There are lots of possibilities here, and given how little research there is on FAP anything you do will be valuable. Warning in advance - this e-mail is much too long. My apologies but I hope it is helpful. I too am thrilled at the prospect of someone new interested in FAP research, so I would like to do everything possible to help get you and your students started and engaged in this.
First, I think there are important measurement issues to be worked out and studied with FAP. I described some of these in my first e-mail to this listserve. For example, we need research on FAP case conceptualization (e.g., using the FIAT or a related scheme). I imagine that this research could start with a non-clinical sample, like undergraduates. A FAP therapist could interview students to develop a conceptualization of CRB1s and 2s with the FIAT, and have the student track them for a week or two. The study could focus on interviewer reliability - for example, do two FAP therapists identify the same CRB1s and 2s with the same student "client"? Or, the study could focus on if the CRB1s and 2s can be reliable tracked over time by the student. Some other measures of the CRB1s and 2s would also have to be used to establish that the identified CRB1s and 2s are valid. This seems tricky but important to do.
A similar measurement issue is with the FAPRS - we need data showing that raters can reliably come up with the same codes for the same behaviors. This research would involve training a student to perform FAP, videotaping the sessions, training two groups of raters in the FAPRS and then having them both rate the tapes independently.
These are very important research questions in my eyes that are related to FAP but are not FAP treatment research ideas exactly.
As far as FAP treatment research is concerned directly, you mentioned in another e-mail that one possibility was to teach FAP to a group of younger students who are just starting with clients. You would simply compare the outcomes of clients with FAP therapists to some other group of clients. In any study like this, the key is always the nature of the comparison condition: The easiest way to show that FAP works is to compare it to nothing, like a wait-list control condition. This is supposedly the right place to start with research, as you wouldn't want to do something more complicated if the treatment isn't even better than nothing. For example, see the recent study by Castonguay et al. (2004) in which they compared a FAP-ish version of cognitive therapy to a wait-list condition (I've put the reference below). Personally, even though it is the right place to start I don't find it very interesting, because it is pretty easy to show that an active treatment is better than nothing, especially for depression. Nontheless such a design would suit your purposes, because it is easy to find an effect so you don't need a large sample, and the design is simple so it is appropriate for a student to do. At least have random assignment to FAP or the waitlist.
Castonguay, L.G., Schut, A.J., Aikins, D.E., Constantino, M.J., Laurenceau, J., Bologh, L., Burns, D.D. (2004). Integrative Cognitive Therapy for Depression: A Preliminary Investigation. Journal of Psychotherapy Integration. Vol. 14, No. 1, 4-20.
Another possibility: I am very interested in this issue of therapist training, as I have now completed a few FAP workshops and would really like to know if what I am doing makes a difference. So your suggested study seems doable but I have found that training students to do FAP is quite hard as the FAP moves require considerable comfort with intense interpersonal situations, disclosure, and providing feedback to others that some newer students have difficulty with. This is where ACT training comes in handy I think, as it targets that discomfort directly. Given how little we know about how to train FAP, it might be interesting simply to test a training method. The outcome would simply be whether or not the students were doing FAP, not whether or not FAP helps clients. If only we knew Swedish, after training students in FAP you could send tapes to one of us to rate whether or not FAP was occurring. Given we don't know Swedish, you'd have to figure out how to determine if FAP was occurring yourself. This is where Glenn's FAPRS is useful. However, it is quite hard to use and also requires considerable expertise and training. Ultimately, however, learning the FAPRS and using it is the way to go in my opinion, as it really captures the essence of FAP because it is a functional coding system. However, an easier measure to use, which I think would suit the purposes of this idea I'm proposing, is a measure we've developed called the THISS, which is more of a traditional topographical adherence measure. Though not as good a measure conceptually as the FAPRS, it could be adapted rather easily to determine if someone was doing FAP, and it is easier to train raters to use reliably. Also take a look at some analyses of our earlier study that are related to this issue. I've attached the version of this paper that is now in press with Psychotherapy Research.
Another idea which you would be perfect for you personally is combining FAP and ACT. There are one or two papers on this and even some data (the recent smoking cessation study in Behavior Therapy is an ACT + FAP study even though the title only said ACT). It is my contention that FAP should make ACT better. In fact, I even got Steve to say something close to this just this weekend. I think one thing that is missing from ACT is an appreciation for how the therapist identifies the behavioral repertoires of interest, shapes them up, and facilitates the generalization of improved behaviors. This is of course the strength of FAP, for it is a system that does just that. For example, in ACT the therapist may choose to do the "observer self" exercise, in which the client is led to remember an experience from several years ago, then an experience from childhood, then to contemplate various roles, emotions and so forth over the course of life, in order to become aware of "self-as-context" and to practice defusion and mindfulness. FAP asks: What behavioral repertoire is being shaped through this exercise? How is the therapist reinforcing this repertoire, and how will behaviors that occur in session during the exercise generalize to the outside world? One would presume the behaviors generated by the exercise must be reinforced if we want them to occur again. How does this occur? ACT suggests that such exercises exert their effects through relational transformations of function and other verbal processes, but unless you are Dermot or Steve it is next to impossible to understand this and it is very hard to stay behavioral in your conceptualization (again, unless you are Dermot or Steve, but sometimes I even wonder about them). I'm not sure what kind of study could be done on this topic with students but I think there are lots of possibilities. For example, you could have therapists do ACT and then some also learn FAP and see if this makes a difference. The key here would be how you would measure outcomes: Exactly how should FAP improve ACT? This would have to be worked out, but it is very interesting to me. In essence this is a similar study to what we did with FAP and Cognitive Therapy for depression. The problem is you would need lots of clients to find an effect, unless there is some way to do this as a series of single-case designs.
Personally, I have become mostly interested in pursuing a multiple-baseline single-subject approach to FAP research. The idea that the student starts doing treatment but withholds FAP. Meanwhile we track how the client is doing using the FIAT. Then, if we can establish a stable baseline in responding on the FIAT measures, we introduce FAP in a big way all at once and see if we can get movement on the measures. I will be presenting a very preliminary version of this idea at ABA next month, but be warned - I have no meaningful data yet. I am really just presenting the idea (although there will be some data).
That's all for now. Again, hope some or any of this is helpful.
Jonathan Kanter
JoAnne Dahl wrote:
Thanks Bob and all of you for your incredibly supportive response to my inquiry!! On behalf of myself and all of my very enthusiastic gang of students we are thrilled to have an online contact with the giants in FAP. This is how research should be and you are modeling a wonderful generosity by sharing your instruments and knowledge with us. We have received now quite a bit of material from Glenn which we will start translating into swedish and by doing so try and understand it. As soon as we get our feet wet and get our research design on paper we will put it up on the FAP list and see what you all think. We would like to start the first actual clinical trials in the fall and get all the instruments done now. Thanks again to all of you!! best from a beautiful spring evening in Uppsala On Apr 26, 2005, at 3:57 AM, Robert Kohlenberg wrote:Joanne I'd like to reiterate what Gareth has already said. First, I like the design of the study you have in mind. The usual outcome variables should be used-- BDI, SCL-90, etc. I also suggest using interpersonal outcomes as well-- social support, relationship satisfaction, improvements in interpersonal relationship problems. We have used a number of these. Then- the process variables- the CRIVI and THISS that we have used. Glenn's approach is among the most promising. Jonathan Kanter's analysis of relationship improvements that are related to sessions in which FAP occurs is also intriguing (do I have this right Jonathan?). An interesting finding in our FECT study was that social avoidance was decreased-- this fits well with ACT goals. Let us know if you want more information on any of these. Bob Kohlenberg----- Original Message ----- From: G. Holman To: functionalanalyticpsychotherapy@yahoogroups.com Cc: jo_anne.dahl@... Sent: Friday, April 22, 2005 1:46 PM Subject: Re: [functionalanalyticpsychotherapy] FAP research Hi Joanne, Thanks for your message. We've recently had a couple of posts - from Jonathan Kanter at the University of Wisconsin Milwaukee, and Glenn Callaghan at San Jose State University - that discuss some ongoing and devloping FAP research. I will forward them on to you. Also, if you haven't already, check out the references page at www.functionalanalyticpsyschotherapy.com Coding therapist and client behavior is a big concern of ours, and we have developed a few different methods. The emails from Jonathan and Glenn discuss a couple - and should also convey that this research is very open for development. We also have a couple of instruments that code therapist turns at speech according to whether or how they are FAP-adherent. The more complex of the two is described briefly in Kohlenberg, Kanter et al 2002. The simple one codes turns according to whether they engage the therapeutic relationship or therapeutic process in an idiographic way or not (e.g. a fap intervention vs. a normal CT intervention). In the past, we have mainly been concerned with how FAP processes as independent variables contribute to outcomes as dependent variables. Though the small FAP open trial (see the ref above) also addressed whether FAP training as IV might increase FAP processes as DV. I hope this helps. I personally would be very interested in research about FAP clinical training, since I am a beginning graduate student myself. I'd like to hear more about what you're thinking - and I'd be happy to try to answer any other questions you might have. Gareth Holman at University of Washington On Thu, 21 Apr 2005, joannedahloliver wrote:Hi list, My name is joAnne Dahl and I work as a professor in clinicalpsychology at the universityof uppsala. At the initiative of my interested students we will behaving our first FAPcourse here within the clinical program,. Several of my graduatestudents would like to dotheir thesis on FAP. We had the idea that we could randomizedgroups of students into twogroups and give one of the groups FAP training and then evaluateboth groups as theymeet their first clients. We thought we could rate the interactionson video as well as getratings from the clients and the therapists. My question is what kind of experiences do you all who work withFAP have as theindependent and dependant variables in doing such research. Whatkinds of researchquestions have you had. Does anyone have any suggestions as whatneeds to be done. Ihave a gold mine of cleaver curious and interested students, thanksfrom Joanne DahlYahoo! Groups LinksYahoo! Groups Links • To visit your group on the web, go to: http://groups.yahoo.com/group/functionalanalyticpsychotherapy/ • To unsubscribe from this group, send an email to: functionalanalyticpsychotherapy-unsubscribe@yahoogroups.com • Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.JoAnne Dahl, Ph.D Associate Professor Department of Psychology Uppsala University, Uppsala Sweden cell 070 6634345 ------------------------ Yahoo! Groups Sponsor --------------------~--> Ever feel sad or cry for no reason at all? Depression. Narrated by Kate Hudson. http://us.click.yahoo.com/1visLB/esnJAA/xGEGAA/GuSolB/TM --------------------------------------------------------------------~-> Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/functionalanalyticpsychotherapy/ <*> To unsubscribe from this group, send an email to: functionalanalyticpsychotherapy-unsubscribe@yahoogroups.com <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
-- Jonathan W. Kanter, Ph.D. Assistant Professor and Clinic Coordinator Department of Psychology University of Wisconsin-Milwaukee P.O. Box 413 Milwaukee, WI 53201 Office: Garland Hall 238C (414) 229-3834
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