The Body Image Psychological Inflexibility Scale: development and psychometric properties.

Body image disturbance and body dysmorphic disorder (BDD) have been researched from a variety of psychological approaches. Psychological inflexibility, or avoidance of one's own cognitive and affective states at a cost to personal values, may be a useful construct to understand these problems. In an effort to clarify the role of psychological inflexibility in body image disturbance and BDD, a measure was created based on the principles of Acceptance and Commitment Therapy (ACT). The scale was developed by generating new items to represent the construct and revising items from an existing scale measuring aspects of body image psychological inflexibility. The study was conducted with an ethnically diverse undergraduate population using three samples during the validation process. Participants completed multiple assessments to determine the validity of the measure and were interviewed for BDD. The 16-item scale has internal consistency (α = 0.93), a single factor solution, convergent validity, and test re-test reliability (r = 0.90). Data demonstrate a relationship between psychological inflexibility and body image disturbance indicating empirical support for an ACT conceptualization of body image problems and the use of this measure for body image disturbance and BDD.

The use of awareness, courage, therapeutic love, and behavioral interpretation in Functional Analytic Psychotherapy.

Interventions from Functional Analytic Psychotherapy focus on what happens in-session between clients and therapists to create more intense and curative therapeutic relationships. The methods described--being aware of clients' clinically relevant behaviors, being courageous in evoking clinically relevant behaviors, reinforcing improvements with therapeutic love, and using behavioral interpretations to help clients generalize changes to daily life--point to compelling directions in personal growth and change for both clients and therapists.

An Empirical Model of Body Image Disturbance Using Behavioral Principles found in Functional Analytic Psychotherapy and Acceptance and Commitment Therapy.

The literature examining body image disturbance and Body Dysmorphic Disorder (BDD) is fraught with competing theoretical constructions of the etiology and nosology of these problems. Recent studies on various forms of psychopathology suggest that intrapersonal processes, including experiential avoidance, and interpersonal processes such as difficulties identifying and expressing emotions with others, correlate with higher levels of psychopathology. The present study aimed to investigate the relationship of body image disturbance and diagnosable BDD to the contemporary behavioral variables of experiential avoidance and interpersonal expression of affect. A large sample of participants including those who are diagnosable with BDD were examined. Results indicate that both intrapersonal and interpersonal variables are significant predictors of both body image disturbance in a large population and of BDD as a subsample and that these variables may be important targets for treatment. This principle-based conceptualization has parsimony and potential utility for clinical interventions of these problems. Implications are discussed for the use of contemporary behavioral treatments such as Functional Analytic Psychotherapy and Acceptance and Commitment Therapy to address both body image disturbance and BDD.

Predicting consideration of cosmetic surgery in a college population: a continuum of body image disturbance and the importance of coping strategies.

Elective cosmetic surgeries are increasing in the American population with reasons linked to body image disturbance and body dysmorphic disorder (BDD). Little research exists documenting the continuum of body image disturbance and its relationship to seeking surgery. The present research examined data from 544 participants, 55 of whom were diagnosable with BDD. Using assessments for body image disturbance, problematic coping strategies, and BDD symptomatology, results provided evidence for a continuum of body image distress. Logistic regression analysis supported the hypothesis that increased levels of body image disturbance and one type of problematic coping strategy (Appearance Fixing) predicted consideration of cosmetic surgery. Of participants diagnosable with BDD, those who considered cosmetic surgery showed more severe body image disturbance and problematic coping than those who did not consider surgery. These results have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions.

Efeitos de um treino em psicoterapia analítica funcional sobre a identificação feita pelo terapeuta de comportamentos clinicamente relevantes de seu cliente / The effects of a functional analytic psychotherapy training on the therapist’s identification of clinical relevant behaviors

O presente artigo relata um estudo que investigou o efeito de um treino, com supervisões de acordo com a Psicoterapia Analítica Funcional (FAP) sobre a identificação feita pelo terapeuta de comportamentos clinicamente relevantes de seu cliente. O método consistiu de um delineamento A/B aplicado a 15 sessões de psicoterapia. As sessões foram conduzidas por um terapeuta iniciante e um cliente cujo problema clínico estava centrado em dificuldades interpessoais. Nas cinco sessões iniciais o terapeuta em treino recebeu uma supervisão convencional e leu literatura sobre assertividade. A partir da quinta sessão o terapeuta recebeu a supervisão conforme a FAP. Os principais componentes da supervisão foram o preenchimento de um questionário (FIAT), que investiga padrões de comportamento interpessoal, a modelagem direta pelo supervisor no aqui/agora da supervisão de comportamento interpessoais relevantes para a terapia, a indicação de bibliografia sobre a FAP e discussão das leituras, além de esclarecimentos acerca dos comportamentos clinicamente relevantes do cliente. Os resultados indicaram que após a introdução da FAP, o participante tendeu a indicar mais comportamentos do cliente relacionados à melhora e mais verbalizações de autoconhecimento, enquanto que as indicações dos comportamentos relacionados ao problema tenderam a decrescer ao longo das sessões. Os resultados sugerem que o terapeuta passou a indicar dimensões do comportamento de seu cliente que iam além do problema clínico. Tais resultados foram discutidos em termos das contribuições da FAP para a promoção da mudança clínica que se torna mais viável quando as dimensões comportamentais que possibilitam a modelagem direta na sessão são percebidas pelo terapeuta.

This article reports a study that investigated the effect of supervision of Functional Analytic Psychotherapy (FAP) on the therapist’s identification of client’s clinically relevant behaviors (CRB). The method consisted of an A/B design applied to 15 psychotherapy sessions. The sessions were conducted by a trainee therapist and his client whose clinical problems centered on interpersonal difficulties. During the five sessions, the therapist received traditional supervision and read additional material relevant to assertive behaviors. Since the 5th session the therapist received supervision in conducting FAP. The main supervision components were: 1) complete an idiographic questionnaire (FIAT) comprising five interpersonal behavior patterns; 2) the direct shaping of therapist behaviors, conducted by supervisor during the supervision session, focusing the relevant interpersonal behaviors for the therapy; 3) directing readings about FAP and a discussion of those readings; 4) and clarifications about the client’s CRB. The results indicated that after the FAP introduction, the therapist tended to recognize and report more client behaviors related to clinical change and also made more verbalizations related to self-knowledge; while the indications of behaviors related to the clinical problem tended to decrease through sessions. The results indicated that the therapist tended to perceive new dimensions of the client’s behavior. Such data were discussed in terms of the FAP contribution for promoting clinical change; that is, clinical change is more likely if those dimensions can be noticed and used by the therapist in directly shaping in-session client behaviors.

Efeitos de um treino em psicoterapia analítica funcional sobre a identificação feita pelo terapeuta de comportamentos clinicamente relevantes de seu cliente / The effects of a functional analytic psychotherapy training on the therapist’s identification of clinical relevant behaviors

O presente artigo relata um estudo que investigou o efeito de um treino, com supervisões de acordo com a Psicoterapia Analítica Funcional (FAP) sobre a identificação feita pelo terapeuta de comportamentos clinicamente relevantes de seu cliente. O método consistiu de um delineamento A/B aplicado a 15 sessões de psicoterapia. As sessões foram conduzidas por um terapeuta iniciante e um cliente cujo problema clínico estava centrado em dificuldades interpessoais. Nas cinco sessões iniciais o terapeuta em treino recebeu uma supervisão convencional e leu literatura sobre assertividade. A partir da quinta sessão o terapeuta recebeu a supervisão conforme a FAP. Os principais componentes da supervisão foram o preenchimento de um questionário (FIAT), que investiga padrões de comportamento interpessoal, a modelagem direta pelo supervisor no aqui/agora da supervisão de comportamento interpessoais relevantes para a terapia, a indicação de bibliografia sobre a FAP e discussão das leituras, além de esclarecimentos acerca dos comportamentos clinicamente relevantes do cliente. Os resultados indicaram que após a introdução da FAP, o participante tendeu a indicar mais comportamentos do cliente relacionados à melhora e mais verbalizações de autoconhecimento, enquanto que as indicações dos comportamentos relacionados ao problema tenderam a decrescer ao longo das sessões. Os resultados sugerem que o terapeuta passou a indicar dimensões do comportamento de seu cliente que iam além do problema clínico. Tais resultados foram discutidos em termos das contribuições da FAP para a promoção da mudança clínica que se torna mais viável quando as dimensões comportamentais que possibilitam a modelagem direta na sessão são percebidas pelo terapeuta(AU)

This article reports a study that investigated the effect of supervision of Functional Analytic Psychotherapy (FAP) on the therapist’s identification of client’s clinically relevant behaviors (CRB). The method consisted of an A/B design applied to 15 psychotherapy sessions. The sessions were conducted by a trainee therapist and his client whose clinical problems centered on interpersonal difficulties. During the five sessions, the therapist received traditional supervision and read additional material relevant to assertive behaviors. Since the 5th session the therapist received supervision in conducting FAP. The main supervision components were: 1) complete an idiographic questionnaire (FIAT) comprising five interpersonal behavior patterns; 2) the direct shaping of therapist behaviors, conducted by supervisor during the supervision session, focusing the relevant interpersonal behaviors for the therapy; 3) directing readings about FAP and a discussion of those readings; 4) and clarifications about the client’s CRB. The results indicated that after the FAP introduction, the therapist tended to recognize and report more client behaviors related to clinical change and also made more verbalizations related to self-knowledge; while the indications of behaviors related to the clinical problem tended to decrease through sessions. The results indicated that the therapist tended to perceive new dimensions of the client’s behavior. Such data were discussed in terms of the FAP contribution for promoting clinical change; that is, clinical change is more likely if those dimensions can be noticed and used by the therapist in directly shaping in-session client behaviors(AU)

A micro-process analysis of Functional Analytic Psychotherapy's mechanism of change.

This study sought to clarify the micro-process of Functional Analytic Psychotherapy (FAP) by using the Functional Analytic Psychotherapy Rating Scale (FAPRS) to code every client and therapist turn of speech over the course of successful treatment of an individual meeting diagnostic criteria for depression and histrionic personality disorder. Treatment consisted of cognitive behavioral therapy alone followed by the addition of FAP techniques in a unique A / A+B design. In-session client behavior improved following the shift to FAP techniques, and micro-process data suggested that client behavior was effectively shaped by in-vivo FAP procedures. These results support FAP's purported mechanisms of change and highlight the advantages of utilizing molecular coding systems to explore these mechanisms.

Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial.

Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings. Compared with patients who received education alone, after 3 months those in the ACT condition were more likely to use these coping strategies, to report better diabetes self-care, and to have glycated hemoglobin (HbA-sub(1C)) values in the target range. Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C).