A Randomized Controlled Trial of Functional Analytic Psychotherapy Versus Watchful Waiting: Enhancing Social Connectedness and Reducing Anxiety and Avoidance

• Published in: Behavior analysis (Washington, D.C.) D.C.), 2016-08, Vol.16 (3), p.103-122
• Main Authors: Maitland, Daniel W. M., Petts, Rachel A., Knott, Lindsey E., Briggs, Christopher A., Moore, Justin A., Gaynor, Scott T.
• Format: Article
• Language: English
• Subjects: Anxiety Disorders; Avoidant Personality Disorder; Female; Functional Analysis; Human; Male; Psychotherapy; Social Connectedness
• ISSN: 2372-9414; 2372-9414
• DOI: 10.1037/bar0000051

Treatments targeting social connectedness have the potential to address a significant public health concern. Functional analytic psychotherapy (FAP) is based on a behavioral interpretation of how the therapeutic relationship can serve as a significant agent of change. Examine the efficacy of FAP compared to watchful waiting (WW) in a randomized controlled trial. Twenty-two participants with difficulties in interpersonal relating, according to the Fear of Intimacy Scale (FIS), and who met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for an anxiety disorder or avoidant personality disorder, were randomized to 6 (45-60 min) sessions of FAP (n = 11) or 6 (15 min) sessions of WW (n = 11). FAP outcomes were superior on the primary dependent variables: FIS, Psychiatric Diagnostic Screening Questionnaire (PDSQ) total symptom score, and DSM-IV-TR diagnostic status (as determined by blinded assessors). Adherence coding of sessions showed group differences on the FAP subscale (application of the FAP rules), but not on the supportive listening subscale. Measures of therapeutic alliance also favored FAP. The Working Alliance Inventory-Short Form (WAI) served as a statistical mediator of the relationship between treatment and FIS change and the FAP subscale mediated change on the PDSQ. FAP was more beneficial than WW and, while not definitive, some evidence was found to support the hypothesis that the effects were mediated by events occurring in the therapy relationship. These results are consistent with the FAP model of change. Replication and extension with larger and more diverse samples and more stringent control conditions seems warranted.