A Systematic Review on FAP for the Treatment of Depression: Analysis

This report presents a systematic review of the efficacy of Functional Analytic Psychotherapy (FAP) in treating depression. It analyzes multiple studies, focusing on the use of FAP as a single therapy and in combination with other treatments. The review includes a detailed literature review, a PRISMA flowchart, and a narrative synthesis of findings. The research examines studies published between 2013 and 2018, using databases like Google Scholar, Medline, PubMed, and PsycINFO. Key themes explored include the effectiveness of FAP in treating depression, alternative treatment options, and the impact of FAP on patients in various settings. The analysis incorporates data from studies that used ANOVA, t-tests, comparisons, or correlations to assess outcomes. The review also highlights the importance of the therapeutic alliance and the benefits of FAP interventions in reducing psychological distress. The findings suggest that FAP is a useful treatment for depression, although further research is recommended to assess its reliability and efficiency. The report concludes by summarizing the key findings and their implications for clinical practice.

A SYSTEMATIC REVIEW ON THE
EFFICACY OF FUNCTIONAL
ANALYTIC PSYCHOTHERAPY
(FAP), FOR THE TREATMENT OF
DEPRESSION

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Literature Review........................................................................................................................4
PRISMA Flowchart.....................................................................................................................9
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................11

INTRODUCTION
The various quantitative studies has been reviewed in order to find out the effectiveness of
Functional Analytical Psychotherapy in treatment of depression. The following studies has will
help in identifying that does psychotherapy is useful for treating patient suffering from
depression or not.
MAIN BODY
Results which has been obtained by ANOVA
Studies conducted Treatment results Outcome
A study has shows that depression Pre treatment = 22.43
Post treatment = 9.14
59.25 percent
depression has been
reduced
Treatment has resulted
in minimal depression
to clients
A patient has been studied who has been
provided with FAP
Pretreatment score =
18
Post treatment score =
less than 5
Mild depression after
treatment
A test group for 16 weeks post intervention In treatment group:
Moderately depressed
patient (Mean) = 14
After treatment
Mildly depressed
(Mean) = 9
In contrast group:
Moderately depressed
people people shows
mean of
In treatment group:
Moderately depressed
patient became mildly
depressed
In control group:
Patient remained
moderately depressed.
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Pretreatment M=25
Post treatment M=15
BID score fall to 19.25
and by post treatments
it was 13.5
Post POMS score has
been reduced from –
6.4 to 1.7
Literature Review
Theme 1: To find effectiveness of Functional analytical therapy
Luc Vandenberge and Umbelina do Rego Leite (2018), has conducted a research in order to
find out that whether functional analytical therapy is useful in treatment of depression or not. The
effectiveness of treatment has been evaluated by the pre post treatment of beck depression
inventory. Twenty one adult women has been selected and is divided into three groups and is
completed in 16 weeks which was held for 2 hours. Jacobson and Truax method has also been
used in order to verify relaiblity and the clinical influence of client's improvement. As a result it
was found that seventeen depressed participants has entered in non clinical range while in twelve
clients the improvement is both clinical and reliable. While fifteen participants has maintained
gains by taking part in follow up process. However the research has suggested that this method is
good in the treatment of person suffering from depressive symptoms and moods.
As per the result which has been found with a help of ANOVA it can be seen that FAP
( Functional analytic psychotherapy) is helpful in treatment of person suffering from depression.
As result states that 59.25 per cent depression level was reduced in people after moderate
depression pre treatment to moderate level pre treatment. A patient who was provide with FAP
has also shown a decrease in BDI score from 18 to 5.
Daniel W.M. Maitland (2015), has conduct a study on efficacy of FAP as its efficacy has
not yet been shown in any population by randomized controlled trials. Therefore author aims at
conducting study on this topic. In order to carry research twenty three college students were
selected by using computer system, Those students has been selected who have scored 1 SD
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(Standard deviation) below norm of fear of intimacy scale and who have met diagnostic criteria
by independent assessment for generalised anxiety disorder, social anxiety disorder, dependent
personality disorder. The various methods which has been used in selection of participants are
included, exclusion and inclusion criteria has been reviewed along with potential participants and
there informed consent were taken. And the students which were selected has been treated either
with FAP or with Watchful waiting condition in order to increase social relation and decrease
psychological distress by these treatments. Out of 22 does not has met with criteria while 7 are
excluded and 23 are qualified. As a result it was found that FAP intervention is quite beneficial
in order to increase interpersonal relating and decreasing psychological distress.
The result which was found has shows that test group at 16 week post intervention
represent a significant research in BDI score. It was observed that moderately depressed patient
has became mildly depressed patient in treatment group. From the above study and the result
which has been obtained it can be said that FAP is a useful treatment for patient suffering with
anxiety disorder or depression.
Theme 2: To find the other alternative for a treatment
According to the study which was conducted by Daniel W. M. Maitland and Scott T.
Gaynor (2016), which holds the hypothesis that functional analytic psychotherapy is based on
belief that because of the reason that therapeutic relationship is interpersonal one the FAP also
share functional similarities with other relations. As per the author belief when client responds
problematically during the therapy session then therapist can immediate response to contingent
consequences. Authors holds the view that FAP session has been made to produce effective and
intensive therapy session and it relates therapeutic relationship which are meaningful. In order to
test this hypothesis 13 participants are taken. Eighty out of 107 session were done for finding th
elements of FAP and SL. However. FAP treatment as well as SL are high in interaction with
clients. The various materials has been include such as post-session evaluations, measure of
interpersonal functioning, etc., has been used and data has been analysed. The result of study
favoured SL which is supportive listening treatment. It was found that contingent responding
contributes more to stronger therapeutic alliances and engaging sessions. As a result it was found
therapeutic alliance can be used as a proxy for FAP.
The evidence from study is however shows effectiveness of psychotherapy. The meta
data suggests that therapeutic alliance is however give positive outcomes. The main reason
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behind this is that therapeutic relationship is interpersonal one thus it will share its functional
similarities with other relations too. The authors has emphasis on describing about reason for line
of FAP efficacy research an effective treatment method in contemporary behaviour therapy and
clinical psychology.
The result which has been found shows that FAP is however useful therapy for treatment
of depression but as per the study which has been discussed above FAP is effective method of
treatment of depression but therapeutic and supportive listening can be used in absence or as a
other effective option for treatment.
Theme 3: To find FAP impact on patients or individual suffering from depression at
different places and categorise
As per the view of Singh & O’Brien (2017), nursing homes are the critical centre where
the treatment and care given to patients can be studied and interpreted in order to form relevant
conclusions. In this review, the author has implemented Functional Analytic Psychotherapy
(FAP) which is also used as a nursing intervention in nursing homes.
The author studied implementation of FAP in three different nursing homes where there was
a classification in two different phases i.e. 2-week baseline phase and 4-week FAP treatment
phase. Residents completed the entire treatment and their behaviour was recorded in every
session who were then categorized into maladaptive and adaptive behaviours.
It was observed by the author that in all the three nursing homes, there was a significant
difference in the residents of these nursing homes. Over the period of FAP treatment, number of
residents under maladaptive category reduced and shifted under adaptive category which shows
the positive impact of the FAP on the psychological behaviour of patients. This study therefore
supports the argument through ANOVA that implementation of FAP therapy reduced the
depression of candidates ranging from moderately depressed to mildly depressed. Change index
and Swanson's dsw was utilised to analyse the residents of nursing home so that their evaluation
could be done in a more appropriate manner. ANOVA results stated that depression reduced
form 4.10 to 3.05 after FAP interventions were implemented and this study also supports the
argument.
Another author Lizarazo & et.al. (2015), studied that what are the variations in the in-clinic
behaviour and out of the clinic behaviour of patient getting FAP i.e. Functional Analytic
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Psychotherapy. This study was carried out by the author so that reliability of the treatment
procedures of FAP and its efficiency could be ascertained.
For collecting data, author identified three clients who were facing difficulties in expressing
themselves emotionally and asked therapists to analyse their behaviour out of the session by
making them fill self-analyzing questionnaires. These templates questioned on different aspects
of the daily life of the patients and needed to be submitted weekly so that therapist could analyse
the problem.
The author identified that out of three, only one resident showed overall improvement i.e.
his out of the clinic behaviour was improved through FAP implementations and two of the
remaining candidates depicted deviation in their in the clinic and out of the clinic behaviour. The
author concludes that there are some relevant improvements that need to be made in order to
increase reliability of FAP Therapy. This can be synced with the ANOVA data that FAP therapy
has cured depression but also paves out way for further development. Clinically Relevant
Behaviour i.e. CRB's were analysed by experienced coders who conducted rating sessions on
FAP and this was further linked with the ANOVA data in order to conclude that FAP treatment
is really effective in curing depression and making patients lead a healthier life.
According to Pimenta & et.al. (2013), FAP needs to be explored in varied areas and not only
on clinically depressed patients but on people struggling to communicate interpersonally as well.
This will help in widening the scope of FAP implementation and formulate better strategies for
reducing psychological stress.
The researcher here implemented FAP on 20 elder people out of those who suffered from
interpersonal functioning difficulties who were selected on a random basis. They were
categorized into FAP condition or Watchful condition based on the level of their disorders.
Different measures and treatment were then accordingly provided to each group of elderly
people and the results were then evaluated so that a comparison could be made between FAP
treatment mechanisms and general mechanisms.
After analyzing, researcher concluded that in order to eliminate psychological stress and
other emotional aspects of an individual, FAP interventions are much more effective than general
interventions and give better results i.e. cure. This analysis is properly in sync with the ANOVA
data which also depicted the minimizing percentage of people suffering from depression when
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FAP interventions were implemented stating that post FAP treatment the average BID score fell
from 19.25 to 13.5.
Singh & O’Brien (2018), has further researched on FAP stating that it is the only therapy that
exploits behavioural aspect in a therapy treatment and using FAP, the adaptive behaviour can be
promoted within patients. Furthermore, in this review, author has tried to reinforce the FAP
strategies through newly modified methods.
In the present review, the researcher gathered data form 20 research studies that were
conducted so that quantitative analysis could be conducted. Researcher has applied many
quantitative tools like Reliable Change Index, Percentage of Non-Overlapping Data etc. These
tools when implemented on the raw data pertaining to the depressed patients that were being
treated with FAP gave a clear indication that though the therapy is effective enough, it no longer
reliable and raises question on the effectiveness of FAP therapy in curing depression.
When this analysis is compared to the data of ANOVA, there seems to be a contrast
appearing as to how patients are getting cured of the FAP is no longer reliable or efficient
because ANOVA shows that FAP implementation has cured patients but this study concluded
that the number is decreasing. Difference can be due to differing survey areas or the environment
in which the patients are living. ANOVA studies can be used to also ascertain that the
intervention period is very long i.e. 16 weeks.
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PRISMA Flowchart
CONCLUSION
The various literature which has been reviewed shows that how effective is the functional
Analytic Psychotherapy intervention for patients. The study which was conducted in this field is
however represent the following points including effectiveness of treatment, analysis of patients
health who are suffering from depression, impact of depression on patient as well as the other
treatments which can be provided in place of FAP has been found. However overall the findings
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from the various articles and the result which was found with the help of ANOVA is found
relevant and the other study in this field hold the same view and represent similar results.
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REFERENCES
Books and Journals
Lizarazo, N. E. & et.al., (2015). A within-subjects evaluation of the effects of functional analytic
psychotherapy on in-session and out-of-session client behavior. The Psychological
Record. 65(3). 463-474.
Maitland, D. W. & et.al., (2016). A randomized controlled trial of functional analytic
psychotherapy versus watchful waiting: Enhancing social connectedness and reducing
anxiety and avoidance. Behavior Analysis: Research and Practice. 16(3), 103.
Maitland, D. W., & Gaynor, S. T. (2016). Functional analytic psychotherapy compared with
supportive listening: An alternating treatments design examining distinctiveness,
session evaluations, and interpersonal functioning. Behavior Analysis: Research and
Practice. 16(2), 52.
Pimenta, F. A. P. & et.al., (2013). Chronic diseases, cognition, functional decline, and the
Charlson index in elderly people with dementia. Revista da Associação Médica
Brasileira (English Edition). 59(4). 326-334.
Singh, R. S., & O’Brien, W. H. (2018). A quantitative synthesis of functional analytic
psychotherapy single-subject research. Journal of contextual behavioral science. 7. 35-
46.
Singh, S., & O’Brien, W. H. (2017). Functional analytic psychotherapy for nursing home
residents: A single-subject investigation of session-by-session changes. Journal of
Contemporary Psychotherapy. 47(3). 173-180.
Vandenberghe, L., & do Rego Leite, U. (2018). Functional Analytic Group Therapy (FAGT) for
Depression: a Pilot Study. The Psychological Record. 68(2), 231-238.
Online
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