Background: Cognitive difficulties are common in multiple sclerosis (MS) and are associated with poorer quality of life, reduced independence, and lower employment. Despite growing interest in cognitive rehabilitation, existing interventions often lack generalisability and accessibility. Strengthening Mental Abilities with Relational Training (SMART) is a digital intervention targeting relational skills, which are theorised to underpin broader cognitive functioning. This trial evaluated the feasibility, acceptability, and preliminary signals of efficacy of SMART for people with MS experiencing cognitive difficulties. Methods: We conducted a three-arm parallel-group feasibility randomised controlled trial. Participants with a diagnosis of MS and self-reported cognitive problems were recruited from three NHS sites and randomised (1:1:1) to SMART plus treatment-as-usual (TAU), Active control (Sudoku) plus TAU, or TAU alone. Primary feasibility outcomes included recruitment, retention, intervention adherence, and data completeness. Acceptability was assessed using intervention-usage data and participant feedback. Candidate outcome measures included the Perceived Deficits Questionnaire (PDQ), Symbol Digit Modalities Test (SDMT), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), EQ-5D-5L, and ICECAP-A. Assessments took place at baseline, 3 months, and 6 months. The study was co-developed with people living with MS and their families through embedded patient and public involvement and engagement processes. Results: A total of 43 participants were randomised (72% of target). Retention was 84% at 3-month follow-up and 77% at 6 months. SMART adherence was high, with 93% of participants meeting the predefined criterion for training adherence. Acceptability feedback was consistently positive across arms. Data completeness for self-report and performance outcomes was acceptable (typically 60–80% across measures), though return rates for RBANS were lower due to postal logistics. Exploratory analysis suggested a moderate effect of SMART on perceived cognitive difficulties (PDQ, Cohen’s d = 0.85 vs Active control; 0.69 vs TAU), with confidence intervals supporting the possibility of a clinically meaningful benefit. No clear between-group signal was observed on the SDMT. Conclusions: Trial procedures were feasible, and the SMART intervention was acceptable to people with MS. Findings support progression to a fully powered trial, with minor refinements to recruitment and assessment processes. Trial Registration: Registration ID: ClinicalTrials.gov: NCT04975685 – registered on July 23rd, 2021

The current research assessed the utility of the Function Acquisition Speed Test (FAST) in predicting group affiliation and voting behavior in relation to abortion rights. Participants, consisting of those with a self-declared pro-life or pro-choice attitude, were exposed to a FAST procedure, along with an Implicit Association Test (IAT) and an explicit attitude to abortion questionnaire. Significant differences in test scores were observed across the pro-life and pro-choice groups, as well as across the Yes and No referendum voters for both the FAST and IAT. All three tests predicted pro-life and pro-choice group membership and voting behavior satisfactorily. The IAT and FAST both correlated highly with scores on the explicit attitude scale. In addition, FAST and IAT scores were found to satisfactorily predict voting behavior even when scored using each other’s scoring algorithms. Importantly, a logistic regression analysis showed that neither the FAST nor the IAT added significant predictive value beyond that of the explicit measure alone. The implications of these findings for the utility of the FAST for behavioral prediction are discussed.

This study aimed to assess the sensitivity of the indirect Function Acquisition Speed Test (FAST) method for detecting differences in the relatedness of socially sensitive stimulus categories as a means of indexing socially relevant biases. Experiment 1 employed 98 participants and found clear bias in the sample using both self-reports and the FAST method. This effect interacted with the gender identity of participants, with females more likely to demonstrate a pro-female bias than males. FAST scores correlated with scores on a self-report contemporary sexism scale, but not with scores on an old-fashioned sexism scale. Experiment 2 employed 52 participants and the same stimuli as Experiment 1. It found significant anti-Black bias across the entire cohort that did not interact with the ethnicity of the participants, half of whom were white. It is interesting that participants self-reported a pro-Black bias on the Modern Racism Scale. No correlation was found between FAST scores and the self-reported measures. Conclusions regarding the viability of the FAST as a useful behavior-analytic measure within social research are considered.

A study conducted by Mizael et al. (2016) successfully reduced negative evaluations of Black faces and minimized the valence differences between ratings of Black and White faces by establishing equivalent relations that conflicted with racial bias. We replicated this procedure in a repeated measures design and included the doll test and an implicit test to investigate generalization. Nine children who demonstrated negative evaluations of Black faces were trained to relate a positive symbol (A1) to an abstract stimulus (B1) and B1 to images of Black faces (C1). Racial bias measures were repeated twice a week and 15 days after the intervention. Eight participants formed an equivalence relation between Black faces and the positive symbol that was maintained two weeks after the intervention. Before the intervention, there was a significant difference between the evaluations of White and Black faces; after the intervention, there was no significant difference. Two out of three participants with implicit racial bias showed reduced bias postintervention, and one of the four participants with racial bias in the doll test displayed intervention generalization. Overall, our findings replicated the results of Mizael et al. (2016). However, the high level of disparity between stimuli used in the initial participant screening bias test and those employed in the tests for function change generalization pose challenges for interpreting the results. Further research is necessary to more firmly establish reliable function transformation and generalization procedures.

The current study examined the effect of an online relational skills training program, strengthening mental abilities with relational training (SMART), on scores on standardized classroom diagnostic assessments. Several previous studies suggested that this novel intervention has a reliable impact on intelligence scores and some domains of cognitive ability relevant in the educational setting. The current study employed a single-blind design and a matched control group in the delivery of the SMART intervention in 45-min sessions 1–3 times per week over approximately 10 weeks, with students completing the intervention within two weeks of each other. Standardized classroom diagnostic assessments were delivered pre- and post-intervention. The results showed that, controlling for baseline scores, the intervention group performed significantly better than the controls in the mathematics and reading domains post-intervention. Gains in both reading and mathematics were large and significant from pre- to post-intervention for the treatment group, but modest significant gains were also found for the control group.

This article provides a comprehensive overview of the development of a behavior-analytic alternative to the popular implicit association test (IAT), namely, the function acquisition speed test (FAST). The IAT appears, prima facia , to indirectly assess participants’ learning histories with regard to the categorization of stimuli. However, its origin within cognitive psychology has rendered it replete with mentalism, conceptual ambiguity, statistical arbitrariness, and confounding procedural artifacts. The most popular behavioral alternative to the IAT, the widely used implicit relational assessment procedure (IRAP), has inherited many of these concerning artifacts. In this article, we present a behavior-analytic critique of both the IAT and IRAP, and argue that a behavior-analytic approach to implicit measures must have stimulus control front and center in its analysis. We then outline a series of early research studies that provided the basis for a potentially superior procedure within our field. We go on to outline how this early research was harnessed in stepwise research, guided by a strict adherence to traditional behavior-analytic methods for the analysis of stimulus relations, to increasingly modify a test format fit for the behavior analyst interested in assessing stimulus relatedness.

A large array of randomized controlled trials and meta analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.

Cognitive defusion is among the main components of Acceptance and Commitment Therapy (ACT), a contextual behavioral approach to psychotherapy. Defusion serves as a middle-level term, and, as such, may be useful for applying and disseminating behavior science, despite its lower precision. However, some authors argue that for middle-level terms in psychotherapy to be useful to clinicians, they need to be clearly linked to basic behavioral concepts, with higher precision; and that this is not currently the case with defusion. Our objective is to increase the pragmatic utility of the concept of "cognitive defusion" by providing a more nuanced, multifaceted and process-based definition of the term. In order to do this, we surveyed the ACT literature regarding defusion and critically examined it through the lens of conceptual analysis. This culminated in a revised and updated conceptualization of defusion in terms of its relationship to basic behavioral concepts, in which defusion is an outcome that may be achieved through different processes.

The current study served to replicate the finding that extensive derived relational responding fluency training using the SMART (strengthening mental abilities with relational training) method can enhance intelligence quotient scores, while controlling for baseline levels of intelligence and attentional skills. Two separate groups of children based on school enrolment, aged 10–11 years, were assigned to a control or treatment condition en masse (i.e., not individual random assignment). All participants were administered the Test of Everyday Attention at baseline and completed the Wechsler Abbreviated Scale of Intelligence (WASI-II) at baseline and follow-up. Supervised training in derived relational responding fluency was administered at regular intervals over several months for the intervention group only. Results showed that there was a significant increase in IQ scores from baseline to follow-up for the intervention group only. However, controlling for baseline intelligence scores or any of three separate sub-indices of attentional skills eliminated this effect. This outcome serves as an indicator of the importance of controlling for baseline factors in intervention studies and the random allocation of participants to treatment and control groups.

Background Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions—such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need—and recognised research priority—for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS—requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing—and examining the feasibility of trialling—a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning. Methods The primary objective of this study aims to conduct a feasibility study to inform the development of a definitive trial of SMART for improving cognitive functioning in people with MS. The secondary objective is to develop the framework for a cost-effectiveness analysis alongside a definitive trial, and the exploratory objective is to assess the signal of efficacy. Discussion As a feasibility trial, outcomes are unlikely to immediately effect changes to NHS practice. However, this is a necessary step towards developing a definitive trial—and will give us a signal of efficacy, a prerequisite for progression to a definitive trial. If found to be clinically and cost-effective, the latter trial could create a step-change in MS cognitive rehabilitation—improving service delivery and optimising support with limited additional resources. Trial registration Registration ID: ClnicalTrials.gov: NCT04975685—registered on July 23rd, 2021. Protocol version: 2.0, 25 November 2021

Background: Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. Methods: This study aimed to test the usability and acceptability of a computerised cognitive training intervention—Strengthening Mental Abilities Through Relational Training (SMART) —for people with MS, through a mostly qualitative prefeasibility design (n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol (n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement (n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results: Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. Conclusions: This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis.

En el capítulo anterior argumentamos que la función adaptativa más importante del análisis verbal pragmático es la construcción de fórmulas verbales que permitan aumentar o disminuir las funciones del ambiente, detectar posibles resultados y realizar largas secuencias de conducta encaminadas hacia las posibles consecuencias. Según la TMR, los efectos de las redes relacionales y del análisis verbal pragmático formarían parte de este proceso de comprensión y regulación verbal. En este capítulo desmenuzaremos la definición de la comprensión verbal según la TMR y, a continuación, consideraremos la cuestión de la regulación verbal y el seguimiento de reglas. Para ello, consideraremos tres categorías funcionales de control verbal y ofreceremos posibles interpretaciones desde la TMR sobre por qué un oyente puede, o no, seguir una regla concreta...

Los psicólogos conductuales han abordado previamente el campo de la psicología social utilizando conceptos conductuales tradicionales y, en aquellos casos en los que se necesitaba recurrir a procesos verbales, se extraían conceptos de Conducta verbal de Skinner (p.ej., Guerin, 1992). La TMR está empezando a utilizarse en algunos estudios conductuales sobre procesos psicológicos sociales (p.ej., Barnes, Lalor, Smeets y Roche, 1996; Kohlenberg, Hayes y Hayes, 1991; Roche y Barnes, 1996, 1997; Watt, Keenan, Barnes y Cairns, 1991). En el este capítulo utilizaremos la TMR para interpretar algunos de los fenómenos clave que han sido destacados en la literatura sobre la psicología social. Nuestro propósito es, simplemente, ilustrar cómo la TMR podría utilizarse para desarrollar un enfoque conductual moderno sobre la conducta social humana. Por tanto, este capítulo es una orientación para guiar las acciones futuras, más que una exposición definitiva de la psicología social desde la TMR...

El lenguaje humano y el uso que hacemos de él para comunicarnos o entender el mundo requiere derivar relaciones entre acontecimientos: por ejemplo, si A=B y A=C, entonces B=C. La teoría del marco relacional sostiene que esas interpretaciones son el núcleo de cualquier psicología del lenguaje y la cognición. Desde una edad muy temprana, los seres humanos aprenden relaciones de similitud, diferencia, comparación, tiempo, etc., y modifican lo que hacen en una situación determinada en función de la relación derivada de esta con otras situaciones y lo que saben de ellas. Este volumen va más allá de la teoría y proporciona las herramientas empíricas y conceptuales necesarias para llevar a cabo un análisis experimental de prácticamente todos los temas sustantivos del lenguaje y la cognición humanos, tanto básicos como aplicados. Como sugiere el término “postskinneriano”, este volumen estimula a la psicología conductual al repensar muchas de las formulaciones teóricas específicas de su líder histórico más prominente, especialmente en el ámbito del lenguaje y la cognición proponiendo nuevas direcciones. La necesidad de un análisis pragmático del lenguaje y la cognición es conmensurable a las extensiones y aplicaciones de tal formulación. Este libro será de interés no sólo para los teóricos de la conducta, sino también para los psicólogos cognitivos, terapeutas, educadores y cualquier persona que se interese por la conducta humana.

La intención de este capítulo es resumir algunas de las características clave de la TMR y abordar algunas de las críticas más comunes que se han realizado desde los planteamientos conductuales. Hemos aprendido a partir de la experiencia que incluso los lectores más sofisticados malinterpretan fácilmente muchos de los conceptos básicos de la TMR. Para evitar esto en la medida de lo posible, en este capítulo expondremos nuestra visión de manera sucinta, y después abordaremos cada una de sus características principales en el mismo orden en el que aparecen en negrita en el siguiente enunciado...

Al intentar describir y explicar el desarrollo humano, los psicólogos conductuales suelen argumentar que las constancias que se observan en el desarrollo son el producto de contingencias ambientales relativamente estables, que dan lugar a conductas cada vez más complejas (Gewirtz y Peláez-Nogueras, 1992). Sugieren que los cambios en la conducta están causados, en gran medida, por cambios en las contingencias ambientales y en las características del contexto actual en el que se sitúa una conducta determinada. Consideran que las contingencias interactúan con la historia del individuo (p.ej., los repertorios de conducta que ya se han establecido) en lo relativo, tanto al cambio en la conducta, como a las constancias del desarrollo (véase Rosales-Ruiz y Baer, 1996, para una exposición más completa de esta distinción)....

This study aimed to verify the role of three parameters on the formation of equivalence classes between Black faces and a positive symbol, in children who demonstrated negative bias toward Black faces in a pretest. Maintenance was also verified 6 weeks after equivalence tests. Forty-six children (11 Black; 27 girls) who demonstrated racial bias in a pretest were divided into four groups. All groups first learned AB relations (A1 and A2 were, respectively, a positive and a negative symbol, and B were abstract stimuli) and then BC relations (C1 was a Black face and C2 was an abstract stimulus). The Control Group then advanced immediately to equivalence tests (AC, and CA, without differential consequences). For the Mixed Training Group, a block of trials mixing AB and BC relations, with differential consequences, preceded equivalence tests. For the Feedback Reduction Group, equivalence tests were preceded by a trial block mixing AB and BC relations, but with feedback in 50% of trials. The Symmetry Group received symmetry tests after training of each baseline relation. Thirty-three children showed class formation relating Black faces and the positive symbol, and 27 maintained at least one of the equivalence relations after 6 weeks. Average biases toward Black faces were positive in a posttest, for participants who formed equivalence classes, and remained negative for those that did not form classes. The Control Group showed less pronounced bias reduction and maintenance of relations after 6 weeks, suggesting that these outcomes may be affected by training parameters.

Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training (CCT) program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted.

Increasing evidence suggests that the relatedness of stimuli within the Function Acquisition Speed Test (FAST) methodology is sensitive to the learning histories of participants. For example, this method is sensitive to differences in the amount of baseline training provided to establish stimulus equivalence relations using arbitrary stimuli (Cummins et al., 2018a). However, it has not yet been investigated whether the relatedness of stimuli within the FAST varies based on differential nodal distances between stimuli within stimulus classes. If so, the FAST could serve an important adjunct assessment procedure for researchers who wish not only to assess the formation of stimulus classes using traditional methods, such as matching-to-sample, but also the relative relatedness of stimuli within complex stimulus classes (i.e., nodal distance). The current study sought to investigate this possibility. Participants (n = 16) were trained in the formation of two 4-member equivalence classes consisting of arbitrary nonsense syllables. Following this, participants completed three FAST assessments, each of which probed for the relatedness of stimulus pairs of differing nodal distance. Group- and individual-level analyses broadly demonstrated that relatedness varied as a function of nodal distances in pre-trained stimulus classes. However, results also highlighted some limitations of the FAST at the individual level.

The present study examined the preliminary efficacy of an ultra-brief cognitive defusion intervention, compared to a positive self-affirmation intervention, on moderate subclinical Public Speaking Anxiety (PSA). Sixty-three participants (M = 25.70 years,, SD = 9.48) first completed a questionnaire assessing PSA symptomology and were then randomly assigned to receive one of two interventions (cognitive defusion, positive self-affirmation) or nothing at all (no-treatment control). All participants then performed an impromptu speech task before recompleting the questionnaire. A significant decrease in PSA was reported within the cognitive defusion condition, relative to the positive self-affirmation and no-treatment control conditions. An ultra-brief cognitive defusion intervention has the potential to reduce short-term anxiety among those with moderate PSA.