USING STATISTICAL PROCESS CONTROL TO MAKE DATA-BASED CLINICAL DECISIONS

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Demings management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.     

States of identity: a perspective drawing upon Fordham's model and infant studies

This paper examines the Jungian concept of identity and distinguishes it from projective identification and participation mystique which also refer to non-differentiation between self and object but involve projective mechanisms. Clinical work by Fordham and a psychoanalytic infant observation are used to illustrate early perceptual operations defined by experimental researches. These operations are understood to be expressions of the primary self which manifest themselves before the structuring necessary for normal projective identification. This paper attempts to describe an intersubjective experience between mother and baby that allows for their separate ways of relating, but does not depend on projective mechanisms that can exist only after there has been adequate development.     

Methodological Issues in Treatment Research for Anxiety Disorders in Youth

This article identifies and addresses three methodological domains relevant to the treatment of anxiety disorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status. Multiple-method measurement issues include child and parent reports, observations, and structured interviewing. Our examination of change issues considers comorbidity, analyzing the intent-to-treat sample, treatment spillover, and clinical as well as statistical significance. Problems are identified and potential ameliorative strategies are offered.     

Weighted likelihood estimation of ability in item response theory

Applications of item response theory, which depend upon its parameter invariance property, require that parameter estimates be unbiased. A new method, weighted likelihood estimation (WLE), is derived, and proved to be less biased than maximum likelihood estimation (MLE) with the same asymptotic variance and normal distribution. WLE removes the first order bias term from MLE. Two Monte Carlo studies compare WLE with MLE and Bayesian modal estimation (BME) of ability in conventional tests and tailored tests, assuming the item parameters are known constants. The Monte Carlo studies favor WLE over MLE and BME on several criteria over a wide range of the ability scale.     

Thought-action fusion: a comprehensive analysis using structural equation modeling

Thought-action fusion (TAF), the phenomenon whereby one has difficulty separating cognitions from corresponding behaviors, has implications in a wide variety of disturbances, including eating disorders, obsessive-compulsive disorder, generalized anxiety disorder, and panic disorder. Numerous constructs believed to contribute to the etiology or maintenance of TAF have been identified in the literature, but to date, no study has empirically integrated these findings into a comprehensive model. In this study, we examined simultaneously an array of variables thought to be related to TAF, and subsequently developed a model that elucidates the role of those variables that seem most involved in this phenomenon using a structural equation modeling approach. Results indicated that religiosity, as predicted by ethnic identity, was a significant predictor of TAF. Additionally, the relation between ethnic identity and TAF was partially mediated by an inflated sense of responsibility. Both TAF and obsessive-compulsive symptoms were found to be significant predictors of engagement in neutralization activities. Clinical and theoretical implications are discussed.     

The Development and Initial Validation of the Cognitive Fusion Questionnaire

Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, “defusion” interventions aim to “unhook” thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories, and self-stories. A number of similar concepts have been described in the psychology literature (e.g., decentering, metacognition, mentalization, and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. While there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed-upon measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1,800 people across diverse samples show good preliminary evidence of the CFQ’s factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.