The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Interobserver agreement and procedural fidelity: An odd asymmetry

We examined articles with experiments published in the Journal of Applied Behavior Analysis and in Behavior Analysis in Practice from 2017 through 2021 to determine how frequently procedural fidelity was assessed. When procedural fidelity was assessed, we determined how often a measure of interobserver agreement for those fidelity data was provided. We also determined how often a measure of interobserver agreement for participants' behavior was provided. Across both journals and all years, 54.7% of relevant articles provided a measure of procedural fidelity. Of them, 17.7% provided a measure of interobserver agreement for procedural fidelity. In marked contrast, 96.4% provided interobserver agreement data for participants' behavior. It is unfortunate that applied behavior analysts frequently fail to provide procedural fidelity data and, when they do, often fail to provide interobserver agreement data for the fidelity data. Reviewers for, and editors of, behavior-analytic journals are encouraged to strongly consider the relative value of procedural fidelity and agreement on procedural fidelity measures when rendering recommendations on the suitability of a given submission.     

An Epistolary Conversation

This written exchange is between a senior and a younger Jungian analyst on issues relevant to the development of analytical psychology throughout the world today. The younger analyst, Stefano Carpani, considers himself a neo-Jungian. He explains to John Beebe, known for post-Jungian contributions to the study of typology, integrity, and gender, how important it is to include sociological perspectives alongside those that stem from the Jungian practice of relational psychoanalysis. The degree to which analysis has become an extended meditation on the relation of individual self-exploration to supra-personal Self-realization is emphasized by both authors, who envision this introspection leading to an expanded inner openness that Carpani has called “absolute freedom.” The authors conclude that absolute freedom is a space of engaged reflection that can permit an informed but individualized approach to the complexities of the world soul today.     

Conflict of interest: the importance of potential

The UK Medical Research Council (MRC) takes the issue of conflict of interest very seriously. The overall aim is to preserve a climate in which personal and organisational innovation can flourish while ensuring that potential conflicts are disclosed and identified and conflicts are either avoided or managed with integrity. The approach needs to encompass the MRC’s various responsibilities and the levels at which conflicts might arise: MRC staff (scientists and administrators); the governing Council; research Boards and committees; external peer-reviewers; and applicants for funding. To achieve its goals, the MRC has issued practical guidance on various aspects of conflict of interest. For the future, the MRC has identified the continuing commercialisation of science and the increasing involvement of lay people in scientific decision-making as special challenges in this area. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

The American experience: Lessons learned

This paper discusses ten lessons learned since 1989 about handling allegations of scientific misconduct involving biomedical and behavioral research supported by the U. S. Public Health Service. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998. The opinions expressed herein are those of the author and do not necessarily represent the views of the Office of Research Integrity, the U.S. Department of Health and Human Services, or any other federal agency.     

Training parents to implement pediatric feeding protocols

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.     

Impact of treatment integrity on intervention effectiveness

Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity failures and the efficacy of behavioral interventions. Avenues for future research are provided.