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Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

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In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors' personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.

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BACKGROUND: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. OBJECTIVE: This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. METHODS: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs. RESULTS: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. CONCLUSIONS: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32992.

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Behavioral technicians (BT) within the field of applied behavior analysis may be at greater risk for experiencing burnout and stress due to the nature of their clients, job demands, and work environments. Burnout and stress may negatively impact BT's work performances, more specifically, their treatment integrity. Acceptance and Commitment Training (ACT) may be a useful tool to address the private events as well as the covert and overt behaviors associated with burnout and stress. The purpose of this study was to investigate the effects of an ACT intervention on improving treatment integrity and reducing work-related burnout and stress amongst BTs. Four BTs participated in an ACT workshop, and their treatment integrity as well as their burnout and stress levels were measured prior to and following the ACT workshop. Treatment integrity increased for all participants, suggesting that ACT-based interventions may be an effective approach to improving work performance (i.e., treatment integrity) amongst BTs who may experience workplace burnout and stress.

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The present article considers acceptance and commitment training (ACT) from the perspective of interbehavioral psychology. Specifically, J. R. Kantor's (1957) explicit distinction between constructs and events is reviewed, with particular attention given to the use of ACT in the practice settings of applied behavior analysis. It is recommended that practitioners be especially sensitive to the distinction between constructs and events as they consider employing ACT interventions. The interbehavioral field construct of interbehavioral psychology is briefly described as a context for conceptualizing both practice and research related to ACT in behavior analysis. Related conceptual issues, especially issues pertaining to the subject matter of behavior analysis and the Skinnerian concept of private events, are considered. The potential value of further integrating interbehavioral thinking into ACT practice and research is described.

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The current study investigated the effect of relational training on improving engagement during acceptance and commitment training (ACT) sessions that aimed to reduce maladaptive behavior. Three female children diagnosed with autism participated in the current research. The relational training protocol involved eight programs designed to improve participants' ability to engage in relational responding. A concurrent multiple-baseline across-participants design was used, and participants' maladaptive behavior during ACT sessions was recorded. Results indicated a decrease in maladaptive behavior for one of the three participants, with a medium to large treatment effect. A secondary measure also showed improvement in all three participants' performance during ACT sessions. The percentage of nonoverlapping data and Cohen's d suggest a small to moderate treatment effect. Implications for implementing ACT with individuals diagnosed with autism are discussed.

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Acceptance and commitment therapy (ACT) is a contemporary approach to dealing with unhelpful private events and improving psychological flexibility (Hayes et al., 2006) that is often used in psychotherapy (Szabo, 2019). Nonpsychotherapeutic uses of ACT have been referred to as acceptance and commitment training (ACTraining; Moran, 2011, 2015; Szabo, 2019), which refers to the use of one or more of six processes-present moment attention or mindfulness, values clarification, committed action, self-as-context, defusion, and acceptance (Hayes et al., 2006)-implemented outside of psychotherapeutic settings. There has been a recent increase in interest in ACTraining within the behavior-analytic community, which has led behavior analysts to question whether ACTraining is useful to the field of applied behavior analysis (ABA) and whether it is within the scope of practice of behavior analysts. Tarbox et al. (2020) proposed that the use of ACTraining is within the scope of practice of behavior analysts and aligns with the seven dimensions of ABA as outlined by Baer et al. (1968). The purpose of the current study was to provide a systematic review of single-case research designs that measure the behavioral effects of ACTraining components conducted with individuals with autism spectrum disorder or developmental disorders, their parents, and their staff, and to inform clinicians and researchers about what variables have been evaluated and what gaps still exist.

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Acceptance and commitment therapy (ACT) is a contemporary behavior-analytic approach to intervening on verbal behavior for the purposes of bringing about socially meaningful overt behavior change. Although originally developed as a behavior-analytic approach to psychotherapy, the conceptual functional analyses and procedures that form the core of ACT have been disseminated broadly outside of clinical psychology, including within the field of applied behavior analysis (ABA). This article discusses the use of ACT within mainstream ABA practice and provides preliminary conceptual functional analyses and practical guidelines for incorporating ACT within the scope of practice of applied behavior analysts.

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Acceptance describes mediating behaviors in which an individual reduces escape and avoidance behaviors in response to unwanted private events while also encouraging increased appetitive control. Given the recent resurgence of interest in acceptance and commitment therapy/training (ACT) in applied behavior analysis (ABA), a review of this core treatment process is warranted. Acceptance has strong empirical support within the psychological and contextual behavioral science literatures, with treatment outcome studies, self-report measures research, and behavioral laboratory tasks all supporting the process. A review of select publications in behavior-analytic journals found that acceptance also has preliminary evidence of effectiveness across a variety of populations and problem behaviors in ABA. An application of acceptance in an ABA context is discussed, and recommendations for a more functional approach to acceptance and other ACT processes are offered. Acceptance interventions fall within the scope of practice of ABA in several contexts and are of relevance to mainstream ABA practitioners.

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Acceptance and commitment training (ACT) has received support for addressing a number of difficulties within clinical behavior analysis, organizational settings, caregiver support, and other behavior change efforts. ACT is distinguished from many other approaches in its emphasis on values: aspects of life that clients find meaningful and important. Working with values lets behavior analysts draw on the functional properties of language to influence behavior. These techniques can help organize behavior to be influenced by long-term reinforcers, even in the face of short-term aversives, which may arise in the course of behavior change. Many exercises have been developed within the values arena with various strengths and limitations. This article provides an overview of commonly used approaches and aspects relevant to implementation. Considerations related to scope of practice, social desirability in responding, and aversive private events are also discussed.

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The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents' autistic children's behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents' ratings of their children's challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children's behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.

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AIMS: To determine whether an educational programme targeting the reaction of veterinary personnel to difficult client interactions reduced burden transfer, stress and burnout in veterinary staff. METHODS: Employees of three small-animal veterinary hospitals in the south-western United States of America were recruited and randomised to intervention (educational programme; n = 16) or control (no intervention; n = 18) groups. Participants of this randomised, parallel arms trial completed pre-programme assessment including the Burden Transfer Inventory (BTI), Perceived Stress Scale, and Copenhagen Burnout Inventory. Assessment was followed by two, group-format educational sessions, based on acceptance and commitment training, tailored to reducing reactivity to difficult veterinary client interactions (intervention group only). After training was completed, both groups were assessed using the same measures and the intervention participants provided use and acceptability ratings. RESULTS: Intervention participants rated the programme as useful and appropriate, and reported that programme techniques were used a median of 43 (min 9, max 68) times during the 2 weeks prior to retesting. Relative to pre-programme scores, median post-programme scores for reaction (subscore of BTI) to difficult client interactions decreased in the intervention group (33 vs. 54; p = 0.047), but not in the control group (51 vs. 59; p = 0.210). Changes in median scores for stress and burnout from pre- to post-programme were non-significant for both groups. CONCLUSIONS: This pilot and feasibility trial showed high rates of acceptability and use by participants, as well as promising reductions in burden transfer. A larger scale clinical trial with follow-up at extended time points is needed to more fully examine the efficacy of this novel programme. CLINICAL RELEVANCE: Preliminary findings suggest this programme may be a useful approach to reducing occupational distress for individuals working in veterinary practice.

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Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioural skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across 4 participants. Quantitative data on fidelity and confidence were collected at baseline, post-training, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioural skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-021-00628-x.

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Examining behavior within the context of applied behavior analysis (ABA) from the perspective of acceptance and commitment training (ACTr), while understanding the role of relational framing and the transformation of stimulus function, can better equip behavior analysts to effectively address complex behavior that may be influenced by covert verbal behavior. This approach may lead to a more comprehensive analysis of behavior and result in more effective interventions for socially significant change. The aim of this article is to provide behavior analysts with information and guidance on using relational frame theory (RFT) and ACTr in behavior-analytic services. The article first provides a rationale for considering thoughts as behavior and outlines important components of RFT. Subsequently, the benefits of employing ACTr in ABA are highlighted, including brief descriptions and examples of the use of ACTr within ABA practice. The article highlights the importance of expanding the consideration of maintaining variables when attempting to address maladaptive covert verbal behavior and ultimately aims to encourage a greater number of behavior analysts to adopt RFT and ACTr practices in applied settings.

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This study aimed to explore whether an acceptance and commitment (ACT) approach to stress management training improved the levels of depression, anxiety, and stress among a group of twenty-two health professionals from an intensive care unit. Questionnaires were administered before and after training, and follow-up was carried out one month after training, including semi-structured interviews with nine participants. The results reflected that the quasi-experimental group reduced their depression and stress levels significantly and showed improvements in stress in the follow-up. A qualitative thematic analysis of interviews showed that nurses were seeking a tool that would help them to cope more effectively with stressful situations and increase their knowledge of stress management. The themes in the professionals' comments claimed specific improvements in their health, well-being, relationships, and psychological processes. In conclusion, ACT-based trainings offer a possible framework for mental health promotion in health care organizations. (AU)

Este estudio tiene como objetivo explorar si un enfoque de aceptación y compromiso (TAC) para el entrenamiento en el manejo del estrés mejora los niveles de depresión, ansiedad y estrés en un grupo de 22 profesionales de la salud de una unidad de cuidados intensivos. Los cuestionarios se administraron antes y después del entrenamiento y el seguimiento se llevó a cabo un mes después del mismo, incluyendo entrevistas semiestructuradas con 9 de los participantes. Los resultados reflejaron que el grupo cuasiexperimental redujo sus niveles de depresión y estrés significativamente y mejoró el estrés durante el seguimiento. Un análisis temático cualitativo de las entrevistas mostró que los profesionales de enfermería buscaban una herramienta que les ayudara a hacer frente más eficazmente a las situaciones de estrés aumentando el conocimiento en su manejo. Los comentarios de los profesionales reflejaban mejoras específicas en su salud, bienestar, relaciones y procesos psicológicos. En conclusión, los entrenamientos basados en TAC ofrecen un posible marco para mejorar la salud mental en las organizaciones de atención médica. (AU)

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As part of the child-rearing process, situations that invite difficult conversations will inevitably arise. Oftentimes, there are no guidelines or structure for how to discuss topics such as sex education, systemic racism, bullying, grieving, and gun violence. Accordingly, adults may feel at a loss for how to address difficult topics and may even avoid difficult conversations completely. When adults choose to have these conversations, they may imitate the conversations their caregivers had with them, and therefore further the cycle of systemic racism, often unknowingly and unintentionally. Racial injustice has been a core part of the American experience since the founding of the republic; hence, conversations about systemic racism are long overdue. The need has significantly increased, given the current socio-political climate. Social justice may be a sensitive topic for some, but it is a needed conversation for all, including children with Autism Spectrum Disorder (ASD). Currently available curricula and teaching manuals in the Applied Behavior Analysis (ABA) literature include little or no resources for caregivers on how to address systemic racism with their children on the spectrum. Children with ASD should be educated about how they, and their families, can combat systemic racism in their everyday lives. The present paper addresses this gap in available treatment resources by offering practical suggestions and guidelines for how adults can address the topic of systemic racism with children on the autism spectrum to educate them and prepare them to contribute to a more equitable and just future.

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The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health. For parents, shaping these processes may help promote family nurturance, support children's prosocial behavior, and provide effective and consistent use of evidence-based parenting "kernels." The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.

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The COVID-19 pandemic has dramatically uprooted the lives of families around the world. Families living with children with autism spectrum disorder (ASD) may be particularly affected due to being abruptly deprived of their usual in-person support from applied behavior analysis (ABA) service providers. This article gives how-to instructions on 18 simple acceptance and commitment training (ACT) programs that can be used as supplements to ongoing ABA services to support children with ASD whose verbal repertoires may play a part in the challenges they are facing during the current crisis. We describe several challenges that have been frequently reported by families and ABA practitioners during the pandemic. For each behavioral challenge, we provide a brief practical description, brief behavioral conceptual description, and how-to guidance on implementing ACT procedures that address each behavioral challenge at a functional level. The Appendix contains child-friendly worksheets for practitioners to use as visual supports while implementing the intervention procedures.

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Despite ongoing efforts to eradicate racism, it persists globally, negatively affecting education, mental health, community relations, and economic development. Every behavior analyst can, and should, contribute to the reduction of racism in some way. Unfortunately, little behavior-analytic research exists to guide us. This article proposes ways that members of our scientific community can learn about racism from a behavioral perspective, extend experimental analyses of prejudice, and intervene to reduce racism in varied settings. It describes both traditional behavior-analytic and functional-contextualist accounts of racism and summarizes the small amount of related empirical and applied research. The review suggests that combining traditional behavior-analytic methods with acceptance and commitment training techniques may attenuate racism more effectively. The article ends with a call to collaborate around this globally important issue-and to do more to reduce racism.

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Parents managing their home environments during government-ordered stay-at-home periods are likely to need new skills for occupying their children's time with activities that promote health and emotional well-being. Moreover, parents and children know they need help managing these circumstances. Perhaps for the first time, behavior analysts hold the reinforcers for increasing parental involvement in effective child-rearing practices. In fact, behavior analysts can help parents enlist their children in managing the household by framing their behavior in terms of hidden superpowers. In the current article, we argue that behavior analysts have a range of tools to offer that are grounded in evidence-based principles, strategies, and kernels-or essential units of behavioral influence. When combined into scheduled daily practices and invoked by children taught to see their use of the tools as nothing short of heroic, these practices function as "vaccinations" that inoculate families against toxic and unsafe behaviors.