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Assessing the field effectiveness of acceptance and commitment therapy: An example of the manipulated training research method
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Health care reform and managed care have produced a growing emphasis on field effectiveness research. The present paper proposes a simple methodological model for conducting such research that can assimilate all of the setting features of effectiveness questions while not requiring that researchers abandon experimental controls in favor of survey methods. This “manipulated training method” is then applied to an analysis of the field effectiveness of Acceptance and Commitment Therapy (ACT). Seventeen master's-level therapists and one psychologist (those not receiving training = 10; receiving training = 8) participated in a 1-year project. The training package consisted of a didactic workshop, an intensive clinical training, and monthly supervision groups. Prior to training and following training the clients of all clinicians in the project were assessed. Among other findings, clients of ACT-trained therapists reported significantly better coping than the clients of untrained therapists and were more likely to have completed treatment in the 5 months following initiation of treatment. A structural equation model indicated that ACT training accounted for differential coping outcomes. There was also evidence that training improved clients' self-ratings of psychological acceptance. At 5 months following the initial session, clients of ACT-trained therapists were more likely than clients of untrained therapists to have concluded therapy, and were more likely to agree with their clinician regarding the ongoing status of therapy. Implications for research on clinical effectiveness and technology transfer of behavior therapy are discussed.