John P Forsyth

• Doctor of Philosophy
• Managing Director at University at Albany, State University of New York

The current case describes the implementation of Acceptance and Commitment Therapy (ACT) and self-compassion interventions with a 37-year-old Queer Hispanic woman “Cynthia” (pseudonym). Cynthia presented to a university training clinic, reporting pervasive difficulties with anxiety, an associated pattern of depressive episodes, and a trauma history...

The present case details a successful treatment response to 21 sessions of Acceptance and Commitment Therapy (ACT) delivered via teletherapy for mixed anxiety and depressive symptomology during the COVID-19 pandemic. The client (“Natalie”), a 19-year-old, White, cisgender female, presented to a university training clinic reporting primary problemat...

Finden Sie anhaltende Ruhe und inneren Frieden. Sind Sie oft ängstlich oder gestresst? Machen Sie sich ständig Sorgen um Dinge, die auf Sie zukommen könnten, oder grübeln über Vergangenes? Ist es mittlerweile normal für Sie, ständig Angst zu haben? Wenn das der Fall ist, dann ist es an der Zeit, einen Stift in die Hand zu nehmen und die Angst mit H...

Problematic smartphone use (PSU) is associated with numerous costs. Yet, the phenomenology of PSU is not well understood, particularly regarding the relative contribution of transdiagnostic factors in the development, maintenance, and treatment of PSU. The present study aimed to evaluate one transdiagnostic factor, namely psychological inflexibilit...

Though anger is a common human emotion, the unfettered behavioral expression of anger is often costly, contributing to a range of functional impairments, poor quality of life, and both physical and mental health problems. The current case illustrates how a third-generation cognitive behavioral therapy, Acceptance and Commitment Therapy (ACT), may b...

Background and Objectives Meditation practices have been marketed broadly to ameliorate human suffering. As such, individuals may seek out and use meditation to control or manage unpleasant thoughts and emotions. Emotion and thought control research suggest that meditation used in this way may potentiate unpleasant private experiences and contribut...

Evaluating how, for whom, and under what conditions psychosocial treatments work is an important component of anxiety disorder treatment development. Yet, research regarding mediators and moderators of self-help interventions is sparse. The current project is a secondary analysis of mediators, moderators, and correlates of outcome of a randomized w...

Experiential avoidance (EA), cognitive fusion (CF), and lack of present-moment awareness contribute to the development and maintenance of various forms of psychopathology, principally through their negative impact on value-guided action. However, little research has examined these behavioral processes at the daily level and, as such, the temporal a...

Objective: Evaluate the incremental effects of a computerized values clarification (VC) activity on anxiety symptomology and quality of life over and above establishment of a mindfulness meditation (MM) practice. Method: Anxious participants (N = 120, Female = 86; Mage = 22.26) were randomly assigned to a 2-week, 10-min daily MM practice + contr...

Mindfulness-based interventions (MBIs) are efficacious and effective for a variety of mental and physical health problems. Mindfulness meditation is a primary therapeutic strategy employed within MBIs and is hypothesized to increase mindfulness and, in turn, lead to positive outcomes. However, evidence in support of mindfulness meditation practice...

Research using the Implicit Relational Assessment Procedure (IRAP) suggests that a positive bias toward thinness, rather than a negative bias toward fatness, might underlie implicitly assessed evaluative responding regarding body image. Because these results contrast with reports of widespread anti-fat attitudes, we aimed to clarify the nature of i...

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health...

The central aim of the present article is to review (1) the conceptual basis and rationale guiding the use of single-case designs in experimental and applied contexts and (2) the advantages, disadvantages, and flexible application of the main varieties of single-case design strategies. In so doing, emphasis is placed on the value of a single-case d...

Within Acceptance and Commitment Therapy (ACT), valued-living is a primary outcome. Indeed, the overarching goal of ACT is to facilitate psychological flexibility and behavior linked with desired life directions. Yet, there have been few systematic efforts to understand how factors associated with values (e.g., social pressure to enact certain valu...

Acceptance and Commitment Therapy (ACT) utilizes cognitive defusion strategies to alter the function of unwanted, distressing thoughts so as to reduce their impact and foster greater psychological flexibility. Though defusion is linked to several positive outcomes (e.g., reduced thought believability, improved pain tolerance), it remains unclear wh...

Objective: Veterans with PTSD smoke at rates two to three times higher than the general population, while their quit rate is less than half that of the general population. The present study evaluated the feasibility, acceptability, and preliminary efficacy of Acceptance and Commitment Therapy for Veterans With Posttraumatic Stress Disorder (PTSD)...

Anxiety disorders are associated with numerous costs and poor quality of life (QOL), and yet are highly treatable. The present study evaluated the relations between putative change processes, anxiety symptom severity, and QOL by employing path analysis to compare two theoretically-derived models of anxious psychopathology in an examination of pre-i...

The tendency for anxious individuals to selectively attend to threatening information is believed to cause and exacerbate anxious emotional responding in a self-perpetuating cycle. The present study sought to examine the relation between differential interoceptive conditioning (IC) using carbon dioxide inhalation as a panicogenic unconditioned stim...

Objective: Stigma associated with behavioral health problems in the military pose challenges to accurate base rate estimations. Recent work has highlighted the importance of anonymous assessment methods, yet no study to date has assessed the ability of anonymous self-report measures to mitigate the impact of stigma on honest reporting. This study...

Two experiments were designed to replicate and extend previous findings on the transformation of avoidance response functions in accordance with the relational frames of Same and Opposite. Participants were first exposed to nonarbitrary and arbitrary relational training and testing. Next, during avoidance conditioning, one stimulus from the relatio...

Veterans with posttraumatic stress disorder (PTSD) have high rates of smoking and significant difficulties with quitting. Acceptance and mindfulness-based techniques may enhance smoking cessation approaches for veterans with PTSD as they are designed to improve emotion regulation skills related to coping with elevated negative affect and withdrawal...

Cognitive fusion-or the tendency to buy into the literal meaning of thoughts, feelings, and bodily sensations-plays an important role in the etiology and maintenance of anxiety disorders and figures prominently in third-generation behavior therapies such as acceptance and commitment therapy (ACT). Nonetheless, there is a lack of validated self-repo...

Interoceptive fear conditioning is at the core of contemporary behavioral accounts of panic disorder. Yet, to date only one study has attempted to evaluate interoceptive fear conditioning in humans (see Acheson, Forsyth, Prenoveau, & Bouton, 2007). That study used brief (physiologically inert) and longer-duration (panicogenic) inhalations of 20% CO...

The goal of this paper is to familiarize clinicians with the use of Acceptance and Commitment Therapy (ACT) for problem anger by describing the application of ACT to a case of a 45-year-old man struggling with anger. ACT is an approach and set of intervention technologies that support acceptance and mindfulness processes linked with commitment and...

The current article reports two experiments designed to examine the effects of creating competing approach and avoidance response func-tions for 2 stimuli that participate in the same derived stimulus rela-tion. Experiment 1 involved establishing each of 2 distinct members (i.e., B1 and D1) of the same 1-node equivalence relation (A-B-C-D) as a dis...

Mindfulness has received considerable attention as a correlate of psychological well-being and potential mechanism for the success of mindfulness-based interventions (MBIs). Despite a common emphasis of mindfulness, at least in name, among MBIs, mindfulness proves difficult to assess, warranting consideration of other common components. Self-compas...

Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system for which there is no known cure. The condition is associated with a range of physical, psychological, and emotional difficulties and often results in reduced quality of life (QOL). Acceptance and Commitment Therapy (ACT) is a newer cognitive-behavior therapy th...

The construct of emotion regulation has been increasingly investigated in the last decade, and this work has important implications for advancing anxiety disorder theory. This paper reviews research demonstrating that: 1) emotion (i.e., fear and anxiety) and emotion regulation are distinct, non-redundant, constructs that can be differentiated at th...

Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiet...

Sex differences in incidence and severity of some stress-related, neuropsychiatric disorders are often reported to favor men, suggesting that women may be more vulnerable to aberrant hypothalamic-pituitary-adrenal (HPA) axis responses to stress. In this review, we discuss several investigations that we, and others, have conducted assessing salivary...

Research has shown that emotional avoidance and anxiety sensitivity are associated with more self-reported fear and distress in response to laboratory fear challenge procedures. The present study aimed to expand upon this work and examined how emotional avoidance and anxiety sensitivity are related to emotional and physiological responses to an obs...

This analogue experiment used fear conditioning and extinction procedures to establish and reduce fearful responding and then test for fear renewal following a context change. Healthy undergraduates (N=61) underwent a differential fear conditioning procedure using geometric shapes as conditioned stimuli (CS) and inhalations of 20% CO(2)-enriched ai...

Early identification of disease and intervention when necessary are a cornerstone of contemporary medical practice. This approach has been successful in reducing suffering associated with the progression of unchecked medical problems to full-blown disease. Many healthcare systems, in turn, support this approach via routine checkups. The same cannot...

Gender differences in measures of anxiety sensitivity (AS) are similar to gender differences across anxiety disorders; females exhibit higher levels of AS and a greater prevalence of anxiety disorders than males. The current study confirms higher scores on the Anxiety Sensitivity Index (ASI) in females. Further analysis reveals, however, that gende...

This article reviews research concerning the possible relationship between tonic immobility (TI) and human reactions to sexual assault. This review includes a description of the characteristic features of TI and a discussion of the most widely accepted theoretical explanation for TI. The possibility that humans may exhibit TI is explored and condit...

Contemporary models of panic attacks suggest that panic problems exist on a continuum and highlight the need to understand what differentiates persons who have never had a panic attack versus persons who have had panic attacks but have not yet developed panic disorder (i.e., non-clinical panickers). Accordingly, the present study evaluated several...

The present study evaluated sex differences in observational fear conditioning using modeled "mock" panic attacks as an unconditioned stimulus (UCS). Fifty-nine carefully prescreened healthy undergraduate participants (30 women) underwent 3 consecutive differential conditioning phases: habituation, acquisition, and extinction. It was expected that...

Fear and its conditioned basis are not disordered processes per se but become so when they alter their form, frequency, or occurrence in humans. The regulation of anxiety and fear using any number of strategies may result in temporary relief-for example, anxiety reduction via negative reinforcement. Yet the cumulative effect over time of such actio...

Tonic immobility (TI) is an involuntary component of the fear response that is characterized by freezing or immobility in situations involving extreme fear coupled with physical restraint. The present investigation evaluated the factor structure of the Tonic Immobility Scale (TIS; Forsyth, J. P., Marx, B., Fusé, T. M. K., Heidt, J., & Gallup, G. G....

The present analog study compared the effectiveness of an acceptance- and control-based intervention on pain tolerance using a cold pressor task, and is a partial replication and extension of the Hayes, Bissett et al. (Hayes, S. C., Bissett, R.T., Korn, Z., Zettle, R. D., Rosenfarb, I. S., Cooper, L. D., & Grundt, A. M. (1999). The impact of accept...

Despite the role afforded interoceptive fear conditioning in etiologic accounts of panic disorder, there are no good experimental demonstrations of such learning in humans. The aim of the present study was to evaluate the interoceptive conditioning account using 20% carbon dioxide (CO(2))-enriched air as an interoceptive conditioned stimulus (CS) (...

Research on the emergence of human avoidance behavior in the absence of direct contact with an aversive event is somewhat limited. Consistent with work on derived relational responding, the present study sought to investigate the transformation of avoidance response functions in accordance with the relational frames of Same and Opposite. Participan...

Anxious persons show automatic and strategic attentional biases for threatening information. Yet, the mechanisms and processes that underlie such biases remain unclear. The central aim of the present study was to elucidate the relation between observational threat learning and the acquisition and extinction of biased threat processing by integratin...

Replies to the article by Mineka and Zinbarg (see record 2006-00920-002 ), which illustrated how a contemporary learning theory informs the etiology and maintenance of anxiety disorders. In our view, the challenge facing contemporary learning theory is to explain how and why potentiated fear conditioning is problematic and capable of yielding an an...

The present investigation evaluated the Anxiety Sensitivity (AS) taxon using the 16-item Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986) and its relation with two theoretically relevant cognitive processes associated with panic vulnerability: bodily vigilance and perceived uncontrollability over anxiety-related events. Taxometr...

This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), as indexed by the 16-item Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986), by using taxometric and factor-analytic approaches in an integrative manner. Taxometric analyses indicated that AS has a taxonic...

The present study sought to (a) test whether autonomic (i.e., electrodermal) and evaluative conditioning can be differentially established to verbal CSs, and (b) whether extinction procedures can reliably attenuate differential conditioned evaluative responding. Thirty undergraduates underwent a 10-min adaptation period followed by three consecutiv...

Epidemiological studies show that women are twice as likely as men to develop panic disorder (PD) during their lifetimes. Data from retrospective studies also suggest that women are more distressed by panic and other negative emotional states than men, and that this tendency may precede the development of PD. The present prospective study sought to...

Extending previous work, we conducted two studies concerning the toxic influences of experiential avoidance (EA) as a core mechanism in the development and maintenance of psychological distress, and disruption of pleasant, engaging, and spontaneous activity. Of particular interest was whether EA accounted for relationships between coping and emotio...

Two experiments investigated the derived transfer of functions through equivalence relations established using a stimulus pairing observation procedure. In Experiment 1, participants were trained on a simple discrimination (A1+/A2-) and then a stimulus pairing observation procedure was used to establish 4 stimulus pairings (A1-B1, A2-B2, B1-C1, B2-...

Among ethical concerns associated with biological challenge procedures is the risk of potentiating panic attacks in otherwise healthy persons who have no history of panic. The aim of the present study was to determine if repeated exposure to 20% CO2 challenge increases the risk of developing panic attacks in a nonclinical sample. One hundred and fi...

The present study examined tonic immobility (TI) in victims of childhood sexual abuse (CSA). Female undergraduates (n=39) and female psychiatric inpatients (n=41) who experienced CSA completed a series of questionnaires assessing aspects of their victimization history, psychological functioning, and TI symptoms. Over fifty-two percent of all partic...

The present study investigated the relationship between panic disorder and emotional sensitivity processes related to smoking. Participants were 170 young adult (mean age = 25.2 [8.4]) regular smokers (mean cigarettes per day = 15.6 [2.4]) with (n = 69) and without (n = 101) a primary diagnosis of panic disorder. Consistent with prediction, smokers...

The psychometric properties of the Anxiety Control Questionnaire (ACQ) were evaluated in 1,550 outpatients with DSM-IV anxiety and mood disorders and 360 nonclinical participants. Counter to prior findings, exploratory factor analyses produced a 3-factor solution (Emotion Control, Threat Control, Stress Control) based on 15 of the ACQ's original 30...

Healthy undergraduates high (n = 27) and low (n = 27) in experiential avoidance underwent twelve 20 s inhalations of 20% carbon dioxide-enriched air, while physiological (e.g., skin conductance, heart rate, EMG, and end-tidal CO2) and subjective (e.g., subjective units of distress, evaluative ratings, number and severity of panic symptoms endorsed)...

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor a...

The promotion and dissemination of empirically supported (ESTs) and manualized therapies are important, albeit controversial, developments within clinical science and practice. To date, studies evaluating training opportunities and attitudes about such treatments at the graduate, predoctoral internship, and postdoctoral levels have focused on the o...

The aim of the present study was to evaluate anxiety-related psychological risk factors (e.g., anxiety sensitivity, perceived uncontrollability, emotional avoidance) and their relation to drug of choice and addiction severity in an inpatient residential substance abuse population. Fully detoxified veterans (N=94) meeting criteria for Axis I substan...

The present study evaluated 2 interrelated hypotheses concerning the relation between specific anxiety sensitivity dimensions and how one responds to bodily sensations in a population with no known history of psychopathology (N = 214). Specifically, the Physical Concerns subscale of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. G...

Despite the proliferation of manualized treatments, and clinical trials that generally support their efficacy, there is a need for further documenting the effectiveness of a manualized treatment for Generalized Anxiety Disorder (GAD)—the Mastery of Your Anxiety and Worry (MAW) protocol. A single-case treatment outcome study using the MAW program wi...

Panic attacks are symptomatically heterogeneous but efforts to describe such heterogeneity are relatively new. With regard to symptom presentation, at least three types of panic attack have been proposed based on the coupling or decoupling of verbal-cognitive and physiological symptoms: prototypic, cognitive, and nonfearful panic. The central aim o...

The widespread use of so-called “biological” challenges in the anxiety disorders has produced an impressive literature that has helped elucidate the nature and phenomenology of panic attacks. Yet, researchers have barely scratched the surface in terms of demonstrating the practical relevance and utility of such procedures in the routine assessment...

The present study evaluated panic-relevant cognitive processes in a sample of persons ( n = 70) who met criteria for either: (a) a positive panic attack history and regular smoking (smoking at least 10 cigarettes per day for S 12 months); (2) a positive panic attack history but no history of smoking; or (3) regular smoking history alone (smoking at...

Psychopathology research is the scientific foundation for legitimate and credible forms of clinical practice and the ethical delivery of mental health services. Experimental psychopathology is a subfield of psychopathology research; its aims are to elucidate variables and processes that contribute, either in whole or in part, to the etiology, exace...

Plaud (J Clin Psychol 57, 1089-1102, 1109-1111, 1119-1120) and Ilardi and Feldman (J Clin Psychol 57, 1067-1088, 1103-1107, 1113-1117, 1121-1124) argue for two very different approaches to clinical science and practice (i.e., behavior analysis and cognitive neuroscience, respectively). We comment on the assets and liabilities of both perspectives a...

Debates have ensued over whether fear conditioning is mainly a function of the strength of the aversive unconditioned stimulus (DCS) or the severity and intensity of the unconditioned response (UCR). The present study introduces a novel and clinically relevant preparation to test these competing hypotheses. Sex-balanced groups of undergraduate part...

Predictability, or lack thereof, is believed to play a critical role in the development and maintenance of anxiety, with unpredictability being associated with heightened levels of anxious and fearful responding. Despite the potential importance of predictability in theoretical accounts of emotional dysregulation, currently no standardized assessme...

Increasingly carbon dioxide-enriched air is being used as an aversive unconditioned stimulus in laboratory examinations of anxiety. Yet, little is known about the stability of the autonomic and subjective effects of this stimulus across repeated inhalations and sessions. We examined whether repeated administrations of high concentrations of CO2-enr...

The increasing recognition that panic attacks are heterogeneous phenomena necessitates better and more objective criteria to define and examine what constitutes a panic attack. The central aim of the present study was to classify subtypes of panic attacks (i.e. prototypic, cognitive, and non-fearful) in a nonclinical sample (N=96) based on the conc...

In recent years it has been suggested that behavior therapy, characterized in part by single-subject designs and an idiographic approach to addressing practical problems, is drifting from its experimental roots. To examine trends in behavior therapy, and to provide an objective index of drift, two archival studies were conducted to identify publica...

Anxiety sensitivity has been implicated as a risk factor in the development and maintenance of anxiety and fear-related disorders. Indeed, persons who score high on the anxiety sensitivity index (ASI) are generally more responsive to biological challenge procedures such as CO2-inhalation that directly evoke the feared bodily events. One would expec...

Laboratory-based experimental research has led to important breakthroughs in our understanding and treatment of anxiety disorders as well as other types of psychopathology. Despite the importance of this work, the relevance of laboratory-based research using clinical and nonclinical populations has been understated—particularly given concerns about...

Anxiety sensitivity has been implicated as a risk factor in the development and maintenance of anxiety and fear-related disorders. Indeed, persons who score high on the anxiety sensitivity index (ASI) are generally more responsive to biological challenge procedures such as CO2-inhalation that directly evoke the feared bodily events. One would expec...

Although researchers successfully have used carbon dioxide-enriched air in experimental and clinical preparations, its functional properties may differ across laboratories due to procedural differences. Additionally, current procedures may be too simplistic for more complex experimental designs. To address these issues, we present three devices for...

This study examined the relation between the intensity of CO2-induced psychophysiological responses and content-specific fear conditioning. Sex-balanced groups of undergraduates (N = 96) were assigned to 1 of 3 conditioned stimuli (CSs) differing in fear-relevance, and within each CS, to either 20% or 13% CO2-enriched air (unconditioned stimuli [UC...

This study examined the relation between the intensity of COP-induced psychophysiological responses and content-specific fear conditioning. Sex-balanced groups of undergraduates (N = 96) were assigned to 1 of 3 conditioned stimuli (CSs) differing in fear-relevance, and within each CS, to either 20% or 13% CO2-enriched air (unconditioned stimuli [UC...

In recent years numerous disagreements and controversies have ensued over the place of Pavlovian or associative conditioning in the etiology of specific phobias and other fear-related clinical syndromes. A major source of disagreement emerged from clinical observations suggesting that environmental aversive conditioning events could not be identifi...

Almost since its inception, the behavior therapy movement has defined itself in terms of advancement. Advancement, in turn, implies progress or moving forward, not stagnation, or regress and moving backward. Over the last 30 years, behavior therapy has witnessed notable advancements, but also periods of stagnation, and at times regress. The challen...

In a spirit of intellectual honestly, Franks (1997) provides an evaluation of the best and worst of behavior therapy from the eyes of a founding member. In so doing, he notes that conceptual and theoretical advancement of behavior therapy as a science has given way to professional advancement. In this commentary, it is agreed that behavior therapy,...

We sketch the cognitive-behavioral debate and outline the purpose of the subsequent articles. Together, these articles constitute a symposium designed to show how behavior analysts can learn from the work of cognitivists and cognitive-behavior therapists. This is done by interpreting some cognitive concepts in terms that are familiar and acceptable...

Behavior analysis is defined as a natural science approach to behavior--with both basic and applied branches--and contrasted with cognitive psychology. Behavior analysis is described as an integrated science that views a person's interactions with the environment as selecting certain behaviors--or rather, environment-behavior relations--making them...

Clients often provide reasons, justifications, and explanations (i.e., attributions) about the causes of their problems and what they believe needs to be done to ameliorate them. Behavior therapists also frequently generate hypotheses about causal factors contributing to client behavior problems. We discuss the function of attributing in the contex...

In this commentary, we address some of the divisive issues between cognitive theorists and behavior analysts concerning the aims and goals of science and differing views of causality. We suggest that evidence for the causal status of cognition has been inconclusive, largely due to the fact that most of this research can be framed in terms of enviro...