2016-11-22-15-40-42 - v2In our lab we ideate, develop and test digital behavioral health interventions for under-served populations, such as individuals who experience persistent mental health symptoms, addiction, or chronic pain. Our lab applies a variety of tools and methods, including group clinical trials methodology, single case experimental designs, user centered design methods and novel analytic tools for small N data. We specialize in (1) designing digital tools to foster the practice of psychological flexibility and mindfulness, and (2) the general application of a therapeutic approach called Acceptance and Commitment Therapy. Our lab has received funding from the National Institute on Drug Abuse, Pfizer, The University of Washington Innovation Award, and Duke’s Center for Addiction Science and Technology. We are located in the city of Durham, North Carolina (US), in a 540 square feet space adjacent to Duke University.

vilardaga-lab at duke.edu
2812 Erwin Rd, Durham, NC 27705
Office Phone: 919-681-3441

Current Directions

  • Testing novel approaches for smoking cessation in people with serious mental illness. The ‘Quit on the Go’ Trial (NCT03069482), is the first NIH funded smoking cessation trial testing mobile interventions in people serious mental illness (R00DA037276, PI: Vilardaga).
  • Developing and testing novel interventions for people suffering with Chronic Pain. This project, funded by Pfizer, developed a digital intervention based on Acceptance and Commitment Therapy and is currently testing it in an open trial.
  • Developing a novel framework for self-experimentation and healthcare delivery using agile methodologies (i.e., single case experimental designs) and novel analytic methods (i.e., randomization tests). This project is funded by the 2015 University of Washington Innovation Award.

Selected Contributions

Vilardaga, R., Rizo, J., Kientz, J., McDonell, M.G., Ries, R., & Sobel, K. (2016). User experience evaluation of a smoking cessation app in people with Serious Mental Illness, Nicotine & Tobacco Research, 18(5):1032-1038. doi: 10.1093/ntr/ntv256; PubMed PMID: 26581430.
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In this study, we conducted an user experience evaluation of a smoking cessation app developed by the National Cancer Institute (NCI QuitPal), that provides guidance and recommendations to tailor smoking cessation apps for individuals with chronic mental illness

Introduction: Smoking rates among people with serious mental illness are 3 to 4 times higher than the general population, yet currently there are no smoking cessation apps specifically designed to address this need. We report the results of a User Experience (UX) evaluation of a National Cancer Institute smoking cessation app, QuitPal, and provide user centered design data that can be used to tailor smoking cessation apps for this population.

Methods: 240 hours of field experience with QuitPal, 10 hours of recorded interviews and task performances, usage logs and a self-reported usability scale, informed the results of our study. Participants were five individuals recruited from a community mental health clinic with a reported serious mental illness history. Performance, self-reports, usage logs and interview data were triangulated to identify critical usability errors and user experience (UX) themes emerging from this population.

Results: Data suggests QuitPal has below average levels of usability, elevated time on task performances and required considerable amounts of guidance. User experience themes provided critical information to tailor smoking cessation apps for this population, such as the importance of breaking down “cessation” into smaller steps and use of a reward system.

Conclusions: This is the first study to examine the UX of a smoking cessation app among people with serious mental illness. Data from this study will inform future research efforts to expand the effectiveness and reach of smoking cessation apps for this highly nicotine dependent yet under-served population.

Karkar, R. Zia, J., Vilardaga, R., Mishra, S.R., Fogarty, J., Munson, S.A. & Kientz, J.A. (2016). A Framework for self-experimentation in personalized health. Journal of the American Medical Informatics Association, 23(3):440-8. PubMed PMID: 26644399.
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In this study we provided empirical support for a self-experimentation system through mobile technology that could be a promising approach to advancing personalized health

Objective: To describe an interdisciplinary and methodological framework for applying single case study designs to self-experimentation in personalized health. We examine our framework’s applicability to various health conditions and present an initial case study with irritable bowel syndrome (IBS).

Methods and Materials: An in-depth literature review was performed to develop the framework and to identify absolute and desired health condition requirements for the application of this framework. We developed mobile application prototypes, storyboards, and process flows of our framework using IBS as our case study. We conducted three focus groups and an online survey using a human-centered design approach for assessing our framework’s feasibility.

Results:  All six focus group participants had a positive view about our framework and volunteered to participate in future studies. Most stated they would trust the results because it was their own data being analyzed. They were most concerned about confounds, non-meaningful measures, and erroneous assumptions on the timing of trigger effects. Survey respondents (N = 60) were more likely to be adherent to an 8 versus 12-day study length even if it meant lower confidence results.

Discussion: Implementation of our self-experimentation framework in a mobile application appears to be feasible for people with IBS. This framework can likely be applied to other health conditions. Considerations include the learning curve for teaching self-experimentation to non-experts and the challenges involved in operationalizing and customizing study designs.

Conclusion: Using mobile technology to guide people through self-experimentation to investigate health questions is a feasible and promising approach to advancing personalized health.

Vilardaga, R., Heffner, J.L., Mercer, L.D., & Bricker, J. (2014). Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered acceptance and commitment therapy. Behaviour Research and Therapy, 61:89-95. doi:10.1016/j.brat.2014.07.008, PubMed PMID: 25156397.
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This study provided evidence in support of the role of counselor techniques designed to increase individuals’ awareness and openness to experience urges to smoke in a telephone trial of Acceptance and Commitment Therapy for smoking cessation

No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors’ use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors’ use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists’ techniques as predictors of outcome during the course of treatment.
Portraits: June 25, 2014

Vilardaga, R., Hayes, S. C., Atkins, D. C., Bresee, C., & Kambiz, A. (2013). Comparing experiential acceptance and cognitive reappraisal as predictors of functional outcome in individuals with serious mental illness. Behaviour Research and Therapy, 51(8):425–433. doi:http://dx.doi.org/10.1016/j.brat.2013.04.003, PubMed PMID: 23747581.
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In this study we reported strong and reliable associations between momentary levels of experiential acceptance and subsequent quality of life amongst individuals with psychotic disorders

Background: Two psychological regulation strategies to cope with psychotic symptoms proposed by the cognitive behavioral tradition were examined in this study: cognitive reappraisal and experiential acceptance. Although cognitive behavior therapy for psychosis has increasing empirical support, little is known about the role of these two strategies using methods of known ecological validity. Methods: Intensive longitudinal data was gathered from 25 individuals diagnosed with a psychiatric disorder with psychotic features. During the course of six days we measured contextual factors, psychotic and stressful events, psychological regulation strategies and functional outcome. Results: Positive psychotic symptoms and stressful events had negative associations with quality of life and affect, whereas experiential acceptance had positive associations with them. Cognitive reappraisal had inconsistent associations with quality of life and no association with affect. Social interactions and engagement in activities had a positive association with quality of life. Results were supported by additional and exploratory analyses. Conclusions: Across measures of functional outcome, experiential acceptance appears to be an effective coping strategy for individuals facing psychotic and stressful experiences, whereas cognitive reappraisal does not. In order to inform treatment development efforts, results suggest the need to further investigate the role of these psychological regulation strategies using ecologically valid methods.

Vilardaga, R., Bricker, J., & McDonell, M. (2014). The promise of mobile technologies and single case designs for the study of individuals in their natural environment. Journal of Contextual Behavioral Science, 3(2):148-153. doi:10.1016/j.jcbs.2014.03.003, PubMed PMID: 24949285.
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In this paper we review and discuss the opportunities and implications of combining single case designs, mobile technology and novel analytic methods for the experimental study of individuals in their natural environment

Mobile technologies are growing rapidly around the world to broad demographics of society. These technologies hold great promise for their integration with Single Case Designs (SCDs) and the study of individuals in their natural environment. This paper discusses the theoretical, methodological and analytic implications of these tools for the advancement of the contextual behavioral etiology of behavioral disorders, and their remediation. We hope this paper will highlight the scientific advantages of combining mobile technologies and SCDs and encourage their adoption among CBS scientists.

Vilardaga, R., Hayes, S.C., Levin, M. & Muto, T. (2009). Creating a strategy for progress: A contextual behavioral science approach. The Behavior Analyst, 32, 105-133. PubMed PMID: 22478516.
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This paper discusses a proposal for a contextual behavioral science approach that puts emphasis in the following pivotal features: theory, flexible language systems for applied workers and methodological diversity

Behavior analysis is a field dedicated to the development and application of behavioral principles to the understanding and modification of the psychological actions of organisms. As such, behavior analysis was committed from the beginning to a comprehensive account of behavior, stretching from animal learning to complex human behavior. Despite that lofty goal, basic behavior analysis is having a generally harder time finding academic support, and applied behavior analysis has narrowed its focus. In the present paper we argue that both of these trends relate to the challenge of human language and cognition, and that developments within clinical behavior analysis and the analysis of derived relational responding are providing a way forward. To take full advantage of these developments, however, we argue that behavior analysts need to articulate their unique approach to theory, to develop more flexible language systems for applied workers, and to expand their methodological flexibility. This approach, which we term contextual behavioral science, is meant as an evolutionary step that will allow behavior analysis to better capture the center of modern psychological concerns in both the basic and applied areas. Clinical behavior analysis is showing a way forward for behavior analysis to regain its vision as a comprehensive approach to behavior.

Vilardaga, R., Hayes, S.C. (2009). Acceptance and Commitment Therapy and the Therapeutic Relationship Stance. European Psychotherapy, 9, 117-140.
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A new theoretical model to conceptualize the therapeutic relationship and a tool for clinicians to increase flexible connectedness with their clients

This paper characterizes the ACT therapeutic relationship stance in the context of the findings of the common factors literature and the relationship between therapeutic alliance and outcomes. We describe some foundational aspects of the ACT model (its philosophical set of assumptions, its scientific theory of language and cognition, and its operating system of clinical intervention) and how they form the ACT therapeutic relationship stance. We also provide a possible theoretical model of the therapeutic relationship and a specific exercise to foster it that can be used by clinicians. Overall, we hold the therapeutic relationship as an important component of the therapeutic process and we argue that the ACT model, as a contextual behavioral science strategic approach (VILARDAGA, HAYES, LEVIN, & MUTO, 2009) provides a clearer understanding of the impact of the therapeutic relationship on outcomes, together with a clearer rationale to both improve the therapeutic relationship and research it.

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