Transcript Speaking across islands - Association for Contextual Behavioral

Speaking across islands
Building communication between ACT
and other approaches to clinical psychology
Chair:
Presenters:
Matthieu Villatte, PhD
J.T. Blackledge, PhD
Joseph Ciarrochi, PhD
Hank Robb, PhD
My journey to ACT
or
How I came to shave my head to look like
Steven Hayes
Multiplicity of models in psychology
PSYCHOLOGY
The choice of scientific psychology
Operationalization
of concepts
• Critics: Deshumanization!
Modification of theories
The choice of Behavior Analysis over
cognitive psychology
Monism
Precise operationalization
of concepts
• Critics: What about thinking?
The choice of CBT over ABA
Use of language
Interest for thoughts
• Critics: Do you really know what you are doing?
The choice of ACT
Behavior analysis
CBT
Humanism
• Critics: Meditation?! Symptoms not targeted?!
How clarifying gaps and building
bridges?
• Maybe with psychological flexibility…
Now, let’s let the experts talk
John T. Blackledge, Ph. D.
Morehead State University
Kentucky
• How might one ‘pitch’ RFT to a
conventional behavior analyst so that
he/she might actually hear what RFT is?
–What does RFT have in common with the
conventional ‘Skinnerian’ brand of applied
behavior analysis, and what data speaks to
RFT as a useful addition to ABA?
• What does ACT have in common with
conventional behavior therapy?
–And how might one accurately & effectively
pitch ACT to a conventional behavior
therapist?
• Applied Behavior Analysis:
–Uses direct operant and respondent principles
to teach language/practical skills/appropriate
behavior to individuals with developmental
disabilities, dementia, traumatic brain injury.
–Also uses these same principles for parent
training.
–Some applied behavior analysts make explicit
use of stimulus equivalence theory (more likely
use it without explicit awareness).
• Well over 150 published, peer-reviewed
empirical studies on RFT.
–Many of these either suggest explicit
applications or RFT in ABA, or have actually
successfully applied RFT principles with
‘traditional’ ABA populations.
• Anecdotally, more ‘conventional’ applied
behavior analysts appear to be softening to
RFT….
– “My impression……is that we've reached a critical
mass in new, young people getting interested in a
contemporary approaches to language and
cognition that lead to usable strategies for
promoting behavior change. These kids are pulling
along the generation that is one step older.”
– “My ABA experience: RFT vs. traditional verbal
behavior analyses: The war is won. Game over.
There are a few dinosaurs left at ABA who will
advocate for the old position but there is no
• Just as with Skinner’s (1957) account,
RFT views verbal behavior as operant
behavior
–We say and think what we say and think under
certain conditions because of a history of
reinforcement for saying and thinking those
things under similar conditions.
• Difference: RFT adds the notion of
relational operants.
–Skinner: Direct operant account—must have a
direct history of reinforcement for a specific
verbal utterance (or one that is formally
similar) in order for it to occur.
–RFT: Stimuli can be verbally related in a
variety of ways. After many instances of
relating stimuli in a variety of ways and being
reinforced for such responses, relational
responding becomes an overarching operant
class of behaviors.
• Other (Skinnerian) examples of
overarching operant classes of behavior:
–Generalized imitation
–Generalized attending (attending to stimuli that
are formally similar to those reinforcement has
previously been received for)
–Both are initially operant responses that
initially occur given only specific stimuli……but
then generalize and are brought to bear on a
great variety of novel stimuli.
–Same concept with relational responding
• Murray Sidman: Stimulus Equivalence.
• Generally accepted as a ‘legitimate and
useful’ part of ABA.
• Essentially, posits that relations of
equivalence and nonequivalance between
stimuli can be trained.
–e.g., “apple” equivalent to actual apple; “good”
nonequivalant to “bad”
• RFT simply adds more relations
– Actually, not that simple—RFT also adds a more
systematic and comprehensive account of how
relational responding emerges and develops
• Rehfeldt & Barnes-Holmes (2009): Derived
relational responding: applications for
learners with autism and other developmental
disabilities.
– Instructional control
– Reading & spelling
– Functional communication
– Analogical reasoning
– Perspective taking
– Empathy
– Mathematical reasoning
• Highlight continuity:
– Verbal behavior as operant behavior
– Relational responding is simply a response—
responding as if a specific relation existed between 2
or more stimuli
– Relational responding as an overarching operant
class—like generalized imitation or generalized
attending
– RFT as a simple extension of stimulus equivalence—
more relations than just equivalence/nonequivalence
• Applied data indicating what it can add to
conventional ABA programs
– And study after study with results that direct operant &
• Not as easy as pitching RFT
• Also, not as relevant
–Not many straight behavioral psychotherapists
around anyway.
–Psychotherapy for their clients and/or
caretakers is often off the radar screen for
applied behavior analysts (or not appropriate)
–Strictly speaking, data on ACT for ABA
populations (including caretakers) is currently
very lean.
• Broadly speaking, behavioral learning principles are
used to effect change in both
• Behavior is conceptualized functionally, not
topographically
– Focus on problematic behaviors, not DSM syndromes.
• Both CBA and ACT make heavy use of exposure,
behavioral activation, skills training.
• Both assume that the same behavioral learning
processes that produce problem behavior must typically
be used to change those behaviors.
• Both assume that the same behavioral
learning processes that produce problem
behavior must typically be used to change
those behaviors.
–Since RFT forms the foundation of ACT, it is
assumed that derived relational responding is
one of the learning processes that causes
behavioral problems---and one of the learning
processes that must thus be used to change
those problem behaviors.
• Arguably bizarre looking sub-processes like defusion,
adopting a sense of self as context, and increasing
contact with the present moment simply work to
counteract the problematic effects of relational framing.
– Just like classical extinction might be used to
counteract the problematic effects of classical
conditioning that has contributed to postraumatic
stress.
• The focus on acceptance is simply intended to counter
frequent instances of problematic avoidance human
beings engage in.
• The focus on values is fully in the spirit of Skinner’s
desire to put behavior increasingly under appetetive (vs.
aversive) control.
• Straight behavioral treatments like exposure &
behavioral activation.
• ACT is an acknowledgement that an additional learning
process (relational framing) contributes heavily to human
behavior……..
– Which suggests that techniques which address that
process should be folded into therapy
• ……and a careful, systematic, and empirically-based
attempt to try to increase the effectiveness of
conventional behavior therapy.
• Highlight continuity
– Both make heavy use of exposure, BA, skills training
– Both conceptualize behavior functionally
– Both use learning processes that cause problems to
solve problems
– Since RFT posits a new, human-specific learning
process, ACT uses some new strategies to try to
counter that process’s negative effects.
• Honor the foundation
– Conventional BT works well.
– ACT is a behaviorally consistent (albeit somewhat
extended) attempt to raise the bar even higher.
Integrating CBT and ACT
Joseph Ciarrochi,
School of Psychology,
University of Wollongong
Function and Form
Cognitive restructuring
• Can not be defined a-priori as effective or
ineffective.
• Depends on belief being restructured
• Depends on type of restructuring
Connecting the function of
beliefs to the intervention
• Accuracy: Client believes a thought
because (s)he thinks it accurately reflects
“reality” and helps him/her to act
effectively.
• Obtaining Social Reinforcement: Client
believes thought
• Experiential Avoidance
• Punishing others
• Coherence
Cognitive Restructing focused on
“elaborating” rather than subtracting
• Rebound
• Reinforcing experiential avoidance
• Unintentional elaboration (and
accessibility) of networks
• Increasing causal important of
thought
• Return to fear evidence
How do you know the air is “too dense”
with words ?(derived from Wilson, mindfulness for two)
• 1.Evaluations are present.
• 2. The conversation is complex and busy.
• 3. The dialogue is confusing and you
and/or the client are trying hard to
clarifythings.
• 4. The dialogue is adversarial (for
example, “You seem to be in conflict”)
Letting some “nonverbal air” into the room
(derived from Wilson, mindfulness for two)
• 5. There are warnings about the
consequences of things (“Yes, but …”).
• 6. There is a strong future or past
orientation to the conversation.
• 7. There is a strong orientation as to what
something means about you and others..
Letting some “nonverbal air” into the room
(derived from Wilson, mindfulness for two)
• 8. There is an emphasis on problem
solving.
• 9. The discussion feels old and familiar,
like something you’ve gone over a
thousand
• times.
• 10. The presence of “but” (for example, “I’d
do that, but …”).
Increasing flexibility by
playing around with worldview
Speaking Across Islands: Building
Communication Between ACT and
Other Approaches to Clinical
Psychology
“The Island of Humanistic Psychology”
Hank Robb, Ph.D., ABPP, Reno, NV, 2010
Potentially Useful Historical
Background
The first “Humanist Manifesto” was
signed in the United States in 1933. It
spawned the American Humanist
Association which during the 1960’s
presented its “Humanist of the Year”
award to both Carl Rogers and B.F.
Skinner.
The major sticking point in
successfully crossing to this
“island” will be that Humanistic
Psychology will insist on what
it sees as both “humanistic”
ends and “humanistic” means.
Thus, Humanistic Psychology opposed
aversive stimulation (punishment) in the
treatment of the head-banging of autistic
children because even though the ends
were “humanistic,” i.e. reduction in headbanging, the “means,” i.e.aversive
stimulation, were not.
“Bridges” with
Humanistic Psychology
Values
Mindfulness
Self As Context
Acceptance of Thoughts Images & Sensations
Contact with the Present Moment
“Blocks” with Humanistic
Psychology
Values as “Chosen” rather than “given absolutely”
Self as Context viewed as a function of language
Defusion from thoughts and images likely to be OK
but not defusion from sensations which are
regarded as “truer”
Blocks with Humanistic
Psychology
A pragmatic theory of truth rather than a
correspondence theory of truth
Righteous indignation rather than workability will be
endorsed by some Humanistic Psychologists
Viewing humans behavior as a function of historical
and current contexts and, thus, not viewing
humans as “basically good”
Blocks with Humanistic
Psychology
Seeing “therapist moves” to achieve certain client
responses as “manipulation” and, thus “wrong”
An almost visceral negativity toward anything
smacking of “behaviorism” including the word itself