Transcript ACTing

ACTing
Using Relational Frame Theory (RFT) and
Acceptance and Commitment Therapy (ACT)
to Predict and Influence Human Behavior
Amy R. Murrell, Ph.D.
Department of Psychology
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About me & behavior
analysis
No formal training in traditional behavior analysis
– But I think like a behavior analyst and here is why…
• Viewed importance in ideographic information
• Undergraduate at U of Memphis
– Attention to context (Bob Cohen)
– Question medical model and DSM nosology (Houts)
• Grad. training at U of Mississippi
– Practica working w/individuals with DD, MR
– Kelly Wilson, ACT & RFT
• ABA Conventions
– Attended many presentations (and eventually gave)
– Purchased and read many books (even wrote pieces)
Outline
• Brief history of BA and Behavior Therapy
• A little glimpse into RFT
– Indirect conditioning, RGB, stimulus control
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Clinical relevance/RFT&ACT connection
Introduction to ACT
What a return to BA might have for psychology
What might RFT and ACT add to traditional BA
Questions, reactions, etc.
History:
Behaviorism to Applied Behavior
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Analysis
William James (pragmatism)
Pavlov (respondent conditioning) in early 1900s
Thorndike (functionalist/law of effect)
Watson (father of behaviorism) & Mary Cover Jones (20s)
– Psychology as the Behaviorist Views It (1913)
• Skinner (operant conditioning)
– On the Behavior of Organisms (1938)
– Science and Human Behavior (1953)
– Verbal Behavior (1957)
• Keller and Schoenfeld (1950)
History BA to Behavior
Therapy
• Ayllon, Azrin, Baer, Bijou, Ferster, Fuller,
Goldiamond, Lindsley, Michael, Verplanck
– Late 1940s to late 1960s
– Very little distance between clinic and lab
– “Behavior therapy, or conditioning therapy, is the use of
experimentally established principles of learning for the
purpose of changing maladaptive behavior.” (Wolpe,
1969)
• 2nd Wave (change what clients think)
– RCTs and EVTs
• Disconnect from lab (all about outcome research)
– And the effect sizes haven’t changed much
– And not much evidence that it works the way thought it would
But what about
cognition…
There is something different about “typically
developing” or verbally competent humans
AND previous, traditional BA accounts
have not been well received by psychology
because they did not address this well
…cognition…
– There is a need to address stimulus control that
emerges from indirectly experienced
contingencies
• Insensitivity to direct contingencies
– Instructionally induced control (higher order class)
• RGB alters function of stimuli
• Transfer and transformation of function
**Leads to less contact with environmental
contingencies and fewer opportunities to learn new
behavior = narrow and inflexible behavior repertoire
Verbal (Indirect) Learning Processes
Bi-Directional Transformation of 
Function
*equivalence here but not only
“Car”
“Car”
1. Mutual
Entailment
Car
3. Transformation
of Stimulus
Function
2. Combinatorial
Mutual
Entailment
smells
“Car”
Car
danger
Lemon
sounds
“Car” or Car
streets
Burger
speed
wind
What Indirect
Conditioning Gives Us
• Good
– Ability to balance long- and short- term contingencies
– Communication over time and distance
– Broad ability to evaluate, categorize, sort
– Broad ability to plan and execute based on evaluations
** Advantage in treatment
• Bad
– Can’t turn it off and may turn on you
Trained by
critical parents
Me
“Nothing but trouble”
“Not as good as your brother”
“So stupid, irritating…”
Trained via
interaction w/
social-verbal
community
Unworthy
of love
“bad”
me, myself, I
unworthy of love
me=bad=unworthy of love
Social context
DIRECT RESPONDING
negatively reinforced
AVOID
do not learn new relations
no contact with appetitives
poor social skills
more aversives available
The Have-to Disease
• People with alcoholism have to drink
• People with OCD have to wash, count, etc
• People who are therapists have to be
experts, be smart, save their clients,_____
In each case, there is an inflexibility involved
Have To
• Usually have to disease arises from aversive
control where there is increased arousal and
decreased sensitivity to broad context and
related to that fewer emitted behaviors
• Want to lessen the support for narrow and
inflexible (shifting context)
– Sometimes aversives even become appetitive
**This is what ACT clinicians intend to do
Contact with the
Present Moment
Acceptance
Values
Essential
Components
of ACT
Defusion
Committed
Action
Self as
Context
Acceptance and
Mindfulness
Processes
Contact with the
Present Moment
Acceptance
Values
Defusion
Committed
Action
Self as
Context
Contact with the
Present Moment
Commitment
and Behavior
Change Processes
Acceptance
Values
Defusion
Committed
Action
Self as
Context
How
• Metaphor
• Experiential exercises
• Densely interpersonal relationship
– Clinician as conditioned reinforcer
• Through the use of functional analysis
Preparing to Begin
Functional Assessment
• Same process as traditional but different purpose
– Goal is to identify A-B-C chain for creating more
meaningful life rather than reduce/eliminate
• Identify painful content
• Identify what client does to get rid of it
• Identify values
– Task analysis sometimes necessary
• Identify how avoidance interferes
Acceptance
• Allow self to have whole of experiences
– When doing so foster effective action
• No
– Dangerous, unhealthy, or unproductive situations
– Emotional wallowing
• Yes
– Thoughts, emotions, memories, history, bodily states,
behavioral dispositions
– Hopelessness of struggle
Acceptance
• Didactic Exercise (Conversation Topics)
– Mule in the well
• Experiential Exercise (Imaginal Exposure)
– Workability of avoidance
• File card
• Increase tolerance for aversive through desensitization
*Didactic and experiential overlap too
Talking and teaching vs. slowing down, getting centered,
probably closing eyes BUT really all exposure/defusion
and do both together
Fusion
• Fusion is the process whereby certain verbal
functions dominate over other directly and
indirectly available psychological functions
– Cognition stands in for experience
• Gum exercise
Defusion/Exposure
• Defusion is the process whereby other directly
and indirectly available psychological functions
become available
• ANYTHING that involves interacting with the
aversive event that is not avoidance
– Distancing or change the link between setting
and problem behavior
• Optimally, a wide variety of rich interactions
– As different as possible from the usual ways
of interacting (functionally, if not formally)
Defusion
• Should attack aspects of context that support narrowness
• Didactic exercise (Conversation Topics)
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Treat “the mind” as an external event; almost as a separate person
Point out a literal paradox inherent in normal thinking
Get off your buts (and tries)
Key metaphor
Repetition, silly voice, etc.
debrief
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The bus driver metaphor (esp. for groups)
Many stories—same beginning, different end
Leaves in a stream
Physicalize and set to side (imagine)
• Experiential exercise (Imaginal Exposure)
Self-as-Context and Contact
with the Present Moment• Contact with current contingencies
– Here and now
– Showing up
– Where is nose, hair
– Appreciation without evaluation
-Therapist great session, Therapist bad session
• Sense of self that is a safe and consistent
– Observe and accept all changing experiences in both
self and clients
Valuing
• Powerful reinforcement- hard work for something
• Talk in terms of importance and consistency
• Didactic exercise
– Coke and 7-up metaphor
– List of values, goals, and barriers
– Compass (will look at in more detail)
• Experiential exercise
– Tombstone
– Pen through hand
– Waited values
Committed Action
• Making life about living values
– Not about eliminating pain
• Team building
– Note barriers, failures, need to recommit
“Often people attempt to live their lives backwards; they try to have
more things, or more money, in order to do more of what they want, so
they will be happier. The way it actually works is the reverse. You
must first be who you really are, then do what you need to do, in order
to have what you want.”
--Margaret Young
Return to BA roots &
RFT/ACT
• Most effective treatments based on BA
– Perhaps remove obstacles thorough RFT/ACT
– Sensitive to the sometimes paradoxical effects
of rule-based direct change strategies
– Sensitive to the importance of what our clients
say and think
– Sensitive to the non-mechanical relationship
between thinking and other behaviors
– Psychology needs basic process accounts