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

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

• 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

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 ProcessesBi-Directional Transformation of

Function*equivalence here but not only

“Car”

Car Lemon Burger

“Car” or Car

speedsounds

streets

smells

danger windCar

“Car”

“Car”

2. Combinatorial Mutual Entailment

3. Transformation of Stimulus Function

1. Mutual Entailment

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

Me

Unworthy of love

“Nothing but trouble”“Not as good as your brother”“So stupid, irritating…”

Trained via interaction w/social-verbal community

Trained by critical parents

“bad” unworthy of love

Social context

me, myself, Ime=bad=unworthy of love

DIRECT RESPONDING

do not learn new relations

AVOIDnegatively reinforced

poor social skills

more aversives availableno contact with appetitives

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

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

EssentialComponents

of ACT

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Acceptance and Mindfulness

Processes

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Commitment and Behavior

Change Processes

How

• Metaphor

• Experiential exercises

• Densely interpersonal relationship– Clinician as conditioned reinforcer

• Through the use of functional analysis

Preparing to BeginFunctional 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)

– 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

• Experiential exercise (Imaginal Exposure)– The bus driver metaphor (esp. for groups)– Many stories—same beginning, different end– Leaves in a stream– Physicalize and set to side (imagine)

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