6/28/2019
Acceptance Commitment Therapy and Relational Frame Theory Karolina LaBrecque PhD
What is ACT
• Acceptance and Commitment Therapy (ACT) is unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.
(https://contextualscience.org/act )
What is ACT
• Acceptance- “The active and aware embrace of private events that are occasioned by our history, without unnecessary attempts to change their frequency or form, especially when doing so causes psychological harm.”
• Commitment-”Serious of actions that move in the direction of chosen values, regardless of internally experienced barriers.”
(Luoma, J., Hayes, S., Walser, R., 2007)
1 6/28/2019
What is ACT
• Developed by Steven C. Hayes in 1982 it is considered a third generation of Cognitive Behavioral Therapy.
• The therapist practicing ACT emphasize the role of acceptance of one situation and mindfulness. Those lead to second-order changes instead of changes in cognitive content.
• It has its roots in ABA, specifically in functional contextualism. Which is closely related to radical behaviorism. (Ruiz,J., 2012)
Functional Contextualism
• Predicting and influencing behavior is of most importance. • It considers the behavior as an act in context rather than breaking it down into small units. • It defines behavior in accordance with radical behaviorism which includes privets events. • Psychological events are not “bad "or problematic; what is problematic is the context in which they occur and the function they serve. (Turrell, S., Bell, M., 2016)
Functional Contextualism cont.
• It emphasis on pragmatic truth criterion: • It does not dispute the “truth” of their cognition • The criterion is “workability” of the behavior
• A behavior is “workable” or “true” if it leads clients in direction that meters to them. • In ACT we help clients identified what meters to them, their values and the function of their behavior in relation to those values. (Turrell, S., Bell, M., 2016)
2 6/28/2019
Applied Behavioral Analysis
ABC of behavior-what influences what we do
A-antecedents B-behavior itself C-Consequence
ABC of Behaviors
Antecedents of behavior
Setting events-
The general surrounding circumstances that operate as inhibiting or facilitation conditions in a behavioral unit (motivational, emotional or contextual).
ABC of Behaviors
Antecedents of behavior/setting events
Physical setting- physical environment; Current repertoire of the person- what the person knows; History effect including summation of previous learning traits. Motivational Operations -Environmental variable that alters the reinforcing or punishing effectiveness of some stimulus, object or event and alters the current frequency of all behaviors that has been reinforced or punished by that stimulus
3 6/28/2019
ABC of Behaviors
Antecedents of behavior Abolishing Operations –temporarily decreases the reinforcing effectiveness of a stimulus, object or event.
Establishing Operations – temporarily increases the reinforcing effectiveness of a stimulus, object or event.
ABC of Behaviors
Behavior itself (what is the function)
Tangible -access to reinforcement materials or other stimuli. Escape -a contingency in which response terminates an ongoing stimulus Avoidance - a contingency in which a response prevents or postpones the presentation of a stimulus. Attention - social positive reinforcement. Sensory/ automatic –directly produce their own reinforcement.
(Cooper, J Heron T., Heward, W., 2007)
ABC of Behaviors
Consequence of behavior Reinforcement (+/-): increases the frequency of future behavior
Punishment (+/-): decreases the frequency of future behavior
4 6/28/2019
Applied Behavioral Analysis
Rule- Governed Behavior “Behavior controlled by a rule (a verbal statement of an antecedent- behavior-consequence contingency); Enables human behavior to come under the indirect control of temporally remote or improbable but potentially significant consequences. Often used in contrast to contingency shaped behavior.”
(Cooper, J Heron T., Heward, W., 2007)
Applied Behavioral Analysis
Rule- Governed Behavior
Rule-governed behavior=absence of direct experience with environment
It is not very sensitive to change in environment (we may not change the rule or behavior in a face of conflicting experiences). (described by clients as “habits”) (Turrell, S., Bell, M., 2016)
Applied Behavioral Analysis /Rule/Rule----Governed Behavior
Pliance – The habit of following a verbal rule, based on a history of being socially reinforced for rule-following, whether or not the rule –following is otherwise successful. Under control of particular speaker.
We do what we are told because of consequence delivered by another Do your homework! (Luoma, J., Hayes, S., Walser, R., 2007; Turrell, S., Bell, M., 2016)
5 6/28/2019
Applied Behavioral Analysis /Rule/Rule----Governed Behavior
Tracking – “Following a verbal rule, based on a history of correspondence between the rule and the non-arbitrary consequences contracted by following the rule.”
Develops after pliance is established;
Do your homework and you will get good marks at school (experienced good grades after doing homework).
(Luoma, J., Hayes, S., Walser, R., 2007; Turrell, S., Bell, M., 2016)
Applied Behavioral Analysis /Rule/Rule----Governed Behavior
Augmunetnals – A type of rule that alters the reinforcing nature (aversive or pleasurable) of an event (external or internal behavior) based of what is said about event. They establish control based not only on the relations between stimuli, but also the abstract consequences that have not ye been experienced.
Study hard and you will get a good job when you grow up.
(Turrell, S., Bell, M., 2016)
ABC of Behaviors Applied to ACT
Antecedent Stimulus Behavior Consequence Flood of thoughts about Meeting people at the Leaving the partyReduction of anxious people not liking me party (escape) feeling and thoughts. (Negative reinforcement)
Antecedent Stimulus Behavior Consequence Flood of thoughts about Meeting people at the Connecting with Having fun, experience people not liking me party peers/having aligned with values (accept, stop and watch) conversation (Positive reinforcement) (attention)
6 6/28/2019
Relational Frame Theory (RFT) The core RFT assumption:
Contemporary behavior- analytic account of human language and cognition;
“Humans are able to respond relationally to objects or events when the relation is not defined by the physical properties of objects but either by contextual controlled cues”.
Particular kinds of relational responding are called relational frames.
(Montoya-Rodríguez, M.,M., Molina, F. J., & Mchugh, L., 2017)
Relational Frame Theory (RFT)
The core RFT assumption:
Relating is used in reference to our use of language to connect nonaribtrary stimuli;
“Relational framing” is used in reference to relating arbitrate stimuli Relational framing has two main features:
Functional context-refers to psychological impact of the relating Relational context –how events are related
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT) Relational Frames
• Coordination -identity, sameness or similarity -A=B • Opposition –A is opposite of B • Distinction -responding to one event in terms of its differences with another event • Comparison- A is worse/better than B • Hierarchy- A is attribute of B
(Montoya-Rodríguez, M.,M., Molina, F. J., & Mchugh, L., 2017)
7 6/28/2019
Relational Frame Theory (RFT) Relational Frames
• Temporality- A occurs before B • Spatiality- A is below/above B • Conditionality –if /than • Causality –cause effect relationships • Deictic relations –specifying a relationship in terms of the perspective of the speaker I-you; here- there; now-than. Established within a social context involving countless experiences of I vs. You.
(Montoya-Rodríguez, M.,M., Molina, F. J., & Mchugh, L., 2017)
Relational Frame Theory (RFT)
The core RFT assumption:
Derive Relational Responding –is learner behavior that consists of:
Mutual entailment;
Combinatorial entailment;
Transformation of stimulus function;
Those are considered as three main properties of relating
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Mutual Entailment
Relations between the object and the spoken word are trained in one direction and the reverse relationship is derived without direct training.
(Turrell, S., Bell, M., 2016)
8 6/28/2019
Relational Frame Theory (RFT)
Mutual Entailment
Children learn bidirectioanlity of relationships between spoken words, objects and written words.
They learn a relation of coordination or sameness between the spoken word and the object so we don’t have to teach in both directions.
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Mutual Entailment
It happens based on nonarbitraty feature of the stimuli (those that we experience with our senses);
It happens over multiple learning trials.
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Combinatorial Entailment
Involves training two relationships and deriving four untrained relationships resulting in a total of six relationships.
(Turrell, S., Bell, M., 2016)
9 6/28/2019
Relational Frame Theory (RFT)
Combinatoral Entailment
Training of relations takes place with reinforcement and over multiple examples of particular type of relation in which events relate to one another based on their nonaribratry features;
The number of relations that can be derived are not restricted to six, but are limitless, as networks expand and connect to other networks over the course of development;
Once we learn to relate and derive we do so automatically when encountering new stimuli.
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Combinatoral Entailment
This relation with time extend to include the internal privet events;
Once the relations are established the function of a given stimulus will transfer to other stimulus;
Stimulus Equivalence
(Turrell, S., Bell, M., 2016)
Applied Behavioral Analysis /RFT
Stimulus Equivalence
The emergence of accurate responding to untrained and non- reinforced stimulus-stimulus relations following the reinforcement of responses to some stimulus-stimulus relations. A positive demonstration of reflexivity, symmetry and transitivity is needed. If A=B; B=C, than A=C
(Cooper, J Heron T., Heward, W., 2007)
10 6/28/2019
Applied Behavioral Analysis /RFT
Stimulus Equivalence:
Reflexivity ( general identity matching) –occurs when in the absence of training and reinforcement a response will select a stimulus that is matched to itself. A=A
=
(Cooper, J Heron T., Heward, W., 2007)
Applied Behavioral Analysis /RFT
Stimulus Equivalence:
Symmetry –occurs with the reversibility of the sample stimulus and comparison stimulus. A=B than B=A
=Dog than Dog=
(Cooper, J Heron T., Heward, W., 2007)
Applied Behavioral Analysis /RFT
Stimulus Equivalence:
Transitivity –derive (untrained) stimulus-stimulus relation that emerges as a product of training two other stimulus-stimulus relations. A=B and B=C than A=C
=Dog and Dog =Fear Than
= Fear
(Cooper, J Heron T., Heward, W., 2007)
11 6/28/2019
Relational Frame Theory (RFT)
Transformation of Stimulus Function
The internal privet behavior associated with a stimulus- thoughts, emotions, physical sensations, memories and urges that are evoke by the object are transferred to the spoken and written world.
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Arbitrary Applied Relational Responding (AARR):
Everything Relates to Everything
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
Arbitrary Applied Relational Responding (AARR):
• Refers to verbal behavior that relates stimuli based on arbitrary features. • Virtually any feature of the environment can serve as an arbitrary contextual cue; • Things that were previously rewarding can become aversive and vice a versa.
(Turrell, S., Bell, M., 2016)
12 6/28/2019
Relational Frame Theory (RFT)
To summarize: • Arbitrary contextual cues in the external environment enter into relational networks with one another; • These elicit approach or avoidance behavior. • Highly complex narrative about the “self” can be created and perpetuated. (Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT)
To summarize: • We explain, predict and rationalize our behavior. • The complex network becomes our “story” /”self as content”. • This story not only describes past behavior, but may guide future behavior.
(Turrell, S., Bell, M., 2016)
Relational Frame Theory (RFT) To summarize: Through deictic framing and experiencing our sense of who we are as being equivalent to what our mind tells us about ourselves.
WE BECOME FUESED WITH OUR STORY (Turrell, S., Bell, M., 2016)
13 6/28/2019
THE ACT SOLUTION
• Psychological flexibility -ability to accept context of unwanted privet experiences and commit to what matters in our lives; • The idea that we can often respond to present moment without relaying on inflexible, rigid, rule governed behavior;
ACT is about accepting what is inside while moving ahead with what matters.
(Turrell, S., Bell, M., 2016)
THE ACT PROCESS
• Two kinds of privet experiences:
• “Clean emotions”-evoked by our current circumstances –everyone has them.
• “Dirty emotions”-evoked by our attempts to get rid of what we don’t want to experience.
(Turrell, S., Bell, M., 2016)
Therapeutic Processes of ACT
ACT Model of Psychopathology emphasizes 6 core problems: • Cognitive Fusion • Experimental Avoidance • Dominance of the Conceptualized Past and Future; Limited Self Knowledge • Attachment to Conceptualized Self • Lack of Values Clarity/Contact • Inaction, Impulsivity or Avoidant Persistence (Luoma, J., Hayes, S., Walser, R., 2007)
14 6/28/2019
Therapeutic Processes of ACT
Experimental avoidance/control: • The attempt to control or alter the form, frequency, or situational sensitivity of internal experiences, even when doing so could cause behavioral harm.
(Luoma, J., Hayes, S., Walser, R., 2007)
Therapeutic Processes of ACT
Cognitive Fusion: • Tendency of humans to get caught up in the content of what they are thinking so that it dominates over other useful sources of behavioral regulation. • Its not what we think that is most troublesome: it is how we relate to what we think.
(Luoma, J., Hayes, S., Walser, R., 2007)
Therapeutic Processes of ACT
Dominance of the Conceptualized Past and Future; Limited Self Knowledge
Fusion and avoidance tend to pull us out of the present moment which: • Reduces flexible awareness of privet events; • Increases the like hood of experiential avoidance.
(Luoma, J., Hayes, S., Walser, R., 2007)
15 6/28/2019
Therapeutic Processes of ACT
Attachment to the Conceptualized Self
Attachment to our story-which gets us stuck in past/future.
(Luoma, J., Hayes, S., Walser, R., 2007)
Therapeutic Processes of ACT
Lack of Values Clarity/ Contact
• Values are about living in a chosen and meaningful way, they are the map that we can guide our lives. • To the extend that behavior is tied up in experiential avoidance, a person will have a hard time contacting what really meters in his or her life.
(Luoma, J., Hayes, S., Walser, R., 2007)
Therapeutic Processes of ACT
Inaction, Impulsivity or Avoidant Persistence
Inability to behave effectively with regard to chosen values. Impulsivity or rigid persistence is manifested instead of flexible actions directed toward long-term ends.
(Luoma, J., Hayes, S., Walser, R., 2007)
16 6/28/2019
Therapeutic Processes of ACT
6 core therapeutic process of ACT address the 6 core problems. • Acceptance (vs. Experimental Avoidance); • Cognitive Defusion (vs. Cognitive Fusion); • Self as Context (Attachment to Conceptualized Self); • Mindfulness (Dominance of the Conceptualized Past and Future; Limited Self Knowledge); • Values (Lack of Values Clarity/Contact); • Committed actions (Inaction, Impulsivity or Avoidant Persistence); (Luoma, J., Hayes, S., Walser, R., 2007)
Therapeutic Processes of ACT
Acceptance
Ability to “allow” unwanted private events of behavior to simply let them be present until they pass rather than trying to push them away or avoid. Exploration of feelings with an open curiosity and sense of self-compassion.
(Turrell, S., Bell, M., 2016)
17 6/28/2019
Therapeutic Processes of ACT
Defusion
Ability to take thoughts less literally and to see all private experiences/events for what they are (thoughts, feelings, sensations etc.)
(Turrell, S., Bell, M., 2016)
Therapeutic Processes of ACT
Mindfulness
Practice that helps clients return to present moment, gently distancing themselves from relational networks. It is a practice bringing attention on purpose to the here and now, without judgment.
(Turrell, S., Bell, M., 2016)
Therapeutic Processes of ACT
Self-as-Context Ability to stand back and see the self from “outside”. The process involves the development of an alternate observing perspective, “the observing self”.
(Turrell, S., Bell, M., 2016)
18 6/28/2019
Therapeutic Processes of ACT Values
Identification of values makes taking action possible. Clients are encourage to identify what they truly and fundamentally value and envision what life would look like if their behavior was consistent with their values.
(Turrell, S., Bell, M., 2016)
Therapeutic Processes of ACT
Committed Actions
Those are concrete steps, that can be uncomfortable that clients take to live life according to their values. Usually this action bring unwanted privet events so this step requires mindfulness, acceptance, and defusion from internal events.
(Turrell, S., Bell, M., 2016)
Practical Application of ACT
Stress Test anxiety Social anxiety disorder Depression Obsessive-compulsive disorder Psychosis Chronic pain Substance abuse Diabetes
19 6/28/2019
Practical Application of ACT
I use it: TBI ADHD Business Coaching Parenting Coaching
ACT MATRIX
5 Senses Experiences
Actions Intended to Actions that lead in the Get Rid Of Unwanted Privet directions of what is Experiences important Me Noticing
Who or Unwanted Private Experiences What is That Come Up When Moving Important Toward What’s Important (Values)
Mental Experiences
Effectiveness of ACT
Ruiz (2012) did met -analysis comparing traditional, second generation CBT to ACT and concluded that:
ACT might be a better suited to patients suffering comorbid depression in addition to an anxiety disorder; or eating pathology in addition to emotional disorders.
CBT might be a better option than ACT among anxious participants without comorbid depression and medium level of anxiety.
ACT leads to at least the same degree of symptom reduction at posttreatment and follow up.
(Ruiz,J., 2012)
20 6/28/2019
Effectiveness of ACT
Ruiz (2012) did met -analysis comparing traditional, second generation CBT to ACT and concluded that:
ACT seams to obtain generally better results than CBT when comparing primary outcomes.
ACT reduces anxiety symptoms to the same degree as CBT, and possibly products greater reductions of depression symptoms.
ACT might show better immediate improvements on quality of life than CBT.
(Ruiz,J., 2012)
ACT in EAAT
Understanding the clients “story” and triggers; (ex client A- teachers, school work=full panic attacks)
Developing strong goals that are concurrent with IEP/ life goal;
Making sure that the goals come from client and not outside source (especially important in work with teens);
Especially useful in programing for PTSD, anxiety, veteran work (ex snow=car wrack; snow=danger)
ACT in EAAT
BABY STEPS!
The rate of positive reinforcement has to be very high;
Shaping- acknowledge even the smallest step in the right direction;
Pairing- pair yourself and the horse with rewards’
21 6/28/2019
Blackledge, J., T. (2003). An Introduction to RelationReference Frame Theory: Basics and Application. The Behavioral Analysts Today 3 (4), 421-433 Cooper, John O., Heron, Timothy E.Heward, William L.. (2007) Applied behavior analysis /Upper Saddle River, N.J. : Pearson/Merrill-Prentice Hall, Hayues, S. (2005). Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy . Oakland, CA: New Harbinger Publications Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT : An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: Turrell, S., 2011 Keystone Outback Teens and Adolescents in Individual and Group Therapy . Oakland, CA: Context Press.
22