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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