Speaking across islands

Building communication between ACT

and other approaches to clinical psychology

Chair:

Matthieu Villatte, PhD

Presenters:

J.T. Blackledge, PhD

Joseph Ciarrochi, PhD

Hank Robb, PhD

My journey to ACTor

How I came to shave my head to look like Steven Hayes

Multiplicity of models in psychology

PSYCHOLOGY

The choice of scientific psychology

• Critics: Deshumanization!

Operationalization of concepts

Modification of theories

The choice of Behavior Analysis over cognitive psychology

• Critics: What about thinking?

Monism

Precise operationalization of concepts

The choice of CBT over ABA

• Critics: Do you really know what you are doing?

Use of language

Interest for thoughts

The choice of ACT

• Critics: Meditation?! Symptoms not targeted?!

Behavior analysis

CBT

Humanism

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 substance left in their arguments and the writing is on the wall for all to see.”

• 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.• i.e., relational responses are then brought to bear on novel

stimuli

• 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

– Developing self-directed rules

– Teaching flexibility and creativity

• 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 &

respondent accounts cannot explain.

• 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.

Data!

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 world-

view

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 head-banging, 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