Values, Verbal Relations and Compassion: Can We Do a Better Job of Facing Global Challenges

Steven C. HayesUniversity of Nevada

The World is Facing a Series of Behavioral Challenges

• “…. knowing is not enough; action is needed. Why should it occur? That is perhaps the most terrifying question in the history of the human species” (Skinner, 1982) 

Terrifying Because(from Paul Chance)

• Immediate consequences outweigh delayed consequences. People want to live in a world with clean air, but also want to drive Hummers.

• Some chemicals are destructively reinforcing. The reinforcing power of sugar, salt, or drugs threaten our health.

The List• Consequences for the individual outweigh

consequences for others. We often fail to make sacrifices for the common good.

• In the absence of counter-control, the use of aversives tends to be very reinforcing to those who use them. For example, Abu Ghraib

The List• Coincidental events often strengthen

ineffective behavior. Superstition often wins out over rationality.

• Simple, familiar wrong ideas are preferred over complex, alien but correct ideas. For example, evolution is rejected by 75% of the US population

The List

• Susceptibility to social reinforcement can incline us toward extreme views. For example, 9-11 was perpetrated by mostly well-educated, middle-class people with families but who spent a lot of time interacting with others who shared extreme beliefs

The List • Strong aversives presented abruptly prompt 

appropriate action, but strong aversives following a long string of aversives that gradually increase in strength often do not. This suggests that so long as conditions worsen gradually, we will tolerate bad air, foul water, loud noise, psychological and physical abuse, and crime that would once have been considered intolerable.

The Processes• Weak delayed consequences for positive behaviors or

powerful short term ones of negative behaviors• Weak social concern or cooperation or using aversives

on others• Impulse and superstition rather than scientific data

and reason• Entanglement with socially supported deviant beliefs• Lack of attention to gradual aversives

The Problems• Obesity and health• Drugs• Over-population• Lack of self-control • Poverty • Violence• Pollution and global warming

Reformulating the Questions

• Not why are we controlled by short term consequences – it is why we ever fail to be.

• Not why do we show low concern for others – it is why we ever cooperate or show compassion for others

• Not why aren’t we controlled by scientific data – it is how is it that science ever makes a difference

• Can a psychological flexibility model help? Is it relevant?• I will share data only from the last three years

Not Why are We Controlled by Short term Consequences

Rather, How Do We Ever Fail to Be?

04/24/23

Within a Psychological Flexibility Model

Acceptance and Defusion Increase Willingness to Experience Discomfort of Foregoing Short Term Reinforcers;

Use Values or Motivative Augmentals to Increase Psychological Presence of Chosen Long Term Consequences

Social Processes that Support Both

Weight MaintenanceLillis et al., 2009

• 87 participants who had completed at least 6 months of organized weight loss intervention (on average their 37th try)

• Randomized to 1 day ACT workshop (n = 43) or TAU Control (n = 44)

Acceptance, Defusion from Self-Stigma and Values

• Focused on values and patterns of avoidance toward weight-related thoughts, feelings, and bodily sensations

• No diet, physical activity, self-monitoring, or weight education components

Process Results

AAQ

1.4

1.0

.6

.4

.20

1.2

.8

Coh

en’s

d Im

prov

emen

t

- .2- .4 Control

ACT

AAQW Breath Holding

Small

Medium

Large

Effect Sizes:

Pre to Follow-Up Weight Change

% gaining 5+ lbs % losing 5+ lbs

35

25

151050

3 month follow-up

p < .001

d = 1.21

30

20

AC

T

Con

trol

ACT for Diabetes Management Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007, JCCP

• Randomized controlled trial with poor, mostly minority clients

• 40 / group: ACT plus diabetes education (one six-hour workshop) or diabetes education (also a six hour workshop)

• Only 3 hours were different content

Pre to Follow up ChangeAAQ

(Diabetes)

Ed’n ACT

Self- Management

Ed’n ACT

% in Diabetic Control

Ed’n ACT

50%

25%

0%

50%

25%

0%

10

5

0

AAQD and Self-Management mediated blood glucose outcomes

Pediatric Chronic PainWicksell, Melin, Lekander, & Olsson, Pain, 2010

• 32 children w/ longstanding pediatric pain• Average of 32 mo pain duration• Randomly assigned to ACT or

multidiscipinary Rx & medication (MDT). • ACT = 12 session; MDT = 23

Pain Interference

2Post 3.5 mo 6.5 moPa

in I n

t erf

eren

ce (1

-10)

Pre

4

6

Effect of Writing About Your ValuesCohen, Garcia, Purdie-Vaughns, Apfel, & Brzustoski (2009), Science, 234, 400-403.

• 385 middle school children followed through 7th and 8th grade

• Randomly assigned to a series of short (15 minute) writing assignments at the beginning of 7th grade on their values in various specific domains and the importance of these values

Impact on GPA Thru Middle School3.5

3.0

2.5

2.0

1.5

1.0Pre 1 2 3 4 1 2 3 4

Year 1 Year 2

European Americans or High Achieving African-Americans Both Conditions and Ethnic Groups Are Identical

Low Achieving African-Americans

Values

Control

Motivating Physical Exercise Jackson et al., in preparation

• 46 female students in a spinning class• Identify fitness motivation via IRAP• Prompt during class – compare to form based

prompts or IRAP identified low motivators

105

95

85

1 5 93 7

1 5 93 7 1 5 93 7

1 5 93 7

105

95

85

105

95

85

105

95

85

Perc

enta

ge o

f In

stru

ctor

’s H

eart

R

ate

Exercise Sessions

BaselinePositive Goals

Forms

Bsln Prompts Bsln Prompts

Average Difference from Baseline

Green = Positive Implicit Goals

Blue = Instruction About Form

Average Difference from Baseline

Green = Non-Preferred “Positive” Implicit Goals

Blue = Instruction About Form-10

-8

-6

-4

-2

0

2

4

6

8

10

DIF

FERE

NCE

IN %

OF

INST

RUCT

ORS

AVE

RAG

E H

EART

RAT

E

17 18

18

Randomized Trial: ACT vs. TAUTapper et al., 2009

• 62 overweight women (BMI = 31.6)• All participants already in weight loss programs• 4 two-hour sessions. 26 attended at least one; 31

left in existing diet• Short ACT protocol• Pre / Post / 6 month follow up

BMI.5

-.5

-1

Overall - “Never apply”

Change in Weekly Exercise3

0

-1

Overall - “Never apply”

1

2

Physical Fitness Butryn, Forman, Hoffman, Shaw, and Juarascio, under submission

• 46 female students assigned to two 2-hour workshops (two weeks apart) on ACT or education about fitness.

• “Post” at week four; follow up at week seven • Primary measure: use of exercise facilities at

the University Athletic Center (these were automatically recorded from the swipe cards, resulting in a high integrity measure with no drop outs)

Weekly Number of Exercise Sessions

Pre Post

1.8V

isits

to th

e A

thle

tic C

ente

r

1.0

2.2

Follow Up

ACT

1.4

.6

.2

Fitness Education

The Question Is Not Why Aren’t We Controlled by Scientific Data

Instead of Impulses

It Is How Can We Increase the Impact of Scientific Data

04/24/23

Within the PF Model:

Link Science Knowledge to Values;

Use Acceptance and Defusion to Deal with the Discomfort of Newness and

the Interference of Alternative Beliefs

04/24/23

Adopting ESTsVarra, Hayes, Roget, & Fisher, JCCP, 2008

• 59 drug and alcohol counselors randomly assigned to – One day ACT workshop focused on the

psychological barriers to learning – Control condition: One day workshop on EAP

policies– Both groups then do a one day educational

workshop on the science behind the use of agonists and antagonists

Frequency of Perceived Barriers to Using Empirically Supported Treatments

Pre Post

75M

ean

Scor

e

Phase

70

ACT plus ACT plus EducationEducation

Control Control plus plus

EducationEducation65

Believability of Perceived Barriers to Using Empirically Supported Treatments

Pre Post

70M

e an

Sco r

e

Phase

65

ACT plus ACT plus EducationEducation

Control Control plus plus

EducationEducation

60

Willingness to Use Pharmacotherapy

Pre Post

3.5

3.25

2.25

Mea

n Sc

ore

on 1

-5 S

cal e

Phase

3

2.75

2.5

ACT plus ACT plus EducationEducation

Control Control plus plus

EducationEducation2

Subsequent Use of Pharmacotherapy

Pre 3 month Follow - up

3.5

3.25

2.25

Phase

3

2.75

2.5

ACT plus ACT plus EducationEducation

Control Control plus plus

EducationEducation

2

The Question Is Not Why Do We Show Low Concern For Others

It Is How Can We Promote Cooperation, Compassion and Concern

for Others

04/24/23

Within the PF Model

Promote a Social/Perspective Taking Sense of Self

Link Self-Acceptance and Compassion

Link Values and Compassion

04/24/23

Experiential Avoidance and MH Stigma Masuda et al., 2007

• RCT comparing education focused on prevalence and costs of stigma toward mental health problems, and accurate information about them

• ACT focused on defusion from and mindfulness of prejudicial thoughts, acceptance of difficult prejudicial feelings, and values

ACT for Mental Health Stigma

Pre Post F-Up

-25

-30

-35

-40

Ave

rage

MH

Stig

ma

Sco

re

ACT

Education

Lo EA

Hi EA

Racial PrejudiceLillis & Hayes, 2007

• Replicated with ACT versus Education for racial bias in a college student population

• Within subject test (16 with A/B/A/C/A and 16 with A/C/A/B/A)

• 32 participants in a two racial differences classes

• 90 minute class period• “follow up” = next class period

Assessment Items

• Bias Awareness– I feel that I am aware of my own biases

• Bias Does Not Affect Me– I feel that my prejudicial thoughts are a

significant barrier to me being culturally sensitive

– My biases and prejudices affect how I interact with people from different racial and ethnic backgrounds.

Assessment Items • Acceptance

– It is OK to have prejudiced thoughts or racial stereotypes

– I try not to think negative thoughts I have about people from different racial or ethnic backgrounds.

• Defusion and Action– When I evaluate someone negatively, I am able to

recognize that this is just a reaction, not an objective fact.

– It’s ok to have friends that I have prejudicial thoughts about from time to time.

Assessment Items • Positive Action

– I would attend a social event where I was the only person of my race/ ethnic background.

– I believe that I am able to transcend racial boundaries with my actions.

– I plan to actively seek out experiences that could expose me to people who have a different cultural, racial, or ethnic background than me.

– I am likely to join a campus organization or participate in a campus event that is focused on cultural diversity.

Percentage of Possible Improvement Obtained

-20 -10 0 10 20 30 40

Ed Pre-fup

Ed Pre-Po

ACT Pre-Fup

ACT pre-Po

THEN

NOW

YOU

I

HERE

THERE

RFT Take on the Formation of RFT Take on the Formation of Self and Perspective TakingSelf and Perspective Taking

The I-Here-Nowness of Awareness is the Foundation of Perspective Taking

Self-as-context

But If “From Hereness” is Relational

• It says something very profound: I don’t get to show up as a conscious human being until you show up as a conscious human being

• One of the way we measure perspective taking are “Theory of Mind” assessments

• Are deictic relations and Theory of Mind performances related?

152535455565758595

105

Pre SingleReversals

DoubleReversals

Phases

Perc

ent C

orre

ct Deictic

ToM

At Least Broadly, They AreAt Least Broadly, They Are

For general direction of the relationship only. These data are from 2 unpublished studies, one by another author, so details could change

Why This Matters

• A perspective taking sense of self is social• Which is why your pain can pain me • I need to accept my own pain in order to care

about yours in a healthy way• Gives a personal motivation beyond values and

evolution for empathy and caring for others

Experiential Avoidance, Shame, and Stigma Toward Others

Weight Self Stigma

Experiential Avoidance .76**

Negative Attitudes Toward Otherswith Weight Problems .33**

164 persons dealing with weight (Lillis et al)

And Guess What?

Weight Self Stigma

Weight Problems.40**

Mental Health Problems.42**

Quality of Life-.68**

What That Says

• Compassion toward others is related to some degree to self-compassion and to liberation from entanglement with judgments

• Those processes have tangible positive effects on the person, giving some possible motivation to deal with a judgmental lack of compassion

Caring About Being With Others

Roger Vilardaga, Ana Estévez, Michael E. Levin and Steven C. Hayes

Social Anhedonia

I/YouHere/There

Now/Then

-

Perspective Taking Empathy Experiential

Avoidance

JoySadness

- - +

Repertoire Narrowing

Social AnhedoniaR2 ∆F β

Step 1 .036 1.87 Gender -.17 Age -.09Step 2 .10* 6.91 Gender -.13 Age -.10 Deictic ability -.26*Step 3 .15* 5.17 Gender -.06 Age -.04 Deictic ability -.23* Empathic concern -.23*Step 4 .26** 14.60 Gender -.02 Age .05 Deictic ability -.18† Empathic concern -.26* Experiential Avoidance .35**

The Question Is Not Why Do We Become Entangled With Deviant Beliefs

It is How Do We Disentangle Ourselves from Them

04/24/23

Within the PF Model

Defusion and Mindfulness Skills;Cost in Valued Behavior

04/24/23

ACT for Self-Stigma / ShameLuoma, Kohlenberg, et al., under review

134 participants in a 28 day in-patient drug program

Randomly assigned to 6-hour ACT group focused particularly on self-judgment and shame

Shame Outcomes: Better for TAU

Pre Post

110

105

100

95

90

85

Ave

rage

Sco

re

TAU

ACT

Quality of Life Outcomes: Better for TAU

Pre Post

80

76

72

70

Ave

rage

Sco

re

TAU

ACT

74

78

Group ACT for Shame:Substance Use Outcomes

1 Month

6

5

4

3

2

1

0

Follow Up

Day

s / M

onth

Usi

ng

D

rugs

or A

lcoh

ol TAU

ACT

Group ACT for Shame:Substance Use Outcomes

1 Month 2 Month 3 Month

6

5

4

3

2

1

0

Follow Up

Day

s / M

onth

Usi

ng

D

rugs

or A

lcoh

ol TAU

ACTd = 1.21

Shame Outcomes

Pre Post 3 Mo F-Up

110

105

100

95

90

85

Ave

rage

Sco

re

TAU

ACT

r with use at follow up = -.51 (p < .01)

r with use at follow up = ns

Quality of Life Outcomes

Pre Post 3 Mo F-Up

80

76

72

70

Ave

rage

Sco

re

TAU

ACT

74

78

Where We Are

Good start but it is not enough There are some sour notes at the level of

technology Social trends are not good – if psychological

flexibility is key Enormous increase in exposure to horror and

chatter

What is Missing

Content wise: no studies on global warming and energy consumption; violent conflict; prevention; creating values-based groups.

We need to think about our work in a broader social context

We have natural allies Could we scale the model?

Can We Extend It?

Projects are underway that will test these ideas But we can take heart in the connection with

evolutionist thinking and data

Elinor Ostrom2009 Nobel Prize in Economics

Elinor Ostrom’s Eight Steps1) Clearly Defined Boundaries. The identity of the group and its rights to the

common resource must be clearly delineated.

2) Proportional equivalence between benefits and costs. Members of thegroup must negotiate a system that rewards members for their contributions.High status and other disproportionate benefits must be earned.

3) Collective-choice arrangements. Group members must be able to create their own rules and make their own decisions by consensus. People hate being told what to do but will work hard for group goals that they have agreed upon.

4) Monitoring. Managing a commons is inherently vulnerable to free-riding and active exploitation. Unless these locally advantageous strategies can be detected at relatively low cost, the tragedy of the commons will occur.

Elinor Ostrom’s Eight Steps5) Graduated sanctions. Transgressions need not require heavy-handedpunishment, at least initially. Often gossip or a gentle reminder is sufficient,but more severe forms of punishment must also be waiting in the wings for use when necessary.

6) Conflict resolution mechanisms. It must be possible to resolve conflicts quickly and in ways that are perceived as fair by members of the group.

7) Some recognition of rights to organize. Groups must have the authority to manage their own affairs. Externally imposed rules are unlikely to be adapted to local circumstances and violate ingredient 3.

8) For groups that are part of larger social systems, there must be nested enterprises. The previous ingredients work best in relatively small groups. Society at a larger scale must be multicellular, with groups interacting with groups, often in multiple layers.

Effective monitoring by monitors who are part of or accountable to the appropriators;

Mechanisms of conflict resolution are cheap and to easy access;

The self-determination of the

community is recognized by higher-

level authorities;Collective-choice

arrangements allow most resource

appropriators to participate in the decision-making

process;

There is a scale of graduated sanctions for

resource appropriators

who violate community rules;

Rules regarding the appropriation and provision of common resources are adapted to local conditions;

In the case of larger common-pool resources: organization in the form of multiple layers of nested enterprises, with small local CPRs at the base level.

The World is Facing a Series of Behavioral Challenges

• We cannot rely on the politicians and soldiers to solve this problem for us

• The CBS community needs to consider the implications of its work for the health and well being of human beings and the global challenges they face