Speaking across islands

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Speaking across islands

• Building communication between ACT
• and other approaches to clinical psychology

Presenters J.T. Blackledge, PhD Joseph
Ciarrochi, PhD Hank Robb, PhD
Chair Matthieu Villatte, PhD
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My journey to ACT

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

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Multiplicity of models in psychology
PSYCHOLOGY
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The choice of scientific psychology
Operationalization of concepts
Modification of theories

• Critics Deshumanization!

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The choice of Behavior Analysis over cognitive
psychology
Monism Precise operationalization of concepts

• Critics What about thinking?

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The choice of CBT over ABA
Use of language Interest for thoughts

• Critics Do you really know what you are doing?

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The choice of ACT
Behavior analysis CBT Humanism

• Critics Meditation?! Symptoms not targeted?!

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How clarifying gaps and building bridges?

• Maybe with psychological flexibility

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Now, lets let the experts talk
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ACT, RFT, Conventional Behavior Analysis
Bridges, Gaps, and Group Hugs.

• John T. Blackledge, Ph. D.
• Morehead State University
• Kentucky

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• 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?

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RFT ABA

• 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).

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The Data is Showing the Way.

• 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.

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The Data is Showing the Way.

• Anecdotally, more conventional applied behavior
  analysts appear to be softening to RFT.
• My impressionis 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.

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At a fundamental level, RFT really is continuous
with conventional behavioral theory

• Just as with Skinners (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.

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RFT as a Slight Continuation of Skinnerian
Behavior Analysis

• Difference RFT adds the notion of relational
  operants.
• Skinner Direct operant accountmust 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

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RFT as a Slight Continuation of Skinnerian
Behavior Analysis

• 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 stimulibut
  then generalize and are brought to bear on a
  great variety of novel stimuli.
• Same concept with relational responding

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RFT as a Slight Continuation of Sidmanian
Behavior Analysis

• 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 simpleRFT also adds a more
  systematic and comprehensive account of how
  relational responding emerges and develops

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RFT and Applied Data

• 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

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So, how do you pitch RFT to a conventional
applied behavior analyst?

• Highlight continuity
• Verbal behavior as operant behavior
• Relational responding is simply a
  responseresponding as if a specific relation
  existed between 2 or more stimuli
• Relational responding as an overarching operant
  classlike generalized imitation or generalized
  attending
• RFT as a simple extension of stimulus
  equivalencemore 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.

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Pitching ACT to Conventional Behaviorists

• 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.

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But what are the Commonalities between ACT
Conventional BA?

• 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.

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Continuity between ACT Conventional CBA

• 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.

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Continuity between ACT Conventional CBA

• 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
  Skinners desire to put behavior increasingly
  under appetetive (vs. aversive) control.

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Honoring the Effectiveness of Conventional
Behavior Therapy

• 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.

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So, how do you pitch ACT to a conventional
behavior therapist?

• 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 processs negative effects.
• Honor the foundation
• Conventional BT works well.
• ACT is a behaviorally consistent (albeit somewhat
  extended) attempt to raise the bar even higher.

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So, how do you pitch ACT to a conventional
behavior therapist?

• Data!

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Integrating CBT and ACT

• Joseph Ciarrochi,
• School of Psychology,
• University of Wollongong

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Function and Form
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Cognitive restructuring

• Can not be defined a-priori as effective or
  ineffective.
• Depends on belief being restructured
• Depends on type of restructuring

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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

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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

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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)

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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..

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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 youve gone over a thousand
• times.
• 10. The presence of but (for example, Id do
  that, but ).

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Increasing flexibility by playing around with
world-view
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Speaking Across Islands Building Communication
Between ACT and Other Approaches to Clinical
PsychologyThe Island of Humanistic Psychology
Hank Robb, Ph.D., ABPP, Reno, NV, 2010
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Potentially Useful Historical BackgroundThe
first Humanist Manifesto was signed in the
United States in 1933. It spawned the American
Humanist Association which during the 1960s
presented its Humanist of the Year award to
both Carl Rogers and B.F. Skinner.

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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.
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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.
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Bridges with Humanistic Psychology

• Values
• Mindfulness
• Self As Context
• Acceptance of Thoughts Images Sensations
• Contact with the Present Moment

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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

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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

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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