Empirical Support for the Utility of a Three-Step Perspective Taking Model for the Development of Psychosis Proneness in College Students Roger Vilardaga, Ana Estévez, Michael E. Levin and Steven C. Hayes University of Nevada, Reno and Universidad de Deusto WC ABCS, Reno NV, June 22, 2010

Key points of presentation Study conducted in colaboration with Ana Estévez from the Universidad de Deusto in Bilbao, Spain Contextual behavioral approach DV: Social anhedonia IVs: Experiential Avoidance, Empathy, Perspective taking Design: Cross-sectional Results suggest three processes that together can help us understand psychosis pronenness and that can be targetted in future ACT protocols for psychosis

Background Psychosis proneness Social anhedonia has been shown to predict psychosis (Chapman et al, 1994; Kwapil et al, 1997; Gooding et al, 2005) And it relates to features that are characteristic of schizophrenia: Social adjustment (Mishlove et al, 1985) Lack of friends (Kwapil, 1998) Working memory (Gooding et al 2003)

Relational Frame Theory Behavioral account of language and cognition Verbal stimuli have an impact on human behavior through their participation in relational frames Relational frames allow individuals to interact with the world more effectively without the need to experience it directly There are multiple kinds of relational frames (i.e., coordination, hierarchy, opposition)

Betrang sour salivation citrus bumpy lemonade yellow Limoo Betrang 1. Mutual Entailment 2. Combinatorial Entailment 3. Transformation of Functions sour salivation citrus bumpy lemonadeyellow Defining properties of relational frames Note: Slide borrowed from Ian Stewart, 2008, June. attention rushian? what?

RFT preliminary studies (Villatte et al, 2008, 2009, 2010) Deficits in a specific type of relational framing among individuals diagnosed with psychosis and/or high social anhedonia RFT can provide: – A more fine-grained analysis of psychosis proneness – Key targets for the remediation of deficits in individuals with high social anhedonia and schizophrenia

Perspective-taking Deictic framing Experiential avoidance Contextual control over deictic functions Social Anhedonia I/You Here/There Now/Then I/You Excitement Affection Joy I/You Sadness Fear Hate Contextual control Empathy Transformation of functions of deictic relations 3 step model and predictions DRT (Vilardaga et al, 2009) IRI (Davis, 1983) AAQ (Hayes, 2004) rSAS (Eckblad, 1982)

Development of new deictic protocol with more ecological validity We made the wording of trials more appropriate for an adult population: each single trial added a new content: We eliminated simples and simplified reversals: – i.e., instead of “if I were you and you were me”, we asked “If you were me” or “If I were you” and balanced it TRIALS STRUCTURE (total trials = 375) ComplexityREVERSALSDOUBLE REVERSALS Trial typesI-YOUHERE-THERENOW-THEN HERE-THERE/ NOW-THEN I-YOU/ HERE-THERE # trials75 TRIALS CONTENT NOW-THEN“in a month,” “last week,” “ten years ago,” etc. HERE-THERE“Tahoe,” “Los Angeles,” “Singapur,” etc. I-YOU“Marc,” “Maria,” “John,” etc.

Duke is watching the sunset on the rooftop, and Dafney is watching TV in the living room. If the rooftop was the living room, what would Duke be watching? The sunset The TV 18 to go Example of deictic assessment trial

Now Floyd is digging a hole in Death Valley, and next winter he will be making snow angels in the Alps. If Death Valley was the Alps and now was later, what would Floyd be doing now? Making snow angels Making snow angels Digging a hole 1 to go Example of deictic assessment trial

Improvements in procedure ›Thanks to Ruth Anne Rehfeldt we elaborated on her basic VBA code and created a new automated procedure ›Data was automatically written in a text file: ›Accuracy ›Fluency (response time) ›Mistake latency ›Less social desirability effects ›We solved ceiling effects of previous empathy ratings by adding more empathy questions

Participants College students from University of Deusto (Bilbao, Spain): N=110 Criteria: – Being fluent in Spanish Sample characteristics: – 88.2% female – Mean age: 20 (range: 18-32) – Caucasian – Participant’s father: 9% college degree, 20% high school, 25% school diploma, 13% professional school

Predictors of social anhedonia; Sequential multiple regression Social Anhedonia R2R2 ∆F∆Fβ95% CI Step Gender -.17 [-.308,.018] Age -.09 [-.042,.016] Step 2.10*6.914 Gender -.13 [-.270,.052] Age -.10 [-.043,.014] Deictic ability -.26* [.004,.029] Step 3.15*5.172 Gender -.06 [-.218,.113] Age -.04 [-.035,.023] Deictic ability -.23* [.003,.027] Empathic concern -.23* [.010,.148] Step 4.26** Gender -.02 [-.172,.139] Age.05 [-.020,.035] Deictic ability -.18† [.000,.023] Empathic concern -.26* [.024,.154] Experiential Avoidance.35** [-.015, -.005] Note: *p<.05, **p≤.001, †p<.10

Perspective-taking Deictic framing Experiential avoidance Contextual control over deictic functions Social Anhedonia Empathy Transformation of functions of deictic relations Significant (p=.000) 26% variance Medium effect size Marginally significant in predicted direction r =.13† Non significant but in predicted direction r =.03ns Significant at 2nd and 3rd step (β = -.23*) but not last (p=.056) in predicted direction Significant at 3rd and last step (β = -.26*) in predicted direction Significant at last step (β =.35**) in predicted direction 10% 15% 26%

Limitations and future directions Early study Non-clinical population Cross-sectional design / need stronger methods --- Test the same model longitudinally and experimentally Behavioral measures of empathic concern and experiential avoidance are highly needed Further basic research to understand the contextual factors that give rise to each of these behavioral processes We have collected data from 162 participants responding to the same measures

Conclusion This data suggests that in addition to psychological flexibility, future ACT protocols for psychosis might consider targeting individuals’ ability to engage in deictic framing and their ability to transform its functions. We recommend this is done with the development of behavioral tasks to train/measure each of these processes.

The essence of the ACT model

is a Contextual Behavioral Strategy

Thanks for your attention Contact information/resources: A ppt/audio version of this presentation will be posted in the following website: Association for Contextual Behavioral Science: Roger Vilardaga, M.A.: