Measuring the process of values Tobias Lundgren Karolinska Institute, Clinical Neuro science Department of Psychology Stockholm University

Agenda Talk about the process of developing a values instrument Talk about the process of developing a values instrument –Pedagogical tool, clinical tool, outcome and process measure Pros and cons Pros and cons Results you get from BEVS Results you get from BEVS

The development Started as a clinical tool, community development Started as a clinical tool, community development Home work, building session contexts, diaries, etc etc Home work, building session contexts, diaries, etc etc Measure therapeutic progress with values as reference not only symptom relief or predefined quality of life Measure therapeutic progress with values as reference not only symptom relief or predefined quality of life Closer to behavior that potentially reinforce new behavior repertoires Closer to behavior that potentially reinforce new behavior repertoires Attempted to move away from categorical self report measures to criterion related ones Attempted to move away from categorical self report measures to criterion related ones

Far from In vicinity Close Bullseye Value: Friends Direction: respect, have fun, be able to talk about all kind of things, closeness Give support, Place an X on the dartboard on the place that best represents how close you came towards being in your valued direction during the last to weeks

Far from In vicinity Close Bullseye 5 B) How often are you doing things you want to do in the face of difficulties and emotional resistance? Place an X on the dartboard were it best represents how you live in the face of difficulties. 5 A) What stands between you and the life you want?______________________________________________ ___________________________________________________

In sum, four things to do 1) define a value, 2) Score and measure the distance between how things has been during the last 2 weeks and how you want things to be, 3) evaluate barriers/what stops you from living in that direction, Score that as well… 4) define steps you would be willing to take, together with all your fears to move closer towards your values

Development of the BEVS Started by asking persons in different cultures what they really valued in life if fears and obstacles was put aside for a moment Started by asking persons in different cultures what they really valued in life if fears and obstacles was put aside for a moment

Descriptive statistics of the total number of valued choices described in categories and the mean distance from B-E. (N=84). Chosen valuesNumber Relations44 Leisure12 Work/education26 Health 2 Total 84

My life is just as I want it to be My life is far from how I want it to be Work/ Education Leisure Personal growth/ Health Relation- ships

Psychometrics Did the work around the BEVS validity, reliability, factor analysis etc etc. Did the work around the BEVS validity, reliability, factor analysis etc etc. Used it in studies and it worked both as outcome and process measure Used it in studies and it worked both as outcome and process measure

There are pros I think Clinically helpful Clinically helpful Create a context of values right from the start Create a context of values right from the start Clients define content Clients define content We measure what we want to change We measure what we want to change Fits well with the functional analysis Fits well with the functional analysis Step towards evaluating mechanisms of change Step towards evaluating mechanisms of change You can be flexible and use the Bull’s-Eye metaphor in different ways BUT You can be flexible and use the Bull’s-Eye metaphor in different ways BUT

Some Cons Sometimes hard to define values for clients, becomes goals, they don’t get what to do, therapists get confused etc. Sometimes hard to define values for clients, becomes goals, they don’t get what to do, therapists get confused etc. Need to train administrators Need to train administrators Still self report even though clients themselves define the content Still self report even though clients themselves define the content Content changes over time and we want to be sensitive to that even though one of the nice things with the measure is that it is not the content we are interested in it is the process and research wise the scores. Content changes over time and we want to be sensitive to that even though one of the nice things with the measure is that it is not the content we are interested in it is the process and research wise the scores.

Bulls-Eye in process research In a treatment outcome study for persons suffering from epilepsy, pre to follow up changes in seizure reduction and increase in quality of life were mediated through ACT processes such as values attainment, defusion, acceptance and persistency in living a valued life even in the face of difficulties and emotional resistance. In a treatment outcome study for persons suffering from epilepsy, pre to follow up changes in seizure reduction and increase in quality of life were mediated through ACT processes such as values attainment, defusion, acceptance and persistency in living a valued life even in the face of difficulties and emotional resistance. Lundgren, T., Dahl, J., Hayes, S. Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy, Journal of Behavior Medicine, In press.

AB C N=27 Self rated scores on B-E

A B C N=27 Self rated scores on B-E

ACT ST

Criterion-Related Validity Correlations with acceptance and Action Questioner II (AAQ 2) N=148 Correlations with acceptance and Action Questioner II (AAQ 2) N=148 –Bulls-Eye Total-.26 * –Bulls-Eye 1 (relations) -.38 * –Bulls-Eye 2 (work) -.25 * –Bulls-Eye 3 (play) -.25 * –Bulls-Eye 4 (health) -.29 *

Criterion-Related Validity Correlations with Satisfaction With Life Scale (SWLS) N=148 Correlations with Satisfaction With Life Scale (SWLS) N=148 –Bulls-Eye Total.47 * –Bulls-Eye 1 (relations).45 * –Bulls-Eye 2 (work).32 * –Bulls-Eye 3 (play).47 * –Bulls-Eye 4 (health).51 *

Criterion-Related Validity Correlations with Depression and Anxiety Scale (DASS) N=148 Correlations with Depression and Anxiety Scale (DASS) N=148 –Bulls-Eye Total -.42 * –Bulls-Eye 1 (relations) -.27 * –Bulls-Eye 2 (work) -.27 * –Bulls-Eye 3 (play) -.33 * –Bulls-Eye 4 (health) -.38 *

Reliability N=148 Pearson’s Correlation after repeated measure Pearson’s Correlation after repeated measure –Test re-test reliability.85

What to do? Use new technology to get closer to behavior and experiencing sampling Use new technology to get closer to behavior and experiencing sampling Be aware of what kind of data you will get when you use different ways of measuring Be aware of what kind of data you will get when you use different ways of measuring Look for behavioral measure Look for behavioral measure Measure with different tools Measure with different tools Help each other to continue the development Help each other to continue the development

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