1. Department of Psychology
ACTing
Using Relational Frame Theory (RFT) and Acceptance and Commitment Therapy (ACT) to Predict and Influence Human Behavior
Amy R. Murrell, Ph.D.
Department of Psychology

2. About me & behavior analysis
No formal training in traditional behavior analysis
But I think like a behavior analyst and here is why…
Viewed importance in ideographic information
Undergraduate at U of Memphis
Attention to context (Bob Cohen)
Question medical model and DSM nosology (Houts)
Grad. training at U of Mississippi
Practica working w/individuals with DD, MR
Kelly Wilson, ACT & RFT
ABA Conventions
Attended many presentations (and eventually gave)
Purchased and read many books (even wrote pieces)
Start off with a caveat- no classes in behavior analysis (at least not as traditionally done)
Still, I am interested in applying learning principles to human behavior. I identify more strongly with that than almost any other characteristic of my professional make-up. The only thing that I feel more strongly about it is my desire to help people live more meaningful lives. I am fascinated by people and their learning histories. I cannot think of any better way to dignify the uniqueness of every person and every situation than doing individualized assessment and treatment. Therefore, I don’t make ontological assumptions about psychopathology or behavior problems. I do my work from a functional analytic perspective, looking for variables that maintain behavior and ways that context can be manipulated to produce behavior change.
My approach was shaped by a number of things, including… which is how I got before you today, AND I am still learning.

3. Outline Brief history of BA and Behavior Therapy
A little glimpse into RFT
Indirect conditioning, RGB, stimulus control
Clinical relevance/RFT&ACT connection
Introduction to ACT
What a return to BA might have for psychology
What might RFT and ACT add to traditional BA
Questions, reactions, etc.

4. History: Behaviorism to Applied Behavior Analysis
William James (pragmatism)
Pavlov (respondent conditioning) in early 1900s
Thorndike (functionalist/law of effect)
Watson (father of behaviorism) & Mary Cover Jones (20s)
Psychology as the Behaviorist Views It (1913)
Skinner (operant conditioning)
On the Behavior of Organisms (1938)
Science and Human Behavior (1953)
Verbal Behavior (1957)
Keller and Schoenfeld (1950)
The roots of behaviorism can be traced far back- at least to the early 1900s when Pavlov when discovering classical conditioning principles and Thorndike was conducting systematic study of behavior that evidenced reinforcement. By the 1920s, Mary Cover Jones (in her work with little Peter and the white rabbit) was already using conditioning principles to treat psychological distress.However, many would say that Skinner’s work solidly defined behavior analysis.

5. History BA to Behavior Therapy
Ayllon, Azrin, Baer, Bijou, Ferster, Fuller, Goldiamond, Lindsley, Michael, Verplanck
Late 1940s to late 1960s
Very little distance between clinic and lab
“Behavior therapy, or conditioning therapy, is the use of experimentally established principles of learning for the purpose of changing maladaptive behavior.” (Wolpe, 1969)
2nd Wave (change what clients think)
RCTs and EVTs
Disconnect from lab (all about outcome research)
And the effect sizes haven’t changed much
And not much evidence that it works the way thought it would
Keller and Schoenfeld really made clear that Skinnerian principles could be applied consistently to human behavior, and for the next several years, several researchers began to apply operant (as well as respondent) conditioning principles to the treatment of maladaptive human behavior. There are a lot of people who did a good deal of this work. Only some are listed here. It became evident that psychological treatment based on the science of learning could make huge differences in peoples’ lives.
However, many of these studies had been conducted with children or adults with mental retardation or other disabilities. As this is not the typical, verbal client who presents for therapy. Psychologists began to question how to deal with language and especially cognition. The popular idea became that therapy should focus on changing clients’ thoughts and assumed that feelings and overt behaviors would follow suit. With this shift to the 2nd wave of behavioral treatment, came the use of randomized controlled trials to establish empirically validated treatments. And, CBT worked. This seemed to many to be an adequate answer to the cognition dilemma, however, more recent meta-analyses and dismantling studies have shown that effectiveness of CBT has been somewhat stagnant and that it does not work through the mechanisms which were proposed. Related to that, another problem is that we lost emphasis on basic research. So, we might know CBT works but not why, and thus there is no way to really influence behavior.

6. But what about cognition…
There is something different about “typically developing” or verbally competent humans AND previous, traditional BA accounts have not been well received by psychology because they did not address this well

7. …cognition…
There is a need to address stimulus control that emerges from indirectly experienced contingencies
Insensitivity to direct contingencies
Instructionally induced control (higher order class)
RGB alters function of stimuli
Transfer and transformation of function
**Leads to less contact with environmental contingencies and fewer opportunities to learn new behavior = narrow and inflexible behavior repertoire
What I mean by indirect is that behavior comes under the control of verbal stuff about contingences rather than by the contingencies themselves. Insensitivity to schedules of reinforcement has been shown multiple times. Shimoff, Matthews, Catania, Baron, Galizio, Malott, Hayes, Barnes-Holmes, and others have conducted studies that examine the impact of verbally instructed rules that vary from reinforcement that is provided. So for example, a participant is told (either verbally or in writing) to respond quickly to a computer task while they are being reinforced (with points, for example) to respond at a low rate. We do know that certain manipulations affect performance, such that different schedules of reinforcement (lean reinforcement is related to higher insensitivity), the role of social consequences, the similarity between the rule and the direct contingencies, for example, may affect response. There are reasons, therefore, to consider context of rules. What is apparent throughout is that rules can change the functions of stimuli, so that previously neutral stimuli come to have control over behavior. There is a good deal of basic process research that supports this, mostly through the use of match(ing)-to-sample procedures that examine stimulus equivalence. Many researchers have now demonstrated that discriminative consequential and other functions can be transferred between stimulus events in a class. Some recent work by Dougher and colleagues shows contextual control of stimulus transformation in various relations. So, if train that A is less than b which is less than C. And then, train a small shock to A, participants will work to avoid C.

8. Verbal (Indirect) Learning Processes *equivalence here but not only
Bi-Directional Transformation of  Function
*equivalence here but not only
“Car”
1. Mutual Entailment
“Car”
Car
Lemon
Burger
3. Transformation of Stimulus Function
2. Combinatorial Mutual Entailment
So, how does indirect conditioning occur? There are three core processes that are involved. Note that this refers to equivalence but really many other relationships (any relationship like more/less, etc.) So in stimulus equivalence literature, this equates to reflexivity, symmetry, transitivity, and transfer of function. But stimuli, according to RFT, can be in a frame of coordination, opposition, bigger/smaller than, etc.
speed
sounds
streets
smells
danger
wind
“Car”
“Car” or Car
Car

9. What Indirect Conditioning Gives Us
Good
Ability to balance long- and short- term contingencies
Communication over time and distance
Broad ability to evaluate, categorize, sort
Broad ability to plan and execute based on evaluations
** Advantage in treatment
Bad
Can’t turn it off and may turn on you

10. Me Unworthy of love Trained by critical parents “Nothing but trouble”
“Not as good as your brother”
“So stupid, irritating…”
Let’s look at an example of this.
Imagine a child who is repeatedly told by her parents that she is ….
Then later, through interaction with the social-verbal community, she derives a more general negative self-discrimination that those things that her parents said is related to being unworthy of love. Without any additional direct experiences, she will derive that she is unworthy of love.
This kind of indirect conditioning may well be responsible for the complexity seen in clinical problems. Because…
We have, not only all our direct training history with regard to SELF, BUT ALSO all relations among relevant stimulus events to contend with.
Trained via
interaction w/
social-verbal
community
Unworthy
of love

11. no contact with appetitives
“bad”
unworthy of love
me=bad=unworthy of love
me, myself, I
Social context
DIRECT RESPONDING
Lets follow this out…look at how such self-relevant private events may exert stimulus control over behavior…
A young child is constantly criticized by her parents. Over time she comes to relate self-referring stimuli (me, myself, I, her name) with “bad.” Via interaction with social-verbal community stimulus event “bad” comes to participate in a frame of coordination (i.e., equivalence) with “unworthy of love.”
In a social context, such as an intimate relationship, these stimulus relations (me=bad=unworthy of love) become psychologically present and direct responding. So, she begins to avoid social situations that make these stimulus events present (as they are painful and aversive).
Avoidance of social situations is negatively reinforced As a result, she never has the opportunity to learn new relations and there is no contact with other contingencies that would reinforce more adaptive social behaviors (such as appetitives available in interpersonal relationships). Avoidance of social situations eventually results in poor social skills.
A child with poor social skills will likely have more aversives available in the environment e.g., the child may be shunned or teased, for example)
(and the cycle of maladaptive social behavior will thus be perpetuated.
How do we make the aversive functions of “me” less salient in social contexts—so that may have broad and flexible behavioral repertoire—make other response functions available so that behavior may be organized in a way that is more adaptive?
Exposure and defusion techniques.
negatively reinforced
AVOID
poor social skills
do not learn new relations
no contact with appetitives
more aversives available

12. The Have-to Disease People with alcoholism have to drink
People with OCD have to wash, count, etc
People who are therapists have to be experts, be smart, save their clients,_____
In each case, there is an inflexibility involved

13. Have To
Usually have to disease arises from aversive control where there is increased arousal and decreased sensitivity to broad context and related to that fewer emitted behaviors
Want to lessen the support for narrow and inflexible (shifting context)
Sometimes aversives even become appetitive
**This is what ACT clinicians intend to do

14. So how does ACT go about treatment efforts
So how does ACT go about treatment efforts? There are six essential components. They are… They can be divided into two areas of work…

15. Acceptance and Mindfulness Processes
Mostly about antecedent control- fusion with stimulus events including private events as literal, so examine and attempt to manipulate what happens before avoidant and other problem behaviors in order to predict and influence it-
If negative thoughts, feelings, bodily states, and behavioral predispositions are conditioned stimuli, then we can do exposure (direct) and defusion (relational)
Purpose-to develop broad and flexible behavior repertoires

16. Commitment and Behavior Change Processes
Mostly about consequential control- after behavior-motivating factor-behavioral activation is key as is importance of choice

17. How Metaphor Experiential exercises Densely interpersonal relationship
Clinician as conditioned reinforcer
Through the use of functional analysis

18. Preparing to Begin Functional Assessment
Same process as traditional but different purpose
Goal is to identify A-B-C chain for creating more meaningful life rather than reduce/eliminate
Identify painful content
Identify what client does to get rid of it
Identify values
Task analysis sometimes necessary
Identify how avoidance interferes

19. Acceptance Allow self to have whole of experiences No Yes
When doing so foster effective action No
Dangerous, unhealthy, or unproductive situations
Emotional wallowing
Yes
Thoughts, emotions, memories, history, bodily states, behavioral dispositions
Hopelessness of struggle

20. Acceptance Didactic Exercise (Conversation Topics)
Mule in the well
Experiential Exercise (Imaginal Exposure)
Workability of avoidance
File card
Increase tolerance for aversive through desensitization
*Didactic and experiential overlap too
Talking and teaching vs. slowing down, getting centered, probably closing eyes BUT really all exposure/defusion and do both together

21. Fusion
Fusion is the process whereby certain verbal functions dominate over other directly and indirectly available psychological functions
Cognition stands in for experience
Gum exercise
Example of fusion-Saliva

22. Defusion/Exposure
Defusion is the process whereby other directly and indirectly available psychological functions become available
ANYTHING that involves interacting with the aversive event that is not avoidance
Distancing or change the link between setting and problem behavior
Optimally, a wide variety of rich interactions
As different as possible from the usual ways of interacting (functionally, if not formally)

23. Defusion Should attack aspects of context that support narrowness
Didactic exercise (Conversation Topics)
Treat “the mind” as an external event; almost as a separate person
Point out a literal paradox inherent in normal thinking
Get off your buts (and tries)
Key metaphor
Repetition, silly voice, etc.
debrief
Experiential exercise (Imaginal Exposure)
The bus driver metaphor (esp. for groups)
Many stories—same beginning, different end
Leaves in a stream
Physicalize and set to side (imagine) .

24. Self-as-Context and Contact with the Present Moment-
Contact with current contingencies
Here and now
Showing up
Where is nose, hair
Appreciation without evaluation
-Therapist great session, Therapist bad session
Sense of self that is a safe and consistent
Observe and accept all changing experiences in both self and clients
These fit in on both sides of the model. The main goals are to… As with others, there are metaphors and exercises that are relevant to this work
If you lost a limb, would you still be you
DO OBSERVER EXERCISE

25. Valuing Powerful reinforcement- hard work for something
Talk in terms of importance and consistency
Didactic exercise
Coke and 7-up metaphor
List of values, goals, and barriers
Compass (will look at in more detail)
Experiential exercise
Tombstone
Pen through hand
Waited values
DO PEN EXERCISE

26. Committed Action Making life about living values
Not about eliminating pain
Team building
Note barriers, failures, need to recommit
“Often people attempt to live their lives backwards; they try to have more things, or more money, in order to do more of what they want, so they will be happier. The way it actually works is the reverse. You must first be who you really are, then do what you need to do, in order to have what you want.”
--Margaret Young
Commitment to be committed when slip

27. Return to BA roots & RFT/ACT
Most effective treatments based on BA
Perhaps remove obstacles thorough RFT/ACT
Sensitive to the sometimes paradoxical effects of rule-based direct change strategies
Sensitive to the importance of what our clients say and think
Sensitive to the non-mechanical relationship between thinking and other behaviors
Psychology needs basic process accounts