Relational frame theory,acceptance and commitment therapy,and a functional analytic definition of mindfulness

The present article interprets mindfulness from the point of view of the effects of language and cognition on human action. Relational Frame Theory is described to show how human suffering is created by entanglement with the cognitive networks made possible by language. Mindfulness can be understood as a collection of related processes that function to undermine the dominance of verbal networks, especially involving temporal and evaluative relations. These processes include acceptance, defusion, contact with the present moment, and the transcendent sense of self. Each of these components of mindfulness are targeted in Acceptance and Commitment Therapy, and there is some evidence that they underlie the therapeutic changes induced by this approach. The relation between the present approach to mindfulness and other approaches is discussed.     

Creating a strategy for progress: a contextual behavioral science approach

Behavior analysis is a field dedicated to the development and application of behavioral principles to the understanding and modification of the psychological actions of organisms. As such, behavior analysis was committed from the beginning to a comprehensive account of behavior, stretching from animal learning to complex human behavior. Despite that lofty goal, basic behavior analysis is having a generally harder time finding academic support, and applied behavior analysis has narrowed its focus. In the present paper we argue that both of these trends relate to the challenge of human language and cognition, and that developments within clinical behavior analysis and the analysis of derived relational responding are providing a way forward. To take full advantage of these developments, however, we argue that behavior analysts need to articulate their unique approach to theory, to develop more flexible language systems for applied workers, and to expand their methodological flexibility. This approach, which we term contextual behavioral science, is meant as an evolutionary step that will allow behavior analysis to better capture the center of modern psychological concerns in both the basic and applied areas. Clinical behavior analysis is showing a way forward for behavior analysis to regain its vision as a comprehensive approach to behavior.     

Letting a little nonverbal air into the room: Insights from acceptance and commitment therapy Part 1: Philosophical and theoretical underpinnings

In recent years, a new “wave” of mindfulness based Cognitive Behavior Therapies (CBT) has become popular. Such approaches include Acceptance and Commitment Therapy (ACT; Acceptance and commitment therapy: An experiential approach to behaviour change. New York: Guilford Press, 1999), Mindfulness-based Cognitive Therapy for Depression (Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press, 2002), and Mindfulness-based Stress Management (Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing, 1990). In contrast to traditional CBT, these approaches often minimize attempts to change the form and frequency of dysfunctional thoughts. Is there any way to integrate traditional CBT with mindfulness based CBT? To answer this question, we discuss the philosophical and theoretical underpinnings of one form of traditional CBT (Rational-Emotive and Cognitive Behavioral Therapy) and one form of mindfulness based CBT (ACT). We argue that some aspects of each therapy can be integrated. However, in order to prevent techniques from being used haphazardly or inconsistently, we suggest that the different forms of CBT need to be driven by a common philosophical orientation (e.g., functional contextualism) and theoretical orientation (e.g., Relational Frame Theory).     

THIS IS NOT B. F. SKINNER'S BEHAVIOR ANALYSIS: A REVIEW OF HAYES,STROSAHL, AND WILSON'S ACCEPTANCE AND COMMITMENT THERAPY

Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999) is an important addition to and extension of the growing field of clinical behavior analysis. The book provides a comprehensive introduction to a new therapy that is rooted in functional contextualistic philosophy and a “post-Skinnerian” behavior-analytic theory of verbal behavior. It begins with the assertion that language or verbal processes are at the heart of psychopathology and human suffering and goes on to describe a therapeutic approach that seeks to undermine these verbal processes and facilitate clients' active commitment to value-driven behavior change. Along the way, the book provides a compelling behavior-analytic account of a number of important but neglected issues in behavior analysis, including human suffering, the nature and function of private events, the self, suicide, anxiety, depression, values, responsibility, and commitment. In so doing, the book cogently challenges the unfortunately common but erroneous assertion that behaviorism does not and perhaps cannot address the complexity of the human condition. The present review provides a general overview of the book, summarizes its chapters, and raises a number of questions that might be addressed in future research.     

LETTING A LITTLE NONVERBAL AIR INTO THE ROOM: INSIGHTS FROM ACCEPTANCE AND COMMITMENT THERAPY PART 2: APPLICATIONS

Acceptance and Commitment Therapy (ACT) and Rational-Emotive Behavior Therapy (REBT) seem to have much in common. For example, they both seek to increase client’s willingness to accept inevitable, unpleasant experience. However, the techniques the therapies use to increase acceptance are often quite different. Building on the philosophical and theoretical framework presented in the previous paper, we discuss the major practical differences between ACT and REBT. We then suggest some concrete ways that the two approaches can be integrated. Such integration may greatly expand the sorts of techniques that a therapist can effectively use in the therapy room. Address correspondence to Joseph Ciarrochi, Department of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia     

The Importance of Theory in Cognitive Behavior Therapy: A Perspective of Contextual Behavioral Science

For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called “third generation” models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture.     

The nature of clinical depression: symptoms, syndromes, and behavior analysis

In this article we discuss the traditional behavioral models of depression and some of the challenges analyzing a phenomenon with such complex and varied features. We present the traditional model and suggest that it does not capture the complexity of the phenomenon, nor do syndromal models of depression that dominate the mainstream conceptualization of depression. Instead, we emphasize ideographic analysis and present depression as a maladaptive dysregulation of an ultimately adaptive elicited emotional response. We emphasize environmental factors, specifically aversive control and private verbal events, in terms of relational frame theory, that may transform an adaptive response into a maladaptive disorder. We consider the role of negative thought processes and rumination, common and debilitating aspects of depression that have traditionally been neglected by behavior analysts.     

Relating different perspectives on how outcomes of behavior influence behavior

Many researchers have tackled the question of how behavior is influenced by its outcomes. Some have adopted a nonmechanistic (functional) perspective that attempts to describe the influence of outcomes on behavior. Others have adopted a mechanistic (cognitive) perspective that attempts to explain the influence of outcomes on behavior. Orthogonal to this distinction, some have focused on the influence of outcomes that a behavior had in the past, whereas others also consider the influence of outcomes that a behavior might have in the future. In this article, we relate these different perspectives with the goal of reducing misunderstandings and fostering collaborations between researchers who adopt different perspectives on the common question of how behavior is influenced by its outcomes.     

Addressing Anger,Stress, and Alcohol-Related Difficulties in the Military: An ACT Intervention

The use of alcohol to manage emotion is a common technique seen in military service personnel, the implication of which is evident in the relationship between alcohol misuse and mood disorders. However, investigations into transdiagnostic treatments aimed at addressing the common underlying processes to these problems in military personnel are lacking. The present study aimed to investigate the efficacy of a real-world Acceptance and Commitment Therapy (ACT)-based intervention undergone by 262 military personnel. A quasi-experimental prepost design was employed (interim 1 month postintervention) with a waitlist control group utilized to compare differences over time between those who promptly completed the week-long intervention course and the delayed waitlist participants. In line with predictions, the intervention group showed greater improvement (cf. preintervention waitlist group) in emotion management, and greater reductions in levels of alcohol consumption, aggression, anxiety, stress, and perceptions of others being responsible for their circumstances. No significant differences were found in the comparison of both groups’ 1-month postintervention results (i.e., both groups evidenced similar improvements); suggesting having to wait to start the course had little effect on its impact. The results suggest the course holds promise for helping military service personnel improve a range of psychosocial outcomes. Further testing with a more rigorous methodology is recommended, as is using a more proactive approach in the promotion and implementation of future courses.     

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

Religiosity and the value of being moral: Understanding the meaning of morality through a personal values perspective

We demonstrate how religiosity predicts relationships between personal values and perceptions of morality in four studies across two cultures (Jews in Israel and mainly Christians in the US). In Studies 1A (N = 337) and 1B (N = 200), we explored the commonalities and differences between religious and non-religious participants in the association between values and the importance of being moral. In Studies 2A (N = 131) and 2B (N = 250), we tested the role of religiosity in the association between values and evaluations of others’ morality. Power (negatively) and Benevolence (positively) were associated with morality across levels of religiosity. The associations with Conservation were more positive for more religious participants; the associations with Universalism were more positive for less religious participants. Finally, the associations with at least one of the Openness-to-change values were more negative if a person was more religious. Studies 2A and 2B showed these associations existed over and above differences in personal values.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

A contemporary behavior analysis of anxiety and avoidance

Despite the central status of avoidance in explaining the etiology and maintenance of anxiety disorders, surprisingly little behavioral research has been conducted on human avoidance. In the present paper, first we provide a brief review of the empirical literature on avoidance. Next, we describe the implications of research on derived relational responding and the transformation of functions for a contemporary behavioral account of avoidance, before providing several illustrative research examples of laboratory-based analogues of key clinical treatment processes. Finally, we suggest some challenges and opportunities that lie ahead for behavioral research on anxiety and avoidance.     

Murray Sidman's contributions to clinical behavior analysis

Murray Sidman was not himself a clinician nor directly involved in clinical research. Nevertheless, his experimental and conceptual work, especially in the area of stimulus equivalence, profoundly influenced the development of clinical behavior analysis. Before his work on stimulus equivalence, clinicians with a behavior analytic world view working with verbally sophisticated humans, were making some progress in understanding clinical phenomena and in developing innovative therapies. However, given the obvious and predominant role of verbal processes in both the development and treatment of clinical problems, that progress was constrained by the existing behavior analytic account of verbal behavior. Most fundamentally, it was hard to understand how, in the apparent absence of direct training, verbal events, even novel verbal events, acquire the functions of the nonverbal events that they stand for or represent. Sidman's work on stimulus equivalence, especially the transfer (transformation) of functions, offered an answer and thereby provided a conceptual framework of symbolic behavior around which clinical behavior analysis could cohere and develop.     

Data In Search Of A Principle: A Review Of Relational Frame Theory: A Post-Skinnerian Count Of Human Language And Cognition.

Responding to derived relations among stimuli and events is the subject of an accelerating research program that represents one of the major behavior analytic approaches to complex behavior. Relational Frame Theory: A Post‐Skinnerian Account of Human Language and Cognition (Hayes, Barnes‐Holmes, & Roche, 2001) offers a conceptual framework for this work and explores its implications for verbal behavior and a variety of other domains of complex human behavior. The authors dismiss Skinner's interpretation of verbal behavior as unproductive and conceptually flawed and suggest a new definition and a new paradigm for the investigation of verbal phenomena. I found the empirical phenomena important but the conceptual discussion incomplete. A new principle of behavior is promised, but critical features of this principle are not offered. In the absence of an explicit principle, the theory itself is difficult to evaluate. Counterexamples suggest a role for mediating behavior, perhaps covert, thus raising the question whether a new principle is needed at all. The performance of subjects in relational frame experiments may be a mosaic of elementary behavioral units, some of which are verbal. If so, verbal behavior underlies relational behavior; it is not defined by it. I defend Skinner's definition of verbal behavior and argue that an account of relational behavior must be integrated with Skinner's analysis; it will not replace it.     

Molar functional relations and clinical behavior analysis: implications for assessment and treatment

The experimental analysis of behavior has identified several molar functional relations that are highly relevant to clinical behavior analysis. These include matching, discounting, momentum, and variability. Matching provides a broader analysis of how multiple sources of reinforcement influence how individuals choose to allocate their time and offers an empirical rationale for reducing problem behavior by increasing adaptive behavior. Discounting highlights the functional relations that affect self-control. Momentum specifies the variables responsible for persistence in challenging situations. Variability characterizes a functional dimension of behavior that is essential for learning and problem solving. These concepts have important implications for clinical practice and research. A selective review of these concepts is presented, and their implications for assessment and treatment are discussed with two goals: to inform basic scientists about the relevance of their work and to invite clinical behavior analysts to broaden the conceptual basis for their work.     

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies’ quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.     

Social values influence the adequacy conditions of scientific theories: beyond inductive risk

The ‘death of evidence’ issue in Canada raises the spectre of politicized science, and thus the question of what role social values may have in science and how this meshes with objectivity and evidence. I first criticize philosophical accounts that have to separate different steps of research to restrict the influence of social and other non-epistemic values. A prominent account that social values may play a role even in the context of theory acceptance is the argument from inductive risk. It maintains that the more severe the social consequences of erroneously accepting a theory would be, the more evidence is needed before the theory may be accepted. However, an implication of this position is that increasing evidence makes the impact of social values converge to zero; and I argue for a stronger role for social values. On this position, social values (together with epistemic values and other empirical considerations) may determine a theory’s conditions of adequacy, which among other things can include considerations about what makes a scientific account unbiased and complete. I illustrate this based on recent theories of human evolution and the social behaviour of non-human primates, where some of the social values implicated are feminist values. While many philosophical accounts (both arguments from inductive risk and from underdetermination) conceptualize the relevance of social values in terms of making inferences from evidence, I argue for the need for a broader philosophical framework, which is also motivated by issues pertaining to scientific explanation.     

Presence and search for meaning in sport: Initial construct validation

According to Frankl (1959), the will to meaning is a fundamental human motive. Perceiving life as meaningful is associated with a number of sources and positive outcomes. Similar findings emerged when looking at domain-specific meaning, such as work. Surprisingly, sport-specific meaning is yet to be empirically investigated or measured. Therefore, the purpose of this two-study project was to examine the psychometric properties of the Meaning in Sport Questionnaire (MSQ), a sport-specific meaning measure. Survey responses (n = 329) from Study 1 were used to assess factorial validity and measurement invariance for the MSQ. Results from Study 2 with a different sample (n = 402) supported initial convergent validity for the two subscales of presence and search for meaning in sport. The MSQ is a new measure that can be used to investigate the extent to which athletes perceive their sport to be meaningful and search for such meaning.