ACT/RFT Reader's Update (December, 2009)

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Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process Cognitive-behavioral approaches to pain management have an established record of empirical support. However, as true with other behavioral problems, the mechanism by which improvement occurred is inconsistent with the theoretical underpinnings of CBT. In a recent paper, Vowles and McCracken add to their ongoing line of research in acceptance-based approaches to the treatment of chronic pain. In their paper, they present their findings of an inter-disciplinary treatment program based in Acceptance and Commitment Therapy, with a focus on acceptance and values-based action. One-hundred seventy-one participants completed the program which consisted of 3 to 4 weeks of inpatient treatment for about 30 hours per week. Participants improved across almost all domains, including pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance, and effect sizes for these improvements were medium to large. Analysis of reliable change revealed that 75.4% of participants improved in at least one key domain assessed. In contrast with CBT-based approaches to pain management, improvements across these domains were associated with ACT's proposed mechanisms of action, namely, acceptance of pain and values-based action. The authors conclude that these findings provide support for the ACT model of treatment for chronic pain, and the processes associated with improvement – acceptance and values-based action.

Vowles, K., & McCracken, L. (2008). Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. Journal of consulting and clinical psychology, 76(3), 397-407.

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Rule-Governed Behavior and Psychological Problems Humans, uniquely among animals, can come to understand and respond to linguistic rules, both effective ones and not so effective ones. The effective ones help us to learn and adapt to our environment. The ineffective ones can cause maladaptive behavior and diminish our lives considerably. This paper presents a functional analysis of patterns of rule-governed behavior (RGB) and shows how rules can contribute to psychopathology. Rules have been described as antecedent stimuli that alter the functions of stimuli in our environment. They allow us to respond to that environment in complex and efficacious ways. But what are rules? Relational Frame theory suggests that we humans learn to respond in accordance with abstract relational patterns based on cues (e.g., SAME). Rules are essentially combinations of cues that specify particular relations between environmental stimuli and between environment and behavior and thus allow us to respond in new ways (‘transformation of function’). The paper describes three functional patterns of RGB. These are pliance, tracking and augmental rule following. Pliance is RGB under the control of a history of socially mediated reinforcement for coordination between behavior and antecedent verbal stimuli (rules). A typical example might be a child obeying the rule ‘Don’t touch my laptop’ because their parent has given them this rule and because their parent has previously provided consequences for following or not following rules. Tracking is RGB under the control of a history of coordination between the rule and the way the environment is arranged independently of the rule. An example might be a child obeying the parental rule ‘Eat your breakfast because it will give you more energy’ because in the past the child has experienced the effect of other rules that have been accurate in their description of the environment. If this rule also shows coordination (i.e., the child finds an increase in energy when they eat breakfast), then this will further strengthen tracking behavior. Augmenting is RGB due to relational networks that alter the degree to which events function as consequences. The example given is ‘Eat your vegetables to be a big strong boy’. If this rule makes vegetable eating more reinforcing then it might be described as augmenting. Each of these patterns has its advantages and its disadvantages, including maladaptive behavior. It’s useful for children to learn pliance since this allows them to acquire useful adaptive habits, but doing things just because one is told to can make one insensitive to one’s environment. Tracking allows independence from social whim, but tracking can also lead to ineffective behavior; for example, tracking short term reinforcement can mean one misses longer term reinforcement. Augmenting is the most advanced form of rule governed behavior and as such it can interact with and reinforce either of the other two functional patterns resulting in strongly adaptive or maladaptive patterns. Experiential avoidance can be a product of the latter while valuing, an important part of the antidote to EA, is an example of the former. Törneke, Luciano and Valdivia (2008) have provided an excellent description of RGB and its relationship to psychopathology.

Törneke, N. Luciano, C. & Valdivia Salas, S. (2008). Rule-Governed Behavior and Psychological Problems. International Journal of Psychology and Psychological Therapy, 8 (2), 141-156.

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Brief Review: A Parametric Study of Cognitive Defusion and Believability The effects of the “Milk, milk, milk” exercise are dependent upon the length of the intervention: Reducing distress in respect to private events has been a major emphasis of traditional behavioral and cognitive behavioral therapies. The inclusion of mindfulness interventions in some contemporary therapies like ACT has shifted this focus from distress reduction to changing the behavior regulatory functions of distressing private events. One means of examining this change is by asking clients about the believability of their thoughts. Defusion interventions represent efforts to disrupt this behavior regulation, and the “milk, milk, milk” exercise is the intervention examined in this article. Two studies examined the effect of this exercise on the emotional discomfort and believability of a negative, self-relevant word identified by the participant as sufficiently problematic. Each study varied the amount of time spent repeating the word – 0, 3, or 20 seconds in study 1 and 1, 10, or 30 seconds in study 2. A rationale for the procedure and training with the word “milk” was provided before each intervention. Results showed that emotional distress reduced significantly within 3-10 seconds, while believability reduced significantly only after 20-30 seconds. The difference in timing for these reductions suggests that discomfort and believability are functionally distinct behaviors. The authors suggest extending defusion exercises until the believability of thoughts, rather than just emotional distress, diminishes.

Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33, 250-262.

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Brief Review: Relational Frame Theory and Social Categorization The Matching-to-Sample procedure can transform the functions of arbitrary stimuli in the Implicit Associations Test: This study examined the acquisition of obesity stigma to arbitrary stimuli. More specifically, the matching-to-sample (MTS) procedure was used to provide relational conditioning sufficient to generate a transformation of stimulus functions for stigma to images of either horizontal or vertical lines. The Implicit Associations Test (IAT) was used to detect this transformation of functions. Fifty undergraduate psychology students engaged in a series of five computerized tasks: (1) an IAT containing evaluative words and images of horizontal and vertical lines, to confirm a lack of pre-existing bias, (2) an established IAT for detecting implicit evaluative bias toward obesity, to confirm the presence of pre-existing bias, (3) two MTS tasks providing relational conditioning sufficient to generate the transfer of positive and negative evaluative functions to images of horizontal and vertical lines, (4) the same IAT used in step 1, to assess for the acquisition of bias, and (5) the same IAT used in step 2. Results confirmed no pre-existing bias at time 1, a large and significant predicted bias at time 2, and a small and significant predicted bias at time 4. The results of this study are discussed in respect to an RFT account of the development of stigma and social categorization and contrasted with a more mainstream, cognitive account known as the Social Knowledge Structure.

Weinstein, J. H., Wilson, K. G., Drake, C. E., & Kellum, K. K. (2008). A relational frame theory contribution to social categorization. Behavior and Social Issues, 17, 39-64.