ACBS Spotlight: Bridging the RFT - Clinical Process Gap

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As the CBS community gears up for the 8th World Conference in Reno, NV in June, there has been talk of how this year, the community is focusing on how we can make further strides in translational research and not only learn how to talk to others doing work of interest to us, but also to seek out ways to collaborate. Our mission: Find new ways to alleviate human suffering, stretch our intellect and reach for new questions and new ways of answering them, and learn from the tools developed by others.

What may be easy to see is how ACT research can fit into this mission -- there has been a surge in analog and process-oriented studies in addition to studies examining the mediators and moderators of outcomes. And ACT is reaching new corners of the clinical world and is appealing to many all over the world who are dedicated to helping people with every problem under the sun live more meaningful and value-directed lives.

What may be harder to see is the importance of strengthening our clinical work with basic science. And yet, the express and stated purpose of contextual behavioral science is to continually link what we do with clients to empirically-supported processes based upon basic principles. It's sometimes harder to see how RFT fits into what we say to clients on a daily basis, but there is a growing research base that helps us see just that.

If we look carefully at the empirical base in RFT we'll see that in recent years, we've had quite an impressive increase in studies that have used RFT theory, principles and preparations to examine, predict and influence responding to clinically relevant phenomena.

Case in point: Hooper, Saunders and McHugh at Swasea University in Wales have a paper in press in which they examined the role of derived relational responding in the "paradoxical effect" of thought suppression. To refresh, the paradoxical effect they refer to is the fact there is a fairly consistent finding in research particularly by Wegner and colleagues, that when subjects are instructed to suppress a particular thought, the unwanted thought appears to rebound or increase in frequency. Hooper and colleagues view this phenomenon through a lens of RFT -- if you are a clinician, think about the Chocolate Cake exercise in ACT. How do you know you've successfully avoided thinking about chocolate cake? Well, (insert the thought you did have here) is NOT... "chocolate cake". In the immortal words of Homer Simpson: D'oh! And there it is!! From an RFT perspective, the stimulus to be suppressed is present in the rule to suppress.

Hooper and colleagues set up a common RFT procedure, in which relations between certain novel words are directly trained, and others are tested for derived relations. For example, the relations "A is greater than B", and "B is greater than C" are directly trained. Then researchers test the relationships between A and C (not trained) to see if participants derive that A is greater than C -- and most normal adults do.

In Hooper's study, they trained that "word A is the same as word B" and that "word A should be suppressed" (removed from the computer screen when it appeared). In testing, participants indeed suppressed word B, indicating both that the relation between A and B was derived and that there was a transformation of function ("suppression") between A and B through that derived relation.

Here is a graph of their results:

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You will notice that the derived words and the directly trained words were removed from the screen at the same rate, as compared to the no-instruction control group and that unrelated words were not removed from the screen nearly as often.

What does this mean? Well, for one thing it means that we have yet another study that demonstrates the importance of RFT in understanding clinical phenomena. For another, it means that humans are likely to attempt to suppress or avoid contact with even things that they have not had direct experience with (e.g., being attacked by a dog, or dying)-- something most clinicians see on a daily basis.

As the authors suggest, this study lends empirical support to well-known clinical phenomena. Some of the symptoms of depression, phobias, obsessive-compulsive disorder, and post-traumatic stress responses may develop via generalization of the suppression function through derived relational responding, and we can see that through this generalization process, unwanted thoughts may eventually become more prevalent and distressing.

This study is not the first to examine such clinical phenomena -- and that is a fact that we can be proud of as a community. (Want to see more? Check out the Empirical Support page in the RFT section of the site.)

How, then, do we use this information to move toward intervening in these areas? Well, that is something we can all do as a community. Some of the moves within ACT are already aiming to reduce the impact of such generalization.

But knowing the research, we may start to see the importance of present moment awareness, broadening of attention, and increased behavioral variability in the presence of the unwanted stimuli as ways to diminish the impact of this process. We hope to prevent (or at least reduce) additional equivalence relations between unwanted stimuli and other stimuli from developing and we hope to help clients experience new relations between stimuli that have appetitive functions.

For example, a snake may be experienced as scary, yucky, and unpredictable and have an avoidance function, but if it also is "fascinating", "helpful in reducing rodent infestations", "intricately patterned"and "loved by someone I love" then we have broadened the relational network. And if some of these new relations have appetitive functions (eg., "enjoyment" and "approach") perhaps the aversive functions do not hold quite as much power for the person. I can't be sure, but Kelly Wilson can probably tell you more about how this worked for him when his daughter fell in love with a very large snake.

So, CBS community, let's keep our eyes open for ways to keep bridging this gap.

Interested in RFT? Not sure if you understand enough (or want to) to really get into RFT?

Perhaps it's a perfect time to broaden your relational network for what RFT means to you. Maybe it's not just "confusing" "overly technical" and "way over my head" but also "helpful in my clinical work" and "way cool"!

If you find yourself connecting with a value for approaching it, check out the RFT. We're in the process of updating them and they will soon contain lot more info to help even the most novice person get started with a working understanding of RFT.

Oh, and of course there is the World Conference in Reno where there is guaranteed to be at least one excellent workshop on RFT for new-comers. We hope to see you there!!

Read other entries in the ACBS Spotlight series here.