L4; Acceptance & Commitment Therapy

Pain catastrophizing

An exaggerated negative response during an actual or anticipated painful experience. Catastrophizers ruminate on and magnify the pain, and they often feel helpless in the face of the pain. Exaggerate; Ruminate; Helplessness

Hayes Paper

Classical behaviorism often uses the classical conditioning framework, while radical behaviorism uses the operant conditioning framework. For example, when analyzing a particular behavior, a classical behaviorist will attempt to identify the stimulus that has been associated with the target behavior...

Cognitive delusion

Defusion - Seeing inner experiences as they are (a sound, symbol, just a thought) without seeing them as literal truths that influence us to take (unwanted) actions (cognitive) fusion

(Fear Avoidance model: Vlaeyen & Linton, 2000)

Situation: Pain Cognitions: Pain catastrophizing Emotions, mood: Fear, anxiety Behavior: Avoidance Consequences: More pain, Disuse, Disability

Behavior Therapy and CBT

Situations, cognitions, emotions and mood, behavior

ACT

Situations; Cognitions; Emotions, mood; Valued life activities

What makes relational framing clinically relevant is that functions given to one member of related events tend to alter the functions of other members.

Suppose a child has never before seen or played with a cat. After learning "C-A-T" → animal, and C-A-T → "cat" the child can derive four additional relations: (1) animal → C-A-T, (2) "cat" → C-A-T, (3) "cat" → animal, (4) animal → "cat" -> Now suppose that the child is scratched while playing with a cat, cries and runs away. Later the child hears mother saying, "Oh, look! A cat." Now the child again cries and runs away, even though the child was never scratched in the presence of the words "Oh, look! A cat." Indeed, in this example, the oral name never was trained in the presence of the animal. Such effects may help explain why, for example, people can have an initial panic attack while "trapped" in a shopping mall, and soon find that they are worrying about being "trapped" in an open field or on a bridge. What brings these situations together is not their formal properties in a simple sense, but the verbal/cognitive activities that relate these events. !!!

Another ACT metaphor: The unwanted party guest

The "Unwelcome Party Guest" is an ACT metaphor that can be used to symbolize those unwelcome, inconvenient, or even unwanted "guests" that visit us in our daily lives. An unwelcome party guest in the lives of many these days of uncertainty is anxiety.

Process: Values

Goal: Discover your values, like being assertive, authentic, generous, forgiving, patient, powerful, orderly. Questions to ask your client? - What makes life worthwhile to you? - How do you want to be remembered after retirement by your colleagues?

functional contextualism

In functional contextualism, "prediction and influence" is seen as a unified goal (analyses should help accomplish both simultaneously), and for that reason functional contextual analyses always include contextual variables. Accomplishing a goal of influencing behavior requires successful manipulation of events, and only contextual variables can be manipulated directly (Hayes & Brownstein, 1986). = Stated another way, analyses that deal only in psychological dependent variables (e.g., emotion, thought, overt action) can never be fully adequate as measured against the pragmatic purposes of functional contextualism. Thus, the environmentalism of behavior analysis is not dogmatic, but pragmatic (practical over idealistic)

The core analytic unit of functional contextualism is the "ongoing act in context." The core components of functional contextualism are:

The core components of functional (a) focus on the whole event, (b) sensitivity to the role of context in understanding the nature and function of an event, (c) emphasis on a pragmatic truth criterion, and (d) specific scientific goals against which to apply that truth criterion.

Conclusion

The experience of doing therapy becomes vastly different with ACT. It is no longer about getting rid of bad feelings or getting over old trauma. Instead it is about creating a rich, full and meaningful life. This is confirmed by the findings where it was showed that ACT increases therapist effectiveness and Hayes et al (2004) who showed that it reduces burnout. If I had to summarise ACT on a t-shirt, it would read: 'Embrace your demons, and follow your heart.'

Acceptance and Commitment Therapy - The general clinical goals

The general clinical goals of ACT are to undermine the grip of the literal verbal content of cognition that occasions avoidance behavior and to construct an alternative context where behavior in alignment with one's value is more likely to occur.

The key goal of ACT

The key goal of ACT is to support the client in feeling and thinking what they directly feel and think already, as it is, not as what it says it is, and to help the client move in a valued direction, with all of their history and automatic reactions. - ACT techniques are simply means designed to find a psychological context from which that is possible. The process of ACT is a cycle of detecting cognitive fusion and avoidance, defusing and letting go (thus establishing new, more flexible functions for these events) and moving in a valued direction in a way that builds larger and larger patterns of effective behavior.

Functional Contextualism

The philosophy of science that underlies RFT; focus on physical, social & cultural settings an event occurs within & on a person's history of interacting with their environment

Dealing with cognition

The single biggest failure of the first wave of behavior therapy was failing to deal adequately with cognition. This was not the fault of behavior therapy so much as S-R (Stimulus-Response) learning theory and behavior analysis, which had both stumbled in this domain. The second wave dealt with the topic but did so either by adopting a more clinically based approach, which undermined the link between behavior therapy and basic theory or by embracing a relatively mechanistic cognitive psychology (based on "information processing" and computer metaphors), which emphasizes the arrangement of dependent variables that enable prediction rather than differentially emphasizing those contextual variables that can be directly manipulated in the service of psychological change. ACT takes a third and entirely new path. ACT is built on a functional contextual program of basic research on language and cognition: Relational Frame Theory (Hayes et al., 2001). The presence of such a research program allows a new, post-Skinnerian approach to language and cognition that attempts to provide manipulable basic principles for all forms of cognitive intervention.

The Truth Criterion; Contextualism

The truth criterion of all forms of contextualism is successful working (Hayes et al., 1988). What is considered "true" is what works. In order to know what works, however, one must know what one is working toward: there must be a clear a priori statement of an analytic goal (Hayes, 1993). In contextualism, ultimate goals enable analysis (that is, they allow a pragmatic truth criterion to be applied) — they are not themselves the results of the analysis. This means that while ultimate goals are foundational in contextualism, they can only be stated, not justified.

The rise of constructivism and similar postmodernist (and post-postmodernist) theories have weakened the idea that scientific theories identify discrete parts of reality that can then be organized into comprehensive models

These changes in philosophy of science have gradually weakened the assumptive base of both the 1st and 2nd wave of behavioral and cognitive therapies and their underlying theories in favor of a more instrumentalist and contextual approach. Changes within the thinking of earlier proponents have sometimes revealed that same process. Over time it has become clear that many treatments (both pharmacological and psychotherapeutic) have broad effects, and pathological processes tend to be similarly broad in their prevalence and impact. As these data were absorbed, some research clinicians began to think in terms of more general models and treatment approaches, which set the stage for an empirical analysis of second-order, not merely first-order, change strategies. - Factors such as these can set the stage, but change requires new ideas and innovations. - These have come, and from all corners of behavior therapy. - From the more behavioral side, exposure-based therapies began to focus more on contact with internal events, seeking to alter the function of these events, not necessarily their form per see. - This + other findings gradually led to a more contextual rather than simple eliminative approach - The positive outcomes for DBT provided strong support for the role of both acceptance and change and for the value of mindfulness in behavior therapy - In the cognitive wing, attentional and metacognitive perspectives began to shift the focus from first-order cognitive change. - This shift undermined the idea that the form or frequency of specific problematic cognitions was key, focusing instead on the cognitive context and coping strategies related to these specific thoughts. More emphasis began to be given to contacting the present moment, similarly redirecting treatment from first-order change to the psychological context in which cognition occurs. Finally, Mindfulness-Based Cognitive Therapy provided dramatic evidence that it was possible to alter the function of thoughts without first altering their form. ACT is in line with these same changes.

These kinds of phenomena are precisely why the cognitive revolution occurred in behavior therapy in the first place, BUT

These kinds of phenomena are precisely why the cognitive revolution occurred in behavior therapy in the first place, but because of mechanistic assumptions it was thought that an undesirable thought → action or emotion → action relation should be modified by changing the form, frequency, or situational sensitivity of private events themselves. RFT suggests a third-wave alternative: change the contexts that support a thought → action or emotion → action relation (or an emotion → thought → action relation, and any similar variants). CHANGE THE CONTEXT THAT SUPPORTS A THOUGHT Experiential acceptance and cognitive deffusion are prime examples of ACT techniques that attempt to do just that.

As a general style, ACT relies on relatively nonlinear uses of language, since language processes themselves (at least in certain contexts) are thought to be the primary source of rigid and ineffective repertoires.

Thus ACT relies heavily on paradox, metaphors, stories, exercises, behavioral tasks, and experiential processes, while logical analysis has a relatively limited role.

Why is experiential avoidance problematic?

Meditation, mindfulness and other tools can help us avoid unwanted thoughts, says social psychologist Daniel Wegner. Comment: "Try to pose for yourself this task: not to think of a polar bear, and you will see that the cursed thing will come to mind every minute."

VALUES AND COMMITTED ACTION

Values in the ACT are areas of life that are important to the person and can motivate actions. Lack of values clarity Committed action - undertake actions in accordance with values. This part of the ACT is the place where traditional behavioral techniques are integrated. Inactivity, activity avoidance

The struggle switch

Values vs. Goals https://www.youtube.com/watch?v=T-lRbuy4XtA

Russ Harris; values vs. goals; Flavour and Savour exercise

Values vs. goals; https://www.youtube.com/watch?v=T-lRbuy4XtA Flavour and Savour exercise https://www.youtube.com/watch?v=rPtHb3mjrnU

Healthy normality vs. Destructive normality

Western psychology is founded on the assumption of healthy normality: that by their nature, humans are psychologically healthy, and given a healthy environment, lifestyle, and social context (with opportunities for 'self-actualization'), humans will naturally be happy and content. From this perspective, psychological suffering is seen as abnormal; a disease or syndrome driven by unusual pathological processes. ACT assumes that the psychological processes of a normal human mind are often destructive, and create psychological suffering for us all, sooner or later. Furthermore, ACT postulates that the root of this suffering is human language itself.

Acceptance and Commitment Therapy is one of the recent mindfulness-based behaviour therapies shown to be effective with a diverse range of clinical conditions.

Western psychology: 'healthy normality' ACT: psychological processes of a normal human mind are often destructive and create psychological suffering. Symptom reduction is not a goal of ACT, based on the view that ongoing attempts to get rid of 'symptoms' can create clinical disorders in the 1st place. RUSSELL HARRIS provides an overview of ACT with a background of the suffering generated by experiential avoidance and emotional control. A case study illustrates the six core principles of developing psychological flexibility; 1) defusion, 2) acceptance, 3) contact with the present moment, 4) the observing self, 5) values, and 6) committed action.

According to RFT, human language and cognition are both dependent on relational frames.

When we think, reason, speak with meaning, or listen with understanding, we do so by deriving relations among events — among words and events, words and words, events and events. Unlike Skinner's verbal operants, what is unique about relational operants is that they alter how direct learning processes themselves work. For example, the transformation of stimulus functions alters how stimulus control operates since now events can acquire functions through indirect, relational (i.e., "cognitive") means. From Skinner's observations, verbal operants are the units or elements of communication that collectively inform our use of language i.e. the way language is broken down in different elements for different purposes. It involves the speaker and the listener responding in relation to the behavior of the speaker. Thus, unlike Skinner's account, according to RFT it is not just possible, it is necessary to analyze cognition in order to understand human behavior. This insight corrects the mistake of the first wave, but provides a contextual way forward that differs from the more mechanistic approach of the second.

'clean discomfort' vs. 'dirty discomfort'

Without struggle, we get a natural level of physical and emotional discomfort, depending on who we are and the situation we're in. In ACT, we call this 'clean discomfort'. There's no avoiding 'clean discomfort'. Life serves it up to all of us in one way or another. However, once we start struggling with it, our discomfort levels increase rapidly. This additional suffering, we call 'dirty discomfort'. Our struggle switch is like an emotional amplifier— switch it on, and we can have anger about our anxiety, anxiety about our anger, depression about our depression, or guilt about our guilt.

Instrumentalism (or constructivism)

instrumentalism, in the philosophy of science, the view that the value of scientific concepts and theories is determined not by whether they are literally true or correspond to reality in some sense but by the extent to which they help to make accurate empirical predictions or to resolve conceptual problems.

Thoughts that often occur in persons with chronic pain

My pain will never go away I'm worthless What did I do wrong? I can't do anything anymore I'm a burden to everyone My life has no use I'm weak I can't keep up like this

Psychological flexibility: Be present, Open up, Do what matters

Open: Disengage from unhelpful cognitions, emotions, and behavior Centered: Take perspective and experience the flow of contextual, bodily, and psychological events Engaged: Identify values and undertake action accordingly

Arbitrary stimulus

stimulus whose characteristics do not normally invoke a certain response An arbitrary stimulus is an arbitrarily chosen cue paired with a biologically significant event (e.g., Unconditioned stimulus (US)). It does not have to share any inherent relationship with the US.

Acceptance & Commitment Therapy

• A-C-T - pronounced as 'ACT' • Within 'third wave of CBTs' Acceptance of negative internal experiences - e.g. low self-esteem thoughts, anxiety, fear, anger, pain To be able to live a committed, meaningful life https://www.youtube.com/watch?v=NdaCEO4WtDU

Everything a person would attempt to change, alter, get rid of, control or avoid negative thoughts, emotions or other experiences

• Turn to your neighbor. • Take 5 minutes to discuss... What are the different avoidance strategies that you apply yourself and/or that you would expect to occur in people who suffer from depression, anxiety disorders, chronic pain, eating or substance use disorders (etc.)?

Methodological behaviorism provided a ready means for the transition from the first to the second wave of behavior therapy:

"One can study inferred events or processes and remain a behaviorist as long as these events or processes have measurable and operational referents"

Chronic pain

- 'Pain > 3 to 6 months or beyond expected healing time' - Prevalence: 15-20% (2.2 million in The Netherlands) - Large functional disabilities reported (social, work, household, etc) - 40% suffer from comorbid depression, 25% from anxiety -> Chronic pain is very difficult to treat effectively with medication -> (C)BT models also apply to chronic pain (i.e. the way we think, feel, and behave in response to pain influences our pain levels and functional limitations)

ACT effectiveness

- 2010: Evidence-based treatment for chronic pain by APA - Majority of Dutch rehabilitation centers use ACT as the primary treatment for chronic pain (Trompetter et al., 2014) - Effect sizes are positive, similar to traditional CBT

ACT for depression, anxiety & chronic pain

- 2020 meta-analysis - 18 randomized controlled trials - ACT protocol and no other (medical) treatment - Significant positive effects - similar to effect sizes of traditional CBT - Most effective for mild (vs major) depression, adults (vs minors), and in longer-term (3-month follow-up)

ACT for depression, anxiety & chronic pain

- 2020 review - 36 randomized controlled trials - Confirms positive effects of previous meta-analyses - Mostly investigated: depression, GAD, social anxiety, OCD (less: phobias, panic disorder) - Effect sizes largely equivalent to traditional CBTs

Therapeutic Assumptions and Clinical Stance

- ACT assumes that dramatic, powerful change is possible and possible quickly, because it is the general context and purpose of action that is the true problem, not the historically produced and well-conditioned content of life difficulties. What the client is feeling, thinking, remembering, or otherwise experiencing is never assumed to be the core difficulty, even though human beings will initially focus on difficult content as the core of their problems. - For instance, "anxiety" is not assumed to be the problem in "anxiety disorders"; "mood" is not assumed to be the problem in "mood disorders"; "thought" is not assumed to be the problem in "thought disorders," and so on. - In ACT, it is the tendency to take these experiences literally and then to fight against them that is viewed as harmful !!! - ACT therapists assume that it is neither possible nor healthy to attempt to rescue clients from the difficulty and challenge of growth. It is inherently difficult to be a human being. - ACT therapists compassionately accept no reasons and stories as "true" if these stories are functionally useless or harmful, regardless of their reasonableness !!! - Issue is workability, not reasonableness. This applies as well to ACT itself, and thus it is more important as an ACT therapist to do as you say than to say what to do. - For example, if the client is trapped, frustrated, confused, afraid, angry, or anxious, the ACT stance suggests that this is not so much a problem as it is an opportunity to work on how powerful events in the here and now can become barriers to growth. - In exactly the same way, if the therapist feels trapped, frustrated, confused, afraid, angry, or anxious, it is the therapist's job to open up to these experiences, recognizing the humanizing opportunity they provide to put themselves into the shoes of their clients and to do the same work without avoiding or moving one up. Because of this quality, the therapeutic relationship is important, powerful, and deliberately equal in ACT.

RFT

RFT points directly to the likelihood of cognitive fusion and experiential avoidance, the danger of suppression and disputation, the importance of cognitive defusion and experiential acceptance, the importance of certain senses of "self," and the centrality of values, among other implications. All of these have been expanded into treatment approaches within ACT.

Today

- Explain where ACT falls under the 'CBT-umbrella', and why - Explain the Psychological Flexibility model that informs ACT, and its 6 therapeutic processes - Describe some ACT exercises and their working mechanisms - Describe the effectiveness of ACT for depression, anxiety, and chronic pain - Compare ACT to more traditional (C)BT - Name ACT's philosophical roots (functional contextualism) and theoretical roots (Relational Frame Theory)

Values are

....not goals ....not feelings ....motivating ....yours ....dynamic

2 major types of contextualism, organized in terms of their goals

1) Descriptive contextualism (e.g., hermeneutics, dramaturgy, narrative psychology, feminist psychology, social constructionism, and the like), which seeks an appreciation of the participants in a whole event, 2) Functional contextualism (e.g., behavior analysis), which seeks the prediction and influence of ongoing interactions between whole organisms and historically and situationally defined contexts. -> Analyses are sought that have precision (only certain terms and concepts apply to a given phenomenon), scope (principles apply to a range of phenomena), and depth (they cohere across scientific levels of analysis, such as biology, psychology, and cultural anthropology).

Favorite avoidance strategies - examples

1. Prevention strategies - avoid specific situations, work, parties, etc. 2. Distraction strategies - watch tv, work too long hours 3. Numbing strategies - pain killers, eating, drinking, smoking

CBT-umbrella

1960s: Behavior Therapy (Skinner) - All behaviors are learned by operant/classical conditioning - Change by reinforcing desirable behavior and eliminating the unwanted ones (Exposure with phobias) 1980s: Cognitive Behavior Therapy (Beck, Ellis) - Integrates thoughts and beliefs in understanding and changing behavior and emotional experiences - Thoughts, feelings, and behaviors combine to influence each other and QoL (CBT) 2000s: 3rd wave CBTs (Kabat-Zinn, Hayes) - Shift from symptoms/illness to the holistic promotion of well-being and mental health. - Integrates focus on e.g. acceptance, personal values, and mindfulness skills, to help a person live life to the fullest in the presence of adversity (ACT, MBSR, MBCT, DBT)

First Order Change vs. Second Order Change

1st: occurs when a client makes a superficial change to deal with a problem, but the change does not alter the underlying structure of the family 2nd: alters the underlying structure and thus makes a difference that is longer lasting

Acceptance

Acceptance - Allowing inner experiences to occur without attempting to alter or lessen their presence. Acceptance is an action; it is a way one behaves — not an attitude or a feeling!!! Experiential avoidance Twohig & Levin, 2017

Relational Frame Theory

According to RFT, the core of human language and cognition is the ability to learn to relate events under arbitrary contextual control. Nonarbitrary stimulus relations are those defined by formal properties of related events. If one object looks the same as another, or bigger than another, a wide variety of animals would be able to learn that relation and then show it with new objects that are formally related in the same way (Reese, 1968). Human beings seem especially able to abstract the features of such relational responding and bring them under contextual control so that relational learning will transfer to events that are not necessarily related formally but rather are related on the basis of these arbitrary cues ("arbitrary" in this context means "by social whim or convention"). For example, having learned that "x" is "smaller than" "X," humans may later be able to apply this stimulus relation to events under the control of arbitrary cues (such as the words "smaller than"). A very young child will know, say, that a nickel is bigger than a dime, but a slightly older child will learn that a nickel is "smaller than" a dime by attribution, even though in a formal sense it is not.

The Second Wave

- In the late 1960s, neo-behaviorists began to abandon simple associative concepts of learning - more flexible mediational principles and mechanistic computer metaphors. - new cognitive psychology established a much more liberal theoretical approach that appealed to hypothesized internal psychological machinery. - The failure of SR learning theory was paralleled by Skinner's (1957) failure to provide an empirically adequate analysis of language and cognition. - This failure is especially poignant because "radical" behaviorism overthrew the Watsonian restriction against the direct scientific analysis of thoughts, feelings, and other private events. - Skinner did so (1945) on the grounds that a behavioral analysis of scientists themselves was necessary (thus the word "radical") and when that analysis was made it was clear that scientific objectivity depended not on the target or location of analyzed events but on the nature of the contingencies controlling the observations of them. Objectivity could occur in the analysis of private events, and scientifically unacceptable subjectivity could occur in the analysis of publicly observed events (or vice versa). That fundamental break with the Watsonian tradition (under the entirely inappropriate label of "radical behaviorism") was not appreciated for what it was because Skinner's analysis of language and cognition led him to conclude that while a scientifically valid study of thoughts and feelings was possible, it was not needed to understand overt behavior. Language and cognition were conceived of as simple operant behavior and as such it added nothing fundamentally new to the contingency stream surrounding other behaviors. Thus, a door was opened by Skinner, but few behavior analysts walked through it or would have had any reason to do so.

Experiential avoidance

- Not wanting to stay in contact with negative thoughts or emotions - Attempting to change or get rid of these experiences Solve the underlying problem, ignore, distract (go out with friends, watch tv, work too long hours), ruminate, minimalize, numb yourself (pain killers, drugs, drink, eat, smoke)

Other defusion techniques

- Speak thoughts aloud, very slowly - Speak thoughts aloud, using a different (funny) voice - Keeping a thought diary - Replacing 'but' for 'and' I would like to do XXXXX, BUT......... VS I would like to do XXXXX AND ......... https://www.youtube.com/watch?v=XvnEn1Y-gcQ - Relational Frame Theory (RFT)

ACT - conceptualization of psychological events

- a set of ongoing interactions between whole organisms and historically and situationally defined contexts. Removal of a client's problematic behaviors from the contexts that participate in that event (e.g., merely analyzing manifested behavioral symptoms themselves) is thought to miss the nature of the problem and avenues for its solution. Reductionism of all kinds is resisted, whether that be reduction across levels of analysis (e.g., biological reductionism) or within the psychological domain (e.g., physicalistic definitions of behavior or contextual events).

In the second wave

- irrational thoughts, pathological cognitive schemas, or faulty information-processing styles would be weakened or eliminated through their detection, correction, testing, and disputation, - much as anxiety was to be replaced by relaxation in the first wave. Beck, for example, said: "Although there have been many definitions of cognitive therapy, I have been most satisfied with the notion that cognitive therapy is best viewed as the application of the cognitive model of a particular disorder with the use of a variety of techniques designed to modify the dysfunctional beliefs and faulty information processing characteristic of each disorder"

In second-wave interventions:

- the content of this thought is usually directly targeted: the - logical flaws inherent in its content might be pointed out; - the truth of the thought might be tested; - or alternative reconstructions might be trained. All of these presuppose that the form, frequency, or situational sensitivity of the thought itself leads directly to emotional and behavioral effects — an inherently mechanistic assumption.

Implications of RFT 1) Experiential avoidance and the failure of suppression

1) Experiential avoidance and the failure of suppression One of the most pathological processes known is experiential avoidance: the attempt to escape or avoid private events, even when the attempt to do so causes psychological harm. Emotion focused and avoidant strategies predict negative outcomes in depression, substance abuse, the sequelae of child sexual abuse, and many other areas. Deliberate attempts to suppress thoughts and feelings can increase their occurrence and behavioral impact, and can greatly complicate exposure- based strategies Although amplified by the culture, RFT suggests that such processes are built into human language and cognition itself. A nonhuman trying to avoid pain can do so readily by avoiding the situations in which it has occurred in the past. A human being does not have this option because relational frames allow pain to occur in almost any situation (via a transformation of stimulus functions) and their arbitrary contextual control prevents the success of purely situational solutions such as those followed by nonhumans. E.g. Thoughts of a recently dead spouse might be cued by pictures, depressed mood, a comment in a conversation, a beautiful sunset, or any of myriad other cues. Unable to control pain by situational means, humans begin to try to avoid the painful thoughts and feelings themselves. Unfortunately, many of these means (e.g., suppression) will ultimately themselves come to cue the avoided event because they strengthen the underlying relational frames ("don't think of x" will serve as a contextual cue for "x" and the psychological presences of the actual event it is related to). !!

Three features of functional contextualism as a philosophy of science are worth mentioning here because they are echoed in ACT itself + they provide a contrast to the mechanistic mainstream.

1) First, functional contextualism is a realistic philosophy that nevertheless, on epistemological grounds, rejects ontology. ACT and RFT are not trying to find what is objectively true or real because we know the world only through our interactions in and with it, and these interactions are always historically and contextually limited. Instead, ACT and RFT are theories and interventions designed to make a particular difference, and they are "true" only to the degree that they do so. In a parallel way, ACT clients are encouraged to abandon any interest in the literal truth of their own thoughts or evaluations; instead, they are encouraged to embrace a passionate and ongoing interest in how to live according to their values. Epistemology = theories of knowledge. Ontology = existential conditions related to material, social, cultural, and political contexts. 2) Second, functional contextualism is holistic and context focused — no event affects another in a mechanical way. In ACT there is a conscious posture of openness and acceptance toward all psychological events, even if they are formally "negative," "irrational," or even "psychotic": The issue is not in the presence of any particular event but in its contextually established function and meaning. 3) Finally, the foundational nature of goals in contextualism is reflected in the ACT's emphasis on chosen values as a necessary component of a meaningful life and indeed a meaningful course of treatment

There are 3 main properties of this kind of relational learning. When all three features are established with a given type of relational responding, we call the performance a "relational frame."

1) Such relations show mutual entailment or "bidirectionality." If a person learns that A relates in a particular way to B in a context, then this must entail some kind of relation between B and A in that context. For example, if a person is taught that hot is the same as boiling, that person will derive that boiling is the same as hot. 2) Such relations show combinatorial entailment: If a person learns in a particular context that A relates in a particular way to B, and B relates in a particular way to C, then this must entail some kind of mutual relation between A and C in that context. For example, if by attribution a nickel is smaller than a dime and a dime is smaller than a quarter, then it will be derived that a quarter is bigger than a nickel and a nickel is smaller than a quarter. 3) Such relations enable a transformation of stimulus functions among related stimuli. If you need to buy candy and a dime is known to be valuable, it will be derived that a nickel will be less valuable and a quarter will be more valuable, without necessarily directly purchasing candy with nickels and quarters.

6 core principles of ACT to help clients develop psychological flexibility

1. Cognitive defusion 2. Acceptance 3. Contact with the present moment 4. The observing self 5. Values 6. Committed actions

Implications of RFT 2) Cognitive fusion

2) Cognitive fusion Relational networks are extraordinarily difficult to break up, even with direct, contradictory training, in part because myriad derived relations are available to maintain and reestablish a given relational network. In practical terms this means that elaborated relational networks rarely really go away — they are simply further elaborated. Detecting that one is deriving coherent relational networks (e.g., learning that one is "right"), or that relating events is leading to effective outcomes (e.g., learning that one has "solved the problem"), and similar processes in essence provide automatic reinforcement for the action of deriving stimulus relations. As a result, it is very difficult to slow down language and cognition once it is well established, despite its originally instrumental nature. This combination of features means that stimulus functions from relational frames typically dominate over other sources of behavioral regulation in humans without any awareness of the process involved (what we term "cognitive fusion"), making an individual less in contact with here-and-now experience and direct contingencies and more dominated by verbal rules and evaluations Through a transformation of stimulus functions, the environment will seemingly "contain" stimulus functions that are dependent on relational frames, without the relational process itself necessarily being evident. -> The fearful person who constructs a fearful environment will act is if that fearsomeness has been discovered, not constructed. Because behavior governed by relational networks is notoriously insensitive to contradictory experiences, very ineffective verbal formulations can continue to create harm even when little environmental support is provided for them.

methodological behaviorism

A brand of behaviorism which asserts that, for methodological reasons, psychologists should study only those behaviors that can be directly observed.

Psychological Flexibility model

A model of how thoughts and emotions influence behavior and of how to create healthy and durable behavior change Being in contact with the present moment, fully aware of emotions, sensations, and thoughts, welcoming them including the undesired ones, while moving in a pattern of behavior in the service of chosen values

constructivism

A philosophy of learning based on the premise that people construct their own understanding of the world they live in through reflection on experiences

Anomalies - traditional narrative of the second wave

According to the traditional narrative of the second wave, the limitations of previous behavioral methods and conditioning models were largely corrected by the addition of cognitive change methods and models. While giving cognitive variables increased weight is generally acknowledged to have been a step forward, various anomalies are forcing a reexamination of certain aspects of this traditional narrative, particularly the core idea that direct cognitive change is a necessary or primary method of clinical improvement in most cases.

Philosophical and theoretical roots of ACT

ACT is rooted in the pragmatic philosophy of functional contextualism, a specific variety of contextualism that has as its goal the prediction and influence of events, with precision, scope and depth. Contextualism views psychological events as ongoing actions of the whole organism interacting in and with historically and situationally defined contexts. These actions are whole events that can only be broken up for pragmatic purposes, not ontologically.

What is unique to ACT?

ACT is the only Western psychotherapy developed in conjunction with its own basic research program into human language and cognition—Relational Frame Theory (RFT). In stark contrast to most Western psychotherapy, ACT does not have symptom reduction as a goal. This is based on the view that the ongoing attempt to get rid of 'symptoms' actually creates a clinical disorder in the first place. As soon as a private experience is labeled a 'symptom', it immediately sets up a struggle with it because a 'symptom' is by definition something 'pathological'; something we should try to get rid of. In ACT, the aim is to transform our relationship with our difficult thoughts and feelings, so that we no longer perceive them as 'symptoms'. Instead, we learn to perceive them as harmless, even if uncomfortable, transient psychological events. Ironically, it is through this process that ACT actually achieves symptom reduction—but as a by-product and not the goal. Another way in which ACT is unique is that it doesn't rest on the assumption of 'healthy normality'.

Skepticism about the value of "truth" is pervasive.

ACT therapists are cautioned not to argue or persuade. The issue is the client's life and the client's experience, not opinions and beliefs, however well meant. The issue is always the function of events, not their decontextualized form or frequency. The key question is thus "What is this in the service of?" NOT "Is this true or false?"

Acceptance inherently involves "exposure" and thus ACT connects with all of the exposure-based behavior therapies (a point I will pick up again later) but not for an emotional regulatory purpose.

Feeling a feeling to get it to diminish involves a simultaneous process of feeling, and cognitively fused processes of measuring, evaluating, and comparing, such as, "I am feeling this much anxiety, which is more (or less) than it was and this is good (or bad)." Acceptance and willingness in ACT lead to a different kind of exposure: experiencing actively and fully in the present, moment by moment, for the proximal purpose of experiencing actively and fully in the present, moment by moment.

Proces: Acceptance / Stop experiential avoidance

First goal: Discover your favorite ways to avoid pain or other unwanted negative experiences Questions to ask your client: - What did you do to get rid of your pain / other negative experiences? - What are your favorite avoidance strategies? - Were these strategies effective in the short- and long-term?

First Order Change vs. Second Order Change

First-Order Change. First-order change is change that occurs on the behavioral level without impacting the operating rules of the system. These changes are considered more superficial and less sustainable than second-order changes.

Functional contextualism

Functional contextualism serves as the basis of a theory of language known as relational frame theory and its most prominent application, acceptance and commitment therapy. It is an extension and contextualistic interpretation of B.F. Skinner's radical behaviorism first delineated by Steven C.

ACT therapists are passionately interested in what the client truly wants, but not necessarily with the means that the culture specifies for achieving these ends.

It is this distinction that allows ACT therapists to compassionately confront unworkable agendas without invalidation because the client's experience is respected as the ultimate arbiter. - For example, typically an anxiety-disordered person wants to get rid of anxiety. It could be experienced as invalidating to refuse to work directly on that desired outcome. At another level, however, the anxious client wants to get rid of anxiety in order to do something such as living a vital human life. Lack of anxiety is not the ultimate goal — it is a means to an end. - Since often it has failed as a means, ACT suggests abandoning that means — simply because the client's own experience suggests its unworkability. - Furthermore, ACT provides something else that the client can do with these previously avoided or fused events, while moving directly and quickly to the ultimate goal (e.g., establishing relationships, participating, contributing). - The larger message thus is validating (trust your experience) and empowering (you can live a powerful life from here, without first winning a war with your own history).