Finding Clinical Behavior Analysis: Part I

Finding Clinical Behavior Analysis: Part I

by Angela Coreil, PhD

In my recent invited talk at CalABA on Clinical Behavior Analysis as a way of unifying the behavioral sciences, I alluded to a series of painful learning experiences that brought me to Clinical Behavior Analysis.

My training path has been long and winding – all with the intention of finding ways to improve clinical treatment. You see, I grew up with a close family member experiencing a great deal of impairment, emotional pain, and later addiction. I was present for years of this family member seeking treatment and even as a child seeing failures in the systems meant to help her. I watched her go through the revolving door of inpatient units, which became like brief vacations to her. I watched as therapists seemed helpless to soothe her pain. And, I watched as she was prescribed pill after pill to ease her pain. I was at an early age effectively an involuntary ‘mental health’ crisis worker.

This led to a passion for understanding human behavior and a desire to find better ways to address human suffering. I believed that I could best influence treatment by becoming a process and outcomes researcher and set upon a long path to become this. I spent a number of years gaining experience on process and outcomes studies at a number of major research institutions in Houston, Texas where I lived. Then I happened upon on a job as a Research Coordinator for a project called “Opportunity Houston.” This was a large grant focused on treating dual diagnosis (mental health + addiction) homeless individuals. The study focused in some respects on enriching the environments of those experiencing addiction by providing housing and work, contingent on improving maintenance of sobriety. I later learned this was a study in part of Kelly Wilson’s design, an ACT founder. At the time, I would not have known who he was but the William “Dub” Norwood was my advisor there and he was an early ACT devotee.  

It was through him that I began to be exposed to ACT and then entered the University of Houston – Clear Lake for my master’s in Clinical Psychology. Following this, I started my doctorate in Clinical Psychology under Rob Zettle, Steve Hayes’ first student who played a strong role in developing ACT back when it was called “Comprehensive Distancing.” Throughout my master’s I found myself drawn to ACT, in its stance that human suffering was a natural part of the human experience and often an extension of otherwise adaptive behavior. In my early exposures to Beckian Cognitive Behavior Therapy, I was often presented with a list of ‘cognitive distortions’ and told that treatment would in part be helping clients recognize their ‘cognitive distortions.’ At the time, I found this conceptualization offensive and insensitive. I could not imagine myself telling other humans experiencing pain that their painful thoughts were ‘distortions’ of reality.

I would say that the way that clinical psychology training is currently structured – learning deeply the key elements of treatment is not an easy experience. We are typically taught behavioral principles but soon after we begin to divide off into camps to learn the particular language ways of our chosen orientations. I broke from this tradition repeatedly because beyond my allegiance to “ACT” was the guiding rule that my mission was to find ways to understand and improve treatment as a process researcher. I became more fluid in ACT treatment and began to depart from “canned ACT” in the early years of my doctorate. I had early experiences of clients with Obsessive-Compulsive Disorder” finding ways to “compulse” (momentarily avoid or reduce their anxiety) with the very ACT exercises I provided them. One client taught mindfulness, returned the next week to tell me how effective mindfulness had been in reducing their anxiety. I asked what had occurred and the client recounted engaging in mindfulness ‘instead of’ compulsions each time they became anxious. 

I went back to Rob and told him what had occurred and in his monotone way of beating a dead horse for my benefit he said ‘Yes, of course.’ And, then followed it with the ‘Hole in the Field’ metaphor to illustrate how I’d simply given the client a new shovel. Now, I would need to again – get them to drop their new improved ‘shovel.’ This was all in the context of learning Exposure and Response Prevention (ERP) also known within the behavior analytic community still as desensitization.

It was working in OCD and specializing in a particular technique that was widely endorsed across theoretical orientations as the ‘gold standard’ (i.e., ERP) for treating anxiety and related disorders that allowed me, I believe, to be able to track more about the differences in models as a I learned. After learning this technique well embedded in ACT, I sought out an Advanced Assistantship with the closest highly regarded research and treatment specialty center in Kansas. My clinical supervisor was widely regarded as a highly-skilled Beckian Cognitive Behavioral Therapy clinician and researcher. My initial learning experiences here were somewhat disorienting; however, as I went in with experience and skill validated by ACT experts. Fairly quickly into my training at this center, it became clear that ACT was not particularly favored by my supervisor and to treat clients under her supervision using similar language was quick to elicit punishment.

I remember writing back to my lab at that time and questioning whether I was actually proficient in ERP and ACT. The response I received was telling – but for years I did not fully understand the impact of what I was told in the full context of my academic experience. Rob told me that my ACT and ERP was fine and that I would simply have to ‘learn their language.’ He mentioned that as Steve Hayes’ first student he was also sent to work under the competing theoretical model for his internship year – under Aaron Beck. Though he never disclosed much about this experience directly it often seemed apparent that his internship year had probably not been easy on him.

I’d like to say that I won this particular CBT expert over; in fact, I learned the language and got out as soon as possible. I seemed to be fighting a battle far bigger than myself with zero footing as a new mother of a 4-month old just pre-internship. From here, I moved onto working at Rogers Memorial Hospital under Brad Reimann and running the day-to-day clinical management of an adult Intensive Outpatient Program for OCD in Oconomowoc, Wisconsin. By that time, I had mastered the CBT language and found myself commended and promoted for my treatment skill.

 

Notes from CalABA 2022: A field ready for change.

Notes from CalABA 2022: A field ready for change.

by Angela Coreil, PhD

Fields Ready for Change: Notes from CalABA 2022

As I sit here today, recalling my experience of CalABA and the responses to talks, including but not limited to my own talk on unifying the sciences, it is clear that change is both needed and wanted. We find ourselves in a world where COVID has altered how we operate in our lives and in our world. We have found ourselves in the ‘Great Resignation’ of people leaving their positions and rethinking their priorities out of necessity.

I too have been on this journey. Long before 2020, I found myself embedded in a system of seemingly unworkable contingencies. This led to several years of inventing and reinventing myself and my career – and finally to freedom from the system that had held me down for a decade. It is from this perspective and with this experience that I find myself advocating for the field to be better, not because I am the right person to do so, but because I built myself a system that allows me to speak up more freely than most.

At CalABA 2022, I was able to speak at my first in-person conference since freeing myself from academia. I found myself re-invigorated by the presence, energy, and curiosity of those who attended my talk: Clinical Behavior Analysis: Unifying the Behavioral Sciences. It was inspiring to see how many people were already thinking about how to find a common language between behavior analysis and psychology and how many people were working in positions where they both needed and wanted more guidance on how to navigate the intersection between our fields.

There were a number of patterns that were evident in the responses of attendees. First, many were unaware that Clinical Behavior Analysis has existed since the 1950s. Second, the pervading thought was that additional degrees would help broach this gap – yet, those with multiple degrees broaching both fields still had the same questions. “Which hat am I operating under?”, “How do I know if I am still in scope?”, “Where does ‘ACT’ begin and end in relation to RFT and to the clinical situation I find myself in on a daily basis?” Many were struggling with how to speak to colleagues and stakeholders about the areas where our fields meet and divide. And, as I presented regarding the bubble forming as more behavior analysts enter the field and nearly all enter the Autism treatment area – there was recognition of how this affects the perception of behavior analysis, drives the narrowing of treatment programs, and ultimately will leave behavior analysts vulnerable to changes that are not under their control (e.g., changes in the DSM, etc).

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Defusion, ACT and RFT

Defusion, ACT and RFT

by John Wesenberg, M.S., BCBA, LBA

                                                                                         Defusion, ACT and RFT

A core process of Acceptance and Commit Therapy (ACT) is defusion. ACT processes by nature are often confusing for behavior analysts as they are not described precisely, and often cannot be. Defusion is often described assisting client in “creating some distance”, though momentary, from their thoughts and feelings that function as ‘rules.’ Defusion is meant to help the client contact direct contingencies when relating to verbal symbolic stimuli has become more dominant. In terms of Relational Frame Theory – defusion occurs when we alter the form, function, or frequency of a stimuli such that histories of verbal relating fall away and direct contingencies are briefly contacted.

For example, a popular exercise demonstrating defusion is the ‘milk, milk, milk” exercise. In this exercise, the clinician brings up “milk” and asks participants to think about milk. The clinician may then ask if in the process of thinking about “milk” whether the client is able to in some sense contact the taste, texture, or experience of their previous history with milk. Most individuals will report that they can contact “milk” though not present in the room with them now. The clinician may then engage the client in an exercise where the word “milk” is repeated in rapid succession, out loud, for a minute. Following this exercise – the clinician may ask what the client may have noticed about their experience of “milk” during and directly after the exercise. When the exercise has functioned as intended, the client will often report that they noticed things they had not before – for example that “milk, milk, milk” said repeatedly and rapidly sounds like “quacking” or that during the exercise they briefly ‘lost’ connection with their previous ‘experience’ of the taste, feel, etc of “milk.” Thus – defusion is meant to use the properties of verbal symbolic behavior to alter briefly which contingencies the client can track.     

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Reference

Barnes-Holmes, Y., Barnes-Holmes, D., McHugh, L., & Hayes, S. C. (2004). Relational frame theory: some implications for understanding and treating human psychopathology. International Journal of Psychology and Psychological Therapy, 4, (2), 355-375).

 

Rule Governance and the use of Values to Facilitate Exposure for OCD

Rule Governance and the use of Values to Facilitate Exposure for OCD

by John Wesenberg, M.S., BCBA, LBA

Rule Governance and use of Values to Facilitate Exposure for OCD

Behavior is dynamic and influenced by many contingencies simultaneously. Relational Frame Theory (Hayes et al., 2001) is an extension of behavior analytic principles to the human ability to learn language/symbols and the affects of these over-riding behavioral repertoires on our behavior. This extension accounts for much of human psychopathology that had defied previous parsimonious behavior analytic explanations.

“Values” are verbal constructions of meaningful directions for our lives. For example, a person may value “being a warm father.” This is by nature something that can never be “completed” but we can also always act in accordance with this statement. Orienting to values can serve as a motivating augmental. That is, the stimulus functions of a particular stimulus may be augmented to make them more or less salient.  For example, changing a diaper may for most be a rather aversive experience but for the father who holds the value of “being a warm father” and brings this to the experience of changing diapers – diaper changing may be transformed to almost an enjoyable task!

Within the clinical context, treatment of Obsessive Compulsive Disorder may be facilitated through presenting stimuli that remind the individual of their values at key points during exposures. For example, an individual who engages in excessive washing/ cleaning compulsions due to contamination concerns may be ‘stuck’ in a loop of avoiding an aversive experience in the short term through compulsions (e.g., excessive bathing and grooming). If this individual values “being a warm father” as described above – this may be used to help facilitate new flexibility in his behavioral repertoire in the presence of normally aversive and avoided “contamination.” For example, in treatment the father may be asked to engage in exposures that involve changing mock or real diapers. The client may normally rate this as a “7” on a scale from “[not anxiety provoking at all] 0 to 10 [extremely anxiety provoking]” normally. The clinician can present the task in the context of conversation that prompts the client to attend to their values, for example “John, I know that you value being a warm father. Does loving your child and caring for them warmly mean that you will care for their basic needs?” “Can you bring your love for your child into this moment to help you move towards what matters most?” [Note: All examples are by nature topographical and function of these statements must be assessed and applied ideographically, rather than topographically.] If these statements function as a motivative augmental for the client – the client may report that their starting anxiety rating lowered, “I know that I said this was a ‘7’, but now it feels like a ‘5’ when I think of my son.” Additionally, you may see that the client is more willing to approach, maintain contact, or resist compulsions – as the aversive functions of ‘contamination’ are augmented to a more workable range for the client.

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Reference

Barnes-Holmes, Y., Barnes-Holmes, D., McHugh, L., & Hayes, S. C. (2004). Relational frame theory: some implications for understanding and treating human psychopathology. International Journal of Psychology and Psychological Therapy, 4, (2), 355-375).

Hayes, C. S., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A Post- Skinnerian Account of Human Language and Cognition. New York, NY: Kluwer Academic/ Plenum Publishers

 

An ACT Approach to Adolescent Suicide

An ACT Approach to Adolescent Suicide

by Amy R. Murrell, Ph.D.

             The paper summarized here, was written by myself and former students (Al-Jabari, Moyer, Novamo, and Connally), and published in the International Journal of Behavioral Consultation and Therapy in 2014 examines the problem of adolescent suicide from an Acceptance and Commitment Therapy (ACT) practitioner’s perspective. At the time of the paper’s publication, according to the Centers for Disease Control and Prevention (2014), approximately 4,600 young people completed suicide annually in the United States. At the time of this summary, that number is nearly 7,000 (Centers for Disease Control and Prevention, 2019). I chose to summarize this paper for two reasons: I wish that number were moving in the opposite direction, and I think the conceptualization written about here is useful.

            Of course, more adolescents attempt suicide and have ideation about suicide than complete it. Those youth are important to discuss from a functional contextual point of view, and that is what this article does. It is divided into seven major sections. The first section discusses the prevalence, antecedents, and consequences of adolescent suicidal behavior. The second introduces experiential avoidance, and the third introduces the ACT model. The next section is “the heart” of the paper, giving an ACT conceptualization of adolescent suicidal behavior. The next two sections talk about a specific client, first hypothetically and then with a case example. The final section summarizes the state of relevant empirical evidence to date (at the time of publication). Here I will cover just a bit of each section, so you get a feel for the article’s content. I am biased, but I think you should give it a read.

            The article states that there are some behaviors (e.g., substance abuse) that co-occur with and may predict suicidal ideation and attempt, but there are also individuals who have no previous diagnosis who have suicidal behavior. It is obvious, therefore, that there is no set pattern or easy prediction – with one caveat. Past behavior is the best predictor of future behavior. The costs of suicidal behavior are great. According to Yang and Lester (2007), every year in the United States alone, non-fatal suicide attempts cost about 4.72 billion dollars. The consequences go far beyond money, though. The article talks of cluster suicides, survivor guilt, and worsening negative emotional experiences. 

            This leads into the discussion of experiential avoidance (EA), noting that attempts to control, suppress, lessen, or avoid those negative emotions (or thoughts, bodily sensations, and/or places that might make them more likely) may worsen distress. Next, ACT is introduced as a treatment to address EA. In both the section on EA and the section on ACT, assumptions of functional contextualism are addressed (e.g., all behaviors serve specific purposes in specific settings). This is the perfect segue to Chiles and Strosahl’s (2005) definition of suicidal behavior as learned behavior that functions as an avoidance of – or escape from – negative emotions.

            In brief, ACT views suicide as a perfectly reasonable solution to feeling stuck or hopeless. Suicidal behavior is seen as the result of normative human language and cognition processes. The article states that normalizing suicidal behavior shifts the therapeutic context to an open and honest one that may help reduce client shame. Just as a little teaser, there is a discussion about relational framing related to thoughts of suicide and how that may bring relief. There are several intervention strategies suggested (e.g., values with specific future-oriented goals). The hypothetical client is used as a way to provide context for how suicidal behavior, in general, might be discussed. The issues of safety planning and contracting are discussed in this section as well.

            The ACT approach to these issues is different from many other clinical takes; if you don’t know it, you might find it an interesting read. A de-identified client example illustrating how defusion, values and several other ACT components were used to address suicidal behavior is the last section before empirical evidence is provided. The case example illustrates that, as is often the case, the client remains quite anxious yet she is living out her values more and thinking of suicide less.

            The data summary indicated the need for research on suicidal behavior. This is still a particular need. Fortunately, however, in the last six years the evidence for ACT with adolescents has increased. Since this paper was written, there have been 10 randomized controlled trials with participants under the age of 18. For details, see the Association for Contextual Behavioral Sciences State of the Evidence Page.

References:

ACBS State of the Evidence Page https://contextualscience.org/state_of_the_act_evidence.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2011b). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Last Updated February 25, 2014. [cited]. Retrieved from http://libproxy.library.unt.edu:2465/injury/wisqars/fatal_injury_reports.html

Centers for Disease Control and Prevention, NCHS Data Brief, No. 352, Oct 2019 [ online]. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf

Chiles, J. A. & Strosahl, K. D. (2005). Clinical manual for assessment and treatment of suicidal patients. Arlington, VA, US: American Psychiatric Publishing, Inc.

Murrell, A. R., Al-Jabari, R., Moyer, D., Novamo, E., & Connally, M. L. (2014). An acceptance and commitment therapy approach to adolescent suicide. International Journal of Behavioral Consultation and Therapy9(3), 41–46. https://libproxy.library.unt.edu:2147/10.1037/h0101639

Yang, B., & Lester, D. (2007). Recalculating the economic cost of suicide. Death Studies31(4), 351–361. 10.1080/07481180601187209

 

Exposure to Privilege

Exposure to Privilege

The Function of Privilege within Our Science and Beyond

Angela Cathey, MA, LPA

If you’re familiar with my writing or social media, you are probably familiar with my tendency to advocate for the underrepresented and disempowered in our society. Recently, I’ve found myself in a Facebook debate about this, in my social feed, that warrants a more elaborate response. I am also a woman, in a science dominated by men in power positions, who continually seek to ‘educate’ me further when I disagree with them. So, read this post with all that in mind.

First, I’d like to acknowledge that posts on Facebook conversations are not an adequate medium for debate. Without our voices, without posture, and without other cues that reflect the complexity of our perspective we are virtually guaranteed to keep arguing even when we agree. Our specific wording, the individual’s perception of us, and the nature of the media itself are likely to drive the other’s responses more than what we’re intending to express. This is simply a result of how the contextual variables inherent in social media (e.g., anonymity, slow responsivity, lack of complexity, and a public venue) tend to function for us.

We are faceless, sometimes nameless, words on paper expressing complex ideas in bumper sticker length responses. This is in part why social media results in long, sometimes heated, and often pointless debates so frequently. We are not faced with the person behind the idea, the whole idea, cues about the person’s emotion – and are left responding mostly to our relata and words that are themselves varied in function. We miss the complexity of other’s ideas, knowledge, and experiences. This is, in large part, how words, and people, function out of context.

The post I made that began the debate was a repost of a USA Today post, entitled “All college students should take a mandatory course on black history and white privilege.” I will attempt not to recount the debate here in detail, name the individual, nor shame the individual for their perspective. I choose to believe that the individual is arguing because they, like myself, believe that our science can do a better job of moving the world forward. I choose to see us as on the same side. What occurred in the debate; however, encapsulates why I believe that our society needs “mandatory” exposure to the ideas and experiences of others and the impact of “privilege.”

We are all privileged and disadvantaged in some ways; however, those with less power in our society frequently have no way to express their perspectives without it being perceived as punishing to the majority. This is, in part, the essence of privilege. Those with power and privilege see their perspective represented all around them in their everyday experience. Those with power and privilege are more likely than those without, to be surrounded by people and experiences that reinforce their beliefs about themselves and others. Those without privilege are faced with few representations of themselves, punishing representations of themselves by the majority, and to find themselves represented in and responded to – as caricatures.

In some ways, being an underrepresented minority in like attempting to express complex ideas, about heated topics, on social media. The underrepresented are prone to be responded to based on relata. The complexity of their ‘selves’ (instead of their idea) responded to with hostility because their ‘otherness’ does not fit neatly into the boxes of those with the dominant view.

This is the influence of verbal symbolic rules, how they function interpersonally, and why I believe we should all be constantly exposed to the perspectives of others. We, in particular, need experiential exposure to minority perspectives in as many forms as possible. Some of these are going to be punishing for us, some of them are going to be overwhelming, and some of them are going to be affirming. And, we need to realize as a society that all of this is important for us to experience for our collective good. A course in white privilege or black history is a drop in the bucket. It may function for many aversively, and yet, we have to start embedding the minority experience in the lives of the majority. We are a society moving further and further away from complexity and existing in worlds that function as echo chambers. Within social media, within science, and within society – most of us have the privilege of being able to ‘unlike’, ignore, and benefit from the inherent reinforcement of our views from the dominant representations of our views surrounding us.

This is why exposure to the perspectives of disempowered minorities must be in some way “mandatory.” The coherence of those with significant privilege, in any form, is reinforced simply by existing in a world that endorses their perspective on nearly every level of their existence, all day, every day. The privileged have no reason, on mass, to decide to hear and appreciate the complexity of the minority experience. It tends to violate the sense of ‘self’ of the privileged to even hear that they/we are privileged. My colleague who debates me recognizes this and yet misses the complexity of my argument for mandatory exposure to the perspectives of minorities and our privilege.

True recognition of privilege and the perspectives of minorities that will create change means creating interventions that are embedded throughout our society. It means that media is created by minorities, it means that representations of the perspectives of minorities are embedded into our society in so many ways that they become not the expressions of an unknown caricature “other” but as part of our collective view of ourselves, our history, and our ability to change, together.

And, for the one who inspired the post, if the complexity of my perspective results in further attempts to correct me by insisting I simply need education on the basis of our science, on my feed, don’t be surprised if you get a more explicit public lesson on male privilege in our field and how your behavior functions aversively as ‘mansplaining.’ I am the female owner of a behavior analytic education site who disagrees with you, insisting that I need to educate myself in single-case design, reinforcement, and punishment because I disagree with you –  without stepping back to consider the context surrounding your behavior is an act of privilege in action.

 

RFT: Let me show you something beautiful.

RFT: Let me show you something beautiful.

AUGUST 11, 2016, original post to angela.cathey.com

Stop over thinking RFT and feel it.

I would say that sometimes it takes a different perspective to look at the tools we are given and see them quite differently. We, the second and third generation ACTers, FAPers, and rising CFTers… we are reveling, rejecting, remixing, and refining the elegance of technical masterpieces.

So, here is one of my remixes. I don’t like connecting with RFT in examples of coin size, driving, or equations about how cats = “cats” and … =Screen Shot 2016-08-03 at 11.03.28 PM

Okay, he’s cute. I’ll give you that… but he’s still a cat.

RFT is the rhythm of human thought and feeling. Just because the Internet is officially full of cats. doesn’t mean that our conceptualizations of human thought and language should be. (No offense to the cat lovers or Schrode’ [inside joke]}

So what is more human? Art.

Here’s a different way of connecting with frames. Take a moment to look at the picture below. Notice.

Screen Shot 2016-08-03 at 10.26.48 PM

Feel your eyes pulled to the highest point? The background falling away into fuzziness. There’s a feeling of being pulled upward higher. This is a visual metaphor for how a hierarchical functions. This is what connecting with values, belonging, purpose… does to your sense of the world. You tune into the higher point and the rest falls away into the distance.

Now, look at this picture.

Screen Shot 2016-08-03 at 11.17.51 PM

Notice how the pieces fall away and the whole pops forth? You notice the togetherness, the uniformity of what is actually separate pieces. When we feel in coordination with something we move towards it, we identify with it, we become in some way a reflection of the other. (This is also a bit hierarchical, but “frames” are always functional concepts so let’s stick with what ‘works’.)

Now look at this picture.

Screen Shot 2016-08-03 at 11.21.53 PM

Maybe you could technically ‘see’ that this is tree bark but that’s not likely to be what you were paying attention to. Context sensitivity is like zooming in. You see the details. You experience, and you might be hyper- sensitive to a change in the context. For example, a giant ladybug landing in the middle of this might jolt your attention more so if you’re more contextually sensitive in-the-moment.

Now look at this picture.

Screen Shot 2016-08-03 at 11.14.02 PM.png

This is a visual metaphor for coherence. See how your mind likes the fitting together of randomness into a pattern? It’s naturally reinforcing. People don’t like messes.

Now look at this:

Screen Shot 2016-08-11 at 7.33.12 AM

This is a bit like the concept of adaptive peaks. Sometimes we can miss the forest, sunrise, and distance when we’re focusing on making wishes on the dandelions we can see in the immediate path.

 

If you like learning about Relational Frame Theory, behavior analysis, principles, or the philosophy of science in different forms – let us know in the comments. If you’d like to learn more feel free to check our selection of online, on-demand, and live training events.

RFT: The Guerilla guide to pro-social change

RFT: The Guerilla guide to pro-social change

Original post to angelacathey.com, July 2016

Welcome to Frame Club. A Guerilla guide to pro-social change with RFT.

Screen Shot 2016-07-25 at 6.18.35 AM

The world is full of simple repetitive messaging. Everything is a bumper sticker. “Party A is evil, party B is good” and…. shootingsdiscriminationand ignorance follow.

Life and people aren’t bumper stickers. 

The repetitive simple messaging we’re privy to means that we’re deriving copies of copies of copies. That’s not good.  We’re also used to this and insensitive at times to direct contact contingencies. So, we get around rules in other ways for instance politicians can now move us more effectively through associative frame speak than through direct logic (eh hem… Drumpf for President anyone?).

And yet, we’re not doomed to idiocracy.

We know that simple low complexity derivation begets 1) rules, which leads to 2) unawareness (rule-governed insensitivity to contingencies).

When you add to that mix pain, you get: 1) avoidance, that leads of course to resilient and contagious ideas. This is why we teach acceptance by metaphor and experience. You can’t just say “accept” because you end up with a useless rigid rule and lack of awareness of the contingencies around it.

So, let’s acknowledge what’s there and why it’s there.

We all have histories of learning negative discriminatory relations about race, sex, gender, social class, body image, and a whole host of other things.

Even if they weren’t outright stated (aka you didn’t hear racist, sexist, anti-gay messaging regularly) simple repetition of any situation creates rules which spread in our minds in a variety of ways. We then deal with this in predictable ways.

Some of these rules may come about just through noticing differences and similarities between ourselves and others (Roche, Barnes-Holmes, Barnes-Holmes, Stewart, and O’Hora, 2002) and this influences our behavior.

So, we’re going to have these relations as a bi-product of our natural tendencies to categorize and organize our worlds (if we didn’t life would be a bit like 50 first dates. Where everything would be new and foreign each time we contacted it. That’s not workable. )

We’re going to have these rules in our heads about people that are painful as a result of living. We can try to wish them away but that’s just going to result in rules in the other direction then create insensitivity to direct contingencies (even if they’re as big as a gorilla in the room.)

Unfortunately, there is no erasing of relations. We all have painful thoughts that we’d rather not acknowledge.

Luckily, there’s been some great work on what this is in the social realm and what we can do about it (see Vilardaga, Levin, Hildebrant, Hayes, & Yadavia 2008, May ABA – need to log into ACBS for access) or Vilardaga, Hayes, Levin 2014 – The Flexible Connectedness Model).

We can deal with relations that are problematic in a variety of ways.

In some cases, we can simply derive new more complex relations that fade the old relations in importance; however, when the rule is more stubborn (i.e, involves any pain as it so often does when rules latch on to humans) this often won’t be enough.

We often need a shift in context (defusion, mindfulness of the contingencies of that drive our behavior in non-rule-based form). We can also combine these with combinations of context shift like this Deictic Framing Exercise (exercise by Vilardaga, Levin, Hayes, 2008 – video by Gareth Holman). This type of exercise combines several relations that move us past rule-based insensitivity including shifts in deictic and deictic related framing (temporal, hierarchial, etc.).

 This is likely to work for those who are willing to engage. 

However, we know that coherence, simplicity, avoidance of pain… all of this is self-reinforcing and we can’t expect a large portion of the population to sit down and do a perspective-taking exercise just yet. So, what can we do?

 Adapt the message or the context.

If argumentation and rule-based insensitivity are likely you need to adapt the message. Go metaphorical, go high complexity, and go associative. Feelings aren’t as easily blocked (see every perfume commercial ever made.)

Or shift the context, humor can work well at getting our attention when insensitivity is the norm (see Old Spice Muscle Pump  commercials that get our attention when we normally tune commercials out).

When humor, feeling, metaphor, aren’t practical and/or the consequences are too high, we can also reduce the accessibility of Sds (discriminative stimuli) if we know what’s pulling the problematic frames. We could be enacting this in some of our institutions (e.g., the justice system) now. We know the impact of race on judgments and sentencing and yet we just keep sending people into the justice system and pretending human bias isn’t there. When are we going to just start recognizing and adjusting to human bias tendencies to protect people? We’ll tend to engage in mass scale rule-based insensitivity to avoid contacting what’s difficult (see the DARE program and abstinence education for policies that continue to be funded despite their widely recognized ineffectiveness).

Contextual Behavioral Science and RFT can begin to mindfully examine these contingencies if we take the time to look at what’s going on with a stance of self-other compassion without blaming or shaming either party we can start from a new context where together we step forward to understand what keeps us stuck hurting ourselves and each other.

You and I: Understanding and measuring high impact Functional Analytic Psychotherapy (FAP)

You and I: Understanding and measuring high impact Functional Analytic Psychotherapy (FAP)

Original Post to AngelaCathey.com on July 24th, 2016
by Angela Cathey

There are many ways to understand every therapy. Here I’ll offer a granular analysis of what seems to occur in the high impact FAP. What I present here is not an opposition to the current model of FAP but a different layer of analysis. I would agree that contingent reinforcement of behavior is a key mechanism of FAP. The purpose of an RFT-level analysis is to offer additional ways to measure and understand some of the effects of FAP that are otherwise difficult to characterize and measure.

I’m focusing on the symbolic relations that are created in what I call ‘high impact’ FAP. What I’m calling to in this description is the tendency of present moment relational therapy to become more powerful and evocative than one would normally suspect of a treatment based on reinforcement of adaptive behavior via the therapeutic relationship.

Those of you who have been to a FAP intensive or are highly experienced in FAP may be familiar with the report of FAP being “life-changing”, “transformative”, etc. To some extent one would hope most treatments are experienced this way; however, the rate which participants report intense response to FAP is likely higher. And, an RFT driven analysis there are empirical logical explanations for why those that experience FAP as moving may experience it as life-altering.)

Note that RFT is about symbolic relations and their properties. Patterns of pairing (between behavior, language in any form, sensations/perceptions, contexts) can all become meaningful over time through association with important (e.g., painful, joyful) experiences.

This is no different than operant reinforcement or classical conditioning – the type of pairing, the frequency/schedule, context, etc. all affect the relations made. The only difference here is that the SD can show up more easily symbolically (via language or some other cue).

So, let’s now look at perspective (the “I”) that orients your experience. You walk through life each day seeing, doing, feeling, thinking… and each of these things becomes a part of your continuing experience. In some way, they have become paired with the “I”. Perhaps very weakly paired but paired none the less. (See RFT: The space-time of the human universe for further description of perspective).

Experiences that happen over and over, including consistencies in the way that people describe you or relate to you become a part of your “I” and your concept of the other, or symbolic “YOU”.

The way you explain what occurs in these relations gives them additional power as it becomes a symbolically ‘sticky’ way of seeing the world (i.e., coherence relations, schema). You see others through this story of yourself and yourself as well. They, similarly, have stories about themselves and others and how people relate by which they organize their experience.

Now consider that everything you do in a relationship creates associations between:

The “YOU” and “I” present, or symbolically referenced (spoken about, etc.). Further, the emotions you express, the way that you talk about yourself and others, the behaviors you emit in any respect all become attached to the “YOUs” and “Is” in the room. (Yes, plural “I”s through the sometimes distinct tracks of symbolically defined behavior (e.g., roles, contexts, etc.) serving to create classes of behavior that ‘hang’ together.

Stop and consider that for a bit… Do you often belittle yourself in your own mind or in front of others? If you do you may find that people’s behavior towards you will begin to reflect this relation or that your own behavior towards your self will become less compassionate over time.

Our learning histories, ‘sticky’self-stories, and current histories all affect our sense of self and other. And, because the “I” is theoretically the relation most complexly derived (it is always there as a part of the associations forming) transformation of the “I” can ripple through all the attached relations.

Stop and think for a minute. All your sensory experience, all your visual perceptions, all your everything is hooked right through that “I” relation. So, what if it is altered? What will you experience?

If the alteration is “good”, perhaps you feel like this?

Now let’s switch to thinking about the process of an intimate relationship, using a lovely cheesy music video metaphor that we’ll then build upon both these to discuss the complex symbolic relating that can occur in high impact FAP.

Do watch as it will help you connect to the symbolic journey we’re going on through metaphor. The Story of My Life

Imagine that the moments of your life are pictures. The experiences that reflect complexity (ERRRs) most often are a series of pictures with richly emotional colorful (good or bad) details. See the birth of your child, and the hundreds of pictures to capture the complex experiences that follow.

Now, look around your home… are there single large photos blown up… special moments you wanted to save. These are likely snapshots of complexly derived moments (see the pictures from Hawaii… feel the sand beneath your toes? Sometimes complexity is lovely.

Now there are thousands of random shots in between that capture random moments, important relationships, accomplishments… and because this is your life, not a photo album imagine that all the moments you never wanted to remember are also there. In their full, and sometimes awful glory.

That time you fell on your ass in front of a crowd…

Your worst mistakes. All of them are memorialized in all their complex and highly derived glory (because rumination derives!) in big lovely photographs you keep hidden away.

All these moments that form the history of you, your pain, your joys, your disappointments… see them all strung along the wall back behind you (in time).

Now imagine opening your heart and mind to pull out these photographs and show another. Each time that you hand a painful or joyful memory to this person a connection between you forms, a connection between both of you and the memories seen, the emotional expressions of both (YOU and I) then shape the memories and the relationship. There’s a heck of a lot of relating going on here – temporal, deictic, high complexity, transformation of stimulus functions through coordination/distinction/opposition with the other.

And, this… is just a close relationship. This isn’t even therapy.

Notice how we all are deeply affected by our relations, good or bad, to those around us.

People are a core of our experience, our ‘self’, and our world.

Now, let’s work towards understanding the complexities of high impact Functional Analytic Psychotherapy relating.

Open this and listen while you Imagine.

Let’s walk through a super simplified course of FAP via the special case of intensives. For the unfamiliar, this is 3-4 day long training of therapists who come to hone their skills together by experiential practice.

Much like most FAP treatment itself it generally begins with some sort of Life History or discussion of adaptive (CRB2) and maladaptive (CRB1) behaviors. The very discussion pulls the relations along from the past, symbolically, to accompany the present. The power of the past (pain and joy) becomes more accessible by relation.

Now you begin to hand not the pictures described above but your real present moment experience (that is sometimes still fused with pain) to your colleagues. You may be brought to tears by the transformation of stimulus functions simply involved in discussing your pain and struggles in front of another.

As you engage in this interaction the other makes out-to-in parallels creating a symbolic I-YOU relation linking to the past relations involved (to people and behaviors that can be present in the now for changing).

In doing this, you are allowing the present moment interaction to alter contingencies set in other relationships because the attachment of past and present I-YOU to in the moment I-YOU is like creating a transcendent I-YOU.

The impact of the learning experience naturally becomes stronger as the symbolically present and in vivo relations combine. Anything altered through reinforcement or otherwise, can now affect the past, the present, the “I” and the “YOU” in the present, and all other “Is” and “YOUs” relevant to these relations.

At this point, contingent reinforcement takes on a new life. You’re shaping behavior but you’re also shaping relations, which allows you to interact with and shape someone’s relating to what occurred long with someone else. The shaping of that entire chain of relation can in a sense begin to over-write the relations of the self, the other, and the world.

The result can be “magic” and leave people changed. A present moment, relational therapy, driven by behaviorism. This is powerful medicine (not without its challenges).

Intensives, in particular, may evoke strong reactions as days of present moment relating in a uniquely supportive environment while bringing in other relations and experiencing the transformation of pain from long ago… it’s a bit like flooding of the deictic relations with new, hopefully adaptive, learning.

What are your thoughts on this and the complications of what we’re describing? Let us know in the comments. If you’re interested in more writing on clincial behavior analysis, RFT, principles, or the philosophy of science – let us know. Also, check out our selection on-line, on-demand, and live training on related topics!

Human Attachment: The ‘Why’ of Connection

Human Attachment: The ‘Why’ of Connection

Attachment and Cooperation

by Broderick Sawyer, PhD

When we want to improve upon our ability to reach any mutual goal that involves more than one person- businesses, sports teams, government, and even 1 on 1 personal relationships- attachment theory can be particularly helpful in improving human cooperation.

Attachment Theory is more complicated than any one article, but when we focus on the process of building human relationships and day to day interacting, it becomes clear that this process is largely responsible for how we feel about ourselves, which then influences how we interact with others. That is to say: Self-image = how we feel others perceive us.

Our gift as human beings is our ability to fit into and contribute to social groups effectively, without rocking the preverbal boat by interacting in ways that are not conducive to the interaction ‘style’ of the group. If we imagine our brains as computers that need to be programmed so that we can have a final ‘version’ of ourselves by adulthood, it would then be obvious that our childhood, adolescent, and early adulthood experiences have much to do with developing our social style, via developing our self-image.

While genetics do predict certain predispositions to certain ways of behaving, let me dispel the myth that genetic traits predict who we are all the way throughout adulthood and drive humans to become ‘fixed’ beings. This is nonsense, and backed by what we call ‘neuroplasticity’: the ability of the brain to adapt to the input that it is receiving at every moment throughout our lives. If we change our environment, the people we interact with, or if bad things happen to us, our brain literally creates NEW neural pathways to adapt to new circumstances. Why does it seem like we can become ‘fixed’? Well, the more we continue on in our current circumstances, these neural pathways become stronger, which causes whatever behavior we are doing to become more of habit and way easier to do- rather than change.

One thing, however, is fixed. We all have the same capabilities for honest, compassion-driven communication, but unfortunately, evolution does not care about our abilities to be compassionate, rather, our continuing to breathe, eat, sleep, and reproduce. This does not necessarily require compassionate interaction. Thankfully, the world of psychology is a developing field that can provide us various loopholes to develop a more compassionate style of interaction, and this starts with understanding various “styles” of interacting, how they came to develop, and what this means for our interactions with others as adults.

A challenge to our readers, can you drop to the level of Relational Frame Theory and Behavior Analysis and provide an account of what’s described above in behavior analytic language?

What drives us to attachment? What maintains attachment styles? What do you see ‘underneath the hood’ in your language?

Are you interested in learning more about principles, behavior analysis, RFT, and taking an integrative look at our field? Let us know in the comments and check out our online, on-demand events!

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