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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!

Angela Coreil, PhD

Angela Coreil, PhD

Consultant and Educator

Angela J. Coreil, PhD works with individuals and organizations to promote better connected, purposeful, and effective living through behavior analytic principles. She has over a decade of clinical experience treating human suffering and promoting human excellence using Acceptance and Commitment Therapy (ACT) and other behavioral therapies. She now focuses on the promotion and translation of Clinical Behavior Analysis as a way to improve our science.

The Power of Choice

The Power of Choice

‘by Angela Cathey, MA, LPC

Recently, we had the good fortune of having Benji Schoendorff, MA, MSc for an interview. Benji is a renowned Acceptance and Commitment trainer. He is a joint owner of the Contextual Psychology Institute (CPI) with his wife Marie-France Bolduc. They and their beloved son travel the world doing their part to put ‘psychological flexibility in the water supply.’ Benji is a deeply principle-driven clinician and trainer. His work is highly informed by Relational Frame Theory (RFT) and behavior analysis. In addition to the training that Benji does to increase the skill of individuals, Benji and the Contextual Psychology Institute (CPI) also work to improve contexts by training organizations to better engage with the ‘difficult’ in the service of reaching their goals and values.

Below, we discuss some of Benji’s recent work and thoughts on applying ACT to organizations.  

Angela: “Benji, you’re a celebrated trainer of ACT and FAP. You travel the world teaching others to be more aware, mindful, and courageous in how they work with each other. Though you’ve had a great deal of impact on many in psychology, by teaching evidence-based interventions, your work has ventured more and more into changing larger contexts as well. Can you tell me a bit about this focus and how it has brought you further into consulting?”

Benji: “My personal mission, and that of our institute, is to slip psychological flexibility in the water supply. What I mean by ‘psychological flexibility’ is the ability to choose to do what matters, even in the presence of obstacles. It is about choice. Individuals who are ‘stuck’ feel they don’t have a choice, and the same is true of teams and organizations—and of course of individuals within teams and organizations. We all know that businesses and organizations are sitting atop a hard to tap gold mine: employee engagement. I believe being able to choose to do what matters in your professional life just as much as in your personal life is the key to both well-being and to fully engaging in our lives and work. After all, we spend a good chunk of our waking life working. Yet paradoxically, our present organizational structures largely deprive us of choice. Is it a wonder that employees aren’t as engaged as they could be? What we’ve discovered is that using the applied principles of modern behavioral science, there is an easy and intuitive way to increase ‘psychological flexibility’ in the workplace and in organizations. It’s a simple and intuitive model we call The ACT Matrix and I believe it has the potential to revolutionize our working lives as much as our personal lives.”

Angela: “That’s wonderful Benji. For those who haven’t met you, can perhaps tell us a bit more of what is it like to work with you personally in personal or organizational psychological flexibility initiatives?”

Benji: “In the spirit of 360-degree feedback, I’d invite you to ask my team members and past clients. I think they would say that I am creative, passionate, values-driven, flexible, fun to work with and always human. My working style is highly participatory and I love to make work fun! I seek to create contexts in which people can best contact their resources and make their own best choices. I believe every person can make their own choices and I know how to inspire folks to feel that way. As a leader, I trust my team members to make decisions, preferring to advise than dictate. As a consultant, I connect with my clients’ unique needs and perspectives to help them identify original and above all workable ways to reach their goals.”

Angela: “I see the flexibility and awareness in the way you pursue life itself. It takes a deep commitment to innovation and humanity to truly walk the path you espouse so fully. I’m excited to be working with your team more closely these days and enjoying the development of technology and change with you. Can you tell us what your strengths and ‘learning edges’ are?”

Benji: “The learning edge feels tricky… I have many learning edges. The one I am working on at the moment is to further develop my ability to integrate the technology you are developing into my consulting work to help clients track how effective working with The ACT Matrix can be to foster team and individual productivity and empowerment. I am also working on being more compassionate and validating, more consistent in my work, more responsive.”

Angela: “Those are certainly worthwhile goals and lately, it seems like you’re all over the world putting these into place while doing workshops? How do you see this work developing as you put ‘psychological flexibility into the water’ so to speak?”

Benji: “Well, I am trying to write a lot of blogs and of course I give lots of trainings, nearly one a week, and we are getting more trainers to work with our institute, though that’s barely started.”

Angela: “That’s wonderful! I am looking forward to seeing more from you and CPI. Tell me, is there a leader, idea, or experience that has most influenced you on your path?”

Benji: “The person that has most influenced me in my work is without question Steven Hayes, the main founder of Acceptance and Commitment Therapy or Training (ACT). Steve is an absolute trailblazer, and the sweetest human being, combining the sharpest intellect and a deeply human heart. His stroke of genius was to see that human suffering and getting stuck are not ‘pathological’ processes, but an inevitable byproduct of how our minds work. He set about to understand what processes could account for the difficulties we experience and what to do so we can more easily get unstuck and do what’s important to us. That makes ACT translatable to the world of business and organizations. In my organizational work, I am so grateful to Kevin Polk and colleagues who developed The ACT Matrix, a simple and intuitive way to bring the power of Acceptance and Commitment Training (ACT) to the world of business.”

“Finally, I want to mention Dennis Bakke’s books, ‘The Decision Maker’ and ‘Joy at Work’. Bakke built a 47,000-strong multinational Electricity-generation company by radically devolving decision-making to his employees. His core idea is that if we treat people as fully responsible adults in the workplace by letting them make all the decisions that concern them, they will fully engage in their work. For Bakke as for me, this doesn’t just make perfect business sense, it is a core value for the full realization of our human potential.”

Angela: “Interesting. There’s been a great deal developing across fields that I believe will change the face of our workplaces in the future. As our lives have become more connected by technology, I believe we’ve become more disconnected in our lives. Workplaces offer these wonderful microcosms of our lives and networks, both socially and technologically. In an era of constant movement and short job tenure, the characters in our lives are ever-changing, connected-but-not… our lives and well-being increasingly seem tied to our ability to co-exist productively, sustainably, and cooperatively with others who may not know us or understand us. This is both exciting and terrifying. We have the chance to grow as a species, but will we choose to? I believe that if there are people like you, who choose to walk the more challenging paths, we may have a chance. Thank you so much for your time, Benji. I look forward to seeing more and more of your work and deepening the ties between our organizations.”

 

What is Acceptance and Commitment Therapy?

What is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy or “ACT” said as one word is considered one of a new wave of cognitive-behavioral therapies, including Dialectical Behavioral Therapy (DBT), Functional Analytic Psychotherapy (FAP), and others. These treatments largely involve many of the aspects common in traditional cognitive-behavioral therapies but with important technical and theoretical differences (Hayes, Strosahl, & Wilson, 1999). In ACT there is a focus on “accepting” what is out of the client’s control and commit to changing what is in their control, to improve their lives (Orsillo & Roemer, 2005). ACT includes the use of mindfulness, to assist in reaching these goals, which has long been a part of Eastern philosophies such as Buddhism and Taoism. Mindfulness can be explained as being aware of your experiences moment to moment and experiencing them with openness and interest, rather than judgment (Hayes et al., 1999; Orsillo & Roemer, 2005).

ACT is a tradition based on Functional Contextualism (Hayes et al., 1999). Functional contextualism is a form of pragmatism, which states events should be understood as a whole, in context, and as ongoing (Hayes et al., 1999). This is in opposition with most traditional views of behavioral therapies, which are more present-focused and tend to limit their focus to what is appears directly relevant to the presenting problem. Also important in functional contextualism is the following of pragmatic truth criterion. Pragmatic truth criterion refers to judge the effectiveness of our actions based on how they meet our goals rather than their match to some supposed concrete reality. In this line of thought, no ‘truth’ is universal; what is true is only what works in getting a person to their unique goals. This differs from most traditional cognitive-behavioral treatments that might focus on having clients test the validity of their thoughts in quasi scientific manner against reality. In ACT, a person we would tend not to ask a client to test their thoughts regarding fears to see if they are “valid” or “logical” fears. In ACT, the focus is on whether believing the thought constricts or expands the individual’s ability to live a valued life. This is often referred to as “workability” and is a central concept to contextualism. “Context” here refers to how the behavior occurs and what rules govern the behavior (Hayes et al., 1999). Within ACT the context of the behavior, and not the form, of the behavior itself is the focus of change. Thus, symptom reduction is not directly an aim of ACT but rather a side effect (Hayes et al., 1999). From the ACT perspective, suffering is both a necessary and unavoidable part of life, but the way we experience suffering is determined by our understanding of it (Hayes et al., 1999).

Also essential to the foundation of Acceptance and Commitment Therapy is its take on the role of human language in human suffering. Understood through Relational Frame Theory, human language as a process results in destruction, dysfunction, and pathological processes (Hayes et al., 1999). Language is necessary for the advancement of human society and each individual, however; the associations we make through language eventually cause us misery. Relational Frame Theory (RFT) suggests that through behavioral conditioning language itself can affect how we feel. As we learn language, conditioning creates “mutual entailment” or bi-directionality in associations between words, feelings, and things. It is in this way that children learn that words and things are equivalent (Hayes et al., 1999). However, it is his essential feature in learning to communicate with others that can later cause us a great deal of suffering. Since the words we have learned trigger the images and feelings they have been paired with in our past; we are prone to sometimes feel emotional pain unnecessarily. Just as when you think of the word “lemon”, you have an immediate reaction to taste sour you can have a response to the word “anxiety”, such that thinking about the word “anxiety” can make you feel anxious. This creates problems because as most people try to avoid feeling unpleasant feelings; they cause themselves the very feelings they are trying to avoid. For example, to think, “Don’t get anxious!” includes the thought of “anxiety”, and thus feelings of anxiety (Hayes et al., 1999; Orsillo & Roemer, 2005). These conditioned relationships in our minds are the result of often life long patterns of association, and thus are also quite difficult associations to break up. And, in fact, though we can break them up they quite often resurge (Hayes et al., 1999).

Through ACT individuals learn to reduce the impact of conditioned language associations on their feelings and actions. ACT takes the position that because of the way we process language, according to RFT, our typical methods for solving problems logically in the outside world are inappropriate for solving problems with thoughts and feelings. We tend to assume that we must simply determine the reason for some unpleasant feeling or behavior and remove it, to remedy unpleasant feelings or consequences. This leads us to the culturally supported idea that thoughts and feelings are good explanations for what we do. So, though we have the capability to act contrary to our thoughts and feelings, we assume that to control our actions we must control the feelings and thoughts associated with them. However, as RFT indicates, the more we endeavor to control our thoughts the more we will suffer from them. Therefore an important feature of ACT is to reduce experiential avoidance, or the unwillingness to experience certain feelings (Hayes et al., 1999; Orsillo & Roemer, 2005). What we have to realize is that it is perfectly normal to feel unpleasant feelings at times and that the objective to control, reduce, or rid ourselves of these feelings is not a successful approach (Hayes et al., 1999).

ACT suggests that the alternative to experiential avoidance is acceptance, and mindfulness, as in accepting that feeling unpleasant sometimes is a natural and necessary part of life. ACT also suggests that choice and committed action are more appropriate ways to deal with life than avoidance. ACT’s goals include the shift from understanding words as content to context; learning to understand both the benefits of language and how it can affect us negatively when we do not take into account the learning context (Hayes et al., 1999).  ACT seeks to undermine unworkable change agendas, such as experiential avoidance, by helping clients realize their refusal to feel and accept causes more pain. In addition, ACT seeks to help individuals identify and clarify their life direction and goals. ACT therapists endeavor to suspend their own judgment regarding what goals a person should have, because from the ACT perspective, the appropriateness of goals is subjective, and the client should pursue those goals important to them (Hayes et al., 1999).

Therapeutic tools used in ACT, to reach ACT consistent goals, include: the use of metaphors, therapeutic paradox, and experiential exercises (Hayes et al., 1999). Metaphors are used to reduce the impact of literal language and to prevent the client from simply following the requests of the therapist without achieving true understanding. Since metaphors cannot be exactly interpreted, they cannot be exactly followed; the client is forced to experience and understand rather than rely on the therapist’s direction (Hayes et al., 1999). Therapeutic paradox is similarly used to reduce the impact of literal language on the client. The client is given a task where they can experience the consequences of not avoiding their symptoms, which typically includes a reduction in the symptom. Experiential Exercises can also be used to change the verbal context of situations, so that the client can learn to observe and study their feelings without imposing judgment on them. ACT methods include many metaphors and experiential exercises to address different problems and different frames of mind. Another tool used by ACT therapists is creating “hopelessness” in clients by pointing out the failure of previously used methods to control their feelings. This technique motivates the client to accept new ways of understanding their problems and new solutions for them (Hayes et al., 1999). As mentioned above, ACT therapists help clients explore their values and help them learn to lead their lives in accordance with these values. This last phase of treatment is often more behaviorally oriented than other phases of ACT; it includes intense discussion over the client’s values and behavioral strategies to assist the client in reducing discrepancies between their actions and values (Hayes et al., 1999).

Recent years have seen an explosion in ACT-related research and the effectiveness of ACT in many different populations and with many different diagnoses. Hayes and associates continue to conduct training seminars, workshops, and conferences devoted to the promotion and further development of ACT theory and methods. Clinicians also continue to develop a wider variety of useful metaphors and experiential exercises to inspire clients to a new understanding of their problems and motivate them to “ACT” in line with their values (Hayes et al., 1999).

Angela Coreil, PhD

Angela Coreil, PhD

Consultant and Educator

Angela J. Coreil, PhD works with individuals and organizations to promote better connected, purposeful, and effective living through behavior analytic principles. She has over a decade of clinical experience treating human suffering and promoting human excellence using Acceptance and Commitment Therapy (ACT) and other behavioral therapies. She now focuses on the promotion and translation of Clinical Behavior Analysis as a way to improve our science.

The impact of an Acceptance and Commitment Therapy (ACT) intervention on parent behavior towards children with Autism

The impact of an Acceptance and Commitment Therapy (ACT) intervention on parent behavior towards children with Autism

by Lisa Truong

Parents of children with autism or other developmental delays often face difficult challenges and negative private thoughts, which in turn inhibits parents’ abilities to implement effective interventions for their children. The parents’ behaviors are influenced by rule-governed behavior as opposed to contingency shaped behavior. Contingency-shaped behavior is controlled by being exposed to environmental contingencies, while rule-governed behavior (RGB) is an effect of our ability to derive rules from other experiences. Our ability to learn from other experiences and the verbal behavior of others and then apply it to other situations is thought to be an essential human ability that explains many of our higher thinking capabilities. However, RGB can result in over-extension of rules to situations in which they do not apply. One particular category of RBGs, called plys (or “pliance”) is the over-extension of socially derived rules for behavior. For example, a child told by a parent that they should always wear a jacket when they go outside may derive a rule driven by social contingencies rather than the appropriate response to the environment. If the child then tends to put on their jacket based on the rule, without regard for whether it is hot or cold outside, then this child is acting in pliance. This is likely to occur, in part, because one of the known properties of RGB is a reduction in sensitivity to environmental contingencies and contingency-shaped behavior. In a sense, the stronger RGB, the more in tune an individual is with rules rather than the environment. This tends to result in behavior that becomes increasingly narrow and inflexible.

Parents may also act in rule-governed ways when it comes to responding to their child’s behavior. An example would be how a parent would respond to their child crying in public. Rather than ignoring the child’s inappropriate behavior, parents tend to act according to societal expectations. Further, parents may experience accompanying aversive emotional states (e.g., anxiety and embarrassment) and seek to avoid these emotions by parenting in such a way that ends their child’s problematic behavior more quickly in the short-run but extends the life of the behavior through reinforcement. This can lead parents struggling to deal with their own private events to effectively follow behavior plans.

Acceptance and Commitment Therapy (ACT) is a contemporary behavior analytic approach to addressing these private events. The goal of ACT is to increase response flexibility so that clients can better track and engage in behaviors that lead them toward valued living. The ability to act in such ways is often referred to as “psychological flexibility.” Recent research has shown that parenting-specific psychological flexibility leads to more adaptive parenting behaviors and lower levels of child problem behaviors.

The main goal of ACT for parents of children on the autism spectrum is to increase adaptive parenting behaviors in the service of the parents’ values. Parents are asked to identify specific overt behaviors (e.g., playing with their child for at least 15 minutes each day) which would move them towards their own parenting values. A 2017 study (Gould, Tarbox, & Coyne) indicated that a six-week ACT protocol produced an increase in value-directed, overt behaviors in parents with children with autism. These increases in value-directed behavior were maintained at follow-up.

Sources

Gould, E. R., Tarbox, J., & Coyne, L. (2018). Evaluating the effects of Acceptance and Commitment Therapy on overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7, 81-88.

Lisa Truong

Lisa Truong

Contributing Writer

Lisa Truong graduated from the University of Texas of Austin with degrees in Psychology and Human Development and Family Sciences, with a concentration in personal relationships. She has over a year of experience in the applied behavioral analysis field and currently works as a behavior therapist at The Behavior Exchange. She has experience working with children from 2 to 16 years of age in both clinical and in-home settings. She also has an interest in tech, visual design, and art since she was young. Since graduating, she has been trying to find opportunities to bridge behavioral sciences, technology, and visual aesthetics to create beautiful and easy-to-follow experiences.

A behavioral intervention to reduce the impact of stigma (ACT).

A behavioral intervention to reduce the impact of stigma (ACT).

by Lisa Truong

Psychological inflexibility is a psychological process that can be used to explain how stigma affects us. Recent research (Krafft, Ferrell, Levin, & Twohig, 2017) indicates that distress experienced in reaction to stigmatization is less when those experiencing stigmatization are more “psychologically flexible.” Psychological flexibility is a mid-level construct frequently used in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) that refers to adaptive flexibility in behavioral repertoire, particularly in the face of distress or barriers.

Many groups (e.g., racial minorities, sexual minorities, and various social classes) experience stigmatization and distress as a result of this stigmatization. It is believed that observed elevations in psychological and physical health issues in these groups may be, in part, a result of the effects of stigmatization. Further, people who belong to stigmatized groups may generalize the stigmatization to their own self-concept, further exacerbating their distress. Self-stigmatization may lead to isolating behaviors and a lower overall quality of life.

ACT is believed to reduce the negative effects of stigma by targeting the relationship with stigmatizing thoughts and attitudes. ACT techniques were developed based on Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001) a post-Skinnerian behavior analytic formulation of how thought and human language develops. ACT techniques are thus meant increase one’s ability to accurately track the natural environment and react adaptively, rather than getting hung up in the distressing and awareness reducing properties that occur as a result of “languaging.” In practice, this means that ACT practitioners build psychological flexibility by experientially teaching them how to engage in adaptive behaviors in accordance with their values, even when difficult emotions come along for the ride. This often involves the use of metaphor, experiential exercises, and other techniques that briefly alter the functions of verbal behavior such that other contingencies may be better contacted.

Numerous studies now indicate that ACT interventions for reducing the detrimental effects of stigmatization above other alternatives (e.g., education, multi-cultural training). These studies support the efficacy of ACT as an intervention for reducing the distress associated with stigmatization and reducing internalized negative self-concept. Further, similar research has indicated that ACT may reduce the negative impact of stigma in a variety of groups, including but not limited to: those with Schizophrenia, HIV, obesity, substance abuse issues, and those who belong to racial and sexual minority groups.

Sources

Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A post-
Skinnerian account of human language and cognition. Kluwer Academic: New York.

Hayes, S. C., Strosahl, K. D., & Wilson, K. (1999). Acceptance and Commitment Therapy: An 
experiential approach to behavior change. Gilford Press: New York.

Krafft, J., Ferrell, J.; Levin, M. E.; & Twohig, M. P., (In Press). Psychological inflexibility and 
stigma: A meta-analytic review. Journal of Contextual Behavioral Science

Lisa Truong

Lisa Truong

Contributing Writer

Lisa Truong graduated from the University of Texas of Austin with degrees in Psychology and Human Development and Family Sciences, with a concentration in personal relationships. She has over a year of experience in the applied behavioral analysis field and currently works as a behavior therapist at The Behavior Exchange. She has experience working with children from 2 to 16 years of age in both clinical and in-home settings. She also has an interest in tech, visual design, and art since she was young. Since graduating, she has been trying to find opportunities to bridge behavioral sciences, technology, and visual aesthetics to create beautiful and easy-to-follow experiences.

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