Psychological Flexibility and the Extension of Knowledge in Contextual Behavioral and Cognitive Therapy. Steven C. Hayes University of Nevada

Transcription

1 Psychological Flexibility and the Extension of Knowledge in Contextual Behavioral and Cognitive Therapy Steven C. Hayes University of Nevada

2 What is Psychotherapy? We were asked to try to answer this question, but the actual focus of my talk is elsewhere. How can be best develop psychotherapy?

3 What is Psychotherapy? My answer first, my argument about development second Psychotherapy is the management of evolutionary processes at the psychosocial level (genetic, epigenetic, behavioral, symbolic, episymbolic)

4 Evolving a Behavioral System Happens By undermining repertoire narrowing and rigidity inducing processes, and fostering conscious chosen variability and selection processes at the most useful level of analysis

5 Rigidity Inducing Processes: The Big Four Excessive behavioral governance by verbal rules / cognitive relations Avoidance, especially of experiences The conceptualized self ( ego ) Diminished contact with the present moment

6 Undermining Inflexibility / Fostering Flexibility 1. Foster greater openness: a. Undermine excessive literality and encourage cognitive flexibility b. Undermine avoidance and encourage emotional flexibility

7 Undermining Inflexibility / Fostering Flexibility 2. Foster greater awareness: a. Foster flexible, voluntary contact with the present moment b. Undermine the conceptualized self and foster a perspective-taking sense of self

8 Undermining Inflexibility / Fostering Flexibility 3. Foster choice and engagement a. Foster values choices b. Foster larger patterns of flexible and effective action linked to chosen values

9 Stated Another Way: Psychotherapy is a Means of Fostering Psychological Flexibility is contacting the present moment more fully as a conscious human being, as it is, not as what it says it is, and based on what the situation affords, changing or persisting in behavior in the service of chosen values. This is also the model underlying ACT

10 Open Acceptance Essential Components of ACT Defusion

11 Contact with the Present Moment Acceptance Essential Components of ACT Defusion Centered Or Aware Self as Context

12 Contact with the Present Moment Actively Engaged Acceptance Values Essential Components of ACT Defusion Committed Action Self as Context

13 The Core of Psychotherapy Establish a relationship that models, instigates, and supports psychological flexibility

14 Development: Facing Failure The technological model (syndromes and packages) Purpose is to get to functional units: diseases with known etiology, course, and response to treatment

15 Facing Failure Result: Not a single psychiatric disease; not a single biological marker that is sensitive and specific Manual proliferation; slice and dice; weakly fitted to individuals The model does not tell you want to do next

16 Facing Failure Functional analysis ran into the wall of human cognition It too does not tell you what to do next

17 What we Wanted A modern form of functional analysis and a development system that is practical It was not linear but a lot of this happened in the 15 year gap in ACT outcome research

18 Get Clear on Assumptions: Functional Contextualism Basic unit: the act-in-context Whole is primary; parts are derived Truth criterion: successful working Goal: prediction-and-influence with precision, scope, and depth

19 If You Need Principles, Develop Then Mutual interest model: basic and applied psychologists working on the same domain We began with rule governed behavior, which lead to language and cognition Result: Relational Frame Theory

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21 Thankfully, It is Getting Easier

22 How to Have Practical and Progressive Theories: Always Have Two Embraced multi-level analytic abstractive theories Mid-level terms for ease of use linked to inductively derived behavioral principles

23 The Hexagon is a Mid-Level Theory It is like OS X or Windows RFT is like C++

24 Model of Theory Development

25 Practically Filtered Procedures Targeting Core Processes Breadth Public health perspective Dissemination Practicality

26 Tested Not Just by RCTs (About 53) But Also by Effectiveness 3 studies Mediation About 25 Moderation About 8 Component analysis About 70 Training studies All being done in a reticulated fashion

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28 Finally, Nesting it Inside Evolution Science The behavior of organisms is a single field in which both phylogeny and ontogeny must be taken into account (Skinner, 1977)

29 ACT and Evolution Evolution in four words: Variation and selective retention ACT in a few more: Undermine repertoire narrowing processes Situate action in the conscious present Choose your selection criteria Evolve a more vital life

30 The Advantages of Seeing Psychotherapy Development This Way 1. You can end up with pragmatically useful basic contextual theories to give away and to apply elsewhere

31 Impact of Relational Training on IQ: Normal Children (8 to 12 y o)

32 The Advantages of Seeing Psychotherapy Development This Way 2. You end up with empirically supported processes and procedures, not just name brand packages

33 The Advantages of Seeing Psychotherapy Development This Way 3. You can target an incredible range of problems with the same principles and processes Let me prove that with the 5 RCTs published on ACT in JCCP over the last decade

34 Impact on Rehospitalization 1.0 ACT Treatment as Usual Days After Initial Release

35 and it Mediates Outcomes AAQ (Diabetes) 10 Change in Follow up 50% Self- Management 50% % in Diabetic Control 5 25% 25% 0 0% 0% Ed n ACT Ed n ACT Ed n ACT

36 Subsequent Use of Pharmacotherapy ACT plus Education Control plus Education Three months later ACT group reports a large increase in actually using pharmacotherapy more frequently. p <.001 Pre Phase 3 month Follow - up

37 OCD

38 Shame Outcomes: Better for TAU Average Score TAU ACT 85 Pre Post

39 Group ACT for Shame: Substance Use Outcomes TAU ACT 1 Month Follow Up Days / Month Using Drugs or Alcohol

40 Group ACT for Shame: Substance Use Outcomes 6 Days / Month Using Drugs or Alcohol TAU ACT d = Month 2 Month 3 Month Follow Up

41 Average Score Shame Outcomes r with use at follow up = -.51 (p <.01) ACT TAU r with use at follow up = ns Pre Post 3 Mo F-Up

42 We Call This Approach Contextual Behavioral Science We hold our 10 th World Conference in DC this July; 5000 members strong A German chapter is forming right now