ACT for PARENTS with a Child with Autism Presented by Stephanie A. Sokolosky, EdD, BCBA-D, LBA, LSSP, LPA 1
Objectives Overview of ACT Training/Therapy Exploring ACT training for parents with a child/family member with autism or other disability 2
Acceptance and Commitment Therapy (ACT) Acceptance and Commitment Therapy/Training Based on radical behaviorism, functional contextualism, Relational Frame Theory (RFT), and Applied Behavior Analysis (ABA) ABA is one method that has been shown to be effective with individuals with autism ACT is a program that focuses on private events Hayes et al., 2003; Barnes-Holmes, Hayes, Barnes-Holmes, & Roche, 2002 3
Boat and Demons ACT clinicians use many metaphors Metaphor that exemplifies how private events are directly related to behavior Harris, 2009 4
Private event When talking about stress, the ABA world uses the term private event when discussing a covert stimulus (e.g., thought, image, physical sensation, emotion) or response (e.g., thinking, visualizing, remembering) (Skinner, 1974). These private events impact future behaviors, and are important in parenting. Private events are mediated by verbal repertoires. 5
What is ACT? ACT is a contemporary behavioral approach that supports the establishment of a healthy, flexible approach to managing difficult thoughts and feelings by addressing direct experiences (Hayes et al., 2003) ACT core concepts include mindfulness; identifying important personal values; increasing adaptive, flexible repertoires of behavior; and reducing rigid responses (Blackledge & Drake, 2013) 6
How is ACT related to Parenting? Raising a child with autism contributes to high levels of stress for parents (Eikeseth, Klintwall, Hayward, & Gale, 2015) Distress may contribute to a parent s ability to manage the child s behavior (Osborne, McHugh, Saunders, & Reed, 2008) This type of distress leads to aversive private events (e.g., unproductive thoughts, image, emotions, physical sensations) 7
How is ACT related to parenting? Private events are largely ignored in parent training literature (Snyder, Lambert & Twohig, 2011) ON CARD Write down a private event/thought about a difficult situation that you have experienced in your parenting (or other complex situation/responsibility) No one will see this Aversive in nature We will talk about this later 8
How is ACT related to Parenting? Contingency-shaped behavior touching stove and burning hand learn by consequences Rule-governed behaviors (RGB) told to not touch the hot stove Not learn by actual consequences of behavior Example: Not touch the door Hayes, Brownstein, Zettle, Rosenfarb, & Kom (1986) 9
How is ACT related to parenting? Rule-governed behavior may lead to narrowing our options Example: Have you ever said, I m never going to do that again. Think of our families who have a child with autism. 10
How is ACT related to Parenting? ACT is a method of learning to tolerate aversive events and using some of the ACT methods to increase your willingness to be more flexible with yourself and with others. 11
ACT for Parents Parent training model developed by Evelyn Gould, Jonathan Tarbox, and Lisa Coyne (Gould, 2017) Purpose of this research was to develop a program designed for parents who have a child with autism Overall goal was to examine the effects of ACT on values-directed overt behavior in parents and assessment the treatment effectiveness 12
ACT Core Processes Values Identification Mindfulness Defusion Acceptance Committed Action Hayes et al., 2003 13
Values Identification Values identification is a verbal statement identifying something/a condition/a person that motivates us to move Toward and contributes positively to our lives Some values help us identify things we want to move Away from experiential avoidance Some values are designed to support long-term positive reinforcers -- healthy lifestyle Some values support shorter term reinforcers (e.g. goal) Weight Watchers for today Hayes et al., 2003 14
Mindfulness Mindfulness in ACT training helps the individual attend to stimuli in the present moment (McHugh, Proctor, Herzog, Schock, & Reed, 2012) For our parents, mindfulness may be helpful when responding to difficult private events (Cachia, Anderson, & Moore, 2016) Increasing attention to the present moment may help parents notice important moments (e.g. child smiling) (Gould, 2017) 15
Defusion Fusion occurs when two conditions, thoughts, or events occur together (e.g., Do umbrellas cause rain?) De-fusion is a way of disrupting the fusion that may occur, which may lead to rigid thinking, and may lead to applying rules in a narrow way (Snyder et al., 2011) De-fusion helps us better experience and tolerate aversive experiences 16
Acceptance An approach response and/or the absence of an escape response in respect to aversive stimulation (Blackledge & Drake, 2013) For our parents, the goal of acceptance is to identify problematic private events, and learn new skills (behaviors) that help the parent become more comfortable when faced with these uncomfortable thoughts or emotions (Hayes et al., 2003) This is one of the most important components for our parents, since there are often chronic challenges (Blackledge & Hayes, 2006) 17
Committed Action The ultimate goal is for parents to identify actions that will help them be more adaptive as a parent, and lead to accomplishment of the parent values These skills are learned through shaping, selfmanagement, goal-setting, and behavior contracts What is one thing I can do differently today? Coyne, McHugh, & Martinez, 2011 18
Two Parent Measures Acceptance and Action Questionnaire II (AAQ-II; Bond et al., 2011) 7 item Likert scale Measures psychological flexibility in adults Lower score suggests greater levels of psychological flexibility Self-Compassion Scale (SCS; Neff, 2003) 26 item Likert scale Measures self-compassion in adults Higher score suggests greater self-compassion 19
The Parent Group Initial plan was to have a parent group with 3 parents This did not work, and became an individual training model Two parents completed the trainings Sessions included lecture, discussion, modeling, role-play and practice 20
Sessions Each session emphasized one component of the ACT Core Concepts Session 1 Values-based Session 2 Basic mindfulness skills Session 3 Defusion skills Session 4 The Matrix Session 5 Values Clarification Session 6 Self-care exercises 21
Parent Participants Self-report measures Acceptance and Action Questionnaire II (AAQ-II, Bond et al., 2011) Self-Compassion Scale (SCS, Neff, 2003) Pre-Post assessments Identified values and some behaviors related to the values Completed the 6 sessions Each session targeted one of the core concepts 22
AAQ-II Participant Results Sara Linda Pre Post Pre Post 23 21 14 17 25 20 15 10 Pre Post 5 0 Sara Linda 23
SCS Subscale mean scores Participant Sara Linda Pre Post Pre Post Self-Kindness 2.80 2.40 3.40 3.40 Self-Judgment 3.40 3.20 2.40 3.00 Common Humanity 4.00 5.00 2.40 3.00 Isolation 3.00 2.75 4.00 3.03 Mindfulness 3.00 4.25 3.75 3.27 Over-identification 4.25 3.75 2.75 3.50 24
SCS Results Sara 6 5 4 3 2 1 Sara Pre Sara Post 0 25
SCS Results Linda 4.5 4 3.5 3 2.5 2 1.5 1 Linda Pre Linda Pos 0.5 0 26
Lessons learned Homework is difficult for the parents to complete written documentation homework Verbal reports that the ACT methods were helpful on a daily basis The metaphors are helpful Implementing the new behaviors can happen very quickly With experience, understanding the importance in changing the relational frame is helpful with difficult private events 27
That s What ACT s All About Dr. Stephanie A. Sokolosky Stephanie.sokolosky @gmail.com 956 216 7552 Harlingen, Texas 28
References Blackledge, J. T., & Drake, C. E. (2013). Acceptance and commitment therapy: Empirical and theoretical considerations. In S. Dymond, & B. Roche (Eds.), Advances in Relational Frame Theory and Contextual Behavioral Science: Research and Application (pp. 219 252). Oakland, CA: New Harbinger. Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with Autism. Child and Family Behavior Therapy, 28(1), 1 18. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. C., Guenole, N., Orcutt, H. K., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire II: A revised measure of psychological flexibility and acceptance. Behavior Therapy, 42, 676 688. Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: a systematic review. Journal of Child and Family Studies, 25(1), 1 14. Coyne, L. W., McHugh, L., & Martinez, E. R. (2011). Acceptance and commitment therapy (ACT): Advances and applications with children, adolescents, and families. Child and Adolescent Psychiatric Clinics of North America, 20(2), 379 399. 29
References Dixon, M. R. (2014) ACT for children with autism and emotional challenges. Carbondale, IL: Shawnee Scientific Press. Eikeseth, S., Klintwall, L., Hayward, D., & Gale, C. (2015). Stress in parents of children with autism participating in early and intensive behavioral intervention. European Journal of Behavior Analysis, 16(1), 112 120. Gould, E., Journal of Contextual Behavioral Science (2017). http://dx.doi.org/10.1016/j.jcbs.2017.06.003 Harris, R. (2009). ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications. Hayes, S. C., Brownstein, A. J., Zettle, R. D., Rosenfarb, I., & Korn, Z. (1986). Rule governed behavior and sensitivity to changing consequences of responding. Journal of the Experimental Analysis of Behavior, 45(3), 237 256. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2003). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York, NY: Guilford Press. 30
References McHugh, L., Procter, J., Herzog, M., Schock, A. K., & Reed, P. (2012). The effect of mindfulness on extinction and behavioral resurgence. Learning & Behavior, 40(4), 405 415. Neff, K. D. (2003). The development and validation of a scale to measure selfcompassion. Self and Identity, 2(3), 223 250. Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1092 1103. Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2016). The essential guide to the ACT matrix: A step-by-step approach to Using the ACT matrix model in clinical practice. Oakland, CA: New Harbinger Publications. Singh, N. N., Lancioni, G. E., Winton, A. S., Karazsia, B. T., Myers, R. E., Latham, L. L., & Singh, J. (2014). Mindfulness-Based Positive Behavior Support (MBPBS) for mothers of adolescents with autism spectrum disorder: Effects on adolescents' behavior and parental stress. Mindfulness, 5(6), 646 657. Skinner, B. F. (1974). About Behaviorism. New York: Knopf. Snyder, K., Lambert, J., & Twohig, M. P. (2011). Defusion: A behavior-analytic strategy for addressing private events. Behavior Analysis in Practice, 4, 4 13. 31
ACT Matrix 5 SENSES -- BEHAVIORS AWAY TOWARDS ` MENTAL THOUGHTS/FEELINGS Polk, Schoendorff, Webster, & Olaz, 2016 32