A preliminary Experimental Analysis of Values-oriented and Defusion methods in ACT*

Rosa M. VizcaínoCarmen LucianoFrancisco J. RuizVanessa Sánchez

University of Almería, Spain

Olga Gutiérrez-MartínezUniversity of Barcelona, Spain* Actually published (see last slide)

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)

•A third wave, contextually based behavior therapy.

•Theoretically rooted in Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001).

•Effective in a wide range of psychological disorders, health problems, etc. (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Ruiz, 2010).

• ACT promotes psychological flexibility reducing problematic experiential avoidance by taking responsibility with own values even in the presence of discomforting private events (acceptance).

• ACT promotes acceptance through values clarification and defusion middle-level terms

• Metaphors and experiential exercises are main clinical methods to alter problematic regulation of behavior.

• However, the verbal processes or transformations defining these methods are still not well known.

Steps to alter problematic regulation…

• Valued oriented methods involve the verbal discrimination of what one wants, what one is doing to get it,

and the results in the short and the long terms It seems to work through comparative, temporal and perspective-taking cues.

• Acceptance methods involve the verbal discrimination of the paradoxical effects

It seems to work by changing from opposition to inclusion relations between valued actions and discomfort.

Steps to alter problematic regulation…

• Defusion methods aim the person behaves in the present moment under the control of the relevant stimulus function instead of behaving according to the literality or the verbal functions of thoughts/feelings

• Defusion methods take many forms and, perhaps, are the least understood in basic terms

• * Different types of components in exercises : “exposure to PE” “I and my PE” “the higher level, the self functions (what I want)”….

* … Different types of transformations

EXAMPLES… All verbal discrimination…

Defusion, type 1 or B*. …between the person as being here and their thoughts/feelings as being there (I-HERE-NOW and my thoughts THERE) Deictic relational cues

Defusion, type 2 or C*. …to establish a sense of self as a locus or perspective with INCLUSION functions: “I contain my thoughts”, etc Deictic and hierarchical relational cues

Defusion/self-as-context/values, type 3 or D*. … to potentiate the functions of the self as the “top” of the hierarchy to choose and direct the person`s behavior Deictic and hierarchical relational cues

*Luciano, Ruiz, Vizcaíno et al. (2011)

Current Study Preliminary attempt to isolate the

deictic and hierarchical transformations apparently involved in defusion exercises

Protocol “Defusion-I”Deictic framing

(type 1 or B)

Protocol “Defusion-II”Deictic & hierarchical

(types 1, 2 & 3 or B,C.& D)

Values-oriented session, (type 0 or A)

15 young students with problematic behaviors

METHOD

Participants• 15 adolescents (8 girls, 12-15 years) 3 groups of 4-7

• Selected among a pool of 81 Secondary school students based on high scores in BASC (behavioral and emotional problems in young children and teachers` reports

• Two profiles:

▫Impulsive (N = 7)

▫Emotional (N = 8).

• Two types of participants (explain later)

▫High-risk (N = 6)

▫Low-risk (N = 9)

Main Dependent VariablesSelf-report of impulsive (IBI) or emotional behaviors (EBI) 28 items assessing specific problematic behaviors with ratings of

frequency (0-10) Items with a rating of 4 or higher considered problematic

behaviors Examples of IBI items: Blaming other. Do things to be expulsed from the classroom. To hit my brothers or sisters. Examples of EBI items: To quit exams or not going classes when feeling anxious. Get closed in my room when feeling sad. Don’t talk with others because of fear to appear ridiculous

Main Dependent Variables

•A reduced adaptation of the Acceptance without Judgement scale of Kentucky Inventory of Mindfulness Skills (KIMS), as indicative of defusion.

•Spanish Adaptation of Avoidance and Fusion Questionnaire (AFQ), as indicative of experiential avoidance.

Criteria for Problematic Levels

•High level of problematic behaviors 6 or more problematic behaviors, High risk participants, N = 6

•Low level of problematic behaviors fewer than 6 problematic behaviors, Low risk participants, N = 9

Quasi-experimental design with repeated measures:

a between-subject variable with two levels: Protocol Defusion-I and Protocol Defusion-II

a within-subject variable: the repeated measures on the corresponding dependent variables, before, during and after the respective protocols

Defusion-I Low risk participants

Defusion-II Low and High risk participants

Design

Procedure Overview

Parents’ Consent:

81 students 1st, 2nd, &

3rd secondary studies (13-16 years)

Participantsassesment

and selection of

at-risk adolescents

Brief Values Session

(1 session)

DefusionProtocols(I or II)

3-4 sessions

Post and Follow-up4 months

Brief Values Session (paper and pencil anonymous task)

Goal: Discriminati

on own problematic behaviors

Write the things that you have

said you do a lot

How do you feel?

Now, imagine that you

keep doing these

things 5-10 more years

… what do you think

would happen?

Now, imagine that you

stop doing these

things ….What do you think

would happen? …And in

5-10 years?

Now that you realize

what would

happen in a few

years from now, what

do you choose to

do? …a) Stop

b) Continue

Identification

of Problematic

BehaviorsPerspective

Taking Choosing

Two Defusion Protocols

Deictic protocol (3/4 sesions 30-min)

MET with general private events

MET with problematic

private events *Notice your breath and do nothing*What thought are you having? * … put in a word?* … put in front of you?*Do nothing with it, only contemplate it.

Imagine that you were studying very difficult things all the day. What sensation would you have? What is the form of this sensation? Take a pictureOnly contemplate it.

Think in the moments where you feel bad or angry... What thought or sensation do you have?In a word… Put it in front of you…a photo…how it looks like? … do nothing but contemplate it.

DEICTIC FRAMING

Deictic & Hierarchical (3/4 ses 30-min)

MET with general private events

MET with problematic

private events

*Notice your breath and do nothing*What thought are you having? * … put in a word?* … put in front of you?*Do nothing with it, only contemplate it.Who is having that thought

Imagine that you were studying very difficult things all the day. What sensation would you have? What is the form of this sensation? Take a pictureOnly contemplate it. Respond to you who is having that thought

Think in the moments where you feel bad or angry... What thought or sensation do you have? ..I n a word… Put it in front of you…a photo…how it looks like? … do nothing but contemplate it.. See yourself letting the ...in charge…what you do when .. picture of that…you like… a word … See you in charge...You have room for your thoughts, feelings, etc. ¿Who do you like to be in charge? You or your thoughts/feelings?Choose: Stop or Continue?

DEICTIC & Hierarchical FRAMING

RESULTS

Low-risk Participants (N = 9)

Deictic

Deictic + Hierarchical

Low-risk Ss (N = 9)Defusion II: DEICTIC + HIERARCHICAL Exercises

Defusion I: DEICTIC Exercises

High-risk Ss (N =6)Defusion II: DEICTIC + HIERARCHICAL Exercises

DISCUSSION• The single values-oriented session impacted

in half of Ss, mostly Low-risk reduced PB

• Defusion I (deictic) /v/ II (deictic/hierarchy):

Only Low-risk Ss :

• Defusion I reduced but not maintained• Defusion II reduced and maintained zero at 4-m

FU• Reduction ran together to changes in AFQ &

KIMS• Age and type (impulsive or emotional) were not

relevant. • They valorated helpful in doing better

High-risk Ss: only Defusion II•A general reduction in all of them •More than half maintained at FU •Reductions and increases in PB correlated

with defusion measure (KIMS)•AFQ measure does not seem too sensible..

Better adaptation?•They valorared helpful in doing better

• Teachers: informal evaluation… •…student`s behaving as better. This

correlated with self-report changes

DISCUSSION

•Most participants benefit: doing better –reports- and not being instructed but making choices.

•Values oriented-session relevant with lower PB•Defusion I (exercises I-PE, there) not sufficient even

with Low-risk Ss.•Defusion II (exercises hierarchical cues). impacted and

maintained for Low-risk Ss.•Defusion II did also for High-risk Ss. but more

variability. More training or individually given?•The defusion exercises seem to work by increasing

acceptance without judment.• It seems relevant the relacional cues in the exercises to

alter the functions of private events.

CONCLUDING…

•D-II: It seems that framing of thoughts/feelings in a hierarchical context and given it explicit control functions made a relevant change.

•Defusion II protocol involved deictic and hierarchical cues. It was suited to potentiate: ▫ the self-as-context as the higher level of the hierarchy, and▫to potentiate its funcional role: the direction in behavior

regulation

•This is connected to Values, to Acceptance, and necessarily to Self-context and Be-present.

CONCLUDING…

•Replications with high and low. More Ss.•Adapted to school but more colaboration

needed•Similar profiles in the group•Experiential task as in basic studies•Direct measures of problems and valued

actions•Refining questionnaires measures (AFQ)• Isolation of the different relational cues in

Defusion II•…. Ongoing

Further research …