Measuring the process of Measuring the process of valuesvalues

Tobias LundgrenTobias Lundgren

Karolinska Institute, Clinical Neuro science Karolinska Institute, Clinical Neuro science

Department of Psychology Stockholm UniversityDepartment of Psychology Stockholm University

AgendaAgenda

• Talk about the process of developing a Talk about the process of developing a values instrument values instrument – Pedagogical tool, clinical tool, outcome and Pedagogical tool, clinical tool, outcome and

process measureprocess measure

• Pros and consPros and cons

• Results you get from BEVSResults you get from BEVS

The development The development

• Started as a clinical tool, community developmentStarted as a clinical tool, community development

• Home work, building session contexts, diaries, etc Home work, building session contexts, diaries, etc etcetc

• Measure therapeutic progress with values as Measure therapeutic progress with values as reference not only symptom relief or predefined reference not only symptom relief or predefined quality of lifequality of life

• Closer to behavior that potentially reinforce new Closer to behavior that potentially reinforce new behavior repertoires behavior repertoires

• Attempted to move away from categorical self Attempted to move away from categorical self report measures to criterion related onesreport measures to criterion related ones

Far from

In vicinity

Close

Bullseye

Value: Friends

Direction: respect, have fun, be able to talk about all kind of things, closenessGive support,

Place an X on the dartboard on the place that best represents how close you came towardsbeing in your valued direction during the last to weeks

Far from

In vicinity

Close

Bullseye

5 B) How often are you doing things you want to do in the face of difficulties and emotional resistance? Place an X on the dartboard were it best represents how you live in the face of difficulties.

5 A) What stands between you and the life you want?______________________________________________

___________________________________________________

___________________________________________________

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In sum, four things to doIn sum, four things to do

1)1) define a value, define a value,

2)2) Score and measure the distance between how Score and measure the distance between how things has been during the last 2 weeks and how you things has been during the last 2 weeks and how you want things to be, want things to be,

3)3) evaluate barriers/what stops you from living in that evaluate barriers/what stops you from living in that direction, Score that as well…direction, Score that as well…

4)4) define steps you would be willing to take, together define steps you would be willing to take, together with all your fears to move closer towards your valueswith all your fears to move closer towards your values

Development of the BEVSDevelopment of the BEVS

• Started by asking persons in different Started by asking persons in different cultures what they really valued in life if cultures what they really valued in life if fears and obstacles was put aside for a fears and obstacles was put aside for a momentmoment

Descriptive statistics of the total number of Descriptive statistics of the total number of valued choices described in categories and the valued choices described in categories and the mean distance from B-E. (N=84). mean distance from B-E. (N=84).

Chosen valuesChosen values Number Number RelationsRelations 4444LeisureLeisure 1212Work/educationWork/education 2626Health Health 22Total Total 8484

My life is just as I want it to be

My life is far from how I want it to be

Work/ Education

Leisure

Personal growth/Health

Relation-ships

Psychometrics Psychometrics

• Did the work around the BEVS validity, Did the work around the BEVS validity, reliability, factor analysis etc etc. reliability, factor analysis etc etc.

• Used it in studies and it worked both as Used it in studies and it worked both as outcome and process measureoutcome and process measure

There are pros I thinkThere are pros I think

• Clinically helpfulClinically helpful

• Create a context of values right from the startCreate a context of values right from the start

• Clients define contentClients define content

• We measure what we want to changeWe measure what we want to change

• Fits well with the functional analysisFits well with the functional analysis

• Step towards evaluating mechanisms of changeStep towards evaluating mechanisms of change

• You can be flexible and use the Bull’s-Eye You can be flexible and use the Bull’s-Eye metaphor in different ways BUT metaphor in different ways BUT

Some ConsSome Cons

• Sometimes hard to define values for clients, becomes goals, Sometimes hard to define values for clients, becomes goals, they donthey don’’t get what to do, therapists get confused etc. t get what to do, therapists get confused etc.

• Need to train administratorsNeed to train administrators

• Still self report even though clients themselves define the Still self report even though clients themselves define the contentcontent

• Content changes over time and we want to be sensitive to Content changes over time and we want to be sensitive to that even though one of the nice things with the measure is that even though one of the nice things with the measure is that it is not the content we are interested in it is the process that it is not the content we are interested in it is the process and research wise the scores. and research wise the scores.

Bulls-Eye in process researchBulls-Eye in process research

• In a treatment outcome study for persons In a treatment outcome study for persons suffering from epilepsy, pre to follow up changes suffering from epilepsy, pre to follow up changes in seizure reduction and increase in quality of life in seizure reduction and increase in quality of life were mediated through ACT processes such as were mediated through ACT processes such as values attainment, defusion, acceptance and values attainment, defusion, acceptance and persistency in living a valued life even in the persistency in living a valued life even in the face of difficulties and emotional resistance. face of difficulties and emotional resistance.

Lundgren, T., Dahl, J., Hayes, S. Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy, Journal of Behavior Medicine, In press.

A B C

N=27

Self rated scores on B-E

AB

C

N=27

Self rated scores on B-E

ACTST

Criterion-Related ValidityCriterion-Related Validity

• Correlations with acceptance and Action Correlations with acceptance and Action Questioner II (AAQ 2) N=148Questioner II (AAQ 2) N=148– Bulls-Eye TotalBulls-Eye Total -.26 *-.26 *– Bulls-Eye 1 (relations) -.38 *Bulls-Eye 1 (relations) -.38 *– Bulls-Eye 2 (work) -.25 *Bulls-Eye 2 (work) -.25 *– Bulls-Eye 3 (play) -.25 *Bulls-Eye 3 (play) -.25 *– Bulls-Eye 4 (health) Bulls-Eye 4 (health) -.29 *-.29 *

Criterion-Related ValidityCriterion-Related Validity

• Correlations with Satisfaction With Life Correlations with Satisfaction With Life Scale (SWLS) N=148Scale (SWLS) N=148– Bulls-Eye TotalBulls-Eye Total .47 *.47 *– Bulls-Eye 1 (relations) .45 *Bulls-Eye 1 (relations) .45 *– Bulls-Eye 2 (work) .32 *Bulls-Eye 2 (work) .32 *– Bulls-Eye 3 (play) .47 *Bulls-Eye 3 (play) .47 *– Bulls-Eye 4 (health) Bulls-Eye 4 (health) .51 *.51 *

Criterion-Related ValidityCriterion-Related Validity

• Correlations with Depression and Anxiety Correlations with Depression and Anxiety Scale (DASS) N=148Scale (DASS) N=148– Bulls-Eye Total Bulls-Eye Total -.42 * -.42 *– Bulls-Eye 1 (relations) -.27 *Bulls-Eye 1 (relations) -.27 *– Bulls-Eye 2 (work) -.27 * Bulls-Eye 2 (work) -.27 * – Bulls-Eye 3 (play) -.33 *Bulls-Eye 3 (play) -.33 *– Bulls-Eye 4 (health) Bulls-Eye 4 (health) -.38 *-.38 *

Reliability N=148Reliability N=148

• Pearson’s Correlation after repeated Pearson’s Correlation after repeated measuremeasure– Test re-test reliability .85Test re-test reliability .85

What to do?What to do?

• Use new technology to get closer to Use new technology to get closer to behavior and experiencing samplingbehavior and experiencing sampling

• Be aware of what kind of data you will get Be aware of what kind of data you will get when you use different ways of measuringwhen you use different ways of measuring

• Look for behavioral measureLook for behavioral measure

• Measure with different toolsMeasure with different tools

• Help each other to continue the Help each other to continue the developmentdevelopment

Contact informationContact information

• Tobias.Lundgren@psychology.su.seTobias.Lundgren@psychology.su.se