Supercharging therapy with values
Dr. Joseph Ciarrochi,
School of Psychology, University of Wollongong
Structure of talk
• Part 1 Theory
• Part II. Behavioral Activation
– Evidence behavioral Activation is effective.
• Part III: Values clarification
– Evidence values clarification is effective
– How to work with values
Part I: A Unified Theory
What happens to people’s
dreams?
• “The very great majority kill themselves
long long before their time.
• Live as children; grow pale as
adolescents; show a flash of life in love;
die in their twenties and join the poor
things that creep angry and restless
about the earth”
(O’Brian, 1991, p. 526).
ACT as a Unified framework
An extremely brief and pictorial
description of Relational Frame Theory
Fusion and Avoidance, two key
processes that play a role in interfering
with value-congruent living
How do we lose touch with what we value?
Fusion is the dominance of particular verbal functions
over other potentially available nonverbal and verbal
functions (Hayes et al., 1999).
Fusion and avoidance. Fusion makes it possible for our private experiences (the bees above)
to seem like physical threats. It allows us to spend time avoiding our experiences, just as we
would avoid an outside threat
Avoidance takes a great deal of energy and is often
inconsistent with other activities, e.g., distress
provoking valued-activities
Desire (or values) and fear are two sides of the same coin. If
can’t have distress, then you often must give up what you
desire or value
Acceptance and Commitment Therapy
(ACT) and Behavioural Activation (BA)
• Shared philosophy of science: Functional
Contextualism
– Behaviourist
– Emphasis on functional analysis
– Emphasis on context rather than content
• Shared therapeutic processes
– Activation of behaviour
– Undermining of harmful avoidance behavior
– Mindfulness
– Exposure
Distinctions between ACT and
BA
• ACT is based on a behavioral theory of language. Like
traditional CBT, ACT views cognition as playing a key
controlling role in suffering. However , ACT and traditional
CBT differ in how they conceptualize and treat client problems
(Ciarrochi & Bailey, 2008).
•
•
Cognitive Defusion. ACT attempts to change the way one interacts
with or relates to thoughts by creating contexts in which their unhelpful
functions are diminished.
Self-as-Context- ACT helps people to contact with the sense of self as a
locus or perspective (e.g., the “observer” self). This self gives clients a
place to observe their experience and learn to let go of unhelpful selfevaluations. They learn that they are not the same as their evaluations;
they are not the same as their pain, their depression.
Distinctions between ACT and
BA
• Activities versus values
• ACT tends to emphasize values more
than traditional BA, which focuses a bit
more on activity scheduling
Part II: Behavioral Activation
Study 1 supporting BA as“well-established”
treatment for depression (Chambless et al., 1996)
• McLean and Hakstian (1979) JCCP. Behavior
therapy superior to other therapies at immediate
follow-up (9 of 10 indices), and marginally superior
on follow-up (7 of 10 indices)
• Behaviour therapy had lowest dropout (5% compared
to 26% to 36% for other treatments)
Study 2 supporting BA as“well-established”
treatment for depression (Chambless et al., 1996)
• Jacobson et al. , 1996, (JCCP) compared three
conditions.
• Conditions
– Behavioural Activation (BA)
– BA + automatic thought challenging (ATC)
– BA+ATC+ downward arrow/core belief
• Results
– Behavioral activation alone was as effective in treating depression
as BA combined with cognitive interventions.
– Gortner et al. 1999 showed effects held at 2 year follow-up
More research supporting behavioural activation
Dimidjian et al., 2006, JCCP. Study of Major
Depression
•
•
•
•
Compared behavioural activation to Cognitive Therapy and
Antidepressent medication (ADM)
BA found to be comparable in efficacy to ADM, and more efficacious
than CT.
Differential treatment effects obtained only for most severely depressed
For more severly depressed participants, BA and ADM comparable
Cuijpers et al., 2007 CPR. Meta-analysis
• BA effective (effect size =.87) and effects fairly
consistent across studies
Is behavioral activation effective for other
disorders, such as anxiety?
• ACT theory posits similar processes: fusion and avoidance.
• Approximately 50% of individuals with depression have a
coexistant anxiety disorder ( Kessler et al., 1996; Mineka, Watson, and Clark, 1998)
• Anxiety and depression share many symptoms (e.g., difficulties
concentrating, restlessness, fatigue, and sleep problems.
• Decrease in control and predictability may be common in both
disorders
• Anxiety and mood disorders may be variable manifestations of
similar neurobiological processes (See Hopko, et al., 2006, for review of similarities
between anxiety and depression)
Exposure in the service of activating valued
behaviour
Is behavioral activation useful in
treating anxiety
• Small study of pure B.A. with PTSD
shows B.A. was effective
• Social anxiety: Exposure is as effective
as CT and full CBT package in treating
social anxiety
• ACT, with big BA component, is
effective in treating anxiety
(Jakupac, et al., 2006)
(Powers, et al., 2008)
(Block, & Wulfert, 2000;
Dalrymple & herbert, 2007; Forman et al,2007; Zettle, 2003)
Part III: Values
What are values?
• Wilson, Sandoz, Kitchens, and Roberts, 2008,
under review
• 1) Values are ongoing patterns of activity
– Not achievable, can’t be completed
– Goals are achievable and serve values
What are values?
• 2) values are a special class of reinforcer
– Can me distant in time, and occur in tiny increments
– Can refer to benefits that , in principle , could never contact
(e.g., afterlife)
What are values?
• 3) values are verbal
– Language makes present psychological
functions without direct operant or classical
conditioning processes
What are values?
Values are a special class of reinforcers that
are verbally constructed, dynamic, ongoing
patterns of activity, for which the predominant
reinforcer is intrinsic in the correspondence
between the individual behaviour and valued
behavoural pattern (Wilson, et al., 2008)
Values, what are they good
for?
• Values have tremendous transformational power
• Theoretically, values set up the possibility for
behaviours to become more reinforcing or punishing
because of their relation to value statements
Empirical evidence: Values work is likely to be
good for the client
Values affirmation buffers the stress
response
•All participants rank order values in terms of
personal importance
•Trier social stress task—involves telling
subjects they will have to do stressful speech
task and mental arithmetic.
Cresswall et al., 2005, Psychological Science
Values affirmation buffers the stress
response
Affirmation manipulation
•Answer question like: Assuming that you have
sufficient ability, would you prefer to be (a) a
banker (b) a politician
•Experimental condition. Answered questions
relating to top-ranked value
•Control. Answers questions relating to fifth
ranked value
Salivary cortisol response to stress in the
value-affirmation and control groups
Pretest and postest self-report stress measure, as function
of self-resources (self-esteem and optimism)
Value affirmation improves objective
performance
• Cohen et al., 2006, Science
• Theory
1. People are motivated to maintain self-integrity
2. Negative group characterizations (e.g., black
stereotypes in U.S.) pose chronic threat to selfintegrity
3. This threat, if too severe, can undermine
performance
Value affirmation improves objective
performance
• Main study and replication
• Treatment and control condition presented a list of
values
• Treatment condition: indicate most important values.
Write about why value important to you
• Control condition. Indicate least important value and
why this value might be important to someone else
Values clarification and tolerance for
pain
Is their benefit to connecting pain-related
thoughts to actions in a valued direction?
Paez-Blarrina, M. et al., 2007, Behavior Modification; Paez-Blarrina et al.
,2008, Behaviour Research and Therapy
Values clarification and tolerance for
pain
Pain task
1. Perform cognitive task. If do well, get points, which
can be exchanged for a reward at the end of the task.
2. Red asterisk appears on screen.
1. If choose “finish”, then task ends and no shock.
2. If continue, more chance for points but also a
shock. (this is behavioural measure of pain
tolerance)
Values clarification and tolerance for
pain
Key Conditions
•ACT-values protocol—depicted pain as a part
of valued action
•Control-values protocol—pain is opposed to
valued living
•No values protocol
Values clarification and tolerance for
pain
Findings
•7/10 ACT-values intervention tolerated maximum number of
shocks; Only 1/10 and 2/10 tolerated in the control and untrained
condition, respectively.
•Pain believability. Do you keep going even when you think the
task is causing you “very much pain.”
•9/10 kept going in ACT-values; Only 5/10 and 3/10 kept going in
the control and untrained conditions respectively
•These differences were significant
Measuring and using values in
therapy
ACT intervention
Survey of Life Principles
Past research in values
• Values work (Schwartz, et al., Rokeach et al.).
– What is most important to you?
– Are there Universal values?
• Personal strivings (Sheldon, Emmons, Deci).
– What do you strive for
– Why do you strive? Is it for authentic or controlled
reasons?
• We will call both of these “guiding principles” for
ease of reference
Towards a behavioural approach to values and
goals: Recasting Needs
• Both value and striving literature seek to identify
universal needs that underpin all guiding principles
• Need is identified by observing that positive
psychological consequences result from conditions
that allow its satisfaction and negative consequences
accrue in situations that thrwart it (deci and ryan, 2001, pg 229)
• Instead of speaking in terms of “needs”, I will speak
in terms of categories of reinforcer.
Towards a behavioural approach to values and
goals: type of rule following
• Pliance- rule governed behavior under control of apparent speakermediated consequences for a correspondence between the rule and the
relevant behavior. (Zettle and Hayes, 1982; Hayes, Wilson, and Stroshal,
2001)
• Factors that impact pliance
– ability of speaker to monitor compliance, and deliver consequences
– importance of consequences to listener
– others (history, credibility; Hayes and zettle)
• Problem with pliance. Excessive pliance, e.g., wanting to “be good”
and please others, can dominate over ones direct, personal expeirence
of what works
• Reinforcers are arbitrary
Towards a behavioural approach to values and
goals: type of rule following
• Tracking- rule governed behavior under control of apparent
correspondence between the rule and the way the world is
arranged. (Zettle and Hayes, 1982)
• Factors that impact tracking
– Listeners history with the rule giver
– Correspondence between the rule and other rules or events in
the listener’s history
– Importance of the consequence implied by the rule
– Extent rule successfully leads to reinforcement, avoid
punishment
• Speaker does not mediate compliance (e.g., the rule could be
conveyed by a book and have the same effect); (Hayes and Zettle, 1982)
Recasting Self-Determination Theory in
behavioural terms.
Pliance
Deci and Ryban, 2000, psychological science
Tracking
The ImPActS intervention model
Importance
Important principles are expected to involve
tracking
ACT can be used to help people discover what
principles are or are not important to them.
Pressure
ACT can be used to undermine the power of
unhelpful, pliance-based principles
Activity
ACT can be used to increase the amount of
principle-congruent activity and the likelihood of
contacting reinforcers
Success
ACT can be used to increase people’s success at
living principles (e.g., via overcoming barriers and
reinforcing commitment)
Research on values
• The area emphasizes the Importance
component of the ImPActS model.
The structure of values
(Schwarz)
Values and behaviour
• ImPActS
• Values importance has predicted more than 15
different behaviours
• e.g., voting for political party, choosing a
university course
• Other predicted behaviours: delinquency,
cooperation, competition, consumer
purchasing, environmental behaviours,
religious behaviours
(See Bardi and Schwartz, 2003)
Values and well-being
• ImPActS
• The following were positively related to subjective well-being
– Achievement: Personal success through demonstrating competence
according to social standards. (Successful, capable, ambitious,
influential)
– Stimulation: Excitement, novelty, and challenge in life. (Daring, a
varied life, an exciting life)
– Self-direction: Independent thought and action-choosing, creating,
exploring. (Creativity, freedom, independent, curious, choosing
own goals)
•
Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc
Values and well-being
• ImPActS
• The following were negatively related to well-being
– Conformity: Restraint of actions, inclinations, and impulses
likely to upset or harm others and violate social expectations
or norms. (Politeness, obedient, self-discipline, honouring
parents and elders)
– Security: Safety, harmony and stability of society, of
relationships, and of self. (Family security, national security,
social order, clean, reciprocation of favors)
–
Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc
Values and well-being
• ImPActS
• The researchers failed to find a positive association of subjective
well-being and
– Universalism: Understanding, appreciation, tolerance and protection for the
welfare of all people and for nature. (Broadminded, wisdom, social justice,
equality, a world at peace, a world of beauty, unity with nature, protecting
the environment)
– Benevolence: Preservation and enhancement of the welfare of people with
whom one is in frequent personal contact. (Helpful, honest, forgiving, loyal,
responsible)
• Seemed inconsistent with the notion that concern for others
rather than self promotes subjective well-being
• A false dichotomy?
•
Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc
Succeeding at what is important to
you
• ImPActS
• Congruity between people's values and their environment
promotes well-being, regardless of the particular values to which
people ascribe importance.
• Power values were negatively associated with well-being
amongst psychology students, and higher satisfaction amongst
business administration students. The business folks were also
happier the more they were into achievement values.
•
Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc
Succeeding at what is important to you
• ImPActS
• Life satisfaction influenced when satisfied in value-congruent
domain.
• More specifically, global life satisfaction was strongly influenced
by social life for individuals high in Benevolence values,
whereas it was strongly influenced by family life for individuals
high in Conformity values.
• Satisfaction with grades was a stronger predictor of global life
satisfaction for individuals who stress achievement than for those
who do not.
• Within-individual variation of day-to-day satisfaction is strongly
influenced by daily success with the most valued domain.
•
Oishi, et al., j of personality, 1999
Personal strivings
• Key Researchers: Sheldon, Emmons, Elliot, and
Others
• Idiographic. People describe their own personal
strivings and do not select from a set items, as in
values work
• Emphasis on Self-concordance. To what extent do
people pursue their goals because the goals fit with
their underlying interests and values rather than
because others pressure them to pursue the goal.
Universal “needs, “ or categories
of reinforcer
• Competence or “effectance—propensity to
have an effect on the environment as well as
to attain valued outcomes within it.
• Relatedness -- desire to feel connected to
others, to love and care, and to be loved and
care
• Autonomy refers to volition—the organisimic
desire to self-organize experience and
behavior and to have activity be concordant
with one’s integrated sense of self
Personal strivings: key findings
• Self concordance relates to subjective well-being across many
cultures (Sheldon, 2002; Sheldon et al., 2004)
• Longitudinal study. Making progress towards goals predicted
well-being. However, this depended on the “organismic
congruence” of the goal. That is, goal achievement led to
increased well-being for those people who pursued goals for
more autonomous reasons, and those goals that are oriented
towards more intrinsic outcomes (Sheldon and Kasser, 1998)
• This relates to Importance and Pressure in the ImPActS model
Personal strivings: Avoidance goals
• Elliot and sheldon (1998) coded goals in terms of approach and
avoidance
– Approach goals: get in good shape, be more gentle and
humble
– Avoidance goals: avoid procrastination, don’t be lazy
• People with avoidance goals tend to feel less competent and in
control and experience greater reporting of physical symptoms
(Elliot and Sheldon, 1998)
• Elliot, Sheldon, and Church (1997) had students classify goals
as approach oriented or avoidance oriented. Avoidance striving
was deleterious to both retrospective and longitudinal well-being
The survey of life principles (SLP)
• Ciarrochi and Bailey, in press; Stefanic and Ciarrochi, 2008;
Frearson and Ciarrochi, 2008
• The SLP attempts to combine the best parts of the values
literature and the personal strivings literature, and attempts to do
so in a way that is useful to clinic
• SLP provides people with wide variety of principles to choose
from. This has the advantage of prompting people to think about
principles they might have not considered for awhile, or might
have forgotten
• SLP measures extent principle is due to self versus other pressure
The survey of life principles (SLP)
• 53 items, sampled to cover every major domain identified in
values literature, goals literature, and job interests literature.
– Somewhat heavy emphasis on social principles, given their
clinical relevance.
– Three items related to experiential control (e.g., “having a
stress free life”)
• Principles written in a verb form, in keeping with the ACT
definition of values as being “ongoing patterns of activity.”
• Principles were written to have maximal personal relevance (e.g.,
“A world of beauty” changed to “creating beauty”)
The survey of life principles (SLP)
• Items are call “principles”, because they could refer to
either values or abstract goals (e.g., “being honest”
might be either value or goal)
• Two open end items for people to write down own
principles
Four dimensions of the SLP
1) Importance. The extent a person finds princple to be
personally imporant
2) Pressure. The extent person feels pressured to hold
principle. Pressure can come from other people,
groups, media, society, etc.
3) Activity. Each principle is rated in terms of whether
the person wanted to put it into play
4) Success. If person wanted to put a principle into
play, then they rated that principle in terms of their
level of success.
SLP: Early findings
•
First study conducted with 300 University Students
–
•
We focused on variables of interest to clinicians: e.g.,
measures of emotional well-being, psychological wellbeing, social support, and relationship satisfaction
The next study will be conducted later this year with
600 year 12 adolescents. We have been conducting a
longitudinal study with these students for 7 years.
–
–
Includes broad range of measures related to social and
emotional well-being
Involves ratings by peers and teachers
Each SLP global score makes a distinctive
contribution to well-being
Importance
Female
Male
Pressure
Activity
Success
Description
Low scores indicate the
person finds few principles
to be important
High scores indicate the
person feels pressure from
others to hold principles
Low scores indicate that the
person is putting reduced
number of principles into
play
Low scores indicate that the
person is not succeeding at
principles
Low Score
5.81
Mean
6.51
High Score
7.19
5.90
5.57
3.14
6.57
6.3
4.54
7.24
7.03
5.98
23.63
31.18
38.73
3.05
3.48
3.91
SLP Global scores and emotional
well being
Global score
Positive Affect
Sadness
Hostility
Importance
.10
.08
.11
Pressure
-.10
.11*
.12*
Activity
.22**
.01
-.09
Success
.36**
-.34**
-.31**
Variance
explained
23%
14%
12%
*p < .05; ** p< .01
Note: These are the Betas from regression analysis. All variables were
entered simultaneously, so Beta represents the unique variance
explained by each global score, after controlling for the other scores
SLP Global scores and Psychological
well-being
Global score
Autonomy
Relations with
others
Purpose
Importance
-.12*
.08
.27**
Pressure
-.25**
-.15**
-.12*
Activity
.11
.04
.14**
Success
.30**
.36**
.39**
Variance
explained
18%
18%
29%
*p < .05; ** p< .01
Note: These are the Betas from regression analysis. All variables were
entered simultaneously, so Beta represents the unique variance
explained by each global score, after controlling for the other scores
Predicting social wellbeing
Global score
Romantic
relationship
satisfaction
Social
support
numbers
Social
support
satisfact.
Global Success
.12
.09
.18*
Prosocial Import.
.24**
.07
.12*
Having genuine and close
friends-success
.00
.20**
.14*
Having relationships involving
love and affection-success
.41**
-.04
.21**
Variance explained
32%
7%
20%
*p < .05; ** p< .01
Note: The global score “success” was the only one to uniquely predict each of
the social well-beings. However, prediction was much improved by using the
more specific social principles
Resisting pressure?
3.7
3.6
Success
3.5
3.4
Low Pressure
High Pressure
3.3
3.2
3.1
3
Low Importance
High importance
One needs to look at local as
well as global indices
• Importance of power not related to wellbeing. Indeed , it is related to higher
hostility
• Importance of wealth was not related to
well-being
Top 10 most important values
1
Having genuine and close friends
2
Being loyal to friends, family, and/or my group
3
Maintaining the safety and security of my loved ones
4
Having relationships involving love and affection
5
Feeling good about myself (experiential control item)
6
Striving to be a better person
7
Experiencing positive mood states (experiential control item)
8
Being Honest
9
Having an enjoyable, leisurely life
10
Being safe from danger
Top 10 most pressured values
1
Meeting my obligations
2
Being ambitious and hardworking
3
Being physically fit
4
Showing respect to parents and elders
5
Eating healthy food
6
Being honest
7
Being self-sufficient
8
Striving to be a better person
9
Being competent and effective
10
Being safe from danger
Top 10 most successful values
1
Being loyal to friends, family, and/or my group
2
Enjoying food and drink
3
Being safe from danger
4
Having genuine and close friends
5
Being honest
6
Maintaining the safety and security of my loved ones
7
Making sure to repay favors and not be indebted to people
8
Showing respect to parents and elders
9
Having relationships involving love and affection
10
Enjoying music, art, and/or drama
Top 10 failures
1
Leading a stress free life (experiential control)
2
Having a sense of accomplishment and making a lasting contribution
3
Promoting justice and caring for the weak
4
Gaining wisdom and a mature understanding of life
5
Being wealthy
6
Being at one with god or the universe
7
Feeling good about myself (experiential control)
8
Striving to be a better person
9
Being physically fit
10
Having an enjoyable, leisurely life
13
Experiencing positive mood states (experiential control)
Note: Failure index= Importance – success.
Principle compatibilities and
incompatibilities
Principle
• Having genuine and close friends
•
•
•
Perceived compatibilities
Being loyal to friends, family, and/or my group
Having relationships involving love and affection
Emotion control principles (e.g., Leading a stress-free life,
feeling good about myself)
Perceived incompatibilities
• Gaining wisdom and a mature understanding of life
• Artistic principles
Comment
• Surprising disconnect between many pro-social principles (e.g.,
honesty) and friendship
•
•
•
•
•
Principle
Having relationships involving love and affection
Perceived Compatibilities
Having genuine and close friends
Maintaining the safety and security of my loved ones
Being sexually active
Being safe from danger
Perceived incompatibilities
• Sensation seeking principles (Having a life filled with adventure)
• Nonsocial activities (Building and repairing things; working
outdoors)
Comment
• Where are the prosocial virtues? Honesty, loyalty, helping others
•
•
•
•
•
•
•
Principle
Prosocial : Being loyal, honest, maintaining security and safety
of loved ones, respecting parents and elders, helping others
Perceived Compatibilities
Being safe from danger
Resolving disputes
Showing respect for tradition
Perceived incompatibilities
Power (e.g., having influence; having authority, being in charge)
Sensation seeking
Artistic
Principle
Being wealthy
Perceived Compatibilities
•
•
•
•
•
Power principles
Sensation seeking principles
Achievement principles
Being sexually active; being sexually desirable (both M and F)
Emotion control
Perceived incompatibilities
•
•
•
•
•
Helping others
Being at one with nature
Being at one with god
Being artistic
Promoting justice and caring for the weak
Principle
Power: having influence of people, having authority, being in
charge
Perceived Compatibilities
• Achievement principles (e.g., being ambitious and hard working)
• Being sexually desirable
Perceived incompatibilities
•
•
•
•
•
•
Being honest
Respecting parents and elders
Helping people
Being at one with nature
Being at one with god, practicing religion
Promoting justice and caring for the weak
Utilizing the SLP
Importance ratings
1. What do clients value most? What is likely to be the
subject of therapy
2. Values themes. Social. Power. Art? Achievment
3. Look out for low global values ratings. Might
suggest a client has no idea what they value, or
refuses to acknowledge values
Likely intervention:Values clarification (see card
sorting task)
Utilizing the SLP
Restricted range of principles
•
Clients may endorse very few principles as
important.
• They may endorse several as important, but state that
they have not tried to put them into play.
• Finally, they may rate a number of value clusters as
unimportant
• What are the barriers to putting the values into play?
Likely interventions: acceptance, defusion, or
overcoming practical barriers?
Utilizing the SLP
Dominance of experiential control items
•
High importance on experiential control dimension
• Nothing inherently wrong with experiential control,
unless in conflicts with other important principles
Likely interventions: Creative hopelessness,
acceptance
Utilizing the SLP
Presence of strong pressure
• Research suggests that pressured principles tend not
to lead to vital living or well-being (Sheldon &
Kasser, 1995) and tend to be associated with hostility
and sadness (Stefanic & Ciarrochi, 2008).
• Danger of contercompliance: In reaction to pressure,
the client refuses to act according to the principle, or
acts contrary to the principle
Utilizing the SLP
Presence of strong pressure: Interventions
• Therapist behaviours: acting with humility in session,
undermining your own authority, encouraging clients
to not believe anything you say
• Remove source of pressure. E.g., imagine nobody
knew you were living the principle. Would you still
live it?
• Seek to identify past experience that was vital. E.g.,
sweet spot exercise. Connect their valued statements
to this vital past
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