Generation I – Applied Behavior Analysis
Classical
Operant
Transition:
Stimulus → response
Stimulus → thought → response
Thought → emotion → behavior
Generation II – Cognitive Process Correction
Change Variable – Self-Talk
• Awareness of Self Talk
• Attention to Self Talk
• Analysis of Self Talk
• Alternatives to Self Talk
• Adaptation to Self Talk
Transition:
Social learning theory
Neural network learning theory – biological underpinning
Context → meaning
Generation III – Cognitive Reconstruction
Change Variable – Context
• Perception: specific experience sensations
• History: specific accumulation of experiences and meanings
• Attributions: externals/internals
• Expectations: optimistic/pessimistic
• Implications: different relationships
• Disposition: different sensibilities
•
Summary: Projected Generation IV – Prevention & Rehabilitation
This chapter is concerned with the development of behavior analysis and the scientific constructs that allowed for the incremental development of cognitive intervention in a second and third generation.
INTRODUCTION
The behavior intervention movement was designed to produce a scientifically based analysis of behavior problems, to develop the interventions cast in terms of basic psychological processes, and to develop well-specified and empirically validated intervention for defined problems. The major empirical observation concerned itself with:
Stimulus ————————Response
The type of response given had an impact on the frequency of the stimulus. When a stimulus was reinforced [rewarded], its frequency seemed to increase. When it was not reinforced, it tended to diminish. This Law of Effect lead to the idea that one could productively intervene by manipulation of the environment in which the client was functioning and an attempt to ensure that the environment reinforced [rewarded] what the constituents considered to be appropriate behaviors [following appropriate stimulus with positive responses]. While this process has had some major success, particularly with clients with developmental disabilities, it also had many failures. Most of the failures are reconciled with the belief that the clinician was unable to control all of the parts of the environment or did not properly carry out the process.
The Role of the School Psychologist
Usually the school psychologists if involved in first-generation change were responsible for the functional behavior assessment [FBA] and for the development of a behavior plan. They may or may not be responsible for the supervision of the person implementing the plan. As we move in to the second and third generations, we will identify similar functions: assessment, recommendation, design and either supervision and/or implementation. The last function will demand increasingly skilled counselors. This fact combined with increased responsibility for schools to provide psychological counseling may lead to increased implementation by psychologists. An alternative, particularly for the third generation implementation, may be to have the school psychologist develop and support an outside agency in the implementation process and monitor its performance.
TRANSITION
Of concern to clinicians and researchers in the first generation effort, was the concept of private thoughts and how these mediated an experience. These private thoughts seemed to mediate the behavioral response and, if contrary to the manipulation of the public response, affected the ability to prompt change.
“A private event may be distinguished by its limited accessibility but not, so far as we know, by any special structure or nature. We have no reason to suppose that the stimulating effect of an inflamed tooth is essentially different from that of, say, a hot stove. The stove, however, is capable of affecting more than one person in approximately the same way” (Skinner, 1953).
The distinction between private and public events is one of accessibility. The fact that private thoughts are inaccessible to the public does not imply that they do not follow behavioral laws. Private events are considered part of the causal chain, of behavior, although Skinner claimed that they could never be initiating causes, but only ever exert discriminative stimulus control.
Just how these private events discriminate is through the influence of the personal ‘meaning’ that the individual gives to the event or series of events and the development of an emotional reaction that is influenced by the selected meaning.
In other words, it is not the experience of the event that matters, but rather the interpretation of the event based on prior knowledge from prior experience.
Thoughts cause emotions. This is the essential insight of cognitive intervention. All cognitive techniques flow out of this one simple idea: that thoughts cause emotions. The many emotions people feel are preceded and caused by a thought, however abbreviated, fleeting, or unnoticed that thought may be. In short, you are the sum total of what you think. It also means that emotions are cognitive events, not biological.
Events by themselves have no emotional content. In fact, an event has no meaning at all until the person gives it meaning. It is the interpretation of an event that causes the emotions. The perceptions of an event are given meaning as good or bad, pleasant or unpleasant, and this determination leads to the identification of an emotion that is appropriate. All emotions are biographical – meaning that we select the appropriate emotion by reviewing the history of our experiences. The influence of thought is often represented as the ‘ABC’ model of emotions:
A. Event —> B. Thought —> C. Emotions
Knowledge is contextual. Consider a one-sentence definition [knowledge] of the word ‘set’. The word is said to have more definitions than any other word in the English language. Thus, the only feasible definition is that ‘set’ has a variety of meaning depending on the context in which it is used. To have a set of something is quite different from setting something down. You could, I suppose, set down a chess set – but that may be unsettling.
The core of human language and cognition is the learned and contextually controlled ability to arbitrarily relate events mutually and in combination, and to change the function of specific events based on their relationship to others experiences.
It may be helpful to cite examples:
A. Event: You are late to your locker and then cannot get the combination to work.
B. Thought: You interpret the event by saying to yourself, “Oh no, this is awful; I’m stuck—I’ll be late for class.”
C. Emotion: You experience an emotion appropriate to your thoughts. In this case, you may feel depressed and anxious about being late. Or perhaps you will feel anger, because you believe that someone else made you late.
Habituation & Automaticity
Redundancy Effects show that we generally lose consciousness of repeated and predictable events. Anything that is done repetitiously becomes habituated and automatic. This is why we practice. Athletes practice repetitions so that in a critical moment, they automatically do what is expected. When everything is going on automatically for the athlete, s/he describes it as ‘being in the flow’. In the same way, a repetition of thought becomes automatic. The language that we use to articulate these thoughts may be extreme and distorted or balanced and rational. “I am stupid!” is an extreme and emotional statement unlike expressing the same meaning by stating “I really don’t know what I am doing here!”.
Meaning is in the ‘eye of the beholder’. Meaning is derived by recalling other times an event like this happened and determining from memory what the outcome or reinforcement was. Thus, once an event is given a negative meaning, there is a tendency for this negative to escalate with future experiences that are similar to the first. In this manner ‘attitudes’ towards certain groups of phenomenon occur. I like/don’t like – fill in the blanks. Thus meaning and attitudes are learned covert behavior.
GENERATION II – COGNITIVE PROCESS CORRECTION
If we can change how we think about something, we can change the emotions we ascribe to it. And if our emotions change, we are predisposed to act differently. Distressing thought is caused by patterns of cognitive errors that are identified through ‘leakage’ from self-talk. These errors include, but are not limited to:
• Filtering: You focus on the negative details while ignoring all the positive aspects of a situation.
• Polarized Thinking: Things are black or white, good or bad. You have to be perfect or you’re a failure. There’s no middle ground, no room for mistakes.
• Overgeneralization: You reach a general conclusion based on a single incident or piece of evidence. You exaggerate the frequency of problems and use negative global labels.
• Mind Reading: Without their saying so, you know what people are feeling and why they act the way they do. In particular, you have certain knowledge of how people think and feel about you.
• Catastrophizing: You expect, even visualize disaster. You notice or hear about a problem and start asking, “What if?” What if tragedy strikes? What if it happens to me?
• Magnifying: You exaggerate the degree or intensity of a problem. You turn up the volume on anything bad, making it loud, large, and overwhelming.
• Personalization: You assume that everything people do or say is some kind of reaction to you. You also compare yourself to others, trying to determine who is smarter, more competent, better looking, and so on.
• Shoulds: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you, and you feel guilty when you violate the rules.
The intervention provides a method of correcting these cognitive processing errors through the use of awareness of automatic thoughts and attendance to them through counting and journals, analysis of the thoughts and seeking evidence to support or reject them, the process of defining alternative meaning and more balanced and rational thoughts, and finally adaptation through habituation and reinforcement. The technique for doing this was originally one devised by Aaron Beck and Albert Ellis. The five-step process includes:
1) Awareness to automatic self-talk and the cognitive errors that occur
2) Attendance to these cognitive errors or distorted thoughts
3) Analysis of the distortion with a formal method similar to a detective or a scientist seeking truth and utility. This is usually done in a public situation with a counselor to help avoid the confirmation bias.
4) The development of alternative, more balanced and rational expressions of the thoughts, and
5) Adaptation to the best of these alternatives through habituation.
This is a rather left brain, logical process that uses a formal process of investigation such as the scientific method and a public [with counselor] process to help overcome the confirmation bias [When trying to assess whether a belief is valid, people tend to seek out information that would potentially confirm the belief, over information that might disconfirm it].
However, cognitive psychologists have found other ways to change meaning with clients that include right bring interactions. The techniques include, but are not limited to:
GUIDED IMAGERY
Guided imagery is a term used to describe a range of techniques from simple visualization and direct imagery-based suggestion through metaphor and storytelling.¬ Guided imagery is used to help teach psychophysiologic relaxation, to relieve symptoms, to stimulate healing responses in the body, and to help people tolerate procedures and treatments more easily. The ultimate mechanisms of imagery are still a mystery. In the last twenty years, however, we have learned that imagery is a natural language of a major part of our nervous system. In most people, the left brain is primarily responsible for speaking, writing, and understanding language; it thinks logically and analytically and identifies itself by the name of the person to whom it belongs. The right brain, in contrast, thinks in pictures, sounds, spatial relationships, and feelings. It is relatively silent, though highly intelligent. The left-brain analyzes, taking things apart, while the right brain synthesizes, putting pieces together. The left is a better logical thinker; the right is more attuned to emotions. The left is most concerned with the outer world of culture, agreements, business, and time, while the right is more concerned with the inner world of perception, physiology, form, and emotion.
The right brain has a special relationship not only to imagery but also to emotions. This is another of the major strengths it brings to the healing adventure. Many studies have shown that the right brain is specialized to recognize emotion in facial expressions, body language, speech, and even music. This is critical to healing because emotions are not only psychological but physical states that are at the root of a great deal of illness and disease. Studies in England and the United States have found that from 50% to 75% of all problems presenting to a primary care clinic are emotional, social, or familial in origin, though they are being expressed by pain or illness.
Imagery can be helpful in so many ways that it is more accurate to think of it as a way of treating people rather than a way of treating disorders. Imagery is essentially a way of thinking that uses sensory attributes and, in the absence of competing sensory cues; the body tends to respond to imagery as it would to a genuine external experience. While working in an interactive mode, the guide’s purpose is not to offer solutions, but to create a setting in which clients can most effectively access their own resources, solve their own problems, and discover their own solutions. This occurs as clients are introduced to their imagery-making abilities, their ‘unconscious mind’, their ‘right-brain thinking’, their ‘inner wisdom’, or whatever other metaphor or description is comfortable for both the guide and client. As they work together, the guide models calmness, trust in the client’s resourcefulness, and respect for the process of questioning the unconscious for its own solutions.
More specifically, the Interactive Imagery Guide’s role is to:
• Assess the appropriateness of imagery for this client.
• Create a safe place for exploration by the client.
• Teach the simple relaxation and imagery dialogue techniques used to access inner resources and solutions.
• Prompt the client with content-free language if the process stalls.
• Encourage the client to imagine their solutions, how they can brainstorm through barriers, create effective plans for change, and continue to refine their actions until they reach their goals.
Imagery can help you whether you have simple tension headaches or a life-threatening disease. Through imagery, you can learn to relax and be more comfortable in almost any situation, whether you are ill or well. You may be able to reduce, modify, or eliminate pain. You can use imagery to help you see if your lifestyle habits have contributed to your illness and to see what changes you can make to support your recovery. Imagery can help you tap inner strengths and find hope, courage, patience, perseverance, love, and other qualities that can help you cope with, transcend, or sometimes even recover from almost any illness. There are, of course, certain symptoms and illnesses that seem to be more readily responsive to imagery than others. Conditions that are caused by or aggravated by stress often respond very well to imagery techniques. These include such common problems as headaches, neck pain, back pain, ‘nervous stomach’, spastic colon, allergies, palpitations, dizziness, fatigue, and anxiety. Other major health problems including heart disease, cancer, arthritis, and neurological illnesses are often complicated by or cause stress, anxiety, and depression. The emotional aspects of any illness can often be helped through imagery, and relieving the emotional distress may in turn encourage physical healing.
REFRAMING
Meaning, as we indicated earlier, is a contextual thing. In Mind-lines: Lines for Changing Minds, Hall & Bodenhamer give this outline of meaning and reframing.
1. Meaning Isn’t Real. It does Not Exist ‘Out There”
Meanings have no reality ‘out there’. Meaning only arises and coheres within a mind – it only exists as part of a given person’s internal world. It emerges as a neuro-linguistic product from our interactions with people, events, ideas, etc. as a completely internal thing.
2. Meaning is made out of ’thoughts’
The idea of meaning arose from the fact that we can ‘hold things in mind’. This is the significance of the original words for meaning in Old High German and Middle English. What we hold in mind are representations, thoughts, ideas.
3. Meaning slips and slides
As a non-thing, we can’t expect meaning to have a static or rigid quality. Instead it keeps moving and shifting. Meaning has plasticity to it so that it bends, stretches, moves, slips, slides, etc. Realizing this will help keep us from thinking of it, or treating it as solid or permanent. If meaning arises by ‘mind’ in ‘mind’ – then we can expect it to come and go according to the functioning of consciousness.
Meaning does not and cannot exist apart form a meaning-maker. It takes a human mind to create, communicate, and experience meaning. While there exists a ‘plasticity’ to ‘meaning’ that even the language used to describe meaning does not solidify, this does not make it so relative that we can make anything mean anything. But it does suggest that we should expect to discover fluidity to ‘meaning’ such that it keeps shifting and changing and never stays put.
4. We construct meaning – and invent reality
Because it takes a meaning-maker to create meaning, meaning emerges in our experience as a human construct. Philosophically we call this understanding of meaning ‘Constructivism’. Recognizing this empowers us in thinking about and working with ‘meanings’. Ultimately, we construct or construe our internal realities. The old biblical proverb expressed this in a simple but succinct way: “As a man thinks in his heart, so he is.” ‘Reality’ thus operates as a function of our maps [i.e., perceptions and constructions]. This, in turn, leads to the realization of our personal responsibility for constructing useful ideas and maps.
5. Meaning occurs in frames of reference
As a human construct that arises as a thinker-feeler uses his or her consciousness to create ‘meaning’, meaning always exists in some frame or context.
What significance does this have? Primarily it directs us to go looking for the frame.
“What frame of reference does this or that idea occur within?”
“What frame is this person using to say or perceive this?”
“What frame has to be there in order for this statement to make sense?”
Frame-less meanings do not, and cannot, occur. When you have a meaning, you have a frame of reference. An idea, thought or emotion as a personal meaning attains much of it’s ‘meaning’ from the ideas, experiences, events that it references.
6. Frames govern meanings
Frames govern, modulate, organize, drive and control the experiences that occur within them [i.e., the thoughts, feelings, language, behavior and responses]. When we set a frame that frame will govern the consequences and conclusions that follow. Korzybski called this ‘logical fate’.
The statement “I love you” means one thing when you say it to your wife. It means another when you say it to your father.
Reframing then is a process of helping the client find another frame of reference in which to consider the experience, thereby changing the meaning of the experience. If I walked up to you and started talking about your automobile, I have thereby ‘set the frame’ for our conversation. Setting the frame refers to setting either the content of the subject mater or the context for the subject matter. If I ask, ‘what automobile do you prefer?’; I have set the context of the conversation as eliciting your preference [i.e., values and criteria] while simultaneously, I have set the content of discussing particular automobiles.
A subtly occurs in this. Namely, that while the language of the question gets you to focus on the content of the automobile, at a higher logical level, I have actually set a frame whereby I can elicit your values and standards. I haven’t done so explicitly, only implicitly. And if “I have ears to hear” I will learn about your values and your strategy for decision-making.
When you learn how to embed various contents within higher-level contexts you will know how to preclude another person’s conscious awareness as well as how to include it.
ANCHORS: If someone is in a certain mental or emotional state, you can set up an anchor. That means you can trigger this state by associating it with an external stimulus. Anchors can be a specific hand gesture or a picture (visual), a word, sound or voice tone (auditory), a touch or a movement (kinesthetic), a smell (olfactory) or a taste (gustatory). With anchors you can easily change and control your own or someone’s emotional state.
When anchoring, you have to follow these conditions:
– Uniqueness of stimulus: The anchor should be something that you don’t do in other situations. So don’t anchor something like clapping the hands (Only if you want to go into a specific state when you are at the theater and have to clap your hands)
– Intensity of experience: You have to be associated into the experience. It should be strong.
– Purity of experience: Your experience should be without contamination.
– Timing of anchor: The experience should be at its peak. You have to wait for the right moment to set up the anchor.
– Accuracy of replication of anchor: Different kind of touches is different anchors. You have to do the same thing when you set up and fire off the anchor.
First, you have to know which state you want to anchor. It can be any kind of state, like confidence, happiness, and so on. Then, you have to choose an anchor. This can be any touch, word, sound or movement. If you anchor yourself, you normally use a touch as an anchor. It could be something like touching your ear, scratching your nose, giving your wrist a squeeze or touching your thumb and first two fingers together. Now, go into the state you want to anchor. This can be done by:
– Recalling a time in your past when you felt the way you want to feel every time you fire off the anchor. Close your eyes and see yourself from a dissociated point of view. Step into the picture and look at this scene as if you were looking through your eyes (associated point of view). See, hear and feel everything as if you were actually there.
– Imagining a time where you could have felt this way. Step into this picture – be associated into this scene.
– Associating into somebody else of whom you know that he feels this way. First, see him from a dissociated point of view. Then, move into the image of him, associate into him. You will begin to feel the same things you think he feels.
– Doing something in which you feel this way. If you know that there is an activity in which you are in the state you want to anchor, use this activity to anchor your state. For example, if you want to anchor happiness, do everything that will make you happy. Read some jokes, play games, have fun, etc..
You can make your state stronger by changing the submodalities; the aspect of sensory input – e.g., sound, color, tone, etc.
And now, anchor this state. Simply do the thing you have chosen as your anchor.
You can test your anchor by going into a normal state and then firing off your anchor. If your state doesn’t change the way you want it to, go back and make your state stronger and better.
RELAXATION
Relaxation training refers to the regular practice of one or more of a group of specific relaxation exercises. These exercises most often involve a combination of deep breathing, muscle relaxation, and visualization techniques, which have been proven to release the muscular tension that the body stores during times of stress. Deep relaxation and anxiety are physiological opposites. Methods include:
• Abdominal Breathing
– Lie down and close the eyes noticing sensations in the body
– Place on hand on the chest and the other on the abdomen
– Let the breath find its own pace
– Count exhalations [1 to 10] and repeat
• Progressive Muscle Relaxation
– Arms: hands, elbows/biceps, triceps
– Head: eyebrows, squinch face, eyes & mouth, jaw & tongue, neck
– Midsection: shoulders, arms, stomach & abdomen, back
– Legs: buttocks & thighs, inner thigh, toes
• Simultaneous Contractions
• Cue-controlled relaxation
– Breathe in, relax
• Visualization
– Comfortable place
– Peaceful scene
– Absorbing scene elements
– Eliminate gaps
– Colors, light source, temperature, smell, touch
– Perspective changes
• Peaceful scenes
– Beach
– Forest
– Train
Neural Network Learning Theory
How this learning [habituation] actually occurs is better understood, perhaps, from a biological perspective.
It is well established that brains are made up of two basic structures — neurons and synapses — and that together they form extensive ‘neural networks’ that perform all psychological operations such as thinking, learning, memory and emotion. These network operations both drive, and are in part driven by, motor activity. Neurons are the individual brain cells, of which there are estimated to be around 100 billion in humans. Synapses are the connections between and among neurons, and there are thought to be about 100 of them connecting the average neuron to its neighbors. That makes 10 trillion synapses in all — enough to encode and store all the information that comes our way many times over
Neuroscientists have discovered that our brains are physically altered by what we experience and thus learn. It is as if the chips in your computer were actually rewired somewhat every time you ran a program. The ‘event’ that has just occurred has become part of your experience and has been added to your personal learning history. This begins a process in which some of the synapses in your brain become more efficient in transmitting signals to the “downstream” neurons they’re connected to, and others become less efficient. These local efficiencies are called synaptic weights. The synaptic weights represent the habituation of automaticity.
As life goes on, synaptic-weight patterns change. The experience is encoded by a change in the pattern of synaptic weights in some network or — most often — an interconnected, overlapping set of networks in your brain. This change constitutes your memory for the event — including all of its implications and ramifications. This all goes on without much conscious effort or even awareness on your part. Because the newly altered networks are interconnected and overlapping, they constitute an intricate ‘filing system’ for memory retrieval. When in future any encoded aspect of what you have learned about becomes personally relevant, several or all of the affected networks can be activated
Gregory Edleman goes a step further and proposes that an evolutionary process takes place. Not one that selects organisms and takes millions of years, but one that occurs within each particular organism, and within its lifetime, by competition among cells, or selection of groups of cells for attention in the brain. This biological theory of the mind, which he calls neural Darwinism, or the Theory of Neuronal Group Selection [TNGS], serves quite well as the underpinnings for the management of cognitive change.
Any change in the process of thought offers the opportunity to change the future process. If we were to replace the thought – “I am stupid!” – with the thought “I need to study harder to get better grades”, and habituate the second thought, we create in the brain two alternative networks. Since the person is likely to choose thoughts that are more satisfying and gratifying, the replacement thought is likely to be used and disuse of the prior thought would weaken the neuronal network. It is this exchange of thoughts that offers the opportunity of changing the emotions and thereby influencing new behavior.
Appraisal Process
What this means is that cognitive interventions are all contextual in that the cognitive process of appraisal is a process with the goal of giving meaning to events and experiences and meaning can only be attained in context. The meaning of being dunked in water is totally different if it occurs in a church service or in a swimming pool. It is not the experience, but the interpretation of the experience that matters. Thus, cognitive intervention occurs when the client is helped to change the meaning of the experience and meaning is described in terms of the ‘appraisal’ process that follows a distinct pattern.
The event occurs and the appraisal begins:
What happened?
Is it something I have experiences before? If so, what meaning did I give to it then? What implications did it carry? Is this the same?
If it never happened before, what is it most like [analogy – a process of comparing the similarities of two experiences – one known and one unknown – to determine the implications of the one that is unknown]. For experiences that relate either directly or metaphorically to something that is well known, there may be a predisposition [attitude] toward it, answering automatically [without conscious thought] some of the questions that follow.
Once the experience is recalled or described, I must then attribute a cause – was it internally or externally caused? The implications of this attribution are that I may or may not have some degree of control over the experience. The impact upon me may have to do with the stability or controllability of the experience. If the control is external, this also is cause for implications of intent. The meaning of an experience is entirely different if the outcome was intended.
I bump into someone in the hall. I have interpreted this experience before as bullying. Therefore, I decide that the person deliberately bumped me and tried to hurt me. I hit him.
OR
I bump into someone in the hall. I have in the past interpreted this experience as my own clumsiness. I feel embarrassed, get red faced and mumble an apology.
After attributing a cause to the experience, I must examine how this experience affects my ability to predict and control the world – am I more or less likely to be effective in the future – what are my expectations? Do I expect to be clumsy in the future or can I avoid this experience next time?
Finally, I need to deal with the disposition – what am I going to do about the experience? This is a major interface with the ‘other’ – connection to associations and relationships. The dispositions in our example led to violence or embarrassment and avoidance.
Cognitive Variables to be Modified
If four people have the same experience at the same place and the same time; they will probably end up with four different meanings, and as a result, four different dispositions. This is because of the many variables, including, but not limited to:
• Perception: specific experience sensations
• History: specific accumulation of experiences and meanings
• Attributions: externals/internals
• Expectations: optimistic/pessimistic
• Implications: different relationships
• Disposition: different sensibilities
Since the meaning of the experience is concerned with all of these variables and all of these variables are changeable, the cognitive experience is based on the same principles as traditional behavioral variables, except that the clinician or other people in the environment cannot control the cognitive variables, with the exception of the messages being sent. But the other variables can be influenced. The method of influence is the introduction of the uncertainty of context. The context of the above incident could be accidental or intentional [on the part of myself and/or the other person], may cause or not cause harm, may be witness or unwitnessed by a third party, etc.
The behavior principle of reinforcement is then focused on the interface between action and the context being influenced to support changes in the most positive process of giving meaning. I will reinforce the accident context by apologizing and accepting the apology.
While the process is defined above dealing with a single incident, the change process considers psychological events as ongoing actions of the whole organism interacting in and with historically and situationally defined contexts. These actions are whole events that can only be broken up for pragmatic purposes. Further these sequences are connected to interpersonal relationships. When dealing with a person with problems in living we are invariable dealing with the way they relate or avoid relating.
Criterion for Change
Many people will tell you that they want things to be different, but they often cannot express how they should be different, except that the pain should stop. This is a major area of exploration in clinical counseling – what should change look like. Because goals specify how to apply the pragmatic truth/utility criterion it is important to start any change process by identifying the client’s goals. This is not always an easy process as the most serious problems in living often develop as avoidance experience rather than activating experiences. Therefore, the client not only may not have considered developing goals, but also is actively avoiding activation of such a process – I cannot fail, if I have not expectations. The implementation of living becomes mostly automated and not conscious, so the process of exploring goals is one of activating consciousness around these contextual issues. Another hindrance to goal development may be the feelings of hopelessness and helplessness [external attributions of stability and controllability] and expectations of failure. Nonetheless, the process of developing goals is an important part of changing meaning.
The specifics of the goals are the chosen values and are the necessary precursor to the assessment of workability because values specify the criteria for the application of workability or utility. The causal analyses of utility are limited to events that are directly changeable in context. From such a perspective, thoughts and feelings do not cause other actions, except as regulated by context. Therefore, it is possible to go beyond attempting to change specific thoughts or feelings in order to change overt behavior, and to consider changing the historical contexts [attitudes/schema] that causally links these psychological domains. This approach has been defined as the third generation of behavioral intervention.
The most popular cognitive change process is one that addresses the specifics of the appraisal process in relation to automatic thoughts [self talk]. We have referred to this as Cognitive Process Correction and have included many of the Beck and Ellis constructs. However, to suggest that this is the limit of the second generation cognitive change interventions is to ignore a whole field of specific techniques which include addressing the elements of perception, imagining, relaxation, reframing, anchoring, an so on. Unfortunately, protocols, such as the Beck protocol for depression are identified as techniques, but each protocol for depression, anxiety, anger, etc., includes some of the specific techniques identified above. The technique of reframing, for example is used in almost every incident of cognitive intervention for depression, anxiety, post traumatic stress, obsessive compulsive behaviors, and so on.
THIRD GENERATION: COGNITIVE RESTRUCTURE
Nonetheless, for persons with severe and persistent problems in living caused by psychological problems that promote a self-destructive way of life, a third generation approach is growing in importance. We have identified this approach as Cognitive Restructuring, indicating the necessity of addressing large parts of the cognitive architecture focusing on the schema [attitudes, predisposition] of self and others in universal, rather than specific terms. While this process has been implemented over some time period, it has generally been approached through the development of protocols that string together a variety of techniques individually developed for the major maladjustment of the individual client. The real impetus of the third generation interventions is the development of standardized ‘programs’ such as Dialectical Behavior Therapy, Acceptance & Commitment Therapy, Mindfulness-Based Cognitive, and other meta-cognitive approaches. These ‘programs’ group the specific ‘techniques’ into protocols for purposes of addressing broader psychological issues of the whole person – modeled on the construct addressing the person and not the disorder indicated in Guided Imagery.
In addition, clinicians and researchers are developing new avenues of development including:
1) Increasing awareness of Buddhist psychology and increasingly implementing techniques of mindfulness and acceptance, as well as other philosophical perspectives [e.g., the use of meditation]; and,
2) The study of language and its implications, beginning with the use of transformational grammar by Neurolinguistic Programming. The structure of language is an increasingly powerful tool.
In order to sample this movement, we will excerpt from a description of Acceptance & Commitment Therapy. This is, of course, only one of the new protocols.
ACT theoretical roots
Relational Frame Theory was developed into a comprehensive basic experimental research program used to guide the development of ACT itself. RFT has become one of the most actively researched basic behavior analytic theories of human behavior, with over 70 empirical studies focused on it tenets. RFT is initially technically difficult, and it requires mastery of several new terms, but fortunately only a broad overview is necessary in the present context.
The core of human language and cognition is the learned and contextually controlled ability to arbitrarily relate events mutually and in combination, and to change the functions of specific events based on their relations to others. For example, very young children will know that a nickel is larger than a dime by physical size, but not until later will the child understand that a nickel is smaller than a dime by social attribution. In addition to being arbitrarily applicable (a nickel is ‘smaller’ than a dime merely by social convention), this more psychologically complex relation is mutual (e.g., if a nickel is smaller than a dime, a dime is bigger than a nickel), combinatorial (e.g., if a penny is smaller than a nickel and a nickel is smaller than a dime then a penny is smaller than a dime), and alters the function of related events (if a nickel has been used to buy candy a dime will now be preferred even if it has never actually been used before). The applied implications of RFT derive from several sources, but three critical features are that:
1) Human cognition is a specific kind of learned behavior. For example, RFT researchers have recently shown that arbitrarily applicable comparative relations (the nickel and dime situation just mentioned) can be trained as an overarching operant in young children
2) Cognition alters the effects of other behavioral processes. For example, a person who has been shocked in the presence of B and who learns that B is smaller than C, will show a greater emotional response to C than to B, even though B was directly paired with shock, and;
3) Cognitive relations and cognitive functions are regulated by different contextual features of a situation.
The primary implications of RFT in the area of psychological concerns and interventions extend from the three important features just described:
1) Verbal problem solving and reasoning is based on some of the same cognitive processes that can lead to psychological disorder, and thus it is not practical to eliminate these processes,
2) Much as extinction inhibits but does not eliminate learned responding, the common sense idea that cognitive networks can be logically restricted or eliminated is generally not psychologically sound because these networks are the reflection of historical learning processes ;
3) Direct change attempts focused on key constructs in cognitive networks creates a context that tends to elaborate the network in that content and increase the functional importance of these constructs, and
4) Since the content and the impact of cognitive schema are controlled by distinct contextual features, it is possible to reduce the impact of negative cognitions whether or not they continue to occur in a particular form by changing the context.
Taken together, these four implications mean that it is often neither wise nor necessary to focus primarily on the content of cognitive networks in clinical intervention. Fortunately, the theory suggests that it is quite possible instead to focus on their functions in context.
In ACT, virtually every component of the technology is connected conceptually to RFT, and several of these connections have been studied empirically.
Psychological Inflexibility
While psychological problems can emerge from the general absence of relational abilities (e.g., in the case of autism), a primary source of difficulty is the way that language and cognition interact with direct contingencies to produce an inability to persist or change behavior even for the benefit of long term valued ends. This kind of psychological inflexibility seems to emerge from weak or unhelpful contextual control over language processes themselves, and the model is thus linked point to point to the basic analysis. This yields an accessible and clinically useful middle level theory.
In general terms cognitive fusion refers to excessive or improper regulation of behavior by verbal processes, such as rules and derived relational networks. For example, in Horney’s ‘tyranny of the shoulds’, it holds that e.g., “I should be better at math” is a verbal rule that impinges on the behavior only in the context of math. The inflexibility caused by such a ‘should’ is enhanced if in the presence of a relationship known for promoting the ‘should’ – e.g., a parent who constantly avows, “You should be better in math”. In this circumstance it is conceivable that the individual is inhibited in solving math problems even in light of a desire to pass the course and graduate [values/goals]
In contexts that foster such fusion, human behavior is guided more by relatively inflexible verbal networks than by contacted environmental contingencies. As a result, people may act in a way that is inconsistent with what the environment affords relevant to chosen values and goals. The form or content of cognition is not directly troublesome, unless contextual features lead this cognitive content to regulate human action in unhelpful ways.
The social/verbal community largely sustains the functional contexts that tend to have such deleterious effects. There are several.
• A context of literality treats symbols (e.g., the thought, ‘‘life is hopeless’’) as one would referents (i.e., a truly hopeless life).
• A context of reason-giving bases action or inaction excessively on the constructed ‘causes’ of owns own behavior, especially when these processes point to non-changeable ‘causes’ such as conditioned private events.
• A context of experiential control focuses on the manipulation of emotional and cognitive states as a primary goal and metric of successful living.
These contexts are interrelated, which helps explain why cognitive fusion supports experiential avoidance — the attempt to alter the form, frequency, or situational sensitivity of private events even when doing so causes behavioral harm. Our math ‘should’ leads to an avoidance of math as well as an emotional state that makes math more difficult even to the extent of failure.
Due to the temporal and comparative relations present in human language, so-called ‘negative’ emotions are verbally predicted, evaluated, and avoided. “I will fail and look like a fool.” I will get sick or cause a ruckus in order to avoid taking the math test”. Experiential avoidance is based on this natural language process—a pattern that is then amplified by the culture into a general focus on ‘feeling good’ and avoiding pain. Unfortunately, attempts to avoid uncomfortable private events tend to increase their functional importance — both because they become more salient and because these control efforts are themselves verbal linked to conceptualized negative outcomes — and thus tend to narrow the range of behaviors that are possible since many behaviors might evoke these feared private events. A better approach would be to accept the uncomfortable situation as normal and deal as effectively as possible in it. This more balanced and rational approach allows for better performance and differential reinforcement.
The social demand for reason giving and the practical utility of human symbolic behavior draws the person into attempts to understand and explain psychological events even when this is unnecessary. “I should be better in math because….” “I am not good in math because….” Contact with the present moment decreases as people begin to live ‘in their heads’.
The conceptualized past and future, and the conceptualized self, gain more regulatory power over behavior, further contributing to inflexibility. For example, it can become more important to be right about who is responsible for personal pain, than it is to live more effectively with the history one has; it can be more important to defend a verbal view of oneself (e.g., being a victim, never being angry, being broken, etc.) than to engage in more workable forms of behavior that do not fit that that verbalization. Furthermore, since emotions and thoughts are commonly used as reasons for other actions, reason giving tends to draw the person into even more focus on the world within as the proper source of behavioral regulation, further exacerbating experiential avoidance patterns. Again psychological inflexibility is the result.
In the world of overt behavior, this means that long-term desired qualities of life (i.e., values) take a backseat to more immediate goals of being right, looking good, feeling good, defending a conceptualized self, and so on. People lose contact with what they want in life, beyond relief from psychological pain. Patterns of action emerge and gradually dominate the person’s repertoire that are detached from long-term desired qualities of living. Behavioral repertoires narrow and become less sensitive to the current context as it affords valued actions. Persistence and change in the service of effectiveness is less likely.
Six core processes of ACT
Intervention targets each of these core problems with the general goal of increasing psychological flexibility—the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. Each of these areas is conceptualized as a positive psychological skill, not merely a method of avoiding problems in living.
Acceptance
Acceptance is taught as an alternative to experiential avoidance. Acceptance derives from Buddhist psychology and is a major tenet of it. Acceptance involves the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm. For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action.
Cognitive defusion
Cognitive defusion techniques increase flexibility through attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form [content], frequency or situational sensitivity. Said another way, ACT attempts to change the way one psychologically distances their interactions with or relation to thoughts by creating contexts in which their unhelpful functions are diminished. There are scores of such techniques that have been developed for a wide variety of clinical presentations. For example, a negative thought could be watched dispassionately, repeated out loud until only its sound remains, or treated as an externally observed event by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, label the process of thinking (“I am having the thought that I am no good”), or examine the historical thoughts, feelings, and memories that occur while they experience that thought. Such procedures attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather than what it is directly experienced to be (e.g., the thought “I am no good”). The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency. Less attachment increases the flexibility to act in contrary ways.
Being present
ACT promotes ongoing non-judgmental contact with psychological and environmental events as they occur. The goal is to have clients experience the world more directly so that their behavior is more flexible and thus their actions more consistent with the values that they hold. This is accomplished by allowing workability to exert more control over behavior; and by using language more as a tool to note and describe events, not simply to predict and judge them. A sense of self called ‘self as process’ is actively encouraged: the defused, non-judgmental ongoing description of thoughts, feelings, and other private events. ‘Self as process’ is a Buddhist conception in which one identifies the self as every changing – Buddhist would suggest that nothing is eternal and every thing is changing. In the context of self as process, no rule can abide for those rules were created for the self that was, not the self that will be.
Self as context
As a result of relational frames such as I versus You, Now versus Then, and Here versus There, human language leads to a sense of self as a locus or perspective, and provides a transcendent, spiritual side to normal verbal humans. There is growing evidence of its importance to language functions such as empathy, theory of mind, sense of self, and the like. In brief the idea is that ‘I’ emerges over large sets of exemplars of perspective-taking relations, but since this sense of self is a context for verbal knowing, not the content of that knowing, its limits cannot be consciously known. Self as context is important in part because from this standpoint, one can be aware of one’s own flow of experiences without attachment to them or an investment in which particular experiences occur: thus defusion and acceptance is fostered. Self as context is fostered in ACT by mindfulness exercises, metaphors, and experiential processes. Mindfulness again is a Buddhist conception – indicating that one is constantly aware of what one is thinking – the ‘me’ that watches me. By being aware of your own private thoughts from an uninvolved perspective, we can separate ourselves from the cognitions that are occurring.
Values
Values are chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment. ACT uses a variety of exercises to help a client choose life directions in various domains (e.g., family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g., ‘‘I should value X’’ or ‘‘A good person would value Y’’ or ‘‘My mother wants me to value Z’’). Acceptance, defusion, being present, and so on are not ends in themselves; rather they clear the path for a more vital, values consistent life.
Committed action
Finally, ACT encourages the development of larger and larger patterns of effective action linked to chosen values. In this regard, ACT looks very much like traditional behavior therapy, and almost any behaviorally coherent behavior change method can be fitted into an ACT protocol, including exposure, skills acquisition, shaping methods, goal setting, and the like. Unlike values, which are constantly instantiated but never achieved as an object, concrete goals that are values consistent can be achieved and ACT protocols almost always involve counseling work and homework linked to short, medium, and long-term behavior change goals. Behavior change efforts in turn lead to contact with psychological barriers that are addressed through other processes (acceptance, defusion, and so on).
The Core Processes
The core ACT processes are both overlapping and interrelated. Taken as a whole, each supports the other and all target psychological flexibility: the process of contacting the present moment fully as a conscious human being and persisting or changing behavior in the service of chosen values. The six processes can be chunked into two groupings. Mindfulness and acceptance processes involve acceptance, defusion, contact with the present moment, and self as context. Indeed, these four processes provide a workable behavioral definition of mindfulness. Commitment and behavior change processes involve contact with the present moment, self as context, values, and committed action. Contact with the present moment and self as context occur in both groupings because all psychological activity of conscious human beings involves the now as known.
Mindfulness/acceptance Commitment/Behavior
Acceptance Values
Defusion Committed action
Being present Being present
Self as Context Self as Context
ACT is an approach to psychological intervention defined in terms of certain theoretical processes, not a specific technology. In theoretical and process terms we can define ACT as a psychological intervention based on modern behavioral psychology that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility.
Hopefully, the reader is able to understand how the ‘program’ is designed and how the individual techniques are organized to effect change. This program, of course is not alone, but it represents and increasing attempt to address the whole person, rather than just the symptoms of distress.
Almost all of these third generation programs are likely to be selected after the second generation interventions have failed to be successful.
CONCLUSION
It should be expected that a fourth generation be on the horizon. The reason for this expectation is based on the knowledge that the ‘meaning’ that we learn to give to experiences is based to a large extent upon the messages given by significant others. The more that significant people in the child’s life can mindfully provide balanced and rational messages about experiences, the more likely it is that the child will grow into an adult with these skills. This presents two opportunities. The first is to develop prevention programs that help parents and teachers shape their messages and the second is to identify and provide services to parents and teachers who send problematic messages. Combining the Functional Cognitive Behavior Assessment with a Community Assessment Support Team provides a basis to identify both distorted input and outcome at the same time and to take a community approach to resolution.
Jerome R. Gardner