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Values, Verbal Relations and Compassion: Can We Do a Better Job of Facing Global Challenges
Steven C. HayesUniversity of Nevada
The World is Facing a Series of Behavioral Challenges
• “…. knowing is not enough; action is needed. Why should it occur? That is perhaps the most terrifying question in the history of the human species” (Skinner, 1982)
Terrifying Because(from Paul Chance)
• Immediate consequences outweigh delayed consequences. People want to live in a world with clean air, but also want to drive Hummers.
• Some chemicals are destructively reinforcing. The reinforcing power of sugar, salt, or drugs threaten our health.
The List
• Consequences for the individual outweigh consequences for others. We often fail to make sacrifices for the common good.
• In the absence of counter-control, the use of aversives tends to be very reinforcing to those who use them. For example, Abu Ghraib
The List• Coincidental events often strengthen
ineffective behavior. Superstition often wins out over rationality.
• Simple, familiar wrong ideas are preferred over complex, alien but correct ideas. For example, evolution is rejected by 75% of the US population
The List
• Susceptibility to social reinforcement can incline us toward extreme views. For example, 9-11 was perpetrated by mostly well-educated, middle-class people with families but who spent a lot of time interacting with others who shared extreme beliefs
The List
• Strong aversives presented abruptly prompt appropriate action, but strong aversives following a long string of aversives that gradually increase in strength often do not. This suggests that so long as conditions worsen gradually, we will tolerate bad air, foul water, loud noise, psychological and physical abuse, and crime that would once have been considered intolerable.
The Processes
• Weak delayed consequences for positive behaviors or powerful short term ones of negative behaviors
• Weak social concern or cooperation or using aversives on others
• Impulse and superstition rather than scientific data and reason
• Entanglement with socially supported deviant beliefs
• Lack of attention to gradual aversives
The Problems• Obesity and health
• Drugs
• Over-population
• Lack of self-control
• Poverty
• Violence
• Pollution and global warming
Reformulating the Questions
• Not why are we controlled by short term consequences – it is why we ever fail to be.
• Not why do we show low concern for others – it is why we ever cooperate or show compassion for others
• Not why aren’t we controlled by scientific data – it is how is it that science ever makes a difference
• Can a psychological flexibility model help? Is it relevant?
• I will share data only from the last three years
Within a Psychological Flexibility Model
Acceptance and Defusion Increase Willingness to Experience Discomfort of Foregoing Short Term Reinforcers;
Use Values or Motivative Augmentals to Increase Psychological Presence of Chosen Long Term Consequences
Social Processes that Support Both
Weight MaintenanceLillis et al., 2009
• 87 participants who had completed at least 6 months of organized weight loss intervention (on average their 37th try)
• Randomized to 1 day ACT workshop (n = 43) or TAU Control (n = 44)
Acceptance, Defusion from Self-Stigma and Values
• Focused on values and patterns of avoidance toward weight-related thoughts, feelings, and bodily sensations
• No diet, physical activity, self-monitoring, or weight education components
Process Results
AAQ
1.4
1.0
.6
.4
.2
0
1.2
.8
Coh
en’s
d I
mpr
ovem
ent
- .2
- .4 Control
ACT
AAQW Breath Holding
Small
Medium
Large
Effect Sizes:
Pre to Follow-Up Weight Change
% gaining 5+ lbs % losing 5+ lbs
35
25
15
10
5
0
3 month follow-up
p < .001
d = 1.21
30
20
AC
T
Co
ntr
ol
ACT for Diabetes Management Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007, JCCP
• Randomized controlled trial with poor, mostly minority clients
• 40 / group: ACT plus diabetes education (one six-hour workshop) or diabetes education (also a six hour workshop)
• Only 3 hours were different content
Pre to Follow up ChangeAAQ
(Diabetes)
Ed’n ACT
Self- Management
Ed’n ACT
% in Diabetic Control
Ed’n ACT
50%
25%
0%
50%
25%
0%
10
5
0
AAQD and Self-Management mediated blood glucose outcomes
Pediatric Chronic PainWicksell, Melin, Lekander, & Olsson, Pain, 2010
• 32 children w/ longstanding pediatric pain• Average of 32 mo pain duration• Randomly assigned to ACT or
multidiscipinary Rx & medication (MDT). • ACT = 12 session; MDT = 23
Effect of Writing About Your ValuesCohen, Garcia, Purdie-Vaughns, Apfel, & Brzustoski (2009), Science, 234, 400-403.
• 385 middle school children followed through 7th and 8th grade
• Randomly assigned to a series of short (15 minute) writing assignments at the beginning of 7th grade on their values in various specific domains and the importance of these values
Impact on GPA Thru Middle School
3.5
3.0
2.5
2.0
1.5
1.0Pre 1 2 3 4 1 2 3 4
Year 1 Year 2
European Americans or High Achieving African-Americans Both Conditions and Ethnic Groups Are Identical
Low Achieving African-Americans
Values
Control
Motivating Physical Exercise Jackson et al., in preparation
• 46 female students in a spinning class• Identify fitness motivation via IRAP• Prompt during class – compare to form based
prompts or IRAP identified low motivators
105
95
85
1 5 93 7
1 5 93 7 1 5 93 7
1 5 93 7
105
95
85
105
95
85
105
95
85
Per
cen
tag
e o
f In
stru
cto
r’s
Hea
rt
Rat
e
Exercise Sessions
BaselinePositive Goals
Forms
Bsln Prompts Bsln Prompts
Average Difference from Baseline
Green = Non-Preferred “Positive” Implicit Goals
Blue = Instruction About Form-10
-8
-6
-4
-2
0
2
4
6
8
10
DIF
FER
EN
CE I
N %
OF I
NS
TR
UC
TO
RS
AV
ER
AG
E
HEA
RT R
ATE
17 18
18
Randomized Trial: ACT vs. TAUTapper et al., 2009
• 62 overweight women (BMI = 31.6)• All participants already in weight loss programs• 4 two-hour sessions. 26 attended at least one; 31
left in existing diet• Short ACT protocol• Pre / Post / 6 month follow up
Physical Fitness Butryn, Forman, Hoffman, Shaw, and Juarascio, under submission
• 46 female students assigned to two 2-hour workshops (two weeks apart) on ACT or education about fitness.
• “Post” at week four; follow up at week seven • Primary measure: use of exercise facilities at
the University Athletic Center (these were automatically recorded from the swipe cards, resulting in a high integrity measure with no drop outs)
Weekly Number of Exercise Sessions
Pre Post
1.8V
isit
s to
the
Ath
leti
c C
ente
r
1.0
2.2
Follow Up
ACT
1.4
.6
.2
Fitness Education
The Question Is Not Why Aren’t We Controlled by Scientific Data
Instead of Impulses
It Is How Can We Increase the Impact of Scientific Data
04/19/23
Within the PF Model:
Link Science Knowledge to Values;
Use Acceptance and Defusion to Deal with the Discomfort of Newness and
the Interference of Alternative Beliefs
04/19/23
Adopting ESTsVarra, Hayes, Roget, & Fisher, JCCP, 2008
• 59 drug and alcohol counselors randomly assigned to
– One day ACT workshop focused on the psychological barriers to learning
– Control condition: One day workshop on EAP policies
– Both groups then do a one day educational workshop on the science behind the use of agonists and antagonists
Frequency of Perceived Barriers to Using Empirically Supported Treatments
Pre Post
75M
ean
Sco
re
Phase
70
ACT plus ACT plus EducationEducation
Control Control plus plus
EducationEducation65
Believability of Perceived Barriers to Using Empirically Supported Treatments
Pre Post
70M
ean
Sco
re
Phase
65
ACT plus ACT plus EducationEducation
Control Control plus plus
EducationEducation
60
Willingness to Use Pharmacotherapy
Pre Post
3.5
3.25
2.25
Mea
n S
core
on
1-5
Sca
le
Phase
3
2.75
2.5
ACT plus ACT plus EducationEducation
Control Control plus plus
EducationEducation2
Subsequent Use of Pharmacotherapy
Pre 3 month Follow - up
3.5
3.25
2.25
Phase
3
2.75
2.5
ACT plus ACT plus EducationEducation
Control Control plus plus
EducationEducation
2
The Question Is Not Why Do We Show Low Concern For Others
It Is How Can We Promote Cooperation, Compassion and Concern
for Others
04/19/23
Within the PF Model
Promote a Social/Perspective Taking Sense of Self
Link Self-Acceptance and Compassion
Link Values and Compassion
04/19/23
Experiential Avoidance and MH Stigma Masuda et al., 2007
• RCT comparing education focused on prevalence and costs of stigma toward mental health problems, and accurate information about them
• ACT focused on defusion from and mindfulness of prejudicial thoughts, acceptance of difficult prejudicial feelings, and values
ACT for Mental Health Stigma
Pre Post F-Up
-25
-30
-35
-40
Ave
rage
MH
Stig
ma
Sco
re
ACT
Education
Lo EA
Hi EA
Racial PrejudiceLillis & Hayes, 2007
• Replicated with ACT versus Education for racial bias in a college student population
• Within subject test (16 with A/B/A/C/A and 16 with A/C/A/B/A)
• 32 participants in a two racial differences classes
• 90 minute class period
• “follow up” = next class period
Assessment Items
• Bias Awareness– I feel that I am aware of my own biases
• Bias Does Not Affect Me– I feel that my prejudicial thoughts are a
significant barrier to me being culturally sensitive
– My biases and prejudices affect how I interact with people from different racial and ethnic backgrounds.
Assessment Items • Acceptance
– It is OK to have prejudiced thoughts or racial stereotypes
– I try not to think negative thoughts I have about people from different racial or ethnic backgrounds.
• Defusion and Action– When I evaluate someone negatively, I am able to
recognize that this is just a reaction, not an objective fact.
– It’s ok to have friends that I have prejudicial thoughts about from time to time.
Assessment Items • Positive Action
– I would attend a social event where I was the only person of my race/ ethnic background.
– I believe that I am able to transcend racial boundaries with my actions.
– I plan to actively seek out experiences that could expose me to people who have a different cultural, racial, or ethnic background than me.
– I am likely to join a campus organization or participate in a campus event that is focused on cultural diversity.
Percentage of Possible Improvement Obtained
-20 -10 0 10 20 30 40
Ed Pre-fup
Ed Pre-Po
ACT Pre-Fup
ACT pre-Po
THEN
NOW
YOU
I
HERE
THERE
RFT Take on the Formation of RFT Take on the Formation of Self and Perspective TakingSelf and Perspective Taking
But If “From Hereness” is Relational
• It says something very profound: I don’t get to show up as a conscious human being until you show up as a conscious human being
• One of the way we measure perspective taking are “Theory of Mind” assessments
• Are deictic relations and Theory of Mind performances related?
152535455565758595
105
Pre SingleReversals
DoubleReversals
Phases
Pe
rce
nt
Co
rre
ct Deictic
ToM
At Least Broadly, They AreAt Least Broadly, They Are
For general direction of the relationship only. These data are from 2 unpublished studies, one by another author, so details could change
Why This Matters
• A perspective taking sense of self is social
• Which is why your pain can pain me
• I need to accept my own pain in order to care about yours in a healthy way
• Gives a personal motivation beyond values and evolution for empathy and caring for others
Experiential Avoidance, Shame, and Stigma Toward Others
Weight Self Stigma
Experiential Avoidance .76**
Negative Attitudes Toward Otherswith Weight Problems .33**
164 persons dealing with weight (Lillis et al)
And Guess What?
Weight Self Stigma
Weight Problems.40**
Mental Health Problems.42**
Quality of Life-.68**
What That Says
• Compassion toward others is related to some degree to self-compassion and to liberation from entanglement with judgments
• Those processes have tangible positive effects on the person, giving some possible motivation to deal with a judgmental lack of compassion
Caring About Being With Others
Roger Vilardaga, Ana Estévez, Michael E. Levin and Steven C. Hayes
Social Anhedonia
I/You
Here/There
Now/Then
-
Perspective Taking
EmpathyExperiential Avoidance
JoySadness
- - +
Repertoire Narrowing
Social AnhedoniaR2 ∆F β
Step 1 .036 1.87 Gender -.17 Age -.09Step 2 .10* 6.91 Gender -.13 Age -.10 Deictic ability -.26*Step 3 .15* 5.17 Gender -.06 Age -.04 Deictic ability -.23* Empathic concern -.23*Step 4 .26** 14.60 Gender -.02 Age .05 Deictic ability -.18† Empathic concern -.26* Experiential Avoidance .35**
The Question Is Not Why Do We Become Entangled With Deviant Beliefs
It is How Do We Disentangle Ourselves from Them
04/19/23
ACT for Self-Stigma / ShameLuoma, Kohlenberg, et al., under review
134 participants in a 28 day in-patient drug program
Randomly assigned to 6-hour ACT group focused particularly on self-judgment and shame
Group ACT for Shame:Substance Use Outcomes
1 Month
6
5
4
3
2
1
0
Follow Up
Day
s / M
onth
Usi
ng
D
rugs
or
Alc
ohol TAU
ACT
Group ACT for Shame:Substance Use Outcomes
1 Month 2 Month 3 Month
6
5
4
3
2
1
0
Follow Up
Day
s / M
onth
Usi
ng
D
rugs
or
Alc
ohol TAU
ACTd = 1.21
Shame Outcomes
Pre Post 3 Mo F-Up
110
105
100
95
90
85
Ave
rage
Sco
re
TAU
ACT
r with use at follow up = -.51 (p < .01)
r with use at follow up = ns
Where We Are
Good start but it is not enough There are some sour notes at the level of
technology Social trends are not good – if psychological
flexibility is key Enormous increase in exposure to horror and
chatter
What is Missing
Content wise: no studies on global warming and energy consumption; violent conflict; prevention; creating values-based groups.
We need to think about our work in a broader social context
We have natural allies Could we scale the model?
Can We Extend It?
Projects are underway that will test these ideas But we can take heart in the connection with
evolutionist thinking and data
Elinor Ostrom’s Eight Steps
1) Clearly Defined Boundaries. The identity of the group and its rights to the common resource must be clearly delineated.
2) Proportional equivalence between benefits and costs. Members of thegroup must negotiate a system that rewards members for their contributions.High status and other disproportionate benefits must be earned.
3) Collective-choice arrangements. Group members must be able to create their own rules and make their own decisions by consensus. People hate being told what to do but will work hard for group goals that they have agreed upon.
4) Monitoring. Managing a commons is inherently vulnerable to free-riding and active exploitation. Unless these locally advantageous strategies can be detected at relatively low cost, the tragedy of the commons will occur.
Elinor Ostrom’s Eight Steps5) Graduated sanctions. Transgressions need not require heavy-handedpunishment, at least initially. Often gossip or a gentle reminder is sufficient,but more severe forms of punishment must also be waiting in the wings for use when necessary.
6) Conflict resolution mechanisms. It must be possible to resolve conflicts quickly and in ways that are perceived as fair by members of the group.
7) Some recognition of rights to organize. Groups must have the authority to manage their own affairs. Externally imposed rules are unlikely to be adapted to local circumstances and violate ingredient 3.
8) For groups that are part of larger social systems, there must be nested enterprises. The previous ingredients work best in relatively small groups. Society at a larger scale must be multicellular, with groups interacting with groups, often in multiple layers.
Effective monitoring by monitors who are part of or accountable to the appropriators;
Mechanisms of conflict resolution are cheap and to easy access;
The self-determination of the
community is recognized by higher-
level authorities;Collective-choice
arrangements allow most resource
appropriators to participate in the decision-making
process;
There is a scale of graduated sanctions for
resource appropriators
who violate community rules;
Rules regarding the appropriation and provision of common resources are adapted to local conditions;
In the case of larger common-pool resources: organization in the form of multiple layers of nested enterprises, with small local CPRs at the base level.