Elizabeth V. Gifford

Acceptance-Based Treatment for Smoking Cessation

This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.

A Preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts

The present study compared methadone maintenance alone to methadone maintenance in combination with 16 weeks of either Intensive Twelve-Step Facilitation (ITSF) or Acceptance and Commitment Therapy (ACT) in a preliminary efficacy trial with polysubstance-abusing opiate addicts who were continuing to use drugs while on methadone maintenance. Results showed that the addition of ACT was associated with lower objectively assessed opiate and total drug use during follow-up than methadone maintenance alone, and lower subjective measures of total drug use at follow-up. An intent-to-treat analysis which assumed that missing drug data indicated drug use also provided support for the reliability of objectively assessed total drug use decreases in the ACT condition. ITSF reduced objective measures of total drug use during follow-up but not in the intent-to-treat analyses. Most measures of adjustment and psychological distress improved in all conditions, but there was no evidence of differential improvement across conditions in these areas. Both ACT and ITSF merit further exploration as a means of reducing severe drug abuse.

The Trouble with Language: Experiential Avoidance, Rules, and the Nature of Verbal Events

Experiential avoidance is the attempt to escape or avoid certain private experiences, such as particular feelings, memories, behavioral predispositions, or thoughts In this article, we discuss evidence that experiential avoidance is both pervasive and often harmful to human functioning We argue that experiential avoidance can be explained by two verbal processes, and we provide basic behavioral evidence on both the bidirectionality of derived stimulus relations in verbal humans and the insensitivity to the effects of responding produced by verbal rules If this analysis is correct, experiential avoidance is built into human language and thus can be undermined only with difficulty

Does Acceptance and Relationship Focused Behavior Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy for Smoking Cessation☆

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.

Functional Contextualism: A Pragmatic Philosophy for Behavioral Science

Publisher Summary This chapter presents an overview of functional contextualism which is a pragmatic philosophy for behavioral science. The chapter describes contextualism as functional contextualism, that is, as a pragmatic philosophy for behavioral science. It demonstrates the differences between mechanism and pragmatism; contextualism as a form of pragmatism; the philosophical inconsistency in behavior analysis stemming from inconsistency in Skinners writing; the specific commonalities between contextualism and the pragmatic wing of behavior analysis; and some of the implications of adopting functional contextualism as an explicit philosophy for behavior analysis, particularly the freedom from implicit prejudices that have prevented behavior analysts from undertaking the analysis of private events. One goal of a pragmatic approach to the philosophy of science is to prevent the obstruction of useful inquiry. Behavior analysis and pragmatism have common roots in the American cultural tradition. Pragmatism interpreted in the context of behavior analysis evolves into a functional philosophy of science. Behavior analysis interpreted in the context of pragmatism clarifies its existing goals and subject matter, encouraging an integrated, focused, yet flexible science of behavior.

FACT: THE UTILITY OF AN INTEGRATION OF FUNCTIONAL ANALYTIC PSYCHOTHERAPY AND ACCEPTANCE AND COMMITMENT THERAPY TO ALLEVIATE HUMAN SUFFERING

Functional analytic psychotherapy(FAP) and acceptance and commitmenttherapy (ACT) are 2 contemporarybehavioral therapies designed toaddress complex clinical problems. The2 therapies are described, and areas ofconvergence and divergence arediscussed. A new psychotherapyintegrating the 2—functional-analyticacceptance and commitment therapy(FACT)—is defined. It is argued thatFACT enhances the utility of FAP orACT alone by expanding the target oftherapy to include both interpersonaland intrapersonal client behaviors. Inaddition, the authors posit that theintervention technologies used in FAPand ACT enhance one another. Theauthors also address the followingtopics: populations for whom FACTwould be most beneficial, supervisionand training issues, current empiricalresearch on FACT, and FACT’sapplicability and generalization.

Moral behavior and the development of verbal regulation

The present paper examines the relationship between the development of moral behavior and the development of verbal regulatory processes. Relational frame theory and the distinctions among pliance, tracking, and augmenting forms of rule governance are applied to the domain of moral behavior and its development, in order to identify the specific social and verbal contingencies that are responsible for an evolving moral repertoire. It is argued that moral behavior is controlled by relational and rule-following repertoires, and that these can be arranged into a rough progression: pliance, tracking, augmenting, social concern for pliance, social concern for tracking, and social concern for augmenting. Congruence with data derived from other research traditions is examined, and applied implications are explored.

14 Stimulus classes and stimulus relations: Arbitrarily applicable relational responding as an operant

Publisher Summary The chapter discusses stimulus classes and stimulus relations. Humans show remarkable forms of stimulus control based upon seemingly arbitrary relations among stimuli. Normal adults who are told that a bottle contains poison will probably avoid that bottle, perhaps for life. The research interest in equivalence and other derived stimulus relations documents the fascination such performances have for behavioral psychologists. As with any behavior, a satisfactory behavior analytic account of these performances requires a specification of the nature of the activity and the antecedent, consequential, motivative, and other variables involved in its manipulation and prediction. This chapter includes one such analysis and explores some of its implications for the understanding of human stimulus control. It discusses the basic premises of relational frame theory (RFT) and the ways in which it informs an understanding of complex stimulus control among verbally competent humans. Most of the work on derived stimulus relations has been done on stimulus equivalence. There are several preparations used to establish stimulus equivalence in an experimental setting, but by far the most popular is matching-to-sample (MTS). In arbitrary MTS, a sample stimulus appears with an array of comparison stimuli, one of which is then selected. The stimulus arrangements and responses required vary.

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse.

INTRODUCTION An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST). METHODS Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; 9 2-hr group and 6 50-min individual sessions) or ST (N = 22; 6 90-min group and 1 20-min individual session), plus 8 weeks of transdermal nicotine patch. RESULTS At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium- to large-effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small- to medium-effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses. CONCLUSIONS Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.

Avoidance and Inflexibility as a Common Clinical Pathway in Obesity and Smoking Treatment

This brief study presents reductions in avoidance and inflexibility as a potential common clinical pathway to intervene on for both smoking cessation and weight control. A mediation analysis—using the Avoidance and Inflexibility Scale (AIS)—was conducted on a group of participants (N = 84) who were shown to improve weight control outcomes after receiving an Acceptance and Commitment Therapy (ACT) intervention. Results were then compared to a previous study using the same process measure (AIS) for smoking cessation. Results suggest a common clinical pathway.