Richard T. Bissett

Measuring experiential avoidance: A preliminary test of a working model

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.

THE IMPACT OF ACCEPTANCE VERSUS CONTROL RATIONALES ON PAIN TOLERANCE

Acceptance approaches, which have been receiving increased attention within behavior therapy, seek to undermine the linkage between private events and overt behavior, rather than attempting to control the form or frequency of private events per se. Research comparing control versus acceptance strategies is limited. The present study examined the behavioral and subjective impact of a control-based versus acceptance rationale, using a cold pressor task. Subjects in the acceptance group demonstrated greater tolerance of pain compared to the control-based and placebo groups. Only the control-based rationale targeted the subjective experience of pain but it did not differ across rationales. Results confirmed that acceptance was effective in manipulating the believability of reason giving, a key process measure. By encouraging individuals to distance themselves from their private events, acceptance methods may help reduce the use of emotional reasons to explain behavior and hence shift concern from moderating thoughts and feelings to experiencing the consequences of one’s action. Acceptance is a promising new technique. Its effect is all the more surprising given that it teaches principles (e.g., “thoughts do not cause behavior”) that run counter both to the popular culture and to the dominant approaches within empirical clinical intervention.

DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies?

Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Functional Analytic Psychotherapy have recently come under fire for “getting ahead of their data” ( Corrigan, 2001 ). The current article presents a descriptive review of some of the actual evidence available. Dialectical Behavior Therapy and Acceptance and Commitment Therapy have a small but growing body of outcome research supporting these procedures and the theoretical mechanisms thought to be responsible for them. Functional Analytic Psychotherapy has a limited research base, but its central claim is well substantiated. The claims made in the published literature about these technologies, at least by their originators, seem proportionate to the strength of the current evidence. There is no indication that those interested in the new wave of behavior therapy innovations are less committed to empirical evaluation than has always been the case in behavior therapy.

The Impact of Acceptance and Commitment Training and Multicultural Training on the Stigmatizing Attitudes and Professional Burnout of Substance Abuse Counselors.

Empirically validated methods for reducing stigma and prejudice toward recipients of behavioral health-care services are badly needed. In the present study, two packages presented in 1-day workshops were compared to a biologically oriented educational control condition in the alleviation of stigmatizing attitudes in drug abuse counselors. One, Acceptance and Commitment Training (ACT), utilized acceptance, defusion, mindfulness, and values methods. The other, multicultural training, sensitized participants to group prejudices and biases. Measures of stigma and burnout were taken pretraining, posttraining, and after a 3-month follow-up. Results showed that multicultural training had an impact on stigmatizing attitudes and burnout post-intervention but not at follow-up, but showed better gains in a sense of personal accomplishment as compared to the educational control at follow-up. ACT had a positive impact on stigma at follow-up and on burnout at posttreatment and follow-up and follow-up gains in burnout exceeded those of multicultural training. ACT also significantly changed the believability of stigmatizing attitudes. This process mediated the impact of ACT but not multicultural training on follow-up stigma and burnout. This preliminary study opens new avenues for reducing stigma and burnout in behavioral health counselors.

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.

Derived Stimulus Relations Produce Mediated and Episodic Priming

If derived stimulus relations can serve as a beginning behavioral model of semantic meaning, many of the cognitive findings shown with semantic relations should apply to derived stimulus relations. The present study examined whether priming in a lexical decision task occurs in equivalence relations. In the primary experiment, subjects were trained to form three 3- member equivalence classes of “word-like” nonsense words. Subjects were then given a battery of lexical recognition tasks that included previously trained equivalence class members. The priming effect for stimuli in an equivalence class, whether stimulus relations were directly trained or derived, was as strong as that previously reported for associated words. Control conditions show that these effects were due to derived stimulus relations, not to alternative sources of control. Priming through equivalence classes provides one of the more robust instances of what in the cognitive literature are termed “episodic priming” and “mediated priming.” These results provide some additional support for the idea that derived stimulus relations are a useful preliminary behavioral model of semantic relations, and that they supply a useful procedure for research on priming more generally.

Protocol analysis and the "silent dog" method of analyzing the impact of self-generated rules.

Within the cognitive literature, verbal protocols of cognitive events are plagued by difficult questions of unconsciousness, completeness, reactivity, and validity. In this paper we argue that these concerns apply with much less force or not at all when protocol analysis is used to determine whether a given instance of behavior is governed by self-generated rules. When adequate controls are used, some patterns of results allow this question to be answered unambiguously and in a manner untouched by the philosophical hurdles encountered within the cognitive literature on protocol analysis. We argue that in at least some circumstances a slightly modified version of protocol analysis allows us to know, in a functional sense, what a person was thinking. Protocol analysis can be very useful to behavior analysts who are interested in determining whether task-relevant behavior is controlled by self-generated rules or is purely contingency shaped.