Supercharging therapy with values

Supercharging therapy with values
Dr. Joseph Ciarrochi, School of Psychology, University of Wollongong Special thanks to natalie stefanic, for all her intellectual discussion and research on this topic

Structure of talk Part 1 Theory Part II. Behavioral Activation
Evidence behavioral Activation is effective. Part III: Values clarification Evidence values clarification is effective How to work with values

Part I: A Unified Theory

What happens to people’s dreams?
“The very great majority kill themselves long long before their time. Live as children; grow pale as adolescents; show a flash of life in love; die in their twenties and join the poor things that creep angry and restless about the earth” (O’Brian, 1991, p. 526).

ACT as a Unified framework
An extremely brief and pictorial description of Relational Frame Theory Fusion and Avoidance, two key processes that play a role in interfering with value-congruent living

How do we lose touch with what we value
How do we lose touch with what we value? Fusion is the dominance of particular verbal functions over other potentially available nonverbal and verbal functions (Hayes et al., 1999).

Fusion and avoidance. Fusion makes it possible for our private experiences (the bees above) to seem like physical threats. It allows us to spend time avoiding our experiences, just as we would avoid an outside threat

Avoidance takes a great deal of energy and is often inconsistent with other activities, e.g., distress provoking valued-activities

Desire (or values) and fear are two sides of the same coin
Desire (or values) and fear are two sides of the same coin. If can’t have distress, then you often must give up what you desire or value

Acceptance and Commitment Therapy (ACT) and Behavioural Activation (BA)
Shared philosophy of science: Functional Contextualism Behaviourist Emphasis on functional analysis Emphasis on context rather than content Shared therapeutic processes Activation of behaviour Undermining of harmful avoidance behavior Mindfulness Exposure

Distinctions between ACT and BA
ACT is based on a behavioral theory of language. Like traditional CBT, ACT views cognition as playing a key controlling role in suffering. However , ACT and traditional CBT differ in how they conceptualize and treat client problems (Ciarrochi & Bailey, 2008). Cognitive Defusion. ACT attempts to change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished. Self-as-Context- ACT helps people to contact with the sense of self as a locus or perspective (e.g., the “observer” self). This self gives clients a place to observe their experience and learn to let go of unhelpful self-evaluations. They learn that they are not the same as their evaluations; they are not the same as their pain, their depression.

Distinctions between ACT and BA
Activities versus values ACT tends to emphasize values more than traditional BA, which focuses a bit more on activity scheduling

Part II: Behavioral Activation

Study 1 supporting BA as“well-established” treatment for depression (Chambless et al., 1996)
McLean and Hakstian (1979) JCCP. Behavior therapy superior to other therapies at immediate follow-up (9 of 10 indices), and marginally superior on follow-up (7 of 10 indices) Behaviour therapy had lowest dropout (5% compared to 26% to 36% for other treatments)

Study 2 supporting BA as“well-established” treatment for depression (Chambless et al., 1996)
Jacobson et al. , 1996, (JCCP) compared three conditions. Conditions Behavioural Activation (BA) BA + automatic thought challenging (ATC) BA+ATC+ downward arrow/core belief Results Behavioral activation alone was as effective in treating depression as BA combined with cognitive interventions. Gortner et al showed effects held at 2 year follow-up

More research supporting behavioural activation
Dimidjian et al., 2006, JCCP. Study of Major Depression Compared behavioural activation to Cognitive Therapy and Antidepressent medication (ADM) BA found to be comparable in efficacy to ADM, and more efficacious than CT. Differential treatment effects obtained only for most severely depressed For more severly depressed participants, BA and ADM comparable Cuijpers et al., 2007 CPR. Meta-analysis BA effective (effect size =.87) and effects fairly consistent across studies

Is behavioral activation effective for other disorders, such as anxiety?
ACT theory posits similar processes: fusion and avoidance. Approximately 50% of individuals with depression have a coexistant anxiety disorder ( Kessler et al., 1996; Mineka, Watson, and Clark, 1998) Anxiety and depression share many symptoms (e.g., difficulties concentrating, restlessness, fatigue, and sleep problems. Decrease in control and predictability may be common in both disorders Anxiety and mood disorders may be variable manifestations of similar neurobiological processes (See Hopko, et al., 2006, for review of similarities between anxiety and depression)

Exposure in the service of activating valued behaviour

Is behavioral activation useful in treating anxiety
Small study of pure B.A. with PTSD shows B.A. was effective (Jakupac, et al., 2006) Social anxiety: Exposure is as effective as CT and full CBT package in treating social anxiety (Powers, et al., 2008) ACT, with big BA component, is effective in treating anxiety (Block, & Wulfert, 2000; Dalrymple & herbert, 2007; Forman et al,2007; Zettle, 2003)

Part III: Values

What are values? Wilson, Sandoz, Kitchens, and Roberts, 2008, under review 1) Values are ongoing patterns of activity Not achievable, can’t be completed Goals are achievable and serve values

What are values? 2) values are a special class of reinforcer
Can me distant in time, and occur in tiny increments Can refer to benefits that , in principle , could never contact (e.g., afterlife) Animals driven more by primary reinforcers (food shelter, water) and events correlated with those reinforcers (secondary reinforcers). These reinforcers usually occur in close proximity and reasonably large magnitude to serve as reinforcers (Wilson, et al., 2008)

What are values? 3) values are verbal
Language makes present psychological functions without direct operant or classical conditioning processes

What are values? Values are a special class of reinforcers that are verbally constructed, dynamic, ongoing patterns of activity, for which the predominant reinforcer is intrinsic in the correspondence between the individual behaviour and valued behavoural pattern (Wilson, et al., 2008)

Values, what are they good for?
Values have tremendous transformational power Theoretically, values set up the possibility for behaviours to become more reinforcing or punishing because of their relation to value statements Reinforcing:“Washing dishes” can go from tedious to joyous if “washing dishes” is in the service of “being a loving partner.” Punishing: Working extra hours can become increaingly aversive if it is seen as inconsistent with “being a loving partner.”

Empirical evidence: Values work is likely to be good for the client

Values affirmation buffers the stress response
All participants rank order values in terms of personal importance Trier social stress task—involves telling subjects they will have to do stressful speech task and mental arithmetic. Cresswall et al., 2005, Psychological Science

Values affirmation buffers the stress response
Affirmation manipulation Answer question like: Assuming that you have sufficient ability, would you prefer to be (a) a banker (b) a politician Experimental condition. Answered questions relating to top-ranked value Control. Answers questions relating to fifth ranked value

Salivary cortisol response to stress in the value-affirmation and control groups

Pretest and postest self-report stress measure, as function of self-resources (self-esteem and optimism) Values affirmation may exacerbate stress (at least self-report) in people with low self-resources Affirmation was sufficient to buffer participants neuroendocrine responses to stress, and this effect did not depend on dispositional self-resources.

Value affirmation improves objective performance
Cohen et al., 2006, Science Theory People are motivated to maintain self-integrity Negative group characterizations (e.g., black stereotypes in U.S.) pose chronic threat to self-integrity This threat, if too severe, can undermine performance

Value affirmation improves objective performance
Main study and replication Treatment and control condition presented a list of values Treatment condition: indicate most important values. Write about why value important to you Control condition. Indicate least important value and why this value might be important to someone else

Values clarification and tolerance for pain
Is their benefit to connecting pain-related thoughts to actions in a valued direction? Paez-Blarrina, M. et al., 2007, Behavior Modification; Paez-Blarrina et al. ,2008, Behaviour Research and Therapy Marisa Paez-Blarrina…Coming out of Carmen Lucianos Act lab in spain

Pain task Perform cognitive task. If do well, get points, which can be exchanged for a reward at the end of the task. Red asterisk appears on screen. If choose “finish”, then task ends and no shock. If continue, more chance for points but also a shock. (this is behavioural measure of pain tolerance)

Key Conditions ACT-values protocol—depicted pain as a part of valued action Control-values protocol—pain is opposed to valued living No values protocol

Findings 7/10 ACT-values intervention tolerated maximum number of shocks; Only 1/10 and 2/10 tolerated in the control and untrained condition, respectively. Pain believability. Do you keep going even when you think the task is causing you “very much pain.” 9/10 kept going in ACT-values; Only 5/10 and 3/10 kept going in the control and untrained conditions respectively These differences were significant

Measuring and using values in therapy
ACT intervention Survey of Life Principles

Past research in values
Values work (Schwartz, et al., Rokeach et al.). What is most important to you? Are there Universal values? Personal strivings (Sheldon, Emmons, Deci). What do you strive for Why do you strive? Is it for authentic or controlled reasons? We will call both of these “guiding principles” for ease of reference

Towards a behavioural approach to values and goals: Recasting Needs
Both value and striving literature seek to identify universal needs that underpin all guiding principles Need is identified by observing that positive psychological consequences result from conditions that allow its satisfaction and negative consequences accrue in situations that thrwart it (deci and ryan, 2001, pg 229) Instead of speaking in terms of “needs”, I will speak in terms of categories of reinforcer.

Towards a behavioural approach to values and goals: type of rule following
Pliance- rule governed behavior under control of apparent speaker-mediated consequences for a correspondence between the rule and the relevant behavior. (Zettle and Hayes, 1982; Hayes, Wilson, and Stroshal, 2001) Factors that impact pliance ability of speaker to monitor compliance, and deliver consequences importance of consequences to listener others (history, credibility; Hayes and zettle) Problem with pliance. Excessive pliance, e.g., wanting to “be good” and please others, can dominate over ones direct, personal expeirence of what works Reinforcers are arbitrary Note: contercompliance the other side of the compliance coin Arbitrary versus natural reinforcer. Natural reinforcer is dependent on the form of the behavior in that situation(e.g., kicking a glass results in it breaking) Other , more arbitrary things

Towards a behavioural approach to values and goals: type of rule following
Tracking- rule governed behavior under control of apparent correspondence between the rule and the way the world is arranged. (Zettle and Hayes, 1982) Factors that impact tracking Listeners history with the rule giver Correspondence between the rule and other rules or events in the listener’s history Importance of the consequence implied by the rule Extent rule successfully leads to reinforcement, avoid punishment Speaker does not mediate compliance (e.g., the rule could be conveyed by a book and have the same effect); (Hayes and Zettle, 1982)

Recasting Self-Determination Theory in behavioural terms.
Pliance Tracking Deci and Ryban, 2000, psychological science

The ImPActS intervention model
Importance Important principles are expected to involve tracking ACT can be used to help people discover what principles are or are not important to them. Pressure ACT can be used to undermine the power of unhelpful, pliance-based principles Activity ACT can be used to increase the amount of principle-congruent activity and the likelihood of contacting reinforcers Success ACT can be used to increase people’s success at living principles (e.g., via overcoming barriers and reinforcing commitment)

Research on values The area emphasizes the Importance component of the ImPActS model.

The structure of values (Schwarz)
values as cognitive representations of three universal requirements: (a) biological needs, (b) interactional requirements for interpersonal coordination, and (c) societal demands for group welfare and survival. Therefore, in building a typology of the content domains of values, we theorized that values could be derived from the universal human requirements reflected in needs (organism), social motives (interaction), and social institutional demands. Of course, particular value contents may be grounded in more than one type of universal requirement. Emphasis on importance. The survey of life principles sought to sample three items from each domain

Values and behaviour ImPActS
Values importance has predicted more than 15 different behaviours e.g., voting for political party, choosing a university course Other predicted behaviours: delinquency, cooperation, competition, consumer purchasing, environmental behaviours, religious behaviours (See Bardi and Schwartz, 2003)

Values and well-being ImPActS
The following were positively related to subjective well-being Achievement: Personal success through demonstrating competence according to social standards. (Successful, capable, ambitious, influential) Stimulation: Excitement, novelty, and challenge in life. (Daring, a varied life, an exciting life) Self-direction: Independent thought and action-choosing, creating, exploring. (Creativity, freedom, independent, curious, choosing own goals) Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc

The following were negatively related to well-being Conformity: Restraint of actions, inclinations, and impulses likely to upset or harm others and violate social expectations or norms. (Politeness, obedient, self-discipline, honouring parents and elders) Security: Safety, harmony and stability of society, of relationships, and of self. (Family security, national security, social order, clean, reciprocation of favors) Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc

The researchers failed to find a positive association of subjective well-being and Universalism: Understanding, appreciation, tolerance and protection for the welfare of all people and for nature. (Broadminded, wisdom, social justice, equality, a world at peace, a world of beauty, unity with nature, protecting the environment) Benevolence: Preservation and enhancement of the welfare of people with whom one is in frequent personal contact. (Helpful, honest, forgiving, loyal, responsible) Seemed inconsistent with the notion that concern for others rather than self promotes subjective well-being A false dichotomy? Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc

Succeeding at what is important to you
ImPActS Congruity between people's values and their environment promotes well-being, regardless of the particular values to which people ascribe importance. Power values were negatively associated with well-being amongst psychology students, and higher satisfaction amongst business administration students. The business folks were also happier the more they were into achievement values. Sagiv and Schwarz, 2000, Eur. Jn., of Soc. Psyc The survey of life principles contains10 items that get at various career related interests

Succeeding at what is important to you
ImPActS Life satisfaction influenced when satisfied in value-congruent domain. More specifically, global life satisfaction was strongly influenced by social life for individuals high in Benevolence values, whereas it was strongly influenced by family life for individuals high in Conformity values. Satisfaction with grades was a stronger predictor of global life satisfaction for individuals who stress achievement than for those who do not. Within-individual variation of day-to-day satisfaction is strongly influenced by daily success with the most valued domain. Oishi, et al., j of personality, 1999 Domain satisfaction most highly related to domain success in our study

Personal strivings Key Researchers: Sheldon, Emmons, Elliot, and Others Idiographic. People describe their own personal strivings and do not select from a set items, as in values work Emphasis on Self-concordance. To what extent do people pursue their goals because the goals fit with their underlying interests and values rather than because others pressure them to pursue the goal.

Universal “needs, “ or categories of reinforcer
Competence or “effectance—propensity to have an effect on the environment as well as to attain valued outcomes within it. Relatedness -- desire to feel connected to others, to love and care, and to be loved and care Autonomy refers to volition—the organisimic desire to self-organize experience and behavior and to have activity be concordant with one’s integrated sense of self These can be viewed as classes of reinforcers from a behavioral perspective

Personal strivings: key findings
Self concordance relates to subjective well-being across many cultures (Sheldon, 2002; Sheldon et al., 2004) Longitudinal study. Making progress towards goals predicted well-being. However, this depended on the “organismic congruence” of the goal. That is, goal achievement led to increased well-being for those people who pursued goals for more autonomous reasons, and those goals that are oriented towards more intrinsic outcomes (Sheldon and Kasser, 1998) This relates to Importance and Pressure in the ImPActS model

Personal strivings: Avoidance goals
Elliot and sheldon (1998) coded goals in terms of approach and avoidance Approach goals: get in good shape, be more gentle and humble Avoidance goals: avoid procrastination, don’t be lazy People with avoidance goals tend to feel less competent and in control and experience greater reporting of physical symptoms (Elliot and Sheldon, 1998) Elliot, Sheldon, and Church (1997) had students classify goals as approach oriented or avoidance oriented. Avoidance striving was deleterious to both retrospective and longitudinal well-being

The survey of life principles (SLP)
Ciarrochi and Bailey, in press; Stefanic and Ciarrochi, 2008; Frearson and Ciarrochi, 2008 The SLP attempts to combine the best parts of the values literature and the personal strivings literature, and attempts to do so in a way that is useful to clinic SLP provides people with wide variety of principles to choose from. This has the advantage of prompting people to think about principles they might have not considered for awhile, or might have forgotten SLP measures extent principle is due to self versus other pressure

53 items, sampled to cover every major domain identified in values literature, goals literature, and job interests literature. Somewhat heavy emphasis on social principles, given their clinical relevance. Three items related to experiential control (e.g., “having a stress free life”) Principles written in a verb form, in keeping with the ACT definition of values as being “ongoing patterns of activity.” Principles were written to have maximal personal relevance (e.g., “A world of beauty” changed to “creating beauty”)

Items are call “principles”, because they could refer to either values or abstract goals (e.g., “being honest” might be either value or goal) Two open end items for people to write down own principles

Four dimensions of the SLP
Importance. The extent a person finds princple to be personally imporant Pressure. The extent person feels pressured to hold principle. Pressure can come from other people, groups, media, society, etc. Activity. Each principle is rated in terms of whether the person wanted to put it into play Success. If person wanted to put a principle into play, then they rated that principle in terms of their level of success.

SLP: Early findings First study conducted with 300 University Students
We focused on variables of interest to clinicians: e.g., measures of emotional well-being, psychological well-being, social support, and relationship satisfaction The next study will be conducted later this year with 600 year 12 adolescents. We have been conducting a longitudinal study with these students for 7 years. Includes broad range of measures related to social and emotional well-being Involves ratings by peers and teachers

Each SLP global score makes a distinctive contribution to well-being
Description Low Score Mean High Score Importance Low scores indicate the person finds few principles to be important 5.81 6.51 7.19 Female 5.90 6.57 7.24 Male 5.57 6.3 7.03 Pressure High scores indicate the person feels pressure from others to hold principles 3.14 4.54 5.98 Activity Low scores indicate that the person is putting reduced number of principles into play 23.63 31.18 38.73 Success Low scores indicate that the person is not succeeding at principles 3.05 3.48 3.91

SLP Global scores and emotional well being
Positive Affect Sadness Hostility Importance .10 .08 .11 Pressure -.10 .11* .12* Activity .22** .01 -.09 Success .36** -.34** -.31** Variance explained 23% 14% 12% *p < .05; ** p< .01 Note: These are the Betas from regression analysis. All variables were entered simultaneously, so Beta represents the unique variance explained by each global score, after controlling for the other scores

SLP Global scores and Psychological well-being
Autonomy Relations with others Purpose Importance -.12* .08 .27** Pressure -.25** -.15** Activity .11 .04 .14** Success .30** .36** .39** Variance explained 18% 29% *p < .05; ** p< .01 Note: These are the Betas from regression analysis. All variables were entered simultaneously, so Beta represents the unique variance explained by each global score, after controlling for the other scores

Predicting social wellbeing
Global score Romantic relationship satisfaction Social support numbers Social support satisfact. Global Success .12 .09 .18* Prosocial Import. .24** .07 .12* Having genuine and close friends-success .00 .20** .14* Having relationships involving love and affection-success .41** -.04 .21** Variance explained 32% 7% 20% *p < .05; ** p< .01 Note: The global score “success” was the only one to uniquely predict each of the social well-beings. However, prediction was much improved by using the more specific social principles

Resisting pressure?

One needs to look at local as well as global indices
Importance of power not related to well-being. Indeed , it is related to higher hostility Importance of wealth was not related to well-being

Top 10 most important values
Having genuine and close friends 2 Being loyal to friends, family, and/or my group 3 Maintaining the safety and security of my loved ones 4 Having relationships involving love and affection 5 Feeling good about myself (experiential control item) 6 Striving to be a better person 7 Experiencing positive mood states (experiential control item) 8 Being Honest 9 Having an enjoyable, leisurely life 10 Being safe from danger

Top 10 most pressured values
Meeting my obligations 2 Being ambitious and hardworking 3 Being physically fit 4 Showing respect to parents and elders 5 Eating healthy food 6 Being honest 7 Being self-sufficient 8 Striving to be a better person 9 Being competent and effective 10 Being safe from danger

Top 10 most successful values
Being loyal to friends, family, and/or my group 2 Enjoying food and drink 3 Being safe from danger 4 Having genuine and close friends 5 Being honest 6 Maintaining the safety and security of my loved ones 7 Making sure to repay favors and not be indebted to people 8 Showing respect to parents and elders 9 Having relationships involving love and affection 10 Enjoying music, art, and/or drama

Top 10 failures 1 Leading a stress free life (experiential control) 2 Having a sense of accomplishment and making a lasting contribution 3 Promoting justice and caring for the weak 4 Gaining wisdom and a mature understanding of life 5 Being wealthy 6 Being at one with god or the universe 7 Feeling good about myself (experiential control) 8 Striving to be a better person 9 Being physically fit 10 Having an enjoyable, leisurely life 13 Experiencing positive mood states (experiential control) Note: Failure index= Importance – success.

Principle compatibilities and incompatibilities

Perceived compatibilities Perceived incompatibilities
Principle Having genuine and close friends Perceived compatibilities Being loyal to friends, family, and/or my group Having relationships involving love and affection Emotion control principles (e.g., Leading a stress-free life, feeling good about myself) Perceived incompatibilities Gaining wisdom and a mature understanding of life Artistic principles Comment Surprising disconnect between many pro-social principles (e.g., honesty) and friendship

Perceived Compatibilities Perceived incompatibilities
Principle Having relationships involving love and affection Perceived Compatibilities Having genuine and close friends Maintaining the safety and security of my loved ones Being sexually active Being safe from danger Perceived incompatibilities Sensation seeking principles (Having a life filled with adventure) Nonsocial activities (Building and repairing things; working outdoors) Comment Where are the prosocial virtues? Honesty, loyalty, helping others

Principle Prosocial : Being loyal, honest, maintaining security and safety of loved ones, respecting parents and elders, helping others Perceived Compatibilities Being safe from danger Resolving disputes Showing respect for tradition Perceived incompatibilities Power (e.g., having influence; having authority, being in charge) Sensation seeking Artistic

Principle Being wealthy Perceived Compatibilities Power principles Sensation seeking principles Achievement principles Being sexually active; being sexually desirable (both M and F) Emotion control Perceived incompatibilities Helping others Being at one with nature Being at one with god Being artistic Promoting justice and caring for the weak

Principle Power: having influence of people, having authority, being in charge Perceived Compatibilities Achievement principles (e.g., being ambitious and hard working) Being sexually desirable Perceived incompatibilities Being honest Respecting parents and elders Helping people Being at one with nature Being at one with god, practicing religion Promoting justice and caring for the weak

Utilizing the SLP Importance ratings
What do clients value most? What is likely to be the subject of therapy Values themes. Social. Power. Art? Achievment Look out for low global values ratings. Might suggest a client has no idea what they value, or refuses to acknowledge values Likely intervention:Values clarification (see card sorting task)

Restricted range of principles
Utilizing the SLP Restricted range of principles Clients may endorse very few principles as important. They may endorse several as important, but state that they have not tried to put them into play. Finally, they may rate a number of value clusters as unimportant What are the barriers to putting the values into play? Likely interventions: acceptance, defusion, or overcoming practical barriers?

Dominance of experiential control items
Utilizing the SLP Dominance of experiential control items High importance on experiential control dimension Nothing inherently wrong with experiential control, unless in conflicts with other important principles Likely interventions: Creative hopelessness, acceptance

Presence of strong pressure
Utilizing the SLP Presence of strong pressure Research suggests that pressured principles tend not to lead to vital living or well-being (Sheldon & Kasser, 1995) and tend to be associated with hostility and sadness (Stefanic & Ciarrochi, 2008). Danger of contercompliance: In reaction to pressure, the client refuses to act according to the principle, or acts contrary to the principle

Presence of strong pressure: Interventions
Utilizing the SLP Presence of strong pressure: Interventions Therapist behaviours: acting with humility in session, undermining your own authority, encouraging clients to not believe anything you say Remove source of pressure. E.g., imagine nobody knew you were living the principle. Would you still live it? Seek to identify past experience that was vital. E.g., sweet spot exercise. Connect their valued statements to this vital past

References Bardi, A., & Schwarz, S. Values and Behavior: Strength and Structure of Relations. Personality and Social Psychology Bulleting, 29, Block, J. A., & Wulfert, E. . (2000). Acceptance or change: Treating socially anxious college students with ACT or CBGT. The Behavior Analyst Today, 1, Braithwaite, V. A., & Law, H. G. (1985). Structure of human values: Testing the adequacy of the Rokeach value survey. Journal of Personality & Social Psychology, 49, Chambless, D. L., Sanderson, W. C., Shoham, V., Bennett Johnson, S., Pope, K. S., Crits-Christoph, P., Baker, M., Johnson, B., Woody, S. R., Sue, S., Beutler, L., Williams, D. A., & McCurry, S. (1996). An update on empirically validated therapies. Clinical Psychologist, 49, UOW Library Clinical Psychologist, 49, Ciarrochi, J., & Bailey, A. (In press). A CBT-Practicioner's Guide to ACT: How to Bridge the Gap Between Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications, Inc. Cohen, G. L. G., Julio; Apfel, Nancy; Master, Allison. (2006). Reducing the Racial Achievement Gap: A Social-Psychological Intervention. Science, 313, Creswell, J. D. W., William T; Taylor, Shelley E; Sherman, David K; Gruenewald, Tara L; Mann, Traci. (2005). Affirmation of Personal Values Buffers Neuroendocrine and Psychological Stress Responses. Psychological Science(16), Dalrymple, K. L., & Herbert, J. D. . (2007). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A pilot study. Behavior Modification, 31, Dimidjian, S., Dobson, K., Kohlenberg, R., Gallop, R., Markley, D., Atkins, D., et al. (2006). Randomized Trial of Behavioural Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatement of Adults with Major Depression. Journal of Consulting and Clinical Psychology, 74,

References Elliot, A. J., & Sheldon, K. M. (1998). Avoidance personal goals and the personality-illness relationship. Journal of Personality and Social Psychology, 75(5), Elliot, A. J., Sheldon, K. M., & Church, M. A. (1997). Avoidance personal goals and subjective well-being. Personality and Social Psychology Bulletin Vol 23(9) Sep 1997, Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. . (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31, Frearson, J., & Ciarrochi, J. (2008). Linking Life Principles to Romantic Relationships and Social Support.Unpublished manuscript, University of Wollongong. Hopko, D., Robertson, S., & Lejuez, C. (2006). Behavioural Activation for Anxiety Disorders. The Behaviorist Analyst Today, 7, Jacobson, N. S., Dobson, K. S., Truax, P., Addis, M. E., Koerner, K., Gollen, J., et al. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting & Clinical Psychology, 64(2), Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, Jakupak, M., Roberts, L., Martell, L., Mulick, P., Michael, S., Reed, R., et al. (2006). A Pilot Study of Behavioural Activation for Veterans with Postraumatic Stress Disorder. Journal of Traumatic Stress, 19, Martell, C. R., Addis, M., & Jacobson, N. (2001). Depression in Context: Strategies for Guided Action. New York: WW Norton & Co. McLean, P. D., & Hakstian, A. R. (1979). Clinical depression: Comparative efficacy of outpatient treatements. Journal of Consulting and Clinical Psychology, 47, O'Brian, P. (1991). H.M.S. Surprise. New York: W. W. Norton & Company. Oishi, S., Diener, E., Suh, E., & Lucas, R. (1999). Value as a moderator in Subjective Well-Being. Journal of Personality 67,

References Paez-Blarrina, M. L., Carmen; Gutierrez-Martinez, Olga; Valdivia, Sonsoles; Ortega, Jose; Rodriguez-Valverde, Miguel. (2008). The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based. Behaviour Research and Therapy, 46, Paez-Blarrina, M. L., Carmen; Gutierrez-Martinez, Olga; Valdivia, Sonsoles; Rodriguez-Valverde, Miguel; Ortega, Jose. (2008). Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive control--based protocol. Behavior Modification, 32, Power, M., Sigmarsson, S., & Emelkamp, P. (2008). A Meta-Analytic Review of Psychological Treatments for Social Anxiety Disorder. International Journal of Cognitive Therapy, 1, Rokeach, M. (1973). The nature of human values. New York: Free Press. Sagiv, L., & Schwartz, S. H. (2000). Value priorities and subjective well-being: direct relations and congruity effects. European Journal of Social Psychology, 30, Schwartz, S. H., & Bilsky, W. (1987). Toward a Universal Psychological Structure of Human Values. Journal of Personality and Social Psychology, 53, Schwartz, S. H., & Bilsky, W. (1990). Toward a theory of the universal content and structure of values:extensions and cross-cultural replications. Journal of Personality and Social Psychology, 58, Schwartz, S. H., & Boehnke, K. (2004). Evaluating the structure of human values with confirmatory factor analysis. Journal of Research in Personality, 38, Sheldon, K. M., & Elliot, A. J. (1999). Goal striving, need satisfaction, and longitudinal well-being: The self-concordance model. Journal of Personality and Social Psychology, 76(3), Sheldon, K. M., Elliot, A. J., Ryan, R. M., Chirkov, V., Kim, Y., Wu, C., et al. (2004). Self-concordance and subjective well-being in four cultures. Journal of Cross-Cultural Psychology, 35(2), Sheldon, K. M., & Kasser, T. (1998). Pursuing personal goals: Skills enable progress, but not all progress is beneficial. Personality and Social Psychology Bulletin, 24(12), Stefanic, N., & Ciarrochi, J. (2008). Linking Life Principles to Emotional and Psychological Well-Being.Unpublished manuscript, University of Wollongong. Wilson, K., Sandoz, E., Kitchens, J., & Roberts, M. (2008). The Valued Living Questionnaire: Defining and Measuring Valued Action within a Behavioral Framework.Unpublished manuscript, University of Mississippi. Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. Psychological Record, 53(2),

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