1. A preliminary Experimental Analysis of Values-oriented and Defusion methods in ACT* Rosa M. Vizcaíno Carmen Luciano Francisco J. Ruiz Vanessa Sánchez University of Almería, Spain Olga Gutiérrez-Martínez University of Barcelona, Spain * Actually published (see last slide)

2. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) A third wave, contextually based behavior therapy. Theoretically rooted in Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001). Effective in a wide range of psychological disorders, health problems, etc. (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Ruiz, 2010).

3. ACT promotes psychological flexibility  reducing problematic experiential avoidance by taking responsibility with own values even in the presence of discomforting private events (acceptance). ACT promotes acceptance through values clarification and defusion  middle-level terms Metaphors and experiential exercises are main clinical methods to alter problematic regulation of behavior. However, the verbal processes or transformations defining these methods are still not well known.

4. Steps to alter problematic regulation… Valued oriented methods involve the verbal discrimination of what one wants, what one is doing to get it, and the results in the short and the long terms It seems to work through comparative, temporal and perspective-taking cues. Acceptance methods involve the verbal discrimination of the paradoxical effects It seems to work by changing from opposition to inclusion relations between valued actions and discomfort.

5. Steps to alter problematic regulation… Defusion methods aim the person behaves in the present moment under the control of the relevant stimulus function instead of behaving according to the literality or the verbal functions of thoughts/feelings Defusion methods take many forms and, perhaps, are the least understood in basic terms * Different types of components in exercises : “exposure to PE” “I and my PE” “the higher level, the self functions (what I want)”…. * … Different types of transformations

6. EXAMPLES… All verbal discrimination… Defusion, type 1 or B*. …between the person as being here and their thoughts/feelings as being there (I- HERE-NOW and my thoughts THERE)  Deictic relational cues Defusion, type 2 or C*. …to establish a sense of self as a locus or perspective with INCLUSION functions: “I contain my thoughts”, etc  Deictic and hierarchical relational cues Defusion/self-as-context/values, type 3 or D*. … to potentiate the functions of the self as the “top” of the hierarchy to choose and direct the person`s behavior  Deictic and hierarchical relational cues *Luciano, Ruiz, Vizcaíno et al. (2011)

7. Current Study Preliminary attempt to isolate the deictic and hierarchical transformations apparently involved in defusion exercises Protocol “Defusion-I” Deictic framing (type 1 or B) Protocol “Defusion-II” Deictic & hierarchical (types 1, 2 & 3 or B,C.& D) Values-oriented session, (type 0 or A) 15 young students with problematic behaviors

8. METHOD

9. Participants 15 adolescents (8 girls, 12-15 years)  3 groups of 4-7 Selected among a pool of 81 Secondary school students based on high scores in BASC (behavioral and emotional problems in young children and teachers` reports Two profiles: ▫ Impulsive (N = 7) ▫ Emotional (N = 8). Two types of participants (explain later) ▫ High-risk (N = 6) ▫ Low-risk (N = 9)

10. Main Dependent Variables Self-report of impulsive (IBI) or emotional behaviors (EBI)  28 items assessing specific problematic behaviors with ratings of frequency (0-10)  Items with a rating of 4 or higher considered problematic behaviors  Examples of IBI items: Blaming other. Do things to be expulsed from the classroom. To hit my brothers or sisters.  Examples of EBI items: To quit exams or not going classes when feeling anxious. Get closed in my room when feeling sad. Don’t talk with others because of fear to appear ridiculous

11. Main Dependent Variables A reduced adaptation of the Acceptance without Judgement scale of Kentucky Inventory of Mindfulness Skills (KIMS), as indicative of defusion. Spanish Adaptation of Avoidance and Fusion Questionnaire (AFQ), as indicative of experiential avoidance.

12. Criteria for Problematic Levels High level of problematic behaviors  6 or more problematic behaviors, High risk participants, N = 6 Low level of problematic behaviors  fewer than 6 problematic behaviors, Low risk participants, N = 9

13. Quasi-experimental design with repeated measures: a between-subject variable with two levels: Protocol Defusion-I and Protocol Defusion-II a within-subject variable: the repeated measures on the corresponding dependent variables, before, during and after the respective protocols Defusion-I  Low risk participants Defusion-II  Low and High risk participants Design

14. Procedure Overview Parents’ Consent: 81 students 1 st, 2 nd, & 3 rd secondary studies (13-16 years) Participants assesment and selection of at-risk adolescents Brief Values Session (1 session) Defusion Protocols (I or II) 3-4 sessions Post and Follow-up 4 months

15. Brief Values Session (paper and pencil anonymous task)  Goal: Discrimination own problematic behaviors Write the things that you have said you do a lot How do you feel? Now, imagine that you keep doing these things 5-10 more years  … what do you think would happen? Now, imagine that you stop doing these things ….What do you think would happen? …And in 5- 10 years? Now that you realize what would happen in a few years from now, what do you choose to do? … a) Stop b) Continue Identification of Problematic Behaviors Perspective Taking Choosing

16. Two Defusion Protocols DEFUSION-I: Only deictic interactions: > I-my PE (type 1 or B) DEFUSION-II: Deictic and hierarchical interactions:  “I-my PE” plus + (type 1 or B)  “I contain my PE” + (type 2 or C)  “I am the boss, I am in charge, I want..(type 3 or D) (partially applied as a computer task)

17. Deictic protocol (3/4 sesions 30-min) MET with general private events MET with problematic private events *Notice your breath and do nothing *What thought are you having? * … put in a word? * … put in front of you? *Do nothing with it, only contemplate it. Imagine that you were studying very difficult things all the day. What sensation would you have? What is the form of this sensation? Take a picture Only contemplate it. Think in the moments where you feel bad or angry... What thought or sensation do you have? In a word… Put it in front of you…a photo…how it looks like? … do nothing but contemplate it. DEICTIC FRAMING

18. Deictic & Hierarchical (3/4 ses 30-min) MET with general private events MET with problematic private events *Notice your breath and do nothing *What thought are you having? * … put in a word? * … put in front of you? *Do nothing with it, only contemplate it. Who is having that thought Imagine that you were studying very difficult things all the day. What sensation would you have? What is the form of this sensation? Take a picture Only contemplate it. Respond to you who is having that thought Think in the moments where you feel bad or angry... What thought or sensation do you have?..I n a word… Put it in front of you…a photo…how it looks like? … do nothing but contemplate it.. See yourself letting the...in charge…what you do when.. picture of that…you like… a word … See you in charge... You have room for your thoughts, feelings, etc. ¿Who do you like to be in charge? You or your thoughts/feelings? Choose: Stop or Continue? DEICTIC & Hierarchical FRAMING

19. RESULTS

20. Low-risk Participants (N = 9) Deictic Deictic + Hierarchical

21. Low-risk Ss (N = 9) Defusion II: DEICTIC + HIERARCHICAL Exercises Defusion I: DEICTIC Exercises

22. High-risk Ss (N =6) Defusion II: DEICTIC + HIERARCHICAL Exercises

23. DISCUSSION The single values-oriented session impacted in half of Ss, mostly Low-risk reduced PB Defusion I (deictic) /v/ II (deictic/hierarchy): Only Low-risk Ss : Defusion I reduced but not maintained Defusion II reduced and maintained zero at 4-m FU Reduction ran together to changes in AFQ & KIMS Age and type (impulsive or emotional) were not relevant. They valorated helpful in doing better

24. High-risk Ss: only Defusion II A general reduction in all of them More than half maintained at FU Reductions and increases in PB correlated with defusion measure (KIMS) AFQ measure does not seem too sensible.. Better adaptation? They valorared helpful in doing better Teachers: informal evaluation… …student`s behaving as better. This correlated with self-report changes DISCUSSION

25. Most participants benefit: doing better –reports- and not being instructed but making choices. Values oriented-session relevant with lower PB Defusion I (exercises I-PE, there) not sufficient even with Low-risk Ss. Defusion II (exercises hierarchical cues). impacted and maintained for Low-risk Ss. Defusion II did also for High-risk Ss. but more variability. More training or individually given? The defusion exercises seem to work by increasing acceptance without judment. It seems relevant the relacional cues in the exercises to alter the functions of private events. CONCLUDING…

26. D-II: It seems that framing of thoughts/feelings in a hierarchical context and given it explicit control functions made a relevant change. Defusion II protocol involved deictic and hierarchical cues. It was suited to potentiate: ▫ the self-as-context as the higher level of the hierarchy, and ▫to potentiate its funcional role: the direction in behavior regulation This is connected to Values, to Acceptance, and necessarily to Self-context and Be-present. CONCLUDING…

27. Replications with high and low. More Ss. Adapted to school but more colaboration needed Similar profiles in the group Experiential task as in basic studies Direct measures of problems and valued actions Refining questionnaires measures (AFQ) Isolation of the different relational cues in Defusion II …. Ongoing Further research …

28. Actually published: http://www.ijpsy.com Luciano, Ruiz, Vizcaíno et al. (2011). A relational Frame Analysis of Defusion Interactions in Acceptance and Commitment Therapy. A preliminary and quasi- experimental study with at-risk adolescents International Journal of Psychology and Psychological Therapy, 11, 2, 165-182 ◦THANKS