You and I: Understanding and measuring high impact Functional Analytic Psychotherapy (FAP)

 

There are many ways to understand every therapy. Here I’ll offer a granular analysis of what seems to occur in the high impact FAP. What I present here is not an opposition to the current model of FAP but a different layer of analysis. I would agree that contingent reinforcement of behavior is a key mechanism of FAP. The purpose of an RFT level analysis is to offer additional ways to measure and understand some of the effects of FAP that are harder to characterize and measure.

I’m focusing on the symbolic relations that are created in what I call ‘high impact’ FAP. What I’m calling to in this description is the tendency of present moment relational therapy to become more powerful and evocative than one would normally suspect of a treatment based on reinforcement of adaptive behavior via the therapeutic relationship.

Those of you who have been to a FAP intensive or are highly experienced in FAP may be familiar with the report of FAP being “life changing”, “transformative”, etc. (Not that all treatments don’t have those that experience it this way… but the rate of this intense response seems a bit higher  in FAP. And, an RFT driven analysis there are empirical logical explanations for why those that experience FAP as moving may experience it as life altering.)

Note that RFT is about symbolic relations and their properties. Patterns of pairing (between behavior, language in any form, sensations/perceptions, contexts) can all become meaningful over time through association with important (e.g., painful, joyful) experiences.

This is no different than operant reinforcement or classical conditioning – the type of pairing, the frequency/schedule, context, etc. all affect the relations made. The only difference here is that the SD can show up more easily symbolically (via language or some other cue).

So, let’s now look at perspective (the “I”) that orients your experience. You walk through life each day seeing, doing, feeling, thinking… and each of these things becomes a part of your continuing experience. In some way, they have become paired with the “I”. Perhaps very weakly paired but paired none the less. (See RFT: The space-time of the human universe for further description of perspective).

Experiences that happen over and over, including consistencies in the way that people describe you or relate to you become a part of your “I” and your concept of the other, or symbolic “YOU”.

The way you explain what occurs in these relations gives them additional power as it becomes a symbolically ‘sticky’ way of seeing the world (i.e., coherence relations, schema). You see others through this story of yourself and yourself as well. They, similarly, have stories about themselves and others and how people relate by which they organize their experience.

Now consider that everything you do in a relationship creates an associations between:

The “YOU” and “I” present, or symbolically referenced (spoken about, etc.). Further the emotions you express, the way that you talk about yourself and others, the behaviors you emit in any respect all become attached to the “YOUs” and “Is” in the room. (Yes, plural “I”s through the sometimes distinct tracks of symbolically defined behavior (e.g., roles, contexts, etc.) serving to create classes of behavior that ‘hang’ together.

Stop and consider that for a bit… Do you often belittle yourself in your own mind or in front of others? If you do you may find that people’s behavior towards you will begin to reflect this relation or that your own behavior towards your self will become less compassionate over time.

Our learning histories, ‘sticky’ self stories, and current histories all affect the our sense of self and other. And, because the “I” is theoretically the relation most complexly derived (it is always there as a part of the associations forming) transformation of the “I” can ripple through all the attached relations.

Stop and think for a minute. All your sensory experience, all your visual perceptions, all your everything is hooked right through that “I” relation. So, what if it is altered? What will you experience?

If the alteration is “good”, perhaps you feel like this?

Screen Shot 2016-07-23 at 6.06.56 PM

 

Now let’s switch to thinking about the process of an intimate relationship, using a lovely cheesy music video metaphor that we’ll then build upon both these to discuss the complex symbolic relating than can occur in high impact FAP.

Do watch as it will help you connect to the symbolic journey we’re going on through metaphor. The Story of My Life

Imagine that the moments of your life are pictures. The experiences that reflect complexity (ERRRs) most often are a series of pictures with richly emotional colorful (good or bad) details. See the birth of your child, and the hundreds of picture to capture the complex experiences that follow.

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“Why did you take a picture of me gassy?”

Now look around your home… are there single large photos blown up… special moments you wanted to save. These are likely snap shots of complexly derived moments (see the pictures from Hawaii… feel the sand beneath your toes? 😉 Sometimes complexity is lovely.

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Now there are thousands of random shots in between that capture random moments, important relationships, accomplishments… and because this is your life, not a photo album imagine that all the moments you never wanted to remember are also there. In their full, and sometimes awful glory.

That time you fell on your ass in front of a crowd…

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Your worst mistakes. All of them are memorialized in all their complex and highly derived glory (because rumination derives!) in big lovely photographs you keep hidden away.

All these moments that form the history of you, your pain, your joys, your disappointments… see them all strung along the wall back behind you (in time).

Now imagine opening your heart and mind to pull out these photographs and show another. Each time that you hand a painful or joyful memory to this person a connection between you forms, a connection between both of you and the memories seen, the emotional expressions of both (YOU and I) then shape the memories and the relationship. There’s a heck of a lot of relating going on here – temporal, deictic, high complexity, transformation of stimulus functions through coordination/distinction/opposition with the other.

And, this… is just a close relationship. This isn’t even therapy.

Notice how we all are deeply affected by our relations, good or bad, to those around us.

People are a core of our experience, ourself, and our world.

Now, let’s work towards understanding the complexities of high impact Functional Analytic Psychotherapy relating.

Open this and listen while you Imagine.

Let’s walk through a super simplified course of FAP via the special case of intensives. For the unfamiliar this is 3-4 day long training of therapists who come to hone their skills together by experiential practice.

Much like most FAP treatment itself it generally begins with some sort of Life History or discussion of adaptive (CRB2) and maladaptive (CRB1) behaviors. The very discussion pulls the relations along from the past, symbolically, to accompany the present. The power of the past (pain and joy) becomes more accessible by relation.

Now you begin to hand not the pictures described above but your real present moment experience (that is sometimes still fused with pain) to your colleagues. You may be brought to tears by the transformation of stimulus functions simply involved in discussing your pain and struggles in front of another.

As you engage in this interaction the other makes out-to-in parallels creating a symbolic I-YOU relation linking to the past relations involved (to people and behaviors that can be present in the now for changing).

In doing this, you are allowing the present moment interaction to alter contingencies set in other relationships because the attachment of past and present I-YOU to in the moment I-YOU is like creating a transcendent I-YOU.

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The impact of the learning experience naturally becomes stronger as the symbolically present and in vivo relations combine. Anything altered through reinforcement or otherwise can now be affect the past, the present, the “I” and the “YOU” in the present, and all other “Is”and “YOUs” relevant to these relations.

At this point contingent reinforcement takes on a new life. You’re shaping behavior but you’re also shaping relations, which allows you to interact with and shape someone’s relating to what occurred long with someone else. The shaping of that entire chain of relation can in a sense begin to over-write the relations of the self, the other, and the world.

The result can be “magic” and leave people changed. A present moment, relational therapy, driven by behaviorism. This is powerful medicine (not without its challenges).

Intensives in particular may evoke strong reactions as days of present moment relating in a uniquely supportive environment while bringing in other relations and experiencing the transformation of pain from long ago… it’s a bit like flooding of the deictic relations with new (hopefully adaptive) learning.

And if this weren’t all interesting enough, as a measurement geek, I love the implications of how to test for these unique effects.

I won’t go into too much detail here (because I’d like for someone to contact me and run one or more of these as study. 🙂

But let’s play with the implications here. Self relations are generally highly complex networks (see all of personality theory, schemas, etc. that would object to notions of the core of who you are behaviorally or otherwise being significantly or lastingly altered over the course of 3 days.) And yet, if many people describe an experience as “transformative” that is indeed the magnitude of experience they’re cueing us into. (Sure. It could be rule-governed behavior at work but its a little strange for people to keep emitting rule-governed behavior in contexts where the contingencies go the other way.)

So, by empirical logic we can link up what RFT may predict through combinations of relations and previous research. Then couldn’t we demonstrate something impressive by moving schemas in 3 days? (YSQ-3 anyone?)

This is not entirely CBS consistent for measurement but hey… sometimes you have to use what you’ve got. If the pre-post difference in YSQ exceeds test-retest significantly, and further, if it does so in ways we’d predict based on RFT then we can demonstrate change nomothetically on an ideographic functionally defined treatment.

There also ways to add to this with Ecological Momentary Assessment (EMA) and Natural Language Processing to watch these processes unfold in a high grain multi-method approach.

If you want to do this or would like other methods for similar studies to support efficacy or effectiveness research on FAP, email me at Presence.for.change @ gmail.com

 

Copyright 2016 © Angela Cathey. All Rights Reserved.

 

 

 

 

 

 

Functional Relational Analysis: Using RFT to guide Functional Analysis (FA)

Here’s an outline to today’s post:

  1. Functional Analysis (FA) our most powerful and under-utilized tool.
  2. What RFT can offer to FA.
  3. General guidelines for bringing RFT-FA into the room via integration with the 5 Rules of FAP.
  4. A few groups of relations described functionally
  5. What RFT guided FA could  do for our ability to assess the effectiveness of functionally oriented treatments (e.g., FAP).

RFT has a lot to offer for the applicability, precision, and utility of Functional Analysis.

Consider that FA is one of our most powerful therapeutic frameworks in behaviorism (underlying most of our orientations), yet it has fallen out of use in the clinical environment.

Why? Because:

1.) We are generally not in the clients environment to see the variables controlling their behavior.

2). People are exceedingly bad at understanding/describing the variables that control their own behavior (see above on seeing everything through your own relational history and Measurement: Why we get no R.E.S.P.E.C.T. which explains how CBS has tried to deal with issues of measurement relation to behavior).

3.) And, in the therapy hour what you can do with FA is often to teach the client how to recognize (and hopefully influence) their own behavior or contexts, outside the therapy environment. Then you hope for the best.

So, let’s consider FA and what RFT-informed Functional Analysis has to offer clinicians:

First, by gaining and experiential knowledge of RFT/REC we get a much better picture of what variables may be controlling the client’s behavior, in the room and in their lives.

Second, we get a much better picture of how to intervene effectively by being able to test our hypotheses (often per session) by altering the variables in the room (in present moment) and paying attention to the client’s response, our experience, and other contextual variables.

Thus, with RFT/REC we can go a long way to restoring our ability to use functional analysis during the therapeutic hour. (Not to mention getting more of the warm fuzzy feeling you get when you realize you’re doing something that’s ‘working’ for the client.)

So, let’s talk about how can begin to use RFT in Functional Analysis. I’ll present some general guidelines and then discuss the how and why of these.

You’ll also notice that this is going to map right onto the “5 Rules” of Functional Analytic Psychotherapy (FAP; FAP Training Events). This is purposeful as in my experience: 1) FAP is already one of the models that purposely trains you to bring FA into the present moment and look at behavior functionally, rather than topographically, and all we’re really doing here is adding knowledge of how the properties of symbolic relating also get tied into all the other ‘behaviors’ you see. 

Note: This isn’t meant to substitute or be better than learning RFT in other forms. If you want a full, more advanced understanding of RFT, I would recommend starting with Villatte, Villatte, and Hayes’ Mastering the Clinical Conversation or Matt Villatte’s online course on RFT through Practice Ground. Much of what I say here is an entry point to what these resources and others (such as Hayes’ Rule-governed Behavior) may teach you.

  1. First, and, above all else listen to the client’s experience. (Rule 1: Watch for CRB1s AND watch for the general pattern of behavior (verbally and ‘non-verbally’ around important relations.)
    1. Look for rule-governed behavior and rules (If you’re in a stuck spot and feel like you’re bumping your head against the wall it’s highly likely that either you and/or the client are responding to a ‘rule’.) This Rule 1 again but rule-governed behavior is such a big factor in break down of communication I feel it stands repeating.
    2. Understand what the HOW of the behavior tells you. (Again, Rule 1 in FAP but extended to understanding, using RFT, the function and properties the symbolic relations that show up in the room.)
  2. Start altering the context in the room, in the moment, with your hypotheses and noting the clients HOW of response. (This is Rule 2, Evoke, from the FAP model, except evoke is also extended to using RFT to evoke verbal relations and understand the client’s response.)
  3. Relate (functionally). (This is Rule 3, Reinforce, from the FAP model… except for when you bring RFT into the miss you begin to see how many more ways you can affect the client’s relating to you, themselves, the world, their pain, etc… right their in the moment. This may sound a bit foreign but I almost promise you that you’re already doing some form of it. If your an ACT clinician and the client is fused… then you get them to defuse. Congrats! You just moved a relation! Except RFT has far more to offer than defusion. Some of which I’ll describe below.)
  4. Note your impact on relations as well as other behavior (Rule 4, Notice your impact except extended to noticing your impact on relations and their properties as well as other behavior).
  5. Provide functional interpretations (Rule 5, in FAP) except that I would say that ‘functional’ may need to also be seen from an RFT perspective. Sometimes it’s helpful to provide direct feedback about the relations you perceive but we also know that humans like simplicity a bit too much. Careful with the providing interpretations that may easily be turned into rules (and rule-based insensitivity) so tread lightly and experientially here.

Included in this, but discussed less is an assumption of general knowledge regarding Functional Analysis and Functional Assessment. For readers that want a review of this start here: Iwata & Dozier, 2008Gareth Holman’s Intro to FA on Practice Ground, and for mapping out your effect for research (or warm fuzzies) begin with Koerner and Holman’s 2014 Single-case designs in clinical practice.

It’s good to have a general awareness of how the character of the behavior (e.g., approach/repeat may indicate presence of reinforcing qualities) may indicate relations. Then in the FA you learn the problematic relation only through noticing what moves the relation in a more adaptive direction (functionally determined).

How do you know what’s adaptive? I like Villatte, Villatte, and Hayes’ Mastering the Clinical Conversation overall framework.

That is:

The overall goals of treatment are:

  1. Helping the client flexible context sensitivity and functional coherence (read awareness when its adaptive and an overall system of relating that ‘works’ for the client)

The overall means of treatment are:

  1. Transforming symbolic functions by altering context (read influencing relations and their properties by any of your symbolic behavior in the room with the client, etc.)

So, in doing a Functional Relational Analysis we’re doing in the moment analysis with the goal of increasing adaptive relating as defined by Villatte, Villatte, and Hayes in the manner in which we influence relating with the 5 Rules in FAP (you following me?)

So, now about the business of recognizing relations that can be influenced in your RFT-FA. First, let’s begin by making things a bit more simple some relations that frequently come up and affect treatment in the moment.

Screen Shot 2016-07-23 at 10.22.10 AM

  1. Rule-governed behavior – consider this a kind of fusion, that in whatever form usually results inability to contact important contingencies at hand.
    1. Example(s): “Jimmy is always anxious.” vs “Jimmy is anxious.” vs. “Jimmy sometimes gets anxious.” Inherent in these statements are a rule. Though you’d need ideographic context they may likely indicate different levels of fusion with the rule (based on the way their stated) about Jimmy’s behavior. The intensity/rigidity and lack of noticing other contingencies may give you a good idea about how fused the speaker is to the rule and how unaware they may be when Jimmy acts in ways that are non-anxious (see later post on discrimination/stigma/violence towards others).  Keep in mind that almost any kind of relation can be rule-ified into inflexibility over time, repetition, etc.
    2. How to influence it: Defusion, context changes of many sorts (emotion, , experientially walking through of the contingencies that allows the person to note what was previously missed, etc.
    3. How to assess your impact: Is the person now loosening in their behavior guided by the rule? Is their language around the rule more flexible?
  2. Influencing awareness towards whole or  parts – here I’m talking about several relations in combination functionally. We often use distinction framing (this but not that) combination (this and this), opposition (this is the opposite of that) to bring more awareness to the parts and pieces. Some forms of mindfulness can be going towards noticing the parts and
    1. Examples(s): Hierarchicals and moving towards seeing the self or experience as a part of the continuing experience… I am this feeling, this moment, this etc. vs I am more than my experience.
    2. How to influence it: Mindfulness either noticing of continuity, wholeness or otherwise noticing detail.
    3. How to assess your impact: Do they seem (verbally or otherwise) more aware the direction needed to note important contingencies? Other relations can also be added in but let’s focus on these for now.

 

What can elements of an RFT allows us fine grain and repeated attempts to change relating of several types each session. We can aim for more or less flexibility, more or less awareness of certain contingencies, more adaptive stories about the “self” and its experience. This can allow several dimensions for FA beyond  what is normally present.

Add the REC Model in and you can evaluate behavior based on its complexity and derivation (allowing you to watch whether you need to increase the variety and complexity of learning experiences to make it stable and adaptive learning.

Further elaborating on this kind of work up might allow us to more effectively assess some of the benefits of functionally oriented treatments?

Essentially, mapping out change in other relations would add further refined dimensions to assess change on. For example, we know that one of the mechanisms responsible for the effectiveness of FAP is likely to be contingent reinforcement (see Kanter, Landes, Busch, Rusch, Brown, Baruch, and Holman 2006 Effect of contingent reinforcement) and that systems can be derived for measuring change based on this functional target (see Callaghan 2001 FIAT Functional Ideographic Assessment Template).

With RFT everything can be parsed relationally in some respect (every treatment, nearly every behavior, diagnosis, etc.). This in combination with other FA relations (e.g., reinforcement) can allow us to examine change across therapies, diagnoses, contexts, etc. Further, noticing the change in relation in verbal behavior gives us many more opportunities for altering and assessing our impact each session.

If you’re thinking that assessment and coding of verbal relations would take years, wait for the posts on Natural Language Processing, Machine Learning, and sensor-based experience sampling.

Copyright 2016 © Angela Cathey. All Rights Reserved.

 

 

 

 

 

 

 

RFT: The space-time of the human universe

I’m going to start this post off by telling you a little secret.

I get a little obsessive with ideas.

Give me something interesting to think about and I’m a kid with a Rubik’s cube all over again. When I immersed myself in RFT I turned that Rubik’s cube so many times I dreamt in RFT. (Yes, I know that’s weird.)

While you’re adjusting to that information, let me show you why I will probably never get tired of playing with this toy.

RFT: a ‘thing’ of infinite beauty and utility.

I’m going to show you several metaphorical, philosophical, and sometimes down right fun, ways to understand RFT. Then will pin those down onto logical and high utility ways of using RFT.

This will include:

  • Understanding ‘constructs’ vs. the relations described by RFT.
  • Understanding RFT ‘properties’.
  • Doing an RFT guided Functional Analysis (FA), and how that allows you to bring FA into therapy room with a client (see next post instead).
  • And, finally how to use experiential knowledge and empirical logic to explicate process, and then, measure it (because pure theorizing is fairy dust for an applied researcher/clinician) (Also, see next posts).

CONSTRUCTS, RELATIONS, AND THE BEAUTY OF THE UNIVERSE

First, let’s loosen your frames a bit and help you connect.

I’m going to go Karl Sagan for a moment and teach you some astrophysics and RFT.

Imagine the earth and planets swirling about in space. They all have this rhythm and dance to how they move about each other. Imagine now that those planets are constructs (e.g., “psychological flexibility”, “courage”, “love”, “present-moment-focus”, “mindfulness”, “habituation”, “transference”… out to infinity in verbally symbolic influenced constructs).

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Media: hqwide.com

Now looking out on the planets we are like the astronomers once were… seeing these celestial bodies in awe but not understanding their rhythms. We can see them dancing around each other but we can’t tell why. Most of our scientific method in psychology is based around this level of mystery… we assume we know very little and that every hypothesis is a bit like glancing in the telescope and hoping we see planets crash together. If we see it, and we haven’t spent all day looking through the telescope… then that’s an important finding! And, because we can’t all watch the whole universe we each pick a few planets (constructs) to watch intensely.

Now let go of your favorite planets for a moment and zoom back… look at the big picture. See the planets moving across time…

Now drop to a different level of analysis.  In this picture we see what we later understood about the planets and their orbits.

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Media: boainformacao.com.br

What we understood that gave us infinite and useful knowledge about space (even beyond the planets we could see) was as Karl Sagan put it “gravity is geometry.”

Gravity is a distortion in space-time that forms a kind of net that allows the weight of the planets to pull against each other. This is what gives them their lovely dances in relation to each other.

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Media: www.realclearscience.com

RFT is the gravity and geometry. It shows us how the constructs influenced by human verbal/symbolic behavior dance together.

This is ‘true’ in many ways:

Gravity is a very ‘real’ force to be reckoned with and yet you can’t ‘prove’ it in most contexts. We just trust that it’s there because it is useful to do so. The construct of gravity is a description of relation. It’s a useful explanation in daily life for why it would be stupid to hold the DSM-5 over your foot and drop it. Sure, you could go ask Karl Sagan for the formula and proof but in the mean time… you should probably still move your foot out of the way of the DSM.

In the same way, RFT relations can’t be ‘proven’ in the moment. That’s not the point in applied work though. Like the web you see below the planets, what RFT gives us is far more powerful than a view of the actual planets. It gives a way to predict and intervene in the moment in nearly anything influenced by human thought. (If that doesn’t inspire awe like looking out into the stars… go back and read again.)

 Planets collide…

On another level, what it does is let use see the planets in a new light. They are no longer separate planets dancing unpredictably in space. They are a tiny visible piece of the universe dancing an understandable rhythm influenced by the interlocking distortion of space-time that holds in relation to each other.

And just like this conception of gravity as space-time distortion… RFT allows us to come up with some amazing ways of understanding our universe.

Time Travel: Theories, paradoxes, and possibilities

http://www.space.com/21675-time-travel.html

UNDERSTANDING PROPERTIES OF RFT: SIGNAL IN NOISE 

Now that we’ve talked space-time distortion let’s blow you’re mind a bit more by learning to understand the properties of RFT and what RFT is really speaking to in a very different way than your used to (aka sans algebra).

You’ve all seen the diagrams explaining how the letters in the word “cat” = a picture of a cat = the sound of “cat” spoken. You may have also seen the complex ‘algebra’ that formulaically explains properties of RFT like transformation of stimulus function.

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See: https://contextualscience.org/transformation_of_stimulus_functions

Yikes! So, that formula is sheer genius but not particularly functional for people who don’t understand RFT pretty well already. Explaining RFT in these terms to those who are learning is a bit like explaining gravity as a formula. In some way it is ‘true’ but if you want someone to understand the meaning of gravity, you’re better off dropping the DSM on their foot.

Let’s understand the meaning of RFT at a deeper more experiential level.

RFT explains the inter-relations of different elements of our behavior and context.

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Cathey (2016)

This is a functional diagram of the way properties of RFT and operant/classical conditioning tell us our behaviors are inter-related.

It’s not perfect. Anyone can tell you these aren’t entirely separate…

Our experience is actually much more like this.

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Picture: indulgy.com

Let’s dig a little deeper…

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Diagram: Cathey (2016)

So, in some way we are this relational signal that we experience as a whole, which isn’t entirely separate from our experience of our external context (blurry line). What we perceive in the world is viewed through our internal context (if you’re inside that bubble looking out everything will be tinted blue). This is why we can all react different ways to the ‘same’ ‘external’ stimuli and why we may act differently in different contexts. All is through the filter of our experience and through relation, after we become old enough to have a symbolic world. This symbolic world is in some respect verbal but more importantly highly symbolic. Words/language are one important network that forms the scaffolding of our internal experience, and which we can somewhat efficiently use to show others our world.

That ‘sticky’ scaffolding gives words power.

So, RFT is not just a theory of language. It is a theory of symbolism.

‘Anything can become anything’ because it is nearly all symbolic at some level.

Sensation, perception, visual stimuli, auditory stimuli, words, actions… they are all symbolic soup of experience and your own relational history makes some of those cues more salient than others.

For example… listen to just a seconds of this music… close your eyes. Notice the feelings and thoughts.

Mystery Music

Now, what you all experienced was the same stimuli but how it affected you is through relation, in a very deep way.

My experience is not yours, in great part, because of my distinct relational history with this stimuli.

For me, that song is chills, tears in my eyes, the taste of a tequila shot (hey… I was nervous that day), and a visual of walking down the isle to my husband. It will never again be separate from those moments and the love I feel for my husband BECAUSE of the RELATIONS it obtained when I chose it for that defining moment in our relationship.

For you, maybe it was just squeaky violin music or something pretty. This is RFT. The song had no words and yet it is still symbolic and influenced by what I say. Now, if you meet me you will have the words above as a scaffolding between our worlds.

As you read them you were likely able, in some part, to experience part of my experience but even still through your relational history. For those of you who know me… the experience of learning this information might have been more intense if I’m close to you or if you experience me as like you. This is predictable based on RFT, a frame of coordination (she is like me) or (I like her) will increase your experience of my description. A frame of distinction (I am not like her) or (this is crap, etc.) will decrease intensity of the experience (transformation of stimulus functions) evoked by reading my experience.

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Cathey (2016)

Thus our experiences are tinted, amplified, and de-amplified by the frames in which we hold ourselves, those we are exposed to, and many other contextual variables that influence our experience.

Isn’t it lovely? We’re are all connected, through relation. (Imagine: You can totally win 6 degrees to Kevin Bacon now. 😉

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Media: www.mangowed.com

Further, your actual perceptual, emotional, behavioral, and verbal experience is predicable based on RFT and the significance or depth of the learning you have related to the the stimuli (REC Model; Hughes, Barnes-Holmes, Vahey, 2012Barnes-Holmes, Barnes-Holmes, Stewart, & Boles (2010)).

So, let’s switch frames a bit to get ready for clinical/social applications:

Let’s look at the REC Model of some things we could cause us to feel fear or disgust….

This is a functional example (its not perfect… but let’s hope it gets the job done).

Look at the items in the REC Model below and note your emotional response.

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Cathey (2016)

What I’m willing to bet is that even though you likely have some very rich sensory experiences (high connectivity) of food poisoning, unless you’ve had one recently you probably didn’t have much of a response to that stimuli. As a US resident, few of us will have a strong visceral response to Ebola as its not connected to most things in our daily worlds. Few of us will have had direct experience with it.

Now here’s the curious part… What was your response to the gun woman? What was your response to Hitler?

If you had a more intense emotional response to Hitler that is understandable based on REC, but few other theories would predict this or allow for testing of it. We could say that we have “habituated” to gun violence. Or, perhaps we’ve now heard so many derivations of this occurring that we can now control the response to it, as it is sunken into the rich networks of other relations.

Hitler on the other hand… I’m guessing no one reading this met him. Yet you may have felt a lurch of disgust even stronger than the food poisoning picture.

Without RFT and personal experience with this it is difficult to make sense of your response to Hitler, vs food poisoning, vs. mass shootings, vs. Ebola.

Stay with me here. A low complexity network with high derivation is a bit like all the relations flowing through this single point of symbolic ‘evil’.  If he is a single point of relation through which all we know about the Holocaust and those horrors is filtered there is a lot of derivation through repeated understanding but little complexity (as everything is history, etc compared to actual experience). This kind of highly derived but not complex network of emotional learning lends itself to strong/rigid/somewhat two dimensional responses.

Otherwise it’s a little difficult to explain why we’d have such a strong response to someone none of us have ever met AND yet have a have a much more moderated response to gun violence.

Now, let’s switch gears with this new experiential understanding of RFT. I’ll show you how you can use this kind of understanding to better inform Functional Analysis (FA) and bring FA into the therapy room in the present moment.

See next post: RELATIONAL FRAME THEORY GUIDED FUNCTIONAL ANALYSIS

 Copyright 2016 © Angela Cathey. All Rights Reserved.

Measurement: A key change strategy

Sometimes effective change has to come from the bottom up. This may be the case in the behavioral sciences where the proliferation of construct-based measurement has lead to pervasive problems in the scientific endeavor itself.

The behavioral sciences are those that focus on issues that influence us nearly non-stop in our daily lives. And yet, these fields are now obstructed by reliance on methods of measurement and research that oppose the findings of the field itself.

We know that human behavior is influenced by many inter-related factors and yet the pace of growth and influence by the behavioral sciences has stalled. Why?

The field, as a whole, continues to rely on outdated measurement methodology and technology, mostly as a result of the nature of academia itself. In a ‘Publish or Perish’ academic culture innovation and effective change are risky endeavors. Academics must often choose between publishing and obtaining career milestones key to their own survival and innovative/integrative work that may better move the world.

This is apparent in how the Behavioral Sciences major funding agencies NIMH and NIH are shaping their current funding agendas.

The National Institute of Mental Health (NIMH) has moved towards the Research Domain Criteria Initiative (RDoC) which requires heavy integration of biological factors into research design. This initiative, though well intentioned, seems in opposition with a wealth of evidence from the behavioral sciences that indicate that biological factors alone carry little weight in development or differentiation of psychological ‘disorders’ and human distress.

The National Institutes of Health (NIH) has arrived at similar policies to push the behavioral sciences into integration. Their most recent funding initiatives mandate the behavioral sciences to determine a ‘standard metric.’ This is a response in part, to the wide-spread reproducibility crises within behavioral research. See: The Chronicle of Higher Education: The flaw at the heart of psychological research )

At the heart of both these issues is our over-reliance on constructs. Once required to account for the wide array of human behavior that appeared measurable by basic behavioral principles (e.g., Operant, Classical Conditioning). The inability to measure and thus, influence, a wide-array of human behavior led to a proliferation of frequently useful construct-based research and development.

As this progressed the field has moved away from what is directly observable to measurement and statistical methods that determine truth and usefulness of data based on of reliability in measurement and reduction of ‘error’-based variance. This once necessary methodological and statistical jump has left the field inattentive to advances that can unify its efforts.

Several, if not many of these advances, that could move change in our world have been largely ignored in the competitive and bureaucratic world of academia. Our organization seeks to advance these cross-disciplinary innovations in an effort to create a behavioral science and world that moves human development.

References of Interest

Wilson, Hayes, Gregg, & Zettle (2001). Psychopathology and Psychotherapy (Chapter in Big Purple).

Wilson (2001). Some notes on constructs: Types and validation from a contextual behavioral perspective

Hughes, Barnes-Holmes, & Vahey (2012). Holding onto our functional roots while exploring new intellectual islands: A voyage through implicit cognition research The Relational Elaboration Coherence model and RFT based assessment

Vilardaga, Bricker, & McDonell (2014). The promise of mobile technologies and single case study designs for the study of individuals in their natural environments.

Iwata, DeLeon, & Roscoe (2013) The FAST. Functional Analysis Screening Tool

Hurl, Wrightman, Hayes, & Virues-Ortega (2016). Does a pre-intervention functional assessment increase intervention effectiveness? A meta-analysis of within-subject interrupted time-series studies.

 

 

 

 

 

 

Relational Frame Theory (RFT)- What's the big deal?

First, I must confess here that I am a geek. I love theory, research, tech, philosophy, cultural anthropology, and quantum physics. I’m also a bit of a social activist. (So, imagine me in person as something in between a female Sheldon from Big Bang Theory and a card carrying hippy [Sorry, Dad but it’s still true].)

I’ve always had a need to understand how things work, straight down to reality (for reference see movie collection with worn out copies of The Matrix, Inception, and Fight Club). To some extent there’s always been a part of me screaming, “you’re not your f$%#$ing khakis!”… “so, what are you?; what are we?; and, why?!?”

I carried that into an interest in process and outcomes research. When I found RFT the first time I can’t say it drew my interest. Reading the original Acceptance and Commitment Therapy text I’m sure I fell asleep with the book on my face chapters 1-3.

Some 10 years later I was doing Prolonged Exposure, ACT, and FAP with those who’d experienced severe and complex trauma and treating severe OCD. Here, more clinically aware then I’d been as a noob therapist, I kept running across quirks in treatment and assessment that weren’t well explained in the literature. One of those phenomena was that what tended to most amp up or dampen exposure intensity within OCD and PTSD wasn’t what you’d expect. I found that often the stimuli or experiences that were most painful for people were linked to their values or their sense of themselves/others. I also noticed that sometimes hierarchies needed to include exposure to stimuli that just didn’t fit into normal models of fear conditioning (see exposures to milk shakes, umbrellas, The Doors, and emotions themselves). And, weirder yet… that a change in context could sometimes seemingly result in immediate ‘habituation’.

So, what’s the deal with RFT? Isn’t this just another theory to add to your dusty reading stack? No. Put it on top, like yesterday.

RFT is a theory of how relating becomes a part of our processing of the world. We are richly hooked into our very verbal sense-making of the world. Our internal verbal-ish history can become a more predominate shaper of perception in the moment than even previous classical or operant conditioning. Move over Bandura and those ridiculous Bobo dolls… we’re onto something big.

Yes, it’s a big deal. HUGE. The most coherent, expansive, and useful theories we have in psychology that allow us to predict and influence behavior are operant and classical conditioning-based. Functional Analysis (FA) is a corner stone of modern behaviorist therapies and yet we’re saying that even if you account for all the ‘external’ context you could be missing the most important variable in the room.

Our ideographic and collective history of verbal relating influences our perception. Note: this is not the same as ‘language’. What we’re talking about is a hodgepodge mix of learning history, language, internal rules, sensations, etc. that people often hear as “language”). It’s not about language its about relational history that gets heavily influenced by language because that’s the framework we see the world from. Just think… when is the last time that voice in your head actually shut up? Never. We are verbal and that verbal-ness is often key in high-jacking a human’s response to the contingencies in the room.

Further, we understand that the specific ways and frequencies in which we relate things can influence our perception, behavior, emotion in predictable ways.
So, this verbal relational soup of history is on-going and influencing our contact with the world. This is pretty profound, but in itself, esoteric at best. Like a knowledge of quantum mechanics and M-theory (hey, I warned you…) it’s cool but what can we DO with it?

That’s where we really start getting to the sexiness inherent in RFT. RFT describes properties of relating such that you can walk back and forth with empirical logic from observation, to assessment, to intervention strategy.

If we head back to the exposure therapy examples I provided there’s a logic
to pin under what otherwise might not make sense. Take the example of values
intensifying exposure via values. Yes, that might be covered by ACT mid-
level terms but it doesn’t give you a full picture. If we consider
properties inherent in various types of ‘framing’ that might be at hand in
values we not only know what to do to move this material with the client but
we also have indications of other, less intuitive things that might also be
amply or de-amplify an exposure (outside of valued outcomes). We can
reasonably say that hierarchical framing is likely at hand with a value or
some form of comparison framing. Knowing that we might also be able to find
other material that move exposures up and down the hierarchy or alter
intensity of anxiety within exposure simply by relation (hypothetically
other concepts that my amplify or de-amplify intensity might then be self-
concept, concept of the world, of others, identification to one’s race,
social status, etc.) All of these of course are ideographically determined
yet likely areas to check. All of them allowing for, potentially, more
flexible ways to promote context generalization… without even leaving the
office. I could go on about the usefulness and precision of RFT with regard
to exposure therapy but I’ll save that for another post.

What’s more you can do this underneath the level of therapeutic orientation and diagnosis. Everything becomes about relations that we can influence without clinging to our own preferred tools that ALL work in some ways. (Yes, that’s right. I’m a behaviorist and I believe those psychoanalytic folks may be getting it right too. Just differently. None of us has a total lock-down on effective treatment.)

I see this as the real beauty of RFT; unification of psychology (across all areas influenced by human thought, across levels of analysis, across basic and applied, across therapeutic orientation, and across diagnoses). Psychology is currently an elaborated mess of opposing theories, big egos, and lack of cooperation.

Can’t we all just get along? Didn’t we get in this to help people?!?! Then have the cojones to put down your tenure track research plan of further and further narrowing and get enough RFT to rip the hood off of your own orientation biases.

If you aren’t yet convinced of the benefits of this way of thinking you’re in luck. If you’re a CBS clinician you’ll surely encounter more RFT track in the future conferences and the reading on RFT has become infinitely less snooze worth over the last few years.

If you’re interested in getting a bit more acquainted with RFT I’d recommend starting with Villatte, Villatte, & Hayes (2015) Mastering the Clinical Conversation: Language as intervention.

 

Copyright 2016 © Angela Cathey. All Rights Reserved.

Post Contextual Behavioral Science Conference Musings 2016

If you weren’t able to attend the annual Contextual Behavioral Science conference in Seattle, WA this year you missed quite a conference.

In the post Seattle glow there are a few overall themes that were more than worth sharing. I’ll discuss some of these briefly and others at length in future posts.

Here’s a brief synopsis:

1) Relational Frame Theory (RFT) is here and you’d better start taking notice.

This year’s conference had an entire track of RFT driven workshops and talks. And, while the general consensus for most clinical psychologists in response to RFT is still somewhere between, “huh?” and “@#$#@#$.” The winds are a changing. This incredibly useful theory describing properties of verbal symbolic relating that appear to affect everything from sense of self, empathy, and behavioral outcomes that can’t otherwise be predicted based on operant and classical conditioning alone. Much more on this in future posts.

2) Integration is where it’s at.

This has always been a theme in Contextual Behavioral Science but the call to action is becoming louder and, slightly, more integrated itself. This years conference hosted big names from familiar third wave family members, including: Dialectical Behavior Therapy’s Marsha Linehan; Functional Analytic Psychotherapy’s Bob Kohlenberg and Mavis Tsai; and all the usual Acceptance and Commitment Therapy players. There were also talks by Tony Biglan and others known for their integrative tendencies. Of note this year, however, was the more apparent presence of the business community and therapeutic technologies that bridge the gap from therapy to influence of society. This was evident with the presence of David Sloan and his pro-social model.

3) Current assessment and statistical strategies are sadly inadequate for characterizations of human behavior.

If you’re a contextual behavioral clinician/researcher up on the research this is no surprise to you but this year the call to arms was louder and clearer. One panel discussion on assessment at CBS this year was called ‘Shreddin it’ in reference to the suggestion of Kelly Koerner (chair) that we, as psychologists, simply shred our paper questionnaires and wait for better assessment strategies. That’s the situation. Much more on this in future posts.

4) We see the benefit of technology integration in psychology but we’re a little intimidated.

This one hurts a bit as I am a bit for me as a techie. Tech has grown so much, become so much cheaper, and has the potential to address large scale problems not only in psychology but in society. Yet, for the most part, many of these technologies have gone underused simply due to lack of awareness and perceived difficulty associated with them. As a technie myself I’ve encountered these confusions endlessly from colleagues. When I discuss Natural Language Processing (an area with 20+ years of research under its belt) people look at me as if I’ve just said I can grant them three wishes. I’ve encountered near the same caliber content in response to my work in Ecological Momentary Assessment (EMA) and mentions of Machine Learning or AI. There’s something about the frames that participate with the terms “Machine Learning” and “AI” that seem to only participate in coordination with “psychosis” for psychologists. Yes, I admit… they sound magical but the days of this technology being out of reach for psychologists are gone. Open source adaptable technology is here if you’ll simply learn to use it. (So much more on this in future posts.)

5) Society needs change.

On my first night in Seattle for the Functional Analytic Psychotherapy (FAP) intensive a large group of us decided to go to a local gay club to see a show. This same night while we were all standing together in the warmth of inclusion and the presence of friends from across the globe we see only once a year… a tragedy struck. The next morning as I sat with 70+ contextual behavioral clinicians working to improve their own ability to promote human connection through behaviorism… we learned of the massacre at an Orlando gay club. I don’t think it registered for me for a few days. Now, still… I feel the moving in and out of avoidance of this horror. I saw it affect my community both in that room and felt the reverberations of this event throughout the intensive and CBS following. The consensus seems clear amongst the CBS community that we need to help society move towards more adaptive, flexible, and inclusive behavior. Without this, we seem set on a path to self-other destruction.

Copyright 2016 © Angela Cathey. All Rights Reserved.