Values Work in ACT: Dignifying Treatment of Disordered Eating

1. Values Work in ACT:Dignifying Treatment of Disordered Eating Emily K. Sandoz, M. S. & Kelly G. Wilson, Ph. D.

2. Why I Care • “Too much…”

3. Forms of Disordered Eating • Varied topographies • AN, BN, BED • Similar Patterning around food and body image • Rigid • Narrow • Insensitive

4. Functions of Disordered Eating • Similar Functions? • High levels aversive control • Arousal • Escape/avoidance • Low levels appetitive control • Variability in orientation, etc. • Positive reinforcement

5. ACT Model of Psychological Health

6. ACT for Disordered Eating • Loosening aversive control • Present Moment, Acceptance, Defusion, Self • Enhancing appetitive control • Present Moment, Values, Commitment, Self

7. A Note on Values • Identified as important in many traditions • Recently emerging science of valuing • Defined a number of different ways • Some facilitate science

8. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

9. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

10. Values are Behavior • Not standards out in the world • Not ideas or traits inside of us • Things people do

11. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

12. Values are Freely Chosen • Experienced as a free choice • No “have-to” • Determined by history • Free from aversive control

13. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, whichestablish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

14. Values are Reinforcers • Not objects • Transition to a world that one would work for

15. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

16. Values are Establishing Operations • Another kind of transition • A consequence already there becomes a reinforcer

17. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, whichestablish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

18. Values are Intrinsic • Independent of results or outcome • Defined by relationship with the pattern

19. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

20. Values take Different Forms • Functionally defined • Forms change over time • Context-specific

21. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

22. Values are Verbal • Relational Frame Theory • Transform functions or meaning of world without direct conditioning

23. Values • In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

24. Deficits in Valued Living • Repertoire dominated by behaviors that: • Lack freedom • Narrow, rigid, insensitive • Escape and/or avoidance • Reinforced by outcome

25. Values & Medical Issues • Values are not Goals • Medical stabilization often primary treatment goal • Can do stabilization in a way that is valued or not • Chosen or not • For something or not

26. Values & Medical Issues • Medical risks ever present aversive • Introduce inflexibility in therapist • Can have those risks in a way that is valued or not • Chosen or not • For something or not

27. Values Construction • Shape valued living (successive approximations): • Assess valued living • Occasion experiential contact w/ values (valued living) • Establish as reinforcers for Tx & Bx change

28. Values Construction • Shape valued living (successive approximations): • Determine where she is • Facilitate a step forward • Therapeutic contract around that • Repeat

29. Vulnerabilities & Permission • Values & vulnerabilities intimate • Revealing how can be hurt • Present own vulnerability first • Need the client to help • Ask permission

30. Values Work on a Continuum • Continuum of valued living • Can be loosely described in stages • Vary in degree of intensity, brevity, location in time, explicitness of instruction, etc. • Likelihood of defense

31. Stage 1 Values Work • Aiming for contact with any moment not dominated by aversive control • Often found in moment just following relief • Example: Free Breath

32. Stage 2 Values Work • Aiming for moment dominated by appetitive control • May or may not be linked to chosen values • Example: Sweet spot

33. Stage 3 Values Work • Aiming for beginning of a pattern of choice • Introducing world where choice would be possible • Example: Magic Wand

34. Stage 4 Values Work • Aiming for increased patterning of valued living • Introducing choice in this world, with its obstacles • Example: A Free Choice

35. A Word on Commitment • Noticing when not engaged in valued living • And turning back • Seeing client where she is, and starting there • Seeing self where you are, and starting there

36. Thanks so much to Kelly Koerner, for inviting me. Thanks to the group for making me think all this through. Thanks to my mentor, Kelly Wilson, from whose words everything I say is wholly derivative.

37. For references, etc… Emily K. Sandoz eksandoz@olemiss.edu Kelly G. Wilson kwilson@olemiss.edu