What does the Future hold for Middle-Level Processes in ACT?

1. What does the Future hold for Middle-Level Processes in ACT? Yvonne Barnes-Holmes & Dermot Barnes-Holmes

2. In the Beginning . . . • In ACT, there were: • Treatment protocols • And some non-technical terms, including: • cognitive distancing/defusion • values • acceptance • the three selves • literality

3. In the Beginning . . . • In RFT: • There was a steadily growing body of abstract research with lots of A1s, B1s, and C1s • We had identified the basic relational families and had reached deictics • We had started to look at the relating of relations in metaphor • We were working on rules as pliance, tracking, and augmentals • We were starting to look at human relational development and remedial education

4. In the Beginning . . . • Although some might find it hard to believe, that period has been called the ‘Golden Age’ of contextual behavioral science • Because even though we were a lot further from center stage than we are now (we were still firmly entrenched in the behavioral ghetto), we all believed that we were ‘onto something’, but possibly with the exception of Steve and Dermot (who seem to know everything and can even predict the future) most of us couldn’t see how these different strands connected, nor how they ever would, even those of us who were involved in all strands • We never even thought to ask then ‘how could RFT possibly account for what we were doing in therapy?’

5. In the Interim . . . • As the work on both ACT and RFT fronts filtered out, we had to generate a language that allowed us to communicate about what we were doing, especially in ACT where it was much more likely that we would attract clinicians from outside the behavioral domain • But it is essential to remember that the result of this effort was not a lab-generated set of terms, they were not based on RFT -- they were what Skinner would call ‘ellipitical but convenient’ • They simply facilitated discussions about the work and were intended to function as an orienting exercise • And in practice they were used by still a relatively small group of people and they were on the whole ACT or RFT specific, with limited integration by an even smaller number of people, so it didn’t matter a great deal that they were non-technical because all of those who used them were fully aware of that scientific risk

6. In the Interim . . . • In practically all scientific communities, there simply isn’t time to wait for the research to generate and refine precise technical terms before expansion or attempts to make connections with other disciplines • And so, quite deliberately, a heuristic model was created, containing a set of terms that serve the aims that we have, primarily translation to non-behavioral clinicians and researchers • That’s what the hexaflex did for ACT

7. In the Interim . . . • The hexaflex is a heuristic model, but it is not a model of technical processes because these processes have not been subject to functional analyses • And this is a common top-down strategy, if we started with a bottom-up analysis, there would be no hexaflex • If we start with a top-down model, the aim becomes about searching for scientific functional analytic terms that might map onto those already present within the model (acceptance, defusion, values, etc.) • But this type of hard/soft mapping may be neither possible nor useful

8. In the Interim . . . • For example, if existing processes turn out not to be functionally identifiable, then they would have to be abandoned • But, that is difficult to do once a model gets established in a verbal community, especially when this occurred in the absence of functional evidence • So, what we have been trying to do thus far is integrate RFT concepts into a top-down heuristic model, thus mixing two types of analyses • And to be honest, it has not been productive, not to mention the frustration as researchers when constrained in this way • For example, practically all research sites have found it impossible to separate defusion, acceptance and willingness in the lab, the terms always collapse together and appear to be largely functionally non-distinct (clinicians often report the same)

9. The Crossroads . . . • So eventually you come to a crossroads where: • Your non-technical terms begin to show ‘wear and tear’ • Their non-technical nature begins to obstruct, rather than facilitate, research • And yet as the ‘model’ reaches more and more people, and they believe it to be a technical account, there is more and more pressure for top-down research

10. The Crossroads . . . • And paradoxically, many people have forgotten or failed to appreciate that the terms we set out with were heuristics • Worse still, the existing model and terms have become reified and it gets harder to loosen our grip on them • In other words, we start believing, for example, that there is a technical process called fusion and yet it is practically impossible to get prediction and influence over this under laboratory conditions

11. The Crossroads . . . • And this is a tenuous and potentially dangerous place for us to be because one of the key strengths that we have put forward is our behavioral, technical, research-consistent argument (the community is called ACBS for a reason, so the science base must be CBS) • But it doesn’t take much to pick holes in it when our basic concepts are non-technical terms • For example, fusion is not like reinforcement, in which you can very easily create a context in which you can say that something occurred, what occurred was reinforcement, it wasn’t something else, and you could easily make it happen again

12. The Classic Conceptual Problem • The ‘process-procedure-outcome’ dilemma is faced by all ‘top-down’ terms • Consider, for example, the term ‘acceptance’ • Acceptance is used to describe a process that appears to have happened when we use acceptance-based techniques to attain the outcome of greater acceptance in someone who previously showed low acceptance • This is a completely circular argument in which acceptance is used as process (what was going on is assumed to be acceptance), as a technique (that’s what we were using), and as an outcome (that’s what we achieved) • Is this really a better account than elsewhere, is it CBS?

13. Making the Turn . . . • And so, it is time for integrated discussion and choice (and ACT people should surely be better at this than the RFT geeks) • ACT can continue with a largely non-technical and at times ‘fluffy’ conceptual basis (e.g., ‘contact with the present moment’) • And RFT can go off to the great blue yonder of cognitive and social psychology and implicit attitudes, with its BIRRs and EERRs • And, as we say in ACT, we would both have ‘lost before we played’

14. What We Have . . . • And after more than 20 years of RFT and basic process research, we have much more than most clinicians realize • The empirical basis of RFT’s account of derived relations as verbal operants is beyond question • So practically everything that humans do is verbal, including human suffering and how this can be changed • So, what is the RFT way of describing what we see in our clients, how can we see it, and how can it be changed? • In short, RFT people don’t use middle-level processes because they are not technical terms (with high precision, scope, and depth) and because they don’t need them, they have RFT

15. Metaphors • Ian Stewart’s basic work provided what appears to be a sound RFT model of analogy and metaphor as relating relations • This permits a transformation of literal linguistic functions to metaphorical functions and thus permits a change in perspective regarding psychological content • The coordination of perspectives between therapist and client and the transformations of emotional functions through these captures the non-technical and opaque term ‘compassion’, among others

16. Struggling with Anxiety is Like Struggling in Quicksand Struggle with anxiety Struggle in quicksand CAUSAL RELATION CAUSAL RELATION EQUIVALENT & CAUSAL Panic Attack Drowning Arbitrary Crel for Co-ordination Rumination Somatic tension Thrashing Exhaustion Can’t breathe More tension Choking Can’t breathe

17. Understanding the Self • The deictic relations look like a good account of the different levels of self • They appear to fit well with the three selves and with defusion • They seem to allow us to see where techniques (not processes) of mindfulness fit with existing ACT techniques

18. The Decitics & Three Selves HERE-NOW Observer Doer Self as Content Content is rigid and attached to perspective Perspective (Self) HERE-NOW Psychological Content + HERE-NOW Self as Process Content is on-going & experiential (attached if not) THERE-THEN Self as Context Perspective remains stable and constant

19. Relational Responding Differs along Various Dimensions • The IRAP and the REC model • BIRRs (Brief and Immediate Relational Responses) and EERRs (Extended and Elaborate Relational Responses) • Implications for • fusion/defusion • acceptance • contact with the present moment • self • values

20. Behavioral Flexibility • Recent discussion with Torneke, Bond, and Luciano have generated the following RFT definition of behavioral flexibility: Psychological flexibility is the ability to notice and react to your thoughts, feelings, and behavior in order to give one the opportunity to take action towards important ends. In technical terms: psychological flexibility involves responding to one's own responding as participating in a frame of hierarchy with the deictic “I”, accompanied by a substantial reduction in the behavioral control functions of the response in question. Additional relational responding may thus occur that specifies appetitive augmental functions combined with actions that are coordinated with that relational responding.

21. From Here . . . • As RFT concepts get expanded upon, the need for non-technical middle-level terms in ACT should decline • We only had them because they were necessary for orienting and communication purposes, not because they offered precision, scope, and depth • They served communicative functions, not strictly scientific ones • If the agenda is truly CBS, we must move towards contextual functional behavioral concepts, that is what we are good at and what we have to offer that is above and beyond most other traditions • Why would a master baker eat crusts of bread when she could bake herself a delicious cake? Why would she not serve the cake to her guests, if baking is what she does best?