values work in act: dignifying treatment of disordered eating

UM Center for Contextual Psychology

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Values Work in ACT:Dignifying Treatment of Disordered Eating

Values Work in ACT:Dignifying Treatment of Disordered Eating

Emily K. Sandoz, M. S.

& Kelly G. Wilson, Ph. D.

Emily K. Sandoz, M. S.

& Kelly G. Wilson, Ph. D.

Why I CareWhy I Care

• “Too much…”• “Too much…”

Forms of Disordered EatingForms of Disordered Eating

• Varied topographies AN, BN, BED

• Similar Patterning around food and body image Rigid Narrow Insensitive

• Varied topographies AN, BN, BED

• Similar Patterning around food and body image Rigid Narrow Insensitive

Functions of Disordered EatingFunctions of Disordered Eating

• Similar Functions?

High levels aversive control

• Arousal

• Escape/avoidance

Low levels appetitive control

• Variability in orientation, etc.

• Positive reinforcement

• Similar Functions?

High levels aversive control

• Arousal

• Escape/avoidance

Low levels appetitive control

• Variability in orientation, etc.

• Positive reinforcement

ACT Model of Psychological HealthACT Model of Psychological Health

ACT for Disordered EatingACT for Disordered Eating

• Loosening aversive control Present Moment, Acceptance,

Defusion, Self

• Enhancing appetitive control Present Moment, Values,

Commitment, Self

• Loosening aversive control Present Moment, Acceptance,

Defusion, Self

• Enhancing appetitive control Present Moment, Values,

Commitment, Self

A Note on ValuesA Note on Values

• Identified as important in many traditions

• Recently emerging science of valuing

• Defined a number of different ways

• Some facilitate science

• Identified as important in many traditions

• Recently emerging science of valuing

• Defined a number of different ways

• Some facilitate science

ValuesValues

• 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.

• 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.

ValuesValues

• 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.

• 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.

Values are BehaviorValues are Behavior

• Not standards out in the world

• Not ideas or traits inside of us

• Things people do

• Not standards out in the world

• Not ideas or traits inside of us

• Things people do

ValuesValues

• 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.

• 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.

Values are Freely ChosenValues are Freely Chosen

• Experienced as a free choice

• No “have-to”

• Determined by history

• Free from aversive control

• Experienced as a free choice

• No “have-to”

• Determined by history

• Free from aversive control

ValuesValues

• 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.

• 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.

Values are ReinforcersValues are Reinforcers

• Not objects

• Transition to a world that one would work for

• Not objects

• Transition to a world that one would work for

ValuesValues

• 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.

• 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.

Values are Establishing OperationsValues are Establishing Operations

• Another kind of transition

• A consequence already there becomes a reinforcer

• Another kind of transition

• A consequence already there becomes a reinforcer

ValuesValues

• 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.

• 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.

Values are IntrinsicValues are Intrinsic

• Independent of results or outcome

• Defined by relationship with the pattern

• Independent of results or outcome

• Defined by relationship with the pattern

ValuesValues

• 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.

• 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.

Values take Different Forms Values take Different Forms

• Functionally defined

Forms change over time

Context-specific

• Functionally defined

Forms change over time

Context-specific

ValuesValues

• 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.

• 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.

Values are VerbalValues are Verbal

• Relational Frame Theory

• Transform functions or meaning of world without direct conditioning

• Relational Frame Theory

• Transform functions or meaning of world without direct conditioning

ValuesValues

• 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.

• 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.

Deficits in Valued Living Deficits in Valued Living

• Repertoire dominated by behaviors that:

Lack freedom

Narrow, rigid, insensitive

Escape and/or avoidance

Reinforced by outcome

• Repertoire dominated by behaviors that:

Lack freedom

Narrow, rigid, insensitive

Escape and/or avoidance

Reinforced by outcome

Values & Medical IssuesValues & 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

• 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

Values & Medical IssuesValues & 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

• 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

Values Construction Values Construction

• Shape valued living (successive approximations):

Assess valued living

Occasion experiential contact w/ values (valued living)

Establish as reinforcers for Tx & Bx change

• Shape valued living (successive approximations):

Assess valued living

Occasion experiential contact w/ values (valued living)

Establish as reinforcers for Tx & Bx change

Values Construction Values Construction

• Shape valued living (successive approximations):

Determine where she is

Facilitate a step forward

Therapeutic contract around that

Repeat

• Shape valued living (successive approximations):

Determine where she is

Facilitate a step forward

Therapeutic contract around that

Repeat

Vulnerabilities & PermissionVulnerabilities & Permission

• Values & vulnerabilities intimate Revealing how can be hurt

• Present own vulnerability first Need the client to help

• Ask permission

• Values & vulnerabilities intimate Revealing how can be hurt

• Present own vulnerability first Need the client to help

• Ask permission

Values Work on a ContinuumValues 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

• 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

Stage 1 Values WorkStage 1 Values Work

• Aiming for contact with any moment not dominated by aversive control

• Often found in moment just following relief

• Example: Free Breath

• Aiming for contact with any moment not dominated by aversive control

• Often found in moment just following relief

• Example: Free Breath

Stage 2 Values WorkStage 2 Values Work

• Aiming for moment dominated by appetitive control

• May or may not be linked to chosen values

• Example: Sweet spot

• Aiming for moment dominated by appetitive control

• May or may not be linked to chosen values

• Example: Sweet spot

Stage 3 Values WorkStage 3 Values Work

• Aiming for beginning of a pattern of choice

• Introducing world where choice would be possible

• Example: Magic Wand

• Aiming for beginning of a pattern of choice

• Introducing world where choice would be possible

• Example: Magic Wand

Stage 4 Values WorkStage 4 Values Work

• Aiming for increased patterning of valued living

• Introducing choice in this world, with its obstacles

• Example: A Free Choice

• Aiming for increased patterning of valued living

• Introducing choice in this world, with its obstacles

• Example: A Free Choice

A Word on CommitmentA 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

• 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

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.

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.

For references, etc…

Emily K. Sandoz

eksandoz@olemiss.edu

Kelly G. Wilson

kwilson@olemiss.edu

For references, etc…

Emily K. Sandoz

eksandoz@olemiss.edu

Kelly G. Wilson

kwilson@olemiss.edu