values work in act: dignifying treatment of disordered eating
DESCRIPTION
Values Work in ACT: Dignifying Treatment of Disordered Eating. Emily K. Sandoz, M. S. & Kelly G. Wilson, Ph. D. Why I Care. “Too much…”. Forms of Disordered Eating. Varied topographies AN, BN, BED Similar Patterning around food and body image Rigid Narrow Insensitive. - PowerPoint PPT PresentationTRANSCRIPT
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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
Kelly G. Wilson
For references, etc…
Emily K. Sandoz
Kelly G. Wilson