Acceptance and Commitment Training Within the Scope of Practice of Applied Behavior Analysis

Abstract

Acceptance and commitment therapy (ACT) is a contemporary behavior-analytic approach to intervening on verbal behavior for the purposes of bringing about socially meaningful overt behavior change. Although originally developed as a behavior-analytic approach to psychotherapy, the conceptual functional analyses and procedures that form the core of ACT have been disseminated broadly outside of clinical psychology, including within the field of applied behavior analysis (ABA). This article discusses the use of ACT within mainstream ABA practice and provides preliminary conceptual functional analyses and practical guidelines for incorporating ACT within the scope of practice of applied behavior analysts.

This is a preview of subscription content, access via your institution.

Fig. 1.

References

  1. Alvero, A. M., Bucklin, B. M., & Austin, J. (2001). An objective review of the effectiveness and essential characteristics of performance feedback in organizational settings (1985–1998). Journal of Organizational Behavior Management, 21(1), 3–29. https://doi.org/10.1300/J075v21n01_02

    Article  Google Scholar 

  2. American Psychological Association. (2016). Psychological treatments. Retrieved from the Society of Clinical Psychology Division 12 website: https://www.div12.org/treatments/

  3. Baer, DM., Wolf, M. M., & Resley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91.

  4. Barron, B. F., Verkuylen, L., Belisle, J., Paliliunas, D., & Dixon, M. R. (2019). Teaching “then-later” and “here-there” relations to children with autism: An evaluation of single reversals and transformation of stimulus function. Behavior Analysis in Practice, 12, 167–175. https://doi.org/10.1007/s40617-018-0216-1

    Article  PubMed  Google Scholar 

  5. Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Littleton, CO: Author.

    Google Scholar 

  6. Behavior Analyst Certification Board. (2017). BCBA/BCaBA task list (5th ed.). Littleton, CO: Author.

    Google Scholar 

  7. Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child and Family Behavior Therapy, 28, 1–18. https://doi.org/10.1300/j019v28n0

    Article  Google Scholar 

  8. Blackledge, J.T., & Drake, C.E (2013). Acceptance and commitment theraphy: Empirical and theoritical considerations. In S. Dymond & Roche (Eds.), Advances in relational frame theory: Research and application (p.219–252). Oakland, CA: New Harbinger Publiations, Inc.

  9. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688. https://doi.org/10.1016/j.beth.2011.03.007

  10. Bondy, A., & Frost, L. (2001). The picture exchange communication system. Behavior Modification, 25, 725–744. https://doi.org/10.1177/0145445501255004

    Article  PubMed  Google Scholar 

  11. Brazeau, K., Rehfeldt, R. A., Mazo, A., Smalley, S., Krus, S., & Henson, L. (2017). On the efficacy of mindfulness, defusion, and behavioral skills training on job interviewing skills in dually-diagnosed adults with developmental disorders. Journal of Contextual Behavioral Science, 6(2), 145–151. https://doi.org/10.1016/j.jcbs.2017.04.002

    Article  Google Scholar 

  12. Brodhead, M.T., Quigley, S.P., & Wilczynski, S.M. (2018). A call for discussion about scope of competence in behavior analysis. Behavior Analysis in Practice, 11(4), 424–435.

  13. Castro, M., Rehfeldt, R. A., & Root, W. B. (2016). On the role of values clarification and committed actions in enhancing the engagement of direct care workers with clients with severe developmental disorders. Journal of Contextual Behavioral Science, 5(4), 201–207. https://doi.org/10.1016/j.jcbs.2016.09.003

    Article  Google Scholar 

  14. Chancey, C., Weihl, C., Root, W. B., Rehfeldt, R. A., McCauley, D., Takeguchi, K., & Pritchard, J. (2019). The impact of mindfulness skills on interactions between direct care staff and adults with developmental disabilities. Journal of Contextual Behavioral Science, 12, 160–169. https://doi.org/10.1016/j.jcbs.2018.07.004

    Article  Google Scholar 

  15. Chase, J. A., Houmanfar, R., Hayes, S. C., Ward, T. A., Vilardaga, J. P., & Follette, V. M. (2013). Values are not just goals: Online ACT-based values training adds to goal-setting in improving undergraduate college student performance. Journal of Contextual Behavioral Science, 2, 79–84. https://doi.org/10.1016/j.jcbs.2013.08.002

    Article  Google Scholar 

  16. Chawla, N., & Ostafin, B. D. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63, 871–890. https://doi.org/10.1002/jclp.20400

  17. Cooper, J.O., Heron, T.E., & Heward, W.L. (2002). Applied Behavior analysis. Hoboken, NJ:

  18. Critchfield, T., & Rehfeldt, R. A. (2020). Engineering emergent learning with nonequivalence relations. In J. O. Cooper, T. E. Heron, & W. L. Heward (Eds.), Applied behavior analysis (3rd ed.) 497–526. London, UK: Pearson.

  19. Department of Veterans Affairs. (2016). VA/DoD clinical practice guideline for the management of major depressive disorder: Version 3.0. Retrieved from: https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf

  20. Devany, J. M., Hayes, S. C., & Nelson, R. O. (1986). Equivalence class formation in language-able and language-disabled children. Journal of the Experimental Analysis of Behavior, 46, 243–257. https://doi.org/10.1901/jeab.1986.46-243

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dixon, M. R. (2014). ACT for children with autism and emotional challenges. Carbondale, IL: Shawnee Scientific Press.

    Google Scholar 

  22. Dixon, M.R. & Paliliunas, D. (2017). AIM: A behavior analytic curriculum for social-emotional development in children. Carbondale, IL: Shawnee Scientific Press.

  23. Dixon, M. R., Blevins, A., Belisle, J., & Bethel, B. (2019). Teaching children with autism extended verbal utterances under audience control in the context of show-and-tell. Behavior Analysis in Practice, 12, 194–198. https://doi.org/10.1007/s40617-018-0250-z

    Article  PubMed  Google Scholar 

  24. Dollard, J., & Miller, N. E. (1950). Personality and psychotherapy: An analysis in terms of learning, thinking, and culture. New York, NY: McGraw-Hill.

    Google Scholar 

  25. Eilers, H. J., & Hayes, S. C. (2015). Exposure and response prevention therapy with cognitive defusion exercises to reduce repetitive and restrictive behaviors displayed by children with autism spectrum disorder. Research in Autism Spectrum Disorders, 19, 18–31. https://doi.org/10.1016/j.rasd.2014.12.014

    Article  Google Scholar 

  26. Estes, W. K., & Skinner, B. F. (1941). Some quantitative properties of anxiety. Journal of Experimental Psychology, 29(5), 390–400. https://doi.org/10.1037/h0062283

  27. Gould, E. R., Tarbox, J., & Coyne, L. (2018). Evaluating the effects of acceptance and commitment training on the overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7, 81–88. https://doi.org/10.1016/j.jcbs.2017.06.003

    Article  Google Scholar 

  28. Harris, R. (2008). The willingness and action plan. Retrieved from thehappinesstrap.com/upimages/Willingness_and_Action_Plan.pdf

  29. Hayes, S.C. (n.d.). State of the ACT Evidence. Retrieved from: https://contextualscience.org/state_of_the_act_evidence

  30. Hayes, S. C. (1982, May). Rule-governed behavior and psychopathology. Invited address presented at the meeting of the Association for Behavior Analysis International, Milwaukee, WI.

  31. Hayes, S. C. (1983, May). Semantic therapy, cognition, rule-governed behavior, and psychopathology: A radical behavioral approach. Invited workshop presented at the meeting of the Association for Behavior Analysis International, Milwaukee, WI.

  32. Hayes, S. C. (1984). Making sense of spirituality. Behaviorism, 12, 99–110. https://www.jstor.org/stable/27759047

  33. Hayes, S.C. (2020). ACT Randomized Controlled Trials Since 1986. Retrieved from : https://contextualscience.org/ACT_Randomized_Controlled_Trials

  34. Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. New York, NY: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  35. Hayes, S. C., Bond, F., Barnes-Holmes, D., & Austin, J. (Eds.). (2006). Acceptance and mindfulness at work: Acceptance and commitment therapy, relational frame theory, and organizational behavior management. Binghamton, NY: Haworth.

    Google Scholar 

  36. Hayes, S. C., & Brownstein, A. J. (1985, May). Verbal behavior, equivalence classes, and rules: New definitions, data, and directions. Invited address presented at the meeting of the Association for Behavior Analysis International, Columbus, OH.

  37. Hayes, S. C., & Brownstein, A. J. (1986). Mentalism, behavior-behavior relations and a behavior analytic view of the purposes of science. The Behavior Analyst, 9, 175–190. https://doi.org/10.1007/BF03391944

  38. Hayes, S. C., Brownstein, A. J., Haas, J. R., & Greenway, D. E. (1986). Instructions, multiple schedules, and extinction: Distinguishing rule-governed from schedule controlled behavior. Journal of the Experimental Analysis of Behavior, 46, 137–147. https://doi.org/10.1901/jeab.1986.46-137

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hayes, S. C., Brownstein, A. J., Zettle, R. D., Rosenfarb, I., & Korn, Z. (1986). Rule-governed behavior and sensitivity to changing consequences of responding. Journal of the Experimental Analysis of Behavior, 45, 237–256. https://doi.org/10.1901/jeab.1986.45-237

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hayes, S. C., & Cone, J. D. (1981). Reduction in residential consumption of electricity through simple monthly feedback. Journal of Applied Behavior Analysis, 14, 81–88. https://doi.org/10.1901/jaba.1981.14-81

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hayes, S. C., & Hayes, L. J. (1992). Some clinical implications of contextualistic behaviorism: The example of cognition. Behavior Therapy, 23(2), 225–249. https://doi.org/10.1016/S0005-7894(05)80383-1

  42. Hayes, S. C., Hayes, L. J., & Reese, H. W. (1988). Finding the philosophical core: A review of Stephen C. Pepper’s World hypotheses. Journal of the Experimental Analysis of Behavior, 50, 97–111. https://doi.org/10.1901/jeab.1988.50-97

    Article  PubMed  Google Scholar 

  43. Hayes, S. C., McCurry, S. M., Afari, N., & Wilson, K. (1991). Acceptance and . . . A therapy manual for the treatment of emotional avoidance. Reno: Context Press.

    Google Scholar 

  44. Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578. https://doi.org/10.1007/BF03395492

  45. Hayes, S. C., Zettle, R. D., & Rosenfarb, I. (1989). Rule following. In S. C. Hayes (Ed.), Rule-governed behavior: Cognition, contingencies, and instructional control (pp. 191–220). New York, NY: Plenum.

    Google Scholar 

  46. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press.

  47. Hawkes, A. L., Chambers, S.K., Pakenham, K.I., Patrao, T.A., Baade, P.D., Lynch, B.M., Aitken, J.F., Meng, X., & Courneya, K.S., (2013). Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomzed controlled trial. Journal of clinical oncology: official journal of the American Society of Clinical Oncolgy, 31(28), 2313–2321. https://doi.org/10.1200/JCO.2012.45.5873

  48. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2(1), 3–20. https://doi.org/10.1016/0270-4684(82)90003-9

  49. Ju, W.C., & Hayes, S.C. (2008). Verbal stablishing stimuli: Testing the motivative effect of stimuli in a derived relation with consequences. The Psychological Record, 58(3), 339–363

  50. Kanfer, F. H. (1961). Comments on learning in psychotherapy. Psychological Reports, 9(3), 681–699. https://doi.org/10.2466/pr0.1961.9.3.681

  51. Kasson, E. M., & Wilson, A. N. (2016). Preliminary evidence on the efficacy of mindfulness combined with traditional classroom management strategies. Behavior Analysis in Practice, 10, 242–251. https://doi.org/10.1007/s40617-016-0160-x

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kazdin, A.E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). Oxford: Oxford University Press

  53. Kohlenberg, R. J., Tsai, M., & Dougher, M. J. (1993). The dimensions of clinical behavior analysis. The Behavior Analyst, 16(2), 271–282. https://doi.org/10.1007/BF03392636

  54. Krasner, L. (1963). Reinforcement, verbal behavior and psychotherapy. American Journal of Orthopsychiatry, 33, 601–613. https://doi.org/10.1111/j.1939-0025.1963.b01008.x

  55. Levin, M. E., Haeger, J., & Smith, G. S. (2017). Examining the role of implicit emotional judgments in social anxiety and experiential avoidance. Journal of Psychopathology and Behavioral Assessment, 39, 264–278. https://doi.org/10.1007/s10862-016-9583-5

    Article  Google Scholar 

  56. Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43, 741–756. https://doi.org/10.1016/j.beth.2012.05.003

    Article  PubMed  Google Scholar 

  57. Luciano, C., Ruiz, F. J., Torres, R. M. V., Martín, V. S., Martínez, O. G., & López, J. C. L. (2011). A relational frame analysis of defusion interactions in acceptance and commitment therapy: A preliminary and quasi-experimental study with at-risk adolescents. International Journal of Psychology and Psychological Therapy, 11, 165–182. https://www.redalyc.org/pdf/560/56019292001.pdf

  58. Mace, F. C., Hock, M. L., Lalli, J. S., West, B. J., Belfiore, P., Pinter, E., & Kirby Brown, D. (1988). Behavioral momentum in the treatment of noncompliance. Journal of Applied Behavior Analysis, 21, 123–141. https://doi.org/10.1901/jaba.1988.21-123

    Article  PubMed  PubMed Central  Google Scholar 

  59. Masuda, A., Hayes, S. C., Sackett, C. F., & Twohig, M. P. (2004). Cognitive defusion and self-relevant negative thoughts: Examining the impact of a ninety year old technique. Behaviour Research and Therapy, 42, 477–485. https://doi.org/10.1016/j.brat.2003.10.008

    Article  PubMed  Google Scholar 

  60. McCracken, L. M., & Jones, R. (2012). Treatment for chronic pain for adults in the seventh and eighth decades of life: A preliminary study of acceptance and commitment therapy (ACT). Pain Medicine, 13(7), 860–867. https://doi.org/10.1111/j.1526-4637.2012.01407.x

    Article  PubMed  Google Scholar 

  61. McEnteggart, C.A., (2018). Brief Tutorial on Acceptance an Commiment Theraphy as Seen Throuh the Lense of Derived Simulus Relations. Perspectives on Behavioral Science, 41, 215–227. https://doi.org/10.1007/s40614-018-0149-6

  62. Monestes, J. L., Greville, W. J., & Hooper, N. (2017). Derived insensitivity: Rule-based insensitivity to contingencies propagates through equivalence. Learning and Motivation, 59, 55–63. https://doi.org/10.1016/j.lmot.2017.08.003

    Article  Google Scholar 

  63. Moran, D. J. (2014). Mindful action plan. Retrieved from contextualscience.org/files/49%20FriAM%20-%20Batten%20and%20Moran-%20XXXX.pdf

  64. Neef, N. A., Mace, F. C., Shea, M. C., & Shade, D. (1992). Effects of reinforcer rate and reinforcer quality on time allocation: Extensions of matching theory to educational settings. Journal of Applied Behavior Analysis, 25, 691–699. https://doi.org/10.1901/jaba.1992.25-691

    Article  PubMed  PubMed Central  Google Scholar 

  65. Pahnke, J., Lundgren, R. T., Hursti, T., & Hirvikoski, T. (2014). Outcomes of an acceptance and commitment therapy-based skills training group for students with high-functioning autism spectrum disorder: A quasi-experimental pilot study. Autism, 18, 953–964. https://doi.org/10.1177/1362361313501091

    Article  PubMed  Google Scholar 

  66. Singh, N. N., Lancioni, G. E., Winton, A. S. W., Adkins, A. D., Singh, J., & Singh, A. N. (2007). Mindfulness training assists individuals with moderate mental retardation to maintain their community placements. Behavior Modification, 31, 800–814. https://doi.org/10.1177/0145445507300925

    Article  PubMed  Google Scholar 

  67. Skinner, B. F. (1953). Science and human behavior. New York, NY: Macmillan.

    Google Scholar 

  68. Skinner, B.F., (1969). Contingencies of reinforcement: A theoritical analysis. NJ: Prentice Hall.

  69. Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45, 840–850. https://doi.org/10.1016/j.beth.2014.07.001

    Article  PubMed  Google Scholar 

  70. Szabo, T. G. (2019). Acceptance and commitment training for reducing inflexible behaviors in children with autism. Journal of Contextual Behavioral Science, 12, 178–188. https://doi.org/10.1016/j.jcbs.2019.03.001

    Article  Google Scholar 

  71. Szabo, T. G., & Dixon, M. R., (2016). Contextual behavior science and education. In R.D. Zettle S.C. Hayes, D. Barnes-Holmes, & A. Biglan (Eds.), Wiley Handbook of Contextual Behavioral Science (422–458). Medford, MA: Wiley

  72. Szabo, T., & Tarbox, J. (2018). Acceptance and commitment training and the scope of practice of BCBAs [Web log post]. https://bsci21.org/acceptance-and-commitment-training-and-the-scope-of-practice-of-bcbas

  73. Szabo, T. G., Willis, P. G., & Palinski, C. J. (2019). Watch me try: Improving athletic performance of young adults with ASD. Advances in Neurodevelopmental Disorders. Advance online publication. https://rdcu.be/bQKlb

  74. Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice. Advance online publication. https://doi.org/10.1007/s40617-018-00289-3

  75. Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York, NY: Guilford.

    Google Scholar 

  76. Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11(2), 203–214. https://doi.org/10.1901/jaba.1978.11-203

  77. Zettle, R. D. (2005). The evolution of a contextual approach to therapy: From comprehensive distancing to ACT. International Journal of Behavioral Consultation and Therapy, 1(2), 77–89. https://doi.org/10.1037/h0100736

    Article  Google Scholar 

  78. Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30–38. https://doi.org/10.1007/BF03392813

Download references

Author Note

The authors would like to thank Drs. Evelyn Gould, Emily Sandoz, Steven C. Hayes, and Courtney Tarbox for their contributions throughout the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jonathan Tarbox.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The authors declare that this article did not involve research with human subjects and therefore was not reviewed by a research ethics committee.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tarbox, J., Szabo, T.G. & Aclan, M. Acceptance and Commitment Training Within the Scope of Practice of Applied Behavior Analysis. Behav Analysis Practice (2020). https://doi.org/10.1007/s40617-020-00466-3

Download citation

Keywords

  • Acceptance and commitment therapy
  • Acceptance and commitment training
  • Scope of practice
  • Applied behavior analysis