Values, Verbal Relations and Compassion:
Can We Do a Better Job of
Facing Global Challenges
Steven C. Hayes
University of Nevada
The World is Facing a Series of
Behavioral Challenges
• “…. knowing is not enough; action is needed. Why should it
occur? That is perhaps the most terrifying question in the
history of the human species” (Skinner, 1982)
Terrifying Because
(from Paul Chance)
• Immediate consequences outweigh delayed
consequences. People want to live in a world
with clean air, but also want to drive
Hummers.
• Some chemicals are destructively reinforcing.
The reinforcing power of sugar, salt, or drugs
threaten our health.
The List
• Consequences for the individual outweigh
consequences for others. We often fail to make
sacrifices for the common good.
• In the absence of counter-control, the use of
aversives tends to be very reinforcing to those
who use them. For example, Abu Ghraib
The List
• Coincidental events often strengthen
ineffective behavior. Superstition often wins
out over rationality.
• Simple, familiar wrong ideas are preferred
over complex, alien but correct ideas. For
example, evolution is rejected by 75% of the
US population
The List
• Susceptibility to social reinforcement can
incline us toward extreme views. For example,
9-11 was perpetrated by mostly well-educated,
middle-class people with families but who
spent a lot of time interacting with others who
shared extreme beliefs
The List
• Strong aversives presented abruptly
prompt appropriate action, but strong aversives
following a long string of aversives that gradually
increase in strength often do not. This suggests
that so long as conditions worsen gradually, we
will tolerate bad air, foul water, loud noise,
psychological and physical abuse, and crime that
would once have been considered intolerable.
The Processes
• Weak delayed consequences for positive behaviors or
powerful short term ones of negative behaviors
• Weak social concern or cooperation or using aversives
on others
• Impulse and superstition rather than scientific data
and reason
• Entanglement with socially supported deviant beliefs
• Lack of attention to gradual aversives
The Problems
•
•
•
•
•
•
•
Obesity and health
Drugs
Over-population
Lack of self-control
Poverty
Violence
Pollution and global warming
Reformulating the Questions
• Not why are we controlled by short term consequences – it
is why we ever fail to be.
• Not why do we show low concern for others – it is why
we ever cooperate or show compassion for others
• Not why aren’t we controlled by scientific data – it is how
is it that science ever makes a difference
• Can a psychological flexibility model help? Is it relevant?
• I will share data only from the last three years
Inflexible
Attention
to Past and
Future
Lack of
Values
Clarity
Experiential
Avoidance
Psychological
Inflexibility
Inaction,
Impulsivity,
Avoidant
Persistence
Cognitive
Fusion
Conceptual
Self / Weak
Perspective
Taking
The Present
Moment
“Be Here Now”
Values
“Know What
Matters”
Acceptance
“Opening Up”
Psychological
Flexibility
“Be Present, Show Up,
and Do What Matters”
Committed
Action
“Do What
Works”
Defusion
“Watch Your
Thinking”
Self as Context
Perspective
Taking
Not Why are We Controlled by Short
term Consequences
Rather, How Do We Ever Fail to Be?
7/28/2017
Within a
Psychological Flexibility Model
Acceptance and Defusion Increase Willingness to Experience
Discomfort of Foregoing Short Term Reinforcers;
Use Values or Motivative Augmentals to Increase
Psychological Presence of Chosen Long Term Consequences
Social Processes that Support Both
Weight Maintenance
Lillis et al., 2009
• 87 participants who had completed at least 6
months of organized weight loss intervention
(on average their 37th try)
• Randomized to 1 day ACT workshop (n = 43)
or TAU Control (n = 44)
Acceptance, Defusion from
Self-Stigma and Values
• Focused on values and patterns of avoidance
toward weight-related thoughts, feelings, and
bodily sensations
• No diet, physical activity, self-monitoring, or
weight education components
Process Results
Cohen’s d Improvement
1.4
1.2
Effect
Sizes:
ACT
1.0
.8
.6
Large
Medium
.4
.2
0
- .2
Small
Control
- .4
AAQ
AAQW
Breath
Holding
Pre to Follow-Up Weight Change
35
30
p < .001
ACT
5
Control
25
20
15
10
3 month
follow-up
0
% gaining 5+ lbs
% losing 5+ lbs
d = 1.21
ACT for Diabetes Management
Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007, JCCP
• Randomized controlled trial with poor, mostly
minority clients
• 40 / group: ACT plus diabetes education (one sixhour workshop) or diabetes education (also a six
hour workshop)
• Only 3 hours were different content
Pre to Follow up Change
AAQ
(Diabetes)
% in
Diabetic
Control
SelfManagement
10
50%
50%
5
25%
25%
0
0%
0%
Ed’n ACT
Ed’n ACT
Ed’n ACT
AAQD and Self-Management mediated blood glucose outcomes
Pediatric Chronic Pain
Wicksell, Melin, Lekander, & Olsson, Pain, 2010
• 32 children w/ longstanding pediatric pain
• Average of 32 mo pain duration
• Randomly assigned to ACT or
multidiscipinary Rx & medication (MDT).
• ACT = 12 session; MDT = 23
Pain Interference
6
4
2
Pre
Post
3.5 mo
6.5 mo
Effect of Writing About Your Values
Cohen, Garcia, Purdie-Vaughns, Apfel, & Brzustoski (2009), Science, 234, 400-403.
• 385 middle school children followed
through 7th and 8th grade
• Randomly assigned to a series of short (15
minute) writing assignments at the
beginning of 7th grade on their values in
various specific domains and the
importance of these values
Impact on GPA Thru Middle School
3.5
European Americans or High Achieving African-Americans
Both Conditions and Ethnic Groups Are Identical
3.0
2.5
Low Achieving African-Americans
2.0
Values
1.5
Control
1.0
Pre
1
2
3
Year 1
4
1
2
3
Year 2
4
Motivating Physical Exercise
Jackson et al., in preparation
• 46 female students in a spinning class
• Identify fitness motivation via IRAP
• Prompt during class – compare to form based
prompts or IRAP identified low motivators
Percentage of
Instructor’s Heart Rate
Bsln
Prompts
Bsln
105
105
95
95
85
85
1
3
5
7
9
105
Baseline
Positive Goals
Forms 105
95
95
85
85
1
3
5
7
9
Prompts
1
3
5
7
9
1
3
5
7
9
Exercise Sessions
Average Difference from Baseline
Green = Positive Implicit Goals
Blue = Instruction About Form
Average Difference from Baseline
DIFFERENCE IN % OF INSTRUCTORS AVERAGE
HEART RATE
10
8
Green = Non-Preferred
“Positive” Implicit Goals
6
4
2
18
0
17
18
-2
-4
-6
-8
-10
Blue = Instruction About Form
Randomized Trial: ACT vs. TAU
Tapper et al., 2009
• 62 overweight women (BMI = 31.6)
• All participants already in weight loss programs
• 4 two-hour sessions. 26 attended at least one; 31
left in existing diet
• Short ACT protocol
• Pre / Post / 6 month follow up
BMI
.5
Overall
-.5
-1
- “Never apply”
Change in Weekly Exercise
3
2
1
0
-1
Overall
- “Never apply”
Physical Fitness
Butryn, Forman, Hoffman, Shaw, and Juarascio, under submission
• 46 female students assigned to two 2-hour
workshops (two weeks apart) on ACT or
education about fitness.
• “Post” at week four; follow up at week seven
• Primary measure: use of exercise facilities at
the University Athletic Center (these were
automatically recorded from the swipe cards,
resulting in a high integrity measure with no
drop outs)
Weekly Number of Exercise Sessions
2.2
ACT
Visits to the Athletic Center
1.8
1.4
1.0
.6
Fitness Education
.2
Pre
Post
Follow Up
The Question Is Not Why Aren’t We
Controlled by Scientific Data
Instead of Impulses
It Is How Can We Increase the Impact
of Scientific Data
7/28/2017
Within the PF Model:
Link Science Knowledge to Values;
Use Acceptance and Defusion to Deal
with the Discomfort of Newness and
the Interference of Alternative Beliefs
7/28/2017
Adopting ESTs
Varra, Hayes, Roget, & Fisher, JCCP, 2008
• 59 drug and alcohol counselors randomly
assigned to
– One day ACT workshop focused on the
psychological barriers to learning
– Control condition: One day workshop on
EAP policies
– Both groups then do a one day educational
workshop on the science behind the use of
agonists and antagonists
Frequency of Perceived Barriers to
Using Empirically Supported Treatments
75
ACT plus
Education
70
Control
plus
Education
65
Pre
Post
Phase
Believability of Perceived Barriers to
Using Empirically Supported Treatments
70
Control
plus
Education
65
60
ACT plus
Education
Pre
Post
Phase
Willingness to Use Pharmacotherapy
3.5
3.25
ACT plus
Education
3
2.75
Control
plus
Education
2.5
2.25
2
Pre
Post
Phase
Subsequent Use of Pharmacotherapy
3.5
3.25
ACT plus
Education
3
2.75
Control
plus
Education
2.5
2.25
2
Pre
3 month
Follow - up
Phase
The Question Is Not Why Do We
Show Low Concern For Others
It Is How Can We Promote
Cooperation, Compassion and Concern
for Others
7/28/2017
Within the PF Model
Promote a Social/Perspective Taking
Sense of Self
Link Self-Acceptance and Compassion
Link Values and Compassion
7/28/2017
Experiential Avoidance and MH Stigma
Masuda et al., 2007
• RCT comparing education focused on prevalence
and costs of stigma toward mental health
problems, and accurate information about them
• ACT focused on defusion from and mindfulness
of prejudicial thoughts, acceptance of difficult
prejudicial feelings, and values
Average MH Stigma Score
ACT for Mental Health Stigma
-25
Education
Hi EA
-30 Lo EA
ACT
-35
-40
Pre
Post
F-Up
Racial Prejudice
Lillis & Hayes, 2007
• Replicated with ACT versus Education for
racial bias in a college student population
• Within subject test (16 with A/B/A/C/A and
16 with A/C/A/B/A)
• 32 participants in a two racial differences
classes
• 90 minute class period
• “follow up” = next class period
Assessment Items
• Bias Awareness
– I feel that I am aware of my own biases
• Bias Does Not Affect Me
– I feel that my prejudicial thoughts are a
significant barrier to me being culturally
sensitive
– My biases and prejudices affect how I interact
with people from different racial and ethnic
backgrounds.
Assessment Items
• Acceptance
– It is OK to have prejudiced thoughts or racial
stereotypes
– I try not to think negative thoughts I have about people
from different racial or ethnic backgrounds.
• Defusion and Action
– When I evaluate someone negatively, I am able to
recognize that this is just a reaction, not an objective
fact.
– It’s ok to have friends that I have prejudicial thoughts
about from time to time.
Assessment Items
• Positive Action
– I would attend a social event where I was the only
person of my race/ ethnic background.
– I believe that I am able to transcend racial boundaries
with my actions.
– I plan to actively seek out experiences that could expose
me to people who have a different cultural, racial, or
ethnic background than me.
– I am likely to join a campus organization or participate
in a campus event that is focused on cultural diversity.
Percentage of Possible Improvement Obtained
nes s
e
r
a
Aw
r ie rs
r
a
B
f
ent o
m
e
g
wled
o
n
k
A
tanc e
p
e
c
Ac
si
De fu
eA
ositiv
-20
P
-10
Ed Pre-fup
Ed Pre-Po
ACT Pre-Fup
ACT pre-Po
on
ction
0
10
20
30
40
RFT Take on the Formation of
Self and Perspective Taking
YOU
HERE
NOW
I
THEN
THERE
The I-Here-Nowness of Awareness
is the Foundation of Perspective Taking
Self-as-context
But If “From Hereness” is Relational
• It says something very profound: I don’t get to
show up as a conscious human being until you
show up as a conscious human being
• One of the way we measure perspective taking
are “Theory of Mind” assessments
• Are deictic relations and Theory of Mind
performances related?
Percent Correct
At Least Broadly, They Are
105
95
85
75
65
55
45
35
25
15
Deictic
ToM
Pre
Single
Reversals
Double
Reversals
Phases
For general direction of the relationship only. These data are from 2 unpublished studies, one by another author, so details could change
Why This Matters
• A perspective taking sense of self is social
• Which is why your pain can pain me
• I need to accept my own pain in order to care
about yours in a healthy way
• Gives a personal motivation beyond values and
evolution for empathy and caring for others
Experiential Avoidance, Shame,
and Stigma Toward Others
164 persons dealing with weight (Lillis et al)
Weight Self Stigma
Experiential Avoidance
.76**
Negative Attitudes Toward Others
with Weight Problems
.33**
And Guess What?
Weight Self Stigma
Weight Problems
.40**
Mental Health Problems
.42**
Quality of Life
-.68**
What That Says
• Compassion toward others is related to some
degree to self-compassion and to liberation
from entanglement with judgments
• Those processes have tangible positive effects
on the person, giving some possible motivation
to deal with a judgmental lack of compassion
Roger Vilardaga, Ana Estévez, Michael E. Levin and Steven C. Hayes
Caring About Being With Others
Perspective
Taking
Experiential
Avoidance
Empathy
Joy
Sadness
Now/Then
I/You
Here/There
-
--
Repertoire
Narrowing
+
Social Anhedonia
R2
Step 1
Gender
Age
Step 2
Gender
Age
Deictic ability
Step 3
Gender
Age
Deictic ability
Empathic concern
Step 4
Gender
Age
Deictic ability
Empathic concern
Experiential Avoidance
Social Anhedonia
∆F
β
.036
1.87
.10*
6.91
.15*
5.17
.26**
14.60
-.17
-.09
-.13
-.10
-.26*
-.06
-.04
-.23*
-.23*
-.02
.05
-.18†
-.26*
.35**
The Question Is Not Why Do
We Become Entangled
With Deviant Beliefs
It is How Do We Disentangle
Ourselves from Them
7/28/2017
Within the PF Model
Defusion and Mindfulness Skills;
Cost in Valued Behavior
7/28/2017
ACT for Self-Stigma / Shame
Luoma, Kohlenberg, et al., under review
134 participants in a 28 day in-patient drug
program
Randomly assigned to 6-hour ACT group
focused particularly on self-judgment and shame
Shame Outcomes: Better for TAU
ACT
Average Score
110
105
100
95
90
TAU
85
Pre
Post
Quality of Life Outcomes: Better for TAU
Average Score
80
78
76
74
TAU
72
ACT
70
Pre
Post
Days / Month Using
Drugs or Alcohol
Group ACT for Shame:
Substance Use Outcomes
6
5
TAU
4
3
2
1
ACT
0
1 Month
Follow Up
Days / Month Using
Drugs or Alcohol
Group ACT for Shame:
Substance Use Outcomes
6
5
TAU
4
3
2
1
ACT
d = 1.21
0
1 Month
2 Month
Follow Up
3 Month
Shame Outcomes
Average Score
110
ACT
r with use
at follow up = ns
105
100
95
90
r with use
at follow up =
-.51 (p < .01)
TAU
85
Pre
Post
3 Mo F-Up
Quality of Life Outcomes
Average Score
80
ACT
78
76
74
TAU
72
70
Pre
Post
3 Mo F-Up
Where We Are
 Good start but it is not enough
 There are some sour notes at the level of
technology
 Social trends are not good – if psychological
flexibility is key
 Enormous increase in exposure to horror and
chatter
What is Missing
 Content wise: no studies on global warming and
energy consumption; violent conflict;
prevention; creating values-based groups.
 We need to think about our work in a broader
social context
 We have natural allies
 Could we scale the model?
Weak Data /
Inflexible
Attention
Lack of
Values Clarity
and Group
Choice
Suppress
Difficult
Material
Organizational
Inflexibility
Judgmental &
Rigid
Practices
Delinked to
Workability
Inaction,
Impulsivity,
Avoidant
Persistence
Conceptual
Organizatn
Weak
Perspective
Taking
Good
Monitoring
/ Flexible
Attending
Clear Values
and Goals /
Chosen by
Group
Openness to
Distress,
Problems,
Conflict
Organizational
Flexibility
Active Steps
Linked to
Values and
Goals
Multiple
Views,
Filtered by
Workability
Aware of
Perspective/
Context and
that of
Others
Can We Extend It?
 Projects are underway that will test these ideas
 But we can take heart in the connection with
evolutionist thinking and data
Elinor Ostrom
2009 Nobel Prize in Economics
Elinor Ostrom’s Eight Steps
1) Clearly Defined Boundaries. The identity of the group and its rights to the
common resource must be clearly delineated.
2) Proportional equivalence between benefits and costs. Members of the
group must negotiate a system that rewards members for their contributions.
High status and other disproportionate benefits must be earned.
3) Collective-choice arrangements. Group members must be able to create
their own rules and make their own decisions by consensus. People hate
being told what to do but will work hard for group goals that they have agreed
upon.
4) Monitoring. Managing a commons is inherently vulnerable to free-riding and
active exploitation. Unless these locally advantageous strategies can be
detected at relatively low cost, the tragedy of the commons will occur.
Elinor Ostrom’s Eight Steps
5) Graduated sanctions. Transgressions need not require heavy-handed
punishment, at least initially. Often gossip or a gentle reminder is sufficient,
but more severe forms of punishment must also be waiting in the wings for
use when necessary.
6) Conflict resolution mechanisms. It must be possible to resolve conflicts
quickly and in ways that are perceived as fair by members of the group.
7) Some recognition of rights to organize. Groups must have the authority to
manage their own affairs. Externally imposed rules are unlikely to be adapted
to local circumstances and violate ingredient 3.
8) For groups that are part of larger social systems, there must be nested
enterprises. The previous ingredients work best in relatively small groups.
Society at a larger scale must be multicellular, with groups interacting with
groups, often in multiple layers.
Effective monitoring by monitors who are part of or accountable to the
The selfappropriators;
determination of the
community is
Good
recognized by
Monitoring
higher-level
/
Flexible
Mechanisms
authorities;
Attending
of conflict
Collective-choice
resolution are
Clear Values arrangements allow
Openness to
cheap and to
most resource
and Goals /
Distress,
easy access;
appropriators to
Problems,
Chosen by
participate in the
Conflict
Group
decision-making
process;
Rules regarding the
appropriation and
There is a scale
provision of common
of graduated
resources are
sanctions for
Active Steps
Multiple
adapted to local
resource
Linked to
Views,
conditions;
appropriators
Filtered by
Values and
Workability
who violate
Goals
community rules;
Aware of
Organizational
Flexibility
Meets
Elinor Ostrom
In the case of larger common-pool
resources: organization in the form of
multiple layers of nested enterprises,
with small local CPRs at the base level.
Perspective/
Context and
that of
Others
The World is Facing a
Series of Behavioral Challenges
• We cannot rely on the politicians and soldiers to solve this
problem for us
• The CBS community needs to consider the implications of
its work for the health and well being of human beings and
the global challenges they face