Behavioral commitments involve choosing and engaging in actions that are consistent with one’s values while practicing the other components of ACT. This phase of treat- ment could also be called the “behavior change phase” and is where more traditional behavior change procedures are utilized. What makes it different than straight behavior therapy is that all behavior change procedures are done from an ACT approach. The client learns to practice acceptance and defusion from problematic thoughts and feel- ings when the thoughts occur during the exercises. Also, the use of these procedures is always linked up to the client’s values. It is assumed that larger and larger behavior patterns will develop and that the client’s repertoire will expand in terms of both overt skills and psychological flexibility.
The exercises and behavioral commitments will vary greatly depending on the par- ticular behavior problem. The exercises could involve using more behaviorally based treatment procedures from other validated treatment protocols or, if appropriate, asking children to commit to change areas of their lives. Here are a few examples: A child with ADHD could sit through class for longer and longer periods. A child with oppositional
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defiant disorder could practice giving a compliment to a peer whom he usually bullies, or he might go longer and longer periods of time without arguing. A child diagnosed with conduct disorder could similarly make commitments to not engage in harmful behaviors for specified periods of time while engaging in acceptance and defusion. For example, when making behavioral commitments or engaging in values-based exercises, the child might be encouraged to experience “discomfort” openly and to notice his thoughts and feelings as just that—thoughts and feelings.
Conclusion
In summary, there are many empirically supported approaches clinicians can use when working with children who struggle with externalizing problems. The present chapter has highlighted how traditional behavior therapies based on functional assessments can be augmented by integrating ACT-based conceptualizations and strategies with chil- dren, their caregivers, or both. In particular, ACT seems to target some of the mecha- nisms that research suggests contribute to the maintenance of externalizing problems. Moreover, the methods that derive from an ACT conceptualization seem to go beyond contingency management or cognitive behavioral procedures. In general, ACT involves learning to accept the presence of private events, seeing them for what they are, and making commitments to engage in behaviors that are linked to larger valued behaviors. Whether this approach is empirically useful with preventing or treating externalizing disorders will require well-crafted research. The purpose of our chapter was to orient cli- nicians and researchers to some ways these approaches might be developed and tested.
References
Barnes-Holmes, Y., Barnes-Holmes, D., & Smeets, P. M. (2004). Establishing relational responding in accordance with opposite as generalized operant behavior in young children. International Journal of Psychology and Psychological Therapy, 4, 559–586. Barnes-Holmes, Y., Barnes-Holmes, D., Smeets, P. M., Strand, P., & Friman, P. (2004).
Establishing relational responding in accordance with more-than and less-than as generalized operant behavior in young children. International Journal of Psychology and Psychological Therapy, 4, 531–558.
Berens, N. M., & Hayes, S. C. (2007). Arbitrarily applicable comparative relations: Experimental evidence for a relational operant. Journal of Applied Behavior Analysis, 40, 45–71.
Berlin, K. S., Sato, A. F., Jastrowski, K. E., Woods, D. W., & Davies, W. H. (2006, November). Effects of experiential avoidance on parenting practices and adolescent out- comes. In K. S. Berlin & A. R. Murrell (Chairs), Extending acceptance and mindfulness research to parents, families, and adolescents: Process, empirical findings, clinical implica- tions, and future directions. Symposium presented to the Association for Behavioral and Cognitive Therapies, Chicago, IL.
Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment therapy in the support of parents of children diagnosed with autism. Child and Family Behavior Therapy, 28, 1–18.
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem- focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156–163.
Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments for conduct- disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180–189.
Burke, J., Loeber, R., & Birmaher, B. (2002). Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1275–1293.
Cohen, D., & Strayer, J. (1996). Empathy in conduct disordered and comparison youth. Developmental Psychology, 32, 988–998.
Cole, P. M., Zahn-Waxler, C., Fox, N. A., Usher, B. A., & Welsh, J. D. (1996). Individual differences in emotion regulation and behavior problems in preschool children. Journal of Abnormal Psychology, 105, 518–529.
Coyne, L. W., & Wilson, K. G. (2004). The role of cognitive fusion in impaired parent- ing: An RFT analysis. International Journal of Psychology and Psychological Therapy, 4, 469–486.
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information- processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101.
Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785–802. de Castro, B. O., Veerman, J. W., Koops, W., Bosch, J. D., & Monshouwer, H. J.
(2002). Hostile attribution of intent and aggressive behavior: A meta-analysis. Child Development, 73, 916–934.
Dishion, T. J., & Andrews, D. W. (1995). Preventing escalation in problem behaviors with high-risk young adolescents: Immediate and 1-year outcomes. Journal of Consulting and Clinical Psychology, 63, 538–548.
183
Acceptance and Commitment Therapy for Childhood Externalizing Disorders
Dougher, M. J., Hamilton, D., Fink, B., & Harrington, J. (2007). Transformation of the discriminative and eliciting functions of generalized relational stimuli. Journal of the Experimental Analysis of Behavior, 88, 179-197.
Eyberg, S. M., & Boggs, S. R. (1998). Parent-child interaction therapy for oppositional preschoolers. In C. E. Schaefer & J. M. Briesmeister (Eds.), Handbook of parent train- ing: Parents as co-therapists for children’s behavior problems (2nd ed., pp. 61–97). New York: Wiley.
Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Bradsma, L. L., & Lowe, M. R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372-2386. Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.,
Rasmussen-Hall, M. L., et al. (2004). Acceptance theory–based treatment for smoking cessation: An initial trial of acceptance and commitment therapy. Behavior Therapy, 35, 689–705.
Greco, L. A., & Eifert, G. H. (2004). Treating parent-adolescent conflict: Is acceptance the missing link for an integrative family therapy? Cognitive and Behavioral Practice, 11, 305–314.
Greco, L. A., Heffner, M., Poe, S., Ritchie, S., Polak, M., & Lynch, S. K. (2005).Maternal adjustment following preterm birth: Contributions of experiential avoidance. Behavior Therapy, 36, 177–184.
Greco, L. A., Lambert, W., & Baer, R. A. (in press). Psychological inflexibility in child- hood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychological Assessment.
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A random- ized controlled trial. Journal of Consulting and Clinical Psychology, 75, 336–343. Happe, F., & Frith, U. (1996). Theory of mind and social impairment in children with
conduct disorder. British Journal of Developmental Psychology, 14, 385–398.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavior therapy. Behavior Therapy, 35, 639–665.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. New York: Plenum.
Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and com- mitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1–25.
Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35–54.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Emotional avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.
Heagle, A., & Rehfeldt, R. A. (2006). Teaching perspective-taking skills to typically developing children through derived relational responding. The Journal of Intensive Early Behavioral Intervention, 3, 8–34.
Huey, W. C., & Rank, R. C. (1984). Effects of counselor and peer-led group assertive training on black adolescent aggression. Journal of Counseling Psychology, 31, 95–98. Hughes, C., Dunn, J., & White, A. (1998). Trick or treat?: Uneven understanding of
mind and emotion and executive dysfunction in “hard-to-manage” preschoolers. Journal of Child Psychology and Psychiatry and Allied Disciplines, 39, 981–994.
Kazdin, A. E., Esveldt-Dawson, K., French, N. H., & Unis, A. S. (1987). Problem-solving skills training and relationship therapy in the treatment of antisocial child behavior. Journal of Consulting and Clinical Psychology, 55, 76–85.
Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of accep- tance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747–766.
Lochman, J. E., Burch, P. R., Curry, J. F., & Lampron, L. B. (1984). Treatment and gen- eralization effects of cognitive-behavioral and goal-setting interventions with aggres- sive boys. Journal of Consulting and Clinical Psychology, 52, 915–916.
Lochman, J. E., & Dodge, K. A. (1994) Social cognitive processes of severely violent, moderately aggressive, and nonaggressive boys. Journal of Consulting and Clinical Psychology, 62, 366–374.
Lonigan, C. J., Elbert, J. C., & Johnson, S. B. (1998). Empirically supported psychoso- cial interventions for children: An overview. Journal of Clinical Child Psychology, 27, 138–145.
Luciano, C., Becerra, I. G., & Valverde, M. R. (2007). The role of multiple-exemplar training and naming in establishing derived equivalence in an infant. Journal of the Experimental Analysis of Behavior, 87, 349–365.
Luoma, J. B., Hayes, S. C., Twohig, M. P., Roget, N., Fisher, G., Padilla, M., Bissett, R., et al. (2007). Augmenting continuing education with psychologically focused group consultation: Effects on adoption of group drug counseling. Psychotherapy Theory, Research, Practice, Training, 44, 463-469.
185
Acceptance and Commitment Therapy for Childhood Externalizing Disorders
McCart, M. R., Priester, P. E., Davies, W. H., & Azen, R. (2006). Differential effec- tiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: A meta-analysis. Journal of Abnormal Child Psychology, 34, 527–543.
McHugh, L., Barnes-Holmes Y., & Barnes-Holmes, D. (2004). Perspective taking as rela- tional responding: A developmental profile. Psychological Record, 54, 115–144.
Miller, G. E., & Prinz, R. J. (1990). Enhancement of social learning family interventions for childhood conduct disorder. Psychological Bulletin, 108, 291–307.
Murrell, A. R., Coyne, L. W., & Wilson, K. G. (2004). ACT with children, adolescents, and their parents. In S. C. Hayes and K. D. Strosahl (Eds.), A practical guide to accep- tance and commitment therapy (pp. 249–274). New York: Springer.
Patterson, G. R., Reid, J. B., & Eddy, J. M. (2002). A brief history of the Oregon Model. In J. B. Reid, G. R. Patterson, & J. Snyder (Eds.), Antisocial behavior in chil- dren: Developmental theories and models for intervention. Washington, DC: American Psychological Association.
Perry, D. G., Perry, L. C., & Rasmussen, P. (1986). Cognitive social learning mediators of aggression. Child Development, 57, 700–711.
Rehfeldt, R. A., Dillen, J. E., Ziomek, M. M., & Kowalchuk, R. K. (2007). Assessing relational learning deficits in perspective-taking in children with high-functioning autism spectrum disorder. Psychological Record, 57, 23–47.
Reid, J. B., Patterson, G. R., & Snyder, J. (2002). Antisocial behavior in children and adolescents: A developmental analysis and model for intervention. Washington, DC: American Psychological Association.
Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problems: A meta-analytic review. Journal of Child Psychology and Psychiatry, 47, 99–111.
Seidman, L. J., Biederman, J., Faraone, S. V., Weber, W., & Ouellette, C. (1997). Toward defining a neuropsychology of attention deficit–hyperactivity disorder: Performance of children and adolescents from a large clinically referred sample. Journal of Consulting and Clinical Psychology, 65, 150–160.
Stormshak, E. A., Bierman, K. L., McMahon, R. J., & Lengua, L. J. (2000). Parenting practices and child disruptive behavior problems in early elementary school. Journal of Clinical Child Psychology, 29, 17–29.
Twohig, M. P., Hayes, S. C., & Berens, N. M. (in press). A contemporary behavioral analysis of childhood behavior problems. In D. W. Woods & J. Kantor (Eds.), A modern behavioral analysis of clinical problems. Reno, NV: Context Press.
Varra, A. A. (2006). The effect of acceptance and commitment training on clinician willingness to use empirically-supported pharmacotherapy for drug and alcohol abuse. Unpublished doctoral dissertation, University of Nevada, Reno.
Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93–109.
Weil, T. M. (2007). The impact of training deictic frames on perspective taking with young children: A relational frame approach to theory of mind. Unpublished doctoral dissertation, University of Nevada, Reno.
Werba, B. E., Eyberg, S. M., Boggs, S. R., & Algina, J. (2006). Predicting outcome in parent-child interaction therapy: Success and attrition. Behavior Modification, 30, 618–646.
Whelan, R., & Barnes-Holmes, D. (2004). The transformation of consequential func- tions in accordance with the relational frames of same and opposite. Journal of the Experimental Analysis of Behavior, 82, 177–195.
Wilson, K. G., & Hayes, S. C. (1996). Resurgence of derived stimulus relations. Journal of the Experimental Analysis of Behavior, 66, 267–281.