by Ruth Anne Rehfeldt, PhD, and William B. Root
Most behavior analysts learn very little in their graduate training about intervening on their clients’ thoughts, feelings, and emotions. In fact, behaviorists have debated for decades whether we should even be concerned with such phenomena. In our work with highly verbal individuals with developmental disorders such as autism spectrum disorder and intellectual disabilities, it has become very apparent to us that as behavior analysts, we shouldn’t only be concerned about our clients’ thoughts, feelings, and emotions—we should focus on such private events as a regular part of our behavioral programming. If we don’t, we are implementing a technology that is limited in scope and will have few long-term benefits for a client beyond the narrow confines of a behavior plan.
Ten to forty percent of all people with developmental disorders living in community settings have a diagnosed mental health condition. Teens with autism spectrum disorder are often frequent victims of bullying, and highly capable adults with the disorder are often unemployed and socially isolated. In our experience, rigidity in thoughts and experiential avoidance are almost a given in these populations. Practitioners who can help their clients loosen their grip on unhelpful, rigid ways of thinking may give their clients long-lasting skills that are transportable from one setting to the next.
We believe that acceptance and commitment training (ACT) should be adopted and routinely used by behavior analysts. With the expertise in observing and defining behavior and evaluating behavior change, behavior analysts are well suited to identify committed actions that will help their clients engage in vital lives with purpose. Behavior programs that focus both on skill acquisition and the reduction in challenging behavior may be more effective if components of acceptance and commitment therapy are included. We found that mindfulness and defusion enhanced the efficacy of behavioral skills training, for example (Brazeau et al., in press).
Not surprisingly, staff working with individuals with developmental disorders may also experience psychological inflexibility, as evidenced by the high frequency of job stress and burnout amongst frontline staff. It seems that when psychological flexibility is targeted in staff, their interactions with clients change for the better. We found that staff actually interacted with clients more frequently following values and committed action workshops (Castro et al., 2016). These are good reasons that not only clients, but parents, staff, and other caregivers could also benefit from the inclusion of acceptance and commitment training as a regular component of parent and staff training.
In our ACT work with adolescents and adults with high-functioning autism spectrum disorder, we teach clients to engage in a meaningful relationship with the “self.” Without a technology for private events, many of the important challenges facing individuals with this disorder could be left unaddressed. B.F. Skinner championed a comprehensive account of all behavior, including behaviors within the skin. The adoption of ACT by behavior analysts is consistent with this goal.
Brazeau, K., Rehfeldt, R. A., Mazo, A., Smalley, S., Krus, S., & Henson, L. (in press). On the Effects of Mindfulness, Defusion, and Behavioral Skills Training on Job. Interviewing Skills in Dually-Diagnosed Adults with Developmental Disorders. Journal of Contextual Behavioral Sciences.
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 Sciences, 5, 201-107.
The Arc of Western Michigan. (n.d.). The take charge helpline. Retrieved May 2, 2017. from http://www.thearcww.org/helpline/topic/mental-illness-and-people-with-developmental-disabilities/.