ACT and RFT as Prosocial OBM in an ABA School Based Partial Hospital Program

Dear blog reader, joining us this month on the series is Dr. Stuart Libman (M.D.). Dr Libman has a wonderfully rich and interesting professional history that has drawn on many ‘silos’ within behavior-analysis and psychology more generally to inform his work in psychiatry, psychotherapy, applied behavior analysis, and evolutionary science to name a few. His passion for making a difference at both the individual and group level is exemplified by his ongoing collaborative ‘silo breaking’ work and his efforts to promote prosocial. Stu’s story is another wonderful example of the benefits of consistently seeking to work across all sorts of intellectual boundaries for the good of the work and making a difference with it. So, sit back, relax, and enjoy the read!

Colin and Dermot

About the author: 

Stuart Libman, M.D. is a Board Certified Child, Adolescent and Family Psychiatrist, with further sub-specialization in Sports Psychiatry. After graduating from Ohio University and the School of Medicine at Case Western Reserve University, he completed training in Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry at the University of Pittsburgh. Dr. Libman serves as a Peer Reviewed ACT Trainer for the Association of Contextual Behavioral Science, as a Prosocial Facilitator, and as the Medical Director of the PLEA School Based Partial Hospital Program that provides behavior analytically based education and treatment to a referred population of children and youth with diagnoses on the Autistic Spectrum. He has experience providing executive coaching and organizational consultation in school districts, law firms, hospitals, business corporations, universities and sports teams. In addition, he has presented at such conferences as the Annual Meeting(s) of the American Academy of Child and Adolescent Psychiatry, Applied Behavior Analysis International, the Association for Contextual Behavioral Science, and the International Precision Teaching Conference, on topics ranging from a Developmental Framework for Adult Participation in Youth Sports, to a Psychiatric Perspective on ABA as Precision Teaching and ACT, to ACT and Prosocial Workshops for audiences in these as well as various other professional settings.

Selection by consequences is a causal mode found only in living things, or in machines made by living things. It was first recognized in natural selection, but it also accounts for the shaping and maintenance of the behavior of individuals and the evolution of cultures.

~BF Skinner, Selection by Consequences, Science, Vol 213, 31 July 1981

Introduction:

The essential feature of Evolution Science is the process of variation, selection and retention in specified contexts. Prosocial (www.prosocial.world) seeks to create multilevel evolutionary cooperation and collaboration for individuals and groups of all types and sizes by integrating Acceptance and Commitment Training (ACT) with the Core Design Principles (CDP’s) of Successful Organizations for which Dr. Elinor Ostrom won the 2009 Nobel Prize in Economics. ACT provides behavior analytic skill training towards increasing psychological flexibility, that is, our ability to remain oriented towards pursuing a valued life course even when we are facing adverse contingencies. The CDP’s provide guidance in helping organizations operate with clarity of purpose, fairness, and contextual sensitivity. Both ACT and the CDP’s rely on Relational Frame Theory (RFT), a functional analytic theory of language and cognition prerequisite for the symbolic communication that informs individual behavior and cultural evolution. Moreover, both ACT and the CDP’s serve to increase behavioral options that can be selected by the individual’s values or the organization’s purpose and then retained by the effects of positively reinforcing accomplishments and adaptations.

In this blog entry, we will explore “the shaping and maintenance of the behavior of individuals and the evolution of cultures” through a story about the PLEA (https://plea-agency.org/) School Based Partial Hospital Program (SBPHP) that I serve as Medical Director. Located in Pittsburgh, Pennsylvania, the PLEA SBPHP is grounded in principles of Applied Behavior Analysis (ABA) and treats a population of referred children with diagnoses on the Autistic Spectrum. ACT was initially introduced at PLEA two decades ago and then expanded upon from an initial focus on individuals to the broader perspective afforded when ACT is combined with Ostrom’s CDP’s in a Prosocial approach to Organizational Behavior Management (OBM).

Whew, that’s a lot of acronyms for an introduction, isn’t it?! We’ve had to work long and hard to build connections within and across the silos of Behavior Analysis to come up with this size bowl of alphabet soup! A few years ago, as I was preparing to deliver an invited presentation entitled “Evolving Organizationally: ACT as OBM in a School Based Partial Hospital Program—A Story of Evidence Shaped Practice” at the 2019 ABAI Annual Conference in Chicago, my SBPHP colleagues assisted me in developing an elevator slide—one slide that could be used to briefly describe what we do, or that could be used to introduce a longer presentation. Let’s see if starting here helps with our acronymic array (Figure 1).

Figure 1. “Elevator Slide.” PLEA is grounded in ABA. RFT and ACT serve to promote individual psychological flexibility and organizational performance. When Prosocial is added, the organization is perceived differently in its own right and in the context of its “systemic forest.”

Please take a moment to consider our endeavor. Notice what is attracting your attention and then your thoughts about this slide. Are you responding favorably? Are you curious enough about how a small, non-profit, public-sector agency came to formulate such a slide that you want to learn more? Are you finding yourself becoming critical and ready to move onto more pressing business? If so, don’t you at least want to know why in the world Dr. Colin Harte and Dr. Dermot Barnes-Holmes would have requested this contribution to their blog series on symbolic communication and thought? Might this paragraph itself constitute an example of “ROE-M’ing,” the RFT-based behavioral unit of analysis they and their colleagues have recently proposed, involving a non-linear, dynamic process of Relating, Orienting, and Evoking under the influence of relevant Motivating contingencies? More about “ROE-M’ing” in a few paragraphs. First, given that the “context” of this blog includes not only our current contingencies but also our histories as manifest in the present moment, let’s consider how this slide “evolved” before re-orienting ourselves to contextual “ROE-M’ing” more directly.

When I began working at PLEA in 1985, the program was in transition from a developmental preschool, founded fifteen years earlier by a group of parents seeking to create a means of helping their Autistic children, to a publicly funded SBPHP in need of a Medical Director. At that time, treatment was based in the TEACCH model (https://teacch.com/). Over the course of the next decade, we became increasingly aware of the scientific evidence emerging from the research of Ivar Lovaas and colleagues at UCLA. During this time period, after a local hospital disbanded a “Lovaas clinic” that was failing to generate sufficient revenue, PLEA provided a clinical home for those cast adrift, and then gradually began incorporating Discrete Trial Training into our service delivery. We also collaborated with a local school district to send one of our staff for a year of training at the Princeton Child Development Institute (https://pcdi.org/), and subsequently began incorporating their behavior analytic approach into our classrooms as well. Under the influence of our new Clinical Director, we then began experimenting with adding Precision Teaching (PT), with additional emphasis on Verbal Behavior, into one of our six classrooms, and then throughout the entire SBPHP.

ACT’ing at PLEA:

As our programmatic grounding in Applied Behavior Analysis solidified and the added demands being placed on our staff to engage in PT became increasingly clear, we became more aware of needing to provide them with additional support beyond instructional in-service training. In addition to arranging for our Clinical Director and various staff to receive additional training in PT by traveling to Seattle and participating in the Morningside Teachers Academy, we also began experimenting with a new approach, recently published in book form (1st edition in 1999) (2nd edition in 2011, referenced below) called Acceptance and Commitment Therapy (ACT). After a few years of in-house efforts to train our staff in ACT’s Hexaflex model of Psychological Flexibility, we learned about research Dr. Tony Biglan was conducting in which he provided individually-focused ACT training to staff throughout an entire special needs preschool program. We also learned about organizational research being conducted in England as subsequently encapsulated in the book, Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-being and Performance. Knowledge of this growing research base led us to seek and receive grant support from the Staunton Farm Foundation (SFF) that funded a series of six visits over two years in which Dr. Kelly Wilson provided ACT training to our entire agency. We subsequently requested and received a second SFF grant that funded an 18-month project in which Dr. Lisa Coyne, then in the process of becoming Clinical Director of the newly developed Pediatric OCD Program at Harvard Medical School, and accompanied to Pittsburgh by Dr. Evelyn Gould and Dr. Jonathan Tarbox, trained PLEA personnel in her approach to providing ACT training to parents of youngsters with diagnoses on the Autistic spectrum. A third SFF grant enabled us to establish PLEA’s ACT Institute, with the mission of providing ACT training to other mental health agencies and schools throughout Western Pennsylvania.

As PLEA became more clinically conversant with ACT, we also sought to increase our understanding of Relational Frame Theory for enhancing our application of ACT with our staff and families and our teaching of language to our Autistic students. We initially relied on emerging research and then the publication of Derived Relational Responding Applications for Learners with Autism and Other Developmental Disabilities. More recently, we were able to arrange agency-wide training in the emerging PEAK curriculum (https://www.peak2aba.com/).  RFT also has served us well as we began integrating ACT and then Prosocial into administrative functions at PLEA.

OBM at PLEA: From ACT and RFT to Prosocial

Towards the end of our initial training grant in 2012, Kelly Wilson introduced us to the ACT Matrix, a diagrammatic form of Psychological Flexibility that immediately became useful for us in conceptualizing our own behaviors and in case-formulations with the children we serve (Figure 2). Given our programmatic emphasis on Functional Analysis, we found the Matrix quite helpful in assessing the functions of topographically challenging behaviors. We subsequently began using the Matrix in our work with families after learning during our training with Lisa Coyne that she, too, was using this framework in her 5-session workshop sequence for teaching ACT to parents.

Figure 2. The ACT Matrix. The vertical axis invites us to engage in “noticing” differences between “Outer” Behavior (the outer world of observable behavior) and “Inner” Behavior (our inner experiences). The horizontal axis invites us to engage in “noticing” differences between moving “Towards” engaging in valued actions and seeking to move “Away” from our distress. Each quadrant, summarized in one word, contains one of the four questions. The green vector from lower left to upper right, accompanied by the narrower red vector, reflects the way in which distress often accompanies “moving towards.” Special thanks to Dr. Kevin Polk and colleagues for their original formulation.

Two further developments have significantly shaped our approach to Organizational Behavior Management at PLEA: the creation of Prosocial and the proposal of the HDML/ROE-M update to RFT. These updates to RFT have served to enhance our ability to apply Prosocial both at PLEA and in our consultations with other organizations.

Prosocial emerged from two sequential collaborative endeavors, first that of the evolutionary biologist David Sloan Wilson with Elinor Ostrom, in which they sought to apply her CDP’s to groups of all kinds, and then that of David Sloan Wilson and Steven C. Hayes, in which they and a group of colleagues from the Association for Contextual Behavioral Science began a process of integrating Ostrom’s CDP’s with ACT’s model of Psychological Flexibility. As elaborated in the book they subsequently co-authored with Paul Atkins entitled Prosocial: Using Evolutionary Science to Build Productive, Equitable and Collaborative Groups, a procedure was developed for introducing the ACT Matrix, first by focusing each quadrant of the Matrix on the involved individuals, and then by conducting a second iteration in which each of the questions are posed to the group as a whole. Following these steps, attention then is directed to introducing and exploring each of the eight CDP’s: 1) Strong group identity and understanding of shared purpose; 2) Fair distribution of responsibilities, costs, and benefits; 3) Fair and inclusive decision-making; 4) Monitoring agreed-upon behaviors; 5) Warranted course-corrections (including indicated sanctions); 6) Fair and efficient conflict resolution; 7) Authority to self-govern; and 8) Collaborative relations with other groups.

However, as we began implementing Prosocial in our internal operations and external consultations, both PLEA’s Executive Director and the CEO of a multinational corporation with whom I was consulting expressed concern that it felt as if they were being asked to think in two different ways simultaneously. That is, while both quickly grasped the Matrix and also understood that the CDP’s were principles to apply, not rules to follow, neither could see how the Matrix and the CDP’s quite fit together. Fortunately, the emerging development of updating RFT in the form of the HDML and ROE-M came to our rescue in providing a means of analyzing and resolving this conceptual problem.

As Colin Harte and Dermot Barnes-Holmes noted in their recent ABAI blog (https://science.abainternational.org/2021/03/29/wherever-i-roe-m-there-i-am-an-rft-technical-account-of-the-verbal-self-and-altered-states-of-consciousness/): A growing number of recent experimental and conceptual analyses in RFT have focused on a framework that proposes five key levels of relational development; (i) mutual entailing, (ii) relational framing, (iii) relational networking, (iv) relating relations, and (v) relating relational networks. These five levels of relational activity are seen as intersecting with four dimensions that target key variables that may be manipulated in exploring the dynamic nature of arbitrarily applicable relational responding (AARR; the generic concept used in RFT to define human language and cognition itself). The four dimensions are coherence, complexity, derivation, and flexibility. Coherence refers to the extent to which a pattern of derived relational responding coheres or is consistent with previously established patterns of such responding. Complexity refers to the level of detail or density of a particular pattern of derived relational responding. Derivation refers to the extent to which a particular pattern of derived relational responding has been “practiced” or emitted in the past. Flexibility refers to the extent to which a given instance of derived relational responding may be modified by contextual variables.

At PLEA, two sequential steps enabled us to resolve our “Prosocial dilemma” and proceed with developing plans to improve how each organization was operating. First, although the HDML framework emerged from molecularly focused research, we used a more molar approach to create the “ROE-M’ing Matrix” (Figure 3). Recognizing that the feedback from our Executive Director and the corporate executive could be seen as a request for a more coherent “relating of relational networks” (Level 5 of the HDML Framework), we then derived the “CDP Matrix” (Figure 4), in which we integrated the CDP’s into the Matrix, thus enhancing our ability to relate the CDP’s to an assessment of how organizations are functioning with respect to each of Ostrom’s principles. This greatly facilitated each executive officer then being able to more flexibly entertain how the integrated view of Prosocial we had derived could enable them to consider specific projects for testing potential evolutionary changes within their respective organizations.

Figure 3. “ROE-M’ing Matrix,”with HDML Tables located in each of the two lower quadrants. Under the influence of relevant Motivating contingencies, there is a dynamic interaction amongst Orienting (to inner or outer stimuli), Relating (the appetitive or aversive stories we tell ourselves), and Evoking (behavior/function).

Figure 4. “CDP Matrix,” in which Ostrom’s Core Design Principles have been integrated into the ACT Matrix. When an organization is functioning well, there is a clear understanding of shared purpose as reflected in CDP 1 (Lower Right Quadrant), and attention is being directed effectively towards CDP’s 2, 3, 7, and 8 (Upper Right Quadrant). However, as so often is the case in organizations, when issues of concern arise (Lower Left Quadrant), individuals and groups tend to engage in fight/flight behaviors of the Human Stress Response (Upper Left Quadrant). Thus, it is important for successful organizational functioning to have in place a system of monitoring (CDP 4), as well as means for getting back on track when necessary (CDP 5) and for addressing conflict when it (inevitably) arises (CDP 6).

Over the course of time, Behavioral Systems Analysis has provided PLEA with awareness of such contingencies, macrocontingencies and metacontingencies as those pertaining to Diversity, Equity, and Inclusion, as well as those related to the continuing challenges of maintaining relationships with referral sources and securing adequate funding to support agency operations. Prosocial has added the theoretical and pragmatic coherence of a functional analytic approach, akin to using a “matrix camera with interchangeable lenses” that enables us to “zoom in” on individual students and staff, and then to “pan out” to our families, to our classroom teams, to our administrative team, to our Board of Directors (who also have been trained in Prosocial), to our broader systemic context.

Conclusion: Which Elevator Button to Push?

When Colin Harte and Dermot Barnes-Holmes (with whom I have been consulting for the past several years about clinical implications of developments in RFT research) approached me about writing this entry for the blog series on Symbolic Language and Thought, I quickly oriented to their desire to place emphasis on the theme of collaboration and cooperation. As I have sought to convey, PLEA has very much benefitted from developing relationships across the kinds of silos that Colin and Dermot pointed to within Behavior Analysis and that David Sloan Wilson has identified more broadly within the larger field of Academia. Elinor Ostrom’s eighth CDP of “collaborative relations with other groups” speaks directly to this challenge, and sets the stage for then implementing all eight of the principles at the next highest level of systemic organization, and then the next, and then the next, and then the next after that, from our organizations to our local communities, to our regional associations, to our nations, to our entire planet. Our needs as a species are ever so great for Prosocializing within and across all these levels, aren’t they?!

If this elevator ride has appealed to you in some fashion, then what button might you push as you prepare to disembark? Perhaps by trying on for size the Individual Matrix, or the Group Matrix, or the ROE-M’ing Matrix or the CDP Matrix, say with an issue of personal or professional or organizational concern, and then looking to see what you derive about its usefulness? Or perhaps you might consider reading the book, mentioned above and referenced below, on Prosocial, or perhaps even entertain the idea of pursuing training in Prosocial (see “The Training” button at www.prosocial.world)? Or perhaps you might consider checking out David Sloan Wilson’s first-ever novel (A Prosocial parallel to Walden Two?), Atlas Hugged (https://atlashugged.world/), a fictional accompaniment to his latest scientific publication, This View of Life: Completing the Darwinian Revolution?

I hope this blog proves useful in modelling and fostering collaboration and cooperation amongst scientists of research and/or clinical persuasions. What can be said with certainty is this: both more research and more clinical experimentation with the evolutionary stream of symbolic thought and language as well as with the cultural implications of Prosocial will be necessary for RFT and Prosocial to continue making a longitudinal difference for our species and for our planet.

References

Atkins, W.B.P., Wilson, D.S., & Hayes, S.C. (2019). Prosocial: Using evolutionary science to build productive, equitable, and collaborative groups. Context Press.

Barnes-Holmes, D., Barnes-Holmes, Y., Luciano, C., & McEnteggart, C. (2017). From IRAP and REC model to a multi-dimensional multi-level framework for analysing the dynamics of arbitrarily applicable relational responding. Journal of Contextual Behavioural Science, 6(4), 473-483. https://doi.org/10.1016/j.jcbs.2017.08.001

Biglan, A., Layton, G.L., Jones, L.B., Hankins, M, & Rusby, J.C. (2013). The value of workshops on psychological flexibility for early childhood special education staff. Topics in Early Childhood Special Education, 32(4), 196-210.

Flaxman, P.E., Bond, F.W., & Livheim, F. (2013). Mindful and effective employee: An Acceptance and Commitment Therapy training manual for improving well-being and performance. New Harbinger.

Harte, C. & Barnes-Holmes, D. (In press). A primer on Relational Frame Theory (RFT). In M.P. Twohig, M.E. Levin, & J.M. Peterson (Eds.), The Oxford Handbook of Acceptance and Commitment Therapy. Oxford University Press.

Hayes, S.C., Barnes-Holmes, D., & Roche, B. (Eds) (2001). Relational Frame Theory: A Post-Skinnerian account of human language and cognition. Springer.

Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). Acceptance and Commitment Therapy: The process and practice of mindful change. Guilford Press.

Hayes, S. C., Atkins, P., & Wilson, D. S. (in press). Prosocial: Using an evolutionary approach to modify cooperation in small groups. Chapter to appear in Houmanfar, R., Fryling, M., & Alavosius, M. (Eds). Applied behavior science in organizations: Consilience of historical and emerging trends in organizational behavior management. Taylor & Francis.

Johnson, K., Street, E.M., Kieta, A.R., & Robbins, J. (2021). The Morningside Model of Generative Instruction. Sloan Publishing.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Mallot, M.E. (2003). Paradox of organizational change: Engineering organizations with behavioral systems analysis. Context Press.

Mallot, M.E., & Glenn, S.S. (2006). Targets of intervention in cultural and behavioral change. Behavior and Social Issues, 15, 31-56.

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372.

Polk, K.L. & Schoendorff, B. (2014). The ACT Matrix: A new approach to building psychological flexibility across settings and populations. Context Press.

Rehfeldt, R.A. & Barnes-Holmes, Y. (Eds) (2019). Derived Relational Responding Applications for Learners with Autism and Other Developmental Disabilities. New Harbinger.

Whittingham, K. & Coyne, L. (2019). Acceptance and Commitment Therapy: The clinician’s guide for supporting parents. Academic Press.

Wilson, D.S. (2019). This view of life: Completing the Darwinian Revolution. Pantheon.

Wilson, D.S., Hayes, S.C., Biglan, A., & Embry, D.D. (2014). Evolving the future: Toward a science of intentional change. Behavior and Brain Sciences, 37(5), 395-460. https://doi.org/10.1017/S0140525X13001593

Wilson, D.S., Ostrom, E., & Cox, M.E. (2013). Generalizing the core design principles for the efficacy of groups. Journal of Economic Behavior & Organization, 90S, S21-S32.