ArticlePDF Available

Values and values work in cognitive behavioral therapy

Authors:

Abstract

Background Values influence our thought patterns, emotions, wishes, and needs. Although individuals may be fully aware of their value systems, these often lie more or less outside the area of full consciousness. At least occasional awareness of one's priorities and set of values may be an effective means of self-regulation. Method Literature review and description of cases. Results Cognitive behavioral therapy is aimed at dealing with practical problems and goals in life through changes in cognitive processes, behavior, and emotional reactions. Changes to some values naturally accompany changes to these processes. Life values also underlie motivation to achieve therapeutic changes. For this reason, clarification of patients’ life values is important to therapists as focusing on values aids in connecting therapeutic goals with important areas of life. In addition to a better understanding of patients’ life stories and difficulties that have brought them to a psychotherapist, the identified value system may become a part of everyday CBT strategies such as time management, cognitive restructuring or accommodation of conditional assumptions. Conclusion Identification and assessment of life values and their use in the course of therapy is a process that increases patients’ motivation to face unpleasant emotions and make careful steps in CBT in order to achieve therapeutic goals. Knowing the patient's life values may help the therapist set therapeutic goals that are associated with significant areas of the patient's life. Together with other CBT techniques, this value-oriented approach increases the effectiveness of therapy and durability of its outcomes after its completion.
Act Nerv Super Rediviva 2015; 57(1–2): 40
48
REVIEW ARTICLE
Activitas Nervosa Superior Rediviva Volume 57 No. 1–2 2015
This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles
and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
Values and values work in cognitive behavioral therapy
Jana V 1, Jan P 2, Marie O2,3, Zuzana S3, Petr M 4
1 Faculty of Humanities, Charles University in Prague, Czech Republic; 2 Department of Psychiatry, Faculty
of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Czech Republic;
3 Department of Psychology, Faculty of Arts, Palacký University Olomouc, Czech Republic; 4 Mental Hospital
Kroměříž, Czech Republic.
Correspondence to: Jana Vyskocilova , Faculty of Humanities, Charles University in Prague, Czech Republic.
e-mail: vyskocilovajana@seznam.cz
Submitted: 2015-02-08 Accepted: 2015-03-18 Published online: 2015-04-01
Key words:
values; cognitive behavioral therapy; ethics
Act Nerv Super Rediviva 2015; 57(1–2): 40–48 ANSR571215A08 © 2015 Act Nerv Super Rediviva
Abstract
Values influence our thought patterns, emotions, wishes, and needs. Although individuals
may be fully aware of their value systems, these often lie more or less outside the area
of full consciousness. At least occasional awareness of ones priorities and set of values
may be an effective means of self-regulation. Cognitive behavioral therapy is aimed at
dealing with practical problems and goals in life through changes in cognitive processes,
behavior, and emotional reactions. Changes to some values naturally accompany changes
to these processes. Life values also underlie motivation to achieve therapeutic changes.
For this reason, clarification of patients’ life values is important to therapists as focusing
on values aids in connecting therapeutic goals with important areas of life. In addition to
a better understanding of patients’ life stories and difficulties that have brought them to a
psychotherapist, the identified value system may become a part of everyday CBT strate-
gies such as time management, cognitive restructuring or accommodation of conditional
assumptions.
I
Traditionally, values have been a well-established
topic in some psychotherapeutic schools of thought.
For existential psychotherapy, values and the meaning
of life are an essential element. A significant support
stressed by these therapies is to realize that individuals
need not passively endure suffering but even if they
are unable to change their difficult situation, they
always have freedom to choose an adaptive attitude
to their suffering. This may be achieved by realizing
values that transcend them. Thus, sufferings are rela-
tivized, life becomes meaningful, and one’s example
of how to cope with suffering may give strength to
others (Längle 2002). Values that are the source of
the meaning of life canalize motive and behavior and
affect emotions when essential needs are satisfied or
frustrated (Křivohlavý 2006). They serve as a cogni-
tive framework through which peoples lives become
meaningful and purposeful (Halama 2007). To a
certain extent, however, ones hierarchy of values is
always undergoing changes with respect to that per-
sons particular periods of life (Längle 2002). Despite
the non-negligible interindividual variability of values
espoused there are values shared by many people.
These are values that enable people to live together in
relative peace and enjoy life (Snyder 2000). Given their
significance and broad sphere of influence, values, for
this reason, cannot be limited to a single psychothera-
peutic school of thought. Being concerned with peo-
ple’s stories and suffering and accompanying clients in
being able to cope with their stories, understand the
sources of their suffering and make future adaptive
changes to their experiencing and behavior, psycho-
41
Act Nerv Super Rediviva Vol. 57 No. 1–2 2015
Values and values work in cognitive behavioral therapy
therapy can hardly avoid the issue of values. Cognitive
behavioral therapy (CBT) is primarily focused on solv-
ing practical problems and goals in life through changes
in cognitive processes, behavior, and emotional reac-
tions. These changes are frequently related to changes
in some values. Life values also underlie motivation to
achieve therapeutic changes. The paper aims to discuss
the importance of values for psychotherapy, point to the
potential use of values in CBT and try to outline their
application in the already established psychotherapeu-
tic strategies.
V
Values may be described as fundamental attitudes
guiding our mental processes and behavior. Halama
(2007, p. 64) defines them as “a particular psycho-
logical phenomenon (framework, pattern) comprising
particular convictions about relations and connections
between various parts of an individual’s outer and
inner worlds and representations of desired states and
goals the person is motivated to accomplish based on
these convictions. Values produce the belief that life is
meaningful and serve as a measure of how meaningful
ones actions are, that is, consistent with that persons
value system. However, values also influence emotions
and their physiological correlates. Feelings emerge as
feedback on ones actions and experienced events. They
facilitate orientation in the world and ones activities
there. Feelings, rather than thoughts, underlie values
(Längle 2002). Awareness of a vague dissatisfaction
with life often points to values that are weak or unable
to satisfy the feeling of lifes meaningfulness. Similarly,
a sense of joy seemingly unrelated to anything in par-
ticular often testifies to experienced meaning. However,
fulfillment of values may be related to not only posi-
tive feelings. For instance, an individual respecting the
value of self-sacrifice for others may voluntarily choose
to suffer on behalf of others. An extreme example is
self-immolation of Jan Palach, who wanted to rouse
the resistance of the Czechoslovak people against the
oppressive political regime one year after the 1968
occupation of the country.
A value system may be fully realized but also partly
or wholly unconscious. If it is beyond the reach of con-
sciousness, ones actions may seem unreasonable or ego-
dystonic. An example may be a child who is aware that
his father treats his mother badly but, when adapting
to traumatic situations, he identifies with the aggressor
and, despite his disgust at such behavior, unconsciously
internalizes and repeats his father’s life scenario and
attitudes later. Alternatively, the child may avoid iden-
tification and, as an adult, act according to his realized
inner convictions that are neither an accurate reflection
of his parents convictions nor their mirror opposites.
Awareness of ones value system need not automati-
cally lead to behavior consistent with that. In a certain
situation, an individual may, temporarily or perma-
nently, compromise or change the system, or act under
the influence of a need opposed to significant values.
For example, a woman to whom good manners and
self-control are an important value of her self-concept
gets drunk at a company party and rudely criticizes her
colleagues. The next day, she feels guilty and ponders on
her “failure”; later, she strives for even stricter self-con-
trol. For this reason, not only clarification and refining
ones life values but also identification of all significant
needs may together promote an individual’s adequate
and adaptive self-regulation and personal well-being. It
is also one of the ways to authenticity.
A value system may serve as an integrating element
of the whole personality, but only if the espoused values
are adequately flexible and not contradictory. Conflict-
ing needs and the related values are, for instance, a
desire for close or even symbiotic relationships together
with a deeply-rooted fear of abandonment, resulting in
avoidance behavior of individuals with borderline fea-
tures. Such a combination contributes to frequent inter-
personal conflicts and disharmonious relationships in
these patients.
By contrast, the presence and attainment of values
having the quality of self-transcendence serve as a buffer
against the negative impact of stress, anxiety or depres-
sion (Halama 2007; Frankl 1994). However, not every
value system is adaptive and flexible enough to perform
this protective function. Dysfunctional values are those
based on early maladaptive schemas, as is often the
case with individuals suffering from personality disor-
ders (Young et al 2003). For this reason, when treating
personality disorders, work with schemas is naturally
interconnected with focus on changes in value orienta-
tion. In addition to the quality of self-transcendence, it
is also desirable that the meaning of life be filled with
several elements to avoid falling into despair should one
of them fail (Halama 2007). It is no coincidence that
one of typical features accompanying depression is a
feeling of meaninglessness of life, with the loss of the
meaning preceding depression (e.g. in case of the loss
of a job that one was fully devoted to and took satis-
faction from). A severely traumatic event may lead to
reassessment of the value system or inability to include
experienced events into a meaningful story (we often
hear patient saying that they are “unable to think” and
are so overwhelmed by hurting feelings that it is impos-
sible for them to take a detached point of view). Values
based on self-transcendence were termed as growth
needs by Maslow, as opposed to deficiency needs linked
to unmet needs (Maslow 1968; Křivohlavý 2006). These
become the focus of attention and with increasing time
of frustration, an effort to meet them becomes increas-
ingly important for an individual. For example, during
a theatrical performance, a hungry person pays more
attention to his or her hunger and does not enjoy the
show. Unmet needs also may not be in accordance with
ones conscious value orientation. So, for instance, if an
individual is convinced that the highest value in life is
42
Copyright © 2015 Activitas Nervosa Superior Rediviva ISSN 1337-933X
Jana Vyskocilova, Jan Prasko, Marie Ociskova, Zuzana Sedlackova, Petr Mozny
secure and independent he or she does act in accor-
dance with that but his or her need for intimacy and
belongingness will remain unmet because of realization
of a need represented by that critical value. Long-term
suppression of frustrated needs may result in various
maladaptive attempts at their satisfaction.
N     
In CBT, a therapist focuses on goals based on needs
explicitly formulated by a patient; thus, deeper values
and convictions may be missed. Putting other critical
values at risk in an attempt to achieve the preset goal of
therapy may produce the patient’s resistance, and the
treatment may reach a stalemate. If more attention is
paid to the patients value system, a goal may be set that
is desired by the patient and is not in conflict with his
or her values and needs. Sometimes, this is referred to
as the secondary gain of illness preventing successful
treatment; however, the term often has negative con-
notations to the patient. Others characterize the resis-
tance with the paradox “change me without me having
to change. The therapist should be aware of the fact
that the patients resistance may be related to impor-
tant values he or she holds. For this reason, accusations
against the patient may maintain the stalemate rather
than solve it. If the therapist approaches the resistance
in the therapeutic relationship with an attitude of open
curiosity, the situation may be an opportunity to under-
stand the patient better and to strengthen the thera-
peutic relationship. For patients who behave in such a
manner that they repeatedly provoke adverse reactions
of others, successful management of the resistance may
be a corrective emotional experience.
Thus, resistance to psychotherapy, as manifested, for
instance, by unwillingness to openly talk about inner
experiences or to do agreed-upon homework, may be
related to the patient’s values and motifs that have not
been reflected in its course. These are often related to
subjectively meaningful needs. As such, needs may be
understood as a motivating force that starts up and
maintains certain behaviors. Needs may be classified
as positive, providing motivation for goal achievement
(e.g. a desire), or negative, motivating for avoidance
behavior (e.g. fear, anxiety or resistance). Thus, needs
necessarily influence the course of psychotherapy and
its outcome. Human needs may also be classified as bio-
logically older and younger or material and spiritual.
Younger needs are related to attitudes; these are referred
to as schemas in CBT. Attitudes depend on values, their
personal importance, and cultural adaptation, mainly
to the social group the individual is positively related
to. Alcohol-dependent people find it very difficult to
abstain permanently when they continue to meet their
friends for whom consolidation of the value of their
meetings is associated with alcohol consumption.
According to Erich Fromm (1956), the prime moti-
vating force in human existence is a conflict between
striving for freedom and striving for security. Fromm
(1956) identified the following five existential needs:
(a) a need for relatedness (a need to care for somebody
or something, be responsible for others, share good and
bad with them); (b) a need to be active and creative
when shaping ones own life; an optimal solution is the
act of creation (in production of offspring, ideas, art
or material products); (c) a need for being an integral
part of the world means being rooted in one’s home or
community since childhood; (d) a need for ones iden-
tity separates an individual from others in the sense
of realizing one’s real self; being aware of the bound-
aries between the self and the world is a prerequisite
for a feeling of control over life direction and ones own
active creation; being unaware of one’s individuality
means blind conformity in an effort to act like others
and thus living a non-authentic life; and (e) a need for
order (internally consistent way of interpreting the
world). The frame of interpretation is made of a series
of convictions allowing people to organize and under-
stand the reality. It is often based on self-transcendence.
It may be a religious belief, awareness of the meaning of
life, or both. Without this transcendence, mental health
is fragile.
Fromm understands the alternatives of having and
being as two distinct types of orientation towards one-
self and the world (Fromm 1956). These influence how
an individual perceives one’s own life goals and values
as well as one’s own identity. An individual-oriented
toward having uses an external object and is one-
self only if that person has something. That person is
obsessed with having objects and a desire to have them.
Love, reason and productive activity, on the other hand,
are values that arise and grow only to the extent that
they are practiced. They cannot be bought or owned but
can only be performed. Unlike property, they cannot be
expended but grow and increase when used.
Values were also dealt with by Viktor E. Frankl.
According to this author, a mature individual makes
decisions about oneself and is aware of one’s responsi-
bility for choosing and realizing ones own life journey
(Frankl 1994). The fundamental life force is a desire to
uncover and fulfill the meaning of life considered the
highest value. An individual’s life consists of a series
of self-creating processes, events, and actions aimed
at choosing and realizing one’s meaning of life or life
journey. According to Frank, there are three types of
personal values:
a. Creative values (work, creating new things, etc.) can
only be realized by actions. Their fulfillment depends
on whether a person also holds the place he or she
got from the life, how he or she works, etc.
b. Experiential values (love, cognition, beauty, etc.) are
actualized when the world is taken from an indi-
vidual’s inside and may be realized in experiencing.
These include experiences such as being immersed
in the beauty of a piano concerto, enjoying natural
beauties, etc.
43
Act Nerv Super Rediviva Vol. 57 No. 1–2 2015
Values and values work in cognitive behavioral therapy
c. Attitudinal values (morality, meaning of suffering,
etc.) are related to attitudes to situations that cannot
be changed such as death, illness or loss.
Even though the possibilities to realize creative or
experiential values may be limited due to, for instance,
illness, it is always possible to realize attitudinal values.
Frankl is convinced that humans are responsible for
values; being a human mean being aware and accountable.
If people run from the responsibility of choice or
pin their hopes on false values, they lose the meaning
of life. Existential frustration develops, leading to dis-
turbed functioning or personality. The task of psycho-
therapy, referred to as existential analysis by Frankl, is
to help patients in creating their own world view. The
goals are both to cope with the reality (accepting losses
and limits, bringing about a compromise between the
demands of the unconscious and the requirements of
reality) and to transform the reality when possible and
relevant (Frankl 1963). People should not ask about
the meaning of life but respond to it by taking over the
responsibility for it. As long as creative values are at the
forefront of the life task, there is a coincidence of their
actualization and one’s work. However, this natural rela-
tionship may be distorted if one is so busy earning the
means for living that he or she forgets life itself; then,
for example, the pursuit of wealth becomes an end in
itself and not a means of fulfilling values.
According to other existential therapists such as
Rollo May (1961), the primary source for escaping from
the responsibility of choice is an individual’s effort to
conform to demands of the social environment. That
person denies ones most personal needs, loses contact
with oneself and prevents oneself from both natural
satisfaction of instinctive motives and establishing open
interpersonal relationships. The key source of mental
distortion is alienation towards oneself and the mean-
ing of one’s life. If psychotherapy relieves the patient
from symptoms and “cures” him or her by aiming at
social adaptation only, it is inadequate in the long-term
since the loss of one’s self-awareness and self-realization
are maintained or even deepened.
Carl R. Rogers stated that the core of human nature
is inherently constructive, realistic, purposive and for-
ward moving (Rogers 1951). In his opinion, a human
being is an active, energetic and self-directed force of
energy-oriented towards future goals. Rogers optimisti-
cally assumed an underlying flow of movement towards
constructive fulfillment” of their inherent possibilities
in humans. For Rogers, such fulfillment was a sig-
nificant general value. He was convinced that people
have a natural tendency towards independence, social
responsibility, creativity, and maturity. According to
Rogers (1961), one’s behavior is controlled by interpre-
tation of stimulus situations. Past experiences influence
the meaning of present ones; current behavior always
depends on current perception and understanding and
predictions of the future. Self-concept, the way people
think about themselves, is developed in the process of
interaction with others. It is a combination of diversely
perceived and experienced images of self (parents, part-
ner, employee, athlete, etc.) actualized in various con-
texts and roles. Apart from our perception of what we
think we are like, self-concept also involves our percep-
tion of what we would like to, or could, be like (an ideal
self). The term conscious self-concept (Rogers 1969)
includes: (a) a need to experience oneself in accordance
with this self-concept; (b) a need for positive regard
from others, in particular significant others; (c) a need
for positive self-acceptance. Since self-concept and self-
appraisal result from contacts with people and human
possibilities are limited, an “existential conflict” may
develop between these needs, paralyzing potential self-
actualization (Rogers 1951).
According to Abraham Maslow, the most signifi-
cant possibility of humans is their unique need for
self-realization (Maslow 1968). This is an individual’s
desire to fulfill oneself and converting oneself into what
one potentially is or could be. This need is considered a
growth need” by Maslow; the other classes of needs are
referred to as deficiency. In his theory, the activation of
behavior is determined by one or more unmet needs.
If lower hierarchy needs are unsatisfied, they tend to
predominate while the most advanced needs recede.
For example, while patients suffer from severe symp-
toms of acute anxiety and experiences fear, a need for
security is greater for them than a necessity of accep-
tance or self-realization. Experiences from therapy
evidence this; for example, patients with panic disorder
or depression are not interested in solving relationship
problems as long as they suffer from significant symp-
toms (Praško et al 2007). Only after all deficiency needs
are met, their behavior starts to be determined by the
higher, growth needs for self-actualization. Maslow
believed that people are motivated to seek and realize
personal goals that make their lives meaningful and
rewarding. According to Maslow, needs are inherent
and may be hierarchically classified into the following
five categories:
1. Physiological needs related to the biological survival
of an individual as an organism (e.g. to eat, drink,
breathe, sleep, be warm, dispose of body waste or be
free from pain). If any of them is unmet, it rapidly
starts to predominate while the others lose their
importance and become secondary.
2. Safety and security needs (e.g. search for certainty,
stability and reliability; a necessity of structure,
limits, and order; avoidance of unknown and threat-
ening). Although most apparent in children, they are
manifested throughout the lifespan, being evoked by
confrontation with real danger.
3. Affiliation needs (e.g. for solidarity, affection, and
love, to belong somewhere and to somebody, have
a home, accept and be accepted, and love and be
loved). If these are unmet, an individual experiences
painful loneliness, ostracism, hostility and rejection.
44
Copyright © 2015 Activitas Nervosa Superior Rediviva ISSN 1337-933X
Jana Vyskocilova, Jan Prasko, Marie Ociskova, Zuzana Sedlackova, Petr Mozny
4. Recognition, respect and self-respect needs (e.g. for
achievement, prestige, appreciation from others and
self-esteem).
5. Self-actualizing needs (e.g. for full use of one’s poten-
tial for growth and development). Needs to become
everything an individual is capable of, use one’s tal-
ents, capacities, and potentialities. These needs are
related to the need for knowledge and understand-
ing as well as esthetic needs.
When a lower level need in the hierarchy is satisfied
it loses its motivating force and higher needs emerge,
producing restlessness and discontent and leading to
a change in interests and learning new ways of doing
things until satisfied. Often, however, humans typi-
cally are willing to resist satisfying the lower needs (e.g.
to starve or, in extreme cases, even to die) in order to
satisfy higher needs (e.g. self-esteem, belongingness
or self-actualization) (Maslow 1968). Maslow was
convinced that the achievement of self-actualization
allows, to a great extent, subordination of deficiency
motivation to goals resulting from growth motivation.
C  
 
In any treatment, including CBT, changing unhealthy
ways of thinking (cognition), emotional reactions or
habitual behaviors is not easy if patients are not moti-
vated enough. Similarly, it is demotivating for patients
if the goals of therapy are so far from the actual reality
that they are unable to imagine how many steps they
would have to do to reach them. In addition, changes
achieved in therapy tend to be transient if they are not
consistent with the patients’ life values.
Moreover, it is the assessment of patients’ life values
and connecting the therapy goals with their satisfac-
tion that is one of important sources of motivation for
patients to undergo demanding and often emotionally
unpleasant experiences necessarily associated with psy-
chotherapy, with CBT being no exception.
The original therapy, as described by, for example,
Wolpe (1969) and Marks (1988), was not at all con-
cerned with patients’ values; it only focused on overt
behavior and the methods to influence it.
Classical cognitive therapy, as defined by Ellis (1962)
and Beck (1976), dealt with patients’ values rather
implicitly, in the form of the so-called cognitive sche-
mata, core beliefs, conditional rules, irrational ways of
thinking, musturbation, etc. Even though these authors
focused on investigating and changing the forms of
cognitive processed assumed to maintain mental disor-
ders and increase patients’ suffering, the term “values”
was only exceptionally used in their works.
The topic of life values, in connection with search-
ing for ways of motivating patients’ motivation and
improving the effectiveness of CBT in patients who
fail to respond to standard CBT methods, was studied
in detailed by authors representing the so-called third
wave of CBT such as S. C. Hayes (acceptance and com-
mitment therapy), M. M. Linehan (dialectical behavior
therapy) or J. Young (schema therapy).
According to the CBT theory, every individual lives
his or her own life as a unique human being. Their core
beliefs or schemata, usually created during early child-
hood, format the fundamental pattern for appraisal
of oneself, other people and the world around, as well
as expectations for the future (Beck 1976). Under the
influence of further life experiences, these schemata
may be changed or strengthened and in particular situ-
ations, they are either active or dormant. In the same
person, schemata may be activated in various situations
that may be contradictory; for example, at work they
think and act according to the scheme “people cannot
be trusted”, while among the loved ones, the scheme
“people are trustworthy” is active. During CBT, these
schemata are gradually uncovered and usually are
found to be closely related to the value system. To a
great extent, values and schemata are taken from the
surroundings, being relatively stable, critically undis-
puted and only partly realized by the person. However,
they are open to awareness, the limits of their validity
and usefulness may be examined, and may be changed
by therapy.
Clarification of life values may be crucial in CBT,
particularly in patients confused by their thoughts and
feelings that tend to suppress or avoid painful emo-
tions and thus lose the opportunity to choose mean-
ingful and value-based actions. Only if they can fully
realize their struggles and long-term values, they can
find more energy inside themselves, allowing them to
face unpleasant situations, increase their psychological
flexibility and find meaning in their lives. Therapists
should help these people clarify their personal values
and reconcile them with behavior and life goal choices.
The essential questions may be “What gives your life
meaning and what are your important values?” It is also
important that patients learn to distinguish values from
goals and systematically train behavior that leads to the
set objectives and fulfills their values at the same time.
Some patients, in particular those suffering from
mental problems for a long time, refuse to believe that
they could do something valuable in their lives unless
their symptoms recede. If therapists are successful in
clarifying their client’s critical values and adjust the
therapy goals to them, patients are motivated to strive
to achieve the goals despite persisting symptoms and
their activity may lead to relief of the symptoms. For
example, a depressed woman finds it difficult to make
herself get up and start doing something in the morn-
ing. However, if her significant value is being a good
mother, it is easier for her to overcome her reluctance
as her task would be to make her children’s breakfast
and get them ready for school. This activity in turn
improves her self-appraisal and reduces her “I am use-
less” depressogenic belief. This mechanism of increas-
45
Act Nerv Super Rediviva Vol. 57 No. 1–2 2015
Values and values work in cognitive behavioral therapy
ing motivation to important life values is the basis of a
therapeutic approach called behavioral activation (Mar-
tell et al., 2001) that has proved successful in treating
chronic depression. Together with their patients, thera-
pists carefully plan their daily activities and make sure
that the patients gradually increase their activity and
that for the patients the activities are either pleasant or
unpleasant (unavoidable obligation) but consistent with
their life values. So, at the end of the day, the depressed
patient comes to the conclusion that she was down-
hearted throughout the morning and nothing brought
her pleasure but, in accordance with her value of being
a good mother, she get her children ready for school
and praised herself for that; together with other activi-
ties, this process decreases the level of her depression in
the long term.
Working with values is also an integral part of the
so-called acceptance and commitment therapy (ACT;
Hayes et al 1999). Hayes uses a metaphor to describe
the difference between treatment goals and values.
Goals are like particular places in the countryside. A
goal may be, for instance, climbing a specific hill. A
value is like a compass showing the patient the direc-
tion to go to feel that he or she has a meaningful life. So
a value may be “going south”. If the selected goal – the
hill – is in the south, the patient is more motivated to
expend the effort associated with reaching it than he
would be if the therapist wanted him to train his climb-
ing skills on hill located in the west. The metaphor also
suggests that a goal may be reached at a particular
moment, or we can tell that it has not achieved yet. On
the other hand, a value can never be achieved (there
is no “South, only the south direction); it can only be
more or less fulfilled every day, depending on whether
we are heading more or less south. Naturally, there
may be obstacles in our life that make us change the
direction but if we have the compass or a value, we can
continue in the right direction as soon as the circum-
stances permit. If a patient’s value is, say, “being a good
father to my children,” there is no moment at which
he could say that the goal has definitely been attained.
His task may be to read the children a bedtime story,
and his therapeutic goal may be to do it at least three
times a week for the next six months. A task may be
accomplished, and a goal may be achieved, but a value
is like a horizon that keeps receding as we approach it.
However, it may or may not be fulfilled by our particu-
lar actions every day.
For this reason, to increase and maintain a patients
motivation to undertake therapeutic tasks and to set
and achieve therapeutic goals, it is important for the
CBT therapist to clarify the patient’s particular values.
However, the clarification of life values must be
accompanied by the therapist’s assessment of the client’s
current skills. If, for example, the client’s social skills are
inadequate and he or she does not know how to respond
to criticism or start a conversation, then, despite being
motivated to participate more in society, it is necessary
to pick up the skills first in therapy through assertive-
ness training before using them in real-life situations.
The clarification of critical values helps to enhance
the desirable change as it interconnects problem-
atic behavior with its valuable result. For example, in
exposure therapy that is most effective in phobias and
obsessive-compulsive disorder, the problem may be a
patient’s avoidance and assurance behaviors to evade
unpleasant experiences such as anxiety or disgust. If the
therapist succeeds in interconnecting a graded expo-
sure plan with the patient’s essential life values, he or
she is more able to cope with these unpleasant emotions
(Wilson & Murrell 2004) and the effectiveness of expo-
sure is higher.
When clarifying life values, however, several prob-
lems may be encountered.
First, patients report values that are responses to the
outer pressure from the environment (family, col-
leagues, peers or therapists) rather than their own
values. For example, a student states that she wants
to finish her college education not because of herself
but to satisfy her parents. Even though to a certain
extent, the choice of values is also determined by
other people’s demands, they should be mostly the
patients’ own choice. For this reason, it is important
that therapists encourage the patients to disclose
their own authentic values openly.
Another problem is that initially, patients themselves
actually do not know which values are important
to them as they are not used to think about them.
This is the case in patients whose current situation
and severity of symptoms is so overwhelming that
they want to “just survive” and thinking about other
values seems strange to them (Miller & Rollnick
2002). In such patients, therapists should focus on
symptom relief and emotional calming and post-
pone the search of goals consistent with life values
to a later time when the primary goals are achieved.
• Sometimes values chosen by the client may be in
conflict with the therapist’s values. These are often
values that are in conflict with the moral prin-
ciples as well. Such values are, for example, a need
for revenge or a need to show others that they are
worse. These values mostly occur in response to real
or alleged injustice. If the client’s goal is to do harm
to others, a way must be found to understand the
deeper primary need and the value hidden under
this motivation.
V 
Values are a guide for decisions as to what is right, good,
meaningful or valid for a particular person. Difficul-
ties with clarification of values may produce stress and
feelings of confusion, anxiety or helplessness. Values
clarification us a strategy that may help patients better
understand their feelings and motifs and, at the same
time, better orient towards future steps. It also allows
46
Copyright © 2015 Activitas Nervosa Superior Rediviva ISSN 1337-933X
Jana Vyskocilova, Jan Prasko, Marie Ociskova, Zuzana Sedlackova, Petr Mozny
them to reflect on moral dilemmas. Values clarification
is not only necessary for improving their conditions
and increasing their well-being, but it may also influ-
ence their contacts with other people and improve their
quality of life. In values clarification, a step-by-step
approach is advisable since the process is a complex
internal reflection that cannot be handled by patients
at once. Twohig and Crosby (2008) recommend the fol-
lowing seven steps:
1. Creating distance from social pressures. A patient’s
behavior may be determined by external rules and
not by his or her free choice. The first step is to help
the patient distinguish between their motivation
and what “should be done”. After clarification of the
social pressure the therapist helps the patient adapt
his or her own attitude, that is, what he or she really
wants.
2. Defining the concept of values with the patient. The
therapist and the patient clarify that values are dif-
ferent from goals but at a particular moment, an
effort can be made to pursue an individual value.
Values cannot be achieved, but they aid in setting
meaningful goals and working towards them in a
valuable way. In therapy, personal values are most
important, not those imposed from outside.
3. Defining personal values. The therapists aim is to
make the client realize what he or she values in vari-
ous areas of life. The client should be offered a table
with the main areas of life values that he or she can
consider (Table 1).
4. Importance (significance) of individual values. Then,
the therapist discusses with the patients how impor-
tant is each of ten areas of values for him or her per-
sonally. The patient’s assessment should “come from
the heart” rather than be a logical consideration of
pros and cons. Each of the areas should be rated on
a scale of 1 to 10, where 1 means not at all impor-
tant, and 10 means most significant. The therapist
encourages the patient to choose freely and not
according to general expectations or to obtain the
therapist’s approval.
5. Determining how the patients current actions are
consistent with the relevant areas of values. For each
of the selected areas of values, the patient rates
how consistent his or her current actions are with
that. Once again, the 1 to 10 scales is used, where 1
means not at all consistent, and 10 means completely
consistent. The aim is to make the patient realize
in which area he or she would like to make some
changes, not think critically about himself or her-
self. If there is considerable inconsistency between
personal importance of a particular area and the
patient’s current behavior, which are may become a
target for further psychotherapeutic interventions.
6. Choosing immediate goals consistent with values.
Similar to other CBT techniques, defining goals
consistent with values should be specific. Consis-
tency between objectives and values is emphasized.
Frequently, a step-by-step approach to the goals is
chosen, especially if behavior consistent with a par-
ticular value is new or difficult.
7. Behaving in accordance with objectives and values.
The patient gradually tries to change his or her
behavior to be able to pursue his or her values better.
The therapist helps him or her using several stan-
dard CBT techniques such as time planning, social
skills training, problem-solving, graded exposure,
systematic homework, etc.
Knowing the patient’s life values may be beneficial in
many basic CBT techniques, for example in:
• Time management. Many clients with mental health
issues have problems prioritizing. They typically
change from one activity to another and live cha-
otic lives. Meaningful planning of activities may be
of considerable help to anxious and depressed cli-
ents and those with borderline personality disorder
(Praško et al 2007). Mechanical hour-by-hour plan is
necessary for clients with severe depression who are
apathetic and lacking energy. The following ques-
tions may be helpful: What could you do today that
is important to you in the long-term perspective?
What value does it serve? What sense does it have
in the long term? What do you expect from your life
in the long term? In what life roles can you fulfill
that? What is important for you in your family, job,
relations? What can you do in the following week
to realize that? Discussion on life priorities may
focus on topics such as personal life roles (mother,
wife, partner, daughter, employee, the human being,
experiencing person, etc.). The therapist must trans-
fer the patients long-term priorities into individual
small steps in the patients daily plan.
• Cognitive restructuring. The method may be used
for the patient’s growth (Sharoff 2002). It is useful
for overcoming blocks in the self-actualization ten-
dency. By testing the validity of one’s own automatic
thoughts and attitudes as though from a distance, the
patient gains more freedom and may better decide
which cognitive processes to accept and which to
try and change in accordance with his or her values.
When working with schemas and derived assump-
tions, the patient may realize that some of his or her
values are based on unrealistic attitudes (e.g. “I must
be perfect”) and he or she only follows the values
to avoid or compensate for his or her core beliefs of
being unloved, useless, etc. “Perfection,” however, is
not that much of a value in their lives.
• Accommodation of conditional assumptions. In the
client’s life, numerous conditional assumptions may
act as value frameworks created in childhood that
are no longer beneficial, for example “Everybody
must like me, “I must not make a mistake” or “I
always have everything under control. Learned in
childhood and adolescence, these assumptions sig-
nificantly influence the patient’s life and usually are
47
Act Nerv Super Rediviva Vol. 57 No. 1–2 2015
Values and values work in cognitive behavioral therapy
Tab. 1. Life values clarification.
Area Value Processing
Importance 1–10
Consistence 1–10
Life deviation
Marriage / couples /
intimate relations
What kind of person would you like to be in your intimate relationship?
It may be helpful if you think about how you would like to behave in
such a relationship and then derive the values that motivate you to
such behavior. What are the motives? How do they reflect what you
appreciate in the relationship? Do not state particular goals (e.g. “I
would like to get married”) as there will be an opportunity to do that
later.
Sensitive to the other person, tolerant, non-suspicious. Values – leave
others free, help others. In a relationship, I appreciate freedom and
reciprocity.
10 5 5 – Now, after the split, I have no
partner, but when we lived together, I
guess I tried to fulfill that a lot, I just was
jealous and suspicious of her.
Parenting Think about what being a father/mother means to you. What would
you be like in that role? You may answer the question even if you do not
have children. What would you be like in the role of someone who is a
support to others?
A loving father, providing support and freedom.
To be interested in the children and their problems, call them and
write to them, support their studies, but let them choose freely how
and what they want to study, what partners they would like to have or
what they will do.
10 7 3 – I do not keep in regular touch with
them as I work too much.
Other family relations This area is concerned with the extended family, that is, not only the
husband/wife and children but also other family relations. Think about
what kind of a son/daughter, uncle/aunt, grandfather/grandmother,
father-in-law/mother-in-law, etc. you would like to be. What would
you like to be like in your family relations? You can consider either the
extended or the immediate family. What values should be manifested in
this area of your life?
Decent and helpful, not interfering in other people’s lives but
interested in the relatives.
A value again: let others exercise their right to determination and help
them if I can and if they ask for it.
6 5 1 – I neglect them, I help when they
need it but I do not actively maintain
contact with them.
Friendships / social
relations
Friendship is another area of personal relations that most people
appreciate. What kind of friend would you like to be? Think about your
best friends and see of you are able to use the relations to derive values
important to you in that area.
A true friend giving open feedback and supporting friends,
independent of others, self-reliant, not needing their help much,
rather exchanging opinions with them and supporting each other
emotionally.
8 5 3 – Recently, I have neglected my
friends, I feel ashamed of the split, I work
all the time, I stopped seeing some of
them after the split.
Career / employment To most people, work and career are important as they spend a great
deal of time in this area. No matter whether your work is easy or highly
specialized, the values in this area are a relevant issue. What kind of
employee would you like to be? What do you care most about in your
work? What would you like to achieve in your career?
I would like to be a good boss that others can talk to, able to solve
problems in the workplace and of the subordinates, and able to define
needs of the whole. I want to be a loyal and faithful employee as long
as I can trust my bosses. Most of all, I care about having good job and
harmonious workplace relations. I would appreciate if some things that
I or we know were transferred to other settings.
10 8 2 – I work a lot but pay less attention
to workplace relations – I prefer
performance to humanity and I would
like to do something about it.
Education / training /
personal growth
This area includes all types of education and personal development.
School education is just one example. The area involves everything you
learn in your life. This includes the effort required when reading a book.
What kind of student would you like to be? How would you like to be
engaged in this area of your life?
I would like to continue with my training to keep in touch with the
latest developments in the field. There is no “must” in that, I learn
with joy and freely what I am really interested in and I would like to
continue with that. I am not considering formal education but I cannot
rule out that in the future I might try and get a degree. I would like to
learn a bit more about psychology and to join a psychotherapy group –
to get to know myself as well as others not to harm them.
6 5 1 – I could put more stress on
education but I do not feel that need
at the moment. I feel the need to
better understand human psychology,
therefore, I will start with therapy,
preferably group therapy.
Leisure / recreation /
hobbies
Leisure time, recreation and hobbies are important for most of us. In
this area of our lives we recharge our batteries; during these activities,
we often meet friends or relatives. Think about what meaning your
hobbies, sports activities, games, trips and other recreational activities
have to you? What values should be manifested during these activities
in your life?
I like books, sports, movies, theatre and sightseeing. I do that for
myself as I am interested in all these things, for the feelings of
enrichment and beauty, but I also do it together with my children and
I love to see that they enjoy it, I feel as if I impart something of that to
them – this gives me one of the most meaningful feelings.
7 3 4 – I will spend less time doing sports
and travelling with my children now that
Jolana has left me but we try to find a
reasonable compromise.
Spirituality Spirituality not necessarily means organized religion although it
definitely is included in this area. Spirituality is everything that helps us
feel connected with something that transcends you, evokes feelings of
miraculousness or transcendence. This includes what you believe in, your
spiritual and religious practices and your relations with others in this
area. What would you like to be like in this area of your life?
I am not a believer and I even do not properly know what
transcendence is, I get feelings from miraculousness from love to
my wife (unfortunately she has just passed away) and love to my
children, I also get feelings of miraculousness from nature, animals
and people as well because everybody is interesting. I can share that
with my children and friends but I probably do not want anything else
in this area.
4 2 2 – I do not feel and perceive that sense
as important for me unless it means
enjoying life on the earth as that is
what I do.
Citizenship How would you like to be of help to society? What kind of member of a
community would you like to be? What would you like to be like in the
social/political/charity/social areas?
I would like to be of help to society but I do not know how. I try to
help people around me and give some money to poor people begging,
sometimes I donate money to charity. I could do more as helping
others is my value.
7 2 5 - Now I have more opportunities to
think of the unfortunate people who are
disabled and to do something for them.
Health / physical well-
being
We are all physical beings and another important area of our lives is
caring for our bodies through exercise, healthy diet and reasonable
physical habits. What values do you follow in this area or your life?
I want to be healthy, this is an important value for me, therefore I try
to exercise and eat regularly although I am not always successful. The
main value in this area is that I want to keep good health for myself
and also to be able to help my family so that they do not have to take
care of me if I am ill.
6 4 4 – There is plenty to improve on even
though this is not that important to
me. I could exercise regularly, not just
occasionally, and buy more fruit and
vegetables.
48
Copyright © 2015 Activitas Nervosa Superior Rediviva ISSN 1337-933X
Jana Vyskocilova, Jan Prasko, Marie Ociskova, Zuzana Sedlackova, Petr Mozny
one of the sources of excessive stress and inability to
act in accordance with mature values. Accommoda-
tion is a process in which conditional assumptions
are clarified, their origin and impact on the current
life are determined and the related emotional states
are processed to allow the patient to adopt a new,
more beneficial, attitude. This new position is more
stable if it is consistent with the patient’s values. If,
for example, the original conditional assumption
leading to the patients emotional exhaustion and
depression is described by the statement “I have to
do everything perfectly or I do not gain respect from
others” and the significant value was “perfect work”,
after reconsideration of the original assumption
the new assumption was described as “I want to do
things that are meaningful to me and fulfill me” and
was related to the value “to live a meaningful life”.
C
Identification and assessment of life values and their
use in the course of therapy is a process that increases
patients’ motivation to face unpleasant emotions and
make careful steps in CBT in order to achieve thera-
peutic goals. Knowing the patient’s life values may help
the therapist set therapeutic goals that are associated
with significant areas of the patient’s life. Together with
other CBT techniques, this value-oriented approach
increases the effectiveness of therapy and durability of
its outcomes after its completion.
REFERENCES
1 Beck AT (1976) Cognitive Therapy and the Emotional Disorder.
International Universities Press, New York, ISBN 978-0823609901.
2 Ellis A (1962) Reason and Emotion in Psychotherapy, Lyle Stuart,
New Jersey, ISBN 978-0818401220.
3 Frankl VE (1963) Man’s Search for Meaning. An Introduction to
Logotherapy. New York 1963. (překlad: Vůle ke smyslu. Brno,
Cesta 1994)
4 Fromm E (1956) The Art of Living. Harper and Row.
5 Halama P (2007) Zmysel života zpohľadu psychológie. Bratislava,
Slovak Academic Press, ISBN 978-808095023, 223s.
6 Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and Com-
mitment Therapy: An Experiential Approach to Behavior Change.
New York: Guilford, ISBN 978-1572304819, 304 p.
7 Hayes SC & Smith S (2005) Get Out of Your Mind & Into Your
Life, New Harbinger Publications, Oakland, CA, USA, ISBN 978-
1572244252, 190 p.
8 Křivohlavý J (2006) Psychologie smysluplnosti existence: Otázky
na vrcholu života. Praha, Grada Publishing. ISBN 80-247-1370-5,
204 s.
9 Längle A (2002) Smysluplně žít: Aplikovaná existenciální analýza.
Brno, Cesta, ISBN 80-7295-037-1, 79 s.
10 Linehan MM (2003) Dialectical Behavior Therapy with Suicidal
Adolescents. Guilford Press, New York.
11 Marks I (1988) Care and Cure of Neuroses. Washington: American
Psychological Press.
12 Martell CR, Addis ME, Jacobson NS (2001) Depression in Context:
Strategies for Guided Action. New York, W. W. Norton, ISBN 978-
0393703504, 256 p.
13 Maslow AH (1970) Motivation and Personality. New York, Harper
and Row, 369p.
14 Maslow AH (1968) Toward a Psychology of Being. New York, Van
Nostrand, 240 p.
15 May R (1961) Existential Psychology. New York, Random House,
126 p.
16 Miller WR & Rollnick S (2002) Motivational Interviewing:
Preparing People for Change. New York: Guilford, ISBN 978-
1572305632, 419 p.
17 Praško J, Možný P, Šlepecký M, editors (2007) Kognitivně behav-
iorální terapie psychických poruch. Triton, Praha, 1063 s.
18 Rogers CR (1951) Client-Centered Therapy: Its Current Practice,
Implications, and Theory: Boston, Houghton Mifflin.
19 Rogers CR (1969) Freedom to Learn. Columbus, Merrill.
20 Rogers CR (1961) On Becoming a Person. Boston, Houghton Mif-
flin.
21 Sharoff K (2002) Cognitive Coping Therapy. Brunner-Routledge,
New York, ISBN 1-58391-317-3.
22 Snyder CRR (2000) Handbook of Hope: Theory, Measures, &
Applications. NewYork, Academic Press, ISBN 978-0126540505,
440 p.
23 Twohig MP & Crosby JM (2008) Values Clarification. In: 0’Dono-
hue WT, Fisher JE, editors. Cognitive Behavior Therapy: Applying
Empirically Supported Techniques in Your Practice. Second Ed.
Willey & Sons, p. 583–588.
24 Wilson KG & Murrell AR (2004) Values Work in Acceptance and
Commitment Therapy. In Hayes SC, Follette VM & Linehan MM,
editors. Mindfulness and Acceptance. New York: Guilford, p.
120–151.
25 Wolpe J (1969) The Practice of Behavior Therapy. Pergamon
Press, New York, ISBN 0080065635.
26 Young JE, Klosko JS, Weishaar ME (2003) Schema Therapy. A
Practitioner’s Guide. Guilford, New York, ISBN 978-1593853723,
436 p.
... Considering values and beliefs in the field of positive psychology, past studies stated that the two constructs are tied upon each other (Prinzing, 2019). The former precedes the latter in that beliefs are built on value (Abiogu et al., 2021;Vyskocilova et al., 2015) hence the belief systems are determined by the standard value system sets (Vyskocilova et al., 2015). That is value is a key variable that creates beliefs. ...
... Considering values and beliefs in the field of positive psychology, past studies stated that the two constructs are tied upon each other (Prinzing, 2019). The former precedes the latter in that beliefs are built on value (Abiogu et al., 2021;Vyskocilova et al., 2015) hence the belief systems are determined by the standard value system sets (Vyskocilova et al., 2015). That is value is a key variable that creates beliefs. ...
... In same vein, emotional and behavioral disposition is inextricably significantly related to value system (Schwartz, 1999). Since value system determines people perceptions, attitudes, behavior, and emotion (Vyskocilova et al., 2015;Jensen, 2003), beliefs cannot be separated from value and can be used to measure each other (Abiogu et al., 2021). This demonstrated that if an individual has negative value system, he/she is prone to distorted behavioural responses. ...
Article
Full-text available
School children living with blindness have been reported to struggle with value system and an unrealistic decision-making process. This study examined the efficacy of rational emotive behavior intervention (REBT) in reducing the negative self-belief/personal of upper basic school children living with blindness. A group-randomized trial design was adopted using 56 primary school children who are living with blindness. The participants received a value-based rational emotive behavior program and were assessed at three points using PVS and ABS-2-AV. Analysis utilizing ANCOVA showed that there was no significant difference between the treatment and control groups in initial negative self-belief/maladaptive value using ABS-2-AV and PVS. At post-treatment, the effect of V-REBP was significant in changing negative self-belief/maladaptive value and follow-up assessment respectively, in favor of the treatment group. The result of this study was further supported by previous studies (e.g. Ejekwu in J Emot Dev 1(1):23–35, 2017) which argue that REBT is significantly effective in reducing maladaptive personal value systems, erroneously conceived school goals among the visually impaired population. Given the significant impact of the rational emotive behavior intervention, rational-emotive experts practicing in special schools can use REBT techniques to alter the maladaptive value systems in individuals living with blindness.
... It makes them have negative demystification of self and disregard of other people's values and dignity. Evidence showed that value system is related to how people think, behave and act, therefore, value has multiple dimensions considering the meanings and usages across cultures (Vyskocilova et al. 2015;Jensen 2003). The dimensions include religious value (this has to do with the individual relationship with things that are sacred), behavioral values (this has to do with laws, the does and don'ts of the society), economic value (worth of product and materials), use value (this include positive and functional regards), cultural value (this has to do with societal norms) and perceptional value (which includes individuals thought, reasoning, and belief) (Graeber 2001;Harpe 2005;Abiogu et al. 2020;Jensen 2003). ...
... The dimensions include religious value (this has to do with the individual relationship with things that are sacred), behavioral values (this has to do with laws, the does and don'ts of the society), economic value (worth of product and materials), use value (this include positive and functional regards), cultural value (this has to do with societal norms) and perceptional value (which includes individuals thought, reasoning, and belief) (Graeber 2001;Harpe 2005;Abiogu et al. 2020;Jensen 2003). The above assertion implies that value could be associated with cognition/consciousness, human behavior, beliefs, etc. Probably this might have inform Vyskocilova et al. (2015) when they argued that values could be linked to cognitive and behavioral processes. That is to say, value is associated with pattern of thought, feeling, and desired states (Halama 2007). ...
... That is to say, value is associated with pattern of thought, feeling, and desired states (Halama 2007). Justifying the connectivity between value and belief, previous literature remarked that the latter is dependent on the former (Vyskocilova et al. 2015). If the belief is irrational it is likely to proceed from a negative value system. ...
Article
Full-text available
Studies have shown that unvalued life and moral decadence among Nigerian students have reached an unbearable level (e.g. Adebisi in Adv Soc Sci Res J 5(2):190–199, 2018). Hence, this study was undertaken to find out if and how REBE can impact on negative value system among students. A total of 146 participants allocated randomly to the intervention group and the no-contact control group served as participants in this study. A 12-week REBE-programme that focused on reducing the negative value system was delivered to the intervention group by the therapists. Data analyses were completed using repeated-measures ANOVA. The result showed that REBE-programme strategy is significantly impactful in improving desirable value systems as measured by LVI at the posttest. Similarly, the effect of the treatment was maintained by the participants in treatment group compared to those in the comparison group at follow-up stage. Given the results obtained, we concluded that rational emotive behavioral education has a therapeutic effect in reducing negative value orientation among students exhibiting inappropriate behaviors and maintain greater enhanced improvement overtime. This is also the first study that tested the impact of rational emotive behavioral education on improving a desirable value system. Therefore, we suggest that future studies explore the impact of rational emotive behavioral education on a negative value system among students using similar populations.
... Personal values are fundamental attitudes guiding our mental processes and behaviour, and they produce the belief that life is meaningful (Vyskocilova et al., 2015). They are an important element in Cognitive-Behavioural Therapy (CBT) in mental health services (Selva, 2021). ...
Article
Full-text available
Purpose – The purpose of the paper is to extend the People Value Stream concept further by developing a view of what the world would look like through the eyes of a positive psychology employee-centred lens. We hope to provide a frame for further discussion, research, and practical application in this area. Design/methodology/approach – In this conceptual paper, the authors draw on their collective 120 plus years of experience with Lean and HRM through leading, teaching, researching, and consulting in the area. Findings – The People Value Stream concept is extended here by ideating how the “Voice of the Employee” could be used to enhance our existing knowledge of Lean. Relying on a range of cognitive psychological theories, particularly Self-Determination Theory, we show how it might be possible to develop a highly engaged workforce primarily by unlocking their intrinsic motivation through a “Self-Development & Growth Cycle”. This cycle is the people-improvement version of the seminal Deming process-improvement PDCA cycle. It can be applied within a job crafting “Personal Cockpit”. We also highlight a range of outputs and wider implications that create a pull for team leaders and senior management wishing to move to a real Servant Leader model. It will also help those developing and supporting people-related policies and procedures both within organisations and in trade unions. Originality – This paper turns the existing literature about people within Lean upside down. For the first time in an academic paper, it discusses what would be the implications for the Lean world if we truly started understanding and deploying the explicit “Voice of the Employee” rather than just the established Lean “Voice of the Owner”-led Hoshin Kanri approach. We show how a lack of knowledge in these areas by the Lean community is limiting Lean’s engagement of people and its sustainability.
... 2. Values clarification beyond defining treatment goals seems highly valuable for patients with multimorbidity and high levels of chronicity [38]. As one of the six core processes, values clarification is an essential part of ACT and integration of this process into CBT has also been proposed [39]. 3. Mindfulness (Being Present) as an aware, accepting, and nonjudgmental attitude towards difficult experiences (emotions, thoughts, but also physical complaints) is an integral part of the six ACT core processes [40]. ...
Article
Objective Transdiagnostic approaches are needed to effectively treat patients with a broad range of diagnoses and comorbidities in routine general hospital care. Yet the evidence for the effectiveness of treatments beyond Cognitive Behavioral Therapy (CBT) is largely lacking. We describe the process of implementing an interdisciplinary multi-professional Acceptance and Commitment Therapy (ACT)-based treatment for patients with psychiatric and physical health conditions and present outcomes before and after implementation. Method The present investigation was a naturalistic comparative study comparing ACT-based (n = 126) vs. CBT-based (n = 127) treatments in a psychiatric day hospital in Berlin, Germany. Within- and between-group changes (pre- to post-treatment) in everyday functioning and health-related quality of life (primary outcomes; assessed by the Short Form 36 (SF-36)), as well as anxiety and depressive symptoms (secondary outcomes; assessed by the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory-II (BDI-II)), were analyzed with Generalized Linear Models, and Wilcoxon signed-rank tests and effect size r. Results Data analysis showed statistically significant improvements from pre- to post-treatment (r ranging from 0.27 to 0.61, p < .001) for most SF-36 scales as well as for all HADS and BDI-II scores (r ranging from 0.38 to 0.60, p < .001) for both the ACT and CBT groups. ACT and CBT showed comparable effects in relation to clinical outcomes. Conclusion An interdisciplinary multi-professional ACT-based group treatment is a valuable approach for patients with psychiatric and physical health conditions in real-life hospital settings, with effects equivalent to CBT interventions.
... Some of the needs are related to the attitudes that are discussed as schemas in CBT. Attitudes could be governed by values, their personal prominence, and cultural adaptation, primarily to the social context of the person (Vyskocilova et al. 2015b). ...
Article
Full-text available
Background: Obsessive compulsive disorder (OCD) is a disabling mental disorder with the chronic and difficult course. The disorder is accompanied by numerous limitations in personal and interpersonal functioning. OCD decreases the quality of life and the chance to maintain relationships and professional status. The patients with OCD often experience a severe disabling course of the disorder. Even the individuals, who follow treatment advice, are often still highly symptomatic. In the last decade, the concept of the needs has been assessed as an extent of the traditional outcome evaluation in order to focus on the identification of the specific needs of the patients and their relatives, improve the patients´ overall mental condition and quality of life, and also to increase the treatment effectiveness of the mental disorders. The objective of the article was to review the current literature about unmet needs of the OCD patients and their caregivers. Method: A computerized search of the literature published between January 2000 and June 2016 was conducted in MEDLINE, and additional papers were extracted using keywords "obsessive compulsive disorder","needs", "pharmacotherapy", "CBT", and "family" in various combinations. Primary selection selected the total of 449 articles. According to the established criteria, 168 articles were chosen. After a detailed examination of the full texts, 53 articles remained. Secondary articles from the reference lists of primarily selected papers were read and evaluated for the eligibility and added to the final list of the articles (n = 107). Results: The needs of the OCD patients might differ at various stages and severity of the disorder. Four sets of the needs were identified: the needs connected with the symptoms, the treatment, the quality of life, and the family. The patients suffering from OCD often experience many limitations in the fulfillment of their fundamental human needs such as disturbed patients´ functioning in the common life, family, at work, in the ability to realize their goals, skills, potential, capacity to follow prescribed treatment, take medication, cooperate in addressing the root causes of their problems, reduce obsessive thoughts and compulsive behavior, as well as their willingness to realize exposures with the desire to resolve the situation. Conclusion: Monitoring the patients´ needs may be relevant for the treatment of the individuals suffering from OCD. A bigger focus on the patients´ needs could be beneficial and should be targeted in the treatment.
Book
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
Article
The authors describe dialectical behavior therapy (DBT) as developed by Linehan for the treatment of adults with borderline personality disorder and explain how they have adapted DBT for the treatment of suicidal adolescents. The modifications involved in dialectical behavior therapy for adolescents include shortening the length of treatment from 1 year to 12 weeks, reducing the total number of skills taught, incorporating family members into the treatment, simplifying the language used in handouts and skills training lectures, and adding an optional 12 week follow-up Patient Consultation Group. The implementation of DBT for suicidal adolescents is then illustrated by a case study.
Article
Behavioral activation is a positive approach to treating depression. Working within this framework the therapist helps clients to see depression not as something inside of them but as a natural consequence of the way they cope with the shifting contexts of daily life. There is no search for mental illness, skill deficits, or distortions in thinking. Rather, the therapist coaches the client to engage in activities that will lead to a more rewarding life. This book is arranged in 3 parts. Part I reviews theories of depression and various treatments for depression, particularly pharmacological treatments, cognitive therapy, and behavioral therapy. Part II describes the behavioral activation treatment approach and provides ample case transcript material. Part III looks at problems that can arise in therapy and at future opportunities for the use of behavioral activation. Combining practical, theoretical, and empirical discussions, this book will be of value to a wide range of clinicians, students, and anyone interested in the treatment of depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This book is a continuation of my Motivation and Personality, published in 1954. It was constructed in about the same way, that is, by doing one piece at a time of the larger theoretical structure. It is a predecessor to work yet to be done toward the construction of a comprehensive, systematic and empirically based general psychology and philosophy which includes both the depths and the heights of human nature. The last chapter is to some extent a program for this future work, and serves as a bridge to it. It is a first attempt to integrate the "health-and-growth psychology" with psychopathology and psychoanalytic dynamics, the dynamic with the holistic, Becoming with Being, good with evil, positive with negative. Phrased in another way, it is an effort to build on the general psychoanalytic base and on the scientific-positivistic base of experimental psychology, the Eupsychian, B-psychological and metamotivational superstructure which these two systems lack, going beyond their limits. (PsycINFO Database Record (c) 2012 APA, all rights reserved)