Acceptance and Commitment Training Within the Scope of Practice of Applied Behavior Analysis

Abstract

Acceptance and commitment therapy (ACT) is a contemporary behavior-analytic approach to intervening on verbal behavior for the purposes of bringing about socially meaningful overt behavior change. Although originally developed as a behavior-analytic approach to psychotherapy, the conceptual functional analyses and procedures that form the core of ACT have been disseminated broadly outside of clinical psychology, including within the field of applied behavior analysis (ABA). This article discusses the use of ACT within mainstream ABA practice and provides preliminary conceptual functional analyses and practical guidelines for incorporating ACT within the scope of practice of applied behavior analysts.

Full text

SPECIAL ISSUE: ACCEPTANCE AND COMMITMENT TRAINING IN BEHAVIOR ANALYSIS
Acceptance and Commitment Training Within the Scope of Practice
of Applied Behavior Analysis
Jonathan Tarbox
1
&Thomas G. Szabo
2
&Megan Aclan
1
#Association for Behavior Analysis International 2020
Abstract
Acceptance and commitment therapy (ACT) is a contemporary behavior-analytic approach to intervening on verbal behavior for
the purposes of bringing about socially meaningful overt behavior change. Although originally developed as a behavior-analytic
approach to psychotherapy, the conceptual functional analyses and procedures that form the core of ACT have been disseminated
broadly outside of clinical psychology, including within the field of applied behavior analysis (ABA). This article discusses the
use of ACT within mainstream ABA practice and provides preliminary conceptual functional analyses and practical guidelines
for incorporating ACT within the scope of practice of applied behavior analysts.
Keywords Acceptance and commitment therapy .Acceptance and commitment training .Scope of practice .Applied behavior
analysis
Acceptance and commitment therapy (ACT) is a behavior-
analytic approach to addressing problematic verbal behavior
involved in behavioral rigidity and insensitivity to socially
significant contingencies. The overall goal of ACT is to in-
crease psychological flexibility, which consists of engaging in
skillful behavior in the presence of aversive experiences in the
service of living a rich and meaningful life. A substantial
empirical literature has established ACT as an empirically
supported treatment. Since 2015, over 15 meta-analyses of
ACT methods have been published (for a list, see Hayes, S.
C. (n.d.). A meta-analysis in 2012 found 66 ACT component
studies (Levin, Hildebrandt, Lillis, & Hayes, 2012), and
dozens more such studies have appeared since. Over 60 me-
diational studies have been published, and most find that
changes in the core processes of ACT are functionally impor-
tant to ACT outcomes https://contextualscience.org/act_
studies_with_mediational_data.
ACT was originally developed and continues to be primar-
ily applied within psychotherapeutic and counseling contexts.
However, over the years, a wide range of professions have
shown interest in applying ACT outside such settings. For
example, nurses and health professionals have successfully
usedACTinhealthcoachingsessionstohelppatientsrecover
from colorectal cancer treatment (Hawkes et al., 2013).
Similar efforts have been made by teachers, physical thera-
pists, sports coaches, occupational therapists, dentists, diabe-
tes educators, and professionals from other disciplines (e.g.,
Kasson & Wilson, 2016; McCracken & Jones, 2012;Pahnke,
Lundgren, Hursti, & Hirvikoski, 2014; Szabo & Dixon,
2016). In recent years, interest in ACT from within the applied
behavior analysis (ABA) community has continued to grow,
and ACT is increasingly integrated into behavior-analytic
practice by Board Certified Behavior Analysts (BCBAs).
The present article contextualizes this trend in the history
and current status of behavior analysis and explores how
ACT fits within the scope of practice of BCBAs.
The Behavior-Analytic Roots of ACT
The course of development of ACT illustrates its deep roots in
behavior analysis from the outset. ACT research began to
emerge in 1981 from Steven Hayes’s lab at the University of
North Carolina, Greensboro, a laboratory jointly led by an
*Jonathan Tarbox
jtarbox@usc.edu
1
Psychology, University of Southern California, Los Angeles, CA,
USA
2
School of Behavior Analysis, Florida Institute of Technology,
Melbourne, FL, USA
Behavior Analysis in Practice
https://doi.org/10.1007/s40617-020-00466-3

established behavior-analytic basic researcher, Aaron
Brownstein (see Zettle, 2005, for a historical account). This
early ACT research sought to address the repertoire-
narrowing effects of verbal rules (e.g., Hayes, Brownstein,
Haas, & Greenway, 1986; Hayes, Brownstein, Zettle,
Rosenfarb & Korn, 1986). A 1982 talk by Steven Hayes at
the annual convention of the Association for Behavior
Analysis International (ABAI) on rule-governed behavior
and psychopathology (Hayes, 1982) led to the first ACT
workshop to be held at a scientific meeting. The ABAI work-
shop, titled “Semantic Therapy, Cognition, Rule-Governed
Behavior, and Psychopathology: A Radical Behavioral
Approach”(Hayes, 1983), was followed a year later by what
is arguably the first article on both ACT and relational frame
theory (RFT) in the journal Behaviorism (Hayes, 1984). The
first extended presentation of RFT quickly followed at ABAI
in 1985 (Hayes & Brownstein, 1985).
Empirical articles on what would later become ACT soon
appeared (e.g., Zettle & Hayes, 1986). However, the initial
focus in the early development of ACT was on empirical
investigations of the rigidity of rule-governed behavior and
the link between derived stimulus relations and language de-
velopment, published in the Journal of the Experimental
Analysis of Behavior (e.g., Devany, Hayes, & Nelson, 1986;
Hayes, Brownstein, Haas, & Greenway, 1986;Hayes,
Brownstein, Zettle, Rosenfarb, & Korn, 1986). As these data
converged on RFT as a basic behavioral account of human
language and cognition, Hayes and colleagues’conceptual
work focused on the refinement of radical behaviorism as a
philosophy of science (Hayes, Hayes, & Reese, 1988)tomore
adequately address the relation between private events and
overt action in a nonmentalistic way (e.g., Hayes &
Brownstein, 1986). Over the next 15 years, theoretical and
philosophical foundations were clarified (e.g., Hayes &
Hayes, 1992), and ACT was refined and manualized (Hayes,
McCurry, Afari, & Wilson, 1991).
In the more than 35-year history of the development of ACT,
the basic and applied data supporting its implementation as a
mainstream psychological intervention have flourished. There
are currently over 300 published randomized controlled trials of
ACT Hayes, S.C. (2020). As such, ACT has been listed as an
empirically supported treatment approach by Division 12 of the
American Psychological Association (2016)andbythe
Department of Veterans Affairs (2016), among other organiza-
tions. Data have also been published that are more consistent
with behavior-analytic research methods and intervention fo-
cuses. Single-case and time-series analyses demonstrating the
effectiveness of ACT have been published, in addition to sev-
eral dozen studies utilizing overt behavioral or physiological
measures (e.g., Castro, Rehfeldt, & Root, 2016;Gould,
Tarbox, & Coyne, 2018; Szabo, 2019; Szabo, Willis, &
Palinski, 2019). This empirical work is increasingly central to
topics of concern to most BCBAs. For example, a search of the
Web of Science reveals that ACT has been referred to in 32
articles on developmental disabilities or parent training. Indeed,
articles in journals published by ABAI over the past 35 years
include 98 references to ACT and 650 references to RFT.
There are indications that this body of work is increasingly
penetrating the BCBA practice community. A growing number
of ACT and RFT presentations are evident at ABA conferences,
and in 2018, ABAI hosted a 1-day, single-track special event on
ACT immediately postconference. Commercial ACT training
workshops aimed at ABA practitioners, as well as a small num-
ber of books on applications of ACT to learners with ASD (the
most common population served by ABA practitioners), have
also emerged (Dixon, 2014; Dixon & Paliliunas, 2017). Recent
revisions of BCBA competency standards increasingly point to
the theoretical underpinnings and technologies central to ACT,
as will be discussed later in the article. Finally, a chapter on RFT
and ACT (Critchfield & Rehfeldt, 2020) was included in the
most recent edition of the text Applied Behavior Analysis
(Cooper, Heron, & Heward, 2020), which is widely considered
the classic textbook on ABA.
Several contextual factors seem to be contributing to the
increased interest in ACT in behavior analysis. As the number
of practicing BCBAs grows exponentially (from just over
6,000 in 2010, to over 33,000 in 2018), so does the demand
for evidence-based behavioral technologies that can meet the
increasingly diverse needs of consumers seeking ABA-based
treatment services. Practitioners often find themselves ad-
dressing complex behavioral repertoires that require innova-
tive, higher level programming that goes beyond what they
typically receive direct training in during the course of their
graduate studies and supervised fieldwork. BCBAs are tasked
with designing effective programs for (a) establishing and
developing the verbal repertoires of clients and (b) addressing
problematic patterns of behavior that tend to emerge with the
development of such repertoires. In addition, the majority of a
BCBA’s professional activities involve interacting with indi-
viduals withcomplex verbal repertoires (i.e., parents, teachers,
staff, colleagues, and other providers), either directly (during
observations, training sessions, phone calls, meetings, etc.) or
indirectly (via e-mails, treatment plans, written notes, etc.).
Thus, a functional understanding of language, as it occurs in
typically developing adults, appears critical to a BCBA’ssuc-
cess. In short, the growing interest in ACT by BCBAs seems
to be occasioned by client needs and consequated by its effec-
tiveness in addressing those needs.
The growing interest in ACT from within the applied
behavior-analytic community poses some potential practical
and ethical challenges. ACT as applied within the traditional
scope of practice of BCBAs has not been widely disseminated,
and most BCBAs have not had significant training or experience
in ACT or RFT. Some uses and forms of ACT are properly the
realm of clinical psychology or other disciplines, but many
others are perfectly suited to the profession of ABA.
Behav Analysis Practice

ACT as ABA
The acronym “ACT”originally stood for “acceptance and
commitment therapy,”but for the last 15 years, the term “ac-
ceptance and commitment training”hasbeenusedtodescribe
applications of ACT in nonpsychotherapeutic settings (Hayes,
Strosahl, & Wilson, 2011; Hayes et al., 2004). A search via
Google Scholar shows that the term “acceptance and commit-
ment training”has appeared over 1,000 times in the world’s
scientific literature. Although the term “ACT”continues to be
used by a wide range of professions, we will use the acronym
“ACTraining”to more clearly distinguish between ACT as
applied in psychotherapeutic or counseling settings and ACT
as applied within the scope of practice of BCBAs. We are not
suggesting that the term “ACT”is inappropriate for behavior
analysts. We do, however, seek to emphasize the difference
between ACT as a training method appropriately integrated
into the work of BCBAs versus ACT utilized by psychother-
apy or counseling professions.
According to the Behavior Analyst Certification Board
(BACB; www.bacb.com), behavior analysis is the “scientific
study of principles of learningand behavior,”consisting of the
basic natural science of the experimental analysis of behavior
and of the application of that natural science, ABA.
Specifically, ABA is defined as a systematic approach for
influencing socially significant behavior through the
application of behavioral principles to the identification and
manipulation of reliably related environmental variables.
BCBAs provide services to improve organizational
functioning (e.g., staff performance, employee training,
management and compensation practices), skill deficits (e.g.,
communication, social behavior, health and wellness
behaviors), and socially unacceptable behavior (e.g.,
aggression, self-injurious behavior). Thus, our most basic
proposition is that ACTraining should be based in the same
basic natural science and explicitly involve the application of
the behavioral principles that extend from that work to the
manipulation of the controlling environment in a way that
improves socially significant overt behavior. Put simply,
ACT as practiced within ABA should meet all of the same
standards that define any other practice within ABA (e.g.,
Baer, Wolf, & Risley, 1968), and we discuss many such ex-
amples in this article.
Linkage to Behavioral Principles
ABA is characterized, in part, by its commitment to being
conceptually systematic (Baer et al., 1968), meaning that be-
havior analysts observe and analyze behavior in context and
design interventions from an understanding of the functional
relationship between behavior and the environment, in terms
of behavioral principles. The importance of remaining
conceptually systematic is perhaps even greater when
adapting interventions that were originally developed for prac-
titioners outside of ABA (e.g., ACT interventions). After
ABA practitioners have been substantially trained in the
behavior-analytic conceptual analyses that form the core of
ACTraining, they can then both (a) adapt traditional ACT
methods for incorporation into ABA interventions and (b)
create their own ACTraining interventions consistent with
their own client-specific functional assessments.
Understanding how ACT works in terms of behavioral prin-
ciples allows the ABA practitioner to implement ACT func-
tionally, rather than simply implementing procedures as pure
technology. This is consistent with what ABA practitioners do
when they use more mainstream ABA procedures, such as
functional communication training, discrete-trial training, or
natural environment training.
AccordingtotheACTmodel,psychological flexibility is the
ability to contact the present moment regardless of aversive
thoughts and feelings based on the situation and one’spersonal
values (Hayes et al., 2004). Specifically, one identifies that the
thought or feeling is only temporary and engages in behaviors
that result in long-term value to one’s life. For instance, a parent
may continue to place a tantrum on extinction, although she
feels uncomfortable when hearing the crying and whining, to
bring about more meaningful interactions with her child in the
future. Psychological flexibility can be conceptualized as in-
volving six functionally defined behavioral repertoires, all of
which support one another. These six repertoires are typically
described in “middle-level terms”(i.e., terms that serve to ori-
ent the behavior analyst to particular functional relations be-
tween the environment and behavior) and comprise the six
points of the ACT hexlaflex: acceptance, defusion, present mo-
ment attention, self-as-context, values, and committed action
(Hayes, Bond, Barnes-Holmes, & Austin, 2006). In what fol-
lows, we describe each of the six dimensions in two ways: (a)
as repertoires of behavior that ACT is designed to strengthen
and (b) as procedures used to strengthen these repertoires
(much the same as “functional communication training”refers
both to relations of reinforcement for communication and ex-
tinction for challenging behavior and to the procedures used to
bring those relations about).
Values
Increasing valued living is described as the primary goal of
ACT (Hayes et al., 2011). Behaviorally, values can be con-
ceptually analyzed to be rules that function as verbal motivat-
ing operations that increase or decrease the effectiveness of
stimuli as reinforcers or punishers, thereby supporting overt
behaviors that produce those stimuli. Consider a BCBA who
has been avoiding parent training sessions and engaging in
negative thoughts (i.e., private verbal behavior) such as “I
can’t believe I have to work with another uncooperative
Behav Analysis Practice

parent.”The BCBA may reflect on the situation by clarifying
her values. For example, she might assert, “I am going to do
whatever I can to ensure this child receives the best care pos-
sible, including taking on the challenge of supporting the par-
ents who may not want to do everything I recommend.”If this
small values intervention is effective in helping the BCBA
engage the parent, the BCBA may then take the opportunity
to implement a values intervention with the parent to help the
parent move toward her values. For example, the BCBA could
suggest the parent write her own unique values statement,
such as “I care about being an advocate for my child.”These
practices help transform the stimulus function of events that
are otherwise aversive and that evoke avoidance responses.
When the BCBA or parent in this example articulates an im-
portant value, aversive stimuli that participate in equivalence
networks with the stated value acquire new, more appetitive
stimulus functions. In the context of freshly articulated values,
the parent is more likely to ask questions in individualized
education plan meetings and the BCBA to make recommen-
dations, even when they might be challenged by the parent.
Overall, values interventions may enable a BCBA to add
powerful appetitive functions (or intermediary reinforcers) to
an otherwise aversive situation, providing a parent, staff mem-
ber, client, or teacher with the motivation he or she needs to
persevere in the face of adversity. Values interventions thus
support rule-following repertoires that are oriented toward
larger, longer term positive reinforcers, versus short-term es-
cape (Blackledge & Drake, 2013). For example, during an
intake meeting, the BCBA might engage the parent in a values
exercise such as “The Three Wishes”(Gould et al., 2018),
where the BCBA asks the parent, “If you could have anything
in the world for your child, what would it be?”to which the
parent might respond with something like “I want my child to
be able to express herself and to be safe.”The BCBA might
subsequently link all treatment recommendations back to
those parent values, potentially increasing the likelihood of
securing buy-in and commitment to treatment protocols
(e.g., “I want to introduce this augmentative and alternative
communication [AAC] device in the service of helping
Shanice express her needs and be understood, no matter where
she is or who she is talking to.”), as well as reconnecting the
parent with his or her values when things get difficult (e.g., “I
am willing to go through this, in the service of Shanice being
safe from harm, happy, and independent in the future.”).
Present Moment Attention
Present moment attention (often referred to as “mindfulness”
or “present moment awareness”in the ACT literature) in-
volves strengthening one’s repertoire of attending to stimuli
in the present moment, while weakening one’srepertoireof
attending to one’s own verbal behavior with respect to past,
future, or imagined events. Present moment attention training
thus aims to increase sensitivity to environmental contingen-
cies and weaken unhelpful sources of verbal stimulus control.
In practice, this involves evoking and reinforcing attention to
different aspects of immediate experience. For example, par-
ents might be taught to discriminate when they are “in the
world”(i.e., in contact with direct contingencies) versus “in
their heads”(i.e., primarily attending to private verbal stimuli,
e.g., “Ican’tdothis”). The purpose of this training is to facil-
itate contact with overt environmental stimuli (e.g., the child
seeking out the AAC device) that might occasion more adap-
tive parenting responses that support the child’s treatment
(e.g., reinforcing the child’s use of functional communica-
tion), as opposed to engaging in avoidance (e.g., obsessively
researching treatment articles online) in the presence of aver-
sive private stimuli (e.g., feelings of grief about the child’s
diagnosis and worry about the future).
Furthermore, present moment procedures involve training
one to pay attention to one’s own attending behavior. In cases
where one notices one’s attention wander, one redirects one’s
own attending behavior back to present moment stimuli. Put
differently, one learns to tact one’s own attending behavior,
and the occasion of tacting wandering attention, itself, be-
comes a discriminative stimulus for redirecting one’s own
attention back to the present moment, thus comprising a sec-
ondary repertoire of self-managing one’s own ongoing attend-
ing behavior (Skinner, 1953, Chapter 15). An everyday exam-
ple of such behavior that is likely familiar to anyone who
drives an automobile is when one suddenly notices that one
is not looking at the road while driving and then redirects
one’s own attention back to the road.
Acceptance
Acceptance can be thought of as approach behavior (or the
absence of avoidance or escape) in the presence of aversive
stimuli, thus creating a context for more varied and potentially
more adaptive behaviors to occur and then contact natural
reinforcers. Thus, an ABA practitioner might train acceptance
anytime avoidance is interfering with the task at hand. In prac-
tice, this involves weakening rule-governed, negatively rein-
forced repertoires by directly evoking and reinforcing the abil-
ity to approach previously aversive events (public and pri-
vate). For example, in the context of parent training, a
BCBA might train a parent in acceptance while following
through with an extinction procedure aimed at producing
long-term positive (i.e., values-directed) outcomes, instead
of engaging in typical avoidance behavior when the parent
contacts aversive private events in the moment (the stress of
seeing and hearing the child in distress).
In the context of parent training, BCBAs can model accep-
tance by saying things like “IknowI’m supposed to be the
expert, but honestly, doing extinction is really hard for me too.
And it’s the stand that I’m willing to take for your child.”
Behav Analysis Practice

BCBAs can directly reinforce parents’acceptance behavior by
creating a supportive context for parents to choose difficult
actions and then directly reinforce when they do so. For ex-
ample, the BCBA might suggest during parent training, “Ican
see this is frightening to you. You’re worried about getting it
wrong. How about we run the extinction procedure together
today? You’re not alone. I’ll be here. We’re in this together.”
As the parent begins to conduct the procedure, the BCBA
might respond by saying, “Iknowthatwasn’t an easy choice,
and I’m impressed. Through your actions, you are showing
that you are willing to do pretty much whatever it takes to help
your child, and that’s pretty awesome. Let’s do this!”
In the case of a BCBA applying ACT procedures to one’s
own self-management, if the BCBA is struggling with a chal-
lenging parent training situation and experiences aversive pri-
vate events (e.g., feelings of frustration and thoughts such as
“Ican’tdothisanymore!”or “This is pointless.”), rather than
avoiding returning a parent’s phone call, the BCBA might
take a few minutes to purposefully observe his or her feelings
of frustration and the difficult thoughts he is she is having, and
thereby “allow them to be there.”The BCBA might write
down his or her thoughts on a Post-it and then state his or
her willingness to talk with the parent by connecting to values
(“Even though it feels pointless and frustrating, I’mwillingto
call this parent because I care about doing the best I can for
this family, and I care about being a compassionate, respon-
sive behavior analyst.”). Hence, a previously aversive situa-
tion now becomes an opportunity to contact reinforcement by
behaving in a values-consistent manner.
Defusion
From a commonsense perspective, defusion is the embodi-
ment of perhaps the most central of behavioral concepts:
The mind does not control behavior. In contrast to how our
mentalistic society has trained us all to believe that the mind
causes behavior, and therefore that we should take our
thoughts very seriously, defusion procedures are about teach-
ing people to notice their private events for what they really
are: just more stimuli in their environment. A behavioral con-
ceptual analysis of defusion is considerably more complex
and involves rule-governed behavior. The problem to which
defusion is directed is referred to as “fusion”in the ACT
literature and means overly rigid control of behavior by rules.
Defusion, then, refers to a weakening of overly rigid rule
control over behavior, such that other functions (verbally
and nonverbally established) can come to bear. Defusion pro-
cedures thus seek to disrupt narrow, inflexible functions of a
person’s private verbal stimuli (i.e., thoughts), so that a
broader, more flexible repertoire of responding to those
thoughts as private stimuli might be established. Thus, an
ABA practitioner might train defusion anytime thoughts
(i.e., private verbal stimuli) dominate attention, producing
unworkable patterns of behavior. In practice, this involves
training attention to the process of thinking. For example, if
a client is continuously distracted from attending to school
activities by thoughts that she is going to fail or “is dumb,”
the BCBA might teach the child to playfully visualize think-
ing these negative thoughts as falling down a rabbit hole.
Rather than continuing to fall down the hole, the student is
taught to verbally “catch herself from dropping farther into the
hole.”The student is thus taught to tact her negative thoughts
as a “rabbit hole,”a context in which to reorient attention back
to the task at hand.
Of course, for less verbally adept students, such talk is too
abstract. With such students, it may be helpful to physicalize
metaphors. In the previous example, the BCBA might teach
the child to respond to her own negative self-talk by literally
spreading her arms out to “stop”herself. If the social context
of the classroom is not appropriate for the student to spread
her arms wide, she could be taught to subtly spread her hands
out slightly. In each case, responding to one’s own negative
self-talk metaphorically can create a context for more variable
behavior, rather than simply avoiding difficult social or aca-
demic situations that evoke the negative self-talk.
Defusion procedures generally disrupt the function of un-
helpful rules by either adding neutral functions to those rules
or by adding humorous functions. An example of adding a
neutral function is imagining one’s thoughts as a radio stuck
on “negative FM.”For example, consider a parent who tells
the BCBA that he or she is having the thought “Ican’tdo
extinction.”The BCBA might say something like
I know doing extinction is unreasonably difficult, and
when we do it, our minds will inevitably tell us stuff that
isn’t helpful. But what if it was possible to just notice
our thoughts as just another thing in our environment,
annoying and painful, but not always as directions that
we have to follow. If you are willing, try taking a minute
and imagining your extinction mind is like a radio that’s
stuck on the station “I can’t FM.”It would be really
irritating for your radio to be stuck like that, but you
wouldn’t have to do whatever the DJ said, right? If
you had to, you could keep doing what mattered, even
with a really negative DJ talking in the background.
Maybe it’s worth trying to imagine that while you im-
plement extinction.
Of course, there is nothing special about the metaphor of a
stuck radio station. The BCBA might use any other metaphor
that is a familiar example of repeating messages that one does
not necessarily have to listen to—for example, a stock market
ticker tape, a sign being trailed by an airplane in the sky, or a
broken record player.
An example of a defusion exercise that adds humor-
ous functions to maladaptive verbal stimuli is where the
Behav Analysis Practice

BCBA asks the person to repeat the problematic thoughts
(i.e., verbal behavior) in a silly voice. For example, if a
child with ASD is having difficulty with losing a board
game and says, “Ican’t lose this game!”the BCBA
might say something like
Look, I hate losing too. If you can win, awesome, then
win. But when I can’t win, one thing that helps me is to
repeat my thought back to myself but in the voice of
Yoda from Star Wars.IfI’m losing a game, and it’s
driving me nuts, I might just say “Lose this game, I
can’t!”[while talking in a silly accent that resembles
the Yoda character]. Are you willing to give it a shot?
Try it—just say something like Yoda.
At first the BCBA may have to provide echoic prompts and
contrived reinforcement to teach the child to say his thoughts
in a “Yoda voice,”and then fade prompts and reinforcement
as the child continues to use the newly learned defusion skill.
There is nothing about silly voices, per se, that are necessary
for defusion to work. What matters is that, functionally, the
practitioner helps the learner engage in some other more flex-
ible and varied behavior in the presence of whatever rules are
evoking avoidant behavior. In lay terms, defusion is about
teaching learners to “not take their own minds so seriously.”
Self-as-Context
Self-as-context describes an awareness of oneself as the con-
text for all of one’s experiences (i.e., observing that one’s
behavior is distinct from other external and internal events;
Levin et al., 2012). Behavior analytically, self-as-context
might be thought of as a flexible perspective-taking repertoire.
Viewed from the standpoint of RFT, self-as-context involves
training flexible deictic relations of I/you, here/there, and now/
then. In this way, self-as-context procedures involve shaping
flexible, self-directed verbal behavior in the presence of pri-
vate events that vary across time (e.g., memories of the past
and concerns for the future), place (e.g., different situations,
relationships, roles), and person (e.g., different perspectives
on the same event). Thus, an ABA practitioner might train
self-as-context anytime rules about the self (i.e., in lay terms,
self-conceptualizations like roles, relationships, characteris-
tics, and evaluations) limit flexibility and hinder values-
directed overt behavior. For example, if a client defends his
disruptive behavior by describing himself as a “class clown,”
the BCBA might teach the child to consider (a) the different
ways he might describe himself in different situations or at
different times in his life and (b) the different ways others in
his life (e.g., parent, favorite teacher, or friend) might describe
him based on what they see. Similarly, if a father resists a
behavior intervention plan and says something like “I’mjust
a softy; I can’tbestrictlikethat,”the behavior analyst might
say something like
I understand what you’re saying. You care about being
sensitive to your child’s needs, and I appreciate that.
And . . . when we are so focused on being a particular
way, like being a softy and not being too strict, we might
find ourselves trapped. It can make the current situation
more difficult. When I get stuck on particular beliefs
about the way I am, sometimes I try reframing it by
noticing that these beliefs are just one particular way
that I act in certain situations; they don’t necessarily
have to dictate my action in all circumstances. There
are times when I have the thought that I need to be
perfect at my job. One trick I use on myself is to just
restate my belief but with some added perspective. For
example, I might say, “InoticeI’m having the thought
that I’m a behavior analyst that is supposed to have it all
figured out.”Are you willing to give that a shot and see
how it works?
Distinguishing Between Defusion and Self-As-Context
Behavior analysts new to ACT may find the distinction be-
tween defusion and self-as-context unclear. In lay terms,
defusion targets unworkable rules and thoughts about the out-
side world, whereas self-as-context addresses unhelpful rules
and thoughts about the self. Said behaviorally, defusion pro-
cedures weaken rigid control by rules that describe the envi-
ronment outside of oneself, whereas self-as-context interven-
tions weaken the influence of rules that describe oneself or
others. Both classes of intervention seek to weaken excessive-
ly rigid rule control, one with respect to rules in general, and
the other with respect to rules influencing perspective-taking
behavior.
In practice, it is common for defusion and self-as-context
procedures to overlap based on their shared roles in helping
trainees identify that their thoughts, whether about themselves
or not, do not need to control their actions. Topographically
similar procedures could target the defusion repertoire or the
self-as-context repertoire to produce functionally different
outcomes. For example, when a runner looking to move from
running half marathons to full marathons engages in the pri-
vate verbal behavior “I’m never going to reach 26.2 miles,”
she might use the defusion strategy of restating the thought as
“InoticethatI’m having the thought that I’m never going to
reach 26.2 miles.”On a different day, that same runner engag-
ingintheprivateverbalbehavior“Maybe I’m just not the kind
of person who runs marathons”might use the self-as-context
strategy of restating the thought as “I’m a 40-year-old BCBA
noticing myself having the thought that maybe I’m just not the
kind of person who runs marathons.”Although they are
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almost identical topographically, the first example would be
conceptualized as a defusion exercise because it is functional-
ly targeting general rules about training, whereas the second
would be conceptualized as self-as-context because it is
targeting verbal rules about oneself as a person.
When they learn defusion and self-as-context skills,
trainees begin to notice their thoughts and to respond to them
in defused ways. Trainees can also be taught to recognize the
stimuli in the environment that evoke the problematic self-
talk, in order to cue themselves to engage flexibly with
defusion or self-as-context skills. This is analogous to when
BCBAs teach children with autism self-management skills—
specifically, to engage in a functionally appropriate replace-
ment behavior over one that is harmful to themselves or
others.
Committed Action
Committed action is the ultimate goal of ACT and describes a
response class of socially significant overt behaviors that
move one in the direction of one’s stated values. All the other
five behavioral repertoires described previously serve to create
a context for a person to engage in larger and larger patterns of
values-directed committed action. Training committed action
involves training (a) the discrimination of aspects of the im-
mediate context related to values and (b) the engagement in
values-consistent behaviors as appropriate to that context.
Throughout treatment, a BCBA might encourage a client to
identify and tact the function of his or her current behavior
(e.g., “I’m trying to quit the game because it looks like
Michelle is going to win.”) and then identify specific behav-
iors that the child might immediately engage in that are in line
with his or her values (e.g., “I want to be a good friend, and
friends play games together, even though someone loses.”), in
addition to supporting the child in selecting realistic goals to
target outside of treatment sessions (e.g., “Iwanttobringa
game that I’m good at next time and teach Michelle.”). The
BCBA would also seek to prompt and reinforce the child’s
flexibility repertoire more broadly (i.e., defusion, acceptance,
present moment awareness, and values), when private events
arise that previously derailed values-consistent action.
In the context of parent training, a BCBA might directly
instruct that committed action is the desired end point of the
training process and set up a context for a parent to create his
or her own goals, oriented to his or her own values. For
example,
Look, I could tell you what to do and why I think you
should do it. But, honestly, that’s not what parent train-
ing is about. This process is about me giving you skills
to decide what you want to stand for with your child and
what you are willing to do about it. We’ve talked already
about values, and you chose “helping your child get the
most out of life”as your value. I want you to take a few
minutes and write down three different ideas you have
about small but meaningful ways you could change your
behavior this week that would help your child move
toward that value. When you are done, let’s get back
together and narrow the list down to just one thing that
you can commit to doing, the date and time you are
going to do it, and who in your life you are going to
report it to when you get it done.
The BCBA might then give the parent a worksheet, calen-
dar, or planner or encourage the parent to make his or her own,
so that the committed action can be put in writing and then
shared with relevant family members, and so on. A variety of
ready-made committed action worksheets are available to
download for free off of the World Wide Web—for example,
the “Mindful Action Plan”(Moran, 2014), and the
“Willingness and Action Plan”(Harris, 2008). As we know
from the performance management literature, goal setting
works much better if it is followed up with feedback on how
well the parent met the goals the next time the BCBA and the
parent meet, ideally within the next week or two (Alvero,
Bucklin, & Austin, 2001).
Combining the Six Processes
The overall goal of ACT is for the trainee to build behavioral
flexibility through strengthening the six skill repertoires.
Although each skill is conceptualized as equally important,
each may not require equal attention at any given time or with
any given trainee. As with any other skill acquisition target,
the ACT trainer can probe to identify skills that are already at
strength in the trainee’s repertoire. The BCBA may ask the
trainee to talk about his or her thoughts and emotions as “bar-
riers”to desired behavior change, and based on the trainee’s
response, the ACT trainer can then prioritize which ACT skills
to train first. We address this process further in the section on
functional assessment that follows.
RFT: The Engine That Powers ACT
Interventions
The verbal relation expressed in the title of this section is best
described as an analogy: RFT is to ACT as engines are to
automobiles. Readers unfamiliar with RFT and ACT will no
doubt recognize that engines propel cars, and thereby derive
that RFT must do the same for ACT. In doing so, readers
engage in arbitrarily applicable relational responding
(AARR; Hayes, Barnes-Holmes, & Roche, 2001). AARR is
verbal behavior in which stimuli unrelated by virtue of form or
topography (e.g., the words RFT and engine) are related in
accordance with verbal cues that are themselves
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unconstrained by physical dimensions or properties (e.g., the
word “EQUALS”). RFT constitutes the basic account by
which humans learn not only to respond to words but also to
rapidly build verbal relations, sets of relations, and networks
of correlated relational sets.
To illustrate, consider the conditional discriminations one
might quickly make given the analogy that RFT is the engine
that powers ACT. If RFT powers ACT, then verbal behavior
theory powers the picture exchange communication system
(Bondy & Frost, 2001), behavioral momentum theory drives
several treatments for noncompliance (Mace et al., 1988), and
matching theory propels ABA approaches to classroom man-
agement (Neef, Mace, Shea, & Shade, 1992). Further, it fol-
lows that many ABA interventions are torqued by theories
derived from the experimental analysis of human behavior
and that practitioners who have an educational background
in basic research have a much more powerful engine with
which to travel into applied settings.
By itself, RFT has relevance to ABA because it is testable,
and those aspects of the theory that have been investigated in
basic labs have easily found their way into applied programs
of research and practice (e.g., Barron, Verkuylen, Belisle,
Paliliunas, & Dixon, 2019; Dixon, Blevins, Belisle, &
Bethel, 2019). But the importance of RFT as a theory extends
beyond an account of how verbal relations rapidly generate. It
also explains the way verbal relations learned in accordance
with one type of discriminative cue transform in function as
fast as they are initially formed. This feature of verbal learn-
ing, referred to in the RFT literature as the transformation of
stimulus function, is implicated in a class of psychological
suffering that only those with verbal capacity experience,
and it is in this way that RFT’s account of human language
is the engine of all ACT interventions.
By way of example, imagine that Peter, a 14-year-old, is
your most delightful neighbor and is a tremendous musician.
Peter is friends and in a band with Zack, whom you have not
met, though he also lives in your neighborhood. Zack is close
friends with Hank, who you do not know. Because of your
previous relationship with Peter, you derive that Zack must be
delightful because he is close to Peter, and so must Hank,
because he is close to Zack.
Upon talking to your police officer friend, however, you
learn that Hanck and a few friends have recently beaten up
elderly people in his neighborhood to steal their money and
buy musical equipment for their rock band. Immediately,
without any further information, you derive that Zack and
Peter are the friends Hanck was with when attacking the el-
derly people. Until this time, you have related to Peter, and by
extension to Zack, as delightful, but this one bit of informa-
tion, in which neither child has been named directly, leads to a
transformation of their function from delight to disgust. This
change in respondent function is likely to be accompanied by
a change in discriminative and reinforcement functions
associated with their names. That is, the mention of their
names could occasion you to prepare questions for them about
how they earned the money for their musical instruments. Any
hesitation in their answers would reinforce your decision to
ask and provide additional discriminative stimuli for behavior
that would be reinforced by their leaving your neighborhood.
At that point, it is likely that you will experience pain that
reemerges at strength at a much later date when you meet a
new teenager who is a gifted guitarist. It is of relevance here
that the pain you experience at this point in time is a product of
your verbal relating, and not of any interaction with the new
person in the current context. Thus, RFT constitutes a basic
account of verbal learning, and ACT, as a course of treatment,
is designed to deal with the psychological problems that hu-
man language produces (McEnteggart, 2018).
The Seven Dimensions of ABA
When asking the question of how ACTraining fits in the scope
of practice of ABA, a logical question is how it fits into the
seven dimensions that define ABA (Baer et al., 1968). We
have written about this elsewhere (Szabo & Tarbox, 2018),
but we will touch on some key discussion points here.
Applied and Behavioral
The goal of ACT is to improve socially meaningful, opera-
tionally defined overt behaviors that help clients move in the
direction of their chosen values. According to the criteria set
forth by Baer et al. (1968), ACT is both applied,inthatit
addresses socially important problems, and behavioral,inthat
it focuses on changing overt behavior. Private events are ad-
dressed in the process but only to teach clients more flexible,
productive skills for responding to their own private events,
not to change those private events or to give them causal status
in any way. For example, a parent might report that he or she
has the thought “Ican’t just ignore the behavior and watch
him cry.”This thought, as a privately occurring self-rule, may
indeed have a negative influence on the parent’simplementa-
tion of an extinction procedure for his or her child’sattention-
maintained behavior, just as an overtly stated rule could. The
goal of ACTraining would not be to target the content of that
rule, but rather to encourage some variability and flexibility in
how the parent engages with it, for the purposes of increasing
the probability of implementing attention extinction. That is,
the ACT-informed ABA practitioner is concerned with how
the rule functions for the parent in that particular context, not
with changing or eliminating the rule or any other private
behavior. Further, if teaching the parent new ways of
responding to that rule does not help improve the parent’s
overt behavior of implementing extinction, then the change
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is insufficiently large and not one that ACT work strives to
produce.
Similarly, if a behavior analyst was using a values-based
ACTraining intervention aimed at increasing the frequency at
which direct care staff fill out their time sheets in a timely
manner, the goal of the intervention would be overt behavior
change, not a change in private “meaning and purpose,”per
se. In order to use a values intervention, the BCBA may hold a
staff meeting with direct care staff and talk about the shared
values that are meaningful to the staff in their daily work.
Imagine in this case the staff identify “helping children
achieve their greatest potential”as their highest value for
showing up for work. The BCBA leading the meeting might
start by acknowledging how difficult and tedious paperwork
can be, and then link the overt behavior of filling out time
sheets to the value of helping children achieve, by discussing
how paperwork allows clients to access continued funding for
their treatment, as clients must continue to get treatment if
they are to achieve their greatest potential. The BCBA might
pose the question “Is it worth it to be bored and irritated out of
your mind while you do paperwork, if that’swhatittakesto
give these kids a better life in the future?”Thegoalofsucha
discussion is not to change how staff think about time sheets,
but to produce a change in the overt behavior of staff filling
out time sheets, especially in the presence of aversive emo-
tional states (e.g., boredom and frustration) and unhelpful self-
rules (e.g., “Ihatetimesheets.Ididn’t get into this line of
work to spend time on pointless paperwork.”). Again, if the
overt behavior does not improve, additional intervention com-
ponents would need to be added until a socially meaningful
change in behavior is produced.
Effective
The insistence within ACT on producing overt behavior
change that is large enough to produce a meaningful improve-
ment in the learner’s life is the very definition of the effective
dimension of ABA (Baer et al., 1968).
Conceptually Systematic
As we described in the section “Linkage to Behavioral
Principles,”ACTraining, when practiced by well-trained be-
havior analysts who are guided by behavioral principles, is
conceptually systematic. The procedures that comprise ACT
were conceptualized from the standpoint of behavioral princi-
ples from the beginning, and basic behavioral principles are
taught in most ACT treatment manuals. Of course, it is possi-
ble for poorly trained practitioners to rotely implement ACT
procedures as pure technology, without an understanding of
how and why they work in terms of behavioral principles. But
that is, of course, also possible with any other ABA proce-
dures, such as discrete-trial training and functional
communication training. It is probably accurate to say that it
is more challenging to conceptually analyze and understand
all of ACT in terms of behavioral principles, as compared to
more mainstream ABA procedures, but that is likely because
the human behavior involved in ACT is relatively more com-
plex, not due to ACT, per se.
Generality
The goal of establishing generalized behavior change is at the
heart of all ACT work, in that the goal is never to establish
specific topographies of behavior under specific instances of
stimulus control. Rather, the goal of ACTraining is to
strengthen generalized operant repertoires that are then porta-
ble for learners to take into any relevant aspects of their daily
lives. For example, if parents are trained to monitor their own
behavior in implementing their child’s behavior plan in the
service of helping their child live more independently (com-
prising present moment, values, and committed action reper-
toires), then parents might also track their daily behavior of
putting away their own smartphones while playing with their
child, in the service of fostering intimacy and joy in daily life
(also present moment, values, and committed action
repertoires).
ACTrainers also address generalization within the training
process itself and look for trainees to derive their own un-
trained examples of behavioral flexibility. For example, if an
ABA therapist is sharing with his or her BCBA during a su-
pervision meeting that he or she is stressed out by driving in
traffic and not sure if he or she can take it anymore, the BCBA
might try to promote an acceptance repertoireby saying some-
thing like “I wonder if trying not to feel stressed while driving
in rush hour traffic might be a little bit like trying to avoid
drowning by struggling in quicksand.”In assessing generali-
zation, the trainer might look for the ABA therapist to dem-
onstrate a derived extension of the metaphor; for example,
So you are telling me I need to open myself up to the
traffic and just lay flat on top of it? That sounds insane,
but I guess it actually makes sense, in a nonliteral way.
Maybe instead of fighting my way through traffic like I
have been, I can try floating through it on a surfboard.
Or perhaps the ABA therapist might derive a new metaphor
that is functionally the same; for example,
Quicksand—OK, I get it, or maybe it’sliketryingto
stay dry with an umbrella in a hurricane. Maybe I’ll
put an umbrella on the passenger seat of my car to
prompt me to practice acceptance of stress while
driving.
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Of course, inducing people to merely talk like an ACT
trainer is not the goal of ACTraining; changes in socially
relevant overt therapist behavior must also be evaluated, such
as decreases in staff callouts or turnover related to burnout.
To sum up, producing generalization is so fundamental to
all ACT work that it cannot be considered a distinct phase or
goal of treatment, separate from initial acquisition. The dem-
onstration of generalization across aversive events, across and
within ACT self-management repertoires, and across commit-
ted actions is evidence of mastery.
Analytic
ACTraining is analytic in the sense that BCBAs practicing
ACTraining are equally responsible for evaluating whether
or not ACTraining procedures were responsible for observed
behavior changes, just as they are with any other ABA proce-
dures. Careful data collection and some attempt at single-case
experimental design, even in the context of everyday practice,
are as critical to ACTraining as they are to any other area of
specialty within ABA practice.
Technological
Perhaps the least straightforward dimension of ABA is the
status of ACTraining as technological. Like any other scien-
tific procedure, it is critical for ACTraining procedures to be
clearly defined so that they are replicable. It is likely fair to
state that this is a dimension in which ACTraining requires
further development, perhaps largely due to the fact that it is a
relatively new area of practice within ABA. Still, manualized
protocols for ACTraining inside ABA exist (Gould et al.,
2018;Szabo,2019; Szabo et al., 2019), as well as curricula
with clearly defined exercises (Dixon, 2014;Dixon&
Paliliunas, 2018).
To recap, we suggest that ABA practitioners use ACT as a
tool with which to target socially important, observable, mea-
surable behavior and hold themselves accountable for analyz-
ing the extent to which their results are due to their interven-
tion, and not some other environmental event. ABA practi-
tioners using ACT should further demonstrate that their results
are powerful enough that others should see their relevance and
durable enough to warrant moving on to other goals. They
should then make certain to write out what they do in a way
that allows anyone with the instructions and adequate training
to perform the treatment and obtain similar results. Lastly,
ABA practitioners should be prepared to describe to other
professionals the basic principles (i.e., reinforcement,
AARR, etc.) that are the necessary and sufficient ingredients
to explain the strength of the intervention results obtained.
ACTraining and the BACB Task List
One way to organize a discussion of scope of practice of a
discipline is to reference the description of practice provided
by the profession’s credentialing body. The fifth edition of the
BACB Task List (BACB, 2017), hereafter simply referred to
as the Task List, provides an overview of the knowledge and
skills that serve as the foundation for the BCBA and Board
Certified Assistant Behavior Analyst examinations. The Task
List is organized in two major sections: “Foundations,”which
includes underlying principles and knowledge, and
“Applications,”which includes skills and procedures. When
implementing ACTraining inside ABA, all of the Task List
items are relevant, because one is, indeed, practicing ABA.
ACTraining is best conceptualized as a supplement to more
mainstream ABA practices, not as a replacement for anything
on the Task List. However, some of the items on the Task List
are especially relevant to the six sets of functional relations
and procedures that constitute ACT work. In what follows, we
note several of these Task List items and discuss how they are
the active ingredients in ACTraining.
Functional Assessment
Conducting descriptive functional assessments is includ-
ed in the Task List (BACB, 2017, Content Area F-7),
and taking a functional approach to changing behavior
has been considered a best practice for at least a few
decades in the realm of assessment and treatment of
challenging behavior (Iwata, Dorsey, Slifer, Bauman,
&Richman,1982). Functional assessment is also the
foundation ACT, given that it is an intervention based
on a functional analysis of language and avoidant overt
behavior. Functional assessment of such behavior may
include direct descriptive observations (e.g., antecedent-
behavior-consequence data), as well as indirect descrip-
tive assessment (e.g., interviews). Assessment efforts in
ACTraining attempt to identify socially meaningful
overt approach behaviors that are happening too infre-
quently and other escape-maintained behaviors that are
occurring too frequently. For example, a trainer may
engage in too much small talk while observing a trainee
because it results in avoiding having to give meaningful
corrective feedback on the trainee’s performance that
could be improved. If a clinical director identified this
pattern of behavior through direct observation, she might
then follow up with an interview of the trainer, asking why
he did not provide feedback during his session with the train-
ee, and perhaps asking if there was anything in particular he
was thinking (i.e., a covert rule) that might be getting in the
way. The trainer might identify something along the lines of
“It’s the trainee’sfirstweek,andI’m afraid that if I overwhelm
him with too much feedback, he might quit.”Such a statement
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might identify a rule that supports the maladaptive avoidant
behavior of excessive small talk and suppresses the adaptive
overt behavior of giving effective feedback.
In addition to generally attempting to recognize and assess
avoidant behavior, ACT functional assessments focus on
identifying problematic functional relations that map onto
the behavioral conceptual interpretations of the six ACT pro-
cesses described in the “Linkage to Behavioral Principles”
section of this article. Developing procedures for functional
analysis inside of ACT is still in substantial need of empirical
research, but a brief description of some common practices is
warranted. When conducting indirect functional assessments
by interviewing clients, the behavior analyst can look for ev-
idence that might suggest one or more of the six ACT pro-
cesses to be relevant. To identify acceptance as a potential area
to target, the BCBA looks for verbal behavior that tacts aver-
sive experiences for the trainee. For example, when a BCBA
asks a parent to describe the difficulty with implementing
extinction, the parent might reply, “Ijustcan’t take him being
upset.”To identify defusion as a potential area to target, the
BCBA looks for a description of rules the trainee may be
rigidly adhering to. For example, a parent might report, “Ijust
know it’s not going to work; nothing ever works for him.”To
identify self-as-context, the BCBA looks for verbal behavior
focused on statements about who the trainee is; for example,
the parent might say something like “I believe what you are
suggesting works for some parents, but I think I’m just not that
kind of parent.”To identify present moment attention as a
potentially fruitful repertoire to target, the BCBA listens for
descriptions of attending behavior that are focused on the past
or the future; for example, “Ijustcan’t focus on this behavior
plan; all I’m thinking about is how frustrated I am that he has
been acting like this for years and hasn’t gotten better.”To
identify values as a potential repertoire to work on, the BCBA
looks for verbal behavior that describes a lack of perceived
positive reinforcement for the desired behavior; for exam-
ple, the parent might say something like “I just don’t
get why we are doing this.”Finally, to identify commit-
ted action as a potential area to target, the BCBA looks
for the trainee describing a lack of clarity on which
overt behaviors to engage in toward his or her stated
values. For example, the parent might say something
like “I just don’t even know where to start; it all just
seems like too much.”
In sum, using both direct and indirect descriptive
functional assessments of the problematic functional re-
lations that could be interfering with values-directed be-
havior, the BCBA then identifies behaviors and relations
that can be targeted with ACT procedures, as part of the
Task List components described throughout this article.
More future research is needed to identify potential pro-
cedures for conducting brief experimental functional
analyses for prescribing ACTraining strategies.
Rule-Governed Behavior
The Task List requires that BCBAs define, provide examples
of, and use rules to change behavior (BACB, 2017, Content
Area G-6). Given that BCBAs primarily interact with highly
verbal humans (i.e., parents and staff), it is impossible for
BCBAs to avoid rule-governed behavior. The functional dis-
tinctions among types of rule-governance (i.e., pliance, track-
ing, augmenting) emerged from the earliest work on ACT and
RFT itself (e.g., Hayes, Zettle, & Rosenfarb, 1989). ABA
practitioners can thus readily adopt conceptual analyses and
procedures from the ACT literature to establish or diminish
rule-governed behavior and to accomplish other Task List
goals such as to foster generalization or to facilitate
maintenance.
Establishing flexible rule control in circumstances where
rigid rules are not workable is clearly within the scope of
practice of BCBAs. Procedures designed to foster defusion
are examples of methods focused on rule-governed behavior
that ABA practitioners can adopt from ACT. For example,
while training a parent of a child with autism to implement
extinction with the child, the parent might say to the BCBA, “I
can’t ignore this! He needs to understand he doesn’t get to call
all the shots around here!”The BCBA might use defusion
strategies to diminish the impact of ineffective rules of this
kind. In this case, the behavior analyst might say,
I know this is really difficult. So much of what I’m
asking you to do goes against how you’ve learned to
parent. I wonder if you’d be willing to notice with me,
out loud, during our practice today, when I’msaying
one thing, and you’re having thoughts like “Nope!
That won’teverwork!”or “That isn’tright!Hecan’t
just get away with this!”And if I notice you look stuck, I
could ask what your mind is up to.
If the parent agrees, the BCBA would model, instruct,
prompt, and reinforce not only the parent adhering to the
planned ignoring procedure, but also the parent noticing the
presence and function of his or her covert verbal behavior.
Such an intervention could be one for rule-governed behavior
to the extent that it effectively prompts the parent to engage in
alternative, variable forms of rule-deriving (e.g., tracking the
effectiveness of ignoring) and sets the occasion for variable
forms of overt behavior, rather than the parent immediately
avoiding implementing extinction, as he or she has in the past.
Eilers and Hayes (2015) used defusion procedures to weak-
en maladaptive rules surrounding rigidity and accompanying
challenging behavior in children with autism. The participants
displayed rigidity with routines—for example, having to go
first or not letting a train track be dissembled—with overt
verbal rules (e.g., “The track can’tbreak!”) and overt chal-
lenging behaviors that occurred if adults did not follow their
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rules. The defusion procedure consisted of teaching the chil-
dren to state their rules repeatedly in silly voices while their
rules were broken (e.g., other children played with the train
track or took it apart). Results showed, in the first experiment,
that combining defusion with exposure effectively decreased
problem behavior and, in the second experiment, that defusion
combined with exposure was more effective than exposure
alone. An analysis in terms of rule-governed behavior would
suggest this procedure would work because it adds additional
functions tothe rules and because it creates the opportunity for
the learner to engage in other behaviors (as opposed to follow-
ing the rule), which can then come in contact with adult-
delivered consequences (e.g., praise), as well as natural con-
sequences (e.g., playing with others in varied and fun ways).
Therefore, defusion likely works because it decreases the ef-
fectiveness of rules to control behavior in old ways and helps
establish alternative behaviors.
At times, staff or practitioner behavior suggests rigid rules
that tend to reduce sensitivity to direct contingencies by inter-
fering with effective overt behaviors, including behaviors rel-
evant to their work. For example, a staff member might report
to the supervising behavior analyst, “I really don’tthink
there’s anything else I can do with this parent. She’sjustso
stubborn and needs everything to be her way.”If the supervi-
sor then observes the staff member failing to reinforce the
parent’s appropriate questions or attempts during skills train-
ing, the supervisor mighthypothesize that a rigid self-rule may
be undermining successful staff behavior. In addition to fos-
tering defusion, the ABA supervisor might train perspective-
taking to weaken the dominance of rigid rules about oneself or
others and establish more flexible behavior in the face of
whatever contexts typically evoke the problematic rule. For
example, the next time the staff member expresses similar
frustration, the supervisor might say, “Iwonderwhatitisthat
keeps her coming back here and trusting you when she’s
clearly struggling to do it right.”This, and the discussion that
follows, might be an intervention on rule-governed behavior,
to the extent that it evokes the staff member taking the per-
spective of the parent. For example, the staff member’saffect
might soften, and he or she might say, “I mean she really loves
her kid. She’s probably really scared and wants him to be OK.
She just gets so frustrated!”If the intervention functions as
intended, it will then set the occasion for the staff member to
discriminate both the parent’s affect and the staff member’s
effective responding, such that the staff member can respond
with greater sensitivity during training. Such an intervention
would also likely be made more effective if the BCBA helped
the staff member set a measurable goal for committed
action—for example, “catching the parent doing well”and
praising her.
Perhaps the most straightforward way in which
ACTraining involves rule-governed behavior is in the link
between values and committed action. As described earlier,
values interventions involve describing long-delayed, global
classes of positive reinforcers (e.g., “my child being able to
live a full and meaningful life”), and committed action in-
volves stating specific behaviors one is going to engage in,
the antecedent conditions under which one is going to do
them, and how the behaviors are connected to a chosen value.
For example, a parent might write down on a parent training
worksheet,
I am committing to running at least three 10-minute
natural environment training sessions per week with
my child, on Monday, Wednesday, and Friday eve-
nings, to work on generalizing the mands she is learning
in her ABA program, because learning language is go-
ing to help her live a fuller and more meaningful life in
the long run.
Such a committed action statement is a relatively straight-
forward example of Skinner’s (1969) definition of a complete
rule, which describes the antecedent (Monday, Wednesday,
and Friday nights), the behavior (running sessions), and the
consequence (the child living a meaningful life).
Derived Stimulus Relations and Equivalence
The Task List requires that BCBAs be able to define and give
examples of derived stimulus relations and use equivalence-
based instruction (BACB, 2017, Content Area G-12). Derived
stimulus relations and equivalence have always been founda-
tional to ACT work. One example is in addressing experiential
avoidance. Experiential avoidance is overt or covert behavior
that has the function of avoiding uncomfortable thoughts, feel-
ings, or situations (Gould et al., 2018). Such behaviors can
lead to successfully avoiding difficult situations temporarily,
but generally do not result in positive long-term effects. For
instance, the parent uncomfortable with following through
with demands to address her child’s problem behavior may
cancel a parent training session. By canceling the session, she
may avoid spending the hour contriving opportunities to fol-
low through with demands or have to wait out the tantrum;
however, this avoidance will only create a temporary solution
and does not address the long-term goal. The next day, week,
and month later, the child’s tantrums may persist, and precious
learning opportunities may be lost.
Measures of experiential avoidance (e.g., Bond et al.,
2011) are highly predictive of behavioral trajectories over
several years (e.g., Spinhoven, Drost, de Rooij, van Hemert,
& Penninx, 2014), including overt measures such as work
absence (e.g., Bond et al., 2011). Research on equivalence
classes and derived stimulus relations shows that experiential
avoidance is due in part to the equivalence relation derived
between emotions and verbal evaluations. For example, the
statement “anxiety is bad”has long been an item on the most
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common self-report measure of experiential avoidance (Bond
et al., 2011; Hayes et al., 2004). Laboratory tests of the
strength of equivalence relations show that people who are
highly experientially avoidant are more likely to have derived
astrong“anxiety–bad”equivalence relation (Levin, Haeger,
& Smith, 2017). The strength of this equivalence relation in
turn predicts actual behavioral performance in anxiety-
producing tasks and moderates the relationship between in-
creased physiological arousal and premature task termination.
In effect, this equivalence relation undergirds a verbal rule that
is known to have a dramatic negative impact on response
flexibility and sensitivity to direct consequences of responding
(see Chawla & Ostafin, 2007, for a review). Because rule-
based insensitivity to direct consequences of responding trans-
fers through equivalence relations (Monestes, Greville, &
Hooper, 2017), it makes sense for behavior analysts to under-
mine the aversive functions of anxiety that were transferred
via the “anxiety–bad”relation.
One way that a behavior analyst might undermine the func-
tions within such a relation would be to contrive an exercise
that produces anxiety that is at the same time humorous and
playful. Szabo (2019)showedchildrenthattantrummedwhen
game rules were changed during ABA sessions a bowl of ice
and asked if they thought whether it would be painful to hold
their hand at the bottom of the bowl. Participants replied that
they thought it would be painful, and the experimenter then
said, “In a moment, I’m going to ask you to do that. What are
you feeling now?”The participants said that they felt nervous
and related it to the nervousness they felt when game rules
were changed and made more difficult. After this initial
equivalencing task, the participants were then asked to hold
a hand under the ice for as long as they could and instructed
“not to allow themselves to feel cold under any circum-
stances.”Participants were timed, and there was no immediate
feedback. Next, they were asked to draw a hamburger with all
the things they liked on it. Then they were asked if, in order to
be able to have this amazing burger, they would allow some-
one to put some broccoli on it, and they were asked to draw
this too. This exercise was debriefed and followed with a
second effort at holding a hand under the ice, except
this time the participants were instructed to be curious
and marvel at the sensation of being cold. Again, they
were timed, and the event was debriefed. In the second
instance, children held their hand in the ice for nearly
twice as long and said that it was fun. They were then
asked if they thought that sometimes things that they
were asked to do could be more difficult and scarier
than what they had done in the past, and more fun
too. The importance of the exercise was that it added
new context to the initial “anxiety–bad”relationina
functionally novel manner, thus transforming it from a
rigid relation to one that could be shaped, given the
right context.
Motivating Operations
The Task List (BACB, 2017, Content Area G-2) states that
behavior analysts define motivating operations and use them
in their daily practice to help maximize the effectiveness of
reinforcers for adaptive behaviors and minimize the potency
of reinforcers for maladaptive behaviors. Experimental research
has shown that stimuli involved in stimulus equivalence classes
can function as establishing stimuli, or “motivational
augmentals”that alter the function of delayed consequences
and immediately evoke overt behavior with respect to these
outcomes (Ju & Hayes, 2008). A BCBA making use of an
augmental with an athlete whose preparation is waning a few
weeks before a competition might say, “Can you imagine how
good it will feel to be at your best during the comp?”thereby
increasing the salience of the remote outcomes of participating
in athletic drills (Szabo et al., 2019).
Values work isone such example drawn from ACT. Values
are a particular variety of stimuli that verbally establish or
enhance the functions of other stimuli. Said in another way,
values can function as augmentals. For example, ABA prac-
titioners could help parents identify values (e.g., intimacy and
belonging) and then generate goals and objectives for treat-
ment based on those values (e.g., spending time playing with
their child each day). Each potential procedure could then be
examined in terms of not only how it might meet a particular
goal or objective but also how it serves the value. For exam-
ple, during the first stage of behavioral skills training (i.e.,
discussing the rationale of the procedure one is about to train)
for an extinction procedure for tantrums, an ABA practitioner
might describe how implementing extinction opens up the
possibility for intimacy and belonging. In addition, throughout
training, the ABA practitioner might return to this value (e.g.,
“This next part will be a really tough part of the intimacy
journey.”). Such an intervention could serve to improve en-
gagement in difficult extinction procedures, to the extent that
this transforms the aversive functions of implementing extinc-
tion. Put more simply, values interventions may function as
verbally mediated motivating operations, through the transfor-
mation of stimulus functions, due to the derived relational
responding involved. In addition, BCBAs might establish
themselves and the treatment setting as valuable through pairing,
because the reinforcing and motivating functions of values might
transfer to everything else present, including the treatment team.
In this way, the context of treatment might start to function as a
motivating operation for increased engagement in values-directed
behavior. A recent multiple-baseline study demonstrated, for ex-
ample, that the use of ACT procedures for increasing values
clarity was associated with increases in overt values-directed par-
ent behavior in parents of children with autism (Gould et al.,
2018). Importantly, in this study, gains were not only maintained
posttraining, but the greatest effects were observed more than 6
months posttraining.
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Self-Management
The Task List requires that behavior analysts know how to use
self-management procedures (BACB, 2017, Content Area
G-20). Skinner (1953) conceptualized self-management as in-
volving secondary repertoires of behavior that are acquired
and maintained because they help one’s normal ongoing be-
havior be successful (i.e., more likely to be reinforced). A
simple example is how the behavior of making a grocery list
increases the probability that the behavior of shopping will
result in reinforcement. Similarly, the behavior of using a
calendar at work increases the probability of engaging in the
behavior of showing up for meetings one is required to attend,
and therefore increases the probability of reinforcement. The
six repertoires of behavior that make up the ACT hexaflex can
usefully be considered six self-management skills, in that
strengthening each of them may help an individual be more
successful at obtaining long-term positive reinforcement, re-
ferred to as “values.”
Present moment training procedures can be used by ABA
practitioners to train individuals in the self-management be-
havior of noticing one’s own attending behavior. For example,
parents might be trained to tact when they are “here and now,”
versus when they are “in their heads,”in the context of man-
aging their child’s behavior. The rationale for this is that, if
parents are attending primarily to present moment stimuli
(their child’s behavior and their own behavior), they are going
to be more successful at implementing a behavior intervention
plan than if they are attending primarily to other stimuli (e.g.,
their own private verbal behavior about how hard it is). Such
training often starts with a less stressful and less effortful ap-
proximation, such as engaging in daily tasks with greater at-
tention to sensory stimuli, such as washing dishes while no-
ticing the temperature of the water, noticing the feeling of the
soap on the hands, noticing the sounds of the dishes colliding
with one another in the sink, and so on. The purpose of this
training is to alter actions of observation and labeling (i.e., the
behavior of attending) that augment or diminish stimulus con-
trol over other behaviors.
Szabo (2019) asked children who were preoccupied with
thoughts about games with difficult rules to walk quietly and
in sync with an experimenter, who alternately took large slow
steps, wide slow steps, tiny rapid steps, fast large steps, and so
on. Following this, participants were asked to continue to walk
in silence but to list all the smells, sounds, colors, and textures
that they came into contact with that they had not previously
noticed. In the debrief, participants were encouraged to list
times when this could be useful, including times when things
were uncomfortable for them in other respects. Later, they
practiced (a) noticing what they wanted to do the moment that
rules to their favorite games were made more difficult by their
instructor, (b) asking for a turn at changing the rules, and (c)
observing the outcome. In this experiment, the practice of
pausing and bringing attention to the present moment served
as a precursor to effective self-management. As an adjunct to
other direct contingency management procedures, this mind-
fulness strategy was effective at bringing learners’behavior
under relevant stimulus control.
The use of mindfulness methods to foster self-management
has been shown to be beneficial with populations commonly
served by behavior analysts. For example, mindfulness strat-
egies have been shown to help those with developmental dis-
abilities successfully maintain their community placement
(e.g., Singh et al., 2007), improve parent training outcomes
(Blackledge & Hayes, 2006), decrease challenging behavior
of adolescents with autism spectrum disorder (Brazeau et al.,
2017), and improve client affect after mindfulness training for
staff (Castro et al., 2016; Chancey et al., 2019).
The committed action components of ACTraining also fall
squarely under the category of self-management. Many com-
mitted action procedures train learners to state the behaviors
they intend to engage in, what particular value they are in the
service of, when they are going to engage in the behaviors,
how they are going to track the behaviors themselves, and
whom they are going to report to—for example, the
“Mindful Action Plan”worksheet (Moran, 2014). Stating
goals, self-monitoring progress toward goals, and reporting
on progress to others are key defining components of self-
management in classic ABA texts (Cooper et al., 2020).
Goal Setting
Setting socially meaningful behavior change goals is featured on
the Task List (BACB, 2017, Content Area F-3) and, when done
in collaboration with a client, is another well-documented pro-
cedure in behavior-analytic research to promote behavior
change. Controlled research has found that goal setting is more
powerful in producing actual behavior change when it is com-
bined with values work (Chase et al., 2013). If the function of
behavior that achieves treatment goals is centered around avoid-
ance, the BCBA may inadvertently strengthen an avoidant rep-
ertoire. For example, setting the goal of “my child always being
happy”might lead the parent to allow the child to continuously
engage in perseverative play or problematic self-stimulatory be-
havior, and avoid following through with skill development tar-
gets aimed at broadening the child’s play repertoire. In contrast,
the BCBA might promote and maintain adaptive, more flexible
repertoires of parent behavior by framing treatment goals in
terms of parent values. Teaching the child to play with a variety
of toys and games may initially evoke strong emotions and a
variety of avoidant behaviors on the part of the child. That said,
the parent may be willing to persevere with implementing the
treatment program if the BCBA frames the goal in terms of
expanding the child’s interests, finding more things he enjoys,
and giving him more choices with respect to how he spends his
time, ultimately leading to a richer, more joyful life. The BCBA
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might also frame the play goals in terms of fostering dignity by
teaching the child to interact appropriately with age-appropriate
toys and games, and connection to their community, by increas-
ing the child’s ability to interact with and share experiences with
others.
Client Preference and Social Validity
The Task List requires that behavior analysts recommend in-
tervention goals based on client preference and social validity
(BACB, 2017, Content Area H-3). Assessing a person’s indi-
vidual values always requires asking the person what matters
to him or her, which is the heart and soul of social validity
(Wolf, 1978). In addition, ACTraining work always involves
asking individuals to come up with their own committed ac-
tions, based on what they believe moves them toward their
values, which is again a clear example of building social va-
lidity assessment into the identification of the goals of
intervention.
Modeling
The Task List includes the use of modeling as a foundational
behavior-analytic procedure (BACB, 2017, Content Area
G-5). When incorporating ACT into daily ABA practice, be-
havior analysts should model flexible behavior when
interacting with others. Behavior analysts can model accep-
tance with respect to their own and others’difficult private
events that arise during the course of treatment. For example,
when introducing a new behavior intervention plan that
evokes distress and challenging behavior in the child (i.e.,
produces an extinction burst), the behavior analyst can model
acceptance, values, and committed action for staff by tacting
that discomfort and not escaping or avoiding. In doing so, the
behavior analyst might say something like
Honestly, this could be a really tough session. You don’t
need to feel like you have it all figured out. I’mactually
kind of apprehensive too. But I know that following
through for this learner is the best way we can work
toward a better future for him, so I’m doing it.
A BCBA might also model acceptance, values, and com-
mitted action when choosing to discuss difficult topics with a
parent, such as pursuing a conversation about the child’scur-
rent or future placement, prognosis, or treatment trajectory;
fulfillment of treatment hours; the parent’s treatment-
interfering behaviors; and so on. For example, the BCBA
might say,
It’s really important to me to maintain a good relation-
ship with you . . . and it is easier for me to avoid talking
about things that are difficult or tell you things that will
behardtohear...butbyavoidingfeelinguncomfort-
able or upsetting you, I would be choosing being com-
fortable, over fighting for you and Max’s future and
doing the best job I can for you both. So . . . even though
it is going to be really difficult I would like to talk to you
about [topic].
A behavior analyst can model defusion by tacting her pri-
vate experience when working with parents. For example, she
might say,
InoticeI’m having the thought that I’m not being very
helpful to you right now, and it’s getting in the way of
me actually listening and figuring this out with you.
Would it be OK if we pause for a second and start over?
Or a behavior analyst might smile humbly and say to a
parent during a complex conversation where they are not mak-
ing progress,
Hang on a second, my “Behavior Analyst Always Has
to Be Right”theme song is playing in my head again.
That’s probably not the most helpful thing right now.
Let’s see how we can compromise so we can make a
plan to move forward.
Using Single-Case Experimental Designs
ABA research and practice have always been concerned with
empirically evaluating the effectiveness of interventions (Baer
et al., 1968), and the use of single-case designs for this pur-
pose is codified in Content Area D-5 of the Task List (BACB,
2017). The need to carefully evaluate the effectiveness of
treatment is equally critical for ABA interventions that do or
do not incorporate ACT. The methods used to evaluate wheth-
er it was actually an ACT intervention that produced behavior
change are the same as those used for evaluating any other
ABA intervention component, and rely primarily on single-
case designs. At the very minimum, ABA practitioners look
for large and immediate changes from baseline to treatment
(Kazdin, 2011). For greater rigor, the practitioner might look
at the other clients in her caseload and replicate the evaluation
in a multiple-baseline across-clients design or employ some
other single-case experimental design strategy. Ideally, the
BCBA may attempt a component analysis to determine
whether individual ACT components were effective in bring-
ing about socially meaningful overt behavior change.
Behav Analysis Practice

Competently Managing Emotional Behavior
In the context of ABA procedures that incorporate ACT, cli-
ents’values-incongruent behaviors are discussed openly, and
clients are asked to approach difficult thoughts or feelings. At
these times, clients may sometimes engage in emotional be-
havior. Some BCBAs express concern that eliciting clients’
emotions could be construed as talk therapy, out of bounds for
a behavior analyst, and outside their scope of competence.
When young children with autism or adults with developmen-
tal disabilities react emotionally to behavioral programs,
BCBAs do not express the concern that they may be acting
outside their scope of practice or competence. The stance we
advocate for BCBAs practicing in ACT inside ABA is that
emotional behavior should be considered from both an oper-
ant and a respondent standpoint, for both typically developing
adults and individuals with developmental disabilities.
Although clients may display emotional behavior during
ACTraining, the approach that an ABA ACTrainer takes is
distinct from that of many psychotherapists. In the context of
emotional behavior, we recommend a behavior analyst show
empathy and then move forward with the ACTraining skills
that have been described in this article, which focus on estab-
lishing new self-management skills, rather than intentionally
emotionally evocative intrapersonal exploration that is more
common in psychotherapy. To illustrate the point, consider
the following dialogue, in the context of a hypothetical parent
training interaction between a BCBA and a parent, in which
the BCBA works on acceptance of aversive private events, as
well as implements a defusion procedure (i.e., “Sing Your
Thoughts”):
Behavior analyst (BA): It’s difficult. Jake screams and
curses at you. Then he ignores you for hours after
you’ve pushed him to work with you.
Parent (P): Ihateit.
BA: And your partner doesn’t follow your lead, so Jake
goes to him for affection, leaving you to be the “villain.”
P: (Tears up)
BA: What’s going on for you right now?
P: I feel like a bad mom.
BA: Can you say a little more about that?
P: It’s just, ever since Jake was diagnosed, that’sallI
ever say to myself. (Continues to tear up)ThatI’m a bad
mom.
BA: Sounds like this is very old for you. You’ve been
saying this to yourself for a long time.
P: Yeah, maybe since he was a baby and nothing
seemed to go right with him.
BA: (Choosing not to go deeper into the past) So, I
wonder if you’d be willing to try something rather un-
usual with me. Something very different.
P: (Sniffling) What do you mean?
BA: I sometimes get emotional when I think of the years
Iwastedbeforelearningtotakecareofmyself.Iwas
overweight and inactive. I get this thought “I’m a horri-
ble person for doing this to myself.”
P: Like my “Bad Mom.”
BA: Exactly.
P: So what do you do?
BA: Well, here’swhatI’d like you to try. This is what I
do, and like I said, it works for me, but I don’tknowifit
will work for you. I’d like you to try this.
P: What are we going to do?
BA: Tell me a song that you like. A song that really is
meaningful to you.
P: Um. How about “Piano Man”?
BA: By Billy Joel? OK. Excellent. Can you sing a few
bars for me?
P: (Reluctantly sings a few bars)
BA: (Joins her in a few bars)
P: (Smiling through her tears)OK.Nowwhat?
BA: Well, for me, the next bars I sing might go like this,
“Now Jen was a graduate student and thought,
‘I’ll eat, sleep, and drink when I please,’
But after 6 years, she was all beer and cheese,
And her doctorate was nowhere in sight . . .”
P: (Laughs with BA)
BA: So now I want you to try this thing. You know your
own refrain: “I’m a bad mom.”I’ll bet there’smorethat
comes with it.
P: Yeah, like it’s all my fault, even if I know it’snot.
And I’m cold, and Jake just puts up with me.
BA: I hear you. Thank you for trusting me enough to
share that with me. Can you now do this thing? Can you
sing “Piano Man”but with those words?
P: For real?
BA: Yes.
P: (Pauses, then sings)“Sing us a song, you’re the
world’s worstest mom, sing us a song tonight . . .”
(Tears up and smiles)“’Cause we’re all in the mood to
be laughing at you, and you’ve got it coming, don’t
you?”(Laughs through her tears)
BA: (Laughing with her and tearing up)Yes.That’sit.
What’s opening up for you now?
P: It’s like it still hurts . . .
BA: There’san“and”somewhere in there.
P: Yeah—and it’sOK.
BA: What’sOK?
P: Maybe I can be thinking all that and still . . . do things
that Jake doesn’t like if it means he might one day be
more able to be independent because I persevered.
BA: I love it. Now, in the name of the value you just took
a stand for, would you be willing to set a goal for action
over the next 45 minutes with Jake and some kind of
reinforcer you’ll give yourself for completing the task?
Behav Analysis Practice

P: Sure. How about I do 10 maintenance trials each of
two different programs that you’ve been working on
with Jake? Then maybe I’ll go for a 5-minute walk
around the block by myself to unwind?
BA: Sounds great. Let’sdoit.
Inside this brief dialogue, the behavior analyst used behav-
ioral skills training, first offering a rationale for the coming
exercise, modeling, and then providing practice, reinforce-
ment, and feedback. She allowed the parent to experience a
range of emotions that started with self-pity and worked
through sadness into humor and self-determination. The be-
havior analyst did not shy away from the emotion, nor did she
lean in to elicit more intense emotional responding.
Importantly, there was a moment when the parent wanted to
introspect further into the past and deeper into the content of
her verbal behavior about herself, and the behavior analyst did
not go in this direction. Instead, the behavior analyst
redirected the parent at that moment to an activity aimed at
transforming the function of these rigid self-statements.
An ACT-based psychotherapist may or may not have done
too much different, but the quality could have been more
intense or more emotionally evocative. A psychotherapist
might have asked questions regarding other contexts in which
“I’mbad”might be showing up, or further explored childhood
experiences that may have resulted in the parent learning the
“I’mbad”verbal repertoire. This would be quite helpful for a
client coming in for talk therapy about a general sense of
helplessness in her life, but inappropriate for a BCBA helping
a parent who feels helpless in her ability to implement behav-
ior intervention plans with her child. The BCBA’s role is
limited to that which the client has consented to and hired
the BCBA to work on—in this case, the context of aiding
the parent to implement her part of her child’s ABA treatment,
and this is where the therapist in the previous transcript started
and finished. When emotions were uncovered, the context
was shifted toward playful levity, creating a context for the
parent’s commitment to implement her child’sprogram.The
next step for the BCBA would be to establish contingencies of
reinforcement for this parent to follow through on her com-
mitment and a method of measuring her performance during
and after the session.
Was it necessary in the previous example to talk to the
mother about her negative thoughts and emotions, as opposed
to just instructing her to implement the behavior plan? When
might a BCBA choose to address negative thoughts and feel-
ings while practicing ACTraining? We suggest that BCBAs
only address particular private events if and when there is
some evidence that the client’s verbal behavior surrounding
those private events may be getting in the way of engaging in
socially important overt behavior. For example, when a
behavior analyst asks a parent why he did not implement
extinction, if the parent says, “Implementing extinction makes
me feel like a bad father,”then the words “bad father”might
be worth addressing, to show empathy and compassion for a
parent who is suffering, among other reasons. If, instead, the
parent expressed that he is “just too busy,”then ACTraining
might work on developing some flexibility around verbal be-
havior about being too busy. In short, ACTraining does not
necessitate addressing emotions just for their own sake.
Negative private events are addressed in the same situations
in which overt stimuli would be addressed: when there is
reason to believe they may be interfering with progress in
changing overt behavior.
A final note regarding private events warrants mention.
Human beings talk about thoughts and feelings, and behavior
analysts work with human beings. It is impossible to avoid
talking about thoughts and feelings, and if we try, we run the
risk of appearing cold and uncompassionate (Taylor, LeBlanc,
&Nosik,2018). If we do not use empirically derived
behavior-analytic procedures for talking about private events,
such as ACTraining, then we are left with nothing more than
what we have all learned from our culture to talk about
thoughts and feelings: mentalism. Therefore, ironically, the
harder behavior analysts try to avoid talking about the mind,
the more we may actually end up doing so mentalistically,
rather than behaviorally. The concepts and procedures of
ACTraining provide a behavior-analytic approach for
BCBAs to talk to others about private events when doing so
is in the service of socially meaningful overt behavior change.
Scope of Practice Versus Scope
of Competence
It is important to distinguish between scope of practice and
scope of competence (Brodhead, Quigley, & Wilczynski,
2018). Figure 1is a diagram that depicts the larger psycholog-
ical flexibility model that ACT comprises, as well as examples
of specific disciplines that practice either ACT within psycho-
therapy, on the left half of the diagram, or ACTraining, on the
right half of the diagram. Of course, the actual practices of the
hundreds of thousands of professionals across these disci-
plines do not fit perfectly into these categories, but we propose
that this diagram provides a useful framework for identifying
ACTraining inside of ABA and how it is related to but sepa-
rate from ACT as implemented inside psychotherapy across
many different disciplines.
We have been making the case in this article that
ACTraining methods fit within the behavioral conceptual sys-
tem and overlap substantively with the Task List and are there-
fore within the scope of practice of behavior analysts.
Behav Analysis Practice

However, just because ACTraining is within the professional
scope of practice of BCBAs, it does not mean it is within the
scope of competence of any particular BCBA. Similarly, both
ABA for young children with autism and performance man-
agement consulting to Fortune 500 companies are within the
scope of practice of behavior analysts, but if one has only had
trainingandmentorshipinone,thenoneiscertainlynot
competent to practice the other. ABA practitioners must seek
out specialized training and mentorship from competent
trainers in order to use any ABA procedure, including ACT.
The goal of BCBAs is the deployment of conceptually and
empirically sound methods of behavior change. Thus, the evo-
lution of the scope of practice of BCBAs has occurred, and
must continue to occur, with care and with the agreement and
involvement of the science and profession, in careful and re-
spectful interaction with other related professions.
ACTraining inside ABA must stand up to the criteria pro-
posed by Baer et al. (1968). The present discussion is not
designed to promote any particular future vision of the respon-
sible practice of BCBAs. Rather, the goal is to show that
ACTraining is already within the scope of practice of
BCBAs. Much further research and development are going
to be needed to determine the type and amount of training,
mentorship, and supervision that are required to produce ex-
cellent ACTraining performance inside of ABA. Of course,
the same is also still true of most other specialties within ABA.
Little or no research has been published that has demonstrated
the type, amount, and quality of training necessary, nor any
reliable outcome measure of competence, to produce a clini-
cian who is competent to implement experimental functional
analyses of severe behavior, treatment of feeding disorders, or
organizational behavior management consulting. In all of
these arenas, just as in ACTraining, when a practitioner ex-
pands into a new specialty, she must seek out extensive, high-
quality training, supervision, and mentorship, until she is
deemed competent to practice independently, ideally by
others who are already doing so. Of course, even after one is
competent to practice in any specialty, it is one’s ethical re-
sponsibility to seek out continued peer mentorship, supervi-
sion, and professional development.
When to Refer Out
The BACB Professional and Ethical Compliance Code for
Behavior Analysts (BACB, 2014) states that individual behav-
ior analysts practice only within their own scopes of compe-
tence (Section 1.02) and must refer clients to other providers
when the BCBA is not able to address client needs appropri-
ately (Section 2.03). Because ACT addresses problematic pri-
vate events, behavior analysts often, and properly, wonder
when it would be more appropriate to refer a client out for
the services of a licensed psychologist or other mental health
worker, versus implementing ACTraining inside of ABA ser-
vices herself. This article attempts to identify when and how
ACTraining is within the scope of practice of behavior ana-
lysts, and it is the duty of the individual behavior analyst to
identify her own scope of competence. When a behavior an-
alyst believes that a client demonstrates a need for ABA ser-
vices outside the BCBA’s scope of competence, the client
should be referred to another BCBA who possesses the nec-
essary area of competence. However, when the BCBA be-
lieves the client demonstrates the need for mental health ser-
vices (which are by definition outside the scope of practice of
BCBAs who are not also licensed in another mental health
profession), then the BCBA should refer the client to an ap-
propriate mental health professional. However, as we have
been discussing, this does not mean that the behavior analyst
needs to cease all contact with the client or refuse to discuss
private events. For example, a parent who is struggling with
depression, is receiving psychotherapy for depression, and
also has a child in an ABA program will likely still need to
participate in that child’s ABA program. A BCBA who incor-
porates ACTraining into the parent training approach may be
more effective in training that parent to implement the child’s
behavior plan, even though the BCBA is in no way treating
the parent’s depression. Using ACTraining, the behavior an-
alyst may help the client develop flexibility and values-
oriented behavior around the specific targets that are, indeed,
within the scope of ABA services.
The left column of Table 1lists examples of everyday chal-
lenges that are commonplace in the delivery of ABA services.
Fig. 1. Related but distinct
domains of practicing ACT as
psychotherapy versus ACT as
training, across multiple distinct
but related professions.
Behav Analysis Practice

The middle column lists overly simplified examples of how a
BCBA might use ACTraining to be more effective in her work,
still well within the scope of practice of ABA. The right column
lists overly simplified examples of how a clinical psychologist
might address these same challenges within the scope of his or
her practice. These examples are overly simplified for the pur-
poses of illustrating a discrimination; we do not in any way
suggest that all practitioners fall into one of these two simplistic
caricatures, nor do we suggest that we speak for all clinical
psychologists or BCBAs. In addition, a third group of practi-
tioners has largely not been addressed in this article, for the sake
of clarity and space, and they are similarly left out of this table:
specifically, practitioners who are both behavior analysts and
also licensed mental health professionals, who practice
behavior-analytic ACT as psychotherapy with their clients.
This distinction, too, is an important one, but a sufficient discus-
sion of this is beyond the scope of the current article.
Final Thoughts
We have attempted to provide both conceptual and practical
guidance on how ABA practitioners can begin to incorporate
ACT into their daily practice as behavior analysts. Naturally,
like any important distinction within professional practice, it is
unlikely that reading a single article will ensure appropriate
practice. Therefore, we offer six simple rules:
1. Understand the behavioral principles that undergird any
behavioral procedure used, including methods drawn
from ACT. That is, as behavior analysts, we must remain
conceptually systematic at all times in our practice.
2. Maintain an approach to treatment that fits your role as a
BCBA, including a focus on overt behavior change.
3. Seek consultation from experienced ABA practitioners
who understand the distinction between ACT as practiced
within ABA treatment settings and ACT as practiced in
other settings. Seek out appropriate training and mentor-
ship, including behavioral skills training that continues
until you demonstrate proficient implementation without
assistance.
4. Look for and be guided by empirical behavioral literature
in your application of ACT as a BCBA.
5. Empirically evaluate what you do, and reconsider imme-
diately if the data are not positive.
6. Know when to refer out. Incorporating the functional
analyses and procedures within ACT can enhance one’s
behavior-analytic practice, but it is not a panacea. Just as a
BCBA must know when to refer a client out when one is
not competent to solve a conventional problem of overt
behavior (e.g., feeding disorder, severe self-injurious be-
havior), one must be sensitive to when it is appropriate to
refer a client out when the client is struggling with private
events that are outside one’s scope of competence, regard-
less of whether one is trained in ACT.
In conclusion, we believe that the future of ACT within
ABA is a bright one. The rich and complex functional analy-
ses of verbal behavior and derived relations, along with the
implications these analyses have for helping clients make
Table 1. Practical Challenges Addressed from ACTraining Compared to Psychotherapy Perspectives
Trainee Presentation ABA Practitioner Psychotherapy Practitioner
A parent of a child with autism who is being trained
to manage the child’s behavior reports being
depressed.
Refer the parent to a clinical psychologist. If the
parent is still willing to participate in training, then
consider including ACT components in
behavioral skills training to help the parent engage
in overt behaviors while having negative feelings.
Assess the effectiveness by measuring changes in
overt parent implementation of behavior
management procedures.
Treat core symptoms of depression.
Measure effectiveness by assessing
depressive symptomology.
A BCBA is supervising a staff member, and the staff
member reports that distress over her marital strife
is getting in the way of her doing her job.
Refer the staff member to a psychologist for couples
therapy. Consider implementing ACT
components into behavioral supervision to train
the staff member in self-management strategies
for still engaging in excellent overt performance
while feeling distress.
Deliver couples therapy with the goal of
decreasing marital discord.
A BCBA is engaging an adolescent with autism in
social skills training, and the adolescent reports
that he feels like a loser because he has no friends.
Consider referring the adolescent to a clinical
psychologist for assessment for potential
depression if the reports continue. In the context of
social skills training, adapt ACT components to
help the adolescent learn new and variable rules
about himself in the context of social relations.
If the adolescent’snegativeaffectrisesto
the level of depression, treat the
adolescent for depression with
psychotherapy.
Behav Analysis Practice

meaningful overt behavior changes, have much to contribute
to the practice of ABA. As with any new area of growth within
the field, the dissemination of ACT within ABA will not be
without its bumps. However, by staying close to the philoso-
phy, principles, and procedures that comprise ABA, we be-
lieve that the gradual and careful adoption of ACT functional
analyses and treatment procedures within ABA will yield ben-
efits for behavior analysts and those whose lives we touch.
Author Note The authors would like to thank Drs. Evelyn Gould, Emily
Sandoz, Steven C. Hayes, and Courtney Tarbox for their contributions
throughout the manuscript.
Compliance with Ethical Standards
Conflict of interest The authors declare they have no conflict of interest.
Ethical approval The authors declare that this article did not involve
research with human subjects and therefore was not reviewed by a re-
search ethics committee.
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