Values in Modern Clinical Behavior Analysis

In Search of Meaning: Values in Modern Clinical Behavior Analysis | Free full-text PMC article

One of the distinguishing features of human behavior, compared to that of other species, is the extent to which our lives are influenced by values and purpose.

This uniqueness is based on the fact that, unlike other species, we engage in verbal behavior.

Acceptance and commitment therapy (ACT) provides a theory for values and values-based action, based on basic behavioral principles and grounded in a functional analytic theory of language and cognition that we believe provides a strong foundation for creating flexible assessment and intervention strategies related to personal values.  

Values, within the ACT approach, are defined as

“freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself”
(Wilson & Dufrene, 2009).

In the current paper we will explain the basic theory underlying this definition and situate values within the ACT model of psychotherapy.


In psychology, the idea of human values and their importance is associated primarily with the humanistic movement, according to which people are motivated by psychological growth and self-direction and ultimately strive for the fullest realization or actualization of their human potential.

Rogers (1964) distinguished between conceived values (verbal expressions of preference) and operative values (actual behavior) and suggested that much of human suffering resulted from discrepancies between these two,

intention of guiding clients to live more congruently with their conceptualized values and hence live more fulfilling and psychologically healthy lives

Recent outgrowths of the humanistic movement have become more empirically oriented.

Motivational interviewing (MI; Miller, 1983), for instance, is a modern humanistic approach with a Rogerian focus on values–behavior consistency that has accumulated a good deal of empirical evidence in its favor as a treatment and as an adjunct to increase the effectiveness of other cognitive behavioral methods

Sheldon et al. have provided evidence to link chronic (or lifelong) goal striving with psychological health

Contrasted with goal striving is working narrowly to achieve specific, concrete goals, particularly ones motivated by avoidance

Sheldon’s data indicate that healthy behavior patterns are associated with overarching goals (or values), and that consistent pursuit of positive reinforcers may be better for long-term psychological and physical health than consistent patterns of avoidance.


Traditionally (although there is great variation among CBT therapies), these therapies have been designed to treat sets of symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), and many psychological treatments have focused primarily on ameliorating symptoms

For example, treatment for depression has focused on alleviating feelings of depression by reducing automatic thoughts (e.g., Beck, Rush, Shaw, & Emery, 1979), and treatment for phobias has focused on exposing clients to feared stimuli until the fear response does not occur

However, one feature of these diagnoses and psychological problems has remained largely overlooked as CBT has become increasingly refined; that feature is negative impact on quality of life.

To be diagnosed as a psychological disorder, a problem must cause an individual some functional impairment or clinically significant distress.

However, the presence of significant psychological distress or impairment also invariably influences the person’s ability to live a fulfilling life.

Some CBT practitioners focus only on amelioration of symptoms,

the predominant philosophical perspective in traditional CBT (based on the cognitive model established by Beck et al., 1979) has been hypothetico-deductive cognitivism, a mechanistic approach whose underlying truth criterion is predictive verification.

Hypothetico-deductive cognitivism models specific aspects of the normal functioning of the human mind and makes predictions on this basis regarding future behavior.

However, the predictive truth criterion that characterizes this approach does not lend itself easily to practical application; hence, there is a disconnection between cognitive theory and practical application (e.g., CBT)

even those theories that have been relatively successful in traditional CBT (e.g., Beck et al., 1979) have been specific in their scope and have tended to deemphasize aspects of context, such as overarching values.

Thus, traditional CBT does not lend itself readily to interventions to change behavior relevant to values, or even to measure such behavior.

ACT, in contrast, although situated in the larger tradition of CBT, has its roots in an alternative set of philosophical assumptions that do allow both intervention and measurement of values-relevant behavior.

ACT is closely linked to Relational Frame Theory (RFT), which is a behavior-analytic approach to language and cognition. Behavior analysis itself is rooted in the philosophical assumptions of functional contextualism, a form of scientific pragmatism in which truth is defined by the successful achievement of prediction and influence within the analytic domain


ACT is rooted in behavior analysis, which provides an empirically well-grounded and practically oriented system for prediction and influence of behavior, including value-relevant behavior.

with respect to the context of nonverbal animal behavior, the term might be emitted in the presence of operant reinforcement, especially the establishing operation (EO; e.g., Michael, 1982) in which the actual reinforcing effect of a particular reinforcer is manipulated

The classic example of an EO in the behavioral laboratory is food deprivation, which might be said to increase the reinforcing power or, to lay observers, the value of food.

Although human values involve an increase in complexity, the idea of the EO is still relevant because when someone says that he or she values someone or something, that statement refers to the effectiveness of that person or thing as a reinforcer for their behavior.

According to Zettle and Hayes (1982), there are two types of augmental rules, formative and motivative

  1. Formative augmental rules establish a stimulus as reinforcing or punishing. For example, the statement “These tickets are worth money” establishes the tickets to which it refers as reinforcing or valuable
  2. Motivative augmental rules temporarily alter the effectiveness of a previously established consequence. For example, the realization that “I love my job” may, at least temporarily, make job-relevant activity even more reinforcing than before.

There is now established empirical support for both these forms of augmental rule following.

RFT, which explains verbal behavior, including augmental rule following, as a form of operant behavior and thus acts as a critical theoretical link to explain the exact difference between nonverbal and verbal forms of the EO. In what follows, RFT will be briefly outlined before we consider the ACT-RFT definition of values in detail.

Relational Frame Theory

From the RFT perspective, augmentals and other forms of rule following are forms of verbal behavior or, in RFT terms, arbitrarily applicable relational responding

This concept is explained as follows. Many species can be trained to respond to physical relations between objects, for example, picking the biggest object from an array

However, extensive empirical evidence suggests that language-able humans uniquely can show an additional type of relational responding in which they relate stimuli not based on physical relations alone but based at least to some extent on contextual cues that determine which relation is appropriate.

According to RFT, learning language is based on learning many different patterns of arbitrarily applicable relational responding or relational frames.

Examples include

  • sameness (e.g., “One plus one is equal to two”),
  • opposition (e.g., “Big is the opposite of small”),
  • difference (“A boat is different than a ship”),
  • comparison (e.g., “An elephant is bigger than a mouse”), and
  • perspective taking (e.g., “I am here, but you are there”).

There is an increasing quantity of empirical support for the existence of these and other frames

All relational frames involve three defining features:

  1. mutual entailment,
  2. combinatorial entailment, and
  3. transformation of functions.

Mutual entailment refers to the fact that a relation in one direction between two objects entails or automatically gives rise to a second relation in the opposite direction. For example, if X is greater than Y, then Y is less than X.

Combinatorial entailment is the phenomenon in which two relations are combined to form a third relation. For example, if X > Y and Y > Z, then X > Z and Z < X.

Transformation of stimulus functions is extremely important in relation to the psychological relevance of relational framing because, from an RFT perspective, it is the process according to which language can control our behavior by changing the psychological functions of events in our environment

According to RFT, relational framing, including the transformation of functions of environmental events, is the key process involved in human verbal behavior


ACT-RFT defines values in accordance with theoretical predictions of the form of responding likely to produce optimal psychological outcomes

Values are

“freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself”

The phrase “freely chosen” should also function to indicate that values should not be based on pliance, which is rule-governed behavior in which rule following is under socially mediated consequential control; it can be understood colloquially as obeying a rule in order to please or impress another person.

One of the distinctions made in the ACT clinical environment is between goals and values.

  • Values are hierarchically related to goals, but
  • unlike goals, values can never be fulfilled, satisfied, or completed.

Instead, values are conceptualized as giving an individual’s responding a kind of purpose or direction in each instance of behavior

Values are freely chosen, verbally constructed consequences of “ongoing dynamic patterns of action.”

Values in the ACT Clinical Arena

Unique to the ACT model of psychopathology, however, is the identification of psychological inflexibility as a key barrier to engaging in values-consistent behavior.

Psychological inflexibility is a pattern in which behavior is controlled by verbal contingencies to such an extent that effective environmental control is reduced

ACT sees value–behavior consistency as key to psychological health

ACT tackles psychological inflexibility in two key ways

  1. On the one hand, it fosters mindfulness processes, including acceptance and contact with the present moment (actively contacting both internal and external stimuli, respectively, without attempting to alter their form or frequency) so that the client can learn to respond to private and public experiences without avoidance
  2. The other key component of ACT is commitment to values.

Clinically, clients are encouraged to examine what matters to them in several different life domains

it is not the therapist’s purpose to influence which values a client endorses, but rather to help him or her contact naturally occurring reinforcement for living consistent with his or her chosen values, whatever they may be.

Values clarification is therefore considered to be an important process that continues throughout therapy.

Committed action is the logical extension of values, wherein clients and clinicians work together to foster larger and larger patterns of values-directed behavior, and clients practice being open to contacting reinforcement for engaging in these patterns of behavior via mindfulness skills (e.g., acceptance, defusion, contact with the present moment)

Because ACT is a behavior therapy, any technique for increasing desired behaviors can be employed here, as long as it serves the function of increasing values-based behavior

An important feature of committed action is flexible persistence. This refers to a pattern of consistently monitoring one’s progression toward a chosen value and deciding at particular choice points whether

(a) to change the form of behavior or goals when reinforcement wanes or is particularly infrequent or

(b) to persist in values-relevant behaviors even if psychological and external barriers arise.

Choosing between persistence and changing course should ideally be based on a careful functional analysis of one’s own behavior and the overall effectiveness of either behavioral course with respect to stated values and goals.

Citing the theoretical rationale that values provide the context in which acceptance is possible (one does not typically accept discomfort simply for its own merit), assessing the additive impact of personal values to an acceptance intervention for a distressing task is the logical next step.

As such, researchers have begun to examine the combined effectiveness of values plus acceptance in engaging in experimentally induced discomfort

Measures of values-consistent behavior have thus far been assessed by self-report in the clinical domain

However, self-report measures have several potential limitations for research, including demand characteristics, social desirability, and respondents’ lack of understanding of the constructs being assessed

Particularly relevant from the current perspective, there is promising evidence that targeting values in ACT interventions can increase quality of life, and as such, attention to values may generalize to areas of functioning other than those directly targeted by the intervention.

Taken together, the evidence suggests that personal values is an important area of clinical behavior analysis, and focusing on values in interventions can increase quality of life, decrease suffering, and create a sense of meaning and purpose that may persist long after a client concludes therapy.

Valuing Outside the Box: Increasing Well-Being on a Larger Scale

Of note is a recent shift away from the study of ACT interventions in populations who struggle with a psychological or physical health problem toward a more positive approach, wherein ACT is being applied in areas such as the business world, public school education, and substance abuse counseling in an effort to improve performance and increase overall quality in these environments

ongoing research is examining the application of ACT processes to prevent health problems, reduce smoking and alcohol consumption in youth, and increase safety behaviors on a societal level


ACT conceptualizes values as key not only to the treatment of psychopathology but to the optimization of performance and well-being more generally.  


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