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Pediatric Lifestyle Medicine
Published in James M. Rippe, Lifestyle Medicine, 2019
Jonathan R. Miller, Richard Boles, Stephen R. Daniels
Although functional contextualism per se has not been widely discussed in relation to lifestyle medicine, the impact of approaches aligned with this philosophy are well-documented. For example, patient adherence to recommendations is essential for effective intervention, as the behaviors needing to change typically occur outside of contexts where the provider directly interacts with the patient. In 2003, the World Health Organization (WHO) published a report on adherence to long-term therapies that, among other things, outlined patient-level interventions for improving adherence.28 The report stated that “the most effective adherence-enhancing interventions directed at patients aim to enhance self-regulation or self-management capabilities” and that “such approaches are grounded in basic principles of learning.” As such, we will review some of the fundamental principles developed within the functional contextual framework and highlight their relevance to behavior change in lifestyle medicine in hopes of informing readers’ perspectives when reading subsequent chapters of this section and when conducting lifestyle medicine.
Third-Generation Variants of CBT and CBAT
Published in Marcia L. Rosal, Cognitive-Behavioral Art Therapy, 2018
Hayes (2004) was adamant that psychologists and therapists need to understand that the philosophy of functional contextualism is what undergirds ACT. Functional contextualism has similar assumptions to constructivist ideas. From constructivism came a closer look at contextualizing treatment models as a way of furthering the understanding of human interactions and therapeutic agents of change. Thus all the concepts of ACT “need to be linked to context, defined both historically and situationally, because only contextual variables can be directly manipulated and lead directly to both prediction and influence” (Hayes, 2008, p. 288). In functional contextualism, an objective reality is unknowable, and as related to psychology, refers to the ability to predict and control human behavior (Flaxman, Blackledge, & Bond, 2011). It is also related to the functionality of ACT treatment concepts, which “all flow from the radical pragmatism of its underlying philosophy” (Hayes, 2008, p. 288). Functional contextualism is the foundation of what Levin and Hayes (2009) called contextual behavioral science (CBS), which is a holistic assessment of psychological events, and is fundamental to RFT.
Re-Visioning Cognitive Behavior Therapy for Cancer Patients
Published in Scott Temple, Brief Cognitive Behavior Therapy for Cancer Patients, 2017
More recently within the field of CBT, Hayes deepened the discussion of contextual versus more mechanistic accounts, with regards to language and change (Hayes,Villatte et al., 2011). Hayes’s work, in ACT and Relational Frame Theory, stated the claim that its account is rooted in Functional Contextualism, one of the many forms that contextualism can take (Hayes et al., 1993; Hayes, Villatte et al., 2011). This account is built on pragmatism, a behavioral account of language, and the idea that the truth value of a belief or of overt behaviors is to be found in its functions. And this leads to a foundational assumption in ACT, based on a variety of contextualism called Functional Contextualism: all behavior, internal and overt, can be understood in terms of whether it works in the context of supporting one’s objectives, including living in accordance with one’s cherished values. Detailed accounts of Functional Contextualism can be found elsewhere (Toerneke, 2010; Hayes et al., 2012; Hayes, Villatte et al., 2011). However, the pragmatic roots of this form of CBT bear similarities to William James (1890), for whom “the truth is what works” (Cormier, 2001). The arcane becomes practical.
A Pilot Randomized Controlled Trial (RCT) of Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Chronic Insomnia
Published in Behavioral Sleep Medicine, 2023
Renatha El Rafihi-Ferreira, Charles M Morin, Rosa Hasan, Israel S Brasil, José Humberto Zago Ribeiro, Andrea Cecília Toscanini
ACT-based therapies focus on value-based actions, prioritizing long-term goals, and expansion of behavioral and psychological flexibility. ACT is a functional contextualism approach for which the focal point is the function of behavior and thought or how the individual relates to thoughts, feelings, and behaviors (Collard, 2019; Hayes, 2008). ACT consists of multiple processes (acceptance, defusion, self as context, contact with the present moment, values, and committed action). These make up the Hexaflex that forms the psychological flexibility construct. In this study, we used a combination of these processes. However, we did not compare individual processes (i.e., dismantling trials), thus making it impossible to determine which of these processes or combination of processes were responsible for the insomnia improvement observed post-treatment and at the six-month follow-up.
From form to function: Values and committed action strengthen mindful practices with context and direction
Published in Journal of Sport Psychology in Action, 2019
Patrick Smith, Emily Leeming, Michelle Forman, Steven C Hayes
Acceptance and Commitment Training (or Therapy) (ACT) is based on a functional contextual philosophy of science and a theory of behavioral functioning termed the psychological flexibility model (Hayes, Strosahl, & Wilson, 2012). ACT is based on functional contextualism, a pragmatic philosophy of science focused on predicting and influencing behavioral events with both precision and scope of application, as well as depth across levels of analysis (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). As such, ACT is focused on functional outcomes. This is true in cognitive areas as well because ACT coaches and providers examine the functions of covert verbal processes based on a functional account of human language called Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001). RFT has shown that covert relational responses can influence the frequency of desired behaviors that are more or less in contact with the present context, and more or less able to contact valued outcomes. When covert relation processes become rigid in form they can significantly reduce an individual’s flexible contact with the present moment (Hayes, Barnes-Holmes, & Roche, 2001). For example, an athlete coached to “press through the pain regardless” may miss the sensations that indicate there has been an injury and thereby incur needless downtime. Actions that are emotionally avoidant, dominated by rigid rules, and share very little contact with present opportunities for values-based functions to be expressed in behavior are low in Psychological Flexibility (PF), and tend to become dysfunctional.
Sorting it out: a framework for increasing mental flexibility and valued action in athletes using the ACT matrix
Published in Journal of Sport Psychology in Action, 2019
James Schwabach, Jessica Bartley, Kevin Polk
ACT-based interventions including the Matrix use functional contextualism as a theoretical foundation, and include a multitude of exercises and metaphors that help the user increase mental flexibility and valued-action. These interventions help people behave in line with their values regardless of any unwanted thoughts or emotions that may show up. This can be achieved by working on the six processes that make up the foundation of ACT interventions, which include contact with the present moment, value identification, committed action, self as context, cognitive defusion, and acceptance (for a full description see Hayes et al., 1999). While many ACT exercises work on each of these skills separately, the ACT Matrix combines each process within one framework, allowing the user to intuitively and simultaneously gain practice within many elements of ACT (Schoendorff, Webster, & Polk, 2014). This is accomplished with a simple diagram and a willing user.