Multilevel cultural evolution: From new theory to practical applications.

Evolutionary science has led to many practical applications of genetic evolution but few practical uses of cultural evolution. This is because the entire study of evolution was gene centric for most of the 20th century, relegating the study and application of human cultural change to other disciplines. The formal study of human cultural evolution began in the 1970s and has matured to the point of deriving practical applications. We provide an overview of these developments and examples for the topic areas of complex systems science and engineering, economics and business, mental health and well-being, and global change efforts.

Acceptance and commitment therapy for psychosis: randomised controlled trial.

BACKGROUND: The efficacy of acceptance and commitment therapy (ACT) in psychosis has been reported but not for medication-resistant psychosis. AIMS: To test the efficacy of ACT in a sample of community-residing patients with persisting psychotic symptoms. (Australian New Zealand Clinical Trials Registry: ACTRN12608000210370.) METHOD: The primary outcome was overall mental state at post-therapy (Positive and Negative Syndrome Scale - total); secondary outcomes were psychotic symptom dimensions and functioning. In total, 96 patients were randomised to ACT (n = 49) or befriending (n = 47). Symptom, functioning and process measures were administered at baseline, post-therapy and 6 months later. RESULTS: There was no group difference on overall mental state. In secondary analyses the ACT group showed greater improvement in positive symptoms and hallucination distress at follow-up: Cohen's d = 0.52 (95% CI 0.07-0.98) and 0.65 (95% CI 0.24-1.06), respectively. CONCLUSIONS: Improvements reflected the treatment focus on positive symptoms; however, absence of process-measure changes suggests that the ACT intervention used did not manipulate targeted processes beyond befriending. Symptom-specific therapy refinements, improved investigation of process and attention to cognitive functioning and dose are warranted in future research.

Web-Based Self-Help for Preventing Mental Health Problems in Universities: Comparing Acceptance and Commitment Training to Mental Health Education.

OBJECTIVE: This study sought to test the feasibility of a web-based Acceptance and Commitment Training (ACT) prototype prevention program called ACT on College Life (ACT-CL). METHOD: A sample of 234 university students was randomized to either the ACT-CL website or a mental health education (MHE) website. RESULTS: Findings indicated a lower level of user engagement and satisfaction ratings with the prototype of ACT-CL than the MHE website. There were no significant differences between conditions on outcome measures at post or follow-up. However, statistical trends suggested the MHE condition actually led to greater remission of severe symptoms than the ACT-CL condition among those with severe symptoms at baseline. There were no differences between conditions on ACT process of change measures. Changes in psychological flexibility were predictive of changes in mental health across conditions, but relations dissipated over time. Furthermore, greater engagement in some components of ACT-CL predicted improvements in psychological flexibility, though not on mental health outcomes. CONCLUSIONS: The effects of the ACT-CL program on mental health outcomes and ACT process measures were largely equivalent to those of an education website, although there was a lower level of program engagement with ACT-CL. Findings are discussed in the context of feasibility issues and lessons learned for program revisions.

Examining the role of psychological inflexibility, perspective taking, and empathic concern in generalized prejudice.

Research to-date on generalized prejudice has focused primarily on personality factors. Further work is needed identifying manipulable variables that directly inform antiprejudice interventions. This study examined three such variables: empathic concern, perspective taking, and psychological inflexibility/flexibility with prejudiced thoughts, as a test of the flexible connectedness model. A sample of 604 undergraduate students completed online surveys. A model indicated prejudice measures loaded onto a latent variable of generalized prejudice. In a second model, psychological inflexibility, flexibility, empathic concern, and perspective taking were all significant, independent predictors of generalized prejudice. Psychological inflexibility also predicted prejudice above and beyond personality and general inflexibility variables. Results suggest the three components of the flexible connectedness model may be important targets for prejudice interventions.

The Origin and Evolution of the Behavior Analysis Program at the University of Nevada, Reno.

The origins of the Behavior Analysis program at the University of Nevada, Reno by way of a self-capitalized model through its transition to a more typical graduate program is described. Details of the original proposal to establish the program and the funding model are described. Some of the unusual features of the program executed in this way are discussed, along with problems engendered by the model. Also included is the diversification of faculty interests over time. The status of the program, now, after 25 years of operation, is presented.

Feasibility of an acceptance and commitment therapy adjunctive web-based program for counseling centers.

Web-based adjunctive tools provide a promising method for addressing the challenges college counseling centers face in meeting the mental health needs of students. The current study tested an initial adjunctive prototype based on acceptance and commitment therapy (ACT) in a pre-post open trial with 30 counselors and 82 student clients across 4 counseling centers. Results indicated high ratings of program satisfaction and usability with counselors and students. The majority of students completed at least part of the program. Significant improvements were found across almost all outcome and ACT process measures with student clients. Improvements in student outcomes were predicted by both changes in psychological inflexibility and how often counselors discussed the program with students. Results are discussed in relation to support for and future development of a flexible, adjunctive ACT program for counseling centers.

A randomised controlled trial of acceptance and commitment therapy (ACT) for psychosis: study protocol.

BACKGROUND: Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis. It is, however, a challenging therapy to deliver and, in the context of increasingly rigorous trials, recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes. Acceptance and commitment therapy shows promise as a briefer, more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis. The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms. METHODS/DESIGN: This is a single (rater)-blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition, Befriending. Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication. Following baseline assessment, participants are randomly allocated to treatment condition with blinded, post-treatment assessments conducted at the end of treatment and at 6 months follow-up. The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale. Secondary outcomes include preoccupation, conviction, distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales, as well as social functioning and service utilisation. The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required. The model of change underpinning ACT will be tested using mediation analyses. DISCUSSION: This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis with an active comparison condition. The rigor of the design will provide an important test of its action and efficacy in this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12608000210370. Date registered: 18 April 2008.

Stigma predicts residential treatment length for substance use disorder.

BACKGROUND: Stigma has been suggested as a possible contributor to the high rates of treatment attrition in substance-dependent individuals, but no published empirical studies have examined this association. OBJECTIVES: The present paper assessed the relationship between baseline stigma variables and length of treatment stay in a sample of patients in a residential addictions treatment unit. METHODS: The relationship between baseline stigma variables (self-stigma, enacted stigma, and shame) and length of stay for participants (n=103) in a residential addictions treatment unit was examined. RESULTS: Higher self-stigma predicted longer stay in residential addictions treatment, even after controlling for age, marital status, race, overall mental health, social support, enacted stigma, and internalized shame. However, other stigma variables (i.e. internalized shame, stigma-related rejection) did not reliably predict length of treatment stay. CONCLUSION: These results are consistent with other findings suggesting that people with higher self-stigma may have a lowered sense of self-efficacy and heightened fear of being stigmatized and therefore retreat into more protected settings such as residential treatment, potentially resulting in higher treatment costs. Specialized clinical interventions may be necessary to help participants cope with reduced self-efficacy and fear of being stigmatized.

Evolving the future: toward a science of intentional change.

Humans possess great capacity for behavioral and cultural change, but our ability to manage change is still limited. This article has two major objectives: first, to sketch a basic science of intentional change centered on evolution; second, to provide examples of intentional behavioral and cultural change from the applied behavioral sciences, which are largely unknown to the basic sciences community. All species have evolved mechanisms of phenotypic plasticity that enable them to respond adaptively to their environments. Some mechanisms of phenotypic plasticity count as evolutionary processes in their own right. The human capacity for symbolic thought provides an inheritance system having the same kind of combinatorial diversity as does genetic recombination and antibody formation. Taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to one another. The applied behavioral sciences include well-validated examples of successfully managing behavioral and cultural change at scales ranging from individuals to small groups to large populations. However, these examples are largely unknown beyond their disciplinary boundaries, for lack of a unifying theoretical framework. Viewed from an evolutionary perspective, they are examples of managing evolved mechanisms of phenotypic plasticity, including open-ended processes of variation and selection. Once the many branches of the basic and applied behavioral sciences become conceptually unified, we are closer to a science of intentional change than one might think.

Psychological flexibility and cognitive-affective processes in young adults' daily lives.

Psychological flexibility plays a crucial role in how young adults adapt to their evolving cognitive and emotional landscapes. Our study investigated a core aspect of psychological flexibility in young adults: adaptive variability and maladaptive rigidity in the capacity for behavior change. We examined the interplay of these elements with cognitive-affective processes within a dynamic network, uncovering their manifestation in everyday life. Through an Ecological Momentary Assessment design, we collected intensive longitudinal data over 3 weeks from 114 young adults ages 19 to 32. Using a dynamic network approach, we assessed the temporal dynamics and individual variability in flexibility in relation to cognitive-affective processes in this sample. Rigidity exhibited the strongest directed association with other variables in the temporal network as well as highest strength centrality, demonstrating particularly strong associations to other variables in the contemporaneous network. In conclusion, the results of this study suggest that rigidity in young adults is associated with negative affect and cognitions at the same time point and the immediate future.

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse.

INTRODUCTION: An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST). METHODS: Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; 9 2-hr group and 6 50-min individual sessions) or ST (N = 22; 6 90-min group and 1 20-min individual session), plus 8 weeks of transdermal nicotine patch. RESULTS: At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium- to large-effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small- to medium-effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses. CONCLUSIONS: Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.

A biphasic relational approach to the evolution of human consciousness: Un enfoque relacional bifásico para la evolución de la conciencia humana.

Background/objective: Human consciousness is arguably unique, and its features are hard to explain. Continuous and discrete accounts of consciousness are commonly viewed as incompatible, but both have limitations. Continuous accounts cannot readily account for what appears to be unique about human consciousness; discrete accounts have a hard time explaining how human consciousness could have evolved. The present position paper shows how both continuous and discontinuously elements can be combined. Method: A biphasic model is constructed by unifying complex systems theory, the evolution of symbolic reasoning as a relational extension of human cooperation, and evolutionary science. The application of this approach to modern views of consciousness is then explored. Results: Our analysis suggests that human consciousness may be viewed as a discontinuous event, that emerged from continuous foundations. This biphasic account contains processes that can be targeted clinically. For example, developmentally delayed children with problems in consciousness may be helped by targeting the processes the present account suggests are important at different levels of complexity. Conclusions: This biphasic relational approach fits with the evolutionary record and with data on human cognitive development. It may be useful in guiding clinical intervention.

The Idionomic Future of Cognitive Behavioral Therapy: What Stands Out From Criticisms of ACT Development.

The present special section critical of Acceptance and Commitment Therapy or Training (ACT in either case) and its basis in psychological flexibility, relational frame theory, functional contextualism, and contextual behavioral science (CBS) contains both worthwhile criticisms and fundamental misunderstandings. Noting the important historical role that behavior analysis has played in the cognitive behavioral therapy (CBT) tradition, we argue that CBS as a modern face of behavior analytic thinking has a potentially important positive role to play in CBT going forward. We clarify functional contextualism and its link to ethical behavior, attempting to clear up misunderstandings that could seriously undermine genuine scientific conversations. We then examine the limits of using syndromes and protocols as a basis for further developing models and methods; the role of measurement and processes of change in driving progress toward more personalized interventions; how pragmatically useful concepts can help basic science inform practice; how both small- and large-scale studies can contribute to scientific progress; and how all these strands can be pulled together to benefit humanity. In each area, we argue that further progress will require major modifications in our traditional approaches to such areas as psychometrics, the conduct of randomized trials, the analysis of findings using traditional normative statistics, and the use of data from diverse cultures and marginalized populations. There have been multiple generational shifts in our field's history, and a similar shift appears to be taking place once again.

An Open-Source Relational Network Derivation Script in R for Modeling and Visualizing Complex Behavior for Scientists and Practitioners.

Relational models of cognition provide parsimonious and actionable models of generative behavior witnessed in humans. They also inform many current computational analogs of cognition including Deep Neural Networks, Reinforcement Learning algorithms, Self-Organizing Maps, as well as blended architectures that are outperforming traditional semantic models. The black box nature of these computer models artificially limits scientific and applied progress and human computer interaction. This paper presents a first in the field attempt to model relational processes using logical derivation scripts and network graph visualizations written in the open-source R language. These tools are presented as a way for researchers and practitioners to begin to explore more complex relational models in a manner that can advance the theory and empirical science, as well as prepare the field for future collaborations with advanced computational models of cognition.

A process-based approach to cognitive behavioral therapy: A theory-based case illustration.

Despite the significant contribution of cognitive-behavioral therapy to effective treatment options for specific syndromes, treatment progress has been stagnating, with response rates plateauing over the past several years. This stagnation has led clinical researchers to call for an approach that instead focuses on processes of change and the individual in their particular context. Process-based therapy (PBT) is a general approach representing a model of models, grounded in evolution science, with an emphasis on idiographic methods, network models of case conceptualization, and enhancing wellbeing. In this paper, we describe the theory underlying PBT and present a case study for how to apply PBT tools and principles to deliver process-informed and person-centered evidence-based treatment. In addition, we discuss lessons learned from our case and provide suggestions for future considerations when implementing PBT in clinical settings.

What the Body Reveals about Lay Knowledge of Psychological Flexibility.

The embodied knowledge of psychological flexibility processes was tested by examining the ability of raters to score whole body pictures based on the degree to which they were open, aware, and engaged. Participants' best and worst physical posture was photographed when asked to think of a difficult psychological matter. Naïve and untrained raters (n = 16) showed excellent reliability while rating the postures of 82 persons from the general population in Reno and Chicago in the USA and recent Iranian immigrants in the Maryland/DC area. Participants showed embodied knowledge of psychological flexibility concepts across all three locations (though significantly less among those recently from Iran). Thus, experience alone appears to teach people that psychological flexibility is helpful, even if they are unable to express this knowledge in words. Implications for psychotherapeutic work is considered.

Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement.

The wide variety of "third wave" cognitive behavioral therapy (CBT) methods (e.g., Acceptance and Commitment Therapy or "ACT", Compassion Focused Therapy, Meta-Cognitive therapy, Functional Analytic Therapy, Dialectic Behavior Therapy, Mindfulness-Based Cognitive Therapy) have left a mark on the field that appears to be growing. As ACT enters its 40th year, the present paper examines key features of its development strategy as a ground from which to consider the future of CBT and evidence-based therapy. We discuss four key features of ACT development: universalism, multi-level and multi-dimensional processes linked to basic principles, idiographic concepts and methods, and an evolutionary approach. We argue that these features have facilitated the development of Process-Based Therapy (PBT) and its Extended Evolutionary Meta-Model (EEMM) of processes of change, but that idiographic methods need special contemporary emphasis, because traditional methodological and statistical approaches to processes of change are based on mathematical assumptions that cannot be met and thus limit progress in this area. We argue we need to target multi-level, multi-dimensional biopsychosocial processes of change evaluated via a functional, idionomic approach that begins with frequent idiographic assessment, and then scales to nomothetic (group level) findings when it improves idiographic fit. To identify candidate processes of change, we review the world's literature on mediational findings of randomized trials of psychological interventions for mental health outcomes. After examining nearly 55,000 studies, we identify 72 measures that have successfully mediated intervention outcomes and have been replicated. The EEMM can readily summarize and understand that set of findings, and idionomic statistical methods are available to turn these processes into a new empirical form of functional analysis applicable to the individual's goals and needs. PBT frees intervention science from the unhelpful latent disease model and creates an approach that promises more rapid progress toward a unified, personalized science of human improvement.

Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies.

A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term "contextual cognitive behavioral therapy" to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.

Murray Sidman: fostering progress through foundational choices.

The contributions of Murray Sidman to the field of behavior analysis have helped to put the field on a progressive path. In this paper we describe three areas as examples, drawn from the larger set of his notable contributions: the analysis of stimulus equivalence in a way that has fostered a behavior-analytic approach to derived stimulus relations and symbolic meaning; the observation and measurement of individual behavior through time; and his stance against punitive applied methods. In each of these areas Sidman was a dedicated behaviorist, avoiding appeals to mentalistic or transcendental forces, opposing hypothetical mediational accounts, and taking a functional and contextual approach. Clarity of assumptions was at the heart of Sidman's effective scientific practices and there is no reason to think that those same assumptions will not carry us further, as evidence mounts in support of these views on psychological research and practice.

"Third-wave" cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry.

For decades, cognitive and behavioral therapies (CBTs) have been tested in randomized controlled trials for specific psychiatric syndromes that were assumed to represent expressions of latent diseases. Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies, further advancement in efficacy and dissemination has been inhibited by a failure to focus on processes of change. This picture appears now to be evolving, due both to a collapse of the idea that mental disorders can be classified into distinct, discrete categories, and to the more central attention given to processes of change in newer, so-called "third-wave" CBTs. Here we review the context for this historic progress and evaluate the impact of these newer methods and models, not as protocols for treating syndromes, but as ways of targeting an expanded range of processes of change. Five key features of "third-wave" therapies are underlined: a focus on context and function; the view that new models and methods should build on other strands of CBT; a focus on broad and flexible repertoires vs. an approach to signs and symptoms; applying processes to the clinician, not just the client; and expanding into more complex issues historically more characteristic of humanistic, existential, analytic, or system-oriented approaches. We argue that these newer methods can be considered in the context of an idiographic approach to process-based functional analysis. Psychological processes of change can be organized into six dimensions: cognition, affect, attention, self, motivation and overt behavior. Several important processes of change combine two or more of these dimensions. Tailoring intervention strategies to target the appropriate processes in a given individual would be a major advance in psychiatry and an important step toward precision mental health care.