The Dynamics of Disease: Toward a Processual Theory of Health.

The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the semantic content of the terms "health" and "disease." In the first section, four meta-theoretical assumptions of the traditional debate are identified and alternative approaches to the problems are presented. Afterwards, the view that health and disease are constituted by a dynamic relation between demands imposed on an organism and individual presuppositions for adequate response is developed. In the last section, the paper takes stock of three possible objections to and clarifies some implications of this approach to the notions of health and disease.

Sex contextualism in laboratory research: Enhancing rigor and precision in the study of sex-related variables.

Understanding sex-related variation in health and illness requires rigorous and precise approaches to revealing underlying mechanisms. A first step is to recognize that sex is not in and of itself a causal mechanism; rather, it is a classification system comprising a set of categories, usually assigned according to a range of varying traits. Moving beyond sex as a system of classification to working with concrete and measurable sex-related variables is necessary for precision. Whether and how these sex-related variables matter-and what patterns of difference they contribute to-will vary in context-specific ways. Second, when researchers incorporate these sex-related variables into research designs, rigorous analytical methods are needed to allow strongly supported conclusions. Third, the interpretation and reporting of sex-related variation require care to ensure that basic and preclinical research advance health equity for all.

Considering hormones as sex- and gender-related factors in biomedical research: Challenging false dichotomies and embracing complexity.

The inclusion of sex and gender considerations in biomedicine has been increasing in light of calls from research and funding agencies, governmental bodies, and advocacy groups to direct research attention to these issues. Although the inclusion of both female and male participants is often an important element, overreliance on a female-male binary tends to oversimplify the interactions between sex- and gender-related factors and health, and runs a risk of being influenced by cultural stereotypes about sex and gender. When biomedical researchers are examining how hormones associated with gender and sex may influence pathways of interest, it is of crucial importance to approach this work with a critical lens on the rhetoric used, and in ways that acknowledge the complexity of hormone physiology. Here, we document the ways in which discourses around sex, gender and hormones shape our scientific thinking and practice in biomedical research, and review how the existing scientific knowledge about hormones reflects a complex and dynamic reality that is often not reflected outside of specialist niches of hormone biology. Where biomedical scientists take up sex- and gender-associated hormones as a way of addressing sex and gender considerations, it is valuable for us to bring a critical lens to the rhetoric and discourses used, to employ a sex contextualist approach in designing experimentation, and be rigorous and reflexive about the approaches used in analysis and interpretation of data. These strategies will allow us to design experimentation that goes beyond binaries, and grapples more directly with the material intricacies of sex, gender, and hormones.

Mental Causation and Motivation: The Motivational Congruence Theory's Perspective.

Mental causation is a deep-rooted debate in the philosophy and psychology literature. It relates to the causal role of mind on the physical world and is tightly linked with the Descartes' dualistic approach towards mind-body interaction. While the role of mental properties might seem obvious in our everyday interaction with the world, there are many arguments that make mental causation inefficacious or redundant within the physical world. In the motivation literature, the issue of mental causation is pivotal. It substantiates the causal role of intrinsic motivation on human behavior. However, the main theoretical streams in the motivation literature take a dualistic approach by dichotomizing different types of motivation into extrinsic and intrinsic ones. This creates a fundamental challenge on the possibility of mental causation in the relationship between motivation and behavior. The three main theoretical streams in the motivation literature consider intrinsic and extrinsic motivations as distinct and independent types of motivation and give a higher weight to one type over the other. This approach makes the role of intrinsic motivation as a mental factor on behavior difficult to interpret. Motivational congruence theory resolves this issue by taking a contextualist and dialectical stance on the relationship between intrinsic motivation, extrinsic motivation, and the context. In a dynamic interaction with each other and the context, the two distinct yet intertwined types of motivation (i.e., intrinsic and extrinsic ones) produce overall motivation which in turn induces behavior. The theory resolves the issue of mental causation both at the surface and deep levels.

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.

Rediscovering Interpersonal Punctuation.

The term punctuation in psychotherapy refers to narrative decisions about when a problem started and who should be held accountable for it. The concept was once a staple of family and systems therapies, but it has largely fallen into disuse. Its near disappearance coincided with the declining interest in those therapeutic approaches rather than as the result of direct attacks on the concept's validity or usefulness. In other words, punctuation seems to have been neglected rather than deliberately abandoned or supplanted. The authors argue for the continuing value of punctuation and its introduction to a new generation of clinicians. They also discuss several theoretical issues that were not well explored during the heyday of punctuation's popularity. Finally, the authors explore and illustrate the practical utility of punctuation in psychotherapeutic contexts.

Paradox and context shift.

The Liar sentence L, which reads 'L is not true', can be used to produce an apparently valid argument proving that L is not true and that L is true. There has been increasing recognition of the appeal of contextualist solutions to the Liar paradox. Contextualist accounts hold that some step in the reasoning induces a context shift that causes the apparently contradictory claims to occur at different contexts. Attempts at identifying the most promising contextualist account often rely on timing arguments, which seek to isolate a step at which the context cannot be claimed to have shifted or must have shifted. The literature contains a number of timing arguments that draw incompatible conclusions about the location of the context shift. I argue that no existing timing arguments succeed. An alternative strategy for assessing contextualist accounts evaluates the plausibility of their explanations of why the context shifts. However, even this strategy yields no clear verdict about which contextualist account is the most promising. I conclude that there are some grounds for optimism and for pessimism about the potential to adequately motivate contextualism.

Functional contextual implementation of an evolutionary, entropy-based, and embodied free energy framework: Utilizing Lagrangian mechanics and evolutionary game theory's truth vs. fitness test of the veridicality of phenomenological experience.

The Bayesian approach of cognitive science largely takes the position that evolution drives perception to produce precepts that are veridical. However, some efforts utilizing evolutionary game theory simulations have shown that perception is more likely based on a fitness function, which promotes survival rather than promoting perceptual truth about the environment. Although these findings do not correspond well with the standard Bayesian approach to cognition, they may correspond with a behavioral functional contextual approach that is ontologically neutral (a-ontological). This approach, formalized through a post-Skinnerian account of behaviorism called relational frame theory (RFT), can, in fact, be shown to correspond well with an evolutionary fitness function, whereby contextual functions form that corresponds to a fitness function interface of the world. This fitness interface approach therefore may help provide a mathematical description for a functional contextual interface of phenomenological experience. Furthermore, this more broadly fits with a neurological active inference approach based on the free-energy principle (FEP) and more broadly with Lagrangian mechanics. These assumptions of how fitness beats truth (FBT) and FEP correspond to RFT are then discussed within a broader multidimensional and evolutionary framework called the extended evolutionary meta-model (EEMM) that has emerged out of the functional contextual behavioral science literature to incorporate principles of cognition, neurobiology, behaviorism, and evolution and are discussed in the context of a novel RFT framework called "Neurobiological and Natural Selection Relational Frame Theory" (N-frame). This framework mathematically connects RFT to FBT, FEP, and EEMM within a single framework that expands into dynamic graph networking. This is then discussed for its implications of empirical work at the non-ergodic process-based idiographic level as applied to individual and societal level dynamic modeling and clinical work. This discussion is framed within the context of individuals that are described as evolutionary adaptive and conscious (observer-self) agents that minimize entropy and can promote a prosocial society through group-level values and psychological flexibility.

Why art? The role of arts in arts and health.

This article is an answer to a report called "What is the evidence on the role of the arts in improving health and well-being?" The authors conclude that the arts have an impact on mental and physical health. Yet, the question of the role of the arts remains unanswered. What is and what is not an art effect? Recently, embodied theory has inspired articles on the perception of art. These articles have not yet received attention in the field of Arts and Health. Scholars in psychosomatic medicine have argued for an approach based on recent work in enactive embodied theory to investigate the connection between the body and the mind. The present article examines how key concepts in this theory relate to art. This leads to a discussion of art in terms of empathy-the relation between the internal state of the artist and the internal state of the beholder. I exemplify with a conceptual framework of musical empathy. Implications for health are addressed.

Case Conceptualizing in Acceptance and Commitment Therapy for Moral Injury: An Active and Ongoing Approach to Understanding and Intervening on Moral Injury.

Acceptance and Commitment Therapy for Moral Injury (ACT-MI; 10-11), is an application of Acceptance and Commitment Therapy principles designed to help individuals live their values, even in the presence of moral pain. ACT-MI differs from other emerging treatments for moral injury in that ACT-MI is not based on a traditional syndromal approach to conceptualizing moral injury, which treats moral injury as a collection of signs and symptoms to be reduced. Rather than assuming moral injury causes suffering through a constellation of symptoms that a person has, in ACT-MI, moral injury is defined by what a person does in response to moral pain. Consistent with this framework, we present a unique approach to moral injury case conceptualization that emphasizes function over form, providing clients the opportunity to break free from the patterns of behavior that cause moral injury-related suffering to persist. Rooted in approaches to conceptualizing that have demonstrated utility in extant interventions (e.g., ACT), ACT-MI clinicians conduct ongoing functional analyses to inform case conceptualization and intervention. Functional analysis is used to disrupt the processes maintaining moral injury, as the client and therapist work to identify and intervene on the behaviors reinforcing avoidance and control of painful internal experiences causing moral injury. In the current article, we guide the reader through a framework for applying functional analysis to the conceptualization of moral injury where the reinforcers driving moral injury are explored. We also provide examples of questions that can be used to help uncover the functions of moral injury consistent behavior. Case examples based on our experiences treating moral injury are presented to demonstrate how various types of morally injurious events can evoke different features of moral pain which in turn motivate different repertoires of avoidance and control. These inflexible patterns of avoidance and control create suffering by engaging in behavior designed to escape moral pain, such as social isolation, spiritual disconnection, reduced self-care, suicidal ideation, and substance use. We discuss how to target this suffering using functional analysis to guide treatment decisions, matching interventional processes within ACT-MI to the specific functions that moral injury-related behavior is serving for an individual. We suggest that the use of functional analytic case formulation procedures described herein can assist clients in disrupting behavioral patterns maintaining moral injury and thereby free them to pursue lives of greater meaning and purpose.

A Functional Contextual Account of Background Knowledge in Categorization: Implications for Artificial General Intelligence and Cognitive Accounts of General Knowledge.

Psychology has benefited from an enormous wealth of knowledge about processes of cognition in relation to how the brain organizes information. Within the categorization literature, this behavior is often explained through theories of memory construction called exemplar theory and prototype theory which are typically based on similarity or rule functions as explanations of how categories emerge. Although these theories work well at modeling highly controlled stimuli in laboratory settings, they often perform less well outside of these settings, such as explaining the emergence of background knowledge processes. In order to explain background knowledge, we present a non-similarity-based post-Skinnerian theory of human language called Relational Frame Theory (RFT) which is rooted in a philosophical world view called functional contextualism (FC). This theory offers a very different interpretation of how categories emerge through the functions of behavior and through contextual cues, which may be of some benefit to existing categorization theories. Specifically, RFT may be able to offer a novel explanation of how background knowledge arises, and we provide some mathematical considerations in order to identify a formal model. Finally, we discuss much of this work within the broader context of general semantic knowledge and artificial intelligence research.

Knowledge embedded.

How should we account for the contextual variability of knowledge claims? Many philosophers favour an invariantist account on which such contextual variability is due entirely to pragmatic factors, leaving no interesting context-sensitivity in the semantic meaning of 'know that.' I reject this invariantist division of labor by arguing that pragmatic invariantists have no principled account of embedded occurrences of 'S knows/doesn't know that p': Occurrences embedded within larger linguistic constructions such as conditional sentences, attitude verbs, expressions of probability, comparatives, and many others, I argue, give rise to a threefold problem of embedded implicatures.

A network analysis of two conceptual approaches to the etiology of PTSD.

Two prominent conceptual models of posttraumatic stress disorder (PTSD) are the cognitive model, associated with cognitive processing therapy (CPT; Resick & Schnicke, 1992), and the functional contextualist model, underlying acceptance and commitment therapy (ACT; Hayes et al., 1999). Network analysis was used to examine dynamic interactions among cognitive (relating to CPT) and functional contextualistic (relating to ACT) variables and PTSD symptoms in a sample of 722 trauma-exposed adults. Results from the cognitive networks highlighted the importance of maladaptive beliefs about threat in maintaining the co-occurrence of PTSD symptoms and cognitive variables. Additionally, PTSD symptoms were more likely to lead to cognitive variables, rather than the reverse direction. Results from the functional contextualist networks identified numerous associations amongst variables that contribute to the co-occurrence of PTSD symptoms and psychological inflexibility. Findings from this study may help generate causal hypotheses that can be tested further using a longitudinal study design.

Selection by consequence: A response to Hayes and Fryling (2019).

The paper by Hayes and Fryling (2019) seeks to inform readers that the Kantorian system of Interbehaviorism has been misunderstood and misrepresented by contextual behavior scientists. Furthermore, these authors suggest that much is to be gained by embracing the system developed by Kantor, most importantly that being large scale system building efforts. We disagree with this position, and find the Kantorian system to be of questionable relevancy and at risk of potential extinction within the behavioral community. We also have concerns that perhaps the insights provided by Hayes and Fryling will fail in recruitment of additional members to the Interbehavioral cause. Although the overarching theme of Interbehaviorism is present within emerging dynamical approaches to behavior science, adopting the vernacular of Kantor may be unnecessary to continue his tradition. We recommend allowing empirical selection to run its course in determining the eventual fate of Kantor's Interbehaviorism.

The untapped potential of behaviour analysis and interprofessional care.

Interprofessional collaboration has become a sought-after component of quality mental health care. Higher education institutions and mental health organizations seek to equip clinicians with the ability to provide cohesive clinical services while working collaboratively with a diverse group of professionals. Although research suggests that there may be benefits of interprofessional collaboration in mental health settings, collaborative practice initiatives have struggled with conceptual and methodological limitations. A behaviour analytic contribution to interprofessional care provides a philosophical position with an analytical goal distinguished by the prediction and influence of events, theoretical clarity, and methodological rigour that are needed within interprofessional research and practice. At the philosophical level, the extension of functional contextualism to interprofessional care research may provide a framework to achieve the valued ends of improving interprofessional collaboration and ultimately improving health-related outcomes for service users. Interprofessional collaboration can be conceptualized as metacontingency, a behaviour analytic concept that allows for a group level analysis of contributing social components. This paper uses the example of mental health care to guide a conceptual analysis of the potential application of behaviour analytic methodology within interprofessional practice, research, and education.

Genomic Contextualism: Shifting the Rhetoric of Genetic Exceptionalism.

As genomic science has evolved, so have policy and practice debates about how to describe and evaluate the ways in which genomic information is treated for individuals, institutions, and society. The term genetic exceptionalism, describing the concept that genetic information is special or unique, and specifically different from other kinds of medical information, has been utilized widely, but often counterproductively in these debates. We offer genomic contextualism as a new term to frame the characteristics of genomic science in the debates. Using stasis theory to draw out the important connection between definitional issues and resulting policies, we argue that the framework of genomic contextualism is better suited to evaluating genomics and its policy-relevant features to arrive at more productive discussion and resolve policy debates.

An extended framework for science.

We may be at the cusp of a next generation framework for science which can be facilitated by understanding current limitations in the context of a divergence of 'scientific' tradition from the Axial Age (800-200 BCE) to the present. A powerful advance may come from fusing certain elements from Western and Eastern traditions, synthesizing the framework with an apt understanding of the divergence. Key traits will include the ethopoetic nature of the scientist with attention to his/her experience of self. The framework will also 'access' knowledge through a state of mind less encumbered with paradoxes, duality, incompatibility and other aporias. Case studies in biology and physics illustrate possibilities.

Mindfulness: ¿proceso, habilidad o estrategia? Un análisis desde el análisis del comportamiento y del contextualismo funcional / Mindfulness: processus, compétence ou stratégie ? Étude de l'analyse comportementale et du contextualisme fonctionnel / Mindfulness: processo, habilidade ou estratégia? Estudo a partir da análise comportamental e do contextualismo funcional / Mindfulness: process, skill or strategy? A behavioral-analytic and functional-contextualistic analysis

Los efectos positivos del mindfulness en el tratamiento de múltiples problemas psicológicos en diversas poblaciones han popularizado su uso dentro de la psicología clínica en los últimos años. No obstante, las investigaciones empíricas y revisiones teóricas sobre el mindfulness muestran tres usos diferentes del mindfulness dentro de las aproximaciones conductuales: como proceso, como habilidad y como estrategia. Las discrepancias en las definiciones de mindfulness han generado ambigüedad con respecto a qué y cómo se investiga este fenómeno. En este trabajo se realizó un análisis conceptual de las definiciones del mindfulness de acuerdo con los supuestos filosóficos analíticos-conductuales y contextualistas-funcionales. Finalmente, se discutió la importancia de contar con una definición precisa y unánime con el fin de desarrollar una agenda coordinada de investigación en esse campo.

Les effets positifs du mindfulness dans le traitement de plusieurs problèmes psychologiques dans différentes populations ont encouragé la psychologie clinique à l'utiliser au cours des dernières années. Cependant, la recherche théorique et empirique sur les examens de pleine conscience montrent trois utilisations différentes de l'attention dans les approches comportementales: comme un processus, comme une compétance et en tant que stratégie. Les divergences dans les définitions de la pleine conscience ont créé une ambiguïté quant à pourquoi et comment ce phénomène est étudié. Cet article est une analyse conceptuelle de la pleine conscience ayant comme paramètres philosophiques l'analyse du comportement et le contextualisme fonctionnel. La discussion finale tourne autour de l'importance d'avoir une définition précise et unanime en vue d'élaborer un programme coordonné de recherche dans ce domaine.

Os efeitos positivos do mindfulness no tratamento de vários problemas psicológicos em diferentes populações incentivaram a psicologia clínica a utilizá-lo nos últimos anos. No entanto, pesquisas empíricas e revisões teóricas sobre o mindfulness mostraram três usos diferentes desse termo segundo perspectivas comportamentais: como processo, como habilidade e como estratégia. As discrepâncias nas definições do mindfulness geraram ambiguidade em relação àquilo que é pesquisado e como é pesquisado. Neste texto, realizou-se uma análise conceitual das definições do mindfulness tendo como bases filosóficas a análise do comportamento e o contextualismo funcional. Por último, discutiu-se a importância de ter uma definição precisa e unânime com o objetivo de desenvolver uma agenda coordenada de pesquisa nesse campo.

Mindfulness has been widely disseminated in clinical psychology in recent years, due to the positive effects on treating several psychological issues in diverse population. Nonetheless, empirical research and theoretical reviews show three different meanings of mindfulness within behavioral approaches: as a process, as skill, and as a strategy. Discrepancies about mindfulness definitions have brought ambiguity to what and how this phenomenon is studied. A conceptual analysis of mindfulness according to behavioral-analytic and functional-contextualistic philosophical traditions is presented. Finally, it was discussed the relevance of employing a precise and consensual definition of mindfulness to develop a coordinated research agenda in this field.

Functional relations and cognitive psychology: Lessons from human performance and animal research.

We consider requirements for effective interdisciplinary communication and explore alternative interpretations of "building bridges between functional and cognitive psychology." If the bridges are intended to connect radical behaviourism and cognitive psychology, or functional contextualism and cognitive psychology, the efforts are unlikely to be successful. But if the bridges are intended to connect functional relationships and cognitive theory, no construction is needed because the bridges already exist within cognitive psychology. We use human performance and animal research to illustrate the latter point and to counter the claim that the functional approach is unique in offering a close relationship between science and practice. Effective communication will be enhanced and, indeed, may only occur if the goal of functional contextualism extends beyond just "the advancement of functional contextual cognitive and behavioral science and practice" to "the advancement of cognitive and behavioral science and practice" without restriction.

Disagreeing in context.

This paper argues for contextualism about predicates of personal taste and evaluative predicates in general, and offers a proposal of how apparently resilient disagreements are to be explained. The present proposal is complementary to others that have been made in the recent literature. Several authors, for instance (López de Sa, 2008; Sundell, 2011; Huvenes, 2012; Marques and García-Carpintero, 2014; Marques, 2014a), have recently defended semantic contextualism for those kinds of predicates from the accusation that it faces the problem of lost disagreement. These authors have proposed that a proper account of the resilient disagreement in the cases studied is to be achieved by an appeal to pragmatic processes, and to conflicting non-doxastic attitudes. It is argued here that the existing contextualist solutions are incomplete as they stand, and are subject to objections because of this. A supplementation of contextualism is offered, together with an explanation of why failed presuppositions of commonality (López de Sa), disputes over the appropriateness of a contextually salient standard (Sundell), and differences in non-doxastic attitudes (Sundell, Huvenes, Marques, and García-Carpintero) give rise to conflicts. This paper claims that conflicts of attitudes are the reason why people still have impressions of disagreement in spite of failed commonality presuppositions, that those conflicts drive metalinguistic disputes over the selection of appropriate standards, and hence conflicting non-doxastic attitudes demand an explanation that is independent of those context dependent pragmatic processes. The paper further argues that the missing explanation is 2-fold: first, disagreement prevails where the properties expressed by taste and value predicates are response-dependent properties, and, secondly, it prevails where those response-dependent properties are involved in evolved systems of coordination that respond to evolutionarily recurrent situations.