Working With Values: An Overview of Approaches and Considerations in Implementation

Abstract

Acceptance and commitment training (ACT) has received support for addressing a number of difficulties within clinical behavior analysis, organizational settings, caregiver support, and other behavior change efforts. ACT is distinguished from many other approaches in its emphasis on values: aspects of life that clients find meaningful and important. Working with values lets behavior analysts draw on the functional properties of language to influence behavior. These techniques can help organize behavior to be influenced by long-term reinforcers, even in the face of short-term aversives, which may arise in the course of behavior change. Many exercises have been developed within the values arena with various strengths and limitations. This article provides an overview of commonly used approaches and aspects relevant to implementation. Considerations related to scope of practice, social desirability in responding, and aversive private events are also discussed.

Acceptance and commitment training (ACT) is a functional approach using verbal interventions to promote behavior change (Hayes et al., 2013; Tarbox, Campbell, & Pio, 2020a). Given its focus on language, considering scholarship on verbal behavior is helpful for understanding ACT. Murray Sidman’s work on stimulus equivalence has been one of the most impactful lines of research within this area. Sidman (1971) attempted to teach a child with an intellectual disability, who was able to match spoken words to their image representations, to read; Sidman found that, after being taught to match spoken words to printed equivalents, the child also learned to match images to printed words, printed words to images, and printed words to spoken words without being trained to do so. Sidman (1971) concluded that spoken words, written words, and their images had become equivalent stimuli. He suggested that stimulus equivalence had broad implications for understanding the functional impact of language, as it accounted for humans responding to words as if they were the things they represent (Sidman, 2018). Stimulus equivalence informed subsequent work on the influence of verbal stimuli on behavior.

Another important line of scholarship has demonstrated that human behavior can be controlled by contingencies specified through verbal statements; this behavior was described as rule governed (Tarbox, Campbell, & Pio, 2020a). An example of this might be if I said, “It’s cold today; you’ll be more comfortable if you wear a coat,” and you put on a coat despite not having experienced the cold yourself (Torneke et al., 2008). Rule-governed behavior allows humans to avoid aversive consequences without having to experience them and to respond to temporally distal contingencies (Tarbox, Campbell, & Pio, 2020a). Furthermore, verbally specified contingencies can have a greater impact on behavior than those directly available within the environment (Levin et al., 2013). You might see the impact of rule governance in your own pursuit of an education in behavior analysis. Through this process, you have likely encountered some proximal aversives, but you have persisted in working toward distal appetitive consequences. Rule governance helped you continue on to graduation and gain licensure.

Scholarship on stimulus equivalence and rule-governed behavior informed the development of relational frame theory (RFT), the conceptual model that serves as the basis for ACT. RFT views verbal behavior as responding to stimuli on the basis of relationships, developed through multiple-exemplar training (Torneke et al., 2008). This behavior has been termed derived relational responding and relational framing (Hayes et al., 2001; Sandoz et al., 2020). Consider a parent asking a child, “Which is bigger?” and the child selecting the larger of two objects. The child in this instance is responding based on a relational property (e.g., the relationship between the two objects) rather than a physical quality. Repeated engagement in similar interactions trains our ability to form relational frames.

Hayes et al. (2001) described relational frames as having the properties of mutual entailment, combinatorial entailment, and transformation of stimulus functions. Mutual entailment can be thought of as bidirectionality; if my dog is bigger than my cat, then my cat is also smaller than my dog. Combinatorial entailment means we can derive new relationships based on existing ones. If I am larger than my dog, and my dog is larger than my cat, then you can derive that I am also larger than my cat. Mutual entailment and combinatorial entailment allow for the transformation of stimulus functions. If the painful feeling of loneliness is the same as the word “alone,” then “alone” is functionally equivalent to the feeling of loneliness. Relational responding can occur on the basis of arbitrary, or socially agreed upon, rather than physical characteristics (Levin et al., 2013). We might label a hair scrunchie as “trendy” now, whereas 10 years ago the same scrunchie might have been “outdated,” and it may become “outdated” again by the time you are reading this. RFT provides a theoretical framework for using language to shape behavior that is applied in ACT.

ACT aims to shape psychological flexibility, which is conceptualized as a client’s ability to organize behavior around the things that matter to them and respond adaptively in the presence of aversive private events (Tarbox, Campbell, & Pio, 2020a). ACT recognizes that derived relational responding and transformation of stimulus functions allow unpleasant thoughts and feelings to arise in any number of contexts (Wilson & Murrell, 2004). A client might remember seeing a family with well-behaved children and experience distress as they consider instances of their child’s less desirable behavior. Through derived relational responding, many aversive private events might arise in relation to these thoughts, such as thinking “I’m a bad parent” and “My child will not succeed in life.” These verbal stimuli may be experienced as painful through transformation of stimulus functions. Behavior that becomes organized around avoiding such aversives can become increasingly narrow and rigid and is discussed as falling under aversive control (Wilson & Dufrene, 2009). Caregivers might start to preemptively avoid instances where their child’s misbehavior can occur, contributing to poorer long-term outcomes. ACT seeks to shape an alternative form of responding, which is broader, more flexible, and motivated by access to reinforcement, described as behavior under appetitive control (Wilson & Dufrene, 2009). A caregiver who organizes their behavior around appetitives, such as forming a meaningful relationship with their child and helping the child succeed, would be engaging in such responding. ACT conceptualizes this repertoire as related to psychological flexibility.

Hayes et al. (2012) provided an overview of psychological flexibility and the six processes that compose it: defusion, acceptance, flexible attention to the present moment, self-as-context, values, and committed action. ACT views these as having converse processes: fusion, experiential avoidance, challenges with flexible attention to the present moment, attachment to the conceptualized self, lack of values clarity, and inaction toward one’s values, respectively. These constitute psychological inflexibility. Defusion can be thought of as the ability to disengage from private events and recognize that they are not literal representations of the world. Its converse, fusion, reflects excessive attachment and weight given to private events. Acceptance has been defined as the willingness to experience aversive private events when doing so is adaptive, whereas experiential avoidance describes maladaptive efforts to avoid or control these. The ability to flexibly shift one’s attention to the present is contrasted with getting caught up with an imagined past or future so strongly that it is challenging to attend to the here and now.

Relating to self as context is described as being able to experience private events without being defined by them, whereas attachment to a conceptualized self refers to rigid attachment and rule-governed behavior associated with self-descriptions (e.g., “I am a bad parent; therefore, I can’t change my discipline practices”). Values refer to the aspects of life that an individual finds most meaningful or important, and lack of values clarity refers to an absence of connection with these. Finally, committed action is defined as behavior consistent with one’s values, and inaction is defined as the lack of such behavior (Hayes et al., 2012). These processes (sometimes described as middle-level terms) are useful in guiding behavior analysts’ interventions (Tarbox, Campbell, & Pio, 2020a), but they are not intended to represent mentalistic constructs (Hayes et al., 2012).

ACT has been used successfully in a number of arenas, including clinical behavior analysis (Sandoz et al., 2020), organizational contexts (Flaxman & Bond, 2010; Little et al., 2020), and caregiver support (Blackledge & Hayes, 2006; Gould et al., 2018). This approach offers a useful set of techniques to behavior analysts working with verbal populations (Dixon & Paliliunas, 2020). ACT is distinguished from other interventions in its emphasis on values (Hayes et al., 2012). Defined as areas that an individual finds meaningful or important, values have been more technically described as verbally constructed, temporally delayed positive reinforcers (Little et al., 2020; Wilson et al., 2010). Behavior that is done in the service of values can be thought of as rule-governed behavior under appetitive control (Sandoz et al., 2020). Performing a boring task, such as cleaning, over the course of a low-paying job differs from the same boring task performed to help a loved one. When the task is done to care for a loved one, the person performing it contacts the verbally constructed value of “family,” allowing its distally reinforcing properties to maintain their engagement in the behavior, even if proximal aspects of the task are unpleasant. In essence, contacting the value helps this person generate the rule “Cleaning helps my grandmother,” which serves as a motivating operation that alters the function of cleaning, such that engagement in it becomes reinforcing (Sandoz et al., 2020; Tarbox, Campbell, & Pio, 2020a). Behavior analysts can perform values work aimed at constructing values to maximize long-term access to reinforcement (Dixon & Paliliunas, 2020). Practically, values work can include helping clients identify their values, attend to areas where their behavior is not values consistent, and inform behavior change efforts (Hayes et al., 2012).

This article presents exemplar ACT values exercises and discusses considerations in their implementation. Values work serves as the focus because of its utility in enhancing motivation for behavior change, which can be easily integrated with other strategies used by behavior analysts. The exercises described review potential forms that values work could take and are intended to demonstrate possibilities within this realm. However, the functional impact is ultimately most important, and behavior analysts can adapt the strategies described to be most relevant to their setting and population.

Putting Values Into Practice

Presenting Values Options

Several exercises present clients with common valued domains and ask them to rate or choose those that are most personally important. Although values are ultimately individualized, some areas, such as social connection, are shared by many people. Clients who have a difficult time identifying valued domains (Whittingham & Coyne, 2019) or have a limited repertoire around values (LeJeune & Luoma, 2019) may find it helpful to be presented with options. As verbal stimuli representing valued areas take on the functional properties of the domains themselves, selecting from among these can serve as a starting point for shaping valuing in the broader context. Exercises that present values options are also structured and may be easier to implement for behavior analysts who are newer to values work.

Bull’s-Eye Values Survey

The Bull’s-Eye Values Survey (BEVS; Lundgren et al., 2012) asks clients to mark the extent to which they have lived consistently with the domains of relationships, health/personal growth, work/education, and leisure on a visual bull’s-eye. Clients are also directed to consider barriers to valued living and come up with values-consistent behavior change they could engage in. These prompts may be used to tie values to other interventions. Behavior analysts may choose to modify value domains so that these are more appropriate to the situation or client population they are working with (Lundgren & Larsson, 2018). For example, a behavior analyst who works with parents might use caregiving as a more targeted domain.

Valued Living Questionnaire

The Valued Living Questionnaire (VLQ; Wilson et al., 2010) is a popular tool used in values interventions (Reilly et al., 2019). The VLQ presents clients with 10 common valued domains: physical self-care, spirituality, citizenship, education, recreation, work, friendship, marriage or couple relations, parenting, and family (distinct from couple relations and parenting; Wilson et al., 2010). Clients are asked to use a 10-point scale to rate the importance of each domain and the extent to which they have behaved consistently with that domain over the past week (Reilly et al., 2019). A second version, the VLQ-2, adds the domains of environment and aesthetics and asks clients to provide more extended ratings: the possibility that something would happen, the current and overall importance of the value, action consistent with the value, satisfaction with this action, and concern about the valued domain (Wilson & Dufrene, 2009). The VLQ and VLQ-2 can help clients verbally construct their personal values and consider discrepancies between these and current behavior Table 1.

Table 1.

Overview of Values Interventions

Approach and examples	Advantages	Limitations
Presenting values options: VLQ, a BEVS, b HFDEI, c values card sorts d	Can be helpful for clients with limited valuing repertoires	May not reflect client values; may prompt evaluation or socially desirable responding
Exploring before commitment: 10 steps to trying on a value, e values prototyping f	Reduces rigidity around values exploration; reinforcement in the broader context can strengthen repertoires	Requires some constructed values
Training discrimination: matrix, g life path and turnaround h	Considers valuing in the context of other processes; free to choose idiosyncratic domains	May be challenging if valuing is poorly developed
Perspective taking: end-of-life exercises, f, i, j, k sweet spot c, l	Brings distal consequences to the present; uses highly personally relevant stimuli	May require social perspective taking; relies on ability to construct the past or future
Metaphors: new shoes, m compass, i jar of objects n	Quickly communicate information	Success determined by learning history
Shaping in discussion	Most flexible approach	May be challenging if valuing is poorly developed

Note. VLQ = Valued Living Questionnaire; BEVS = Bull’s-Eye Values Survey; HFDEI = Hexaflex Functional Dimensional Experiential Interview.

^a Wilson et al. (2010). ^b Lundgren et al. (2012). ^c Wilson and DuFrene (2009). ^d Ciarrochi and Bailey (2008). ^e Dahl et al. (2014). ^f LeJeune and Luoma (2019). ^g Polk (2014). ^h Strosahl et al. (2012). ⁱ Hayes et al. (2012). ^j Eifert and Forsyth (2013). ^k Stern (2014). ^l Wilson and Sandoz (2008). ^m Merwin et al. (2019). ⁿ Stoddard (2014).

Client responses to the VLQ may be informative. Although these are not necessarily reflective of private events, the behavior of marking the VLQ can be considered along with other information. Wilson and Murrell (2004) suggested that several VLQ patterns might be of interest: very high importance and consistency across domains, high discrepancy between importance and consistency, and very low importance in all domains. These scholars noted that clients who rate all domains as very important and behavior as highly consistent with these may be attempting to present themselves in a socially desirable light. Clients who indicate that they do not behave consistently with highly important values may experience distress associated with this. Attending to such discrepancies may highlight the need for change. Those who mark low importance scores across values may have poorly developed valuing repertoires or may view values as unobtainable (Wilson & Murrell, 2004).

Hexaflex Functional Dimensional Experiential Interview

The Hexaflex Functional Dimensional Experiential Interview (HFDEI; Wilson & Dufrene, 2009) combines the VLQ-2 with a more extensive values exercise. As described by Wilson and Dufrene (2009), the HFDEI consists of completing the VLQ-2, followed by the “sitting inside significant questions” exercise and experiential writing. The “sitting inside significant questions” exercise first directs clients to attend to the private events they are experiencing over the course of the exercise. The behavior analyst then asks a series of questions instructing clients to consider each valued domain and the possibilities it might hold for them. After completing this portion, clients are instructed to write about their values for 10 min, and their experience is discussed (Wilson & Dufrene, 2009).

Values Card Sorts

Values card sorts can be used to present clients with cards representing values and ask them to prioritize those that are most interesting or important. An example, the Survey of Guiding Principles (SGP; Ciarrochi & Bailey, 2008), directs clients to examine 60 cards reflecting common values, such as universalism, religion, tradition, and benevolence (Veage et al., 2014). Clients are then asked to select the cards that are most important to them (LeJeune & Luoma, 2019). Behavior analysts working with clients in specific areas, such as organizational issues or parenting, can modify the exercise to ask clients to consider how the values relate to that particular context (Veage et al., 2014). The SGP card sort exercise is freely available at Dr. Ciarrochi’s website (http://josephciarrochi.com/sgp/).

Considerations With Values Options Exercises

The approaches to working with values described in this section ask clients to consider common valued domains and the extent to which these may be relevant to them. Clients with limited valuing repertoires may find it helpful to be presented with options, although it is also possible that an area important to a particular client will not be included. Culture may play a role in this, particularly if the exercise was developed by scholars with a background different from the client. The varied exercises within this group range in the number of options presented, from the four domains within the BEVS to 60 cards in the SGP values card sort. When selecting an exercise working with options, behavior analysts may consider whether their clients would respond better to a simple array or more extensive options. Behavior analysts should keep in mind that, for some clients, being faced with 60 potential values may feel overwhelming, although others may respond well to having more choices. The VLQ and VLQ-2 represent a middle ground, as these have 10 and 12 possible values, respectively. Both the BEVS and the VLQ also ask clients to rate the extent to which they have behaved consistently with values. As valued domains may be recognized as socially desirable, clients may find rating behavioral consistency evaluative, and it is important to present the exercise in a manner that de-emphasizes evaluation. The HFDEI extends the VLQ with more extensive interaction with value domains, further helping develop the valuing repertoire. However, clients who struggle with noticing and labeling private events may not have the skills needed to engage with this exercise. These clients may find being asked to do so extremely frustrating. Behavior analysts may consider clients’ ability to attend to private events when deciding whether or not to use the HFDEI.

Exploring Before Commitment

Due to the nature of relational responding, verbal stimuli associated with values can evoke aversive private events, such as uncertainty and worry about choosing a valued domain. Clients might be concerned that by selecting a particular area, they are defining who they are and limiting subsequent behavior. Worry and concerns within this context may evoke avoidance and rigidity, rather than valuing. One approach to reducing the likelihood of these responses is through verbally framing the interaction as a trial, rather than a commitment, changing the consequences of choosing. Clients may be more willing to interact with a value for a short time if they are doing so with the expectation that they are permitted to stop if they do not like it (Dahl et al., 2014).

Ten Steps to Trying on a Value

“Ten steps to trying on a value” (Dahl et al., 2014) asks clients to select a value they are willing to behave consistently with for a brief period, come up with behaviors to do so, and engage in these behaviors over this time period while using a diary to keep track of their experience. Clients are able to trial what a value might be like for them with less pressure to make the “right” value choice (Dahl et al., 2014).

Values Prototyping

LeJeune and Luoma (2019) similarly described an experience-based approach to values, called values prototyping. They suggest that this exercise be implemented after the client has some familiarity with values and there is a sense of which areas may be important. Like 10 steps to trying on a value, this approach emphasizes that clients do not have to make a commitment and are just trying out an exercise. LeJeune and Luoma suggested numerous strategies for identifying ways to experience a valued domain. Clients may be directed to interview people they view as enacting a domain and imagine what it would be like to engage with it themselves. Behavior analysts may also ask clients to describe an ideal day and consider how this relates to their values. After potential values are selected using these strategies, clients try out the values-consistent behaviors and consider their experience. LeJeune and Luoma noted that the process is intended to be iterative and that different domains may be tested out in this fashion.

Considerations Associated With Exploring Before Commitment

Approaches that frame interactions with values as “exploring” or “trying on” use language to specify the consequences following such a behavior—namely, that clients are free to leave a value should they choose to do so. Values prototyping and the 10 steps to trying on a value involve the behavioral exploration of possibilities, increasing the likelihood that valuing repertoires will be strengthened through reinforcement in the broader environment. However, both exercises require that clients be able to identify a valued domain. Clients who have a more limited valuing repertoire may benefit more from other approaches, such as those that ask clients to consider values options.

Training Discrimination in Values Work

Behavior analysts may train clients to determine when their behaviors are values consistent (Dixon & Paliliunas, 2020). This discrimination typically involves identifying behaviors that seek to avoid aversive private events and those motivated by approaching values (Polk et al., 2016). For example, a parent may fail to implement an intervention aimed at shaping a child’s behavior to avoid associated frustration. This person may also describe caring for their child as a values-consistent action. Through repeated engagement in making these discriminations, clients learn to evaluate whether their behavior is motivated by values or avoidance, helping connect distal consequences to behavior. Engagement in this skill can help clients develop rule-governed behavior that promotes long-term access to appetitives. This skill may be trained through reinforcing successive approximations, where clients might first be praised for engaging with the exercise and receive increasing feedback on the discriminations they are making (Schoendorff et al., 2014).

ACT Matrix

The ACT matrix, developed by Polk (2014), uses a visual grid to guide clients to distinguish private events from external behavior and identify behavior that is moving toward one’s values and away from aversive private events. Clients may be asked to differentiate their experience of a pen or another common object through four of the five senses (e.g., smell, touch, sound, and sight, typically excluding taste for hygiene reasons). After doing this, they are asked to mentally re-create the experience, attending to the distinction between their experience of the external object and its private event representation. Clients are then guided to consider people and things that matter to them and the private events that get in the way, which are framed as mental experiences. For example, a client may say that they care about engaging with their career and indicate that thoughts about saying the wrong thing get in the way of doing so. They would then be asked to describe directly observable behaviors that they do to move toward what matters and away from the private events that get in the way. This client might say that they volunteer to take on unfamiliar tasks as a way to grow in their career, but that they typically avoid giving presentations to stave off worry about saying the wrong thing. This exercise has been applied within many different contexts, including schools, workplaces, and sports settings, as well as with clients struggling with psychological and physical difficulties (Polk, 2014; Schwabach et al., 2018). The simplicity of this approach facilitates its integration with other intervention strategies (Schwabach et al., 2018).

Life Path and Turnaround

The “life path and turnaround” exercise described by (Strosahl et al., 2012) takes a simpler approach to training discrimination. In this exercise, an image with two directions is presented, one labeled as movement toward control over aversives and the other toward meaning and vitality. Clients are asked to consider which direction they are traveling in, the costs and benefits of control, and behaviors consistent with values (Strosahl et al., 2012).

Considerations in Training Discriminations

The exercises that train values discriminations contrast values and committed action with experiential avoidance. Guiding clients to attend to values in relation to these processes offers a more comprehensive approach to shaping psychological flexibility. The matrix and life path and turnaround exercises differ somewhat in their approach. The matrix adds the distinction between private events and observable behavior, which may be helpful in guiding client responses. Without this distinction, a client might describe “thinking positively” as a behavior moving toward their values, which would be less desirable than a directly observable response, such as calling their loved ones, as efforts to control private events are unlikely to be successful (Hayes et al., 2012). The life path and turnaround exercise includes questions that prompt clients to consider the potential challenges associated with control. This instruction helps clients consider the distal consequences of experiential avoidance. Both exercises use broad instructions related to values, asking clients to consider people and things that are important to them (Polk, 2014) or a meaningful direction in life (Strosahl et al., 2012). This breadth allows clients to choose idiosyncratic and personally relevant domains, but these exercises may be more difficult for clients who struggle with identifying valued areas.

Drawing on Perspective Taking

Several strategies direct clients to engage in perspective taking to shape valuing. Perspective-taking exercises take advantage of transformation of stimulus functions, which allow verbal stimuli to construct an imagined future (Hayes et al., 2012) or remembered past (Wilson & Sandoz, 2008). These strategies can help clients contact the reinforcing properties of values and attend to the distal consequences of current behavior.

End-of-Life Exercises

End-of-life exercises prompt clients to consider the meaningful aspects of their existence. The exercise “What Do You Want Your Life to Stand For?” by Hayes et al. (2012) is an example within this category. In this exercise, the client is asked to imagine that friends, family, and other important people are attending their funeral. They are prompted to describe how they would like to be remembered by the important people in their lives and the eulogies these people might say about them. The behavior analyst can mention specific people and pause to allow the client to verbalize the eulogies made by these individuals (Hayes et al., 2012). Behavior analysts may also ask clients to consider what they would want written on their tombstone as an epitaph in a similar strategy (Eifert & Forsyth, 2013). Alternatively, clients may be directed to imagine an end-of-life scenario as a retirement party with toasts that others might make in their honor, if behavior analysts feel that these would be more appropriate than considering one’s funeral (Hayes et al., 2012).

End-of-life exercises can also emphasize the costs of failing to engage with values. LeJeune and Luoma (2019) described the feared-eulogy exercise, in which clients are asked to imagine their life if it were to unfold with their current limited engagement in values-consistent behavior. Alternatively, clients can be directed to compare a values-consistent life and a values-inconsistent life by writing two autobiographies reflecting these paths (Stern, 2014).

Sweet Spot

The sweet-spot exercise asks clients to recall and describe an enjoyable moment in their life (Wilson & Sandoz, 2008). Behavior analysts may start this discussion by offering an example from their own life as an exemplar for the client (Wilson & Dufrene, 2009). The exercise can be conducted as open ended, or behavior analysts may choose to direct focus to a particular valued domain (LeJeune & Luoma, 2019). For example, behavior analysts working with caregivers might ask clients to describe a sweet memory associated with parenting. Clients will be asked to close their eyes and direct their attention to sounds in the room or their own breath (LeJeune & Luoma, 2019; Wilson & Dufrene, 2009). This instruction starts to direct client attention, which is then turned to their memory. Clients are guided to describe the memory and prompted to attend to sensory details while doing so (LeJeune & Luoma, 2019; Wilson & Sandoz, 2008). Clients can also be asked to contact “sweet-spot” moments outside of training with the provider, by writing down sweet-spot moments, engaging in creative expression through drawing or music related to the sweet spot, or sharing sweet-spot descriptions with those they have close relationships with (LeJeune & Luoma, 2019).

Considerations in the Implementation of Perspective Taking

Perspective-taking approaches shape valuing behavior by placing clients in contact with verbally constructed environments. End-of-life exercises take advantage of transformation of stimulus functions to bring distal consequences into the present. By creating imagined futures, clients contact long-term outcomes of their behavior and consider whether these are desirable. The sweet-spot exercise uses a similar approach but guides clients to re-create a remembered past. Although the temporal focus is different, the goal of this exercise is similar: Language is used to bring distal reinforcers into the present moment. The sweet-spot exercise allows clients to contact reinforcement associated with these stimuli and may reestablish associated behavioral repertoires. The two approaches are likely to have different impacts; end-of-life exercises focus more closely on shaping rule-governed behavior, whereas the sweet-spot exercise emphasizes putting clients in contact with the reinforcing properties of values.

Both exercises rely on clients’ ability to imagine another setting. End-of-life exercises add further complexity, as many versions of this approach ask clients to imagine what others might say about them. This requires clients to be skilled in social perspective taking, and behavior analysts may consider whether individual clients are able to use this skill when choosing their approach. The sweet-spot exercise focuses on remembering a sweet experience, rather than constructing an imagined future, and may be less taxing for clients who are more concrete. However, some clients who have had limited contact with reinforcers may struggle to come up with a sweet memory. Considering client history is important in deciding whether this exercise would be helpful.

Using Metaphors

Metaphors rely on derived relational responding to influence behavior by prompting comparison and derivation of novel rules (Foody et al., 2014). For example, Wilson and Dufrene (2009) asked treatment providers to consider whether they were approaching a client as one would a sunset or a math problem to be solved. This example is effective because the use of a brief phrase, such as “appreciating a sunset,” evokes memories of an experience that many behavior analysts might have had. They may recall the changing sky, its colors reflecting in the water, or a breeze and experience any number of other private events. Similarly, many people have likely had the experience of solving a math problem. The phrase “solving a math problem” may bring up memories of considering equations, trying to think logically, and potential frustration associated with challenging problems. It is less likely that a person would remember solving a math problem with the fondness they might have for a sunset. Derived relational responding allows a brief question such as “Are you approaching your client as a sunset or a math problem?” to efficiently communicate information as the relational frames these verbal stimuli participate in are invoked (Foody et al., 2014).

Many metaphors are used within ACT. Merwin et al. (2019) described a “new-shoes” metaphor, in which clients are asked to think about trying on a value as similar to trying on a pair of shoes. The key aspects highlighted in the metaphor are the need to put on and experience the shoes before deciding if one will purchase them, as one could do with a value (Merwin et al., 2019). Stoddard (2014) discussed a professor who puts ping-pong balls, small rocks, sand, and liquid into a jar and highlighted the importance of the order in which these are placed; if the professor puts the bigger objects in first, there is room for the smaller ones in the spaces in between, but the alternative may not be true. The message is that if we do not let more meaningful things take priority, minutiae can take over; however, if we focus on the more important aspects of life, those that are less meaningful will find a way to fit (Stoddard, 2014). Values are also often compared to something representing a direction to travel, such as guiding stars (Whittingham & Coyne, 2019) or a compass (Hayes et al., 2012), rather than a destination. Similarly, one can only graduate from college once, but they can be a lifelong learner in any number of ways. Making the comparison between values and traveling by compass allows behavior analysts to quickly communicate this message.

Considerations in Using Metaphors

Metaphors can be used to quickly communicate information by taking advantage of derived relational responding. A client who is able to consider their life as a jar, ping-pong balls as valued areas, and minutiae as sand can think of valued areas as needing priority before other pieces of life. However, this approach assumes a shared history. Considering whether you are approaching a client as you would a math problem is effective if you have a history working with math. Hobbies, sports, foods, and traditions differ across cultures, and behavior analysts working with those whose backgrounds differ from their own may need to be particularly attentive to these. For example, saying “They smiled at everyone they saw” would evoke verbal stimuli such as optimism and friendliness in American culture or foolishness and strangeness in Ukrainian culture. Client history can also be used to develop metaphors that are particularly relevant to individual clients (Vilatte et al., 2014).

Unstructured Verbal Discussion

In addition to the more structured exercises described, behaviors of interest may also be shaped in verbal interactions (Torneke, 2010). Discussion about what clients want out of life and how their current behavior relates to this may be used to prompt their consideration of values (Hayes et al., 2012). Conversations in this area can help clients verbally construct values and identify how long-term consequences of their behavior relate to these (Wilson & Dufrene, 2009). Additionally, client behavior in response to these prompts, such as verbal statements, pace, and nonverbal aspects of communication, offers useful information (LeJeune & Luoma, 2019; Wilson & Dufrene, 2009). Clients for whom a discussion of values evokes a rigid conversational style and who use terms like “must” and “have to” are likely not engaging in valuing (Luoma et al., 2007). This repertoire may suggest a need to please others or avoid punishment, which is inconsistent with the freely chosen appetitive quality of values (Hayes et al., 2012). Clients who exhibit more pauses and more varied inflection are more likely to be engaging in valuing (LeJeune & Luoma, 2019). Similar to other responding  under appetitive control, verbal behavior reflective of flexibility is more likely to involve greater openness to private events, which may be evidenced by  a slower pace and greater variability. Behavior under aversive control tends to be more narrow and rigid; this can show up as inflexible, rapid speech (Wilson & Dufrene, 2009). Behavior analysts may consider whether clients are exploring the verbally constructed context before them or engaging in the conversational equivalent of avoiding aversives. Attending to these aspects allows behavior analysts to consider whether they should slow clients down by slowing their own pace or asking them to pause and reflect on their private events (Wilson & Sandoz, 2008).

Considerations in Shaping Valuing in Discussion

Using unstructured interactions to shape client behavior is the most flexible and individualized approach. It can be helpful for clients who are able to come up with responses to questions about what they care about most in life. Unstructured discussion can be integrated into other exercises for as long or as short a time as needed. It does not limit the focus to particular areas, like a values card sort or the VLQ does. However, clients who have not developed a repertoire around values may struggle with engaging with questions about what they find most meaningful. These clients may benefit from some of the more structured exercises previously described.

Considerations in Implementation

When to Use Values Work

In addition to values, ACT builds skills related to five other hexaflex processes, acceptance, defusion, self-as-context, flexible attention to the present moment, and committed action (Hayes et al., 2012). For some clients, starting with these processes may be more appropriate than targeting values. Clients for whom private events evoke strong experiential avoidance may benefit from shaping acceptance prior to engaging with values. Others might evidence challenges with fusion or attachment to the conceptualized self and struggle with rigid rule-governed behavior related to these processes. ACT strategies aimed at supporting defusion and responding to self-as-context may be a more useful starting point addressing rigidity associated with these repertoires. Clients who have difficulties in attending and responding in the present moment may benefit from exercises aimed at ameliorating this difficulty, such as mindfulness. Behavior analysts should consider whether the clients they work with have particularly strong challenges within these domains that would make it difficult to work with values. For example, if a client becomes so distressed that they are unwilling to discuss behavior change, targeting acceptance before values may be warranted.

Although behavior analysts should consider other ACT processes, working with values can be a useful approach to support behavioral interventions for many clients. Because values work allows temporally distal reinforcers to influence behavior, values can help clients persist in the face of short-term aversives (Dixon & Paliliunas, 2020). Consider a teacher who is asked to stop attending to a child who is repeatedly crinkling paper during class, an undesirable behavior that is determined to be reinforced by adult attention. When the teacher stops attending to the crinkling, the behavior may initially increase (i.e., extinction burst; Lerman et al., 1999). The teacher might become increasingly frustrated and start to question whether the behavior will truly stop if it is no longer attended to. If they are able to see that ignoring the attention-seeking behavior enacts a value of helping children succeed, they may be better able to persist in implementing the intervention.

Values and Aversive Private Events

Discussion of values can bring up a number of other repertoires. Coming in contact with values can highlight discrepancies between current and values-consistent behavior, leading to distress (Wilson & Murrell, 2004). Some clients may also make statements that center around avoiding unpleasant consequences when prompted to discuss values. For example, “I value relationships because I don’t want to die alone” is an expression of a desire to avoid the aversive consequence of loneliness. In a similar vein, some clients might state that their value is being free of anxiety, frustration, or some other type of private event. These presentations are congruent with broader cultural messaging that aversive private events are indicative of psychological dysfunction and should be eliminated (Wilson & Murrell, 2004). Although these statements might serve as a starting point for other interventions, they are not reflective of valuing as conceptualized within ACT, which is viewed as a behavior under appetitive, rather than aversive, control (Wilson et al., 2010). Behavior analysts should carefully attend to the functional properties of clients’ verbal behavior and keep in mind that the use of terms such as “values” and “meaning” does not necessarily reflect valuing.

Clients may also state that they wish to wait to address values until they are free of aversive private events. Essentially, such clients may be operating under the rule that “the pursuit of the things I care about should wait until I am happy.” These clients may be putting off the things they find meaningful and focusing on attempting to control unpleasant thoughts and feelings (Wilson & Murrell, 2004). Unfortunately, humans are unlikely to succeed in avoiding all aversive private events, and clients operating under this rule may never be able to pursue the things they care about. Clients might also have rigid ideas about what might be possible for them (e.g., believing they are too unlikeable to connect with others or too old to pursue education; Wilson & Sandoz, 2008). Behavior analysts can take varied approaches to these presentations depending on clients’ needs. They may inquire about what clients could do if they were able to be free of distress or what they have done in the past prior to struggling with aversive private events (Luoma et al., 2007). Behavior analysts can also highlight that, unlike private events, values-consistent behavior is under the client’s control and thus may offer a more fruitful path to pursue (LeJeune & Luoma, 2019). Some clients who exhibit rigid avoidance of private events or attachment to verbal stimuli may benefit more from an initial focus on acceptance or defusion, rather than values work.

Values Versus Goals

Clients prompted to discuss values may instead describe their goals. Goals differ from values in that they are tangible achievable outcomes (Lundgren & Larsson, 2018). Getting married, obtaining a college degree, and running a marathon would be considered goals. However, connecting with others, learning, and working on one’s physical health could be potential valued directions. Goals and values serve different functions. For example, once one gets married, the goal has been met. However, being a loving partner is a lifelong direction that one could continue to work toward. Values are less rigid than goals and can be pursued in many different ways (Whittingham & Coyne, 2019). A client who wants to become an Olympic wrestler has a limited possibility of succeeding within this arena, but they can engage in physical fitness through Brazilian jiujitsu, yoga, hiking, and a number of other actions. Querying clients about how things would be different if the goal were accomplished may be a way to get at the value behind the goal (Hayes et al., 2012). LeJeune and Luoma’s (2019) “link the goal” exercise can be used to address this issue. In the link the goal exercise, clients are asked to list goals that they are proudest of accomplishing and to identify shared connections between these as a way to approach values (LeJeune & Luoma, 2019). Notably, although values are distinguished from goals, this discussion is not intended to suggest that goals are not useful. Behavior analysts working with values will likely draw on these to inform behavioral goals (Luoma et al., 2007).

“Challenging” Values

Behavior analysts and clients will likely have different values. Although this is expected, clients may bring up values contrary to what the behavior analyst would want for the client. Generally, ACT aims to shape valuing, rather than particular values content (LeJeune & Luoma, 2019). Imposing one’s own values or moral judgment would be counter to the function of values in ACT (Wilson et al., 2010). Additionally, trying to force values onto a client is unlikely to be effective. Hayes et al. (2012) pointed out that, if expressing judgment of a client who says they value drinking was effective, there would be very few people struggling with alcohol use. If the client’s values are so challenging for a behavior analyst that they cannot work with them effectively, the case may need to be referred to another provider (Luoma et al., 2007).

Pliance

Another challenge that may arise in working with values is clients saying what they think the behavior analyst wants to hear or society might approve of. This behavior, termed pliance, can be thought of as following a rule to impress or gratify others (Plumb et al., 2009). As private events are only directly observable to the individual experiencing these, determining whether client statements reflect values or pliance can be challenging. Use of terms such as “must” and “should” might be consistent with social pressure rather than the things clients truly care about (Luoma et al., 2007). Asking a client to imagine what they might do if no one would know whether that value was enacted may be helpful in addressing pliance (Hayes et al., 2012). Some clients may also not have a clear sense of their values as distinct from what others want; these individuals may benefit from shaping attending toward one’s preferences (LeJeune & Luoma, 2019).

Scope of Practice

Although ACT can be successfully implemented by behavior analysts, it is important to consider the scope of practice. Tarbox, Szabo, and Aclan (Tarbox, Szabo, & Aclan, 2020b) suggested that behavior analysts who are interested in providing ACT receive appropriate supervision and training to ensure competence. Reading, attending trainings, gaining feedback on one’s practice, and similar activities can help develop competence (Dixon et al., 2020). Dixon and Paliliunas (2020) advised that behavior analysts should avoid working with behavioral difficulties for which they have not received training and that ACT should be viewed as a form of verbal instruction, rather than psychotherapy. Although clinical behavior analysis addresses psychological difficulties, which fall under the psychotherapy domain, behavior analysts who do not hold another mental health license may be prohibited from treating these within their jurisdiction (Dixon et al., 2020). However, even if behavior analysts need to refer out a client for psychotherapy, they may still find ACT techniques useful if they are working with this person in another domain. For example, a parent with a mental health concern may still benefit from integrating ACT into parent training (Tarbox, Szabo, & Aclan, 2020b).

Conclusion

ACT offers a flexible approach for behavior analysts working with a range of verbally competent client populations. Values work lies at the heart of ACT and allows temporally distal reinforcers to influence behavior. The exercises described in this article can help clients remain engaged in behavior change efforts when faced with short-term aversives. As a result, values work is broadly applicable within behavior analysis. Behavior analysts working with ACT should obtain appropriate training and consider jurisdictional limitations on practice and potential challenges in implementation.

Declarations

Conflict of interest

I have no conflicts of interest to disclose.