Well, thanks everybody for joining. We're grateful that you're here. Today, we are super grateful to have Dr. Stephen Hayes, who's an emeritus professor of psychology from the University of Nevada, Reno, and president of the Institute for Better Health, a 45-year-old charitable organization dedicated to better mental and behavioral health. He's a true pioneer in the field of mental health and has contributed greatly to both a deeper understanding of human behavior in general, as well as practical mechanisms to help heal and diminish suffering. His work is focused on developing new behavioral science approach called contextual behavioral science, and he's also the co-creator of ACT, Acceptance and Commitment Therapy. He's been celebrated with several awards, such as the Lifetime Achievement Award from the Association of Behavioral and Cognitive Therapies, and the Impact of Science on Application Award from the Society of Advancement of Behavioral Analysis. He's written 47 books and nearly 700 scientific articles, and his CV is super long. We are really grateful that you took the time out of your day to come join us and teach us about ACT and some other of your recent work. So thanks for joining. Well, thanks for the introduction. Thanks for the opportunity. Hello, AAAP. And, you know, I've been interested in addiction for a long time and books on it and so forth, and on council at NIDA. I used to say, hey, why am I even in this? Because my students got me over interested, but in fact, you know, my dad was an alcoholic and I've seen up close and personal some of what happens with addiction in my family. So I'm coming in here with multiple reasons to be here. And I do want to talk about ACT, which is what I'm most known for, but I also want to put it in a larger context because I think the field is changing. I think it needs to. And I want to explain what the change is. And so you're going to hear some cutting edge things, good, you know, that sometimes means they're a little less worked out, but you'll hear some things that you may not have heard before if you followed ACT and my work. As far as, let me just get my slides up. As far as my COIs and things of that kind. Of course, this should have the one that doesn't have the slides on the bottom, right? Is that right, Chris? Does it look clean? Great. I publish books and all that. I don't really consider those COIs. Those are just how you learn about things, but I do have an interest in a commercial app, which I may mention, but won't talk about in detail. And with a charitable one, I'm a president of a charitable organization. And those two things are kind of where I'm going after having retired from the academy. So I'll tag it and note that there's COIs there and try not to do anything that sounds creepy or commercial, but I do want you to know about how I'm trying to put some of the ideas I'll expose you to into the real world of practice and research. So I want to just do kind of an angle here. I said in my CEs and stuff that I'd say what the processes are in act, at least name one intervention for each of the main six processes and say a little bit about the state of the research and I will do that. But I will also much more emphasize where I think the field needs to go. And specifically, I think that it needs to go in the directions of processes of change. And why that is, I'll try to lay that on the talk. But from the point of view of addiction, what does the process of change focus have? Well, I'm going to give you, this is kind of a cheat sheet for an arc of an argument that I'm going to make here, but there's a big reason I think that the field of addiction should be interested in that. For one thing, the comorbidities are so severe as to suggest just a bad diagnostic system as you sometimes have 60, 70% overlap between mental health problems, addiction problems. And that's before you get into things that aren't signs and symptoms, but are simply problems people have. Whether it's chronic pain or relationship problems or problems at work or whatever, which last time I checked were one whole human being and people who are serving human beings should be able to serve them in their professional areas, I think with efficiency and effectiveness across a reasonable range of problems. That I think is going to take a change for us to do that. And the way that we organize the addictions, I think is pretty poor. I mean, you organize it by, for example, the particular substances you're addicted to. Oh, please, that doesn't really tell you very much. Systems of care are so poorly integrated that if you can't think more broadly about addiction in the context of these other issues, good luck, because you're going to have to figure out a way to refer or have a multidisciplinary team. And that's the song people sing, but the reality is that's not the care that they give. It's not like you're going to have three or four or five professionals meeting each with their own little thing, other than it's clinics that can afford it that are grant-driven or otherwise funded that systems of care and then are overburdened. And if you can't do it, you're going to have a hard time referring it often to somebody who can. Plus the treatments that we have for mental health problems, behavioral health problems, prosperity goals of all kinds, issues of performance and things, as well as this corner of the world called addiction, they overlap hugely. It's obviously true in the behavioral addictions. It's true, and I will show a little bit about why even in the mental health areas. And the processes of change are similar. The things that help people walk out of an addiction or walk into one mismanaged are quite similar to the things that would walk you into mental health problems or behavioral difficulty in dealing with physical disease or having problems in social wellness. So for all these reasons, I think this is a reasonable place. Well, it's the place I wanted to go, but these are kind of the cheat sheet version of why. We've lived inside for 50, 60 years of a syndromal approach driven by a latent disease model. That's really a process of change model in ARC because the hope is by identifying signs and symptoms and the clusters that may exist, that you'll be able to identify the functional units underneath them, etiology, course, and response to treatment. In other words, the diseases. And when you know the causal processes, the processes of development and maintenance and the treatment processes of change, when you know all that, you have a functional unit. Unfortunately, in the history of psychiatry, the last one is general paresis. And that's, nobody has an untreated syphilis patient on their caseload, at least I hope you don't. If you do, quick, make a referral to treat the syphilis itself. So I think almost everybody believes this is a bit of a train wreck. You have a strategy that's meant to pay off in a particular way. And after having spent billions of dollars, there's no good examples of actually getting there. I'm old enough to have heard, yeah, but it's just around the corner. It's just around the corner. This set of genetics, epigenetics, brain circuits, you name it, are going to give it to us. Well, if you want to keep listening to that song, okay, but there's other people who don't, such as NIMH and NIAAA for good reasons, I think. Plus the system is hardly simple. I mean, if you look at the DSM-5 diagnoses, you have almost over 10 million ways of combining those signs and symptoms. If you add specifiers, it's 161 septillion combinations. That doesn't sound like simple. And people usually say, yeah, well, we need the diagnostic system to have a name that we can also all agree on. That's such a small benefit. You know, I want something that's functional and tells me what to do. And the opening chapter of the DSM-5 says, don't treat the book that way. Well, if it doesn't have treatment utility, why, it's kind of like you're in a room and you're asked to bake something and you've got a gazillion recipes behind you, but you're not clear how to sort through them. There's no real good evidence that it's progressive. If you look at the psychosocial area, this is outside of addiction, but still it's the same point is true. This is with the best of breed. This is Stefan Hoffman did three meta-analyses where he looked at only the very best trials, placebo-controlled, et cetera, starting up to 2008, then the 10 years after, then the five years after. And this is with anxiety disorders, which is usually thought to be the one where we have the best developed technology. It usually overlaps with depression. So these are effect sizes on co-morbid depression in those trials. And if you just look across all of those years, everything up to 2008, next 10 years, next five, this does not look like progress. This is a smaller and smaller effect sizes. Now you can get meta-analyses with flat effect sizes, but if you know one that says we're getting better, please send it to me, because I don't know of a meta-analysis that says we're getting better in evidence-based therapy. And meanwhile, we're going back to the well over and over and over again with our medications that can be helpful in some circumstances for some people done proper way, but they're often scripted in ways that are not helpful and lead to long-term side effects, some of them lifelong. And by the time you're catching fish in the open ocean, mind you, no longer just the rivers and streams, and they have measurable amounts of painkillers and antidepressants in them, so-called. These are marketing terms. That's not a real, they don't kill pain and they're not antidepressants. But just like the PHQ-9, the marketers come up with cool ideas for how to name things to sell them. This is an excessive use of technology. And I think almost everybody who's careful and cautious and data-driven says, yes, that's true. So what's the alternative? Well, let's just start with the experience of practitioners. The experience of practitioners when they're given a randomized trial, and this is just one kind of randomly picked of depression, CBT versus interpersonal psychotherapy. Now, you present these smooth curves and you tell the practitioners this is what they should expect. The reason I picked this trial is this particular trial happened to take weekly measures and these are all the patients in the trial and their actual sequence or their values of BDI values. And so the clinicians live in this world, the scientists live in this world, and the scientists tell the clinicians they should do what they're being told to do by the research because surely it's the best thing to do. And I don't think that makes sense. It's no wonder that it's hard to get people to attend to science. It's particularly hard in addictions because you have many people in recovery who don't necessarily have the particular training, but I think we can do something very, very different. And ACT, I think, has shown the way about how to do that. But the way that you do it, in my opinion, is to move towards processes of change, but then the warning is everything changes when you do that. I've been on a 10-year journey of this, but it's actually more because it's been in the ACT work, which is now 40 years old, and I'll talk about that in a second. Our very, very first trials were on components and processes in the earliest first study ever done, 1984. Rob Zettel, my first doctoral student's dissertation done with the cooperation of Tim Beck in Philadelphia. That was the title of it. And so I've got a, that's 84 to now, 40-year history of chasing this, but now we have names for it. Now we can call this what my colleague, Stephan Hoffman, and I call process-based therapy, which is to shift the focus from what treatment technique, package, protocol does the best for this syndrome to what core biopsychosocial processes should be targeted with this client, given this goal and this situation, and how can those processes be most effectively and efficiently changed? That's important, I think, because those are the immediate effects. Processes of change happen before outcomes. That's why we call them processes of change, just from the Latin word underneath process, which means a parade or process, and it just means a sequence of things that people do that lead to outcomes or things that their body does in the case of brain circuits, epigenetics, et cetera. And we ain't the only one. There's a whole lot of folks that want to go to processes, Tom Inzel being an example. When he decided that RDoC was where he wanted to take NIMH, he had a number of systems here that he thought were important processes, but he was convinced that the real underlying process was neurodevelopment. That was a mistake, I think, because you don't ask a science question when you already have the answer, and he clearly said the answer, genes and brain circuits, and then these are ways to help us orient your valence systems, cognitive systems, social processes, et cetera, to what those are. $20 billion was spent, and you can read Healing, Tom's book, where he will apologize and say, basically, the scientific equivalence of whoops, or as my mother used to say, schlippens, where the $20 billion is gone, but he's saying, I'm sorry I didn't move the needle in reducing suicide hospitalizations, improving recovery. Well, he went in a process direction, but he said, here's the answer. That was a mistake. What if we went in the process direction and say, well, what is the answer? Well, let's start with how we know that there's a process question and answer. Now, it's done at a level you'll see later on. I'm going to criticize this and say it's a mistake, but in the 50 minutes I got left, and I'm glad I got an hour and 15, because this is a big thing I'm trying to lift here, I'm going to walk into what happened with the third wave of CBT. Third wave is my term, and I invented it in my presidential address and published in 2004, given in 1998 or whatever. It took me a while to write the article, and they fought me like a dog to not publish it, but I finally got it out. But one of its primary characteristics of this move towards acceptance, mindfulness, values, and so forth, it wasn't just ACT, but it was DBT, and MBCT, and metacognitive therapy, and so on, or motivational interviewing, one that would be really popular in the addictions, is that they're all focused on functionally important pathways of change. And so let me dive into the ACT literature, and I'll look at that model, then we'll back out and we'll answer this question more generically for the whole field of mental and behavioral health. And then from there, I can maybe point to some of the very disruptive things that happened when you decide that this is what evidence-based therapy should be about, be prepared to be disoriented. I still am, and I've been working on it for 10 years. The model that's underneath, acceptance and commitment therapy, or acceptance and commitment training when you're using it in an industrial or organizational setting, or as a prevention program, in either case, it's called ACT. The model that's underlying it is called psychological flexibility. And why would you want to look there if you're interested in processes of change? There's a different way of thinking about problems that maybe get us out of this conundrum of a DSM diagnosis that doesn't tell you what to do and is not getting us a progressive scientific literature and is disconnecting us to what clinicians actually see. Well, there's some good reasons. One is that there's a whole lot of data. Just today, I went and looked, there's 1,097 randomized trials on ACT around the world. I know for a fact there's 130 that are still not uploaded that are mostly from the lower middle income countries, which are very, very hard to find and index because often they're not indexed in web of science or whatever. You have to fight like a dog to hear those voices that have been suppressed and ignored around the world. The whole problem of the weird, the Western educated, industrialized, rich democratic countries, they have 10 or 11%. Of those folks, given us 85 to 96, in the case of psychology, 80% of the literature and even more of the citations. But if you fight for it and you find, you can get a broader literature and ACT has it and it's quite deep. And its breadth is not just across higher income countries and LMICs, which it is, something like about 45% of these randomized trials are outside of the higher income countries, I'm proud to say. But also an incredible range of problems. If you just scan across this, there's almost nothing that you can think of that involves human functioning where there's not ACT randomized trials. And it's not because it's one size fits all, the technology changes. It's because the model is process focused in a way and it was built in that way that deliberately has high precision, high scope and high depth processes at its core. Why would you wanna do this if you're just interested in addictions? Well, part of what I said is you can't be just interested in addictions because of comorbidities and the way the healthcare system is organized, you gotta have broader interests and serve your patients. But it's also the case that there's just a hell of a lot of randomized trials and studies on ACT with the addictions. And in some areas, there's indications that it's actually better. And if you've got somebody who's addicted to pornography, for example, I would probably recommend ACT as a first line treatment. If you are looking at something like smoking, the CDC put something out recently that said it looks like it's improving on some of our existing technologies, especially with the app area, Jonathan Bricker's work comparing the consensus CBT app that is the tobacco money settlement put into all of the states and his more ACT-based approach looking like it gets better long-term outcomes, at least in some of the trials and in areas of prevention. What is, but put aside better in terms of outcomes. The one thing, and I just threw up a few meta-analyses, there's a Bitly link where you can go look at just today, I think we're right about 500 meta-analyses on ACT, at least some studies on ACT in the meta-analysis on just every area you can name. Why would you be interested? Well, for one thing, because there's so many different problems and there's meta-analyses in most of these areas now, when you target processes of change that are involved in addiction, let's say, if the person also has, let's say, chronic pain, or they also have, let's say, an anxiety problem, or they also have, let's say, relationship problems, the same processes are gonna apply. So you're doing something that's efficient with people that you train and the people who deliver care, and often it's not the researchers, it's not the leaders and the heads of the clinics, especially in addiction, it's often people in recovery and so forth, and you can find ways to get these processes into the treatment providers' hearts and heads and hands. There's another reason, which is from the very beginning we were process-focused, and you can see it just in the fact that the first mediational analysis was done in 1986. Well, the first article on mediational analysis, Barron and Kenny, was published in 1986. So that's how early we were. The first component analysis was done in the early and mid-'80s, the first process account and so on. So what is this model? I'm going to give you the model in the non-classic ACT way. I'm going to give you the model in the broader way that we're doing inside a perspective of process-based therapy. Why? Because I think the model spreads to other treatment technologies and approaches when you think in this broad way. I promised I'd give you at least one technique and I'm going to find a way to do that at light speed soon, but let me just give you a modified version of the classic hexagon way of thinking about ACT, but use non-ACT terms, broader terms, for what's really involved here. And we'll start at the bottom and we'll spin around, taking perspective on yourself and others, learning to be more flexible in your thoughts and not be so entangled with them or unable to generate a wide range of them, to be more open and flexible with your emotions and not be so avoidant or not be clinging and hanging on to emotions. Something which is especially important in the addictions and is part of what happens with the addictions, it's called a fix for a reason. It's not just fixing broken, it's also holding it in place. Heroin in your veins at a certain level, you're going to be smiling and it doesn't matter what's happening. I think the story I usually say is our first big randomized trial on ACT was with polysubstance abusing heroin addicts who are on methadone and still chipping. And the person I can picture his face telling, when he finally told the story, that he was so high lying on his couch that his daughter was being perpetrated on in the back bedroom and he couldn't get up and leave because he felt so good. And a loving dad, by the way, and he had to walk through hell to clean that up, but he did and ACT helped him. So emotional flexibility is not just not avoidance, it's also not clinging. Attentional flexibility, being able to broaden, narrow, shift, or stay in your attention. In the service of what? In the service of what's important. What do you mean by important? Well, I don't know, what are your values or chosen purpose? What do you want to be about that's intrinsic? Not just the goals, that's great, but what are the qualities of living that you want to put into your behavior and manifest for the world? And how can you do that? How can you create habits? And if one way of doing it is blocked off, find another way to do that. If you want to cluster these six things, I started here and swung around for a reason that I may explain, but if I don't, there is a reason to do it. But if you cluster them by pillars, you can take this hexagon model and turn it into three, which is learning to be more open. Why? Because these two, cognitive rigidity and emotional rigidity are the single most rigidity producing things that we know in all of psychology. If you had to, even outside of language and creatures, but especially for those with language, that is for human beings, these are repertoire narrowing. And if you always do what you've always done, you always get what you've always got. And so any system to evolve needs to be, have healthy variation, but it has to always be fitted to context. There's nothing, absolutely nothing, underline the word and embold it, that is always and everywhere helpful to your life, or always and everywhere hurtful to your life, except maybe suicide. And so you're going to have to learn how to fit what you do to the needs of the moment, linked to what? Linked to the active engagement in a life worth living, linked to the kind of life that you want to live and how to build behavioral habits around that. Open, aware, and actively engaged is a way of talking about principles that are required for systems to evolve. Healthy variability that's selected and retained by practice but fitted to context. Now I'm going to spin through, because I promised I would, and give the shortest example of an intervention in each of these six areas, organized by each of these three pillars. How do we learn to be mentally open? Well, for one thing, we got to put that chatterbox between our ears on a leash. It's 1,000 times younger than other parts of us operate in classical conditioning, has at least been here since the Cambrian, since every species that evolved since 565 million years ago do operate in classical conditioning. But they don't do what we're doing right now, a symbolic talk. Human beings are the only species that's 100% known to do that. And don't tell me about the Kali who has 1,000 words, and we'll show you why it doesn't meet the criteria. But once we get talking, it's really easy to become entangled with that. And so I'll give you an example of something that would back you out of that. Take any self-judgmental talk. This is something that Titchener came up with in 1907. Distill it down to a single word, say it out loud for 30 seconds, at least once per second. If it's, I'm bad, say the word bad, or I'm bad. It's a little slower, better if it's only one word. Just try it. And we have done many, many, many studies on that. Within 30 seconds, the believability of the thought and the distress it produces, these are two impacts and they're somewhat separate in the exact temporal way that it happens. It plummets and the thought has less punch. So learning to sort of play with your thoughts so that you can see your thoughts instead of just seeing the world structured by your thoughts is how you put your mind on a leash. Nowadays, anybody would know about meditation practices and these are one big ways that you do that. You need to learn to feel more openly. If I wanted an example of that, I might say, well, okay, where do you feel this in your body? This fear, this disgust, this anger, this whatever. And I would ask you to start going into what that sensation is like and maybe actually sort of build out an appreciation of the qualities of emotion. If you're chronically running away, you become alexithymic. You don't know how to name and observe just in the same way that if I always diverted my eyes when I saw a sunset, I wouldn't know very much about how to describe it. So in order to open up and know what's going on, just being able to appreciate the dimensions and qualities of emotional experience and have a name for them. A good start might be in pain. There's a reason why we say throbbing pain, stabbing pain, burning pain, because you can see the accompaniments and you know the qualities. It would be nice if you could do the same thing with sadness, if you could do the same thing with jealousy or appreciation, it would help. And starting with your body is a good example of a classic technique. We need to learn to become more aware. What does that mean? It means flexible, fluid and voluntary attention inside and out. And there again, meditation practice, if you wanted a quick, quick, quick example, I would say I can do this in 15 seconds. Focus on what the sole of your right foot feels like without moving. And just notice that that sensation has been there right along, including when I was talking before this moment. And now shift over to your left foot and notice what it feels like. You may even give a word to it, if it's hot or burning, sweaty, throbbing, whatever it is. And now see if you can focus on both at once without just shifting back and forth, but by fuzzing a little bit and broadening your view. Kind of the way I'll mix another metaphor would if you held your finger in front of you and focused on it, and now focused on the room behind the finger. As you do it, if you focus on the finger, the room behind it becomes blurry. If you focus on the room, the finger becomes blurry. So learning how to shift, stay, broaden, and narrow is a skill that you can learn with mindfulness exercise, attentional training, and so forth. And when you do that, you may begin to notice that you're noticing. There's a part of you that showed up when this perspective-taking skill became dominant and consciousness went from simple, greater awareness of the relationship between the world inside and outside, which all creatures, not just humans, have some better than others. The story of evolution is the story of the evolution of consciousness. But when we broke and were able to step back and look back at ourselves, that peace is the peace that allows you to go behind the eyes of another person and have empathy, to imagine what your children will be dealing with if we keep warming the globe, we're dealing now, or we keep putting hate into the world or economic disparities or immigration crisis, either you name it. It's that quality of perspective-taking, catching that there's a part of you that notices and witnesses and observes this more spiritual part of you. And spirituality and finding that part of you is heavy in the addictions for a reason, because when you catch that part of you, you're much more able to walk into the hell of your own history. And as I say to every client I've ever had when I'm treating addiction, don't expect that I'm here to eliminate the addiction and don't expect that this is gonna feel good. Very likely, you're gonna feel worse before you feel better, but I can pretty much promise you'll begin to feel. And from there, life can be built. And then we need to learn how to become more actively engaged in a meaningful life. What is the ruler? What is the metric? And there, I think your values, your intrinsic meaning by choice. And if you want quick ways to get that, sweet, sad heroes and stories, I'll only unpack one. Pick a hero in your life who you think shows you qualities that might be useful to you right now with the challenge that you have in your life. Ideally, somebody that you actually know, but if you wanted to pick somebody that's known only through scriptures or so forth, you could do that. But ideally, somebody you know. And then take the time to just notice the qualities that you appreciate in that person. And I can almost guarantee you, you've now laid out a roadmap to the qualities that you wanna put into your life. In a word, you probably have said a bit of what your values are because that's why you appreciate the person is that you see something in there that's honorable or worthy. And then if you wanna build habits around it, well, there's only one way. It's the same way you learned to reach out and grab something when you were a baby and put it in your mouth. It was the same way you learned to stand up. You're gonna need to practice and you're gonna miss the target over and over again. And so the commitment to a process of the over and over and over again effort, creating habits that are driven by the intrinsic qualities of being and doing that you wanna put in your life is what I mean by learning to become more actively engaged. Now, let's look at the mediators. I promised you I would and I'm gonna do something pretty dramatic. We spent three years as a team, myself, Stephan Hoffman and Joe Sirochi and one of my students, Fred Chen, one of Joe's close colleagues, the editor-elect of the Journal of Contextual Behavioral Science, which is the wing of work that focuses on that. By the way, it has a very good special interest group on addiction, Beldinger-Asadra. That group, last year or a month or two, published a study in which we looked at every single randomized trial ever done in the history of the world in any language, in any journal, on any psychosocial intervention. We didn't do medications that claim to properly identify a process of change in mental and behavioral health. I gave us 55,000 studies almost to rate twice. That's why it took us three years, 50 people, unfunded. Don't do this at home. I do not recommend it. What I'm gonna show you are the measures that replicated at least once. And there were 73 of them in about 300 studies out of all of these. Legitimate, really well-done mediational analyses. If you don't know what that is, it's how you know that change happens. You identify the impact of treatment on a process that occurs before outcomes are fully finished, that controlling for the arm of treatment then predicts outcome. And when that pathway is put into the direct treatment to outcome pathway, it significantly reduces the effect sizes of treatment. That's what a mediator is. I have problems with the way of doing this, but I gotta start from where we are. And that's what we looked at. Why? Because we didn't wanna say, hey, we think X cool. No, we wanted to say, what are the change processes that really matter? So if you haven't seen this study, go check it out. There's the DOI, the slides will be distributed. You can jump over. But either way, you should mentally do a drum roll. I think I've deserved it after three years of working with 50 people on every study ever done in the history of the world. And here's what was found. Psychological flexibility processes, which is our name for open, aware, and actively engaged in the processes that measure that, other than mindfulness. And then mindfulness measures. I didn't say, but I should have. Let me just jump back over here. Being open and aware, those four processes are basically almost word for word, John Kabat-Zinn's definition of mindfulness, other than perspective taking is not called out specifically, nonjudgmental attention, et cetera. If you know John Kabat-Zinn's definition, these four are processes that link to mindfulness. So mindfulness is built into the psychological flexibility model. I'm calling it out separately because there's lots of mindfulness researchers who aren't ACT people and don't wanna be. And so it seemed grabby. But if you just put those two together, it's about 42% of the positive findings that we have that are replicated. Remember, it's only the ones that are replicated. And then it's plummets, but you've got things like dysfunctional thoughts, anxiety, sensitivity, self-efficacy, parenting, physical activity, reappraisal, drinking, rumination, mood, coping skills, social support, aloneness, dysregulation, self-regulation, therapeutic alliance, and so on down. And when you get down this low, it's only two studies out of the 300. It's a pretty small part. Now, how are you gonna organize something this big? Well, you could just go back to the hexagon and say, we're just gonna do that. We thought it would be better to try to come up with a language that everybody, maybe even in your speaker next month, you know, Steve's, well, not Steve, but the internal family systems guy, Schwartz, yeah, will, I think, probably say that something, what he is doing has something to do with evolution. I've not met a major researcher in the psychosocial area who wants to say, I have nothing to do with Darwin. They usually don't wanna say the genes made me do it, although they realize that genes are part of the systems. But if you take a step up and you think of multilevel, multidimensional evolutionary science, which I think is the best way to think, I think multilevel selection is a proven fact now in evolution. And David Sloan Wilson and the late Ed Wilson, the social biology guy, agreed on that late in his life, because Ed Wilson had promoted kin selection as the primary way you get cooperation and so forth. That's another story. But if you think about this as evolving systems, and, you know, your cells are evolving, your organs are evolving, organisms are evolving, species are evolving, groups are evolving, cultures are evolving. These six are the psychological dimensions of evolution. Evolution requires healthy variation, selection, and retention. This is just flat out Darwinian thought. But it's happening at multiple levels, and that adds to Darwinian thought, although he said that, and then it went into, you know, in the blind watchmaker era of the selfish gene and so forth, it almost got squeezed out of evolutionary science. It's back now in spades, because I think, because the data has just proven it. I think it's just data-based. Kin selection is a special case of multilevel selection. You need to think about also the parts and the nestedness of groups within groups. Take the example of something like eukaryotic cells. You know, you can get out in plants, male cytoplasmic sterility, because mitochondria go by the maternal line, and every once in a while, they still are tricking plants to only produce females. And so, you know, cancer, you know, you may be a multicellular organism, but there's always the possibility of the cell saying, shit, I just want more of me. Not that it can talk, but you know what I'm saying. So it's a cooperative system at this level, but not always. Same thing at the cultural level. So multilevel, multidimensional. Now, the thing I was showing to you earlier, the hexagon, if we go to 35,000 feet and then open the door to anybody to come in and play, those six things involve a sense of self, cognition, affect, attention, motivation, and overt behavior. I'm saying it now in the order that I described it earlier in this talk. Self, cognition, affect, attention, motivation, overt behavior. So you can take that and put it in any model. So if you do that, and then you look at all these mediators, then first thing you say is, well, there's some things like anxiety sensitivity. You know, I don't like anxiety and I'm going to run from it. That's pretty close to experiential avoidance. You know, I'm going to run from difficult thoughts or cling to them actually, although it's not in there. Self-compassion, what correlates 0.74 with, you know, Kristin Neff's self-compassion scale with classic psychological flexibility measures. And what does it include? It includes self-kindness, the perspective taking elements of appreciating that you're part of a common humanity and so forth. De-centering, what is it? Well, it's that sense of self. It steps back and notices behavioral activation. Well, what is that engaging and values-based behavior? Neil Jacobson's work in the modern version of behavioral activation. You put that together up to 55%, but then this model also says, well, there's social things and there's brain circuits, genes, epigenes, organ systems, et cetera. If you make room for those, and then you look at these things like, well, how is rumination and worry not attentional inflexibility linked to a kind of cognitive flexibility? How is entanglement with negative thoughts? How about reappraisal? Yeah, reappraisal works by greater cognitive flexibility. We now know that your thoughts don't go away when you reappraise, it's just you're adding new things. It's like having a glass of salty water and adding fresh water so it's less salty. You're not removing the salt grains. It's still in your repertoire. You can still think goofy things, it's just you now are more habitually thinking other things. And so if you go in a friendly way and look at all these processes, you can take every single measure that's ever been replicated as a mediator of psychosocial measures and say that it's an instance of this extended evolutionary meta-model of maybe we call it integrative life flexibility, maybe we don't call it psychological flexibility. So that's a cool part of my talk. By my clock here, I got a little less than 30 minutes. I hope that's true, because I believe I've got a little more than an hour. Here's the warning I want to give you. Is that true? I heard a sound. No, you have, yeah. I have 20 after and we've got till 15. Till four o'clock, till four o'clock. Yeah, yeah, yeah. And we're going to do 15 minutes. So I'm going to try to stop at 345. My time, your time, whatever that is. Okay, now here's the thing I got to warn you about, but here's the brand new stuff. If you get focused on processes of change, we have to shift levels of analysis in our stats and our scientific thinking. And boy, is that disruptive. And any statisticians listening to me, be prepared to hate this talk, but I'm sorry, it has to be said. I think that the stats just make it so. Let me start with a metaphor to explain it. And then I'll show you some data. And then I'll loop back to this theme I've been trying to give, which is let's focus on biopsychosocial processes. And if you had to simplify that, I'd say in your clients, focus on all these dimensions with whatever model you've got, internal family systems, emotion focused therapy, CBT, ACT, I don't care, DBT. You can have multiple models, but this meta model ought to be in there and you better cover most of the rows and columns. Here's the problem. Suppose I said you have to get to the back of this building and there's a vestibule here behind this center door where there's then glass doors behind it. Unfortunately, I'm telling you now, but you don't know it from here. Those doors behind this door are locked. You cannot walk straight ahead. When you get in that vestibule though, there's a door down to the basement and you can go up and out that way. There's a door up the roof and you go over to the fire escape and down that way. Or you can leave the vestibule and go out to an alleyway on the left or an alleyway on the right. That's it. There are no other reasonable and successful routes to take. There's down, up, left or right. There's not straight ahead. If I had an equal distribution of those and I did a mediation analysis the way we classically do it, it could tell us that the way to get to the back is by running through the locked door. The stats work, but it doesn't live that way. And so we've looked at all these mediational studies. When we look one person at a time, how do you do that? I'm gonna show you how. You see something very different and you're dealing in clinical work with one person at a time or one couple or one family, but one unit. You're not dealing with an abstract collective. The groups in our group designs are not intact groups. You're prohibited from analyzing them that way because then the error is no longer independent. If they're actual groups, each group is an N of one and you have to correct for the clustering. No, but in our traditional stats, it's an abstraction, it's a collective. We've been at this for 150 years. Galton put us, he didn't invent the bell curve, Ketele invented it, but he invented the standard deviation. And unlike Ketele who worshipped the mean, Galton worshipped the tips because he thought that they predicted the future of the people who are in those tips. His first book, and he was a grandson of Erasmus Darwin, a cousin of Charles Darwin, and he was very jealous of his cousin's book and its success, Origin of Species, especially the chapter on artificial selection. And he thought that if you're up here at the tip, we should have a lot more of you. And if you're down here, we should have fewer of you. So he invented a field called eugenics. And all of these tools in the psychology of individual differences, all of them, IQ tests, personality tests, all of the statistics, and by the way, diagnosis, were driven by the needs of eugenicists. Now, this is not a smear campaign, but I just want to say, the stats were for a reason. And Bluhler's 1924 textbook on psychiatry, that's only about 10 years or something after he comes up with the term schizophrenia, he says they ought to all be sterilized, go read it. He was a eugenicist. And who were these laws that were written with the active agreement of psychology and psychiatry in the US of A, that then went to Germany, that was the first wave of the Holocaust. It was not Jews first, and I'm Jewish by the maternal line. My great-aunts and uncles died in ovens, half of them. And so, but no, that came after taking care of, in quotes, people who had addiction, alcoholics were exterminated, people who had seizure disorders, people who had mental disabilities of all kinds, people had, et cetera, et cetera, schizophrenics, you name it. That came first, and the mercy hospitals where the families were lied to and told they're being treated when actually they were one at a time being exterminated every single day and buried in mass graves with pretend graves and a picture sent back to the family. Anyway, that history is built into our statistics, but put aside the history, which is loathsome and dirty. The tool was designed for that. Now, here's what happens when you start looking in a different way, when you start doing what you'd have to do to understand how people got to the back of the building, which is every single route matters, every single pathway matters. You have to trace the footsteps of everyone and then characterize them. That means longitudinally over time, you need to do that. I'm gonna show you some data, but I will say one other thing here before I do this. In the 1880s, statistical physics figured out that you can't go from a collection of molecules of gas, like a volume of gas, to predict the behavior of the molecules of gas, which they couldn't measure at the time, unless every molecule showed the same dynamic pattern and there were no trends in the behavior of the molecules. It can't go up or down over time. There are no instances in life sciences that fit those requirements. It's called ergodicity. And Peter Molinar in 2004 was the first person to notice in the life sciences, holy shit, that means we can't go from this model to predicting what's gonna happen to people. I know almost everybody I'm talking to believes this works. It doesn't work, the stats doesn't work. And it's kind of like homogeneity where people say, oh, it doesn't really matter. I'm sorry, it does matter. And I'm gonna try to prove it to you now. These are actual data. These are data on self-compassion versus compassion towards others. These are actual linear trajectories over time where we have several weeks, about 60 data points worth of data on each individual. There's a nice slope up. If you're kinder to yourself, you're kinder to others. That's that orange or that purple line. But you see a lot of scramble. And we do have ways like in meta-analysis of getting worried about scramble. In the meta-analysis, you probably know there's a thing called I squared. There's also Q squared, which I won't spend time on, but I squared has to be less than 0.5 or you can't publish a Cochran report or whatever on the difference between classical CBT and ACT or whatever it is if it's above 0.5 because you can't have so much unexplained variability when you're asking a scientific question and then get put out the mean and say that's the answer to the question. So it has a pretty well worked out and agreed stat in meta-analysis. All right, here's some actual data. I'm gonna come back to those data and show you what it looks like when we do it our way. But first I'm gonna show you what we are now doing. What we're doing is collecting high density longitudinal data and applying modern statistical tools. We're inventing them basically, but drawn from AI methods or from econometrics and other methods that were focused on groups. And now one at a time without any sharing of data or variance from one person to the other, we identify the confidence interval and the central tendency of the relationship for that person. And you may need 60 data points over time to do this EMA style data. What you're looking here is the relationship between mindfulness and emotional wellbeing. And you probably know there's a nice little positive effect. That's a correlation about 0.25, it's not huge. But for most people, the more mindful you are, the way I was showing even out of the ACT model or any model that you have of mindfulness, in general, the happier you are, the less distressed by sadness you are, et cetera. But not for everybody. See these people down here? The more mindful these people are, the more miserable they are emotionally. Now you calculate an I squared, 0.88. If this were a meta-analysis of people instead of a meta-analysis of studies, you would be prohibited from publishing the mean. If you run this in a normal study, the mean and the stats around it is the only thing you'll see. You will not see what actually happened to the person. Percents. We now have a study showing the same thing applies to couples. We have one coming showing the same thing applies to families. And I showed you this graphic. Okay, here's the exact same graphic, but now I'm going to show you something. If you're a stat person, you should be really distressed because I am, and I want to make you distressed. This is what happens when you put it through multilevel modeling, since we all know that the average dozen represent individuals, so you have to model the individual growth curves. And so we'll use modern stats to do that. So what you're saying about what happened, you know, all the way back with the, you know, 1880s, that was then proven as a statistical fact, by the way, in the 1930s, the ergodic theorem was proven science and physics since back-to-back issues of the National Proceedings of Academy of Science, von Neumann-Birkhoff, two world-famous mathematicians proved it in 1930 and 1931. You're telling me old news. I know that the individual, the average doesn't represent the individual. Okay, here's your multilevel modeling where you model the individual first, where you jump up and you do that thing that you're told this is the way we're going to handle the individual. We're going to create individual growth curves, and then we will nest them in cluster them into higher level. That's why it's called multilevel modeling. Okay, do that. Now plot those growth curves. The same data look like this. Does that look like this? No, almost all of them are going up. There's only a couple of them, barely going down to only one outlier. You can see lots of folks going down over here. Why? Let me give you another example. I'll just say why, I won't walk through the stats. This is a breathe in, breathe out, oh my God moment for me when I saw these data. Just came out, Baljinder Sadra, the new editor of JCBS, Journal of Contextual Behavioral Science. And I'm in there as an author. There's the DOI. It was just posted yesterday. It's open access. You can get it. Let's just look at sadness because entanglement and distress over sadness is a single item, EMA item that correlates very high with traditional diagnoses of depression. We're going to collect a lot of data over time. A lot of people, I think it's about 200 people. We've got about 60 data points over time and we're going to do it two ways. We're going to do it just correlated just like you could with an Excel spreadsheet, raw within person correlations. Yeah, but we know that's not the way to do it because any two positive trends will be correlated. The way I usually say it is the size of my ears correlate with my difficulty in finding names but I can guarantee you I'm not stumbling over names because I have big ears, even though I do and they keep getting bigger and bigger, a little bit of evolutionary cruelty. I could pick other organisms, organs rather. I'd like to get bigger and bigger of my ears but here I am with bigger and bigger ears and I can't remember names because they're both age-related. If I did vector autoregression corrected, I correct for the autoregression of each and we have a method to do that. We stole from economics called I for idiographic, Aramax because extraneous variable. It gives you almost the same value. We almost don't need to worry about it. And in general, distress or sadness, and this is correlated with what? Values-based behavior, doing what matters. When you're doing what matters, you have this nice about 0.25 negative relationship with distress or sadness or impacting joy but put that aside, we'll just focus on one panel. This big green spike, what is this? This is after you put people through modern stats and you model individual growth curves and then characterize them through multilevel model. Does this look like that? Now, wait a minute. Let me just explain why you should slap yourself upside the head and say, oh no. See that zero? That means the relationship went from emulative or helpful, if you think distress or sadness is not what you want in life, to hurtful. And by the time you get out here, it's statistically significant within person, within their confidence intervals. A clinician who after all, remember, is seeing these crazy ass things like this, they see that they intervene and it doesn't help. In fact, it looks like the person's more distressed. Why? Because they're more distressed. Now, it's part of a system. And in this article, we walk through why and we give good answers. I'll just say, here's the DOI, go get it. But my point is, my friends, the researchers are being self-deceived actively because these statistical tools still go back to the dirty history of characterizing people for the purpose of sorting them into winners and losers instead of empowering them. And they don't get into the grit and grain of actual life journeys and how to empower people. But there are ways of doing this. And I'm going to show you a couple. This is a beginning, just correlate it. So we're going to develop, I believe, a precision psychology. We have to. And in our precision psychology or psychiatry, what you're going to need to do is you're going to need to model the individual, determine what they need within the individual, and then give them the kernels and elements they need, not one size fits all packages. And if people want trademarked things and levels of training and ties to the founders and all that stupid woo-woo, we're going to need to walk away and say, look, we don't care about that. What we want are what are the elements you have that move the processes I'm targeting? And with respect, we're just not going to climb inside your little cage and live inside your trademark model. We'll use your model to help the person that's in front of us. Now, when you individualize, even if you don't do it with process knowledge, you get better effect sizes. This is a recent meta-analysis showing that. And if you look at when people crash and burn in any form of psychotherapy, the single most common problem is they don't feel as though their individual needs are being met. So being able to individualize in a precision psychology is important, but we're going to have to abandon one size fits all, and we're going to have to just figure out a way to not have the more biologically-oriented folks over here and the psychology folks here and the social folks over here, because these are three aspects of one whole human being. And we're going to have to begin to appreciate that whatever model you have, and here's the psychological flexibility model. Here are measures of each of the main six processes. And here, what we're looking at is positive affect. And we're looking across time within person with four different persons. And just glance at what's significant for each person. And you can see those six processes land differently for every single individual. Well, then what are we going to do? Well, what we can do is start with the fact that some processes help people. The same process sometimes helps persons and sometimes hurts persons in the context of an overall life network. I won't have time to unpack how we get this. This is one that you can get just in the first session. It's inside an app called PsychFlex, COI warning. I own that one with my colleagues. But it's actually, there's a free access you can play with these networks. But when you then start using statistical tools like vector autoregression correlations, this is with an actual person. This person, evolution of psychotherapy, you probably know the conference. I decided to get on stage with a person, do a demonstration, having only met him for five minutes. And the five minutes was, what do you want to work on? And she said, sometimes I say yes when I should say no because my boss makes unreasonable demands. And we looked and sure enough in the diary methods she did and saying yes when she should have said no. And she should have said, I can have that for you boss, but in a day or in two days, not tomorrow morning. Because otherwise my babies are going to bed without a bedtime story and I'm just not going to do it. About one out of five days, she felt as though she was doing things that are unreasonable with regard to her own view. And these flexibility processes that you know from the ACT model all correlated with it. Then we used artificial intelligence tools. I wish I had more time to talk about this one because it's so wonderful. It's a random forest procedure with a thing called a Beruda wrap that a hundred percent protects you from overfitting data which is the big problem of idiographic data. A couple of days can become outliers and they change the whole distribution. But AI has a way of fixing that. When we ran the data through, turns out acceptance didn't help her at all but the other five processes did. You actually create shadow variables that have the same mean and standard deviation as your real variables. And then you run them in decision trees like 3000 times in small groups. I don't have time to talk about it, but it's cool, ultra cool. When we know that these five are there, we no longer need the controls of the shadow variables and I run a final one. And here I'm going to land the plane by just saying what I did with this person and then saying a little bit about what the implication was. This is, did I say yes when I meant no and down is bad, up is good. And the answer is, if she was sort of a little diffused from her thoughts above 64 on a one to 100 finger swipe scale on her phone and in touch with her values above 75 on a finger swipe, she's good. When she gets a little hooked and she kind of forgets her values below 62 on one to 100, Those are the one-off five days that a baby's going to bed without a bedtime story. Then we start digging in and we say, okay, well, that's diffusion, that's values. You know, what's really important in here? And it looks like values is more of the horse than diffusion, even though diffusion came in first. Mindfulness feeds it, but it also helps with committed action, doing what I need to do. So we said, okay, well, let's see what predicts values using the same random forest procedure, but then a final decision tree for that person. I get on stage, I do a reveal, just like HTTV, here's your remodeled house. I said, okay, here's the deal. You already have a solution. If you get, now this is a different measure called the process-based assessment tool, that's more behavioral, that helps us understand flexibility processes. If you are, and what we're predicting now is values, why would we do that? Because our network analysis, this is a procedure called GIMI, group iterative multiple model estimation. I don't have time to unpack it, but it's an awesome structural equation modeling that's done one person at a time. And it tells us this process is important. I get in there and I say, okay, remember now we're looking at values. If your values are high, you're going to be good no matter what happens. If they're low, you're vulnerable. You've gone below that 62, where now you could actually put your babies to bed without a bedtime story. And I say, but look, you've got the solution here. When you're not feeling stuck and you're doing something really hard, how do I know? Well, you can't even read it. It's too small, but it says right there, 84, or does it say 86? Anyway, in the mid eighties on helping your health, which is really high on a finger swipe, it's almost the extreme. You're fine. I said, what are you doing? Because when you do that, she said, I have a yoga practice one hour a day. And as long as I practice yoga, I'm fine. If I skip my yoga, I'm at risk. I said, girl, we're going to work on that. Let's just drop this. And, and, you know, I would have never, ever known on the stage to say, we are going to work on your yoga practice. But the data set, if she can do that, she's protected and everything will work fine. Now these stats that some of which you barely know, we're just now publishing them. That article I put up, uh, and I told you about gender that's, it's just Arama. It's not yet the Bruda, uh, random forest procedure. They break out of where most data scientists are because they're still believing that we're modeling the individual correctly by multi-level modeling. I've shown you one study. We've got six coming. I think two are already impressed is the same story over and over and over. We are lying to ourselves as researchers. And then we lie to clinicians and we tell them that those smooth curves are what they see. And what they see are bowls full of spaghetti. So we've got to stop lying. It's got to start unpacking and every little strand of spaghetti matters because that's a person. So do expect this to be hard. This is a 20 year journey. I'll probably be dead before I see the result. But what am I trying to do with my two minutes left? COI warning. Some of this I sell, some I don't. Uh, we've decided we are going to take high density longitudinal measures, put it through these cutting edge idionomic stats. We had to make up a word, idionomic, instead of normative. The word normative is only 150 years old in the English language, and it was Galton who popularized it in 1860s. And the kids hate it anymore. Anyway, they don't want to buy abnormal texts. They're right. The end of normal is near. Let's figure out instead how to, the word idionomic means ideographically model, and then look for nomothetic consistencies, retaining the ones that help you model most individuals. And if it doesn't do that, you throw it out. In other words, upside down stats, central tendency is not what's true. And people are the source of error. People are what's true. And the collectives are the source of error. Those stats, idionomic stats are thundering out of the labs. We're having a big role in doing it. And MindGrapher is an app that the Institute for Better Health will be selling independently. And here I have no COI, I make nothing. I give money to these people. I'm a volunteer president. But for now it's available only in PsychFlex or another app called ActGuide. If you have an app and want this, we're happy to put it in there. Because what we're trying to do is then take the data and fully data on a data streams, including the data about nudges and bumps that are in this app. So if you decided I'm going to target acceptance, it'll have maybe 50 little ways that you could do it as an extension of your sessions. And you can swipe a finger and boom, it's in your client's pocket. In a fully GDPR and HIPAA compliant way, we don't even know who your clients are. It's privacy by design. If you're broken to the data, we can't even figure it out. But why? Because this journey now of processes of change, if you really, really want to do what is implied by where I started here, where is my figure? I missed it. Give me my figure. Where is it? If we really want to do this, we're going to have to have thousands of journeys that are then put into a database that the scientists can access. And that's what my dream is. That's why I'm president of IBH. That's where we're going to house the data. But to make that relevant, I have to serve the clinicians who are reaching out into the 24 seven world, 167 hours that you don't see your client when you see them one hour a week. And so if you go to that website, psychflex.com, you can get both COI warning. Someday I might make money from that. Believe me, I've made nothing. I've just put money into it. But soon this will be available and you can buy without the entanglement of that app. So my one minute past the goal. Here's my 60 second summary. There's a huge change coming and it's disruptive. We are going to see, I believe, an idiomatic revolution in psychology and psychiatry. Why? Because the DSM is exhausted. It's done. It's finished. Everybody knows it. They just don't know what to do next. High top doesn't solve it. All of these things make the same ergodic error. People are not aware of ergodicity. And when they become aware of it, they should breathe in deep because the violations of our own assumptions are huge. I mean, a hundred times beyond the cutoff to be able to report even the statistics we're reporting and claiming that's what the research shows. The good news is all of our practice community now can be play because if you're going to reach the individual grit and grain of individual lives, it's not the academic medical centers with their gold-plated doorknobs funded by the feds that are going to do it. It's worldwide and it's in every clinic and every corner of private practice. And so that old, old dream that was in early behavior therapy, early evidence-based therapy, you know, the Joe Volpe, I mean, psychiatry was a big part of it. That we could focus on the individual and learn what moves them. Yeah. We didn't have the tools to do a functional analysis then. Now we do. We have the evolution, we have the emotion science, cognitive science, and finally the statistical tools to do this right. And to put an end to Galton's eugenic dreams. And that's my talk. I'm ready to take questions. Well, thank you, Dr. Hayes. So feel free to put questions into the chat or the question and answer, and we can call on you. In the meantime, I just had a couple of questions myself. I think one of the things that you were talking about is, you know, a quote that you said is, you know, we haven't been getting into the actual life journeys of patients and that precision psychology is an important aspect of moving forward. You know, and what came to mind is that, you know, this is great. And this is what I try to do in my own practice. But it involves a lot of creativity. And I think creativity is sometimes de-emphasized in the modern world and not encouraged. So I don't know if you have thoughts on that. I do. I mean, there's an art to seeing the processes in front of you and being able to flow with it. And when you're in a flow with a client, you really don't need the help of any model. You know, you need it when you're not in that flow. But how do you get in the flow when you know that time and seat experience doesn't predict competence? It predicts confidence. There's multiple, multiple meta analyses of that. It's never come up with a different answer. Every practitioner think it doesn't apply to them, but I'm sorry, it has to. You know, you can't be living in Lake Wobegon where all the clinicians are above average. So if you think you know how to build process-focused therapeutic alliances, do be clear that 98% of the clinicians out there believe the same thing. And there are people probably in your care system you wouldn't refer your dog to who've been doing treatment for 20 years. And they know how to produce dependency. They may know how to, you know, act with a lot of confidence. Well, so what we're going to need, and the reason I showed you that basketball hoop is when you have art and you have the skill, you have the craft, the thing that produces that is experience, trial and error work, guidance, and good feedback. You know, I'm consulting with major league ball teams and stuff, and believe me, those performance folks measure every single little thing, bat speed, you know, etc. Well, if you're going to have a precision psychiatry, precision psychology, precision medicine, we're going to have to be shaped to be able to see it. And I think that means we're going to need statistical tools that help us see it. And, and then we can get better. So we've been relying now on symptom change, it's a bad read. Otherwise, we wouldn't have this problem of experience, not predicting competence, because we track that therapeutic alliance. Yeah, probably helpful. But you can also be fooled by that, by dependency and other things like that. feedback on processes of change that are reliable and focusing on what's important is much more likely to be what you need. So let's combine the art that comes from the experience with the scientific tools that help you see when you're doing something that will have long term impact. And what are those? Well, mediators, that's what those are, those are the first thing that changes that indicates that you're going to have follow up outcomes that are good before the outcomes change. So I said, I have some problems with the stats, because there's two top down norma categorical, but we're developing idiomatic mediational stats. And so it's going to be disruptive, but I think we'll be able to land in a way that the more art focused therapists will be feel supported instead of dominated and talked down to, where you'll be able to get nudges and bumps of like, you know, this might be what's going on, do you think? What do you think? Or we've already got, can I just say this, we've already trained AI programs to record the system session, give me what processes are being targeted, take any self report measure you want, put it into MindGrapher, and we can tell you how it correlates with evidence based items of those 73 scales that replicate those almost 1300 items. We've taught chat GPT to say things like, it looks like you're targeting acceptance, that it looks like it moved through the session. And you can get it like in about two minutes when you walk out of the session. Now, it's not turnkey yet. But it's where we're going. If I get the kind of funding I hope to get by begging from charitable organizations, I would really like to see that. And wouldn't you, if you would come out of your session, and right away, your report is written about what you did. And also a little bit about what progress might have been made, based on the transcripts, but not just that the paralinguistic cues, but not just that body posture, not just that wearables on their watch and feeding in their iPhone, and whether or not their heart rate variability changed or whatever it is that you want to put into it. I think that's where we're not, you know, is that's 10 years away. That's not tomorrow. But it's on this pathway. Now, the question was, are values relative? Is there such a thing as harmful values? Well, you know, the whole issue of values, you know, how do I get to be a good boy, you know, chosen qualities of being and doing what we do know is all the flexibility processes empower that. So if you're emotionally avoidant, for example, it's really hard to know your values, because those are the places where you're hurt. I mean, the places you're hurt are the places that you care. Not by accident, if I tell people to tell me the most horrible thing that ever happened, and then ask them to flip it over and ask them, what is that this that you deeply care about? They can say that the betrayal means I really care about loyalty and intimacy, and I want relationships like that. And so on it goes. I think the whole person is the person who should make values choices. So when you're emotionally open, you're not just hooked cognitively, you make those kind of choices as part of a social group, part of a physical being, some of these things are probably programmed into our underlying biology. And we're the social primates, for example. But you could be a hermit, I guess, if you really be a little bit wondering why you want to do that, but it's cool. Now, if you mean by values, just to answer the question of what do you want? You know, kids will say, I want to be rich, you know, I want to be able to have sex with everybody, I want to, you know, whatever, it's stupid stuff. And when you get my age, you know how stupid it is, we try to live it. But no, I don't think outside of our spiritual wisdom traditions, there's any science rulebook that will say thou shalt do this or that. But here's what happens when you don't. Here's what positive psychology, I think, made a mistake on that by listing virtues and stuff. There's a reason why almost half of the randomized trials on ACT are in lower and middle income countries. There's a reason why the World Health Organization is right now in the Ukraine distributing ACT and the single most commonly downloaded book in the whole WHO website is a self-help book on stress based on ACT. The bit.ly link, just put in capital WHO, underline capital ACT, you'll get it. It's in 22 languages. It's in the South Sudan, it's in Turkey, it's around the world. It prevents the development of mental health disorders, a 50% reduction at one year later, with a cartoon book and audio tape delivered by healthcare workers to people who are sitting in dirt in tents with nothing but their lives. When you say, what are your values, and you help people have the psychological flexibility to be able to embrace their values, and you have a definition that makes sense. The intrinsic qualities of being and doing that you want to put in your behavior. Not the goals, not the money, not the fame, not the cheap. No, those are fine if they're on a journey that does this other thing. I can tell you having worked with pedophiles and rapists and murderers and so forth, if you dig down deep enough, I usually find Betty Crocker. Yeah, I believe there could be evil people who have values that are evil. I do believe that. I just haven't met them yet. If you've met them, and I'd say, hope they don't live next door and marry your daughter, as Bob Dylan said. Meanwhile, let's empower the people who are in front of us for their journey and listen. If you're dealing with indigenous Canadians, for example, they have a seven-part model of values that is completely different than yours, completely different. You can't go stomping in there with boots on saying, here's what the value should be. You got to listen. I was just going to ask one last question, and maybe you can correct my misunderstanding. When I think about ACT compared to CBT, they seem like they're quite opposite. CBT, you're supposed to notice an emotion or a thought and say, this is wrong and replace it with something else. Whereas in ACT, you accept there's space on the bus for all the different thoughts. Well, classic CBT, but third wave CBT, which is what ACT was part of, so DBT, MBCT, metacognitive therapy, all have turned away from that. The effect of it, because of that, plus the data, you almost can't meet researchers, at least, or leaders who would say yes to what you just said for CBT. CBT has moved, it's changed. That creates problems for people like myself, because I'm part of that tradition, behavior therapy, behavior analysis, cognitive therapy, cognitive behavior therapy. I sent my first student to Tim Beck after all, but I never bought that model. I thought it was wrong from the beginning. ACT is 40 years old. The first ACT workshop was 42 years ago. The first study was 40 years ago. We've been on a journey with evidence-based therapy. I do think that cartoon, simple summary CBT does clash with cartoon, simple summary ACT, but what if we got to a place where the island archipelago of all these different little things with their heroes and their certification programs, and instead got together on Agora, where they could share ideas and say, well, here are the processes I'm chasing, and here are the processes I'm chasing, and here are the kernels that move it, and here are the kernels that move it. Not just the CBT world, that's diversity, but the motion-focused therapy people, or relational analytic work. Peter Fonagy's mentalization fits inside the EAM just as well as Sue Johnson's EFT or ACT. It doesn't mean the model doesn't matter. What I want to do with ACT is just grow it to the point that it means the EAM, and whether you call it ACT or not, I don't care. We elected somebody president of the ACT community who called it mindfulness-based emotional intelligence training. Do I care? No, not one tiny bit. I just want to thank you for taking the time to teach us about a lot of your most recent ideas in addition to ACT, and we really appreciate your taking the time. Thank you, Dr. Hayes. Yeah, and if I could conclude, say, if you want to, in the 30 seconds we got left, if you want to follow my work, you can go to my website, stevenhayes.com. If you want to find a professional home with people who think like this, go to the Association for Contextual Behavioral Science. There's a very good special interest group on psychiatry and medicine, for example, if that's where you are, or on all of these issues like addiction and personality disorders or whatever it is that you're into, and so I hope I've done something this week. Thanks, Dr. Hayes, and next month we have Richard Schwartz talking about IFS. Thanks, everybody. Peace, love, and life.

Dr. Stephen Hayes

Contextual behavioral science

ACT therapy

Processes of change

Psychological flexibility

Mindfulness

Self-compassion

Mediators of change

Cognitive processes

Emotional processes

Behavioral processes

Precision psychology model