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The effect of present moment awareness and value intervention of ACT on impulsive decision-making and impulsive disinhibition

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The effect of present moment awareness and value intervention of ACT on impulsive decision-making and impulsive disinhibition

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Content The Effect of Present Moment Awareness and Value Intervention of ACT on Impulsive
Decision-Making and Impulsive Disinhibition
by
Yi Yang
A Thesis Presented to the
FACULTY OF THE DANA AND DAVID DORNSIFE COLLEGE OF LETTERS, ARTS AND
SCIENCES
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(APPLIED BEHAVIOR ANALYSIS)
May 2020
Copyright 2020 Yi Yang
ii

TABLE OF CONTENTS
List of Tables……………………………………………………………………………………. iii
List of Figures…………………………………………………………………………………… iv
Abstract………………………………………………………………………………………...….v
1. Impulsivity………………………………………………………………………………….…..1
2. Acceptance and Commitment Therapy (ACT)…………………………………………….….. 8
2.1 Mindfulness and Behavioral Inhibition……………………………………………… 9
2.2 Value Oriented Action and Choice-Making…………………………………………10
2.3 The Present Study…………………………………………….…..………………… 11
3. Method ………………………………………………………………………………………. 12
3.1 Materials……………………………………………………………………………. 12
3.1.1 Delay-Discounting Task………………………………………………………….. 13
3.1.2 Stop Signal Task…………………………………………………………….……. 15
3.1.3 ACT Intervention…………………………………………………………….…… 16
3.2 Participants.………...………………………………………………….…………….17
3.3 Procedure…………………………………………………………….……………... 17
3.4 Statistics…………………………………………………………….………………. 18
4. Results…………………………………………………………….………………………….. 20
5. Discussion…………………………………………………………….……………….……... 30
5.1 Value Intervention Effectiveness…………………………………………………… 30
5.2 Present Moment Intervention Effectiveness………………………………………... 31
5.3 Limitations…………………………………………………………….……………. 32
5.4 Conclusion…………………………………………………………….……………. 33
References…………………………………………………………….……………….……….. 35
Appendices…………………………………………………………….……………….………..47
Appendix 1. Mindful Breathing….………………………………………………………47
Appendix 2. Mindful Observing…….…………………………………………………...48
Appendix 3. Life Compass …………….………………………………………………..49
Appendix 4. Matrix…………………….……………………………………….………..50

iii

List of Tables
Table 1. Value Participant Results………………...……………………………………….…….20
Table 2. Present Moment Awareness Participant Results……………..………………………...23

iv

List of Figures
Figure 1. Cited from Dalley & Robins, 2017.......……………………..…………………………..4
Figure 2. Cited from Herman & Duka, 2019………………………………….…………………..4
Figure 3. The Theoretical Construction of ACT: the Hexaflex………………….………………..9
Figure 4. Instruction and Example of Choices for 1-day Delay of Delay Discounting Task...….14
Figure 5. Instruction and trial timeline for Block 1 in Stop Signal Task…….…………..………16
Figure 6. Instruction and trial timeline for Block 2 in Stop Signal Task……….……..…………16
Figure 7. Non-concurrent Multiple-Baseline AUC and k-Value Across Participants…...………21
Figure 8. Non-concurrent Multiple-Baseline for Go and Stop Error Rate, Go reaction Time and
Block1 Trial Number Across Participant P-1, P-2 and P-3………………………………...25
Figure 9. Non-concurrent Multiple-Baseline for Go and Stop Error Rate, Go reaction Time and
Block1 Trial Number Across Participant P-4, P-5 and P-6………………………………...27
Figure 10. Social Validity Results……..………………………………………………….……..29

v

Abstract
It is well recognized that impulsivity is a multifaceted construct. Numerus behavioral and
neuropsychological studies have provided evidence that decision-making, evaluated by the delay-
discounting task, and response disinhibition, as evaluated by the Stop Signal task, are separate
dimensions or types of impulsivity. Therefore, it would be more niche targeting to treat impulsive
decision-making and impulsive disinhibition differently in clinical practice. Besides, as
impulsivity is a core symptom of many existing disorders, from a transdiagnostic intervention
perspective, employing a differentiated intervention focus might be more efficient. Acceptance
and Commitment Therapy is an intervention that targets transdiagnostic factors and focuses on
increasing psychological flexibility. The present study adopts multiple baseline single-case design
to test the effectiveness of Value intervention of ACT on impulsive decision-making, and Present
Awareness intervention on behavioral disinhibition. The results of the present research found the
value intervention showed a significant effect on the delay discounting performance for four out
of five participants. Interestingly, two of the participants become more impulsive while two other
participants became less impulsive. The intervention effect of the present moment awareness is
inconclusive, due to both the unstable baseline data and lacking of after intervention data points.

Key Words: Impulsivity, Decision-making, Disinhibition, Acceptance and Commitment Therapy
(ACT), Delay Discounting Task, Stop Signal Task.
1

1. Impulsivity
Impulsivity is a multidimensional concept that has been defined variously as aversiveness to
delays or inability to wait, insensitivity to consequences (Sonuga-Barke, 2002), a result of
impaired executive functioning, a tendency to act without forethought or adequate information,
(Bari & Robbins, 2013), and an inability to inhibit inappropriate or risky behaviors (Reynolds,
Ortengren, Richards, & de Wit, 2006). Impulsivity is researched extensively since it is a
transdiagnostic symptom of many psychiatric disorders, including attention-deficit hyperactivity
disorder (ADHD, Swann, Bjork, Moeller, &Dougherty, 2002; Sonuga-Barke, 2002), disruptive
behavior and aggression (Barratt, Stanford, Dowdy, Liebman, & Kent, 1999; Dougherty, Bjork,
Marsh, & Moeller, 2000), problem gambling (Goudriaan, Oosterlaan, De Beurs & Van Den Brink,
2004, 2008; Verdejo-García, Lawrence, & Clark, 2008), bipolar disorder (Swann, Anderson,
Dougherty, & Moeller, 2001; Lewis, Scott, & Frangou, 2009), borderline personality disorder
(Dougherty, Bjork, Huckabee, Moeller, & Swann, 1999), suicide (Corruble, Damy, & Guelfi,
1999), schizophrenia (Gut-Fayand et al., 2001; Dumais et al., 2011), and substance use (Field,
Christiansen, Cole, & Goudie, 2007; Smith, Mattick, Jamadar, & Iredale, 2014). Therefore,
impulsivity is an importance clinical topic and have attracted great research attention.
It is well recognized that impulsivity is a multifaceted construct. Recently, growing research
interest is raising in analysis of the different subtypes or dimensions of impulsivity (e.g., Dom, De
Wilde, Hulstijn, & Sabbe, 2007; Reynolds, Penfold, & Patak, 2008; Bari & Robbins, 2013). The
results from analyzing psychometric measures, such as the Barratt Impulsivity Scale (BIS), and
various laboratory behavioral tasks showed no significant correlations between the results of those
self-report measures and behavioral tasks, as well as between delay discounting tasks and
behavioral tasks, such as Go/No-Go task, Stop Signal task (e.g., Reynolds et al., 2006 ; 2008). On
2

the one hand, biased self-perceptions might exist in self-report measures while the performance on
laboratory behavioral tasks, in contrast, is free of subjective bias (Reynolds et al., 2006). Also, it
is suggested that psychometric measurement results represented trait impulsivity while the
behavioral tasks tested state impulsivity (Bari & Robbins, 2013; Nguyen, Brooks, Bruno, &
Peacock, 2018). Besides, it is regarded that behavioral tasks measure some specific dimension of
impulsivity, while the psychometric measures are deemed as evaluating broader and multifaced
impulsivity aspects (Swann et al., 2002; Sharma, Markon, & Clark, 2014).
On the other hand, the principal-component analysis of the data from various laboratory
behavioral tasks in the study of Reynolds et al. (2006) emerged two components, impulsive
disinhibition (Stop Signal Task, Go/No-Go Task) and impulsive decision-making (Delay-
Discounting Task, Balloon Analog Task), which was consistent with the results of Lane, Cherek,
Rhoades, Pietras and Tcheremissine (2003) that the data of inhibition tasks and delay of reward
tasks loaded to separate factors. The study of Dom et al. in 2007 suggested a three-dimension of
impulsivity as behavioral disinhibition, delay-discounting (hypothetical money discounting), and
risk-discounting. The principal-components and confirmatory analysis of a later study of Reynolds
et al.(2008) further confirmed three components of impulsivity, including impulsive decision-
making (hypothetical money, hypothetical probability and real experiential delay discounting
tasks), impulsive inattention (real experiential delay discounting task, Conners’ Continuous
Performance Test-II), and impulsive disinhibition (Go/Stop or Stop Signal task). In brief, numerus
studies have provided evidence that decision-making, evaluated by the delay-discounting task, and
response disinhibition, as evaluated by the Go/No-Go task and Stop Signal task, are separate
dimensions or types of impulsivity (Swann et al., 2002; Meda et al., 2009; Dick et al., 2010a; Broos
3

et al, 2012; Sharma et al., 2014; Mccarthy, Minami, Bold, Yeh, & Chapman, 2018; Harvanko,
Strickland, Slone, Shelton, & Reynolds, 2019).
This poor congruence of these two types of impulsivity is also corroborated by
psychoneurological research results. It is suggested that the right inferior frontal cortex or the
ventrolateral prefrontal cortex might be critical for response inhibition (Aron, Fletcher, Bullmore,
Sahakian, & Robbins, 2003; Aron, Robbins, Poldrack, 2004; Bari & Robbins, 2013; Sakagami &
Pan, 2007). Temporal delay discounting is found to be related with the medial frontal cortex and
ventral striatum (Hariri et al., 2006; Wittmann, Leland, & Paulus, 2007), orbitofrontal cortex
(Roesch, Olson, & Roesch, 2004) and nucleus accumbens (Cardinal, Pennicott, Sugathapala,
Robbins, & Everitt, 2001; Sonuga-Barke; 2002; Uslaner & Robinson, 2006), especially
dorsolateral prefrontal cortex when the larger later reward was chosen in the delay discounting
task (Mcclure, Ericson, Laibson, Loewenstein, & Cohen, 2007). The review of Dalley and
Robibins (2017) concluded that “stopping impulsivity” (disinhibition, e.g., Stop Signal task) was
regulated by dorsostriatal-dependent mechanisms while “waiting impulsivity” is mainly regulated
by the core and shell subregion of the nucleus accumbens. In a recent review study of Herman and
Duka (2019), the right inferior and middle frontal gyri, anterior cingulate, pre-supplementary
motor area, right inferior parietal lobe, and left middle temporal cortex were identified to
associated with “stopping impulsivity”. Especially, the brain activation during a Stop Signal task
was more predominantly associated with right-hemispheric activities (Rubia et al., 2001; D’alberto,
Funnell, Potter, & Garavan, 2017). The “temporal impulsivity” (e.g., impulsive delay discounting),
in contrast, encompassed a wide range of brain areas including pre-frontal cortex, limbic regions,
basal ganglia, motor cortices, thalamus and insula (Frost, & Mcnaughton, 2017; Herman & Duka,
2019). In other studies, insula lesions were related with decreased temporal impulsivity while
4

medial OFG damage increased myopic impulsive decisions (Sellitto, Ciaramelli, di Pellegrino,
2010; Sellitto, Ciaramelli, Mattioli, di Pellegrino, 2016). In conclusion, the psychoneurological
findings indicated impulsive delay discounting and impulsive disinhibition might reflect relatively
distinct neural mechanism (Dalley & Robbins, 2017).

Figure 1. Cited from Dalley & Robins, 2017.

Figure 2. Cited from Herman & Duka, 2019.
Impulsive decision-making refers to the tendency to forego a larger but delayed reward and to
seek a smaller but more immediate reward, reflects difficulty in awaiting gratification, and can be
5

viewed as a failure to take certain types of temporal factors into account appropriately (Kim & Lee,
2011; Herman & Duka, 2019). This feature of impulsive decision making is reflected in delay
discounting tasks, which is defined as the devaluation of outcomes, such as rewards or efforts,
along with the temporal delayed they are offered (Matta, Gonçalves, & Bizarro, 2012). Decision-
making was suggested to be a comprehensive process, including forming preferences, selecting
and executing actions, and evaluating outcomes based on the choices provided, each predicting a
measurable rewarding or aversive outcome (Ernst & Paulus, 2005). Besides, when applying the
delay discounting tasks on clinical populations, higher rates of discounting have been found among
cocaine and heroin users, alcoholics, pathological gamblers, and cigarette smokers (e.g., Madden,
Petry, Badger, & Bickel, 1997; Bickel & Marsch, 2001; Steward et al., 2017). These findings
further suggested that the rate of discounting is especially high for addiction-related rewards
(Hyman & Malenka, 2001; Hirsh, Morisano, & Peterson, 2008).
Impulsive disinhibition is suggested to emerge when individuals fail to suppress inappropriate
automatic behaviors (Kim & Lee, 2011), which is constantly been tested by the Stop Signal
Paradigm (Metin, Roeyers, Wiersema, van Der Meere, & Sonuga-Barke, 2012). The Stop Signal
task measures the inhibition of a planned response (‘action restraint’) or the inhibition of an already
started action (‘action cancellation’), as the go cue always precedes the stop-signal. It requires two
different sub-tasks: high frequency of fast ‘go’ responses, and low frequency of inhibition
responses on a delayed ‘stop’ signal (Bari & Robbins, 2013; Herman & Duka, 2019; Dalley, Everitt,
& Robbins, 2011; Robinson et al., 2009). The performance on the Stop Signal task is thought to
reflect action cancellation, that is inhibition of the already initiated motor response (Herman &
Duca, 2019). A meta-analysis study on the Stop Signal task performance of ADHD individuals
showed that they exhibited slower mean reaction time, greater reaction time variability, and slower
6

stop-signal reaction. It also suggested that stop-signal reaction time differences reflect a more
generalized deficit in attention processing (Alderson, Rapport, & Kofler, 2007). Besides ADHD,
poor impulsive inhibition was also found among populations with childhood externalizing
disorders and adult antisocial personality disorder (Iacono, Carlson, Taylor, Elkins, & Mcgue,
1999), schizophrenia (Hoonakker, Doignon‐Camus, & Bonnefond, 2017), suicide attempts
(Hesselbrock et al., 2004), and alcohol dependence (Porjesz et al., 2005; Dick et al., 2010a, 2010b).
In conclusion, the heterogeneous nature of the underlying mechanisms and expression of
impulsivity subtypes may indicate it would be better to include different clinical intervention
approaches for different impulsivity subtypes, as well as commonalities and transdiagnostic
symptoms (Dalley & Robbins, 2017). For example, pathophysiologic heterogeneity of the ADHD
population has been evidenced in terms of distinct deficits patterns, as different ADHD subgroups
displayed specific neuropsychologic profiles (Nigg, 2005; Willcutt, Doyle, Nigg, Faraone, &
Pennington, 2005). Sonuga-Barke (2002) proposed a dual pathway model of ADHD to
differentiate the distinct pathology of ADHD, as noted that some children with ADHD perform
more poorly than control subjects on one task measure of impulsive behavior, i.e., tasks assessing
delay aversion, whereas other children with ADHD perform more poorly on a different measure,
such as a measure of inhibitory control (Solanto et al., 2001). In another review study of substance
misuse, drug-dependence characterized by high impulsivity was reflected on both the measures of
inhibition and decision-making as well as different neurobiological pathways, which indicated
neural substrates alternations involved in reward seeking, and capacity to inhibit behavior (Dawe,
Matthew, & Loxton, 2004). Besides, alcoholics were also a heterogeneous population: early-onset
alcoholics had higher levels of impulsive decision making than late-onset alcoholics while late-
onset alcoholics s’ discount rates were similar to control group (Dom, D’Haene, Hulstijn, & Sabbe,
7

2006; Herman & Duka, 2019). Therefore, it would be more niche targeting to treat impulsive
decision-making and impulsive disinhibition differently in clinical practice. Besides, as
impulsivity is a core symptom of many existing disorders, from a transdiagnostic intervention
perspective, employing a differentiated intervention focus might be more efficient (Dawe,
Matthew, & Loxton, 2004).

8

2. Acceptance and Commitment Therapy (ACT)
Emphasizing the fundamental dysfunctional factors while focusing on common effective
treatment techniques, is a cost-effective intervention trend in recent years (e.g., Levin et al., 2017;
Campellone, Sanchez, Fulford, & Kring, 2019). Transdiagnostic approaches can provide a more
parsimonious conceptualization of psychopathology, assessment and treatment. Psychological
inflexibility (e.g., inflexible attention) is deemed as such a core factor of many disorders including
anxiety, substance abuse and other addiction disorders and higher degrees of overall
psychopathology (Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004; Levin, Pistorello, Seeley,
& Hayes, 2014).
Acceptance and Commitment Therapy (as illustrated in Figure 3) is an intervention that targets
transdiagnostic factors and focuses on increasing psychological flexibility. ACT is described as
one of the “third wave” of behavioral and cognitive therapies, which have emerged in recent
decades by combining the behavioral techniques (e.g., value, action), mindfulness, and cognitive
behavioral traditions of acceptance (Hayes & Hofmann, 2017). ACT includes six particular
processes that generally aim to decrease the effects of many inner experiences on overt behavior
and increase the effects of other inner experiences (e.g., self-created values to engage in
meaningful activities) on one's actions. Specifically, inner experiences are targeted through
addressing acceptance (willingness to experience inner experiences and not work to regulate them
when useful), defusion (experiencing inner experiences as they are without additional verbal
functions), self as context (experiencing oneself as the context in which inner experiences occur
and not being defined by inner experiences), being present (or present moment awareness noticing
inner and outer experiences as they occur, nonjudgmentally), values (defining areas of life that are
important that one is willing to work toward), and committed action (moving in the valued
9

direction). Most research on ACT has focused on testing or establishing the general construct
underlying ACT, psychological flexibility, and studies have investigated the utility of ACT or
related techniques (e.g., mindfulness) to examine their efficacy and effectiveness in dealing with
psychological problems, including psychological distress, ADHD, obesity, addiction and so on
(e.g., Bardeen & Fergus, 2016; Levin, Hildebrandt, Lillis, & Hayes, 2012; Bal, Celikbas, &
Batmaz, 2018; Trindade, Ferreira, & Pinto-Gouveia, 2018).

Figure 3. The Theoretical Construction of ACT: the Hexaflex
2.1 Mindfulness and Behavioral Inhibition
In ACT, being present (or present moment awareness), defusion, acceptance, and self-as-
context are mindfulness-related processes, which is defined as self-regulation of attention to
maintain attention to immediate experience with curiosity, openness, and acceptance, to flexibly
orient one’s attention and increase recognition of mental events in the present moment (Bishop et
al., 2004). Training in contact with the present moment is usually the starting point for mindfulness
practice and is included in all other definitions of mindfulness (Fletcher & Hayes, 2005). The Stop
10

Signal task requires sustained attention whereas mindfulness training can effectively maintain the
practitioner’s attention on the immediate experience (Bailey et al., 2019). A burgeoning number
of studies examined the relationship between mindfulness and attentional control across various
populations, including adolescents (e.g., Oberle, Schonert-Reichl, Lawlor, & Thomson, 2011),
college students (e.g., Ainsworth, Eddershaw, Meron, Baldwin, & Garner, 2013; Quaglia,
Goodman, & Brown, 2015), adults (e.g., Rosenberg, Noonan, DeGutis, & Esterman, 2013; Ruocco
& Direkoglu, 2013), elder population (e.g., Prakash, Hussain, & Schirda, 2015), and clinical
populations with attentional deficits (e.g., Tabak, Horan, & Green, 2015; Keith, Blackwood,
Mathew, & Lecci, 2017). For example, compared with controls, high mindfulness individuals were
more accurate at responding to Go and No-Go trials, showed more frontal involvement in sustained
attention rather than activity specific to response inhibition, reflecting an increased capacity to
modulate a range of neural processes in order to meet task requirements (Bailey et al., 2019).
2.2 Value Oriented Action and Choice-Making
The Value component of ACT is a motivating operation, which is intended to increase the
subjective values of established reinforcers (Hayes et al., 2001). Values refer to ongoing patterns
of activity that are actively constructed, dynamic and evolving. Values are freely chosen, verbally
constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish pre-
dominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral
pattern itself (Wilson & DuFrene, 2009). Stated otherwise, values are rules in which to align one’s
actions (Hayes, 2005; Wilson et al, 2010). Besides, since the motivation operation possess two
types of establishing effects, value-altering effect and behavior-altering effect (Cooper, Heron, &
Heward, 2014), values interventions could conceivably either increase actions towards those
values or increase the subjective evaluation of those values, or both. Therefore, values
11

interventions could potentially exhibit two contradictory effects on the delay discounting task: the
participants would either increase the subjective value of the money or increase the action to have
the money. Little previous research has evaluated the effects of values interventions on delay
discounting but one study showed the value intervention increased the subjective value, and
enabled participants to endure longer waiting times or suffering times, such as during food choice
making among the obesity population (Forman, Hoffman, Juarascio, Butryn, & Herbert, 2013).
2.3 The Present Study
The present study adopts multiple baseline single-case design to test the effectiveness of Value
intervention of ACT on impulsive decision-making, and Present Awareness intervention on
behavioral disinhibition.
Hypothesis 1: Values interventions will increase the subjective values and therefore decrease
impulsive decision-making on delay discounting tasks. Alternatively, values interventions may
increase action towards values depicted in the task and therefore increase immediate responding,
which would appear as impulsivity on delay discounting tasks.
Hypothesis 2: Present moment awareness interventions will decrease impulsive disinhibition
on a Stop Signal task.

12

3. Method
A multiple-baseline across participants single-case design is adopted to evaluate the
effectiveness of present-moment awareness and values interventions on repeated measures of
impulsivity at the level of the individual participant. Single-case research design is a research
design most often used in applied fields of psychology, education, and human behavior in which
the subject serves as his/her own control, rather than using another individual/group. In contrast to
group designs that are sensitive to average of groups, single-subject design is sensitive to
individual organism differences. The multiple baseline design is useful for interventions that are
irreversible due to learning effects, and when treatment cannot be withdrawn. Because treatment
is started at different times across the different baselines, it can be concluded that changes are due
to the treatment rather than to a chance factor. Single-case designs are especially suited to
discovering functional relations between behavior and environment that may be idiosyncratic to
individual participants’ behavioral repertoires and learning histories, and therefore can be useful
for initial development and discovery research. By gathering data from many subjects, inferences
can be made about the external validity of the findings. All other things being equal, single-case
designs require replication across a larger number of experiments, each including a small number
of participants to enhance external validity, whereas randomized between-group designs require
replication across a smaller number of experiments, each of which include a large number of
participants.
3.1 Materials
The online software package Psytoolkit (Stout, 2010) was employed to develop the computer-
based delay discounting task and stop signal task. The intervention procedure for present moment
13

awareness and value intervention scripts are adopted from well-established protocols from the
ACT literature (Harris, 2009; Luoma, Hayes, & Walser, 2007; Stoddard, 2014).
3.1.1 Delay-Discounting Task
The present study adapted a titrating sequence, in which the amount of immediate money is
adjusted in titrating increments of immediate rewards. In the titrating procedure, participants are
offered the choice between $1000 available after a delay (1 day, 1 week, 1 month, 6 months, 1
year, 5 years, and 25 years) or a smaller amount available immediately. The immediate amount is
modified based on the participant’s previous choice. An increase in the immediate reward occurs
after choice of the delayed reward, and a decrease in the immediate reward occurs after choice of
the immediate reward. The size of the change decreases by half with each choice. This adjustment
takes place over several trials for each delay with the final immediate amount being the
indifference point for each delay, in which the chose immediate rewards is subjectively equally to
the delayed reward, in this case, $1000 (Rodzon, Berry, & Odum, 2011). The indifference points
determined for 7 different delays (1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years)
are plotted, and a discount function is derived using a curve-fitting analysis: V=A/(1 + kD). The
indifference point for each delay is decided by the midpoint between the last amount of the
immediate reward that had been chosen over the delayed alternative and the last amount of the
immediate reward that had been rejected (Du, Green, & Myerson, 2002; Odum, 2011; Reed,
Kaplan, & Brewer, 2012). The curve-fitting analysis yields a k-value, which provides a
quantitative index of the steepness of the discount curve (Mazur, 1987). The Area Under Curve
(AUC), which equals to (x2 - x1) [(y1 + y2)/2], is another index used to evaluate the impulsivity
during delay discounting (Myerson, Green, & Warusawitharana, 2001; Smith & Hantula,
2008).While the higher k-values reflect greater discounting by delay and therefore greater
14

impulsivity, lower AUC represent greater impulsivity. The delay discounting task in the present
study is computer-based,. The task example is showed in Figure 4.

Figure 4. Instruction and Example of Choices for 1-day Delay of Delay Discounting Task
15

3.1.2 Stop Signal Task
The stop signal task is a computerized test used to assess inhibitory control, which requires
participants to rapidly cancel motor activity after its initiation. The present task consists of two
blocks and the instructions and timelines for the two blocks are illustrated in figure 5 and 6. In the
first training block, participants are required to press B when they see a left arrow, and press N
when they see a right arrow. They are asked to respond as fast and accurate as they can. The green
arrows will only display for 500ms. When they can do at least 20 trials without any mistake, the
training was over and the second testing block began. In the second block, participants are still
required to respond to the left and right arrows, but when the circle around the green arrow turn
red, they should stop and do not press any key. The stop signal onset randomly 50ms, 100ms, or
150ms after the onset of arrow. The total onset time for both the arrow and the red ring is 500 ms.
The reaction time of go and stop (calculated by subtracting the mean stop-signal delay from the
mean reaction time on go trials on each block) trials and error rate during go and stop trials reflects
keeping tracking of stimuli and are deemed as the indexes for sustained attention and executive
function (Baily et al., 2019). The findings of Alderson, Rapport, Hudec, Sarver and Kofler (2010,
2012) on an ADHD group also suggested that the activity level during stop signal task was
primarily associated with basic attentional rather than behavioral inhibition processes. To create
habituation for go trails and decrease the expectation of stop trials, the present study adopts 60 go
trials and 20 stop trials in the second block.
16

Figure 5. Instruction and trial timeline for Block 1 in Stop Signal Task

Figure 6. Instruction and trial timeline for Block 2 in Stop Signal Task
3.1.3 ACT Intervention
Contact with the present moment consists of the practice of mindfulness, which means to “pay
attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience”
(Kabat-Zinn, 2003). The present study chooses the “Mindful Breathing” (Appendix 1) and
“Observing Hand” (Appendix 2) protocols as the intervention for the Present Moment awareness.
Values in ACT are understood as being personal qualities, such as kindness, playfulness or
integrity, that an individual most wants to express in their actions. Such values are highly personal
to the individual and they function as reinforcers for patterns of behavior that are values-consistent
(Wilson & Dufrene, 2009). The present study selects the most popular Value interventions, Life
Compass (Appendix 3) and the Matrix (Appendix 4), as the Values intervention methods.
17

3.2 Participants
Eleven college students from the University of Southern California, who signed on the SONA
subject pool system for class credit, were randomly assigned to receive value intervention and
delay discounting task, or the present moment awareness intervention and stop signal task.
3.3 Procedure
Participants were invited to lab sessions for 1-3 times depending on the times of multiple
baseline and their performance. During the session, after arriving at the lab, participants sign the
informed consent at the beginning of first visit, then complete the Stop Signal task (multiple times)
or the Delay Discounting task (one time) on a computer. Then participants receive either present-
moment intervention or value intervention, which is delivered by an experienced researcher. In the
later revised present moment intervention for participant P-4, P-5 and P-6 , the present moment
intervention was delivered by professional ACT audio recordings.
For present-moment intervention, at the beginning of each Present Moment intervention,
researchers will notify the participants the following direction first: “There is no pass or fail at this
exercise. What you experience is just right. If you find your mind is wandering and being pulled
away from the present moment, just gently bring yourself back to the sound of my voice and the
exercise. Remember that being pulled away and coming back is an important part of learning
focusing your attention.” Then they will deliver the Mindful Breathing intervention to participants,
and then let participants perform the Stop Signal task again. Next, the researcher again trained the
participant with the Hand Observation intervention. After that participants do the Stop Signal task
again. The intervention consists of 4 times in total.
For the value intervention, the researcher lead the participant to clarify his/her values with the
Life Compass, before the computer tasks, the researcher delivered the following instructions:
18

“Now, I would like to invite you to do the computer tasks again. For this time, please keep your
values in mind when you are making your responses to the tasks. Please take one minute to think
about what the connection of your values is with the task. If money is not something you value,
please replace the money with your values, and replace the waiting time with the time/effort you
put for your values.” Then participants do the Delay Discounting task again. Next, the researcher
led the participant to further clarify their value with the matrix, then gave the instruction and let
participants do the Delay Discounting again. The intervention consists of 4 times in total.
In the end, the participants were asked to evaluate the training procedure with 1-5 scores
(1=strongly disagree, 5=strongly agree) on a social validity questionnaire with 6 questions: “I
found that the training procedures used in this study were easy to follow.” “I found that the training
procedures used in this study helped me to keep sustained attention on the task during the task
where I was asked to press B/N or stop.” “I believe that the training procedures used in this study
helped me do better on the rest of the computer tasks.” “I feel like the training used in this study
could be useful in situations in my daily life where I need to focus my attention.” “I feel like the
training used in this study could help me choose what I really value, even if I have to invest a lot
of effort to get it.” “I felt comfortable engaging in the training procedures used in this study.”
3.4 Statistics
For evaluation of present moment awareness intervention effects, the error rate for stop trials,
error rate for go trials, and mean reaction time for go trials, and the number of trials the participants
required to pass block 1 in the Stop Signal task were calculated for baselines and post-intervention
tests. We chose the error rate of stop signal as the principle index as it reflexed the impulsive
disinhibition directly.
19

To evaluate the value intervention effectiveness, k-value and AUC of indifference point value
in delay discounting task (Myerson, Green, & Warusawitharana, 2001) was calculated for
baselines and post-intervention delay discounting tests. An Excel form is built up to calculate the
k-value and AUC (Reed, Kaplan, & Brewer, 2012). The subjective value of the delayed amount
was calculated as the midpoint between the last amount of the immediate reward that had been
chosen over the delayed alternative and the last amount of the immediate reward that had been
rejected (Du, Green, & Myerson, 2002).

20

4. Results
Five participants were assigned to the value intervention. Their AUC and k-value data are
illustrated in Table 1, and their graphs are in Figure 7.

21

Table 1. Value Participant Results

22

Figure 7. Non-concurrent Multiple-Baseline AUC and k-Value Across Participants
According to the data and graph, results of delay discounting tasks of 5 college students showed:
1) for participant V-1 and V-2, the value intervention had an immediate significant effect on their
delay discounting performance, increased their impulsivity; 2) for participant V-3 and V-4, the
value intervention showed an immediate significant effect on their delay discounting performance,
decreased their impulsivity; 3) no intervention effect was observed on participant V-5.
23

Six participants are assigned to the present moment awareness intervention. Their Go trial error
rate and Stop trial error rate, block1 trial number, and Go reaction time data are illustrated in Table
2, and their graphs are in Figure 8 and Figure 9.

24

Table 2. Present Moment Awareness Participant Results
25

26

Figure 8. Non-concurrent Multiple-Baseline for Go and Stop Error Rate, Go reaction Time and Block1 Trial Number
Across Participant P-1, P-2 and P-3
The results of stop signal task of 3 college students showed: 1) for baseline performance,
participant P-1 and P-2 exhibited a trend of increasing error rate and decreasing Go reaction time
towards the end of session 1, while the block1 trial number of P-1 decreased and of P-2 increased
towards the end of session 1; Participant P-3 exhibited a relatively stable error rate and Go reaction
time, and a variable block1 performance; 2) for after the intervention performance, the error rate
of P-1 and P-2 stopped the increasing trend towards the end of the session 2, while P-2 showed a
significant decreasing of the Go reaction time, and P-1 showed a deceased and stable performance
on block1 go trials; participant P-3 maintained her best performance of error rate after intervention
in session 2, and showed a Go reaction time decreasing trend, however, her block1 performance
27

almost maintained her worst performance. The results indicated no significant improvement of
stop signal performance of the 3 participants after the present moment awareness intervention.
To further control the environmental confounding, a headphone was used to block out the
potential environmental sounds that may affect the performance of participants. The present
moment intervention was also delivered by audio clips recorded by ACT professionals, which the
participants received via headphones. In addition, for the stop trials in block 2, the onset latency
of the stop signal was set as fixed 200 ms, instead of the previous randomly varied latency. The
stop signal performance results of the adjusted procedure were illustrated in P-4, P-5 and P-6. In
addition, since it was showed that too many times of stop signal task within a session would evoke
a fatigue effect and decrease the performance of participants, less baseline data were collected
compared to the previous procedure.

28

Figure 9. Non-concurrent Multiple-Baseline for Go and Stop Error Rate, Go reaction Time and Block1 Trial Number
Across Participant P-4, P-5 and P-6
29

The results of P-4, P-5 and P-6 showed: 1) the baseline Stop error rate were variable for all 3
participants and went up at the last baseline datapoint; based on the previous findings that as the
time went on during a session, the Stop error rate of participants became no better than their
previous ones, therefore, they were moved to the intervention phase; 2) instead of went up as a
result of fatigue, the last Stop error data point went down for all 3 participants; however, it is not
conclusive with only 2 data points; the Block1 trial number went down after intervention and
achieved their best performance at the last data point. However, because of unable to collect
enough data (at least 3) points after intervention due to the coronavirus situation, the intervention
effectiveness were uncertain.
The social validity evaluation result is illustrated in Figure 10.

Figure 10. Social Validity Results

30

5. Discussion
The results of the present research found the value intervention showed a significant effect on
the delay discounting performance for four out of five participants. Interestingly, two of the
participants become more impulsive while two other participants became less impulsive. The
intervention effect of the present moment awareness is inconclusive, due to both the unstable
baseline data and lacking of after intervention data points.
5.1 Value Intervention Effectiveness
The values interventions taken from the ACT literature showed the effect of changing the
impulsivity in the participants in the present study. It is interesting that for some participants, the
intervention increased their impulsivity and for others decreased it. Two potential explanations for
this finding are proposed as follow. First, the value component of ACT is a motivating operation.
Put differently, values can be interpreted as rules in which to align one’s actions (Hayes, 2005;
Wilson et al, 2010). According to behavioral principles (Cooper, Heron, & Heward, 2014),
motivating operations generally increase the subjective value of the consequent reinforcer and
temporarily increase the immediate probability of behavior toward that consequent reinforcer.
Although both of these effects are defining characteristics of motivating operations, they could
conceivably produce opposite effects on a delay discounting task: Either increase the value of
larger delayed reinforcers and therefore decrease impulsivity, or increase the immediate
probability of behaving with respect to that reinforcer in this moment, therefore increase
immediate responding, which would be scored as impulsivity in a delay discounting task.
Paradoxically, then, a single behavioral principle could conceivably predict both of the opposing
effects that were observed in the present study.
31

Second, the present findings showed some contradiction to other findings in delay discounting
research. However, the task requirement from other researches were different from the present
study. For example, in the famous marshmallow test with children, the necessary action towards
the reinforcer is “wait,” that is, essentially do nothing. In other studies, the action that participants
needed to take is to “wait” or “suffer” passively from the uncomfortable sounds or video contents
or temperature to get the consequent reinforcer. However, in the present study, when it requires
the participants to take positive actions towards their values, the “wait” action in the delay
discounting may be in contradiction with their motivation. Future research can further explore the
potentially differing effects of values interventions on positive and passive actions, which may
further reflect the appetitive-approach personality of individuals.
5.2 Present Moment Intervention Effectiveness
Overall, there is no clear pattern of effects produced by the present moment intervention
procedures. The stop signal task is sensitive to fatigue, which potentially brought substantial
variability within individuals in baseline. The low number of data points for post intervention also
make it challenging to assess whether the intervention produced effects. It is possible that asking
participants to return more and practice present moment training more would have produced
clearer effects. However, it was not possible to ask participants to return more because the
experiment was required to be shut down as a result of the coronavirus outbreak.
Despite the findings of the present moment experiment being inconclusive, they still provide
some future research directions. First, the stop signal task is sensitive to fatigue and environmental
disturbance. On a single case study level, which requires each individual to compare their own
performance across the time, if the trend of the performance is not going up, with either
maintaining or decreasing trend post-intervention could be interpreted as an effect. Second, if
32

disinhibition is a neural-level characteristic, short-term intervention may not show a significant
effect. In the present study, after intervention, as well as after a long time of cognitive resource
consuming due to the novel session activities (e.g., hand observation), participants seemed
“recharged” from the mindfulness intervention, and then achieved their best performance again.
Therefore, it seems promising to use mindfulness training to improve inhibition. For inhibition
improvement, perhaps a longer-term mindfulness practice is required, which deserves further
research exploration. Third, two components are involved in the stop signal task, attention and
hand motor movement. It is also possible that the present moment awareness intervention did
increase the attention of participants, but that it was harder to accelerate their motor reaction, or
unrelated motor performance. Future research could consider separating these two components.
5.3 Limitations
One limitation of the delay discounting task is that we delivered the following instructions to
participants: “Please take one minute to think about what the connection of your values is with the
task. If money is not something you value, please replace the money with your values, and replace
the waiting time with the time/effort you put for your values.” But we did not actually replace the
money and waiting time with their personal values and effort/time they put into the value. Future
study could consider replace them in the statements of the delay discounting task, which would
place less effort and better facilitate the participants to make accurate response according to their
own decision. One limitation of the stop signal task is that we chose the stop signal error rate as
the principle index to evaluate the change of disinhibition. As illustrated in the data, the results
were in conclusive and participants showed variation across multiple indexes, including stop error
rate, go error rate and go reaction time. Future study could consider employ stop reaction time as
the major index, which is achieved by adjusting the stop signal onset latency based on the previous
33

trial performance of participants to help participants achieve an accurate around 50%, so as to
converge the performance variation to only one index, the stop reaction time (Fauth-Bühler et al.,
2012; Verburgh, Scherder, van Lange, & Oosterlaan, 2014). This method could help to get a more
conclusive results of the intervention effectiveness.
Besides, another potential limitation of the present study is the inclusion of college students as
participants in laboratory settings, as opposed to participants with real clinical challenges in real-
life community settings. However, the growing mental health problems among college students
produce detrimental consequences for their social functions, including personal life management,
academic/career performance and social relationships. According to the investigation from the
World Health Organization World Mental Health International College Student (WMH-ICS) in
2018, 38.4% of college students in 19 colleges across 8 countries reported at least one of the seven
common DSM-IV mental disorders in the past 12 months, including major depression,
mania/hypomania, generalized anxiety disorder, panic disorder, attention deficit/hyperactivity
disorder, alcohol use disorder, and drug use disorder. Therefore, although university lab settings
are indeed artificial in many respects, university students are a population that has substantial
clinical need and who would likely benefit from improvements in impulsivity.
An additional potential limitation is the small number of participants included and the short
duration of the study with each participant. This was necessitated by the corona virus outbreak.
Future research should refine the procedures and include larger numbers of participants.
5.4 Conclusion
In conclusion, previous research, both psychological and neurological, suggest that
disinhibition and delay discounting may be functionally separate classes of impulsivity. Both seem
to be foundational to adaptive human functioning but may be functionally distinct and may
34

therefore require functionally distinct interventions. This master’s thesis is only a preliminary
investigation into whether the two types of impulsivity may respond to different intervention
procedures. Much more future research is needed but the present data provide initial evidence that
values interventions may move responding on delay discounting tasks.
35

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47

Appendix 1. Mindful Breathing

48

Appendix 2. Mindful Observing

49

Appendix 3. Life Compass

50

Appendix 4. Matrix

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Asset Metadata

Creator Yang, Yi (author)

Core Title The effect of present moment awareness and value intervention of ACT on impulsive decision-making and impulsive disinhibition

School College of Letters, Arts and Sciences

Degree Master of Science

Degree Program Applied Behavior Analysis

Publication Date 04/25/2020

Defense Date 03/23/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag acceptance and commitment therapy (ACT),decision-making,delay discounting task,disinhibition,impulsivity,OAI-PMH Harvest,stop signal task

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tarbox, Jonathan (committee chair), Cameron, Michael (committee member), Monterosso, John (committee member)

Creator Email yang318@usc.edu,yangyi.tsinghua@hotmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-287130

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Legacy Identifier etd-YangYi-8333.pdf

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Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

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