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Values and persistence

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Values and persistence

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Content

Values and Persistence
by
Jay Leung

A Thesis Presented to the
FACULTY OF THE USC
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 Jay Leung

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TABLE OF CONTENTS

Abstract .......................................................................................................................................... iii
1.0 Literature Review ...................................................................................................................... 4
1.1 Acceptance ............................................................................................................................ 4
1.2 Defusion ................................................................................................................................ 4
1.3 Self-as-context ...................................................................................................................... 5
1.4 Values ................................................................................................................................... 6
1.5 Present moment ..................................................................................................................... 6
1.6 Committed Action ................................................................................................................. 7
2.0 Methods ..................................................................................................................................... 9
2.1 Participants and Setting ......................................................................................................... 9
2.2 Dependent Variable ............................................................................................................ 10
2.3 Participant Debriefing ......................................................................................................... 10
2.4 Baseline ............................................................................................................................... 10
2.5 Intervention ......................................................................................................................... 12
Value Assessment Rating Form. ........................................................................................... 12
2.6 Follow Up ........................................................................................................................... 16
3.0 Results ..................................................................................................................................... 16
3.1 Persistence ........................................................................................................................... 16
3.2 Debriefing ........................................................................................................................... 17
4.0 Discussion ............................................................................................................................... 18
References ..................................................................................................................................... 21
Appendices .................................................................................................................................... 23

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Abstract
Persistence is needed in virtually all-important areas of human functioning and mindfulness and
values-based interventions have been shown to be effective in a variety of psychology studies,
but little research has evaluated the effects of these approaches on persistence. The objective of
the study was to evaluate the effects of values interventions on lab measures of persistence, in
order to identify interventions that are likely to be effective and/or are good candidates to study
outside of the laboratory. In this study, two participants from the University of Southern
California (USC) were recruited to participate in a persistence task (i.e., listening to unpleasant
sound clips) and brief procedures from the Acceptance and Commitment Therapy literature
focusing on values were evaluated in the lab setting. The duration of the participants’ attending
to the sound clip was recorded and compared between baseline, intervention and follow up
phases in a nonconcurrent multiple baseline across participants design. Data suggested the
intervention was effective in increasing the participants’ performance on one measure of
persistence, their willingness to listen to the sound clip for longer durations after intervention,
and the effects maintained in the follow up phase.

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Values and Persistence
1.0 Literature Review
Acceptance and Commitment Therapy (ACT) is an empirically based psychological
intervention that aims to increase psychological flexibility and strengthen behavioral repertoires
leading to valued action, hence improving quality of life (Hayes, 2004). ACT addresses six
domains of psychological flexibility, consisting of acceptance, present moment awareness,
values, cognitive defusion, committed action, and self-as-context (Harris, 2019). The six ACT
component repertoires are discussed below.
1.1 Acceptance. Acceptance refers to when one is intentionally choosing to experience
aversive private events, such as thoughts, feelings, and bodily sensations, in the service of
accessing values, which can be defined as larger, longer-term positive reinforcers, which would
not be accessible if one chooses to avoid discomfort. In lay language, acceptance involves
making room for negative thoughts and emotions, allowing negative thoughts to occur, and not
react to or avoid it impulsively. Acceptance focuses on the willingness to experience difficult
thoughts and feelings in the service of something that is more important. For example,
acceptance can work as instead of allowing the negative thought 'I need to be perfect' to take
over their behavior, simply acknowledge that 'I realize I have a thought that I need to be perfect'
and not act on it.
1.2 Defusion. The purpose of defusion is to strengthen the flexibility of one’s rule-
following, decrease rigidity in one’s behavior, and to promote flexibly contacting a variety of
naturally occurring consequences for a variety of overt behaviors. In lay language, defusion
exercises help one to realize thoughts and feelings for what they really are, rather than taking
them overly literally and thereby allowing those negative thoughts to get in the way of life. Some

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defusion exercises include manipulating the individual's environments and building more
flexibility around rules by adding humorous functions to the negative thoughts. For example,
when a negative thought takes place, simply repeat the idea in humorous cartoon voices, such as
the Yoda voice or Donald Duck voice, allowing one to “play” with the thought until it alters the
function of the thought, thereby “disarming” it. By adding a humorous function, it allows one to
view or experience the negative thought through a different perspective or sensation. It also
encourages the individual to view his/her negative thoughts with more flexibility. With more
flexibility around thoughts about negative emotions and experiences, individuals are more able
to let go of short-term avoidance behaviors and more able to contemplate behaving flexibly
toward longer-term valued outcomes. For example, rather than avoiding taking up a new hobby
because one won’t be able to “be perfect,” one might try a few different new hobbies and directly
contact the enjoyment and enhanced social contact some of them bring.
1.3 Self-as-context. Self-as-context refers to flexible perspective taking behavior and
defused dietic relating when verbally responding to one-self. Put differently, self-as context
focuses on one own's verbal language descriptions about self and one’s relation to others. Using
lay terms, self-as-context exercises work on one’s ability to be able to look at oneself differently,
and that knowing one is a place where negative thoughts take place, but those thoughts do not
define oneself. This repertoire may help redirect and increase flexibility in how they view
themselves. For example, the individual might encounter thoughts such as, 'I am not good
enough'. Examples of defusion exercises can be 'I am a container that contains a thought that I
think I am not good enough; it does not define me.' Such exercises build the perspective taking
behavior of noticing oneself have thoughts, rather than automatically believing that one’s
negative thoughts about oneself are literally true.

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1.4 Values. Values refers to rules that summarize actions that lead to large verbally
constructed classes of powerful and delayed positive reinforcers. In simple words, values refer to
what an individual truly cares about in life. Values are verbally abstracted, for example, “being a
good friend,” “helping others,” and “making the most of my potential.” Values focus more on the
“direction” one would like to pursue throughout life and they are different from specific tangible
goals that could be attained. For example, a value could be wanting to be a loving father; while a
specific goal toward that value could be having dinner with one’s daughter on a weekly basis. In
such, values help to guide one’s behavior to approach and pursue what matters to one in one’s
life.
Importantly, values also behavior the same way as motivating operations, in that they can
alter the extent to which a particular activity is inherently positively reinforcing or punishing
based on the individual relates that behavior to their own chosen values, or lack thereof. For
example, the behavior of digging a ditch in the hot sun would be naturally punishing to most
people, yet that same behavior done in the context of a Habitat for Humanity project may
actually be enjoyable if one verbally relates the behavior to their own chosen value, such as
“giving back to lose less fortunate.”
1.5 Present moment. Present moment exercises attempt to strengthen the behavior of
paying attention in particular ways. Specifically, having strong present moment awareness
consists of one’s attending behavior being under the stimulus control of present moment stimuli.
Present moment is when an individual is able to engage in the immediate present environment
(i.e., one’s own breathing, the room color, texture on the foot, etc.) without judgement and not to
dwell in one’s own negative thoughts in the past or future. One example is when one is overly

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worried about the future, or consumed by negative past experience, hence preventing the
individual from being present while interacting with loved ones in that moment.
1.6 Committed Action. Committed action is when one identifies specific overt
behavioral goals in alignment with their stated values, and follows through with the commitment,
even in the face of substantial challenges. Committed action as a behavioral repertoire is only
meaningful in the context of values. Values work helps an individual lay out the groundwork of
what truly matters; committed action is the crucial part of identifying realistic goals and making
the goals happen through behavior change efforts.
A substantial amount of literature has suggested ACT has been effectively improving
psychological flexibility and behavioral effectiveness across various settings and domains. For
example, Codd et. al. (2011) shows ACT is effective with decreasing the avoidance of
participants diagnosed with panic disorder with agoraphobia, comorbid social phobia and
generalized anxiety disorder, and posttraumatic stress disorder, and shows clinical improvements
in the participants’ specific anxiety disorders. Woods et. al. (2006) indicates a combined ACT
and Habit Reversal Training (HRT) is effective in decreasing experiential avoidance and
increased treatment compliance in adults with impulse control disorder, trichotillomania (TTM).
Hayes et. al. (2004) evaluates the effectiveness of ACT with polysubstance abusing opiate
addicted participants maintained on methadone; findings indicates ACT is effective in decreasing
total drug use. Other than diagnosable disorders, ACT is proven effective with different types of
distress. Blackledge and Hayes (2006) conducted an ACT workshop with parents of autistic
children. Results showed ACT improves the parents’ score on the Beck Depression Inventory-II
(BDI-II), and the Global Severity Index (GSI) of the Brief Symptom Inventory (BSI), hence help
parents to flexibly adjusting themselves when raising their children. Peterson et. al. (2009)

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evaluated a multi-component treatment including cognitive defusion exercises, mindfulness and
acceptance techniques, and values exercises with married couples. Results suggests ACT is
effective in increasing satisfaction and making meaningful adjustment with their marriage, and
also decreasing the distress in couple. Little, Tarbox, and Alzaabi (2020) used ACT to enhanced
the effectiveness of behavioral skills training for training clinicians in an autism treatment
setting.
Various studies have proven the effectiveness of ACT across populations and settings,
but relatively few studies have evaluated single components in controlled settings. In particular,
few previous studies have evaluated values interventions alone. Component studies are important
when evaluating treatment packages such as ACT because they allow for a more precise
scientific evaluation of the separate contributing factors to intervention success. In addition, lab
research in controlled settings can be valuable because it can create a context for evaluating and
refining individual aspects of procedures which could then be evaluated in real-life clinical
settings outside the lab. In short, evaluating individual components of ACT in laboratory settings
has the potential to add more scientific precision to the study of ACT as a treatment package.
The current study consists of an evaluation of the effects of values-based interventions on
a simple measure of persistence with an aversive task in a lab setting. The Value Assessment
Rating Form (Russ Harris, 2008) is used to allow participants to identify their values and explain
briefly what matters most to them currently in life. The hypothesis of the current study is the
value-based intervention will increase the duration of participants’ engagement in persistence
task, hence more persistence overall. A multiple baseline across three participants was planned
but the study had to be terminated after two participants were completed, due to the COVID-19
outbreak.

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2.0 Methods
The study used a non-concurrent, multiple baseline across participants, single-case
experimental design, to evaluate the effects of the interventions (Kazdin, 2011). Multiple
baseline designs are especially well-suited to study the effects of an intervention that are not
expected to reverse after the intervention is discontinued. Like all single-case experimental
designs, multiple baselines allow the experimenter to carefully analyze the effects of the
intervention on repeated measures of behavior over time, at the level of the individual
participant. Visual analysis of graphed data is used to analyze individual participant data.
2.1 Participants and Setting
Students at the University of Southern California (USC) were recruited through flyers
and emails as participants. The study took place in a lab setting at USC, in the Seely G. Mudd
building, room 529. The study procedures were presented on laptops and noise cancelling
headphones (i.e., the noise cancelling Cowin E7 model) were used. Informed consent was
attained in the first meeting. The primary investigator went through the informed consent to
allow participants to understand his/her rights and the general idea of this study. The total
duration of the study ranged from one to two visits, depending on the individual participants'
data. Each visit was no more than 90 minutes in duration but was typically an average of 60
minutes. Visits were scheduled according to the participants’ preferences and availability and
occurred once per week, with the consistency of six to seven days apart. Participants received
monetary compensation for participating. The amount of monetary compensation was $5 per
hour of session time. Compensation was delivered in the form of e-gift cards to popular stores
(e.g., Amazon) and was delivered to the participant at the end of each study visit.

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2.2 Dependent Variable
The primary dependent variable was a behavioral task that measured persistence, in the
form of listening to an irritating sound. To begin the task, the participant pressed the spacebar on
the computer and the task ended when she/he pressed it again. The duration of time that passed
between the beginning and end of the audio clip was measured.
The total length of the noise clip was 90 seconds, with a variation of tone every three
seconds to avoid listener habituation. In the current study, the primary investigator tested the
dBA of the sound clip with a decibel meter prior to exposing participants to the noise. The range
of the sound level falls between 70-90 dBA, which is within the safety measure as stated by the
OSHA for an 8-hour work day. According to OSHA, typical sounds level that falls around
70dBA is similar to classroom chatter, 80dBA is similar to a freight train that is 100 ft. away,
and 90dBA is close to the sound level of a boiler room (Fig. 3). In short, the sound clip is within
the PEL which is under 90dBA and less than 2 hours.
2.3 Participant Debriefing
After the last trial of each phase, the experimenter debriefed the participant. She asked
the participants to rate how aversive they found the sound clip, from 0 meaning non-aversive at
all, to 10 meaning terrible. In addition, at the end of the study, the experimenter asked
participants to anecdotally report if they found the values exercises useful or were able to use
them in daily life.
2.4 Baseline
A three-minute break is given immediately after the informed consent, with a timer
displaying the countdown. Once the alarm sounds when break time is over, participant is
instructed to put on the headphones and adjust it so it is comfortable on their head. After the

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participants confirmed the headphones are in a comfortable position, the primary investigator
instructed the participants to remove the headphones, orient themselves towards the laptop
monitor and the experimenter delivered task instructions.
During baseline, participants were presented with opportunities to start and stop the
persistence task based on their preferences. They were instructed to orient their gaze towards the
blank white wall in front of them when listening to the sound clip. This was done to avoid
participants diverting their attention towards other items in the room (i.e., such as looking out the
window, starting at the blue sky, etc.), that could contribute to decreasing aversiveness of the
persistence task.
Prior to each trial, the same instructions were delivered. Instructions were as follows:
“You are going to listen to a sound clip with the headphones that you just tried on.
You will be the one who starts and stops the sound clip with the space bar (point
to space bar on laptop keyboard) whenever you want. You will only use the space
bar to start and stop the sound clip. When you are listening to the sound, I would
like you to look at the blank spot right here (i.e., point to white wall in front of
participant) and not anywhere else. There is no right or wrong, better or worse, or
any mind games to trick you. You can stop the sound anytime you like, whenever
you feel like, based on your personal preference and feeling. If you have no
further questions, you can put on the headphone and hit the spacebar to start when
you are ready.”

Once participants hit the spacebar and stopped the sound clip, a three-minute break was
given between each trial. Participants were allowed to do any activities based on their personal
preference. The researcher engaged with participants minimally during break time in baseline.
With a multiple baseline design, each participant requires a different number of baseline
trials to fulfill the experimental design. When data stability is established in the baseline phase,
the primary investigator then proceeds to the intervention phase.

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2.5 Intervention
Value Assessment Rating Form. During the intervention phase, the value assessment
rating form (Russ Harris, 2008) was used to assess what are some of the current values one
individual has between ten main domains (i.e., Couples/intimate relationships, Parenting, Family
relations, Social relations, Employment, Education and training, Recreation, Spirituality,
Citizenship/community, and Health/ Physical well- being). The rating form is depicted in Figure
1.
Couples/intimate relationships. This domain targets on romantic relationships. The
measure seeks to identify what quality does one value in an intimate relationship, and what do
one expect and would love to bring in when building a relationship with the others.
Parenting. The parenting domain focuses on the qualities the father/mother provides in a
parent-to-child relationship. Examples are what parents do one would want to be and the type of
relationship one would love to build with their ‘child’.
Family relations. Family relations refers to the expectation one has or values when
having or building up a relation with family members, such as being a daughter/son,
brother/sister, father/mother, etc.
Social relations. Similar to the couple and family relation, the social relations aspect is
aiming at the relations in social context (i.e., friends). The measure identifies what quality does
one sees in being a ‘good’ friend, what one values in a social relationship, and how would one
like to interact socially in the ‘best’ manner, etc.
Employment. This particular identifies what one hopes to learn and achieve when
developing in current career. Some of the examples are, potential growth in career, quality of
work and supervision expectation, etc.

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Education and training. The education and training targets on what one hope to learn
and build in academic aspect. Elements that one values when learning and in their personal
growth, students that one would like to be, knowledge one would love to gain, etc.
Recreation. Recreation focuses on what activities or hobbits that one prefers or enjoys
doing in their leisure time. Any activities that one does during their leisure time to ease their
mind and destress themselves.
Spirituality. The spirituality aspect is slightly different from the others and is more
personalized to oneself. Spiritualty includes religions, natural or anything one finds relevantly
important to them and falls into the category.
Citizenship/community. Citizenship and community refer to the environment one would
want to live in or would love to create if possible. Activities that one does to contribute to the
community or environment, such as volunteering, recycling, or supporting a political party, etc.
Health/ Physical well-being. This domain focuses on the personal values on one-self’s
health and physical well-being. Physical appearance, strength expectations and eating/drinking
habits are relevant in this domain.
Participants were asked to rate and rank the importance of the ten main domains and how
successfully they have lived their values. They were asked to fill in a brief description in
explaining how the value matters to them in the current moment. Ratings are between 0 to 10,
with 10 as the highest rank, and 9 the next highest, and so on with 0 as the lowest rank. The
detailed instruction is attached on the top of the questionnaire (Fig.1), which is as follows:
‘Read through the accompanying values sheet. For each of the ten domains, write
a few words to summarize your valued direction, E.g., ‘To be a loving,
supportive, caring, partner.’ Rate how important this value is to you on a scale of
0 (low importance) to 10 (high importance). It’s okay to have several values
scoring the same number. Rate how successfully you have lived this value during
the past month on a scale of 0 (not at all successfully) to 10 (very successfully).

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Finally rank these valued directions in order of the importance you place on
working on them right now, with 10 as the highest rank, and 9 the next highest,
and so on.’ (Russ Harris, 2008).

The accompanying values sheet (Fig.2) is a detailed version of the Values Rating
Assessment Scale, which helps explain the ten values domains when participants are filling out
the rating form. The primary investigator used the values sheet as a reference when participants
needed further clarification or assistance to complete the form (i.e., leading questions that aids
participants to identify their values). For example, if participants are not able to identify what
values they have for career/employment domain, the primary investigator will deliver leading
question prompts such as ‘what do you value in your work?’ All prompts delivered are neutral to
avoid shaping up the values of individuals. Cited from the Happiness Trap: Values Worksheet
(Figure 2), sample as follows:
‘1. Family relations. What sort of brother/sister, son/daughter, uncle/auntie do you
want to be? What personal qualities would you like to bring to those
relationships? What sort of relationships would you like to build? How would you
interact with others if you were the ideal you in these relationships?
2. Marriage/couples/intimate relations. What sort of partner would you like to be
in an intimate relationship? What personal qualities would you like to develop?
What sort of relationship would you like to build? How would you interact with
your partner if you were the ‘ideal you’ in this relationship?
3. Parenting. What sort of parent would you like to be? What sort of qualities
would you like to have? What sort of relationships would you like to build with
your children? How would you behave if you were the ‘ideal you’?
4. Friendships/social life. What sort of qualities would you like to bring to your
friendships? If you could be the best friend possible, how would you behave
towards your friends? What sort of friendships would you like to build?
5. Career/employment. What do you value in your work? What would make it
more meaningful? What kind of worker would you like to be? If you were living
up to your own ideal standards, what personal qualities would you like to bring to
your work? What sort of work relations would you like to build?
6. Education/personal growth and development. What do you value about
learning, education, training, or personal growth? What new skills would you like
to learn? What knowledge would you like to gain? What further education appeals
to you? What sort of student would you like to be? What personal qualities would
you like to apply?

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7. Recreation/fun/leisure. What sorts of hobbies, sports, or leisure activities do
you enjoy? How do you relax and unwind? How do you have fun? What sorts of
activities would you like to do?
8. Spirituality. Whatever spirituality means to you is fine. It may be as simple as
communing with nature, or as formal as participation in an organized religious
group. What is important t to you in this area of life?
9. Citizenship/ environment/ community life. How would you like to contribute to
your community or environment, e.g. through volunteering, or recycling, or
supporting a group/ charity/ political party? What sort of environments would you
like to create at home, and at work? What environments would you like to spend
more time in?
10. Health/physical well-being. What are your values related to maintaining your
physical well-being? How do you want to look after your health, with regard to
sleep, diet, exercise, smoking, alcohol, etc.? Why is this important?’ (Russ Harris,
2008)

The intervention condition consists of engaging participants in conversation based on the
Value Assessment Rating Form on different perspectives they value in their current lives. The
primary investigator reads the rating form and picks out the three highest average domains (i.e.
important, success, rank).
General script as follows:
‘Let’s talk about something that you truly value, things and aspects that matter to
you the most, right now in the moment. (Refer to rating form) I see here are some
of the domains that you find matter to you. Which one will you feel comfortable
to share with me today? I understand this is something fairly personal, and if in
anytime that you don’t feel comfortable to talk about this anymore, it is absolutely
fine! Please let me know and we can switch to something else.’

Once participants picked out which domain to target, the primary investigator starts with
general questions and leads participants to address what are some things that they value in the
aspect, what are some of the challenges that got in the way or still in the way, preventing them to
get to where they want to be or the person they want to be. Participants are the lead of the
conversations; the primary investigator is only to use neutral language and not to insert or

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mislead participants to talk about non-existent values or values they think the primary
investigator would prefer.
Prior to each trial, the same instruction delivered in baseline is repeated to the
participants. Similar to baseline condition, the primary investigator ends intervention phase when
data consistency and stability are established.
2.6 Follow Up
Participants are contacted through email for a follow up session in approximately one
calendar week after the intervention session. Follow up session includes four trials with the same
persistence task, with three minutes breaks in between each trial. In follow up sessions, the
primary investigator instructs participants to think of what was discussed in the last visit, hold
onto the idea/thought, and listen to the sound clip again. The same instruction is presented prior
to each trial, making participants aware they are allowed to start and stop the sound clip
whenever they prefer, and there is not right or wrong, or better or worse based on their decision
to terminate the sound. During breaks, the primary investigator engages participants in
conversation regarding to the aversiveness of the sound clip in comparison to last visit; what are
some thoughts that they have when listening to the sound clip; and were they able to implement
some of the techniques discussed in their daily life.
3.0 Results
3.1 Persistence
Figure 3 depicts the duration that both participants listened to the noise clip across all
trials of the experiment. Participant 1 (top panel) listened to the noise very briefly on the first
trial and gradually increased the duration she listened to the sound, stabilizing around 70 seconds
(mean 52.83 seconds per trial for the baseline phase). When intervention was introduced, there

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was an immediate increase to the maximum value of 90 seconds, which persisted for all
remaining trials of the experiment.
The data for participant 2 were similar. The duration she listened to the aversive noise
was initially low, followed by a gradual increase, stabilizing around 50 seconds (mean of 34
seconds per trial for the baseline phase). An immediate increase was observed in the first trial of
the intervention phase, with data stabilizing at the maximum duration of 90 seconds (mean 83.4
seconds per trial for the intervention phase). During the first trial of follow-up the duration
dropped slightly and then remained at the maximum 90 seconds for the remainder of the
experiment (mean duration 86.25 seconds per trial for the follow-up phase). Overall, very low
variability was observed across all phases for both participants, suggesting high experiment
control.
3.2 Debriefing
Participant 1 reported a 9/10 sound clip aversiveness in baseline, and a 6/10 aversiveness
in intervention phase. Participant 1 states, ‘the sound clip itself is still aversive, but it makes it
easier when you have something you care about to hold on to, it means something with a
purpose’. In the follow-up debrief session, participant 1 reported a 6 to 7 out of 10 aversiveness.
Participant 1 reported, ‘The noise is still annoying but tolerable. It helps with what we talked
about last time, I was able to relate, and it is easier to listen to when there is a purpose.’
Participant 1 reported she was able to implement the value-based technique in real life (i.e., her
yoga class) and found it helpful as she can relate to the hardship and challenges in real life, and
that she needs to get over them to be where she wants to be.
In baseline, Participant 2 reported the sound clip a “9 to 10” out of 10 aversiveness.
During intervention phase, Participant 2 stated her tolerance went up “now that is it relatable,”

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but still found it to be “8-9” out of 10. Participant 2 reports she is able to look at the big picture
when doing such exercise, she says, ‘getting to there you have to go through things that you
really do not have to deal with, but those are the thing that are necessary for you to get where
you want to be, I have been trying to avoid it, but those things I need to get done to get to
wherever I want to be, the person I want to become.’ At the end of the visit, Participant 2 asks
for more value-based exercises and thinks it will be very helpful for her current business/career
development. In the follow up phase, Participant 2 reported an 8 out of 10 aversiveness and
stated the sound clip is ‘still really bad’, but it is easier as she can relate to what she is doing
currently in life. Participant 2 said she was able to use it in real life with her own challenges with
work, her roommate, getting out of bed and leave on time this morning. She also finds it really
useful to implement it in real life and asked for more ACT values-based exercises.
In the last trial, primary investigator observed Participant 2 moved her hand and seem
like she wants to stop the sound clip, but she didn’t. The primary investigator asks Participant 1
regarding to the behavior after, and she reports she was able to relate to something bigger
challenges in her life, i.e., moving out of her apartment, and says ‘you just need to overcome it
and do what you need to do, and be in the place where is better for me. I was focusing on that
and making the situation more approachable which is similar with what we did with the sound
clip.’
4.0 Discussion
Overall, a substantial increase in the duration participants were willing to listen to the
aversive noise was observed from the baseline phases to the intervention phases, across both
participants. These results provide initial evidence that values interventions may help participants
persist with uncomfortable tasks in laboratory settings. Furthermore, the effects persisted after

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the values interventions were terminated at one week follow-up. The current results are, of
course, very preliminary. However, the results suggest values-based exercises may help increase
persistence and these results have potentially broad implications. Many of the most important
areas of adaptive functioning in everyday life require persistence with discomfort. The
willingness to experience aversive stimuli in the immediate moment may allow individuals to
access larger, longer-term positive reinforcers. For example, the willingness to study hard now
allows students to access academic success in the long-term. Similarly, working hard now allows
one to make money later. For individuals with anxiety, experiencing fear now is necessary in
order to complete the exposure that leads to decreased anxiety and a more fulfilling life later.
Finally, experiencing the discomfort of exercising now helps one access the opportunity to live a
longer and healthier life later. Although the current study is a small preliminary lab study, both
participants reported that they have been able to apply the learned techniques in real life, which
they report have helped them to make better decisions toward outcomes they care about.
Future research should consider extending values-based interventions to general
populations outside of laboratory settings. Although the current intervention was small in scale
and short in duration, the use of a task that involved aversive stimuli and overt persistence
behavior may have increased the extent to which the task was functionally similar, not just
analogous to, persistence in real life. Put differently, during the intervention phase, listening to
the aversive sound for longer durations actually involved doing something difficult in the
moment, as opposed to verbally reporting how one might behave in the presence of aversive
stimuli. It seems possible then, that this task, itself, might be used as an intervention to bring
about behavior change outside the laboratory. Of course, this is purely speculative, but both
participants anecdotally reported using values interventions on themselves in their lives outside

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the lab. Future research should attempt to use values interventions in the context of lab measures
of persistence to build the more generalized repertoire of persisting in the face of difficulty, when
doing so moves one toward what one truly cares about. For example, after successfully
increasing persistence on a lab task, a researcher might ask a participant, “Wow, look what you
did with this annoying noise. If you could do this terrible task when you focus on what you truly
care about, I wonder what behavior change you might be capable of outside the lab?”
In conclusion, this study represents one small step toward bringing a greater degree of
precision and control to the study of components multicomponent interventions such as ACT.
Persistence is crucial in virtually all aspects of life, so interventions that hold promise of
increasing persistence have the potential of increasing clinicians’ ability to help people achieve
meaningful life goals more generally.

21
References
Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the
support of parents of children diagnosed with autism. Child & Family Behavior Therapy,
28, 1–18. http://dx.doi.org/10.1300/J019v28n01_01.
Codd, R. T., III, Twohig, M. P., Crosby, J. M., & Enno, A. (2011). Treatment of three anxiety
disorder cases with acceptance and commitment therapy in a private practice. Journal of
Cognitive Psychotherapy, 25, 203–217. http://dx.doi.org/10.1891/0889-8391.25.3.203.
Harris, R., & Hayes, S. (2008). The happiness trap. London: Robinson.
Harris, R., L, M., Carnell, L., & Lorscheid, D. (n.d.). The Happiness Trap Online Program.
Retrieved from http://thehappinesstrap.com/
Harris, R. (2019). ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment
Therapy, 2nd edition. Oakland, CA: New Harbinger Publications.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third
wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. doi:
10.1016/s0005-7894(04)80013-3.
Hayes, S. C. et. al. (2004). A preliminary trial of twelve-step facilitation and acceptance and
commitment therapy with polysubstance-abusing methadone-maintained opiate addicts.
Behavior Therapy, 35, 667–688. http://dx.doi.org/10.1016/S0005-7894(04)80014-5.
How loud is too loud? (n.d.). https://www.osha.gov/. Retrieved from
https://www.osha.gov/SLTC/noisehearingconservation/loud.html
Meshes, E., Tarbox, J., & Odum, A. (accepted with revisions). Toward the Development of a
Delay Discounting Model of Experiential Avoidance. Journal of Contextual Behavioral
Science.

22
NIOSH (1996). Preventing occupational hearing loss - a practical guide. doi:
10.26616/nioshpub96110
Peterson, B. D., Eifert, G. H., Feingold, T., & Davidson, S. (2009). Using acceptance and
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http://dx.doi.org/10.1016/j.cbpra.2008.12.009.
Skinner, B. F. (1974). About Behaviorism B.F. Skinner. New York: Knopf;
Valerie A. Evans PhD & Saul Axelrod PhD, BCBA-D (2012) Kazdin, A. E. (2011). Single-Case
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DOI: 10.1080/07317107.2012.654458
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of
acceptance and commitment therapy plus habit reversal for trichotillomania. Behavior
Research and Therapy, 44, 639–656. http://dx.doi.org/10.1016/j.brat.2005.05.006.

23
Appendices

Values Assessment Rating Form
Read through the accompanying values sheet. For each of the ten domains, write a few words to summarize your
valued direction, Eg ‘To be a loving, supportive, caring, partner.’ Rate how important this value is to you on a scale
of 0 (low importance) to 10 (high importance). It’s okay to have several values scoring the same number. Rate how
successfully you have lived this value during the past month on a scale of 0 (not at all successfully) to 10 (very
successfully). Finally rank these valued directions in order of the importance you place on working on them right
now, with 10 as the highest rank, and 9 the next highest, and so on.
Domain
Valued direction
(Write a brief summary, in one or two
sentences, or a few key words.)

Importance Success Rank
Couples/ intimate
relationships

Parenting

Family relations

Social relations

Employment

Education and training

Recreation

Spirituality

Citizenship/ community

Health/ Physical well-
being`

Figure 1: The happiness trap: Value Assessment Rating Form

24

Figure 2. The happiness trap: Values Worksheet

25

Figure 3. Multiple baseline across participant 1 (top) and participant 2 (bottom), depicting the
duration of time they chose to listen to the aversive noise on each trial.

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Asset Metadata

Creator Leung, Jay (author)

Core Title Values and persistence

School College of Letters, Arts and Sciences

Degree Master of Science

Degree Program Applied Behavior Analysis

Publication Date 04/20/2020

Defense Date 03/24/2020

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

Tag acceptance and commitment therapy,ACT,delay discounting,OAI-PMH Harvest,persistence,psychological flexibility,Values,verbal behavior

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tarbox, Jonathan (committee chair), Cameron, Michael (committee member), Lopez, Steven (committee member)

Creator Email jayleung@usc.edu,jayleung97@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-282366

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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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