How you can work with values in CBT
Updated the 12th of April 2023
Working with the patient's values in CBT can have many advantages. Values are not syndrome-specific, and can help with both treatment outcomes and motivation in treatment. Values are a common part of what is called third wave CBT - and specifically takes inspiration from Acceptance and Commitment Therapy (ACT).
What are values?
Values can be defined as specific areas of life that a person finds meaningful to engage in. The term "valued direction" - common in ACT - can thus be defined as a person's consistent behavioral action in areas that a person feels meaningful to engage in. Values have two central components. Degree of importance, as well as commitment. Some values may be very important to a person, while their degree of commitment to values is very low. But values can also be less important, even if the behavioral commitment is high. When you work with values, you want to try to get patients to engage in behaviors that align well with what they find important in life.
Values differ from goals in that they can never be achieved, while goals have quantitative metrics that can be achieved and then checked off. Values are also positively formulated, and not focused on symptom reduction.
7 simple steps to clarify a patient's values in CBT
Working with values can be done flexibly, but initially you can follow a few simple steps.
1. Create distance from social rules
Behaviors that are regular are usually less rewarding than those behaviors that are naturally rewarding. Many different types of rules can have socially rule-driven rewards, such as being rewarded in terms of prestige, social capital, or monetary. The rewards are thus external in relation to the behavior. Other forms of behavior are intrinsically rewarding, and are to a greater extent rewarding in themselves. These are behaviors the patient would have performed if they had been allowed to choose freely. It is helpful to clarify this distinction for patients.
2. Define values
Then values as a concept can be introduced. There you can take up concepts such as the difference between values and goals, and how goals relate to values. Goals can be seen as sub-steps whose purpose is to align with the patient's values.
3. Define personal values
The patient can then be guided in identifying what he/she finds meaningful in larger areas of life. It is common that one has not thought more than superficially about such questions. The goal is to define concrete values within these areas of life.
4. Choosing importance of values
When personal values are defined, the patient is given the opportunity to choose some values that feel particularly meaningful. Here it is important not to focus on reasons, or a rationale for choices. This can easily lead into social rules as reasons for the behavior, which is counterproductive to the purpose of directing behavior toward values. A simple way to choose values is to rank the importance from 1-10 for each value.
5. Choosing alignment to values
After values have been ranked in terms of how important they are, the patient can be guided to visualize a current discrepancy regarding how active these values are right now. The aim is not to blame the patient, but to visualize for the patient which areas have the potential to be activated further. This can be easily done by having the patient rank their current alignment to each rating, from
1-10.
6. Choosing immediate goals in line with values
When the above steps are completed, the patient can be guided in breaking down certain values into concrete behavioral goals that are in line with important values that the patient is not actively manifesting at the moment. A larger goal, for example, can be broken down into three concrete behavioral sub-goals that are concrete, observable and specific. They are also clearly aligned with more comprehensive goals and important values.
7. Choosing behavior that aligns with immediate values
In the last step, the patient is tasked with performing these concrete behaviors between sessions. As a therapist, you guide the implementation and problem solving of concrete behaviors that align well with important values. Over time, these behaviors may increase in both frequency and complexity, while the patient broadens their behavioral repertoire across broader areas of life.
Working with values in CBT can be helpful for many different types of patients. Research shows that it can be integrated well into many different types of treatment protocols, but it can also be a valuable component to work focused with, in line with a behavioral activation protocol, for the right patient profile.
We have built our system to optimize this process for both patient and psychologist. Contact us and we will be happy to show you how we can help.