Trudy Is a 36-year-old single mom with two children. She works shifts in a long-term care facility as a nurse and then comes home to take care of her 14 and 15-year-old girls along with all the household chores that need to be done daily.

She finds herself to be over tired, endlessly agitated with her daughters, and just fed up with the constant cleaning at home. She dreads getting home at the end of her shift and recognizes that this is something that she needs to work on.

Through work, she has learned about ACT and decides to complete the ACT Matrix to get a better understanding of what she Is feeling and how to move in the right direction.

Now that Trudy has identified her values, she is now considering what thoughts and feelings she has when the going gets rough. This has been occurring a lot of late and so she quickly notes all the negative thoughts she has been having.

Now Trudy focuses on what actions she takes when she feels these thoughts. What are the actual behaviours she exhibits when these thoughts take over her brain. She finds these actions difficult to write down. It Is quite an emotional experience.

Next Trudy Identifies the behaviours that will bring her towards her values. She thinks about those things that she wishes would happen naturally. How It would feel to be relaxed coming home? What would make her more relaxed? What would be an Ideal day? Week? This really helps her to Identify how to fill in the next quadrant.

Integrating ACT and the Matrix into Everyday Life

Now you may be wondering, what do I do with all this information?

Trudy takes a picture of the matrix so that she can view It on her phone at any time. Even If she Is having a good day, she looks at It to confirm for herself that she Is committing to the actions she made to move towards her values. There Is much more to learn but this has been a great start to Improving her quality of life.

Step 1: Fill out the ACT Matrix
Step 2: Post it
Step 3: Notice your thoughts and behaviours
Step 4: Refer to the posted Matrix
Step 5: Choose to pivot towards what matters

Once you have filled it out, you can post it in an accessible location at your office or home. Whenever you notice that you are having unwanted thoughts or feelings or engaging in a behaviour that is moving you away from your values, refer to your posted Matrix to help you pivot towards what matters to you.

This is also a great time to start practicing mindfulness, which is an exercise widely used in ACT. Mindfulness is the act of purposefully observing, without judgment or struggle, your life as it is happening in the present moment.

What is Reinforcement?

Reinforcement is what happens immediately after a behaviour occurs, which strengthens it.  When a behaviour is reinforced, it happens more often. Provide positive reinforcement whenever you notice that the individual is engaging in desired behaviours. If you praise an individual just as they finish hanging up their coat in the closet, the next time they take off their coat they will be motivated to hang up the coat again. In this case praise was the reinforcer. 

Everyone has different motivators, therefore what may be reinforcing for one person may not be appealing to another. 

Reinforcement Delivery

There are several components to consider when providing reinforcement:

1. Distinctiveness

• The individual should be able to distinguish between your instructions, other things in the environment, and reinforcement. This is important to remember when providing verbal praise.
• To make verbal praise more distinctive, vary the tone of your voice, be specific.

2. Immediacy

• Reinforcement should be provided 3-5 seconds after the target behaviour occurs.
• Waiting too long (e.g., seconds or minutes) might mean your attempt at reinforcing the target behaviour has no effect and you may have inadvertently reinforced another behaviour.

3. Reinforcer Variation

• Use a variety of reinforcers, not just one. This helps slow down satiation. Satiation is when a reinforcer stops working because it is used too often.
• When trying to reinforce a behaviour, alternate between preferred items or provide choices to the individual.

What To Do

Every time Scott sneezes into his elbow, we smile at him and say, “Great covering your sneeze”. Over the next two weeks he goes from rarely sneezing into his elbow to sneezing into his elbow every time. Smiling at and praising Scott has reinforced the target behaviour. 

What Not To Do

The goal is for Maria to wash her hands after every meal. You know that praise is particularly reinforcing for Maria. You notice that she washes her hands after eating, but you don’t say anything right away because you are busy. A few minutes later when she’s leaving the kitchen, you tell her, “Thanks for washing your hands, Maria”.

Token Economy 

A token economy is a form of behaviour modification designed to increase desirable behaviour and decrease undesirable behaviour with the use of tokens.  Individuals receive tokens immediately after displaying desirable behaviour.  The tokens are collected and later exchanged for a meaningful object or privilege. 

A token board is often used to track the progress of the individual and indicate how many tokens must be earned to exchange for the reinforcer.

Why Are They Effective?

Token economies are a more efficient way of delivering reinforcement. Tokens can be delivered with greater ease than giving an edible or preferred item after each occurrence of the target behaviour. Token economies can also be used with an individual or a group setting, such as a classroom. Delaying the item or activity that the individual wants (backup reinforcer), but contingently delivering the token (learned reinforcer) can teach waiting and maintain motivation during teaching. A token economy can also help prevent an individual from becoming satiated with a reinforcer. Delivery of the reinforcer, like with all other reinforcement methods, must be done frequently and immediately after the target behaviour occurs. The token can be paired with praise or another backup reinforcer.

What Type of Token/Token Board Should Be Used?

Selection of the type of tokens and token board to be used is critical to the implementation of the system.  The token itself should have some reinforcing value to the individual. For example, if the individual is interested in Ninja Turtles, each token could be a character from the show and the token board could be in the form of a slice of pizza. It is beneficial to have tokens that are easy to deliver, are durable and can be easily carried from one activity to another.

For more information and workshops on reinforcement check out this page.

Activity schedules (also referred to as visual schedules) are often used to help individuals understand daily events in their lives. Activity schedules are made up of a series of pictures (photographs, line drawings) or words to communicate a sequence of activities/events/transitions or the steps of a specific activity. The choice to use pictures or words will depend on the communication skills of the individual. 

Label pictures with the exact words that you and others will use to refer to the activity.  For example, it can be confusing to the individual if one person uses the term washroom and another person says toilet.

How to Use A Schedule

1. Identify which visuals are available for the day (e.g., activities and outings).
2. Build your schedule according to the routines the individual will be engaging in for the day. 
3. If there is flexibility in the schedule such as offering choices be sure to have those picture options available (attached to the board or nearby).
4. Review the schedule with the individual. 
5. Use a first /then approach to transition throughout the schedule (e.g., “first shower, then breakfast”).
6. Once the activity is completed, remove the visual from the board saying for example, “breakfast is finished”.
7. Continue these steps (4-6) until the end of the schedule.

Independent Activity Schedules

Independent activity schedules are a set of pictures or words that prompts an individual to engage in a specific sequence of activities. Depending on the individual’s capabilities, the activity can be detailed and broken down into its specific parts, or it can be general, using one picture to cue the individual to engage in the activity. Decrease the use of graduated guidance (physical prompts) as the individual becomes more independent in the task. 

The purpose of using independent activity schedules is to teach individuals to perform a set of activities or tasks eventually without the need for guidance or prompting from others. The use of these schedules increases independence and autonomy in the individuals we support, as well as creating structure throughout their day.

Tips for Teaching An Individual to Use An Independent Schedule

1. The schedule should be set up with the pictures or words necessary and ensure that all of the components of the activity are accessible. For example, if the individual is learning to make toast, provide the bread, butter, toaster and utensils. 
2. Have the individual pick an activity or an item to “work for” once they have completed their schedule.
3. When prompting the individual through the schedule, make sure to stand behind the individual (graduated guidance).
4. The individual should point to each activity and complete them in sequence. It is important to indicate when one activity has been completed before moving on to the next one.
5. As the individual develops independence, you can fade out prompting. Try not to use any verbal prompts, as they are the hardest to fade out.

Visit ConnectABILITY’s visual engine to create your own activity schedule or visual guide.

This article was written by the Clinical Supports Team at Community Living Toronto.