Integrating Skill‐Based Treatment (SBT) and Acceptance & Commitment Training (ACT) in Schools

Dixon et al. (2022) – AIM Curriculum Implementation in Public Schools

Full Citation: Dixon, M.

R., Paliliunas, D., Weber, J., & Schmick, A.

M. (2022).

A large-scale naturalistic evaluation of the AIM curriculum in a public-school setting.

Behavior Analysis in Practice, 15(1), 156–170sciencegate.app. Focus & Findings: This peer-reviewed study evaluated the Accept, Identify, Move (AIM) curriculum – an ACT-based social-emotional learning program – when delivered daily by school staff over an entire school year to 318 students in a public elementary settingpmc.ncbi.nlm.nih.gov.

All students received the AIM lessons (focused on mindfulness, accepting emotions, and value-guided behavior) and completed psychological flexibility self-assessments pre- and post-intervention.

Results showed significant improvements in students’ psychological flexibility – specifically, a drop in avoidance and fusion scores from a pre-test mean of ~20 to a post-test mean of ~14.5 on the Avoidance and Fusion Questionnaire for Youth (AFQ-Y)pmc.ncbi.nlm.nih.gov, indicating reduced experiential avoidance and cognitive fusion.

In essence, students became more open to experiencing emotions/thoughts without resorting to problematic behavior.

Teachers also reported anecdotal reductions in classroom problem behaviors and improved emotional coping skills among students after the year-long AIM implementation (as noted in the discussion of the article). SBT–ACT Connection: While this study focused on ACT (via the AIM curriculum), its implications strongly complement SBT in schools.

By increasing students’ psychological flexibility (a core ACT outcome) and ability to handle discomfort, the AIM curriculum can enhance the effectiveness of SBT for behavior reduction.

Many challenging behaviors addressed by SBT are triggered by inability to cope with denied requests, delays, or negative feedback – exactly the skills AIM targets.

Dixon et al. highlight that ACT interventions like AIM can be feasibly integrated into school routines by teachers, leading to safer, more positive behavior without needing punitive consequencessuppr.wilddata.cnpmc.ncbi.nlm.nih.gov.

In practice, this means a student receiving SBT for problem behavior could simultaneously benefit from AIM lessons that teach them to accept “no” for an answer, recognize and manage feelings, and commit to valued behaviors – thus bridging the two models.

The study demonstrates that an ACT-based curriculum can be scaled up in a school setting with high social validity and measurable student benefits, laying the groundwork for school behavior teams to use ACT techniques alongside SBT protocols.

Key Takeaways for School Teams:

Feasibility: Regular education staff successfully delivered the AIM (ACT) curriculum in classrooms, suggesting that ACT strategies can be woven into daily school schedules without requiring one-on-one therapy timepmc.ncbi.nlm.nih.gov.

Behavior Analysts can train and support teachers to run brief ACT exercises (mindfulness, discussing coping with feelings) as part of class routine. Improved Coping Skills: After a year of ACT instruction, students showed significantly reduced avoidance of difficult feelings and thoughtspmc.ncbi.nlm.nih.gov.

This indicates they were better able to tolerate frustration and delay – exactly the tolerance skills taught during SBT’s communication and delay training.

Thus, ACT curricula like AIM can strengthen the “accepting no” and emotional regulation components of SBT in practice. Complement to SBT: By fostering psychological flexibility, ACT interventions can reduce the likelihood of challenging behavior occurring in the first place.

A public-school behavior team could implement AIM group lessons to pre-teach coping and values skills, while also using SBT for individualized problem behavior treatment.

The two models together create a more comprehensive support: SBT addresses external contingencies and communication, while ACT addresses internal events and resilience. Social Validity and SEL Alignment: The study underscores that ACT-based programs fit well within school social-emotional learning (SEL) frameworks and were well-received by students and staff.

For a district already using AIM and PFA/SBT, this research validates combining them – it shows that teaching mindfulness, acceptance, and values to students is evidence-based and will likely improve the outcomes of behavior intervention plans by making students more receptive and adaptable.

Dixon & Hayes (2022) – Integrating ACT into ABA Practice

Full Citation: Dixon, M.

R., & Hayes, S.

C. (2022).

On the disruptive effects of behavior analysis on behavior analysis: The high cost of keeping out acceptance and commitment therapy and training.

Behavior Analysis in Practice, 18(1), 22–28pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. Focus & Findings: In this recent commentary (published online 2022, in print 2025) by Dr.

Mark Dixon and Dr.

Steven Hayes, the authors provide a conceptual and historical analysis arguing that Acceptance and Commitment Training/Therapy (ACT) rightfully belongs within mainstream ABA practice.

They note that ACT has deep roots in behavior analysis and a large empirical base, yet some behavior analysts resist it.

Dixon and Hayes acknowledge that embracing ACT is “disruptive” to traditional ABA because it brings along Relational Frame Theory (RFT) and a focus on private events (thoughts, feelings) – areas often neglected in favor of direct contingency managementpmc.ncbi.nlm.nih.gov.

However, they contend this disruption is necessary and beneficial.

The article’s key finding (conceptually) is that excluding ACT/RFT from ABA would fundamentally limit and “distort” the field, whereas integrating them will enrich ABA’s scope and effectivenesspmc.ncbi.nlm.nih.gov.

In other words, ACT is presented as a compatible extension of behavior analysis that can improve outcomes by addressing language and cognition.

The commentary does not present new data but reviews 40 years of ACT research and urges practitioners to incorporate ACT methods in behavior-analytic services.

Dixon and Hayes point out that refusing to evolve (by ignoring interventions targeting private events) comes at a high cost – it can impede client progress and scientific development. SBT–ACT Connection: Although not focused on a specific SBT protocol, this article directly supports combining SBT with ACT principles.

The authors argue that behavior analysts can and should use ACT strategies as part of their interventionspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov.

For a team using Dr.

Hanley’s SBT, this provides scholarly validation that adding ACT (e.g.

AIM curriculum or therapist-led acceptance exercises) is within our field’s best practices.

The commentary implies that challenging behaviors (typically treated with SBT’s functional communication and reinforcement) often have relational and emotional underpinnings that ACT can address.

For example, a student might comply during SBT sessions but still struggle with anxiety or rigid thoughts; ACT techniques could help the student accept those internal experiences and stick to learned skills.

Dixon and Hayes explicitly state that integrating ACT does not abandon ABA’s foundations but rather enhances them, since ACT’s focus on values and mindfulness can increase the generalization and durability of behavior changespmc.ncbi.nlm.nih.gov.

They also highlight that ACT’s core goal (psychological flexibility) complements the goals of compassionate, “whole-person” behavior support.

In sum, this article provides a theoretical roadmap for uniting SBT and ACT: use SBT to handle external contingencies and ACT to handle the internal events, for a more holistic approach to behavior change.

Key Takeaways for School Teams:

ACT is Behavior-Analytic: Dixon & Hayes affirm that ACT (or Acceptance and Commitment Training in behavior-analytic terms) is empirically supported and falls within the scope of ABA practicepmc.ncbi.nlm.nih.gov.

School-based BCBAs and RBTs should feel confident incorporating ACT methods (like guided mindfulness, values discussions, and defusion techniques) into behavior plans without viewing it as “outside” of ABA. Synergy Improves Outcomes: The authors argue that keeping ACT out of our interventions has a cost – potentially missing out on improvements in areas like coping and generalizationpmc.ncbi.nlm.nih.gov.

A practical implication is that students receiving SBT for problem behavior may achieve more sustainable progress if we also teach them ACT skills (e.g. how to handle unpleasant feelings or thoughts that trigger the behavior).

The combination targets both external triggers and internal responses. Train Teams in Psychological Flexibility: Behavior teams should be trained not just in functional assessment and reinforcement-based treatments, but also in ACT techniques.

For example, a district behavior specialist might coach staff to use simple ACT-consistent language during SBT sessions (“It’s okay to feel upset – you can have that feeling and still remember our expectations”) to reinforce tolerance and acceptance.

This aligns with Dixon & Hayes’ message that language and cognition (RFT) are integral to behavior – by acknowledging and addressing them, interventions like SBT become more robust. Cultural Shift Toward “Whole Child”: Embracing ACT is part of a broader movement toward compassionate, individualized ABA.

For a public school setting, this means behavior support plans can include goals related to a child’s values and emotional well-being, not just behavior reduction.

Dixon and Hayes note that this shift may be “disruptive” to old ABA habits but ultimately leads to a more humane, effective practicepmc.ncbi.nlm.nih.gov.

School teams can take from this that integrating ACT and SBT is an evolution of ABA that prioritizes student quality of life, aligning with positive behavior support and trauma-informed education initiatives.

Ghaemmaghami et al. (2024) – “Toward Compassion” in Severe Behavior Treatment

Full Citation: Ghaemmaghami, M., Ruppel, K.

W., Cammilleri, A.

P., Fiani, T., & Hanley, G.

P. (2024).

Toward compassion in the assessment and treatment of severe problem behavior.

Behavior Analysis in Practice, Advance online publication, 1–14practicalfunctionalassessment.com. Focus & Findings: Co-authored by Dr.

Greg Hanley, this recent article emphasizes compassionate, trauma-informed refinements to the SBT approach for severe challenging behavior.

The authors note that while ABA has always valued “concern for others” and social validity, in practice many traditional strategies for problem behavior have not sufficiently considered the subjective experiences of clientsresearchgate.netresearchgate.net.

They observe that some common procedures (e.g. standard functional analysis and extinction-based protocols) can inadvertently cause distress, citing continued use of methods that “(a) elicit negative emotional responding, (b) produce bursts of dangerous behavior, (c) are highly intrusive, (d) lack methods to obtain and allow for the withdrawal of assent, and (e) are not guided by client preference.”researchgate.net.

In response, the paper discusses the meaning of “compassion” in behavior assessment/treatment and offers concrete recommendations to make SBT more compassionate.

Key themes include ensuring client assent and choice, minimizing coercion and trauma (for example, by using the enhanced Choice Model of SBT where the client can control some aspects of sessions), focusing on happy, relaxed, engaged (HRE) behavior as goals, and aligning interventions with the individual’s preferences and values.

The authors argue that incorporating these humane practices does not dilute effectiveness – in fact, preliminary evidence and case examples suggest safer, trust-building approaches improve long-term outcomes.

Essentially, Hanley’s team calls for blending traditional SBT with strategies that honor the client’s emotional well-being, thereby treating the whole person and not just the behavior. SBT–ACT Connection: Although this article does not explicitly mention “ACT,” it naturally connects to ACT concepts by prioritizing the alleviation of client suffering and the consideration of private events during treatment.

Many of the “compassionate” strategies parallel ACT practices.

For example, ensuring a child can withdraw assent or take a break if overwhelmed is akin to practicing acceptance – acknowledging the child’s feelings and giving them space, rather than forcing through compliance.

The emphasis on client values and preferences in designing reinforcement and activities resonates with ACT’s focus on values-based action.

The authors implicitly endorse teaching coping skills (like tolerating delay or denied requests in SBT) in a way that the client chooses to engage – this is very much in line with ACT’s idea of committed action (the client consents to work through discomfort in service of their goals).

Notably, the paper references the concept of psychological flexibility and the six core ACT processes as a model for durable behavior changeresearchgate.net, suggesting that building skills like mindfulness and acceptance can enhance treatment maintenance.

By integrating such ACT-informed elements, the SBT process becomes less about control and more about empowerment and skill-building.

In summary, Ghaemmaghami et al. integrate ACT’s spirit of compassion and acceptance into the fabric of SBT, showing practitioners how to reduce trauma and increase trust without sacrificing outcomes.

For a school-based team, this means that in addition to running functional analyses and skill-based protocols, they should attend to the student’s emotional state, model calm acceptance of the student’s feelings, and use collaborative, child-guided strategies – hallmarks of both ACT and today’s “kind ABA.”

Key Takeaways for School Teams:

Assent and Choice are Crucial: The article underscores that allowing students a sense of control during assessment and treatment is a compassionate practice that can prevent escalationresearchgate.net.

In school settings, this could mean letting a student signal when they need a break during SBT sessions, offering choices of reinforcers or tasks, or even using the “My Way” approach (enhanced choice model) where the learner can opt out of demands.

These strategies reflect ACT principles of honoring the person’s feelings and avoiding undue coercion, which can improve the student’s trust in staff and willingness to engage in therapy. Focus on Emotional Well-Being (not just Behavior): A practical implementation from this paper is to monitor the student’s HRE (happy, relaxed, engaged) indicators as key metrics of success, alongside reducing problem behaviorresearchgate.netresearchgate.net.

School BCBAs can train RBTs to look for signs of stress (e.g. anxious vocalizations, tense body language) and pause or adapt the intervention when those appear.

By doing so, the team applies ACT’s emphasis on accepting and addressing emotional experiences.

The result is an SBT process that not only decreases behavior incidents but also leaves the student feeling safe and understood. Incorporate ACT Techniques in SBT Sessions: The compassionate SBT model aligns with using simple ACT techniques during behavior intervention.

For instance, teachers or therapists might lead a quick mindful breathing exercise if a student starts to get frustrated during a functional communication training session.

They might use ACT-consistent language (“I know waiting is hard, and you’re feeling angry – that feeling is okay.

Let’s take a deep breath together.”).

These in-the-moment strategies help the student accept their emotion and commit to the coping skills being taught, blending ACT with SBT seamlessly. Train Staff in Compassionate, Trauma-Informed Care: Ghaemmaghami et al. provide recommendations that staff should be trained to recognize trauma signals and respond with compassion.

For a school district team, this means professional development on trauma-informed ABA and ACT could be beneficial.

Staff will learn to view challenging behavior through an ACT lens (seeing it as often an expression of private events like fear or confusion) and thus respond not with punishment but with validation and guidance.

This approach can reduce staff–student conflict and create a more positive school climate.

As the authors put it, moving toward compassion involves cultural changes in our organizations – promoting empathy, flexibility, and respect in every interactionresearchgate.net. Practical Implication: By integrating the insights from these articles, a public school behavior team can develop a comprehensive model wherein Skill-Based Treatment addresses the environmental triggers and teaches communication skills, while Acceptance and Commitment Training (through curricula like AIM and compassionate care strategies) builds students’ internal resilience and flexibility.

Recent research by Dr.

Hanley and Dr.

Dixon shows that this combined approach is not only theoretically soundpmc.ncbi.nlm.nih.gov but also practically effective in school settingspmc.ncbi.nlm.nih.gov.

Embracing both models allows Behavior Analysts and RBTs in schools to reduce problem behaviors and equip students with lifelong social-emotional skills – a win-win for students, staff, and the overall learning environment. Sources: Recent peer-reviewed articles and commentaries by Dr.

Mark Dixon and Dr.

Greg Hanley’s research teams were used to compile these findingssciencegate.apppmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.govresearchgate.net, with a focus on 2022–2024 publications relevant to school-based ABA practice.

Each source emphasizes the value of combining SBT and ACT principles to achieve compassionate and effective behavioral support in educational contexts.

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Edited by Rob Spain, M.S., BCBA, IBA

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