Is ACT Just a Fad?Is ACT Just a Fad?Addressing the CriticsAddressing the Critics

James D. Herbert, Ph.D.James D. Herbert, Ph.D.

Drexel University Drexel University

Emergence of CriticismEmergence of Criticism

As ACT has moved into the mainstream, a As ACT has moved into the mainstream, a variety of criticisms have emerged from variety of criticisms have emerged from within the academic community within the academic community

As ACT becomes more popular, we can As ACT becomes more popular, we can anticipate even more criticism from even anticipate even more criticism from even more voices more voices

Common theme: ACT is merely the latest Common theme: ACT is merely the latest therapeutic fad to litter the mental health therapeutic fad to litter the mental health landscape landscape

Let’s outline the criticisms so far, Let’s outline the criticisms so far, examine them critically and examine them critically and honestly, and explore how we as honestly, and explore how we as a community may responda community may respond

Complaints about ACTComplaints about ACT

Overly-hyped claims; “getting ahead of Overly-hyped claims; “getting ahead of the data”the data”

Excessive enthusiasm among those Excessive enthusiasm among those interested; the C-wordinterested; the C-word

Grandiose visionsGrandiose visions Proselytizing; ACT as a “way of life.”Proselytizing; ACT as a “way of life.” Promotes “undue influence” by seeking to Promotes “undue influence” by seeking to

identify principles and technologies that identify principles and technologies that could be used to impact behavior without could be used to impact behavior without their explicit consenttheir explicit consent

More Criticisms…More Criticisms…

Experiential exercises in ACT training Experiential exercises in ACT training are coercive & manipulativeare coercive & manipulative

There’s “nothing really new” hereThere’s “nothing really new” here Premature dissemination to the Premature dissemination to the

public via self-help bookspublic via self-help books Both ACT and especially RFT are Both ACT and especially RFT are

plagued by obscurantist jargonplagued by obscurantist jargon

Let’s look at each of Let’s look at each of these in turn…these in turn…

Getting Ahead of the DataGetting Ahead of the Data

Must examine Must examine evidential warrantevidential warrant of specific of specific claims claims

Ratio of theoretical to empirical papers isn’t a Ratio of theoretical to empirical papers isn’t a proxy. Nor are dreams/visionsproxy. Nor are dreams/visions

Some critics are clearly unaware of the data Some critics are clearly unaware of the data that exist; those who are correctly note that that exist; those who are correctly note that it’s limited, but don’t generally compare it’s limited, but don’t generally compare specific claims with evidencespecific claims with evidence

ACT proponents have in fact been ACT proponents have in fact been appropriately cautious in claims appropriately cautious in claims

Our response: Continue to be clear about Our response: Continue to be clear about specific claimsspecific claims

Excessive EnthusiasmExcessive Enthusiasm

Largely based on reactions to Largely based on reactions to listserv, and to reactions of some listserv, and to reactions of some professors to their students returning professors to their students returning inspired from workshopsinspired from workshops

But enthusiasm per se is only a But enthusiasm per se is only a problem if it interferes with critical problem if it interferes with critical thinking. Any evidence of this?thinking. Any evidence of this?

Our response: Make sure not to be Our response: Make sure not to be blinded by enthusiasmblinded by enthusiasm

The “C” word: Is ACT a Cult?The “C” word: Is ACT a Cult? ““Cult” label usually evoked by:Cult” label usually evoked by:

– A closed systemA closed system– a charismatic leadera charismatic leader– a strong profit motivea strong profit motive– financial and/or sexual exploitation of vulnerable financial and/or sexual exploitation of vulnerable

populationspopulations– a hierarchy of secretive levels to pass through in a hierarchy of secretive levels to pass through in

order to gain special knowledge or statusorder to gain special knowledge or status– intolerance of dissentintolerance of dissent

Such groups also:Such groups also:– challenge the status quochallenge the status quo– offer a grand visionoffer a grand vision– engender high levels of enthusiasmengender high levels of enthusiasm

Is ACT a Cult?Is ACT a Cult?

The first set of features don’t apply, The first set of features don’t apply, but the second set clearly dobut the second set clearly do

However, these latter features are However, these latter features are poor discriminators of science vs. poor discriminators of science vs. pseudoscience or cults pseudoscience or cults

Our response: This is silly; ignore itOur response: This is silly; ignore it

Grandiose VisionsGrandiose Visions Rightly or wrongly, ACT does indeed aspire to great Rightly or wrongly, ACT does indeed aspire to great

things things Helps to understand history of behavioral analysis to Helps to understand history of behavioral analysis to

appreciate the historical contextappreciate the historical context Critical to distinguish specific claims from distal Critical to distinguish specific claims from distal

goals/dreams; the former are subject to direct goals/dreams; the former are subject to direct examination via evidential warrant; the latter are notexamination via evidential warrant; the latter are not

Compare biotechnology conference last month in Compare biotechnology conference last month in PhiladelphiaPhiladelphia

Problem is that mainstream psycho-therapies are Problem is that mainstream psycho-therapies are cautious about big claims, whereas many dubious cautious about big claims, whereas many dubious ones are notones are not

Our response: Clarify explicitly the distinction Our response: Clarify explicitly the distinction between specific claims and distal visionsbetween specific claims and distal visions

Proselytizing ACT as a “Way of Life”Proselytizing ACT as a “Way of Life” Two variations: Clinicians must adopt an ACT Two variations: Clinicians must adopt an ACT

perspective to their own life, & the focus of the perspective to their own life, & the focus of the client’s presenting problem is inappropriately client’s presenting problem is inappropriately shifted to ACT-consistent goalsshifted to ACT-consistent goals

Although ACT does suggest that clinicians try out Although ACT does suggest that clinicians try out some principles on themselves, it doesn’t some principles on themselves, it doesn’t requirerequire them to adopt any particular belief systemthem to adopt any particular belief system

Re. clients, again this is not unique to ACT, as all Re. clients, again this is not unique to ACT, as all psychotherapies attempt to socialize the client to psychotherapies attempt to socialize the client to their model. The key in all cases is informed their model. The key in all cases is informed consentconsent

Our response: We could probably be clearer on Our response: We could probably be clearer on these pointsthese points

ACT Seeks “Undue Influence”ACT Seeks “Undue Influence” Familiar criticism to radical behavioristsFamiliar criticism to radical behaviorists Ethics surrounding parameters of informed consent Ethics surrounding parameters of informed consent

is an important cultural value, and like all values, is an important cultural value, and like all values, must be decided independent of science per semust be decided independent of science per se

Extreme Libertarian stance rules out all public Extreme Libertarian stance rules out all public health interventions (e.g., programs promoting health interventions (e.g., programs promoting smoking cessation, safe sex to prevent STDs, smoking cessation, safe sex to prevent STDs, routine diagnostic procedures like mammograms routine diagnostic procedures like mammograms and prostate exams, childhood vaccinations)and prostate exams, childhood vaccinations)

The fact that a technology could possibly be The fact that a technology could possibly be misused is no reason to stifle sciencemisused is no reason to stifle science

Our response: Participate in the broader public Our response: Participate in the broader public ethical dialogueethical dialogue

ACT Offers “Nothing New”ACT Offers “Nothing New”

Generally argued by those with minimal Generally argued by those with minimal familiarity with ACT. Ironically, CBT folks who familiarity with ACT. Ironically, CBT folks who make this argument have themselves been on make this argument have themselves been on the receiving end of this allegation from the receiving end of this allegation from psychoanalysts & others psychoanalysts & others

Many (though not all) techniques and strategies Many (though not all) techniques and strategies are indeed openly borrowed, and so aren’t neware indeed openly borrowed, and so aren’t new

What is new is the organizing model, and What is new is the organizing model, and especially the close link with theory & philosophyespecially the close link with theory & philosophy

Our response: Point this out when challengedOur response: Point this out when challenged

Experiential Exercises in TrainingExperiential Exercises in Training Are Coercive & ManipulativeAre Coercive & Manipulative

Experiential exercises used to highlight Experiential exercises used to highlight consciously self-reflective nature of ACTconsciously self-reflective nature of ACT

But must remember audience, and be very But must remember audience, and be very careful to avoid coercion, even implicitlycareful to avoid coercion, even implicitly

Degree of focus on experiential exercises Degree of focus on experiential exercises remains an unresolved issueremains an unresolved issue

Our response: Examine this issue openly Our response: Examine this issue openly within the communitywithin the community

Self-Help BooksSelf-Help Books Legitimate debate over appropriate threshold for Legitimate debate over appropriate threshold for

direct dissemination via popular literaturedirect dissemination via popular literature One extreme: must have strongly supportive One extreme: must have strongly supportive

data, not only of general approach, but its data, not only of general approach, but its effectiveness effectiveness in the self-help formatin the self-help format and for and for the the specific problemspecific problem in question in question

Other extreme: Anything goesOther extreme: Anything goes Reasonable people can disagree about this, but it Reasonable people can disagree about this, but it

is in no way unique to ACTis in no way unique to ACT Our response: Encourage authors to be Our response: Encourage authors to be

appropriately cautious, while participating in the appropriately cautious, while participating in the broader dialoguebroader dialogue

Obscurantist JargonObscurantist Jargon

The problem is that one person’s The problem is that one person’s obscurantist jargon is another’s technical obscurantist jargon is another’s technical vocabularyvocabulary

Ironic, in that all other areas of natural Ironic, in that all other areas of natural science have technical languagesscience have technical languages

To evaluate jargon, must look at things like To evaluate jargon, must look at things like theoretical coherence, precision, scope, and theoretical coherence, precision, scope, and connectivityconnectivity

Our response: Develop the language as Our response: Develop the language as necessary, but be mindful of Occam’s razor. necessary, but be mindful of Occam’s razor. Distinguish scientific talk from clinical talk Distinguish scientific talk from clinical talk

Bottom Line: Criticisms Fall into Bottom Line: Criticisms Fall into Four CampsFour Camps

Those based on ignoranceThose based on ignorance Those based on styleThose based on style Those in reaction to a challenge to the Those in reaction to a challenge to the

status quostatus quo Those that address substantive issuesThose that address substantive issues

Critical to distinguish these, as each calls Critical to distinguish these, as each calls for different responsesfor different responses

Criticisms Based on IgnoranceCriticisms Based on Ignorance

Educate (e.g., journals, workshops, Educate (e.g., journals, workshops, books, presentations), with a books, presentations), with a sensitivity to the audiencesensitivity to the audience

Criticisms Based on StyleCriticisms Based on Style

Attempt to understand the reaction, Attempt to understand the reaction, and decide how to respond. We are and decide how to respond. We are not obligated to address every not obligated to address every stylistic criticism. But we should be stylistic criticism. But we should be mindful of our audience and our mindful of our audience and our purposepurpose

Criticisms Based on Challenges Criticisms Based on Challenges to the Status Quo:to the Status Quo:

Continue to do good science, Continue to do good science, including modifying theories and including modifying theories and technologies based on datatechnologies based on data

Science is inherently self-correcting, Science is inherently self-correcting, so if ACT lives up to its promise it will so if ACT lives up to its promise it will eventually win hearts and mindseventually win hearts and minds

But be wary of striking the pose of But be wary of striking the pose of Galileo; it isn’t enough to be novel – Galileo; it isn’t enough to be novel – we must also be “right”we must also be “right”

Substantive CriticismsSubstantive Criticisms

Carefully consider substantive Carefully consider substantive criticisms, especially those criticisms, especially those challenging the evidential warrant of challenging the evidential warrant of specific claims and specific specific claims and specific theoretical issuestheoretical issues

Then, offer a thoughtful response, Then, offer a thoughtful response, and remain open to change when and remain open to change when appropriate based on arguments and appropriate based on arguments and datadata