Is ACT Just a Fad? Addressing the Critics

Is ACT Just a Fad?Addressing the Critics James D. Herbert, Ph.D. Drexel University

Emergence of Criticism • As ACT has moved into the mainstream, a variety of criticisms have emerged from within the academic community • As ACT becomes more popular, we can anticipate even more criticism from even more voices • Common theme: ACT is merely the latest therapeutic fad to litter the mental health landscape

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

Complaints about ACT • Overly-hyped claims; “getting ahead of the data” • Excessive enthusiasm among those interested; the C-word • Grandiose visions • Proselytizing; ACT as a “way of life.” • Promotes “undue influence” by seeking to identify principles and technologies that could be used to impact behavior without their explicit consent

More Criticisms… • Experiential exercises in ACT training are coercive & manipulative • There’s “nothing really new” here • Premature dissemination to the public via self-help books • Both ACT and especially RFT are plagued by obscurantist jargon

Let’s look at each of these in turn…

Getting Ahead of the Data • Must examine evidential warrant of specific claims • Ratio of theoretical to empirical papers isn’t a proxy. Nor are dreams/visions • Some critics are clearly unaware of the data that exist; those who are correctly note that it’s limited, but don’t generally compare specific claims with evidence • ACT proponents have in fact been appropriately cautious in claims • Our response: Continue to be clear about specific claims

Excessive Enthusiasm • Largely based on reactions to listserv, and to reactions of some professors to their students returning inspired from workshops • But enthusiasm per se is only a problem if it interferes with critical thinking. Any evidence of this? • Our response: Make sure not to be blinded by enthusiasm

The “C” word: Is ACT a Cult? • “Cult” label usually evoked by: • A closed system • a charismatic leader • a strong profit motive • financial and/or sexual exploitation of vulnerable populations • a hierarchy of secretive levels to pass through in order to gain special knowledge or status • intolerance of dissent • Such groups also: • challenge the status quo • offer a grand vision • engender high levels of enthusiasm

Is ACT a Cult? • The first set of features don’t apply, but the second set clearly do • However, these latter features are poor discriminators of science vs. pseudoscience or cults • Our response: This is silly; ignore it

Grandiose Visions • Rightly or wrongly, ACT does indeed aspire to great things • Helps to understand history of behavioral analysis to appreciate the historical context • Critical to distinguish specific claims from distal goals/dreams; the former are subject to direct examination via evidential warrant; the latter are not • Compare biotechnology conference last month in Philadelphia • Problem is that mainstream psycho-therapies are cautious about big claims, whereas many dubious ones are not • Our response: Clarify explicitly the distinction between specific claims and distal visions

Proselytizing ACT as a “Way of Life” • Two variations: Clinicians must adopt an ACT perspective to their own life, & the focus of the client’s presenting problem is inappropriately shifted to ACT-consistent goals • Although ACT does suggest that clinicians try out some principles on themselves, it doesn’t require them to adopt any particular belief system • Re. clients, again this is not unique to ACT, as all psychotherapies attempt to socialize the client to their model. The key in all cases is informed consent • Our response: We could probably be clearer on these points

ACT Seeks “Undue Influence” • Familiar criticism to radical behaviorists • Ethics surrounding parameters of informed consent is an important cultural value, and like all values, must be decided independent of science per se • Extreme Libertarian stance rules out all public health interventions (e.g., programs promoting smoking cessation, safe sex to prevent STDs, routine diagnostic procedures like mammograms and prostate exams, childhood vaccinations) • The fact that a technology could possibly be misused is no reason to stifle science • Our response: Participate in the broader public ethical dialogue

ACT Offers “Nothing New” • Generally argued by those with minimal familiarity with ACT. Ironically, CBT folks who make this argument have themselves been on the receiving end of this allegation from psychoanalysts & others • Many (though not all) techniques and strategies are indeed openly borrowed, and so aren’t new • What is new is the organizing model, and especially the close link with theory & philosophy • Our response: Point this out when challenged

Experiential Exercises in Training Are Coercive & Manipulative • Experiential exercises used to highlight consciously self-reflective nature of ACT • But must remember audience, and be very careful to avoid coercion, even implicitly • Degree of focus on experiential exercises remains an unresolved issue • Our response: Examine this issue openly within the community

Self-Help Books • Legitimate debate over appropriate threshold for direct dissemination via popular literature • One extreme: must have strongly supportive data, not only of general approach, but its effectiveness in the self-help format and for the specific problem in question • Other extreme: Anything goes • Reasonable people can disagree about this, but it is in no way unique to ACT • Our response: Encourage authors to be appropriately cautious, while participating in the broader dialogue

Obscurantist Jargon • The problem is that one person’s obscurantist jargon is another’s technical vocabulary • Ironic, in that all other areas of natural science have technical languages • To evaluate jargon, must look at things like theoretical coherence, precision, scope, and connectivity • Our response: Develop the language as necessary, but be mindful of Occam’s razor. Distinguish scientific talk from clinical talk

Bottom Line: Criticisms Fall into Four Camps • Those based on ignorance • Those based on style • Those in reaction to a challenge to the status quo • Those that address substantive issues • Critical to distinguish these, as each calls for different responses

Criticisms Based on Ignorance Educate (e.g., journals, workshops, books, presentations), with a sensitivity to the audience

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

Criticisms Based on Challenges to the Status Quo: • Continue to do good science, including modifying theories and technologies based on data • Science is inherently self-correcting, so if ACT lives up to its promise it will eventually win hearts and minds • But be wary of striking the pose of Galileo; it isn’t enough to be novel – we must also be “right”

Substantive Criticisms • Carefully consider substantive criticisms, especially those challenging the evidential warrant of specific claims and specific theoretical issues • Then, offer a thoughtful response, and remain open to change when appropriate based on arguments and data

Is ACT Just a Fad? Addressing the Critics