Is ACT a Cult? Is ACT Just a Fad?

These thoughts are in bullet point form from a power point presentation by James Herbert at Drexel University.

He gave this talk at the ACT Summer Institute at La Salle University in summer of 2005.
I've (SCH) tweaked it to make it more readable and understandable in this form.

 

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

 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. The common theme is that
• ACT is merely the latest therapeutic fad to litter the mental health landscape.

The purpose of these points is to outline the criticisms so far, examine them critically and honestly, and explore how we as a community may respond.

There are a number of complaints about ACT. These include the following: 

• Overly-hyped claims
• “Getting ahead of the data”
• Excessive enthusiasm among those interested
• ACT is a cult
• ACT has excessive and 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
• Experiential exercises in ACT training are coercive and 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

In order to evaluate this we must examine the evidential warrant of specific claims

Some critics have tried to say that the ACT community is making excessive claims based on the ratio of theoretical to empirical papers. But this means that mere interest would indicate excess. That is not fair. The ratio isn’t a proxy. Nor are dreams/visions

Some critics are clearly unaware of the data that exist (e.g., see Hayes, Luoma, Bond, Masuda, & Lillis, 2006); those who are correctly note that it’s limited, but don’t generally compare specific claims with evidence, or consider the research strategy being pursued.

In fact it seems that ACT proponents have in fact been appropriately cautious in claims

Our response: Continue to be clear about specific claims and back claims with evidence

Excessive Enthusiasm

This seems to be largely based on reactions to the 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. Is there any evidence of this? If so, let's look at it, but so far the concerns do not seem to be linked to such interference.

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, or if there is more than one, a very small group of such leaders hand picked by the main 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

So is ACT a Cult?

The first set of features don’t apply. This website is an example; the list serve is an example. Anyone can participate and argue and have their say. But the second set of features clearly do apply. However, these latter features are poor discriminators of science vs. pseudoscience or cults.

Our response: This is silly; ignore it -- but also make sure that we maintain an open, horizontal, self-critical, empirical culture.

Grandiose Visions

Rightly or wrongly, ACT does indeed aspire to great things. Helps to understand history of behavioral analysis to appreciate the historical context. Behavior analysis always had a utopian vision (e.g., Walden II). It is critical to distinguish specific claims from distal goals and dreams; the former are subject to direct examination via evidential warrant; the latter are not.

Problem is that mainstream psychotherapies are cautious about big claims, whereas many dubious ones are not. So unless people look carefully, ACT can look too expansive.

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

Proselytizing ACT as a “Way of Life”

There are two variations of this: Clinicians must adopt an ACT perspective to their own life, and 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.

Regarding clients, 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, and we need to be cautious about things an individual clinical may do in applying ACT to her or her life and things that are said to be "necessary" in the absence of data. Individuals are free to explore -- claims can only be made based of scientific criteria.

ACT Seeks “Undue Influence” Over Others

This is a very familiar criticism to radical behaviorists. There are ethical issues surrounding parameters of informed consent that are an important cultural values. Like all values, must be decided independent of science per se. An 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”

This is generally argued by those with minimal familiarity with ACT. Ironically, traditional CBT folks sometimes who make this argument have themselves been on the receiving end of this allegation from psychoanalysts and 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, a basic research program, and philosophy.

Our response: Point this out when challenged. Help others learn RFT, behavior analysis, and functional contextualism, and to see how this informs treatment development.

Experiential Exercises in Training Are Coercive and Manipulative

Experiential exercises are used in ACT to highlight consciously self-reflective nature of ACT. But we must remember the audience, and be very careful to avoid coercion, even implicitly. Degree of focus on experiential exercises remains an unresolved issue empirically.

Our response: Examine this issue openly within the community, ethically and empirically. Until this is worked out, be mindful of the issues, open to the concerns, and cautious.

Self-Help Books

There is a legitimate debate over appropriate threshold for direct dissemination via popular literature. On the one extreme some say you 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. A growing number of ACT self-help books are being studied in randomized and open trials for effectiveness (as of 2011, we know of trials assessing Get Out of Your Mind, The Mindfulness and Acceptance Workbook for Anxiety, and Living Beyond Your Pain). Even outside of ACT, only a tiny number of books have that. At the 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 - and continuing assessing self-help book efficacy.

Obscurantist Jargon

Some critics see too many new terms in ACT and RFT, and reject them before learning these terms. The problem is that one person’s obscurantist jargon is another’s technical vocabulary. All other areas of natural science have technical languages. To evaluate jargon, must look at things like theoretical coherence, precision, scope, and connectivity. The ACT / RFT community has largely done this so far.

Our response: Develop the language as necessary, but be mindful of Occam’s razor. Distinguish scientific talk from clinical talk. Be prepared to defend the use of a technical term by showing that no existing term would do.

The Bottom Line

These criticisms fall into four camps. Those base on: Ignorance; style; a challenge to the status quo; and substantive issues. It is 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. Remind others that this tradition is not about individuals but a scientific model. If person X has the wrong style, focus on the message, not the messenger and evaluate the evidence.

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” in the sense of useful as considered against the goals of "prediction and influence with precision, scope, and depth"

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.