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

• 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 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. But 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

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.

Steve's reactions to the Time article

The author did a terrific job, in my view. He starts out with a sentence that
has me as a mental patient and finishes with a paragraph that says
for ACT to go mainstream it will have to shed "its icky zealotry and grandiose predictions"
but in between is a pretty serious effort to understand and explain.

I want to acknowledge John Cloud publicly.
If every reporter treats this work as carefully and fairly
we will be blessed. He is an honorable guy who worked really hard
over several months to get it right.

The first thing John said was "I'm doing the RFT tutorial. I'm half way through it."
I paused and replied "OK. If you are doing that, I'm there. If you are that serious
I will answer every question and spend every ounce of energy needed to help you do your work."
And I did. I was an open book (as you can see!). Some of what is in that story my mother
did not know. But he earned that.

Of course, he is a writer, and writer need angles. The angle he chose was
almost mythological: wild eyed rebel vs. the establishment. Even the photos
fit that theme (me in a motorcycle jacket; in a tree fort; etc).
So some of the basic science, the grants etc were deemphasized and things
like bad clothes or weird rings were emphasized.

But, hey, in the grand scheme of things ACT is more outside than inside, so it
was not a functional distortion to omit some things like that.

I apologize for the focus on me. That was not of my doing: John came to ABCT,
interviewed Tim Beck, David Barlow, Judith Beck and many others. He went
and saw talks by Kelly, Kirk, and many others. He then
wrote the story as he chose. I suppose he felt that he needed to get
people to care about the issue enough to read a very long story ... and he did that
by putting my own struggles at center stage.

Mostly all other names in the ACT / RFT universe are not in the story.
I did try repeatedly to push the names of researchers or co-authors
(as John will attest!) but reporters
just make their own calls on such things. And I wish he'd mentioned
behavior analysis at least once (I begged!). But RFT is there by name; and some of the science is there.
He does mention in a general way the students and the researchers and clinicians around the world.
And the World Conference is mentioned! Woo Hoo.
And the website is there ... which may be why you are reading this

I am so thankful that there were no "anti" quotes from the ACT side about anyone.
The story shows us (well, at least me) as a bit goofy, but not negative toward others.
We took a few shots ... but that is to be expected I suppose.

Is this story premature? Maybe, but the culture decides on such things,
and through accident and interest, here we are.

On the issue of grandiosity

No predictions are in there that are grandious. What is in there is the
willingness to see that the culture needs so much more from behavioral science
than it is providing. I did say "Our survival really is at stake." That is so.
Can anyone looking at the "war on terrorism" not realize that soldiers alone cannot do it?
But that does not mean I think we can solve the problem. I did not say that and that is not in the quote.
I just think we have to try. We have to try to solve the problem of hatred. We have to find
a way to help people learn to love themselves and others, and to act in accord with
their deepest values. And I do think we may have a possible path forward inside this work -- let's see.
Together, let's see. That is a grand vision maybe ... but I'm not the only one dreaming.
Who knows about outcome ... can we begin the process?

On the cult deal ... look for the other page and James Herbert's great talk on that given at the ACT
Summer Institute.

My bottom line

In the long run what will matter is the substance: the science and the
human value of the work we do. We will need every ounce of community and shared values
and purpose we've gathered to do our work together as it becomes more visible and as the
resulting centrifugal forces gather. The reason this work is being noticed is because of
a community that cares. It is not a cult. There is no forced agreement. Look at this site!
Anyone can post anything; and to be a member you just join. How much more open can a group be?
I know of no other scientific group that is developing as an open community like this.
How can a shared, open, self-critical community be a cult! It is just a fear word.
To the critics who say it, I say, join the group and post your views. You will
find reason, support, and compassion here, not hierarchy.

So let's keep our eye on the horizon and remember why we got into this work in the first place.
It was not about attention in magazines, nice though that might be.
Unlike the fear expressed from by others outside of this community, it does not run on
artificial agreement or hierarchy -- we need each of us to bring ourselves
forward and to create something of value together. As individuals. Together.

Despite the worries, it seems clear we are entering into the conversation in a new way. That is an opportunity.
It is also a burden. It will cut in multiple ways.

Could I also say on a personal level that I appreciate the support I've received
in this process from many of you who have known it was going on.
The letters and emails I am now getting from people who are suffering are enough to make me weep ...
as my students have seen. Let's remember them. This work is about them.

The Epilepsy study

The epilepsy study mentioned in the article is this one:

Evaluation of Acceptance and Commitment Therapy (ACT) for refractory epilepsy: A randomized control trial in South Africa

The positive effects of psychological methods have long been known, but the research has hardly made an impact on the treatment of epilepsy. The purpose of this study was to develop and evaluate a psychological treatment program consisting of Acceptance and Commitment Therapy (ACT-said as one word) together with some behavioural seizure control technology shown to be successful in earlier research. The method consisted of a RCT group design with repeated measures (N= 27). All participants had an EEG verified epilepsy diagnosis with drug refractory seizures. Participants were randomized into one of two conditions; ACT or attention control (AC). Therapeutic effects were measured by examining changes in quality of life (SWLS and WHOQOL) and total seizure time per month. Both treatment conditions consisted of only 9 hours of professional therapy distributed in two individual and two group sessions during a five-week period. The results showed significant effects over all of the dependent variables for the ACT group as compared to the control group at the 12-month follow ups. Seizures were reduced more than 90% at the one year follow up. The results from this study suggest that a short term psychotherapy program combined with anticonvulsant drugs may help to prevent the long-term disability that occurs from drug refractory seizures.

Key words: Epilepsy, Acceptance and Commitment Therapy, Seizure control techniques, South Africa

Tobias Lundgren, tobiaslundgren455@hotmail.com Cellphone +46 70 612 4555, JoAnne Dahl, JoAnne.dahl@psyk.uu.se Cellphone +46 70 66 34 345 Lennart Melin, Department of Psychology, Uppsala University, Sweden
Bryan Kies Department of Neurology, University of Cape Town, South Africa