Common Misunderstandings About ACT / RFT

Here are a number of common misunderstandings about ACT and RFT. I've listed only ones that I think are demonstrably false. Ones that could be true I have not listed since this page is about misunderstandings, not legitimate weaknesses. Comments follow each. If you know of others, let me know - Steven Hayes

• ACT is just _____ (fill in your favorite: Buddhism, CT, BT, CBT, Logotherapy, a psychology of the will, Gestalt, existential, est, Morita, constructive living, solution focused therapy, Kelly role therapy, and so on and so on)
  Resemblance is a fun game to play but I have yet to have anyone say these things in strong form (it is just _____) when they have really delved into the philosophy, theory, data, and technology. It is actually a positive sign when you see that others are pointing to somewhat similar issues. If multiple paths lead in a direction perhaps that is a direction worth exploring. If folks want to draw the connections above, it would be good to do them seriously and in print so people can understand the connections. The only ones I could see myself fully agreeing to is "ACT is just behavior analysis" ... or, properly understood, "ACT is just behavior therapy," but I'd quickly want to add "but that area itself has to be understood in a different way to say that." As far as roots, some of these are indeed influences on ACT. You could find some historical connections with CT, BT, CBT, Logotherapy, Gestalt, existential, and est for example. Probably a few more and as it expands lots of new things come in. ACT is a vast community now.

• ACT is a cult
  James Herbert has a great powerpoint on this site walking through why that comparison is unfair and inaccurate.

• ACT is just the latest fad
  ACT will ultimately die, as will we all, and it may do so soon, but if you mean that it is frivolous or insubstantial, that is just factually incorrect. When you last over 25 years, do over 100 basic and applied studies, and train over 10,000 people, "fad" is just not an applicable term. We do suspect that the theory underlying ACT is wrong but that is because so far in science all theories have ultimately been shown to be incorrect.

• ACT is new on the scene
  It is over 25 years old.

• ACT is old on the scene and thus its outcome studies should be __ times more
  ACT followed a different development path linked to philosophy, basic research, and process measurement. The 14 years in between outcome studies from 1986 to 2000 that it took to do that should not be held against it ... especially since the detour taken by ACT /RFT in essence was linked to even higher standards and goals. ACT is willing to be held to RCT-linked standards and we have quite a number now. But if you are saying that is all that is important, we will say your sights are set far too low because RCTs alone are not enough to create a progressive field. You need a theory and development strategy that works. If you look at the outcome studies since 2000 it would be a hard case to make that ACT does not care about outcome data.

• ACT seeks ridiculously high goals and thus is making grandiose predictions or claims Aspirations are not predictions or claims. Seeking a comprehensive account of behavior that would apply to all human action has always been the goal of behavior analysis as is shown in things such as Walden II. Why is a grand aspiration grandiose?

• ACT is just for smart people
  It works for the psychotic and there is some limited evidence that it works for the retarded. It works for the poor and the illiterate.

• ACT works only for white middle class Americans
  There are ACT studies from 10 countries includinging countries in Asia and Africa. Successful studies have been done with poor urban black populations; unemployed poor Asian American populations; institutionalized South African blacks, etc. The outcomes are equally good.

• ACT is not committed to science
  Download the studies. And don't say that within arm's reach of me or you'd better be able to duck fast.

• ACT is just a technology
  It is a far more ... do your reading. It is a model linked to a philosophy, basic science, and a strategy of development.

• ACT is just a philosophy
  Ditto.

• ACT is just acceptance
  Ditto.

• ACT is just commitment
  Ditto.

• ACT is just acceptance and commitment
  Aw, come on. This comes from folks reading the titles of books instead of books.

• Acceptance is important because it is a way to change the content of emotion (so ACT is really about that)
  The data suggest otherwise. Emotion do sometimes change, but it predicts behavioral outcomes more poorly that changes in the functions of emotions -- and sometimes good outcomes come without a change in emotion within the extant ACT literature.

• Defusion is important because it is a way to change the content of thought (so ACT is really about that)
  Double ditto. Same point. Also decent data supporting it.

• The ACT model of cognition is no different than any CBT model -- it is just different in its terminology
  If you believe that, have the courage to do your homework in detail and write it up in article form. Then be prepared to have others go after your ideas. We have so far responded to every single serious criticism in print in ACT or RFT, so anyone can read the criticisms and the response and judge the arguments. So far no one, I mean no one, has made the claim above in a careful scholarly article. But it is not the ACT world's obligation to prevent the claim from being made in the hallways of convention hotels or on listserves. Even here we do what we can, however. You are reading exhibit A in that area.

• Defusion is just distancing as that concept is used in CT
  They are indeed related. That is one of the real historical sources of ACT. But in ACT there are scores of such techniques, the are emphasized a great deal, and they are put to a quite different purpose than in traditional CT.

• ACT is just mindfulness as that concept is used by Buddhists or ______ (fill in the blank)
  ACT is clearly broader at the level of theory and technology. Mindfulness is itself a vague and broad term that it is hard to be precise if it is left at that level. That is why we have written 4-5 articles walking through the concept of mindfulness and trying to come up with a tighter analysis of it. When defined in the right way, ACT is a mindfulness-based approach but it is more than that as well.

• Defusion is just exposure in a traditional sense
  Research shows that defusion supports exposure. If you say it is exposure then you have expanded exposure to conver most contact of human beings with events and that is troublesome. Besides exposure itself is not well understood, and ACT folks have a flexibility and pattern-based account of exposure that comports with the ACT model.

• Acceptance is just exposure in a traditional sense
  Research shows that it too supports exposure but for the same reasons as the above that does not mean it is just itself exposure. ACT is an exposure-based technology. We said that in 1987. But its goal is teaching more flexible contact with private events and more flexible patterns of responding. We do not do exposure to reduce emotions (thought they usually are reduced).

• ACT does not care about the relationship
  We have a model of it; we teach it; we emphasize it. We have data showing that ACT gets high aliance scores; they predict outcome; but they are themselves explained in part by changes in acceptance/defusion/valued action.

• ACT eschews meditation and contemplative practice
  It is often in our protocols; ACT targets mindfulness at the level of process in multiple ways however.

• You should not mix behavioral procedures with ACT
  The model says you should. ACT is part of behavior therapy. You don't get to peel it away from the model.

• If you do mix behavioral procedures with ACT you now have a combined treatment
  ACT is a model. Since the model says you should do this, it does not become a combo treatment to follow the model.

• The other aspects of ACT add nothing to the behavioral elements
  We know that they other elements are helpful and that they can support the behavioral elements. If you mean have the other elements that are helpful been shown to make the behavioral elements overall more impactful in outcomes the answer is "not yet in large trials." We shall see.

• The data on traditional CBT is far stronger
  Duh. ACT is part of the CBT / BT / BA family but its specific research program is inherently slower since we focused so much on basic science, processes of change, micro-studies and so on. But dig deeper. The vast majority of what is specifically supported in traditional CBT is stuff that ACT folks agree with anyway. If you insist on drag race studies --OK. Be patient. But you can't start outcomes studies in 2000 and expect less than 10 years later to have the same amount of data as the biggest dog on the block.

• It is surely safe to mix ACT techniques with other techniques I'm more comfortable with while I wait passively to understand the model
  Ah, no. Down that path lies chaos. It is such a poor model of scientific development. Understand first. Get the data. Then change if you must for good theoretical and practical reasons, not just because you feel like it.

• When I do that I should be able to rename it and get famous tomorrow because what I added (here you can pick any of the other misunderstandings -- relationship, emotion, mindfulness, etc etc) is obviously missing from the model
  You can rename it and still come and talk at our conventions etc but branding helps people find the work so at least rename it for a good reason. What is more important? Real progress or a deck on your house and your name in lights?

• You can mix ACT with the cognitive elements of CT / CBT easily
  With some, but it is easy to pervert ACT into the same agenda and ACT has a different one. Be careful. Incoherence is not usually helpful and patients will detect the incoherence if it is there.

• It is safe to do research on ACT without doing any training in ACT
  Is it safe to do surgery that way? You cannot read a book and do this well. Get some training. It is cheap and available and non-proprietary. ACT folks will collaborate and consult. Reach out.

• It is safe to criticize ACT based on what you've heard about it from others who are not expert in it
  What is it about reading carefully that is so aversive?

• ACT contains nothing new
  If you've studied it thoroughly, just say it in print and say why you say that and let us all look at it dispassionately. If you've not done your homework yet, see above.

• ACT is behavioral in an S-R sense
  ACT is actively hostile to S-R psychology.

• ACT is behavioral in a traditional behavior analytic sense
  ACT / RFT is part of behavior analysis, but RFT changes everything. ACT is part of post-Skinnerian behavior analysis -- which is a new form. We call it "contextual behavioral science." Read the RFT book for why we say that.

• For these reasons ACT is not oriented toward cognition
  70-80 studies on cognition later, how can folks still say that?! Come to a training at least.

• For these reasons ACT is not oriented toward emotion
  Come to a training!

• Because ACT is broadly applicable it is based on non-specific clinical process
  The theory says why it is broadly applicable and the process data so far say it is successful due to specific process changes. We now have nearly 15 mediational analyses out or in press.

• Anything that works for such a broad range of problems must be bulls**t
  The theory says why it is broadly applicable. Who are you to say a priori what nature is like?

• There are not many outcome studies on ACT
  About 50 RCTs and several more controlled time series designs and counting. We just really started in the year 2000. (updated - 2011)

• ACT / RFT is a small minority
  Maybe. But there are about 1800 folks on the ACT / RFT listserves and nearly 4100 in the association. Besides, minority or not, we are speaking of ideas and data, not politics. (updated - 2011)

• ACT proponents make excessive claims that go beyond the data
  A quote would be nice.

• ACT is hierarchical and you have to pledge allegiance to a leader to be involved with it
  It's an open list serve; an open website; no certification of therapists; no cut goes to originators from members/trainers/etc; you can get our protocols for free; anyone can become a trainer. Ther are more ACT books by others than by the originators, by far. This is just so unfair.

• ACT processes have not been studied
  Download the list of studies and read them. We think our process data re getting pretty strong.

• RFT can't explain anything other models of cognition cannot explain
  RFT researchers have explained phenomena that other approaches have had hard times with. For example, we are learning how to establish a sense of self, we know a lot about how metaphor works, we know a core process in human cognition. I'll send you some studies if you agree to read them.

• RFT is just jargon
  How much have you carefully read so far? Until you read carefully you cannot distinguish jargon and a technical language. We think it is a techical language. If you disagree, pick a technical term and show how it is the same as another more popular one. Maybe there was a slip.

• ACT is just jargon
  Same reaction as above.

• No one can understand RFT
  Do the RFT tutorial on this website. Yes the basic studies are damn hard to understand ... but it is not beyond anyone reading this website. Physics is hard too -- so?

• No one can understand ACT
  You can. And "understanding" in a purely intellectual sense is not the point for clients anyway. Usually what therapists mean when they say this is that they are afraid that if they don't understand it thoroughl they can't do it effectively. Folks like Raimo Lappalainen have shown that ACT works even when delivered by beginning therapists who don't really understand it. In fact most of the outcome data on ACT was not done with experienced ACT therapists. It's a miracle these studies work at all -- but they do.

• RFT has little to do with ACT
  Many links are there. Others are being developed. ACT and RFT are co-evolving. That is how applied and basic science should relate, we believe.

• ACT folks don't want CT people to be involved and they look down on them
  Ask some CT people who got involved in ACT work what they think about how they were treated. Just ask.

• We don't know which components work because there are no dismantling studies
  ACT comes from an inductive tradition. Rather than wait decades for dismantling studies we've done nearly 20 technique building and micro-analytic studies. Almost every aspect of the model has some targetted research data.

• I hate the enthusiasm of students who do these workshops -- it scares me
  Enthusiasm is not the same as substance ... but must enthusiasm be hostile to substance? Besides I thought you were a scientist. Why let emotion substitute for data just because it is now your emotions (I hate it) at issue? Be consistent. If enthusism creeps you out try to make room for being creeped out, hand on to your legitimate skepticism, and follow the data.

• I just don't like ACT
  See above.

• Talk of spirituality in ACT is creepy
  It is treated as a naturalistic concept. ACT is not a religion.

• I don't want to be told my values
  ACT folks will never do that ... your values are your choice.

• There is no data on ACT in groups
  There are 10 RCTs on ACT in groups right now.

• ACT works through the same process as ____ (fill in your favorite)
  Show me the actual research please.

• ACT is not self-critical
  Lurk on the list serve and see.

• Steve Hayes is a jerk -- I saw him do a mean joke or a mean comment at ABCT
  ACT is not Steve Hayes -- there are scores of leaders in ACT / RFT. Besides, distinguish the message from the messenger. Some of us are confrontational about intellectual issues, but we don't go after people or traditions: just ideas. We are just playing hard. Why not? It is fun and can be helpful. No everyone plays hard though. if you hate folks who do, go to ACT talks (etc) by softer folks. As for mean humor, sometimes roast human slips a bit, but we tease those we respect. In the ACT community we use humor to remind us all that this work is not about the muckity mucks ... it is a shared enterprise and everyone is part who wants to be part and is willing to bring science b=values and caring to the table. If you come to an ACT conference you will see that the ACT / RFT leadership is outright ridiculed in the "follies" and it is just great fun. Anyone has access to the stage. Even cognitive therapists! :)

• ACT is crazy (or my personal favorite variant since I'm writing this, Steve is crazy)
  Ah, finally you are getting somewhere. But as that Time guy said in the last line of the story -- we may just be crazy enough to pull it off. If you are nutty enough to want to help us, come help us succeed.