RE: Re: ACT's attack on CBT

[Guest guest]

In ACT_for_the_Public, Reeves wrote:>> I find it very distressing how the 'creators' of ACT suggest that> CBT is an inadequate and even a harmful therapy ( as underlying CBT> is the message that one needs to modify their thoughts and beliefs> in order to feel better)As one of the sometimes called 'creators,' I am wondering where this was said. I know I never said this. I know Steve and Kirk have never sad this. I have seen people say that "ACT people" have said this, but they never quote anyone actually saying this. I do not doubt that someone may have said this. But I know of no substantial member of the ACT treatment development community that has said this. If they did, I would correct them immediately.CBT , for example, has the most substantial evidence base for the treatment of depression of any treatment on the planet. Further, CBT has been shown in multiple studies to perform equal to antidepressant medications in acute treatment and to outperform antidepressants in the long term followup.There have been studies calling into question some components of CBT, not absolutely conclusive, but certainly calling them into question (such as direct thought change strategies). There has been one study that suggested that behavioral activation might be better than CBT for severe depression. On the other side of the equation, there have been studies showing mindfulness based cognitive therapy produces good effects for severe and refractory depression. But none of these should cause anyone to say ACT, in any conclusive sense, is superior to CBT and should be favored over CBT. The data to draw such a strong conclusion do not exist.In head to head trials, and there are not a lot, and they are what we might call preliminary trials, ACT has performed similarly and a couple times better. Such preliminary evidence is good reason to do larger better controlled trials, but it is not cause to reject CBT outright. That would be premature and irresponsible.I do not personally do CBT. I am compelled by evidence that suggests that SOME element s of CBT are not active ingredients. I am compelled by evidence that seriously questions the mechanisms of action in CBT (the necessity of cognitive change to produce good outcomes). I think we will know a lot more in a pretty short period of time (in science that means maybe 5-10 years). In the mean time, CBT is an entirely legitimate, evidence based treatment and I would not try to dissuade anyone from trying it out.Individuals might say this, but there we are talking about personal impressions and preferences. Those are fine and if you are an individual making your own healthcare decisions. You can quite legitimately say "CBT did not help and ACT did" or visa versa. But personal experience is not the same as a conclusion based on the larger body of scientific evidence.So, who are these ACT 'creators' who have outright rejected CBT as harmful? I think you will be able to find scientists from outside the ACT treatment development community saying we have said this, but if you look at what we have actually said, you will find much more tentative and measured claims.with warm regards,

G. 205 Peabody BuildingPsychology DepartmentUniversity of MississippiOxford, MS 38677ph: fax: academic homepage:www.olemiss.edu/working/kwilson/kwilson.htmalso check outwww.onelifellc.comwww.mindfulnessfortwo.comwww.facebook.com/kellygwilsonwww.tastybehaviorism.comwww.abnormalwootwoot.com

[Guest guest]

ACT does not totally reject control strategies. You will find few absolutes in ACT land. ACT is pragmatic. Control is problem when it obstructs valued living and just to that extent. How much is bad. No one but you can decide, since it is your valued direction. I can think of plenty of instances where avoidance is benign. And, not all avoidance is created equal. There are definitely some forms of avoidance that are far, far more destructive to valued living. I have engaged in many of them.But how about this example, say you avoid interpersonal conflict by going for a walk. Avoidance, sure. Bad, maybe (but some decent side effects). Can I think of more destructive avoidance, you bet. Some days benign avoidance is the best I have. I am willing to give myself room for that.Is that ACT inconsistent? I don't think so. And, if it is, I can live with that.warm regards,

G. 205 Peabody BuildingPsychology DepartmentUniversity of MississippiOxford, MS 38677ph: fax: academic homepage:www.olemiss.edu/working/kwilson/kwilson.htmalso check outwww.onelifellc.comwww.mindfulnessfortwo.comwww.facebook.com/kellygwilsonwww.tastybehaviorism.comwww.abnormalwootwoot.com

Hi Randy, I agree CBT is and never was JUST about disputing thoughts.

But, getting back to my points, how does one reconcile a philosophy that totally rejects control strategies with one that promotes them? They are mutually exclusive. It's either/or.

Kate

> > > >

> > > > So, who are these ACT 'creators' who have outright rejected CBT as

> > > > harmful? I think you will be able to find scientists from outside

> > > > the ACT treatment development community saying we have said this,

> > > > but if you look at what we have actually said, you will find much

> > > > more tentative and measured claims.

> > >

> > > All true. At the same time, it is only common sense to expect that

> > > if the basic stance of the ACT/RFT community implies that other

> > > models of psychotherapy are "less adequate to the human condition,"

> > > exponents of these other models will pick up on this as a general

> > > criticism & get a little ticked off.

> > >

> > > A good example of this stance on the part of ACT/RFT is the 1999 ACT

> > > book for professionals. I remember the first time I picked it up (as

> > > a layperson) and read its opening salvos, I privately went "Whoa!"

> > > My "Whoa" was composed of excitement, but I can imagine that certain

> > > other readers might have been being less than pleased. The book did

> > > not name CBT as such, but it kicked the crap out of the failure of

> > > syndromal thinking & the inadequacy of current treatments to address

> > > pervasive human suffering, etc. etc. And it must have been clear to

> > > most folks as it was to me that CBT, as the much-burnished gold

> > > standard of contemporary psychotherapy, was thereby having the crap

> > > kicked out of it as well.

> > >

> > > Beyond that, from my perspective as an outsider I have noticed the

> > > ACT community over the past two or three years doing a certain

> > > amount of bridge-building and possibly even some slight backpeddling

> > > to reduce a friction that threatened to be unhealthy from a

> > > political POV and therefore from a scientific POV. A very healthy &

> > > smart thing to have done.

> > >

> > > I will be very interested to see the 2nd edition of the 1999 ACT

> > > book to see how the opening salvos cited above have been modified. I

> > > hope they keep their vigor in one form or another.

> > >

> > > - Randy

> > >

> >

>

[Guest guest]

As a theoretical matter, I would even be willing to predict places where disputation would be more or less likely to be effective. I would be willing to bet (which is different than a fact :-) that if fusion and avoidance are low, disputation will be more effective and that the higher fusion and avoidance are, the more impermeable the behavior (including thoughts) will be to disputation.In fact, sometimes when I am working with someone, doing a lot of defusion, acceptance, perspective taking, and present moment work (mindfulness processes) I see them soften a bit. In fact, in the psychosis trials that have been done, you see thought believability change, even though there are no interventions that target thought change. Thought believability changes with no disputation at all. In a certain sense, I imagine that the world is disputing some thoughts all the time. But if we are super fused, we just don't see it.Why? Well, in a more defused accepting place, thoughts soften up and become a bit more permeable to experience.But, at the end of the day, the question is: can we demonstrate scientifically that thought disputing strategies improve outcomes? And, can mindfulness strategies function as useful alternatives in combination? Alone? All empirical questions.Evidence for CBT is great on outcomes. The evidence that those particular disputation strategies cause the good outcomes has been seriously questioned--both empirically and theoretically. And, as a matter of culture change within CBT, I know many CBT folks who are using fewer disputation strategies and more mindfulness and acceptance strategies.Science is a slow process. Lots of studies, by lots of people, will eventually tell the tale.best

G. 205 Peabody BuildingPsychology DepartmentUniversity of MississippiOxford, MS 38677ph: fax: academic homepage:www.olemiss.edu/working/kwilson/kwilson.htmalso check outwww.onelifellc.comwww.mindfulnessfortwo.comwww.facebook.com/kellygwilsonwww.tastybehaviorism.comwww.abnormalwootwoot.com

Thanks for that explanation

I've been under the impression that ACT was more emphatic than this, perhaps I need to do a bit more reading of the ACT literature. I always thought that disputing thoughts was "O-U-T out" in the ACT approach.

Kate

> > > > > >

> > > > > > So, who are these ACT 'creators' who have outright rejected CBT as

> > > > > > harmful? I think you will be able to find scientists from outside

> > > > > > the ACT treatment development community saying we have said this,

> > > > > > but if you look at what we have actually said, you will find much

> > > > > > more tentative and measured claims.

> > > > >

> > > > > All true. At the same time, it is only common sense to expect that

> > > > > if the basic stance of the ACT/RFT community implies that other

> > > > > models of psychotherapy are "less adequate to the human condition,"

> > > > > exponents of these other models will pick up on this as a general

> > > > > criticism & get a little ticked off.

> > > > >

> > > > > A good example of this stance on the part of ACT/RFT is the 1999 ACT

> > > > > book for professionals. I remember the first time I picked it up (as

> > > > > a layperson) and read its opening salvos, I privately went "Whoa!"

> > > > > My "Whoa" was composed of excitement, but I can imagine that certain

> > > > > other readers might have been being less than pleased. The book did

> > > > > not name CBT as such, but it kicked the crap out of the failure of

> > > > > syndromal thinking & the inadequacy of current treatments to address

> > > > > pervasive human suffering, etc. etc. And it must have been clear to

> > > > > most folks as it was to me that CBT, as the much-burnished gold

> > > > > standard of contemporary psychotherapy, was thereby having the crap

> > > > > kicked out of it as well.

> > > > >

> > > > > Beyond that, from my perspective as an outsider I have noticed the

> > > > > ACT community over the past two or three years doing a certain

> > > > > amount of bridge-building and possibly even some slight backpeddling

> > > > > to reduce a friction that threatened to be unhealthy from a

> > > > > political POV and therefore from a scientific POV. A very healthy &

> > > > > smart thing to have done.

> > > > >

> > > > > I will be very interested to see the 2nd edition of the 1999 ACT

> > > > > book to see how the opening salvos cited above have been modified. I

> > > > > hope they keep their vigor in one form or another.

> > > > >

> > > > > - Randy

> > > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Lou,

I am

so very sorry to hear about your friend. And sad for you that you found him...I

can’t imagine how painful that was, and is. So many do not make it through

addiction alive. My sister just barely did (after liver and kidney failure,

then 7 months in the hospital, she received a liver transplant. 16 years later,

she is still here, but it could have so easily gone the other way.)

My

heart goes out to you as you mourn your dear friend.

From: ACT_for_the_Public [mailto:ACT_for_the_Public ] On Behalf Of Lou Lou

Sent: Thursday, October 06, 2011

3:31 AM

To: ACT_for_the_Public

Subject: Re:

Re: ACT's attack on CBT

Hi

group,

I'd

like to buy into this thread (just briefly although I haven’t read it all yet

so forgive me if I repeat).

I

think what is saying is echoed in relation to other therapies as well. As

has been said, it is likely the result of the perception of individuals or

their opinions. I have experienced the same as in relation to DBT.

Since

I have had the utter privilege to be taught them both, I understand the value

each has as a stand-alone therapy. However, they complement each other to the

greatest extent.

asked “Who said that?”, referring to ACT and CBT……here’s an example in relation to DBT……

In

one of Steve’s blog posts he referred to DBT

as a “sister approach”, (quote: “... there

are thousands of ACT clinicians around the world, and many more in sister

approaches such a Mindfulness Based Cognitive Therapy or Dialectical Behavior Therapy”).

For me, (an individual perception) that statement is full of ego

(not a judgement, an observation, (I love your work mate)), I have been wrong

many times and I accept that. I think also it is such a challenge to write when

readers pick on every word (...get the big picture, right!). I feel that Marsha

worked just as vigilantly (with her specialisation) as has Steve et. al. And if I were Marsha...well I’m not sure how I

would receive that...given my lifes

work...(well practiced in

many agencies and in mental health education in Australia...even in Cert. IV).

So...I

hear what you are saying and my advice is to lap it up with openness and

curiosity and see what each therapy, both ACT ‘and’ CBT has to offer you in practice when you have more information.

Best

wishes,

Lou

P.S.

Truly...this pales in comparison when you receive an email from a VALUED friend

saying, “...I'm drinking today as I did the last 3 days. I found...[my

friend]...face down and thought he was passed out, but when I rolled him over I

saw that he was dead. His face was black and purple and I will miss my best buddy....”.

Hurts right! Ohhhh, my

lovely friend! ACT, CBT, DBT...I wish there was something

I could offer him.

From:

To: ACT_for_the_Public <ACT_for_the_Public >

Sent: Thursday, 6 October 2011

1:10 AM

Subject: Re:

Re: ACT's attack on CBT

CBT is a large tradition and ACT is part of

it.

The main CBT society in the

UK

is the British

Association of Behavioural and Cognitive Therapies (BABCP).

The ACT special interest group in the BABCP

has 1500 people in it.

The science battles are within the tradition.

(By the way, as a result of those battles, traditional CBT is moving very rapidly in an ACT direction

so if you get " CBT "

now it may not be the same CBT

you would

have gotten 10 years ago.)

I want to come back to 's core concern tho.

" This is really upsetting me because I feel trapped, I suffer with intense

anxiety and panic and would like to at least have some faith in the CBT that I am being

offered. "

I'd bet this is not

a new thought if you make it more general. Something like

" In order for me to improve I have to first

believe that someone knows how to

remove my panic. "

My question is this.

Would it be possible to take positive steps even without

that worrisome thought changing? In the past have you struggled

to believe as a precondition to change (believe in therapists; believe in

advice you were being given)?

and has that held you back? Have you found that sometimes you do believe

you've found the answer and then your hopes were dashed?

I suffered from panic disorder and I know what it is like from the inside out.

But look to see if your mind is as smart as it says it is.

Does your experience tell you that the " solutions " and " conditions

for improvement " it lays out

are reliable guides that consistently lead you forward?

If not, waiting to it to be soothed and reassured may actually slow

down progress. It might be time to learn how to move forward

even when Mr. Mind says it is not possible and how to be kind to yourself

even when anxiety is peaking.

That is a chunk of what ACT is up to.

- S

C.

Foundation Professor

Department of Psychology /298

University of Nevada

Reno, NV

89557-0062

" Love isn't everything, it's the only thing "

hayes@...

or stevenchayes@...

Fax:

Psych Department:

Contextual Change (you can use this number for messages if need be): (775)

746-2013

Blogs:

Psychology Today http://www.psychologytoday.com/blog/get-out-your-mind

Huffington Post http://www.huffingtonpost.com/steven-c-hayes-phd

If you want my vita, publications, PowerPoint slides, try my training page or

my blog at the ACBS

site:

http://www.contextualpsychology.org/steven_hayes

http://www.contextualpsychology.org/blog/steven_hayes

or you can try my website (it is semi-functional) stevenchayes.com

If you have any questions about ACT or RFT

(articles, AAQ information

etc), please first check the vast resources at website of the Association for

Contextual Behavioral

Science (ACBS): www.contextualpsychology.org.

You have to register on the site to download things, but the cost if up to your

own values.

If you are a professional or student and want to be part of the world wide ACT

discussion or RFT

discussions go to http://health.groups.yahoo.com/group/acceptanceandcommitmenttherapy/join

or

http://health.groups.yahoo.com/group/relationalframetheory/join

If you are a member of the public reading ACT self-help books (e.g., " Get

Out of Your Mind and Into Your Life " etc) and want to be part of the

conversation go to: http://health.groups.yahoo.com/group/ACT_for_the_Public/join

On Wed, Oct

5, 2011 at 7:01 AM, Randy Burgess

wrote:

In ACT for the Public, wrote:

>

> So, who are these ACT 'creators' who have outright rejected CBT as

> harmful? I think you will be able to find scientists from outside

> the ACT treatment development community saying we have said this,

> but if you look at what we have actually said, you will find much

> more tentative and measured claims.

All

true. At the same time, it is only common sense to expect that

if the basic stance of the ACT/RFT

community implies that other

models of psychotherapy are " less adequate to the human condition, "

exponents of these other models will pick up on this as a general

criticism & get a little ticked off.

A good example of this stance on the part of ACT/RFT is the 1999 ACT

book for professionals. I remember the first time I picked it up (as

a layperson) and read its opening salvos, I privately went " Whoa! "

My " Whoa " was composed of excitement, but I can imagine that certain

other readers might have been being less than pleased. The book did

not name CBT as such, but

it kicked the crap out of the failure of

syndromal thinking &

the inadequacy of current treatments to address

pervasive human suffering, etc. etc. And it must have been clear to

most folks as it was to me that CBT,

as the much-burnished gold

standard of contemporary psychotherapy, was thereby having the crap

kicked out of it as well.

Beyond that, from my perspective as an outsider I have noticed the

ACT community over the past two or three years doing a certain

amount of bridge-building and possibly even some slight backpeddling

to reduce a friction that threatened to be unhealthy from a

political POV and therefore

from a scientific POV. A

very healthy &

smart thing to have done.

I will be very interested to see the 2nd

edition of the 1999 ACT

book to see how the opening salvos cited above have been modified. I

hope they keep their vigor

in one form or another.

- Randy