http://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy-ACT

I was struck – again, as I often am – by the claim of effectiveness. Persons with psychosis exposed to four hours of ACT, if not healed, functioning better, at least by one measure.  The patients in the ACT “arm” of the study: their re-admission rate was halved.   The citation was in the Psychotherapy,net article, and here, you can read it for yourself:

http://www.actmindfully.com.au/upimages/bach&hayes-_act_schizophrenia.pdf

As I read it I wondered: Why haven’t these wonderful results ended up in my local inpatient psychiatric facility? What happened between 2002, when the article was published, and now, 2016?  This should be a big deal if it can be replicated!

You, reader, please look at the article. Maybe I missed something.

I did notice that they asked for volunteers, which is always a bias – the bane of the age of the Institutional Review Board (IRB), which requires your informed consent before participating in any trial. We could leave that aside, as across studies, that is a constant.  Nonetheless, the researchers were refused by four of every five patients they asked.  That seems a selection bias of some importance.  And they sought to exclude those who had psychosis and substance abuse, those who had developmental disabilities.  Could that be the reason why this hasn’t been disseminated?  Too narrow a group, uncommon in the general milieu of your average state inpatient psychiatric hospital?

Another question is how has ACT avoided the near universal cycle – the phases the “big” psychotherapies go through in their journey – from idea to hypothesis to experiment to revision to experiments on a larger scale (proliferation) to model to growth (dissemination) to popularity (even enthusiastic popularity!). With results like that cited above, where is the growth and popularity?

Mind you, ACT’s root dates from 1986. And it has a “pedigree.”  Descending from B.F. Skinner’s work in behavioral psychology.  DBT started around the late 1980s – and in the same location, the University of Washington (Seattle, WA).

Or could it be this, noted in one line in the article? That the treatment was delivered by “a psychology intern who had been trained to the point of competence by the developer of the treatment approach.”

How much difference does it make if your clinical supervisor is the developer of the therapy model and you are “trained to the point of competence?”

The popularization of psychotherapy in the 1960s and the 1970s, with headlines in Time for Gestalt Therapy and Transactional Analysis – the unlimited, pervasive and ongoing jokes and cartoons about Psychoanalysis – none of that has happened or is happening with EMDR or ACT or DBT or MI or CBT.

Even though Steven Hayes (the developer of ACT) and ACT were written up in a six page article in Time magazine in 2006.

Serious therapies for serious people, our acronym laden therapies we get training in today, with limited claims – except for their curative powers. Those psychotherapies of the ‘60s and ‘70s did make vast claims as well: they claimed that “Therapy was too good to be limited to the sick.”

Today let’s aim to get reasonably good training, attend workshops, aim for adherence and combine our competence in our selected therapies along with our healing, aim for the alleviation of misery and perhaps better than “just normal” as a result of our efforts.

Postscript:   http://www.stevenchayes.com/

See what Steven Hayes has to say for himself about his major influence – B.F. Skinner – experiences that were linked to Gestalt Therapy at Esalen at Big Sur, California – and what motivates him.