Why to skeptics argue that there is a quite limited support for ACT while advocates seem to say otherwise?
Some skeptics have not really read the whole literature and considered it carefully. Let's put these aside -- they are easy to detect and there is little to say about such criticism. What you then have left behind are honest critics. These are very valuable and helpful people because they can light the way for additional research and development. The differences with honest critics so far seem to be in these areas.
Breadth of the criteria. The ACT / RFT community gives more weight to a model that is working than to RCTs alone. Mediational analyses, RFT progress, AAQ studies, component studies, experimental psychopathology, the like all weigh in very heavily. It is absolutely fair to let RCTs be the ultimate arbiter but if they are the only criterion, right now critics will see less support than people within the ACT / RFT community might believe is there. Over time, however, if the ACT / RFT community does its job, even that problem will be self-correcting because the development path being following includes randomized controlled trials as a centrally important area -- just not the only area.
The temporal measure of progress. Given the larger purpose of ACT / RFT, this harder set of criteria needs to be considered in terms of how hard the actual task is. The ACT / RFT community wants to be held to a high (amazingly high) standard, but this also means that judgments about accomplishment of such goals have to be made in the context of that stated purpose. This does mean that there is a certain prolonged sense of ambiguity. ACT / RFT research is more than 20 years old and critics can still doubt whether we are actually producing a more progressive psychology. That is fair, but then by the time the ACT / RFT community meets its goals to everyone's satisfaction, most folks in psychology and the behavioral sciences will know it, because these goals are so darned lofty.
Breadth of application. The ACT / RFT community think that the breadth of the model really matters, because the model itself claims to be about a deeper understanding of human cognition. In traditional syndromal treatment studies, the models are often quite narrow and breadth of application is not a fair test so when these folks look at ACT / RFT they don't quite know what to say. Right now, only pain and smoking have more than two ACT RCTs … and in both cases only one is yet published. So we are not over the bar in any one area yet, but across the board the progress is more notable and the breadth of application is already pretty amazing. This problem will be self-correcting, however, because if the program succeeds there will be multiple studies of ACT / RFT applications within specific areas.
RCTs versus controlled time series designs. ACT comes from behavior analysis. If you eliminate time series designs in favor of only RCTs, the outcome data weaken.
Quality of controls. Many of these early ACT studies are put together by students and young faculty. Only a few are funded. That is now changing. But these early studies are often amazingly underpowered and the methodological bells and whistles are sometimes not there. This is getting better, and we are starting to see replications with better controls. When you compare ACT to established CBT research from the best labs in the world, you are comparing research programs at two very different stages of development. We shall see what happens over time as funded ACT research becomes more common.
Published versus coming. This is the biggest one. ACT / RFT advocates often know about the data that are coming. We may know the researchers involved and feel that we can make some judgments. If you just look at publications (which an outside critic simply must do in order to be responsible) the picture looks different from the outside than it does from the inside. ACT / RFT research has been going on for 20 years, but it has only been visible for a few years, with the publication of the 1999 book on ACT and the 2001 book on RFT. If the program is truly progressive, these differences will narrow over time however. Those who want to look at the state of the ACT literature as of the beginning of 2006 may want to download the meta-analysis by Hayes, Luoma, Bond, Masuda, and Lillis, 2006. It is in the publications section (and if you are an ACBS member you can get it there ... and if you are not, then click here to join!
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