ACT – Over 100 Randomised Controlled Trials (RCTs)

ACT – Over 100 Randomised Controlled Trials (RCTs)

Posted by Dr Jim Hegarty on 17 August 2014 | Comments

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Well looks like today is the day;  there are now more than 100 published or in press randomised control trials on ACT (Acceptance and Commitment Therapy).   This is the result of over thirty years of work, and development, and so far the model has been supported.  Of course there is more work to be done in order to see where it is most effective, which components of the therapy work best in which situations and so on.   As Steve Hayes, the primary developer of the model states

“So far there are no model failures, and there is a growing base of studies showing that the "open, aware, and active" columns in the psychological flexibility model each contribute to outcomes. Their relationships to basic behavioral, cognitive, and evolutionary processes are still a work in progress, however. “

He also cautions that more work is needed in other areas such as in the development of measures, and clarity around some areas where ACT  could be considered a primary mode of treatment.  Nevertheless, 100 randomised control trials is something of a milestone.  Thirty years of work by a lot of people.  And it is rendered more impressive by the fact that much of the early work on ACT looked at the effectiveness of the processes by which the therapy is supposed to work, not on RCTs.  That is a detailed level of analysis that is only now beginning to be applied more thoroughly to other treatment modalities. 

This milestone did get me thinking though.  Mainly about science, and how it is practiced, or not practised in the modern era.   I remember early on when ACT was beginning to get known.  There was already an impressive number of studies looking at the effectiveness of some of the key components of the model, primarily acceptance and its importance in both psychological distress, and in positive outcomes following treatment.  And there was a very impressive literature around Relational Frame Theory (RFT), the theory of human language and verbal cognition that ACT draws upon.  With a little careful thought it was obvious that other prominent models of therapy did not have such support at a basic scientific level.  It surprised me at the time that instead of interest there was instead a vehement reaction against ACT in some quarters.  People first said it was nothing new, and they were doing it anyway.  In the next breath they dismissed the evidence for ACT without having read it.  Some even called it a “cult” because those involved in it seemed to actually like the therapy and saw its usefulness in their own lives.  For some time now the situation has been very different.  Everyone from mindfulness based therapists to very traditional cognitive therapists seem to use the ACT term defusion when talking about our thinking.  Working with an individual’s values is now the subject of much research, and is more overtly included in many therapies.  Similarly, acceptance and present moment awareness is stressed more among many therapists, and in different therapies.    

It seems ACT has well and truly arrived.  There were several ACT based presentations at the last conference of the New Zealand College of Clinical Psychologists, and two ACT based papers in their last journal.  And the most amazing thing to me was that nobody commented on this.  It seemed natural.  An important task now is to get those using ACT, and ACT based principals to investigate the theories behind these practices, and the literature that supports them so they can use the techniques more effectively.