We Have But One Life: Why Not Reach Higher?

(Sokraten 3 - 2005)

(Steven C. Hayes) - I have been asked the following 10 questions. I found them interesting enough
that I have written rather long answers. My apologies in advance. In between the lines I found myself
formulating answers that ask the question above. Why I say that will be clearer later.

I suppose the other reason I have written such a long piece is that these questions come from Sweden.
I have great respect for what I see happening in Sweden in the behavioral and cognitive therapies.
What I see from Sweden in this area tells me that I am not the only one to find the question I have
used for a title to be an interesting one. Beautiful work is emerging in ACT that can potentially make a
big difference world wide. I want to acknowledge all of the Swedish clinicians and researchers who are
helping to make it so.

On to the questions and answers.

(Sokraten) In your opinion, what characterizes the so-called third wave behavior therapies?

- In my AABT President Address article [Hayes, S. C. (2004). Acceptance and Commitment Therapy,
Relational Frame Theory, and the third wave of behavior therapy. Behavior Therapy, 35, 639-665] I said
this:

”Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive
therapy is particularly sensitive to the context and functions of psychological phenomena, not just
their form, and thus tends to emphasize contextual and experiential change strategies in addition to
more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and
effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize
the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates
and synthesizes previous generations of behavioral and cognitive therapy and carries them forward
into questions, issues, and domains previously addressed primarily by other traditions, in hopes of
improving both understanding and outcomes.”

These are very broad characterizations and there is no clear dividing line between various historical
aspects of our tradition. That is actually a good thing. I was a ”first wave” behavior therapist when the
second wave hit and I remember how painful it was: traditional behavior therapists were told they were
doing something somehow less sophisticated, less honorable, and less important than CBT. First wave
folks were not sure that was true and while there is general agreement that the second wave of traditional
CBT was a step forward, in hindsight we can see that the first wave folks were often as right as they were
wrong. The dividing line was drawn too clearly and we went too far in walking away from traditional
behavioral methods and principles as a result. The same error could happen now. We can no more stop
serious consideration of third wave issues than we can stop the tide from coming in. But we dare not be
silly about this and start throwing out existing concepts and procedures without good data. Far better to
explore what is worthwhile in these new developments and to maintain an open posture about what that
means for what has gone before.
 I personally have little interest in creating pain in the name of creating something worthwhile for our
clients and our world. Part of what buoys me up about the third wave is that it is not anti-cognitive or
anti-behavioral. The third wave is not about shaming pervious aspects of our tradition. The trends I’ve
noted above are occurring within cognitive therapy, cognitive behavior therapy, behavior therapy, and
clinical behavior analysis. That is quite a range. But even though new era should not be about shaming
aspects of our tradition we also need to find a way to look seriously at new ideas when they come along
rather than remaining superficial and saying “this is nonsense” or “this is the same thing as what we were
doing all along.” If it is either, careful analysis will show that.

The pull is very great in some corners to reject these new ideas because they are hard to understand, or
because people are quite enthusiastic about them, or because they come from quarters of the field that
seem unexpected. I have had major leaders in the field dismiss ACT and RFT who, after I spend a few
moments exploring their concerns, I realize have never really read the studies, or chapters, or books. They
have never attended any serious trainings. By itself this is not a problem -- people have their own work to
do, and learning about ACT and RFT need not be part of it. But serious criticism requires more. The role
of an honest critic is a serious and helpful one – but if you want to play this role you have to put in the
time really to see what is going on.

Yet clearly something is happening. The Dalai Lama was at the ICCP meeting this summer in
Gothenburg. Why? It seems fairly obvious to me that clinicians of all types are beginning to emphasize
the relevance of the issues they examine for themselves, not just for their clients. As I note above that is a
core idea in third generation behavioral and cognitive therapy as I noted in my characterization of it.
Mark Williams said it nicely at the ACT / RFT World Conference in Linkoping two summers ago: we are
now trying to create treatments that we ourselves use to foster development of our own lives. That alone
is a real change in our field. It raises difficult issues, but it is leading in very interesting directions and it
has a chance to make what we are doing more humane, humble, and grounded in the richness of human
experience.

When people ask me the question you have asked I often feel as though they are asking “is my work not
as relevant as I thought it was?” My answer would be something like this: your work is as valuable as
ever, but the field also must grow and explore different ideas. These new changes are part of your
tradition so you are connected to them. Yes, there may be new things to learn and new assumptions,
principles, and technologies to explore, but no, you need not be “left behind.” Just be open to the ideas
and to the data and be guided by that and all will be fine. If your instinct is to hang back, then do so – but
be cautious also about defensiveness or wanting to have new ideas fail. Stay skeptical but also stay open.
If your instinct is to jump in, then do so – but be cautious about wanting to be right, to be better than
others, or to mistake enthusiasm about the vision for actual evidence that it is being accomplished.
Explore your enthusiasm but help develop the data we need to know what is working and what is not.

Both uncritical enthusiasm and emotionally-based defensiveness are dangerous and for the same reason:
both are hostile to the ultimate purpose of the behavioral and cognitive therapy tradition – to create an
evidence-based analysis of human functioning that works for the betterment of humankind.

How do “third wave” interventions differ from traditional CBT-interventions?

- I would prefer to answer this in terms of ACT, rather than the third wave generally because there is a lot
of diversity in these new developments. I recognize that the same thing is true in the other half of your
question. What exactly are “traditional CBT-interventions”? Do you mean cognitive disputation? Skills
training? CBT is not any one thing – theoretically or procedurally, so only generalizations are possible
given such a question.

What is different?

I think what is different is the philosophy, basic science, applied theory, targeted processes of change,
and many of the techniques of change. That is a pretty long list and it would take volumes to fully explain
them. In outline form:

1. Philosophy
 ACT is rooted in the pragmatic philosophy of functional contextualism, a specific variety of
contextualism that has as its goal the prediction and influence of events, with precision, scope and depth.
Contextualism views psychological events as ongoing actions of the whole organism interacting in and
with historically and situationally defined contexts. These actions are whole events that can only be
broken up for pragmatic purposes, not ontologically. Because goals specify how to apply the pragmatic
truth criterion of contextualism functional contextualism differs from other varieties of contextualism that
have other goals, such as hermeneutics, narrative psychology, dramaturgy, social constructionism,
feminist psychology, Marxist psychology, and the like. I generally call these ”descriptive contextualists”
because their goal seems to be to appreciate the participants in the whole event. There are contextualistic
varieties of CBT (the constructivists, for example) but they look more like descriptive contextualists than
functional contextualists.

The mainstream of CBT seems mechanistic to me. This is not bad – philosophy is a matter of owning
ones assumptions and assumptions are nothing to thump one’s chest over – but it is different. If you think
of the mind as a computer, you will probably not like ACT. It will feel strange.

Take things like the importance of values in ACT or the importance of cognitive defusion. The former is
needed in order to specify the criteria for the application of workability, which is what a pragmatist takes
to be ”true.” The later is what language looks like if you hold to that pragmatic assumption. If a person
states an irrational thought, a traditional CBT person may want to know how it biases the facts – exactly
what is demanded by the ontological assumption of mechanism – while an ACT person wants to know
what saying that is in the service of and what functional role it plays due to history and context -- exactly
what is demanded by the pragmatic assumptions of contextualism.

2. Basic Theory

Nearly a decade and a half passed between the earliest randomized trials on ACT and those in the
modern era. In that interval, the basic theory of human language and cognition underlying ACT,
Relational Frame Theory was developed into a comprehensive basic experimental research program. RFT
is not a basic theory of ACT. It is a basic theory of cognition. But if RFT is workable and if ACT makes
sense, you have to be able to do a basic analysis of ACT using RFT – just as you would have to be able to
do an analysis of any cognitive procedure using RFT. That is the aspiration – and if you know behavior
analysis you will recognize that it is an entirely traditional aspiration for people who do work on
behavioral principles – the difference is that now we now think we have an angle on human cognition that
is empirically and conceptually workable. We are not fully there yet, of course, but we are now seeing the
RFT studies of defusion, acceptance, values, and so on and the early data are tremendously exciting.
Unless you attend ACT / RFT conferences (such as the World Conference next July in London) you will
not see this work in journals for another few years.

According to RFT, the core of human language and cognition is the learned ability to arbitrarily relate
events, mutually and in combination, and to change the functions of events based on these relations. For
example, very young children will know that a nickel is larger than a dime by physical size, but not until
later will the child understand that a nickel is smaller than a dime by social attribution. RFT researchers
have shown that such relations as knowing that one event is “larger” than another arbitrarily can be
trained as an operant and will alter the impact of other behavioral processes. We even have some new
data seemingly showing that the symmetry of names and objects are trained as an operant in infants.
There are neurobiological data showing that the brain lights up when performing RFT tasks much as it
does when doing natural language tasks modeled by the theory.

Virtually every component of ACT is connected conceptually to RFT, and several of these connections
have been studied empirically. Among other applied implications of RFT, its primary implications in the
area of psychopathology and psychotherapy can be summarized as follows 1. normal cognitive processes
necessary for verbal problem solving and reasoning underlie psychopathology, thus these processes
cannot be eliminated; 2. the content and impact of cognitive networks are controlled by distinct
contextual features; 3. cognitive networks are historical and thus are elaborated over time. Much as
extinction inhibits but does not eliminate learned responding, the logical idea that cognitive networks can
be logically restricted or even eliminated is generally not psychologically sound; and, 4. direct change
attempts focused on key nodes in cognitive networks, tend to elaborate the network in that area and
increase its functional importance. ACT is based on these ideas. Most of traditional CBT is not.
3. Applied Theory

From an ACT / RFT point of view, while psychological problems can emerge from the general absence
of relational abilities (e.g., in the case of mental retardation), the primary source of psychopathology in
most adults and language able children is the way that language and cognition interacts with direct
contingencies to produce an inability to persist or change in the service of long term valued ends. This
kind of psychological inflexibility is argued in ACT and RFT to emerge from weak or unhelpful
contextual control over language processes themselves. The now vast literature on experiential avoidance
is but one example of how this manifests itself. Other processes are cognitive fusion; the domination of
temporal and evaluative relations over contact with the now; the effect of all of this on weak self-
knowledge; attachment to a conceptualized self; unclear values or values based in looking good in the
eyes of others or avoiding pain rather than self-congruent choices; and impulsivity or avoidant
persistence.

The contextual theory behind ACT situates all of these processes in context – it does not leave them “in
the head.” These contexts can be directly changed and that is exactly what ACT tries to do. The
functional contexts that tend to have such deleterious effects include excessive or poorly regulated
contexts of literality, reason-giving, and emotional control, among others. In essence, the contexts that
support verbal / cognitive functions are too widespread and are over applied. Acceptance and mindfulness
are a prophylactic for that excess.

4. Clinical Methods

ACT targets each of these core problems with the general goal of increasing psychological flexibility –
the ability to contact the present moment more fully as a conscious human being, and to change or persist
in behavior when doing so serves valued ends. The six targeted processes are acceptance, defusion, being
present, a transcendent sense of self, values, and committed action.

These core ACT processes are both overlapping and interrelated. Taken as a whole, each seems to
support the other and all target psychological flexibility. They can be chunked into two groupings.
Mindfulness and acceptance processes involve acceptance, defusion, contact with the present moment,
and self as context. Indeed, these four processes provide a workable behavioral definition of mindfulness.
Commitment and behavior change processes involve contact with the present moment, self as context,
values, and committed action. Contact with the present moment and self as context occur in both
groupings because all psychological activity of conscious human beings involves being in the now as
known.

You can draw lots of parallels to new developments in CBT, and even some in traditional CBT, but it is
pretty obvious that these packages are not the same thing. I have trained several thousand therapists in
ACT workshops of one day or more. I have literally never had a single CBT person do extensive training
and come out saying “this is the same as traditional CBT.”

If you want to pick one of the most salient differences, pick defusion (also known as deliteralization). In
ACT, a troublesome thought might be watched dispassionately, repeated out loud until only its sound
remains, or treated as an external observation by giving it a shape, size, color, speed, or form. A person
could thank their mind for such an interesting thought, say it very slowly, or label the process of thinking
(“I am having the thought that I am no good”). They might note how the back and forth of a mental
argument is like a volley ball game and then literally play that out while watching from the sidelines.
There are perhaps 100 defusion techniques that have been written about somewhere in the ACT literature.
Not a one of them involves evaluating or disputing these thoughts.

ACT is an approach to psychological intervention defined in terms of it philosophy, basic principles, and
targeted theoretical processes. You can easily create and test protocols to test ACT with various disorders
but it is not a specific technology anymore than, say, using candy contingently is “reinforcement.” In
theoretical and process terms we can define ACT as a psychological intervention based on modern
behavioral psychology, including Relational Frame Theory, which applies mindfulness and acceptance
processes, and commitment and behavior change processes, to the creation of psychological flexibility.
 In your opinion, are there any potential advantages of third wave behavior therapies such as ACT
(Acceptance and Commitment Therapy) compared to traditional CBT?

- You said “potential” and if the answer is not “yes” there it would be silly to study ACT at all. If you
mean “actual” advantages, the question is entirely an empirical one. If you mean “theoretically speaking”
then that is particularly hard because of my position as an originator, but I will try.

Let’s start with the data.

Right now there are a handful of studies that have looked directly and they tend to be medium to small.
Only 2 are published, and one of these barely mentions outcome because it was a piece on process of
change. So we have a long way to go … but I try to remind myself that the ACT book was only published
in 1999. The natural consequence of focusing on the basics was that all of this important outcome work
was delayed.

Here are the studies done so far:

Rob Zettle, who trained with Beck, did two very small randomized trials on ACT versus CT for
depression – one using individual ACT and CT and the other using ACT and CT group therapy. A much
larger multi-site randomized trial is underway right now.

In his two studies (you can get the citations from the ACT website … just go to
www.acceptanceandcommitmenttherapy.com and find and down load the ACT handout) he found
Cohen’s d’s at post between ACT and CT of 1.23 (individually delivered) and .53 (group) and at follow-
up of .92 and .75. The N was very small though. The ACT group was only an N of 6 in the individual
study and about 10 or so in the group study.

The 4 other studies are brand new and are not published yet. Ann Branstetter did a randomized trial with
end stage cancer distress. Ann was trained in traditional CBT and she applied CBT procedures she
thought would help (such as cognitive restructuring). There was not follow up because the patients were
in end stage cancer but at week 12 ACT had a Cohen’s d of .9 compared to traditional CBT on distress
over dying. You can email her for details – she is at Southwest Missouri State University (you can go to
the directory there for her email I believe).

Jennifer Block’s dissertation at Albany (not out yet … she was just hired as a faculty member at LaSalle
so you should be able to find her email address through the directory there) compared ACT and CBGT in
social phobia and found a Cohen’s d of .45 at post in favor of ACT compared to traditional CBT on the
behavioral measure (standing up and speaking). Carmen Luciano’s team at the University of Almeria just
did a smoking trial comparing ACT and a CBT package used by a Spanish cancer society and found a
Cohen’s d of .42 at a one year follow up on smoking cessation. Raimo Lappalainen and his group at the
University of Tampere has preliminary data in an effectiveness trial comparing ACT and traditional CBT
(using CBT methods linked to functional analysis, such as skills training, or exposure) in a training clinic.
Beginning therapist were randomly assigned one ACT and one traditional CBT client (N = 14 each
condition). Problems ranged across the usual outpatient spectrum. On the SCL 90 the post Cohen’s d was
.62. Evan Foreman and James Herbert reported similar data at AABT last year from their clinic at Drexel
University.

Right now with data I can actually get my hands on, with 205 subjects in 6 studies the average effect size
at post between ACT and CBT is .55 and at follow up (from 8 to 52 weeks) is an identical .55. But we are
very, very early and 2/3 of this has not yet gone through peer review, so I can fully understand (and I
myself embrace) a sense of caution. The happy news is this: we will soon really know. I’d say in 2 years
we will have 10-12 datasets. I’d be shocked if the effect size I just quoted holds up – if it does it would be
revolutionary – but I would not be surprised to see it settle into a positive range. We shall soon see.

As for theoretically:

The strengths of the ACT model as compared to CBT are these.

 1. The model is easily scalable and broadly applicable. If you look at the whole outcome literature done
so far (RCTs, controlled time series designs, and case studies) the problems targeted form a pretty broad
list: PTSD, panic, depression, racist prejudice, burnout, epilepsy, smoking, OCD, pain, psychosis, cancer,
diabetes, multiple sclerosis, sports psychology, attitudes against pharmacotherapy, skin picking, learning
new procedures at work, heroin abuse, worksite stress, work innovation, marijuana abuse, and several
others. Again, several of these are not published yet – but they are all done and they are coming.

2. The putative processes of change are well specified and in some areas there are at least marginally
adequate measures.

3. The mediational analyses seem to be working. I’ve written a summary of this literature for Behaviour
Research and Therapy and there are already 7 successful formal mediational analyses published or
completed and coming. So far the data are very supportive. The processes successfully examined so far
include acceptance, defusion, values, committed action, and psychological flexibility so several processes
aspects have some data in mediational trials.

4. The components seem to be working when inductively tested. There are at least seven such studies with
a total of just under 200 subjects.

5. The basic theory is intricately linked with the technology and itself seems to be working.

For those who believe only in RCTs of technology, what I just said is not very important. I would just
say to such people that the history of science shows that you cannot create a progressive science using
only outcome studies. I explained why in The Scientist-Practitioner (Hayes, Barlow, and Nelson-Gray,
1999) so I won’t fully repeat the argument here. In a nutshell, though, it is this: without good theory, the
technological development problem is based on common sense categories and it becomes empirically and
practically overwhelming. I do not want this to be heard as “Steve Hayes says RCTs are not important.”
I’m not saying that. They are. Hugely. But they are not enough! I risked my career on the idea that
development in the areas of philosophy of science, basic principles, applied theory, specification of
processes of change and effectiveness are just as important (and in the long run more important) than
efficacy tests of technology. I think what is happening right now in ACT / RFT suggests that perhaps it
was an investment worth making.

The scientific game the ACT / RFT group is playing is this: how can we create a truly progressive
science of psychology that can address the human condition in a more adequate way? Are we willing to
stand or fall on RCTs as a measure of success? Yes. But we want and demand another, even more
difficult criteria: seeing a more truly useful psychology emerge as a result. We think it is only fair to insist
that both criteria be considered when considering the kinds of questions being put to me here, and when
folks say that in 20 years (from the first RCT until now) we have “only” done 20 RCTs, I want this much
harder criterion to be factored in as well. We have also “only” created the first truly new behavioral
approach to language and cognition; and we have created a new theory of psychopathology; and we have
clarified a new version of the philosophy of science underlying behavior analysis. Come back in ten years
and let’s see if it was really worth it.

In your opinion, are there any potential advantages of traditional CBT compared to third wave
behavior therapies?

- Again, I do not want to speak for the whole 3rd wave. ACT adds things that may make some third wave
processes safer and more reliable. For example, ACT uses mindfulness procedures but it has many things
in place to make sure these procedures are not used as a form of avoidance and that they do not bring in
cognitive and emotional material that will overwhelm the client. I’m personally more willing to comment
on ACT for that reason.

Right now we have one study (Zettle, 2003; in The Psychological Record) showing a smaller effect size
for ACT than for a CBT procedure (systematic desensitization) and it was with a relatively minor
problem (math anxiety). I have often said (and said in the 1999 ACT book I believe) that it probably does
not make that much sense to use a procedure like ACT with minor problems because the issues it raises
are just too fundamental. I could be proven wrong with data. But I note that even in the Zettle study I just
noted, ACT worked better with highly experientially avoidant subjects; desensitization did not show that
relationship. So I expect CBT to work better in more confined and minor areas. We shall see.

It may also be easier to train CBT. ACT seems subtle at times. This may not turn out to be a big issue
since ACT also focuses on processes therapists themselves have inside themselves … which may be a
good guide. But right now I’m not sure that training in ACT will be as easy. Then again Raimo’s
effectiveness data are reassuring.

Remember, however, that ACT is a model not just a package. All of the behavioral methods and some of
the cognitive ones can easily be put into ACT protocols. They are still ACT. But ultimately we will have
to show that, for example, exposure from an ACT perspective is better than exposure from a traditional
CBT perspective. We have a couple of small studies that indicate that might be true (e.g., see Jill Levitt’s
dissertation in Behavior Therapy, 2004) but not large RCTs on the question. Thankfully some of these are
underway right now (such as in Michelle Craske’s lab) so in a few years we will know.

Is there much in traditional CBT that is helpful? Yes, of course, and virtually all of what is known to
work fits with the ACT model so these procedures can be used from an ACT perspective. Is the ACT
model a better place to put these procedures? Let’s see. The answer will probably not be “yes, always.”
Presumably it is more likely to be “sometimes yes, sometimes no.” But both the yes and no answers will
move us forward

From a theoretical point of view, how do theories of third wave behavior therapies such as Relational
Frame Theory (RFT) relate to traditional CBT-theories?

- I will answer this from the point of view of RFT, not third wave theories in general.

That question is a huge one. Here is a thumbnail response to this very large question.

RFT seeks a broad understanding of cognition. I think in the long run it could be more important than
ACT because if it works the whole of psychology could change.

RFT is developmental, contextual, and behavioral. It gives you ideas about what to change to make
things happen. It is so basic that it goes all the way down to animal behavior and human infants; and yet
so broad in scope that it has clear implications for our understanding of social processes or such human
activities as religion.

We have never had an empirically adequate behavioral, contextual account of cognition. Now we have at
least the beginnings of one and it seems to be braking down the artificial barriers between cognitive and
behavioral science. If you think that is excessive rhetoric, well, underline the sentence and email me in a
decade and we shall together evaluate it.

The theories underlying CBT and CT are not like that. They have relatively low scope and they emerged
typically from clinical concerns. They do not pretend to be the functional equivalent in cognition for what
“behavioral principles” are in non-verbal behavior.

You have to be impressed with what the traditional behavior therapists were able to do with traditional
behavioral principles. It think it was in part because these principles emphasized manipulable contextual
variables. Imagine what we might do with a theory of cognition that emphasized manipulable contextual
variables, if the theory was relatively adequate. Maybe a lot.

Is RFT relatively adequate? Well, we are getting closer and closer to saying “yes” but that is just too
involved of a question to answer in a sentence. It is now a huge literature. But thankfully you will soon be
seeing its results in journals that clinicians read … it has built up to that point. Within 2-3 years everyone
staying awake in CBT will know what I am saying is so.
 At the 5th ICCP in Gothenburg professor Lars-Göran Öst, in his talk on the empirical support of third
wave behavior therapies, argued that there is a quite limited support of third wave behavior therapies
such as ACT. What are your thoughts on that?

- Lars-Göran is a wonderful scientist and an honest critic. When we did the ACT / RFT conference in
Linkoping we invited him to comment and we welcomed his criticism. To this day, every study that
comes to me in final form I send to him.

So why were there differences in Lars-Göran’s talk at ICCP versus my talk there?

Our roles are different and there is a difference in some areas of emphasis. The differences are not ones
of core values. Here are the sources I think might be there.

Breadth of the criteria. I give more weight to a model that is working than to RCTs alone. So I weigh
mediational analyses, RFT progress, AAQ studies, etc very heavily. But it is absolutely fair to let RCTs
be the ultimate arbiter. So I see no core differences – just one of emphasis and one of time.

The temporal measure of progress. Given the larger purpose of ACT / RFT, I want folks to apply this
harder set of criteria with some sense of how hard the actual task is. In my view, we are progressing very
well, despite the 15 year gap mentioned earlier. But if you look just at RCTs, you might think progress is
not as fast. No core difference – just one of emphasis.

Breadth of application. I think the breadth of the model really matters. In traditional syndromal studies
that is not the purpose. 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 pretty amazing. Again, no core difference – just one of
emphasis.

RCTs versus controlled time series designs. As a behavior analyst I trust a good set of time series
designs. I want RCTs ultimately, but I count the times series data was well. I think that may be a
difference but in the long run it will not matter because I too want RCTs to confirm what the time series
designs are telling us.

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 look underpowered and the
methodological bells and whistles are sometimes not there. But it 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. I know what is coming and I have the data sets sent to
me by the world wide ACT community. I know the researchers and I feel I 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. But if my guess about the quality of the data is right in the longer run (say in 1-2
years) what it look like today for me will be evident to outside reviewers. Of course, this is a moving
target. By then I will know the next 2-3 years of data and I may be insufferable. But this difference is
self-corrective. If I am being carried away with enthusiasm, in the long run honest critics will tell us what
is happening. We shall see. Check back in a few years.

I personally trust Lars-Göran. I know that one day he will either say “OK, you have passed the bar” or “it
is now clear you will not pass the bar.” But so far when Lars-Göran says “you are not there yet” we just
agree and work harder. I think he is being fair about where we are right now, given his focus and the
restrictions that come from that. But I also think it is perfectly fine for young people to look at the data
more like I do and say “there may be something cool there.” We need both enthusiasm and skepticism,
and young professionals need to read where things are going years down the line. That is a different role
than an established senior scholar. There is value in both styles and different audiences naturally wind up
on one side of that divide or the other.
Could you tell us something about your current work on ACT and RFT?

- I want a theory of human behavior that allows us truly to make a difference in our homes, schools,
workplace, and clinics. The book that brought me into behavioral psychology was Walden II, and that
passion for impact in how we life our lives has never left me. The ACt / RFT community wants it all: a
technology that works, a theory that works, basic principles, AND a powerful linkage to our deepest
human desires. But we can distinguish aspirations from data – and we have created a culture of openness
and self-criticism that seems scientifically healthy to me.

As far as content, I am very focused on how we can use these procedures to impact on the objectification
and dehumanization of others. Frankly, if we do not solve that problem we may not have a world to worry
about in 25 years. Our early work show we can make a big impact on prejudice and in helping humans to
carry the racist, sexist, elitist thought and feelings society gives us and yet to step toward on creating a
more just world.

I am using ACT to help clinicians learn new things without stress and burnout. I am working on how to
help these methods penetrate the culture.

I am very focused on how to link RFT in an ever tighter way to ACT.

And I want to see if RFT will lead to new methods of education, child interventions, and social change.
So I am doing basic work developing RFT in areas like motivation, metaphor, early childhood education,
persuasion, and the like.

One thing you will see if you come to the ACT / RFT World Conference in London in July 2006 – we
are using ACT and RFT itself to create an ACT / RFT community that is open, non-hierarchical, diverse,
committed, sharing, caring, and just plain fun. I look at the vitality the young professionals and students
show at such meetings and I ask myself “what would happen if we worked together to create a
community dedicated to the production of a psychology worthy of the human needs we are meant to
address?” By appealing to the better nature of out clients (e.g., self-acceptance, mindfulness, values,
commitment) we seem to be creating change in the clinic. It seems to me that by raising our sites as
professionals and creating a supportive, open, generous culture the same might happen in our training
programs, clinics, and research teams. In a concrete reflection of that I spend a lot of my time supporting
ACT and RFT folks around the world.

In your opinion, what is the greatest challenge of contemporary psychotherapy research?

Finding a way to bring science into contact with the deepest issues that are inside human suffering and
human aspiration, without violating the former or minimizing the latter.

Finally, what is your vision of psychotherapy; let us say 10 years from now?

I do not think psychotherapy can stand apart from the science that supports it, so I want to reformulate
the question into this: what is your vision of psychology 10 -20 years from now? With a broader scope of
reference and a longer time frame my vision is the creation of a new empirical contextual psychology that
carries forward and deepens our intellectual tradition, revitalizing basic psychology and linking our work
to principles that help us address problems of human suffering and human growth.

I want to see us create a psychology more adequate to the challenges of the human condition.

I know some will view this vision as laughably large, but this was part of the original vision of
behavioral psychology and behavior therapy. Behavioral psychology lost its way over the issue of human
cognition, and traditional CBT resulted, but perhaps we have found a way forward that will go beyond the
excessively narrow goal of empirically evaluated technologies, to include also the two other aspects of
our original tradition that were left behind: a firm link of application to basic principles, and an expansive
vision of a form of psychology that can help create a better world in every area of human life. If we can
do that, psychology itself may become more robust and useful. That is the vision.
 Thank you for asking these questions of me. I was humbled by the request and hope the answers are of
interest. If something in here is of interest, you can explore this tradition easily at
www.acceptanceandcommitmenttherapy.com and www.relationalframetheory.com

Steven C. Hayes

University of Nevada