Steven C. Hayes

Introduction

Steven C. Hayes (born August 12, 1948) is an American clinical psychologist and Nevada Foundation Professor in the Department of Psychology at the University of Nevada, Reno. He is the originator of two things that have reshaped psychotherapy and behavioural science since the 1980s. The first is acceptance and commitment therapy, or ACT, which treats psychological suffering as a problem of inflexibility rather than a problem of faulty content, and trains people to act on their values while unwanted thoughts and feelings come along for the ride. The second is relational frame theory, an account of human language and cognition built on the claim that the basic unit of thought is not an association but a learned relation. ACT has become one of the most widely practised and most intensively researched psychotherapies of the last generation, with hundreds of randomised trials and adoption by bodies including the World Health Organization; it has also been the subject of an unusually public dispute over what its trial evidence actually shows. Hayes has written or co-written dozens of books and hundreds of articles, and in 2022 he asked for two of his own early papers to be retracted.

Early Life and Education

Hayes took his B.A. in psychology from Loyola Marymount University in Los Angeles in 1970, then an M.A. in 1974 and a Ph.D. in 1977 in clinical psychology at West Virginia University. He completed his clinical internship under David Barlow at the Brown University School of Medicine. He has written and spoken about his own experience of panic attacks early in his academic career, and the emphasis ACT places on making room for frightening private experience rather than arguing with it is often traced back to that period.

His intellectual starting point was behaviourism, and specifically the problem that behaviourism had never solved: language. Skinner's Verbal Behavior had attempted an account in 1957 and had failed, in the eyes of most psychologists, to explain the generativity and relational character of human thought. Hayes's entire research programme can be read as an attempt to finish that unfinished business while staying inside a behavioural framework, and the tension between those two commitments explains both the ambition of his work and much of the criticism it has attracted.

Academic and Professional Career

After a period on the faculty at the University of North Carolina at Greensboro, Hayes joined the University of Nevada, Reno in 1986, where he has remained. He co-founded the university's doctoral programme in behaviour analysis, one of the leading programmes in the field, and was later named Nevada Foundation Professor. He coined the term clinical behavior analysis for the application of behavioural principles to clinical problems.

His professional service is unusually extensive: he has been president of the American Psychological Association's Division 25, of the American Association of Applied and Preventive Psychology, of the Association for Behavioral and Cognitive Therapies, and of the Association for Contextual Behavioral Science, the organisation founded largely to support ACT and relational frame theory. He was the first secretary-treasurer of the American Psychological Society, now the Association for Psychological Science, which he helped form, and he served a five-year term on the National Advisory Council for Drug Abuse at the National Institutes of Health. In 1992 the Institute for Scientific Information listed him as the thirtieth highest-impact psychologist in the world for the period 1986 to 1990.

Major Contributions to Psychology

Relational frame theory

Relational frame theory holds that the core human capacity is not associating events but relating them: responding to one event in terms of another along a dimension specified by context — same as, opposite to, more than, before, because of — and then deriving further relations that were never taught. A child taught that a coin is worth more than a button and a button more than a button-hole can derive that the coin is worth more than the button-hole, and act accordingly, without ever being trained on that pair. Because relational responding is controlled by context rather than by the physical properties of the things related, it is arbitrary in the technical sense, and that arbitrariness is what lets a word stand in for a thing. Hayes and his collaborators presented the theory as a post-Skinnerian account of human language and cognition, and it has been tested in several hundred studies, largely on derived relational responding and its developmental and clinical implications.

Acceptance and commitment therapy

ACT was developed from the early 1980s and named by Hayes around 1982. Its target is psychological flexibility, which is defined as contacting the present moment fully and changing or persisting in behaviour in the service of chosen values. The model organises this into six interlocking processes — acceptance, cognitive defusion, present-moment awareness, self-as-context, values, and committed action — which are often drawn as a hexagon. The crucial departure from earlier cognitive therapy is that ACT does not try to change the content or frequency of difficult thoughts; it tries to change the person's relationship to them, on the argument that the attempt to control private experience is itself the problem. Where Aaron Beck trained patients to dispute distorted thoughts, Hayes trains them to notice thoughts as events and act anyway.

Contextual behavioral science and process-based therapy

Hayes has argued that the behavioural and cognitive therapies are better organised around processes than around syndromes or branded protocols. With Stefan Hofmann and others he has developed process-based therapy, which attempts to match intervention to the specific processes maintaining a given person's problem rather than to a diagnostic category. This is a direct challenge to the protocol-for-each-disorder model that has dominated evidence-based practice since the 1990s.

Major Publications

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press. Second edition, with Strosahl and Wilson, 2011.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. Plenum Press.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639–665.
Hayes, S. C., & Smith, S. (2005). Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy. New Harbinger.
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.
Hayes, S. C. (2019). A Liberated Mind: How to Pivot Toward What Matters. Avery.

Impact and Legacy

ACT is now one of the most widely taught psychotherapies in the world. The World Health Organization distributes ACT-based self-help material, the National Institute for Health and Care Excellence in the United Kingdom recommends it in several areas, the Society of Clinical Psychology lists it as having research support for chronic pain, depression, mixed anxiety, obsessive-compulsive disorder and psychosis, and the US Department of Veterans Affairs and Department of Defense have recognised it. The number of randomised trials runs into the hundreds. The vocabulary Hayes introduced — defusion, values-based action, psychological flexibility — has moved well beyond the clinic into coaching, education, and workplace training.

The evidence base has also been contested more loudly than most. The sharpest challenge came in 2014, when Lars-Göran Öst published a systematic review and meta-analysis of 60 randomised trials with 4,234 participants. He found a mean effect size of only 0.42 across all comparisons, no improvement in methodological quality since his earlier review, a decline in effect size from 0.68 to 0.42, and a small and statistically non-significant advantage of 0.16 over cognitive and behavioural treatments. His conclusion was that ACT did not meet criteria for a well-established treatment for any disorder, being at best probably efficacious for chronic pain and tinnitus and possibly efficacious for depression, psychosis, OCD, mixed anxiety, drug abuse, and workplace stress.

The response was equally unusual. In 2017 a group including Paul Atkins, Joseph Ciarrochi, Brandon Gaudiano, and Hayes himself published a re-examination of Öst's review, documenting 91 factual or interpretive errors touching on 80 per cent of the studies reviewed, arguing that the errors were not random but consistently negative toward ACT, and recommending that the review be set aside. Öst published a rebuttal later that year, and the journal attached an editor's note in 2018. The episode is instructive precisely because both sides have a point: independent meta-analyses by Powers and colleagues in 2009 and A-Tjak and colleagues in 2015 found, as Öst did, that ACT outperforms control conditions but does not reliably outperform established cognitive behaviour therapy. The defensible summary is that ACT is an effective therapy whose advantage over the treatments that preceded it has not been demonstrated, and that the size of its effect depends heavily on the comparator and on the methodological standards applied.

Relational frame theory has drawn a different objection, one that comes from within behaviour analysis as much as from outside it. Critics have argued that RFT relabels the well-established phenomenon of stimulus equivalence in new vocabulary without adding testable content, and that the theory's scope makes it hard to specify in advance what would count against it. Its defenders point to the several hundred studies of derived relational responding and to applications in language development and clinical assessment. The debate remains unresolved and is largely conducted between people who share Hayes's commitment to a behavioural account of cognition.

Finally, in 2022 Hayes became the subject of a controversy that concerns his earliest work rather than his mature contributions. Two papers he published with David Barlow and Kelly Brownell, in 1977 and 1983, described the use of covert sensitisation with homosexual and transgender individuals with the aim of changing sexual arousal and gender identity. After a group of past presidents of the Association for Behavioral and Cognitive Therapies circulated a letter about the organisation's historical role in conversion practices, Hayes issued a personal apology and asked that his own studies be retracted. The episode is a reminder that the boundary between behaviour change and what would now be called conversion therapy was drawn in a different place fifty years ago, and that the drawing of it was contested at the time.

Learn More

B. F. Skinner, whose account of verbal behavior Hayes set out to repair
Aaron Beck, whose cognitive therapy ACT was built in reaction to
Psychotherapy, for the wider field ACT belongs to
Dermot Barnes-Holmes — who built the Implicit Relational Assessment Procedure to measure relational framing

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy. Guilford Press.