Integrating 2nd and 3rd Wave CBT using Metaphors and Imagery Aharoni, R., Jørgensen, N.K, Rosenberg, N. & Winding, C.

The gap between theory and practice More clinicians are trained in both 2nd and 3rd wave CBT: ACT, DBT, UP Disagreement about whether 2nd and 3rd wave can be integrated in a meaningful way

Some claim that meaningful integration is possible Linehan, Barlow, Hayes Incorporating mindfulness training Focus on acceptance rather than change The Gap Barlow, 2011. Linehan, 2014, Hayes, 2005

Others claim they cannot (e.g. Wells, A.) The Gap either you engage with your thoughts about the moment being unpleasant, or you don’t… Wells, 2013

The clinicians’ dilemma The Gap May I implement new techniques in practice? How should I implement them? Should I wait for an RCT study before I implement them?

Psychiatric Center Copenhagen Group therapy for OCD patients 2 groups 14 patients 1 missing data 3 dropouts

Which techniques did we use? 2nd wave 3rd wave Goals and problem list Values Psychoeducation anxiety and emotions Worry-tree Thought suppression (behavioral experiment) Cognitive Restructuring Exposure Mindfulness Attention training Response prevention Acceptance Metaphor and Imagery

Description: Thoughts, Emotions Body Metaphor and Imagery

Behavior: Rumination and Worry Metaphor and Imagery Worry Tree

Behavior: Thought suppression Avoidance Metaphor and Imagery

Alternative behavior: Back to the present moment Metaphor and Imagery

exposure & response prevention “But how to let go..?” exposure & response prevention Attention training Acceptance Mindfulness training “Letting go” Metaphor and Imagery

Cognitive restructuring Arrow down technique Metaphor and Imagery Diffusion Acceptance

Results Results Patients and therapist find these images and metaphors meaningful Patients can distinguish between the interventions Different patients find different interventions most useful in different situations

Symptom Check List - 90 Results N= Pre Mean (SD) Post p = t= Under case Obsessive Compulsive Symptoms (range 0-4; 4= max severity) 10 1,86 (0,75) 0,91 (0,31) 0.004 3,79 90%   Anxiety Symptoms 1,75 (,94) 0,87 (0,47) 0.011 3,18 80% Results

Conclusion Conclusion Integrating 2nd and 3rd wave CBT does not seem to result in confusion among patients The results suggest that 2nd and 3rd wave CBT can be integrated in a meaningful way and show compatible results with previous studies