1. Systems of Psychotherapy: A Transtheoretical Analysis
Chapter 11.
Third-Wave
Therapies

2. Three Waves of Therapy Strict behavior therapy (first wave)
Behavior therapy manifested in cognitive therapy (second wave)
Incorporate acceptance and mindfulness into standard CBT (third wave)

3. Leading Third-Wave Therapies
Acceptance & Commitment Therapy (ACT)
Dialectical Behavior Therapy (DBT)
A bit on other therapies, such as Mindfulness-based Cognitive Therapy

4. A Sketch of Steven Hayes
1948 –
Raised in California during the 1960s in heyday of hippie counterculture
Combined his interest in Eastern philosophy with psychological science
Focused on one CT component: cognitive distancing
Developed ACT in part from his own panic disorder

5. ACT Theory of Psychopathology
Psych processes of normal human mind are frequently destructive; pathology is the norm
We struggle to alter unwanted private events even when decreasing them (experiential avoidance)
Controlling linguistic contexts that perpetuate avoidance leads to pathology (cognitive fusion)

6. ACT Therapeutic Processes
Consciousness raising (present-moment focus)
Choosing (values clarification, committed action)
Catharsis (accept flow of feelings)
Counterconditioning (cognitive diffusion methods, mindfully observe & accept rather than fight)

7. ACT Therapeutic Relationship
Therapist acts as experienced coach
Helps clients identify private events that interfere with effective action
Functions as a value clarification trainer
Facilitates with respect & acceptance
Teaches mindfulness & acceptance skills

8. A Sketch of Marsha Linehan
1943 –
Developed DBT for chronically suicidal and borderline personality disorder
Added acceptance & mindfulness to CBT
Prefers at times that DBT be characterized as expanded behavior therapy
Rooted partially in her own troubling history and meditation training

9. DBT Theory of Psychopathology
Borderline personalities are products of genetic and social abnormalities
BPD has biological predisposition for heightened reactivity to emotional stimuli
BPD individuals vulnerable to invalidation of their emotions and thoughts via punishing, ignoring, and trivializing communications

10. DBT Therapeutic Processes
Mindfulness and meditation for coping with powerful emotions
3 ordered treatment priorities
Deal with threats of self-destructive behaviors
Focus on threats to therapeutic relationship
Skill development (e.g., assertiveness, acceptance, interpersonal training)

11. DBT Therapeutic Processes
Consciousness raising (focus on present without judging)
Choosing (clients become mindful and accept distressing events)
Counterconditioning (skills for changing behavior, mindfulness for accepting situation)
Dialectic between behavior change and radical acceptance

12. DBT Therapeutic Relationship
Foundation is validation and acceptance
Therapists relate like healthy parents
Help set effective limits on emotional reactions that can disrupt therapy
Ensure patients have supportive groups and therapists have supervisory consultations
Shift from parenting to teaching as tx progresses

13. Mindfulness-Based Cognitive Therapy
Began with Beck’s cognitive therapy and added mindfulness-based stress reduction
MBCT developed to prevent relapse of major depressive disorder
Centers on “modes of mind”
Employs consciousness raising, choosing, and counterconditioning (like ACT and DBT)

14. Practicalities of Third-Wave Therapies
Performed in indiv, couple, and group formats with adolescents, adults, and older adults
Training is widely available
Growing applications to multiple disorders and populations
Emphasis on teaching client and clinician the requisite mindfulness skills

15. Effectiveness of Third-Wave Therapies
ACT consistently outperforms no treatment and wait-list controls across disorders, with similar outcomes as CBT
DBT produces average ES of .58 vs. no treatment and is a “treatment of choice” for borderline personality disorder
MBCT effective in delaying or preventing depression relapse

16. Criticisms of Third-Wave Therapies
From a Psychoanalytic Perspective (accepting conflicts rather than resolving)
From a Cognitive-Behavioral Perspective (unnecessary new concepts and methods)
From a Humanistic Perspective (labeling existing effective methods as their own)
From a Cultural Perspective (unwitting acceptance of social injustices)
From an Integrative Perspective (helpful addition but cultural and theoretical appropriation)

17. Future Directions
Ascension of third-wave therapies in next decade seems certain
Attracting clinicians from diverse theoretical persuasions
Represents expanded & more complete CBT
Challenges: Will they demonstrate value above CBT? Will they continue to grow or eventually fade?

18. Key Terms
acceptance Acceptance and Commitment Therapy cognitive fusion cognitive reactivity committed action Diffusion (or defusion) dialectic Dialectical Behavior Therapy differential activation hypothesis
distancing emotional regulation experiential avoidance inquiry interpersonal effectiveness mindfulness mindfulness-based therapies Mindfulness-based Cognitive Therapy (MBBCT)

19. Key Terms (cont.)
mediation modes of mind modular approach present-moment focus radical acceptance
ruminative thinking third-wave therapies validation strategies values values clarification workability

20. Recommended Websites
Association for Contextual Behavioral Science (ACT):
Behavioral Tech Research (DBT):
Linehan Institute:
Mindfulness-Based Cognitive Therapy:
Steve Hayes’ Training Page: