Systems of Psychotherapy: A Transtheoretical Analysis

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): www.contextualpsychology.org/ • Behavioral Tech Research (DBT): www.btechresearch.com/ • Linehan Institute: www.linehaninstitute.org/ • Mindfulness-Based Cognitive Therapy: www.mbct.org/ • Steve Hayes’ Training Page: www.contextualpsychology.org/steve_hayes