Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies

Abstract

A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term "contextual cognitive behavioral therapy" to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…28,30 These qualities are sometimes described as reflected in behavior that is "open, aware, and active." 31 In this model two important sets of influences interact in how behavior is coordinated. One of these is direct experience, including our sensory experience of the world, what we see, hear, smell, taste, and feel directly.…”

“…These processes are described only briefly here but they are more extensively defined in numerous other sources. 27,28,29,30,31,42,47,76 The PF model as a whole is currently not well known within the field of chronic pain. Some of its six constituent processes of PF, however, are gaining prominence, especially acceptance, 4,10,11,18,26,56,58,69,84,87,97 and values-based action.…”

“…It then proposes there are two avenues available for addressing that, change the content of the thoughts and feelings, as is the predominant approach within much of CBT, or change the context that affords the thoughts and feelings their influence, as is increasingly being done in approaches now labeled as acceptance-based, mindfulness-based, "third wave," or contextual CBT. 31,47 Further Analysis: Another Next Generation of the Fear Avoidance Model Recently some of those involved in the development of the FA model proposed that it needs to meet several important challenges and that this would create a next generation of the model. 12 Three primary elements of the model were identified as lacking: (a) a model of normal psychological processes rather than pathological ones, (b) a proposal for how recovery from fear and avoidance is to occur, and (c) appreciation of the context of multiple goals, meaning, in their 12 It is suggested here that the PF model actually addresses each of the proposed challenges to the FA model, creates a model with greater scope, and with no loss of precision.…”

Enhanced psychological flexibility and improved quality of life in chronic fatigue syndrome/myalgic encephalomyelitis

“…Through intervention approaches patients learn over time to manage their energy through effectual behaviour change, reducing fatigue severity [16,17]. The most recent behaviour change model of PF [18] constitutes six related aspects: i) 'Cognitive defusion' (a process through which experiences become less dominated by thoughts, language and verbalised rules); ii) 'Acceptance' (making room for unwanted experiences and creating space to engage with bodily sensations); iii)'Contact with the present moment' (ability to fully engage with current experiences without focus on past or future events); iv) 'Self as context' (experiences of the present moment are defined by 'pure awareness', or the 'observing self'); v)'Values' (desires that can be reflected in our behaviour and relate to goals); vi) 'Committed action' (carrying out effective behaviours that are in line with and guided by our values) [12,13,19]. Mindfulness is a wellbeing strategy used alone or as part of other psychological interventions [20,21] and links to the first four of these six PF core processes [22].…”

Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning

“…These are sometimes summarized as "open, aware, and active". 10 Simply put, acceptance is goal-direct engagement without impractical resistance to unwanted experiences. Cognitive defusion involves contacting one's thoughts in a way that can reduce their influence on our behavior.…”