The third wave of cognitive behavioral therapy and the rise of process‐based care

Abstract

The third wave of cognitive behavioral therapy and the rise of processbased careThe term cognitive behavioral therapy (CBT) identifies a family of interventions that are widely recognized as the set of psychological treatments with the most extensive empirical support 1 . CBT is not monolithic, however, and it has been through several distinct eras, generations, or waves. The first generation of this tradition was behavior therapy: the application of learning principles to well-evaluated methods designed to change overt behavior. By the late 1970s, behavior therapy had moved into the era of classic CBT: a new generation of methods and concepts focused on the role of maladaptive thinking patterns in emotion and behavior, and the use of methods to detect and change those patterns. The arrival of a "third wave" of CBT was declared 13 years ago 2 . The claim was that a change was occurring in orienting assumptions within CBT, and that a set of new behavioral and cognitive approaches were emerging based on contextual concepts focused more on the persons' relationship to thought and emotion than on their content. Third wave methods emphasized such issues as mindfulness, emotions, acceptance, the relationship, values, goals, and meta-cognition. New models and intervention approaches included acceptance and commitment therapy, dialectical behavior therapy, mindfulness-based cognitive therapy, functional analytic psychotherapy, metacognitive therapy, and several others.The idea that a "third wave" of CBT had arrived led to significant controversy 3 . The metaphor of a "wave" suggested to some that previous generations of work would be washed away, but that was not the intent and that was not the result. Waves hitting a shore assimilate and include previous wavesbut they leave behind a changed shore. It seems to us that we are now in a position to begin to evaluate what will be left behind in a more permanent way from third wave CBT. There is no doubt that several concepts and methods that have been central to third wave interventions (mindfulness methods; acceptance-based procedures; decentering; cognitive defusion; values; psychological flexibility processes) are now permanently part of the CBT tradition and indeed of evidence-based therapy more generally, in large part because evidence suggests that they are helpful 4 . These newer concepts and methods now largely co-exist side by side with previously established ones, with the dialectic between them serving as a useful spur to theoretical and technological investigation. In some cases, we now know that traditional CBT methods work in part by changing processes that became central after the arrival of third wave methods 5 . Third wave methods have been added to packages that include traditional behavioral and cognitive methods, resulting in useful approaches 6 . Research has begun to identify moderators indicating when older and newer methods work best with different populations 7 , suggesting that evidence-based practitioners can serve their clients by knowing method...

Functioning with fibromyalgia: The role of psychological flexibility and general psychological acceptance

“…Results suggest that strategies and procedures such as resting, exercise, and activity pacing are collectively not as influential as the development of processes such as self‐efficacy and aspects of PF for individuals with fibromyalgia. This finding is consistent with previous studies that have used the BPCI‐2 in chronic pain samples (McCracken & Vowles, ; Vowles & McCracken, ; Vowles, McCracken, et al, ; Vowles, Sowden, et al, ), and is also consistent with trends in clinical psychology toward process‐based CBT (Hayes & Hofmann, ). There is some evidence to suggest that processes such as self‐efficacy and indeed pain acceptance are change mechanisms within treatment for chronic pain, regardless of the treatment approach (Åkerblom, Perrin, Fischer, & McCracken, ).…”

To what extent are cognitive behaviour therapy competencies incorporated into clinical psychology training? A national survey of Australian universities

“…There is growing evidence for CBT skills demonstrating significant therapeutic gains; such as case formulation‐driven strategies to repair alliance ruptures, enhanced engagement through homework, and Socratic dialogue (Falkenström, Ekeblad, & Holmqvist, ; Kazantzis et al, ; Kazantzis, Brownfield, Mosely, Usatoff, & Flighty, ; Kazantzis, Luong, et al, ). This finding reflects the potential for maximisation in CBT competency training programs that is consistent with the emerging evidence linking process‐based CBT as a core clinical competency (Hayes & Hofmann, , ; Hofmann & Hayes, ).…”

“…The Association for Behavioural and Cognitive Therapies in the United States reported implications of their doctoral level guidelines for education and training in CBT, recommending a progression towards a scientific and ethical philosophy in CBT training programs to maximise CBT efficacy (Klepac et al, ). This work highlighted the opportunity to focus on processes and mechanisms of CBT, as opposed to specific therapy protocols, that led to flexible process‐driven treatment (e.g., Barlow et al, ; Hayes & Hofmann, , ; Hofmann & Hayes, ). Incorporating the principles and procedures of process‐based CBT into a national CBT competency checklist would optimise the EBP of psychology, in that the theoretically derived competencies of CBT will link testable mechanisms moderating and mediating efficacious outcome, and further tailor treatment methods to the needs of individual cases.…”

Mindfulness-Based Interventions for Anxiety and Depression

“…29,30 Mindfulness and acceptance strategies are consistent with general CBT principles, because they target core processes, such as increased emotional awareness and regulation, cognitive flexibility, and goals-based behaviors. 31,32 This is a topic that is outside the boundaries of this chapter, but that is likely to become part of the future of psychotherapy. As we will discuss throughout this review, mindfulness targets one such core processes that has demonstrated efficacy in reducing anxiety and depression symptom severity, both as the core treatment ingredient, as well as when integrated into other treatments.…”