Third Wave Cognitive-Behavioral Therapies

Third wave cognitive-behavioral therapies are so named because they came after the first wave behavioral therapies and the second wave cognitive behavioral therapies. These therapies include mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT). The third wave of CBT emerged after several research findings. One of the primary findings was that the hypothesized mechanism of change in second wave CBTs, changing a maladaptive thought to an adaptive thought, was not shown to be a mechanism of change (Burns & Spangler, 2001). Conversely, researchers found that distancing oneself from the thought (cognitive defusion) and the reinforcing relationship between the therapist and the patient were mechanisms of change. These findings led to exposure-based therapies and mindfulness-based therapies designed to change and bring awareness to internal experiences, respectively (Hayes, 2004). Finally, relational frame theory (RFT) showed that through learning, humans get attached to language and can respond directly to language instead of contingencies (Hayes, 2004). According to RFT, this is the fundamental reason why human beings experience suffering; humans get attached to language, and this attachment can create strong emotions. Humans try to avoid these strong negative emotions in order to control pain and suffering. Therefore, third wave CBT differs from second wave CBT in the belief that thoughts and feelings alone do not cause behavior. In the third wave, context matters. Changing a thought into a more adaptive one will not necessarily change a person’s experience.

MBCT, ACT, and DBT focus more on mindfulness (nonjudgmental awareness of the present moment) rather than the relaxation strategies used in second wave CBT. This encourages the patient to experience the present moment, including their thoughts and emotions, rather than trying avoid negative emotions. In addition, ACT and DBT integrate values into treatment, which is not a core component of second wave CBT.

References

• Burns, D. D., & Spangler, D. L. (2001). Do changes in dysfunctional attitudes mediate changes in depression and anxiety in cognitive behavioral therapy? Behavior Therapy, 32, 33-7-369.
• Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639-665.

Web Resources

• Guide to Mindfulness-based Cognitive Therapy (MBCT.com)
• Association for Contextual Behavioral Science 
• Veteran's Affairs (VA) Continuing Education Course on Acceptance and Commitment Therapy (ACT)
• The Linehan Institute (DBT)

• Dialectical Behavioral Therapy Fact Sheet, published by the National Alliance on Mental Illness (NAMI)

• National Registry of Evidence-based Programs and Practices - ACT
• National Registry of Evidence-based Programs and Practices - DBT
• National Registry of Evidence-based Programs and Practices - MBC

Books

• Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.). (2004). Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York, NY: Guilford Press.
• Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy skills-training manual for therapists. Oakland, CA: New Harbinger Publications.
• Roemer, L., & Orsillo, S. M. (2009). Mindfulness-and acceptance-based behavioral therapies in practice. New York, NY: Guilford Press.
• Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford Press.