Fellow Travelers

The third generation of cognitive behavior therapy (CBT) has been defined this way:

Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes. (Hayes, 2004)

The most unique characteristic of the third wave interventions is the degree of emphasis on contextual and experiential change strategies, including acceptance, defusion, mindfulness, relationship, values, emotional deepening, contact with the present moment, and the like. The purpose of experiential and contextual strategies of this kind is to rapidly alter the function of problematic psychological events, even if their form or frequency does not change or changes only slowly. Mindfulness-based and acceptance technologies show that focus quite clearly. For example, Segal, Teasdale, and Williams (2004) state: “Unlike CBT, there is little emphasis in MBCT on changing the content of thoughts; rather, the emphasis is on changing awareness of and relationship to thoughts.”

It is worth noting that this step is being taken both by techniques that are quite behavior analytic and thus philosophically contextualistic in their rationalization (e.g., Behavioral Activation, ICBT, DBT, ACT, FAP), and by techniques that are quite cognitive in their rationalization (e.g., MBCT, Metacognition).

This is important, because it means that the mainstream itself is changing and there are new opportunities for connection and communication across old boundaries. In a kind of dialectical synthesis of a previous thesis and antithesis, the new wave therapies seem to be healing old wounds and divisions between behavioral and cognitive perspectives. Evidence for this view can be found in the synergies between technologies across of the spectrum of third wave interventions, and in the ways that each of these new approaches has breadth across these divisions regardless of its home of origin. The third wave interventions are not a rejection of the first and second waves of behavioral and cognitive therapy so much as a transformation of these earlier phases into a new, broader, more interconnected form. Thus, while the implications may be revolutionary, the processes giving rise to these developments are evolutionary – as might be expected in an explicitly empirical tradition.

We invite child pages to be added in any of the methods and approaches that are part of a more contextual approach (simply click the "add child page" link at the bottom of the relevant page).

Steven Hayes August 14, 2005 - 11:37am

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Eric Fox August 16, 2005 - 2:00pm

What characterizes the so-called third wave behavior therapies?

”Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes.” (quote from Hayes, 2004).

These are very broad characterizations and there is no clear dividing line between various historical aspects of the behavior therapy tradition.

Steven Hayes July 31, 2005 - 9:50am

How does Relational Frame Theory (RFT) relate to traditional CBT-theories?

That question is a huge one. RFT seeks a broad understanding of cognition. In the long run it could be more important than ACT because if it works the whole of psychology could change.

RFT is developmental, contextual, and behavioral. It gives you ideas about what to change to make things happen. It is so basic that it goes all the way down to animal behavior and human infants; and yet so broad in scope that it has clear implications for our understanding of social processes or such human activities as religion.

We have never had an empirically adequate behavioral, contextual account of cognition. Now we have at least the beginnings of one and it seems to be braking down the artificial barriers between cognitive and behavioral science.

The theories underlying CBT and CT are not like that. They have relatively low scope and they emerged typically from clinical concerns. They do not pretend to be the functional equivalent in cognition for what “behavioral principles” are in non-verbal behavior.

You have to be impressed with what the traditional behavior therapists were able to do with traditional behavioral principles, in part because these principles emphasized manipulable contextual variables. Imagine what we might do with a theory of cognition that emphasized manipulable contextual variables, if the theory was relatively adequate. Maybe a lot.

Steven Hayes July 31, 2005 - 9:54am

ACT, evolutionary biology and severe mental illness

Originally submitted by user dixonph on 7/30/2014:

Edward Hagen's paper: Delusions as Exploitative Behavior
http://bit.ly/1ppVlnu echoes themes of ACT theorists. ACT is held by the founders as a possible aid for even severe psychotic disorders. Contextual behavior theory is not mentioned as such in Hagen's paper. I don't know if Hagen is involved with mental illness treatments, or ACT specifically. The paper seems to be very much in line with ACT principles. That is why I mention it here. I see a connection.

If even severe mental illness is an evolutionary adaptive survival mechanism manifested as a result of a failed social context, then how can ACT help reintegrate the modern sufferer into more successful social connections?

Can there be communities where ACT functions to create an experience of acceptance and support for sufferers even outside the therapeutic setting?

I am looking to see if Edward Hagen is involved with ACBS/ACT. His paper states that he believes anti-psychotic medication will not really help someone with what is called delusional disorder (semi-plausible delusions, continued day to day routine functioning), which is distinct from the bizarre delusions of schizophrenia. He also mentions the harmful side effects of the medications.

I am interested in the potential for ACT in supportive community for mental health sufferers.

Any known efforts among ACT practioners?

Jennifer Krafft March 9, 2016 - 6:45pm

Differences/Similarities between ACT/DBT

ACT and DBT could be considered sister/brother technologies. Both have been described as part of the "third wave" of cognitive-behavioral therapies, which also includes therapies such as mindfulness-based cognitive therapy and integrative behavioral couples therapy (and potentially the new modern behavior analytic form of behavioral activitation by the deceased Jacobson and colleagues that seems to be outperforming cognitive therapy for depression in two trials). This new set of therapies, all of which have a commitment to empirical evaluation and science, tend to differ in important ways from traditional CBT. For example, the third wave tends to pay more attention to secondary change in the area of thoughts and feelings. Traditional CBT tries to help people directly change thoughts and feelings, sort of an in-with-the-good out-with-the-bad approach to cognitive and emotional content. These third wave approaches focus on helping people to change their relationship to these private experiences, rather than trying to change the form, situational sensitivity, or content of these experiences. Emphasis then tends to turn to being effective in one's life and away from working to feel GOOD. Another way to put this is that these therapies tend to help people learn how to FEEL good, rather than to try to feel GOOD. Anyways, there are papers written about this new set of therapies and their similarities and differences for those who want more info.

Here's a little about what I see as differences/similiarities between DBT and ACT, with the disclaimer that I am far from an expert on DBT. DBT and ACT both emerge from a behavioral tradition. Both share the similarity of emphasizing acceptance, mindfulness, and effectiveness of action. In at least those domains they are quite similar. In terms of the theory that underlies them, they are quite different. ACT is closely tied to a modern behavior analytic theory of language and cognition called Relational Frame Theory (RFT), which underlies the approach, and also to traditional behavior analytic principles such as reinforcement. The first clinical trials on ACT were published several years before DBT (in 1985-86 with depression), but then Steve Hayes decided that ACT needed a firmer theoretical foundation and this lead to about 15 years of research and dozens of studies on RFT before the next application of RFT (an ACT clinical trial on psychosis) was published in 1999. My experience with DBT is that its focus has been on developing a technology that is practical, pragmatic, and manualized, with less of an emphasis on developing a comprehensive theory of human behavior. ACT is very closely tied to the broader tradition of behavior analysis and could be considered a form of clinical behavior analysis while DBT seems to be more closely tied to traditional behavior therapy.

In terms of overlap in specific techniques between ACT and DBT, the overlap appears limited. There seems to be very little overlap in terms of the specific techniques, exercises, and metaphors used in session (with the exception of general mindfulness exercises).

In terms of the evidence base, DBT undoubtedly has a stronger evidence with more replication in the more limited areas that it has been tested (e.g., parasuicidality/substance abuse), while ACT has been examined in a wider variety of clinical trials, with less replication, with more disorders (e.g., chronic pain, substance abuse, depression, workplace settings, anxiety, and a dozen or so other), probably due to the broader scope of its underlying theory.

[this is exerpted from an email to a listserv in Oregon and I thought others might be interested in this. Feel free to modify or comment on any disagreement/inconsistencies/extensions]

Jason Luoma February 10, 2006 - 2:39pm