Addresses a new set of behavior therapies developed over ten years. The book covers nontraditional themes such as mindfulness, acceptance, values, spirituality, being in a relationship, focusing on the present moment, and emotional deepening....Novice readers can learn some basic techniques that are part of the ACT model....The book includes chapters for using ACT for specific purposes....I enjoyed reading the book. I really recommend it.
Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Traditionby Steven C. Hayes
Research and practicing psychologists gathered in Reno, Nevada in the summer of 2003 to explore changes in the cognitive-behavioral therapy tradition over the past decade. In 13 papers, they characterize their own approaches clinically, and consider how the focus of their approaches relates to the broader set of issues embraced by the new behavior therapies. They also… See more details below
Research and practicing psychologists gathered in Reno, Nevada in the summer of 2003 to explore changes in the cognitive-behavioral therapy tradition over the past decade. In 13 papers, they characterize their own approaches clinically, and consider how the focus of their approaches relates to the broader set of issues embraced by the new behavior therapies. They also articulate their theoretical models and compare them with others both inside and outside behavioral therapy. Annotation ©2004 Book News, Inc., Portland, OR
"One of the most important treatment developments in recent years has been the theoretical and empirical elaboration of mindfulness and acceptance into evidence-based cognitive-behavioral protocols. Books on this topic, however, have typically focused either on general theory or on clinical applications to narrow segments of psychopathology. Now Hayes, Follette, and Linehan--three of the most creative thinkers in this area--have produced a volume surveying the current status of these new intervention strategies across the wide spectrum of psychopathology. Anyone seeking to remain up to date on the applications of these exciting new procedures with a variety of client problems will want to have this book close at hand."--David H. Barlow, PhD, Center for Anxiety and Related Disorders and Department of Psychology, Boston University
"Some of today's most innovative scientist-practitioners provide an in-depth examination of the many ways that the concepts of mindfulness and acceptance are being integrated into cognitive-behavioral therapy, which hitherto has had little systematic contact with experiential therapies and Eastern philosophies. This book will be of interest to all mental health professionals concerned with enhancing therapeutic change in their patients and with furthering their own personal development. Provocative and at times very wise, this is 'must' reading for researchers and clinicians alike, inviting critical consideration of new and promising ideas and procedures. It is an appropriate text for graduate-level courses in psychotherapy, particularly within clinical psychology programs, and would serve as an excellent basis for a special-topic seminar on mindfulness and acceptance therapies."--Gerald C. Davison, PhD, Department of Psychology, University of Southern California
"This excellent book provides a very readable overview of how the 'third wave' behavioral and cognitive therapies such as ACT, MBCT, and DBT are integrating the concepts of mindfulness, acceptance, the therapeutic relationship, values, spirituality, and meditation into a clinical practice....Heaving utilized some of the ideas with current clients, I would highly recommend this inspiring book to other clinicians as an aid to reflecting on their clinical practice. It is both a readable overview and a useful reference text of clinical wisdom and advances in research."
"Hayes et al. have produced a collection of applied research articles filled with golden nuggets of insights, research, and practice applications for a variety of common clinical issues. These scientist-practitioners continue to demonstrate that their variations of acceptance and change-based strategies have influenced in significant ways not only the traditional cognitive-behavioral based therapeutic traditions but have also—and most importantly—improved the quality of their client's lives."
"The use of acceptance and mindfulness is presented...by an impressive array of authors and researchers in numerous domains including the treatment of refractory depression, trauma, generalized anxiety disorder, eating disorders, alcohol and drug use disorders, and couples therapy."
"An excellent introduction."
"This volume would make an excellent text for a graduate level seminar on CBT and a valued addition to the bookshelf of many practitioners regardless of their theoretical persuasion."
"This is an outstanding and potentially pivotal book, a unique series of therapeutic techniques emphasizing mindfulness, acceptance, values, spirituality, meditations, emotional deepening, focus on the present with an emphasis on the emerging therapeutic relationship....Hayes, Follette, and Linehan have recruited an impressive list of cutting-edge researchers and practitioners to provide an overview of the current state-of-the-art in what is being termed third generation behavior therapy....Any graduate doctorate program in psychology with a behavioral orientation wishing to insure contact with up-to-date thinking would need this book as part of its coursework. This book will be valuable to both starting therapists and those who have been in practice for many years....This book is highly valuable....The concepts and procedures developed are easily adapted to a child and adolescent population....Given the excitement within its pages and the profound impact it may have, it may represent one of the best values in books available today."
"The book is a well-organized, visionary, and pragmatic presentation of multiple new concepts....This book is one not only to read but also to keep on the shelf for reopening by psychiatrists, psychologists, social workers, nurses, and other mental health clinicians who treat, teach, and just enjoy a good adventure of expanding the mind."
"...a rich resource for surveying the theoretical and clinical implications of third-wave behavior therapies....A strength of this volume lies in the compilation of related theoretical models that appear to challenge our thinking about contemporary clinical science and practice."
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Mindfulness and AcceptanceExpanding the Cognitive-Behavioral Tradition
The Guilford PressCopyright © 2004 The Guilford Press
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Chapter OneAcceptance and Commitment Therapy and the New Behavior Therapies Mindfulness, Acceptance, and Relationship
Steven C. Hayes
Beyond their existence in the behavior therapy tradition broadly defined, no single factor unites the methods presented in this volume more than how hard it is to classify them using existing terms within empirical clinical psychology. Many are venturing boldly into areas outside the behavior therapy tradition, such as dialectics, spirituality, relationship, and mindfulness. The methods are unusually flexible, including means that are direct and indirect, didactic and experiential, instructional and metaphorical. Cognitively rationalized approaches are questioning the primacy of changes in cognitive content. Behaviorally rationalized approaches are embracing cognitive topics. What is going on here?
When many new approaches emerge that are difficult to classify, it is possibly a sign that the field itself is reorganizing. This has happen before in behavior therapy. It seems to be happening again (Hayes, in press).
FIRST- AND SECOND-GENERATION BEHAVIOR THERAPY
Behavior therapy (referring to the entire range of behavioral and cognitive therapies, from clinical behavior analysis to cognitivetherapy) emerged as an approach committed to the development of well-specified and rigorously tested applied technologies based on scientifically well-established basic principles (Franks & Wilson, 1974). It rejected existing clinical theories and technologies that were poorly specified, vaguely argued, and little researched. Behavior therapists criticized (e.g., Bandura, 1969, pp. 11-13; Wolpe & Rachman, 1960) the amazing flights of psychoanalytic fancy that could be occasioned by the simplest of phobias or other clinical disorders (e.g., Freud, 1909/1955). As a form of instructive ridicule, behavior therapists trained simple actions by direct shaping in the chronically mentally ill, and then watched with amusement as psychoanalytic colleagues concocted bizarre symbolic interpretations of behaviors that had known and simple histories (e.g., Ayllon, Haughton, & Hughes, 1965). The alternative presented by behavior therapy was direct, humble, rational, and empirical. Abandoning an interest in hypothesized unconscious fears and desires, behavior therapists focused instead on direct symptom relief. The psychoanalytic worry that this would result only in superficial behavioral gains (e.g., Bookbinder, 1962; Schraml & Selg, 1966) was criticized (e.g., Yates, 1958), puzzled over (Bandura, 1969, pp. 48-49), and shown empirically to be largely unfounded (Nurnberger & Hingtgen, 1973).
The rejection of existing clinical concepts and methods had several collateral effects, beyond the inclusion of science and well-established basic principles. It became unfashionable in behavior therapy to dabble in clinical issues that were too subtle, complex, or broad in scope. Clinical targets generally involved "first-order" change. If an anxious child was not going to school, going to school or anxiety about going to school was the target, not unconscious interests or conflicts. The approach was not only first order but also often direct. Perhaps because the products of science are sets of verbal rules, the clinical approaches themselves tended to be presented to clients in relatively straightforward or didactic ways. If social skills were poor, attempts were made to specify verbally the various components of "good social skills" and then train them directly, often including such methods as instructions and feedback.
This first generation of behavior therapy changed dramatically with the advent of cognitive methods. Both stimulus-response associationism and behavior analysis had failed to provide an adequate account of human language and cognition, and early behavior therapists soon learned that they needed to deal with thoughts and feelings in a more direct and central way. The cognitive therapy movement (e.g., Beck, Rush, Shaw, & Emery, 1979; Mahoney, 1974; Meichenbaum, 1977) attempted to do so. The objections of early founders that cognition had been dealt with all along (e.g., Wolpe, 1980) were largely ignored, because it was the centrality of cognition and the ability to deal with it in a natural way that was more at issue. In the absence of adequate basic accounts, early cognitive-behavioral therapies approached cognition in a direct and clinically relevant way. In this work, "cognition" generally referred to the commonsense categories of thoughts, ideas, beliefs, or suppositions. Through the use of questionnaires and clinical interviews focused on such targets, clinicians learned to identify cognitive errors in particular patient populations, and direct means were developed to correct these problems.
Some of the leaders of these new approaches sought to overthrow behavior therapy, as was reflected in Beck's well-known challenge: "Can a fledgling psychotherapy challenge the giants in the field-psychoanalysis and behavior therapy?" (1976, p. 333), but the behavior therapy tradition proved more flexible than that. What made a relatively smooth transition to the second generation of behavior therapy possible was the first-order change focus of the cognitive movement: "Cognitive therapy is best viewed as the application of the cognitive model of a particular disorder with the use of a variety of techniques designed to modify the dysfunctional beliefs and faulty information processing characteristic of each disorder" (Beck, 1993, p. 194). This first-order change focus comported so well with the overall approach of the first wave of behavior therapy that a second generation of behavior therapy could be created simply by expanding the scope, models, and methods of the tradition. "Cognitive-behavioral therapists" added irrational thoughts, pathological cognitive schemas, or faulty information-processing styles to the list of direct targets for change, along with new methods appropriate for these targets. In the second wave of behavior therapy, undesirable thoughts would be weakened or eliminated through their detection, correction, testing, and disputation, much as anxiety was to be replaced by relaxation in the first wave.
All of this happened 25-30 years ago. In the years that have followed, cognitive-behavioral therapy (CBT) has seen unprecedented success. The empirical basis of the field has been enormously strengthened, and in problem area after problem area, empirical clinicians have shown that CBT is helpful. Behavior therapy dominates lists of empirically supported treatments (Chambless et al., 1996) and clinical practice guidelines based on effective approaches (Hayes, Follette, Dawes, & Grady, 1995; Hayes & Gregg, 2001).
CONTEXTS SUPPORTING A NEW GENERATION OF BEHAVIOR THERAPY
Long periods of normal science occur when adherents have interesting work to do, rewards for doing that work, and when the organizational narrative seems to be coherent and progressive. In such phases, it is what is implicit, not what is explicit, that is most powerful. Assumptions about the questions, issues, methods, and forms of evidence appropriate to a field are often more important to maintaining a dominant paradigm than are specific theories, studies, principles, or technologies. Eventually, however, things change. Anomalies emerge that undermine the dominant paradigm. Patterns of support shift, and lines of research become less fruitful. Young professionals enter the field without being as bound to underlying assumptions. Questions that were never resolved reemerge. As a result, new questions dare to be asked and new methods and principles are developed. As the assumptive base of a dominant paradigm weakens or diversifies, this process can accelerate, particularly if new ideas are productive and help remove or resolve previously encountered roadblocks and anomalies. Sometimes change of this kind occurs in a deliberate way, with a political or an even revolutionary quality to it, but more commonly it happens in a humble and entirely natural way. Researchers simply begin to think outside the largely implicit box, and interesting findings emerge. That seems to be exactly what has happened with most of the methods discussed in this volume.
The contexts supporting the emergence of the new behavior therapies are several. First, a number of empirical anomalies have emerged. Clinical improvement in CBT often occurs before the presumptively key features have been adequately implemented (Ilardi & Craighead, 1994). Despite challenges (Tang & DeRubeis, 1999), this disturbing finding has not been adequately explained (Ilardi & Craighead, 1999; Wilson, 1999). Changes in cognitive mediators often fail to explain the impact of CBT (e.g., Burns & Spangler, 2001; Morgenstern & Longabaugh, 2000), particularly in areas that are causal and explanatory rather than descriptive (Beck & Perkins, 2001; Bieling & Kuyken, 2003). Component analyses of CBT (e.g., Gortner, Gollan, Dobson, & Jacobson, 1998; Jacobson et al., 1996; Zettle & Hayes, 1987) have led to the disturbing conclusion that there is "no additive benefit to providing cognitive interventions in cognitive therapy" (Dobson & Khatri, 2000, p. 913).
Second, the underlying treatment development model is showing signs of wear. Effect sizes have largely stagnated for technologies that are rigidly adherent to second-generation assumptions (Öst, 2002). Researchers, who are largely dependent for their funding on a technological model of treatment development (Rounsaville, Carroll, & Onken, 2001), are facing a proliferation of similar treatment manuals (Hayes, 2002b) in the absence of methods for their distillation. The federal funds that fed the rise of the second wave of behavior therapy increasingly have emphasized the need for innovative theory and a link to basic science (Rounsaville et al., 2001), which is leading to new models and to more focus on the empirical anomalies of the second generation. Because some research areas are well-plowed fields, researchers have tended to focus on unusual populations and subpopulations that can be examined within the existing model-but this has sometimes led to the development of new methods that do not fully comport with second-generation assumptions.
Third, the rise of constructivism and similar postmodernist (and postpostmodernist) theories, have weakened the mechanistic assumptions that have dominated in some wings of behavior therapy (Hayes, Hayes, Reese, & Sarbin, 1993). Instead, more pragmatic and contextualistic assumptions have come to the fore (Biglan & Hayes, 1996; Jacobson, 1997). Even the thinking of leaders of second-generation behavior therapy show the assumptive changes (e.g., cf. Beck, Rush, Shaw, & Emery, 1979, with Emery & Campbell, 1986; or Mahoney, 1974, with Mahoney, 2002). This change is subtle, but it is pervasive and powerful, and we discuss it extensively shortly.
THE THIRD WAVE
Contextual changes are not enough to change a field. New ideas are also needed. As the present volume shows, these new ideas have emerged and greatly strengthened over the last decade (cf. Hayes, Jacobson, Follette, & Dougher, 1994, with this volume). On the behavioral side, as exposurebased therapies focused on internal events (Barlow, 2002), it became clearer that it was the function of these events that was most at issue, not their form, frequency, or situational sensitivity per se. The positive outcomes for dialectical behavior therapy (DBT; Linehan, 1993; see Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004, for a recent outcome review) provided strong support for mindfulness and both acceptance and change in the treatment of complex clinical problems. Mindfulness and acceptance are radical additions to behavior therapy, because they challenge the universal applicability of first-order change strategies. Within the cognitive wing, similar changes have occurred. Attentional and metacognitive perspectives (e.g., Wells, 1994) began to make clear that it was the function of problematic cognitions, not their form, that was most relevant. More emphasis began to be given to contacting the present moment (e.g., Borkovec & Roemer, 1994; see Borkovec & Sharpless, Chapter 10, this volume) and mindfulness (Segal, Williams, & Teasdale, 2001; Teasdale et al., 2002), strengthening that shift in focus.
The third generation of behavior therapy has been defined in the following way (Hayes, in press):
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.
Defined in that way, the new behavior therapies carry forward the behavior therapy tradition, but they (1) abandon a sole commitment to first-order change, (2) adopt more contextualistic assumptions, (3) adopt more experiential and indirect change strategies in addition to direct strategies, and (4) considerably broaden the focus of change.
Acceptance and commitment therapy (ACT, said as one word, not as A-C-T; Hayes, Strosahl, & Wilson, 1999) is in line with all of these features of the new behavior therapies. ACT is neither simple behavior therapy nor classic CBT. It is a contextualistic behavioral treatment that sits squarely among the set of third-generation treatments described in this volume. As such, an explication of ACT may help reveal commonalities and connections among some of these other treatments.
ACCEPTANCE AND COMMITMENT THERAPY
ACT emerged from behavior analysis, one of the more misunderstood wings of modern psychology. It is not by accident that several of the new behavior therapies are most closely linked to this wing of behavior therapy, which only recently has developed sufficiently to impact adult psychotherapy in a powerful way.
Behavior analysis is much easier to understand when its philosophical foundations are understood. Although mechanistic forms of behavior analysis exist, by far the more dominant strand of modern behavior analysis is based on a type of American pragmatism we have termed functional contextualism (Hayes, 1993).
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