Cover

Contents

Cover

Title Page

Dedication

Contributors

Foreword

ACCEPTANCE AND MINDFULNESS IN COGNITIVE BEHAVIOR THERAPY

Part I: New Developments in the Behavior Therapy Tradition

1: The Evolution of Cognitive Behavior Therapy

ACCEPTANCE AND MINDFULNESS IN CONTEXT

HISTORICAL ROOTS OF PSYCHOLOGICAL ACCEPTANCE AND MINDFULNESS

CONTEMPORARY CONCEPTUALIZATIONS OF ACCEPTANCE, MINDFULNESS, AND RELATED CONSTRUCTS

CHARACTERISTICS OF ACCEPTANCE-BASED MODELS OF CBT

UNRESOLVED ISSUES WITH REGARD TO COGNITIVE CHANGE STRATEGIES

FUTURE DIRECTIONS

2: Cognitive Therapy

THE COGNITIVE MODEL OF PSYCHOPATHOLOGY AND TREATMENT

MINDFULNESS- AND ACCEPTANCE-BASED STRATEGIES IN COGNITIVE THERAPY

DISTINCTIONS AMONG COGNITIVE THERAPY AND OTHER CBT MODELS

THE NATURE AND VALUE OF COGNITIVE CHANGE STRATEGIES

EMPIRICAL EVIDENCE FOR THE COGNITIVE THEORY

EMPIRICAL EVIDENCE FOR COGNITIVE THERAPY

CONCLUSION

3: Mindfulness-Based Cognitive Therapy

THE TRADITIONAL COGNITIVE BEHAVIORAL MODEL OF THE PSYCHOPATHOLOGY AND TREATMENT OF MAJOR DEPRESSIVE DISORDER

METACOGNITIVE APPROACHES TO EMOTIONAL PROCESSING

METACOGNITIVE PROCESSING AND DEPRESSION

USING MINDFULNESS MEDITATION TO PROMOTE METACOGNITIVE AWARENESS

MBCT FOR DEPRESSION TRIALS

APPLICATIONS OF MINDFULNESS TO ANXIETY DISORDERS

SUMMARY, LINGERING QUESTIONS, AND FUTURE DIRECTIONS

CONCLUSION

4: Metacognitive Therapy

THE CAS

ORIGINS OF THE CAS

COGNITIVE ARCHITECTURE, METACOGNITION, AND EMOTION

NATURE OF METACOGNITIVE THERAPY

HISTORICAL CONTEXT OF MCT

THE ROLE OF MINDFULNESS AND ACCEPTANCE

CASE EXAMPLE

THE NATURE AND VALUE OF DIRECT COGNITIVE CHANGE STRATEGIES

EMPIRICAL SUPPORT FOR MCT THEORY AND THERAPY

EVIDENCE OF TREATMENT EFFECTS

EVIDENCE OF TREATMENT MECHANISMS

FUTURE DIRECTIONS

5: Emotional Schema Therapy

EMOTIONAL SCHEMA THERAPY

COGNITIVE CHANGE STRATEGIES

THE ROLE OF META-AWARENESS

EMOTIONAL SCHEMAS, COGNITIVE THERAPY, AND MINDFULNESS

RESEARCH ON EMOTIONAL SCHEMAS

FUTURE DIRECTIONS

6: Mindfulness-Based Stress Reduction

HISTORICAL CONTEXT AND DESCRIPTION OF THE MODEL

THE ROLE OF MINDFULNESS AND ACCEPTANCE STRATEGIES IN THE INTERVENTION MODEL

CLINICAL DESCRIPTION

THEORETICALLY DISTINCT FEATURES OF MBSR

NATURE AND VALUE OF DIRECT COGNITIVE CHANGE STRATEGIES

SIGNIFICANCE OF METACOGNITIVE AWARENESS, DISTANCING, OR COGNITIVE DEFUSION

COGNITIVE MODIFICATION STRATEGIES AND METACOGNITIVE AWARENESS

NECESSITY OF COGNITIVE CHANGE STRATEGIES

MINDFULNESS, MBSR, AND THE CONCEPT OF PSYCHOPATHOLOGY

TREATMENT OUTCOME STUDIES

MINDFULNESS: MECHANISMS AND PROCESSES

FUTURE DIRECTIONS

EMERGING TRENDS IN MINDFULNESS APPLICATIONS

7: Dialectical Behavior Therapy

MODEL OF PSYCHOPATHOLOGY AND TREATMENT

ROLE OF MINDFULNESS AND ACCEPTANCE STRATEGIES

THEORETICAL AND TECHNICAL DISTINCTIONS FROM OTHER CBT MODELS

THE DBT PERSPECTIVE ON DIRECT COGNITIVE CHANGE STRATEGIES

DATA ON THEORETICAL MODEL AND TREATMENT APPROACH

FUTURE DIRECTIONS IN THE STUDY OF DBT

8: Behavioral Activation in the Context of “Third Wave” Therapies

DESCRIPTION OF THE MODEL OF PSYCHOPATHOLOGY AND TREATMENT

THE ROLE OF MINDFULNESS AND ACCEPTANCE-BASED STRATEGIES IN THE DEVELOPMENT OF THE MODEL

BRIEF CASE DESCRIPTION

WAYS IN WHICH THE MODEL IS THEORETICALLY AND TECHNICALLY DISTINCT FROM OTHER CBT MODELS

THE NATURE AND VALUE OF COGNITIVE CHANGE STRATEGIES

REVIEW OF DATA

BRIEF OVERVIEW OF FUTURE DIRECTIONS

9: Integrative Behavioral Couple Therapy

MODEL OF COUPLE DISTRESS AND TREATMENT

OVERVIEW OF IBCT

ACCEPTANCE-BASED STRATEGIES

CASE EXAMPLE 1

IBCT AND CBT

ROLE OF COGNITION IN IBCT

EMPIRICAL FINDINGS

FUTURE DIRECTIONS

10: Understanding Acceptance and Commitment Therapy in Context

ACT IN THE CBT FAMILY

THE ACT HEXAFLEX MODEL OF PSYCHOLOGICAL WELL-BEING

THE ROLE OF MINDFULNESS AND ACCEPTANCE-BASED STRATEGIES IN THE DEVELOPMENT OF ACT

CASE DESCRIPTION THAT HIGHLIGHTS TYPICAL AND UNIQUE FEATURES OF THE MODEL

DISTANCING, METACOGNITION, MINDFULNESS, AND DEFUSION: VARYING PERSPECTIVES ON COGNITION

BRIEF REVIEW OF EVIDENCE ON THE ACT MODEL

OVERVIEW OF FUTURE DIRECTIONS

Part II: Integration and Synthesis

11: Mindfulness and Acceptance

HISTORICAL CONTEXT

THE COGNITIVE CAUSALITY PREMISE

THE ROLE OF COGNITION

THE FAMILY OF CBT APPROACHES

MINDFULNESS

ACCEPTANCE

CONCLUSION AND FUTURE RESEARCH DIRECTIONS

12: Mindfulness and Acceptance

CHANGES IN THE MODEL OF PSYCHOPATHOLOGY

CHANGES IN THE MODEL OF THERAPEUTIC CHANGE

CHANGES IN THE GOALS OF TREATMENT

IS THIS NEW?

MOVING FROM A TECHNOLOGY-FOCUSED MODEL TO A THEORY-FOCUSED MODEL OF TREATMENT TESTING

MOVING FROM A SYNDROMAL APPROACH TO A FUNCTIONAL APPROACH

MOVING FROM MANUALIZED TREATMENTS TO FLEXIBLE, PROCESS-ORIENTED TREATMENTS

ENHANCING THE RELATIONSHIP OF BASIC AND APPLIED SCIENCE

EXAMINING PHILOSOPHICAL ASSUMPTIONS

CONCLUSION

13: Mindfulness and Acceptance in Cognitive Behavior Therapy

A BRIEF HISTORY OF COGNITIVE BEHAVIOR THERAPY

SOCIOLOGY OF SCIENCE

WHAT’S NEW IN COGNITIVE BEHAVIOR THERAPY?

STAGES OF THERAPY AND PRINCIPLES OF CHANGE

WHERE DO WE GO FROM HERE?

Author Index

Subject Index

This book is printed on acid-free paper.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data

Acceptance and mindfulness in cognitive behavior therapy : understanding and applying the new therapies / edited by James D. Herbert, Evan M. Forman.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-470-47441-9 (pbk. : alk. paper); ISBN 978-0-470-91246-1 (ebk); ISBN 978-0-470-91247-8 (ebk); ISBN 978-0-470-91248-5 (ebk)
1. Mindfulness-based cognitive therapy. 2. Acceptance and commitment therapy.
I. Herbert, James D., 1962. II. Forman, Evan M.
[DNLM: 1. Cognitive Therapy–methods. WM 425.5.C6 A1694 2010]
RC489.M55A33 2010
616.89’1425–dc22
2010019064

To Lynn, Aaron, Sylvia, Elliott, and Joel (JDH)

To Emma and Eli (EMF)

Contributors

Anu Asnaani, MA
Department of Psychology
Boston University
Boston, MA

Aaron T. Beck, MD
Department of Psychiatry
University of Pennsylvania
Philadelphia, PA

Lisa A. Benson, MA
Department of Psychology
University of California at Los Angeles
Los Angeles, CA

Michael J. Bordieri, MA
Department of Psychology
University of Mississippi
Oxford, MS

Andrew Christensen, PhD
Department of Psychology
University of California at Los Angeles
Los Angeles, CA

Gerald C. Davison, PhD
Department of Psychology
University of Southern California
Los Angeles, CA

David J. A. Dozois, PhD
Department of Psychology
University of Western Ontario
London, Ontario
Canada

Samuel J. Dreeben, BA
Department of Psychological and Brain Sciences
University of Louisville
Louisville, KY

Jessica J. Flynn, MSc
Department of Psychology
Kent State University
Kent, OH

Maureen K. Flynn, MA
Department of Psychology University of Mississippi
Oxford, MS

Evan M. Forman, PhD
Department of Psychology
Drexel University, Philadelphia, PA

David M. Fresco, PhD
Department of Psychology
Kent State University
Kent, OH

Marvin R. Goldfried, PhD
Department of Psychology
Stony Brook University
Stony Brook, NY

Julia A. Glombiewski, PhD
Fachbereich Psychologie und Psychotherapie
Philipps-Universität Marburg
Marburg
Germany

Emily A. P. Haigh, PhD
Department of Psychiatry
University of Pennsylvania
Philadelphia, PA

Steven C. Hayes, PhD
Department of Psychology
University of Nevada
Reno, NV

James D. Herbert, PhD
Department of Psychology
Drexel University
Philadelphia, PA

Stefan G. Hofmann, PhD
Department of Psychology
Boston University
Boston, MA

Jonathan Kanter, PhD
Department of Psychology
University of Wisconsin-Milwaukee
Milwaukee, WI

Robert L. Leahy, PhD
American Institute for Cognitive Therapy
New York, NY

Michael Levin, MA
Department of Psychology
University of Nevada
Reno, NV

Nadia N. Lucas, BA
Department of Psychology
University of Mississippi
Oxford, MS

Christopher R. Martell, PhD
Department of Psychiatry and Behavioral Sciences
University of Washington
Seattle, WA

Meghan M. McGinn, MA
Department of Psychology
University of California at Los Angeles
Los Angeles, CA

Douglas S. Mennin, PhD
Department of Psychology
Yale University
New Haven, CT

Clive J. Robins, PhD
Department of Psychiatry and Behavioral Sciences
Duke University
Durham, NC

M. Zachary Rosenthal, PhD
Department of Psychiatry and Behavioral Sciences
Duke University, Durham, NC

Paul Salmon, PhD
Department of Psychological and Brain Sciences
University of Louisville
Louisville, KY

Alice T. Sawyer, MA
Department of Psychology
Boston University
Boston, MA

Sandra E. Sephton, PhD
Department of Psychological and Brain Sciences
University of Louisville
Louisville, KY

Regan M. Slater, BA
Department of Psychology
University of Mississippi
Oxford, MS

Adrian Wells PhD
Professor of Clinical and Experimental Psychopathology
University of Manchester
Manchester
United Kingdom

Kelly G. Wilson, PhD
Department of Psychology
University of Mississippi
Oxford, MS

Foreword

ACCEPTANCE AND MINDFULNESS IN COGNITIVE BEHAVIOR THERAPY

It seems that the acceptance and mindfulness concept has suddenly become pervasive in clinical psychology and related fields. Judging from the barrage of flyers I receive each week, it seems that one can hardly buy a psychological book these days without the terms “mindfulness” or “acceptance” in its title. This is especially true of self-help and other psychology trade books.

But the concept is increasingly found also in serious scientific articles and in convention programs, including – and especially! – those of the Association for Behavioral and Cognitive Therapies, a 45-year old organization that eschewed cognitive constructs in its earliest years, defining the field solely in terms of classical and operant conditioning. This is the behavior therapy that I cut my teeth on in the early 1960s, though even back then there were signs that equating behavior therapy with “the conditioning therapies” was unproductively constraining and not reflective of what self-identified behavior therapists actually did or even how they thought about what they did.

When I was learning behavior therapy and assessment in graduate school from Lazarus, Bandura, and Mischel, there were three kinds of reactions from nonbehavioral colleagues to the sometimes hypomanic pronouncements of the advocates of this “new wave.” The first was “You are treating symptoms, not the disorder/disease itself and therefore you are likely to do harm.” Or second, “I don’t believe your reports of efficacy and effectiveness.” Or third, coming from those who believed that the new approach had some promise, “Well, I’ve been doing ‘that’ for some time, only using different language to talk about the effectiveness of my ministrations.”

I will freely admit that my reactions to the acceptance/mindfulness trend in cognitive behavior therapy often fall into the third category. To be specific, I sometimes find myself believing that the acceptance/mindfulness rhetoric represents less a third wave or new paradigm than it does theoretical and procedural restatements of the thinking and practices of clinicians whose work spans many decades.

For example, Skinner wrote in the 1950s about countercontrol, a theme I myself developed in a 1973 Banff conference, to be greeted by (good-natured?) skepticism bordering on ridicule. And then there is the relaxation training pioneered by Jacobson in the 1920s and adapted by Wolpe and Lazarus decades later as an anti-anxiety “response” for desensitizing maladaptive fear; anyone familiar with teaching this form of self-soothing understands the need to encourage the patient to “go with” the process, accepting and not worrying about new bodily sensations and the wandering of attention. And finally, how different from one another is the tenet in acceptance-based CBT that one can behave differently while accepting inconsistent thoughts (such as “I can’t do it”), from the classic Skinnerian focus on changing overt behavior with little, if any, theoretical or procedural attention being paid to internal thoughts and feelings?

What has tended to be neglected in the midst of partisan battles between those who do and those who not see value in the acceptance/mindfulness approaches is a reasoned, scientifically grounded discourse that would help researchers and clinicians alike sort through the various claims and counter-claims. I am pleased to say that this book, skillfully conceived and edited by James Herbert and Evan Forman, provides just such a sober and open-minded appraisal of a trend that has sometimes suffered both from too much hype by its proponents and too sweeping a rejection by some orthodox cognitive (behavior) therapists who sometimes seem more interested in preserving the status quo than endeavoring to advance evidence-based psychosocial therapy both conceptually and procedurally.

You can imagine my pleasure at learning of a book project dedicated to an appraisal of the mindfulness and acceptance trends in cognitive behavior therapy. I was especially cheered knowing that the book is edited by Herbert and Forman, scholars who have taken a serious look at promising developments within the tradition of CBT without getting carried away with them. They have assembled some of the best and most creative thinkers on the topic in this lively and engaging volume.

The book begins with an introductory chapter by Herbert and Forman that reviews the explosive increase in interest in the concepts of psychological acceptance and mindfulness within CBT. The editors nicely lay out various clinical and theoretical questions that these developments raise and the conflicts that they have provoked within the field. Although clearly sympathetic to these new developments, the editors are careful not to take sides in these debates, leaving the subsequent chapters to speak for themselves.

What follows are a series of chapters on the major contemporary models of CBT. Although traditional perspectives such as cognitive therapy are represented, the focus is primarily on the various novel acceptance-based models. These chapters are written by the leading experts on each model. Each chapter not only describes the model in question but focuses on how it addresses key questions, including the role of direct cognitive change strategies, the role of mindfulness and acceptance, and the scientific status of both its clinical outcomes and theoretical processes.

The second section of the book consists of three chapters that take a broader, more integrative perspective on the various issues raised by the earlier chapters. The first, by proponents of traditional cognitive therapy, addresses these developments from that perspective. The second, by proponents of acceptance-based therapy, likewise provides an analysis from that point of view. Finally, my friend and colleague Marv Goldfried sums up and analyzes the dialogue with insights as a pioneering cognitive behavior therapist that sees values in ideas and practices that go beyond even expanded definitions of CBT.

Is the mindfulness and acceptance trend just old wine in new bottles? If you believe this to be the case, consider that the container that wine sits in can affect the experience of the drink. There’s a reason one wouldn’t imbibe an Opus One red wine directly from the bottle.

Gerald C. Davison, PhD
University of Southern California