______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
Second-wave CBT, focused on the work of Aaron Beck’s cognitive therapy and Albert Ellis’s rational emotive behavior therapy (Ellis & Joffe-Ellis, 2019), extended the goal of behavior change to include mental processing, including cognitive errors and irrational thoughts as mediating factors between first wave’s stimulus and response. Second-wave psychotherapies integrated learning and conditioning paradigms to include restricting or changing thoughts and behaviors by examining and challenging thought patterns, filters, distortions, and auto- matic thoughts and their impact on automatic physiological reactions (Stamp, 2019), with the model of cognitive change 🡪 relieving emotional intensity 🡪 emotional relief (Solkol & Fox, 2019). As we moved from the goal of feeling “good” or eradicat- ing discomfort (e.g., decreasing fear), in the second wave, we moved toward a different relationship to feelings in the third wave. Instead of eradicating or decreasing the emotion of, for example, fear, we change our experience of and relationship with noticing and feeling fear. (“Behavioral Therapies,” 2022). Starting in the 1990s and extending through the new millen- nium, the third wave of cognitive behavioral therapies shifted from the goal of changing, controlling, and eliminating feelings or behaviors to process-based functional analysis, which is a more contextual, holistic, skills- or values-based approach that focus on life goals, quality of life, and functioning (Hayes & Hofmann, 2021). Instead of “fighting” symptoms, third-wave CBT seek to change the relationship to symptoms by bringing experiencing internal sensations such as thoughts, feelings, and urges (“Behavioral Therapies, 2022). Holism in third-wave CBT views the entirety as the unique human experience (physical, psychological, spiritual) as interconnected and greater than the sum of their parts. Rather than treating maladaptive thoughts or behaviors as in first and second wave CBTs, third-wave CBTs are more client-centered, empowering, and honoring the client’s journey in striving toward a satisfying and healthy emotional, physical, and spiritual life, based upon their indi- vidual values (Stamp, 2019). The focus of psychotherapy is frequently on the person and not the symptom or situation. Some third-wave psychotherapies incorporate Eastern concepts and spiritual teachings by including present-focused experience and awareness of thoughts, feelings, and sensations as unidenti- fied observations (Hayes & Hofmann, 2021) Third-Wave Cognitive-Behaviorally Based Therapies Although there are no strict inclusionary or exclusionary criteria for third-wave CBT, many third-wave CBT psychothera- peutic approaches have integrated concepts such as values, mindfulness, acceptance, and metacognition onto a founda- tion of second-wave CBT. Major third-wave psychotherapies include the following (Merwin et al., 2019; Stamp, 2019): • Mindfulness-Based Cognitive Therapy (MBCT) • Mindfulness-Based Stress Reduction (MBSR) • Acceptance and Commitment Therapy (ACT) • Schema Therapy
• Client feedback • Client perceptions of therapy and therapist • Therapist reactions • Structure and pace of therapy sessions • Degree to which the client has been socialized to cognitive therapy (e.g., goal setting, expectations, problem-solving, the cognitive model, and homework) • Identifying/selecting/responding to and modifying automatic thoughts • Objectives • Areas of focus • Interventions • The client’s processing of the therapy content (J. S. Beck, 2020)
Self-Assessment Question
3. Silas has been seeing a cognitive-behavior therapist for six sessions for treatment of depression, life stressors, perfectionism, and lack of motivation. During the sessions he is engaged, eager, and commits to doing homework, but he has not once completed his homework. As his therapist, what would you do? A) Terminate with the client due to non-adherence. The client is not motivated. B) Keep assigning homework. Silas says he wants the homework and will do it. Eventually he will. C) Revisit your case formulation and see if the non-completion of homework is related to case conceptualization and then discuss with Silas. D) Discuss how his perfectionist thoughts are interfering with his compliance. Three Waves of Cognitive-Behaviorally Based Therapies As we’ve discussed, first-wave, or “classical,” CBT has been the foundation of psychotherapy evolution from the 1960s through today. First-wave CBT, likely in reaction to Sigmund Freud’s hypothetical psychoanalytic theories and therapies, is based primarily on empirically verifiable Skinnerian behavioral principles of learning and conditioning, notably operant learn- ing and classical conditioning. First-wave behavioral therapy focuses on stimulus-response or identifying and decreasing the intensity of the relationship between stimulus (e.g., pub- lic speaking, intense relationships, spiders) and the person’s behavioral or emotional response (e.g., avoidance, anger, shame, anxiety, fear) through behavioral techniques such as exposure, shaping, systematic desensitization, among others (“Behavioral Therapies,” 2022).
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