Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
sensations related to that thought in their body? How does one notice the habits of thought in the mind that drive patterns of thought? So, in addition to restricting a thought such as, “I cannot make a mistake or I am a failure,” the therapist might encourage the client to notice and feel the fear, the shame, and the anger. Encourage them to lean in, experience, learn to tolerate the sensations, and change their relationship to the impermanence of these thoughts and sensations. Or, through mindfulness practice, a client develops insight that their irra- tional thoughts are untrue (or previously true but currently unhelpful) “distractions” that drive anxious sensations and interfere with true intimacy in relationships. Many third-wave approaches utilize work with cognitions as a necessary but not sufficient component. COGNITIVE-BEHAVIORAL THERAPY 2020 AND BEYOND The COVID-19 pandemic offered an increased need for CBT and cognitively based psychotherapies. In addition to the virus, COVID-19 produced an “infodemic,” the proliferation of irrational beliefs about COVID-19 created by false and misleading information regarding scientific communities, governments, and other institutions (Magarini et al., 2021). Not just for extremists and those who experience paranoia, conspiracy theories were found to be more likely in those who are younger, with lower level of education, attitudes such as low levels of epistemic trust, avoidance of uncertainty, collective narcissism, extraversion, conspiracy-prone mindset, and higher levels of self-reported risk and anxiety (Magarini et al., 2021). Lockdown, masking, hand-washing–necessary to prevent wide- spread infection–potentially exacerbated anxiety in vulnerable people by focusing on “cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior” (Shafran et al., 2021). COVID-19, with the increased needs for mental health treat- ment in a safe and socially distanced format, provided fodder for the growth of virtual delivery and technologically supported CBT. COVID-19 dramatically changed the role of technology in the personal and professional lives of many people, includ- ing the tremendous increase in the use of telemedicine (Mann et al., 2020), mental health apps (Basu, 2020), and increased demand for online mental health services (Titov et al., 2020). Research trends shifted from how CBT is helpful to exploring and expanding research on safe alternative delivery options for a wide array of mental health concerns. The opportunity that COVID-19 presented challenged clinicians and researchers to research, develop, and disseminate remote treatment, techno- logical supported treatment, applications, peer support, and self-guided treatment. COVID Digital Treatment Plan Fear, false and misleading information, economic strife, and bona fide health risks during COVID-19 were fodder for con- spiracy theories, collective narcissism, distrust, and irrational thoughts (Magarini et al., 2021; Leonhardt, 2021; Jaworsky, 2021). These irrational thoughts resulted in an array of both
• Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
• Compassion Focused Therapy (CFT) • Dialectical Behavior Therapy (DBT) • Functional Analytic Psychotherapy (FAP) • Behaviora l Activation (BA) (Hayes & Hofmann, 2021) These are intended “not as protocols for treating syndromes, but as ways of targeting an expanded range of processes of change. Five key features of third-wave therapies are underlined: a focus on context and function; the view that new models and methods should build on other strands of CBT; a focus on broad and flexible repertoires versus an approach to signs and symptoms; applying processes to the clinician, not just the client; and expanding into more complex issues histori- cally more characteristic of humanistic, existential, analytic, or system-oriented approaches. We argue that these newer methods can be considered in the context of an idiographic approach to process-based functional analysis. Psychological processes of change can be organized into six dimensions: cog- nition, affect, attention, self, motivation, and overt behavior. Several important processes of change combine two or more of these dimensions. Tailoring intervention strategies to target the appropriate processes in each individual would be a major advance in psychiatry and an important step toward precision mental health care.” (Hayes & Hofman, 2021, p. 363). Although building upon previous work and highlighting different goals (behavior, thoughts, quality of life), all these new practices are based upon the principle that “internal processes affect external situations, which, once changed or affected, sometimes result in a change in one’s internal state.” In other words, “how we think and feel about what happens to us impacts us much or even more than those external events themselves” (Stamp, 2019). Research supports the efficacy of third-wave CBTs, though additional research is indicated in the treatment of substance use disorders (SUDs) [Balandeh et al., 2021] and post-traumatic stress symptoms (Benfer et al., 2021). A simplified version of aerophobia allows us to examine each wave’s interrelationship and inherent strengths (See Table 1). Waves two and three certainly subsume principles of earlier waves into their foundation and differences among waves pro- vide clinicians flexibility to match therapeutic interventions to both the presenting issue and needs of the client. In this simplified example, perhaps the best therapeutic approach for the client in your office would be a third-wave approach that incorporates both mindfulness and values-based goals on the foundation of rehearsal and systematic desensitization. Although first- and second-wave cognitive therapies remain focused on cognitions, third-wave therapies utilize a “both-and” approach. In addition to the cognitions and ways cognitive therapists would assess and challenge, how does one feel the
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