The evolution of cognitive behavioural therapy – The third generation and its effectiveness

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

Psychological treatments targeting suicidal behavior disorder (SBD) have been evaluated here in their efficacy through different diagnoses. In particular, transference-focused psychotherapy (TFP), mentalization-based treatment (MBT), interpersonal psychotherapy (IPT), dialectical behavior therapy (DBT), schema-focused therapy (SFT), mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR), acceptance and commitment therapy (ACT), and cognitive behavior therapy (CBT) were the main structured treatments considered here in association with their impact on SBD. Some of them showed higher efficacy in suicide (DBT and MBT). Moreover, some treatments have been primarily studied in a specific diagnosis: TFP, MBT, DBT, and SFT in borderline personality disorder and IPT and CBT in depression. Concerning new treatments, promising preliminary results have been reported (SFT, MBCT, MBSR, and ACT) as well. Summarizing, consistent reduction in suicidal and self-destructive phenomena through psychotherapeutic treatments has been found throughout methodologically heterogeneous trials, in particular focused on DBT and MBT. In conclusion, two movies by the Italian documentarist/director Alina Marazzi have been illustrated in their connection with SBD.

1 - Overview of Mindfulness-and Acceptance-Based Treatment Approaches

Integrating CBT and Third Wave Therapies: Distinctive Features

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Economic Impact of Third-Wave Cognitive Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials

서양의 의료학계나 심리학계에서는 불교의 명상 수행법을 심리치료에 활용하려는 추세가 확산되고 있다. 중생의 고통 해결을 목표로 하는 붓다의 가르침과 현대인이 당면하고 있는 질병의 문제를 다루고 있는 의료계의 만남의 결과로 불교의 명상을 활용한 심신치유프로그램이 다양하게 개발되고 있다. 서양에서 비파사나 명상이 의료 현장에서 공식적인 치유 프로그램으로 정착하게 된 계기는 존 카밧-진의 MBSR 프로그램이 개발되면서 부터이다. MBSR의 직간접 영향 아래에서 MBCT (Mindfulness-Based Cognitive Therapy, 알아차림명상에 기초한 인지치료), DBT(Dialectical Behaviour Therapy, 변증법적 행동치유), ACT(Acceptance and Commitment Therapy, 수용과 전념치료) 등이 속속 개발되고 있다. 불교 명상은 우울증, 불안장애, 공황장애, 주의력 결핍, 공포증과 같은 신경증적 질병을 치유하는 데 효능을 보이고 있다는 연구가 다수를 차지하고 있다. 명상이 정신적인 스트레스 해독제를 넘어 육체적인 질환인 고혈압, 심장병, 통증 완화, 면역력 향상, 항암 효과 등 각종 질병에 대한 치료에도 효과적임을 보여주는 연구가 주류를 이루고 있다. 불교명상이 각종 질병을 비롯한 정신치유에 도움이 되고 심리치료에도 도움이 되지만 불교 명상의 본질이 지혜 개발을 통한 열반의 성취에 있다는 것을 명심해야 할 것이다. 불교를 정신건강기법이나 치료법로써 임상심리학의 범주에 한정하는 위험에 빠져서는 안된다. 불교 명상이 심리치료에 효과적이지만 명상 본래의 기능과 목적에서 벗어나는 것은 전통적인 불교의 입장에선 우려할만한 사항이다.Buddhist meditation-based approaches have been the subject of increasing research interest. In recent years, meditation has been the subject of controlled clinical research. Mental disorders or disease relating to stress are widely spread among people of the modern age. Buddhist meditation is utilized in hospital setting to cope with illness or discomfort. Some research has suggested that therapy incorporating Buddhist meditation might help people with anxiety, depression, and psychological distress associated with chronic illness. Mindfulness-based stress reduction (MBSR) is a Buddhist mindfulness-based program designed initially to assist people with pain and a range of health conditions that were difficult to treat in a hospital setting, using Buddhist mindfulness meditation. Since MBSR is developed, clinical application of Buddhist meditation are followed as MBCT (Mindfulness-Based Cognitive Therapy), DBT(Dialectical Behaviour Therapy), ACT(Acceptance and Commitment Therapy). Buddhist meditation may help with symptom relief and improve quality of life, there is no evidence it helps cure disease. While Buddhist meditation-based therapy such as MBSR has its roots in spiritual teachings, the program itself is secular. We are to keep in mind the original function and nature of Buddhist meditation, which is to develop wisdom to attain Nirvana, not to cure discomfort, physical or mental.

Purpose Multiple sclerosis (MS) is a chronic condition linked to a wide range of psychological difficulties. While traditional cognitive behavioural therapy has been studied extensively with people with MS, much less is known about more recent “third wave” approaches. Methods A scoping review was carried out by performing a systematic search across MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to January 2022. Results From an initial return of 8306 citations, 35 studies were included, 20 of which were randomised controlled trials (RCTs). These showed that four third wave approaches have been investigated with people with MS to date: acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and MBCT may be helpful to address a range of psychological difficulties up to three months post-intervention. However, MS-specific adaptations may be required, and more evidence is needed on longer-term effectiveness. Limited evidence is also available for DBT and ACT, but additional research is warranted before any recommendation can be made. Conclusions As third wave approaches keep being refined, further more rigorous investigations are needed to implement them to the benefit of people with MS. Implications for Rehabilitation Multiple sclerosis is linked to a wide range of psychological difficulties in adults. Little is currently known on third wave psychotherapies for people with MS. Mindfulness-based stress reduction and mindfulness-based cognitive therapy may be helpful to address a wide range of difficulties in MS. Specific adaptations may be needed to deliver suitable therapies to people with MS. Additional research is warranted to build on preliminary findings for DBT and ACT.

The application and adoption of four ‘third wave’ psychotherapies for mental health difficulties and aggression within correctional and forensic settings: A systematic review

The rationale for undertaking this review was to investigate a potential strategy to address the rising prevalence of child and adolescent mental health disorders. The central tenants of mindful parenting appear to be emotional awareness, emotional regulation, attention regulation, intentionality and non-judgmental acceptance. The primary objective of this review was to systematically evaluate the effectiveness of mindful parenting programs in promoting children's, adolescents' and parents' wellbeing, particularly in relation to the intensity of symptoms associated with internalizing (depression, anxiety, stress) and externalizing (conduct) disorders. The secondary objective was to evaluate how effective mindful parenting programs are in improving emotional regulation, attention regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents. Children aged between 0 and 18 years and their parents who have completed a mindful parenting program were the focus of this review. Mindful parenting programs included in this review had a minimum duration of one to two hours per week for 6 to 8 weeks, delivered in a group format, by a facilitator with appropriate training. It included parenting programs that drew upon mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based cognitive behavior therapy, dialectical behavior therapy or acceptance commitment therapy. The comparator was the control or waitlist conditions. This review focused on randomized controlled trials evaluating the effectiveness of mindful parenting programs. Primary outcomes were wellbeing or intensity of symptoms associated with internalizing disorders (depression, anxiety, stress) and externalizing disorders (conduct disorders) in children, adolescents and parents. Secondary outcomes were emotional regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents. Eight databases were searched for studies evaluating mindful parenting programs from 1997 to November 2014. A three-step search strategy was utilized to retrieve both published and unpublished studies written in English from PubMed, PsycINFO, EMBASE, Scopus, Psychological and Behavioral Sciences Collection, CINAHL, Cochrane Library and ProQuest Dissertations and Theses databases. A logic grid was developed for each of the eight databases to identify the indexing terms and synonyms for the keywords "mindful" and "parenting". Methodological limitations included small sample sizes leading to lack of statistical power, multiple testing leading to increased alpha errors in addition to information bias caused by a lack of blinding in the implementation and assessment phase. The data extraction process entailed using the standardized data extraction form from Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument to extract data from the selected studies. The heterogeneity of the samples, the measurement tools and outcomes measured precluded data synthesis through meta-analysis. Conclusions on intervention effects were based on comparisons of the overall statistical significance of the outcomes data. The search yielded 1232 articles, from which seven randomized controlled trials met the inclusion criteria. The findings indicate mindful parenting programs may reduce parental stress, increase parents' emotional awareness of their 10-14-year-old children and reduce preschool children's symptoms associated with externalizing disorders. A recurring finding was that the mindful parenting programs reduced parents' emotional dismissal of their adolescents and preschoolers. At present, there is insufficient evidence to conclude that mindful parenting programs can improve parents' and children's wellbeing because of the methodological quality of the few studies that met the inclusion criteria. Although there is currently insufficient evidence, mindful parenting programs are increasingly used in a variety of contexts. It may not be appropriate for psychotic or severely traumatized individuals. Future studies could make a significant contribution to the field by designing studies with sufficient sample sizes, adequate statistical power as well as blinding participants, facilitators and assessors.

The effectiveness of Mindful Parenting programs in promoting parents' and children's wellbeing: a systematic review protocol

Mindfulness-based interventions for women victims of interpersonal violence: A systematic review

This study aimed to compare dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT) and mindfulness based stress reduction (MBSR) effects on irritable bowel syndrome (IBS) symptoms, quality of life (QOL), anxiety and depression among patients with IBS. Eighty three eligible patients with a Rome- IV diagnosis were randomly allocated in DBT, MBSR, ACT, and control groups (n = 22 per group). All the patients were evaluated for IBS symptoms by IBS Severity Scoring System (IBS-SSS), QOL by irritable bowel syndrome quality of life (IBS-QOL), anxiety by Beck's Anxiety Inventory (BAI) and depression by Beck Depression Inventory- II (BDI-II) on the studied groups at the time of their inclusion in the study and 8 weeks after it. Each of the intervention groups took part in 8 group sessions. Conversely, the control group were evaluated without any intervention. 54 male and 29 female in 4 groups completed the study: DBT (n = 20), MBSR (n = 19), ACT (n = 22), and control groups (n = 22). The results showed significant differences between the groups based on the variables of the IBS-SSS, IBS-QOL, BAI and BDI-II (p < 0.05). Furthermore, the ACT intervention had considerably lower levels of IBS symptoms, anxiety, and depression compared to the other groups; also, the significant impacts of the QOL variable showed the higher scores of the ACT compared to the treatment groups. The therapies could not be applied to other groups of people. Other shortcomings were the absence of a follow-up strategy. This research offers preliminary evidence that ACT is more successful than other therapy groups in reducing IBS symptoms, anxiety and sadness, and improving QOL in IBS patients.

As so-called third wave therapies, Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT), alongside with Mode Deactivation Therapy (MDT), are derivatives of Cognitive Behavioral Therapy (CBT). (Classical behavioral therapies are referred to as the first wave, and classical cognitive therapies as the second wave.) Currently these three types of therapy have been showing an increased amount of success with adolescent youth who have been suffering from disorders such as Conduct Disorder, post-traumatic stress symptomology, and other mood disorders (Apsche, DiMeo, & Kohlenberg, 2012; Apsche, Bass, & Backlund, 2012; Powers, Vording, & Emmelkamp, 2009). Dialectical Behavior Therapy DBT was developed in 1993 by Prof. Marsha Linehan, who wanted to adapt CBT when she recognized the shortcomings of the approach with her borderline personality disordered patients (Bayles, Blossom, & Apsche, 2014). The main objective was to accommodate those specific characteristics such as extreme emotional reactivity and high sensitivity to vulnerabilities like perceived rejection. DBT uses a variation of CBT that teaches the patient specific skills they will need to cope with stress, and to help in regulating their emotions (Apsche, 2010). Since then, it has been shown to be useful for treating a wide variety of presenting issues, including suicidal behaviors, substance abuse, eating disorders, and depression (Murphy & Siv, 2012; Dimeff & Koerner, 2007). The main goal of DBT is to teach the individual the skills that they will need to cope with stress (Apsche & DiMeo, 2012). This gives them tools that they will need to change their current negative coping mechanisms into positive ones that will help them to regulate their emotions and improve relationships with others around them (Apsche, 2010). It will then teach the individual the skills that are needed to cope in a positive manner to stress, regulate their emotions, and to help them improve relationships with other such as for adolescents their parents and other family members. There are four key components that make DBT successful; (a) cognitive behavioral theoretical framework, (b) validation, (c) dialectics, and (d) radical acceptance (Bayles, Blossom, & Apsche, 2014). DBT uses dialectics which applies the concept that everything is made up of opposites and the change that happens is when one opposing force is stronger than the other. This has three basic assumptions, first being; all things are interconnected. Second, change is constant and inevitable. Third, the opposites can be integrated to form a closer approximation (Apsche, 2010; Murphy & Siv; 2012, Apsche, DiMeo, & Kohlenberg, 2012). Today DBT is mainly used with individuals who present strong urges to harm themselves and or who have self-destructive behavior (Apsche, DiMeo, & Kohlenberg, 2012). This is one reason why this has been successful in adolescents, particularly young males. DBT also encourages acceptance and change. The acceptance is unconditional and change is brought about through the direct change of thoughts in a positive manner (Apsche, DiMeo, & Kohlenberg, 2012). DBT has been shown to improve behavior in three strong areas that disordered adolescents typically need help in improving: (a) lack of the needed behavioral coping skills, (b) accepting reality as it is, and (c) maintaining strong commitment to change (Arch, Eifert, Davies, Vilardaga, Rose, & Craske, 2012). DBT gives skills that are needed to become productive members of the outside community in which the individuals live in and helps them to gain a positive perspective on value and acceptance of their personal struggles, and enhances them for positive change (Apsche, Siv, & Matteson, 2005). A downfall to applying CBT elements in the DBT methodology is that since its nature is to constantly challenge the emotions of the individuals it is making it hard for them to accept their beliefs as real and reasonable. …

Mindfulness-Based Interventions (MBIs) are nonpharmacological interventions that show promise for the treatment of a number of mental health conditions. This chapter describes several MBIs, specifically Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) and the research that supports the efficacy of these interventions in the treatment of psychiatric disorders. MBSR and MBCT have been shown to be effective in the treatment of anxiety and depression. DBT has been shown to be effective in the treatment of borderline personality disorder and ACT effective in the treatment of obsessive-compulsive disorder. New MBIs are being developed to work specifically with populations suffering with posttraumatic stress disorder, eating disorders, addictions, and attention deficit hyperactivity disorder. Current research on neural mechanisms associated with mindfulness training and its benefits are demonstrating structural and functional changes in the brain.