Third-wave Therapies Research Articles

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

Honoring the Past and Looking to the Future: Updates on Seminal Behavior Therapy Publications on Current Therapies and Future Directions

This is the introduction to the second of two special issues in honor of the 50th anniversary of the Association for Behavioral and Cognitive Therapies. The goal of this issue is to pay tribute to prior seminal Behavior Therapy publications on current therapies and future directions, to provide an updated review of important topics covered by these papers, and to make recommendations for the future. Each invited paper in this issue highlights a particular Behavior Therapy publication’s contribution to our understanding and also provides an updated review or meta-analysis on the topic of the original paper. The topics covered here include review papers on current therapies such as cognitive and behavioral therapies, youth and family psychotherapy, unified protocols, and third-wave therapies. In addition, we include a review paper on implementation science, and meta-analyses on individualized psychotherapy, and culturally adapted interventions. With the two 50th anniversary issues of Behavior Therapy, we hope to inspire additional research and discussion.

A randomised wait-list controlled clinical trial of the effects of acceptance and commitment therapy in patients with type 1 diabetes: a study protocol.

BackgroundIn order to manage the acute and long-term effects of living with a chronic disease such as diabetes, both medical treatment and good psychosocial support are needed. In this study, we wish to examine whether a psychological group intervention targeting people with poorly controlled type 1 diabetes can be helpful in augmenting quality of life while also lowering participants’ HbA1c level. The group intervention will consist of a brief treatment developed from a branch of cognitive behavioural therapy called acceptance and commitment therapy, which is part of the so-called third wave of cognitive behavioural therapy. Common for these third-wave therapies, the focus is less on the content and restructuring of thoughts and more on the function of behaviour. Here, we describe the protocol and plans for study enrolment.Methods/DesignThis on-going study is designed as a randomised wait-list controlled trial. Eighty patients aged 26–55 years and with an HbA1c level >70 mmol/mol at the time of enrolment will be included.DiscussionIn this study, we will assess the effect of starting acceptance and commitment therapy group treatment for patients with type 1 diabetes and its effect on glycaemic control and well-being.Trial registrationCurrent controlled trials: ISRCTN17006837, registered 12th January 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0101-y) contains supplementary material, which is available to authorized users.

Third-Wave Therapies for Insomnia

The development of psychological and behavioral therapies over the past several decades has led to what is termed the third wave of psychotherapy, a collection of treatments that adopt a new approach to maladaptive cognitions and target broad, contextualistic goals. Within the field of behavioral sleep medicine, treatments for insomnia have followed a similar evolution, and several emerging therapies, including mindfulness and acceptance-based therapies, have begun to accumulate evidence as effective treatments for this sleep disorder over the past several decades. This paper discusses the historical background of the third wave of psychotherapy, introduces each of the third-wave therapies that have been applied to the treatment of insomnia, and reviews the recent literature to critique the effectiveness of these treatments. Relevant controversies with the third-wave therapies are discussed to inform future directions in insomnia research.

Integrative Behavioral Couple Therapy (IBCT) as a third-wave therapy.

This article presents a description of the Integrative Behavioral Couple Therapy (IBCT), and puts forwards its contributions, its techniques and progress, the research data on its usefulness compared to traditional behavioral couple therapy, and explains basically its articulation in third-wave behavior therapies using the concepts of functionality, rule-governed/contingency-shaped behavior and acceptance. A theoretical review of the main IBCT bibliography was carried out. The review shows that this intervention model includes innovative intervention strategies (to promote acceptance and tolerance) that join the already well-known behavioral couple therapy techniques (behavior exchange, communication training and couple problem solving), substantially modifying the therapy. Furthermore, it incorporates useful orientation for especially difficult problems in couples (such as infidelity and substance use, abuse and dependence situations). After this analysis, IBCT is revealed as a new intervention, the scope of which is still spreading among professionals. The acceptance concept, one of the core elements of third-wave therapies, has been fruitfully included in behavioral couple therapy through the IBCT.

Activation comportementale et dépression : une approche de traitement contextuelle

Depression is a widespread psychological disorder that affects approximately one in five North American. Typical reactions to depression include inactivity, isolation, and rumination. Several treatments and psychological interventions have emerged to address this problematic. Cognitive behavioural therapies have received increasingly large amounts of empirical support. A sub-component of cognitive behavioural therapy, behavioural activation, has been shown to in itself effectively treat symptoms of depression. This intervention involves efforts to re-activate the depressed client by having them engage in pleasant, gratifying, leisure, social, or physical activities, thereby counteracting the tendency to be inactive and to isolate oneself. Clients are guided through the process of establishing a list of potentially rewarding social, leisure, mastery-oriented or physical activities, to then establish a gradual hierarchy of objectives to be accomplished over the span of several weeks. Concrete action plans are devised, and solutions to potential obstacles are elaborated. The client is the asked to execute the targeted objective and to record their mood prior to and following the activity. Behavioural activation effectively reverses the downward spiral to depression. Interestingly, studies show that behavioural activation has a positive effect on cognitive activities. It has been shown to reduce rumination and favour cognitive restructuring, without requiring cognitively-based interventions. The advantage of this treatment is therefore that it is simpler to administer in comparison to full-packaged cognitive behavioural therapies, it requires a lesser number of sessions and can be disseminated in a low-intensity format. This article begins by summarizing the origins of the behavioural model of depression, which serves as a basis to the understanding of behavioural activation. This is followed by a detailed explanation of the different phases involved in a behavioural activation intervention. Empirical support for behavioural activation is then presented in regards to depression as well as comorbid physical and psychological health problems. The results of meta-analyses and randomized controlled trials are presented. Behavioural activation is then discussed within the framework of third-wave therapies, discussing the potential role of mindfulness in behavioural activation objectives. Specifically, it is suggested that mindfulness, although not necessarily directly addressed in behavioural activation interventions, is an integral part of this intervention as clients are asked to record their mood and activities and to become cognizant of the relationship between their symptoms of depression and the participation in activities that provide positive reinforcement. This favours self-awareness and allows clients to realize the impact of their actions on their physical and psychological states. In engaging in self-observation and self-recording, and in participating in a variety of tasks and activities, clients are indirectly encouraged to focus on the here and now rather that to succumb to the depressive tendency that is to ruminate. Suggestions are made as to how therapists can include mindfulness-based activities in the behavioural activation hierarchy. It is hypothesized that, due to the calming effect of mindfulness practices on the nervous system, incorporating mindfulness-based activities-such as yoga, tai chi, Qi Gong, or meditation-could for some people enhance the efficacy of behavioural activation interventions and foster a greater sense of well-being. The article concludes by discussing issues that should be addressed in future research. It is suggested that future studies on behavioural activation explore the impacts of incorporating mindfulness-based activities in the behavioural activation hierarchy in comparison to a traditional hierarchy limited to the accomplishment of gratifying or mastery-oriented tasks, social outings, leisure activities and physical activity.

A functional analytic approach to group psychotherapy.

More than two decades ago, Kohlenberg and Tsai (1987) published the first book chapter on Functional Analytic Psychotherapy (FAP), an approach to psychotherapy that is based on the functional analysis of the therapist-client relationship in the individual talk therapy setting. Over time, FAP has consolidated its place among third wave behavior therapies. Third-wave behavior therapy is a strand of treatments that builds upon many of the acquisitions of first-wave (exposure-based) classical behavior therapy and second- wave (based on modifying thoughts and beliefs) cognitive behavior therapy, but differs from them in its distrust of verbal control and its focus on contextual meaning. These differentials give the third-wave behavior therapies an experiential flavor which is strongly evident in FAP. Relying on a client case conceptualization, the FAP therapist observes clinically relevant behavior when it occurs in-session. When it does not occur, he or she evokes it. The curative process depends on the therapist's allowing natural, direct consequences to affect these clinically relevant behaviors in-session. In addition, the therapist monitors and when necessary, promotes generalization. These tasks are interwoven to produce FAP's approach to the healing potential of a relationship. While FAP was developed mainly as an approach to individual psychotherapy, there have been translations into group therapy (e.g. Gaynor & Lawrence, 2002; Hoekstra & Tsai, in press). The present paper presents one such translation. It suggests that, when properly understood, FAP necessarily leads to a type of group therapy that is pragmatically quite different from traditional behavioral group therapy. How could we describe this difference? Since its early days, behavioral group therapy has been distinguished by its teaching technology, including training activities and streamlined learning modules (e.g. Rose, 1977). Group therapies in the cognitive mainstream of behavior therapy (e.g. Free, 1999; Bieling, McCabe & Antony, 2006) tend to maintain this characteristic, through activities such as lectures and structured exercises. Even when, for example, exposure for social phobia is done in-session, the programmed teaching focus is maintained (Becker & Heimberg, 2002). When we apply FAP to the group setting, however, it comes much closer to Group Psychotherapy, which has often focused on unexpected experiences and outcomes (Yalom, 1975; Rutan & Stone, 1984). However, group FAP is not a compromise between these two traditions. The combination of a flexible focus on spontaneously evolving interactions with a functional contextual approach to the healing nature of relationships adds a new dimension to group therapy. The aim of the present article is to discuss how this dimension works. For that purpose, personal experiences in supervising FAP in group therapy will be described. These groups functioned as free-of-charge services for socially disadvantaged patients. First, some points of inspiration for conceptualizing the work in the groups will be presented. Then, it will be described in an informal way how a group can be transformed into a network of healing relationships. It will be shown how this can be done on different levels of analysis, namely that of long-term strategy, of in-session tactics and of moment-to-moment technique. Finally, the transformation of unplanned events into in-vivo learning opportunities will be illustrated with a series of short examples. The chronic pain group experience Our first group, described by Vandenberghe, Cruz and Ferro (2003) was formed at the initiative of the two latter authors with the intention of helping people referred from a nearby pain center. These were patients who did not respond to medical treatment for chronic orofacial pain. The group started in August 2001 as the first in what would become a long series of FAP groups for chronic pain (e.g. Vandenberghe, Ferro & Cruz, 2003; Vandenberghe & Ferro, 2005; Martins-Queiroz & Vandenberghe, 2006). …