Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies

In recent post, I wrote about how Dr. Steven Hayes coined the term "third wave" to describe the recent crop of mindfulness and acceptance-based treatments. In a new paper, Dr. Hayes and his colleagues at the University of Nevada-Reno explore this notion further.

The article examines the theoretical underpinnings of the current generation of mindfulness and acceptance-based psychotherapies, and at the published empirical data supporting the theory. This article provides a fantastic overview of the current state and development of many of these treatments.

Towards the end of article, Hayes and colleagues suggest abandoning the term "third wave" in favor of what they call "contextual cognitive behavioral therapy" or contextual CBT. According to the authors, contextual CBT differs from traditional CBT in several important ways:

1. Contextual CBT emphasizes changing the context and function of psychological events (e.g., thoughts, emotions, physical sensation) rather than the content, accuracy, and frequency. For example, a contextual CBT therapist is more interest in changing how someone relates to self-critical thinking than in changing the thoughts themselves.

2. Contextual CBT focuses more on what the authors call a "transdiagnostic approach to mental health." What this means is that, rather than treat specific diagnoses (e.g., generalized anxiety disorder), contextual CBT therapists focus more on processes (e.g., emotion regulation).

3. Contexutal CBT therapists are encouraged to apply these methods to themselves. For example, leaders of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy groups are encouraged--even required--to maintain their own mindfulness practices.

4. Contextual CBT is less about throwing away techinques and interventions from other treatments than in taking what is useful and applying it in ways that are consistent with the theories underlying contextual CBT.

5. In their final distinction, the authors suggest contextual CBT is being applied to a much broader and deeper range of problems within the human conditions, such as spirituality and values. (The authors admit that this point is more of a "judgment call" than an accepted fact.)

I highly recommend this article for readers of Scientific Mindfulness. It's a great review article for much of what we write about in this blog.

To download a copy of the article, click on the full citation below:

Hayes, S.C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies. Annual Review of Clinical Psychology, 7, 141-168.

The Strange Powers of the Placebo Effect

This video isn't about mindfulness specifically, but I think it's a wonderful illustration of one of the reasons why scientific research is so important. Without controlled studies, it's hard to discern active treatments from placebo because placebo by itself can an effective treatment. It's important to assess whether treatments work for the reasons we think they work; otherwise, we can become lost in a sea of pseudoscientific cures. (If you're interested, click here for a blog post I did about pseudoscience in psychotherapy.)

In Memory of Alan Marlatt's Passing

For those of you who haven't heard, University of Washington professor and researcher Dr. G. Alan Marlatt passed away from melanoma on Monday (3/14/2011). He was 69. My understanding is that the diagnosis was unexpected, and Dr. Marlatt was told he had only days left to live. By report, he passed away in the company of his family.

I've previously talked about Dr. Marlatt's work with Mindfulness-Based Relapse Prevention here in Scientific Mindfulness. Dr. Marlatt has a 30-year history practicing mindfulness and meditation. He started by with Transcendental Meditation hoping it would help lower his blood pressure (it did), and eventually began exploring different Buddhist meditative traditions.

Even if Dr. Marlatt had never incorporated mindfulness into his research, he would be well-known for his other contributions to the study of addictions and substance abuse. He is well-known for his work on harm reduction: the notion that some people who don't want to give up alcohol entirely may learn to drink moderately. He made significant contributions towards understanding relapse.

I had a few brushes with Alan in my career. Early on in my graduate studies, I emailed him a question about problems with alcohol abuse in Buddhist teachers. Not only did he respond, but he suggested we talk about by phone! He was extremely kind and supportive during our brief chat. A year or two later, he was the discussant at a symposium I participated in. I introduced myself again but felt too shy to make an effort at engaging him, as there were others calling for his attention. Everyone I've spoken with about Alan has commented on his kindness and gentleness, an impression I shared.

Alan Marlatt will be missed. We've lost an exceptional researcher, a great contributor towards understanding mindfulness and acceptance-based treatments, and a wonderful man.

Time has a brief article on Dr. Marlatt. To check it out, click here.

For those interested in knowing more about him, Dr. Marlatt wrote a very touching portrait of his history with mindfuless that's worth tracking down:

Marlatt, G. A. (2006). Mindfulness Meditation: Reflections from a Personal Journey. Current Psychology, 25(3), 155-172.

Psychology Today: Bringing ACT to Sierra Leone

In a blog post today on the Psychology Today website, Dr. D.J. Moran, author of ACT in Practice, writes of a recent trip to war-torn Sierra Leone with two other psychologists. Together, they taught two workshops on Acceptance and Commitment Therapy (ACT) to local mental health practitioners. Dr. Moran writes:

In January 2011, my colleagues Beate Ebert and JoAnne Dahl and I set out to present two workshops in evidence-based behavior therapy and Acceptance and Commitment Therapy (ACT).  Beate is a dedicated psychologist and the founder of Commit + Act, the non-governmental agency that planned this trip.  JoAnne has extensive understanding of using ACT with the chronic pain population, but also has experience with bringing ACT to populations that have limited access to mental health care.  Our first five (5) day workshop was in Freetown, S.L. and the second three (3) day workshop was in Serabu, S.L..  Each workshop had over 30 mental health practitioners in attendance.   They were very eager to hear how they could address Post-Traumatic Stress Disorder with behavior therapy and ACT.

Dr. Moran offers a touching sketch of their efforts to bring an evidence-based mindfulness and acceptance-based treatment to therapists in a country that has witnessed unimaginable horror. I can't do it justice to through summary; to read the full post, click here.