Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition by Steven C. Hayes Phd & Victoria M. Follette Phd & Marsha M. Linehan Phd Abpp

Author:Steven C. Hayes Phd & Victoria M. Follette Phd & Marsha M. Linehan Phd Abpp [Hayes, Steven C. Phd & Follette, Victoria M. Phd & Abpp, Marsha M. Linehan Phd]
Language: eng
Format: epub, azw3
ISBN: 9781609189891
Amazon: 1609189892
Publisher: The Guilford Press
Published: 2011-06-22T00:00:00+00:00

UNANSWERED QUESTIONS

As the efficacy of BA continues to be demonstrated in clinical trials, it will likely continue to remain in the forefront of treatments for depression. Demonstrating that the treatment works, however, is a good beginning. There continue to be questions that the treatment outcome studies have not yet answered. First, the success of BA does not sufficiently confirm the behavioral theory of depression. Second, the idea that BA should be a practical and easily learned and disseminated treatment has yet to be confirmed. Third, we do not as yet understand the mechanisms of change in BA. Finally, although the treatment has been stripped down to a handful of techniques, BA may be further dismantled to understand both practical and theoretical implications.

There are different assumptions made in BA and cognitive therapy about the processes that underlie therapeutic change. In BA, it is assumed that an increase in positive reinforcement produces change. Cognitive therapy assumes that there are cognitive mechanisms associated with change. In cognitive therapy, behavior change is seen primarily as a means to change a belief. BA focuses on changing behavior and talks about change from the “outside-in,” whereas cognitive therapy considers attitude change as a necessary component for lasting emotional or behavioral change. The motto used with BA clients is “Activity breeds activity.”

Despite these different assumptions, BA shares processes with cognitive therapy that may contribute to success of treatment. The collaborative therapeutic relationship is an important aspect of BA and cognitive therapy. In BA, clients are asked to work with the therapist as if he or she were a coach. The therapist and client work as a team to develop strategies that the client can try, and both observe and discuss the results of the client’s attempts.

Addis and Carpenter (2000) suggest that clients’ “buying into” the treatment rationale is critical, regardless of the therapeutic techniques used. There is a strong emphasis in both BA and cognitive therapy on presenting the therapy rationale to clients. For example, both provide reading material on the therapeutic rationale to clients in the first session.

BA maintains the general session structure that is required of cognitive therapy. Therapist and client collaborate on an agenda each session, and clients are asked to prioritize items. Therapists also check on the client’s mood. Therapists do not make frequent summaries, as cognitive therapists do, because to do so is thought to be irrelevant to the therapeutic task. No attempts are made to provide insight or new beliefs, so there is little to summarize, with the exception of a brief overview of topics that have been discussed during the session. The goal of BA is to get the client active outside of the therapy session, ultimately. This is accomplished through between-session assignments or homework, another factor common to the two treatments. Finally, in BA, clients are asked to complete the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) prior to each session, as is commonly done in cognitive therapy.

Despite these commonalities, most of the possible BA