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Mindfulness-based and Acceptance-based therapies are gaining vast momentum in the treatment of mental illnesses. These therapy modalities are seen to share some similarity with Cognitive Behaviour Therapy (CBT) (Ost, 2008), however, I am curious to know what conflicts exist in a therapist-client relationship when adopting some of the techniques/foundations from both therapy forms?

For example, in Acceptance and Commitment Therapy (ACT) - defusion (the process of distancing ourselves from our throughts) seems to present some form of conflict to CBT which suggests that cognitive restructuring is fundamental to behavioural change, i.e. "trying to change our thoughts". There may be some conflict within a therapeutic setting.

Questions:

  1. What conflicts can occur in the therapist-client relationship when using mindfulness and acceptance exercises with cognitive behaviour therapy exercises?
  2. In what ways may the two groups complement each other in achieving therapeutic outcomes ^ for the client?

^ Therapeutic outcomes can be assumed as symptomatic alleviation of the mental illness or any other positive outcome towards the alleviation of a mental illness.

Some further examples would be great.

References:

  • Öst, L.G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), pp.296-321

EDIT:

Am eager to find out what people's opinion are about this question. I have modified the question to broaden the scope to mindfulness- and acceptance-based therapies rather than a specific therapy modality. However, I have listed two specific questions to remain specific about the answers. Thank you.

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Interesting question. Side note, sometimes broad is not always better, as it is easier to write a more specific answer than tackle such a huge area.. Just a thought :) –  user3543 Sep 24 '13 at 22:16
    
Thanks ThinksALot. I made the question broader so that I wasn't only focused on Acceptance and Commitment Therapy (ACT) which users may or may not have a heap of knowledge about. –  coeus Sep 24 '13 at 23:14

1 Answer 1

up vote 3 down vote accepted

No takers so I've decided to do some research and theorise if there are any conflicts between these two therapy modalities. Drawing on research by Hofmann & Asmundson (2008), three distinct differences are identified between Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT):

The role of cognitions. "CBT helps patients to identify, challenge, and re-evaluate these rigid rules and adopt a more relaxed and satisfying system of values in order to enhance overall life satisfaction. Instead, ACT subsumes cognitions under the more general term behavior as it is used in behavior analysis, namely “as a term for all forms of psychological activity, both public and private, including cognition” (Hayes et al., 2006, p. 2). In essence, the word cognition has a different meaning in ACT than in CBT; it is a thought process in CBT and a private behavior in ACT."

The role of emotions. "CBT and ACT target different stages in the emotion-generative process: CBT promotes adaptive antecedent-focused emotion regulation strategies, whereas ACT counter-acts maladaptive response-focused emotion regulation strategies. The cognitive restructuring techniques used in CBT are in line with the antecedent-focused emotion regulation strategies, providing skills that are often effective in reducing emotional distress in the long term. Acceptance and mindfulness-based strategies counter suppression and, thereby, alleviate emotional distress."

Philosophical foundation. ACT is based on functional contextualism, which has been proposed as the philosophical basis for behavior analysis to emphasize the functional relations between behavior and environmental events ... CBT is not directly linked to a particular philosophy. The philosophical foundation most closely associated with CBT is critical rationalism, an epistemological philosophy (Popper, 1959) that shares its philosophical roots with the natural sciences."

Potential conflicts

These are theorised based on the above differences between CBT and ACT:

  • Unclear criteria for the suitability of exercises. Since CBT and ACT are clearly disparate therapy modalities, there is no universal guide on when and how to adopt therapeutic exercises from either CBT or ACT in combination or separately. The decision to use certain exercises is influenced highly by the therapist's subjective judgment and past experiences.
  • Unknown effects of combining CBT and ACT. As far as I know, there are no studies on the effects of traditional exercises such as cognitive restructuring (CBT) and mindfulness practice (ACT) when combined together on specific mental illnesses. Prima facie, the former involves deliberate attempt to modify cognitions and the latter involves a systematic process of observing non-judgmentally cognitions. It is difficult to see no conflict without empirical counter-evidence.
  • Potential negating effects. In ACT, Cognitive Defusion involves the process of distancing or separating oneselves metaphorically from their thoughts (Moffitt et al., 2012). If a client initially uses cognitive restructuring techniques to alleviate distress from their mental illness and this becomes conditioned - using cognitive defusion subsequently after that could negate the positive effects of the previous CBT-based technique.

References

  • Hofmann, S.G. & Asmundson, G.J.G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1-16
  • Moffitt, R., Brinkworth, G., Noakes, M. & Mohr, P. (2012). A comparison of cognitive restructuring and cognitive defusion as strategies for resisting a craved food. Psychology & Health, 27(2), 74-90
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I just realised no one answered your bounty. Next time, I'll post an "answer" you can award the bounty and I'll award it back on one of your posts. Just "ping" me @ThinksALot cheers –  user3543 Oct 7 '13 at 16:04

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