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Mar 2015 by PCI College

CBT's Third Generation - Growth, Development, Integration

Eoin Stephens, PCI College President and Programme Leader of the Professional Certificate in Third Generation CBT Approaches, outlines some of the new CBT-based approaches which are gaining popularity as their impact on ingrained, complex problems is increasingly recognised in professional therapy.

Standard Cognitive Behavioural approaches, based on Aaron Beck’s original model, have had a high level of success in working with the most common forms of depression, and with many of the anxiety disorders, as well as contributing significantly to areas such as the treatment of addictions and eating disorders. However, they have struggled to make a significant impact on more ingrained, complex problems such as chronic depression, PTSD, personality disorders, self-harm etc. Their value is also questionable in relation to the more subtle existential life-challenges many clients face. This has led to the development of a variety of “third generation” CBT-inspired approaches, some of the most well-known and influential being Acceptance & Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT), Compassion-Focused Therapy (CFT) and Schema Therapy.

One theme that is picked up by many of the third generation CBT approaches, and which is often attributed to the influence of Buddhist thinking, is that of change as the natural state of things, with peace of mind primarily coming from acceptance of this reality. This paradox of trying versus accepting is well captured in the famous Serenity Prayer widely used by twelve-step programs such as Alcoholics Anonymous: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Another common theme is integration with other approaches, from ancient spiritual practices such as Mindfulness to Attachment Theory, Gestalt Therapy and Neurobiology.

Mindfulness-Based Cognitive Therapy
MBCT was founded by Mark Williams, John Teasdale and Zindel Segal (partially under the influence of Jon Kabat Zinn’s Mindfulness-Based Stress Reduction model), in an attempt to reduce relapse rates in clients recovering from depression. Mindfulness (which is now being incorporated into many other therapeutic approaches) simply involves the conscious effort to stay with present-moment experience as far as is possible (something that Gestalt Therapy emphasised many decades ago). Regular formal Mindfulness Meditation practice is seen as an essential part of this approach (for both therapist and client!)

Acceptance & Commitment Therapy
ACT was founded by Steven Hayes, based on the belief that standard CBT is too focused on gaining control of our lives, and insufficiently sceptical about the objective reality of the linguistic categories on which we base most of our conscious thinking. The ACT approach encourages us to try reducing our tendency to resist and block natural change, along with the more traditional CBT approach of trying to actively create change.

Dialectical Behaviour Therapy
DBT is an integrative therapeutic approach, developed by Marsha Linehan as a way of working with the uniquely complex challenges of clients with a Borderline Personality Disorder profile. Linehan also believed in the need for a balance between focusing on change and focusing on acceptance. The instability, comorbidity, multiple presenting problems and “therapy-interfering behaviours” characteristic of this profile means that therapists need an evidentially-based but therapeutically flexible set of principles, based on constantly updated information from relevant Biological, Environmental, Developmental and Learning theories. There is also a strong emphasis on lifeskills training, including the development of emotional tolerance.

Schema Therapy

Schema Therapy is an innovative, integrative therapy, which borrows elements from Attachment Theory, Gestalt and Psychoanalysis.  It is particularly well suited to treatment-resistant anxiety and depression as well as entrenched, chronic personality disorders (Borderline, Anxious-Avoidant, Narcissistic, Dependent, etc). The Schema Therapy approach includes a focus on unmet core childhood needs and the subsequent formation of early maladaptive schemas, and encourages the use of imagery and other experiential techniques.

Compassion-Focused Therapy

Research shows that the specialised affect regulation system that underpins feelings of reassurance, safeness and well-being seems to be poorly accessible in people with high levels of shame and self-criticism.  The ‘threat’ affect regulation system dominates orientation to their inner and outer worlds.  Accordingly people who experience high levels of shame and self-criticism may struggle to feel relieved, reassured, soothed and safe.  They can have enormous difficulty in being kind to themselves, feeling self-warmth or being self-compassionate. CFT sees compassion as a skill that one can train in, with increasing evidence that focusing on and practicing compassion can influence neurophysiological and immune systems (Davidson 2003).

Studying these approaches can be an interesting experience, combining as they do both familiar and unfamiliar elements. Their integrative focus reflects, I hope, the way forward for the field as a whole, while their attempts to stay evidence-based gives them a credibility that the field is probably still in need of.

Eoin Stephens, MIACP, MACI (March 2015)
PCI College President

Eoin is the Programme Leader of the Professional Certificate in Third Generation CBT Approaches which begins on Saturday 18th April in Dublin City Centre. Examining a variety of CBT-based new therapies, the 30 hour CPD Certificate will include an Integration Day for practitioners to explore how they can integrate the approaches into their own professional client work. Click here for more details and to book now

Relevant Links / Online Resources:

Further Reading:






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