If you were listening to The Anxious Truth or following along with me on social media in 2016 you would have likely heard me use the letters C-B-T quite often. I would reference traditional CBT techniques like fact checking and thought challenging. Those are good things. I still dig them. But now you hear me saying slightly different things. I don’t talk about those more traditional techniques that often and when I do, it’s in a different context. You hear me talk more about psychological flexibility, acceptance, and tolerance of uncertainty far more these days. Why is this?
Well, things change. Research happens. Treatment types evolve. We learn more as we go. I’m often asked about what it means when I say “old school CBT” or “third wave” CBT. I thought today would be a good day to briefly go through the progression from “first wave” to “third wave” treatments when it comes to the problems we’re addressing together.
The first wave of CBT, also known as traditional CBT, was developed in the 1960s by Aaron Beck and Albert Ellis. It focused on helping individuals identify and challenge their distorted thoughts and beliefs, also known as cognitive distortions, that were causing negative emotions and behaviors. This approach was based on the idea that an individual's thoughts, feelings, and behaviors are interconnected and that changing one aspect can have a ripple effect on the others. Key word here …. changing. Keep that in mind.
One of the key techniques used in traditional CBT is the use of cognitive restructuring, which involves helping individuals identify and challenge their negative thoughts and beliefs. This is done through a process of questioning and evaluating the evidence for these thoughts, and developing alternative, more realistic and balanced thoughts. Traditional CBT also emphasizes the importance of changing behaviors through the use of exposure therapy, which involves gradually exposing individuals to their feared situations or stimuli in a controlled and safe environment.
The second wave of CBT, also known as modern CBT, emerged in the 1980s and 1990s. It expanded upon the principles of traditional CBT and included new techniques and approaches that focused on more complex and nuanced issues. Modern CBT focuses on helping individuals develop more adaptive navigation skills and ways of dealing with stress and negative emotions. It also emphasizes the role of social and interpersonal factors in the development and maintenance of mental health problems. In the second wave, CBT took general principles of behaviorism and cognitive processing and added an acknowledgement that there are subtleties and nuances involved pretty much all the damn time. Good move, second wave.
One of the key techniques used in modern CBT is mindfulness, which involves paying attention to one's thoughts and feelings in the present moment without judgment. Note the “without judgment” part. This is important. This can help individuals become more aware of their automatic thoughts and behaviors and develop more adaptive ways of responding to them. See how we’re less focused on the fix at this point?
The third wave of CBT, also known as third generation CBT or CBT 3.0, is a more recent development that has emerged in the 21st century. It builds upon the principles and techniques of traditional and modern CBT and includes new approaches that focus on a more holistic and personalized approach to treatment.
CBT 3.0 emphasizes the importance of tailoring treatment to the unique needs and goals of the individual, and includes techniques such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and functional analytic psychotherapy (FAP). These approaches focus on helping individuals develop a greater sense of self-awareness and self-acceptance. The third wave includes teaching skills such as emotion regulation, distress tolerance, and mindfulness. A perfect example of a third wave therapy is ACT, which involves helping individuals develop a greater sense of acceptance and willingness to experience negative emotions rather than trying to avoid or suppress them. Notice how we went from a focus on changing in the first wave to inclusion of acceptance and acknowledgement today. That’s pretty important in my view because so much of what perpetuates the problems we’re addressing together is that drive to instantly fix things we don’t like or don’t want.
Sometimes we can’t fix things, we can only work with them. As I have progressed in the work that I do, I have seen how this is a key component of recovery philosophy that often gets missed.
The point of the little history lesson today is to help you interpret some of what I write and say, and also to help you clarify and interpret the kind of help you might be getting from a therapist or counselor, or even from other educators and guides online. If someone tells you they’re providing CBT, you can ask them to clarify that. You can ask if they’re going to try to help you change things, or if you will be working on acceptance and finding your ability to navigate even when things aren’t necessarily changeable. When you hear someone online talking about how changing your thoughts is the key, you know they’re either not addressing anxiety disorders, or they still have their eggs in a basket woven primarily in the 1960s and 1970s.
I may be guilty of being a bit overenthusiastic about this stuff at times so hopefully this wasn’t too boring. On Thursday we’ll get back to the usual stuff, so I’ll see you then.
224. From First Wave To Third