Chapter 11: Third-Wave Therapies

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Okay, so have you ever felt like kind of stuck, you know, in this like tug of war with your own thoughts and feelings?

Oh yeah, like you're just like constantly like trying to get them under control.

Exactly.

And like that struggle is precisely what third wave therapies really try to kind of tackle.

You know what's so interesting about these therapies is that they're not about like getting rid of those difficult thoughts or emotions.

They're more about shifting your relationship with them.

Oh, I like that.

Yeah, it's like, you know, learning to surf.

Okay.

You can't stop the waves, right, but you can learn to ride them.

Yeah, that's a great analogy.

Yeah.

So we're going deep today into three major players in this field,

acceptance and commitment or ACT,

dialectical behavior therapy, which is DBT and mindfulness based cognitive therapy or MBCT.

Yes.

And get this, to guide us on this journey, we've got excerpts from a chapter by two absolute giants in the field,

Stephen Hayes and Marshall Linehan.

Huge.

These aren't just any academic, Hayes actually founded ACT and he drew inspiration from his own struggles with panic disorder.

Wow, that's amazing.

And then we have Linehan, the creator of DBT, who has openly spoken about her own mental health journey.

That's so powerful.

So she brings like a deeply personal perspective to her work.

Yeah.

So before we unpack each therapy, can you just give us the big picture?

Like how did this third waves come to be?

Okay.

So imagine like the history of therapy is like a series of waves, right?

Okay.

The first wave was all about behavior, like changing actions through rewards and consequences.

Right.

Then came the second wave, cognitive therapy, which was really focused on changing your thoughts in order to change your feelings and behaviors.

Okay.

So the third wave basically builds upon those foundations, but as a little twist.

Exactly.

It's like they said, okay, let's take the best of what we know from these earlier approaches and let's add something new to it.

Okay.

I'm intrigued.

What if instead of fighting our inner experience, we learn to accept it and even use it to our advantage?

Okay.

Let's start with ACT.

Sure.

What's the core idea?

Well, ACT starts with this radical premise that the human mind, it's naturally wired to generate negative thoughts.

Okay.

It's totally normal.

But the problem happens when we get caught up in trying to suppress or control these thoughts.

Yeah.

Does that make sense?

That's what they call experiential avoidance and it actually can backfire and make things worse.

I've experienced that.

Yeah.

And they have this great analogy in the chapter about a quicksand pit.

Oh yeah.

The more you struggle, the deeper you think.

So ACT helps you step out of that quicksand pit by recognizing that those thoughts are just thoughts.

They're not commands or truths.

So how do you actually do that?

How do you stop those thoughts from running the show?

Well, ACT uses this technique called cognitive diffusion to help you kind of detach from your thoughts.

Okay.

And there's this exercise where you repeat a word over and over again like milk.

Milk.

Yeah, milk, milk.

Okay.

And eventually it loses its meaning and it just becomes a sound.

It's a way of showing that you can observe your thoughts without getting like entangled in them.

That's interesting.

Yeah.

So instead of getting hooked by that thought like I'm a failure, you can just see it as thought passing through like a cloud in the sky.

Exactly.

And ACT doesn't just stop there.

It also emphasizes figuring out your core values, you know, what truly matters to you and taking committed action towards those values even when difficult thoughts and feelings show up.

So it's not just about accepting those thoughts, but it's about using that acceptance to actually move forward in a direction that's meaningful to you.

Yeah.

The goal is to live a rich, full life with those thoughts, not a limited life that's dictated by them.

I like that a lot.

Yeah.

Okay.

So that's ACT in a nutshell.

Yeah.

Now let's shift gears to DBT.

Okay.

This one is known for being particularly helpful for folks who struggle with intense emotions, right?

Absolutely.

DDT was developed by Marshall Linhans specifically for individuals struggling with borderline personality disorder or suicidal behaviors.

And it combines mindfulness with a really deep understanding of how intense emotions work.

The chapter mentions this idea of an invalidating environment.

Can you explain what that means and how it relates to DBT?

Okay.

So picture this.

You have a child who is born with a really supercharged emotional system.

They just feel everything so intensely.

Now imagine that child growing up in an environment where their emotions are constantly dismissed,

punished or ignored.

It sounds really difficult.

That's an invalidating environment and it can be incredibly damaging.

So it's like they're being told that their feelings are wrong.

Yes.

They're not worthy of attention.

Exactly.

And that can lead to a deep sense of shame and confusion.

Right.

It can also lead to them developing some unhealthy coping mechanisms.

So how does DBT address this?

Well, DBT offers a comprehensive toolkit of skills.

All designed to help individuals regulate their emotions, tolerate distress and build healthier relationships.

So it's like giving them a whole new set of tools to handle those really intense emotional storms.

Yeah.

It helps you become the captain of your own emotional ship, so to speak.

Okay.

That's a good one.

All right.

So that's ACT and DBT.

Right.

Now how about MBCT?

How does that fit into the third wave picture?

Well, MBCT stands for mindfulness -based cognitive therapy.

And it's like this really special blend of cognitive therapy and mindfulness practices with a particular focus on preventing relapse in people who have experienced major depression.

Interesting.

The chapter talks about the doing mind versus the being mind.

Okay.

What's that all about?

So think of the doing mind as the part of you that's always like striving, problem -solving, planning,

analyzing.

Okay.

You know, it's useful, but it can also keep us stuck in these cycles of rumination and worry.

Right.

The being mind, on the other hand, is more present -focused.

Okay.

Accepting and open to experience.

So MBCT helps you shift from that constant doing to a more peaceful state of being.

Precisely.

It teaches you to observe your thoughts and feelings without getting carried away by them, recognizing that they're temporary and they don't define you.

And while MBCT was initially developed for depression,

the benefits of mindfulness seem to go way beyond that, right?

Absolutely.

Mindfulness practices can be really helpful for anyone who wants to manage stress, enhance their emotional regulation, and cultivate a sense of well -being.

So it's a really powerful tool for navigating the ups and downs of life.

Exactly.

Now before we dive into a case study to see how these therapies can be applied in real lives, let's just pause for a second and, you know, bring this back to you, the listener.

What stands out to you about these therapies so far?

Yeah.

Is there a particular concept or technique that's grabbing your attention?

It's worth considering which of these approaches might resonate most with your own experiences and challenges?

Because at the end of the day, these therapies offer not just techniques, but a whole new way of relating to your inner world.

I love that.

Yeah.

You know, it's really cool how each of these therapies kind of offers like a different perspective on how we understand and work with like the human experience, you know.

Oh, totally.

It's like they each have their own little superpower, but like at the core, they all share this common thread of acceptance and mindfulness.

Exactly.

So let's see these superpowers in action with the case of Mrs.

C.

Okay, so Mrs.

C is dealing with OCD and hoarding disorder, and like her house is just overflowing with stuff.

Oh, wow.

And she's constantly battling these intrusive thoughts about contamination and like everything being dirty.

So for Mrs.

C, this isn't just like a clutter issue, right?

It's way deeper than that.

Her fear of dirtiness goes beyond like the physical stuff.

It extends to like a sense of moral and emotional dirtiness, you know.

Yeah, and it seems like it's really deeply rooted in her past.

Right.

The Jap mentions she had like a really strict upbringing with all these rules about cleanliness.

So it sounds like she's associating those feelings of guilt and shame with anything that she perceives as dirty.

Exactly.

And like we've learned trying to just suppress or avoid those feelings can actually make them even stronger.

So let's pretend we're looking at this through like the ACT lens.

How might this therapy help Mrs.

C loosen the grip of those intrusive thoughts?

Well, ACT could help her practice cognitive diffusion, you know, separating those thoughts from her sense of self and like recognizing that they're just thoughts.

They're not facts or commands.

So instead of like immediately feeling like she has a cleaner hoard when that thought, this is dirty, pops up, she can just observe it without getting like swept away.

Precisely.

It's about making space for them, not about liking them or anything.

And what about values clarification?

How could that play a role?

So values clarification could help Mrs.

C connect with what truly matters to her.

Maybe it's her relationship with her family, her health, having a peaceful home.

And then using ACT, she could start taking actions that line up with those values, even if it's uncomfortable at first.

So it's about recognizing that even though she can't control those thoughts, she can control how she responds to them.

Right.

Exactly.

OK, so that's the ACT perspective.

How might a DBT therapist approach this?

DBT would offer her validation and skills training.

OK.

So the therapist would acknowledge and validate her struggles right away.

Oh, that's so important, especially with her history of feeling judged.

Totally.

And then the therapist would teach her coping skills to manage those intense emotions and urges that are driving those compulsions.

So instead of cleaning or hoarding to escape those feelings,

she could learn to ride the wave of anxiety using mindfulness or distress tolerance.

DBT also really focuses on interpersonal effectiveness, which could help her communicate her needs to her family and set boundaries.

Yeah, because OCD can be so tough on relationships.

She needs to be able to say, hey, this is what I'm going through and I need your support.

Absolutely.

And let's not forget about mindfulness techniques like those used in MBCT.

Oh, yeah.

Those could be huge for her.

Totally.

Mindfulness could help her become more aware of those urges to clean or hoard without just giving in right away.

Right.

It's like hitting pause between the thought and the action.

And then you have the power to choose.

And through practices like meditation, she could learn to cultivate a sense of calm and acceptance, which could help quiet those intrusive thoughts.

Yeah.

MBCT would encourage her to shift from that doing mind that's always trying to fix things to a more accepting being mind.

This seems like such a game changer for someone like Mrs.

C, who has been stuck in this cycle for so long.

It could be.

Now it's important to remember that no single approach is perfect.

Right.

It's all about finding what works best for each person.

And you know, these therapies, while incredibly valuable, have faced some criticism over the years.

Right.

And it's important to look at them with a critical eye.

One concern is whether they're really better than traditional cognitive behavioral therapy.

Yeah.

Some critics say they're just repackaging CBT techniques with fancier language.

So are we just talking about old wine and new bottles?

Is there really anything new here?

It's a fair question.

And researchers are trying to figure out if these therapies have better outcomes for certain conditions.

Another concern is about cultural appropriation, especially with mindfulness techniques.

Oh, yeah.

That's really important.

Which are borrowed from Eastern traditions.

Right.

Critics worry that detaching these practices from their cultural context can be disrespectful and distort their meaning.

Totally.

So we have to approach these practices with sensitivity and respect.

Yeah.

Making sure they're adapted in a way that's culturally sensitive and clinically effective.

For sure.

And I think it's important to clarify that emphasizing acceptance doesn't mean like passively accepting harmful situations.

Right.

It's about accepting our inner experience, not like saying it's OK for bad things to happen.

So it's about responding to challenges skillfully and with compassion, not just becoming a doormat.

Exactly.

It's about finding that balance between acceptance and action.

OK.

So we've talked about the criticisms now.

Let's look ahead.

What's next for these therapies?

Well, there's growing interest in applying them to a wider range of conditions.

OK.

Like what?

Substance abuse,

OCD, psychosis, ADHD.

You name it.

Wow.

So we might see these therapies being used in more ways to help people with different challenges.

Exactly.

And there's also a movement towards making them more culturally sensitive so they can reach diverse populations.

That's so important for making sure everyone has access to good mental health care.

Absolutely.

Another exciting development is the use of technology like apps.

Oh, yeah.

To make therapy more accessible and convenient.

And these technologies can help us do more research and gather data on how these therapies work.

Exactly.

It's a really interesting time to be following all of this.

It really is.

And speaking of evolution, there's this idea of a modular approach to therapy that's getting some attention.

Modular approach.

What's that?

It means using specific techniques from different third wave therapies instead of sticking to just one.

So instead of saying, OK, you're getting ACT or you're getting DBT, the therapist could use a mix of techniques depending on the person's needs.

Precisely.

It's like creating a personalized toolkit for each person.

I love that.

That sounds really promising.

It is.

So these therapies are not only effective on their own, but their parts can be mixed and matched to create even better treatments.

Right.

It's about finding the right combination of tools and strategies for each individual.

That's so cool.

It really shows how important flexibility is in mental health care.

Totally.

As these therapies continue to evolve, we need to stay committed to critical evaluation, ethical practice and innovation.

Yeah, we need to make sure they're used responsibly and ethically and that research and people's experiences continue to shape them.

Exactly.

And ultimately, it's about giving individuals the tools they need to cultivate well -being, resilience and meaning in their lives.

It's not just about getting rid of symptoms.

It's about helping people live better lives.

Exactly.

So as we wrap up this section, let's bring it back to you, the listener.

What has stood out to you the most from our conversation?

Yeah.

Is there a particular idea or technique you want to learn more about?

Maybe you're interested in cognitive diffusion or radical acceptance.

Or maybe you're drawn to values, clarification and taking action.

Whatever resonates with you, remember that these therapies offer amazing insights into being human and invite us to approach our inner world with curiosity, compassion and courage.

Right.

They remind us that we aren't defined by our thoughts and feelings and that we can choose how we respond to challenges.

And these therapies can help us create a life that's more in line with our values, even when things are hard.

For sure, this deep dive has been a really cool exploration of mental health.

Absolutely.

We hope it's made you curious and inspired you to keep learning about third wave therapies.

Remember, the journey to well -being is a lifelong process and there are so many paths to discover.

These therapies offer tools and perspectives that can help you navigate life with more skill and resilience.

Yeah, it's like these therapies are giving us like a new map for navigating our inner world.

Right.

And one that doesn't rely on us avoiding or pushing away the stuff that makes us human.

It's not about fixing what's broken.

It's more about like learning how to live a better life.

Exactly.

And the exciting thing is these therapies are always evolving and they're really pushing the boundaries of how we think about and approach mental health.

So as we wrap up this deep dive, what's the one thing you really want our listeners to take away from this?

I think the main takeaway is you don't have to be controlled by your thoughts and feelings, you know?

Right.

These therapies offer like a path to freedom, a way to break free from those old patterns and create a life that's more true to yourself.

It's like taking back your power, not by making those difficult experiences go away, but by learning to handle them in a new way.

And remember, this isn't just about therapy.

It's about how we choose to live our lives.

These ideas of acceptance, mindfulness, and values can be used in so many ways, not just in a therapist's office.

So as you go about your day, try to bring a little bit of that third wave thinking with.

You notice when you're getting caught up in your thoughts and see if you can create some space.

Yeah, like a little breathing room.

Right, exactly.

And ask yourself, what really matters to me?

And then see if you can take like even a small step in that direction.

It might feel weird at first, but it definitely gets easier and the rewards are huge.

Well thank you so much for joining us on this deep dive into the world of third wave therapies.

It's been a pleasure.

We hope it's given you some things to think about and maybe even some new tools to try out in your own life.

Keep exploring, keep learning, and keep riding those waves.

And that's it for this episode of the deep dive.

We'll see you next time.