This book is a compilation of
chapters prepared within the context of the Nevada Conference on Mindfulness,
Acceptance, and Relationship held in 2002. Leading scientist-practitioners from
within the cognitive-behavioral tradition (broadly defined) came together to
consider, examine, and explain to one another new directions towards
integrating notions of mindfulness, acceptance, values, spirituality, and
relationship into their various areas of expertise. We can now benefit from
these conversations as captured in this volume, which is fascinating, useful,
and thought-provoking.

What is evident in each chapter is
the commitment to excellent scholarship of scholars and practitioners within
the cognitive-behavioral tradition. Each set of authors grounds its approach
within a particular theoretical framework, which is then used to hypothesize
healing ‘mechanisms’ of particular technologies. There then follows a brief
description of a particular technique or approach, and, where available,
descriptions of results of empirical studies examining each approach, perhaps the
most useful and interesting part of each chapter, at least from a
practitioner’s standpoint. Conclusions are formulated, future directions
addressed, and complete lists of references included. As we go through the
volume, we realize as well that the cognitive-behavioral tradition, when
broadly defined, is broad indeed: there are chapters which take on a more
technical functional behavioral analytic approach (e.g., Hayes’ explication of
Acceptance and Commitment Therapy), while others are definitely more
‘cognitive’ (e.g., Segal, Teasdale, & Williams’ description of
Mindfulness-Based Cognitive Therapy). The problems addressed are wide-ranging
(depression, anxiety, trauma, eating disorders, substance use issues), and both
individual and couple work are explored.

Borkovec and Sharpless have added
an epilogue at the end of their chapter entitled ‘Generalized Anxiety Disorder:
Bringing Cognitive-Behavioral Therapy into the Valued Present’ which addresses
tensions that permeate all the chapters: a major question is whether to look
upon the ‘new therapies’ described in the book as forms of expanding the
cognitive-behavioral tradition, or as the beginnings of a paradigm shift.
Indeed, each set of authors faces the task of both grounding their work in
cognitive-behavioral underpinnings, yet also pushing the boundaries of what has
hitherto been understood to be the province of cognitive-behavioral tradition.
Some chapters are more successful at this dual task than others. Borkovec and
Sharpless’ description of their new initiatives in work with Generalized
Anxiety Disorder, and Segal, Teasdale, and Williams’ discussion of
Mindfulness-Based Cognitive Therapy are most explicitly (and perhaps closely)
tied to ‘traditional ‘ cognitive-behavioral therapy (CBT).

There are awkward moments in some
of the other chapters, however. For example, Kohlberg et al.’s description of
Functional Analytic Psychotherapy sometimes sounds more like the kind of work
done in psychodynamically-oriented interpersonal therapy, in which the therapeutic
relationship is itself used as opportunities for new learning (perhaps also
known as ‘recapitulation of significant primary relationships?’). Marlatt et
al.’s series of studies on the use of Vipassana meditation in the treatment of
alcohol and drug use disorders simply add a ten-day course of Vipassana
meditation to traditional CBT treatment, with little description of how its
integration into treatment was explained to the participants involved.

Perhaps these awkward moments are
indicative of points of growth and potential strength, however. In a very real
sense, this book describes cognitive-behavioral scholars and therapists in the
process of ‘breaking out’ of commonly held boundaries; and issues a call to
practitioners and their clients to do similarly. Repeatedly throughout the
book, the various authors describe their therapeutic approaches in terms of
helping clients expand repertoires of thinking and behaving, increasing
flexibility in their ability to respond to life events. Perhaps this is a call
to scholars and practitioners as well. There may come a time when it will be
impossible to reduce such notions as mindfulness, acceptance, spirituality,
values, and relationship to some of the mechanistic, technological language
deployed in the more traditional cognitive-behavioral analyses of the human
experience.

Already in this volume most of the
authors have changed the level of analysis of thoughts, behaviors, and emotions
from their form to their function. Rather than ‘reductionism,’ problem formulation
seems to be moving toward ‘complication’ – or perhaps it is simply towards
‘completeness.’ Hayes’ work in developing Acceptance and Commitment Therapy
(ACT), as described in the first chapter, points specifically to the role of
contextualization in making this shift: ‘Human beings will initially focus on
difficult content as the core of their problems, but from an ACT perspective,
it is the tendency to take these experiences literally and then to fight
against them that is viewed as most harmful’ (p. 17). In consonance with other
approaches to mindfulness and acceptance described in other chapters, the idea
is that ‘anxiety’ per se is no longer
viewed as ‘negative.’ Rather, it is an individual’s relationship to the
experience of anxiety that can become problematic.

Hayes further contends that
‘contextualization’ stops where pragmatically reasonable in the service of
therapy. One wonders, however, how far one could push this envelope: if one
broadened the analysis further, one could imagine becoming more curious about
what it is about Western society that has made it possible (even necessary) for
the cognitive-behavioral tradition to expand in this particular direction.
There are the obvious hypotheses: growing awareness, tolerance, and acceptance
of non-Western notions of human functioning, coupled with disillusionment with
traditional ‘scientific’ approaches have likely played a large part. There are
also more intriguing, more difficult questions: has our pace of life become so
frenetic that being ‘present in the moment’ (as opposed to worrying about the
future or regretting the past) needs to be relearned? Have we bought into the
notion that we must avoid pain at any cost (definitely at the cost of
experiencing emotion, and even at the cost of life itself)? To try and address
these questions would fall beyond the scope of the cognitive-behavioral
tradition … if only for the moment.

©
2006 Meyen Hertzsprung

Meyen Hertzsprung, Ph.D.,
Staff Psychologist, Addiction Centre, Foothills Medical Centre,
Calgary, Canada.

Categories: Psychotherapy, Psychology