Investigating the similarities and differences between practitioners of second- and third-wave cognitive-behavioral therapies.
Third-wave CBT clinicians pack more techniques into sessions yet hold the same scientific values as second-wave peers.
01Research in Context
What this study did
The team sent a survey to 287 CBT therapists. They asked which tools each person used and how they viewed the work.
The answers split the group into second-wave (pure behavior) and third-wave (mindfulness, ACT, DBT) camps.
What they found
Third-wave therapists listed more tools: mindfulness, acceptance, exposure, and bits from other models. Second-wave folks stayed closer to classic CBT.
Both groups cared about science and clients the same amount. Attitudes were nearly identical; only the toolboxes differed.
How this fits with other research
Rojahn et al. (2012) warns that PTSD meditation studies are still thin. Hattier et al. (2011) shows many clinicians already use those tools anyway. The two papers don’t clash—they simply say ‘practice is ahead of the evidence.’
Prasher et al. (1995) watched panic therapists shift from warm and nondirective to more guiding as trust grew. Hattier et al. (2011) adds that third-wave clinicians keep that warmth while folding in mindfulness.
Foltin (1997) argues behavioral work empowers clients. Hattier et al. (2011) shows third-wave clinicians live this out by offering more choices like values work and self-as-context exercises.
Why it matters
If you call yourself ‘third-wave,’ check that your extra tools are evidence-based, not just trendy. If you’re second-wave, you can borrow mindfulness or acceptance moves without changing your whole model. Either way, keep measuring outcomes—bigger toolboxes only help when they work.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one mindfulness or acceptance exercise you don’t yet track, plot baseline data today, and review client progress after four sessions.
02At a glance
03Original abstract
There has been much discussion in the literature recently regarding the conceptual and technical differences between so-called second- (e.g., Beckian cognitive therapy) and third-wave (e.g., acceptance and commitment therapy) behavioral therapies. Previous research has not addressed the potential similarities and differences among the practitioners of these types of approaches. The current study examined possible differences in the characteristics of second-wave (n = 55) and third-wave cognitive-behavioral therapists (n = 33) using an Internet-based survey. There were differences found at the technical level between the two groups. As expected, third-wave therapists reported greater use of mindfulness/acceptance techniques. Also, third-wave therapists reported greater use of exposure techniques and second-wave therapists reported greater use of cognitive restructuring and relaxation techniques. In general, third-wave clinicians were more eclectic at the technical level and demonstrated significantly greater use of family systems techniques, existential/humanistic techniques, and the total number of techniques. No significant differences were found on the attitudinal measures administered, including reliance on an intuitive thinking style, acceptance of complementary and alternative therapies and related health beliefs, or most attitudes toward evidence-based practices. The authors did not identify many differences between second-wave and third-wave therapists other than in terms of the techniques they employ. The clinical and research implications for these findings are discussed.
Behavior modification, 2011 · doi:10.1177/0145445510393730