Mindfulness and acceptance-based cognitive behavioral therapies: empirical evidence and clinical applications from a Christian perspective

Abstract

Behavior therapy can be historically viewed as consisting of three major generations or waves (Hayes, Luoma, Bond, Masuda, & Lillis, 2006): the first wave of traditional behavioral therapy: the second wave of cognitive behavioral therapy (CBT) which is now over 30 years old; and the third wave that presently consists of relatively contextualistic approaches such as Acceptance and Commitment Therapy (ACT, pronounced as one word; Hayes, Strosahl, & Wilson, 1999; Hayes & Strosahl, 2004), Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002), and Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b). Contemporary CBT has therefore expanded to include such mindfulness and acceptance-based therapies as ACT, MCBT, DBT (Hayes, Follette, & Linehan, 2004; see also Roemer & Orsillo, 2009). These therapies have recently come to occupy a major place in the field of counseling and psychotherapy today (see Tan, 2011). Both their empirical evidence and clinical applications, including selfhelp books, for a wide range of psychological disorders, have grown significantly in the last decade or so (see Baer, 2006; Roemer & Orsillo, 2009; Shapiro & Carlson, 2009). This article will cover research into practice for ACT, MBCT, and DBT, with a Christian perspective provided. Empirical Evidence for Mindfulness and Acceptance-Based Cognitive Behavioral Therapies: ACT, MBCT, and DBT Before briefly reviewing the empirical evidence for the efficacy or effectiveness of ACT, MBCT, and DBT, it is important to have a clear definition of mindfulness, which has been described in various ways (see Baer, 2006; Germer, Siegel, and Fulton, 2005; Shapiro & Carlson, 2009). Bishop et al. (2004) have provided the following helpful operational definition: We propose a two-component model of mindfulness. The first component involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation that is characterized by curiosity, openness, and acceptance (p. 232). Mindfulness and acceptance-based therapies have some spiritual roots in Zen Buddhism, but can also include similar spiritual traditions, such as Roman Catholic and Eastern Orthodox. From a broadly Christian perspective, contemplative spirituality has, for centuries, emphasized the sacrament of the present moment or self-abandonment to divine providence in every moment and every area of life, including the mundane (see de Caussade, 1989; see also Blanton, 2008). This is now often expressed in the essential spiritual task and process of go and letting God take control of the present (as well as the past and future). The Christian tradition of contemplative, meditative, or centering prayer therefore includes aspects of mindfulness and acceptance (e.g., see Benner, 2011; Finley, 2004; Ford, 2009; Foster, 2011; Keating, 2006; Merton, 1996; Pennington, 1982, 1999). However, a biblical perspective on mindfulness and acceptance-based therapies will also be appropriately critical of some aspects of these therapies (see Clinical Applications section of this article). ACT ACT, as developed by Steven Hayes and his colleagues, is based on relational frame theory, with six core processes or components (Hayes, Strosahl, & Wilson, 1999): (D acceptance; (2) cognitive defusion (emphasizing flexibility in place of rigidity in thinking); (3) being present; (4) self as context focusing on a transcendent sense of self; (5) values; and (6) action (in accordance with one's values). ACT helps clients to accept painful experiences rather than fight to change or control or avoid unpleasant feelings. It also encourages clients to clarify what their deepest values are in life and to act or live in accordance to their values in what is called committed action. …