Mindfulness and Acceptance

by Steven C. Hayes, Victoria M. Follette and Marsha M. Linehan (Editors)
Guilford, 2004
Review by Meyen Hertzsprung, Ph.D. on Jan 4th 2006

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.

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

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