The Third Wave of Therapy

(2 of 10)
If Hayes is correct, the way most of us think about psychology is wrong. In the years since Hayes suffered his first panic attacks, an approach called cognitive therapy has become the gold-standard treatment (with or without supplementary drugs) for a wide range of mental illnesses, from depression to post-traumatic stress disorder. And although a good cognitive therapist would never advise a panic patient merely to try to will away his anxiety, the main long-term strategy of cognitive therapy is to attack and ultimately change negative thoughts and beliefs rather than accept them. "I always screw up at work," you might think. Or "Everyone's looking at my fat stomach" or "I can't go to that meeting without having a drink." Part mentor, part coach, part scold, the cognitive therapist questions such beliefs: Do you really screw up at work all the time, or like most people, do you excel sometimes and fail sometimes? Is everyone really looking at your stomach, or are you overgeneralizing about the way people see you? The idea is that the therapist will help the patient develop new, more realistic beliefs.

But Hayes and other top researchers, especially Marsha Linehan and Robert Kohlenberg at the University of Washington in Seattle and Zindel Segal at the University of Toronto, are focusing less on how to manipulate the content of our thoughts and more on how to change their context--to modify the way we see thoughts and feelings so they can't push us around and control our behavior. Segal calls that process disidentifying with thoughts--seeing them not as who we are but as mere reactions. You think people always look at your stomach? Maybe so. Maybe it's huge. Maybe they don't; many of us are just hard on ourselves. But Hayes and like-minded therapists don't try to prove or disprove such thoughts. Whereas cognitive therapists speak of "cognitive errors" and "distorted interpretations," Hayes and the others teach mindfulness, the meditation-inspired practice of observing thoughts without getting entangled in them, approaching them as though they were leaves floating down a stream ("... I want coffee/I should work out/I'm depressed/We need milk ..."). Hayes is the most divisive and ambitious of the third-wave psychologists--so called because they are turning from the second wave of cognitive therapy, which itself largely subsumed the first wave of behavior therapy, devised in part by B.F. Skinner. (Behavior therapy, in turn, broke with the Freudian model by emphasizing observable behaviors over hidden meanings and feelings.)

Hayes and other third wavers say trying to correct negative thoughts can, paradoxically, intensify them, in the same way that a dieter who keeps telling himself "I really don't want the pizza" ends up obsessing about ... pizza. Rather, Hayes and the roughly 12,000 students and professionals who have been trained in his formal psychotherapy, which is called acceptance and commitment therapy (ACT), say we should acknowledge that negative thoughts recur throughout life. Instead of challenging them, Hayes says, we should concentrate on identifying and committing to our values. Once we become willing to feel negative emotions, he argues, we will find it easier to figure out what life should be about and get on with it. That's easier said than done, of course, but his point is that it's hard to think about the big things when we're trying so hard to regulate our thinking.