The Third Wave of Therapy

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For his part, Beck co-authored a paper in the most recent Clinical Psychology Review noting that cognitive therapy "is one of the most extensively researched forms of psychotherapy." The paper summarizes the results of 16 studies of a collective 9,995 subjects and finds a large effect for cognitive therapy in the treatment of unipolar depression, generalized anxiety disorder, post-traumatic stress disorder, social phobia and panic disorder--Hayes' condition. Cognitive therapy was also shown to be somewhat superior to antidepressants. After sending me the paper, Beck e-mailed derisively, "The last time there was a claim for a New Wave ... was the proclamation of 'transpersonal psychology,' which purported to demonstrate some mystical forces between individuals, including, I believe, transmigration of the soul."

But even some cognitive therapists admit that despite 40 years of research, some fundamental questions about the therapy haven't been resolved. That's partly because cognitive therapy involves a variety of techniques. In addition to questioning negative thoughts in the therapy office, cognitive therapists use behavioral homework assignments--for instance, phobic patients may be asked to expose themselves to fears (like Beck going through the tunnel). Depressed clients are asked to schedule regular activities. But if cognitive therapy is all those things, critics say, maybe getting better is a matter of merely changing old behaviors, not questioning negative beliefs.

Beck hypothesizes that the cognitive parts of the therapy--challenging thoughts, developing new beliefs--add value to the changes in everyday behavior and routine that the therapy encourages. But he acknowledges that no trial has proved that. In fact, a team at the University of Washington has shown in two studies that the cognitive elements of the therapy add nothing. Among more severely depressed patients, behavioral techniques like setting up new routines and scheduling activities worked as well as an antidepressant and significantly better than cognitive therapy. When I asked Beck about the studies, he called them "intriguing" but--since no other lab has yet produced similar results--"not yet proven."

Reno, Nev., does not immediately come to mind as home base for a mindfulness guru, but Hayes has taught at the University of Nevada campus in Reno for 20 years. Driving to his house took me past a number of sad old casinos where you can find haggard gamblers trying their luck at 6 a.m., the lights from the slots lambent in their expressionless eyes.

Hayes is tall, completely bald and fond of odd sartorial combinations. One day when we met, he wore black leather shoes with an unfashionably large buckle, gray pants that were too short and a gigantic double-breasted jacket. He once lived on a commune, and he still wears an oversize ring that he said was made by Zuni Indians. "I traded it for some contraband in the '60s in Taos," he told me. His critics will be delighted to learn that Hayes attended two est trainings in Atlanta years ago. He admits that he also dabbled in meditation seminars, "eco-freak" rallies, druggy parties and all the other appurtenances of a radical '70s lifestyle.