The Third Wave of Therapy


The Third Wave of Therapy

Before he was an accomplished psychologist, Steven Hayes was a mental patient. His first panic attack came on suddenly, in 1978, as he sat in a psychology-department meeting at the University of North Carolina at Greensboro, where he was an assistant professor. The meeting had turned into one of those icy personal and philosophical debates common on campuses, but when Hayes tried to make a point, he couldn’t speak. As everyone turned to him, his mouth could only open and close wordlessly, as though it were a broken toy. His heart raced, and he thought he might be having a heart attack. He was 29.

Eventually the attack subsided, but a week later he endured a similar episode in another meeting. Over the next two years, the panic attacks grew more frequent. Overwhelming feelings of anxiety colonized more and more of his life’s terrain. By 1980, Hayes could lecture only with great difficulty, and he virtually never rode in an elevator, walked into a movie theater or ate in a restaurant. Because he couldn’t teach much, he would often show films in his classes, and his hands would shake so badly that he could barely get the 8-mm film into the projector. As a student, he had earned his way from modest programs at colleges in California and West Virginia to an internship at Brown Medical School with esteemed psychologist David Barlow. Hayes had hoped to be a full professor by his early 30s, but what had been a promising career stalled. Today Hayes, who turned 57 in August, hasn’t had a panic attack in a decade, and he is at the top of his field. A past president of the distinguished Association for Behavioral and Cognitive Therapies, he has written or co-written some 300 peer-reviewed articles and 27 books. Few psychologists are so well published. His most recent book, which he wrote with the help of author Spencer Smith, carries the grating self-help title Get Out of Your Mind & Into Your Life . But the book, which has helped thrust Hayes into a bitter debate in psychology, takes two highly unusual turns for a self-help manual: it says at the outset that its advice cannot cure the reader’s pain , and it advises sufferers not to fight negative feelings but to accept them as part of life. Happiness, the book says, is not normal. 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 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 . 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.

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