Third-wave psychotherapy (aka third-wave CBT or third-wave cognitive-behavioral therapy) refers to a movement that focuses on a more holistic and context-driven approach to mental health. I offer most of the third-wave therapies in my practice, often braiding them together for the best results for each client. I also combine them with other approaches, such as existential, logotherapy, and Narrative therapy, which share some common ideals. This post provides an overview of third-wave therapy and an example of how they might work in practice at the end.
If you have specific questions about third-wave psychotherapy and how it might work for you or a loved one, please feel free to call me or schedule a consultation anytime. I generally use third-wave therapy in individual counseling, but there are also ways to use it in couples counseling and family therapy. Of course, I also mix these methods into my clinical specialty areas.
Third-Wave Psychotherapy Overview
While original CBT approaches focused on behaviorism (changing specific behaviors), and the second round of CBT added cognitive restructuring (changing thought patterns), third-wave therapies incorporate mindfulness, acceptance, and an emphasis on values and context rather than just symptom reduction. Third-wave CBT is an exciting advancement.
Third-Wave Psychotherapy History
Third-wave psychotherapy was primarily developed by a group of psychologists and researchers who sought to build upon traditional cognitive-behavioral therapy (CBT) approaches by integrating mindfulness, acceptance, and contextual factors into treatment. While there is no single founder of “third-wave therapy” several key figures were instrumental in its development:
- Steven C. Hayes: A major figure in the third-wave CBT, Hayes developed Acceptance and Commitment Therapy (ACT) in the late 1980s. ACT focuses on accepting difficult thoughts and emotions while committing to actions aligned with personal values. Hayes’ work played a crucial role in shifting the focus of therapy from symptom reduction to psychological flexibility.
- Zindel Segal, Mark Williams, and John Teasdale: These psychologists developed Mindfulness-Based Cognitive Therapy (MBCT), which blends traditional CBT with mindfulness practices. It was designed to prevent depression relapse and is one of the key approaches in the third-wave CBT.
- Paul Gilbert developed Compassion-Focused Therapy (CFT), a third-wave CBT approach that emphasizes self-compassion and addresses the role of self-criticism in mental health. Though less well-known than ACT and DBT, CFT is part of the broader third-wave CBT movement.
These thinkers helped expand traditional CBT into more experiential and holistic approaches, integrating mindfulness, acceptance, and values to promote lasting change. The third wave has become an influential part of modern psychotherapy, especially for conditions like anxiety, depression, and personality disorders.
Key Third-Wave Therapies
As also mentioned above, some key third-wave therapies include:
- Acceptance and Commitment Therapy (ACT): This third-wave psychotherapy emphasizes accepting emotions rather than avoiding them while committing to value-driven actions. Its goal is psychological flexibility—being able to adjust to situations while maintaining personal values.
- Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT is a third-wave cognitive-behavioral approach that integrates mindfulness with skills like emotion regulation, interpersonal effectiveness, and distress tolerance. (I provide DBT therapy for teens but not adults.)
- Mindfulness-Based Cognitive Therapy (MBCT): This third-wave cognitive-behavioral approach combines traditional CBT with mindfulness therapy techniques. This third-wave therapy is used primarily to prevent the relapse of depression by helping individuals observe their thoughts and feelings without judgment.
- Compassion-Focused Therapy (CFT): This more recent third-wave psychotherapy focuses on cultivating self-compassion and reducing self-criticism, which can be a major barrier to psychological well-being.
- Mindfulness-Based Stress Reduction (MBSR): Finally, MBSR is a third-wave cognitive-behavioral approach that uses mindfulness and meditation techniques to reduce stress, anxiety, and chronic pain.
These methods emphasize mindfulness, acceptance, and a nonjudgmental approach to thoughts and feelings. They aim for long-term psychological flexibility rather than quick fixes for specific symptoms.
Third-Wave Therapy Example: ACT
An example of third-wave therapy in action is Acceptance and Commitment Therapy (ACT), which focuses on helping individuals accept their thoughts and feelings without trying to change or avoid them. Instead of trying to eliminate negative emotions, ACT teaches people to live with these experiences while focusing on their core values and taking meaningful actions. The result is a greater sense of meaning and positivity, reducing the power of negative thoughts and feelings. ACT is one of the core third-wave cognitive-behavioral therapies I use.
The following is a brief, fictitious example designed to give you an idea of how this third-wave psychotherapy works.
Example Scenario: Social Anxiety
Jill is a 25-year-old graduate student with social anxiety. Despite being a friendly and engaging person, she avoids situations where she has to interact with others, such as attending social events or speaking in public. Traditionally, cognitive-behavioral therapies might have focused on challenging and reframing her thoughts to be less fearful or anxious about these situations. However, I choose ACT (a third-wave therapy) for Jill, and in session we work on:
- Acceptance: I help Jill recognize and accept that feelings of anxiety may come up in social situations. Instead of trying to suppress or eliminate these feelings, I show her how to acknowledge them without judgment. She practices this for homework in social situations at school, starting with smaller and less challenging ones.
- Mindfulness: I teach Jill mindfulness techniques to observe her anxious thoughts (e.g., “People will judge me”) as just thoughts, not necessarily truths. She learns to experience these thoughts without being consumed by them. In each subsequent session, Jill reports back on how this went, and we refine the mindfulness third-wave therapy techniques as needed to make them more effective.
- Values-Based Action: I help Jill clarify what really matters to her (e.g., building meaningful relationships and achieving professional success) and encourage her to take steps in line with these values, despite the presence of anxiety. For Jill, this includes attending a social networking event in her field even if she feels anxious, as building these relationships is important to her. Again, we only go as fast as Jill is comfortable with in third-wave cognitive behavioral therapy.
ACT Third-Wave Psychotherapy Outcome
The goal of this third-wave cognitive-behavioral approach isn’t to eliminate JIll’s anxiety but to help her live a meaningful life while accepting that discomfort may sometimes be part of that process. Paradoxically, she finds that her social anxiety significantly decreases even though it is not directly targeted.
Third-Wave CBT Example
A good example of third-wave Cognitive-Behavioral Therapy (CBT) is Mindfulness-Based Cognitive Therapy (MBCT), a therapeutic approach combining traditional CBT and mindfulness practices. This third-wave psychotherapy is often used to prevent the recurrence of depression and to help individuals deal with anxiety. As with the above, this fictitious case is designed to show you how third-wave CBT might work in practice.
Example Scenario: Recurrent Depression
John has experienced recurrent bouts of mild depression, which have happened despite most things going well in his life. Traditional CBT might involve identifying and challenging negative thought patterns (e.g., “I’m worthless” or “Nothing ever goes right for me”). In contrast, third-wave cognitive-behavioral MBCT focuses on helping John observe these thoughts more detachedly, without engaging or trying to change them directly.
How MBCT might work
- Mindfulness Practice: I teach John mindfulness meditation techniques, which involve bringing attention to the present moment and observing thoughts, feelings, and bodily sensations without judgment. For example, John practices a “body scan,” paying attention to different bodily sensations, such as observing his breathing. This is a core third-wave cognitive-behavioral technique.
- Decentering from Thoughts: John learns to view his negative thoughts (e.g., “I’m a failure”) as just mental events rather than factual truths. Instead of getting caught up in their content, he is encouraged to observe them as passing phenomena, like clouds in the sky. This third-wave therapy technique reduces the emotional impact of those thoughts.
- Recognizing Early Warning Signs: A key part of MBCT is teaching John to recognize early signs of relapse into depression (such as ruminating or feeling low energy). With mindfulness, he becomes more aware of these signals and can better respond to them mindfully rather than reactively.
- Acceptance and Non-Judgment: Instead of fighting against negative moods or thoughts, John learns to accept their presence without labeling them as good or bad. For example, when he starts feeling sad or unmotivated, he will practice accepting these feelings without immediately assuming they’ll spiral into a full depressive episode.
- Values and Action: Alongside general mindfulness, MBCT helps people reconnect with activities and values that give their life meaning. For John this involves gradually re-engaging in working out, joining adult sports leagues, and volunteering at his church, even while experiencing low mood.
CBT Third-Wave Psychotherapy Outcome:
By blending mindfulness with cognitive approaches, third-wave cognitive-behavioral MBCT helps John break the cycle of rumination and negative thought patterns that often trigger depressive episodes. The focus is not on eliminating negative thoughts but on changing the relationship to those thoughts through awareness and acceptance. For John, this third-wave therapy approach reduces the intensity, duration, and effect of his low mood.
Third-wave Therapies for Children and Adolescents
Third-wave therapies can be adapted effectively for children and adolescents.
For kids, these therapies focus on helping them become more aware of their thoughts and emotions without becoming overwhelmed. Here’s a breakdown of how I might apply them with younger clients:
- Acceptance and Commitment Therapy (ACT): ACT encourages kids to accept challenging feelings instead of avoiding or fighting them. Through activities, metaphors, and games, children learn to recognize their thoughts and emotions without judgment. ACT can be helpful for children experiencing anxiety, depression, and ADHD, helping them practice staying present and clarifying values for decision-making.
- Dialectical Behavior Therapy (DBT): Originally designed for adults with intense emotional experiences, DBT for kids focuses on emotional regulation and distress tolerance. Adaptations for children often involve skill-building games, group activities, and family-based sessions to support their emotional resilience. DBT can be particularly beneficial for children dealing with mood disorders, impulsivity, or self-esteem challenges.
- Mindfulness-Based Cognitive Therapy (MBCT): MBCT combines cognitive therapy with mindfulness practices. For kids, this can look like fun breathing exercises, mindful movement, and sensory activities to build attention and awareness skills. MBCT helps children manage stress and build positive coping strategies, supporting emotional and social growth.
- Compassion-Focused Therapy (CFT): Though less common with younger populations, CFT can help children develop self-compassion and reduce self-criticism, often tailored for those who struggle with perfectionism or harsh self-judgment.
Specific Adaptations for Kids
With kids, third-wave therapies use age-appropriate language and engaging, hands-on activities, such as:
- Using visual aids such as pictures and books and having them create their own artwork. For adolescents, this involves drawing or playing creative games. These visual aids can be a cornerstone of a third-wave cognitive-behavioral approach.
- We use metaphors (like the “thought train” or “worry monster”) and stories to make the abstract concepts of mindfulness, acceptance, and compassion more accessible.
- Playing games that illustrate the concepts of third-wave CBT can help me reach younger children.
- Meeting for group therapy, especially for adolescents, is an effective way of helping them engage and understand the concepts.
Given the above, you can see why I do not usually deliver third-wave CBT or other third-wave therapies to younger children virtually. For those under 13, the best approach is usually in person. The exception is when we do family therapy, or therapy with a parent and child together, where I can help you engage with your child. This can be delivered as virtual psychotherapy.
Summary and My Practice
My clinical psychology practice centers around third-wave therapy. I chose this core approach because it is both powerful and positive. I have seen people find success with third-wave psychotherapy while they are able to focus on their potential and possibilities. I also appreciate third-wave therapies for the ease of combining them with other approaches for even more effective treatment, and they can be used as part of brief therapy courses, and combined with other approaches such as behavioral activation. I use these methods in many of my specialty areas, including sports psychology, therapy for college students, and fear of flying and public speaking phobias.
My practice is integrative, meaning that we can combine different third-wave therapies to maximize your benefit. Third-wave CBT is often my first choice for people with depression and anxiety, but other techniques are also commonly mixed in.
If you have any questions about my practice and how I use third-wave psychotherapy, or specifically how we might work together using third-wave therapies, please feel free to call me or schedule a consultation anytime.
