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Cited by 237Mindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCOVID-19 and Mental Health

The empirical status of the "new wave" of cognitive behavioral therapy

Open access
Hofmann, Stefan G., Sawyer, Alice T., Fang, Angela·2010·Psychiatric Clinics of North America
DOI 10.1016/j.psc.2010.04.006PMC PMC2898899
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Abstract

This article reviews the current state of empirical research on the purported " new wave" of cognitive behavioral therapy (CBT). A particular emphasis is given to mindfulness-based treatments and acceptance and commitment therapy (ACT). Mindfulness-based approaches and ACT are evaluated with regard to their efficacy and comparison with traditional CBT. Deviations from CBT are explained within the context of theory, specifically in terms of the role of cognitions. These differences, however, are not irreconcilable in requiring a separate classification of " new wave" treatments. While subtle and important differences on the theoretical and procedural level might exist, available data do not favor one treatment over another, and do not suggest differential mechanisms of action that warrant a dramatic separation from the CBT family of approaches. Instead, the " new wave" treatments are consistent with the CBT approach, which refers to a family of interventions rather than a single treatment. Thus, the term " new wave" is potentially misleading because it is not an accurate reflection of the contemporary literature. © 2010 Elsevier Inc.

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Crossref · 10.1016/j.psc.2010.04.006

Cites

82 of 82 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 63 cited sources checked · 7 supported · 1 flagged · accuracy not yet measured

  • Findingcitation

    The mindfulness effect sizes exceeded those for psychological placebo in anxiety trials (g=0.45, 95% CI 0.35-0.46) reported in an earlier meta-analysis.

    “These effect sizes are significantly greater than the effect sizes of psychological placebo conditions in anxiety disorder trials (Hedges’s g = 0.45, 95% CI: 0.35 – 0.46) as determined in a previous meta-analytic review [41].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [41] Hofmann, 2008, Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials, J Clin Psychiatry source

      The Results (page unavailable) assign g = 0.45 to CBT’s advantage over placebo on depressive symptoms, with a 95% CI of 0.25–0.65. They do not identify it as the effect size of psychological placebo conditions in anxiety trials; the reported confidence interval also differs from the cited 0.35–0.46. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingown data

    The same meta-analysis found mindfulness-based interventions moderately effective at reducing depression symptoms in clinical samples (g=0.59, 95% CI 0.51-0.66).

    “and depression (Hedges’s g = 0.59, 95% CI: 0.51 – 0.66) in clinical samples.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] Hofmann, 2010, The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review, J Consult Clin Psychol source
  • Premisecitation

    Many studies back the idea that cognitive shifts mediate improvement in panic, social anxiety, OCD, depression, and pain.

    “Numerous studies to date have provided support for this model in a variety of psychiatric disorders including panic disorder [24], social anxiety disorder [25, 26], obsessive-compulsive disorder [27], depression [28, 29], and pain [30].”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [24] Hofmann, 2007, Preliminary evidence for cognitive mediation during cognitive behavioral therapy for panic disorder, J Consult Clin Psychol source
      Experimental — accuracy not yet measured
    • cites [25] Hofmann, 2004, Changes in self-perception during treatment of social phobia, J Consult Clin Psychol source
    • cites [26] Smits, 2006, Cognitive mechanisms of social anxiety reduction: an examination of specificity and temporality, J Consult Clin Psychol source
    • cites [27] Moore, 2007, The cognitive mediation of thought-control strategies, Behav Res Ther source
  • Findingcitation

    A meta-analysis of 39 studies (n=1,140) found mindfulness-based interventions moderately effective at reducing anxiety symptoms in clinical samples (Hedges's g=0.63, 95% CI 0.53-0.73).

    “A total of 39 studies (n = 1,140) were included in the meta-analysis, and effect size estimates suggested that mindfulness-based interventions were moderately effective at reducing symptoms of anxiety (Hedges’s g = 0.63, 95% CI: 0.53 – 0.73)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] Hofmann, 2010, The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review, J Consult Clin Psychol source
  • Findingown data

    For mood-disorder patients, mindfulness interventions showed their largest depression reduction (g=0.5).

    “and for reducing depressive symptoms among patients with mood disorders (Hedges’s g = 0.5).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] Hofmann, 2010, The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review, J Consult Clin Psychol source

      The Results report that mindfulness-based therapy reduced depressive symptoms most strongly in patients diagnosed with depression, but give Hedges’s g = 0.95 for that group, not 0.5. The g = 0.50 figure in the Results is an adjusted estimate for depression across the overall sample, not for patients with mood disorders. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Premisecitation

    In ACT the focus is to identify and alter the function of cognition, whereas in CBT the focus is on both content and function.

    “This results in a theoretical discrepancy between ACT and CBT, whereby the focus in ACT is to identify and alter the function of the cognition, rather than both the content and function as in CBT.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Hayes, 2006, Acceptance and commitment therapy: model, processes, and outcomes, Behav Res Ther source

      The ACT theoretical roots section (p. 5) supports focusing on the functions of cognitions rather than primarily on their content. The discussion of traditional CBT (p. 3) describes direct cognitive change and attention to patterns of thought, but does not establish that CBT focuses on both content and function as the claim says. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Mindfulness-based interventions have been applied as acute treatment for GAD, panic disorder, social anxiety disorder, and depression.

    “mindfulness-based interventions have also been applied as an acute treatment for a variety of psychiatric disorders including generalized anxiety disorder [43, 44], panic disorder [45–47], social anxiety disorder [48, 49], and depression [50–53]”
    Quote in the paperNot a substantial claim1 of 7 sources checked
    • cites [43] Craigie, 2008, Mindfulness-based cognitive therapy for generalized anxiety disorder: a preliminary evaluation, Behav Cogn Psychother source
    • cites [44] Evans, 2008, Mindfulness-based cognitive therapy for generalized anxiety disorder, J Anxiety Disord source
    • cites [45] Kabat-Zinn, 1992, Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders, Am J Psychiatry source
    • cites [46] Kim, 2009, Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder, Depress Anxiety source

      The Assessments section describes an eight-week MBCT program for patients with panic disorder or generalized anxiety disorder, supporting its application as a treatment for those conditions. The Subjects section says participants had received more than six months of pharmacotherapy and that their acute symptoms had stabilized before MBCT began; this study therefore does not support calling it an acute treatment. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [47] Lee, 2007, Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder, J Psychosom Res source
    • cites [48] Bögels, 2006, Mindfulness and task concentration training for social phobia: a pilot study, J Cogn Psychother source
    • cites [49] Koszycki, 2007, Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder, Behav Res Ther source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ACT techniques are believed to work by increasing psychological flexibility, the ability to be aware of the present while adapting to meet valued goals.

    “These techniques are believed to work by increasing one’s psychological flexibility, which refers to the ability to adopt an awareness of the present moment while concurrently adapting this awareness in light of meeting valued goals [1].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Hayes, 2006, Acceptance and commitment therapy: model, processes, and outcomes, Behav Res Ther source

  • May combine two claims.

    Premisecitation

    Thoughts may shift without direct challenging, and cognitive mediation can occur even when therapy does not explicitly target cognitions.

    “cognitive change can occur through means other than explicitly challenging maladaptive cognitions; cognitions can mediate treatment change even when cognitions are not explicitly addressed in treatment.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [23] Hofmann, 2008, Cognitive processes during fear acquisition and extinction in animals and humans: implications for exposure therapy of anxiety disorders, Clin Psychol Rev source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ACT views cognitions as a form of behavior.

    “Specifically, ACT views cognitions as a form of behavior, which is “a term for all forms of psychological activity, both public and private, including cognition” [1, p. 2].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Hayes, 2006, Acceptance and commitment therapy: model, processes, and outcomes, Behav Res Ther source

  • May combine two claims.

    Findingcitation

    The 13 ACT trials in that review were highly heterogeneous in their control conditions and target disorders.

    “Furthermore, the 13 ACT studies included in this review differed greatly with regard to the type of comparison group used—whether it was a control group (i.e., treatment as usual) or an active treatment (e.g., cognitive therapy). The studies also varied widely in the disorders that were treated, ranging from math anxiety and depression to epilepsy, diabetes, and psychosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Öst, 2008, Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis, Behav Res Ther source

  • May combine two claims.

    Findingcitation

    Third-wave RCTs were rated as less methodologically rigorous than CBT trials on sample, design, and therapist factors, a difference that held after adjusting for publication year and journal.

    “These findings, however, are tempered by additional results showing that the methodological rigor of the third-wave RCTs was significantly less stringent than the CBT studies, based on several sample, design, and therapist characteristics, such as representativeness of the sample, reliability of the diagnosis, therapist adherence and competence, and handling of attrition. This remained true even”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Öst, 2008, Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis, Behav Res Ther source

  • Classified as probably not a substantial claim.

    Premisereasoning

    CBT is better viewed as a group of related interventions, not one treatment.

    “CBT should be thought of as a family of interventions rather than as one single treatment.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Hofmann SG, Asmundson GJ. The science of cognitive behavioral therapy. Behav Ther, in press.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] Ellis, 1980, Rational-emotive therapy and cognitive behavior therapy: similarities and differences, Cognit Ther Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Beck's content-specificity hypothesis holds that every emotional disorder has its own distinctive cognitive themes.

    “Beck’s content-specificity hypothesis states that each emotional disorder can be characterized by cognitive content specific to that disorder [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Beck, 1976

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    CBT protocols commonly assume that distorted thoughts cause emotional suffering and that changing those thoughts lowers distress and problematic behavior.

    “a major similarity across protocols is the assumption that maladaptive cognitions are causally linked to emotional distress, and therefore, by modifying cognitions emotional distress and maladaptive behaviors will decrease.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Hofmann SG, Asmundson GJ. The science of cognitive behavioral therapy. Behav Ther, in press.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] Ellis, 1980, Rational-emotive therapy and cognitive behavior therapy: similarities and differences, Cognit Ther Res source
    • The authors state this as an assumption: Maladaptive cognitions causally contribute to emotional distress, and altering them reduces distress and maladaptive behavior.

  • May combine two claims.

    Interpretationreasoning

    The differences between new wave treatments and traditional CBT are not irreconcilable and do not require a separate classification.

    “However, these differences are not irreconcilable in requiring a separate classification of “new wave” treatments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The creators of DBT and MCT regard those therapies as outside the third wave and as extensions of standard CBT.

    “the researchers responsible for developing DBT and MCT posit that their treatments are not part of the “third wave” movement, but rather are firmly grounded in the traditional CBT approach.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites personal communication, August 23, 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites personal communication, August 28, 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The evidence is strongly suggestive that cognitive change mediates treatment effects, though definitive proof awaits stricter statistical tests.

    “Although these studies strongly suggest that changes in cognitions mediate treatment change, future studies that employ strict statistical tests are needed to conclusively demonstrate mediation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    CBT often targets thought content, though not exclusively.

    “In this way, the target of change in CBT is often (but not exclusively) the content of such cognitions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness interventions are thought to reduce avoidance of experience that perpetuates and worsens emotional problems.

    “Mindfulness-based interventions are believed to counter experiential avoidance strategies that maintain and exacerbate emotional disorders”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Bishop, 2004, Mindfulness: a proposed operational definition, Clin Psychol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    CBT comprises related interventions that seek to change maladaptive thoughts and thereby improve emotion regulation, goal pursuit, and social appraisals.

    “CBT is a family of interventions that attempts to modify maladaptive cognitions in order to improve a patient’s emotion regulation, goal setting, and ability to make more adaptive appraisals of social situations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    ACT and CBT have deep theoretical differences but overlap substantially in methods.

    “Although ACT and CBT differ fundamentally in terms of their theoretical underpinnings, they share many similarities with regard to technique.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    By contrast, mindfulness therapies and ACT address how thoughts function and encourage regulation strategies that reduce experiential avoidance.

    “In contrast, mindfulness-based treatments and ACT focus on the function of thoughts and promote emotion regulation strategies that counter experiential avoidance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    DBT grows out of CBT and incorporates mindfulness methods; it is usually used for borderline personality disorder.

    “Another therapy that extends from the CBT framework while integrating mindfulness-based techniques is DBT, a form of therapy that is typically used to treat borderline personality disorder [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Linehan, 1991, Cognitive-behavioral treatment of chronically suicidal borderline patients, Arch Gen Psychiatry source

  • Classified as probably not a substantial claim.

    Premisenone given

    CBT assumes that thoughts help maintain emotional disorders largely by causing emotions and behavior.

    “The basic premise of CBT is that cognitions play an important role in the maintenance of an emotional disorder, primarily through its causal influence on one’s emotions and behaviors.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Maladaptive cognitions causally contribute to emotional distress, and altering them reduces distress and maladaptive behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ACT methods aim at experiential avoidance-unwillingness to face unpleasant feelings, bodily sensations, and thoughts.

    “the set of techniques used in ACT (known as acceptance, cognitive defusion, being present, self as context, values, and committed action) are intended to target experiential avoidance, which is the reluctance to experience negative emotions, physical sensations, and thoughts [61].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Hayes, 2004, DBT, FAP and ACT: how empirically oriented are the new behavior therapy technologies?, Behav Ther source

  • May combine two claims.

    Premisecitation

    ACT is a reformulation of Skinnerian radical behaviorism rather than a branch of CBT, and it rejects the tripartite model's causal interplay among thoughts, behavior, and emotion.

    “Therefore, ACT is not an extension of the CBT model, but is rather a reformulation of Skinnerian radical behaviorism [61], as it rejects the tripartite model and its basic premise of the causative interplay between cognitions, behaviors, and emotions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Hayes, 2004, DBT, FAP and ACT: how empirically oriented are the new behavior therapy technologies?, Behav Ther source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness therapies aim at a present-centered, nonjudgmental mode of awareness.

    “Mindfulness-based treatments emphasize achieving a mental state characterized by present-moment focus and non-judgmental awareness [31–34].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [31] Bishop, 2004, Mindfulness: a proposed operational definition, Clin Psychol source
    • cites [32] Kabat-Zinn, 2003, Mindfulness-based interventions in context: past, present, and future, Clin Psychol

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [33] Melbourne Academic Mindfulness Interest Group, 2006, Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations, Aust N Z J Psychiatry source
    • cites [34] Teasdale, 2000, Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy, J Consult Clin Psychol source

  • Classified as probably not a substantial claim.

    Premisecitation

    MBCT helps patients notice and interrupt a recurring loop linking low mood with maladaptive thinking.

    “By employing both mindfulness and cognitive techniques, MBCT encourages patients to increase their awareness of and break free from this self-perpetuating cycle.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Teasdale, 1988, Cognitive vulnerability to persistent depression, Cogn Emot source
    • The authors state this as an assumption: The main cause of depression relapse is that patients link negative mood with self-critical and hopeless thoughts, leading to maladaptive thinking that intensifies dysphoria and raises risk of future episodes.

  • May combine two claims.

    Premisecitation

    The first meta-analysis of third-wave treatments included 29 RCTs (13 ACT, 13 DBT, one CBASP, two IBCT) and found a moderate effect size for ACT trials (d=0.68), with fail-safe analysis indicating 65 unpublished ACT studies needed for results to become insignificant.

    “The first meta-analysis [3] included 29 randomized controlled trials (RCTs) in various third wave treatments: 13 in ACT, 13 in DBT, one in Cognitive Behavioral Analysis System of Psychotherapy, and two in Integrative Behavioral Couple Therapy. The results revealed a moderate effect size for the ACT trials (d = 0.68), with a fail-safe analysis indicating that 65 unpublished ACT studies would be re”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Öst, 2008, Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis, Behav Res Ther source

  • May combine two claims.

    Premisecitation

    Both therapies employ behavioral methods like exposure, problem-solving, role-play, modeling, and homework; both foster noncontrolling awareness of internal experience; and both address specific fears plus broader quality of life.

    “both ACT and CBT utilize behavioral strategies, such as exposure exercises, problem solving skills, role playing, modelling, and homework, while setting clear and observable goals. In addition, both therapies encourage greater awareness of thoughts, feelings, and sensations without attempting to control or hold onto them. Finally, both approaches target specific concerns and fears, as well as”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Decentering resembles the traditional CBT notion of distancing.

    “The concept of “decentering” is closely related to “distancing” in traditional CBT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    RFT comes from functional contextualism, a behavioral-analytic approach that links language and cognition.

    “RFT extends from a philosophical view called functional contextualism [59, 60], which uses a behavioral analytic model to integrate cognition and language.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [59] Gifford, 1993, Functional contextualism: a pragmatic philosophy for behavioral science

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [60] Pepper, 1942

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Mindfulness treatments and CBT are closely related, yet they differ in subtle but meaningful ways.

    “Although mindfulness-based treatments and CBT interventions are closely related, subtle and important differences exist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACT is grounded in Relational Frame Theory, which explains how language and cognition relate.

    “ACT derives its theoretical basis from Relational Frame Theory (RFT) [58], which is a framework for understanding the relationship between cognition and language.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Hayes, 2001, Relational frame theory: a post-Skinnerian account of human language and cognition, New York: Kluwer Academic;

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    CBT generally builds antecedent-focused regulation skills, whereas ACT mainly addresses maladaptive response-focused strategies.

    “CBT tends to promote strong antecedent-focused emotion regulation skills and ACT primarily targets maladaptive response-focused strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MBCT was first created as a relapse-prevention approach for people who had recovered from depression.

    “It was initially developed to prevent relapse among patients recovered from depression [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Segal, 2002

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    To understand how treatments work, mediation analyses are necessary and cannot be substituted by efficacy trials or component studies.

    “In order to answer the important questions about the mechanism of treatment changes, mediational analyses are essential because they cannot be replaced by efficacy studies or component analyses.”
    Quote in the paperNot a substantial claim
33 of 33

  • The authors state this as an assumption.

    Maladaptive cognitions causally contribute to emotional distress, and altering them reduces distress and maladaptive behavior.

    “a major similarity across protocols is the assumption that maladaptive cognitions are causally linked to emotional distress, and therefore, by modifying cognitions emotional distress and maladaptive behaviors will decrease.”

  • The authors state this as an assumption.

    The main cause of depression relapse is that patients link negative mood with self-critical and hopeless thoughts, leading to maladaptive thinking that intensifies dysphoria and raises risk of future episodes.

    “It is assumed that the main reason for relapse is that patients associate negative mood states with self-deprecating and hopeless cognitions. Therefore, patients react to dysphoria by reverting back to maladaptive thinking patterns, which in turn maintain and intensify their dysphoric mood state and subsequently increase the risk of future major depressive episodes [42].”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • CBT and ACT are evidence-based interventions addressing illness cognitions, perceptions, self-esteem, and social support and improving psychosocial outcomes.

    “Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are examples of evidence-based interventions addressing these factors and improving psychosocial outcomes [35-38].”

    From Risk and Protective Factors of Psychosocial Functioning in Survivors of Childhood Cancer: Results of the DCCSS-LATER Study (2024) · cites this paper as [36]

    The Comparison to Traditional CBT section says CBT and ACT address thoughts and concerns and aim for broader improvements in quality of life. The Efficacy section reports that ACT outperformed control conditions, but also notes methodological limitations and says the reviewed therapies did not meet the cited criteria for empirically supported treatments. The paper does not establish that these interventions address all the specified factors, particularly self-esteem and social support. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Third-wave behavioral therapies, including ACT, DBT, metacognitive therapy, and mindfulness-based cognitive therapy, offer promising avenues for increasing resilience to uncertainty.

    “Beyond traditional CBT, third-wave behavioral therapies, including acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), metacognitive therapy, and mindfulness-based cognitive therapy [176,177], offer promising avenues for increasing resilience to uncertainty [176].”

    From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [177]

    The Approach and Mindfulness-Based Treatments sections describe ACT as promoting psychological flexibility and mindfulness as helping patients deal with stressors, but they do not establish increased resilience to uncertainty specifically. The paper lists all four therapies as treatments Hayes calls “third wave,” then explicitly disagrees with classifying DBT and metacognitive therapy that way (Abstract; page unavailable). Its Conclusion also says further empirical testing is needed before adopting the newer strategies in routine care. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The fact that acceptance may be improved despite not being an explicit treatment target may explain why acceptance-orientated treatments do not result in better results than CBT.

    “The fact that acceptance may be improved despite not being an explicit treatment target, may explain why Hofmann et al. observed that acceptance-orientated treatments (ACT and Mindfulness) do not result in better results than cognitive behaviour therapy (CBT) [66].”

    From Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism. (2013) · cites this paper as [66]

  • Interventions targeting acceptance may be consistent with and complementary to a CBT approach.

    “Interventions targeting acceptance may be consistent with and complementary to a CBT approach [66].”

    From Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism. (2013) · cites this paper as [66]

  • Acceptance-orientated treatments (ACT and Mindfulness) do not result in better results than cognitive behaviour therapy (CBT).

    “Hofmann et al. observed that acceptance-orientated treatments (ACT and Mindfulness) do not result in better results than cognitive behaviour therapy (CBT) [66].”

    From Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism. (2013) · cites this paper as [66]

Cites

Flagged first, then by citations

7 of the 89 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Hofmann, 2008, ACT: new wave or Morita therapy?, Clin Psychol, 15, 280

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Related

Authors
Hofmann, S. G., Sawyer, A. T., & Fang, A.
Affiliations
Boston University (US)
Corresponding author
Hofmann, Stefan G.
ORCID
Venue
Psychiatric Clinics of North America
Publisher
Elsevier BV
Published
2010-09
Volume
33
Issue
3
Pages
701-710
ISSN
0193-953X (ISSN-L)
DOI
10.1016/j.psc.2010.04.006
PMC
PMC2898899
OpenAlex
W2107518217
Semantic Scholar
4be936d6a9c839ac5e2985c7e41c590716fbcaaa
Cited by
237
References
89
Citations by year
2026: 5 · 2025: 11 · 2024: 14 · 2023: 17 · 2022: 12 · 2021: 11 · 2020: 11 · 2019: 13 · 2018: 20 · 2017: 20 · 2016: 20 · 2015: 18 · 2014: 29 · 2013: 17 · 2012: 11
FWCI
11.84
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatric Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
cognitive behavioral therapy, mindfulness-based interventions, acceptance and commitment therapy, treatment efficacy, mechanism of action
MeSH terms
Humans, Psychological Theory, Cognitive Behavioral Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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