1. Integrating 2nd and 3rd Wave CBT using Metaphors and Imagery
Aharoni, R., Jørgensen, N.K, Rosenberg, N. & Winding, C.

2. The gap between theory and practice
More clinicians are trained in both 2nd and 3rd wave CBT: ACT, DBT, UP
Disagreement about whether 2nd and 3rd wave can be integrated in a meaningful way

3. Some claim that meaningful integration is possible Linehan, Barlow, Hayes
Incorporating mindfulness training
Focus on acceptance rather than change
The Gap
Barlow, Linehan, 2014, Hayes, 2005

4. Others claim they cannot (e.g. Wells, A.)
The Gap
either you engage with your thoughts about the moment being unpleasant, or you don’t…
Wells, 2013

5. The clinicians’ dilemma
The Gap
May I implement new techniques in practice?
How should I implement them?
Should I wait for an RCT study before I implement them?

6. Psychiatric Center Copenhagen Group therapy for OCD patients
2 groups
14 patients
1 missing data
3 dropouts

7. Which techniques did we use?
2nd wave
3rd wave
Goals and problem list
Values
Psychoeducation
anxiety and emotions
Worry-tree
Thought suppression (behavioral experiment)
Cognitive Restructuring
Exposure
Mindfulness
Attention training
Response prevention
Acceptance
Metaphor and Imagery

8. Description: Thoughts, Emotions Body
Metaphor and Imagery

9. Behavior: Rumination and Worry
Metaphor and Imagery
Worry Tree

10. Behavior: Thought suppression Avoidance
Metaphor and Imagery

11. Alternative behavior: Back to the present moment
Metaphor and Imagery

12. exposure & response prevention
“But how to let go..?”
exposure & response prevention
Attention training
Acceptance
Mindfulness training
“Letting go”
Metaphor and Imagery

13. Cognitive restructuring Arrow down technique
Metaphor and Imagery
Diffusion
Acceptance

14. Results
Results
Patients and therapist find these images and metaphors meaningful
Patients can distinguish between the interventions
Different patients find different interventions most useful in different situations

15. Symptom Check List - 90 Results N= Pre Mean (SD) Post p = t=
Under case
Obsessive Compulsive Symptoms
(range 0-4; 4= max severity) 10
1,86 (0,75)
0,91 (0,31)
0.004
3,79
90%
Anxiety Symptoms
1,75 (,94)
0,87 (0,47)
0.011
3,18
80%
Results

16. Conclusion Conclusion
Integrating 2nd and 3rd wave CBT does not seem to result in confusion among patients
The results suggest that 2nd and 3rd wave CBT can be integrated in a meaningful way and show compatible results with previous studies