Third-Wave Cognitive Behavioral Therapy

Introduction

Cognitive Behavioral Therapy (CBT), widely considered the gold standard of psychotherapy, was developed in the 1960s with a focus on identifying and challenging maladaptive thinking patterns that influence emotions and behaviors. In the early 2000s, Third-Wave CBT emerged, building on the principles of traditional CBT while placing greater emphasis on mindfulness and acceptance of thoughts and emotions. This blog explores four out of the various modalities within the Third-Wave CBT umbrella.

Third-Wave Cognitive Behavioral Modalities

Acceptance and Commitment Therapy (ACT)

ACT emphasizes acceptance, cognitive defusion, focusing on the present moment, and highlighting the individual’s values and actions.

• Acceptance: Embracing thoughts and feelings without trying to change them.
• Cognitive Defusion: Learning to separate oneself from one’s thoughts.
• Present Moment: Staying consciously connected to the here and now.
• Values and Actions: Clarifying what matters and committing to action.

ACT has shown a 66% greater improvement compared to individuals who did not receive treatment (Perkins et al., 2023). Furthermore, autistic individuals demonstrated clinically significant reductions in stress, hyperactivity, and emotional distress (Powers et al., 2009).

Dialectical Behavior Therapy (DBT)

The primary focuses of DBT are mindfulness, emotion regulation, and distress tolerance. This modality can help individuals become more comfortable with uncomfortable thoughts and feelings through mindfulness and coping strategies. DBT is particularly useful for individuals who experience intense emotions. Within the autistic community, DBT can help manage and navigate intense emotional dysregulation. Furthermore, DBT can help reduce suicidal ideation and alleviate depressive symptoms.

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT emphasizes meditative practice within the therapeutic process. This modality primarily uses a combination of meditation and emotional awareness, focusing on the emotions an individual is feeling. MBCT aims to help improve quality of life by helping individuals stay grounded and present within the moment.

Functional Analytic Psychotherapy (FAP)

FAP puts an emphasis on an individual’s real-time behavior during a therapy session. This modality focuses on how a client presents in session and what emotions and behaviors arise within that therapeutic space. FAP incorporates interpersonal work that focuses on emotional awareness and authentic self-expression.

Within a Functional Analytic Psychotherapy session, the clinician focuses on these five “rules”:

1. Watch: Attentively observe clinically relevant behaviors that appear in the client’s real life.
2. Evoke: Bring out the client’s struggles and emotional patterns within the safe therapeutic space.
3. Reinforce: Praise positive behavioral changes observed during the session.
4. Observe: Pay attention to how the client responds to the therapeutic process, as well as how they react to the clinician’s responses.
5. Promote: Help the client apply the information learned in session and generalize it to their daily life.

Conclusion

Overall, Third-Wave CBT is a great modality for promoting positive changes in clients’ lives while teaching them coping and mindfulness skills along the way. There are many more modalities within the Third-Wave CBT umbrella; however, ACT, DBT, MBCT, and FAP were selected as the focus of this blog due to their widespread use presence in many therapeutic settings.

References

Carvalho, S., Martins, C. P., Almeida, H. S., & Silva, F. (2017). The evolution of cognitive behavioural therapy – The third generation and its effectiveness. European Psychiatry, 41(S1). https://doi.org/10.1016/j.eurpsy.2017.01.1461

Fan, G., Wang, P., Zhang, W., & Chen, X. (2026). Efficacy of dialectical behavior therapy-based interventions for individuals with autism spectrum disorder: A systematic review and meta-analysis. BMC Psychology, 14, Article 732. https://doi.org/10.1186/s40359-026-04729-6

Forbes, Z. N. M., & Miller, K. (2023). Mindfulness-based stress reduction in the treatment of adults with autism spectrum disorder: A systematic review of interventional studies. Review Journal of Autism and Developmental Disorders, 12, 437–454. https://doi.org/10.1007/s40489-023-00398-y

Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry, 16(3), 245–246. https://doi.org/10.1002/wps.20442

Perkins, A. M., Meiser-Stedman, R., Spaul, S. W., Bowers, G., Perkins, A. G., & Pass, L. (2023). The effectiveness of third wave cognitive behavioural therapies for children and adolescents: A systematic review and meta-analysis. British Journal of Clinical Psychology, 62(1), 209–227. https://doi.org/10.1111/bjc.12404

Powers, M. B., Zum Vorde Sive Vording, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73–80. https://doi.org/10.1159/000190790

Tanksale, R., Sofronoff, K., Sheffield, J., & Gilmour, J. (2021). Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial. Autism, 25(4), 995–1008. https://doi.org/10.1177/1362361320974841

Tsai, M., McKelvie, M., Kohlenberg, R., & Kanter, J. W. (2014, December 14). Functional analytic psychotherapy (FAP): Using awareness, courage and love in treatment. Society for the Advancement of Psychotherapy. https://societyforpsychotherapy.org/functional-analytic-psychotherapy-fap-using-awareness-courage-love-treatment/

Weiner, L., Bemmouna, D., Costache, M. E., & Martz, E. (2025). Dialectical behavior therapy in autism. Current Psychiatry Reports, 27(5), 307–318. https://doi.org/10.1007/s11920-025-01596-7