Third wave CBT: The secret to meaningful and lasting change?

Cognitive behavioural therapy (CBT) has revolutionised the way we approach mental health. But, just like technology, therapies evolve too. Enter third wave CBT, a set of innovative approaches that build upon traditional CBT to offer even more comprehensive and lasting change.


Traditional CBT excels at identifying and restructuring negative thought patterns. It's like learning to recognise faulty wiring and fixing it in your mental circuits. However, third wave CBT pushes the boundaries by focusing not just on the 'what' (content) of your thoughts, but also on the 'how' (process) of relating to them.

Understanding the power of your thoughts

Imagine your mind as a computer. Your thoughts are the programs you run, and your resulting emotions and behaviours are the outputs. CBT operates on the principle that negative or distorted thought patterns can lead to difficult emotions and unhealthy behaviours.

However, these thought patterns aren't set in stone. By identifying and challenging them, you can create positive change.

The CBT toolbox: Strategies for change

Traditional CBT equips you with a toolbox of effective strategies to tackle negative thought patterns and improve your emotional well-being. Here are some key techniques:

Cognitive restructuring (CR)

This involves examining the accuracy and helpfulness of your thoughts. You learn to identify 'automatic thoughts' – those that pop up without much conscious effort – and assess if they're realistic or overly negative. By questioning these thoughts and replacing them with more balanced and helpful ones, you can shift your emotional experience.

Behavioural activation (BA)

Sometimes, just getting started can be the hardest part. BA encourages you to participate in activities you used to enjoy or that align with your values. By increasing engagement in pleasurable or productive activities, you can boost mood and challenge avoidance behaviours linked to anxiety or depression.

Exposure and response prevention (ERP)

This strategy is particularly helpful for anxiety disorders and OCD. In ERP, you gradually expose yourself to situations that trigger anxiety or compulsive behaviours, while resisting the urge to engage in "safety behaviours" (actions that temporarily reduce anxiety but reinforce the fear in the long run).

Relaxation techniques (R4L)

CBT often incorporates relaxation techniques like deep breathing, progressive muscle relaxation, and mindfulness meditation. These skills help manage stress and anxiety in the moment, providing a foundation for implementing other CBT strategies.

Cognitive bias modification (CBM)

Our brains naturally develop biases in how we process information. CBM techniques help you become aware of these biases and train your brain to consider evidence more objectively.

Schema change

Schemas are deeply ingrained beliefs about yourself and the world. Unhelpful schemas can contribute to a range of mental health issues. CBT helps you identify these core beliefs and develop strategies to challenge and modify them towards more realistic and adaptive self-perceptions.


This technique helps manage anxiety by challenging "catastrophic thinking." When faced with a situation, you learn to predict a range of possible outcomes, not just the worst-case scenario.

How third wave CBT differs from traditional CBT

Third wave CBT differs from traditional therapies in a few key ways:

Focus on present thoughts

Traditional therapies often delve into the past to understand the origins of problems. CBT, however, focuses primarily on identifying current thoughts, beliefs, and behaviours that are maintaining your difficulties.

Structured and goal-oriented

CBT sessions tend to be highly structured, with clear goals and a collaborative approach between therapist and client. You actively work to develop skills and learn techniques to manage your mental health.

Emphasis on practical skills

CBT emphasises learning concrete strategies, like the techniques mentioned above, to challenge negative thoughts and improve coping mechanisms. This empowers you to take an active role in your own well-being.

What can CBT help with?

Whether traditional or third wave, CBT is a versatile therapy used to treat a wide range of mental health conditions, including:

  • Anxiety disorders: Generalised anxiety disorder, social anxiety disorder, panic disorder, phobias, and obsessive-compulsive disorder (OCD) all benefit from CBT's approach to managing anxious thoughts and behaviours.
  • Depression: CBT helps individuals with depression identify negative thought patterns contributing to low mood and teaches them skills to challenge these patterns and increase engagement in pleasurable activities.
  • Low self-esteem: CBT can be a powerful tool for developing a more positive self-image. By identifying and restructuring negative self-beliefs, you can learn to be kinder to yourself and develop a healthier self-perception.
  • Burnout: CBT can equip you with strategies for managing stress and improving work-life balance. It helps you identify work patterns contributing to burnout and teaches you skills for assertiveness and self-care

And perhaps if you’ve already tried traditional CBT, with limited success, it’s worth considering what sets third wave CBT apart:

  • Focus on psychological flexibility: Traditional CBT tackles specific problems. Third wave CBT goes a step further by helping you develop psychological flexibility. This translates to being able to adapt to changing situations, tolerate difficult emotions, and pursue your values despite internal struggles.
  • Acceptance and mindfulness: Instead of fighting or suppressing unwanted thoughts and feelings, third wave CBT teaches acceptance. This allows you to observe them without judgment and move on with your life. Techniques like mindfulness meditation play a key role in cultivating this skill.
  • Values-based living: Third wave CBT encourages you to connect with your core values – the things that truly matter to you. By aligning your thoughts and actions with these values, you create a sense of purpose and direction, leading to a more fulfilling life.

Third wave CBT encompasses a range of evidence-based therapies, each with its own approach:

  • Acceptance and commitment therapy (ACT): ACT focuses on accepting difficult thoughts and feelings while taking action towards a values-driven life.
  • Dialectical behaviour therapy (DBT): DBT is particularly helpful for individuals struggling with emotional dysregulation and self-harm. It teaches skills for managing emotions, improving relationships, and tolerating distress.
  • Mindfulness-based cognitive therapy (MBCT): MBCT incorporates mindfulness meditation practices into traditional CBT. This approach strengthens your ability to observe thoughts and feelings without getting caught up in them.
  • Metacognitive therapy (MCT): MCT helps you become aware of your thoughts about your thoughts (metacognition). This self-awareness empowers you to challenge unhelpful thinking patterns.

Third wave CBT offers benefits for a wide range of challenges, including:

  • Anxiety disorders: By cultivating acceptance and mindfulness, individuals with anxiety learn to manage anxious thoughts without being controlled by them.
  • Depression: Third wave CBT teaches clients to identify and challenge negative self-beliefs while engaging in activities aligned with their values, leading to a more positive outlook.
  • Chronic pain: This approach helps individuals manage chronic pain by accepting the present moment and focusing on living a meaningful life despite discomfort.
  • Eating disorders: Third wave CBT teaches skills to improve body image and develop a healthier relationship with food.
  • Borderline personality disorder: With its focus on emotional regulation and communication skills, third wave CBT offers valuable tools for individuals with BPD.

The path to meaningful change

Third wave CBT isn't a quick fix. It's a journey of self-discovery and skill development. By learning to accept your thoughts and feelings, identify your values, and cultivate psychological flexibility, you can create lasting positive change in your life. So, if you're ready to move beyond simply managing symptoms and embrace a more meaningful and fulfilling way of being, consider exploring the possibilities of third wave CBT.

Book in with a free consultation with me today to discuss your options whether traditional or third wave CBT would feel like the right fit for you! 

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Bristol BS8 & BS2
Written by Tom Holland-Pearse
Bristol BS8 & BS2

Tom Holland-Pearse: Qualified therapist (9+ yrs) in NHS & private practice. Empowers individuals to navigate life's challenges & build emotional well-being.

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