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Acceptance and Commitment Therapy  

Claudia J. Dewane

Clinical social work is a derivative profession, drawing its knowledge and practice base from several theoretical schools. The four primary theoretical schools contributing to social-work philosophy are psychodynamic, humanist, cognitive–behavioral, and postmodern. Acceptance and commitment therapy (ACT), although considered one of the third-wave behavioral approaches, draws from all four theoretical schools of clinical intervention. This entry gives an overview of ACT development, its essential features, empirical base, tenets and techniques, and relevance to the social-work profession.


Psychological Treatments for Social Anxiety Disorder  

Simona C. Kaplan, Michaela B. Swee, and Richard G. Heimberg

Social anxiety disorder (SAD) is characterized by fear of being negatively evaluated by others in social situations. Multiple psychological interventions have been developed to treat SAD. The most widely studied of these interventions stem from cognitive-behavioral, acceptance-based, interpersonal, and psychodynamic conceptualizations of SAD. In cognitive-behavioral therapy (CBT), patients learn to identify and question maladaptive thoughts and engage in exposures to feared situations to test the accuracy of biased beliefs. Mindfulness and acceptance-based approaches to treating SAD focus on mindful awareness and acceptance of distressing internal experiences (i.e., psychological and physiological symptoms) with the ultimate goal of behavior change and living a meaningful life based on identified values. Interpersonal psychotherapy links SAD to interpersonal problem areas and aims to reduce symptoms by targeting interpersonal difficulties. Psychodynamic psychotherapy for SAD focuses on identifying unresolved conflicts that lead to SAD symptoms, fostering insight and expressiveness, and forming a secure helping alliance. Generally, CBT is the most well-studied of the psychological treatments for SAD, and research demonstrates greater reductions in social anxiety than pill placebo and waitlist controls. Results from randomized controlled trials (RCTs) suggest that mindfulness—and acceptance-based therapies may be as efficacious as CBT, although the body of research remains small; four of five RCTs comparing these approaches to CBT found no differences. RCTs comparing CBT to IPT suggest that CBT is the more efficacious treatment. Two RCTs comparing CBT to psychodynamic psychotherapy suggest that psychodynamic psychotherapy may have efficacy similar to CBT, but that it takes longer to achieve similar outcomes. RCTs examining CBT and pharmacotherapy suggest that the medications phenelzine and clonazepam are as efficacious as CBT for treating SAD and are faster acting, but that patients receiving these medications may be more likely to relapse after treatment is discontinued than patients who received CBT. Research generally does not indicate added benefit of combining psychotherapy with pharmacotherapy above each monotherapy alone, although this body of research is quite variable. Effectiveness studies indicate that CBT is equally effective in community clinics and controlled research trials, but studies of this nature are lacking for other psychological approaches.


Psychological Interpreters of Buddhism  

Ira Helderman

The philologists and cultural commentators who first introduced the word Buddhism into the English lexicon intended it to refer to a “world religion” that was eminently psychological in nature. Finding in Buddhist texts intricate treatises on the function of mentation or on classificatory systems of human cognition, early European and US translators such as Thomas Rhys Davids defined Buddhism as an “ethical psychology.” Through the 19th century, Asian Buddhist leaders from the Japanese monk Shaku Soen to the Sri Lankan/Ceylonese Anagārika Dharmapāla sought to legitimate Buddhist doctrine with appeals to the language of the psychological. Their interlocutors in Europe and the United States, including figures such as Paul Carus, explicitly attempted to align Buddhist doctrine not only with rationalist scientific truth but, in particular, with the then-nascent discipline of psychology. When psychologists and psychotherapists began to examine Buddhist teachings and practice, they thus presumed they would find a protopsychology. Early psychologists of religion such as James Bissett Pratt were predisposed to conclude that “Gotama Buddha was probably the greatest psychologist of his age.” The first psychoanalysts to take an interest in Buddhist traditions likewise assumed that Buddhist practices of a putative “self-absorption” were ancient esoteric means for what Carl Jung called a “penetration into the groundlayers of consciousness.” Jung further pronounced his analytical psychology to have revealed that Buddhist “enlightenment” was, in actuality, a form of psychotherapeutic self-actualization, an idea that frequently resurfaced in later psychological interpretations of Buddhist traditions. Into the early 1960s, Buddhist religious figures such as D. T. Suzuki worked directly with psychological interpreters, including the humanistic psychoanalyst Erich Fromm. In these conversations, Suzuki further advanced ideas such as that Zen Buddhist practices accessed otherwise unreachable depths of the unconscious. As Buddhist communities populated predominantly by so-called “converts” of European descent developed in the United States, they were often based on doctrine that interpreted concepts such as rebirth in psychological terms. Through the 1990s, Buddhist meditative states continued to be the object of psychological and neuropsychological research and experimentation, often with the participation of major Buddhist figures such as the Dalai Lama. And although earlier psychotherapists largely compared psychological and Buddhist frames as a theoretical matter, Buddhist elements began to be increasingly incorporated into actual clinical work. Such activities are perhaps most prominently represented by the ubiquitous use of therapeutic mindfulness practices, but psychotherapists have been influenced by a wide diversity of teachings and practices drawn from diverse contemporary Buddhist communities. Those communities have long been shaped by the idea that a Buddhist path is uniquely psychological, but, strikingly, some have also been founded and led by individuals such as Jack Kornfield or Barry Magid who hold dual roles as psychologists and psychotherapists.