Mindfulness and Acceptance: Expanding the Cognitive — Behavioral Tradition Edited by Steven C. Hayes, Victoria M. Follette & Marsha M. Linehan. New York: Guilford Press. 2004. 319pp. £30.00 (hb). ISBN 1593850662

The vogue for the past three decades or so has been to see the ‘correct’ treatment for depression (as well as a host of other psychiatric disorders) as being centred on a combination of medication and CBT (cognitive-behavioural therapy). Behaviour therapists criticised the amazing flights of psychoanalytic fancy that could be occasioned by the simplest phobias or other clinical disorders. As a form of instructive ridicule, behaviour therapists used to train simple actions by direct shaping in people with chronic mental illness and they watched with amusement as psychoanalytic colleagues concocted bizarre symbolic interpretations of behaviours that had known and simple histories.

Now we appear to be on the cusp of yet another revolution in therapy which could relegate CBT to the history books, rather in the way it claimed to do in turn to psychoanalysis. This new approach has not yet achieved the status of a widely accepted formal name but hinges on ‘mindfulness and acceptance’, which are the key buzz words that pop up again and again in this field. The new perspective on human behaviour borrows hugely from Zen Buddhism. Zen has an exasperating tendency to appear awfully meaningful from a cursory glance and yet impenetrable and impracticable to the clinician anxious to assist patients and relieve suffering that is all too real.

However, this new multi-authored tome edited by several distinguished US professors of psychology is a rigorous attempt to bring together what is known empirically about this emerging therapeutic approach, alongside a comprehensive stab at demonstrating how it is pragmatically different from conventional CBT.

Apparently, we learn that Zen teaches that each moment is complete by itself, and that the world is perfect as it is. So as a result, Zen focuses on acceptance, validation and tolerance instead of change. Finally, in contrast to the experimental evidence required in psychology, Zen emphasises experiential evidence as a means of understanding the world.

The clinicians among the many authors in this text point out for their patients how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality’. The simple act of recognising your thoughts as thoughts can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life.

The idea that the solution to suffering is to increase acceptance of the here and now, and decrease craving and attachment that inevitably keep one clinging to a past that has changed already, is quite different from behaviour therapy's emphasis on developing skills for attaining one's goals.

Yet, the notion that suffering results from things not being the way one strongly wants them to be, or insists they should be, is very compatible with cognitive-behavioural therapies; Albert Ellis is perhaps the clearest, most consistent exponent of this viewpoint.

Even if this new advance overthrows or fundamentally alters CBT, as this book optimistically predicts, when are we going to get an approach in psychiatry that genuinely transforms the motivation of our patients so they engage in therapeutic work in the amazing way the examples in these books seem to revel in? Or perhaps my real issue is that such a fervent desire just isn't too Zen.