Integrating Mindfulness Meditation With Cognitive and

Behavioural Therapies: The Challenge of Combining

Acceptance- and Change-Based Strategies
Mark A Lau, PhD', Shelley F McMain, PhD^

Recent innovations in psychological treatments have integrated mindfulness meditation

techniques with traditional cognitive and behavioural therapies, challenging traditional
cognitive and behavioural therapists to integrate acceptance- and change-based strategies.
This article details how 2 treatments, mindfulness-based cognitive therapy and dialectical
behaviour therapy, have met this challenge. We review the integration rationale underlying
the 2 treatments, how the treatments combine strategies from each modality to accomplish
treatment goals, implications for therapist training, and treatment effectiveness. In addition,
we discuss the challenges of assessing the benefits of incorporating acceptance-based
strategies. Both therapies have integrated acceptance-based mindflilness approaches with
change-based cognitive and behavioural therapies to create efficacious treatments.
(Can J Psychiatry 2005;50:863-869)
Information on author affiliations appears at the end ofthe article.

Clinical Implications
• This review addresses the specific challenges faced by traditional cognitive and behavioural
therapists when integrating mindfulness meditation techniques.
• The primary challenge is the integration of acceptance, as opposed to change-based,
strategies.
• In both MBCT and DBT, adding mindfulness meditation techniques to traditional cognitive
and behavioural therapies resulted in the creation of efficacious treatments.

Limitations
• This discussion of integrating mindfulness meditation with cognitive and behavioural
therapies is limited to 2 treatments for specific clinical presentations.
• Only the challenges faced by traditional cognitive and behavioural therapists are discussed.
• Future research is required to determine the specific contribution ofthe mindfulness
meditation component to therapeutic outcome.

Key Words: mindfulness meditation, cognitive-behavioural therapy, dialectical behaviour

therapy, psychotherapy integration, mindfulness-based cognitive therapy, acceptance
,,, . . . r.^, »n^, ^ „,.,,. T c commonalities, awareness ofthe limitations ofexisting thera-
tthebegmnmgofthe20thcentury, William James fore- ' ^
A , „ , , , . ,,, • n peutic approaches. Western society's current fascination with
cast that Buddhism would become a major influence on *^ *^^
, , ,,^ ^ , - , . . , • ,. the East, and a broader trend toward psychotherapy
Western psychology (1). Over the past 2 decades, his predic-
• ,. u , J u u • • • u • mtegration.
tions have been realized with the growing interest in the mte-
gration of Western psychology and Eastern spirituality. For A specific example of this trend is the integration of Eastern
various reasons, many psychotherapists have turned to Bud- spiritual practices with cognitive-behavioural treatments,
dhist teachings to leam about techniques for examining the which Hayes describes as a third epoch in the evolution of
mind (1-4); these include the identification of therapeutic behaviourally informed therapies (5). In the first phase.
Can J Psychiatry, Vol 50, No 13, November 2005 • 863
The Canadian Journal of Psychiatry—Review Paper
leaming theory and principles were systematically applied to
develop specific behavioural treatments for emotional dis-
orders. The second phase v^'as heralded by the arrival of CT,
which eclipsed purely behavioural models of
psychopathology in favour of accounts featuring the role of
attention, memory, and mental representation. The third
phase, which is in its infancy, features treatments that com-
bine the fundamental properties associated with the 2 earlier
phases with elements derived from Eastern spiritual practices
including, in particular, mindtulness meditation.
However, the introduction of mindflilness-based treatments
can present a challenge to change-oriented cognitive and
behavioural therapists, largely because of the acceptance-
based nature of mindfulness. Kabat-Zinn defmes mindfulness
as "paying attention in a particular way: on purpose, in the
present moment, and nonjudgmentally" (6). This awareness is
based on an attitude of acceptance of personal experience that
entails being experientially open to the reality of the present
moment (7). To illustrate the difference between acceptance
and a change-based CT approach, consider the negative
thought "I am unlovable." Mindfulness practice invites the
meditator to notice and accept this thought as an event occur-
ring in the mind rather than as a truth that defmes the self. Thus
mindfulness can alter one's attitude or relation to thoughts,
such that they are less likely to influence subsequent feelings
and behaviours. In contrast, CT involves the restructuring and
disputation of cognitions and beliefs toward acquiring more
functional ways of viewing the world. The dilemma is how to
integrate 2 seemingly opposed therapy goals.
In this paper, we present 2 innovative treatments that have
independently met the challenge of integrating mindfulness
with cognitive and behavioural therapy: MBCT (8) and
DBT (2). MBCT integrates mindfulness meditation practices
from Jon Kabat-Zinn's mindfulness-based stress-reduction
program (9) with CT to help patients with a history of major
depression reduce their risk of experiencing future depressive
episodes. In contrast, mindfulness in DBT is one component
of a multimodal treatment developed in the context of treating
individuals with multiple disorders who are diagnosed with
BPD. Mindfulness in DBT is a core skill that is taught as well
as an attitude that informs the therapy relationship. In this arti-
cle, we first describe the rationale for integrating mindfulness
into these treatments. Second, we deseribe how this
Abbreviations used in this article
BPD borderline personality disorder
CT cognitive therapy
DBT dialectical behaviour therapy
MBCT mindfulness-based cognitive therapy
MBSR mindfulness-based stress reduction
864
integration informs the theoretical underpinnings of each
treatment and, in tum, treatment delivery itself Third, we dis-
cuss the implications for therapist training. Finally, we briefly
review the empirical literature supporting these integrative
approaches.
Mindfulness-Based Cognitive Therapy
The impetus for developing MBCT came from a growing lit-
erature that suggests depression is best viewed as a chronic,
lifelong, recurrent disorder. For example, patients who
recover from an initial episode of depression have a 50%
ehance of a second episode (10); for those with a history of
2 or more episodes, the relapse and (or) recurrence risk
inereases to 70% to 80% (11). These data, along with the limi-
tations of traditional approaches to preventing depressive
relapse, highlighted the importance of developing novel
approaches to the prophylaxis of depressive relapse and (or)
recurrence.
The theoretical foundation for the development of MBCT is
based on a cognitive vulnerability model of depressive
relapse. This model attempts to explain the increased risk of
relapse and (or) recurrence with increased numbers of previ-
ous depressive episodes, since there is evidence that distinct
processes are involved in the onset of the first depressive epi-
sode, compared with recurrent episodes (12). Whereas major
life stressors are a stronger predietor of the first onset of
depression than of reeurrent episodes, dysphoric mood and
dysflinctional thinking styles are more highly correlated with
a history of depressive episodes, and this correlation is a better
predictor of recurrent episodes than of first episodes. These
results lend support to John Teasdale's differential activation
hypothesis (13) as a variable risk factor for depressive
relapse (14). The differential activation hypothesis maintains
that repeated associations between depressed mood and nega-
tive thinking pattems during episodes of depression lead to a
higher likelihood of reactivation of dysfunctional thinking in
subsequent dysphoric mood states. Therefore, less environ-
mental stress is required to provoke relapse and (or) recur-
rence. Rather, the processes mediating relapse and (or)
recurrence may become more autonomous with increasing
experienee of depression (15). This model suggests that one
can reduce relapse risk, first, by increasing one's awareness of
negative thinking at times of potential relapse and (or) recur-
rence and, then, by responding in ways that allow one to
uncouple from reactivated negative thought streams. Thus
interventions designed to reduce the risk of relapse should
lead to a change in the pattems of eognitive processing that
beeome active in dysphoric states. It is not essential, or even
desirable, that treatment should eliminate sadness. Instead,
the aim should be to normalize thinking pattems in states of
Can J Psychiatry, Vol 50, No 13, November 2005
 Integrating Mindfulness Meditation With Cognitive and Behavioural Therapies
mild sadness so that these moods remain mild and do not
escalate to more severe affective states.
Teasdale and colleagues (15) developed MBGT to achieve
these aims by integrating aspects of GT for depression (16,17)
with components of MBSR (9). Training in mindfiilness
offers practice in "turning toward" rather than "turning away
from" potential difficulties. Participants are invited to culti-
vate an open and accepting orientation to facilitate the devel-
opment of a decentred perspective on thoughts and feelings.
This is done through meditations such as the body scan, mind-
ful stretching, and mindfulness of breath-body-sounds-
thoughts, which teach core skills of concentration; mindful-
ness of thoughts, emotions, feelings, and bodily sensations;
being present; decentreing; acceptance; letting go; "being"
rather than "doing"; and bringing awareness to what is being
experienced in the body. This leads to an "aware" mode of
being characterized by freedom and choice, in contrast to a
mode dominated by habitual, automatic thought patterns. Fur-
ther, increased mindfulness may allow for the early detection
of negative thinking patterns that lead to relapse, thus
enabling preventive action.
Besides cognitive restructuring techniques, GT offers inter-
ventions that can also facilitate decentreing and awareness of
negative thought streams, as well as specific interventions
designed to reduce depressive relapse risk. For example, there
are GT exercises designed to demonstrate how thoughts
change with one's mood; these exercises facilitate "decen-
tred" views such as "thoughts are not facts." Additional tech-
niques such as psychoeducation about depression-related
thoughts and symptoms can facilitate earlier detection of these
experiences, thereby increasing the chance of timely interven-
tions like a previously created relapse-prevention plan.
Thus MBGT emphasizes changing the awareness of, and rela-
tion to, thoughts, rather than changing thought content.
MBGT offers participants a different way of being with emo-
tional pain and distress. The assumption is that cultivating a
decentred relation to negative thinking provides one with the
skills to prevent escalation of negative thinking at times of
potential relapse.
Typically, one instructor teaches MBGT skills in 8 weekly
2- to 3-hour group sessions. In each session, participants
engage in various formal meditation practices designed to
increase moment-by-moment nonjudgmental awareness of
physical sensations, thoughts, and feelings. Daily homework
includes practising these exercises along with exercises
designed to integrate application of awareness skills into daily
life. The creation of specific prevention strategies derived
from traditional GT techniques is presented in the later stages
ofthe 8-week program.
Can J Psychiatry, Vol 50, No 13, November 2005
Integrating mindfulness meditation into MBGT has important
implications for therapist training. Kabat-Zinn and his col-
leagues stress the importance of developing a mindfulness
practice before instructing others. Segal, Williams, and
Teasdale confirm the wisdom of this advice (8). It is important
for instructors to teach from their experience and to embody
the attitudes that they invite participants to practise. For exam-
ple, instructors demonstrate "being present" by paying atten-
tion to what is experienced in the group moment by moment
rather than giving instructions for exercises that will happen
later in the session. To facilitate being present in sessions,
many MBGT instructors meditate as part of their preparation
for each group session and maintain their own daily practice.
Finally, empirical support exists for the efficacy of integrating
mindfulness meditation with GT to reduce the risk of depres-
sive relapse and (or) recurrence. MBGT has been shown to be
efficacious in a recent multicentre, randomized clinical
trial (4). In this study, individuals who had recovered from
recurrent depression were randomized to receive MBGT or to
a wait-list control condition. MBGT significantly reduced the
risk of relapse for individuals with 3 or more previous epi-
sodes. More recently, these results were replicated in a
single-site trial (18). Interestingly, in both studies, individuals
with a history of only 2 depressive episodes did not benefit
from MBGT. These individuals may represent a different pop-
ulation since they reported less childhood abuse and a later
onset of the first depressive episode, compared with those
with 3 or more episodes (18).
Dialectical Behaviour Therapy
Mindfulness and principles derived from Zen philosophy
came to form an important part of DBT because of the per-
ceived limitations of traditional cognitive and behavioural
approaches for the treatment of BPD (2). Linehan recognized
that a major shortcoming of these approaches was their heavy
emphasis on change, which was experienced as invalidating
by patients with BPD. To effectively engage these patients,
more attention needed to be paid to nurturing the therapeutic
relationship. Linehan modified traditional cognitive and
behavioural treatment by placing a greater emphasis on
validation and acceptance.
Linehan theorized that individuals with BPD are highly sensi-
tive to change strategies because these interventions parallel
invalidating experiences that prototypically characterize their
developmental histories (2). A central tenet of Linehan's
biosocial theory is that borderline pathology develops
because of a transaction between pervasive invalidating envi-
ronmental experiences and the individual's biological consti-
tution. As a result of invalidating environmental experiences,
individuals with BPD leam to inhibit their emotions, leading
to deficits in awareness of the basic sensory motor cues
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The Canadian Journal of Psychiatry—Review Paper
associated with emotional experience. They develop deficits
in their ability to acknowledge, accept, and trust their thoughts
and feelings as accurate and legitimate responses to intemai
and environmental events. People with BPD have also failed
to leam how to tolerate distressing life experiences. In sum,
people with BPD fail to internalize an attitude of
self-acceptance.
The implication of this thesis for treatment is that individuals
with BPD need to leam to tolerate distressing life experiences
and to leam self-acceptance. Major emotion theories maintain
that the ability to discriminate emotional experience, includ-
ing the ability to perceive and accurately label experience in
consciousness, is a requisite to emotional regulation and
behavioural control (19-21). Failure to symbolize emotions
interferes with accessing information about needs and goal
priorities that motivate the individual for adaptive action.
Therefore, the acceptance of experience can help to ensure
adaptive functioning and decrease the likelihood of impulsive
behaviours such as suicide attempts or substance abuse. In
DBT, acceptance and validation by the therapist, along with
mindfulness skills, are used to enhance emotional regulation.
DBT was designed for individuals with multiple disorders
who exhibit extreme behavioural dysregulation. In the first
stage of DBT, the primary aim is to reduce extreme behav-
iours and achieve balance by leaming to "walk the middle
path." This notion draws upon the Buddhist concept that
enlightenment is achieved by avoiding being caught and
entangled in extremes (22)—an issue that is as relevant to
therapists as it is to patients, since therapists are also vulnera-
ble to intense reactions.
In DBT, mindfulness meditation is both a skill to be devel-
oped and a set of principles underlying acceptance-based
interventions. Validation is a core strategy in DBT, used to
counteract the effects ofthe invalidating environment and to
foster self-validation. DBT therapists search to validate or
acknowledge the "wisdom" in patients' experience. This
emphasis extends from the Buddhist principle of radical
acceptance and the notion that everything is perfect as it is.
Patients are encouraged to understand that all behaviours can
be understood in terms of logical consequences. To illustrate,
in response to a patient who describes cutting his or her wrist
in order to avoid shameful feelings, a DBT therapist may com-
municate something like this: "It makes sense that you would
want to relieve yourself from painful emotions, since most
people don't like to experience painful feelings." DBT thera-
pists model an attitude of acceptance toward oneself and life
in general. The therapist's genuine acceptance is an essential
element in treatment.
As a core skill, mindfulness is taught within a broader curricu-
lum of skills training (23). The training format consists of a
866
year-long program with weekly 2- to 2.5-hour classes of about
8 patients and 2 facilitators. Mindfulness skills make up the
first of 4 skills modules and involve psychological and behav-
ioural versions of meditative techniques for cultivating
awareness and acceptanee. Patients leam how to recognize
different states of mind along with methods for achieving
mindfulness ("what" skills) and practising mindfulness
("how" skills). Instmction involves didactic and experiential
leaming opportunities supplemented by weekly homework.
In contrast to MBCT, which prescribes a formal meditation
practice, DBT often relies on informal mindfulness practice
such as mindfulness of everyday activities (23). This differ-
ence is based on the opinion that patients with BPD are less
able to productively engage in lengthy sitting practice.
Although DBT therapists are not required to have a formal
meditation practice, Linehan strongly encourages it (24). The
principles of mindfulness and Zen spirituality play an impor-
tant role in therapist training. Working with patients with mul-
tiple disorders is often stressful for therapists. Training in
acceptance practices can help therapists manage their reac-
tions to patients. Several explicit agreements, infonned by
Zen philosophy and mindfulness practice, guide the therapist
consultation process. For example, DBT therapists agree to
remain phenomenologieally empathic, to avoid judgment, to
be mindful of personal limits, to aecept that others may have
different limits, to accept each other's fallibility, and to accept
the inherent capacity of their patients. Linehan asserts that
failure to aecept the limits of others is typically the source of
"staff splitting" (2). The DBT therapist consultation team
meetings and patient skills groups routinely begin with a brief
formal mindfulness practice to facilitate being present in the
moment. Further, probably most DBT therapists would agree
that a personal mindfulness praetice improves therapists'
ability to use experiential knowledge to teach mindfulness
skills.
A growing body of literature substantiates the effectiveness of
DBT. Eight randomized controlled trials that evaluate the
overall effectiveness of a comprehensive DBT treatment have
been published (25-32). No studies examined the specific
components of DBT, such as the effect of mindfulness train-
ing. In 5 ofthe 8 studies, DBT was evaluated against a com-
munity treatment-as-usual control program. In another study,
DBT was contrasted with an approach focused on comprehen-
sive validation plus 12-step program participation (27). With
the exception of one study, which evaluated the effects of anti-
depressant medication plus clinical management in an elderly
population with depression, with or without DBT skills train-
ing and phone coaching (29), all study samples involved indi-
viduals diagnosed with BPD. These studies investigated a
range of dependent variables. DBT was associated with
significantly greater reductions in parasuicidal
Can J Psychiatry, Vol 50, No 13, November 2005
 Integrating Mindfulness Meditation With Cognitive and Behavioural Therapies
behaviour (25,32), self-mutilating and impulsive behav-
iours (30), suicidal ideation and suicidal urges (28), and sub-
stance abuse (26), as well as with better treatment
retention (25,26,30). Additionally, there is some evidence that
DBT is associated with change in secondary behavioural tar-
gets, including reduced anger and dissociation (28) and less
maladaptive pleasing of others (29). In the study of DBT com-
pared with comprehensive validation plus 12-step program
participation, the results supported the efficacy of both
treatments in reducing substance abuse for opioid-dependent
women with BPD (27).
Discussion
In both MBCT and DBT, mindfulness is integrated with cog-
nitive and behavioural approaches to enhance the
psychotherapeutic work. Perhaps the main contribution from
these efforts is to broaden our understanding about how to
bring about change. The rationale for emphasizing mindful-
ness in MBCT and DBT stems from a shared philosophy: the
belief that acceptance of experience, including all of life's
misery, has therapeutic benefit. Both MBCT and DBT
embrace the Zen idea that freedom can be achieved through
nonattachment to experience. This view is based on a commit-
ment to the belief that awareness and acceptance of experi-
ence is a critical component of the change process. In Western
society, change technologies are far more developed and
relied on than are tools of acceptance. This may stem from the
mistaken belief that the only way to help people change is to
push them to do something different. The lesson to be learned
is that embracing and cultivating an attitude of acceptance can
influence the quality of the therapy relationship, patients'
acceptance of self and others, and clinicians' acceptance of
patients. In this way, acceptance strategies can lead to behav-
ioural changes. Further, embracing an accepting attitude can
help therapists dialogue openly about different clinical per-
spectives, can promote cooperation among clinicians, and can
foster the development of novel treatment approaches. In our
view, this openness to acceptance helps to facilitate the
innovative integration of 2 seemingly contrasting approaches.
MBCT and DBT emphasize the importance of therapists'
developing a personal mindftilness meditation practice, in that
experiential knowledge enhances their ability to help patients
learn about mindfulness, to provide adequate explanations of
the concepts, and to model an attitude of acceptance. Mindfiil-
ness practice is also beneficial because it offers a method to
help therapists develop awareness of their reactions toward
patients. Although it is normal for therapists to experience
strong emotions with patients at times, the failure to observe
these reactions can compromise effective treatment. Feelings
of frustration, burnout, overattachment, and desire to rescue
patients can hinder treatment if they develop without
Can J Psychiatry, Vol 50, No 13, November 2005
awareness. Increasing self-awareness through personal mind-
fulness practice can help therapists become more adept at
observing their reactions and modifying them as needed. Fur-
ther, personal mindfulness practice can help therapists
respond to patients with a relational attitude of acceptance and
nonjudgment.
In MBCT and DBT, mindfulness interventions are specifi-
cally tailored to better serve the needs of 2 different clinical
populations. In MBCT, greater emphasis is placed on devel-
oping a formal mindfulness practice than it is in DBT. This
difference appears to stem from divergence in the perceived
capacity or willingness of these 2 patient groups to be aware of
and attend to present experience. Nevertheless, MBCT and
DBT represent modified versions, or hybrids, of the more tra-
ditional mindfulness-based programs. Moreover, several
investigators have provided theoretical rationales for using
similarly structured treatments to treat other disorders, such as
generalized anxiety disorder (7), substance abuse (33), eating
disorders (34), and couple therapy (35).
Interestingly, the growing numbers of cognitive and
behaviourally oriented treatments that combine acceptance-
based strategies vary in the methods used to teach mindful-
ness. Influenced perhaps by their rational roots, both MBCT
and DBT succeed in translating esoteric ideas derived from
Zen teachings about mindfulness into readily definable terms
that are easily understood within the context of a Western
framework. Further, these 2 treatments incorporate traditional
meditation practices. In contrast, acceptance and commitment
therapy attains similar goals without using traditional medita-
tion practices, relying instead on various techniques such as
"willingness and exposure exercises" (36). These methods
offer the benefits of teaching similar skills without requiring
patients to develop a fonnal meditation practice, making
acceptance and commitment therapy a much less demanding
treatment.
Finally, despite growing empirical support for MBCT and
DBT, important limitations to this research should be high-
lighted. First, as mentioned earlier, the study designs for both
treatments did not permit attributing treatment outcomes to
the mindfulness meditation components per se. Future
research is required to determine the specific contribution of
mindfulness meditation techniques to MBCT and DBT out-
comes. For example, studies comparing the fliU treatment
with a treatment without the mindfulness techniques might
allow the contribution of the mindfulness component to be
determined. In addition, MBCT could be compared with a
support group to rule out the effect of nonspecific group fac-
tors. Moreover, there is no evidence that mindfulness medita-
tion techniques increase one's ability to be mindful (37).
Addressing these issues has valuable practical implications,
especially for MBCT, given the demanding nature of the
867
The Canadian Journal of Psychiatry—Review Paper
meditation practice included in this treatment. If meditation
does not increase mindfulness or if mindfulness is not a signif-
icant therapeutic component, then it is difficult to justify
including such a demanding practice. Recent efforts to opera-
tionally defme mindflilness (38) and develop mindfulness.
self-report measures (39,40) will further facilitate the evalua-
tion of the unique contribution of mindfulness meditation to
enhancing mindfiilness and to the outcome of these integrated
treatments.
A second limitation is that the 2 studies supporting the effi-
cacy of MBCT were conducted by the treatment developers,
establishing it only as a possibly efficacious treatment. Other
treatment providers need to conduct fliture studies to defini-
tively establish MBCT as an efficacious treatment. Third, it is
important to assess the degree to which the treatment provid-
ers maintain their own practice to guide treatment dissemina-
tion efforts, since many clinicians do not currently practise
meditation. Fourth, the question of who benefits from mind-
fulness-based interventions needs to be addressed. This is par-
ticularly relevant for MBCT, where individuals with a history
of 2 depressive episodes do not show the same reductions in
relapse risk, compared with those with more tban 2 episodes.
Finally, in all but one of the DBT studies, comparison treat-
ments were minimal or no-treatment conditions. Comparisons
of MBCT with continuation pharmacotherapy, and of DBT
with altemative treatments, are currently underway.
Conclusion
We have reviewed 2 efforts at integrating mindfulness medi-
tation with cognitive and behavioural therapies, namely,
MBCT and DBT, focusing in particular on the challenge of
integrating acceptance versus change-based strategies. Initial
outcome studies have demonstrated the efficacy of both
approaches. Further studies are required to address current
research limitations such as the lack of knowledge about the
unique contribution of mindfulness meditation to the outcome
of these integrated treatments. In addition, future research will
determine the efficacy of similar integration efforts in treating
other disorders, such as generalized anxiety disorder.
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Manuscript received November 2004, revised, and accepted May 2005.
Presented in part at the 19th Annual Convention of The Society for the
Exploration of Psychotherapy Integration; 2003 May; New York (NY).
'Assistant Professor, Department of Psychiatry, University of Toronto,
Toronto, Ontario; Deputy Head, Cognitive Behaviour Therapy Unit,
Centre for Addiction and Mental Health, Toronto, Ontario.
^Assistant Professor, Department of Psychiatry, University of Toronto,
Toronto, Ontario; Head, Dialectical Behaviour Therapy Clinic, Centre for
Addiction and Mental Health, Toronto, Ontario
Address for correspondence: Dr MA Lau, Centre for Addiction and Mental
Health, 250 College St, Toronto, ON M5T 1R8
e-mail: mark_lau@camh.net

Resume : Integrer la meditation de l'attention aux therapies

cognitivo-comportementales : le defi d'allier acceptation et strategies axees sur le
changement
Les innovations recentes des traitements psychologiques ont integre les techniques de meditation de
l'attention avec les therapies cognitivo-comportementales classiques, mettant ainsi les therapeutes
cognitivo-comportementaux classiques au defi d'integrer l'acceptation et les strategies axees sur le
changement. Cet article decrit comment 2 traitements, la therapie cognitive fondee sur l'attention et la
therapie comportementale dialectique ont releve ce defi. Nous examinons le fondement sous-jacent de
l'integration des 2 traitements, la fa9on dont les traitements combinent les strategies de chaque
modalite pour atteindre les objectifs de traitement, les implications sur la formation des therapeutes, et
l'efficacite des traitements. En outre, nous presentons les defis que represente revaluation des
avantages d'incorporer des strategies fondees sur l'acceptation. En somme, les deux therapies ont
integre les approches de l'attention fondees sur l'acceptation avec les therapies
cognitivo-comportementales axees sur le changement pour creer des traitements efficaces.

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