The ingenious inventor of ACT, Steven Hayes, is responsible for a very powerful construct: the description of fusion of awareness, experiential avoidance and its impact on emotional disorders. Experiential avoidance, i.e. “the entangled relationship with internal experiences that is likely to lead to rigid efforts to alter or avoid internal experiences”, plays a key role in a range of affective disorders as well as anxiety disorders. For a therapist to understand the construct, to be able to educate a patient about its nature, and to have tools to overcome it, it seems well worth reading the whole book.

When reading this book, I had a déjà vu from my experience with Steven Hayes' lecture about his ideas: I simply did not fully understand it. However, this time I felt that it was due to the book rather than my modest intellect. The authors coin the umbrella term “Mindfulness and Acceptance Based Behavioural Therapies (ABBT)” for a range of different treatment approaches, which are united by their assumed value in increasing the process of mindfulness. These include: Mindfulness Based Cognitive Therapy (MBCT), Mindfulness Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT) and Integrative Behavioural Couple Therapy (IBCT), as well as Buddhist writings, relaxation techniques and others. This book draws eclectically on each of these treatments and tends to filter out techniques that seem useful to overcome experiential avoidance and fused awareness.

Rather swiftly, they give us an explanation for why this is a treatment that is not disorder specific (although the authors are doing most of their work with Generalized Anxiety Disorder): the medical syndromal model is insufficient. Instead, the authors suggest a dimensional functional approach towards psychopathology where ABBT is always somehow useful. They claim that they offer a practical and accessible guide to integrating acceptance and mindfulness into cognitive-behavioural practice. Behavioural and cognitive conceptualization of a case is traditionally associated with a psychological model for a disorder, e.g. the panic model (Clark, Reference Clark1986). In this case, however, the model is the sequence of entangled awareness, fusion and experiential avoidance, presented as processes relevant for any disorder. Acceptance of negative emotions for any human being, including any therapist, is one of the trickiest concepts to share and to embody. Every patient that we see comes to us to get relief from the overwhelming quality of his or her negative emotional states. I would have hoped for a more subtle, thorough and meaningful exploration of the somewhat paradoxical concept of acceptance.

There are some useful self-monitoring and psycho-educational sheets for patients, but diagrams and bulleted summaries would have helped make this book more user friendly. It is rather densely written and the sequencing of chapters can only be grasped by repeatedly going back to the introduction.

The nature of experiences, that is the nature of emotions and their function, is briefly touched upon. No distinction is made between a healthy and non-healthy negative emotional experience. Normalisation and validation of negative emotions are mentioned but the book does not explain that this is a key element of group interventions like MBCT and MBSR. To put group interventions like MBCT together with individual approaches like ACT under one umbrella called “ABBT” requires further discussion, which this book does not offer. A paragraph on the evolutionary value of emotions and their functional unhelpfulness in case of an emotional disorder would have been essential to hammer home the ingenious concept of experiential avoidance.

I am somewhat concerned that various meditation techniques, often drawn from MBSR or MBCT, are taken out of their carefully designed original context and are presented as a technique that can be just “read out” to the patient. The theory underlying MBSR and MBCT is that the therapist is a meditation practitioner who, to some degree, embodies and models the paradoxical intervention of “changing experience by not trying to change it”. This is contrasted with the ACT approach of making this skill accessible in a more psycho-educational way. ABBT is trying to integrate therapy approaches that could be seen as incompatible (e.g. MBCT and relaxation).

The chapter on valued action, drawn from ACT, is strong. In conjunction with the self-monitoring sheets provided, they add to our understanding of the importance of values and valued action in behavioural and emotional change. Any CBT practitioner will benefit from learning more about how to integrate a discussion about values into their therapy.

Overall, this book is of value to learn about a third wave approach towards emotional distress: to find out that our relationship with our emotional experience may be impaired and to develop a different way to relate to the internal universe. Unfortunately, the book is not as practical as it claims and I struggled to get into it. It is of use to the CBT practitioner who tries to expand his or her skill base into third wave techniques without having to develop a personal meditation practice. The debate between more behavioural approaches like ACT as a “fast track” into de-fusion, or as Teasdale calls it, meta-cognitive awareness, and the more long-winded meditative route, as found in MBCT, remains unresolved. The authors leave it up to research evidence to decide this debate. Until then, we may have to live with the fact that there may be many, sometimes apparently mutually exclusive paths to the holy grail of meta-cognitive awareness and de-fusion.