THE USE
OF
NOVEL,
INTRODUCTION
The cognitive behavioral group of therapies (CBTs) have
ourished over the last four decades. The CBT approach
emphasizes the links between thoughts, feelings, and behaviors connected with, and responsible for, psychological
disorders. CBT is aimed at targeting the maladaptive beliefs
and biased information processing that underpin the distressing emotions and damaging behaviors associated with specic
psychological conditions. However, some research1,2 has
pointed to several problems in the application of CBT. For
instance, Goldfried1,2 noted that CBT fails in several areas.
First, even if CBT provides a micro-analysis of reactions to
specic problematic situations, it usually prevents an exploration of the big picture. Second, because CBT is based on
skills-training orientation, the therapist is most effective if he
or she serves as more a didactic teacher than as a healer.3,4
Further, although CBT has provided effective interventions
for reducing symptomatology, a comprehensive view of the
self is often lacking, leaving CBT at times not able to address
the recent call for more attention to humanism in psychotherapeutic settings.5,6
The need to integrate these rigid protocols of CBT with a
more holistic approach has recently been addressed by the
third-wave psychotherapies, which basically combine CBT
techniques with mindfulness strategies and meditation techniques, guided by some concepts taken from Eastern philosophy, such as acceptance.7,8 The need for a more humanistic
CASE REPORT
S. was a 31-year-old woman, who worked as blue collar
worker in a textile factory and had gone to live with her
boyfriend a year earlier. Since that time, she had been
suffering from panic disorder and agoraphobia, according to
Diagnostic and Statistical Manual of Mental Disorders Fourth
Edition (DSM-IV) criteria. The panic attacks were quite
frequent (on average two per week) and associated with
agoraphobic situations, such as traveling, going to supermarkets, and going to cinema and restaurants. They were also
linked to gastroenterologic symptoms (nausea, stomach-ache,
and dizziness). S. sought a psychotherapeutic intervention in
order to have her panic disorder treated. A CBT program,
based on gradual exposure to feared situations, was carried
out with the patient. She was instructed to keep a diary with
automatic thoughts, error identications, and cognitive
restructuring. After six months of treatment, the panic attacks
had disappeared and she began to feel much better. At this
stage of the therapy, the therapist started to investigate other
problematic areas in the patients life, and S. reported some
difculties with her boyfriend. In her workplace she was being
courted by one of her male colleagues, with whom she had an
affair some years before. She felt she was still attracted to this
other man, but also felt extremely guilty when thinking about
her boyfriend. Additionally, in the same period, a strong