Is there a conflict between Mindfulness-based and Acceptance-based Therapies and Cognitive Behaviour Therapy (CBT)? Mindfulness-based and Acceptance-based therapies are gaining vast momentum in the treatment of mental illnesses. These therapy modalities are seen to share some similarity with Cognitive Behaviour Therapy (CBT) (Ost, 2008), however, I am curious to know what conflicts exist in a therapist-client relationship when adopting some of the techniques/foundations from both therapy forms?

For example, in Acceptance and Commitment Therapy (ACT) - defusion (the process of distancing ourselves from our throughts) seems to present some form of conflict to CBT which suggests that cognitive restructuring is fundamental to behavioural change, i.e. "trying to change our thoughts". There may be some conflict within a therapeutic setting.

Questions:


What conflicts can occur in the therapist-client relationship when using mindfulness and acceptance exercises with cognitive behaviour therapy exercises?
In what ways may the two groups complement each other in achieving therapeutic outcomes ^ for the client?


^ Therapeutic outcomes can be assumed as symptomatic alleviation of the mental illness or any other positive outcome towards the alleviation of a mental illness.

Some further examples would be great.

References:


Öst, L.G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), pp.296-321
No takers so I've decided to do some research and theorise if there are any conflicts between these two therapy modalities. Drawing on research by Hofmann &amp; Asmundson (2008), three distinct differences are identified between Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT):


  The role of cognitions. "CBT helps patients to identify, challenge, and
  re-evaluate these rigid rules and adopt a more relaxed and satisfying
  system of values in order to enhance overall life satisfaction.
  Instead, ACT subsumes cognitions under the more general term behavior
  as it is used in behavior analysis, namely “as a term for all forms of
  psychological activity, both public and private, including cognition”
  (Hayes et al., 2006, p. 2). In essence, the word cognition has a
  different meaning in ACT than in CBT; it is a thought process in CBT
  and a private behavior in ACT."
  
  The role of emotions. "CBT and ACT target different stages in the emotion-generative process: CBT promotes adaptive antecedent-focused
  emotion regulation strategies, whereas ACT counter-acts maladaptive
  response-focused emotion regulation strategies. The cognitive
  restructuring techniques used in CBT are in line with the
  antecedent-focused emotion regulation strategies, providing skills
  that are often effective in reducing emotional distress in the long
  term. Acceptance and mindfulness-based strategies counter suppression
  and, thereby, alleviate emotional distress."
  
  Philosophical foundation. ACT is based on functional contextualism,
  which has been proposed as the philosophical basis for behavior
  analysis to emphasize the functional relations between behavior and
  environmental events ... CBT is not directly linked to a particular
  philosophy. The philosophical foundation most closely associated with
  CBT is critical rationalism, an epistemological philosophy (Popper,
  1959) that shares its philosophical roots with the natural sciences."


Potential conflicts

These are theorised based on the above differences between CBT and ACT:


Unclear criteria for the suitability of exercises. Since CBT and ACT are clearly disparate  therapy modalities, there is no universal guide on when and how to adopt therapeutic exercises from either CBT or ACT in combination or separately. The decision to use certain exercises is influenced highly by the therapist's subjective judgment and past experiences.
Unknown effects of combining CBT and ACT. As far as I know, there are no studies on the effects of traditional exercises such as cognitive restructuring (CBT) and mindfulness practice (ACT) when combined together on specific mental illnesses. Prima facie, the former involves deliberate attempt to modify cognitions and the latter involves a systematic process of observing non-judgmentally cognitions. It is difficult to see no conflict without empirical counter-evidence.
Potential negating effects. In ACT, Cognitive Defusion involves the process of  distancing or separating oneselves metaphorically from their thoughts (Moffitt et al., 2012). If a client initially uses cognitive restructuring techniques to alleviate distress from their mental illness and this becomes conditioned - using cognitive defusion subsequently after that could negate the positive effects of the previous CBT-based technique.


References


Hofmann, S.G. &amp; Asmundson, G.J.G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1-16
Moffitt, R., Brinkworth, G., Noakes, M. &amp; Mohr, P. (2012). A
comparison of cognitive restructuring and cognitive defusion as
strategies for resisting a craved food. Psychology &amp; Health, 27(2),
74-90