Key Constructs in “Classical” and “New Wave” Cognitive Behavioral Psychotherapies: Relationships Among Each Other and With Emotional Distress


  • We thank Dr. Aurora Szentagotai Tatar and Dr. Florin Alin Sava for valuable consultation regarding the adaptation of the AAQ-II, Dr. Krisztina Szabo for providing the study database for the Romanian adaptation of the AAQ-II, as well as Dr. Andrew Hayes and Dr. Kristopher Preacher for important advice on mediation procedures.

Please address correspondence to: Ioana A. Cristea, Babes-Bolyai University, Department of Clinical Psychology and Psychotherapy, No.37, Republicii St., 400015, Cluj-Napoca, Romania. E-mail:



We aimed to relate key constructs from three forms of cognitive behavioral therapy that are often placed in competition: rational emotive behavior therapy, cognitive therapy, and acceptance and commitment therapy. The key constructs of the underlying theories (i.e., irrational beliefs/unconditional self-acceptance, dysfunctional cognitions, experiential avoidance/psychological inflexibility) of these therapies have not been explicitly studied in their relationships to each other and with emotional distress.


We used a cross-sectional design. The variables were selected to indicate key constructs of the three major forms of therapy considered. Study 1 used a sample of 152 students, who were assessed during a stressful period of their semester (mean age = 21.71; 118 females), while Study 2 used a clinical sample of 28 patients with generalized anxiety disorder (mean age = 26.67; 26 females).


Results showed that these constructs, central in the therapies considered, had medium to high associations to each other and to distress. Experiential avoidance was found to mediate the relationship between the other, schema-type cognitive constructs and emotional distress. Moreover, multiple mediation analysis in Study 2 seemed to indicate that the influence of the more general constructs on distress was mediated by experiential avoidance, whose effect seemed to be carried on further by automatic thoughts that were the most proximal to distress.


Although each of the cognitive constructs considered comes with its underlying theory, the relationships between them can no longer be ignored and cognitive behavioral therapy theoretical models reliably accounting for these relationships should be proposed and tested.