The three generations of therapies show the evolution of health-centered psychology.
Throughout the history of psychology, there have been multiple approaches and theories that have emerged with the aim of explaining how the human mind works, what psychological mechanisms influence and participate in our behavior and even how they can be altered in a way. maladaptive patterns of thinking and acting in the form of mental disorders.
At the clinical psychology level, an attempt has been made to help those who suffer from maladaptive disorders and patterns and producers of discomfort through what is known as behavior therapy and the three waves or generations of treatments that it has produced.
Behavior therapy: a brief definition
We call behavior therapy the type of treatment based on experimental psychology in which it is considered that behavior, although predisposed by biology, is determined and can change by the learning and application of patterns of behavior and thought.
In the presence of maladaptive behaviors that generate significant discomfort in the person, it is possible to modify these patterns by teaching other more useful ones.
In this way, the general objective of this type of therapy is to generate a change in the person that can alleviate their suffering and improve their adaptation, enhancing and optimizing their skills and opportunities in the environment. To do this, the aim is to eliminate, add or change one or more behaviors to the individual’s repertoire through learning processes.
This type of therapy focuses on the present moment, working on the current problem and history being only something that informs us of how the current situation has been reached. The psychotherapist will apply the treatment according to the characteristics of the subject to be treated and their circumstances, having to adapt the therapy to each situation.
The three waves or generations of therapies
Although many of the applied techniques and therapies have remained since behavior or behavior modification therapies made their appearance, behavior therapy has not stopped evolving in order to improve both its effectiveness and the understanding of mental processes and behavior on which it works.
So far, we can speak of a total of three great waves or generations of therapies that have followed one another over time according to one or another current of thought predominated, each of them overcoming many of the explanatory and methodological limitations of the previous models .
1. First wave: Behavioral therapies
Behavioral therapy was born at a time in the history of psychology in which behaviorism emerged strongly as a reaction to psychoanalytic therapies born with Sigmund Freud. The latter focused on hypothetical constructs not empirically testable, and considered that behavioral disorders were the expression of poor resolution of unconscious conflicts related to the repression of instincts and needs.
However, the behavioral models were opposed to these considerations, preaching the need to deal with the disorders from verifiable data and verifiable by experience. The behaviorists focused on treating the behavior present at the moment of the problem, worrying about the relationships between stimuli, the reactions and the consequences of these.
The methodology of the first wave
The behavior was understood as a mediated mainly by the association between stimuli and the consequences of the responses given to them. The therapies that appeared at this time are therefore based on conditioning, working on aspects such as the association of stimuli, habituation or sensitization to them or the extinction of reactions to stimuli. First order changes in behavior are caused, working on directly observable behavior.
Some of the treatments belonging to this first generation of behavioral therapies that continue to be applied are exposure therapies, differential reinforcement of behaviors, aversive techniques, shaping, systematic desensitization or the token economy and behavioral contract (if well at present they are applied accompanied by more cognitive treatments).
The proposals of the first wave of Behavioral Therapies were used and continue to be used to treat phobias, create or reestablish behavioral patterns and / or carry out training in people with reduced capacities.
The behaviorist model was for a long time the prevailing paradigm in the field of psychology and the treatment of certain mental disorders. However, their conception and usefulness are limited: these treatments are only successful in specific circumstances and contexts in which variables that have to do with behavior can be manipulated, and they take little into account the effect of psychological variables such as cognition or affected.
The main problem with behaviorism is that although it recognizes the existence of an intermediate element between stimulus and response, due to the lack of empirical data this point was overlooked and considered an inexplorable black box. For these reasons, over time another trend emerged that tried to make up for the shortcomings of this model.
2. Second wave: Cognitive-behavioral therapies
The lack of answer to multiple questions about the processes that mediate between perception and reaction and the ineffectiveness of purely behavioral therapies on many disorders with an effect more typical of the content of thought led many experts to consider that behaviorism was not enough to explain and produce a change in behaviors derived from elements such as convictions or beliefs.
At this point, it began to be considered that the main element that originates the behavior is not the association between stimuli but the thought and the processing of information, giving rise to cognitive theories and information processing. That is, the second wave of Behavioral Therapies.
From this perspective, it was considered that the anomalous patterns of behavior are due to the existence of a series of distorted and dysfunctional schemes, structures and thought processes, which cause a great amount of suffering to those who experience them.
The promoters of the second wave of therapies do not rule out the importance of association and conditioning, but consider that the therapies must be aimed at modifying dysfunctional or deficit beliefs and thoughts. Thus, this current has in fact incorporated many of the behavioral techniques to its repertoire, albeit giving them a new perspective and adding cognitive components. From this combination, cognitive-behavioral therapies emerged .
Emphasizing mental processes
Within this paradigm, great attention is paid to the degree of efficacy of the treatment, maximizing it as far as possible, although at the cost of spending less effort to know why it works.
This second wave has a much higher success rate than the rest in a large number of disorders, in fact the cognitive-behavioral paradigm is one of the most prevalent at the level of clinical psychology today. The goal is to change the cognitions or emotions that provoke the maladaptive behavior, either by restricting or modifying them. Some of the best-known general behavioral therapies are typical of this period, such as Aaron Beck’s Cognitive Therapy for depression, self-instruction therapy or Albert Ellis’s Rational Emotive Therapy, among others.
However, despite its clinical success, this type of therapy also has some problems. Among them is the fact that there is a tendency to try to eradicate everything that generates discomfort, without taking into account that eliminating everything negative can cause rigid behavior patterns that in turn can be maladaptive. In fact, the attempt to control may end up inciting effects contrary to what was intended.
The second wave of therapies also have the added difficulty that the fact both have focused on making effective therapies are neglecting the study of the causes why that n or know well what parts of the process exactly produce positive change. Finally, generalizing the results of this therapy to the usual context of the patient’s life and maintaining them is difficult, and problems such as relapses appear with some frequency
These problems have led to the relatively recent birth of new therapies that try to give account from a renewed perspective; it is the third wave of Behavior Therapies.
Third Wave: Third Generation Therapies
This is the latest wave of behavior modification therapy. These third-generation therapies are considered to belong to those elaborated from the perspective of the need to establish a more contextualized and holistic approach to the person, taking into account not only the symptoms and problems of the subject but also the improvement of the vital situation and the relationship with the environment, as well as the generation of a real and permanent change in the individual that allows the definitive overcoming of the discomfort.
This type of Behavioral Therapy considers that psychological problems are due in large part to the sociocultural and communicational context of the individual, and to the fact that a given behavior is considered normal or aberrant. More than in the fight against symptoms, therapy should focus on reorienting and refocusing the individual’s attention towards goals and values that are important to him, improving the person’s psychosocial adjustment.
A context-focused therapeutic perspective
From third generation therapies, a profound change is sought, entering more into the core of the person and less into the specific situation of the problem, which helps make the changes produced more permanent and significant. The third wave also focuses on providing a better understanding and legitimation of symptoms. Likewise, the objective ceases to be to avoid discomfort or negative thoughts at all costs to help the subject to be able to vary the type of relationship and vision he has of himself and the problem.
Another element to note is the importance given to the therapist-patient relationship, which is considered to be capable of producing changes in the subject’s situation by itself. Through communication between the two, the aim is to make the functionality of the patient’s or client’s behavior change, producing profound changes.
Within this third wave we find therapies such as analytic-functional psychotherapy, dialectical behavioral therapy or Acceptance and Commitment Therapy. Also Mindfulness is very relevant in this wave of therapies, although not as a kind of therapy in itself but as a tool.
- D’Zurilla, TJ and Goldfried, MR (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107-126.
- Hayes, SC (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35, 639-665.
- Mañas, I. (sf). New psychological therapies: The third wave of behavior therapies or third generation therapies. Gazette of Psychology, 40; 26-34. University of Almería.
- Oblitas, LA (2004). “How to do successful psychotherapy?” The 22 most important approaches in contemporary and cutting-edge psychotherapeutic practice. PSICOM Editors. Bogotá DC Colombia. Page 146.
- Vila, J. and Fernández, MC (2004). Psychological treatments. The experimental perspective. Madrid: Pyramid.