Behavioral therapies: first, second and third wave

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 such a way that maladaptive patterns of thinking and acting are produced in form of mental disorders.

At the level of clinical psychology, an attempt has been made to help those who suffer from disorders and maladaptive patterns and producers of discomfort through the known behavior therapy and the three waves or generations of treatments that it has produced.

Behavior therapy: a brief definition

We call behavior therapy type of treatment based on experimental psychology in which it is considered that behavior, although predisposed by biology, is determined and can change by learning and applying patterns of behavior and thinking.

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 who can alleviate your suffering and improve your adjustment, enhancing and optimizing their skills and opportunities in the environment. To do this, it is intended 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 The treatment will be applied according to the characteristics of the subject to be treated and his circumstances, having to adapt the therapy to each situation.

The three waves or generations of therapies

Although many of the techniques and therapies applied 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 the mental and behavioral processes on which it works.

So far, we can speak of a total of three great waves or generations of therapies that have occurred in 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 when behaviorism was emerging 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, behaviorist models opposed these considerations, preaching the need to deal with disorders based on verifiable data and verifiable by experience. The behaviorists focused on treating the behavior present at the time of the problem, worrying about the relationships between stimuli, the reactions and the consequences of these.

The first wave methodology

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 behavior therapies that continue to be applied are exposure therapies, differential reinforcement of behaviors, aversive techniques, shaping, systematic desensitization or token economy, and the behavioral contract (although these are currently applied accompanied by more cognitive).

The proposals of the first wave of Behavioral Therapies were used and continue to be used for the treatment of phobias, create or reestablish behavioral patterns and / or train people with reduced abilities.

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 they can manipulate variables that have to do with behavior, and take little account of the effect of psychological variables such as cognition or affected.

The main problem with behaviorism is that although she recognizes the existence of an intermediate element between stimulus and responseDue 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 response to multiple questions about the processes that mediate between perception and reaction and the ineffectiveness of the purely behavioral therapies on many disorders with an affectation more typical of the content of thought caused that numerous experts considered 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 It is not the association between stimuli but the thought and processing that is made of the information, being born the cognitive theories and the information processing. That is, the second wave of Behavioral Therapies.

From this perspective, it was considered that anomalous patterns of behavior are due to the existence of a series of schemes, distorted and dysfunctional structures and thought processes, which cause a great deal of suffering to those who experiment.

The promoters of the second wave of therapies do not rule out the importance of association and conditioning, but consider that therapies must be targeted modify dysfunctional or deficient beliefs and thoughts. Thus, this current has in fact incorporated many of the behavioral techniques to its repertoire, although giving them a new perspective and adding cognitive components. From this combination arose the cognitive-behavioral therapies.

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 find out why it works.

This second wave has a much higher success rate than the rest in a large number of disordersIn 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 cause the maladaptive behavior, either by restricting or modifying them. Some of the most widely known behavior therapies are typical of this period, such as Aaron Beck's Cognitive Therapy for depression, self-instruction therapy or Rational Emotive Therapy by Albert Ellis, among other.

However, despite its clinical success, this type of therapy also has some problems. Among them stands out the fact that there is a tendency to try to eradicate everything that generates discomfort, regardless of the fact that eliminating all the 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 has the added difficulty that the fact of having focused so much on making the therapies effective neglecting the study of why causes that no it is well known which parts of the process exactly produce a positive change. Finally, generalizing the results of this therapy to the usual context of the patient's life and maintaining them is complicated, and problems such as relapses appear with some frequency

These problems have led to the relatively recent emergence of new therapies who try to give an account from a renewed perspective; it is the third wave of Behavioral Therapies.

Third Wave: Third Generation Therapies

This is the latest wave of behavior modification therapies. They are considered to belong to these third generation therapies those elaborated from the perspective of the need to establish a more contextualized and holistic approach of 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 Behavior Therapies considers that psychological problems are largely due to the sociocultural and communicational context of the individual, and the fact that a given behavior is considered normal or aberrant. More than in the fight against the symptoms, therapy should focus on reorienting and refocusing the attention of the individual towards goals and values ​​important to him, improving the psychosocial adjustment of the person.

A context-focused therapeutic perspective

Third-generation therapies seek a profound change, entering more in the nucleus of the person and less in the concrete situation of the problem, which helps to make the changes produced more permanent and significant. The third wave also focuses on providing a better understanding and legitimation of symptoms. Also, the goal stops being to avoid discomfort or negative thoughts at all costs to move on to help the subject to be able to vary the type of relationship and vision he has of himself and of the trouble.

Another element to highlight 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, it is sought to make the functionality of the behavior of the patient or client change, producing changes at a deep level.

Within this third wave we find therapies such as analytic-functional psychotherapy, dialectical behavioral therapy or Acceptance and commitment therapy. He too Mindfulness It is very relevant within this wave of therapies, although not as a type of therapy in itself but as a tool.

Bibliographic references:

• D'Zurilla, T.J. and Goldfried, M.R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107-126.

• Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35, 639-665.

• Mañas, I. (s.f.). New psychological therapies: The third wave of behavior therapies or third generation therapies. Gazette of psychology, 40; 26-34. University of Almería.

• Oblitas, L.A. (2004). "How to do successful psychotherapy?" The 22 most important approaches in contemporary and cutting-edge psychotherapeutic practice. PSICOM Editors. Bogota D.C. Colombia. P. 146.

• Vila, J. and Fernández, M.C (2004). Psychological treatments. The experimental perspective. Madrid: Pyramid.