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 a way. maladaptive patterns of thinking and acting in the form of mental disorders.
At the level of clinical psychology, attempts have been made to help those who suffer from maladaptive and discomfort-producing disorders and patterns through what is known as behavioral therapy and the three waves or generations of treatments that it has produced.
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 through 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 who can alleviate their suffering and improve their adaptationenhancing 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 we reached the current situation. The psychotherapist will apply the treatment based on 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 techniques and therapies applied have remained since behavioral therapies or behavioral modification 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 talk about a total of three great waves or generations of therapies. that have followed one another over time according to the predominance of one or another current of thought, 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 emerged strongly. as a reaction to the psychoanalytic therapies born with Sigmund Freud. The latter focused on hypothetical constructs that were 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 confront disorders based on data that can be verified and contrasted by experience. Behaviorists focused on treating the behavior present at the time of the problem, worrying about the relationships between stimuli, their reactions, and their consequences.
The first wave methodology
Behavior was understood to be mediated primarily 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 conditioningworking on aspects such as the association of stimuli, habituation or sensitization to them or the extinction of reactions to the 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, molding, systematic desensitization or token economy and the behavioral contract (if (although currently they are applied accompanied by more cognitive treatments).
The proposals of the first wave of Behavioral Therapies were and continue to be used to treat phobias, create or restore behavioral patterns and/or carry out training in people with reduced abilities.
The behaviorist model was the prevailing paradigm in the field of psychology for a long time. 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 the 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 keen.
The main problem with behaviorism is that although it recognizes the existence of an intermediate element between stimulus and responsedue to the lack of empirical data this point was ignored and considered an unexplorable black box. For these reasons, over time another current emerged that tried to make up for the shortcomings of this model.
2. Second wave: Cognitive-behavioral therapies
The lack of answers to multiple questions about the processes that mediate between perception and reaction and the lack of effectiveness of purely behavioral therapies on many disorders that more affect the content of thought caused numerous experts to They 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 causes behavior It is not the association between stimuli but rather the thinking and processing of the information.giving rise to cognitive and information processing theories. 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 distorted and dysfunctional schemes, structures and thought processes, which cause a great deal 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 they consider that therapies must be directed modify dysfunctional or deficient beliefs and thoughts. Thus, this current has in fact incorporated many behavioral techniques into its repertoire, although providing them with 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 effectiveness of the treatment, maximizing it to the extent possible, although at the cost of devoting less effort to knowing 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 predominant in clinical psychology today. The objective is to change the cognitions or emotions that cause the maladaptive behavior, either by restricting or modifying them. Some of the best-known behavioral therapies at a general level 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 stands out the fact that there is a tendency to try to eradicate everything that causes discomfortwithout taking into account that eliminating everything negative can cause rigid behavior patterns that in turn can be maladaptive. In fact, the attempt at control can end up inciting effects contrary to what was intended.
The second wave of therapies also has the added difficulty of having focused so much on making the therapies effective while neglecting the study of why it causes them to be effective. 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 birth of new therapies. that try to give an account from a renewed perspective; This 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 developed 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 connection 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 Therapies considers that psychological problems They are largely due to the sociocultural and communicational context of the individual.and to the fact that a given behavior is considered normal or aberrant. Rather than fighting the symptoms, therapy should focus on reorienting and refocusing the individual’s attention towards goals and values ​​that are important to them, improving the person’s psychosocial adjustment.
A therapeutic perspective focused on context
Third-generation therapies seek a deep-level changeentering 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 the symptoms. Likewise, the objective stops being to avoid discomfort or negative thoughts at all costs and begins to help the subject to be able to vary the type of relationship and vision they have of themselves and the problem.
Another element to highlight is the importance given to the therapist-patient relationship, which is considered to be able to produce changes in the subject’s situation. Through communication between both, we seek to change the functionality of the patient’s or client’s behavior, producing changes at a deep level.
Within this third wave we find therapies such as analytical-functional psychotherapy, dialectical behavioral therapy or Acceptance and Commitment Therapy. Mindfulness is also very relevant within this wave of therapies, although not as a type of therapy in itself but as a tool.
