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It is well known that Wilhelm Wundt is the father of experimental psychology, founding the first formal laboratory for psychological research at the University of Leipzig in 1879; in reality what was then thought as experimental psychology is a far cry from today’s definition. It is also common knowledge that modern psychotherapy was born soon after in Vienna, the work of a certain Sigmund Freud.

What is less well known is that both experimental as well as applied psychology found fertile ground for their development in the United States. In fact, after Freud’s arrival in the United States in 1911, psychoanalysis swept the field of psychiatry to the point that within a few years over 95% of American psychiatrists took up psychoanalytic training.

This monopoly on psychotherapy lasted until the late 1970’s in the United States and well into the 1980’s within European psychiatric circles. In reality, the crisis of psychoanalysis in terms of its capacity to give answers to changing social demands after the Second World War and its ability to “cure”, had already begun in the 1950s, coinciding with the birth of alternative psychotherapeutic models. Amongst these, Behavioral Therapy (BT) certainly played a starring role.

Established simultaneously in several parts of the world, in part thanks to contributions from psychoanalytic therapists who were unsatisfied with their instruments of analysis and intervention, BT spread rapidly throughout Europe and rapidly established itself as one of the therapies that could provide effective solutions to the suffering patient.

Fifty years had passed since John B. Watson’s pioneering work on behaviorism and its applications (Watson & Rayner, 1920; Jones, 1924) before a working model of BT came to the fore. However it’s subsequent evolution took place at a far quicker pace. And the reason for this was simple: as in all models based on scientific thought, BT was open to change, assimilating and integrating ongoing research not only in psychology but also in other scientific fields, giving rise to new forms of analysis and intervention.

The first generation of BT, featuring a radical shift from the well established Psychodynamic Therapies, was soon followed by a set of “innovations”, which took into account previously neglected cognitive aspects. This fusion of Behavioral and Cognitive Therapies is attributed to have given rise to the second generation of BT known as Cognitive Behavioral Therapy (CBT).

Development continues unabated and recent forms of intervention that fall under the umbrella of the third generation of Behavioral Therapies have arisen[1].

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The Roots of Cognitive Behavioral Therapy

Historically, BT can be divided into three generations. The first generation is in part a rebellion against prevailing therapeutic concepts of the day (the Psychoanalytic and Humanistic approaches). Early interventions focused directly on reducing problematic manifestations of behavior, using techniques based on well-defined and strictly validated scientific principles. An example can be made of an individual suffering from social anxiety who avoids situations in which he may be subject to judgment or criticism. The main goal of treatment would involve increasing exposure to such social situations or reducing anxiety from the stressful situations.

However BT was not insulated from events happening outside it. The “cognitive revolution” in psychology took place in the 1960s, and by the 1970s many behavior therapists influenced by it began to call their therapy “Cognitive Behavior Therapy” (CBT). Wilson (1982) states:

During the 1950s and 1960s, the behavior therapies developed within the framework of classical and operant conditioning principles that had originally served importantly to distinguish behavior therapy from other clinical approaches. Over the course of the 1970s, this conceptual commitment to conditioning theory peaked out — some would say even waned. In part this change reflected the shift to more technological considerations governing the increasingly broad application of behavioral techniques that had been developed and refined during the previous period of growth. Moreover, as psychology “went cognitive” during the 1970s, cognitive concepts inevitably were drawn upon to guide and explain treatment strategies, (p. 51).

Mahoney, an early leader in CBT, stated a similar theme (1984):

By the late 1970s it was clear that cognitive behavior therapy was not a fad; indeed it had its own special interest group in the AABT (Association for the Advancement of Behavior Therapy). It had become a more frequent topic at conventions, in journals, and in research, and it had become more pervasively integrated into behavioral psychotherapies. Behavior therapy, like psychology in general, had “gone cognitive.” (p. 9)

Part of this movement argued that learning research was still relevant but the research that should influence second-generation behavior therapy was human learning research that examined cognitive mediators of learning. The argument was that conditioning in humans is not automatic and direct, but rather is mediated by the person’s verbal and cognitive abilities. Awareness, attention, expectancy, attribution, and linguistic representation were constructs thought to be necessary to account for learning. The argument was that animal conditioning models were inadequate for the study of human learning because these neglected to include the unique abilities of humans such as verbal abilities. Thus, these animal conditioning models needed to be supplemented or replaced by cognitive accounts.

Therefore, the advent of cognitivism in the 1960’s brought about a paradigm shift within the field of experimental psychology. While the behavioural model had regarded cognitive processes as an epiphenomenon, a new approach appeared that considered cognitive knowledge of central importance in psychological investigation, while still maintaining an empirical view.

Cognitive therapy is thus born (Beck, Shaw, Rush & Emery, 1979; Meichenbaum, 1977; Mahoney, 1974) and with it, the second generation of BT. The concept of associative learning was abandoned leaving room for more flexible principles which took into account the role of internal experiences (thoughts and feelings) in determining human behavior; humans are, first and foremost, thinking beings, capable of organizing their behavior and modifying it according to circumstances (Bandura, 1969).

The study of irrational thoughts (Ellis, 1977) and cognitive schemata of mental illness (Beck, 1993) has identified how certain errors of cognition can be pervasive in certain types of patients and, for each of these, a variety of techniques are aimed at changing negative automatic thoughts. Returning to the example of the individual with social anxiety, the objectives of graded exposure in social situations, or the reduction of anxiety in relation to those same situations, are extended to include questioning the validity of the automatic thoughts related to the social situation, as well as the judgment of others.

Therefore it is the integration between the first two generations of BT that gives rise to the concept of CBT, which is characterized by a form of psychotherapy aimed at modifying not only overt behaviors but also beliefs, attitudes, cognitive styles and expectations of the client (Galeazzi & Meazzini, 2004).

Bibliography:

Bandura, A. (1969). Principles of Behavior Modification. NY: Holt, Rinehart & Winston, 677 p.

Beck, A. T. (1993). Cognitive therapy: Nature and relation to behavior therapy. Journal of Psychotherapy Practice and Research, 2, 345-356.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.

Ellis, A. (1977). The basic clinical theory of Rational-Emotional Therapy. In A. Ellis, R. Grieger (Eds.), Handbook of Rational-Emotive Therapy. New York: Springer.

Freud, A. (1936). Ego & the Mechanisms of Defence.

Galeazzi, A. & Meazzini, P. (2004). Mind and Behavior. Giunti Editore.

Mahoney, M. J. (1974). Cognition and behavior modification. Cambridge, MA: Ballinger.

Meichenbaum, D. H. (1977). /clean-my-pc-key-generator.html. behavior modification: An integrative approach. NY: Plenum Press.

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Öst, L. G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta analysis. Behavior Research and Therapy, 46, 295-321.

Teasdale, J. D. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10(2), 156-160.

Watson, J., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3 (1), 1-14

Wilson, G.T. (1982). Psychotherapy Process and Procedure: The Behavioral Mandate: Behavior Therapy 13, 291–312 (1982).

[1] These include: Mindfulness-based Cognitive Therapy (mBct) and Mindfulness-Based Stress Reduction (mBsr), Acceptance and Commitment Therapy (act), Dialectical Behavior Therapy (dBt), Functional Analytic Psychotherapy (Fap) and Integrative Behavioral Couples Therapy (iBct).

The approaches of the first two generations of Behavioral Therapy (BT) share the assumption that certain cognitions, emotions and physiological states lead to dysfunctional behavior and, therefore, therapeutic intervention is aimed at eliminating, or at least reducing, these problematic internal events. Third wave therapies are expanding their targets from the mere reduction of symptoms to the development of skills aimed at significantly improving the quality and quantity of activity in which the patient finds value. Even with seriously ill patients, the new behavioral therapies emphasize empowerment and increase in skills and behavioral repertoires that may be used in many contexts (Hayes, 2004).

The emphasis on building healthy behavioral skills, finds its rationale in the assumption that the processes which the patient fights against constantly (judging and attempting to control their internal experiences) are the same as those experienced by the therapist (Hayes, 2004); resulting in the fact that the methods and techniques of these therapies are suitable as much for the therapists as they are for the patients. In efforts made by the patient to increase acceptance of their internal experiences, the therapist is encouraged to form a sincere rapport with the inner most experiences of the patient.

Another feature of these new treatments is to break some of the historical barriers between behavior therapy and the somewhat less scientifically based approaches (e.g. Psychoanalysis, Gestalt therapy and Humanistic therapies) trying to integrate some of their fundamental concepts.

If, for some, the above elements suggest the emergence of a new wave within the field of CBT, for others (e.g. Leahy, 2008; Hofmann, 2008) it is neither a paradigm shift, nor do the therapies have features that confer any greater clinical efficacy. Whilst standard CBT meets the criteria of Empirically Supported Therapies (ESTs) — that is, therapies that have been proven effective through randomized controlled trials — for a wide variety of psychological disorders (Butler, 2006), currently we cannot say the same for the approaches seen in third-generation therapies (Öst, 2008).

Strong supporting evidence that Acceptance and Commitment Therapy (ACT), one of the most studied third wave approaches, is more effective than Cognitive Therapy is for the most part lacking and, when present, is derived from studies that have severe limitations, such as a small sample size or the use of non-clinical samples (Forman, 2007). So the doubt remains whether the third generation therapies actually represent a “new” wave in CBT. Keeping this is mind; it may be interesting to reflect on commonalities and differences between the third generation and the previous two generations.

The first generation’s exposure techniques were one of the most effective tools in the arsenal of CBT. Even though the underlying mechanism for this has yet to be fully understood (Steketee, 2002; Rachman, 1991), the rationale behind exposure techniques are reminiscent of the extinction processes of avoidance responses through the activation of habituation processes to the stimulus, with a progressive reduction and eventual disappearance of the physiological and behavioral reactions associated with them so that the patient learns to cope with the emotions triggered by the feared situations without resorting to avoidance behaviors.

Since experiential avoidance is a central target in third wave approaches, exposure therapy is undoubtedly still widely used; However, although third generation approaches can be similar to those of the previous generations, in terms of exposure techniques, the rational and objectives are different. Patients, in fact, are helped to identify what really matters in their lives and to engage in actions that are in line with these aims and values.

It is inevitable that such techniques may elicit unpleasant thoughts, emotions and physiological sensations, resulting in the impulse to avoid the experiential event. Therefore, third generation approaches are intended to reduce the avoidance behavior and increase the patient’s behavioral repertoire, however not necessarily extinguishing the internal responses (even though the process of extinction may well take place), but accepting them for what are without going against them.

The role attributed to life experiences in helping to create the content of thoughts is a similar concept in both second and third generations, but then there are radical differences with respect to the importance attributed to thought content in the creation and maintenance of psychological disturbances. Starting with the assumption that a stimulus can affect the emotions of a patient only as a consequence of how that emotion is processed and interpreted by his cognitive system, cognitive therapies aim to bring about a change in the patient through the correction of the content of his dysfunctional thoughts; in contrast, third wave therapies state that an excessive focus on the content of thoughts may contribute to worsening of symptoms. Leahy (2008) criticizes this position, citing the amount of empirical research supporting the greater efficacy of cognitive psychotherapy when compared to any other therapeutic approach. On the other hand, while reflecting on the new elements of the third generation, Leahy (2008) admits that the techniques which bring about distancing from ones thoughts through acceptance and mindfulness do not differ significantly from the process of critical thinking, which is the technique used in the cognitive approach.

In conclusion, standard cognitive therapy, which aims to modify the content of thoughts, may hinder the patient’s acceptance of internal experiences; the solution to which has been proposed through the methods and approaches of the third wave. These approaches put forward the idea of changing the patient’s relationship with their own internal events, a process that can be integrated into standard CBT (Hayes, 1999, and Segal, 2002).

Conclusion

Thirty years ago the cognitive behavioral approach to therapy was limited to the treatment of major depressive disorder and a very limited treatment for some anxiety disorders. Most practitioners at that time viewed this approach as rather simplistic, but admittedly effective for a small range of problems. The “deeper” and more “challenging” cases would be the focus for “depth” therapies of various kinds. Although those “depth” therapies provided little evidence of any effectiveness, they were seen as addressing the “real underlying problems.”

Psychotherapy has come a long way since then. As we have seen above, the cognitive behavioral approach to therapy provides an effective treatment modality for the full range of psychiatric disorders. This approach empowers the clinician to provide effective treatment for depression, generalized anxiety, panic disorder, obsessive-compulsive disorder, social anxiety disorder, PTSD, bipolar disorder, schizophrenia, eating disorders, body dysmorphic disorder, couples problems and family therapy issues. Indeed, where medication is part of the treatment approach, CBT increases medication compliance, resulting in a better outcome for patients with severe mental illness. The emergence of case conceptualization and schematic models of personality disorder has provided the clinician with the tools to help patients with longstanding, apparently intractable personality disorders.

Key Feature Of Most 3rd Generation Therapies 2017

Although psychodynamic theorists may still argue that CBT does not address the deeper issues, cognitive behavior therapists argue that CBT does deal with the deeper issues — only, it is done more rapidly and more effectively. New research that indicates that CBT can be effective with patients suffering from borderline personality disorder illustrates the power of case conceptualization within a structured proactive approach. Moreover, the treatment approaches of CBT are not simply derived from clinical lore and convenient anecdotes. Each structured treatment modality is supported by significant empirical research demonstrating its effectiveness.

Key Feature Of Most 3rd Generation Therapies List

Diablo 3 cd key generator. References

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 762-799

Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 638-665.

Hayes S. C., Masuda, A., Bissett, R., Luoma, J., & Gueffero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 33-54.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1151-1168.

Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28(1), 2-16.

Leahy, R. L. (2007). Emotion and psychotherapy. Clinical Psychology: Science ad Practice, 14, 351-357.

Leahy, R. L. (2008). A closer look at ACT. The Behavior Therapist, 31(8), 147-150.

Öst, L. G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta analysis. Behavior Research and Therapy, 46, 295-321.

Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach for preventing relapse. New York: Guilford Press.

Steketee, G. S., & Barlow, D. H. (2002). Obsessive-compulsive disorder. In D. H. Barlow (Ed.), Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed., pp. 515-551). New York: Guilford.

Key Feature Of Most 3rd Generation Therapies List

Teasdale, J. D. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10(2), 156-160.