Throughout the history of psychology, multiple approaches and theories 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 as to produce maladaptive thought and action patterns in the form of mental disorders.

At the level of clinical psychology, attempts have been made to help those who suffer from disorders and patterns of maladjustment and discomfort through the so-called behaviour therapy and the three waves or generations of treatments that it has produced .

Behavioral therapy: a brief definition

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

Thus, 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 this end, the aim is to eliminate, add or change one or several behaviours to the individual’s repertoire through learning processes.

This type of therapy focuses on the present moment, working on the current problem and being history only something that informs us about how the current situation has been reached. The psychotherapist will apply the treatment according to the characteristics of the subject to be treated and his/her 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 behavioural therapies or behavioural modification appeared, behavioural therapy has not ceased to evolve in order to improve both its effectiveness and the understanding of the mental and behavioural processes it works on.

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 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 could not be empirically contrasted, and considered that behavioral disorders were the expression of the poor resolution of unconscious conflicts related to the repression of instincts and needs.

However, the behavioural models were opposed to these considerations, preaching the need to face the disorders from verifiable and contrastable data by experience . The behaviourists focused on dealing with the behaviour present at the moment of the problem, worrying about the relationships between stimuli, reactions and consequences of these.

The first wave methodology

Behavior was understood as being mediated mainly by the association between stimuli and the consequences of the responses given to them. The therapies that appeared at this time were based on conditioning , working on aspects such as the association of stimuli, habituation or sensitization to them or the extinction of the reactions to the stimuli. First order changes in behaviour are provoked, working on directly observable behaviour.

Some of the treatments belonging to this first generation of behavioural therapies that are still being applied are exposure therapies, differential reinforcement of behaviours, aversive techniques, moulding, systematic desensitisation or token economy and behavioural contract (although they are currently applied accompanied by more cognitive treatments).

The proposals of the first wave of Behavioral Therapies were and still are used to treat phobias, create or reestablish behavioral patterns and/or perform training on people with reduced abilities.

The behavioural model was for a long time the prevailing paradigm in the field of psychology and the treatment of certain mental disorders. However, its conception and usefulness are limited: these treatments are only successful in specific circumstances and contexts where variables related to behaviour can be manipulated, and they take little account of the effect of psychological variables such as cognition or affect.

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 ignored and considered an unexplored black box. For these reasons, over time another trend emerged that attempted 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 little effectiveness of purely behavioural therapies on many disorders with a more typical affectation of the content of thought led many experts to consider that behaviourism was not enough to explain and produce a change in behaviour derived from elements such as convictions or beliefs.

At this point, we began to consider that the main element that originates behaviour is not the association between stimuli but rather thought and the processing of information , giving rise to cognitive and information processing theories. In other words, the second wave of Behavioural Therapy.

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 discard the importance of association and conditioning, but they consider that the therapies must be directed to modify the beliefs and dysfunctional or deficient thoughts . Thus, this current has in fact incorporated many of the behavioural techniques into its repertoire, although providing them with a new perspective and adding cognitive components. This combination gave rise to cognitive-behavioral therapies.

Emphasizing mental processes

Within this paradigm, great attention is paid to the degree of effectiveness of the treatment, maximizing it as much as possible, although at the cost of devoting less effort to knowing why it works.

This second wave presents a much higher success rate than the rest in a large number of disorders , being in fact the cognitive-behavioral paradigm one of the most predominant at the level of clinical psychology at present. The aim is to change the cognitions or emotions that cause maladaptive behavior, either by restricting or modifying them. Some of the best known behavioural 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’ Rational Emotional 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 behaviour patterns that in turn can be maladaptive. In fact, the attempt at control may 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 by neglecting to study why it causes n or to know well exactly which parts of the process 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 attempt 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. These third generation therapies include those developed under the perspective of the need to establish a more contextualised 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 link 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 largely due to the socio-cultural and communicational context of the individual , and to the fact that a given behavior is considered normal or aberrant. More than fighting the symptoms, therapy should focus on reorienting and refocusing the individual’s attention towards goals and values that are important to him or her, improving the person’s psychosocial adjustment.

A Context-Centered Therapeutic Perspective

Since the third generation therapies, a change is sought at a deep level , entering more into the nucleus of the person and less into 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 legitimisation of the symptoms. Likewise, the objective is no longer to avoid the discomfort or negative thoughts at all costs but to help the subject to be able to vary the type of relationship and vision he has of himself and of the problem.

Another element to emphasize is the importance given to the therapist-patient relationship, which is considered to be able to produce changes in the subject’s situation by itself. Through the communication between both, the aim is to make the functionality of the patient’s or client’s behaviour change, producing changes at a deep level.

Within this third wave we find therapies such as analytical-functional psychotherapy, dialectical behaviour 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.

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. (n.d.). New psychological therapies: The third wave of behavioral therapies or third generation therapies. Psychology Gazette, 40; 26-34. University of Almería.
  • Oblitas, L.A. (2004). “How to make psychotherapy successful?” The 22 most important approaches in contemporary and avant-garde psychotherapeutic practice. PSICOM Publishers. Bogotá D.C. Colombia. P. 146.
  • Vila,J. and Fernández, M.C (2004). Psychological treatments. The experimental perspective. Madrid: Pirámide.