Academic journal article International Journal of Clinical and Health Psychology

Third-Generation Therapies: Achievements and Challenges1

Academic journal article International Journal of Clinical and Health Psychology

Third-Generation Therapies: Achievements and Challenges1

Article excerpt

ABSTRACT. The term «third-generation therapies» refers to a series of therapies that emerge in the 1990s within the tradition of behavioral therapy. The aim of this article is to review their achievements and challenges. The method involves analyzing recent formulations of these therapies so as to identify their distinctive characteristics and the clinical innovations they represent. As regards their characteristics, it is important to acknowledge the fact that they give back to behavioral therapy its contextual perspective, lost with the advent of cognitive-behavioral therapy, which would now be classed as «second-generation.» This is why they are also called contextual therapies. The two main clinical innovations of these therapies are, on the one hand, psychological inflexibility as a psychopathological model common to various disorders, and on the other, the identification of therapeutic principles, more than specific techniques, in relation to processes of experiential acceptance and behavioral change. Notable among the challenges are those deriving from the very success of these therapies, which have taken on the character of a fashion, without the assumption of the philosophy they entail.

KEYWORDS. ACT. Behavioral activation. Psychological inflexibility. Medical model. Contextual model. Schizophrenia. Theoretical study.

RESUMEN. Las terapias de tercera generación refieren una serie de terapias que surgen en la década de los años noventa en la tradición de la terapia de conducta. El objetivo de este artículo es revisar sus logros y retos. El método consiste en analizar las formulaciones recientes de estas terapias en orden a identificar sus características distintivas y las innovaciones clínicas que representan. Respecto a sus características distintivas, importa reconocer el hecho de que la terapia conductual recupera la perspectiva contextual perdida con la terapia cognitivo-conductual, que quedaría ahora como «segunda generación». Es por lo que estas terapias también se denominan terapias contextuales. En cuanto a las innovaciones clínicas, importan sobre todo las que se refieran a la conceptualización psicopatológica y los principios terapéuticos. La innovación clínica cuenta con dos grandes aportaciones: la inflexibilidad psicológica como modelo psicopatológico común a diversos trastornos, y la identificación de principios terapéuticos, más que técnicas específicas, en torno a procesos de aceptación experiencial y de cambio conductual. Entre los retos se destacan los derivados del propio éxito de estas terapias, que queden como una moda, sin asumir la filosofía que implican.

PALABRAS CLAVE. ACT. Activación conductual. Inflexibilidad psicológica. Modelo médico. Modelo contextual. Esquizofrenia. Estudio teórico.

The term «third-generation behavior therapies» is a designation, but also a slogan, coined by Steven Hayes, the author of one such therapy, in an article from 2004 (Hayes, 2004). As a designation, it refers to a series of therapies that emerge in the 1990s and establish themselves as a new generation in the first ten years of the new century. This movement is called «clinical behavior analysis» because it represents a move away from cognitivism and back toward radical behaviorism and other forms of behaviorism, in particular functional analysis and behavioral models of verbal behavior (Dougher, 2011). As a slogan it is audacious, in that it highlights the novelty of these therapies with respect to the established ones, but it is also risky, insofar as others will follow it, ushering in the «fourth generation», the «ultimate» therapies or the «new wave.» In Spain, where they were introduced in 1996 in a book (Pérez-Álvarez, 1996), they were well accepted and soon built upon, thanks above all to the work of Luciano (Luciano and Hayes, 2001; Wilson and Luciano, 2002) and of others, including Barraca (2009, 2012), García-Montes and Pérez-Álvarez (2001, 2005, 2010), García Palacios (2006), Kohlenberg et al. …

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