Academic journal article International Journal of Psychology and Psychological Therapy

Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy: A Systematic Review and Meta-Analysis of Current Empirical Evidence

Academic journal article International Journal of Psychology and Psychological Therapy

Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy: A Systematic Review and Meta-Analysis of Current Empirical Evidence

Article excerpt

Cognitive behavioral therapy (CBT) is widely considered as the approach to psychotherapy with more empirical support (e.g., Butler, Chapman, Forman, & Beck, 2006). However, as many authors have noted, it is not an easy task to define CBT because diverse theories, principles, models, and techniques can be categorized with this label (e.g., Craske, 2010; Hayes, 2008; Herbert & Forman, 2011; Levin & Hayes, 2011). In this sense, CBT can be better seen as a tradition based on a scientific approach to psychopathology and psychotherapy than a unified and coherent model.

Most authors recognize that CBT had its roots in the works conducted by Skinner (1953), Wolpe (1958) and Eysenck (1952). These authors used learning principles isolated in laboratory settings to develop a series of techniques (e.g., contingency management, systematic desensitization, exposure) to treat several psychological disorders. However, their theoretical postures were different and led to the development of two wings in behavior therapy (BT) (e.g., Dougher & Hayes, 2000): applied behavior analysis closely related to Skinner's radical behaviorism and behavior therapy associated with methodological behaviorism and SR learning theorists. These initial works that were extended between the 1950s and 1960s have been called the first generation of behavior therapy by Hayes (2004).

During the late 1960s, probably due to the dissatisfaction with SR theory to account for human cognition, behavior therapy began to embrace Ellis (1962) and Beck (1963) cognitive approaches. Behavioral and cognitive techniques commenced to be combined in packages of treatment that were then tested. This gradually led to the change from BT to CBT, and was termed by Hayes (2004) as the second generation of BT. However, a main difference from the first generation of BT is that cognitive interventions were developed separately from cognitive science (e.g., Craske, 2010; Hayes, 2004). In practice, some clinicians remained more behaviorally oriented and treated cognitions within a behavioral framework (i.e., applied behavior analysis). Other clinicians embraced an integrative approach and combined behavioral and cognitive techniques. Finally, others were more cognitively focused and considered the content of cognitions as the central factor for behavioral change (Craske, 2010). In spite of these differences, all these clinicians can be seen as CBT-oriented. In the context of this article, this broad view of CBT will be referred to as traditional CBT.

Almost one decade ago, Hayes (2004) proposed the existence of a third generation of CBT represented by therapies that have been developed during the last twenty years and that emphasize the role of acceptance and mindfulness to produce second-order changes instead of changes in cognitive content. One of such therapies, and probably the most representative one, is Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999, 2012; Wilson & Luciano, 2002). In fact, ACT has been the focus of most of the criticisms to the third generation therapies (see reviews in Gaudiano, 2011; Ruiz, 2010).

First, ACT was criticized because of its scarce empirical evidence (Corrigan, 2001). However, a considerable amount of research has been conducted during the last decade showing that ACT is an effective treatment for a wide range of problems (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Ruiz, 2010). Subsequent criticisms (Öst, 2008) focused on the methodological characteristics of ACT studies compared with CBT ones and on whether ACT fulfilled the criteria for being considered as an empirical validated treatment (see Gaudiano, 2009, for a reply). One more recent issue (Powers, Zum Vörde Sive Vörding, & Emmelkamp, 2009) has raised regarding whether ACT has more effect than established treatments (see Levin & Hayes, 2009 for a reply). Finally, ACT has been said to be no different from traditional CBT (e. …

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