Third Wave Behavior Therapies

I’ll continue with another post about psychotherapy. For this post it might be beneficial to read a little about Acceptance and Commitment Therapy and other behavioral therapies to best understand my post. I wrote it assuming that the reader had at least a basic understanding of these therapies.

The first wave of behavior therapy was closely tied to the theories of Skinner and Watson. Second wave treatments added in cognitive components and expanded on basic behaviorism. Third wave models keep many of the good techniques from the first two waves but focus more on contextual behavior than atomistic behavior, flexible skills than pathology, and function than form. Third wave methods emphasize the broad constructs of values, spirituality, relationships, and mindfulness whereas first and second wave therapies are focused mainly on the immediate problems. For example, with second wave behavior therapy, the therapist might seek to challenge and change cognitions but in a third wave therapy the therapist might focus more on understanding and accepting the cognitions and how they tie into a person’s value system (that is not the end goal of third wave therapies – the therapists also seek change but change is effected differently than in second wave therapies).

In Acceptance and Commitment Therapy (ACT) one specific technique is confronting the system. With this, the therapist tries to help clients understand that maybe they aren’t changing what they want to change, not because their problem-solving abilities are ineffectual, but because they might just be trying to solve the wrong problem; it’s like using a hammer to pound in a screw when what they really need is a saw to cut a block of wood. So, a second wave therapist might try to help the client see that they need a screwdriver instead of a hammer or a nail instead of a screw but an ACT therapist might help the client recognize that their real problem (as it fits with their life goals) is not attaching two objects together but cutting them apart.

One of the major assumptions of third wave behavioral therapies is that language is relational – that cognitions, emotions, and actions all need to be understood in context. This means, for example, that responses to cues for negative emotions or cognitions might themselves become cues and exacerbate the problem. So, third wave therapists might seek to change the context of the thoughts and emotions where a second wave therapist might seek to change the cues (or coping behavior associated with cues).

Another key assumption of third wave behavior therapies is that values and spirituality matter. In fact, they drive much of human behavior; therefore, largely ignoring them (as do previous waves of therapies) is ignoring much about the clients themselves. This focus on values allows the therapist (assuming an ACT approach) to help clients discover their true end goals in life and how their current behaviors, emotions, or cognitions are or are not detracting from those goals. Then manageable sub-goals are established and any barriers identified. While third wave techniques are focused on the “now” as are first and second wave therapies, third wave therapies also include a broader context for behavior change.

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