Behavior Therapy was first ushered into clinical practice with the work of Andrew Salter in 1949. He introduced a technique called “assertiveness training” as a means of teaching patients how to develop more effective interpersonal skills. He did this against the backdrop of the then predominant psychoanalytic method of clinical intervention. Salter was subsequently joined by Joseph Wolpe, Arnold Lazarus, and a growing cadre of university-based psychologists to promote a radically new approach to treating and understanding behavioral pathology. Unlike their psychoanalytic counterparts, behavior therapists (and “applied behavior specialists” as well), argued that behavior, all behavior, is the result of learning (conditioning). Concepts like the unconscious, the ego and id were considered far too hypothetical, and critically, not subject to the rigors of scientific research. Behavior therapists allied their theory and practice to basic and applied research. The techniques that developed from this model produced the first effective clinical tools to treat anxiety, depression, problems with self-esteem and a host of pediatric behavior problems. These clinical tools were all developed with the underlying assumption that behavior change was the appropriate focus of clinical practice. A patient’s developmental history was helpful as a means of understanding their learning environment. Problematic behavior, however, was understood to be maintained by current environmental factors, not underlying mental dynamics.
Cognitive Behavior Therapy (CBT) developed in the early 1970s as an outgrowth of behavior therapy. Albert Ellis, Aaron Beck, Donald Meichenbaum and others argued that orthodox behavior therapy was missing a critically important component in understanding and treating patients with behavioral problems. Their formulation of behavior was simple enough. Behavior is the result of: (A) antecedent events; (B) beliefs (i.e. rational and irrational thoughts); and (C) consequences (i.e. emotions and behaviors). According to the cognitive/behavioral model, beliefs can color, and often distort patients’ perceptions and understandings of the world they live in. Aaron Beck, for example, showed how depressed patients’ filter out most of the positive events of their day, while magnifying the importance and frequency of negative events. Beck was able to show that this was the result of a depressive belief system. Cognitive/Behavioral treatments were therefore, designed to challenge patients to test and refute irrational beliefs. The goal in CBT is to change irrational thoughts / beliefs and as a result, affect positive behavior change. As with behavior therapy, CBT is rigorously evaluated for efficacy. Since its inception, CBT has greatly enhanced the breadth and effective value of clinical behavioral practice. Anxiety disorders (panic, social, somatic, agoraphobia, OCD); depressive disorders (dysthymia, major depression); adjustment disorders; anger management; addictive problems; personality disorders…all of these and more can be treated either solely or in conjunction with psychopharmacology to produce significant and lasting results.
Acceptance and Commitment Therapy (ACT) was developed in the 1990s by the work of Steven Hayes and his associates at the University of Nevada, Reno. It is in many respects an outgrowth of both behavior therapy and CBT, but it is clearly distinct from both. ACT shares with its predecessors a commitment to research and clearly seeks to expand upon their advancements in understanding and application. Unlike its predecessors (behavioral and non-behavioral) ACT is based upon “emotional acceptance”. Patients are trained to recognize the paradox of emotional control. Simply put, the more they try to control or fix emotions or thoughts, the worse they feel. Therapeutic success is achievable by learning, as the Serenity Prayer in AA says, to control the things you can control, to accept the things you cannot control, and to have the wisdom to know the difference. It is behavior that is, and always has been the result of choice. Thoughts and feelings are a part of the tapestry of human experience, but they never control behavior. We think and we feel, and all too often we choose to satisfy those thoughts and feelings, but we don’t have to. We can choose to do what makes sense, even when it is not supported by a thought or feeling. The essence of ACT is to free the patient from the helplessness of emotional control and enable them to embrace values-driven choices. The results of ACT have been extraordinary. Anxiety disorders (particularly panic anxiety), depressive disorders, stress, anger and many more have achieved high levels success, often in very few sessions. The impact of ACT has been broadly felt in cognitive behavioral practice. Dialectical Behavior Therapy (DBT) and other Mindfulness-based therapies have incorporated much of the theoretical orientation and practices of ACT. ACT now represents the “cutting-edge” of the behavior therapies.