BEHAVIOR THERAPY 35 , 639–665, 2004
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639 Acceptance and Commitment Therapy,
Relational Frame Theory, and the Third Wave of
Behavioral and Cognitive Therapies
Steven C. Hayes
中山英语培训
University of Nevada, Reno
The first wave of behavior therapy countered the excess and scientific weakness of
existing nonempirical clinical traditions through empirically studied first-order
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change efforts linked to behavioral principles targeting directly relevant clinical tar-
gets. The cond wave was characterized by similar direct change efforts guided by
social learning and cognitive principles that included cognitive in addition to behav-
ioral and emotive targets. Various factors em to have t the stage for a third wave,
including anomalies in the current literature and philosophical changes. Acceptance
and Commitment Therapy (ACT) is one of a number of new interventions from both
behavioral and cognitive wings that em to be moving the field in a different direc-
tion. ACT is explicitly contextualistic and is bad on a basic experimental analysis
of human language and cognition, Relational Frame Theory (RFT). RFT explains
always online什么意思why cognitive fusion and experiential avoidance are both ubiquitous and harmful.
ACT targets the process and is producing supportive data both at the process and
outcome level. The third-wave treatments are characterized by openness to olderapartheid
clinical traditions, a focus on cond order and contextual change, an emphasis of
function over form, and the construction of flexible and effective repertoires, among
other features. They build on the first- and cond-wave treatments, but em to be
carrying the behavior therapy tradition forward into new territory.
Over the last veral years quite a number of behavior therapies have emerged that do not fit easily into traditional categories within the field.Examples include Dialectical Behavior Therapy (DBT; Linehan, 1993), Func-tional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991), Integrative Behavioral Couples Therapy (IBCT; Jacobson & Christenn, 1996), and Mindfulness-Bad Cognitive Therapy (MBCT; Segal, Williams, & Teasdale,2002), among veral others (e.g., Borkovec & Roemer, 1994; McCullough,2000; Marlatt, 2002; Martell, Addis, & Jacobson, 2001; Roemer & Orsillo,
The prent article stems from my AABT Presidential Address. Without deflecting responsi-bility for the current paper, I would like to acknowledge that some of this line of argument appeared previousl
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y in Dutch (Hayes, Masuda, & De Mey, 2003).外语学习软件
Address correspondence to Steven C. Hayes, Department of Psychology/296, University of Nevada, Reno, NV 89557-0062; e-mail: hayes@unr.edu.
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alabama
2002). No one factor unites the new methods, but all have ventured into areas traditionally rerved for the less empirical wings of clinical interven-tion and analysis, emphasizing such issues as acceptance, mindfulness, cog-nitive defusion, dialectics, values, spirituality, and relationship. Their meth-ods are often more experiential than didactic; their underlying philosophies are more contextualistic than mechanistic.
Acceptance and Commitment Therapy (ACT, said as one word, not as let-ters; Hayes, Strosahl, & Wilson, 1999) is another of this group. ACT is hard to categorize. The traditional distinctions (e.g., behavioral versus Gestalt; behavioral versus cognitive) em to be more confusing than clarifying. The-oretically speaking, ACT is rigorously behavioral, but yet is bad on a com-prehensive empirical analysis of human cognition (Relational Frame Theory or RFT; Hayes, Barnes-Holmes, & Roche, 2001). Bad in clinical behavior analysis, ACT nevertheless riously address issues of s
pirituality, values, and lf, among other such topics. Such categorical ambiguity is shared with the majority of the new methods. For example, while ACT is suppodly “behavioral” and MBCT is suppodly “cognitive,” the two em much more cloly allied than either are to, say, Beck’s cognitive therapy on the one hand or to densitization on the other.
When ts of anomalous events co-occur that are difficult to categorize using well-established distinctions, sometimes the field itlf is reorganizing. Behavior therapy has already lived through periods of reorganization in a dis-ciplinary lifetime that now enters its fifth decade. Now may be such a time. The purpo of this article is to explain ACT and to show how it relates to the intellectual and practical evolution that ems to be under way within behav-ior therapy.
The Waves of Behavior Therapy
Behavior therapy can be roughly categorized into three waves or genera-tions (except where more specificity is needed, we will u the term “behav-ior therapy” to refer to the entire range of behavioral and cognitive therapies, from clinical behavior analysis to cognitive therapy). What I mean by a “wave”is a t or formulation of dominant assumptions, methods, and goals, some implicit, that help organize rearch, theory, and practice.
switchbladeThe First Wave
The first wave of behavior therapy was in part a rebellion against prevailing clinical conceptions. Early behavior therapists believed that theories should be built upon the bedrock of scientifically well-established basic principles, and that applied technologies should be well-specified and rigorously tested. In contrast, existing clinical traditions had a very poor link to scientifically established basic principles, vague specification of interventions, and weak scientific evidence in support of the impact of the interventions. Franks and Wilson (1974) showed this dual metatheoretical and empirical concern when
act, rft, and the third wave of behavior therapy641 they defined behavior therapy in terms of “operationally defined learning the-ory and conformity to well-established experimental paradigms” (p. 7).
The objections to existing clinical traditions were shared by both of the major streams within behavior therapy at the time, neo-behaviorism and behavior analysis, and for that reason what united early behavior therapists overrode for a time the substantial differences among them. Both of the tradi-tions were strongly scientifically bad, and thus could unite against the obvi-ous metath
eoretical and empirical weakness of competing clinical paradigms. The core of the objections to analytic and humanistic conceptions was met-atheoretical and empirical, but the specific arguments were substantive. For example, Freud’s ca of Little Hans (1928/1955) was skewered by early behavior therapists, who ridiculed the amazing flights of psychoanalytic fancy the ca study contained (Bandura, 1969, pp. 11–13; Wolpe & Rach-man, 1960). Freud argued that Little Hans was failing to leave home as a means of avoiding Oedipal feelings and resulting castration anxiety. The con-voluted reasoning that led to this conclusion included claims that a hor going through a gate is similar to feces leaving the anus, a loaded cart is like a pregnant woman, and that “the falling hor was not only his dying father but also his mother in childbirth” (Freud, 1955, p. 128). Behavior therapists (Wolpe & Rachman, 1960) had a far simpler explanation. Since Little Hans had en a hor-drawn cart fall over amidst the cries and screams of riders (among veral other hor-related frightening events), it was more plausible that he avoided going outside becau he had a learned fear of hors. Behav-ior therapists poked fun at the complexity of psychoanalytic theorizing by showing experimentally that simple contingencies could readily produce behavior that would occasion bizarre psychoanalytic interpretations (e.g., Ayllon, Haughton, & Hughes, 1965).
Behavior therapy focud directly on problematic behavior and emotion, bad on conditioning and
neo-behavioral principles. The goal would not be to resolve the hypothesized unconscious fears and desires of Little Hans and others like him—the goal would be to get him to go out of the hou and to school. Psychoanalysts ridiculed this approach (e.g., Bookbinder, 1962; Schraml & Selg, 1966) on the grounds that symptom substitution would far outstrip superficial behavioral gains, or that unconscious desires would over-whelm necessary defen mechanisms. But this claim itlf was an object of behavioral criticism (e.g., Yates, 1958) and, while it emed possible from a behavioral point of view (Bandura, 1969, pp. 48–49), as an empirical matter it proved to be much less of a problem than psychoanalysts suppod (Nurn-berger & Hingtgen, 1973).
With a direct change in focus came also a certain narrowing of vision, however. The rejected analytic and humanistic concepts were clinically rich. They generally were designed to address fundamental human issues, such as what people want out of life or why it is hard to be human. Unfortunately, as vague concepts were rejected, their underlying purpos also became rela-tively unfashionable.
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The Second Wave
In the late 1960s, neo-behaviorists began to abandon simple associative concepts of learning in favo
r of more flexible mediational principles and mechanistic computer metaphors. The new cognitive psychology established a much more liberal theoretical approach that appealed to hypothesized inter-nal psychological machinery.
The failure of S-R learning theory was paralleled by Skinner’s (1957) fail-ure to provide an empirically adequate analysis of language and cognition. This failure is especially poignant becau “radical” behaviorism overthrew the Watsonian restriction against the direct scientific analysis of thoughts, feelings, and other private events. Skinner did so (1945) on the grounds that a behavioral analysis of scientists themlves was necessary (thus the word “radical”) and when that analysis was made it was clear that scientific objec-tivity depended not on the target or location of analyzed events but on the nature of the contingencies controlling the obrvations of them. Objectivity could occur in the analysis of private events, and scientifically unacceptable subjectivity could occur in the analysis of publicly obrved events (or vice versa). That fundamental break with the Watsonian tradition (under the entirely inappropriate label of “radical behaviorism”) was not appreciated for what it was becau Skinner’s analysis of language and cognition led him to con-clude that while a scientifically valid study of thoughts and feelings was pos-sible, it was not needed to understand overt behavior. Language and cognition was conceived of as simple operant behavior and as such it
added nothing fundamentally new to the contingency stream surrounding other behaviors. Thus, a door was opened by Skinner, but few behavior analysts walked through it or would have had any reason to do so.
Behavior therapists knew they needed to deal with thoughts and feelings in a more direct and central way. In the context of the failure of both associa-tionism and behavior analysis to provide an adequate account of human lan-guage and cognition, the eds planted by early cognitive mediational accounts of behavior change (e.g., Bandura, 1969) quickly flowered into the cognitive therapy movement (e.g., Beck, Rush, Shaw, & Emery, 1979; Mahoney, 1974; Meichenbaum, 1977). Methodological behaviorism provided a ready means for the transition from the first to the cond wave of behavior therapy: “One can study inferred events or process and remain a behaviorist as long as the events or process have measurable and operational referents” (Franks & Wilson, 1974, p. 7). Some neo-behaviorists objected that cognition had been dealt with all along (e.g., Wolpe, 1980), but this objection was ignored becau what was more at issue was the centrality of cognition and the flexi-bility needed to deal with it in a more natural way. Early cognitive behavior therapies addresd cognition from a direct, clinically relevant point of view. Certain cognitive errors emed characteristic of patient populations, and rearch proceeded directly to the identification of the errors and the meth-ods needed to correct them.
act, rft, and the third wave of behavior therapy643 Some of the central themes of the first wave of behavior therapy were car-ried forward into the cond, including the focus on content changes, or what has been called “first-order” change. In the cond wave, irrational thoughts, pathological cognitive schemas, or faulty information-processing styles would be weakened or eliminated through their detection, correction, testing, and disputation, much as anxiety was to be replaced by relaxation in the first wave. Beck, for example, said: “Although there have been many definitions of cognitive therapy, I have been most satisfied with the notion that cognitive therapy is best viewed as the application of the cognitive model of a particu-lar disorder with the u of a variety of techniques designed to modify the dysfunctional beliefs and faulty information processing characteristic of each disorder” (Beck, 1993, p. 194).
Some leaders of the cond-wave therapies meant to prent an alternate model to both psychoanalysis and the first wave of behavior therapy. Aaron Beck was particularly clear about this, asking the rhetorical question, “Can a fledgling psychotherapy challenge the giants in the field—psychoanalysis and behavior therapy?” (1976, p. 333). Despite that rhetoric, behavior ther-apy expanded to absorb the innovation. Most therapists within organizations like the Association for Advancement of Behavior Therapy emed to resolve the tension between the two waves by taking
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a very large step in the direction of cognitive therapy, but stopping just short of abandonment of the first-wave nsibilities through the u of the “cognitive-behavior therapy” (CBT) label. Behavioral principles were given much less emphasis, and cognitive concepts were given much more, but nothing emed to prohibit the u of empirically supported first-order change methods aimed at overt behavior, emotion, and cognition, depending on the specific situation and preferences of the analyst. In that way, the cond wave largely assimilated the first.
Contexts Supporting a New Wave of Behavior Therapy
When a discipline is markedly successful, it tends to continue in the same direction for a time without a rious examination of its assumptions becau adherents have interesting work to do and rewards for doing that work. Even-tually, however, the assumptions themlves begin to be examined. Anoma-lies gradually emerge that undermine the dominant paradigm. Y ounger members of disciplinary paradigms are less bound to previous assumptions and are thus more prone to question them. Earlier battles and divisions that were never resolved can reemerge if previous minority views once again regain a foothold. When basic assumptions and models begin to be questioned, the discipline enters into a creative but slightly disorienting time in which new formulations emerge and compete with older ones without a broad connsus about the value of the
oolong tea new approaches. The behavioral and cognitive therapies em to be in such a stage. There are multiple reasons, but two will be described here.
Anomalies.According to the traditional narrative of the cond wave, the limitations of previous behavioral methods and conditioning models were
