by Michel Reyes, Ph.D.
Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Functional Analytic Psychotherapy (FAP) are all considered ‘third-wave’ behavior therapies. Dialectical Behavior Therapy and Acceptance and Commitment Therapy are considered empirically supported treatments (ESTs), while Functional Analytic Psychotherapy, though also a principle-based behavior treatment, has yet to amass the same level of empirical validation. New learners of ACT, DBT, and FAP often struggle to distinguish these treatments from each other on the basis of more than their topography. Here, we provide a description of key features of these treatments and their similarities and differences.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy, or DBT, is a principle-based behavioral therapy in which clinicians have a wide range of treatment strategies and protocols that can be used with flexibility according to the client presentation in any particular point in time. DBT is an intersection between behavior therapy and Zen contemplative practice held together with a dialectical philosophy, these three are the foundations of DBT. The Behavioral foundation of DBT is linked to Arthur A. Staats psychological behaviorism and translate in DBT as the adoption of a scientific approach to the study and treatment of behavior, the application of learning theory to explain people’s behavior and the use of empirically supported Behavior Therapy assessment and treatment procedures. Zen foundations can be observed in the introduction of concepts such as Mindfulness and Radical Acceptance, the notion of pain as part of existence, the recognition that the denial of pain creates suffering, and several others. And the dialectical foundations can be noticed in DBT holistic view of behavior and the transactional perspective it takes to its understanding, the adoption of a dialectical perspective in which every perspective on reality is true but partial and so complimentary. And also, DBT embraces a dialectical approach in basically any aspect of DBT such as its biosocial theory, the balance between acceptance and change strategies and the balance between modifying client behavior and changing clients environment. Some distinctive features of comprehensive DBT are the presence of different treatment modalities aimed to develop client’s skills, generalized them, enhance motivation to use them, structure the environment and enhance therapists’ skills and motivation. DBT is an Empirically Supported treatment for adults and adolescents’ problems characterized by great emotion regulation difficulties and severe impulsivity.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy, or ACT, is a treatment rooted in the philosophy of science known as Functional Contextualism and the behaviorism wave known as Contextual Behavioral Science. ACT is, in many senses, the application of Relational Frame Theory, a contextual behavioral approach to the study of language and cognition, to the understanding and treatment of client self-regulatory behavior. ACT therapists seek to promote psychological flexibility, which is the skill to remain aware in the presence of discomfort while behavior is organized according to what is valuable in that particular moment. The way ACT therapists accomplish this is through developing acceptance of aversive private events, present moment awareness and committed action, which is behavior-oriented with the person individual values. ACT targets the tendency to follow ineffective rules, especially those that promote experiential avoidance at the expense of a valued life, through the use of metaphors, experiential exercises and defusion techniques. ACT is an empirically supported intervention for problems related to experiential avoidance and, more broadly, psychological inflexibility.
Functional Analytic Psychotherapy (FAP)
Functional Analytic Psychotherapy, or FAP, is closer to Skinner’s radical behaviorism. It is based on the observation that client’s behavior outside and inside therapy session is, in general, functionally equivalent. And so, the occurrence of behavior inside a session provides a great opportunity to make hypotheses about its controlling variables and a great opportunity to intervention. FAP technique is the application of five rules, this could be understood as observing the occurrence of Clinically Relevant Behaviors abbreviated as CRBs in session, the use therapists natural reactions to evoke CRB, reinforce desirable behavior, and if everything worked well enough analyzing the interaction between client and therapists and generalize desirable behavior shaped and reinforced in session to clients natural environment.
Similarities and Differences between DBT, ACT, and FAP
In this moment, the commonalities I find between DBT and ACT are the notion of suffering as a product of trying to avoid or suppress uncomfortable experience and attachment to rules about the way things and oneself are supposed to work, the goal of creating a life perceive as valuable or worth living, and the integration of acceptance and change, or commitment, interventions to enhance clients ability to stay mindful in the presence of uncomfortable situations while remaining aware of their values and goals, so that they can choose to behave in a conscious or effective way towards their life choosing directions. Both treatments make use of functional analysis, metaphors, experiential exercises and unconventional uses of language to help clients reframe their experience. The main differences would be that DBT adopts a more educative approach while ACT emphasizes an experiential one, DBT adopts a biosocial perspective on behavior while ACT perspective is contextual, DBT philosophy is dialectical while ACT is functional contextualistic, DBT is a treatment applied to a group of community of clients by a community of clinicians and ACT is much more used as an individual intervention although it can be adapted to group or commentary interventions. Both treatments have very specific strategies that make them unique. Also, ACT and FAP, targets functional classes of behavior, while DBT has very clear target priorities that aren’t defined by its function but by their severity.
Other similarities are that DBT, ACT, and FAP put a lot of attention to the transaction between therapist and client’s behavior and the observation of parallels between clients in session and out of session behavior. Also, these 3 therapy models target clients in session behavior as a way to strength client’s useful behaviors that can be generalized to their natural environment. Maybe the differences would be that FAP makes a greater emphasis in the disclosing of therapist’s reactions as a way to evoke and reinforce client’s desirable actions, while DBT and ACT therapists use self-disclosure in more moderated fashion and for additional purposes. Again, DBT has a specific target hierarchy of in session client’s behavior and specific strategies, ACT targets classes of behavior and they have specific strategies to target in session behavior, FAP targets are defined ideographically and since it depends on therapists natural reactions is difficult to define specific treatment processes and strategies.
Dr. Reyes has worked in the development of three public sector outpatient clinics for persons with severe emotion dysregulation problems and coordinated the implementation of a DBT based program in 52 schools in Guadalajara Jalisco. He is co-founder of Mexico’s CBS & Therapy Institute where he coordinates an outpatient DBT program. Michel has published four books in Spanish, two manuals on emotion regulation, another on Functional Analytic Psychotherapy, and co-authored a manual on ACT for grief-related problems. These titles include Functional Analytic Psychotherapy, Emotion Regulation in the Clinical Practice, and Acceptance and Commitment treatment of Grief.