An application of functional analytic psychotherapy in a case of anxiety panic disorder without agoraphobia.

Abstract

According to the DSM-IV (APA, 1994) the that occur with emotional tension and heightened sympathetic activation are classified as anxiety disorders. This system, following formal aspects as criteria for differentiation, classifies up to 12 different within this classification. Despite the function of this clarification this taxonomy offers few clues when it comes to the choice, development and establishment of treatment programs. To treat this type of disorder this is a wide variety of techniques coming from different theoretical bodies (cognitive restructuring, breathing techniques, interoceptive exposure, different forms of relaxation, hypnosis....) The choice of one technique or combination of several is taken on many occasions without considering etiological factors or the maintenance of the disorder in question. This type of action highlights the eclecticism and the conceptual weakness of diagnostic systems like the DSM and the lack of cohesion between the clinical categories derived from them, the possible etiologies, the variables that maintain the disorder and their treatment. As different authors note (Bisset & Hayes, 1999; Ferro, 2001; Hayes, Wilson, Gifford, Follette, & Stosahl, 1996), these problems presented by traditional classification systems are caused by their origins in structural models of evaluation in which the diagnosis is based on the form or topography of behavior. In contrast to this approach, a diagnostic method is suggested from a functional perspective which has a potentially larger use, especially if one of the objectives of evaluation is the design of effective treatment programs. (Hayes & Follette, 1992). From this perspective, the same behavior can have different functions and, on the contrary, the same function can be served by different behaviors. (topographically different and functionally equivalent behaviors and vice versa) Along these lines, Hayes & Follette (1992) describe a type of behavior followed by the escape or of negative emotional experience. This phenomenon has been called experiential avoidance, which refers to cases where a person avoids contact with a series of private experiences and looks to escape, avoid or modify the occurrence of the these experiences and contexts that could produce them. (Ferro, 2000; Friman, Hayes, & Wilson, 1998; Hayes, Strosahl, & Wilson, 1999; Hayes, Wilson et al, 1996; Luciano & Hayes, 2001) These authors have suggested disorders of experimental avoidance as an alternative to the traditional diagnostic criteria based on topographic or structural characteristics of behavior. Logically, with an evaluation that considers functional criteria, the treatment applied should also be governed by the same principles. Therefore, from this perspective, a treatment is suggested that seeks to change the function of the private experiences that the person tries to avoid, rather than to change the form or context of them. In order to do this, alteration of the verbal/social context in which these experiences occur is proposed. Following these principles, and in keeping with a contextual perspective based on recent advances in verbal behavior: bidirectionality, literality of the language, equivalence relations, functional generalization, rule-governed behavior (Hayes S. C., Barnes-Holmes D., & Roche B., 2001), functional analytic psychotherapy has been developed (Kohlenberg & Tsai, 1991). The framework of this therapy is based on an especially thoughful client-therapist relationship. The therapeutic session is the context in which the client's problems should appear. Therefore, the therapist should evoke and distinguish the behavioral problems of the client, referred to here as type 1 clinically relevant behaviors. These appear very frequently in the therapy, especially at the outset. Normally, they are under aversive control and they are maintained by negative reinforcement. …