Historical evolution of acceptance and commitment therapy

Abstract

Introduction: Acceptance and commitment therapy presents itself as a third-generation psychotherapeutic approach that promotes psychological flexibility, acceptance of internal experiences, and value-directed action, in opposition to experiential avoidance. This model arises in the context of criticisms of the traditional cognitive-behavioral paradigm, integrating philosophical and theoretical principles that address human suffering from a functional and contextual view.

Objective: To examine the historical evolution of acceptance and commitment therapy from its initial bases to its current applications and evidence.

Method: A narrative review of the scientific literature was performed, consulting databases such as PubMed, PsycINFO, and Google Scholar. Systematic reviews, meta-analyses, theoretical articles, and foundational texts published between 2006 and 2025 were included, prioritizing sources documenting the model's theoretical, empirical, and applied development.

Results: The beginnings date from the late 1980s, with main contributions from Steven Hayes and collaborators, based on functional contextualism and relational frame theory. In the 1990s, the hexaflex is consolidated as the central axis, incorporating mindfulness and preliminary evidence in clinical trials for anxiety and depression. In the 21st century, recent meta-analyses validate its efficacy in diverse populations, with digital and transdiagnostic adaptations, although discussions persist on mechanisms and comparisons with other approaches.

Conclusions: The trajectory of this therapy shows progress toward comprehensive contextual interventions, with solid empirical evidence endorsing its utility to enhance psychological flexibility in varied clinical contexts.