COMMENTARY United We Stand: Emphasizing Commonalities Across Cognitive-Behavioral Therapies

Hunter College and the Graduate Center, City University of New York. Electronic address: .
Behavior Therapy (Impact Factor: 2.43). 04/2013; DOI: 10.1016/j.beth.2013.02.004

ABSTRACT Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multicomponent approaches, incorporated alterna-tive therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (a) context engagement to promote adaptive imagining and enacting of new experiences; (b) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (c) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components, including behavioral exposure/activation, at-tention training, acceptance/tolerance, decentering/defusion, and cognitive reframing, may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relation-ships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science.

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    ABSTRACT: ContextThe cultivation of mindfulness and acceptance has been theoretically and empirically associated with psychological ancillary well-being and has demonstrated efficacy in the treatment of various disorders. Hence, mindfulness and acceptance-based treatments (MABTs) have recently been explored for the treatment of social anxiety disorder (SAD). This review aims to evaluate the benefits of MABTs for SAD.Methods Systematic review of studies investigating an MABT for individuals with SAD, using PsycInfo, Medline, PubMed, and Cochrane Central Register of Controlled Trials.ResultsNine studies were identified. Significant improvements in symptomatology were demonstrated following the MABT, but benefits were equivalent or less than yielded by cognitive-behavioral therapy (CBT).LimitationsThe few treatment studies available were compromised by significant methodological weaknesses and high risk of bias across domains. Studies were largely uncontrolled with small sample sizes. The hybrid nature of these interventions creates ambiguity regarding the specific utility of treatment components or combinations.ConclusionsMABTs demonstrate significant benefits for reducing SAD symptomatology; however, outcomes should be interpreted with caution until appropriate further research is conducted. Furthermore, the benefit of MABTs above and beyond CBT must be considered tentative at best; thus, CBT remains best practice for first-line treatment of SAD.
    Journal of Clinical Psychology 12/2014; DOI:10.1002/jclp.22144 · 2.12 Impact Factor
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    ABSTRACT: Generalized anxiety disorder (GAD) is a psychological disorder characterized by chronic and severe worry. The past thirty years have seen a surge in the understanding of GAD, and specific advances have been made in how the disorder is conceptualized and treated within the field of psychology. However, despite these advances, GAD remains the most treatment refractory anxiety disorder. The current chapter, therefore, provides an overview of the current conceptualization of GAD, including its key symptoms and features. In addition, this chapter highlights many of the specific theoretical and treatment advances of the past several decades. Finally, this chapter will explore future directions that the field may be able to take in an attempt to better understand and treat this disorder.
    Primer on Anxiety Disorders: Translational Perspectives on Diagnosis and Treatment, 1 edited by Daniel Pine, Barbara Olasov Rothbaum, Kerry Ressler, 03/2015: chapter 22: pages 315-328; Oxford University Press.
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    ABSTRACT: This article examines the role of the therapist's self-reflection and self-revelation in case formulation. We believe that a collaboratively constructed case formulation must always be considered in the context of an evolving therapeutic relationship. Further, self-reflection and self-revelation on the part of the therapist are critical for a more elaborate and nuanced case formulation and for understanding the patient. This highlights the importance of attunement to the here and now and the evolving therapeutic relationship. From this attunement, the therapist's self-reflection and self-revelation can emerge further, which can lead to the patient's personal growth and increased self-other awareness. To illustrate our point, we present an integrative, relational model in the case of a patient who has been in treatment. © 2015 Wiley Periodicals, Inc.
    Journal of Clinical Psychology 03/2015; 71(5). DOI:10.1002/jclp.22183 · 2.12 Impact Factor


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May 31, 2014