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: 3.69). 04/2013; 44(2). DOI: 10.1016/j.beth.2013.02.004


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.

Download full-text


Available from: David M Fresco,
  • Source
    • "We thus conducted this study to examine the extent to which different theory-driven approaches affect public perceptions of ET and specifically, to assess whether newer approaches to conducting or framing ET (ACT, inhibitory learning) lead to superior treatment credibility over more traditional CBT approaches. We originally set out to compare traditional CBT and ACT rationales for exposure therapy but quickly realized there were significant areas of overlap between them (e.g., Arch & Craske, 2008; Mennin et al., 2013). We also wanted to include new developments in inhibitory learning approaches to exposure (Craske et al., 2008; Craske, Treanor, et al., 2014; Deacon et al., 2013) that overlapped yet were not fully captured by either traditional CBT or ACT perspectives. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is understood about how the public perceives exposure-based therapy (ET) for treating anxiety and trauma-related disorders or how ET rationales affect treatment credibility. Distinct approaches to framing ET are practiced, including those emphasized in traditional cognitive behavioral therapy, acceptance and commitment therapy, and the more recent inhibitory learning model. However, their relative effect on ET's credibility remains unknown. A final sample of 964 U.S. adults provided baseline views of ET. Participants rated ET treatment credibility following a simple ET definition (pre-rationale) and following randomization to rationale modules addressing ET goals, fear, and cognitive strategies from distinct theoretical perspectives (post-rationale). Baseline ET views, symptoms, and sociodemographic characteristics were examined as putative moderators and predictors. At baseline, the majority had never heard of ET. From pre- to post-rationale, ET treatment credibility significantly increased but the rationales' theoretical perspective had little impact. More negative baseline ET views, specific ethnic/racial minority group status, and lower education moderated or predicted greater increases in treatment credibility following the rationale. ET remains relatively unknown as a treatment for anxiety or trauma, supporting the need for direct-to-consumer marketing. Diverse theory-driven rationales similarly increased ET credibility, particularly among those less likely to use ET. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 05/2015; 72. DOI:10.1016/j.brat.2015.05.008 · 3.85 Impact Factor
    • "Even in countries with wide access to treatment, the high comorbidity of GAD with other disorders makes treatment of both of GAD and comorbid disorders less efficacious and more costly, and recovery less predictable and stable. GAD is the least successfully treated anxiety disorder (Newman et al., 2013), and people with comorbid GAD and depression may engage more in negative self-referential thought—making them especially treatment refractory (Mennin and Fresco, 2013). "
    [Show abstract] [Hide abstract]
    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.
  • Source
    • "Using the constructs of self-as-content, self-as-process, and self-as-construct, ACT highlights the significant role of decentering (e.g., looking at a thought, not looking from a thought, experiencing self as context where thoughts come and go) in the promotion of psychological flexibility. Additionally, the extant literature explicitly states a conceptual link between decentering and rapid vocal repetition exercises in ACT (Luoma & Hayes, 2008; Masuda et al., 2004; McCracken et al., 2013; Mennin et al., 2013), although its empirical link has not been fully investigated. Second, previous defusion studies have not adequately measured decentering associated with a target thought, although the believability scale was designed to at least partially capture this functional aspect (Masuda et al., 2004; Masuda, Twohig, et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the current analogue experiment was to investigate the impact of a cognitive defusion strategy, rapid vocal repetition, on self-identified negative body image thoughts. Undergraduate students (N=254) were randomized to one of five protocols: defusion condition with an experiential exercise for a self-identified negative body image thought, defusion without such an experiential exercise, distraction with an experiential exercise with the target thought, distraction without such an experiential exercise, and an experimental control task. At post-intervention, the defusion condition with an experiential exercise with the target negative body image thought showed significantly lower discomfort associated with that thought than distraction conditions and experimental control group, and this condition demonstrated greater decentering than the distraction condition without experiential exercise and the control group. The defusion condition with the experiential exercise with the target thought also demonstrated a greater reduction in believability than the other four conditions. Overall, our findings highlight the importance of including rapid vocation repetition of a target body image thought when trying to change the discomfort, believability, and decentering associated with that thought.
    Journal of Contextual Behavioral Science 03/2015; 4(2). DOI:10.1016/j.jcbs.2015.02.003
Show more