The Importance of Theory in Cognitive Behavior Therapy: A Perspective of Contextual Behavioral Science

Butler Hospital/Alpert Medical School of Brown University


For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called "third generation" models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture. There is nothing so practical as a good theory. — Lewin (1951, p. 169) For years, scholars of the family of psychotherapy approaches known under the broad umbrella of cognitive behavior therapy (CBT) have been calling for an increased focus on the theories that underlie applied technologies. The common theme of these appeals is that there has been a gradual erosion of the strong connection between theory and technique that characterized the field's early days, and that a renewed focus on such links will lead to more rapid and reliable advances in our understanding, devel-opment, testing, implementation, and dissemination of CBT approaches. In his 1984 presidential address of the Association for Advancement of Behavior Therapy (now the Association for Behavioral and Cognitive Therapies; ABCT), Alan Ross lamented that "a reading of the current literature on behavior therapy suggests that the field is at risk of losing its momentum in a preoccupation with technological refinements at the expense of theoretical develop-ments" (Ross, 1985, p. 195). Wilson and Franks (1982) similarly decried the rapid proliferation of clinical techniques decoupled from theory, suggest-ing that this trend could ultimately sow the seeds of the field's demise. More recently, Beck (2012) noted that ". . . the robustness of a therapy is based on the complexity and richness of the underlying theory. A robust theory, for example, can generate new therapies or can draw on existing therapies that are consistent with it" (p. 6). David and Montgomery (2011) proposed a new framework for defining evidence-based psychological practice that pri-oritizes the level of empirical support of the theory Available online at

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    • "Interpersonal theories of psychopathology can be interpreted within a broader framework of psychological flexibility theory (Levin et al., 2012) … a translational theory that bridges basic research and intervention (for a full description of psychological flexibility theory, see Hayes, Strosahl, & Wilson, 2012; Herbert, Gaudiano, & Forman, 2013; Levin et al., 2012). Within psychological flexibility theory, experiential avoidance is conceptualized to disrupt the pursuit of personally held values and contributes to psychosocial distress (Bond et al., 2011). "
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    ABSTRACT: This pilot study employed a moderated mediation framework to examine whether negative expectations of interpersonal relationships explained the relationship between experiential avoidance and interpersonal problems. University students (N=159) completed measures of experiential avoidance, negative perceptions and expectations of interpersonal relationships (e.g., hostility, attachment anxiety), and interpersonal problems (e.g., coldness, social avoidance, dominating tendencies, and vindictiveness). Attachment anxiety explained the relationship between experiential avoidance and interpersonal problems involving coldness and social avoidance, with a stronger relationship at high levels of experiential avoidance. In addition, hostility explained the relationship between experiential avoidance and interpersonal problems involving dominant and vindictive tendencies. Moreover, experiential avoidance interacted with attachment anxiety and hostility to predict higher levels of interpersonal problems as evidenced by stronger indirect associations among participants reporting higher levels of experiential avoidance. Results of this pilot study provide a preliminary empirical model that integrates the literatures on experiential avoidance and interpersonal problems.
    Journal of Contextual Behavioral Science 09/2014; 3(4). DOI:10.1016/j.jcbs.2014.08.003
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    • "Les mécanismes et procédures appliqués reposent sur des études fondamentales, des études de démantèlement (visant à déterminer les composantes d'une approche), des études corrélationnelles, des études de médiation et de modération. Herbert, Gaudiano et Forman (2013) abondent dans le même sens en affirmant que la qualité de la théorie que le praticien adopte, ainsi que sa maîtrise de celle-ci (incluant les notions sur l'épistémologie), peuvent être des facteurs clés dans l'efficacité d'une psychothérapie menée dans un cadre cognitif et comportemental. "
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    ABSTRACT: This article questions the clinical utility of the DSM-5. It describes some limits of the categorical approach of the DSM and empirically validated psychotherapies. It suggests focusing on common psychological mechanisms among mental disorders beyond the categorial approach of DSM which considers and treats each one as a different and separate entity, thus leading to the increase number of treatments. The article suggests that trans-diagnostic cognitive behavioral approaches have a high potential to meet the needs of patients encountered in the mental health care system who frequently showcase complex problems. Taking Acceptance and Commitment Therapy (ACT) as an example, the article aims at illustrating a dimensional trans-diagnostic conception of psychiatric disorders.
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    ABSTRACT: The papers in this special series, edited by Pilecki and McKay (2013--this issue), are devoted to examining the theory-practice gap in cognitive-behavior therapy (CBT). A gap between theory and practice can occur at more than one level. First, there exists a substantial and concerning gap between the theories and interventions supported by research and those being offered to patients in the community (i.e., research-practice gap). There is also a growing concern in the field that the techniques and procedures that characterize cognitive-behavioral therapies are becoming increasingly divorced from underlying theories (i.e., theory-procedure gap). In the present commentary we hope to summarize and comment on some of the themes, issues, and future directions raised by our contributors.
    Behavior therapy 12/2013; 44(4):609-613. DOI:10.1016/j.beth.2013.06.001 · 3.69 Impact Factor