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

Butler Hospital/Alpert Medical School of Brown University

ABSTRACT 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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Available from: Evan M Forman, Jun 29, 2015
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