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EDITORIAL
Is CBT already the Dominant Paradigm in
Psychotherapy Research and Practice?
With this issue we launch the fourth volume of
our journal since its name change to Cognitive
Behaviour Therapy. At this point we thought it
would be worth reflecting on the general
status of cognitive behaviour therapy (CBT)
in research and in practice. Using the stand-
ard search engines, like Medline and Psycho-
logical Abstracts, it is stunning to note that
CBT is represented for almost all psychiatric
conditions as well as numerous somatic
conditions. In fact, it is difficult to find a
major condition for which psychosocial inter-
ventions are implicated where CBT has not
been tested or, in many cases, become the
treatment paradigm of choice.
The literature is not without debate (usually
healthy in nature) regarding how specific the
effects of CBT are and what constitutes its
effective components. While there might be
some truth in the notion of equal effectiveness
for some conditions (e.g., mild to moderate
depression) and compared with some alter-
native forms of psychotherapy (e.g., interper-
sonal therapy), the notion that the therapeutic
relationship is sufficient for success in treat-
ment is far from established. Indeed, the
surprisingly similar effects of guided self-help
interventions (based on CBT) compared to in-
person psychotherapy raises serious doubt
about the degree of therapist contact needed
for successful treatment outcome and, at least
to some degree, the general importance of
therapeutic alliance.
This is not to suggest that therapeutic
alliance is not an important part of CBT.
Instead, the point is that there remains plenty of
room for the notion that specific CBT techni-
ques are a necessary component of successful
outcome for many conditions. And, this is an
issue on which much CBT research has focused.
Some diagnostic categories (e.g., borderline
personality disorder, hypochondriasis, post-
traumatic stress disorder) require considerable
therapist contact and, in many cases, repeat
appointments that focus solely on establish-
ing a trusting relationship. There is nothing
inherent in CBT that calls for only brief
intervention; however, when briefer and
more cost-effective treatments have demon-
strated efficacy, they are likely to become the
preference of choice relative to equally
effective but more costly and time-consuming
therapy. The explosion of research compar-
ing telephone- and web-assisted self-help
programs against standard CBT and other
treatment packages is representative of the
type of work being done in this area. This
brings up the issue of cost-effectiveness. In
spite of the often claimed cost-effectiveness
of CBT, we still have a long way to go to
support such claims with robust scientific
evidence.
What then are the reasons behind the
rapidly expanding growth of CBT? We would
like to suggest candidates and possibly reiter-
ate what other people have said. There are
several. First and foremost, CBT is rooted in
the scientific approach and the associated
belief that evidence cannot be inferred from a
common sense understanding of relevant
issues. This necessitates careful testing in
empirical trials. It is interesting to note that
CBT has been tested in randomized trials for a
very large number of conditions that span
early childhood through old age. This feature
makes CBT a very attractive candidate in the
current era of accountability for evidence of
program efficacy in health care.
Second, CBT assessment and treatments are
often based on findings from intensive
research on the mechanisms underlying tar-
geted conditions. Here we find both experi-
mental and correlational investigations. For
example, experimentation regarding factors
like cognitive bias and information processing
has informed clinicians as to specific stimuli
#2005 Taylor & Francis Ltd ISSN 1650-6073
DOI 10.1080/16506070510008489
Cognitive Behaviour Therapy Vol 34, No 1, pp. 1–2, 2005
that capture a person’s attention, are a source
of concern, warrant coverage in therapy, and
can be assessed as an objective indicator of
post-treatment change. Likewise, several
groundbreaking observations in correlational
research have been made and later incorpo-
rated in treatment protocols (e.g., the notion
of safety behaviours in anxiety disorders, the
role of relational frames in acceptance and
commitment therapy, the concept of fear
avoidance in the treatment of chronic pain).
Third, CBT may be increasing in overall
impact because of the incorporation of scienti-
fically derived treatment techniques and the-
oretical constructs from related areas. For
example, the use of relaxation methods would
not inevitably be regarded as a CBT method,
but it is used by many CBT clinicians in
practice and perhaps even more so by clinical
researchers. More recently, mindfullness-
based interventions and, in some cases,
techniques indistinguishable from meditation
are being incorporated into both CBT
research and practice protocols. In relation
to this it is also worth pointing out the cross
fertilization between different specialities
within CBT. For example, research on the
anxiety disorders is often highly relevant for
research on CBT for somatic conditions.
Should CBT clinicians and researchers stick
to the tradition of incorporating scientifically
validated theories and procedures, it would be
surprising if CBT would look the same in the
future. However, by claiming that CBT is
already the dominant psychotherapy para-
digm, we assume that specific techniques
endorsed by CBT clinicians (e.g., home-work
assignments), will be used to a great extent by
proponents of other theoretical orientations in
the near future. Likewise, concepts and
therapeutic procedures from alternative thera-
pies (e.g., client-focused therapy) will, if they
stand the test of empirical trials and can be
reasonably explained by theory, be incorpo-
rated into CBT for certain diagnostic groups.
Fourth, the emergence of CBT as the major
psychotherapy paradigm has been fostered
by the close collaboration between CBT
researchers and clinicians and those from the
medical profession regarding medical nomen-
clature. For instance, for numerous DSM-IV
diagnostic categories CBT is often the only
therapy that has been tested. The active role
of several members of the CBT community in
the field trials and development of the latest
DSM editions are just an example of how
CBT has managed to fit in with the medical
system. Some CBT researchers and clinicians
might oppose this and refuse to adopt the
notion of psychiatric diagnoses (in particular,
in the radical behaviourist branch of CBT).
However, others might argue that diagnostic
labels facilitate research and clinical work,
and since so many CBT studies have been
conducted using these labels, it is not surpris-
ing that finance departments and other fund-
ing bodies only find CBT when they search
the literature for empirically tested treatments
for specific conditions.
This leads us back to our journal –
Cognitive Behaviour Therapy – and our wish
that it will be part of the exciting develop-
ments within CBT. We anticipate that 2005
will provide you with a plenitude of interest-
ing papers and, with our recent Medline
indexing, that these papers will have an even
greater impact on advances in CBT research
and practice.
Gerhard Andersson
Gordon J. G. Asmundson
Per Carlbring
Ata Ghaderi
Stefan G. Hofmann
Sherry H. Stewart
2Editorial COGNITIVE BEHAVIOUR THERAPY
... In the same year, the Unga Vuxna (Young Adults) service was initiated in Östergötland County. Methods and theoretical perspectives from cognitive-behavioural therapy (CBT) 17 were used as one starting point for the service design. Rather than diagnosing and treating psychiatric disease, the goal was to be able to help young people with psychological problems to learn strategies to manage undesired thoughts and behaviours associated with anxiety, depression and psychological distress. ...
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Chapter
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