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.

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Available from: Evan M Forman
    • "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.
    No preview · Article · Sep 2014 · Journal of Contextual Behavioral Science
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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.
    Full-text · Article · Jan 2014
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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.
    No preview · Article · Dec 2013 · Behavior therapy