The theoretical contributions of the cognitive theorists (Beck, Ellis etc.), together with the initial contributions of the behavioural theorists (Pavlov, Skinner, Wolpe etc.) provided for the foundation of modern-day CBT theory and practice.
Modern-day CBT-based treatments for emotional and behavioural disorders are however, continually being altered and revised. These revisions are the product of what we are continually learning from research about which factors are primarily responsible for the onset and maintenance of psychological disorders.
The recommended treatment guidelines for CBT-based interventions with anxiety disorders, depression, borderline personality disorder, insomnia, anger, substance use disorders, habit disorders and schizophrenia have changed substantially over the last 20 and even the last 10 years. For instance, we now know that using controlled breathing and relaxation training as a primary intervention strategy for panic disorder is not the most useful way of tackling this highly treatable condition and may even reduce long-term prognosis.
We also now know that trying to reduce, suppress or remove negative thoughts is less helpful than what we once thought when working with individuals with depression. We know that how individuals react to their negative thoughts and emotions is of greater importance than whether or not they have negative thoughts or emotions in the context of anxiety or depression, for example.
There have been a number of more recent theoretical models that have gained momentum over the course of the last decade, many of which are considered as part of “the third wave” movement within the CBT tradition. Dialectical Behaviour Therapy (DBT), Metacognitive Therapy (MCT) and Acceptance and Commitment Therapy (ACT) would be typical examples thereof. Each of these “newer” models within the CBT tradition emphasises the notion of non-judgmental acceptance, awareness of and mindfulness toward negative thoughts and emotional states as a means of reacting in a more functional manner toward these states.
The concept of mindfulness is regularly cited within modern-day CBT treatment models and is often a significant treatment component that is introduced earlier on in treatment but is not considered a means of treatment itself, in isolation. Mindfulness is typically used as a means of emotional regulation and in reducing emotionally-driven behaviours that perpetuate emotional disturbance.
The table below provides a short summary of the most prominent treatment components associated with modern-day CBT. These core treatment components would typically be accompanied by standard treatment components such as psychoeducation, motivational enhancement and relapse prevention.
|Diagnosis||CBT Treatment Components||Prominent Researchers/ Authors|
|Panic Disorder||Cognitive Restructuring, Mindfulness, Interoceptive and Situational Exposure||Barlow|
|PTSD||Cognitive Restructuring, Prolonged Imaginal and Situational (in vivo) Exposure||Foa|
Ehlers & Clark
|Social Phobia||Cognitive Restructuring, Mindfulness, Interoceptive and Situational Exposure||Heimberg|
Clarke and Wells
|Obsessive Compulsive Disorder||Cognitive Restructuring, Mindfulness, Imaginal or Cognitive or Situational Exposure and Response Prevention||Foa, Abramowitz|
Salkovskis, Rachman, Radomsky, Piacentini, Whittal
|Phobias||Cognitive Restructuring, Mindfulness, Interoceptive and Prolonged Situational Exposure||Ollendick and Ost|
|Generalized Anxiety Disorder||Cognitive Restructuring, Meta-cognitive Therapy, Mindfulness, Imaginal/Cognitive Exposure, Situational (Uncertainty) Exposure||Wells, Dugas, Ladouceur, Borkovec|
|Depression||Cognitive Restructuring, Mindfulness, Behavioural Activation, Behavioural Assignments||Beck, Hollon, Freeman|
|Insomnia||Cognitive Restructuring, Sleep Hygiene, Stimulus Control, Graded Sleep Restriction||Edinger, Carney|
|Tic Disorders||Mindfulness, Awareness Training, Habit Reversal, Cognitive Restructuring||Woods, Piacentini|
|Schizophrenia||Activity Monitoring, Behavioural Activation, Cognitive Restructuring, Behavioural Assignments/Evidence Gathering||Kingdon, Beck, Turkington, Grant|
|Bipolar Mood Disorder||Psychoeduction, Cognitive Restructuring aimed at Enhancing Adjustment, Mood Awareness Training, Stimulus Control, Cognitive Restructuring, Relapse Prevention||Basco, Rush, Otto, Knauz|
|Anger Related Problems||Cognitive Restructuring, Mindfulness/Relaxation Training, Situational Exposure||Di Giuseppe, Tafrate, Kassinove|
|Substance Related Disorders||Cognitive Restructuring, Mindfulness, Stimulus Control, Urge/Interoceptive and Situational Exposure, Contingency Management,||Carrol, Miller, Rollnick, Petry|
|Compulsive Gambling||Cognitive Restructuring, Mindfulness, Stimulus Control, Urge Interoceptive and Situational Exposure, Contingency Management||Ladouceur|
|Habit Disorders (Skin Picking, Trichotillomania)||Mindfulness, Stimulus Control, Habit Reversal, Acceptance Practices||Woods, Piancentini, Tolin, Franklin|
|Borderline Personality Disorder||Dialectical Behaviour Therapy, Schema Therapy||Linehan, Young|
|ADHD (Adults)||Behavioural Intervention aimed at enhancing Organization and Planning, Reducing Distractibility, Reducing Procrastination. Cognitive Restructuring||Safren, Otto|
|Anorexia Nervosa||Behavioural Planning aimed at Weight Gain, Systematic Exposure, Motivational Enhancement, Monitoring, Cognitive Restructuring,||Fairburn, Wilson, Agras|
|Bulimia Nervosa||Psychoeducation, Motivational Enhancement, Monitoring, Stimulus Control, Cognitive Restructuring, Urge Tolerance and Mindfulness||Fairburn, Wilson, Agras|
|Hypochondriasis||Cognitive Restructuring, Mindfulness, Imaginal/Cognitive Exposure/Situational (Uncertainty) Exposure and Response Prevention, Interoceptive Exposure||Salkovskis, Barsky|
Written by Bradley Drake and Jaco Rossouw, Centre for Cognitive-Behaviour Therapy, Cape Town, South-Africa. For further details visit: www.cognitive-behaviour-therapy.co.za. (October 2011)