CBT treatment options


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.

DiagnosisCBT Treatment ComponentsProminent Researchers/ Authors
Panic DisorderCognitive Restructuring, Mindfulness, Interoceptive and Situational ExposureBarlow
PTSDCognitive Restructuring, Prolonged Imaginal and Situational (in vivo) ExposureFoa
Ehlers & Clark
Social PhobiaCognitive Restructuring, Mindfulness, Interoceptive and Situational ExposureHeimberg
Clarke and Wells
Hoffman, Albano
Obsessive Compulsive DisorderCognitive Restructuring, Mindfulness, Imaginal or Cognitive or Situational Exposure and Response PreventionFoa, Abramowitz
Salkovskis, Rachman, Radomsky, Piacentini, Whittal
PhobiasCognitive Restructuring, Mindfulness, Interoceptive and Prolonged Situational ExposureOllendick and Ost
Generalized Anxiety DisorderCognitive Restructuring, Meta-cognitive Therapy, Mindfulness, Imaginal/Cognitive Exposure, Situational (Uncertainty) ExposureWells, Dugas, Ladouceur, Borkovec
DepressionCognitive Restructuring, Mindfulness, Behavioural Activation, Behavioural AssignmentsBeck, Hollon, Freeman
InsomniaCognitive Restructuring, Sleep Hygiene, Stimulus Control, Graded Sleep RestrictionEdinger, Carney
Tic DisordersMindfulness, Awareness Training, Habit Reversal, Cognitive RestructuringWoods, Piacentini
SchizophreniaActivity Monitoring, Behavioural Activation, Cognitive Restructuring, Behavioural Assignments/Evidence GatheringKingdon, Beck, Turkington, Grant
Bipolar Mood DisorderPsychoeduction, Cognitive Restructuring aimed at Enhancing Adjustment, Mood Awareness Training, Stimulus Control, Cognitive Restructuring, Relapse PreventionBasco, Rush, Otto, Knauz
Anger Related ProblemsCognitive Restructuring, Mindfulness/Relaxation Training, Situational ExposureDi Giuseppe, Tafrate, Kassinove
Substance Related DisordersCognitive Restructuring, Mindfulness, Stimulus Control, Urge/Interoceptive and Situational Exposure, Contingency Management,Carrol, Miller, Rollnick, Petry
Compulsive GamblingCognitive Restructuring, Mindfulness, Stimulus Control, Urge Interoceptive and Situational Exposure, Contingency ManagementLadouceur
Habit Disorders (Skin Picking, Trichotillomania)Mindfulness, Stimulus Control, Habit Reversal, Acceptance PracticesWoods, Piancentini, Tolin, Franklin
Borderline Personality DisorderDialectical Behaviour Therapy, Schema TherapyLinehan, Young
ADHD (Adults)Behavioural Intervention aimed at enhancing Organization and Planning, Reducing Distractibility, Reducing Procrastination. Cognitive RestructuringSafren, Otto
Anorexia NervosaBehavioural Planning aimed at Weight Gain, Systematic Exposure, Motivational Enhancement, Monitoring, Cognitive Restructuring,Fairburn, Wilson, Agras
Bulimia NervosaPsychoeducation, Motivational Enhancement, Monitoring, Stimulus Control, Cognitive Restructuring, Urge Tolerance and MindfulnessFairburn, Wilson, Agras
HypochondriasisCognitive Restructuring, Mindfulness, Imaginal/Cognitive Exposure/Situational (Uncertainty) Exposure and Response Prevention, Interoceptive ExposureSalkovskis, 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)

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