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25 October 2011

CBT treatment options

CBT experts outline the different treatment options.

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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
Craske
Clarke
PTSD Cognitive Restructuring, Prolonged Imaginal and Situational (in vivo) Exposure Foa
Ehlers & Clark
Resick
Social Phobia Cognitive Restructuring, Mindfulness, Interoceptive and Situational Exposure Heimberg
Clarke and Wells
Hoffman, Albano
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)

 

 
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