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Explore CBT, DBT, psychodynamic, and other empirically supported treatments.
A comparison diagram showing the reciprocal relationship between thoughts, feelings, and behaviors.
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Evidence-based practice in psychology (EBPP) involves integrating the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. Understanding major therapeutic approaches, their mechanisms, and the evidence supporting them is essential for competent clinical practice.
Core Principles: - Thoughts, feelings, and behaviors are interconnected - Maladaptive cognitions contribute to psychological problems - Changing cognitions and behaviors leads to emotional improvement - Skills-based, time-limited, present-focused
Cognitive Techniques: - Cognitive restructuring: Identifying and challenging distorted thoughts - Socratic questioning: Guided discovery - Thought records: Documenting and analyzing thoughts - Behavioral experiments: Testing beliefs empirically
Behavioral Techniques: - Behavioral activation: Increasing engagement in rewarding activities - Exposure: Gradual confrontation of feared stimuli - Skills training: Social skills, problem-solving, relaxation
Efficacy: Strong evidence for depression, anxiety disorders, OCD, PTSD, eating disorders, insomnia, and many other conditions. Considered gold-standard treatment for many disorders.
Developed by Marsha Linehan for borderline personality disorder (BPD)
Core Dialectic: Balancing acceptance AND change
Treatment Components: - Individual Therapy: Weekly sessions targeting life-threatening behaviors, therapy-interfering behaviors, and quality of life - Skills Training Group: Weekly group teaching DBT skills - Phone Coaching: As-needed support for skill generalization - Consultation Team: Support for therapists
Four Skills Modules: - Mindfulness: Present-moment awareness, nonjudgmental observation - Distress Tolerance: Crisis survival skills, radical acceptance - Emotion Regulation: Understanding and managing emotions - Interpersonal Effectiveness: Assertiveness, relationship skills
Efficacy: Strong evidence for BPD, self-harm, suicidal behavior. Adapted for eating disorders, substance use, depression.
Theoretical Foundation: Relational Frame Theory, psychological flexibility model
Six Core Processes: - Acceptance: Willingness to experience thoughts and feelings - Cognitive Defusion: Reducing fusion with thoughts - Present Moment Awareness: Mindful attention to now - Self-as-Context: Observer perspective on experience - Values: Clarifying what matters most - Committed Action: Behavior aligned with values
Goal: Increase psychological flexibility rather than symptom reduction per se
Techniques: - Mindfulness exercises - Metaphors and experiential exercises - Values clarification - Behavioral commitment strategies
Efficacy: Evidence for depression, anxiety, chronic pain, substance use, psychosis. Transdiagnostic approach.
Core Principles: - Unconscious processes influence behavior - Early experiences shape current patterns - Therapeutic relationship is central - Insight leads to change
Key Concepts: - Transference: Patient's feelings toward therapist based on past relationships - Countertransference: Therapist's emotional reactions - Resistance: Unconscious opposition to therapeutic progress - Defense Mechanisms: Unconscious strategies to manage anxiety
Modern Approaches: - Short-Term Psychodynamic Therapy: Time-limited, focused - Mentalization-Based Treatment: Understanding mental states - Transference-Focused Psychotherapy: For personality disorders
Efficacy: Evidence for depression, anxiety, personality disorders, somatic symptoms. Effects may continue to grow after treatment ends.
Mechanisms: - Habituation: Anxiety decreases with prolonged exposure - Extinction: New learning that feared outcomes don't occur - Inhibitory learning: New memory competes with fear memory
Types of Exposure: - In Vivo: Real-life exposure to feared stimuli - Imaginal: Visualization of feared scenarios - Interoceptive: Exposure to feared bodily sensations - Virtual Reality: Computer-simulated environments
Prolonged Exposure (PE) for PTSD: - Imaginal exposure to trauma memory - In vivo exposure to avoided situations - Processing of trauma memories
Exposure and Response Prevention (ERP) for OCD: - Exposure to obsessional triggers - Prevention of compulsive rituals
Efficacy: Strong evidence for anxiety disorders, OCD, PTSD.
Developed by Klerman and Weissman for depression
Theoretical Basis: Depression occurs in interpersonal context; improving relationships improves depression
Four Problem Areas: - Grief: Complicated bereavement - Role Disputes: Conflicts with significant others - Role Transitions: Major life changes - Interpersonal Deficits: Chronic relationship difficulties
Structure: - Time-limited (12-16 sessions) - Focus on current relationships - Improve communication and problem-solving
Efficacy: Strong evidence for depression (comparable to CBT). Adapted for eating disorders, bipolar disorder, anxiety.
Common Factors (account for significant outcome variance): - Therapeutic Alliance: Strongest predictor of outcome - Empathy: Therapist understanding - Positive Regard: Warmth and acceptance - Expectations: Hope and expectancy of improvement - Cultural Adaptation: Matching to client context
Integrative Approaches: - Technical Eclecticism: Using techniques from various approaches - Theoretical Integration: Synthesizing theories - Assimilative Integration: Home base with openness to other techniques - Common Factors Approach: Emphasizing shared elements
Principles of Therapeutic Change: - Match treatment to client characteristics - Build strong alliance - Enhance motivation for change - Foster insight and new perspectives - Encourage new experiences and behaviors
Comparing traditional cognitive-behavioral therapy with acceptance-based approaches.
| CBT (Traditional) | ACT (Third-Wave) | |
|---|---|---|
| Goal regarding thoughts | Change thought content/accuracy | Change relationship to thoughts |
| Primary Mechanism | Cognitive restructuring | Psychological flexibility |
| View of Symptoms | Targets for reduction | Experiences to be accepted while acting on values |
3 questions to test your understanding of this topic
Beck, J. S. (2020). Cognitive Behavior Therapy: Basics and Beyond. Guilford Press (3rd ed.).
Linehan, M. M. (2015). DBT Skills Training Manual. Guilford Press (2nd ed.).
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. Guilford Press (2nd ed.).
Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate. Routledge (2nd ed.).
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. Oxford University Press.
Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2018). The Guide to Interpersonal Psychotherapy. Oxford University Press.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2018). Mindfulness-Based Cognitive Therapy for Depression. Guilford Press (2nd ed.).
Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge.
Craske, M. G., et al. (2014). Maximizing Exposure Therapy: An Inhibitory Learning Approach. Behaviour Research and Therapy, 58, 10-23.
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy Relationships That Work III. Psychotherapy, 55(4), 303-315.
