The Situation Has Clearly Changed: So What Are We Going to Do About It?

doi:10.1016/j.cbpra.2015.09.001

Cognitive and Behavioral Practice

Volume 23, Issue 4, November 2016, Pages 446-450

https://doi.org/10.1016/j.cbpra.2015.09.001 Get rights and content

Abstract

Although cognitive behavior therapy (CBT) has been an enormous empirical and practical success over its 50 + year history, the situational factors that led to its success are changing. In this paper I briefly summarize the history of CBT, and list a number of current challenges that could be dangerous to the future health of CBT if they are ignored or mishandled. I make six recommendations that I believe will be of help going forward: focusing on theory and basic principles; embracing transdiagnostic thinking even more strongly; abandoning syndromal classification once and for all; creating a functional diagnostic system with treatment utility; integrating biology into behavioral science by aligning with modern multidimensional, multilevel evolution science; and becoming more serious about delivery systems. The future of CBT could be exciting if we are able to adjust to changing conditions in a flexible way.

Section snippets

The Rise of CBT

The founders of behavior therapy (BT) and of the progenitor of the Association for Behavioral and Cognitive Therapies (ABCT) had a goal in mind for their new discipline: They created a field based on a dual commitment to scientifically well-validated clinical protocols and the application of laboratory-based basic behavioral principles. It is important for young readers to understand that this commitment was not to randomized controlled trials (RCTs) focused on psychiatric syndromes.

The Current Context

In the last few years, change has been rapid. The Affordable Care Act has made it clear that psychological interventions would expand across disciplines within primary medical homes, undermining the vision of treatment protocols delivered in specialty mental health as a primary model of treatment delivery. The DSM-5 was released either to yawns or to the sound of only slightly suppressed guffaws. Finally recognizing the grotesque scientific failure of syndromal classification in mental health,

Back to the Future

I am going to try to describe what I think is a way forward that could help us rise to this set of challenges. I have been asked to link this short article to my personal career, however, so first I will add some details that will put these recommendations into a personal context.

I was trained as a behavior analyst, and both of my primary mentors (John Cone and David Barlow) were at ease describing themselves that way. As a student I bought in to the idea of high-precision/high-scope principles

Conclusion

The steps I am advocating have been cast in terms related to my own history and the CBS community, but some of these same basic steps seem to characterize the work of more mainstream CBT researchers, such as David Barlow, Michelle Craske, or Stefan Hofmann, just to name a few. CBT has had a wonderful run and the CBT tradition has a lot of life left in it yet, if it can turn toward a more process and principle focus linked to the needs of particular human beings and human groups. Our future is

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The different levels of treatment for any given disease are tied together theoretically because they all correct the same fault but in different ways: treatments are complementary not competitive. Different psychotherapies have been presented as competitive both historically (Eysenck, 1961) and in the present day (Barlow, 2016; Hayes, 2016) because there is no consensus about the underlying fault that needs correcting. The competitive relationship between psychotherapeutic interventions has been questioned.
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The Situation Has Clearly Changed: So What Are We Going to Do About It?

Abstract

Section snippets

The Rise of CBT

The Current Context

Back to the Future

Conclusion

Behavior Therapy

Journal of Contextual Behavioral Science

Current Opinion in Psychology

Advances in relational frame theory: Research and application

Relational Frame Theory: A Post-Skinnerian account of human language and cognition

Mentalism, behavior–behavior relations and a behavior analytic view of the purposes of science

The Behavior Analyst