001

Table of Contents
 
Title Page
Copyright Page
PREFACE
Acknowledgements
CONTRIBUTORS
COGNITIVE BEHAVIOR THERAPY
 
1 INTRODUCTION
2 PSYCHOLOGICAL ACCEPTANCE
 
THE GROWTH OF PSYCHOLOGICAL ACCEPTANCE IN CBT
CONCEPTUALIZATIONS OF ACCEPTANCE
CLINICAL INTERVENTIONS TO PROMOTE PSYCHOLOGICAL ACCEPTANCE
WHEN IS ACCEPTANCE RECOMMENDED, AND WHEN IS IT LIKELY TO BE LESS EFFECTIVE?
UNRESOLVED ISSUES AND DIRECTIONS FOR FUTURE RESEARCH
CONCLUSION
 
3 ANGER (NEGATIVE IMPULSE) CONTROL
 
RESPONSIVE POPULATIONS AND CONTRAINDICATIONS
ANGER MEASUREMENT
THOUGHT STOPPING
RELAXATION TRAINING
PROBLEM-SOLVING SKILLS TRAINING
SELF-REINFORCEMENT
URGE CONTROL
EVIDENCE-BASED APPLICATIONS
RESOURCES
CONCLUSIONS
 
4 ASSERTIVENESS SKILLS AND THE MANAGEMENT OF RELATED FACTORS
 
BEHAVIORAL, COGNITIVE-AFFECTIVE, AND SOCIAL FACTORS INFLUENCING ASSERTIVENESS
ASSESSMENT
PRECONDITIONS FOR ASSERTIVENESS
ASSESSMENT OF ASSERTIVENESS SKILLS AND PERFORMANCE ABILITIES
BEHAVIORAL OBSERVATION
ASSERTIVENESS TRAINING
ASSERTIVENESS IN SPECIFIC CONTEXTS
CONCLUSION
 
5 ATTRIBUTION CHANGE
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
HOW TO APPLY ATTRIBUTION CHANGE TECHNIQUES: OVERVIEW
STEP-BY-STEP PROCEDURES
 
6 BEHAVIORAL ACTIVATION TREATMENT FOR DEPRESSION
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TREATMENT
OTHER DECISIONS IN DECIDING WHETHER TO USE BEHAVIORAL ACTIVATION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
FINAL CONSIDERATIONS
 
7 RESPONSE CHAINING
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
HOW DOES THIS TECHNIQUE WORK?
COMPLETING AND VALIDATING A TASK ANALYSIS
DETERMINE WHAT CHAINING PROCEDURE TO USE
 
8 BEHAVIORAL CONTRACTING
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
ASSOCIATED CHALLENGES
STEP-BY-STEP PROCEDURES
 
9 BIBLIOTHERAPY UTILIZING COGNITIVE BEHAVIOR THERAPY
 
EVIDENCE-BASED APPLICATION
LIMITS OF BIBLIOTHERAPY
FACTORS TO CONSIDER WHEN RECOMMENDING BIBLIOTHERAPY
PRACTICE RECOMMENDATIONS
CONCLUSION
 
10 BREATHING RETRAINING AND DIAPHRAGMATIC BREATHING TECHNIQUES
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
EVIDENCE-BASED APPLICATIONS
CONTRAINDICATIONS OF THE TECHNIQUE
OTHER DECISION FACTORS WHEN DECIDING TO USE THE TECHNIQUE
HOW DOES BREATHING RETRAINING WORK?
STEP-BY-STEP PROCEDURES
 
11 CLASSROOM MANAGEMENT
 
CLASSROOM RULES
ENHANCING CLASSROOM ENVIRONMENT
REINFORCEMENT STRATEGIES
 
12 COGNITIVE DEFUSION
 
EVIDENCE FOR THE EFFECTIVENESS OF COGNITIVE DEFUSION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TECHNIQUE
OTHER DECISIONS IN DECIDING WHETHER TO USE COGNITIVE DEFUSION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
THINKING VERSUS EXPERIENCE
OBJECTIFYING THOUGHT
A THOUGHT IS A THOUGHT IS A THOUGHT
FOCUS ON THE FUNCTIONAL UTILITY OF THOUGHTS
CONCLUSION
 
13 COGNITIVE RESTRUCTURING OF THE DISPUTING OF IRRATIONAL BELIEFS
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE THIS TECHNIQUE
HOW DOES THIS TREATMENT WORK?
CONCLUSION
 
14 COGNITIVE RESTRUCTURING: BEHAVIORAL TESTS OF NEGATIVE COGNITIONS
 
HOW TO USE BEHAVIORAL TESTS TO COUNTER NEGATIVE THINKING
EXAMPLES OF BEHAVIORAL TESTS TO COUNTER NEGATIVE THINKING
SUMMARY AND CONCLUSIONS
 
15 COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING
 
PROPOSED MECHANISMS OF EFFECT
COMMUNICATION SKILLS TRAINING PROCEDURES
FUNCTION OF SPEAKER/LISTENER SKILLS
STEP-BY-STEP PROCEDURES FOR SPEAKER/LISTENER SKILLS
FUNCTION OF PROBLEM-SOLVING SKILLS
STEP-BY-STEP PROCEDURES FOR PROBLEM-SOLVING SKILLS FOR COUPLES
GENERALIZABILITY
EVIDENCE-BASED APPLICATIONS
SUMMARY
 
16 COMPLIANCE WITH MEDICAL REGIMENS
 
MAJOR THEORIES OF COMPLIANCE
GUIDELINES FOR COMPLIANCE ENHANCEMENT
AN EXAMPLE OF COMPLIANCE ENHANCEMENT
 
17 CONTINGENCY MANAGEMENT INTERVENTIONS
 
GENERAL PRINCIPLES OF CONTINGENCY MANAGEMENT
APPLICATIONS OF CONTINGENCY MANAGEMENT
DESIGNING AN EFFECTIVE CONTINGENCY MANAGEMENT INTERVENTION
BARRIERS TO IMPLEMENTATION
 
18 DAILY BEHAVIOR REPORT CARDS: HOME-SCHOOL CONTINGENCY MANAGEMENT PROCEDURES
 
TREATMENT ACCEPTABILITY
FOR WHOM IS THE INTERVENTION APPROPRIATE?
HOW DOES THE INTERVENTION WORK?
STEPS TO DEVELOPING AND USING A SCHOOL-HOME NOTE
 
19 DIALECTICS IN COGNITIVE AND BEHAVIOR THERAPY
 
DIALECTICS IN COGNITIVE AND BEHAVIOR THERAPY
WHO MIGHT BENEFIT FROM DIALECTICAL STRATEGIES
THEORY OR MECHANISM BY WHICH DIALECTICS IS HYPOTHESIZED TO WORK
SPECIFIC DIALECTICAL TREATMENT STRATEGIES
CONCLUSIONS
 
20 DIFFERENTIAL REINFORCEMENT OF LOW-RATE BEHAVIOR
 
OVERVIEW
EXAMPLES OF DRL
USING DRL SCHEDULES
LIMITATIONS OF DRL
FUTURE WORK
CONCLUSION
 
21 DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR AND DIFFERENTIAL REINFORCEMENT ...
 
CONSIDERATIONS PRIOR TO IMPLEMENTING A DRO/DRA PROCEDURE
DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR (DRO)
DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR (DRA)
SUMMARY
 
22 DIRECTED MASTURBATION: A TREATMENT OF FEMALE ORGASMIC DISORDER
 
INTRODUCTION
EVIDENCE-BASED APPLICATIONS
WHO MIGHT BENEFIT FROM THIS TREATMENT
CONTRAINDICATIONS FOR TREATMENT
THE INITIAL INTERVIEW
STEP-BY-STEP PROCEDURES
KEY ELEMENTS OF THE DIRECTED MASTURBATION PROGRAM
PROBLEMS TO DEAL WITH DURING THE TREATMENT PROGRAM
DISCUSSION
 
23 DISTRESS TOLERANCE
 
EMPIRICAL EVIDENCE SUPPORTING THE USE OF DISTRESS TOLERANCE
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRADICTIONS
DECIDING TO USE DISTRESS TOLERANCE
DISTRESS TOLERANCE TECHNOLOGY
PROCEDURES
CONCLUSION
 
24 EMOTION REGULATION
 
UNDERSTANDING EMOTION REGULATION AND DYSREGULATION
EMOTION REGULATION STRATEGIES AND INTERVENTIONS
 
25 ENCOPRESIS: BIOBEHAVIORAL TREATMENT
 
INTRODUCTION
UNDERLYING PROCESSES
EVALUATION
CONTRAINDICATIONS
TREATMENT OF FE
PREVENTION
CONCLUSION
 
26 EXPRESSIVE WRITING
 
HOW TO DO EXPRESSIVE WRITING
WHO BENEFITS FROM EXPRESSIVE WRITING?
CONTRAINDICATIONS
WHY DOES EXPRESSIVE WRITING WORK?
SUGGESTED USES
 
27 FLOODING
 
WHEN ARE FLOODING PROCEDURES USED?
ARE FLOODING PROCEDURES EFFECTIVE IN REDUCING FEAR?
WHY DOES FLOODING WORK?
HOW TO CONDUCT FLOODING IN VIVO
HOW TO CONDUCT FLOODING IN IMAGINATION
CONCLUSION: HELPING THE CLIENT HANDLE DISTRESS
FUTURE DIRECTIONS
EVIDENCE-BASED APPLICATIONS
 
28 EXPERIMENTAL FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIOR
 
BACKGROUND
WHO MIGHT BENEFIT FROM THE FUNCTIONAL ANALYSIS
POSSIBLE CONTRAINDICATIONS
ADDITIONAL CONSIDERATIONS
HOW DOES THE FUNCTIONAL ANALYSIS WORK?
EMPIRICAL SUPPORT FOR THE FUNCTIONAL ANALYSIS
STEP-BY-STEP INSTRUCTIONS
LINKING THE FUNCTIONAL ANALYSIS TO TREATMENT
 
29 FUNCTIONAL COMMUNICATION TRAINING TO TREAT CHALLENGING BEHAVIOR
 
WHO MIGHT BENEFIT FROM THIS TREATMENT
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TREATMENT WORK?
EVIDENCE FOR THE EFFECTIVENESS OF FCT
STEP-BY-STEP PROCEDURES
PREDICTING SUCCESSFUL OUTCOMES
 
30 FUNCTIONAL SELF-INSTRUCTION TRAINING TO PROMOTE GENERALIZED LEARNING
 
STEP 1: SELECT AN ARRAY OF EXAMPLES
STEP 2: CLASSIFY RESPONSES INTO TEACHING SETS
STEP 3: DIVIDE MEMBERS OF THE TEACHING SET INTO TRAINING EXAMPLES THAT WILL ...
STEP 4: TEACH SELF-INSTRUCTION
STEP 5: EVALUATE THE EFFECTS OF TRAINING
STEP 6: WITHDRAW TRAINING BASED ON STUDENT PERFORMANCE
CONCLUSION
 
31 GROUP INTERVENTIONS
 
INTRODUCTION
WHO MIGHT BENEFIT FROM GROUP INTERVENTIONS?
CONTRAINDICATIONS
PRACTICAL CONSIDERATIONS
STEP-BY-STEP PROCEDURES
 
32 HABIT REVERSAL TRAINING
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
 
33 HARM REDUCTION
 
EVIDENCE-BASED APPLICATIONS OF HARM REDUCTION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THIS THERAPY
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
 
34 PUTTING IT ON THE STREET: HOMEWORK IN COGNITIVE BEHAVIORAL THERAPY
 
THERAPIST USE OF HOMEWORK
EVIDENCE-BASED APPLICATIONS OF HOMEWORK
WHAT IS THE PROCESS BY WHICH HOMEWORK PRODUCES ITS EFFECTS IN THERAPY?
USE OF HOMEWORK WITH SPECIFIC POPULATIONS
HOW DOES HOMEWORK WORK?
WHO MIGHT BENEFIT FROM HOMEWORK ASSIGNMENTS
CONTRAINDICATIONS FOR HOMEWORK ASSIGNMENTS
OTHER FACTORS IN DECIDING WHETHER TO USE HOMEWORK
STEP-BY-STEP PROCEDURES FOR USING HOMEWORK
 
35 THE PROLONGED CS EXPOSURE TECHNIQUES OF IMPLOSIVE (FLOODING) THERAPY
 
IMPLOSIVE THEORY
OVERVIEW OF THE THERAPEUTIC EXTENSION OF IMPLOSIVE THEORY
CONTRAINDICATION OF THE TREATMENT
OTHER ISSUES IN DECIDING WHETHER TO USE AN EXPOSURE BEHAVIORAL APPROACH
HOW DOES THE TECHNIQUE WORK?
A STEP-BY-STEP PROCEDURAL OUTLINE OF IMPLOSION THERAPY
DEALING WITH RESISTANCE AND DEFENSES
SESSION SPACING AND TREATMENT DURATION
EVIDENCE-BASED APPLICATIONS
ADDENDUM
 
36 COGNITIVE BEHAVIORAL TREATMENT OF INSOMNIA
 
INTRODUCTION AND BACKGROUND
THE COGNITIVE BEHAVIORAL MODEL OF INSOMNIA
DIAGNOSIS AND ASSESSMENT OF INSOMNIA
THE COGNITIVE BEHAVIORAL TREATMENT OF INSOMNIA
CONCLUSION
 
37 INTEROCEPTIVE EXPOSURE FOR PANIC DISORDER
 
WHO MIGHT BENEFIT FROM THIS TREATMENT?
CONTRAINDICATIONS OF THE TREATMENT
OTHER CONSIDERATIONS IN DECIDING WHETHER TO USE INTEROCEPTIVE EXPOSURE
HOW DOES INTEROCEPTIVE EXPOSURE WORK?
STEP-BY-STEP GUIDE ON HOW TO IMPLEMENT INTEROCEPTIVE EXPOSURE
CONDUCTING AN IDIOGRAPHIC ASSESSMENT AND FUNCTIONAL ANALYSIS
PROVIDING CLIENTS WITH AN ADEQUATE RATIONALE FOR INTEROCEPTIVE EXPOSURE
STRUCTURE AND SELECTION OF INTEROCEPTIVE EXPOSURE EXERCISES
TYPES OF INTEROCEPTIVE EXPOSURE EXERCISES
IMPLEMENTATION OF INTEROCEPTIVE EXPOSURE
EXPOSURE HOMEWORK
PROMOTING GENERALIZATION USING NATURALISTIC EXPOSURE
STRATEGIES TO UNDERMINE AVOIDANCE AND SAFETY-SEEKING BEHAVIORS
 
38 LIVE (IN VIVO) EXPOSURE
 
WHO MIGHT BENEFIT FROM IN VIVO EXPOSURE
EVIDENCE-BASED APPLICATIONS
CONTRAINDICATIONS
ANY OTHER DECISION FACTORS IN DECIDING WHETHER TO USE THE TECHNIQUE
HOW DOES IN VIVO EXPOSURE WORK?
STEP-BY-STEP PROCEDURES
 
39 APPLICATIONS OF THE MATCHING LAW
 
APPLICATIONS
CONSIDERATIONS
STEP-BY-STEP PROCDURES
FOCUS ON APPLIED IMPLICATIONS
SUMMARY
 
40 MINDFULNESS PRACTICE
 
PRIMARY MINDFULNESS STRATEGIES AND THEIR EMPIRICAL STATUS
WHO MIGHT BENEFIT FROM MINDFULNESS STRATEGIES AND CONTRAINDICATIONS OF THE TREATMENT
OTHER FACTORS TO CONSIDER IN DECIDING WHETHER TO USE MINDFULNESS STRATEGIES
HOW DOES MINDFULNESS PRACTICE WORK?
STEP-BY-STEP GUIDELINES FOR THE CLINICAL USE OF MINDFULNESS PRACTICE
 
41 MODERATE DRINKING TRAINING FOR PROBLEM DRINKERS
 
MODERATION TRAINING APPROACHES
KEY ELEMENTS OF MODERATION TRAINING
WHO IS LIKELY TO BENEFIT FROM MODERATION TRAINING?
THE RISKS OF MODERATION
CONCLUSION
 
42 MULTIMODAL BEHAVIOR THERAPY
 
CONTEXT
ENTER COGNITIVE RESTRUCTURING AND MORE
WHO MIGHT BENEFIT FROM THIS APPROACH
CONTRAINDICATIONS
THEORY AND MECHANISM
TWO SPECIFIC MULTIMODAL PROCEDURES
ILLUSTRATIVE CASE
A STEP-BY-STEP INQUIRY
 
43 POSITIVE PSYCHOLOGY: A BEHAVIORAL CONCEPTUALIZATION AND APPLICATION TO ...
 
THE HISTORICAL ROOTS OF POSITIVE PSYCHOLOGY
CURRENT PERSPECTIVES IN THE POSITIVE PSYCHOLOGY MOVEMENT
BEHAVIORISM AND POSITIVE PSYCHOLOGY: COMMON FACTORS
CONTEMPORARY BEHAVIORAL THERAPIES AND POSITIVE PSYCHOLOGY
CRITICISMS OF POSITIVE PSYCHOLOGY
CONCLUSION
 
44 MOTIVATIONAL INTERVIEWING
 
RESEARCH ON THE EFFICACY OF MI
WHO MIGHT BENEFIT FROM MI?
THEORETICAL UNDERPINNINGS OF MI
THE PRACTICE OF MOTIVATIONAL INTERVIEWING
CONCLUSION
 
45 NONCONTINGENT REINFORCEMENT AS A TREATMENT FOR PROBLEM BEHAVIOR
 
CONTRAINDICATIONS OF THE TECHNIQUE
CONSIDERATIONS
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
WHEN NCR DOES NOT DECREASE PROBLEM BEHAVIOR
 
46 PAIN MANAGEMENT
 
KEY CONCEPTUAL FACTORS
COGNITIVE BEHAVIORAL THERAPY FOR CHRONIC PAIN
A SESSION-BY-SESSION GUIDE TO A TYPICAL COURSE OF TREATMENT
EVIDENCE-BASED APPLICATIONS
CONCLUSION
 
47 PARENT TRAINING
 
THEORY
INTERVENTION
PARENT TRAINING PROCEDURES
CAVEAT
 
48 SELF-EFFICACY INTERVENTIONS: GUIDED MASTERY THERAPY
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
 
49 POSITIVE ATTENTION
 
ADVANTAGES OF THE TECHNIQUE
LIMITATIONS OF THE TECHNIQUE
WHO MIGHT BENEFIT FROM POSITIVE ATTENTION?
HOW DOES POSITIVE ATTENTION WORK?
POSITIVE ATTENTION IN PARENT-CHILD INTERACTION THERAPY
FUNCTIONAL ANALYSIS IN PCIT
STEP-BY-STEP PROCEDURES
 
50 PROBLEM-SOLVING THERAPY
 
SOCIAL PROBLEM SOLVING
EVIDENCED-BASED APPLICATIONS
CONTRAINDICATIONS
EVIDENCE FOR THE EFFICACY OF PST
STEP-BY-STEP GUIDE
 
51 PUNISHMENT
 
THE OPERATION OF PUNISHMENT
THE FUNCTION OF PROBLEM BEHAVIOR
EFFECTIVENESS OF PUNISHMENT
IDENTIFYING FUNCTIONAL TREATMENTS
CASE EXAMPLES
SUMMARY
 
52 RAPID SMOKING
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE RAPID SMOKING
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
EVIDENCE-BASED APPLICATIONS
 
53 RELAPSE PREVENTION
 
WHO MIGHT BENEFIT
INDICATIONS/CONTRAINDICATIONS
OTHER FACTORS TO CONSIDER
THEORETICAL BASES
TREATMENT COMPONENTS
PROCEDURES
FINAL COMMENTS
 
54 RELAXATION
 
KEY DEVELOPMENTS IN RELAXATION TRAINING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
FURTHER CONSIDERATIONS
 
55 RESPONSE PREVENTION
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
OTHER FACTORS IN DECIDING WHETHER TO USE RESPONSE PREVENTION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
 
56 SATIATION THERAPY
 
LIMITS OF SATIATION THERAPY
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
HOW DOES SATIATION THERAPY WORK?
STEP-BY-STEP TECHNIQUE
 
57 IDENTIFYING AND MODIFYING MALADAPTIVE SCHEMAS
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
STEP-BY-STEP PROCEDURES
EVIDENCE-BASED APPLICATIONS
 
58 SELF-MANAGEMENT
 
HOW DOES IT WORK?
EVIDENCE FOR THE EFFECTIVENESS OF SELF-MANAGEMENT THERAPY
INDICATIONS AND CONTRAINDICATIONS
TOPIC-BY-TOPIC PROCEDURES
 
59 SAFETY TRAINING/VIOLENCE PREVENTION USING THE SAFECARE PARENT TRAINING MODEL
 
OVERVIEW
WHO MIGHT BENEFIT FROM SAFECARE?
CONTRAINDICATIONS FOR SAFECARE
HOW DOES SAFECARE WORK?
STEP-BY-STEP PROCEDURES FOR SAFECARE
IMPLEMENTATION OF SAFECARE
 
60 SELF-MONITORING AS A TREATMENT VEHICLE
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
VARIABLES RELATED TO THE EFFECTIVENESS OF SELF-MONITORING
FACTORS TO CONSIDER IN DECIDING WHETHER TO USE SELF-MONITORING
STEP-BY-STEP PROCEDURES
 
61 SENSATE FOCUS
 
INTRODUCTION
WHO MIGHT BENEFIT FROM SENSATE FOCUS?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE SENSATE FOCUS
HOW DOES SENSATE FOCUS WORK?
EVIDENCE FOR THE EFFECTIVENESS OF SENSATE FOCUS
STEP-BY-STEP PROCEDURES
HOW TO AVOID COMMON PROBLEMS
 
62 SHAPING
 
DEFINITION OF SHAPING
CASE EXAMPLES
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
OTHER FACTORS TO CONSIDER WHEN DECIDING WHETHER TO USE THIS TECHNIQUE
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
 
63 SOCIAL SKILLS TRAINING
 
WHO WILL BENEFIT FROM SOCIAL SKILLS TRAINING?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE SOCIAL SKILLS TRAINING
HOW DOES SOCIAL SKILLS TRAINING WORK?
STEP-BY-STEP PROCEDURES
EXAMPLES OF EVIDENCE-BASED APPLICATIONS
 
64 SQUEEZE TECHNIQUE FOR THE TREATMENT OF PREMATURE EJACULATION
 
WHO MIGHT BENEFIT FROM THIS TREATMENT?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE THE SQUEEZE TECHNIQUE
CLINICAL APPLICATION OF THE SQUEEZE TECHNIQUE
CURRENT APPLICATIONS OF THIS TREATMENT
 
65 STIMULUS CONTROL
 
STIMULUS CONTROL AND CLASSICAL CONDITIONING
STIMULUS CONTROL AND OPERANT CONDITIONING
RULES AND STIMULUS CONTROL
STIMULUS CONTROL BY THE CONSEQUENCES OF BEHAVIOR
TREATING INSOMNIA THROUGH STIMULUS CONTROL
HOW TO IMPLEMENT STIMULUS CONTROL PROCEDURES
 
66 STIMULUS PREFERENCE ASSESSMENT
 
ADVANTAGES OF THE TECHNIQUE
WHO MIGHT BENEFIT FROM STIMULUS PREFERENCE ASSESSMENT?
HOW DOES THE TECHNIQUE WORK?
EVIDENCE FOR THE EFFECTIVENESS OF STIMULUS PREFERENCE ASSESSMENT
WHEN TO CHOOSE ONE PROCEDURE OVER ANOTHER
 
67 STRESS INOCULATION TRAINING
 
WHO MIGHT BENEFIT FROM SIT?
CONTRAINDICATIONS
HOW DOES SIT WORK?
STEP-BY-STEP PROCEDURES
A PROCEDURAL FLOW CHART OF STRESS INOCULATION TRAINING
 
68 STRESS MANAGEMENT INTERVENTION
 
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE STRESS MANAGEMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
EVIDENCED-BASED APPLICATIONS
CONCLUSION
 
69 SYSTEMATIC DESENSITIZATION
 
TYPES OF SYSTEMATIC DESENSITIZATION
EVIDENCED-BASED APPLICATIONS
CONTRAINDICATIONS
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES: TRADITIONAL SYSTEMATIC DESENSITIZATION
KEY ELEMENTS OF SYSTEMATIC DESENSITIZATION
 
70 THINK-ALOUD TECHNIQUES
 
THINK-ALOUD METHODS OF COGNITIVE ASSESSMENT
THE “ARTICULATED THOUGHTS IN SIMULATED SITUATIONS” THINK-ALOUD COGNITIVE ...
CONCLUSION
 
71 TIME-OUT, TIME-IN, AND TASK-BASED GROUNDING
 
INTRODUCTION
UNDERLYING PROCESSES
EVIDENCE OF EFFECTIVENESS
CONTRAINDICATIONS
THE ROLE OF TIME-IN
USING TO
TASK-BASED GROUNDING: A RECENT EXTENSION OF TO
CONCLUSION
 
72 GUIDELINES FOR DEVELOPING AND MANAGING A TOKEN ECONOMY
 
WHO MIGHT BENEFIT FROM A TOKEN ECONOMY?
FACTORS IN DECIDING WHETHER TO USE A TOKEN ECONOMY
GUIDELINES
 
73 URGE SURFING
 
CLINICAL POPULATIONS
URGE SURFING STEP-BY-STEP
 
74 VALIDATION PRINCIPLES AND STRATEGIES
 
WHO MIGHT BENEFIT FROM VALIDATION?
WHAT TO VALIDATE
CONTRAINDICATIONS
HOW DOES THE TECHNIQUE WORK?
EVIDENCE FOR THE EFFECTIVENESS OF VALIDATION
STEP-BY-STEP PROCEDURES
 
75 VALUES CLARIFICATION
 
WHO MIGHT BENEFIT FROM VALUES CLARIFICATION?
CONTRAINDICATIONS
HOW DOES VALUES CLARIFICATION WORK?
STEP-BY-STEP PROCEDURES
EVIDENCE-BASED APPLICATIONS
SUMMARY
 
COGNITIVE BEHAVIOR THERAPY
AUTHOR INDEX
SUBJECT INDEX

001

PREFACE
Over the last three decades there has been a significant increase in interest in cognitive behavior therapy. This has occurred for several reasons: 1) Mounting experimental evidence supports the effectiveness of cognitive behavioral therapy for certain psychological problems induding high incidence problems such as depression and the anxiety disorders. The well-known Chambless report, for example, identifies many cognitive behavioral therapies as being empirically supported. In fact, cognitive behavioral techniques comprise most of the list. 2) Cognitive behavior therapy tends to be relatively brief and often can be delivered in groups. Therefore it can be more cost-effective than some alternatives and be seen to offer good value. These qualities have become particularly important in the era of managed care with its emphasis upon cost containment. 3) Cognitive behavior therapy has been applied with varying success to a wide variety of problems (see Fisher and O’Donohue, 2006 for over 70 behavioral health problems in which CBT can be considered an evidence based treatment. Thus, it has considerable scope and utility for the practitioner in general practice or the professional involved in the training of therapists. 4) Cognitive behavior therapy is a relatively straight forward and clearly operationalized approach to psychotherapy. This does not mean that case formulation or implementing these techniques is easy. However, CBT is more learnable that techniques such as psychoanalysis or Gestalt therapy. 5) Cognitive behavioral therapy is a therapy system comprised of many individual techniques, with researchers and practitioners constantly adding to this inventory. A given behavior therapist, because of his or her specialty, may know or use only a small subset of these. A clinician or clinical researcher may want to creatively combine individual techniques to treat some intransigent problem or an unfamiliar or complicated clinical presentation.
This volume attempts to bring together all of the specific techniques of cognitive behavior therapy. It does this in an ecumenical fashion. Historically, and currently, there are divisions inside behavior therapy that this book attempts to ignore. For example, cognitive and more traditionally behavioral techniques are included. This offended some prospective authors who were clearly warriors in the cognitive-behavioral battle. We wanted to be inclusive, particularly because pragmatically the outcome research favors both sides of this particular battle.
Our major interest in compiling this book was twofold: First we noted the lack of a volume that provides detailed descriptions of the techniques of cognitive behavioral therapy. Many books mentioned these but few described the techniques in detail. The absence of a comprehensive collection of the methods of cognitive-behavior therapy creates a gap in the training of students and in the faithful practice of cognitive behavior therapy. Second, with the increased interest in cognitive behavior therapy, particularly by the payers in managed care, there has been an increasing bastardization of behavior therapy. Some therapists are claiming they are administering some technique (e.g., relapse prevention or contingency management) when they clearly are not. This phenomenon, in our experience, rarely involves intentional deception but instead reflects an ignorance of the complexities of faith-fully implementing these techniques. This book is aimed at reducing this problem.
There is an important question regarding the extent to which a clinician can faithfully implement these techniques without a deeper understanding of behavior therapy. The evidence is not clear and of course the question is actually more complicated. Perhaps a generically skilled therapist with certain kinds of clients and certain kinds of techniques can implement the techniques well. On the other hand, a less skilled therapist dealing with a complicated clinical presentation utilizing a more subtle technique might not do so well. There is certainly a Gordon Paul type ultimate question lurking here. Something like: “What kind of therapist, with what type of problem, using what kind of cognitive behavior therapy technique, with what kind of training, can have what kinds of effects. . .” With the risk of being seen as self-promoting, the reader can learn about the learning and conditioning underpinnings of many of thes techniques in O’Donohue (1998); and more of the theories associated with these techniques in O’Donohue and Krasner (1995). Fisher and O’Donohue (2006) provide a description of particular problems that these techniques can be used with.
 
 
References
 
Fisher, J.E.,& O’Donohue, W.T. (2006) Practitioner’s guide to evidence based psychotherapy. New York: Springer.
O’Donohue, W., & Krasner, L. (Eds.). (1995). Theories of behavior therapy. Washington: APA Books.
O’Donohue, W. (Ed.). (1998). Learning and behavior therapy. Boston: Allyn & Bacon.

ACKNOWLEDGMENTS
We wish to thank all the chapter authors. They uniformly wrote excellent chapters and completed these quickly.
We’d also like to thank our editor at John Wiley & Sons, Patricia Rossi. She shared our vision for this book, gave us some excellent suggestions for improvement, and has been wonderful to work with.
We’d also like to thank Linda Goddard for all her secretarial skills and expert assistance in all aspects of the manuscript preparation; she was invaluable.
Finally, we’d like to thank our families for their support, and especially our children, Katie and Annie, for their enthusiasm and delightfulness.

CONTRIBUTORS
Jonathan S. Abramowitz
University of North Carolina
Chapel Hill, NC
 
 
Dean T. Acheson
University at Albany, SUNY
Albany, NY
 
 
Jennifer H. Adams
University of Colorado at Denver
Denver, CO
 
Mark A. Adams, Ph.D., B.C.B.A
Best Consulting, Inc.
Fresno, CA
 
K. Angeleque Akin-Little
Massey University
Auckland, New Zealand
 
Mark Alavosius, Ph.D.
University of Nevada, Reno
Reno, NV
 
Claudia Avina, Ph.D.
University of Nevada, Reno
Reno, NV
 
Jenna L. Baddeley, M.A.
The University of Texas at Austin
Austin, TX
 
Anjali Barretto, Ph.D.
Gonzaga University
Spokane, WA
 
Wendy K. Berg, M.A.
University of Iowa
Iowa City, IA
 
Jennifer L. Best, Ph.D.
University of North Carolina
Charlotte, NC
 
Arthur W. Blume, Ph.D.
University of North Carolina
Charlotte, NC
 
Stephen R. Boggs, Ph.D.
University of Florida
Gainesville, FL
 
John C. Borrero, Ph.D.
University of Maryland
Baltimore, MD
 
Carrie S.W. Borrero, Ph.D.
Kennedy-Krieger Institute
Baltimore, MD
 
Stephanie Both, Ph. D.
Leiden University Medical Center
Leiden, Netherlands
 
J. Annette Brooks, Ph. D.
New Mexico VA Healthcare System
Albuquerque, NM
 
Jeffery A. Buchanan
Minnesota State University
Mankato, MN
 
Eric Burkholder
Dublin Unified School District
Department of Special Education
Dublin, CA
 
James E. Carr, Ph.D.
Western Michigan University
Kalamazoo, MI
 
Lavina L. Cavasos
New Mexico VA Healthcare System
Albuquerque, NM
 
Daniel Cervone, Ph.D.
University of Illinois at Chicago
Chicago, IL
 
Stacey M. Cherup
University of Nevada, Reno
Reno, NV
 
Kim Christiansen
Carson City, NV
 
Linda J. Cooper-Brown, Ph.D.
University of Iowa Children’s Hospital
Iowa City, IA
 
Michelle G. Craske, Ph.D.
UCLA
Los Angeles, CA
 
Dan Crimmins, Ph.D.
The Marcus Institute
Atlanta, GA
 
Wendy Crook
University of Nevada, Reno
Reno, NV
 
Jesse M. Crosby
Utah State University
Logan, UT
 
Joseph Dagen
University of Nevada, Reno
Reno, NV
 
Gerald C. Davison, Ph.D.
UCLA
Los Angeles, CA
 
Kim DeRuyk, Ph.D.
Boys’ Town
Boys’ Town, NE
 
Sona Dimidjian, Ph.D.
University of Colorado
Boulder, CO
 
Keith S. Dobson, Ph.D.
University of Calgary
Calgary, Canada
 
Brad Donohue, Ph.D.
University of Nevada, Las Vegas
Las Vegas, NV
 
Crissa Draper
University of Nevada, Reno
Reno, NV
 
Claudia Drossel, Ph.D.
University of Nevada, Reno
Reno, NV
 
Melanie P. Duckworth, Ph.D.
University of Nevada, Reno
Reno, NV
 
V. Mark Durand
University of South Florida
St. Petersburg, FL
 
Anna Edwards, Ph.D.
The Marcus Institute
Atlanta, GA
 
Albert Ellis, Ph.D.
Deceased
 
Erica L. England
Drexel University
Philadelphia, PA
 
Sheila M. Eyberg, Ph.D.
University of Florida
Gainesville, FL
 
Kyle E. Ferguson, M.A.
Riverview Hospital
Coquitlam, BC, Canada
 
Jane E. Fisher, Ph.D.
University of Nevada, Reno
Reno, NV
 
Edna B. Foa, Ph.D.
University of Pennsylvania
Philadelphia, PA
 
Evan M. Forman
Drexel University
Philadelphia, PA
 
John P. Forsyth, Ph.D.
University at Albany (SUNY)
Albany, NY
 
Maxwell R. Frank
University of Hawaii at Manoa
Honolulu, HI
 
Michelle A. Frank
Kennedy-Krieger Institute
Baltimore, MD
 
Martin E. Franklin, Ph.D.
University of Pennsylvania
Philadelphia, PA
 
Patrick C. Friman, Ph.D.
Father Flanagan’s Boys’ Home
Boys’ Town, NE
 
Armida R. Fruzzetti
University of Nevada, Reno
Reno, NV
 
Alan E. Fruzzetti, Ph.D.
University of Nevada, Reno
Reno, NV
 
Tiffany Fuse, Ph.D.
National Center for PTSD
Jamaica Plain, MA
 
Christina G. Garrison-Diehn
University of Nevada, Reno
Reno, NV
 
Robert J. Gatchel, Ph.D.
University of Texas at Arlington
Arlington, TX
 
Scott Gaynor, Ph.D.
Western Michigan University
Kalamazoo, MI
 
Patrick M. Ghezzi, Ph.D.
University of Nevada, Reno
Reno, NV
 
Elizabeth V. Gifford, Ph.D.
University of Nevada, Reno
Reno, NV
 
Alan M. Gross
University of Mississippi
University, MI
 
Kate E. Hamilton
Peter Lougheed Centre
Calgary, Canada
 
Jay Harding, Ed.S.
University of Iowa
Iowa City, IA
 
Cathi D. Harris, M.A.
Washington Special Commitment Center
Steilacoom, WA
 
Nicole L. Hausman
Kennedy-Krieger Institute
Baltimore, MD
 
Steven C. Hayes
University of Nevada, Reno
Reno, NV
 
Holly Hazlett-Stevens
University of Nevada, Reno
Reno, NV
 
Lara S. Head, Ph.D.
University of Wisconsin
Madison, WI
 
Elaine M. Heiby
University of Hawaii at Manoa
Honolulu, HI
 
James D. Herbert, Ph.D.
Drexel University
Philadelphia, PA
 
Ramona Houmanfar, Ph.D.
University of Nevada, Reno
Reno, NV
 
Kathryn L. Humphreys, Ph.D.
National Center for PTSD,
VA Boston Healthcare System
Boston, MA
 
Nicole N. Jacobs, Ph.D.
University of Nebraska
 
Alyssa H. Kalata, M.A.
Western Michigan University
Kalamazoo, MI
 
Mary Lou Kelley, Ph.D.
Louisiana State University
Baton Rouge, LA
 
Brian C. Kersh, Ph.D.
New Mexico VA Healthcare System
Albuquerque, NM
 
Kelly Koerner
EBP
Seattle, WA
 
Douglas Kostewicz, Ph.D.
University of Pittsburgh
Pittsburgh, PA
 
Ellen Laan, Ph.D.
University of Amsterdam
Amsterdam, Netherlands
 
Arnold A. Lazarus, Ph.D.
Rutgers, The State University of New Jersey
Piscataway, NJ
 
Linda A. LeBlanc, Ph.D.
Western Michigan University
Kalamazoo, MI
 
Deborah A. Ledley, Ph.D.
University of Pennsylvania
Penn Valley, PA
 
Jung Eun Lee
University of Nevada, Reno
Reno, NV
 
Eric R. Levensky, Ph.D.
New Mexico VA Healthcare System
Albuquerque, NM
 
Donald J. Levis, Ph.D.
Binghamton University
Binghamton, NY
 
Jennifer M. Lexington, Ph.D.
University of Massachusetts Amherst
Amherst, MA
 
Marsha M. Linehan, Ph.D.
University of Washington
Seattle, WA
 
Steven G. Little, Ph.D.
Massey University
Auckland, New Zealand
 
Andy Lloyd, Ph.D.
U.S. Army
 
Jessa R. Love
Western Michigan University
Kalamazoo, MI
 
Tamara M. Loverich, Ph.D.
Eastern Michigan University
 
Jason B. Luoma, Ph.D.
Portland Psychotherapy Clinic
Portland, OR
 
John R. Lutzker, Ph.D.
The Marcus Institute
Atlanta, GA
 
Kenneth R. MacAleese, M.A., B.C.B.A.
Reno, NV
 
Kristen A. Maglieri, Ph.D.
Trinity College
Dublin, Ireland
 
Christine Maguth Nezu, Ph.D.
Drexel University
Philadelphia, PA
 
Gayla Margolin, Ph.D.
UCLA
Los Angeles, CA
 
G. Alan Marlatt, Ph.D.
University of Washington
Seattle, WA
 
Christopher Martell
Private Practice
Seattle, WA
 
Brian P. Marx, Ph.D.
National Center for PTSD,
VA Boston Healthcare System
Boston, MA
 
Mary McMurran
University of Nottingham
Nottingham, United Kingdom
 
Donald Meichenbaum, Ph.D.
University of Waterloo
Waterloo, Ontario, Canada
 
Victoria E. Mercer
University of Nevada, Reno
Reno, NV
 
Eileen Merges
St. John Fisher College
Rochester, NY
 
Gerald I. Metalsky, Ph.D.
Lawrence University
Appleton, WI
 
Raymond G. Miltenberger, Ph.D., B.C.B.A.
University of South Florida
Tampa, FL
 
Sally A. Moore
University of Washington
Seattle, WA
 
Kevin J. Moore
Oregon Social Learning Center,
Community Programs
Eugene, OR
 
Karen Murphy
University of Nevada, Reno
Reno, NV
 
Adel C. Najdowski
Center for Autism and Related
Disorders, Inc.
Tarzana, CA
 
Amy E. Naugle, Ph.D.
Western Michigan University
Kalamazoo, MI
 
Cory F. Newman, Ph.D.
University of Pennsylvania
Philadelphia, PA
 
Kirk A.B. Newring, Ph.D.
Nebraska Dept. of Correctional Services
 
William D. Newsome
University of Nevada, Reno
Reno, NV
 
Arthur M. Nezu, Ph.D.
Drexel University
Philadelphia, PA
 
Amanda Nicholson-Adams, Ph.D., B.C.B.A.
California State University at Fresno
Fresno, CA
 
William T. O’Donohue, Ph.D.
University of Nevada, Reno
Reno, NV
 
Pamella H. Oliver, Ph.D.
California State University, Fullerton
Fullerton, CA
 
Jennette L. Palcic
Louisiana State University
Baton Rouge, LA
 
Gerald R. Patterson, Ph.D.
Oregon Social Learning Center
Eugene, OR
 
James W. Pennebaker
The University of Texas at Austin
Austin, TX
 
Michael L. Perlis, Ph.D.
University of Rochester
Rochester, NY
 
Katherine A. Peterson
Utah State University
Logan, UT
 
Wilfred R. Pigeon, Ph.D.
University of Rochester Medical Center
Rochester, NY
 
Alan Poling, Ph.D.
Western Michigan University
Kalamazoo, MI
 
Lisa Regev, Ph.D.
University of Nevada, Reno
Reno, NV
 
Lynn P. Rehm, Ph.D.
University of Houston
Houston, TX
 
Jennifer Resetar, Ph.D.
Boys’ Town
Boys’ Town, NE
 
Patricia Robinson, Ph.D.
Mountainview Consulting Group, Inc.
Zillah, WA
 
Richard C. Robertson, Ph.D.
Baylor University Medical Center
Dallas, TX
 
Frederick Rotgers, Psy.D., ABPP
Philadelphia College of Osteopathic
Medicine
Philadelphia, PA
 
Frank R. Rush, Ph.D.
Pennsylvania State University
University Park, PA
 
Joel Schmidt, Ph.D.
VA Northern California Healthcare System
Oakland, CA
 
Walter D. Scott, Ph.D.
University of Wyoming
Laramie, WY
 
Christine Segrin
University of Arizona
Tucson, AZ
 
Rachel E. Sgambati
Carson City, NV
 
Deacon Shoenberger
University of Nevada, Reno
Reno, NV
 
David M. Slagle
University of Washington
Seattle, WA
 
Rachel S.F. Tarbox
The Chicago School of Professional
Psychology at Los Angeles
Los Angeles, CA
 
Kendra Tracy
University of Nevada, Las Vegas
Las Vegas, NV
 
Michael P. Twohig, Ph.D.
Utah State University
Logan, UT
 
Timothy R. Vollmer, Ph.D.
University of Florida
Gainesville, FL
 
David P. Wacker, Ph.D.
University of Iowa Children’s Hospital
Iowa City, IA
 
Michelle D. Wallace, Ph.D.
California State University, Los Angeles
Los Angeles, CA
 
Todd A. Ward
University of Wellington
Wellington, New Zealand
 
Jennifer Wheeler, Ph.D.
Private Practice
Seattle, WA
 
Daniel J. Whitaker, Ph.D.
The Marcus Institute
Atlanta, GA
 
Larry W. Williams, Ph.D.
University of Nevada, Reno
Reno, NV
 
Ginger R. Wilson, Ph.D.
The ABRITE Organization
Santa Cruz, CA
 
J. M. Worrall
University of Nevada, Reno
Reno, NV
 
Marat Zanov
University of Southern California
Los Angeles, CA
 
Lori A. Zoellner, Ph.D.
University of Washington
Seattle, WA

COGNITIVE BEHAVIOR THERAPY

1 INTRODUCTION
William O’Donohue and Jane E. Fisher
 
 
Cognitive behavior therapy (CBT) is an approach to human problems that can be viewed from several interrelated perspectives: philosophical, theoretical, methodological, assessment oriented, and technological. This book focuses on the last aspect, so crucial to clinical practice, but situated in the other four, much as any one of a cube’s six sides is situated among all of the others.
Philosophically, CBT can be viewed as being associated (or, according to some who put it more strongly, derived) with one or another variety of behaviorism (O’Donohue & Kitchener, 1999). The behaviorisms are generally philosophies of science and philosophies of mind—that is, ways of defining and approaching the understanding of the problems traditionally associated with psychology.
There are at least two broad issues at the philosophical level: (1) What particular form of behaviorism is being embraced (O’Donohue & Kitchener, 1999, have identified at least 14), and (2) what is the nature of the relationship or association between this philosophy and the practice of CBT? Some have argued that behaviorism is irrelevant to behavior therapy—that one can practice behavior therapy and either reject behaviorism or be agnostic with regard to all forms of it. While an individual practitioner can behave in this way, some of the deeper structure that can be generative and guiding is lost. One can drive a car without an understanding of its workings, but one probably can’t design a better car or modify an existing car without such an understanding. Similarly, a knowledge of behaviorism allows greater understanding of the choice points implicit in any technology. For example, why not view the client’s problem as a neurological difficulty and intervene at this level? Behaviorism often provides possible answers to this kind of general challenge. However, we suggest that in recent decades there has been an unfortunate trend away from a philosophical understanding of behavior therapy to a more technique-oriented understanding.
The second aspect of behavior therapy is its theoretical structure. Here the issues are less philosophical—less about general epistemic issues—and more about substantive assertions regarding more specific problems as well as the principles appealed to in making these assertions. What is panic? What are its causes? What is the role of operant conditioning in children’s oppositional behavior? How does one prevent relapse? Should cognitions be modified or accepted?
There are also a wide variety of theories associated with behavior therapy (O’Donohue & Krasner, 1995), including:
• Reciprocal inhibition
• Response deprivation
• Molar regulatory theory
• Two-factor fear theory
• Implosion theory
• Learned alarms
• Bioinformational theory
• Self-control theory
• Developmental theories
• Coercion theory
• Self-efficacy theory
• Attribution theory
• Information processing theory
• Relational frame theory
• Relapse prevention
• Evolutionary theory
• Marxist theory
• Feminist theory
• Dialectical theory
• Acceptance theory
• Functional analytic theory
• Interbehavioral theory
Theories can provide answers or at least testable hypotheses for questions regarding more specific problems, such as these: What is the basic nature of this kind of clinical problem? How does this problem develop? What maintains this problem? What are its associated features and why? How is this problem possibly modified? What makes this technique work? What are contraindications? What are boundary conditions?
The third aspect of CBT is its program for knowledge generation. In the main, CBT is experimental and relies on a mixture of group experimental designs (e.g., the randomized controlled trial) and single-subject experimental designs (although in the largest perspective it can be seen to include correlational designs and even case studies). Methodologically, CBT generally embraces constructs such as social validity, clinical significance, follow-up measurements, manualized treatment, adherence and competence checks, the measurement of process variables, independent replications, and real-world effectiveness research. This toolbox is complex, but one can discern a few distinct styles—such as that of the applied behavior analyst and that of the cognitive therapist (O’Donohue & Houts, 1985). Other styles can be seen when the nature of the question differs—for example, when the interest is in measurement development and validation or in the questions typically associated with experimental psychopathology. CBT is solidly in the stream of “clinical science” and as part of this general approach views an experimental approach as key (see Lilienfeld and O’Donohue, 2007, for a fuller exposition of clinical science).
The fourth aspect of CBT is its approach to measurement. Here, a key issue is how to accurately detect and quantify variables of interest. Cognitive behavior therapy is associated with both a distinctive delineation of the domain of interest and distinct methods for measuring this. In general, behavioral assessment can be distinguished from more traditional measurement approaches by its focus on sampling of behavior rather than looking for signs of more abstract constructs. There are diverse streams of thought within the CBT tradition, however, from the embrace of traditional psychometric standards to the radically functional (e.g., Hayes, Nelson, & Jarrett, 1987). Some of the chapters in this volume deal with assessment techniques either because they are central to therapy or because assessment methods themselves are so reactive that they may be seen, in part, as treatment. However, in the main, this book does not focus on the measurement aspect, leaving that task to other fine anthologies (e.g., Haynes & Heiby , in press).
The final aspect of CBT is techne—skilled practice. No amount of philosophy or theory will relieve clinicians from this level of analysis. A surgeon may be a biological determinist philosophically and may hold to certain theories of cancer and cancer treatment, but to help patients the surgeon still needs to implement surgical technique in a skilled manner. Similarly, cognitive behavior therapists need to be skilled in the execution of their techniques. In fact, an interesting set of research questions involves the relationship between the degree of skill (e.g., poor, novice, experienced, master) and therapy outcome. This may also be a function of specific technique (e.g., progressive muscle relaxation may have different relationship with skill level than emotional regulation training). For example, if a clinician arranges potential positive reinforcers that are too distal in contingency manager it will be less effective. Similarly, if a clinician conducts systematic desensitization with only a few steps in a fear hierarchy, with weakly trained progressive muscle relaxation skills, and pairings that are few and of very short duration, it is unlikely to be as effective as it could otherwise be.
We’ve identified approximately 80 distinct techniques in CBT, covering both standard behavior therapy and cognitive therapy techniques, and relatively recently developed procedures such as acceptance strategies and mindfulness. This number has to qualify CBT as one of the most variegated therapy systems. This diversity no doubt derives from an interplay of complex factors:
• The multiple learning theories upon which traditional behavior therapy is based (O’Donohue, 1998).
• The multielemental nature of each of these theories (e.g., setting events, discrimination training, schedules of reinforcement, generalization processes, fading, etc.).
• The influence of other elements of experimental psychology such as experimental cognitive science.
• The influence of other branches of psychology such as social psychology.
• The influences of other intellectual domains (dialectics) or other fields of inquiry (mindfulness).
• The interface of these with a particular kind of clinical problem (e.g., borderline personality disorder).
• The creativity and ambitions of the developers.
 
But whatever the source of this tremendous variety, the presence of such a large number of major distinctive techniques leaves no doubt as to the multifactorial nature of contemporary CBT. It leaves an interesting question regarding how broad competence ought to be across these techniques in order for one to be considered a well-trained cognitive behavior therapist. One of the key variables emerging in the medical literature regarding quality is number of times the physician has implemented the particular technique. One generally finds that hundreds or thousands of times produces outcomes better than those in the dozens. Thus, there can be a bandwith/fidelity trade-off in behavior therapy that can have interesting associations with quality. Those that know more techniques may be less skilled at implementing any particular one.
We’ve asked each of the chapter authors to follow a standard format, because we thought these main topics would delineate a bit of the context and all of the essential features needed to competently execute these techniques. We wanted them to describe who might benefit from this technique, contraindications, other factors relevant to making the decision to use or not to use the technique, how the technique might work (i.e., what process or pathway it may be associated with), and some of the evidence for its effectiveness. The major section of the chapter is a step-by-step guide that explains exactly how to implement the technique. Finally, we asked authors to include a brief table outlining the major elements of the technique.
The very number and diversity of CBT techniques place a significant burden on any practitioner of CBT and, even more so, on the student. It is our hope that this volume, by clearly and concisely describing these techniques, will ease this burden. We also hope that precision about techniques can help the field continue to keep its eye on Gordon Paul’s (1969) classic question: What techniques, delivered by what type of therapist, for what kind of client, with what kind of clinical problem, in what kind of setting, produces what kind of result, by what kind of process?
 
 
References
 
Haynes, S., & Heiby, E. (in press). The encyclopedia of behavioral assessment.
Hayes, S. C., Nelson, R. O., & Jarrett, R. (1987). Treatment utility of assessment: A functional approach to evaluating the quality of assessment. American Psychologist, 42, 963-974.
Lilienfeld, S., & O’Donohue, W. (Eds.). (2007). The great ideas of clinical science. New York: Routledge.
O’Donohue, W. (Ed.). (1998). Learning and behavior therapy . Boston: Allyn and Bacon.
O’Donohue, W., & Houts, A. C. (1985). The two disciplines of behavior therapy. Psychological Record, 35(2), 155-163.
O’Donohue, W., & Kitchener, R. (1999). Handbook of behaviorism. San Diego: Academic Press.
O’Donohue, W., & Kramer, L. (Eds.). (1995). Theories of behavior therapy. Washington, DC: APA Books.
Paul, G. L. (1969). Behavior modification research: Design and tactics. In C. M. Franks (Ed.), Behavior therapy: Appraisal and status (pp. 29-62). New York: McGraw-Hill.

2 PSYCHOLOGICAL ACCEPTANCE
James D. Herbert, Evan M. Forman, and Erica L. England
 
 
In one form or another, all psychotherapies seek to produce change. Individuals seek consultation from psychotherapists when they are experiencing emotional pain, struggling with life problems, or when they are not functioning well in school, work, or relationships. The explicit goal is to achieve changes that will reduce pain or suffering, resolve outstanding problems, or enhance functioning. There has also been a longstanding recognition that such change requires some sense of self-acceptance, understood as the ability to respond less self-critically and judgmentally, thereby establishing the context for more effective functioning. Prior to the advent of behavior therapy, psychotherapists traditionally focused less on changing distressing symptoms themselves, concentrating instead on modifying other processes on the assumption that changes in such processes would result in more fundamental, profound, and permanent improvements in distress (Sulloway, 1983). Psychoanalysts sought to increase insight into the developmental origins of unconscious conflicts. By rendering the unconscious conscious, unacceptable drives and fantasies become acceptable to the ego. Humanistic therapists likewise sought to increase congruence between different facets of the self, thereby promoting a sense of self-acceptance. Although the ultimate goal was change, the prevailing clinical wisdom was that targeting distressing thoughts, feelings, or behavior directly would be ineffective at best, and possibly even counterproductive.
Early behavior therapists rejected the idea that change required interventions focusing on processes not directly related to actual presenting problems. Instead, they directly targeted their patients’ difficulties. Behavior therapists focused on modifying environmental factors thought to be responsible for problematic behavior, broadly conceived to include distressing thoughts and feelings in addition to overt behavior. Although one might need to accept temporary, short-term distress associated with certain interventions, the overall focus was on changing the form or frequency of distressing behaviors rather than accepting them. This approach was dramatically successful. Effective technologies were developed to increase social skills, desensitize fears, and manage disruptive behavior among children, as well as to address many other problems (Bongar & Beutler, 1995; Goldfried & Davison, 1994). As behavior therapy matured through the last decades of the twentieth century, there evolved an increased focus on changing thoughts and beliefs, and the field itself came to be known by the term cognitive behavior therapy (CBT). The various clinical strategies and techniques falling under the rubric of CBT all shared a focus on directly targeting problems using instrumental change strategies. Although acceptance of one’s distressing experiences was indirectly targeted in some cases (e.g., acceptance of anxious sensations during exposure-based therapies), even then the ultimate goal was change (e.g., anxiety reduction), and the overall focus of clinical interventions remained squarely on direct change.

THE GROWTH OF PSYCHOLOGICAL ACCEPTANCE IN CBT

It is perhaps ironic, then, that the field of CBT currently finds itself at the forefront of a movement that questions the utility of such direct change strategies under certain circumstances and promotes instead the rather paradoxical idea that more pervasive and enduring improvements in suffering and quality of life may result from accepting, rather than attempting to change, one’s distressing subjective experience. This distinction between direct change efforts and psychological acceptance as a vehicle for change has been described in various ways, including first-order versus second-order change, change in content versus context, and change in form versus function (Hayes, 2001). Regardless of terminology, a number of CBT models have emerged over the past decade that highlight efforts to accept, rather than directly change, distressing experiences, including thoughts, beliefs, feelings, memories, and sensations. These approaches have not abandoned all direct change strategies. Rather, as described later, they suggest that changes in some areas are best facilitated by acceptance in others. It is worth noting that there is no hard-and-fast distinction between traditional change-oriented and acceptance-oriented models of CBT (Orsillo, Roemer, Lerner, & Tull, 2004). A key ultimate goal of both approaches is behavior change (broadly writ), and both draw on technologies that either implicitly or explicitly seek to increase psychological acceptance. Rather, the models differ in the relative degree of emphasis on acceptance versus change processes.
FIGURE 2.1 PsychInfo Citations for Keywords “Experiential Acceptance,” “Psychological Acceptance,” or “Experiential Avoidance.”
003
The recent growth of interest in these approaches is undeniable. For example, as illustrated in Figure 2.1, the PsychInfo database reveals a steady growth in the hits of the keywords experiential acceptance, its synonym psychological acceptance, and experiential avoidance (which is an antonym for the first two) from 2 in 2000 to 35 in 2007. Parallel increases can be found in related databases (e.g., Medline), and in the titles of conference proceedings (e.g., the annual meeting of the Association for Behavioral and Cognitive Therapies).
2