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Classic CBT: A Typical Protocol
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Classic Cognitive Behavioral Therapy

Profile image of J F PagelJ F Pagel

2020

https://doi.org/10.1007/978-3-030-55909-0_10
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Abstract
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Cognitive Behavioral Therapy (CBT) has evolved significantly since its inception, merging behavioral and cognitive strategies to treat various psychiatric disorders effectively. Initially developed as a structured therapy for severe maladaptive behaviors, CBT's applications have expanded to include anxiety, mood disorders, and even chronic pain, achieving better outcomes than many previous psychotherapeutic methods. The paper discusses the history of CBT, its various forms—including classic and third-generation approaches—and emphasizes the importance of evidence-based practices in treating diverse psychological conditions, while cautioning against conflating distinct therapies under the CBT umbrella.

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a section of the journal Frontiers in Psychiatry Why Cognitive Behavioral Therapy is the Current Gold Standard of psychotherapy
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Taking into account the number of publications/studies, academic programs, and/or practicing professionals, cognitive behavioral therapy (CBT) is arguably the gold standard of the psychotherapy field. However, recently, some colleagues have argued for plurality in psychotherapy, questioning the status of CBT as the gold standard in psychotherapy (1), because many studies are of low quality and/ or the comparator conditions are weak (i.e., wait list rather than active comparators), thus challenging CBT's prominent status among academic programs and practitioners. We think that many issues factor into the gold-standard designation. If gold standard is defined as best standard we can have in the field, then, indeed, CBT is not the gold standard, and CBT, as a progressive research program, would not even argue for such a status at this moment. However, if gold standard is defined as best standard we have in the field at the moment, then we argue that CBT is, indeed, the gold standard. In this paper, we argue that CBT is the gold-standard psychological treatment-as the best standard we have in the field currently available-for the following reasons [see also Hofmann et al. (2)]: (1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behavior (e.g., information processing). At the same time, there is clearly room for further improvement, both in terms of CBT's efficacy/effectiveness and its underlying theories/ mechanisms of change. We further argue for an integrated scientific psychotherapy, with CBT serving as the foundational platform for integration. Modern CBT is an umbrella term of empirically supported treatments for clearly defined psychopathologies that are targeted with specific treatment strategies (3). More recently, CBT has included a more trans-diagnostic/process-based and personalized approach, with the ultimate goal of linking the therapeutic technique to the process and the individual client (4). Traditionally, clinical trials examining the efficacy of CBT include waitlist control, placebo conditions, treatment as usual/TAU, and other alternative treatments (including psychodynamic therapies and pharmacotherapies). Although a number of CBT trials have included weak comparisons (e.g., wait list control conditions), there are also many studies that compared CBT to strong comparison conditions (e.g., pill or psychological placebo, TAU, other psychotherapies, pharmacotherapy), meeting the stringent criteria of an empirically supported treatment (5). Indeed, Cuijpers et al. (6) found that about 54% of total trials for depression (about 34 trials) and about 20% of total trials for anxiety (about 25) met the criteria for a strong comparison (i.e., pill placebo or TAU). Cuijpers et al. (6) further reported that 17% of the total trials for depression and anxiety were of high quality and that the

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The Empirical Status of the ''New Wave'' of Cognitive Behavioral Therapy
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Cognitive-behavioral therapy versus other therapies: Redux
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► Reanalyzed studies from an earlier meta-analysis (viz., Tolin, 2010) of CBT treatments ► Meta-analyzed the relative efficacy of CBT and non-CBT treatments for adult anxiety. ► No differences between CBT and non-CBT for non-targeted measures in the re-analysis ► CBT experts were surveyed to consensually identify treatments as CBT or non-CBT. ► No differences between CBT and bona fide non-CBT treatments for anxiety disorders a b s t r a c t Despite the evidence suggesting that all treatments intended to be therapeutic are equally efficacious, the conjecture that one form of treatment, namely cognitive-behavioral therapy (CBT), is superior to all other treatment persists. The purpose of the current study was to (a) reanalyze the clinical trials from an earlier meta-analysis that compared CBT to 'other therapies' for depression and anxiety (viz., Tolin, 2010) and (b) conduct a methodologically rigorous and comprehensive meta-analysis to determine the relative efficacy of CBT and bona fide non-CBT treatments for adult anxiety disorders. Although the reanalysis was consistent with the earlier meta-analysis' findings of small to medium effect sizes for disorder-specific symptom measures, the reanalysis revealed no evidence for the superiority of CBT for depression and anxiety for outcomes that were not disorder-specific. Following the reanalysis, a comprehensive anxiety meta-analysis that utilized a survey of 91 CBT experts from the Association of Behavioral and Cognitive Therapists (ABCT) to consensually identify CBT treatments was conducted. Thirteen clinical trials met the inclusion criteria. There were no differences between CBT treatments and bona fide non-CBT treatments across disorder-specific and non-disorder specific symptom measures. These analyses, in combination with previous meta-analytic findings, fail to provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments.

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