The Importance of Theory in CBT

After an auspicious period during which the effectiveness of new CBT approaches, including Acceptance and Commitment Therapy (ACT), has been tested on the majority of disorders, more and more articles are looking now into theoretical and epistemological aspects of the approach. Questions such as “Is ACT more effective than “traditional” CBT?” or “Is the methodology of ACT different from cognitive psychology?” are being taken out of the literature, to ask now what the emphasis on theory in ACT (especially Relational Frame Theory) brings to CBT.

This is what James Herbert, Brandon Gaudiano and Evan Forman suggest in an article in Behavior Therapy. As the authors point out, academics working on cognitive and behavioral models have been regrettting the fact that CBT has moved so far away from basic research for several decades now. The initial interactions between research and clinical practice, which had made it possible to experimentally test therapeutic approaches or to apply laboratory discoveries in clinical practice, has gradually been replaced by “simple” clinical research aimed at evaluating the effectiveness of treatments using a rigorous methodology.

However, this state of affairs is starting to change. Acceptance and Commitment Therapy is effectively based on a robust theoretical model, and seeks to maintain a strong relationship between this theoretical model and clinical practice. Certain therapeutic approaches of ACT are direct applications of fundamental discoveries. Others emanate from clinical practice, have been created by clinicians, and are now being tested in the laboratory. It is this type of back-and-forth that Steven Hayes has described as a “reticulated” approach (Hayes, Barnes-Holmes & Wilson, 2012).

The question that has heated many keyboards in international discussion forums still remains: “Does a clinician need to understand the theory that underlies Acceptance and Commitment Therapy, and if so, how much theoretical knowledge is required to be most effective?” While the question of how much theoretical knowledge a clinician needs is still an empirical question that needs to be tested, Herbert and his colleagues believe that applied theoretical knowledge can significantly improve the effectiveness of care, especially in complex clinical situations (i.e., whenever the patient cannot overcome his or her difficulties alone, for example, by means of bibliotherapy). Having knowledge of fundamental psychological mechanisms allows a great deal of autonomy in the implementation of clinical approaches adapted to each patient. More than learning “techniques”, the clinician is advised to understand how they work and their objectives in order to use them effectively and appropriately. Clearly, an understanding of the theory would allow for a more flexible application of the learned techniques, more effectively than just a simple “cookie-cutter” interventions. It is for this reason that there are no strict protocols to follow step by step in ACT.

Beyond ACT, the entire field of CBT is progressing thanks to the maintenance of strong links between theory and clinical practice, because the creativity of clinicians informed by theory will allow the discovery of new and more effective clinical approaches.

Source: Herbert, J.D., Gaudiano, B.A., & Forman, E.M (2013). The Importance of Theory in Cognitive Behavior Therapy: A perspective of Contextual Behavioral Science. Behavior Therapy.

The complete article can be found here

On the same subject, you can also read my editorial in the Journal de Thérapie Comportementale et Cognitive of December 2013 (French version only for the moment, sorry about that, but google is your friend).

Translated by Chelsea Davis-Laurin

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