Steven C. Hayes, PhD
Department of Psychology, University of Nevada, Reno
Stefan G. Hofmann, PhD
Department of Psychological and Brain Sciences, Boston University
The goal of this book is to present the core processes of cognitive behavioral therapy (CBT) in a way that honors the behavioral, cognitive, and acceptance and mindfulness wings of this family of approaches. The book is unique not just in its breadth, but in its attempt to lay the foundation for real understanding and common purpose among these wings and traditions.
So far as we are aware, this textbook is the first to be broadly based on the new training standards for teaching the clinical competencies developed by the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education (Klepac et al., 2012). What we will refer to here as the “training task force,” organized under the auspices of the Association for Behavioral and Cognitive Therapies (ABCT), brought together representatives from fourteen organizations for four days of face-to-face meetings and several phone conferences spread out over ten months in 2011 and 2012. The organizations ranged across the wings and generations of thought in cognitive and behavioral practice, from the Academy of Cognitive Therapy to the Association for Contextual Behavioral Science, and from the International Society for the Improvement and Teaching of Dialectical Behavior Therapy to the Association for Behavior Analysis International.
This training task force was charged with developing guidelines for integrating doctoral education and training in cognitive and behavioral psychology in the United States. The result was a thoughtful review of the contemporary literature and concrete recommendations that serve as the basis for this book.
No one book could cover all of the areas that the training standards do. We decided to set aside training issues in research methods and assessment, since they are so well covered in existing volumes, and instead focus on areas that seem to us to involve new ideas and new sensitivities that are not well represented in existing volumes.
In the area of scientific attitude, the task force training standards take two strong stands: “The first proposition is that doctoral study in CBP [cognitive and behavioral psychology] includes foundational work in the philosophy of science” (Klepac et al. p. 691), and the “second proposition is that ethical decision making is fundamental to CBP, and should permeate all aspects of research and practice” (p. 692). Both of these stands are woven into section 1 of this book, which addresses the nature of behavioral and cognitive therapies, and are carried forward in other chapters.
To our knowledge, the present volume is the first CBT text to fully explore the implications of what the training standards call “overarching scientific ‘world views’” (p. 691). The training task force argues, we believe correctly, that training in the various philosophical worldviews underlying different cognitive and behavioral methods is key to having the ability to communicate across its various wings, waves, and traditions:
Many psychologists may not be aware of the implicit assumptions that underlie their work, which can lead to considerable confusion and controversy of a sort that impedes progress in the science itself. Different philosophies of science (and especially the epistemologies represented by those philosophical systems) lead not only to different methods of inquiry, but also to different interpretations of data, including at times different interpretations of the very same data. Failure to appreciate differences in preanalytic assumptions can lead to frustration among scholars and practitioners alike, who become puzzled when their colleagues fail to be convinced of the implications of certain clinical observations or research findings. Lack of awareness of one’s philosophical assumptions also precludes critical examination and comparison of alternative philosophies of science. (p. 691)
The task force listed seventeen core clinical competencies of known importance and suggested that the focus of education should be on “training in the basic principles behind [these] interventions” (p. 696). These principles were said to emerge from an understanding of several key domains, such as understanding learning theory, cognition, emotion, the therapeutic relationship, and neuroscience.
These guidelines are a key focus in this volume. This book includes chapters for all of the core clinical competencies mentioned in the standards and all of the key process domains, as well as a chapter on evolution science. For each clinical competency, the authors also attempted to focus on core processes and principles that account for the impact of these methods.
We believe that examining evidence-based intervention in light of the ideas in the new training standards allows the field to redefine evidence-based therapy to mean the targeting of evidence-based process with evidence-based procedures that alleviate the problems and promote the prosperity of people. We believe that a focus on process-based therapy will guide the field far into the future. Identifying core processes will enable us to avoid the constraints of using protocol for syndromes as the primary empirical approach to treatment and instead allow us to directly link treatment to theory.
We hope this text serves as one important step in this direction. We intend for it to serve as a reference and graduate text in clinical intervention for behavioral and cognitive therapies, broadly defined. We believe it provides practitioners, researchers, interns, and students with a thorough review of the core processes involved in contemporary behavioral and cognitive therapies and, to some degree, in evidence-based therapy more generally. The focus on evidence-based competencies in this book is designed to make readers step back from the more specific protocols and skills that are often highlighted in different treatments and to embrace core processes that are common to many empirically supported approaches. We explicitly mean for it to span the various traditions and generations of different behavioral and cognitive therapies, while at the same time respect what is unique about their different processes of research and development.
This book is divided into three sections. Section 1 addresses the nature of behavioral and cognitive therapies and includes chapters on the history of CBT development—from its inception as a discredited new treatment model to its position today at the forefront of evidence-based therapies, philosophy of science, ethics, and the changing role of practice. Section 2 focuses on the principles, domains, and areas that serve as the theoretical foundations of CBT as a collection of empirically supported treatments; these principles, domains, and areas include behavioral principles, cognition, emotion, neuroscience, and evolution science. Section 3 discusses the core clinical competencies that make up the bulk of CBT interventions, including contingency management, stimulus control, shaping, self-management, arousal reduction, coping and emotion regulation, problem solving, exposure strategies, behavioral activation, interpersonal skills, cognitive reappraisal, modifying core beliefs, defusion/distancing, enhancing psychological acceptance, values, mindfulness and integrative approaches, motivational strategies, and crisis management. Each of these chapters about competencies focuses on the known mediator and moderators that link these methods to the process domains and principles described earlier in the book. The book ends with a summary of what we’ve learned and future directions for this field.
We, the two editors of this textbook, might seem like an odd couple. In fact, we are an odd couple. Although both of us served as president of ABCT, our philosophical backgrounds are quite different. We are both considered prominent figures in the communities representing the two seemingly opposing camps in contemporary CBT: the acceptance and commitment therapy/new generation CBT (Hayes) and the Beckian/more traditional CBT (Hofmann). After a stormy beginning with countless heated debates during panel discussions (often resembling the academic version of boxing matches or wrestling events) and in writing, we became close friends and collaborators. We have been continuously working to identify common ground while respecting our differences and points of view. Our mutual goal has always been the same: moving the science and practice of clinical intervention forward.
Because of our status in different wings of the field, we were able to assemble a diverse and stellar group of contributing authors. They have been able to combine their expertise to produce this groundbreaking, contemporary text that brings together the best of behavior therapy, behavior analysis, cognitive therapy, and acceptance- and mindfulness-based therapies, emphasizing the core processes of change in intervention that every clinician should know. We hope it helps set the stage for a new era of process-based therapy that will move the field beyond its era of silos toward an era of scientific progress that will positively impact the lives of those we serve.
Klepac, R. K., Ronan, G. F., Andrasik, F., Arnold, K. D., Belar, C. D., Berry, S. L., et al. (2012). Guidelines for cognitive behavioral training within doctoral psychology programs in the United States: Report of the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education. Behavior Therapy, 43(4), 687–697.