Chapter 12 Approaches to Treatment and Therapy 437• Relapses. Cognitive-behavioral approaches can
reduce the rate of relapse among people with
problems such as substance abuse, depression,
sexual offending, and even schizophrenia (Hayes
et al., 2004; Witkiewitz & Marlatt, 2004).However, no single type of therapy can help ev-
eryone. Despite their many successes, behavior and
cognitive therapies have had some failures, espe-
cially with people who are unmotivated to carry out
a behavioral or cognitive program or who have per-
sonality disorders. Also, cognitive-behavior thera-
pies are designed for specific, identifiable problems,
but sometimes people seek therapy for less clearly
defined reasons, such as wishing to introspect about
their feelings or explore moral dilemmas.
There is no simple rule for how long therapy
needs to last. Sometimes a single session of treat-
ment is enough to bring improvement, if it is
based on sound principles. A therapy called moti-
vational interviewing, which focuses specifically on
increasing a client’s motivation to overcome prob-
lems such as drinking, smoking, and binge eating,
has been shown to be effective in as few as one or
two sessions (Burke et al., 2003; Cassin et al., 2008;
Miller & Rollnick, 2002). The therapist essentially
puts the client into a state of cognitive dissonance
(see Chapter 7): “I want to be healthy and I see
myself as a smart, competent person, but here I am
doing something stupid and self-defeating. Do I
want to feel better or not?” The therapist then of-
fers the client a cognitive and behavioral strategy
of improvement (Wagner & Ingersoll, 2008).
Some problems, however, are chronic or par-
ticularly difficult to treat and respond better to lon-
ger therapy. According to one meta-analysis of eight
randomized controlled studies, long-term psychody-
namic therapy (lasting a year or more) can be morenext 18 months as those who were simply given
referrals for help (Brown et al., 2005).• Anxiety disorders. Exposure techniques are more
effective than any other treatment for PTSD,
agoraphobia, and specific phobias such as fear
of dogs or flying. CBT is often more effective
than medication for panic disorder, general-
ized anxiety disorder, and obsessive-compulsive
disorder (Barlow, 2004; Mitte, 2005; Otto et al.,
2009; Tolin, 2010).
Watch the Video Edna Foa: Anxiety Treatment at
MyPsychLab• Anger and impulsive violence. Cognitive therapy
is often successful in reducing chronic anger,
abusiveness, and hostility, and it also teaches
people how to express anger more calmly and
constructively (Deffenbacher et al., 2003).
• Health problems. Cognitive and behavior thera-
pies are highly successful in helping people cope
with pain, chronic fatigue syndrome, headaches,
and irritable bowel syndrome; quit smoking;
recover from eating disorders; overcome insom-
nia and other sleep problems; and manage other
health problems (Butler et al., 1991; Crits-
Christoph, Wilson, & Hollon, 2005; Skinner
et al., 1990; Stepanski & Perlis, 2000).
• Child and adolescent behavior problems. Behavior
therapy is the most effective treatment for be-
havior problems that range from bed-wetting
to impulsive anger, and even for problems that
have biological origins, such as autism (Rogers &
Vismara, 2008). Behavior therapy works regard-
less of the child’s age, the therapist’s experience,
or the specific problem (Weisz et al., 1995).
Cognitive-behavior therapy can help people who are grumpy, bashful, and maybe even
dopey—as well as people who have far more serious problems.© The New Yorker Collection 1991 Mike Twohy from cartoonbank.com. All Rights Reserved