improvement or adjustment in the psychotherapy
situation even though this adjustment fails to gener-
alize to nontherapy settings.
Lack of a Unifying Theory. A final problem
with behavior therapy may be its potential for
theoretical chaos. At present, it is an amalgam of
techniques—some from the operant tradition,
others from a classical conditioning base, and still
others that are heavily cognitive in nature. Without
an integrating theoretical framework, individual
clinicians may find themselves flailing about in a
morass of competing techniques, each claiming to
be forms of CBT. What is needed is a systematic
theoretical position that will incorporate the tech-
niques, classify them, and help the clinician decide
when and under what conditions to use one
technique rather than another. Such a theoretical
framework would be infinitely more efficient than
multiple rules of thumb.
The Future
Over a decade ago, Wilson (1997) reflected on
CBT’s past and highlighted some of the challenges
for the future. His reflections and concerns are still
relevant to CBT as it is practiced today. Wilson
noted the need for wider dissemination and adop-
tion of CBT; given its strong empirical support, it is
somewhat surprising that these techniques are not
more widely used. Additionally, Wilson (1997) is
concerned that CBT remain firmly linked to
advances in psychological science:
To fulfill its original promise of linking
clinical practice to advances in scientific
research, behavior therapy must be
responsive to developments both in
experimental psychology and biology.
Dramatic breakthroughs in genetics and
neuroscience have already revolutionized
the biological sciences, and progress will
likely continue to unlock the secrets of the
brain. A better understanding of the role of
brain mechanisms in the development and
maintenance of clinical disorders, and in
the modification of these disorders via both
pharmacological and behavioral methods,
will arguably improve our theories of
behavior change. (p. 454)CHAPTER SUMMARY
Behavior therapy is based on the assumption that
clinical problems should be addressed using assess-
ment and treatment techniques that have empirical
support and are based on established principles from
experimental psychology. Although procedures
derived from classical and operant conditioning ini-
tially dominated this approach, behavior therapy has
been broadened to include procedures that draw
from learning theories based on observational learn-
ing and cognitive processes.
Traditional behavioral treatments include system-
atic desensitization, exposure therapy, behavior
rehearsal, contingency management, and aversion
therapy. These treatments have documented efficacy,
and several are the treatments of choice for certain
clinical problems (e.g., systematic desensitization for
phobias, exposure plus response prevention for
obsessive-compulsive disorder). Cognitive-behavioral
treatments emphasize the roles of thinking, expecta-
tions, and beliefs in the etiology and maintenance of
clinical problems. Examples of cognitive-behavioral
techniques include modeling, rational restructuring,
stress inoculation training, cognitive therapy, and dia-
lectical behavior therapy. The most recent list of
examples of evidence-based treatments is dominated
by cognitive-behavioral and traditional behavioral
techniques.
CBT has had a positive impact on the field
because of its wide range of effective and efficient
treatments. It has been the leader in manualizing
treatments, facilitating research, training, and prac-
tice. In many ways, it is the ideal therapeuticPSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 427