disorders (Fairburn et al., 1991), and personality dis-
orders (Beck, Freeman, & Associates, 1990), to cite
but a few examples. Empirical studies suggest that it
may be an especially effective form of intervention
for a broad range of clinical problems (Hollon &
Beck, 1994, 2004; Smith et al., 1980).
Dialectical Behavior Therapy
Dialectical behavior therapy(DBT; Linehan, 1993) is a
relatively new cognitive-behavioral treatment for
borderline personality disorder (BPD) and related
conditions involving emotional dysregulation and
impulsivity. Linehan developed DBT based on her
clinical experience with women diagnosed with
BPD who engaged in self-injurious behavior. The
theory behind DBT posits that individuals are born
with emotionally vulnerable temperamental styles
that, in interaction with an“invalidating”family
environment, lead to emotional dysregulation and
self-harming behaviors. Invalidating environments
are those in which a person’s wants and feelings
are discounted or disrespected and efforts to com-
municate are disregarded or punished.
DBT involves skills training in problem-solving
techniques, emotional regulation, and interpersonal
skills. The skills training takes place in a validating
therapeutic environment, usually involving both an
individual DBT therapist as well as group DBT
skills training. Clients in DBT cycle twice through
four skills training modules: (a)mindfulness(the abil-
ity to be aware of the moment, not to be distracted,
and to be nonjudgmental); (b)emotional regulation
(identifying emotions, appreciating the effects of
emotions on oneself and others, learning to coun-
teract negative emotional states and to engage in
behavior that will increase positive emotions);
(c)distress tolerance(learning to cope with stressful
situations and to self-soothe); and (d)interpersonal
effectiveness(learning to deal effectively with inter-
personal conflict, to appropriately get one’s desires
and needs met, and to appropriately say no to
unwanted demands from others). Individuals are
asked to commit to 12 months of DBT treatment.
DBT has been shown more effective than“treat-
ment as usual”in reducing self-harm behaviors,
number of days of hospitalization, and substance
use (Koerner & Linehan, 2000). Box 14-7 presents
an excerpt from a DBT therapy session, and
Box 14-8 presents the work of DBT therapist
Dr. Ronda Reitz.An Evaluation of Behavior Therapy
Proponents of CBT see their progress as tangible
evidence of what can be accomplished when the
mentalistic, subjective, and nonscientific“mumbo
jumbo”of psychodynamics or phenomenology is
cast aside. Critics, on the other hand, see CBT as
superficial, pretentiously scientific, and even dehu-
manizing in its mechanistic attempts to change
human behavior. Indeed, these criticisms reflect
many of the “myths”about CBT (Goldfried &
Davison, 1994). In any case, more clinical psychol-
ogists describe their orientation as cognitive or
behavioral than any other orientation (Norcross,
Karpiak, & Santoro, 2005).
We now examine some of the strengths and
limitations of the behavioral and cognitive behav-
ioral approaches and then close with a summary of
some of the challenges ahead.Strengths
In many ways, CBT has changed the fields of psy-
chotherapy and clinical psychology (Wilson, 1997).
What follows is a discussion of several major ways
that CBT has had an impact.Efficacy. As mentioned throughout this chapter,
there is ample evidence that a wide variety of
behavioral and cognitive-behavioral therapies are
efficacious (Chambless et al., 1998; DeRubeis &
Crits-Christoph, 1998; Emmelkamp, 1994; Hollon
& Beck, 1994, 2004; Kazdin & Weisz, 1998; Smith
et al., 1980; Tolin, 2010). In fact, behavior therapy
and CBT appear to be the treatment of choice
for many disorders (Tolin, 2010). The reader
may recall the results of the Smith et al. (1980)420 CHAPTER 14