What is special about CBT?

Cognitive behavior therapy (CBT) can be seen as the only paradigm in psychotherapy. Something can call itself a paradigm if it has proven to have problem-solving capacity. When it is not proven to be effective it is called a theory. On top of this, CBT is also effective for many types of disorders, in contrast to specific treatment forms such as EMDR (only used for PTSD symptoms). Other advantages of CBT are that it is a fast form of treatment, which also makes it cheaper, and that it can be described in a manual, so that it can be scaled and easier to teach to others. A disadvantage of a manual is that it may be difficult to apply to all disorders because one disorder is not the other, but it is impossible to make a different manual for each disorder. One must also be able to understand the manual and the main and side issues in it well, making the understanding of the underlying idea and principles of change and therapy especially important.

For instance: exposure and modification of beliefs are important in anxiety disorders, skills training and crisis management (contingency management) are important in developmental disorders and autism spectrum disorders.

Therapy is not an art that some can and others cannot do. In that respect it can be called a technique in which the active components of change are skilfully applied. A therapist must therefore ask himself every session which techniques for change he is applying in therapy. This also means that therapists cannot just choose a therapy that interests them, they must apply therapies that have been shown to be effective. In this process, unspecific factors such as empathy and warmth, are of great importance. Therapeutic eclecticism is also excluded (adding techniques to CBT from therapies that are not proven effective), unless components of other empirically proven therapies are added.

Another advantage of making the core principles of effective therapy explicit is that it can lead to the development of new, alternative ways to apply these principles. Individual therapy is often expensive and inaccessible, but by knowing effective principles one can look for ways to make these principles available in a more accessible way (for example self-help books and e-health).

What are the principles of CBT?

CBT started with a few principles in the 1950s (Skinner: contingency management; Wolpe: relaxation and exposure in its systematic desensitization), but now consists of many principles that are all interrelated. The principles consist of different layers, starting on the surface with ideas of philosophy and science, folowing with the theories of CBT, underneath them empirical laws, then the principles derived from other sources, principles (general rules describing potential working mechanisms, for example exposure), and finally techniques (making a principle concrete, for example systematic desensitization).

The 13 main principles:

• Job analysis and contingency management
• Skills training
• Exposure
• Relaxation
• Cognitive restructuring
• Problem solving
• Self-regulation
• Behavioral activation
• Social skills
• Emotion regulation
• Communication
• Positive psychology
• Acceptance