Behavioral Interventions in Cognitive Behavior Therapy: Practical Guidance for Putting Theory into Action


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Integrated discussion of CBT is praiseworthy
(November 2008 Issue)

“Behavioral Interventions in Cognitive Behavior Therapy: Practical Guidance for Putting Theory into Action”
By Richard F. Farmer and
Alexander L. Chapman
American Psychological Association
Washington, D.C., 2008

By James K. Luiselli, Ed.D., ABPP, BCBA

Cognitive behavior therapy (CBT) is an effective treatment for many psychological disorders. However, CBT is not a singular therapeutic approach but an amalgam of many procedures. Furthermore, there are different theories about the degree to which cognitive constructs contribute to clinical problems. This book emphasizes the "behavior" dimension of CBT in the form of a practical guide "for putting theory into action."

Psychologists Richard F. Farmer and Alexander L. Chapman set the tone of the book by highlighting research showing that various behavioral interventions within CBT are associated with positive treatment effects. For example, behavioral activation for major depressive disorder, direct or imagined exposure for anxiety disorders and exposure with response prevention for Obsessive Compulsive Disorder are just some of the behavioral methods responsible for the success of CBT.

All of the chapters in the book present a detailed appraisal of assessment and treatment procedures. There are several chapters dealing with core features of behavioral assessment, notably diagnostic interviewing, functional analysis, direct observation and self-monitoring. Among many objectives, comprehensive behavioral assessment must lead to meaningful case formulation, which the authors address clearly in a separate chapter.

Armed with a wealth of evidence-based behavioral intervention procedures, how does a clinician develop a reasonable treatment plan? Farmer and Chapman answer this question with an instructive chapter that explicates an empirical and collaborative problem solving model. Their recommendations are uniquely suited to a CBT framework, as exemplified in a detailed case illustration.

Intervention formed of behavioral learning principles relies on changing environmental contingencies that promote and maintain clinical problems. This process is complex for even the most seasoned practitioner. To their credit, Farmer and Chapman provide a wonderfully crafted overview of contemporary procedures and operations for helping people behave more successfully and overcome emotional distress.

Because traditional CBT targets a person's thoughts and beliefs, the authors devote considerable pages to "thinking as a form of behavior." Their orientation is that what a person thinks about life events serves a function relative to environmental consequences that are pleasurable or aversive. Accordingly, many negative thoughts (e.g., "Nothing makes a difference, I'll always be a failure.") can be altered through "behavioral experiments" that are thought-disconfirming. What Farmer and Chapman provide is a rich description of action oriented procedures that fit with a dominant CBT interpretation.

Other chapters in the book explore methods for changing behavior by teaching social skills, implementing exposure-focused interventions and conducting so called "third generation" CBT consistent with acceptance and mindfulness philosophies. These chapters, like others in the book, are aided by case descriptions and helpful content summaries.

"Behavioral Interventions in Cognitive Behavior Therapy" is a solid accomplishment. It is a perfect text for academic coursework devoted to behavioral psychology and cognitive therapies. Psychologists and other mental health specialists should read the book to stay acquainted with best practices. The integrated discussion of behavioral theory, research and clinical advice is praiseworthy, making the book must reading for professionals who teach and practice CBT.

James K. Luiselli, Ed.D., ABPP, BCBA, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.