Cognitive Behavioral Therapy (CBT) is different from other therapeutic approaches by focusing on ways a person’s cognitions (i.e., thoughts), emotions and behaviors are connected and affect one another—and by teaching concrete skills to strengthen all three related areas of functioning. 

Dialectical Behavior Therapy (DBT) balances acceptance of an individual in real time with intensive efforts to make positive change, by increasing adaptability and decreasing unhelpful or destructive behavior.

Acceptance and Commitment Therapy (ACT) develops and expands psychological flexibility, encompassing an individual’s emotional openness and—according to personal values and goals—ability to adapt thoughts and behaviors.

Behavioral Parent Training (BPT) teaches parents to modify their own behaviors to reduce disruptive, noncompliant, anxious or aggressive behaviors in their child and to improve their relationship with their child.

Parent-Child Interaction Therapy (PCIT)–informed treatments help parents and their young children ages 2-7, who are experiencing behavioral and/or emotional difficulties, including PCIT for Child Behavioral Problems & PCIT for Selective Mutism.

Parent management training (PMT) teaches better parenting skills, decreases child oppositional, aggressive and antisocial behavior and emphasizes the mutually reinforcing nature of the parent-child relationship.

MATCH-ADTC (Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems) is a guided, component-based intervention for children and their families, with the goal of improving their ability to manage co-occurring symptoms and enhance functioning.

Interpersonal psychotherapy (IPT) centers on resolving interpersonal problems and relieving symptoms in response to current difficulties in everyday relationships with other people.

Compassion-focused therapy (CFT) promotes mental and emotional healing by encouraging people in treatment to be compassionate toward themselves and other people.

Treating eating disorders can be successful with a combination of cognitive-behavioral approaches (along with psychotherapy, nutritional counseling and medical care), including:

Family-based treatment (FBT) is the leading treatment for adolescent eating disorders, shown to be highly effective and faster acting than other treatments.

Enhanced CBT (CBT-E) helps individuals decide to normalize eating and/ or gain weight, rather than having this decision imposed upon them.

Adolescent-focused therapy (AFT) treats adolescent anorexia, by reducing risky behaviors and focusing on strengthening the teen’s sense of self. 

Typically, the therapist and client, often with the family, collaborate to set goals. Treatment is structured to ensure material is covered—with built-in flexibility. 

Sessions involve discussion of current moods and difficulties, a review of homework and progress on prior work, learning a new skill, discussion of a particular issue and setting homework for the next session.

Homework, a key component of primary EBTs, guides clients to practice new skills in daily life and try out new behaviors and thinking strategies. 

Data are used to better target therapy and monitor progress, but not to critique the client. Together the therapist and client assemble and use data to assess problems and potential solutions. 

• • Questionnaires can track changes in symptoms over the course of treatment
  • Self-monitoring exercises can track aspects of the treatment plan, such as changes in mood, self-critical thoughts or unhealthy behaviors

Depending on a client’s needs, behavior therapies may involve the following:

Responses to unhealthy thinking

Cognitive restructuring to stop negative thinking patterns that cause distorted beliefs about oneself, the world or others. Someone with social phobia can challenge social rejection as being inevitable, for example.

Strategies to promote more effective problem-solving and decision-making

Mindfulness techniques to recognize negative thinking need not determine behavior

Responses to unhealthy behaviors

Gaining a sense of control in routinely predictable situations that once seemed overwhelming. Clients gradually approach what they were avoiding, due to fear (anxiety) or low motivation (depression)

Planning activities that provide a sense of pleasure or mastery to promote a more enjoyable and fulfilling life

Training in skills, such as how to communicate more effectively, be assertive or enhance social interactions

Responses to painful feelings

Working on accepting or tolerating painful emotions or trying to change those emotions in the moment

Relaxation exercises to help reduce overall stress

Strategies to manage extreme emotional reactions, such as ways to deal with intense anger or urges to harm oneself

Nutrition and exercise counseling

All anxiety and mood disorders need to involve lessons in positive eating and exercise to maintain a healthy weight and lifestyle. For those with obesity or at risk for developing eating disorders, nutrition and exercise programs can be geared to even the youngest children. 

Biofeedback

This mind-body therapy uses sensitive instruments to measure the body’s physical responses—heart rate, galvanic skin response (changes in sweat gland activity) and breathing pattern—and feed them back to clients to help them gain control of negative mind-and-body functions and change attitudes and behaviors. 

Psychotropic medication

Most behavior therapists prefer to help clients learn to “replace pills with skills.” Yet medications typically work faster and involve less time and effort. Considerations:

• • CBT and DBT can be conducted with or without medication. It is important that medication helps rather than interferes with therapy.
  • Research is limited on the effectiveness of medication use with DBT to treat symptoms of behavioral conditions and associated problems.
  • Adding medications can help when behavior therapies produce some relief, but do not fully resolve problems. They can sometimes help “turn down the volume” of the client’s anxiety or depressive symptoms, to then help the client better engage in active therapeutic content, skills practice and implementation, and therapeutic change.

It is normal to have short-term disruptions in how an individual functions at home, school or work. However, if problems persist and changes are significant, a child, adolescent or young adult could benefit from strategies and consultation provided by mental health professionals. 

Better to act sooner than later

Untreated problems can be damaging, while effective treatment can result in significant reductions in symptoms, contribute to living a more fulfilling and satisfying life and better functioning in daily life. After completing treatment, clients report feeling happier, more in control and being a better family member and friend.

Level of subjective distress: 

• • How are you/your child doing right now?
  • Are you/they living the life you/they hoped it would be—and what could be different? 
  • Are you/your child feeling overwhelmed by problems and stressful situations and events in your home?

Functioning at home, school or work:

• • Do you/your child fulfill daily responsibilities? How are you doing in your job? How is your child doing in school?
  • Has daily activity changed from what you/your child did a few weeks, months or years ago?
  • Is it more difficult to do things you/your child once did?
  • As a parent, do you spend less time with your children or find yourself less patient or engaged?
  • Are you/your child completing work/school tasks on time and as accurately as before?
  • Have you/your child received negative feedback?

Social Relationships:

• • How much time do you/your child spend with family and friends?
  • Have your/your child’s interactions or activities changed from before experiencing problems?
  • How much does being with friends and family cause discomfort or exhaustion?

Symptoms may be associated with anxiety and depression or relate to other emotional and behavioral problems. Other problems can include different symptoms. Questions you may be asked:

• • What changes have you noticed in your/your child’s body and mind?
  • What changes do you note in your/your child’s energy, appetite and sleep? What about heart rate, breathing and sweating?
  • Have your/your child’s moods and interest in activities changes recently? In what way?
  • Do you think about bad things that have happened or might happen, beyond your control?

Some limitations of behavioral therapy

Therapists can describe their treatment as CBT or DBT, for example, even when they offer something quite different. It is appropriate to know what training a potential therapist has received.

Behavioral treatment does not work for everyone and not always within a reasonable period of time. It may be necessary to change approach—or add medication.

CONNECT TO CARE

References

Association for Behavioral and Cognitive Therapies (ABCT)

Association for Behavioral and Cognitive Therapies (ABCT) – on parent training

Boces

Child Health and Development Institute

Compassionate Mind Foundation

Effective Child Therapy

Enhanced Cognitive Behavior Therapy

Good Therapy

Growing Minds

Interpersonal psychotherapy

Lives in the Balance

Motivational Interviewing Network of Trainers (MINT) 

National Institute of Mental Health (NIMH) – on eating disorders

National Institute of Justice

National Library of Medicine

Parent child interaction therapy

Parent management training

PCIT.org

Psychology Today – on acceptance and commitment therapy (IPT)

Psychology Today – on interpersonal therapy (IPT)

VeryWellMind – on family-based therapy (FBT)