CLINICAL QUALITY OF CARE – PRACTICE PARAMETERS 

Office of the Chief Medical Officer 
Clinical Operations 


Cognitive Behavioral Therapy

Psych-2
 
Category: Psychotherapy 
Published Date: February 2020
  1. INTRODUCTION
    1. Cognitive-Behavioral Therapy (CBT) is a specific and integrated form of psychotherapy that consists of highly standardized (manual driven) interventions. Specialized training is required to develop the skills necessary to practice standardized CBT. Techniques that form components of this psychotherapy are essential for the treatment of several mood and anxiety disorders. These techniques may be usefully employed even when used outside of standardized CBT.
    2. CBT techniques include:
      1. Altering negative schemas: self, world, and future
      2. Cognitive rehearsal
      3. Cognitive restructuring
      4. Education
      5. Environmental reshaping
      6. Gradual exposure to anxiety eliciting stimulus
      7. Positive imagery
      8. Problem-solving
      9. Relapse-prevention and consolidation techniques
      10. Relaxation
      11. Response or ritual prevention
      12. Self-control strategies
      13. Self-monitoring
         
  2. EVALUATION AND ASSESSMENT
    1. Selection
      1. Selection and use of CBT techniques should be informed by knowledge of the individual’s diagnosis, symptoms, functional level, environmental support, and linguistic and cultural background.
    2. Essential Use
      1. Selected CBT techniques should be a part of all psychotherapeutic interventions for individuals with diagnoses of generalized anxiety disorder, obsessive-compulsive disorder, panic disorders, specific phobias, and social phobias. 
      2. Selected CBT techniques should be a part of all psychotherapeutic interventions for the treatment of substance abuse and dependence.
      3. Selected CBT techniques should be a part of all psychotherapeutic interventions for the treatment of individuals with major depressive disorder in whom sufficient motivation and insight are present.
      4. Selected CBT techniques should be a part of all psychotherapeutic interventions for the treatment of individuals with eating disorders.
    3. Optional Use
      1. Selected CBT techniques may be a part of psychotherapeutic interventions for the treatment of individuals with diagnoses of PTSD, borderline personality disorder, and adjustment disorders.
    4. Assessment for Selection of Techniques
      1. An assessment for the selection of CBT techniques should include:
        1. Motivation
        2. Ability to tolerate anxiety
        3. Ability to engage in self-monitoring
        4. Cognitive effects of concurrent psychopharmacologic, interventions and/or ECT
    5. Frequency
      1. CBT techniques must occur at sufficient frequency and for sufficient duration to ensure clinical results.
    6. Necessary Resources
      1. CBT instruction manuals and environments conducive to the practice of relaxation techniques and/or stimulus exposure should be available.
    7. Therapist Training
      1. All therapists must have a working knowledge of CBT techniques, and manual trained therapists must be available for consultation.