Common Factors (Dobson and Dobson)

Evidence-Based Practice of Cognitive-Behavioral Therapy, Second Edition (Dobson & Dobson):

• CBT often compared to wait-list or TAU; TAU can be "a fairly minimal treatment plan." CBT often is comparable to other active therapies (5643). 
• CBT superior for sleep disorders, many anxiety disorders (including panic, OCD, social anxiety, PTSD, specific phobias); CBT is equivalent for other problems, including depression and addictions (5660). 
• Castonguay and Beutler write that "the differences among treatments account for no more than 10% of the variability in client change." Therapeutic alliance also accounts for about 10% (5660).
• CBT not answer for everything (5667).

Long debate on what factors cause change in therapy: nonspecific factors (factors not specific to any specific treatment) and specific factors. Many factors are necessary but none alone are sufficient. Factors associated with clinical outcome: client factors (clinical factors, personal factors), therapist factors (training, adherence/competence), relationship factors (alliance and collaboration, problem-oriented), treatment factors (process variables, techniques/methods) (5699).

Client Factors associated with better treatment outcomes (5730):

• Lower problem severity and lower problem chronicity. 
• Lower number of presenting problems. 
• No personality disorder. 
• Positive expectations about treatment. 
• Younger age (for dysphoric disorders).
• Race/ethnicity: lack of racial/ethnic group members and racial/ethnic match between client and therapist (for dysphoric disorders). 
• Collaborative treatments (treatments that did not induce client resistance) (for dysphoric disorders). 
• See Haby, Donnelly, Corry, and Vos; Hamilton and Dobson; Saatsi, Hardy, and Cahil; and Castonguay and Beutler.

Therapist Factors (5747):

• Not much research showing the therapist training plays a part; more research needed. 

Relationship Factors (5763):

• See Cognitive Therapy Scale, which largely measures relationship. 
• Treatment integrity = treatment adherence and treatment competence. Adherence = "the extent to which a therapist adheres to a particular model of therapy and performs interventions consistent with that approach, but does not use methods from other models." Competence = "the skillful and timely deployment of adhered-to interventions." 
• Those who focus on nonspecific factors and favor eclectic approach (see here, here, here) vs. those who focus on specific factors (see here). 

Treatment Factors (5812):

• Demonstrably effective factors: alliance in individual, group, and family psychotherapy; cohesion in group therapy; empathy; collecting client feedback.
• Probably effective: goal consensus; collaboration; positive regard. (Collaboration = alliance.)
• Promising but not enough research: congruence/genuineness; repairing alliance ruptures; managing countertransference.
• See resources (5813-5829). 
• Strong evidence that homework, esp. early in therapy, is a strong predictor of treatment outcome (5862). 

Barlow et al. write about CBT's three transdiagnostic principles: (a) altering antecedent cognitive reappraisals; (b) preventing emotional avoidance; and (c) facilitating action tendencies not associated with the emotion that is dysregulated (6033). See Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide and Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents: Therapist Guide.