Elsevier

Behavior Therapy

Volume 35, Issue 2, Spring 2004, Pages 205-230
Behavior Therapy

Invited Article
Toward a unified treatment for emotional disorders*

https://doi.org/10.1016/S0005-7894(04)80036-4Get rights and content

Over 40 years of development of cognitive behavioral approaches to treating anxiety and related emotional disorders have left us with highly efficacious treatments that are increasingly widely accepted. Nevertheless, these manualized protocols have become numerous and somewhat complex, restricting effective training and dissemination. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structure among these disorders supercedes differences. This suggests the possibility of distilling a set of psychological procedures that would comprise a unified intervention for emotional disorders. Based on theory and data emerging from the fields of learning, emotional development and regulation, and cognitive science, we identify three fundamental therapeutic components relevant to the treatment of emotional disorders generally. These three components include (a) altering antecedent cognitive reappraisals; (b) preventing emotional avoidance; and (c) facilitating action tendencies not associated with the emotion that is dysregulated. This treatment takes place in the context of provoking emotional expression (emotional exposure) through situational, internal, and somatic (interoceptive cues), as well as through standard mood-induction exercises, and differs from patient to patient only in the situational cues and exercises utilized. Theory and rationale supporting this new approach are described along with some preliminary experience with the protocol. This unified treatment may represent a more efficient and possibly a more effective strategy in treating emotional disorders, pending further evaluation.

References (110)

  • HaririA.R. et al.

    Neocortical modulation of the amygdala response to fearful stimuli

    Biological Psychiatry

    (2003)
  • HollonS.D. et al.

    Psychosocial intervention development for the prevention and treatment of depression: Promoting innovation and increasing access

    Biological Psychiatry

    (2002)
  • JanssonL. et al.

    Behavioral treatments for agoraphobia: An evaluative review

    Clinical Psychology Review

    (1982)
  • KamphuisJ.H. et al.

    Effects of distraction and guided threat reappraisal on fear reduction during exposure based treatments for specific fears

    Behaviour Research and Therapy

    (2000)
  • LynchT.R. et al.

    A mediational model relating affect intensity, emotion inhibition, and psychological distress

    Behavior Therapy

    (2001)
  • RachmanS.J.

    Emotional processing

    Behaviour Research and Therapy

    (1980)
  • RachmanS.J.

    The primary of affect: Some theoretical implications

    Behaviour Research and Therapy

    (1981)
  • SalkovskisP.M. et al.

    An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia

    Behaviour Research and Therapy

    (1999)
  • SloanT. et al.

    The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: An experimental investigation

    Behaviour Research and Therapy

    (2002)
  • AgrasW.S. et al.

    Social reinforcement in the modification of agoraphobia

    Archives of General Psychiatry

    (1968)
  • AndrewsG.

    Classification of neurotic disorders

    Journal of the Royal Society of Medicine

    (1990)
  • AndrewsG.

    Comorbidity in neurotic disorders: The similarities are more important than the differences

  • AscherL.M.

    Paradoxical intention

  • BanduraA.

    Social learning theory

    (1977)
  • BarlowD.H.

    Anxiety and its disorders: The nature and treatment of anxiety and panic

    (1988)
  • BarlowD.H.

    Disorders of emotion

    Psychological Inquiry

    (1991)
  • BarlowD.H.

    Effectiveness of behavior treatment for panic disorder with and without agoraphobia

  • BarlowD.H.

    Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory

    American Psychologist

    (2000)
  • BarlowD.H.

    Anxiety and its disorders: The nature and treatment of anxiety and panic

    (2002)
  • BarlowD.H. et al.

    Psychological treatment of panic

    (1988)
  • BarlowD.H. et al.

    Mastery of your anxiety and panic (MAP3): Client workbook for anxiety and panic

    (2000)
  • BarlowD.H. et al.

    Cognitive behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial

    Journal of the American Medical Association

    (2000)
  • BarlowD.H. et al.

    The scientist-practitioner: Research and accountability in clinical and educational settings

    (1984)
  • BarlowD.H. et al.

    Single case experimental designs: Strategies for studying behavior change

    (1984)
  • BecharaA. et al.

    Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making

    Journal of Neuroscience

    (1999)
  • BeckA.T.

    Depression: Causes and treatment

    (1972)
  • BeckA.T. et al.

    Anxiety disorders and phobias: A cognitive perspective

    (1985)
  • BeckA.T. et al.

    Cognitive therapy of depression

    (1979)
  • BorkovecT.D. et al.

    Effects of psychotherapy on comorbid conditions in generalized anxiety disorder

    Journal of Consulting and Clinical Psychology

    (1995)
  • BoutonM.E. et al.

    A modern learning-theory perspective on the etiology of panic disorder

    Psychological Review

    (2001)
  • BrennerE.M. et al.

    Emotion regulation during childhood: Developmental, interpersonal, and individual considerations

  • BrownT.A. et al.

    Diagnostic comorbidity in panic disorder: Effect on treatment outcome and course of comorbid diagnoses following treatment

    Journal of Consulting and Clinical Psychology

    (1995)
  • BrownT.A. et al.

    Classification of anxiety and mood disorders

  • BrownT.A. et al.

    Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample

    Journal of Abnormal Psychology

    (2001)
  • BrownT.A. et al.

    Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal

    Journal of Abnormal Psychology

    (1998)
  • Campbell-SillsL. et al.

    The relevance of emotion regulatory processes to anxiety and mood disorder

    (2003)
  • ChorpitaB.F. et al.

    The structure of negative emotions in a clinical sample of children and adolescents

    Journal of Abnormal Child Psychology

    (1998)
  • ChorpitaB.F. et al.

    The development of anxiety: The role of control in the early environment

    Psychological Bulletin

    (1998)
  • ClarkD.A. et al.

    Common and specific dimensions of self-reported anxiety and depression: Implications for the cognitive and tripartite models

    Journal of Abnormal Psychology

    (1994)
  • Cited by (0)

    *

    This work was supported in part by NIMH Award 5 R01 MH45965, “Treatment of Panic Disorder: Long-Term Strategies.”

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