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Cited by 172Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

United we stand: emphasizing commonalities across cognitive-behavioral therapies.

Open access
Mennin, Douglas S., Ellard, Kristen K., Fresco, David M., Gross, James J.·2013·Behavior Therapy
DOI 10.1016/j.beth.2013.02.004PMC PMC4992341
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Abstract

Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multicomponent approaches, incorporated alternative therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (a) context engagement to promote adaptive imagining and enacting of new experiences; (b) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (c) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components, including behavioral exposure/activation, attention training, acceptance/tolerance, decentering/defusion, and cognitive reframing, may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relationships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science.

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Crossref · 10.1016/j.beth.2013.02.004

Cites

125 of 125 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

25 of 105 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Comorbid anxiety and depression may lead to difficulties resolving approach/avoidance valuation.

    “comorbid anxiety and depression may lead to difficulties resolving approach/avoidance valuation”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Stein & Paulus, 2009 source

      In “Imbalance of Approach and Avoidance: The Yin and Yang of Anxiety Disorders” (page not provided), the authors propose that PTSD involves an approach–avoidance imbalance and suggest that fear and avoidance may predominate early, with depression later. The paper does not specifically say that comorbid anxiety and depression cause difficulty resolving approach/avoidance valuation. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    Bipolar spectrum disorders are characterized by hyperactive behavioral tendencies reflecting reward and goal systems without regard for threat and danger cues.

    “bipolar spectrum disorders are characterized by hyperactive behavioral tendencies reflective of reward and goal systems without regard for contextual cues to threat and danger”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Alloy et al., 2012 source

      The “Behavioral Approach System (BAS) Model: Theory and Evidence” section describes heightened sensitivity to reward and goal cues and excessive goal-striving in people with bipolar spectrum disorders. It does not say they disregard contextual cues to threat or danger; that part of the claim is unsupported by the passages in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    When attending to an emotion like sadness, individuals can develop the capacity to notice bodily sensory qualities rather than cognitively appraising the emotion and ruminating.

    “when attending to an emotion such as sadness, individuals can develop the capacity to attend to one’s body and notice the sensory qualities rather than cognitively appraising the emotion and engaging in rumination in response to the emotion”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Farb et al., 2007 source
  • Premisecitation

    Recent ABM studies find increased ability to improve directed attention away from hypervigilant threat focus and subsequent symptom/impairment improvement, particularly for anxiety disorders.

    “Recent attentional bias modification (ABM) studies find an increased ability to improve directed attention away from a hypervigilant threat focus and subsequent improvement in symptoms and impairment, particularly for anxiety disorders”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Amir et al., 2009 source

      The Discussion reports that the attention modification group showed less bias toward threat and fewer anxiety symptoms than the control group. The Results also report that more participants in that group no longer met diagnostic criteria for generalized anxiety disorder. The paper does not report a separate improvement in impairment, and its findings directly concern GAD rather than anxiety disorders broadly. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Cognitive distancing helps individuals disengage from intense emotion, its motivational impetus, and maladaptive self-referential processing in favor of a more experiential perspective on personally relevant emotionally laden information.

    “Cognitive distancing helps individuals disengage from an intense emotion, its corresponding motivational impetus, and associated maladaptive self-referential processing in favor of a more experiential perspective with respect to personally relevant emotionally laden information”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Farb et al., 2007 source

      The Discussion reports that, after mindfulness training, experiential focus shifted toward a more detached analysis of sensory events and away from their affective, self-referential value. The Abstract also describes experiential focus as disengaging from self-referential elaboration. The paper does not establish that this process disengages people from intense emotion or its motivational impetus; its task used personality-trait adjectives rather than testing those outcomes. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • May combine two claims. 35
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Premisecitation

    Depressed individuals are less responsive to reward contexts and fail to distinguish large from small rewards.

    “depressed individuals are less responsive to contexts for reward (e.g., Bogdan & Pizzagalli, 2006) and fail to distinguish between options yielding large versus small rewards”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Bogdan & Pizzagalli, 2006 source

      The Discussion (page unavailable) reports reduced reward responsiveness under acute stress, especially among participants with more anhedonic symptoms. But the participants were healthy female controls, not depressed individuals, so the citation does not establish the claim for that population. The citation is attached to the reward-responsiveness clause, not the subsequent large-versus-small-rewards clause. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Forbes, Shaw, & Dahl, 2006 source

  • May combine two claims.

    Premisecitation

    In vivo exposure for social phobia, imaginal exposure for PTSD, and interoceptive exposure for panic disorder have demonstrated extensive efficacy.

    “In vivo exposures for conditions such as social phobia (Blanco et al., 2010), imaginal exposures for conditions such as posttraumatic stress disorder (Cloitre et al., 2002; Foa, 2011), and interoceptive exposures for conditions such as panic disorder (Craske & Barlow, 2008) have demonstrated extensive efficacy.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Blanco et al., 2010 source

      The Methods (Treatments; page unavailable) describe real-life exposure as part of cognitive behavioral group therapy for social anxiety disorder. The Discussion (page unavailable) says reviews support CBT’s efficacy, but also says this trial’s CBT group was generally not superior to placebo in pairwise comparisons. Because exposure was delivered alongside cognitive techniques, the paper does not establish extensive efficacy for in vivo exposure itself. The PTSD and panic-disorder clauses cite other sources and are not attributed to Blanco et al. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Cloitre et al., 2002; Foa, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Craske & Barlow, 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Improvements in clinical outcome and distress tolerance occur when targeted by treatments designed to improve distress tolerance skills.

    “improvements in clinical outcome and distress tolerance occur when targeted by treatments designed to improve distress tolerance skills”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bornovalova et al., 2012 source

      Section 3.3 reports that patients receiving the distress-tolerance intervention SIDI improved in both distress tolerance and depressive symptoms. But depressive-symptom improvement was comparable across groups, and the Discussion (Section 4) says the study did not examine longer-term clinical outcomes such as relapse. The claim is therefore broader than the demonstrated effect of this intervention in residential substance-use treatment. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Formal mindfulness training reduces depressive symptoms and rumination while improving sustained attention and perceptual sensitivity.

    “Engaging in formal mindfulness training reduces depressive symptoms and rumination while improving sustained attention (e.g., Chambers, Lo, & Allen, 2008) and perceptual sensitivity (e.g., MacLean et al., 2010).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Chambers, Lo, & Allen, 2008 source
    • cites MacLean et al., 2010 source

  • May combine two claims.

    Premisecitation

    tCBTs have been around longer and have achieved a significant empirical base.

    “tCBTs have been around longer and thus have achieved a significant empirical base”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Butler, Chapman, Forman, & Beck, 2006 source

      The Abstract calls CBT one of the most extensively researched forms of psychotherapy and reports over 325 published outcome studies; the Summary and conclusions traces its application across disorders to the 1970s. The paper does not establish that traditional CBT is older than the therapies being compared or that its age caused its larger empirical base. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Tolin, 2010 source

  • May combine two claims.

    Premisecitation

    In an open-label BA trial, 9 of 12 MDD patients were treatment responders and showed gains in self-report reward sensitivity and normalization of neural activity related to reward selection, anticipation, and feedback.

    “Findings revealed that 9 of 12 patients were classified as treatment responders and evidenced gains in self-report reward sensitivity and associated normalization of neural activity related to reward selection, reward anticipation, and reward feedback.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Dichter et al., 2009 source

      The Results report that 9 of 12 MDD participants responded, and the Discussion describes normalized neural activity during reward selection, anticipation, and feedback. However, the Results show only numerical increases in self-report reward-related scores, with no significant changes on the anhedonia measures. The paper does not establish that those self-report changes were associated with the neural changes or occurred specifically in responders. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Cognitive distancing is negatively related to self-report measures of depressive symptoms, anxiety symptoms, depressive rumination, experiential avoidance, and expressive suppression.

    “Fresco, Moore, and colleagues (2007) found cognitive distancing to be negatively related to self-report measures of depressive symptoms, anxiety symptoms, depressive rumination, experiential avoidance, and expressive suppression.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Fresco, Moore et al., 2007 source

  • May combine two claims.

    Premisecitation

    fMRI findings from a subset of Bieling et al. trial patients showed hyperactivation of medial prefrontal regions implicated in self-referential processing predicted earlier relapse, while increased activation in visual processing regions predicted treatment durability.

    “Findings from an fMRI study on a subset of patients from the Bieling et al. trial revealed that hyperactivation of medial prefrontal regions implicated in self-referential processing predicted earlier relapse whereas increased activation in visual processing regions, interpreted as a capacity to observe emotionally evocative percepts, predicted treatment durability”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Farb, Anderson, Bloch, & Segal, 2011 source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisereasoning

    This approach aligns CBT mechanism research with intervention science and NIMH priorities such as RDoC because it is agnostic to treatment theory and can help elucidate biobehavioral markers reliably dissociable in patient subgroups versus healthy controls.

    “This approach aligns CBT mechanism research with the growing multidisciplinary field of intervention science as well as with NIMH priorities such as the Research Domain Criteria initiative (i.e, “RDoC”; Sanislow et al., 2010) since it is agnostic to treatment theory and can help elucidate biobehavioral markers that are reliably dissociable in patient subgroups as compared to healthy controls.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Sanislow et al., 2010 source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    To achieve behavioral adaptation, CBTs share change principles targeting different points along an emotional trajectory: context engagement encompasses behavioral exposure and behavioral activation; attention change encompasses attention training and acceptance/tolerance; cognitive change encompasses decentering/defusion and cognitive reframing.

    “to achieve a common goal of behavioral adaptation, CBTs share change principles that target responding at different points along an emotional trajectory (Gross, 2002), including context engagement which can be seen as encompassing therapeutic processes of behavioral exposure and behavioral activation; attention change, which can be seen as encompassing therapeutic processes of attention training”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Gross, 2002 source
    • Rests on an assumption: A lack of cohesion limits opportunities for the CBT field to align in a shared vision and a common language to offer these CBTs to the larger community.

  • May combine two claims.

    Interpretationcitation

    A capacity to change cognitions and relinquish one's original interpretation may undermine passive, repetitive elaborative processes central to transdiagnostic psychopathology and promote flexibility allowing more effective, rather than habitual, behavioral reactions.

    “A capacity to change cognitions and relinquish one’s original interpretation may undermine passive, repetitive elaborative processes central to transdiagnostic psychopathology (e.g., rumination; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008) and promote flexibility that allows for more effective, rather than habitual, behavioral reactions.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008 source

  • May combine two claims.

    Premisecitation

    Optimal reward learning requires assigning value to rewarding stimuli, predicting when and where they occur, and taking actions informed by those predictions.

    “Optimal reward learning requires us to assign value to possibly rewarding stimuli, make predictions about when and where we might encounter these stimuli, and take behavioral actions that are informed by these predictions”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites O’Doherty, 2004 source

  • May combine two claims.

    Premisereasoning

    Deficits in establishing adaptive context-appropriate contingencies and inability to learn new contingencies are key difficulties across emotional disorders.

    “Deficits in establishing adaptive and context appropriate contingencies, and the inability to learn new contingencies, represent key difficulties across emotional disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    No existing CBT approach focuses fully on any single process or principle; current approaches target multiple entry points in the emotional cascade.

    “no existing approach can claim to focus fully on any one process or principle. More likely, current CBT approaches target multiple entry points in the emotional cascade”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    ACT values delineation helps clarify behavioral actions and promotes motivation and endurance in facing fears, possibly through superior inhibitory learning.

    “one important aspect of ACT is the delineation of values, which reflect construed desired life consequences, and in turn, help individuals clarify behavioral actions and promote motivation and endurance of instances such as facing one’s fears in a variety of contexts, which may be successful through the encouragement of superior inhibitory learning”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites S. Hayes et al., 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Wilson & Murrell, 2004

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Cognitive reframing and decentering/defusion primarily reflect the cognitive change principle.

    “cognitive change is a target of cognitive reframing interventions (i.e., encouraging the changing of one’s evaluation of an event to alter its emotional significance) but can also be seen as a principle that encompasses meta-cognitive distancing processes including decentering/defusion”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Mindfulness practices improve exposure therapy via enhanced attention capacity, better discrimination and recall of fear cues, and increased tolerance to fearful stimuli.

    “Treanor (2011) recently reviewed findings and proposed how mindfulness practices improve exposure therapy via enhanced attention capacity, better discrimination and recall of fear cues, and an increased tolerance to remain in contact with fearful stimuli.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Treanor (2011) source

  • May combine two claims.

    Premisenone given

    Fear extinction reflects un-pairing of CS-US associations but does not eliminate the original association.

    “Fear extinction reflects the un-pairing of conditional stimulus (CS)-unconditional stimulus (US) associations but does not mean an elimination of the original CS-US association.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Normative functioning involves continuously engaging and resolving reward-threat conflicts to take effective behavioral action.

    “Normative functioning represents a constant state of engaging and resolving conflicts of reward and threat in service of taking effective behavioral action.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A basic directive of adaptive organisms is to balance engaging reward and minimizing loss while seeking safety and avoiding threat.

    “One of the most basic directives of an adaptive organism is to bring balance with respect to engaging reward and minimizing loss while seeking safety and avoiding threat”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dollard & Miller, 1950

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Exposure therapy derives from classical conditioning principles and encourages engagement of threat-perceived contexts.

    “This approach derives from principles of classical conditioning, tracing back to the work of Wolpe (1958), and directly encourages the engagement of threat-perceived contexts.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolpe (1958)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    These common therapeutic processes are best understood by their relationships to the core CBT change principles.

    “are best understood by their relationships to these core CBT change principles.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A predominant focus on comparative efficacy may be ill advised given high overlap among CBTs and likely costly, time-consuming, incremental information.

    “a predominant focus on comparative efficacy may be ill advised given the likelihood of high overlap among these approaches and, hence, any direct comparison is likely to be costly, time consuming, and incremental in the information it provides”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ability to flexibly move attention entails leading attention to various aspects of an experience.

    “The ability to flexibly move attention entails leading attention to various different aspects of an experience”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Szymura, Smigasiewicz, & Corr, 2007 source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisereasoning

    Comparative efficacy RCT design is the gold standard for determining if a treatment with new components is efficacious.

    “This comparative efficacy RCT design is the gold standard for determining if a treatment comprised of new components is efficacious.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    People with various psychopathologies differ from healthy controls in showing less flexible attention, strong biases toward negative or threatening cues, and trouble disengaging from negative stimuli; these patterns are central to emotional disorders.

    “Several converging lines of research suggest that reduced attentional flexibility and rigid attentional biases towards negative or threatening information, as well as difficulty disengaging from negative stimuli differentiate individuals with numerous psychopathologies from healthy controls and reflect key characteristics of emotional disorders”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Joormann & Gotlib, 2007 source
    • cites Mathews & MacLeod, 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Ability to sustain attention involves maintaining focus and re-directing attention back when it wanders.

    “The ability to sustain attention refers to maintaining this focus on the target stimuli (see Posner & Rothbart, 1992) as well as actively re-directing attention back to the target stimuli when attention has wandered”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Posner & Rothbart, 1992

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Smallwood & Schooler, 2006 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Behavioral adaptation requires the ability to flexibly direct attention via constriction or expansion according to situational demands.

    “Behavioral adaptation requires the ability to flexibly direct attention via constriction or expansion according to situational demands.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Delineating common characteristics can generate a collective language and investigative strategy that may increase precision and efficiency in understanding and treating refractory psychopathologies.

    “By delineating these common characteristics, a collective language and investigative strategy can be generated that may help increase precision and efficiency in advancing our understanding and treatment of refractory psychopathologies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Attentional change improves one's ability to focus, sustain, or flexibly move attention.

    “A principle of attentional change can be seen as improving one’s ability to focus attention on a target stimulus, sustain attention on the chosen stimulus, or flexibly move attention to different stimuli.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Despite methodological weaknesses in some studies, initial evidence indicates rCBTs are efficacious.

    “Despite methodological weaknesses in some studies (Öst, 2008), initial evidence indicates that rCBTs are efficacious”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Öst, 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites S. Hayes et al., this issue

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BA conceptualization views depression as resulting from inability to engage behavioral repertoires that deliver positive reinforcement, leading to withdrawal and deprivation.

    “The BA conceptualization of depression views depressed individuals as no longer able to engage the behavioral repertoires capable of delivering positive reinforcement in their lives—thereby resulting in depression, withdrawal, and an ever-deepening vicious circle of deprivation from positive reinforcement”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lewinsohn, 1974

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Constricted, narrowly focused attention is adaptive during potential threat, while broadened attention is more adaptive when no threat is present.

    “Constricted, narrowly focused attention is adaptive during times of potential threat (i.e., concentrating resources on the threat and facilitating the selection and mobilization of appropriate responses; Friedman & Forster, 2010) but when no threat is present, broadened attention is more adaptive (facilitating exploratory behavior and allowing for the detection of new information and novel IncentI”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Friedman & Forster, 2010 source

  • May combine two claims.

    Premisecitation

    Hyper-responsivity to threatening information and attentional bias occur within milliseconds and appear to influence further processing almost immediately.

    “Hyper-responsivity towards threatening information and attentional bias occur within milliseconds, and appear to influence further processing almost immediately”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mathews & MacLeod, 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ability to focus attention involves actively choosing the stimulus to attend to.

    “The ability to focus attention involves actively choosing the stimulus to which one will attend”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kabat-Zinn, 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    A distanced perspective from aversive stimuli can decrease psychological distress and the believability of negative, self-relevant thoughts.

    “a distanced perspective from aversive stimuli can decrease psychological distress (e.g., Davis, Gross, & Ochsner, 2011) and the believability of negative, self-relevant thoughts (Masuda et al., 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Davis, Gross, & Ochsner, 2011 source
    • cites Masuda et al., 2010 source

  • May combine two claims.

    Premisenone given

    In ABM, participants trained to attend away from threatening cues using a modified dot-probe paradigm showed increased disengagement from threat cues, changes in attention bias, and decreased distress by self-report and interviewer measures.

    “In ABM, participants who were trained to attend away from threatening cues using a modified dot-probe paradigm showed an increased ability to disengage from threat-related cues, changes in attention bias, and a decrease in distress as indicated by self-report and interviewer measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Ferster posited depression is largely a disorder of emotional withdrawal worsened by escape/avoidance instead of pursuing positive reinforcement.

    “Ferster (1973) also posited that depression was largely a disorder of emotional withdrawal and that one of the ways that depressed individuals worsened their situation was by inordinately orienting their lives in service of escape and avoidance of aversive situations instead of pursuing opportunities for positive reinforcement.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ferster (1973) source

  • May combine two claims.

    Premisecitation

    CBT therapists promote reframing by encouraging clients to monitor and interpret emotionally provocative events, challenge ascribed meaning through logical questioning, identify cognitive distortions, and generate new more rational and realistic meanings.

    “One way that CBT therapists promote reframing is to encourage clients to monitor and interpret emotionally provocative events. When interpretations are found to be unrealistic or unhelpful, the therapist helps clients challenge the ascribed meaning through logical questioning, identification of cognitive “distortions” (i.e., interpretations that are not based on logic), and encourage clients to”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Beck et al., 1979

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Assessing common target mechanisms in various approaches may help better understand patient characteristics that predict treatment success and failure.

    “assessing common target mechanisms in various approaches may help us better understand patient characteristics that predict treatment success and failure”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Traditional methods such as Rounsaville, Carroll, and Onken's stage model provide established frameworks for determining how a treatment produces change and what are the most important core components.

    “Traditional methods such as Rounsaville, Carroll, and Onken’s (2001) stage model provide established frameworks for determining how a treatment produces change and what are the most important core components.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rounsaville, Carroll, and Onken, 2001 source

  • May combine two claims.

    Premisecitation

    Self-reported decentering predicts acute treatment response in MDD following cognitive therapy but not medication, durability of treatment gains, and prevention of MDD relapse following MBCT.

    “self-reported decentering predicts acute treatment response in MDD following cognitive therapy but not medication (Fresco, Segal et al., 2007), durability of treatment gains (Fresco, Segal et al., 2007) and in the prevention of MDD relapse following MBCT (Bieling et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Fresco, Segal et al., 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Bieling et al., 2012 source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    This approach is ultimately more cost effective than waiting to establish efficacy before testing how and why a treatment works.

    “This approach is ultimately more cost effective than waiting to establish efficacy before testing how and why a treatment works.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It is unclear whether cognitive distancing as opposed to reframing was the active process of change given the limits of self-report.

    “It is unclear, however, if cognitive distancing as opposed to reframing (see below) was the active process of change given the limits of self-report.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More parsimonious treatments require less formal training to implement, lead to greater integrity and adherence, and are thus able to have superior outcomes.

    “Cougle (2012) has pointed out that more parsimonious treatments require less formal training in order to implement, lead to greater integrity and adherence, and are, thus, able to have superior outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cougle, 2012 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    CBT packages are technically eclectic, comprised of heterogeneous components, complicating identification of key principles and processes that lead to successful outcome.

    “CBT packages are technically eclectic (i.e., comprised of heterogeneous components) thereby complicating the identification of key principles and processes that lead to successful outcome”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dobson, this issue

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    There are likely other common change principles and processes that CBT approaches encompass.

    “there are likely other common change principles and processes that CBT approaches encompass”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    ACT does not encourage challenging thought content but emphasizes descriptive metaphors or analogies that encourage changing perspectives on difficult emotional experiences from requiring avoidance and escape to viewing them as natural responses best allowed and not overly controlled.

    “Although ACT does not encourage challenging of thought content, it does emphasize the use of descriptive metaphors or analogies that encourage changing of perspectives on difficult emotional experiences from one of requiring avoidance and escape to one of viewing them as natural responses that are best allowed and not overly controlled”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites S. Hayes et al., 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Distancing manipulations reduce depressotypic thought accessibility, diminish emotional recounting, and increase accuracy of reconstruals of past events in depressed individuals.

    “distancing manipulations have also been shown to reduce depressotypic thought accessibility, diminished emotional recounting, and increase accuracy of reconstruals of past events in individuals who are depressed”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kross et al., 2012 source

  • May combine two claims.

    Premisecitation

    Studies have found distress-reducing benefits from inducing realistic/objective reappraisal, positive reappraisal, other-focused compassionate reappraisal, and self-focused compassionate reappraisal of personally emotionally provocative events.

    “Studies have found distress-reducing benefits from inducing realistic/objective reappraisal (e.g., Ray et al., 2008), positive reappraisal (e.g., Ray et al., 2008), other-focused compassionate reappraisal (e.g., Witvliet, DeYoung, Hofelich, & DeYoung, 2011), and self-focused compassionate reappraisal (e.g., Leary et al., 2007) of personally emotionally provocative events.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Ray et al., 2008 source
    • cites Witvliet et al., 2011 source
    • cites Leary et al., 2007 source

  • May combine two claims.

    Premisecitation

    Existing treatments are quite heterogeneous and thus it might be difficult to isolate the role of common characteristics.

    “existing treatments are quite heterogeneous and, thus, it might be difficult to isolate the role of common characteristics”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dobson, this issue

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

51 of 51

  • The paper relies on this without support.

    Disorders with high comorbidity, unyielding course, and poor life satisfaction remain refractory to existing treatments.

    “disorders characterized by high levels of comorbidity, unyielding course, and poor life satisfaction, remain refractory to existing treatments.”

  • The paper relies on this without support.

    Competition and disunity are natural responses to a diversifying field.

    “competition and disunity are natural responses to a diversifying field”

  • The paper relies on this without support.

    A lack of cohesion limits opportunities for the CBT field to align in a shared vision and a common language to offer these CBTs to the larger community.

    “a lack of cohesion limits opportunities for the CBT field to align in a shared vision and a common language to offer these CBTs to the larger community.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Current trials are testing ERT transdiagnostically because research has shown that core components of distress disorders such as worry and rumination exist across the diagnostic spectrum.

    “Current trials are testing ERT transdiagnostically as research has demonstrated that core components of distress disorders such as worry and rumination exist across the diagnostic spectrum (Mennin & Fresco, 2013).”

    From A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults. (2018) · cites this paper as Mennin & Fresco, 2013

    The paper’s introductory discussion identifies Emotion Regulation Therapy (ERT) as an integrative CBT approach, and the Context Engagement section discusses difficulties shared across emotional disorders. It does not say that current trials are testing ERT transdiagnostically or establish that worry and rumination occur across the diagnostic spectrum; searches for those terms and for ERT trials did not locate such a passage. No page number was provided in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Core intervention principles that address both lesser and greater elaborative processes may be the conceptual framework underlying successful CBT interventions.

    “core intervention principles that address both lesser and greater elaborative processes (i.e., simultaneously increasing attentional flexibility, improving meta-cognitive processing, and promoting the engagement of both threat and reward contexts) may be the conceptual framework that underlies successful CBT interventions77.”

    From AN OPEN TRIAL OF EMOTION REGULATION THERAPY FOR GENERALIZED ANXIETY DISORDER AND COOCCURRING DEPRESSION. (2015) · cites this paper as [77]

  • Participants showed gains from pre- to posttreatment and through 9-month follow-up in model-related general outcomes including negative emotionality, emotion regulation, and mindfulness, and in specific ERT skills targets including shifting and sustaining attention, distancing/decentering, and reappraising.

    “Additionally, participants showed gains from pre-to posttreatment and through the 9-month follow-up in model-related general outcomes including negative emotionality, emotion regulation, and mindfulness as well as more specific ERT-related skills training targets including shifting and sustaining attention, distancing/decentering, and reappraising (Mennin & Fresco, 2013).”

    From A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults. (2018) · cites this paper as Mennin & Fresco, 2013

    Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Homework is an integral part of most contemporary CBTs, based on the premise that new skills are best acquired and consolidated through everyday practice.

    “homework is an integral part of most contemporary CBTs, rooted in the premise that new skills are best acquired and consolidated through training in everyday life [20]”

    From Moderators and mediators of emotion regulation therapy for psychologically distressed caregivers of cancer patients: secondary analyses from a randomized controlled trial. (2021) · cites this paper as [20]

    The “CBT Principles and Processes That Promote Behavioral Adaptation” and “Context Engagement” sections discuss enacting new experiences and learning adaptive responses, but do not say that homework is integral to most CBTs or that everyday practice is how new skills are best acquired and consolidated. Searches for “homework” and for everyday practice and skill consolidation found no passage addressing that claim. (LLM, conf=0.70)

    Experimental — accuracy not yet measured

  • Therapeutic alliance, a non-MBI-specific ingredient, correlates with outcomes in MBIs across several studies, although null associations have also been reported (e.g., with smoking abstinence).

    “Therapeutic alliance, also a non-MBI-specific ingredient, has been shown to correlate with outcomes in MBIs across several studies100,105,107, although null associations have also been reported (for example, with smoking abstinence107).”

    From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [107]

Cites

Flagged first, then by citations

2 of the 127 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Posner, 1992, Attentional regulation: From mechanism to culture, International Journal of Psychology, 27, 41

Cited by

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Related

Authors
Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J.
Affiliations
  • The Graduate Center, CUNY (US)
  • Boston University (US)
  • Kent State University (US)
  • Stanford University (US)
Corresponding author
Mennin, Douglas S.
ORCID
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2013-06
Volume
44
Issue
2
Pages
234-248
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2013.02.004
PMC
PMC4992341
OpenAlex
W2043250118
Cited by
172
References
127
Citations by year
2026: 6 · 2025: 9 · 2024: 6 · 2023: 14 · 2022: 23 · 2021: 19 · 2020: 8 · 2019: 13 · 2018: 17 · 2017: 20 · 2016: 11 · 2015: 13 · 2014: 9 · 2013: 4
FWCI
16.66
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34MH070682)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
cognitive behavioral therapy, behavioral adaptation, cognitive change, perspective taking, attention training, decentering, cognitive reframing, multicomponent intervention, meditation
MeSH terms
Anxiety Disorders, Behavior, Behavior Therapy, Humans, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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