Cognitive-behavioral treatments (CBT) for the anxiety disorders are steeped in a tradition of learning theory and empiricism, stemming back to the beginning of the twentieth century and standing the test of time in rigorous clinical trials and experimental research. This chapter reviews the overarching model and standard components of cognitive and behavioral practice, and highlights a number of critical issues and academic debates that now face the discipline. Recent cognitive-behavioral conceptualizations build upon anxious apprehension and focus on the experience of emotion dysregulation. Treatment from the CBT perspective is multifaceted and geared towards addressing each of the three components of anxiety (cognitive, affective/somatic, and behavioral) through specific, empirically derived techniques. These techniques include psychoeducation, self-monitoring, relaxation, cognitive restructuring, and exposures. Providing CBT to individuals suffering from anxiety is a complex and continually evolving process.

Studies examining the transportability of efficacious treatments into community settings point to the vast differences between research and practice conditions. This chapter reviews the research literature on postdisaster trauma treatments for children and adolescents. The randomized controlled studies of trauma-focused (TF)-cognitive-behavioral treatments (CBT) with sexually abused children and the nonrandomized studies supporting cognitive-behavioral treatments suggest promising approaches for children affected by other types of trauma. The Child and Adolescent Trauma Treatments and Services (CATS) project extended these findings by demonstrating that these trauma-specific cognitive-behavioral approaches can be successful with youth exposed to a mass disaster. The study suggests that community clinicians can be trained effectively on CBT approaches even in postdisaster situations. To more fully advance the field of study, future investigations must find ways to employ a range of rigorous research designs that can provide some flexibility for examining delivery of targeted mental health interventions in postdisaster environments.

Cognitive-behavioral treatments effectively reduce the panic, anxiety and associated avoidance behavior in panic disorder and agoraphobia, as well as the social anxiety and avoidance behavior in social phobia. An important issue is whether the treatment protocols of randomized controlled trials and the associated patient improvement can be replicated in routine care. The evidence from epidemiological and clinical samples indicates that while the majority of sufferers seek treatment for their complaint, this nonspecialized treatment appears to have little impact on the course of their disorder. Data presented in this chapter shows that the outcome for some people who leave specialist care is good, and that people in the community with an anxiety disorder are, on average, less disabled than their counterparts who attend specialist treatment programs. Most importantly, all health services must deliver treatments that produce clinically significant change in both symptoms and the disability associated with a disorder.