This chapter covers generalized anxiety disorder, panic disorder, specific phobia, social anxiety disorder, agoraphobia, separation anxiety disorder, and selective mutism. Based on a review using the new criteria for empirically supported treatments, there is strong research support for: (a) exposure therapies for specific phobias, (b) cognitive and behavioral therapies for generalized anxiety disorder, (c) cognitive-behavioral therapy for panic disorder, and (d) cognitive-behavioral therapy for social anxiety disorder. The two primary components of treatment include exposure and addressing cognitive biases. Each of these components is broken down into additional parts. A sidebar also discusses acceptance and commitment therapy.

Autism spectrum disorder and intellectual developmental disorder are often comorbidly diagnosed, but many adults meet criteria for just one of these disorders. Broad approaches include applied behavior analysis, cognitive-behavioral therapy, mindfulness based therapy, social skills interventions, and employment-related interventions. A sidebar discusses co-occurring mental health conditions.

Using the new criteria for empirically supported treatments, cognitive-behavioral therapy and contingency management were both given strong recommendations for substance use disorders. Credible components of treatment include skills training, motivational enhancement, and access to nondrug alternative reinforcement. A sidebar discusses mutual support organizations such as Alcoholics Anonymous. Another sidebar describes harm reduction strategies.

Clinical practice guidelines identify several efficacious treatments for posttraumatic stress disorder, including prolonged exposure therapy, cognitive processing therapy, and trauma-focused cognitive-behavioral therapy. Credible components of treatment include psychoeducation, homework, exposure therapy, and cognitive techniques. A sidebar discusses how different categories of traumatic events can influence treatment choices. Another sidebar reviews the controversy over eye movement desensitization and reprocessing.

Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. The treatments with the most research support are cognitive-behavioral therapy, interpersonal psychotherapy, and family based treatment. Credible components of treatment include psychoeducational strategies, nutritional/dietary strategies, exposure therapy, social support, in-session weighing, cognitive strategies, and relapse prevention. A sidebar describes body checking and body avoidance.

The primary focus of this chapter is chronic pain. Treatment approaches discussed include cognitive-behavioral therapy and acceptance and commitment therapy. Credible components of treatment include behavioral goals, exposure, activity pacing, cognitive skills training, acceptance, relaxation, mindfulness, and psychological flexibility. A sidebar describes somatic symptom disorder.

Broad approaches to treating attention-deficit/hyperactivity disorder in adults include cognitive-behavioral therapy and dialectical behavior therapy. Credible components of treatment include an emphasis in learning theory, time estimation, temporal discounting, prioritizing/planning, self-instruction, cognitive refraining, and mindfulness. A sidebar discusses co-occurring conditions such as anxiety and depression.

Current clinical practice guidelines highlight several treatment approaches for depressive disorders, including acceptance and commitment therapy, behavior therapy, cognitive-behavioral therapy, interpersonal psychotherapy, and short-term psychodynamic psychotherapy. Credible components of treatment include behavioral activation, cognitive restructuring, problem solving, mindfulness, and a focus on interpersonal targets. The chapter also includes a sidebar on the importance of cultural humility.

This chapter discusses schizophrenia and other psychosis spectrum disorders. Treatment approaches include cognitive-behavioral therapy, assertive community treatment, family therapy, social learning/token economy programs, supported employment, cognitive remediation, and peer support. Credible components of treatment include psychoeducation, skill acquisition, emotional regulation strategies, interpersonal support, and care coordination. A sidebar highlights the importance of common factors such as empathy.

The target of couple therapy is a couple’s intimate relationship, and treatment involves one of the variations of behavioral couple therapy. Credible components of treatment include early assessment of goals and commitment, measurement-based care, and focusing on positive exchanges between partners. A sidebar discusses preventative interventions, and another sidebar explores self-directed and brief programs. The chapter also discusses the assessment of intimate partner violence.

The therapeutic relationship constitutes the heart and soul of the enterprise. Second only to the patient’s contribution, the relationship is the most powerful predictor of, and contributor to, outcome. Its effectiveness cuts across theoretical orientations (transtheoretical) and largely across client problems (transdiagnostic). This chapter reviews evidence-based psychotherapy relationships, primarily with adults in individual treatment. We begin by defining terms and summarizing the meta-analytic evidence on effective relationship behaviors or components (what works). That is followed by a summary of ineffective or discredited relationship behaviors (what does not work). We advance therapeutic and training practices based on this research evidence. The chapter finishes with multiple caveats, concluding thoughts, and useful resources.

Sexual dysfunctions are diagnosed differently in women and men. Diagnoses for women include female sexual interest/arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder. Diagnoses for men include hypoactive sexual desire disorder, erectile disorder, delayed ejaculation, and premature ejaculation. Research on treatments is limited. Common components of psychological treatments include psychoeducation, cognitive restructuring/emotional regulation, stimulus control/desensitization, contextual modifications, mindfulness, and relationship skill building. A sidebar describes comprehensive sex education for youth.

Patients with personality disorder, especially borderline personality disorder, are challenging for psychotherapy. Yet there is good evidence that most patients can recover if offered specific forms of specialized therapy that are empirically supported treatments. The majority of research studies in personality disorder have focused on borderline personality disorder, and we have only limited data on other categories. The strongest findings for the efficacy of treatment concern dialectical behavior therapy, but other options may yield similar results. Credible components include teaching emotion regulation skills and a present-oriented focus. Some of the effects of effective therapy could be specific to underlying theory and methods, while others may depend on common factors. A sidebar discusses self-injurious thoughts and behaviors in youth.

Dissociative disorders encompass depersonalization, derealization, dissociative amnesia, dissociative identity disorder, and other diagnostic classifications. The treatment literature for dissociative disorders is limited. Some emerging and promising treatments include phase-oriented treatment, cognitive-behavioral therapy, dialectical behavior therapy, schema therapy, the Unified Protocol, and the Treatment of Patients with the Dissociative Disorders Network Program. A sidebar provides recommendations for future research; another sidebar discusses access to treatment.

The primary focus of this chapter is antisocial personality disorder with additional discussion on conduct disorder. Cognitive-behavioral approaches have the most research support, and specific examples of these approaches include Reasoning and Rehabilitation, Cognitive Self-Change, and Aggression Replacement Training. Credible components of treatment include developing treatment readiness, learning key skills, and preparing for post-treatment life. A sidebar describes the treatment process.

The most efficacious treatments for bipolar disorder include cognitive-behavioral therapy, family-focused therapy, and systemic care. Credible components of treatment include psychoeducation, cognitive restructuring, social support, and relapse prevention. The chapter also include a sidebar on research therapists and another on overcoming challenges to learning and implementing therapy.

This chapter focuses on Tourette’s disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Broad approaches to treatment include habit reversal training, comprehensive behavioral intervention for tics, and exposure and response prevention. Credible components of treatment include increasing tic awareness, competing response training, social support, identifying and modifying tic-exacerbating antecedents and consequences, motivational techniques, strategies to promote generalization, mastery and maintenance of treatment gains, and psychoeducation. A sidebar discusses treatment format.

Insomnia disorder involves trouble falling asleep, trouble staying asleep, or both. A review using the new criteria for empirically supported treatments gave a strong recommendation for cognitive-behavioral therapy for insomnia. Credible components of treatment include stimulus control, sleep restriction, and relaxation therapies. A sidebar discusses components requiring further research.

This chapter focuses on cognitive loss related to neurocognitive disorders. Both behavioral and cognitive interventions are discussed, and caregiver support is also an important topic. Basic components include education and healthcare navigation, as well as reducing vascular risk factors and preventing excess disability. Other credible components include a problem-solving stance, systematic observations, stimulus control, reestablishing chains/sequences, access to meaningful events, differential reinforcement, intervening on social contingencies, cognitive reframing, and distress tolerance skills. A sidebar discusses format and duration of intervention.

This opening chapter defines the concept of science-based therapy. The original framework for characterizing an approach as an empirically supported treatment is presented, for both well-established treatments and probably efficacious treatments. Also presented, a newer framework – sometimes called “the Tolin criteria” – provides greater emphasis to meaningful functional outcome improvement, meaningful effects in nonresearch settings, and lasting improvements. Other concepts in this chapter include evidence-based practice and pseudoscience in therapy.