Advancing evidence-based CBT requires personalization, technological integration, and overcoming implementation challenges.
FREMONT, CA: Evidence-based psychotherapies, particularly cognitive behavioral therapy (CBT), have made remarkable strides in mental health. However, their global implementation within mental health systems can be viewed as incremental progress due to various factors. These factors include incompatibility with other psychotherapeutic models, deviation from evidence-based guidelines in routine care, and a shortage of trained clinicians.
Most randomized controlled trials (RCTs) thus far have evaluated CBT packages of multiple therapeutic elements designed for individuals categorized according to diagnostic criteria. However, within these packages, some elements may be more effective than others for specific individuals, leading to potential iatrogenic effects, inefficiency, and treatment discontinuation. Additionally, relying solely on diagnostic categorization for treatment selection ignores the heterogeneity within diagnoses. To address these limitations, transdiagnostic approaches based on symptom dimensions offer more precise and personalized mental health care. Hierarchical latent structural models and symptom network approaches are promising in this regard, enabling targeted interventions that match individuals more effectively. Emerging evidence supports the idea of prescribing specific treatment elements for better outcomes.
A treatment elements approach aligns with targeting specific dysregulations in physiology, cognition, behavior, or emotion contributing to psychopathology. Neuroscience and behavioral science advances have refined exposure therapy for fear and anxiety symptoms by focusing on fear extinction. Similarly, advancements in reward processing have led to interventions targeting reward hyposensitivity in anhedonia symptoms across anxiety and depressive disorders. By evaluating target engagement, interventions can be iteratively refined based on the specific dysregulations being addressed.
