This chapter describes the nature of depression, explaining that this disorder is not only prevalent in the population, but is also characterized by relapse and recurrence. Cognitive theories of depression share the idea that individual differences in maladaptive thinking and negative appraisals of life stress account for the disorder. Most contemporary cognitive models of depression have involved refinements and expansions of Beck's original theory. Cognitive therapy aims to help individuals shift their cognitive appraisals from ones that are unhealthy and maladaptive to ones that are more evidence-based and adaptive. The effectiveness of cognitive-behavioral therapy (CBT) is based on the extent to which patients learn to use the skills conveyed in therapy outside of the actual session. CBT is well supported for the treatment of an acute episode of depression and serves as a prophylaxis against subsequent episodes.

Bipolar disorder is characterized by the occurrence of one or more manic, hypomanic, or mixed episodes and is typified by periods of mood instability. Pharmacologic treatment of bipolar disorder is associated with significant problems of medication adherence. Cognitive-behavioral therapy is an effective and empirically supported psychosocial treatment for bipolar disorder. Key elements of the CBT intervention include psychoeducation, training in medication adherence, stress management, and cognitive restructuring. In addition to CBT, several other psychosocial treatments have been applied to bipolar disorder. Group treatment has been used for bipolar disorder as a potentially cost-effective method to prevent recurrence. High rates of comorbidity exist among patients with bipolar disorder. At the present time, the evidence for the efficacy of psychosocial interventions for bipolar disorder has never been stronger. The efficacy of psychosocial treatment on specific symptom areas, prominently including the role of anger and anxiety management, needs to be investigated.

The chapter focuses on the metacognitive model of generalized anxiety disorder (GAD) and describes the structure, choice, and implementation of treatment strategies in metacognitive therapy (MCT). Difficult to control worry is the central feature of GAD. Worry is a predominantly verbal conceptual process involving chains of negative thoughts. The majority of psychotherapy outcome research conducted on GAD has focused on interventions that fall under the rubric of cognitive-behavioral therapy (CBT). A considerable number of meta-analytic reviews and over 30 clinical trials have resulted in clinical guidelines recommending CBT as a first line treatment for GAD. Adrian Wells advanced a metacognitive model and treatment of GAD with the aim of improving therapeutic outcomes. Metacognitive therapy aims to modify negative beliefs about the uncontrollability and danger of worrying, and provide the patient with alternative nonconceptually based strategies for reacting to negative thoughts.

This chapter provides a combination of empirical evidence along with an emphasis on clinical skills and techniques for the treatment of social anxiety disorder. Individuals with social anxiety disorder may experience anxiety and/or avoidance of a variety of social situations, including parties, and public speaking. Although there have been a multitude of studies of the efficacy of cognitive-behavioral therapies and pharmacotherapies for social anxiety disorder, this chapter focuses on the combination of exposure and cognitive techniques. Social anxiety disorder is a debilitating disorder that follows a chronic course. Inclusion of a clinical case gives a flavor for the types of clients with social anxiety disorder treated in clinic, although these clients cover a wide spectrum of severity and impairment. The chapter highlights certain key areas in the treatment protocol in which the therapist makes decisions based on empirical evidence and to a great extent on their clinical skills and experience.

This chapter provides an overview of psychological accounts of specific phobia and describes a standard protocol for in vivo exposure, the current treatment of choice for specific phobia. Specific phobia is one of the most common psychiatric disorders in the general population, with documented lifetime prevalence estimates ranging between 9.4% and 12.5%. Specific phobias frequently co-occur with other DSM-IV disorders as an additional diagnosis, particularly when the predominant diagnosis is an anxiety disorder or a mood disorder. Behavioral treatments for specific phobias are rooted in Mowrer's classic two-stage theory of fear development. The chapter examines the role of cognitive factors in specific phobia. Recent research suggests that visual and somatic mental imagery may also play a role in the maintenance of specific phobia. There are a number of challenges that clinicians and clients may encounter during exposure treatment for specific phobia.

Panic disorder is characterized by unexpected panic attacks, anxiety about experiencing future attacks, and avoidance or dread of situations where attacks might occur. Panic disorder can be diagnosed either with or without the presence of agoraphobia. Cognitive-behavioral therapy (CBT) is an empirically supported intervention that American Psychiatric Association guidelines recommend with substantial clinical confidence for the treatment of panic disorder. Sessions begin with a brief review of material from the prior week, enabling the therapist to assess the client's perception and understanding of previously covered material. When treating panic disorder with CBT, therapists integrate their knowledge of available research, their clinical experience, and their understanding of a client's particular circumstances and characteristics when making clinical decisions. Decisions about how to implement a CBT technique, or whether to use it at all, can also be influenced by client characteristics and clinical expertise.