This is the best of times and the worst of times for prevention education; we have more resources than ever before but more issues. In this article we focus on how we see these issues and the trends in the field from which these issues emerge. To set the context for discussing these issues, we will provide an overview of the field of preventive education in the context of public policy issues on marriage, provide an overview of trends in prevention programs that have a cognitive-behavioral therapy (CBT) emphasis, focusing on our work with the Prevention and Relationship Education Program (PREP), and then we will identify and discuss the critical issues that we see in the prevention field. Throughout the article we will integrate theory, research, and clinical illustrations.

Research has demonstrated support for the efficacy of mindfulness-based stress reduction (MBSR) in alleviating psychological distress and symptoms. Less is known, however, about the mechanisms through which MBSR achieves its outcomes. This study examined mindfulness and self-compassion as potential mediators of MBSR’s effects on several processes and behaviors related to emotion regulation, using data from a randomized trial of MBSR versus waitlist (WL), in which MBSR participants demonstrated significantly greater improvements in worry, fear of emotion, difficulties in emotion regulation, suppression of anger, and aggressive anger expression. Mediation analysis using bootstrap resampling indicated that increases in self-compassion mediated MBSR’s effects on worry, controlling for change in mindfulness. Increases in mindfulness mediated the intervention’s effects on difficulties in emotion regulation, controlling for change in self-compassion. Both variables mediated MBSR’s effects on fear of emotion. These findings highlight the importance of mindfulness and self-compassion as key processes of change that underlie MBSR’s outcomes.

Some theoretical positions see cognitive therapy and behavior therapy as separate while others see the two as integrated forms of treatment. An open question is how these perspectives are reflected in therapeutic practice and whether in routine care one should speak from different modes and schools of treatment or rather an integrated form of cognitive-behavior therapy. Thirteen hundred and forty-four epidemiologically representative and extensive case reports, written for treatment application in routine outpatient care, were analyzed by content-analytic methods. The results indicated that cognitive and behavioral interventions were used at the same rate and in an integrated way under the heading of behavior therapy. Some differences in treatment modes were found between different mental disorders. In depressive disorders cognitive methods were slightly more prevalent (95%) than behavioral methods (86%) while in anxiety disorders behavioral techniques (95%) were used somewhat more frequently than cognitive methods (83%). It was concluded that under the perspective of epidemiology of care an integrated form of cognitive behavior therapy is what therapists actually provide.

First responders face significant risks with respect to their mental health including exposure to traumatic events and subsequent development of posttraumatic stress disorder (PTSD). There are many established psychological treatment guidelines for PTSD, but there are reasons to believe that first responders differ significantly from the general population and would benefit from a targeted approach to treatment planning. The authors present a cognitive behavioral model of first responder PTSD, which integrates important factors related to this population as well as an illustrative case study. This model may be useful in identifying stuck points, maintenance factors, and targets for psychological treatment.

Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia nervosa, but there is less empirical data on its usefulness with anorexia nervosa or binge-eating disorder. The use of cognitive-behavioral therapy (CBT) is recommended as the first line of treatment for bulimia nervosa and strongly recommended in combination when medications alone have not been effective. Combined treatment also improves symptoms such as anxiety, depression, and dietary restriction. Empirical studies support the usefulness of CBT with binge-eating disorder and suggest higher remission rates with combined treatment. No single psychotherapy or medicine alone is effective in treating anorexia nervosa. CBT is typically used as part of a comprehensive treatment program with nutritional rehabilitation and prudent use of medication. Both CBT and medication may have benefits in maintaining gains for anorexia nervosa patients after inpatient treatment. More research on CBT alone and in combination with medication is needed to adequately understand the respective roles of these therapies in a comprehensive treatment of eating disorders.

Within traditional cognitive therapy, cognitive restructuring is often used to challenge the veracity of dysfunctional thoughts. In contrast, acceptance and commitment therapy (ACT) uses “cognitive defusion” techniques to change the function of negative thoughts rather than modify their content. Previous research has shown that a cognitive defusion technique known as the “milk exercise” (rapidly repeating a self-referential, one-word thought such as “fat”) reduces the discomfort and believability associated with negative thoughts. This study sought to replicate and extend these findings by comparing the impact of cognitive defusion with that of cognitive restructuring in a sample of participants distressed by negative thoughts about their body shape. Participants received a detailed rationale and training followed by instructions to practice the assigned technique as homework for 1 week. Results indicated that both cognitive techniques produced substantial improvements that generalized well beyond the specific thoughts targeted for treatment. Clear differences in treatment process and the course of improvement were evident. Findings are discussed in the context of theoretical and practical similarities and differences between these two approaches.