Introducing Flexible CBT:
Cognitive Behavioral Therapy for Co-Morbid Conditions
Conventional Cognitive Behavioral Therapy (CBT) protocols represent one of the few clinical
options for effective treatment of behavioral health conditions including post traumatic stress
disorder (PTSD), depression, drug and alcohol abuse and anxiety disorders. Conventional CBT
has been shown to reduce depression relapse, anxiety related symptoms and improve patient
activities of daily living. These conventional CBT practices are consistently found to be the most
effective treatment options for a myriad of behavioral health conditions, yet it is estimated that
less than 5% of care providers nationwide are competent in CBT.
Limitations of Conventional CBT
Individual Training for Individual Conditions Limits CBT
Cognitive Behavioral Therapy techniques are designed to target and treat specific behavioral
health conditions. Differing CBT protocols exist to address the variety of behavioral health
conditions that most benefit from CBT. Protocols are tailored to specifically treat PTSD,
depression, anxiety, addition, etc. While protocols are effective for each separate condition,
the level of specificity limits the utility of conventional CBT in treating individual patients with
multiple and overlapping conditions. Patients with this level of "co-morbidity" are difficult to
treat using a single conventional CBT protocol.
Additionally, having multiple protocols for various conditions leads to a large degree of
variability in treatment. A RAND study assessing the number of Service members who suffer
from "the invisible wounds of war" identified two important points: 1. "Of those (Service
members) who have a mental disorder and also sought medical care for that problem, just
over half received minimally adequate treatment" and 2. The "signature injuries" of the most
recent wars have a large degree of overlap with an estimated 37% having some degree of
overlapping symptoms of PTSD, depression and TBI. Of those who displayed some degree of
co-morbidity, 49% had symptoms related to all three conditions.1 While this study was limited
to a discussion of only these three behavioral health conditions, it points to the high level of
co-morbidity seen in the returning Service member, and the challenge for care providers to
deliver effective treatment.
The Benefits of Flexible CBT
Combining the Best of Conventional CBT into a Single Best Practice
Developed at McLean Hospital/Harvard Medical School, Flexible CBT is academically validated. Since 2004, the Flexible
CBT treatment model has been studied and proven effective for complex patients with highly co-morbid conditions.
Over 1,200 patients have participated in Flexible CBT research at Harvard, validating the effectiveness of the treatment
model. Subjects who underwent Flexible CBT treatment demonstrated an increased utilization of CBT skills and
improvement in behavioral activation (improved daily function), with corresponding decreases in negative thoughts,
depression scores, and overall psychiatric symptom scores. Physicians and care providers who use Flexible CBT treat
the "whole person" - all symptoms and functional problems associated with co-morbid conditions. The result? Instead
of treating each condition with entirely separate treatment protocols, patients with multiple diagnosed conditions now
only require a single treatment approach that addresses the functional problems of each condition. This unification of
CBT best practices into a single treatment approach results in a vastly improved standard of care that meets the needs
of individual patients in their unique life contexts.
Flexible CBT Online
Scalable, Deployable and Cost Effective Training
Atheneum Learning now offers a Flexible CBT Online training suite. Developed by the same Harvard clinicians who
pioneered Flexible CBT, the online suite uses evidence-based skills training to guide the clinician through the principles
of Flexible CBT. This training suite provides up to 20 Continuing Medical Education (CME) credits certified by McLean
Hospital/Harvard Medical School. Because the training is offered online, with supplementary webinars (live and
archived) and web resources, it is easily scalable to provide self-paced learning to a large and busy medical force, with
added training support built in for 6 months. Reportable metrics are built in to the system to assess the competency
level of all care providers who complete the training. This allows leaders to know objectively the strength of their
clinical force. Where typical certification training requires travel to conferences coupled with day-long lectures, online
CBT training uses interactive training to engage the provider, and is available 24/7, anywhere/anytime there is Internet
access. This type of training is estimated to save $1,500 per user vs. traditional conference based training. That scales to
more than $1.5M per 1,000 providers.
Learn more about Flexible CBT here!
1 Tanielian and Jaycox, 2008. "The Invisible Wounds of War," RAND, pg 97
