Exposure therapy is widely recognized as an effective psychological treatment for OCD but it is not successful in every case. Poorly executed exposure techniques could be implicated. Negative perceptions contribute to poor execution, pitfalls, or the underutilization of this therapy altogether. This, along with common ED misconceptions that are cultural and disorder-specific, can also result in poor treatment for those with EDs. It is important that the therapist has a thorough understanding of the patient’s presentation to ensure that exposures target the precise core fear for new learning. Lack of understanding can lead to mistakes and missed opportunities to enhance exposure, such as failing to explain the rationale, reducing safety behaviors, or overusing a hierarchy. An inexperienced therapist may not understand the importance of discussing the role of family and friends and how their accommodation can perpetuate symptoms, hindering new learning and preventing lasting change. The therapist should be able to identify the core fear, triggers, and avoidance behaviors in the patient and use strategies to enhance inhibitory learning and maximize the chances of successful treatment.

Somatic symptom disorder (SSD) entails a preoccupation with one or more physical symptoms that are attributed to a nonpsychiatric disease. Research on treatment for SSD supports the use of cognitive behavioral therapy (CBT) for reducing symptomatology and improving physical functioning and quality of life. This chapter summarizes the research base for CBT for SSD and provides a clinical guide to formulating, assessing, and implementing CBT for clients with SSD. Assessment requires ruling out organic medical conditions and assessing triggers of SSD, beliefs about body sensations, and associated safety behaviors. The use of a functional assessment and self-monitoring aids in developing an idiosyncratic case conceptualization. Treatment includes psychoeducation, cognitive restructuring to challenge beliefs about bodily sensations, a mix of interoceptive, in vivo, and imaginal exposure, and the elimination of all safety behaviors. The chapter concludes with a summary of recent advances in treatment of SSD, including mindfulness-based approaches.

Although fear can protect us from harm and prepare us for danger, disproportionately extreme fear can turn into a specific phobia when it leads to extreme avoidance of and distress in feared situations, thereby interfering with our lives and mental well-being. This chapter gives instructions and examples of how an assessment and mini formulation for specific phobias can help to construct a ‘fear hierarchy’ and to understand which ‘safety behaviors’ can maintain phobias. With case illustrations, the chapter describes how to apply exposure therapy, the cornerstone CBT method for specific phobias, in which an individual gradually confronts each trigger in the fear hierarchy while refraining from safety behaviors. The chapter also outlines how to overcome common difficulties with exposure therapy and how to measure therapy outcomes. Finally, cognitive restructuring is discussed as a CBT approach for specific phobias in which exposure-based activities are used to test and challenge exaggerated or unhelpful ideas about feared situations.

Clark and Wells advanced a cognitive model of social anxiety disorder (SAD) that has received substantial empirical support. The model accounts for the persistence of SAD with reference to a set of specific cognitive behavioral mechanisms involving feedback cycles that are responsible for maintaining the problem. Cognitive behavioral therapy (CBT) derived from this model aims to address these mechanisms, which include, among others, maladaptive self-processing and styles of coping consisting of safety behaviors and anticipatory and post-event processing. The treatment is recognized as the treatment of choice in clinical guidelines. We present the Clark and Wells’s model of SAD in detail and describe how SAD can be treated with CBT. Furthermore, we address topics such as clinical management and assessment, research supporting CBT for SAD, and further developments based on the metacognitive model.