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Cognitive · 2025

Tridimensional CBT (TriD-CBT)

Change is organised by modifying the strategies of attention, cognition and behaviour that, in trying to resolve distress, end up maintaining it.

Tridimensional CBT (TriD-CBT) is a transdiagnostic and pragmatic cognitive-behavioural framework formulated by Kadir Özdel and Mehmet Hakan Türkçapar in order to integrate, within a common architecture, interventions drawn from different traditions of cognitive-behavioural therapy. The model proposes that much of the maintenance of psychological suffering can be formulated by examining three interrelated domains: attention or focus, appraisal and cognitive operations, and behaviour. In each domain it distinguishes relatively involuntary or automatic components from more voluntary or controllable strategies, arguing that intervention should focus particularly on the latter when they function as coping attempts that produce immediate relief but maintain or aggravate the problem. One and the same difficulty may involve, for example, automatic intrusive thoughts, deliberate rumination, self-focused attention, threat monitoring, avoidance, safety behaviours or compulsions; TriD-CBT organises these phenomena within a joint formulation and makes it possible to select techniques from cognitive therapy, behavioural therapy, third-wave therapies or metacognitive therapy according to the function they serve in each dimension. The model is presented as a framework for assessment, psychoeducation, formulation, selection of interventions and relapse prevention, and its authors stress that in its current state it constitutes primarily an integrative theoretical and clinical proposal whose specific efficacy, distinctive techniques and manualisation still require empirical research.

Theory of change

The person changes when they recognise and modify the controllable strategies of attention, thinking and behaviour that maintain their involuntary emotional reactions and develop more functional responses across the three domains.

Core ideas

  1. The diversity of CBT can be organised by means of three functional domains

    TriD-CBT starts from the premise that behavioural, cognitive, metacognitive and third-wave schools emphasise different processes but can locate much of their intervention within three areas: attention or focus, cognitive operations and behaviour. The proposal seeks a common structure that makes it possible to recognise what a technique is really modifying without requiring the clinician to adopt the whole theory of the school that produced it. (Özdel & Turkcapar, 2025, Tridimensional model of CBT).

  2. Attention, cognition and behaviour are interdependent domains

    The three domains continuously modify one another: attention determines which information is selected, cognitive operations organise and elaborate that information, and behaviour produces consequences that alter both the environment and future appraisals. An intervention may fail when it changes one dimension while the others continue to generate the same maintaining pattern, which is why TriD-CBT recommends formulating them together. (Özdel & Turkcapar, 2025, Tridimensional model of CBT).

  3. The clinically decisive distinction is what happens automatically and which strategy can be modified

    Intrusive thoughts, emotional arousal, physiological responses or initial captures of attention may appear without a voluntary decision, whereas ruminating, monitoring, avoiding, checking or neutralising usually have a greater strategic component. This distinction shifts the intervention from the attempt to control the automatic symptom directly towards the modification of responses that the patient can learn to recognise and reorganise. The boundary is graded and some phenomena combine both levels of control. (Özdel & Turkcapar, 2025; Beck & Clark, 1997).

  4. Many symptoms are also coping attempts

    Behaviours such as compulsions, social withdrawal, avoidance or safety behaviours may appear in the diagnostic criteria and at the same time function as strategies intended to neutralise fear, uncertainty, shame or other primary experiences. TriD-CBT considers it clinically essential to understand what the person is trying to resolve with the response and how its immediate consequences reinforce its repetition. (Özdel & Turkcapar, 2025, Tridimensional model of CBT).

  5. Repetitive thinking is an operation distinct from automatic thinking

    A negative thought may arise automatically without the person choosing it, whereas worry, rumination, searching for answers, prolonged self-criticism or neutralisation represent subsequent processes that keep the negative material active. This separation makes it possible to intervene on the mode of processing without requiring the immediate elimination of intrusive mental contents, and is consistent with the transdiagnostic evidence on rumination, worry and suppression. (Özdel & Turkcapar, 2025; McLaughlin, Borkovec, & Sibrava, 2007; Yapan, Türkçapar, & Boysan, 2022).

  6. Attention constitutes a therapeutic target of the same conceptual rank as cognition and behaviour

    TriD-CBT explicitly incorporates the attentional focus as a third dimension and distinguishes between automatic captures and strategies such as self-focused attention or sustained threat monitoring. This inclusion makes it possible to understand why a person may go on generating information congruent with the problem even while modifying thoughts or behaviour, and opens the framework to attentional control techniques drawn from metacognitive and third-wave approaches. (Özdel & Turkcapar, 2025; Wells & Matthews, 1996; Armstrong & Olatunji, 2012).

  7. Function and consequences determine whether a behaviour maintains the problem

    TriD-CBT avoids classifying an action as pathological on the basis of its form alone. The same behaviour may be functional or dysfunctional depending on context, intention and consequences; what is decisive is whether it broadens adaptation and learning or whether it is reinforced by immediate relief and restricts new experiences. Avoidance, safety and compulsions illustrate how a strategy may be effective in the short term and harmful in its cumulative effect. (Özdel & Turkcapar, 2025; Craske et al., 2014).

  8. Integration is carried out by the function of the techniques and not by an indiscriminate mixing of theories

    The model aims to reconcile apparently incompatible interventions by locating them according to the process they modify. Cognitive restructuring, exposure, behavioural activation, defusion, attention training or postponement of rumination may form part of a single plan when the formulation identifies a specific function for each. The integration remains within the cognitive-behavioural universe and preserves a pragmatic criterion for the selection of techniques. (Özdel & Turkcapar, 2025, Tridimensional model of CBT).

  9. Transdiagnosticity derives from shared processes and not from ignoring clinical differences

    TriD-CBT is considered a universal transdiagnostic model because attention, cognitive operations and behaviour can be assessed across different disorders, and processes such as rumination, automatic thinking, dysfunctional attitudes, suppression or avoidance cut across diagnostic categories. The particular configuration and the weight of each strategy may vary according to the problem, so that the universality of the architecture does not imply that all cases are homogeneous. (Özdel & Turkcapar, 2025; Yapan, Türkçapar, & Boysan, 2022; Schaeuffele et al., 2021; Dalgleish et al., 2020).

  10. TriD-CBT is currently an integrative framework under development and not a validated treatment package

    The foundational publication presents an architecture for organising assessment, formulation, psychoeducation and CBT interventions, but the authors acknowledge that its assumptions require specific testing and that distinctive techniques, clinical guidelines, case studies and trials comparing TriD-modified interventions with existing alternatives have still to be developed. Its current value therefore lies in the integrative formulation proposed, while its differential efficacy remains an open empirical question. (Özdel & Turkcapar, 2025, Tridimensional model of CBT, Limitations and Future directions).

Influences

  • Behaviourism and learning theory
  • Cognitive therapy and schema theory
  • Models of automatic and strategic processing
  • Transdiagnostic approaches
  • Psychotherapy integration and technical eclecticism
  • Third-wave cognitive-behavioural therapies
  • Metacognitive Therapy (MCT)
  • Acceptance and Commitment Therapy (ACT)
  • Process-Based Therapy (PBT)

Key references

  • Özdel, K., & Turkcapar, M. H. (2025). Tridimensional model of CBT: a transdiagnostic and transtheoretical pragmatic model. Frontiers in Psychology, 16, 1555047. https://doi.org/10.3389/fpsyg.2025.1555047
  • Yapan, S., Türkçapar, M. H., & Boysan, M. (2022). Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. Current Psychology, 41, 5896–5912. https://doi.org/10.1007/s12144-020-01086-4
  • Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58. https://doi.org/10.1016/S0005-7967(96)00069-1
  • Wells, A., & Matthews, G. (1996). Modelling cognition in emotional disorder: The S-REF model. Behaviour Research and Therapy, 34(11–12), 881–888. https://doi.org/10.1016/S0005-7967(96)00050-2
  • Armstrong, T., & Olatunji, B. O. (2012). Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis. Clinical Psychology Review, 32(8), 704–723. https://doi.org/10.1016/j.cpr.2012.09.004
  • McLaughlin, K. A., Borkovec, T. D., & Sibrava, N. J. (2007). The effects of worry and rumination on affect states and cognitive activity. Behavior Therapy, 38(1), 23–38.
  • Schaeuffele, C., Schulz, A., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2021). CBT at the crossroads: The rise of transdiagnostic treatments. International Journal of Cognitive Therapy, 14, 86–113. https://doi.org/10.1007/s41811-020-00095-2
  • Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of Consulting and Clinical Psychology, 88(3), 179–195. https://doi.org/10.1037/ccp0000482
  • Hayes, S. C., & Hofmann, S. G. (2021). Third-wave cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry. World Psychiatry, 20(3), 363–375.
  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006