UNIT 3: Therapeutic Approaches MODULE: Cognitive Behavioural Therapy

Transcription

1 UNIT 3: Therapeutic Approaches MODULE: Cognitive Behavioural Therapy Module co-ordinators: Gemma Ridel and Ken Laidlaw (2015 Cohort)

2 Unit: Module: Module co-ordinator: Learning Objectives Therapeutic Approaches Cognitive Behavioural Therapy Gemma Ridel This will build on from first and second year teaching to develop trainees knowledge and skills in CBT theory and practice. By the end of the trainees will be introduced to advances in the theory, models and practice of CBT, including third wave approaches such as Acceptance and Commitment therapy and Mindfulness. Trainees will also be taught transdiagnostic approaches such as CBT for low self esteem. Considering trainee s developmental needs, there will also be sessions on supervision and consultation using a CBT model, as well as working at core belief level. Assessment: To achieve this, the objectives of the are to provide teaching on: Appropriate assessment methods and techniques within CBT. Understanding theory and evidence base relating to these CBT assessment techniques. Formulation To achieve this, the objectives of the are to provide teaching on: Understanding the theory and evidence base for CBT models of formulation. Skills in collaboratively developing CBT formulations using the outcomes of assessment, drawing on theory, research, and specific CBT models. Skills in using knowledge of biology, development, social, cultural, and neuropsychological processes across the lifespan to facilitate adaptation of specific CBT formulations to individuals, groups, families, organisations, and communities. Skills in collaboratively using CBT formulations to guide specific and appropriate management plans including the setting of timescales within the CBT model. Skills in developing a formulation through a shared understanding in a way that is accessible and helps the client better understand their experience. Intervention The objectives of the are to provide teaching on: Understanding specific CBT techniques and processes as applied when working with a range of individuals in distress. Understanding the theory, professional guidelines, and evidence base in relation to CBT techniques. Understanding how to select CBT techniques collaboratively to meet the needs of an individual, groups or communities Conducting CBT in a way that promotes recovery of personal and social functioning as informed by service user values and goals.

3 Evaluation and Outcome Monitoring The objectives of the are to provide teaching on: Reviewing the ongoing effectiveness of CBT through monitoring of processes and outcomes, across multiple dimensions of functioning, in relation to recovery, values and goals and as informed by service user feedback as well as clinical indicators so that formulations and intervention can be modified/revised accordingly (Professional Responsibility) Building critical evaluation skills in relation to the evidence base and practice in CBT (Reflective Practice). Recognising when (further) intervention is inappropriate, or unlikely to be helpful, and communicating this sensitively to the clients and carers. NB: We aim to deliver the CBT s in line with the Roth and Pilling Competency framework and the BABCP core curriculum BABCP-Core-Curriculum.pdf

4 CBT Stream (2015 Cohort) The 3 rd year teaching will build on the fundamental knowledge trainees have developed over the 1 st and 2 nd year. In other words, trainees will be introduced to advances in the theory, models and practice of CBT. This will be with the aim to develop advanced skills in preparation for qualified status. YEAR TIME (HOURS) TOPIC LEARNING OBJECTIVES 3 3 Imagery Assessment, Formulation, Intervention and Evaluation Trainees will develop and advance CBT techniques through teaching and practice on imagery in CBT interventions. To introduce the importance and role of imagery in CBT practice To consider the role of imagery from assessment, formulation and treatment. To describe and practice using a couple of examples of imagery interventions and evaluate their effectiveness. 3 3 CBT for Bi-Polar Trainees will learn about the theoretical concepts and CBT approach to Bi-Polar through teaching on assessment, formulation, intervention, and outcome evaluation. 3 6 Acceptance Commitment Therapy 3 3 Mindfulness in CBT 3 3 Working at Core Belief level Summarise the behaviour theories underlying Acceptance and Commitment Therapy (ACT) Discuss the evidence based for ACT for different types of mental health conditions Explain psychological suffering using six components of the psychological inflexibility model Use one or two mindfulness and defusion exercises to increase the clients present moment awareness and acceptance Use an exercise to identify the clients core values and committed actions Intervention and Evaluation Trainees will develop and advance Mindfulness techniques within CBT through further teaching and practice on : The obstacles to using mindfulness with clients (and to practising it ourselves). Mindfulness approaches and techniques may be indicated (and contraindicated). Broader uses of Mindfulness with health and education Ability to identify and help client modify core beliefs Identifying beliefs o Downward arrow

5 YEAR TIME (HOURS) TOPIC LEARNING OBJECTIVES o How to present core beliefs to the client Modifying beliefs o Using standard techniques (e.g Behavioural experiments, socratic questioning) o Additional techniques (e.g. core belief worksheet, restructuring early memories) 3 3 Supervision & Consultation using a CBT model Intervention and Evaluation Trainees will develop and advance CBT techniques through teaching and practice on the use of CBT within supervision and consultation. This will include teaching on: The cognitive model as used in supervision and consultation The difference between supervision and consultation in a clinical setting Practice of the socratic approach to helping others practice (pairs exercise) Freeston model Dilemmas 3 CBT with Parents : Trainees will develop and advance CBT techniques through teaching and practice on working with parents in the application of CBT. This will include teaching on: Evidence base for CBT with Parents Systemic CBT Family interventions 3 6 CBT for Low Self- Esteem An Example of Addressing Deeper Levels of Cognition Trainees will develop and advance CBT skills through teaching on advanced trans-diagnostic models of CBT. This will provide teaching on: - Characteristics of low self-esteem - Assessment and Measures - CBT model of self-esteem (Fennell, 1997) - Intervention strategies for low self-esteem (including positive qualities surveys, positive data logs, continuum techniques), with reference to how to tackle deeper levels of cognition (including historical review of core beliefs, bi-directional continua, prejudice model)

6 YEAR TIME (HOURS) TOPIC 3 3 Therapist drift and transdiagnostic approaches to CBT LEARNING OBJECTIVES - Skills practice: continuum technique What is therapist drift How to deal with our therapy interfering behaviours How do we approach transdiagnostic models in the context of an evidence-based culture

7 The details in grey are for information only and illustrate 2015 Cohort teaching in Years 1 and 2. YEAR TIME TOPIC LEARNING OBJECTIVES 1 ½ day Introduction to CBT 1 1 day Fundamentals of CBT 1 1 day CBT for Depression Formulation & Evaluation Trainees will learn about the theoretical concepts, evidence base, and evaluation of behaviour therapy through: Introduction to the theoretical principles & practices of CBT Key characteristics of CBT levels of Cognition Introduction to the evidence base for CBT Outline the framework for additional teaching Trainees will learn about the theoretical concepts, fundamental model and fundamental intervention techniques of CBT through teaching on : CBT Assessment CBT Agenda setting and structuring sessions Goal Setting and Tracking Outcomes Guided Discovery/Use of Socratic Questions Homework setting and non-compliance issues Ending and relapse planning Skills practice: Goal-setting & Guided discovery Trainees will learn about the theoretical concepts and CBT approach to depression through teaching on : CBT Model of Depression Assessment and Measures for Depression & CBT CBT Formulation (case conceptualisation) for Major Depressive Disorder Overview of CBT intervention behavioural, cognitive and meta-cognitive interventions.

8 YEAR TIME TOPIC LEARNING OBJECTIVES 1 1 day CBT for Anxiety 1 1/2 day Panic: theory, presentation assessment and intervention CBT with Children 45 BABCP min (lunch time) 1 1 day Social Anxiety Disorder Skills practice: Behavioural interventions Behavioural Activation Trainees will learn about the theoretical concepts and CBT approach to anxiety through teaching on : Vicious Flower Formulation (case conceptualisation) Safety Behaviours Cognitive Interventions identifying and re-evaluating unhelpful thoughts, strategies for working with unhelpful thoughts Thought Diaries, Evidence recording sheets Skills practice: identifying NATS and looking for evidence The diagnostic features of panic disorder Assessment and Measures (including panic diaries and mood diaries) CBT model of panic disorder (Clark, 1986) In Vivo exposure and behavioural experiments Cognitive interventions for Panic Disorder Skills practice: formulating using a specific CBT model (Clark panic model). Trainees will learn about the application of CBT to work with children through teaching on : Evidence base for CBT for CYP Adapting for developmental needs, ability level, being creative Working systemically with CBT Skills practice: adapting for developmental needs (case studies) and/or planning creative treatment plans (given case vignettes) Evaluation Trainees will learn about the how the Course meets the minimum training standards (MTS) as detailed by the British Association for Behavioural and Cognitive Psychotherapies (BABCP). Trainees will learn about the theoretical concepts and CBT approach to social anxiety through teaching on :

9 YEAR TIME TOPIC LEARNING OBJECTIVES 1 1 day CBT for Obsessive Compulsive Disorder Part 1 & day CBT for Generalised Anxiety Disorder 1 1 day CBT for Post- Traumatic Stress Disorder - Assessment and Measures - Psychological models and theories - Clarke & Wells models of Social Phobia Overview of treatment - Skills practice Trainees will learn about the theoretical concepts and CBT approach to OCD through teaching on : - The diagnostic features of OCD - Assessment & Measures - CBT models of OCD (including Salkovskis model) - Intervention strategies for OCD - Skills practice: identifying thoughts and distinguishing these from meaning attributed to thoughts Trainees will learn about the theoretical concepts and CBT approach to GAD through teaching on : - The diagnostic features of GAD - Assessment & Measures (including worry records and mood diaries) - CBT model of GAD (Wells, 1995) - Intervention strategies for GAD (including advantages-disadvantages analysis, behavioural experiments, modifying beliefs about worry) - Skills practice: behavioural experiments Trainees will learn about the theoretical concepts and CBT approach to PTSD through teaching on : - The diagnostic features of PTSD - Assessment & Measures - CBT models of trauma (including Ehlers & Clark s model) - Intervention strategies for PTSD (including reliving and updating hotspots) - Skills practice: explaining rationale for reliving using metaphors 1 1 day CBT for Self Harm Assessment, Formulation, Intervention Trainees will learn about the theoretical concepts and CBT approach to self-harm through teaching on: The key characteristics to consider when working with self-harm

10 YEAR TIME TOPIC LEARNING OBJECTIVES 2 ½ day CBT for people with learning disabilities Conducting a thorough risk assessment and crisis plan Interventions available to help clients Evidence base Formulation, Intervention, and Evaluation Trainees will learn about the application of CBT to work with people with learning disabilities through teaching on : - Evidence base - Considerations & Adaptations for this client group - Specific models 2 ½ day Mindfulness Intervention and Evaluation Trainees will learn about the Mindfulness techniques within CBT through teaching on : The concept of mindfulness and how it can be applied in our clinical work. The obstacles to using mindfulness with clients (and to practising it ourselves). Mindfulness approaches and techniques may be indicated (and contraindicated). Broader uses of Mindfulness with health and education

11 Teaching sessions from other s which have significant content related to Psychological Therapies Year Module LEARNING OBJECTIVES NOTES 1 Unit 1:Core Clinical skills workshop 1: developing Assessment see ½ day therapeutic interviewing skills 1 Unit 1:Core Structured clinical interviewing, assessment, Assessment see ½ day diagnosis and classification 1 Unit 1:Core The therapeutic alliance Assessment see ½ day 1 Unit 1:Core Clinical skills workshop 3: Formulation Formulation see ½ day 1 Unit 1:Core Clinical skills workshop 4: therapy skills videoed Intervention see 1 day role play 1 Unit 1:Core Clinical skills workshop 5: Power, boundaries Evaluation see ½ day and dealing with difficult situations 1 Unit 1:Core Supervision: being supervised and using tapes Evaluation see ½ day in supervision 1 Problems, Disorders & populations adult Introduction to anxiety and depression Assessment, Formulation, ½ day 1 Children, young people, and families 2 Problems, Disorders, & populations adult Internalizing problems: anxiety and depression in children Eating disorders adults and young people Assessment, Formulation, Assessment, Formulation, ½ day ½ day 2 Problems, Personality disorders (Schema-based CBT) Assessment, Formulation, ½ day

12 Disorders, & populations adult 2 Problems, Disorders, & populations adult 2 Problems, Disorders, & populations Older Adults: 2 Clinical Health Psychology 2 Clinical Health Psychology 2 Problems, Disorders, & populations Older Adults: Psychosis CBT with older adults Paediatric clinical health psychology Drug and Alcohol Gerontology and contemporary understandings of the experience of ageing Assessment, Formulation, Assessment, Formulation, Assessment, Formulation, Assessment, Formulation, Assessment, Formulation, 1 day 1 day 1 day ½ day ½ day Additional Learning Resources Any year ½- 1 day Self/Peer Directed Compassion Focused Therapy see website Online

13 General Texts Beck, J. (2011). Cognitive Therapy for Challenging Problems: what to do when the basics don t work. New York. NY: Guilford Press. Beck, J. (2011). Cognitive Therapy: The Basics and Beyond (2 nd Ed). New York, NY: Guildford Press. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, B. (1987). Cognitive therapy of depression. New York, NY: Guildford Press. Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford, UK: Oxford University Press. Blackburn, I. M, James, I. A., Milne, D. L. & Reichelt, F. K. (2001). Cognitive Therapy Scale Revised (CTS-R). Newcastle upon Tyne, UK: Tyne & Wear NHS Trust. Bruch, M (Ed.) (2015). Beyond Diagnosis: Case Formulation in Cognitive Behavioural Therapy (2 nd Ed.) London, UK: Wiley- Blackwell. Butler, G., Fennell, M.J., Hackmann, M. (2010). Cognitive- Behavioural Therapy for Anxiety Disorders: Mastering Clinical Challenges. London, UK: Guilford Press. Gilbert, P. & Leahy, R.L. (2009). The Therapeutic relationship in the cognitive behavioural psychotherapies. New York, NY: Routledge. Greenberger, D. & Padesky, C. A. (2015). Mind Over Mood: Change How you Feel by Changing the Way you think (2 nd Ed.). London, UK: Guildford Press. Hawton, K. & Salkovskis, P. (1989). Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide. Oxford, UK: Oxford University Press. Mueller, M., Kennerley, H., McManus, F., Westbrook. D (2010). Oxford Guide to Surviving as a CBT Therapist. Oxford, UK: Oxford University Press. Padesky, C. & Greenberger, D. (1995). Clinician s guide to Mind over Mood. New York, NY: Guilford Press. Roth, A. & Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy with people with depression and with anxiety disorders. Department of Health. Retrieved from: Shafran, R., Brosan, L., Cooper, P. (2013). The Complete CBT Guide for Anxiety. London, UK: Constable & Robinson Ltd. Stott, R., Mansell, W., Salkovskis, P. M., Lavender, A. & Cartwright- Hatton, S. (2010). Oxford Guide to Metaphors in CBT: Building Cognitive Bridges. Oxford, UK: Oxford University Press.

14 Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, England: Wiley. Wells, A. (2000). Emotional Disorders and Meta Cognition: Innovative Cognitive Therapy. Chichester, England: Wiley- Blackwell. Westbrook, D., Kennerley, H., & Kirk, J. (2016). An Introduction to Cognitive Behaviour Therapy: Skills and Applications (3 rd Revised Ed.). London: Sage CBT for Children & Young People Friedberg, R.D., & McClure, J.M. (2015). Clinical Practice of Cognitive Therapy with Children and Adolescents: The Nuts and Bolts (2 nd Ed.). New York, NY: Guildford Press. Fuggle, P., Dunsmuir, S., & Curry, V. (2012). CBT with Children, Young People and Families. London, UK: Sage. Kendall, P (2011). Child and Adolescent Therapy: Cognitive Behavioural Procedures. New York, NY: Guildford Press. Stallard, P. (2002). Think Good-Feel Good: A Cognitive Behaviour Therapy Workbook for Children and Young People. Chichester, England: John Wiley & Sons. Stallard, P. (2005). A Clinician's Guide to Think Good-Feel Good: Using CBT with children and young people. Chichester, England: John Wiley & Sons. CBT for Older Adults Laidlaw, K., Thompson, L.W., & Gallagher-Thompson, D. (2013). Cognitive Behaviour Therapy with Older People. Chichester, England: John Wiley & Sons, Ltd. Pachana, N., Laidlaw, K., & Knight, B. (Eds) (2010). Casebook of Clinical Geropsychology: International Perspectives on Practice. Oxford, UK: Oxford University Press. CBT for Learning Disabilities Stenfert Kroese, B., Dagnan, D., & Loumidis, K. (Eds.) (1997). Cognitive-Behaviour Therapy for People with Learning Disabilities. London, UK: Routledge. Taylor, J. L., Lindsay, W. R., Hastings, R. P., Hatton, C. (Eds.) (2013). Psychological therapies for adults with intellectual disabilities. Chichester, England: John Wiley & Sons. Service User and Carer Perspective Clarke, H., Rees, A., & Hardy, G. (2004). The big idea: Clients perspectives of change processes in cognitive therapy. Psychology and Psychotherapy: Theory, Research and Practice, 77, DOI: / Morberg Pain, C., Chadwick, P., & Abba, N. (2008). Clients experience of case formulation in cognitive behaviour therapy for psychosis. British Journal of Clinical Psychology, 47, DOI: / X235962

15 Westra, H. A., Aviram, A., Barnes, M., & Angus, L. (2010). Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive behavioural therapy, Psychotherapy Research, 20, , DOI: /

16 HCPC (2015) standards of proficiency covered in the teaching on this : 2. Be able to practice within the legal and ethical boundaries of their profession 4. Be able to practise as an autonomous professional, exercising their own professional judgement 5. Be aware of the impact of culture, equality and diversity on practice 8. Be able to communicate effectively 9. Be able to work appropriately with others 11. Be able to reflect on and review practice BPS (2015) competencies covered in the teaching on this Module: 1. Generalizable meta-competencies 2. Psychological Assessment 3. Psychological Formulation 4. Psychological Intervention 5. Evaluation 7. Personal and professional skills and values 8. Communication and teaching 9. Organisational and systemic influence and leadership 12. Be able to assure the quality of their practice 13. Understand the key concepts of the knowledge base relevant to their profession 14. Be able to draw on appropriate knowledge and skills to inform practice Information on BABCP standards of accreditation can be found at: