Cognitive Behavioral Therapy Practice Research Articles

Creating a cognitive–behavioural therapy (CBT) skills cascade for palliative care practitioners

IntroductionEmotional distress is common in palliative care and access to expert psychological help is limited. We have developed, evaluated and cascaded a brief training in CBT skills for palliative care...

From Mindfulness to Meta-mindfulness: Further Integration of Meta-mindfulness Concept and Strategies into Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) has been shown to be an efficacious treatment for a wide range of psychological disorders. In the last three decades, there has been a fruitful and successful integration of Buddhist thought and practices in CBT through the concept of mindfulness. Mindfulness is actually only one of the eight contemplative practice guidelines of the Middle Way, a pan-Buddhist principle for overcoming suffering and generating happiness. Hence, in Western literature, although the integration of the mindfulness concept was successful, it is rather narrow and does not reflect the complexity of mindfulness as in Buddhism. This may have impeded the use of its full potential in clinical practice. This article therefore will highlight the lesser known aspect of mindfulness (Right Mindfulness) in the Middle Way and its synergistic relationship with the other seven practice guidelines (i.e., Right Speech, Action, Livelihood, Effort, Concentration, Thought, and View). We then propose their potential integration and application in an evidence-based CBT approach. It is suggested that by integrating this broader meta-mindfulness approach, further advances in CBT practices, research, and training can be made to benefit the human race.

Supervising Cognitive-Behavioral Psychotherapy: Pressing Needs, Impressing Possibilities

While accounts of the practice of cognitive behavioral therapy (CBT) supervision have been available over the past 15 years and have demonstrated consistency in terms of an overall model specifying the structure, process and content of supervision sessions, a number of gaps can be identified in the literature on the clinical supervision of CBT. Comprehensive consensus statements of the competencies underlying clinical supervision have been developed both in the United States (Falender et al., J Clin Psychol, 60, 771–785, 2004) and in the United Kingdom (Roth and Pilling, IAPT supervision competencies framework, University College London, 1992), but there has been a lack of attention to relevant theory and to procedural detail. As a consequence, the literature on CBT supervision has only recently begun to assimilate concepts from the wider supervision field (e.g. developmental models), and there is as yet no manual that would allow supervisors to make explicit determinations of competency. Furthermore, supervision in general continues to suffer both from the absence of compelling empirical support demonstrating its effectiveness in improving clinical outcomes, and there is a lack of explicitly-defined supervisory procedures that can be reliably observed and measured. Unfortunately, this combination of factors hampers the development of CBT supervision (e.g. it complicates efforts to provide a standardized framework for training in supervision). As an important starting point in ‘treating’ the underdeveloped state of CBT supervision, we outline a formulation of its current condition, then suggest some promising interventions.

Cognitive Behavioral Group Treatment for Chinese People with Depressive Symptoms in Hong Kong: Participants’ Perspectives

This study documents the experiences of 20 Chinese people in Hong Kong who participated in group cognitive behavioral therapy (CBT). They were asked to comment on the aspects of the group content and process that they found to be useful or not useful in dealing with their depressive moods. In general, they reported that the groups helped them gain awareness of their thought and behavioral patterns and learn new cognitive and behavioral strategies. Certain aspects of the group process, however, such as the outpouring of negative emotions, were considered by the participants to be counterproductive to their learning and practice of CBT.

Das biopsychosoziale Modell als Leitfaden für die Behandlung von muskuloskelettalen Schmerzen und Behinderungen durch bewegungsbasierte Therapie

BACKGROUND: Whether or not pain patients presenting to physiotherapists are suited for rehabilitation using movement-based treatments depends critically on the nature of the underlying pathology. OBJECTIVE/METHOD/RESULTS: Examples are given of suitable and unsuitable pathologies. However, even when not contraindicated, where clinical decisions are based on the outmoded ”biomedical” (structure-based) model, which often seems to be the case, the chances of success are seriously limited. ”Best practice” evidence indicates that better clinical outcomes, along with therapists’ improved perceptions of self efficacy, are likely to be achieved by strategies that also address psychological drivers of musculoskeletal pain. On the basis of examples and evidence it is argued, that well-trained physiotherapists are ideally positioned to utilise appropriate strategies based on the principles and practice of cognitive behavioural therapy. CONCLUSION:Cognitive behavioural therapy is a product of the now preferred biopsychosocial model of pain and pain-related disability.

The clinical practice of Cognitive Behavioural Therapy for children and young people with a diagnosis of Asperger’s Syndrome

Children and young people diagnosed with Asperger's Syndrome (AS) have significant social-communication difficulties and impaired empathy and theory of mind skills. These difficulties place them at risk of developing mental health problems, particularly anxiety, depression and obsessive compulsive disorder. Although Cognitive Behavioural Therapy (CBT) is recognised as an effective intervention for these problems in both child and adult populations, little research has specifically looked at the use of CBT with children and young people with an AS diagnosis. However, limited evidence suggests that CBT, if suitably adapted, is a feasible and potentially helpful treatment option. This paper focuses on the clinical practice of CBT and explores how the underpinning therapeutic relationship can be modified to meet the cognitive needs of this particular group of young clients.

Common themes and cognitive biases in the negative thoughts of women with recurrent genital herpes: clinical reflections and implications for cognitive behaviour therapy

There is a relatively high prevalence of psychological distress among individuals with recurrent genital herpes. Clinical experience suggests that women who experience psychological distress typically present to clinical psychology services with similar negative thoughts and cognitive biases. The current paper describes seven themes that were common in the negative thoughts of five women presenting with psychological distress associated with recurrent genital herpes. Simple content theme analysis was used to analyse assessment and therapy session notes. Themes included: negative perceptions of the self and sex/sexual history; concerns about the risk and responsibility of transmitting the virus to sexual partners; concerns about the experience of disclosure and the possibility of rejection following disclosure; and misinterpretation of bodily sensations. A number of cognitive biases were evident in the women's negative thoughts. Cognitive biases included catastrophising, predicting the future, all-or-nothing thinking and self-blame. Implications for the practice of cognitive behaviour therapy with individuals who are distressed by a diagnosis of recurrent genital herpes are discussed.

Can a ‘return-to-work’ agenda fit within the theory and practice of CBT for depression and anxiety disorders?

AbstractHelping service users to return to work has emerged as a key therapeutic objective of the Improving Access to Psychological Therapies (IAPT) initiative. IAPT programmes implement National Institute for Health and Clinical Excellence (NICE) guidelines, especially cognitive behaviour therapy (CBT), for people suffering from anxiety and depression. However, relatively little research has been conducted to date into whether, or how, cognitive behavioural interventions can help individuals return to work. This paper reviews literature and research into CBT and occupational outcomes and considers whether a return-to-work agenda may jeopardize the therapeutic alliance which is suggested to be necessary for effective CBT. Moreover, through the use of clinical examples from our practice, we suggest ways in which employment issues might be integrated into CBT for depression and anxiety disorders. We conclude that a return-to-work agenda can be utilized during therapy while maintaining a collaborative and secure therapeutic relationship, especially, perhaps if work issues are embedded within the formulation. However, further research is needed, not only to determine whether CBT can help individuals return to work but also how CBT might best integrate a return-to-work agenda.

Introduction

Spiritual and religious beliefs and practices are commonplace in the general population of North America today. In recognition of this fact, research on the interplay of spirituality, religion, and psychological variables increased substantially over the past 3 decades; a recent PsycInfo search identified over 28,000 scientific contributions to this area. However, the relevance of spirituality and religion to clinical practice remains poorly understood. As a result, many practitioners of empirically supported treatments may be reticent to address spirituality and religion in the course of their work. The intent of this special series is to help demystify this topic with the hope of increasing dissemination of spiritually sensitive, empirically supported treatments. The authors in this series cast some light on this understudied topic by highlighting several salient spiritual and religious issues in behavior change. Moreover, based on case material, the authors illustrate how to assess for and address both adaptive and maladaptive utilizations of spirituality and religion in the practice of cognitive behavior therapy. This introductory paper presents a rationale for why it is important to address this topic, and provides an overview of recent research developments in the creation of spiritually integrated psychosocial treatments.

Keep it Simple—The Transdiagnostic Approach to CBT

A special issue of the International Journal of Cognitive Therapy on the transdiagnostic approach to cognitive behavioural therapy (CBT) is both timely, and also long overdue. Clinicians, researchers and theorists have been commenting on the commonalities in the psychological processes involved in human distress and dysfunction since the dawn of psychotherapy. The transdiagnostic approach, in recent years, merely provides a formalised method for this enterprise – to systematically evaluate the degree of overlap in cognitive and behavioural maintenance processes across a wide range of psychological disorders. This special issue provides articles that introduce the approach, evaluate the evidence to support it, explore its clinical utility and imbue it with a contemporary theoretical perspective. As the above quotes imply, the long term aim of the transdiagnostic approach is to simplify the science and practice of CBT to an appropriate level – one that reflects the universality of human psychology and captures the principles required to make CBT as efficient and comprehensively applicable as is scientifically possible.

Clients' experience of case formulation in cognitive behaviour therapy for psychosis

Case formulation (CF) is considered essential to the practice of cognitive behaviour therapy, and crucial when working with more complex problems such as psychosis. Several claims are made for the beneficial impact of CF on clients, although little empirical research has been conducted. The study used content analysis methodology to assess clients' experience of the CF process in cognitive behaviour therapy for psychosis. In addition, therapists ranked seven documented benefits for them of CF. Thirteen clients and their respective therapists were interviewed 2-3 weeks after shared written formulation. Overall, clients' reactions to CF were cognitively, behaviourally, and emotionally complex, and subject to change over time. Therapists reported that they found the CF to be most useful in increasing their understanding of their clients. Formulation is a complex process for clients, and future research into CF faces methodological challenges.

From Cognitive Behaviour Therapy (CBT) to Cognitive Behaviour Coaching (CBC)

This article focuses on how the principles and practice of cognitive behaviour therapy (CBT) can be adapted to the field of coaching to become cognitive behaviour coaching (CBC) and the current empirical status of CBC is discussed. The centrepiece of CBC practice is the ABCDE model of identifying psychological blocks and their removal. Typical tools and techniques used in CBC are outlined and ten key questions to ask in coaching are advanced. What CBC can offer coaches is discussed and, finally, suggestions are made to point out when coaching should really be counselling.

Review of Cognitive-behavioural therapy in groups.

PETER J. BIELING, RANDI E. McCABE and MARTIN M. ANTONY Cognitive-Behavioural Therapy in Groups Guilford Press, 2006, 440 pages (ISBN: 9781593853259, $45.00 Hardcover) Reviewed by MICHELLE HARING Cognitive behaviour therapy (CBT) is a widely used, evidence-based treatment for a variety of different psychological problems. Among the many strengths of this approach are its well-developed dieoretical underpinnings, strong research base, and the availability of excellent treatment manuals. With increasing pressure to make effective treatments more accessible and cost effective, many psychologists and health care professionals are being asked to provide CBT in a group format. Clinicians who treat clients using group CBT recognize that administering this treatment in a group is qualitatively different from administering the same treatment to an individual, and often try to balance the goal-directed didactic components of CBT with awareness of group processes. However, research and guidelines are lacking regarding how to effectively and optimally deliver CBT in a group format with appropriate consideration of group processes. This book, written by three well-known experts in the science, practice, and teaching of CBT, aims to provide a bridge between manualized CBT and the theory and knowledge of group process factors in order to understand how CBT can be most productively operationalized within a group context. Throughout this excellent book, the authors convey the message that attention to process in CBT groups is as necessary to a successful group experience as knowing how to teach basic CBT skills. They provide specific guidance about how to use the properties of groups to facilitate learning of concepts and strategies in order to maximize change. They also provide information about structuring groups, effective leadership skills, and how to manage many of the common challenges associated with group process. In so doing, these authors address a significant gap in most group CBT treatment manuals. In Part One, the authors identify and describe group process factors relevant to CBT and develop a framework for utilizing and integrating these factors into the practice of group CBT. In Chapter One, the authors briefly review the group process literature, identifying key therapeutic principles and process factors relevant to any well-functioning CBT group. In Chapter Two, the authors integrate knowledge from the group process literature with an understanding of key aspects of CBT and present a new taxonomy of relevant process factors. They also review how these factors may be incorporated into the standard structure of a CBT group session. In Chapters Three and Four, the authors review specific cognitive and behavioural techniques and how these are best taught within a group context. In Chapters Five and Six, they review key structural elements of CBT groups, including client/patient selection, therapist factors and session structure, and commonly arising problems in CBT groups, along with suggestions on how to manage these problems. Part Two of this book consists of a collection of chapters on how to conduct effective group CBT for specific disorders with coverage of techniques, process issues, and challenges particular to each disorder. There are individual chapters on Panic Disorder and Agoraphobia, Obsessive-Compulsive Disorder, Social Anxiety Disorder, Depression, Bipolar Disorder, Eating Disorders, Substance Abuse, Personality Disorders, and Schizophrenia. The first six chapters of this section were written by the lead authors, with the remaining three chapters written by invited authors. Each chapter follows a similar structure, providing a description of key features of the disorder, the cognitive-behavioural model of the disorder, a concise review of the literature on effective treatment approaches (with special attention to group treatment) , a review of issues relevant to assessment and structuring of group treatment, and a review of key treatment components. …

Are Depressed Adolescents Routinely Offered CBT? A Brief Review of Current Practice

AbstractAn increasing body of research in support of cognitive-behavioural therapy (CBT) for adolescent depression has emerged during the last two decades. However, it has been suggested that empirically supported treatments are seldom carried out in clinical practice. Although the reasons for this are likely to be diverse, it is argued that mental health services have an ethical responsibility to offer evidence-based interventions. Whether empirically supported interventions, such as CBT, are consistently offered to depressed adolescents attending Child and Adolescent Mental Health Services (CAMHS) is currently unknown. A primary aim of this study was to survey the use of CBT for depression in a number of United Kingdom (UK) CAMHS settings. A postal questionnaire was sent to 117 members of the BABCP Children, Adolescents and Families Special Interest Branch, of which 44 completed questionnaires were returned. Descriptive statistics indicate that just over half of the organizations represented routinely offered CBT to depressed adolescents. CBT practice and the transportation of evidence-based research findings to CAMHS settings are discussed.

The Availability of Cognitive Behaviour Therapy Within Specialist Child and Adolescent Mental Health Services (CAMHS): A National Survey

The National Institute for Clinical Excellence has recommended cognitive behaviour therapy (CBT) for a number of common child and adolescent mental health disorders. The aim of this study was to clarify the practice of CBT within specialist child and adolescent mental health services in the United Kingdom. A survey was distributed to specialist child mental health workers through national organizations and professional bodies. Approximately 10% of specialist CAMHS professionals replied (n = 540). One in five reported CBT to be their dominant therapeutic approach, whilst 40% rarely used CBT. Specialist post-qualification training had been undertaken by 21.0% of respondents, with over two-thirds identifying training needs in the core skills of CBT. This survey suggests that the capacity of specialist CAMHS to meet the requirements of NICE in terms of the availability of CBT skills is doubtful. There is a need to develop CBT training and supervision infra-structures.

Predicting Changes in Obsessive Compulsive Symptoms Over a Six-Month Follow-Up: A Prospective Test of Cognitive Models of Obsessive Compulsive Disorder

Cognitive models of obsessive compulsive disorder (OCD) propose that OCD-related beliefs (e.g., inflated responsibility) and negative life events should predict changes in OC symptoms over time (Rachman, 1997, Behaviour Research and Therapy, 35, 793–802; Rachman, 1998, Behaviour Research and Therapy, 36, 385–401; Rachman, 2002, Behaviour Research and Therapy, 40, 625–639; Salkovskis, 1985, Behaviour Research and Therapy, 23, 571–583; Salkovskis & Kirk, 1997, In The science and practice of cognitive behavior therapy. Oxford: Oxford University Press). However, very little research has tested these longitudinal predictions. The current study sought to replicate and extend findings by Coles and Horng (2006, Cognitive Therapy and Research, 30, 723–746) showing that OCD-related beliefs and negative life events significantly predicted changes in the frequency of OC symptoms over 6 weeks. Results of the current study, using a 6-month prospective longitudinal design, provided modest support for cognitive models of OCD. Negative life events significantly predicted residual change in both the frequency of, and distress associated with, OC symptoms. Initial OCD-related beliefs significantly predicted residual change in the distress associated with OC symptoms, but there was much additional variance to be accounted for. Additional data are presented that both examine the specificity of these predictors to changes in OC symptoms versus social anxiety and depressive symptoms, and explore particular types of life events in predicting symptom changes over time.

Theoretical Development and Clinical Practice of Cognitive Behavior Therapy in Correctional Facilities

Theoretical Development and Clinical Practice of Cognitive Behavior Therapy in Correctional Facilities

Cognitive Behavior Therapy: Basic Principles and Recent Advances

Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (1–3), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 4–7). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.

When simplifying life is not so bad: the link between rigidity, stressful life events, and mental health in an undergraduate population

Decades of research have generally shown that being more rigid is associated with poorer mental health. We investigated whether all aspects of what has been termed “rigidity” are harmful. In particular, we hypothesized that the desire for simple structure (DSS) will not be associated with poor mental health, and in some cases might be associated with better mental health. In contrast, the intolerance of uncertainty (IU) was hypothesized to be associated with a wide range of indices of poor mental health. We also hypothesized that people high in IU would be less resilient in the face of stressful life events. Results across two cross-sectional surveys (N=240; N=331) supported our hypotheses. DSS was associated with less hopelessness, whereas IU was associated with more depression, anxiety, stress, suicidal ideation, and hopelessness. In addition, moderational analysis supported the hypothesis that IU magnifies the adversive effect of stressful life events on depression, anxiety and hopelessness. IU was more strongly related to the negative indices of well-being than to the positive index of life satisfaction. The implications of these findings for cognitive behavioural therapy practice are discussed.

Empiricism, mechanism, and the practice of cognitive-behavior therapy

The thesis of this article is that a case formulation-driven approach to clinical work that relies on a case formulation and a hypothesis-testing approach to each case facilitates the use, in clinical settings, of empirically supported treatments (ESTs) that were developed in research settings. The two touchstones of a case formulation-driven approach to cognitive-behavior therapy (CBT) are, as the title of the article indicates, mechanism and empiricism . In a formulation-driven approach, the therapist relies on hypotheses about the mechanisms causing, maintaining, and promoting change in problem behaviors. The therapist also adopts an empirical approach to each case that includes hypothesis-testing and repeated data collection to evaluate the process and progress of treatment. This article describes the main features of a case formulation-driven approach to CBT, shows how it addresses many of the obstacles that impede practitioners from using empirically supported protocols in their daily clinical work, examines its intellectual origins and some data supporting its effectiveness, and concludes with a discussion of implications of the method for future developments in the field.