Cognitive Behavioural Therapy - Ministry Of Health
CognitiveB e h a v i o u ra lT h e ra p yC O R E I N F O R M AT I O NDOCUMENTMARCH 20075CARMHACentre for Applied Research inMental Health and AddictionFaculty of Health SciencesSimon Fraser University
Centre for AppliedResearch in Mental Healthand Addictions (CARMHA)www.carmha.caSFU @ Harbour Centre, Faculty of Health Sciences7200 - 515 W. Hastings Street, Vancouver BC V6B 5K3Library and Archives Canada Cataloguing in Publication DataSomers, Julian.Cognitive behavioural therapy [electronic resource]“The Core information document on cognitive-behavioural therapy was developed by the Centrefor Applied Research in Mental Health and Addiction (CARMHA) at Simon Fraser Universityunder the direction of the Mental Health and Addiction Branch, Ministry of Health”—P. i.“Principal author: Julian Somers ; contributing author: Matthew Querée”Available also on the Internet.ISBN 0-7726-5598-71. Cognitive therapy. 2. Mental illness – Treatment. 3. Mental illness - Bibliography. I. Querée, Matthew.II. British Columbia. Mental Health and Addictions.III. Simon Fraser University. Centre for Applied Researchin Mental Health and Addictions. IV. British Columbia. Ministry of Health.RC489.C63S65 2006616.89’14209711C2006-960147-X
DisclaimerResearch in the medical and behavioural sciences and informationabout cognitive behavioural therapy and pharmacological treatmentsfor mental disorders and addictions is rapidly changing. Furthermore,medical and health concerns are unique to each individual and requireindividual attention and care. Accordingly, it is recommended thatyou consult with your physician and a qualified cognitive behaviouralpractitioner before acting on any of the information in this book.Core Information Document on Cognitive-Behavioural TherapyThe Core Information Document on Cognitive-Behavioural Therapywas developed by the Centre for Applied Research in Mental Healthand Addictions (CARMHA) at the Simon Fraser University under thedirection of the Mental Health and Addictions Branch, Ministry ofHealth, Government of British Columbia. This document is part of anumber of best practice documents released by government to supporthigh quality mental health and addictions care in the province.N OT E : The terms cognitive behavioural therapy, cognitive-behaviourtherapy, and cognitive-behavioural therapy are synonymous and usedinterchangeably throughout this document.C O G N I T I V E B E H AV I O U R A L T H E R A P YiCORE INFORMATION DOCUMENT
Principal AuthorJulian Somers, MSc., PhDContributing AuthorMatthew Querée, BA (Hons.), M.App.Psych.Research AssistantsJessica BroderickBonnie LeungBritish Columbia Ministry of Health AdvisorsGulrose Jiwani, RN MNAddictions Performance Specialist, Mental Health and AddictionsWayne Fullerton, Ed.D, R.Psych.Mental Health SpecialistThe authors wish to thank the following individuals and groups for valuableadvice and assistance during the development of the current report:Lead Research ConsultantsWarren Mansell, BAHons (Cantab) DPHil (Oxford) DCLinPsy CPsycholLecturer, Department of PsychologyUniversity of Manchester, UKRoz Shafran, PhDPsychologist, Department of PsychiatryOxford University, UKC O G N I T I V E B E H AV I O U R A L T H E R A P YiiCORE INFORMATION DOCUMENT
CBT Expert and Stakeholder ReviewersDan Bilsker, PhD, RPsychClinical Assistant Professor,Department of PsychiatryUniversity of British ColumbiaKaren R. Cohen, PhDAssociate Executive Directorand Registrar AccreditationCanadian Psychological AssociationPeter Coleridge, Senior AdvisorProvincial Health Services AuthorityKenneth D. Craig, PhD, RPsychProfessor Emeritus,Department of PsychologyUniversity of British ColumbiaPeter Mclean, PhD, RPsychDirector, Anxiety Disorders UnitProfessor, Department of PsychiatryUniversity of British ColumbiaJohn Service, PhD, CPsychExecutive DirectorCanadian Psychological AssociationRajpal Singh, PhD, RPsychPsychologist,Vancouver-Richmond Health BoardMulticultural Mental HealthLiaison Worker, South AsianMental Health TeamPatrick Smith, PhDSenior Advisor, Mental Healthand AddictionsProvincial Health Services AuthorityPhil UpshallMood Disorders Society of CanadaDavid Wong, PhD, RPsychPsychologist, Chinese Mental WellnessAssociation of CanadaBill MussellChairman and PresidentNative Mental HealthAssociation of CanadaPrincipal Educator, Sal’i’shan InstituteMichelle Patterson, PhDResearch Scientist,CARMHA, SFUSimon A. Rego, PsyDAssistant Professor,Psychiatry and Behavioral SciencesAssociate Director of Training,Adult CBTAlbert Einstein College of MedicineMontefiore Medical CenterNew York, USAC O G N I T I V E B E H AV I O U R A L T H E R A P YiiiCORE INFORMATION DOCUMENT
C O G N I T I V E B E H AV I O U R A L T H E R A P YivCORE INFORMATION DOCUMENT
Ta b l e o f C o n t e n t sC H A P T E R 1 : I N T R O D U C T I O N TO T H E C O R E I N F O R M AT I O N D O C U M E N TT h e N e e d f o r a “ C o re I n f o r m a t i o n D o c u m e n t ”A R e s o u rc e f o r Va r i o u s R e a d e rsWh a t i s C B T ?Fo r m s o f C B TW h o P ro v i d e s C B T ?C l i n i c a l Tr a i n i n g i n C B T1123445C H A P T E R 2 : W H AT I S C O G N I T I V E - B E H AV I O U R A L T H E R A P Y ( C B T ) ?1.0 T h i n k i n g2.0 Behaviour3 . 0 T h e T h e ra p y78910CHAPTER 3: D E P R E S S I O N1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Pa t i e n t Po p u l a t i o n s3.0 Effects on Relapse Rates4 . 0 E f f e c t s o n G l o b a l M e a s u re s o f F u n c t i o n i n g5 . 0 C o m b i n e d C B T a n d P h a r m a c o l o g i c a l Tr e a t m e n t6.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s7 . 0 B r i e f T h e ra p y a n d ‘ R a p i d R e s p o n d e rs ’8.0 Self-Help and CBT9 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T f o r D e p re s s i o n ?1 0 . 0 R o l e o f t h e Fa m i l y11.0 Summary151618181919CHAPTER 4: BIPOLAR DISORDER1 . 0 T h e C o n t e n t o f t h e T h e ra p y2.0 Effects of CBT3.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s4 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T f o r B i p o l a r D i s o rd e r ?5 . 0 R o l e o f t h e Fa m i l y6.0 SummaryC O G N I T I V E B E H AV I O U R A L T H E R A P YvCORE INFORMATION DOCUMENT19202021222225262828292930
Ta b l e o f C o n t e n t sC H A P T E R 5 : S U B S TA N C E U S E D I S O R D E R S1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Po p u l a t i o n s3.0 Effects on Relapse Rates4 . 0 C o m b i n e d C B T a n d P h a r m a c o l o g i c a l Tr e a t m e n t5.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s6 . 0 B r i e f I n t e r v e n t i o n s, B r i e f T h e ra p y a n d C B T7.0 Self-Help and CBT8 . 0 C o n c u r re n t D i s o rd e rs a n d C B T9.0 Wh a t P re d i c t s A B e t t e r R e s p o n s e To C B T w i t h S u b s t a n c e U s e D i s o rd e rs ?1 0 . 0 R o l e o f t h e Fa m i l y11.0 SummaryCHAPTER 6: G E N E R A L I Z E D A N X I E T Y D I S O R D E R ( G A D )1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Po p u l a t i o n s3 . 0 G ro u p Tr e a t m e n t s4.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s5.0 Comparison with Pharmacological Interventions6.0 Self-Help and CBT7 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T ?8 . 0 R o l e o f t h e Fa m i l y9.0 SummaryC H A P T E R 7 : PA N I C D I S O R D E R1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Po p u l a t i o n s3 . 0 G ro u p Tr e a t m e n t s4.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s5.0 Comparison with Pharmacological Interventions6 . 0 P re d i c t o rs o f O u t c o m e7 . 0 P re s e n t a t i o n a t E m e rg e n c y D e p a r t m e n t s8.0 Self-Help and CBT9 . 0 R o l e o f t h e Fa m i l y10.0 SummaryC O G N I T I V E B E H AV I O U R A L T H E R A P YviCORE INFORMATION 505354575757585858595959
Ta b l e o f C o n t e n t sCHAPTER 8: OBSESSIVE-COMPULSIVE DISORDER (OCD)1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Po p u l a t i o n s3 . 0 L o n g - Te r m O u t c o m e4.0 Pharmacological Options5 . 0 C o m b i n e d C B T a n d P h a r m a c o l o g i c a l Tr e a t m e n t6.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s7 . 0 B r i e f T h e ra p y a n d ‘ R a p i d R e s p o n d e rs ’8.0 Tr e a t m e n t R e f ra c t o r y O C D9.0 Self-Help and CBT1 0 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T ?1 1 . 0 R o l e o f t h e Fa m i l y12.0 Summary616365656666CHAPTER 9: SPECIFIC PHOBIAS1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Po p u l a t i o n s3 . 0 G ro u p Tr e a t m e n t s4.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s5.0 Comparison with Pharmacological Interventions6.0 Self-Help and CBT7 . 0 W h a t P re d i c t s B e t t e r R e s p o n s e s t o C B T ?8 . 0 R o l e o f t h e Fa m i l y9.0 Summary71717374747474757575CHAPTER 10: SCHIZOPHRENIA A N D P S Y C H O S I S1 . 0 T h e C o n t e n t o f t h e T h e ra p y2.0 Tr e a t m e n t Po p u l a t i o n s3.0 Effects on Symptoms4.0 Effects on Relapse Rates5 . 0 E f f e c t s o n G l o b a l M e a s u re s o f F u n c t i o n i n g6.0 Effects on Social A n x i e t y7.0 Early Intervention8.0 Is CBT Superior to a Non-Specific Psychosocial Intervention?9 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T ?1 0 . 0 R o l e o f t h e Fa m i l y1 1 . 0 G e n e ra l i z a t i o n t o C l i n i c a l S e t t i n g s a n d S t e p p e d C a re12.0 Summary77787980808081818182828283C O G N I T I V E B E H AV I O U R A L T H E R A P YviiCORE INFORMATION DOCUMENT67676768686969
Ta b l e o f C o n t e n t sC H A P T E R 1 1 : E AT I N G D I S O R D E R S1 . 0 T h e C o n t e n t o f t h e T h e ra p y2 . 0 E f f e c t s o n S y m p t o m s i n D i f f e re n t Pa t i e n t Po p u l a t i o n s3.0 Effects on Relapse Rates4 . 0 C o m b i n e d C B T a n d P h a r m a c o l o g i c a l Tr e a t m e n t5.0 Comparison with Non-Specific Interventionsa n d O t h e r P s y c h o l o g i c a l T h e ra p i e s6 . 0 G ro u p C B T7 . 0 W h a t P re d i c t s a B e t t e r R e s p o n s e t o C B T w i t h E a t i n g D i s o rd e rs ?8.0 Tr e a t m e n t R e f ra c t o r y E a t i n g D i s o rd e rs9.0 Self-Help and CBT1 0 . 0 R o l e o f t h e Fa m i l y11.0 Summary90919191929393C H A P T E R 1 2 : S T E P P E D A P P R OACH TO C A R E A N D A LT E R N AT I V EWAYS O F D E L I V E R I N G C B T95RESOURCE LIST1.0 We b s i t e s2.0 Vi d e o s, D V D s, a n d A u d i o t a p e s3.0 Tr a i n i n g C o u rs e s a n d Wo r k s h o p s4 . 0 E v a l u a t e d C o m p u t e r S o f t w a re t o a s s i s t i n C B T Tr e a t m e n t5 . 0 B o o k s a n d Tr e a t m e n t M a n u a l s9999102103104105REFERENCESC h a p t e r 1 I n t ro d u c t i o nC h a p t e r 2 W h a t i s C o g n i t i v e B e h a v i o u ra l T h e ra p y ( C B T ) ?C h a p t e r 3 D e p re s s i o nC h a p t e r 4 B i p o l a r D i s o rd e rC h a p t e r 5 S u b s t a n c e U s e D i s o rd e rsC h a p t e r 6 G e n e ra l i z e d A n x i e t y D i s o rd e r ( G A D )C h a p t e r 7 Pa n i c D i s o rd e rC h a p t e r 8 O b s e s s i v e - C o m p u l s i v e D i s o rd e r ( O C D )Chapter 9 S p e c i f i c P h o b i a sC h a p t e r 1 0 S c h i z o p h re n i a a n d P s y c h o s i sC h a p t e r 1 1 E a t i n g D i s o rd e rsC h a p t e r 1 2 S t e p p e d A p p ro a c h t o C a re A n d A l t e r n a t i v e w a y sof Delivering CBT109109109109113114120122125127128130C O G N I T I V E B E H AV I O U R A L T H E R A P YviiiCORE INFORMATION DOCUMENT8586888990133
C H A P T E R 1 I n t ro d u c t i o n t o t h e C o re I n f o r m a t i o n D o c u m e n tT h e N e e d f o r a “ C o re I n f o r m a t i o n D o c u m e n t ”Cognitive-behavioural therapy (CBT) holds a unique status in the fieldof mental health – CBT is effective for many psychological problems, isrelatively brief, and is well received by individuals. A large volume ofresearch has been published regarding CBT, including a number ofwell-designed studies involving people in “real world” clinical settings.Yet despite this large base of evidence, information about CBT has notbeen well communicated to consumers, families, and providers of healthcare. Consequently, CBT is not being used as extensively as the researchwould warrant.Many individuals (consumers, families, and professionals alike) areunaware of the effectiveness of CBT for different problems. There isadditional uncertainty about the effectiveness of different formats ofCBT (for example, individual, group or self-help formats), who canprovide CBT, how to access their services, and other treatments withwhich CBT is used (for example, the use of medication and CBT together).This Core Information Document has been assembled for the benefit ofindividuals, families and service providers interested in a broad summaryof information relating to CBT and its effectiveness.CBT is attracting increasing levels of interest from health care professionals,consumers and families. A variety of factors may contribute to this risein popularity. First, recent decades have seen a growing recognitionof the high prevalence rates of many psychological problems. Mentaldisorders negatively affect the quality of life for the person as well as hisor her family. Many of these disorders (including depression, anxiety,and alcohol problems) have been shown to respond well to CBT. Second,we face increased demands for efficient and cost-effective health careservices. CBT has the benefits of being structured, effective and, inmost cases, relatively brief. Third, people are increasingly interested inalternatives to medications. In some cases, CBT represents a proven, andsometimes superior, alternative to medication. In other cases, CBT is abeneficial addition to medication, hastening improvement and helpingto maintain improvements over time. Fourth, CBT models “consumerfocused care”, in which practitioners and individuals work together tobuild the tools individuals need to make changes necessary to livingC O G N I T I V E B E H AV I O U R A L T H E R A P Y1CORE INFORMATION DOCUMENT
C H A P T E R 1 I n t ro d u c t i o n t o t h e C o re I n f o r m a t i o n D o c u m e n tbetter. Fifth, the strategies and skills of CBT can be applied to many oflife’s challenges. The strategies and skills a person acquires to managedepression, for example, can also be used to manage chronic pain,control drinking or maintain exercise. The effectiveness of CBT inchanging and maintaining changes in behaviour makes it veryimportant to consumers and to health care services.A R e s o u rc e f o r Va r i o u s R e a d e rsInterest in CBT has been expressed among diverse groups inBritish Columbia, including policy makers, health administrators,health service providers who are non-specialists in mental health,as well as consumers and their families. This Core InformationDocument is offered as a resource to each of these groups. Thereis a vast literature relating to CBT, including books, articles andinternet resources. This document provides a brief overview of CBTand summarizes evidence supporting the effectiveness of CBT fora variety of psychological problems.Many resources relating to CBT appear throughout the text, includingweb and print based resources for consumers, educational resourcesfor health care professionals, and sources of further information forinterested readers. Most of the information has been organizedaround the diagnostic labels used in the International Classificationof Diseases1 and the Diagnostic and Statistical Manual2 (Fourth Edition Text Revision). The layout of the Core Information Document is intendedto serve as a convenient reference to clinicians, consumers and familymembers who are interested in the application of CBT for a particulartype of problem. Vignettes (hypothetical) are provided to brieflyillustrate the types of psychological problems considered in eachchapter. Diagnostic criteria are provided as well, representing theformal definitions used in research on CBT.C O G N I T I V E B E H AV I O U R A L T H E R A P Y2CORE INFORMATION DOCUMENT
C H A P T E R 1 I n t ro d u c t i o n t o t h e C o re I n f o r m a t i o n D o c u m e n tWhat is CBT?CBT is a psychological treatment that addresses the interactions betweenhow we think, feel and behave. It is usually time-limited (approximately10-20 sessions), focuses on current problems and follows a structuredstyle of intervention. The development and administration of CBT havebeen closely guided by research. Evidence now supports the effectivenessof CBT for many common mental disorders. For some disorders, carefullydesigned research has led international expert consensus panels toidentify CBT as the current “treatment of choice”.CBT is less like a single intervention and more like a family oftreatments and practices. Practitioners of CBT may emphasize differentaspects of treatment (cognitive, emotional, or behavioural) based onthe training of the practitioner. Nevertheless, the identified techniquesof CBT prove their family resemblance in a number of ways. Alltechniques and approaches to CBT are practically applied. What getsused (that is, which technique for which problem) is what has beenproven effective and the techniques themselves derive from science(for example, the ‘behavioural experiments’ used to help peopleovercome feared objects or situations). CBT has been studied andeffectively implemented with persons who have multiple andcomplex needs, and who may be receiving additional forms oftreatment, or have had no success with other kinds of treatment.C O G N I T I V E B E H AV I O U R A L T H E R A P Y3CORE INFORMATION DOCUMENT
C H A P T E R 1 I n t ro d u c t i o n t o t h e C o re I n f o r m a t i o n D o c u m e n tFo r m s o f C B TCBT continues to evolve with different formats and emphases asresearch support emerges. The majority of evidence supporting CBTis drawn from studies involving expert practitioners working withindividuals over a specified number of sessions (for example, between10 and 20 one-hour sessions). A smaller number of studies supports theeffectiveness of CBT when administered in groups. The principlesof CBT have also been incorporated in some self-directed resources(for example, self-help books, computer programs). Together, theseinterventions represent an emerging continuum or range of stepsto the delivery of CBT. Individuals who do not respond to an initialstep, for example “bibliotherapy”, could be redirected to a facilitatedself-care program, group CBT, or one-on-one CBT as needed. Treatmentplanning and selection of procedures are based on discussion andjudgment of health service providers trained in CBT and involved inthe care.W h o P ro v i d e s C B T ?The appropriate and effective use of CBT presumes the practitioneris a qualified health practitioner with training in assessment andtreatment of mental health problems and specific training in CBT.The general clinical skills required of the practitioner include theabilities to establish a collaborative therapeutic alliance, to assessand address complications of mental disorders (for example, risk ofsuicide in depression) and to conduct a differential diagnosi
CHAPTER 1: INTRODUCTION TO THE CORE INFORMATION DOCUMENT 1 The Need for a “Core Information Document” 1 A Resource for Various Readers 2 What is CBT? 3 Forms of CBT 4 Who Provides CBT? 4 Clinical Training in CBT 5 CHAPTER 2: WHAT IS COGNITIVE-BEHAVIOURAL THERAPY (CBT)? 7 1.0 Thinking 8 2.0 Behaviour
Cognitive-Behavioural Therapy EVIDENCE BRIEF Cognitive-Behavioural Therapy (CBT) is a core form of psychological treatment for . training would be vital as to be effective, CBT . behavioural skills to help them manage problematic emotional states such as anger, and increase their capacity for self-control.
Association of Behavioural and Cognitive Psychotherapies (BABCP) for training Cognitive Behavioural Psychotherapists The MSc in Cognitive Behavioural Psychotherapy (CBP) is an advanced professional training . The course team have a wide range of expertise and skills within Cognitive Behavioural Therapy. The team keep up to day with evidence .
Cognitive Behavioural Therapy (CBT) has made a massive contribution to mental health care, but it is a broad tradition with some practitioners at the cognitive end and some at the behavioural end. CBT has also evolved over the years. APS definition: Cognitive Behaviour Therapy (CBT) is a focused approach based on the premise that cognitions
MSc Cognitive Behavioural Therapy; Postgraduate Diploma (Professional Route) in Cognitive Behavioural Therapy - Programme Specification Goldsmiths, University of London 3 3. Personal suitability assessed by the application form, references and a screening interview 4. Be required to demonstrate interpersonal and personal capacities to provide a
The courses will have a cognitive behavioural theoretical base with preference for approaches with the soundest evidence and where cognitive and behavioural techniques are integrated in therapy. In addition to providing practical intensive and detailed skills training to facilitate skill
7. Principal methods of cognitive-behavioural work 55 Therapeutic approaches and ‘schools’ Behaviour modification Behaviour therapy methods Social skills training Self -instructional traini ng Problem -solving training Rational -Emotive Therapy Cognitive therapy Schema-focused therapy Inter -relationships and overlaps 8. Change processes 67
Cognitive-Behaviour Therapy 1 Cognitive-Behaviour Therapy and Problem Drinking: A Meta-analysis Introduction Cognitive-Behavioural Therapy (CBT) is a form of psychotherapy that combines cognitive-based and behaviour-based techniques in an effort to effect behaviour change (Beck, 1970; El
Cognitive-behavioural therapy (CBT) –CBT is a general model of psychotherapy, within which several specific approaches can be identified, which vary in terms of the target problem(s) they address and specific intervention components. In general, however, CBT approaches use a combination of behavioural and cognitive principles and interventions.
