What Is Cognitive Behavioral Therapy

2y ago
31 Views
2 Downloads
4.09 MB
227 Pages
Last View : 13d ago
Last Download : 2m ago
Upload by : Tripp Mcmullen
Transcription

*VNUP[P]L )LOH]PVYHS ;OLYHW MVY LWYLZZPVU PU L[LYHUZ HUK 4PSP[HY :LY]PJLTLTILYZ;OLYHWPZ[ 4HU\HS(T LUaLS 7O .YLNVY 2 )YV U 7O )YHKSL , 2HYSPU 7O

Cognitive Behavioral Therapy for Depressionin Veterans and Military ServicemembersTherapist ManualAmy Wenzel, Ph.D.Gregory K. Brown, Ph.D.Bradley E. Karlin, Ph.D.Suggested Citation: Wenzel, A., Brown, G. K., & Karlin, B. E. (2011). Cognitive BehavioralTherapy for Depression in Veterans and Military Servicemembers: Therapist Manual.Washington, DC: U.S. Department of Veterans Affairs.

TABLE OF CONTENTSTABLE OF FIGURES AND EXHIBITS .iiiACKNOWLEDGEMENTS .ivPREFACE .1INTRODUCTION .3What Is Cognitive Behavioral Therapy? .3Organization of This Manual .3Cases .4PART I: COGNITIVE BEHAVIORAL MODEL .7Underlying Theory of CBT .7Cognitive Theory .7Basic Cognitive Model .8Characteristics of Automatic Thoughts .8Expanded Cognitive Model .10Behavioral Theory.13Integration of Cognitive and Behavioral Theory .16CBT Case Conceptualization .16PART II: GENERAL SESSION STRUCTURE .37Brief Mood Check .37Bridge from Previous Session .41Agenda Setting .43Review of Previous Session Homework .47Discussion of Agenda Items .50Periodic Summaries .51Homework Assignment .52Final Summary and Feedback .57Implementing the Session Structure .58PART III: INITIAL PHASE OF TREATMENT.61Initial Clinical Assessment.62Motivational Enhancement .62Short-Term Goals .63Consequences of Psychological Symptoms .65Benefits of Reducing Psychological Symptoms .67Attitudes and Expectations Toward Treatment .67Obstacles to Participating in Treatment .70Socialization into CBT .72Setting Treatment Goals .75Suicide Risk Assessment and Safety Planning .76PART IV: MIDDLE PHASE OF TREATMENT .79Behavioral Strategies .79Activity Monitoring.79Activity Scheduling .87Pleasant Events Schedule .93Alternative Activity Scheduling Strategies .95Behavioral Activation .99Graded Task Assignment .100Relaxation Training and Controlled Breathing .101CBT for Depression in Veterans and Military Servicemembers: Therapist Manuali

Cognitive Strategies .103Working with Automatic Thoughts .104Identifying Automatic Thoughts .104Evaluating Automatic Thoughts .110Coping Cards.120The 3Cs Approach: Catch It, Check It, Change It .123Working with Core Beliefs .124Core Belief Identification .124Core Belief Modification .126Problem-Solving Strategies .134Evaluating Pros and Cons .140PART V: LATER PHASE OF TREATMENT .143Reviewing Progress Toward Treatment Goals .143Review and Consolidation of Skills .144Additional Treatment Planning .145Continuation of Treatment .145Tapering Treatment Sessions .145Referring for Additional Treatment .146Termination of Treatment .146CONCLUSION .148REFERENCES .151GLOSSARY .155APPENDIX .159CBT for Depression in Veterans and Military Servicemembers: Therapist Manualii

TABLE OF FIGURES AND EXHIBITSFigure 1.1: General CBT Approach .7Figure 1.2. Basic Cognitive Model .8Figure 1.3. Negative Cognitive Triad .10Figure 1.4. Expanded Cognitive Model .11Figure 1.5. Levels of Cognitive Processing .12Figure 1.6. Vicious Cycle of Depression .14Figure 1.7. General CBT Paradigm .16Figure 1.8. Cognitive Conceptualization Diagram .18Exhibit 1.1. Cognitive Conceptualization Diagram for Jack .22Exhibit 1.2. Cognitive Conceptualization Diagram for Kate .26Exhibit 1.3. Cognitive Conceptualization Diagram for Michael .29Exhibit 1.4. Cognitive Conceptualization Diagram for Claire .33Figure 1.9. Timeline of CBT.35Figure 3.1. Balance Between Relationship-Enhancing and CBT Strategies .62Exhibit 3.1. Treatment Goals for Sample Cases .76Exhibit 4.1. Kate’s Activity Monitoring Form .84Exhibit 4.2. Excerpt from Kate’s Activity Schedule Form .93Exhibit 4.3 Claire’s Modified Activity Schedule .96Figure 4.1. Three-Column Thought Record .107Exhibit 4.4. Jack’s Three-Column Thought Record: Step #1 .108Exhibit 4.5. Jack’s Three-Column Thought Record: Step #2 .108Exhibit 4.6. Jack’s Three-Column Thought Record: Step #3 .109Figure 4.2. The Link Between Situations, Emotions, and Thoughts .110Figure 4.3. Five-Column Thought Record .114Exhibit 4.7. Kate’s Five-Column Thought Record: Step #4.116Exhibit 4.8. Kate’s Five-Column Thought Record: Step #5.117Exhibit 4.9. Claire’s Coping Card.122Figure 4.4. Catch It, Check It, Change It. .123Exhibit 4.10. Claire’s Pros and Cons . 141CBT for Depression in Veterans and Military Servicemembers: Therapist Manualiii

ACKNOWLEDGMENTSSupport for this manual was provided by the Office of Mental Health Services, VACentral Office, U.S. Department of Veterans Affairs.CBT for Depression in Veterans and Military Servicemembers: Therapist Manualiv

PREFACEIn an effort to bring evidence-based psychotherapies from the laboratory to thetherapy room and realize the full potential of these treatments for Veterans, theDepartment of Veterans Affairs (VA) has developed national initiatives todisseminate and implement evidence-based psychotherapies for depression,posttraumatic stress disorder (PTSD), serious mental illness, and other conditionsthroughout the Veterans Health Administration (VHA), the health care arm of VA. Aspart of this effort, VA has developed a national staff training program in CognitiveBehavioral Therapy (CBT) for depression. This training in CBT represents the largestCBT training initiative in the nation. The overall goal of the CBT for DepressionTraining Program is to provide competency-based training to VA mental health staff,which includes experientially based workshop training followed by ongoing, weeklyconsultation with an expert in the treatment. The training focuses on both the theoryand application of CBT for the treatment of depression on the basis of the protocoldescribed in this manual, which has been adapted specifically for the treatment ofdepressed Veterans and Military Servicemembers. Initial program evaluation resultshave shown that the training and implementation of this therapy protocol by VAmental health therapists have significantly enhanced therapist skills and patientoutcomes (Karlin, 2009; Karlin et al., 2010). This manual is designed to serve as atraining resource for therapists completing the VA CBT for Depression TrainingProgram, as well as for others inside and outside of VHA and the military who areinterested in further developing their CBT skills.Although the focus of this manual is on the application of CBT for depression, themanual and treatment protocol are based on core CBT competencies that can beadapted and applied to treat other mental health and behavioral health conditions. Inthis protocol, cognitive and behavioral theory and strategies are incorporated in anintegrated fashion and guided by a careful case conceptualization, which is animportant component of this treatment. In addition, the protocol placessignificant emphasis on the therapeutic relationship, which is a critical We believe that CBT done wellcontextual variable in CBT. We believe that CBT done well requires a requires a very strong andvery strong and supportive therapeutic alliance. In this way, CBT for supportive therapeutic alliance.Depression in Veterans and Military Servicemembers stronglyemphasizes the therapy in Cognitive Behavioral Therapy and differs from morepsychoeducational or primarily skills-based approaches to CBT. In our experience,case conceptualization-driven treatment and the focus on the therapeutic relationshipare especially important therapy ingredients when working with depressed Veterans.Included throughout this manual are fictitious cases that represent composites ofdepressed Veterans and Military Servicemembers we have treated. These cases aredesigned to illustrate and make concrete the application of CBT skills with “real-life”patients. In addition to this manual, we have developed a companion therapist trainingvideo (U.S. Department of Veterans Affairs, 2010) that demonstrates many CBTstrategies with the case examples presented in this manual. Key therapist and patientworksheets and forms for use in implementing this protocol are referenced throughoutthis manual and are provided in the Appendix.CBT for Depression in Veterans and Military Servicemembers: Therapist Manual1

Whether you are new to CBT or are seeking to expand your CBT skills, our hope isthat this manual will be a useful resource to you and will help promote the deliveryand fidelity of CBT with depressed Veterans and Military Servicemembers.CBT for Depression in Veterans and Military Servicemembers: Therapist Manual2

INTRODUCTION

INTRODUCTIONWhat Is Cognitive Behavioral Therapy?Cognitive Behavioral Therapy (CBT) is a structured, time-limited, present-focusedapproach to psychotherapy that helps patients develop strategies to modifydysfunctional thinking patterns or cognitions (i.e., the “C” in CBT) and maladaptiveemotions and behaviors (i.e., the “B” in CBT) in order to assist them in resolvingcurrent problems. A typical course of CBT is approximately 16 sessions, in whichpatients are seen on a weekly or biweekly basis. CBT was originally developed totreat depression (A. T. Beck, 1967; A. T. Beck, Rush, Shaw, & Emery, 1979), and ithas since been adapted to the treatment of anxiety disorders (A. T. Beck & Emery,1985), substance use disorders (A. T. Beck, Wright, Newman, & Liese, 1993),personality disorders (A. T. Beck, Freeman, Davis, & Associates, 2004), eatingdisorders (Fairburn, 2000), bipolar disorder (Basco & Rush, 1996), and evenschizophrenia (A. T. Beck, Rector, Stolar, & Grant, 2009)! Many patients showsubstantial improvement after 4 to 18 sessions of CBT (Hirsch, Jolley, & Williams,2000). Contemporary research shows that CBT is efficacious in treating mild,moderate, and severe mental health symptoms (e.g., DeRubeis et al., 2005; Elkin etal., 1989), that it is equally as efficacious as psychotropic medications in the shortterm, and that it is more efficacious than psychotropic medications in the long term(see Hollon, Stewart, & Strunk, 2006, for a review). There is a great deal of researchsupporting CBT’s efficacy for treating an array of mental disorders using bothindividual (Butler, Chapman, Forman, & Beck, 2006) and group (Craigie & Nathan,2009) formats. CognitiveBehavioralTherapyOrganization of This ManualThis manual is organized into five main parts: (a) cognitive behavioral theory and themanner in which the theory translates to treatment, (b) CBT session structure, (c)interventions that take place in the initial phase of treatment, (d) interventions thattake place in the middle phase of treatment, and (e) interventions that take place in thelater phase of treatment.Throughout these five main parts, case examples created on the basis of actualclinical experience are provided to illustrate the application of cognitive andbehavioral strategies. Moreover, specific pointers for implementing the strategies, aswell as common obstacles that therapists experience and ways to overcome them, aresummarized. This manual was written specifically for implementing CBT withVeterans and Military Servicemembers. The content of the protocol, as well asspecific issues in the application of CBT, are presented with this particular populationin mind. In addition, certain therapy components and processes are given emphasis inthis protocol to address commonly observed issues in the delivery of CBT withdepressed Veterans and Military Servicemembers. For simplicity, we primarily usethe terms patients and Veterans. These te

This manual is designed to serve as a training resource for therapists completing the VA CBT for Depression Training Program, as well as for others inside and outside of VHA and the military who are interested in further developing their CBT skills. Although the focus of this manual is on the application of CBT for depression, the

Related Documents:

A) Introduction to Islamic Integrated Cognitive Behavioral Therapy (IICBT) Islamic Integrated Cognitive Behavioral Therapy is an adaptation of the Religiously Integrated Cognitive Behavioral Therapy (Islamic version), a manualiz

indicated that the most effective interventions are those that use cognitive-behavioral techniques to improve mental functioning. Cognitive-behavioral treatments have become a dominant therapy in clinical psychology, and analyses of cognitive-behavioral programs for offenders have come to positive conclusions. Chapter 2: What is Cognitive .

Cognitive science and the Conceptual foundations of Cognitive-behavioral therapy: viva la evolution! 74 Rick E. Ingram and Greg J. Siegle chaPTEr 4. Cognitive-behavioral therapy and psychotherapy integration 94 T. Mark Harwood, Larry E. Beutler, and Mylea Charvat ParT ii. aSSESSmEnT conSidEraTionS chaPTEr 5. Cognitive assessment: issues and .

Cognitive Behavioral Therapy for Chronic Pain Among Veterans. Introduction. What is Cognitive Behavioral Therapy for Chronic Pain? Cognitive Behavioral Therapy (CBT) is a widely researched, time-limited psychotherapeutic approach that has been shown . to be efficacious across a number of mental and behavioral conditions.

cognitive therapy techniques. In this case, a behavioral technique such as deep breathing may be easier to implement, which may help to calm and focus thinking. 1This is also referred to as Cognitive–Behavior Therapy, which gives the behavioral components of CBT more emphasis. Another known term is Cognitive–Behavioral Treatment.

Tx Session #4: Review, titrate, cognitive therapy I Tx Session #5: Review, titrate, cognitive therapy II Tx Session #6: Review, titrate, insomnia relapse prevention CBT-I is typically 4 to 8 weekly treatment sessions (Perlis et al. Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide. 2005)

An analysis of programs and practices in CrimeSolutions.gov finds that cognitive behavioral therapy can deter crime, assist victims and prevent recidivism. P erhaps no other intervention has attracted more attention across the criminal justice system than cognitive behavioral therapy (CBT). First widely used in the latter half of the 20th

Keywords: mindfulness, mindfulness-based cognitive therapy, stress, college counselors, nursing, single-subject experimental design Mindfulness-based cognitive therapy (MBCT) has been described as part of a third generation of cognitive therapies (Harrington & Pickles, 2009). Along with dialectical behavioral therapy and others like it, MBCT has