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Paul Stallard. A Clinician's Guide to CBT for Children to Young Adults
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
A Clinician’s Guide to CBT for Children to Young Adults. A Companion to Think Good, Feel Good and Thinking Good, Feeling Better
About this book
Acknowledgements
Online resources
CHAPTER ONE Introduction and overview
CBT as an intervention
CBT as a preventative intervention
CBT with younger children
CBT with children and young people with learning difficulties
Technologically delivered CBT
Involving parents
The competencies to deliver child‐focused CBT
Assessing competence
Cognitive Behaviour Therapy Scale for Children and Young People
CORE philosophy
Child‐centred
Outcome‐focused
Reflective
Empowering
CHAPTER TWO PRECISE
The therapeutic alliance
Partnership
The understanding and views of the young person and their parents are elicited
Encourages and invites the young person to participate in the generation of ideas, option appraisal, and decision making
Involves the young person and parent/carer in goal and target setting, intervention planning, home assignments, and experiments
Encourages the young person to provide open and honest feedback about therapy sessions
Right developmental level
Ensures an optimal balance between cognitive and behavioural techniques
Uses simple, clear, jargon‐free language that is respectful and not patronising
Uses a variety of verbal (direct and indirect approaches) and non‐verbal techniques
Appropriately involves parents/carers/others
Case Study Courtney has anger outbursts
Empathy
Conveys interest and concern using active listening, reflection, and summaries
Acknowledges and appropriately responds to verbal and non‐verbal expressions and emotional responses
Demonstrates an open, respectful, non‐judgemental, caring approach
Empathises with parents/carers about their own difficulties and the impact of these on their ability to help their child
Creative
Tailors the concepts and methods of CBT around the interests of the young person
Uses an appropriate range of verbal and non‐verbal methods to facilitate understanding and engagement
Creatively uses a range of methods
Utilises the preferred media of the young person
Investigation
Creates a process of collaborative inquiry in which cognitions, beliefs, and assumptions are subject to objective evaluation
Fully involves young people in the design of experiments
Helps young people and parents/carers to consider alternative explanations about events
Encourages reflection
Self‐efficacy
Identifies and highlights strengths and personal resources
Encourages identification of helpful skills and strategies
Develops personal coping strategies
Reinforces use of new skills
Enjoyable and engaging
Uses an appropriate mix of materials, activities, humour
Maintains an appropriate balance between task and relationship‐strengthening activities
Attends to the young person’s interests and incorporates them into the intervention
Presents as positive and hopeful
PRECISE in practice. Case Study Ella’s obsessional thoughts
Case Study Joshua’s negative thinking
CHAPTER THREE A: Assessment and goals
Undertakes a full assessment of the presenting problem involving, as appropriate, reports from others
Complements assessment with routine outcome measures (ROMs)
Negotiates goals and the dates when progress will be reviewed
Identification of goals
Prioritisation of goals
Whose goals?
Inappropriate goals
Uses diaries, tick charts, thought bubbles, and rating scales to identify and assess symptoms, emotions, thoughts, and behaviour
Case Study Sarah feels faint
Tick charts
Thought bubbles
Visualisation
Stories
Rating scales
Pie charts
Case Study Theo’s washing
Assesses motivation and readiness to change
Pre‐contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
CHAPTER FOUR B: Behavioural
Uses behavioural techniques such as developing hierarchies, graded exposure, and response prevention. Developing hierarchies
Graded exposure
Response prevention
Case Study John is worried about germs
Problems when undertaking exposure. Young person avoidance
Clinician avoidance
Anxiety does not come down
Is the young person focusing on their anxiety?
Are parents/carers appropriately involved?
Uses behavioural techniques such as activity rescheduling and behavioural activation. Activity rescheduling
Case Study Alison feels down
Behavioural activation
Problems when undertaking behavioural activation. I didn’t feel like doing it
I did it, but I don’t feel any better
I did it, but so what?
It’s not important
Provides a clear rationale for using behavioural strategies
Identifies and implements reward and contingency plans
Models, uses role play, structured problem‐solving approaches, or skills training. Model how to cope
Reward the child for facing their challenge
Be positive and encouraging
Learn to tolerate unpleasant emotions
Encourage and reward independence
Learn from others
Role play
Problem solving
Skills training
CHAPTER FIVE C: Cognitions
Facilitates cognitive awareness. Cognitive content
Levels of cognitions
Core beliefs/cognitive schemas
Identifying core beliefs/cognitive schemas: the downward arrow
Case Study Freya worries about making a fool of herself
Identifying core beliefs/cognitive schemas: questionnaires
Predictions
‘I wonder what happens’
The if/then quiz
What if assumptions aren’t clear
Automatic thoughts
Uses thought records and bubbles. Direct questions
Indirect approaches. The thought catcher
Thought bubbles
Thought diaries
Identifies cognitions that are functional and helpful and those that are dysfunctional or unhelpful
Unhelpful thoughts
Helpful thoughts
Identifies important dysfunctional cognitions and common cognitive biases (‘thinking traps’)
The negative filter
Blowing things up
Predicting failure
Being down on yourself
Setting yourself up to fail
Facilitates the generation of alternative balanced cognitions by thought challenging and alternative perspective taking
What is the evidence?
The 4Cs
What would someone else say?
Case Study Jaz falls out with her friend
Facilitates continuum work using rating scales
Uses techniques such as mindfulness, acceptance, and compassion. Mindfulness
FOCUS
Mindful activities
Compassion
Treat yourself like a friend
Speak kindly to yourself
Look after yourself
Acceptance
Focus on strengths and achievements
Kindness
CHAPTER SIX D: Discovery
Facilitates self‐discovery and reflection through use of the Socratic dialogue
The Socratic dialogue
Memory questions
Translation questions
Interpretation questions
Application questions
Analysis questions
Synthesis questions
Evaluation questions
What makes a good Socratic question? Clear and specific
Answerable
Uses the young person’s language
Attends to overlooked information
Remains focused
Case Study Mike is worried about his cat
Common difficulties. It becomes an unpleasant question‐and‐answer inquisition
The young person can’t understand or answer the questions
Can’t synthesise new information
Facilitates self‐discovery through alternative perspective taking and attending to new or overlooked information. Perspective taking
Responsibility pies
Case Study Joshua’s accident
Attends to overlooked information
Analogical comparisons
Systematically testing the assumed relationship
Case Study Marla worries she will pass germs to others
Evaluates beliefs, assumptions, and cognitions through behavioural experiments or prediction testing
Cognition‐ and prediction‐testing experiments
Experiments to test what happens if they behave differently
Information‐gathering experiments
Planning a behavioural experiment
Case Study Prediction‐testing experiments: Caleb thinks he is a failure
What thought or belief do you want to test?
What experiment could you undertake to test this?
What do you think will happen?
What happened?
What have you found out?
Has this changed your thought or belief?
Case Study Active experiments: Laura’s social anxiety
What thought or belief do you want to test?
What experiment could you undertake to test this?
What do you think will happen?
What happened?
What have you found out?
Has this changed your thought or belief?
Case Study Information gathering experiments: Adam’s formulation
CHAPTER SEVEN E: Emotions
Develops emotional literacy by facilitating the identification of a range of emotions
Helps to distinguish between different emotions and identifies key body signals. Body signals
Feeling diaries
Case Study William feels sad
Emotional logs
Case Study Isabella feels down
Develops emotional management skills such as relaxation, guided imagery, controlled breathing, calming activities
Progressive muscle relaxation
Calming imagery
Case Study Aisha’s calming image
Diaphragmatic (controlled) breathing
Change the feeling
Develops emotional management skills such as physical activity, letting feelings go, emotional metaphors, and imagery. Physical activity
Let the feeling go
Emotional metaphors
Emotive imagery
Case Study Anthony’s humorous image
Develops emotional management skills such as self‐soothing, mind games, and mindfulness. Self‐soothing
Mind games
Mindfulness
Talk with someone
CHAPTER EIGHT F: Formulations
Provides a coherent and understandable rationale for the use of CBT
Provides a collaborative understanding of events which links thoughts, emotions, and behaviour (maintenance formulations) Mini‐formulations (two‐ or three‐system models)
Case Study Rhiannon is unhappy and scared
Maintenance formulations
Case Study Naomi cuts herself
Four‐system formulations
Case Study Abdul’s anxiety
Remember the strengths
Provides an understanding of important past events and relationships (onset formulations)
Case Study Mary’s anxiety
Includes, as appropriate, the role of parent/carers in the onset or maintenance of the child/young person’s problems
Case Study Sally’s anxiety
Activities and goals/targets are clearly linked to the formulation
Common problems. Difficulty identifying thoughts or feelings
Is it important to distinguish between different levels of cognitions?
I can’t seem to put this together in a formulation
I’m not sure if the formulation is right
I can’t seem to find all the information to complete the formulation
CHAPTER NINE G: General skills
Prepares and brings the necessary materials and equipment to the meeting
Manages the young person’s behaviour during sessions
Ensures that sessions have an agenda and clear goals and are appropriately structured
General update
Outcome measures update
Home assignment review
Session topic
Home assignment
Session summary and feedback
Ensures good timekeeping so that all tasks are completed
Ensures that the session is appropriately paced, flexible, and responsive to the needs of the young person
Responsive
Case Study Gary is worried about germs
Prepares for endings and relapse prevention
Relapse prevention
What helped?
Build helpful skills into daily life
Remember to practise
Prepare for setbacks
Know your warning signs
Watch out for difficult times
Be kind to yourself
Stay positive
Know when to seek help
Watch out for strong unhelpful ways of thinking
CHAPTER TEN H: Home assignments
Negotiates home assignment tasks
Ensures assignments are meaningful and clearly related to the formulation and clinical session
Ensures assignments are consistent with the young person’s developmental level, interests, and abilities
Assignments are realistic, achievable, and safe
Refers to goals when planning assignments and to rating scales when reviewing progress
Case Study Harry wants to get fitter
Case Study Fatima’s unhelpful thoughts
Assignments are reviewed and reflection encouraged
CHAPTER ELEVEN Putting it together
Anxiety. Effectiveness
Rationale informing the intervention
Core components of CBT interventions for anxiety disorders
Parents
Important cognitions
Depression. Effectiveness
Rationale informing the intervention
Core components of CBT interventions for depression
Parents
Important cognitions
Obsessive‐compulsive disorder (OCD) Effectiveness
Rationale informing the intervention
Core components of CBT interventions for OCD
Parents
Important cognitions
Post‐traumatic stress disorder (PTSD) Effectiveness
Rationale informing the intervention
Core components of CBT interventions for PTSD
Parents
Important cognitions
When it doesn’t go right
Is the young person motivated to change?
Case Study Sam’s costs of change
Are the young person and their family engaged with the intervention?
Case Study Jade is anxious and depressed
How has the intervention been delivered?
CHAPTER TWELVE Resources
The Chain of Events
The Negative Trap
Four systems
How did this happen?
Session rating scale
Scales of change
Anxiety intervention plan
Depression intervention plan
OCD intervention plan
PTSD intervention plan
Motivation
Engagement
Intervention delivery
Reflective practice
The Cognitive Behaviour Therapy Scale for Children and Young People (CBTS‐CYP) PROCESS ‐ PRECISE
SKILLS… the ABCs…
Beating anxiety
Understand your anxious feelings
The avoidance trap
Learn to relax
Physical exercise
Relaxing activities
Controlled breathing
Quick relaxation
Identify your anxious thoughts
Are you stuck in a thinking trap?
Check your thoughts
Step back from your worrying thoughts
Face your fears
Remember to praise yourself
Fighting back depression
Getting started is hard work
Check what you do and how you feel
Change what you do
Get busy
Identify your unhelpful thoughts
Are you stuck in a thinking trap?
Challenge the way you think
Step back from your thoughts
Be kind to yourself
Learn to problem solve
Find the positives
Controlling worries and habits
We all have worries
Because you think it, doesn’t mean it will happen
Trying to stop your thoughts makes them worse
Learn to manage your anxiety
Physical exercise
Relaxing activities
Controlled breathing
Relaxation exercises
Identify your unhelpful thoughts
Check them out
Dump your habits
You will feel anxious, but it will get easier
Coping with trauma
Reclaim your life
Manage your emotions
Relaxation
Sleep
Anger
Tell your story
Check out what you think
Face your fears
References
Index
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