A Clinician's Guide to CBT for Children to Young Adults

Description: PAUL STALLARD is Professor of Child and Family Mental Health at the University of Bath and Head of Psychological Therapies (CAMHS) for Oxford Health NHS Foundation Trust. He is a clinical psychologist who has worked with children and young people for 40 years using Cognitive Behaviour Therapy (CBT). He is also an active researcher and has been involved in many studies exploring the use and effectiveness of CBT with children and young people. About this book xiii Acknowledgements xv Online resources xvii 1 Introduction and overview 1 CBT as an intervention 1 CBT as a preventative intervention 2 CBT with younger children 3 CBT with children and young people with learning difficulties 4 Technologically delivered CBT 5 Involving parents 6 The competencies to deliver child-focused CBT 7 Assessing competence 8 Cognitive Behaviour Therapy Scale for Children and Young People 9 CORE philosophy 13 Child-centred 14 Outcome-focused 15 Reflective 16 Empowering 17 2 PRECISE 19 The therapeutic alliance 19 Partnership 21 Eliciting the young person's and parents' understanding and views 22 Encourages the young person to participate in decision making 23 Involves the young person and parents/carers in planning the intervention 24 Encourages the young person to provide feedback about sessions 25 Right developmental level 25 Ensures an optimal balance between cognitive and behavioural techniques 26 Uses simple, clear, jargon-free language 27 Uses a variety of verbal (direct and indirect approaches) and non-verbal techniques 28 Appropriately involves parents/carers/others 28 Courtney has anger outbursts 30 Empathy 30 Conveys interest and concern using active listening, reflection, and summaries 30 Acknowledges and responds to emotional responses 32 Demonstrates an open, respectful, non-judgemental, caring approach 33 Empathises with parents 34 Creative 35 Tailors the concepts and methods of CBT around the interests of the young person 35 Uses a range of verbal and non-verbal methods 36 Creatively uses a range of methods 37 Utilises the preferred media of the young person 38 Investigation 39 Creates a process of collaborative inquiry 39 Fully involves young people in the design of experiments 40 Helps young people and parents/carers to consider alternative explanations 41 Encourages reflection 42 Self-efficacy 42 Identifies and highlights strengths and personal resources 43 Encourages identification of helpful skills and strategies 44 Develops personal coping strategies 44 Reinforces use of new skills 45 Enjoyable and engaging 45 Uses an appropriate mix of materials, activities, humour 46 Maintains an appropriate balance between task and relationship-strengthening activities 46 Attends to the young person's interests and incorporates them into the intervention 47 Presents as positive and hopeful 48 PRECISE in practice 48 Ella's obsessional thoughts 48 Joshua's negative thinking 49 3 A: Assessment and goals 51 Undertakes a full assessment of the presenting problem 51 Compliments assessment with routine outcome measures (ROMs) 53 Negotiates goals and the dates when progress will be reviewed 55 Identification of goals 56 Prioritisation of goals 57 Whose goals? 57 Inappropriate goals 58 Uses diaries, thought bubbles, and rating scales 59 Sarah feels faint 59 Tick charts 60 Thought bubbles 60 Visualisation 61 Stories 62 Rating scales 63 Pie charts 63 Theo's washing 64 Assesses motivation and readiness to change 64 Pre-contemplation 65 Contemplation 67 Preparation 67 Action 68 Maintenance 68 Relapse 68 4 B: Behavioural 69 Uses behavioural techniques to facilitate therapeutic change 70 Developing hierarchies 70 Graded exposure 72 Response prevention 74 John is worried about germs 75 Problems when undertaking exposure 75 Young person avoidance 75 Clinician avoidance 76 Anxiety does not come down 76 Is the young person focusing on their anxiety? 77 Are parents/carers appropriately involved? 77 Uses behavioural techniques such as activity rescheduling and behavioural activation 77 Activity rescheduling 77 Alison feels down 78 Behavioural activation 79 Problems when undertaking behavioural activation 80 I didn't feel like doing it 80 I did it, but I don't feel any better 81 I did it, but so what? 81 It's not important 81 Provides a clear rationale for using behavioural strategies 82 Identifies and implements reward and contingency plans 82 Models, uses role play, structured problem-solving approaches, or skills training 85 Model how to cope 85 Role play 87 Problem solving 88 Skills training 89 5 C: Cognitions 91 Facilitates cognitive awareness 92 Cognitive content 92 Levels of cognitions 92 Freya worries about making a fool of herself 93 Uses thought records and bubbles 96 Identifies functional and dysfunctional cognitions 98 Unhelpful thoughts 99 Helpful thoughts 99 Identifies common cognitive biases ('thinking traps') 99 The negative filter 100 Blowing things up 100 Predicting failure 101 Being down on yourself 101 Setting yourself up to fail 101 Facilitates thought challenging and perspective taking 102 What is the evidence? 102 The 4Cs 103 What would someone else say? 103 Jaz falls out with her friend 104 Facilitates continuum work using rating scales 104 Uses techniques such as mindfulness, acceptance, and compassion 105 Mindfulness 105 Compassion 107 Acceptance 109 Kindness 110 6 D: Discovery 111 Facilitates discovery and reflection through use of the Socratic dialogue 111 The Socratic dialogue 113 What makes a good Socratic question? 116 Mike is worried about his cat 118 Common difficulties 120 Alternative perspective taking and attending to new or overlooked information 122 Perspective taking 122 Responsibility pies 123 Joshua's accident 123 Attends to overlooked information 124 Analogical comparisons 124 Systematically testing the assumed relationship 125 Marla worries she will pass germs to others 126 Behavioural experiments and prediction testing 127 Cognition- and prediction-testing experiments 127 Planning a behavioural experiment 128 Prediction-testing experiments: Caleb thinks he is a failure 129 Active experiments: Laura's social anxiety 130 Information gathering experiments: Adam's formulation 131 7 E: Emotions 133 Develops emotional literacy by facilitating the identification of a range of emotions 133 Helps to distinguish between different emotions and identifies key body signals 135 Body signals 135 Feeling diaries 135 William feels sad 136 Emotional logs 137 Isabella feels down 137 Relaxation, guided imagery, controlled breathing, and calming activities 138 Progressive muscle relaxation 139 Calming imagery 141 Aisha's calming image 141 Diaphragmatic (controlled) breathing 142 Change the feeling 143 Physical activity, letting feelings go, emotional metaphors, and imagery 144 Physical activity 144 Let the feeling go 144 Emotional metaphors 145 Emotive imagery 145 Anthony's humorous image 146 Self-soothing, mind-games, and mindfulness 146 Self-soothing 146 Mind games 147 Mindfulness 147 Talk with someone 148 8 F: Formulations 149 Provides a coherent and understandable rationale for the use of CBT 149 Linking thoughts, emotions, and behaviours 151 Mini-formulations (two- or three-system models) 151 Rhiannon is unhappy and scared 152 Maintenance formulations 154 Naomi cuts herself 154 Four-system formulations 155 Abdul's anxiety 156 Remember the strengths 157 Provides an understanding of important past events and relationships (onset formulations) 158 Mary's anxiety 161 Includes parental/family factors in formulations 163 Sally's anxiety 163 Activities and goals/targets are clearly linked to the formulation 165 Common problems 167 Difficulty identifying thoughts or feelings 167 Is it important to distinguish between different levels of cognitions? 168 I can't seem to put this together in a formulation 168 I'm not sure if the formulation is right 169 I can't seem to find all the information to complete the formulation 169 9 G: General skills 171 Prepares and brings the necessary materials and equipment to the meeting 171 Manages the young person's behaviour during sessions 172 Ensures that sessions have an agenda and clear goals and are appropriately structured 174 General update 175 Outcome measures update 175 Home assignment review 175 Session topic 176 Home assignment 176 Session summary and feedback 176 Ensures good timekeeping so that all tasks are completed 177 Sessions are appropriately paced, flexible, and responsive 178 Responsive 180 Gary is worried about germs 180 Prepares for endings and relapse prevention 181 Relapse prevention 181 10 H: Home assignments 185 Negotiates home assignments 185 Assignments are meaningful and related to the formulation 188 Assignments are consistent with the young person's developmental level 189 Assignments are realistic, achievable, and safe 191 Refers to goals when planning assignments and to rating scales when reviewing progress 193 Harry wants to get fitter 193 Fatima's unhelpful thoughts 194 Assignments are reviewed and reflection encouraged 195 11 Putting it together 199 Anxiety 200 Effectiveness 200 Rationale informing the intervention 200 Core components of CBT interventions for anxiety disorders 201 Parents 202 Important cognitions 202 Depression 203 Effectiveness 203 Rationale informing the intervention 204 Core components of CBT interventions for depression 205 Parents 206 Important cognitions 206 Obsessive-compulsive disorder (OCD) 207 Effectiveness 207 Rationale informing the intervention 208 Core components of CBT interventions for OCD 209 Parents 210 Important cognitions 210 Post-traumatic stress disorder (PTSD) 210 Effectiveness 210 Rationale informing the intervention 211 Core components of CBT interventions for PTSD 211 Parents 212 Important cognitions 213 When it doesn't go right 213 Is the young person motivated to change? 215 Sam's costs of change 217 Are the young person and their family engaged with the intervention? 219 Jade is anxious and depressed 221 How has the intervention been delivered? 224 12 Resources 229 The Chain of Events 230 The Negative Trap 231 Four systems 232 How did this happen? 233 Session rating scale 234 Scales of change 235 Anxiety intervention plan 236 Depression intervention plan 237 OCD intervention plan 238 PTSD intervention plan 239 Motivation 240 Engagement 241 Intervention delivery 242 Reflective practice 243 The Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) 244 Beating anxiety 259 Fighting back depression 264 Controlling worries and habits 270 Coping with trauma 275 References 279 Index 291

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