Clinician's Guide to CBT for Children to Young Adults

Clinician's Guide to CBT for Children to Young Adults

A Companion to Think Good, Feel Good and Thinking Good, Feeling Better

Stallard, Paul

John Wiley & Sons Inc

12/2020

320

Mole

Inglês

9781119396314

15 a 20 dias

874

Descrição não disponível.
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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CBT; cbt for children; cognitive behavior therapy; cognitive behavior therapy for children; cognitive behavioural therapy; cognitive behavioural therapy for children; think good feel good; thinking good feeling better; cbt for adolescents