A therapist guide to brief cognitive behavioral therapy

A THERAPIST’S GUIDE TO BRIEF COGNITIVE BEHAVIORAL THERAPY JEFFREY A. CULLY, PH.D. ANDRA L. TETEN, PH.D. Published by the Department of Veterans Affairs, South Central Mental Illness Research, Education, and Clinical Center (MIRECC), 2008. Suggested citation: Cully, J.A., & Teten, A.L. 2008. A Therapist’s Guide to Brief Cognitive Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, Houston. To request a copy of this manual, please contact Michael Kauth at michael.kauth@va.gov ACKNOWLEDGMENTS We would like to thank the multiple individuals and organizations that supported this work. This project emanated from our passion for teaching and our desire to increase the availability and quality of cognitivebehavioral therapies in health care settings. Our mentors and colleagues were instrumental in their encouragement and feedback. We would like to give special thanks to the following individuals: Evelyn Sandeen, PhD and Melinda Stanley, PhD (expert consultants); Sparkle Hamilton, MA (project assistant); and Heather Mingus (Graphic Artist); Anne Simons, PhD (past CBT supervisor – AT). We are also grateful to the support of the Veterans Health Administration 2IÀFHRI5HVHDUFKDQG'HYHORSPHQWDQG2IÀFHRI$FDGHPLF$IÀOLDWLRQV 6RXWK&HQWUDO0,5(&&DQG%D\ORU&ROOHJHRI0HGLFLQH This work was supported by a Clinical Educator Grant from the South Central 0,5(&& 7+(%5,()&%70$18$/ This manual is designed for mental health practitioners who want to establish a solid foundation of cognitive behavioral therapy (CBT) skills. Concepts contained in the manual detail the basic steps needed to provide CBT (“Practicing CBT 101”) with the intent that users will feel increasingly comfortable conducting CBT. The manual is not designed for advanced CBT practitioners. Instructional material in this program is designed to be used within the context of a psychotherapy supervisory relationship to ensure appropriate application of the training materials and timely feedback, which are viewed as critical to the development of CBT skills. The content of this manual is a compilation of foundational works on CBT, such as Judith Beck’s (1995) Cognitive Therapy: Basics and Beyond, with the addition of key skills needed for developing CBT therapists. The information is condensed and packaged to be highly applicable for use in a brief therapy model and to aid in rapid training. 7$%/(2)&217(176 (66(17,$/36<&+27+(5$3<6.,//6 02'8/( 723,& 1 Introduction to Brief Cognitive Behavioral Therapy (CBT) .... 06   8VLQJ6XSHUYLVLRQ   1RQVSHFLÀF)DFWRUVLQ3V\FKRWKHUDS\ 4 Case Conceptualization and Treatment Planning .............. 18 ESSENTIAL CBT SKILLS 02'8/( 723,& 5 Orienting the Patient to Brief Cognitive Behavioral Therapy .. 28 6 Goal Setting ............................................................................. 32 7 Agenda Setting ........................................................................ 36 8 Homework .................................................................................. 40 9 Identifying Maladaptive Thoughts and Beliefs .................. 44 10 Challenging Maladaptive Thoughts and Beliefs .................. 54 11 Behavioral Activation ............................................................. 60 12 Problem Solving ....................................................................... 66  14  5HOD[DWLRQ Ending Treatment and Maintaining Changes ..................... 82 5()(5(1&(668**(67(' $1' 6833/(0(17$/ 5($',1*6   $33(1',; $ 3$7,(17 +$1'2876   $33(1',; % 6$03/( 75($70(17 287/,1(6   ESSENTIAL PSYCHOTHERAPY SKILLS ! 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CGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: CGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: CGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . CGGGGGGGGGGGGGC : : : : $: %: 8: <: =: : :: . 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