Cognitive Behavioural Interviewing for Adult Disorders

A Practical Handbook

Peter H. Wilson, Susan H Spence, David J. Kavanagh

• Publisher: Taylor & Francis
• Year: 2018
• eBook ISBN: 9780429834585
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Originally published in 1989, the primary aim of this text was to provide a guide to the interview assessment of a wide range of common adult psychological problems. Emphasis is placed on the kinds of problems that were frequently encountered in outpatient centres at the time. The authors provide a general introduction to the nature and causes of each of the selected problems, with a focus on the kind of background knowledge that may be useful in the planning of initial interviews and the selection of appropriate interventions. Detailed examples are provided of the questions that may help elicit information on the history, severity, and causes of the problems for individual clients, and there is also a brief discussion of selected formal assessment instruments for each problem area. A major aim of the text is to teach basic principles of problem identification, behavioural analysis and a structured approach to assessment.

1

Introduction

Aim and content of this book

The aim of this book is to provide guidelines for the conduct of initial interviews with people who present with some of the very common problems for which psychological assistance is sought. The book is intended to form a bridge between the numerous texts on behavioural assessment and those that review and describe the cognitive and behavioural treatments for psychological problems. Many of the texts on behavioural assessment place considerable emphasis on the assessment of the severity of the problems. Thus, they provide valuable information concerning the self-report, physiological and objective measurement procedures that the clinician may find useful in the assessment of many problems. The books on behavioural and cognitive therapies typically describe the treatment procedures that can be employed with the numerous disorders with which the clinician needs to deal. However, an important step in the process of assessment is the conduct of the initial interview in which information needs to be gathered from clients in a systematic, thorough, useful and economic manner. Such information, if well-collected, is essential for the specification of those aspects of the presenting problems that are important in designing appropriate and successful treatment interventions. The aim of this book is to assist the clinician in conducting initial interviews with clients who present with some of the most common problems.

The problems include depression, anxiety and phobias, headaches, insomnia, sexual problems, excessive consumption of alcohol and other drugs, social competence problems and obesity. These problems are those which the student in clinical training is likely to meet in a typical outpatient setting in which a cognitive-behavioural approach is adopted. They span a range of areas including serious psychopathology, behavioural medicine, and problems of everyday living. It is hoped that detailed discussion of these problems might serve as a model for the design of interviews with people who present with other similar problems which we do not cover in this book, such as pain, obsessive-compulsive disorder or habitual behaviour problems. We have chosen to omit discussion of marital problems because of the need to consider additional complexities involved in such cases. There is a widespread view that standard interviews of the type presented here for other problems may best be avoided in the assessment of marital problems. Certain other problems such as anorexia nervosa, or psychotic disorders like schizophrenia or bipolar affective disorder have been omitted because they are more likely to be seen in inpatient units. While we have had to limit the focus of the book, we hope that certain general principles concerning the structure and content of cognitive-behavioural interviewing will be gleaned from the detailed examination of the selected topics, which will serve the clinician well in dealing with other problem areas.

This book is based on the assumptions that rational explanations exist for the causes of problems experienced as psychological disorders, that a knowledge of the likely causal processes is important for an adequate understanding of such disorders and that such knowledge, when applied to an individual case, will result in more efficacious and efficient treatment. These beliefs are consistent with a general experimental-clinical approach to psychological disorders, which implies that such disorders occur as a result of various behavioural, cognitive, social and physiological processes. This approach suggests that important distinctions can be made between various disorders in terms of their likely causality, and that, even within categories of disorders, there is a need to distinguish between possibly different psychological and physical processes that may play a causal, maintaining or ancillary role.

In each chapter, we will provide a summary of the current knowledge about a specific disorder, usually beginning with some discussion about the primary features that are generally considered to characterise the disorder and its potential subtypes, before going on to discuss the likely content of an initial interview. We have employed the diagnostic scheme presented in the Diagnostic and Statistical Manual of DSM-III (American Psychiatric Association, 1980) and its revision, DSM-III-R (1987). However, it ought to be noted that any classification system is an attempt by researchers and clinicians to bring about some order out of apparent chaos. Any such classification scheme reflects our ways of viewing the phenomena at a given point in time, and is subject to potential errors of perception, organisation and theory. Clinicians and students sometimes regard DSM-III as a stone tablet handed down to us from some omniscient authority. Such a view is likely to be dangerous if it prevents us from gaining new insights into the massive range of features that we meet in clinical practice. In this book, we use DSM-III-R as a starting point for the classification of some of the disorders under discussion, although this approach is not intended to imply complete acceptance of DSM-III-R. Thus, we will draw attention to potential inadequacies in this classification scheme where we consider that such views may be helpful to the reader.

What is cognitive-behavioural interviewing?

In this book we use the term ‘cognitive-behavioural interviewing’ to refer to the procedure by which information is obtained from a client that will assist in the identification of the presenting problem(s), the description of important aspects of the problems and the selection of appropriate treatment interventions. The term ‘cognitive behavioural’ is used to denote the general theoretical position from which this approach was derived. This term is being used in its broad sense, which includes consideration of overt behaviour, cognitive components and physiological activity. Throughout the book there is an acceptance of the theoretical importance of antecedents and consequences of behaviour and thought in the development and maintenance of psychological problems. We are in agreement with many other contemporary researchers in this field that cognitive processes are also relevant to an understanding of these problems (e.g. Bandura, 1977a; Mahoney, 1974; Meichenbaum, 1977), although we do not accept that such cognitive processes are necessarily the primary causative factors in all psychological problems.

The behavioural approach places considerable emphasis on the capacity for behaviour to be elicited by environmental cues. Thus, smoking may be elicited by the presence of cues previously associated with this behaviour such as the presence of an ash-tray, an advertisement or consumption of a cup of coffee. Likewise, it is possible that certain physical reactions such as those that are seen in anxiety may be elicited by environmental stimuli. A portion of the behavioural interview ought to be directed at the identification of cues that may be responsible for eliciting the problem behaviour. Some behaviour may be determined largely by the consequences with which it is followed. Thus, the occurrence of aversive stimuli consequent to the emission of a behaviour will tend to reduce the frequency of that behaviour, and the occurrence of appetitive stimuli will tend to increase the frequency of the behaviour. For each problem, we have discussed those aspects of the potential consequences that the clinician may need to examine in detail. For example, in discussing depression, we have drawn attention to the possibility that some depressive behaviour may be reinforced by the attention of significant others in the person’s environment.

Triple-response modalities

The behavioural approach to assessment places emphasis on the need to examine three response modalities: overt behaviour, cognitive components and physiological activity. Overt behaviour includes objectively observable aspects of the problem, e.g. the number of drinks consumed per day, the frequency of panic attacks, engagement in certain activities. The cognitive components are the thoughts that precede, accompany or follow the occurrence of events or behaviours. Physiological activity refers to those features of the problem that involve some physiological change, e.g. perspiration, heart rate or respiration, or muscle tension. Many psychological problems involve more than one of these modalities. For example, a person with a public-speaking phobia may manifest avoidance of speaking situations, thoughts about appearing foolish prior to being in a speaking situation and an increase in heart rate when exposed to the speaking situation. Thus, assessment is directed at the evaluation of the level of all three modalities. Such information may be helpful in designing specific assessment devices and in selecting treatment components that are likely to be relevant to the manifestation of the problem in a given individual. Much of the research on the triple-response system has revealed a lack of agreement between the three modalities (e.g. Lang, 1968; Rachman & Hodgson, 1974). As a result of this observation, it has been proposed that each system may be controlled by different organismic and environmental factors. An alternative view is that the lack of agreement between the modalities could be expected to occur for several other reasons. First, the agreement between variables within one modality is often low, placing a restriction on the potential size of agreement between modalities. This point is particularly evident in the assessment of physiological activity, such as heart rate, muscle tension or galvanic skin response. Any one of these measures may provide a poor reflection of the physiological aspect of the particular problem under investigation in a particular individual. Second, the variety of assessments available under the rubric of cognitive measurement is also problematic in understanding the relationships between the three modalities. Assessment of cognitions may include self-observation of physiological activity or behaviour, causal attributions, self-ratings of symptom severity, self-efficacy judgments, distorted or irrational thinking and so forth. Many of these types of assessments can be conducted in several different ways and at different points in time in relation to the behaviour. Thus, the failure to find agreement between physiological, cognitive and behavioural modalities may be as much a reflection of the lack of agreement within modalities as it is a reflection of the operation of different systems. In this book, we have chosen, with the above qualification, to preserve the traditional focus on the triple-response modalities as an approach to assessment. Since the primary subject of the book is interviewing, our comments on the triple-assessment are mostly limited to the client’s observations of their physiological, cognitive and behavioural functioning.

An important aspect of the cognitive and behavioural approaches is the emphasis on the evaluation of the present difficulties and circumstances of the person. The present-focus will often help to clarify the nature of the problem, and will generally be useful in providing clear targets for the intervention. It is very helpful to explore carefully the most recent instance of the occurrence of the problem while the details can be retrieved easily. Other instances that are worthy of detailed discussion include any particularly distressing or traumatic occasions. However, it is also necessary to obtain an appropriate amount of information about the person’s previous history, and, in particular, the development of the problem for which help is being sought. Such information may provide useful insights into possible causal factors that may be of assistance in the design of interventions.

One theme that permeates this book is an acceptance of the hypothetico-deductive approach to assessment. In our provision of background information about each problem, we have attempted to summarise the principal theoretical and descriptive details that are necessary to achieve an understanding of the likely complexities of each problem. This approach is intended to result in the reader being able to identify those features of the presenting problem that may be useful in tailoring an individual treatment programme. For example, in the chapter on insomnia, attention is drawn to both the stimulus-control and the hyperarousal theories, and to the kind of information that would be pertinent to the identification of either processes as may occur in a given person. Thus, the clinician might obtain information that suggests the involvement of poor stimulus control as a basis for insomnia in a particular client, and would design an appropriate treatment programme accordingly. Admittedly, not all problems are amenable to such distinctive conceptualisations, and there is considerably more research needed concerning the prediction of treatment outcome and the matching of clients to treatments.

It is important to outline here some of the more general issues that may arise in the initial interview prior to discussion of individual problems. Thus, we will now turn to consideration of the overall structure and procedure of the initial interview, emphasising the clinical skills that are important to the application of the guidelines presented in the remainder of the text.

Some general caveats

In order to provide detailed discussion about each of the selected problems, it has been necessary to isolate each one within a separate chapter. However, the clinician needs to be aware that many clients will present with more than one problem, making it necessary to co...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• 1.Introduction
• 2.Fear and Anxiety Problems
• 3.Depression
• 4.Assessment of Obesity
• 5.Assessment of Interpersonal Problems
• 6.Assessment of Sexual Dysfunction
• 7.Insomnia
• 8.Headaches
• 9.Substance Abuse
• Bibliography
• Subject Index
• Author Index