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

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

Paul Stallard

• Publisher: Wiley
• Year: 2020
• ISBN:
  9781119395461
• Edition: 2
• Topic: Psicología
• Subtopic: Psicología clínica

A powerful and insightful clinical resource for CBT practitioners who work with children and young adults

The newly updated and thoroughly revised Second Edition of this companion to Think Good, Feel Good and Thinking Good, Feeling Better delivers guidance for clinicians using the author's seminal workbooks. This companion work builds upon the workbook materials by offering readers instruction on all aspects of the therapeutic process and a wide range of case studies highlighting specific therapies in action.

A Clinician's Guide covers topics including parental involvement, key cognitive distortions in children, formulations, challenging thoughts, guided discovery, and the use of imagery. The author also includes a chapter focusing on common potential problems that arise in therapy and strategies to overcome them.

The book highlights the underlying philosophy, process, and core skills of employing CBT with children and young people. Readers will appreciate the competency framework, which describes the CORE philosophy, PRECISE process, and the ABCs of specific techniques. The book also includes:

• Additional materials and handouts for use in therapy, including psycho-educational materials for children and parents on common problems, like depression, OCD, PTSD, and anxiety
• Downloadable, multi-use worksheets for use in the clinician's therapeutic sessions
• Practical, real-world case examples that shed light on the techniques and strategies discussed in the book
• A systematic approach to the use of cognitive behavioural therapy to treat common psychological problems

Perfect for professionals and trainees in child and adolescent mental health, like psychiatrists, clinical psychologists, educational psychologists, community psychiatric nurses, and occupational therapists, the book also belongs on the shelves of non-mental health professionals, including school nurses and social workers, who regularly work with children in a therapeutic setting.

CHAPTER ONE
Introduction and overview

Cognitive behaviour therapy (CBT) is a generic term used to describe a variety of interventions that focus on the relationship between cognitions, emotions, and behaviours. These interventions are based on the shared premise that emotional distress is generated by the way we think about particular events that occur. Some ways of thinking are dysfunctional and unhelpful and can lead to the emergence of psychological problems. These unhelpful patterns are maintained by attention and memory biases, emotional responses, and maladaptive ways of behaving such as avoidance.

Traditional CBT interventions focus on identifying, directly challenging, and reappraising dysfunctional cognitions and through so doing reduce emotional distress and unhelpful behaviours. Recent models, often termed third wave, focus on changing the nature of the relationship with these thoughts rather than changing their specific content. Thoughts are understood as mental activity rather than defining reality, with mindfulness, acceptance, compassion, and distress tolerance helping to minimise the emotional distress they generate.

CBT as an intervention

CBT has been well evaluated and has established itself as the most extensively researched of all the child psychotherapies (Graham 2005). Systematic reviews consistently demonstrate that CBT is effective for the treatment of a range of emotional problems in children, adolescents, and young people, including post‐traumatic stress disorder (PTSD; Gutermann et al. 2016; Morina et al. 2016; Smith et al. 2019); anxiety (Bennett et al. 2016; James et al. 2015); depression (Oud et al. 2019; Zhou et al. 2015), and obsessive‐compulsive disorder (OCD; Öst at al. 2016). Research is beginning to document the benefits of third wave CBT interventions such as mindfulness (Dunning et al. 2019; Klingbeil et al. 2017), dialectical behaviour therapy (McCauley et al. 2018), and acceptance and commitment therapy (Hancock et al. 2018).

Brief models of CBT, such as single‐session exposure therapy for the treatment of specific phobias, have been found to be highly effective (Öst & Ollendick 2017). Similarly, brief parent‐guided CBT has been found to be effective in the treatment of anxiety disorders (Cartwright‐Hatton et al. 2011; Creswell et al. 2017). Finally, model‐specific interventions, such as cognitive therapy for social anxiety (Leigh & Clark 2018) or single‐session exposure therapy for specific phobias (Davis et al. 2019), have found encouraging results.

This substantial and consistent evidence has resulted in CBT being recommended by expert groups such as the UK National Institute for Health and Clinical Excellence and the American Academy of Child and Adolescent Psychiatry for the treatment of young people with emotional disorders including depression, OCD, PTSD, and anxiety. This growing evidence base has also promoted the development of national training programmes in CBT. In the UK, the successful Improving Access to Psychological Therapies (IAPT) programme has been extended to children and young people (Shafran et al. 2014).

CBT as a preventative intervention

In addition to being an effective treatment, CBT has proven to be effective in the prevention of mental health problems such as anxiety and depression (Calear & Christensen 2010; Neil & Christensen 2009). Preventive programmes offer the potential to reduce the severity of symptomology of those already displaying problems whilst enhancing the resilience of those who are not currently symptomatic. The results of prevention programmes are encouraging and suggest that school‐based anxiety and depression prevention based on CBT is effective (Dray et al. 2017; Hetrick et al. 2015; Stockings et al. 2016; Werner‐Seidler et al. 2017).

Typically, preventative programmes are provided in schools either to whole classes of young people (e.g. universal approach) or to young people identified as at risk of developing or experiencing problems (e.g. targeted approaches). School‐based programmes have good reach, and integrating them into the school curriculum can help to reduce the stigma attached to mental health so that worries and problems can be more openly acknowledged and discussed (Barrett & Pahl 2006). Reviews suggest that classroom‐based approaches designed to improve mental health and well‐being are effective both as universal and as targeted programmes (Šouláková et al. 2019; Stockings et al. 2016).

There are many CBT anxiety and depression prevention programmes, with the most well evaluated being FRIENDS for Life (Barrett 2010), Penn Resilience Programme (Jaycox et al. 1994), Coping with Stress Course (Clarke et al. 1990), Resourceful Adolescent Program (Shochet et al. 1997), and the Aussie Optimism Programme (Roberts 2006). Whilst the results are generally positive, not all evaluations of these programmes have shown positive effects. The intervention leader requires careful consideration. Whilst teachers and school staff are well placed to deliver these programmes, studies have shown that they may not necessarily be as effective as trained mental health leaders (Stallard, Skrybina, et al. 2014; Werner‐Seidler et al. 2017). It is therefore important to consider the knowledge, support, and supervision of those delivering these programmes.

CBT with younger children

Whilst CBT can routinely be used with children from the age of seven years, comparatively few studies have evaluated the effectiveness of CBT with children under the age of 12 (Ewing et al. 2015). Most studies tend to involve young adolescents aged 12–17. Randomised controlled trials evaluating CBT for the treatment of depression rarely include children under the age of 12 (Forti‐Buratti et al. 2016). For example, Yang et al. (2017) undertook a review and meta‐analysis of CBT for the treatment of depression in children (defined as under the age of 13) and identified only nine studies, with six of these being conducted before the turn of the century.

In terms of anxiety, a few specific programmes for young children have been developed. These include Being Brave (Hirshfeld‐Becker et al. 2010), Taming Sneaky Fears (Monga et al. 2015), and the school‐based universal prevention programme Fun Friends (Pahl & Barrett 2010). Results from these studies are limited but nonetheless encouraging.

A few researchers have developed and explored the effectiveness of CBT with young children with PTSD (Dalgleish et al. 2015; Salloum et al. 2016). For example, Scheeringa et al. (2011) reported the feasibility of a trauma‐focused CBT intervention with children aged three to six who had experienced a life‐threatening event and found a large reduction in PTSD symptoms at six months. Research with OCD is similarly limited, although once again the results are promising. In one of the few studies, Freeman et al. (2014) found that 72% of children aged five to eight with OCD were assessed as ‘much improved’ after completing a 14‐session family‐based CBT programme.

It cannot be assumed that because CBT is effective with young adolescents that it will also be effective with young children. Developmental factors need to be considered and the role of parents/carers requires careful attention. Nonetheless, although research is limited, the results are encouraging and are consistent with those obtained with older samples.

CBT with children and young people with learning difficulties

There is evidence that CBT can be effective with young people with learning difficulties, particularly those with high‐functioning autistic spectrum disorder (ASD; Perihan et al. 2019). For example, studies hav...