Instructional resource for mental health clinicians on using cognitive behavioural therapy with adolescents and young adults
This book complements author Paul Stallard's Think Good, Feel Good and provides a range of Cognitive Behaviour Therapy resources that can be used with adolescents and young adults. Building upon that book's core strengths, it provides psycho-educational materials specifically designed for adolescents and young people. The materials, which have been used in the author's clinical practice, can also be utilized in schools to help adolescents develop better cognitive, emotional and behavioural skills.
Thinking Good, Feeling Better includes traditional CBT ideas and also draws on ideas from the third wave approaches of mindfulness, compassion focused therapy and acceptance and commitment therapy. It includes practical exercises and worksheets that can be used to introduce and develop the key concepts of CBT. The book starts by introducing readers to the origin, basic theory, and rationale behind CBT and explains how the workbook should be used. Chapters cover techniques used in CBT; the process of CBT; valuing oneself; learning to be kind to oneself; mindfulness; controlling feelings; thinking traps; solving problems; facing fears; and more.
Written by an experienced professional with all clinically tested material
Specifically developed for older adolescents and young adults
Reflects current developments in clinical practice
Wide range of downloadable materials
Includes ideas from third wave CBT, Mindfulness, Compassion Focused Therapy and Acceptance and Commitment Therapy
Thinking Good, Feeling Better: A CBT Workbook for Adolescents and Young Adults is a "must have" resource for clinical psychologists, adolescent and young adult psychiatrists, community psychiatric nurses, educational psychologists, and occupational therapists. It is also a valuable resource for those who work with adolescents and young adults including social workers, nurses, practice counsellors, health visitors, teachers and special educational needs coordinators.
Chapter One Cognitive behaviour therapy: theoretical origins, rationale, and techniques
Cognitive behaviour therapy (CBT) is a generic term used to describe a family of psychotherapeutic interventions that focus upon the relationship between cognitive, emotional, and behavioural processes. The overall aim of CBT is to facilitate an awareness of the important role of cognitions on emotions and behaviours (Hofmann, Sawyer, and Fang 2010). CBT therefore embraces the core elements of both cognitive and behavioural theories and has been defined by Kendall and Hollon (1979) as seeking to
preserve the efficacy of behavioural techniques but within a less doctrinaire context that takes account of the child's cognitive interpretations and attributions about events.
Cognitive Behaviour Therapy focuses upon the relationship between what we think (cognitions), how we feel (emotions), and what we do (behaviour).
The first randomised controlled trials demonstrating the effectiveness of CBT for children and adolescents emerged in the early 1900s (Lewinsohn et al. 1990; Kendall 1994). Numerous trials have since been reported resulting in CBT becoming established as the most extensively researched of all the child psychotherapies (Graham 2005). Reviews have found CBT to be an effective intervention for children and adolescents with a range of problems including anxiety (James et al. 2013; Reynolds et al. 2012; Fonagy et al. 2014), depression (Chorpita et al. 2011; Zhou et al. 2015; Thapar et al. 2012), post-traumatic stress disorder (Cary and McMillen 2012; Gillies et al. 2013), chronic pain (Palermo et al. 2010; Fisher et al. 2014), and obsessive compulsive disorder (Franklin et al. 2015). The substantial body of knowledge demonstrating effectiveness 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, obsessive compulsive disorders, post-traumatic stress disorder, and anxiety. This growing evidence base has also prompted the development of a national training programme in the United Kingdom in CBT, Improving Access to Psychological Therapies (IAPT), which has now been extended to children and young people (Shafran et al. 2014).
CBT is an empirically supported psychological intervention.
The foundations of CBT
CBT describes a family of interventions that have evolved over time through three main phases or waves. The first wave was behaviour therapy which focused directly on the relationship between behaviour and emotions. Through the use of learning theory, new behaviours could be learned to replace those that are unhelpful. The second wave, cognitive therapy, built upon behavioural therapy by focusing on the subjective meanings and interpretations that are made about the events that occur. Directly challenging and testing the content of the biases that underpin these cognitions results in alternative, more helpful, balanced, and functional ways of thinking. Third wave CBT focuses on changing the nature of our relationship with our thoughts and emotions rather than actively attempting to change them. Thoughts and feelings are observed as inevitable mental and cognitive process rather than evidence of reality. Third wave models include Acceptance and Commitment Therapy (ACT), Compassion Focused Therapy (CFT), Dialectical Behaviour Therapy (DBT), and Mindfulness-based Cognitive Behaviour Therapy (MCBT).
First wave: behaviour therapy
One of the earliest influences on the development of CBT was that of Pavlov (1927) and classical conditioning. Pavlov highlighted how, with repeated pairings, naturally occurring responses (e.g. salivation) could become associated (i.e. conditioned) with specific stimuli (e.g. the sound of a bell). The work demonstrated that emotional responses, such as fear, could become conditioned with specific events and situations such as snakes or crowded places.
Emotional responses are associated with specific events.
Classical conditioning was extended to human behaviour and clinical problems by Wolpe (1958) who developed the procedure of systematic desensitisation. By pairing fear-inducing stimuli (e.g. watching a snake) with a second stimulus that produces an antagonistic response (i.e. relaxation) the fear response can be reciprocally inhibited. The procedure is now widely used in clinical practice and involves graded exposure, both in vivo and in imagination, to a hierarchy of feared situations whilst remaining relaxed.
Emotional responses can be changed.
The second major behavioural influence was the work of Skinner (1974) who highlighted the significant role of environmental influences upon behaviour. This became known as operant conditioning and focused upon the relationship between antecedents (setting conditions), consequences (reinforcement), and behaviour. In essence, if a particular behaviour increased in occurrence because it is followed by positive consequences, or is not followed by negative consequences, then the behaviour has been reinforced. Behaviour could therefore be changed by altering the consequences or the conditions that evoked them.
Altering antecedents and consequences can change behaviour.
Recognition of the mediating role of cognitive processes was noted by Bandura (1977) and the development of social learning theory. The role of the environment was recognised, but behaviour therapy was extended to highlight the importance of the cognitions that intervene between stimuli and response. The theory demonstrated that learning could occur through watching someone else and proposed a model of self-control based upon self-observation, self-evaluation, and self-reinforcement.
Second wave: cognitive therapy
Behaviour therapy proved very effective, although it was criticised for failing to pay sufficient attention to the meanings and interpretations that are made about the events that occur. This stimulated interest in the development of cognitive therapy with a direct focus on the way individual's process and interpret events and the effect of these on emotions and behaviour.
This phase was heavily influenced by the pioneering work of Ellis (1962) and Beck (1963, 1964). Ellis (1962) developed Rational Emotive Therapy which was based upon the central relationship between cognitions and emotions. The model proposed that emotion and behaviour arise from the way events are construed rather than by the event per se. Thus activating events (A), are assessed against beliefs (B) that result in emotional consequences (C). Beliefs can be either rational or irrational with negative emotional states tending to arise from, and be maintained by, irrational beliefs.
Cognitions and emotions are linked.
The role of maladaptive and distorted cognitions in the development and maintenance of depression was developed through the work of Beck culminating in the publication of Cognitive Therapy for Depression (Beck 1976; Beck et al. 1979). The model proposes that emotional problems arise through biased cognitive processing in which events are distorted in negative and unhelpful ways. Underlying these b...
