Some reminders and tips from Simply Effective Cognitive Behaviour Therapy, to make comments or raise queries use the blog. Over the coming months all the common mental disorders will be covered, keep watching this space!
Based on Chapter One – Simple CBT strengths and limitations, Chapter Two – Getting started – diagnosis and beyond and Chapter Three – The first interview.
- Over half the cases of common mental health problems are missed, this can be prevented by screening (The 7 Minute Mental Health Screen or First Step Questionnaire) and directly asking questions about each of the symptoms in a diagnostic set (The CBT Pocketbook).
- Clients want help with all the disorders from which they are suffering not just the main disorder with which they present.
- A diagnosis indicates which cognitive model is pertinent. Whilst a case formulation represents a specific example of a cognitive model.
- A case formulation is developed by eliciting predisposing factors, precipitating factors, perpetuating factors and protective factors.
- KISS (Keep It Simple Stupid) – Keep therapy simple, include metaphor and simple diagrams.
- Focus on SMART specific, measurable, achievable and realistic targets.
- Remain faithful to the CBT protocol for the disorder/s but with flexibility.
- Always enter the client’s here and now and generally use this to illustrate new teaching.
- The structuring of sessions and the setting/review of homework are likely to be important predictors of how much the client benefits from treatment. Without written homework assignments it is very difficult to judge adherence.
- The client’s reality is usually of suffering from more than one disorder, focus on each disorder within a session and assign homework pertinent to each disorder.
- There is no evidence that ‘generic’ (i.e without a diagnosis) CBT works.
- Include a measure of the severity of the disorder/s and a measure that assesses cognitions that are pertinent to the disorder/s.
- The PHQ-9 for depression and GAD-7 for generalised anxiety disorder are so brief that clients with these disorders can easily complete them after each session for homework, allowing for careful tracking of progress.
- Psychometric tests are not a substitute for diagnosis , they tend to give many false positives, which can lead to a targetting of the wrong disorder.
- Be open-minded about new developments in CBT, but ask what is the evidence that the new approach adds to the effectiveness of the standard approaches outlined in this volume? Beware of marketing and hopping from workshop to workshop.
- Expect to get stuck sometimes in a therapy session, refer to the Pocketbook for help. Accept that learning a skill is largely about learning from mistakes.
- Relapse prevention is an important ingredient of all the programmes. A multi-faceted approach is needed embracing: the construction of a Survival Manual, involvement of significant others, use of self-help books (e.g Feeling Good The New Mood Therapy and Moving On After Trauma) and computer assisted therapy (e.g Mood Gym).
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