Simply Effective Cognitive Behaviour Therapy

Chapter Eight Obsessive-Compulsive Disorder

Paul — Mon, 05 Oct 2009 08:52:44 +0000

Explain to OCD sufferers that their intrusive thoughts/images are normal it is their attempts at neutralising them that leads to their persistent difficulties.
Dare the OCD sufferer to gradually postpone their repetitive behaviour and thereby test out whether there are any deleterious consequences.
Highlight for the OCD sufferer the link between low mood and compulsions, and teach mood management, using the MOOD chart.

Chapter Seven Social Phobia

Paul — Fri, 11 Sep 2009 07:50:35 +0000

Chapter Seven: Social Phobia

For clients with social phobia challenge the ‘story’ they have of others evaluation of them as a consequence of their social interactions.
Encourage the client with social phobia to gradually encounter situations they fear.

Chapter Six from book : Post-traumatic Stress Disorder

Paul — Sat, 08 Aug 2009 13:05:01 +0000

Chapter Six Post-traumatic Stress Disorder

The goal of treatment for post-traumatic stress disorder is to stop clients re-experiencing the trauma. Paradoxically this is achieved by a deliberate specific focus on the details of the trauma by variously writing about it, reading over an account out loud daily until the trauma is simply remembered.
PTSD treatment can be a challenge to the therapeutic alliance in that client’s are committed to blocking the memory, whilst the therapist is suggesting confronting the memory, the impasse can be resolved by focussing on ‘better ways’ of handling the traumatic memory.
Dare PTSD clients to gradually tackle what they have been avoiding.
Social support is the biggest predictor of recovery from PTSD and a family member/friend of the client should if possible be asked to attend at least some of the sessions.

Vocational Rehabilitation Annual Conference – Sheffield 2009

Paul — Wed, 01 Jul 2009 22:52:11 +0000

Directing the Traumatised

by Dr Michael J Scott – Consultant Psychologist

www.simplyeffectivecbt.com

www.posttraumaticstress.co.uk

Vocational Rehabilitation Annual Conference – Sheffield

July 2nd 2009

[ You can click here for an annotated .pdf of the days slide show ]

In this workshop I would like to cover:

1. How to very briefly screen a person for all the common mental health disorders.
2. An overview of the cognitive-behavioural protocols for each of the common disorders.
3. How to very briefly audit the efficacy of any mental health intervention.
4. How to decide on further recommendations.

Screening For The Common Mental Disorders

Half of cases of post-traumatic stress disorder are missed in primary care
Clinicians tend to stop at the first disorder identified
It is the presence of missed additional disorders that often complicate recovery
Poor diagnosis leads to poor treatment
The responses to trauma are very varied necessitating a broad screen
Use the First Step Questionnaire or 7 Minute Interview to help identify and audit appropriate treatment

Extract From The 7 Minute Mental Health Screen

1. Depression (check [Yes | No | Don’t know] on form)

During the past month have you often been bothered by feeling, depressed or hopeless?
During the past month have you often been bothered by little interest or pleasure in doing things?

Is this something with which you would like help?
A positive response to at least one symptom question and the help question suggests that detailed enquiry be made.

Cognitive Behaviour Therapy Is Diagnosis Specific and the NICE Recommended Treatment For:

Depression
Post-traumatic Stress Disorder
Panic Disorder
Generalised anxiety disorder
Social Phobia
Obsessive Compulsive Disorder

Further diagnostic questions for each of these disorders and CBT protocol for each disorder are contained in Simply Effective Cognitive Behaviour Therapy by Michael J Scott (2009) London: Routledge.

CBT Needs To Be Quality Controlled

CBT is essentially educational and homework is a key element, and a major predictor of outcome. If a client has not been given specific homework tasks between sessions with a review in session then the CBT fails quality control.
Across the disorders (with the possible exception of a simple phobia) CBT therapists use a Thought Record to help a client take a photograph of what upsets them from a different angle, if this has not happened then there has been poor fidelity to a CBT protocol and the therapy probably fails quality control.

Example Thought Record – MOOD chart from Simply Effective Cognitive Behaviour Therapy

MOOD chart

Satisfactory Employment Outcome Depends On:

Proper screening for the full range of emotional disorders
Evidence based treatment for all identified disorders
Monitoring of adherence to CBT protocol
Auditing treatment outcome
Redirecting client to appropriate treatment/therapist

7 Minute Mental Health Screen /Audit

Paul — Wed, 01 Jul 2009 17:24:43 +0000

The 7 Minute Mental Health Screen/Audit

This clinician screen covers the common mental disorders and provides interpretative guidance for the self-report version, The First Step Questionnaire. Positive findings can be investigated further by directly accessing the DSM IV TR criteria utilizing the questions on the relevant page in Simply Effective Cognitive Behaviour Therapy (In Press) by Michael J Scott London:Routledge. If the focus is on auditing the effects of an intervention, the time frame for questions can be altered e.g last 2 weeks.

For your convenience, a .pdf of the presentation has been prepared:

7-Minute-Mental-Health-Screen.pdf

The Mental Health Screen / audit form allows you to check off [ Yes | No | Don’t know ] for the following questions:

1. Depression
During the past month have you often been bothered by feeling, depressed or hopeless?
During the past month have you often been bothered by little interest or pleasure in doing things?
Is this something with which you would like help?

A positive response to at least one symptom question and the help question suggests that detailed enquiry be made, page xxx.

2. Panic Disorder and Agoraphobia
Do you have unexpected panic attacks . a sudden rush of intense fear or anxiety?
Do you avoid situations in which the panic attacks might occur?
Is this something with which you would like help?

A positive response to at least one symptom question and the help question suggests that detailed enquiry be made, page xxx .

3. Post-traumatic Stress Disorder
In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you:

i. Have had nightmares about it or thought about it when you did not want to?
ii. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
iii. Were constantly on guard, watchful, or easily startled?
iv. Felt numb or detached from others, activities, or your surroundings?