Cognitive Behaviour Therapies

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Edited by: Windy Dryden

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    List of Figures and Tables

    Figures
    • 2.1 A simple vicious cycle 27
    • 2.2 Reviewing a negative thought 35
    • 2.3 Alan's longitudinal formulation 41
    • 2.4 Short narrative formulation for Alan 42
    • 4.1 The ACT model: positive processes that build psychological flexibility 75
    • 6.1 The S-REF model of psychological disorder with metacognitions revealed 118
    • 6.2 Metacognitive case formulation 129
    • 7.1 The compassion circle 143
    • 7.2 Three types of affect regulation system 145
    • 11.1 Mechanism of BA for depression 243
    • 11.2 BA model of depression related to Beth 251
    • 12.1 A circumplex model of the client's level of control during a session and strategies to regain balance 270
    • 12.2 A control theory hypothesis for the mode of change of different therapy techniques 274
    Tables
    • 0.1 Comparison of chapters in the 1986 and 2011 volumes xiii
    • 2.1 Cognitive specificity 26
    • 2.2 Review questions 39
    • 2.3 Review questions for Alan 43
    • 3.1 A summary of the features of doing and being mode of mind 54
    • 4.1 Central ACT processes 76
    • 5.1 Functions and modes of a DBT programme 97
    • 5.2 Hierarchy of behaviours in Stage 1 of DBT 98
    • 5.3 Renee's preliminary target hierarchy 107
    • 5.4 Chain and solution analysis of cutting behaviour 108
    • 7.1 Example of the key themes in CFT formulation 155
    • 8.1 Early maladaptive schemas 171
    • 9.1 A sample of Dinah's anxiety about losing self-control 207
    • 9.2 Dinah's concern-based goals about dealing with losing self-control 208
    • 11.1 Definition of behavioural concepts used in BA 239
    • 11.2 Excerpt from Beth's activity diary 250
    • 11.3 Behavioural theory related to Beth's depression 252
    • 12.1 A control theory framework for understanding circumstances where the balance of control strays from collaborative exploration 272

    About the Editor and Contributors

    The Editor

    Windy Dryden is Professor of Psychotherapeutic Studies, Goldsmiths, University of London. He is a Fellow of the British Psychological Society and of the British Association for Counselling and Psychotherapy. He began his training in rational emotive behaviour therapy (REBT) in 1977 and became the first Briton to be accredited as an REBT therapist by the Albert Ellis Institute. In 1981, Windy spent a six-month sabbatical at the Center for Cognitive Therapy, University of Pennsylvania, one of the first British psychologists to do an extended training in cognitive therapy. He is a Fellow of the Albert Ellis Institute and a Founding Fellow of the Academy of Cognitive Therapy.

    While his primary therapeutic orientation is REBT, Windy has been very much influenced by his cognitive therapy colleagues and by the working alliance theory of Ed Bordin. His research interests are in the historical and theoretical roots of REBT (with Arthur Still) and the phenomenology of hurt, the study of which is informed by REBT theory.

    Windy is perhaps best known for his voluminous writings in REBT/CBT and the wider field of counselling and psychotherapy. To date he has authored or edited over 185 books, making him probably the most prolific book writer and editor currently alive in the field today. He has also edited 20 book series including the best-selling ‘Counselling in Action’ series.

    Windy was the founding editor of the British Journal of Cognitive Psychotherapy in 1982, which later merged with the Cognitive Behaviorist to become the Journal of Cognitive Psychotherapy: An International Quarterly. Windy was co-founding editor of this journal with E. Thomas Dowd. In 2003, Windy became the editor of the Journal of Rational-Emotive and Cognitive-Behavior Therapy.

    The Contributors

    Rebecca Crane is an occupational therapist who works as a teacher and trainer in mindfulness-based interventions at the Centre for Mindfulness Research and Practice, Bangor University. She has written Mindfulness-Based Cognitive Therapy in the CBT Distinctive Features Series; Routledge, 2009.

    Joe Curran works as a Consultant Cognitive Behavioural Psychotherapist for Sheffield Health and Social Care NHS Foundation Trust. He is course leader for a Postgraduate Diploma in CBT and has an interest in the theory and practice of contextual CBTs, such as behavioural activation and acceptance and commitment therapy.

    David Ekers is a Consultant Nurse and Clinical Lead for ‘Talking Changes’ Improving Access to Psychological Therapies service in Co Durham and Darlington. This role is split between clinical leadership service development and research with the mental Health Research Unit at Durham University. David's main research interests are focused upon primary care mental health provision and in particular improving delivery of effective treatments for anxiety and depression. In particular he is involved in the development and dissemination of behavioural activation for depression across the age bands and provision of collaborative care.

    Peter Fisher is a Senior Lecturer in Clinical Psychology, University of Liverpool and is a supervisor and tutor for the Metacognitive Therapy Institute. He has published over 40 articles and book chapters on metacognitive therapy and cognitive therapy. Currently, his main research interests focus on the development and evaluation of metacognitive therapy for emotional disorders in adult mental health and physical health populations.

    Paul Gilbert is a Professor of Clinical Psychology at the University of Derby. He has published a number of books and over 150 academic papers in the areas of mood disorders, shame and self-criticism. He is a fellow of BPS and a former president of BACBP. He is the founder of the charity the Compassionate Mind Foundation (http://www.compassionatemind.co.uk) and is currently developing and researching the efficacy of compassion focused therapy.

    Simon Houghton is Consultant Cognitive Behavioural Psychotherapist and Clinical Lead for the Obsessive Compulsive Disorder Specialist Team of Sheffield Health and Social Care NHS Foundation Trust. He is also the visiting Consultant Psychotherapist for Riverdale Grange, an independent sector residential clinic for people with eating disorders in Sheffield. Until recently Simon was the Clinical Advisor to the Improving Access to Psychological Therapies programme for Yorkshire and the Humber.

    Warren Mansell is a Reader at the University of Manchester, a clinical psychologist and an accredited cognitive behavioural therapist. He has been the co-chair of the annual conference of the British Association of Behavioural and Cognitive Psychotherapies (BABCP) since 2008 and has authored over 80 publications. In 2011, he received the May Davidson Award from the British Psychological Society for outstanding contribution to clinical psychology in the 10 years since qualifying. His books include: Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment, The Oxford Guide to Metaphors in CBT, Coping with Fears and Phobias: A Step-by-Step Guide to Understanding and Facing Your Anxieties and The Bluffer's Guide to Psychology.

    Sarah Marks is a historian and Research Associate at the Wellcome Trust Centre for the History of Medicine at University College London. Her work ranges across the history of psychology and psychiatry in the British and European contexts, from the 19th century to the present day. Her current research focuses upon the historical development of cognitive and behavioural therapies in the UK, and their place in wider political debates surrounding wellbeing, welfare and governance.

    Dean McMillan is a senior lecturer in Mental Health Services Research at the University of York. He has a background in clinical psychology and a Diploma in cognitive behaviour therapy. His research interests include the development and evaluation of cognitive-behavioural interventions.

    Eric Morris works as a consultant clinical psychologist for the South London and Maudsley NHS Foundation Trust, and has practised acceptance and commitment therapy (ACT) for the past ten years, as well as providing teaching and training in ACT and other contextual behavioural therapies. He is involved in developing and researching mindfulness-based group and individual interventions for psychosis at the Institute of Psychiatry, King's College London.

    Vartouhi Ohanian is a consultant clinical psychologist and Head of Psychology Services in Hounslow, West London Mental Health Trust. Vartouhi has trained extensively in schema therapy since 1991 with Dr Jeffrey Young and Dr Mary Anne Layden. She has been instrumental in introducing and disseminating schema therapy in the UK by organising national workshops since 1996. She is a long-standing member of the International Society for Schema Therapy and is certified by them as a schema therapist and schema therapy training and supervision provider. She is also trained in group schema therapy with borderline personality disorder. She teaches widely in the UK and has presented on schema therapy at the British Association of Behavioural and Cognitive Psychotherapy and eating disorder conferences. She established the first ISST-approved advanced certification training programme in schema therapy in the UK, which has now been running for many years. She has also been invited to run schema therapy training programmes abroad. Vartouhi is co-author of a number of publications on schema therapy with eating disorders and has particular expertise in the use of imagery to bring about schema change.

    Joe Oliver is a clinical psychologist working in the South London and Maudsley NHS Foundation Trust. He works within an early intervention for psychosis team in South London. He has clinical and research interests in the use of acceptance and commitment therapy in working with people with psychosis.

    Rana Rashed is a principal clinical psychologist who currently works in a community mental health setting with clients with severe and enduring mental health problems. She has a specialist interest in working with clients with diagnoses of psychosis and personality disorders. She is a certified schema therapist and is a supervisor on the Schema Therapy Certification Programme.

    John Rhodes is a consultant clinical psychologist in the NHS (Brent, CNWL), working in a service for clients diagnosed as having psychosis and long-term mood disorders. For many years he has used solution focused, narrative and CBT approaches. Publications include Solution Focused Thinking in Schools (1995) with Yasmin Ajmal and Narrative CBT for Psychosis (2009) with Simon Jakes. He is a visiting lecturer at the University of Hertfordshire and honorary lecturer at University College London.

    Dr Michaela Swales is Consultant Clinical Psychologist, Betsi Cadwaladr University Health Board and Senior Lecturer in Clinical Psychology, School of Psychology, Bangor University. She runs a DBT programme for adolescents with a history of chronic suicidal behaviour in a Tier IV inpatient service in North Wales. She is co-author with Dr Heidi Heard of Dialectical Behaviour Therapy in the ‘CBT Distinctive Features Series’ published by Routledge (2009). In November of the same year she was awarded the Cindy Sanderson Outstanding Educator Award by the International Society for the Improvement and Training in DBT at their conference in New York.

    Dr Frank Wills is an independent CB therapist, trainer and author, living in Bristol. He comes originally from the Wirral and supports Tranmere Rovers FC and the England cricket team – activities that have made him so skilled in dealing with anxiety and depression.

    Preface

    In 1986 I co-edited a book with Bill Golden entitled Cognitive-behavioural Approaches to Psychotherapy (1986). In the preface of that book we noted that a recent survey at that time showed that cognitive approaches to psychotherapy, while making their initial mark in the 1950s and early 1960s, were in the mid-1980s one of the leading forces in psychotherapeutic practice. Bill Golden and I began work on that book in 1984, three years after I had returned from a six-month sabbatical at the Center for Cognitive Therapy in Philadelphia. I had edited the first edition of my textbook entitled at that time Individual Therapy in Britain (1984) and wanted to edit a companion volume entitled Cognitive Behaviour Therapy in Britain. The problem was that there were very few British practitioners of CBT at that time, and those that did exist practised mainly cognitive therapy and rational-emotive therapy. I soon learned that if I was going to edit an ‘approaches to CBT’ book it would have to rely heavily on contributors from North America. Of the 18 contributors to the 1986 volume, 15 were from the USA, one was from the Netherlands, one from Italy and one from Britain – me! It made sense, then, for me to team up with an American co-editor, Bill Golden.

    Twenty-six years after the publication of that book, the situation has changed markedly in Britain. There are many more CBT therapists and most of the CBT approaches have British proponents. Indeed, in this book, a number of approaches were pioneered in Britain (e.g. compassion-focused therapy and meta-cognitive therapy). All of the chapters in this book are written by British authors and therefore I decided to edit the volume without an American co-editor. Also, as Sarah Marks shows in Chapter 1, CBT has its own British history. This therapeutic tradition has taken a firm foothold in British counselling and psychotherapy. Thus this volume, as can be seen from Table 0.1, is very different in content from its 1986 predecessor. Indeed, only two approaches (Beck's cognitive therapy and REBT) feature in both volumes.

    Table 0.1 Comparison of chapters in the 1986 and 2012 volumes
    19862012
    • Cognitive Behaviour Modification
    • Cognitive Therapy
    • Structural Cognitive Therapy
    • Rational-Emotive Therapy
    • Rational Behaviour Therapy
    • Cognitive Appraisal Therapy
    • Personal Construct Therapy
    • Interpersonal Cognitive Problem-Solving Therapy
    • Cognitive-Behavioural Hypnotherapy
    • Multimodal Therapy
    • Beck's Cognitive Therapy
    • Mindfulness-based Cognitive Therapy
    • Acceptance and Commitment Therapy
    • Dialectical Behaviour Therapy
    • Metacognitive Therapy
    • Compassion-focused Therapy
    • Schema Therapy
    • Rational Emotive Behaviour Therapy
    • Narrative Cognitive Behaviour Therapy
    • The Transdiagnostic Approach to Cognitive Behaviour Therapy

    Having noted the differences between this book and its predecessor, the major similarity can be found in the chapter structure of both volumes. The following appeared in the preface of the 1986 book, but equally applies to this one:

    Contributors were asked to write to a common chapter structure emphasizing the distinctive features of their approach. First, they were asked to address themselves to the historical development and theoretical underpinnings of their approach. Under this rubric, major theoretical concepts are considered and issues of conceptualizing clients' problems are detailed. Second, the contributors were invited to focus on practical applications. Here, the relationship between therapist and client is outlined and major treatment strategies and techniques are presented. In addition, contributors were asked to address themselves to the issue of obstacles to client progress, how they are conceptualised and what tactics are used to overcome them. Finally, a case example is presented to show how each approach is applied to clinical problems. (Dryden and Golden, 1986: xi–xii)

    In addition to the above instructions, contributors to the 2012 volume were asked to make clear the research status of their approach and to provide five suggested further readings.

    I was tempted to write a concluding chapter in the current volume speculating on the likely future direction of CBT. I have resisted this temptation for one major reason. There was no way Bill Golden and I could have foreseen the developments that have taken place in CBT in Britain and in the world over the 26 years since the original book was published. Should I be around to edit this book again in 26 years' time (I will be 87 then!), then my guess is that CBT as it exists then will be as unrecognisable to me now as today's CBT would have been to Bill and I back then.

    Let me close by thanking all contributors for their excellent work and for the dignified way in which they responded to my feedback and to my continual promptings for them to keep to the chapter structure.

    References
    Dryden, W. (Ed.) (1984) Individual Therapy in Britain. London: Harper & Row.
    Dryden, W. and Golden, W.L. (Eds) (1986) Cognitive-behavioural Approaches to Psychotherapy. London: Harper & Row.

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