Cognitive Behaviour Therapy: Foundations for Practice

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Frank Wills & Diana Sanders

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    Preface to the Third Edition

    As we engaged in writing this third edition of our book first published in 1997, we have realised that cognitive behaviour therapy (CBT) is on the march – perhaps even ‘at the double’. There have been numerous new developments and changes since we both trained in CBT in the early 1990s and the pace of change shows no signs of easing. It has been challenging to write an account of the model that retains its basic integrity but also reflects developing diversity within it. We were both trainees in one of the early cohorts of the Oxford Cognitive Therapy training course – a veritable engine room for CBT development in the UK. Even as we wrote the first edition of this book, Cognitive Therapy: Transforming the Image, in 1997 a major new development was evident in schema-focused therapy (SFT) and first attempts to address interpersonal and characterological issues. As we wrote the second edition in 2004–5, we had to think about how the transdiagnostic and metacognitive approaches and mindfulness-based cognitive therapy (MBCT) were to be understood and incorporated into a coherent model of practice. We were also noticing the first stirrings of acceptance and commitment therapy (ACT) and compassion-focused therapy (CFT) and contemplating what they had to say. Now as we come to submit this third edition in late 2011 we have seen yet more development in all these trends plus what we have called the ‘late flowering’ of the new behavioural approach. It is possible to see in all this diversity parallels with trends within the historical development of other models such as psychoanalysis and humanistic therapy. One can also recognise the same potential for schism and infighting and wonder if the overall integrity of CBT can be retained. Our approach has been to ‘keep our powder dry’ and not to over-react in the face of potential fracturing. We have no doubt that important points of development are raised in many of the new ‘waves’ of CBT and that they can be enthusiastically embraced, but they should not be uncritically embraced. There are other motives, including academic kudos, involved in developing new ‘products’. Psychological therapy is such a fundamentally difficult activity that all of us sometimes think that if only we had one more theory or technique up our sleeves we would finally have it all sown up. We still, after 30 and 40 years of practice respectively, think this – life-long learning indeed! We have been very aware that alongside the production of ‘waves’ of CBT there has also been fearful consumer reactions that one will not be included in the ‘latest thing’ and suddenly find oneself passé, fallen and trampled down by rush of people literally running to avoid exclusion from the ‘hot’ conference workshop. This edition then focuses on retaining the integrity and parsimony of the original CBT approach whilst making appropriate assimilation from new developments from both CBT and other therapeutic models. We will return to these themes to assess how well we think we have managed this testing task in the Epilogue of this book.

    A note on authorship: For this edition Diana has mainly contributed material on MBCT so that Frank has taken more responsibility for writing the rest of the book. Whilst both authors take responsibility for its overall thrust, there are inevitably small differences of emphasis at times.

    Acknowledgements

    We would like to acknowledge the following colleagues and friends who have helped us with this edition – some are ‘the usual suspects’, others new. We thank them with all our hearts: Sheila Brennan, Mo Chandler, Amanda Cole, Elaine Davies, Janet Gray, Alice Oven, Kim Richardson, Christina Surawy, Kate Wharton, Mark Williams, Annie Wills and, of course, each other.

  • Epilogue: Of Books and Waves and Lives

    We began writing the first edition of this book, Cognitive Therapy: Transforming the Image, in 1995. We had both just finished training in CBT on the famous Oxford course and were full of missionary zeal to spread the word on this surprisingly straight-forward and effective, yet also subtly challenging, form of therapy that we had learnt. We wanted others to share the excitement with us and were clear about what we wanted to say and duly set about writing it. Towards the end of our training we had just begun to hear of the schema-focused model and could see that CBT was set to keep changing. As time went on we heard of even more new developments in CBT and these seem to keep coming, but nonetheless when we were asked to write a second edition, subsequently called Cognitive Therapy: an Introduction, around 2002, we were surprised at the sheer amount of material that we eventually had to include, and struggled with how to adapt some previous material and indeed chapter structure to do so. It was not only CBT that was throwing up changes and challenges – so were our lives. As we were thinking about the second edition, Diana was waiting to have a heart and lung transplant and amazed us all by the way she kept writing in spite of her situation.1 New developments in CBT suddenly became named as waves around this time and we just managed to make a first mention of them in this second edition. Just after the successful reception of the new edition, we were also delighted to attend a book launch in 2006 for Diana's book about how she journeyed to her new heart and lungs. We will soon be attending a party for the 10th anniversary of the ‘new Diana’. Frank has been adjusting to ‘retirement’ from the University of Wales and attaining his PhD at the age of 60. Tranmere Rovers avoided relegation on the last day of the season twice – anxiety time!

    In the years building up to this third edition, the waves of CBT have continued to mount and roll up on to the shore with regular monotony. One of the author's has entered a 40th year in practice. Despite the fact that Larry Beutler, with his tongue firmly in his cheek, has argued that one attains competence after 40 years, this author still finds many new things to learn and try with each new day of practice – lifelong learning indeed. The world of therapy no longer seems so straight-forward, and the challenges of writing this edition have indeed been mighty. Major new developments in CBT continued to be evident right up to the final few weeks of writing – it almost feels that the ‘paint’ of the book is not yet dry. At times it has seemed impossible to comprehend that the CBT model would not fall apart from the sheer stress of accommodation.

    The changes that have struck us the most are those of mindfulness and emotion-focused work in CBT. When Frank was first engaging with CBT in the early 1970s, it seemed that the world was at the start of a long march away from experientially and emotionally based modes of therapy. The excesses of the encounter group movement and the ‘far out’ forms of therapy only added to this trend. An American author recalls turning from humanistic therapy because Fritz Perls’ nude marathons in 1969 secretly repelled him! We wonder now if that long march towards cognition and rationality has reached its high-water mark and a movement back the other way is starting. We kind of hope it has, but we hope also that we will not ‘throw the baby out with the bath water’. So much has been learnt and so many steps forward taken, and the signs are that these lessons will not be lost. Whilst we were writing this edition, we were interested to learn of changes in other models too: for example, the evolution of the emotion-focused model that one could argue overlaps with emotion-focused changes to the CBT model, and the briefer and more empirically based models now being built on psychodynamic principles. It seems to us that a spirit of competition and cooperation prevails between therapy models – often, as one of IAPT interviewees said, goading each other to ‘do their stuff’. Also evident was much work that has been quietly progressing over decades – such as behavioural activation models and the transdiagnostic unified protocol from Barlow and colleagues – without much fanfare of being ‘the latest thing’ of the newest wave. Despite having to weigh and assess all these new developments, we have ended the process as CBT loyalists. We think that the basic model and paradigm still hangs together as both a way of understanding clients and a good-value guide to what may help them most. Whilst we find much in new developments to admire, use and learn more about, we believe that we have in this book been able to demonstrate a mode of CBT practice that incorporates much from exciting new developments but also retains much of the reassuring strength of the original parsimonious model. We look forward to hearing from our readers whether they agree with this assessment.

    Frank Wills

    Diana Sanders

    January 2012

    Note

    1 She has written a remarkable book, Will I Still be Me? A Journey Through a Transplant, about her experiences, including her use of mindfulness and CBT in her recovery (Sanders, 2006) – available from Amazon.

    Appendix: Cognitive Behaviour Therapy Resources

    There are a huge number of books and other resources on cognitive therapy and CBT. Included in this Appendix are some of the ones we have found useful. It is now very easy to find information on the Internet and we also list a few of the websites we know about and use, but each one will direct you to many other resources. A search for ‘cognitive therapy’ produces 1,430,000 hits on Google and 4,065 books on Amazon, so happy surfing and reading!

    Classic Texts with History and Origins of Cognitive Therapy

    Beck, A. T. (1976/1989) Cognitive therapy and the emotional disorders. New York: Penguin.

    Beck, A. T., & Emery, G., with Greenberg, R. L. (1985) Anxiety disorders and phobias: a cognitive perspective. New York: Basic Books.

    Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979) Cognitive therapy of depression. New York: Guilford Press.

    General

    Beck, J. S. (1995) Cognitive therapy: basics and beyond. New York: Guilford Press.

    Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M., & Westbrook, D. (2004) The Oxford guide to behavioural experiments in cognitive therapy. Oxford: Oxford University Press.

    Clark, D. M., & Fairbun, C. G. (Eds) (1997) The science and pratice of cognitive behaviour therapy. Oxford: Oxford University Press.

    Dryden, W. (Ed.) (2012) Cognitive behaviour therapies. London: Sage.

    Dryden, W., & Branch, R. (Eds) (2012) The CBT handbook. London: Sage.

    Hawton, K., Salkovskis, P., Kirk, J., & Clark, D. (1989) Cognitive behaviour therapy for psychiatric problems. Oxford: Oxford University Press.

    Leahy, R. L. (2003) Cognitive therapy techniques: a practitioners guide. New York: Guilford Press.

    Padesky, C. A., & Greenberger, D. (1995) Clinician's guide to mind over mood. New York: Guilford Press.

    Persons, J. B. (2008) The case formulation approach to cognitive behaviour therapy. New York: Guilford Press.

    Wells, A. (1997) Cognitive therapy of anxiety disorders. New York: Wiley.

    Wills, F. (2008) Skills in cognitive behaviour counselling & psychotherapy. London: Sage.

    Applications

    Beck, A. T., Reinecke, M. A., & Clark, D. A. (2003) Cognitive therapy across the lifespan: theory, research and practice. Cambridge: Cambridge University Press.

    Bruch, M., & Bond, F. W. (1998) Beyond diagnosis: case formulation approaches in CBT. Chichester: Wiley.

    Clark, D. M., & Fairburn, C. G. (Eds) (1997) The science and practice of cognitive behaviour therapy. Oxford: Oxford University Press.

    Grant, A., Mills, J., Mulhern, R., & Short, N. (2004) Cognitive behavioural therapy in mental health care. London: Sage.

    Salkovskis, P. M. (Ed.) (1996) Frontiers of cognitive therapy. New York: Guilford Press.

    Sanders, D., & Wills, F. (2003) Counselling for anxiety problems. London: Sage. (Also available as eBook.)

    Wells, A. (2009) Metacognitive therapy for anxiety and depression. Chichester: Wiley.

    ‘Third Wave’ CBT Books

    Gilbert, P. (2009) The compassionate mind: a new approach to life's problems. London: Constable Robinson.

    Hayes, S. C., Strosahl, K. D., & Wilson, K. D. (1999) Acceptance and commitment therapy: an experiential approach to behaviour change. New York: Guilford Press.

    Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004) Mindfulness and acceptance: expanding the cognitive-behavioural tradition. New York: Guilford Press.

    Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002) Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.

    Self-Help Books

    Burns, D. D. (1999a) The feeling good handbook (Rev. ed.). New York: Penguin.

    Burns, D. D. (1999b) Feeling good: the new mood therapy (Rev. ed.). New York: Avon Books.

    Butler, G., & Hope, T. (1995) Manage your mind: the mental fitness guide. Oxford: Oxford University Press.

    Fairburn, C. G. (1995) Overcoming binge eating. New York: Guilford Press.

    Farrington, A., & Dalton, L. (2004) Getting through depression with CBT: a young person's guide. Oxford: Blue Stallion (www.oxdev.co.uk).

    Greenberger, D., & Padesky, C. (1995) Mind over mood. New York: Guilford Press.

    Gurney-Smith, B. (2004) Getting through anxiety with CBT: a young person's guide. Oxford: Blue Stallion (www.oxdev.co.uk).

    Harris, R. (2008) The happiness trap. London: Robinson.

    Holdaway, C., & Connolly, N. (2004) Getting through it with CBT: a young person's guide to cognitive behavioural therapy. Oxford: Blue Stallion (www.oxdev.co.uk).

    Young, J. E., & Klosko, J. (1994) Reinventing your life: how to break free from negative life patterns. New York: Penguin Putnam.

    Also, the Constable and Robinson ‘Overcoming’ series:

    Butler, G. (1999) Overcoming social anxiety and shyness. London: Constable and Robinson.

    Davies, W. (2000) Overcoming anger and irritability. London: Constable and Robinson.

    Espie, C. A. (2006) Overcoming insomnia and sleeping problems. London: Constable and Robinson.

    Fennell, M. (1999) Overcoming low self-esteem. London: Constable and Robinson.

    Gilbert, P. (2000) Overcoming depression. London: Constable and Robinson.

    Herbert, C., & Wetmore, A. (1999) Overcoming traumatic stress. London: Constable and Robinson.

    Kennerley, H. (1997) Overcoming anxiety. London: Constable and Robinson.

    Kennerley, H. (2000) Overcoming childhood trauma. London: Constable and Robinson.

    Silove, D. (1997) Overcoming panic. London: Constable and Robinson.

    Veale, D., & Willson, R. (2005) Overcoming obsessive-compulsive disorder. London: Constable and Robinson.

    Booklets are available from Oxford Cognitive Therapy Centre on a variety of problems including depression, low self-esteem, phobias, health anxiety and obsessive compulsive disorder: www.octc.co.uk

    Websites

    British Association for Behavioural and Cognitive Psychotherapy – www.babcp.com

    Compassion focused therapy – http://compassionatemind.co.uk

    Contextual Psychology (ACT) website – http://contextualpsychology.org

    Oxford Mindfulness – www.oxfordmindfulness.org

    Training, accreditation, conferences, therapists; valuable links including NICE guidelines and computer-assisted packages: Oxford Cognitive Therapy Centre – www.octc.co.uk

    Training, workshops, supervision, therapists and so on: The Oxford Development Centre – www.oxdev.co.uk

    Workshops, bookshop, training and therapy: The Beck Institute for Cognitive Therapy and Research – www.beckinstitute.org

    Information about training, bookshop, resources and so on: International Association for Cognitive Psychotherapy – www.cognitivetherapyassociation.org

    European Association for Behavioural and Cognitive Psychotherapies – www.eabct.com

    An umbrella organisation for CBT in Europe: Jeffrey Young's website with resources on schema therapy – www.schematherapy.com

    The Australian Association for Cognitive and Behaviour Therapy (AACBT) – www.psy.uwa.edu.au/aacbt/

    Christine Padesky's website for workshops, training and resources – www.padesky.com

    CBT Arena – www.cbtarena.com

    Resources for professionals and academics and links for professional organisations: The National Association for Cognitive-Behavioural Therapists – www.nacbt.org

    Journals

    Behavioural and Cognitive Psychotherapy: published by Cambridge University Press for the British Association for Behavioural and Cognitive Psychotherapies.

    Behaviour Research and Therapy: published by Elsevier.

    Journal of Cognitive Psychotherapy: official publication for the International Association of Cognitive Psychotherapy, published by Springer.

    Cognitive Behaviour Therapist: published by Cambridge University Press.

    Cognitive Therapy and Research: published by Springer.

    Cognitive and Behavioral Practice: published by the Association for Advancement of Behavior Therapy (AABT).

    Cognitive Behaviour Therapy: formerly Scandinavian Journal of Behaviour Therapy, published by Routledge.

    Videotapes and CDS

    The Theory and Practice of CBT: tapes and CDs showing:

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