We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Poor memory for this time due to repeated admissions, ill-health, and ECT. I was acutely aware and frightened of detention under the Mental Health Act, and of compulsory treatment. Susceptibility to mental illness in families, and how friends and families attempted to explain things. Discussion of my feelings about my psychiatrists and hope that they could help me – also that it was difficult for them as they had never known me well.
We aimed to identify the common types of outcome trajectories for patients with psychosis who take up specialist psychological therapy for persecutory delusions. Knowing the different potential responses to therapy can inform expectations. Further, determining predictors of different outcomes may help in understanding who may benefit.
Methods
We analyzed delusion conviction data from 767 therapy sessions with 64 patients with persistent persecutory delusions (held with at least 60% conviction) who received a six-month psychological intervention (Feeling Safe) during a clinical trial. Latent class trajectory analysis was conducted to identify groups with distinct outcome profiles. The trajectories were validated against independent assessments, including a longer-term follow-up six months after the end of therapy. We also tested potential predictors of the trajectories.
Results
There were four outcome trajectories: (1) Very high delusion conviction/Little improvement (n = 14, 25%), (2) Very high delusion conviction/Large improvement (n = 9, 16%), (3) High delusion conviction/Moderate improvement (n = 17, 31%) and (4) High delusion conviction/Large improvement (n = 15, 27%). The groups did not differ in initial overall delusion severity. The trajectories were consistent with the independent assessments and sustained over time. Three factors predicted trajectories: persecutory delusion conviction, therapy expectations, and positive beliefs about other people.
Conclusions
There are variable responses to psychological therapy for persecutory delusions. Patients with very high delusion conviction can have excellent responses to therapy, though this may take a little longer to observe and such high conviction reduces the likelihood of positive responses. A trajectory approach requires testing in larger datasets but may prove highly informative.
There is considerable evidence that waiting list (WL) control groups overestimate the effect sizes of psychotherapies for depression. It is not clear, however, what are the exact causes for this overestimation. We decided to conduct a meta-analytic study to compare trials on psychotherapy for depression with a WL control group against trials with a care-as-usual (CAU) control group.
Methods
We used an existing meta-analytic database of randomized trials comparing psychological treatments of adult depression with control groups and selected trials using a WL or a CAU control group. We used subgroup and meta-regression analyses to examine differences in effect sizes between WL and CAU controlled trials.
Results
We included 333 randomized controlled trials (472 comparisons; total number participants: 41,480), 141 with a WL and 195 with a CAU control group (3 included both). We found several significant differences between WL and CAU controlled trials (in type of therapy examined, treatment format, recency, target group, recruitment strategy, number of treatment arms and number of depression outcome measures). The overall effect size indicating the difference between treatment and control at post-test for all comparisons was g = 0.77 (95% confidence interval [CI]: 0.71; 0.84) with high heterogeneity (I2 = 84; 95% CI: 82; 85). A highly significant difference was observed between studies with a CAU control group (g = 0.63; 95% CI: 0.55; 0.71; I2 = 85; 95% CI: 83; 86) and studies with a WL (g = 0.95; 95% CI: 0.85; 1.04; I2 = 80; 95% CI: 78; 82; p for difference < 0.001). This difference remained significant in all sensitivity analyses, including a meta-regression analysis in which we adjusted for all differences in characteristics of studies with a WL versus CAU control group. We also found that pre-post effect sizes in WL control conditions (g = 0.37; 95% CI: 0.28; 0.46) were significantly smaller than change within CAU conditions (g = 0.64; 95% CI: 0.50; 0.78). We found few indications that pre-post effect sizes within therapy conditions differed between WL and CAU controlled trials.
Conclusions
WL control conditions considerably overestimate the effect sizes of psychological treatments, compared to trials using CAU control conditions. This overestimation is probably caused by a smaller improvement within the WL condition compared to the improvement in the CAU condition. WL control conditions should be avoided in randomized trials examining psychological treatments of adult depression.
This chapter describes approaches to psychotherapy that grew from learning theory and cognitive psychology, as well as acceptance-based approaches that have a long history in Eastern faiths and philosophies. They are frequently combined in practice and share a strong record of empirical support for their efficacy. The chapter describes behavior therapists’ use of learning-based techniques designed to identify and change maladaptive behavior, and cognitive therapists’ efforts to change clients’ unhelpful thinking patterns about events and themselves that serve to maintain many disorders. The chapter also explains that because behavioral and cognitive approaches are compatible, they are often combined into various forms of cognitive behavior therapy, which is one of today’s most popular approaches to psychological treatment. The chapter also describes acceptance-based approaches, which are central to acceptance and commitment therapy, dialectical behavior therapy, and mindfulness treatments, all of which emphasize the value of accepting thoughts, feelings, and experiences (even negative ones) and learning how to observe reactions without judging them.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Psychosocial intervention, in its broadest sense, is a vital component in the management of all types of depression, from mild depressive reactions to psychotic episodes. Even if pharmacological therapy or ECT is the main treatment, the way in which the clinician assesses, engages the patient, gives information about the illness and its treatment, and provides support contributes significantly to a successful outcome. In addition to this basic level of supportive work, many patients will benefit from more structured forms of psychotherapy. This chapter will consider the psychological and social therapies available for depression and the evidence for their effectiveness. Some general principles of psychological management for the depressed patient will be described.
Cognitive remediation (CR) can reduce the cognitive difficulties experienced by people with psychosis. Adapting CR to be delivered remotely provides new opportunities for extending its use. However, doing so requires further evaluation of its acceptability from service users’ views. We evaluate the acceptability of therapist-supported remote CR from the perspectives of service users using participatory service user-centred methods.
Method:
After receiving 12 weeks of therapist-supported remote CR, service users were interviewed by a service user researcher following a semi-structured 18-question interview guide. Transcripts were analysed using reflexive thematic analysis with themes and codes further validated by a Lived Experience Advisory Panel and member checking.
Results:
The study recruited 26 participants, almost all of whom reported high acceptability of remote CR, and some suggested improvements. Four themes emerged: (1) perceived treatment benefits, (2) remote versus in-person therapy, (3) the therapist’s role, and (4) how it could be better.
Conclusions:
This study used comprehensive service user involvement methods. For some participants, technology use remained a challenge and addressing these difficulties detracted from the therapy experience. These outcomes align with existing research on remote therapy, suggesting that remote CR can expand choice and improve access to treatment for psychosis service users once barriers are addressed. Future use of remote CR should consider technology training and equipment provision to facilitate therapy for service users and therapists.
Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes.
Key learning aims
(1) To recognise and understand the development of PTSD following childbirth and baby loss.
(2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD.
(3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth.
(4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.
We know from decades of research that a key component of stress resilience is being flexible in how we think and how we manage our emotions. We profile individuals who showed exceptional flexibility, including Jerry White, who lost his leg to a landmine. We discuss two psychotherapies that teach flexibility: cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). You will learn evidence-based ways to embrace gratitude and humor, catch and challenge negative thoughts, and work towards accepting situations that you cannot immediately control.
The book provides the reader with a thorough understanding of the model of Schema Therapy, methods and techniques used throughout the process of Schema Therapy treatment. Experienced trainers in Schema Therapy, the authors provide a unique understanding of the questions, challenges, and points of issue experienced by practitioners learning the model. Designed for the practitioner with a specific focus on the theory and practice of modern schema therapy, the book discusses the powerful techniques and cutting-edge developments of the Schema Therapy model, with step-by-step guidance and clinical examples. A comprehensive resource for both students and experienced practitioners providing valuable examples of the model in clinical practice and solutions to the challenges and questions practitioners face in applying the model. Part of the Cambridge Guides to the Psychological Therapies series, offering all the latest scientifically rigorous, and practical information on a range of key, evidence-based psychological interventions for clinicians.
Cognitive techniques in schema therapy make use of an array of methods traditionally drawn from cognitive-behavioral therapy (CBT) but which focus on the ‘schema’ or ‘mode’ level. However, in clients with more chronic presentations (e.g. those with a personality disorder), the healthy part as addressed in traditional CBT is often not sufficiently developed. Cognitive methods and techniques in schema therapy therefore need to be adjusted to the particular mode being targeted and must take into account the limited capacity for rational, reflective processing often seen during the initial phases of therapy. Socratic dialogue, for example, might not prove effective when addressing a Parent mode in the start phase of therapy. Frequently used cognitive techniques in the early phase of schema therapy focus on developing awareness of activated schemas or modes through the use of psychoeducation, using the white board or flip-over to reformulate emotional experiences into modes, and the use of cognitive ‘schema’ or ‘mode’ diaries. In the later stages of therapy cognitive techniques are used to change the beliefs in activated schemas or modes. This can include simple (e.g. listing pros and cons of a coping mode) or more complex techniques (e.g. Socratic dialogue).
The subject of prolonged, complicated and traumatic grief has become more topical as a consequence of the Covid-19 pandemic. CBT practitioners have been asked to provide effective therapeutic responses for clients with enduring distressing grief reactions. These enduring grief conditions have now been categorised as Prolonged Grief Disorder in the two main mental health classification systems: in the ICD -11 in November 2020 and as a revision to the DSM-5 in 2021. In this paper we draw on our research and clinical experience in applying cognitive therapy for PTSD (CT-PTSD) to traumatic bereavement to derive lessons for the treatment of prolonged grief. During the pandemic the authors of this paper delivered several workshops on prolonged grief disorder (PGD) during which clinicians raised several thought-provoking questions; how do we differentiate between normal and abnormal or pathological grief; how do we categorise pathological grief; how effective are existing therapies and is there a role for CBT; and how do our experiences with Cognitive Therapy for PTSD help with conceptualisation and treatment of PGD. The purpose of this paper is to answer these important questions and in so doing, consider the historical and theoretical concepts relating to complex and traumatic grief, factors that differentiate normal grief from abnormal grief, maintenance factors for PGD and implications for CBT treatments.
Theoretical models of neural mechanisms underlying Cognitive Behavior Therapy (CBT) for major depressive disorder (MDD) propose that psychotherapy changes neural functioning of prefrontal cortical structures associated with cognitive-control processes (DeRubeis, Siegle, & Hollon, 2008); however, MDD is persistent and characterized by long-lasting vulnerabilities to recurrence after intervention, suggesting that underlying neural mechanisms of MDD remain despite treatment. It follows that identification of treatment-resistant aberrant neural processes in MDD may inform clinical and research efforts targeting sustained remission. Thus, we sought to identify brain regions showing aberrant neural functioning in MDD that either (1) fail to exhibit substantive change (nonresponse) or (2) exhibit functional changes (response) following CBT.
Methods
To identify treatment-resistant neural processes (as well as neural processes exhibiting change after treatment), we collected functional magnetic resonance imaging (fMRI) data of MDD patients (n = 58) before and after CBT as well as never-depressed controls (n = 35) before and after a similar amount of time. We evaluated fMRI data using conjunction analyses, which utilized several contrast-based criteria to characterize brain regions showing both differences between patients and controls at baseline and nonresponse or response to CBT.
Results
Findings revealed nonresponse in a cerebellar region and response in prefrontal and parietal regions.
Conclusions
Results are consistent with prior theoretical models of CBT's direct effect on cortical regulatory processes but expand on them with identification of additional regions (and associated neural systems) of response and nonresponse to CBT.
Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient.
Key learning aims
(1) To be able to apply Ehlers and Clark’s (2000) cognitive model to PTSD arising from bereavement trauma.
(2) To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life.
(3) To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma.
Since its inclusion in the DSM-III, various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research.
Key learning aims
(1) To understand the clinical implications of the original cognitive model and the revised model of generalised anxiety disorder presented here.
(2) To understand the role of inflated responsibility for safety, safety-seeking behaviours and elevated evidence requirements in generalised anxiety disorder.
(3) To understand and be able to implement treatment recommendations of the revised cognitive model of generalised anxiety disorder.
Patients with social anxiety disorder (SAD) have a range of negative thoughts and beliefs about how they think they come across to others. These include specific fears about doing or saying something that will be judged negatively (e.g. ‘I’ll babble’, ‘I’ll have nothing to say’, ‘I’ll blush’, ‘I’ll sweat’, ‘I’ll shake’, etc.) and more persistent negative self-evaluative beliefs such as ‘I am unlikeable’, ‘I am foolish’, ‘I am inadequate’, ‘I am inferior’, ‘I am weird/different’ and ‘I am boring’. Some therapists may take the presence of such persistent negative self-evaluations as being a separate problem of ‘low self-esteem’, rather than seeing them as a core feature of SAD. This may lead to a delay in addressing the persistent negative self-evaluations until the last stages of treatment, as might be typically done in cognitive therapy for depression. It might also prompt therapist drift from the core interventions of NICE recommended cognitive therapy for social anxiety disorder (CT-SAD). Therapists may be tempted to devote considerable time to interventions for ‘low self-esteem’. Our experience from almost 30 years of treating SAD within the framework of the Clark and Wells (1995) model is that when these digressions are at the cost of core CT-SAD techniques, they have limited value. This article clarifies the role of persistent negative self-evaluations in SAD and shows how these beliefs can be more helpfully addressed from the start, and throughout the course of CT-SAD, using a range of experiential techniques.
Key learning aims
(1) To recognise persistent negative self-evaluations as a key feature of SAD.
(2) To understand that persistent negative self-evaluations are central in the Clark and Wells (1995) cognitive model and how to formulate these as part of SAD.
(3) To be able to use all the experiential interventions in cognitive therapy for SAD to address these beliefs.
Surveys are a powerful technique in cognitive behavioural therapy (CBT). A form of behavioural experiment, surveys can be used to test beliefs, normalise symptoms and experiences, and generate compassionate perspectives. In this article, we discuss why and when to use surveys in CBT interventions for a range of psychological disorders. We also present a step-by-step guide to collaboratively designing surveys with patients, selecting the appropriate recipients, sending out surveys, discussing responses and using key learning as a part of therapy. In doing so, we hope to demonstrate that surveys are a flexible, impactful, time-efficient, individualised technique which can be readily and effectively integrated into CBT interventions.
Key learning aims
After reading this article, it is hoped that readers will be able to:
(1) Conceptualise why surveys can be useful in cognitive behavioural therapy.
(2) Implement collaborative and individualised survey design, delivery and feedback as part of a CBT intervention.
Today, a number of researchers consider the problem of addictive behavior as one of the most global problems for Kazakhstan and Russia. Some scientists consider CBT to be the most effective way to work with addictions. In our country there are no scientific works devoted to the study of addictive beliefs, so we decided to conduct such a study
Objectives
The Objective of the study was to identify the characteristic addictive beliefs of drug addicts with different type of addiction: opioids and synthetic cathinones (designer drugs called “salts”, “bath salts”)
Methods
Questionnaire of addictive beliefs by A, Beck, questionnaire of beliefs about cravings by A. Beck and F. Wright, clinical interview. Descriptive statistics and chi-square test were used for data processing
Results
People with opioid addiction are more likely to believe that their lives will become more depressive if they stop using drugs (p= 0.0347); that drug use is the only way to cope with pain in their life (p= 0.0347) and that they cannot cope with anxiety without drugs (p=0.009). Respondents who use synthetic psychostimulants endorse to believe that addiction is not a problrm for them (p= 0.0358).
Conclusions
Having categorized these beliefs in accordance with A. Beck’s classification, we came to the conclusion that “relief-oriented beliefs” are more typical for people who use opiates. The motive for use is often the desire to alleviate a negative emotional or physical state. For people using psychostimulants “salt”, “anticipatory beliefs” are more characteristic - the desire to experience euphoria and pleasant experiences
Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘misconceptions’ were identified. These included misconceptions about the suitability of the treatment for some types of trauma and/or emotions, the need for stabilisation prior to memory work, the danger of ‘retraumatising’ patients with memory-focused work, the risks of using memory-focused techniques with patients who dissociate, the remote use of trauma-focused techniques, and the perception of trauma-focused CBT as inflexible. In this article, these misconceptions are analysed in light of existing evidence and guidance is provided on using trauma-focused CT-PTSD with a broad range of presentations.
Key learning aims
(1) To recognise common misconceptions about trauma-focused CBT for PTSD and the evidence against them.
(2) To widen understanding of the application of cognitive therapy for PTSD (CT-PTSD) to a broad range of presentations.
(3) To increase confidence in the formulation-driven, flexible, active and creative delivery of CT-PTSD.
After assessing a client a treatment plan is required. The chapter outlines the practical steps in proceeding from a case formulation to a treatment plan. Since many techniques are modified for application in many different clinical problems and psychological disorders, we will concentrate on providing a description of particular procedures that are broadly applicable. The chapter provides practical illustrations of treatment planning with outlines of behaviour therapy, dialectical behaviour therapy, cognitive therapy, and interpersonal psychotherapy. It includes specific examples of clinical cases and explains how these approaches can be subsumed under a transdiagnostic framework of treatment planning. Consideration of transdiagnostic interventions involves targeting negative affect, intolerance of uncertainty, anxiety sensitivity, avoidance and safety behaviours, emotion regulation, and metacognitve therapy.
The current study examined heterogeneous trajectories of suicidal ideation among homeless youth experiencing suicidal ideation over 9 months in a randomized controlled intervention study. Suicidal homeless youth (N = 150) were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) or TAU alone. Youth reported their suicidal ideation four times during a 9-month period. We also assessed pretreatment mental health, demographic information and session attendance as predictors of the subgroups, as well as suicide-related factors as outcomes at the 9-month follow-up. Growth mixture models suggested three distinct trajectory groups among youth: Fast Declining (74.7%), Chronic (19.3%), and Steadily Declining (6.0%). Youth in the Chronic group used more substances at baseline than the Steadily Declining group, were more likely to be White, non-Hispanic than the Fast Declining group, and attended more CTSP sessions than other groups. Contrastingly, youth in the Steadily Declining group all experienced childhood abuse. Finally, youth in the Chronic group showed significant higher risk for future suicide compared to those in the Fast Declining group at 9 months. Findings support the heterogeneity of treatment responses in suicide intervention among homeless youth, with implications to improve treatment efforts in this very high-risk population.