Table Of ContentCognitive Behaviour Therapy
in Sport and Performance
Many sport and performance psychologists worldwide practise cognitive behaviour
therapy (CBT) as a therapeutic and applied practice approach. But no textbook cur-
rently offers a blueprint to understand and use CBT in sport and performance settings.
Cognitive Behaviour Therapy in Sport and Performance: An Applied Practice Guide
builds upon a tangible foundation for the practice of CBT and related techniques in
sport and performance contexts. This new book presents key points to help students
and practitioners bring CBT into the sport and performance context. We focus on the
‘what is’ and the ‘how to’.
Drawing upon the latest research and a wealth of applied practice experience, this
easy-to-use guide takes the reader through each step of the CBT process with case
examples, plain instructions, and worksheets to maximise the quality and depth nec-
essary for effective CBT practice.
As an applied guide, this book educates undergraduates and postgraduates in sport
and performance psychology (and all its variants). This book is an instrumental guid-
ance material for sport and exercise psychology students but also invaluable as a prac-
tice guide for performance psychology trainees in applied practice placements and as
a refresher primer for established professionals.
Paul McCarthy, PhD, leads the taught doctorate in Sport and Exercise Psychology
at Glasgow Caledonian University, UK. He is a BPS chartered psychologist and a
HCPC-registered sport and exercise psychologist.
Sahen Gupta is a Lecturer in Applied Sport & Exercise Psychology at the University of
Portsmouth, UK. He is nearing completion of his Doctorate in Sport and Exercise
Psychology and his Chartered status with BPS and HCPC (April 2023). He focuses on
CBT, resilience, and athlete development for mental health and high performance. He
is the Founder of Discovery Sport and Performance Lab, working to implement sport
psychology across multiple countries and cultures.
Lindsey Burns, PhD, is an Assistant Professor in Psychology at Herriot Watt University,
UK. Lindsey is a Chartered Psychologist with the British Psychological Society and a
HCPC practitioner health psychologist.
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
Cognitive Behaviour Therapy
in Sport and Performance
An Applied Practice Guide
Paul McCarthy, Sahen Gupta,
and Lindsey Burns
Designed cover image: Shiyamek Dasgupta
First published 2023
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Paul J. McCarthy, Sahen Gupta, and Lindsey Burns
The right of Paul J. McCarthy, Sahen Gupta, and Lindsey Burns to be identified as
authors of this work has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
ISBN: 978-1-032-22858-7 (hbk)
ISBN: 978-1-032-22856-3 (pbk)
ISBN: 978-1-003-27451-3 (ebk)
DOI: 10.4324/9781003274513
Typeset in Times
by KnowledgeWorks Global Ltd.
Contents
List of Figures xi
List of Tables xii
SECTION I
Background 1
1 Introducing Cognitive Behaviour Therapy 3
What is CBT? 3
What is the theory underlying CBT? 6
Level 1: Negative automatic thoughts 6
Level 2: Underlying assumptions 6
Level 3: Core beliefs 7
How do the levels work? 8
Why choose CBT? 8
What are the treatment principles? 9
Cognitive techniques 9
Behavioural techniques 10
Physical techniques 10
CBT in sport today 10
2 CBT Training, Supervision, and Delivery 12
The training needs of novice practitioners 12
Assumptions in CBT client-therapist relationship 13
Supervising and being supervised in CBT 14
Getting started with good supervision 15
Setting goals 17
Giving feedback 18
Conducting supervision 18
Professional philosophy and its underpinnings 19
vi Contents
Basic competencies and principles 20
Cognitive Principle 20
Behavioural Principle 21
Continuum Principle 22
Immediacy/Present/Here-Now Principle 23
Proof Principle 24
Evolution Principle 24
Interpersonal Principle 25
SECTION II
Getting Started with CBT 29
3 CBT in the Field: Getting Started 31
The four-factor model 31
Orienting the client to the four-factor model 32
Levels of cognition 34
Level 1: Automatic thoughts 34
Level 2: Underlying assumptions 35
Level 3: Core beliefs 35
Core belief sectors: The triad 37
Downward arrow technique for cognition 38
Getting trapped: Cognitive distortions 39
How do these thinking traps operate? 39
Case vignettes 47
Mo – A professional football player 47
Annette – A junior Wimbledon champion 47
4 The Therapeutic Relationship and the First Session 49
Structure of a CBT session 49
What does a treatment/therapy session look like? 50
Contract or working alliance as a ‘joint project’ 53
Building a collaborative relationship 54
Collaborative empiricism 54
Transference and countertransference 56
Working with young people 56
Motivation for support with young people 57
How many sessions? 58
What is the typical course of events? 58
Setting the agenda 59
Setting the scene 59
Contents vii
5 Assessment and Formulation 61
Formulation: A step-by-step guide 62
Dealing with now 62
Triggers and modifiers: What and where are they? 62
Maintenance factors: Things that keep the problem going 63
Formulation 68
Formulation: Making it and a model 68
Sketching a formulation 69
How does a formulation begin? 71
Going deeper: Cross-sectional formulation 72
Play the detective: Finding triggers and the maintenance cycle 72
The body of cognition 73
Adaptive core beliefs 75
Maladaptive core beliefs 76
Understanding time and life: Longitudinal formulation 77
Working together 79
Doing formulation: Process actions 79
How does a formulation benefit us? 80
6 Measurement in CBT 82
What is measurement? Types/sources of measurement 82
What are measures? 82
Types of measurement 83
Psychometric measurement: What is it and considerations? 84
Psychometric characteristics 85
Validity and reliability 85
Measurement reactivity 85
Relevance and simplicity 85
Context of measurement 86
Time of measurement 86
Socioecological factors 87
Identifying emotions and automatic thoughts 89
Thought diaries 89
Situational trigger detecting worksheet 91
Frequency counts 93
Event duration 94
Self-rating 95
Personal journals/artwork/vlogs 96
Psychometric scales and questionnaires 97
viii Contents
Distinguishing emotions from automatic thoughts 97
Note on Cultural Competence 100
NAT specificity and emotions 101
Rating emotions and intensity 102
Emotional experience and individual differences 102
CBT is ‘cognitive behavioural’, why emotions? 103
Step 1: Identifying emotion type 104
Step 2: Rating emotion intensity 105
Identifying core beliefs (when do you need to?) 105
Belief identification: Detective skills 107
Modifying a negative core belief 109
Identifying thinking traps 109
Avoiding thinking traps: Weighing evidence 110
Developing a new core belief 112
Thought-balancing 113
Defining and clarifying perception 115
Reframing: Playing different tactics/Constructing alternative
explanations 116
Reattribution 116
Strengthening a new core belief 117
Practice before exposure 118
7 Interventions 120
Introduction to facilitating change in CBT 120
Behavioural interventions 121
Behavioural activation 121
TRAP ≫ TRAC intervention technique 122
Behavioural experiments 124
Tinkering with thoughts: Cognitive interventions 126
SITs and SATs 127
PITs and PETs 128
Socratic dialogue 128
A-B-C-D-E 130
Psychological skills training (PST)-based interventions 132
Self-Talk 134
Imagery 137
Emotional/physiological interventions 138
Defusing emotional intensity to manageable levels 138
Emotion/physiological trigger management 139
Progressive muscle relaxation (PMR) 139
Controlled breathing 141
Sleep and sleep hygiene 142
Autonomous CBT training 143
Reinforcing the foundations of the new core belief 146
Contents ix
SECTION III
Reflecting and Enhancing Practice 149
8 Education Issues 151
What are you doing and why you are doing it? 151
Non-verbal, paraverbal, and performance behaviour 153
Educating clients in the model and processes with the aim of
insight and awareness 154
Clients don’t know you – Make them feel welcome 154
Drawing the lines: Boundaries 155
‘Dilemmas’, ‘traps’, ‘snags’, or ‘facilitators’ 156
Relapse prevention and performance facilitation 156
Psychologist and client problems 157
9 Evaluation and Transition to Client Self-Help 160
Assessing the outcome of your work – The client’s perspective 160
Choosing efficacy measures 161
Assessing the outcome of your work – Therapist competence 163
UCL competence framework 164
Self-assessment scales 164
What isn’t working and why – Troubleshooting tips? 165
Transition to client self-sufficiency: Leaving your client with the tools
they need 168
What can the client take away? 168
Plan self-management time 168
Relapse prevention planning 169
Booster sessions 171
10 Troubleshooting 172
Getting stuck: Dig for more information and varied sources of
information 172
Why do people get stuck? 173
Practitioner strategies to getting unstuck 174
Clarify and return to evaluate initial goals 174
Focus on the therapeutic relationship and new client reality 175
Metacommunication and self-reflection 176
Client as a dynamic system in internal conflict 177
Choosing the ‘suitable’ problem and keeping on track 178
Performance slumps 178
What should we do? 179
Injury recovery 181
Seek ‘hidden’ or subliminal NATs in verbalisations and behaviours 183
