Evidence-Based Practice of Cognitive-Behavioral Therapy

370 Pages·2016·16.814 MB·English

by  Deborah Dobson, Keith S. Dobson

ebook
THE GUILFORD PRESS
EVIDENCE-BASED PRACTICE
OF COGNITIVE-BEHAVIORAL THERAPY
Also Available
Handbook of Cognitive-Behavioral Therapies,
Third Edition
Edited by Keith S. Dobson
Evidence-Based
Practice of
Cognitive-Behavioral
Therapy
SECOND EDITION
Deborah Dobson
Keith S. Dobson
The Guilford Press
New York London
Copyright © 2017 The Guilford Press
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Last digit is print number: 9 8 7 6 5 4 3 2 1
The authors have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards
of practice that are accepted at the time of publication. However, in view of the
possibility of human error or changes in behavioral, mental health, or medical
sciences, neither the authors, nor the editors and publisher, nor any other party
who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete,
and they are not responsible for any errors or omissions or the results obtained
from the use of such information. Readers are encouraged to confirm the infor-
mation contained in this book with other sources.
Library of Congress Cataloging-in-Publication Data
Names: Dobson, Deborah J. G. (Deborah June Gora), 1954– author. | Dobson,
Keith S., author.
Title: Evidence-based practice of cognitive-behavioral therapy / Deborah
Dobson, Keith S. Dobson.
Description: Second edition. | New York : The Guilford Press, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2016019998 | ISBN 9781462528455 (hardcover : alk. paper)
Subjects: | MESH: Cognitive Therapy—methods | Mental Disorders—therapy |
Evidence-Based Medicine—methods
Classification: LCC RC489.C63 | NLM WM 425.5.C6 | DDC 616.89/1425—
dc23
LC record available at https://lccn.loc.gov/2016019998
About the Authors
Deborah Dobson, PhD, is a psychologist in private practice in Calgary,
Alberta, Canada, and Adjunct Professor in the Department of Psychol-
ogy at the University of Calgary. She has served as Director of Clinical
Training for the Calgary Clinical Psychology Residency program, and
began the first certificate program in cognitive-behavioral therapy in
Western Canada in 2014. Dr. Dobson served on the board of directors of
the Canadian Association of Cognitive and Behavioural Therapies from
2010 to 2016. She is a recipient of the Governor General’s Caring Cana-
dian Award for her advocacy work with the Canadian Mental Health
Association–Calgary Region. Dr. Dobson’s professional interests include
client advocacy and access to empirically supported treatments, clinical
training and supervision, and cognitive-behavioral therapies for anxiety
disorders.
Keith S. Dobson, PhD, is Professor of Clinical Psychology at the Uni-
versity of Calgary and a Principal Investigator for the Opening Minds
program of the Mental Health Commission of Canada, with a focus on
stigma reduction in the workplace. His research has focused on both cog-
nitive models and cognitive-behavioral therapy for depression. Dr. Dob-
son has published over 230 articles and chapters, 13 books, two DVDs,
and one DVD series. He is a past president of the Canadian Psychological
Association, the Academy of Cognitive Therapy, and the International
Association for Cognitive Psychotherapy. Dr. Dobson is a recipient of
the Award for Distinguished Contributions to the Profession of Psychol-
ogy and the Donald O. Hebb Award for Distinguished Contributions to
the Science of Psychology from the Canadian Psychological Association,
among other honors.
v

Preface
In health care systems around the world, there is a strong emphasis on
evidence-based practice, and a commensurate promotion of treatments
proven to be effective. Increasingly, clinicians are required to utilize effec-
tive and efficient treatments for mental health problems. Publicly funded
systems are often faced with constraints on the range and amount of
service that they can provide, while privately funded services seek to con-
trol costs in order to maximize shareholder profits. In both contexts, the
ability to identify and implement effective and time-limited treatments is
considered a benefit, and thus practice guidelines have evolved to favor
such approaches.
Mental health practice guidelines have included cognitive-behav-
ioral therapy as a psychological treatment of choice for many different
problems, as it has been shown to be an effective and efficient approach.
Consequently, many students and practitioners seek training in cognitive-
behavioral therapy. They also want to understand how the results of psy-
chotherapy outcome and process research apply to practice. If a treat-
ment is “evidence based,” how does that evidence translate into clinical
practice? What specifics of practice are supported by research findings?
Conversely, what are the limits of our knowledge, and what are the
areas where clinical judgment and sound ethical reasoning must guide
clinicians’ behavior? This second edition of Evidence-Based Practice of
Cognitive-Behavioral Therapy attempts to answer these questions and
to bridge the gap between practice and research, as well as to highlight
innovations and updates in the field.
While many texts have been written on cognitive-behavioral ther-
apy, very few of them have addressed this therapy from the perspectives
of practice, science, and the systems within which they are embedded.
The trend within the field has been to focus on specific problem areas,
diagnostic conditions, and/or specialized types of therapy. As a result,
we increasingly know which interventions work for which problems,
vii
viii Preface
and yet relatively little has been written about transdiagnostic cognitive-
behavioral therapy applications that can guide the clinician. There is
much that is similar about various applications of cognitive-behavioral
therapy, and this book describes “common factors” in assessment, inter-
vention, and consultation. Indeed, many aspects of this treatment have
become mainstream and are assumed to be best practice; this book also
explores the empirical support behind them. We also identify areas where
the evidence lags behind practice, both to make practitioners aware of
them and to promote research to address critical questions. In addition,
we identify a number of myths about cognitive-behavioral therapy to
provide readers with a sense of our perspective on the field.
This book will be particularly useful to people who are in the process
of discovering cognitive-behavioral therapy, including graduate students
and interns in clinical and counseling psychology, residents in psychiatry,
trainees in other mental health disciplines, and new practitioners. Based
on feedback we received on the first edition, even seasoned psychothera-
pists may find useful reinforcement of their ideas here, or discover “nug-
gets” to integrate into their practice. In this text, we have worked to be
as practical as possible, and to make links to practice based on the best
available evidence.
This book reflects an attempt to integrate the best of science with
the realities of clinical practice. We have tried to be both practical and
realistic about what cognitive-behavioral therapy can provide. All of the
chapters that focus on practice discuss their respective topics and provide
examples and case materials. We regularly make reference to clients to
illustrate particular concepts or techniques. We have also used the ficti-
tious therapy case of “Stephen” as a running illustration of the applica-
tion of cognitive-behavioral therapy from assessment to completion of
treatment. None of the clients in this book is an exact portrayal of a real
person; rather, they represent edited, composite, fictionalized representa-
tions of cases and situations we have encountered. As many clients are
not “textbook” cases, and all therapists run into difficulties, we discuss
some of the common challenges encountered in practice and have pro-
vided numerous suggestions to address these challenges.
In contrast to the more practical chapters of the book, the final chap-
ter takes a step back from the application of cognitive-behavioral ther-
apy with individuals in order to examine some of the contextual issues
that surround this psychotherapeutic approach, as well as the outcome
research base. It is difficult for practitioners to have the time and energy
to review the research literature, and so we summarize this literature and
review the key meta-analytic studies that have been published since the
first edition of this text.