Practical CBT : Using Functional Analysis and Standardised Homework in Everyday Therapy. PDF
Preview Practical CBT : Using Functional Analysis and Standardised Homework in Everyday Therapy.
P R A C PRACTICAL CBT T I C A L C B T Using Functional It is the clinician’s task to take what we know works and to tailor it to the person seeking help. Successfully ‘selling’ Analysis and this therapeutic model to the client relies on clearly explaining what is happening and reinforcing session Standardised achievements with effective change-directed homework. Homework in Practical CBT is designed for a range of mental health professionals who have a basic grounding in learning theory Everyday Therapy and cognitive–behaviour therapy but want to know how best to apply it in their day-to-day practice. The book provides explicit assessment-to-treatment pathways with links to over 45 tried and tested ready-to-use homework scripts covering a range of common therapy issues including self-monitoring, self-esteem, decision- making, depression, anxiety, sleep, and anger. The author is a highly experienced clinician with a firm adherence to the scientist–practitioner model and the use of evidence-based protocols. Gary Bakkeris a clinical psychologist with 28 years of experience working with children, adolescents, adults, couples, and families in clinics, hospitals, community centres, and for 20 years in private practice. He trained in CBT when it was newly emerging as the evidence-based therapy of choice, receiving the Fiona Allen Prize during his masters program. Gary has since given innumerable seminars and workshops on themes in CBT, all the while honing its presentation, clarity, and acceptability for his clients, resulting in the verbatim suggested scripts that comprise much of this book. He has bridged the gap between G Gary Bakker attention to the psychotherapy process and outcome A research, and the demands of practical real-world therapy. R Y B A K K E R PRACTICAL CBT Using Functional Analysis and Standardised Homework in Everyday Therapy Gary Bakker First published in 2008 by Australian Academic Press Pty Ltd 32 Jeays Street Bowen Hills QLD 4006 Australia www.australianacademicpress.com.au Copyright © 2008 Gary Bakker Reproduction and communication for academic purposes: The Australian Copyright Act 1968 (Cwlth) allows a maximum of one chapter or 10% of the pages of this work, whichever is the greater, to be reproduced and/or communicated by any educational institution for its educational pur- poses provided that the educational institution (or the body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act. For details of the CAL licence for educational institutions contact: Copyright Agency Limited Level 19, 157 Liverpool Street Sydney NSW 2000 Telephone: (02) 9394 7600 Facsimile: (02) 9394 7601 E-mail: [email protected] Reproduction and communication for other purposes: Except as permitted under the Act (for example, a fair dealing for the purposes of study, research, criticism or review) no part of this book may be reproduced, stored in a retrieval system, communicated or transmitted in any form or by any means without prior written permission. All inquiries should be made to the publisher at the address above. National Library of Australia Cataloguing-in-Publication Data: Author: Bakker, Gary. Title: Practical CBT : using functional analysis, problem-maintaining-circles, and standardised homework in everyday therapy / Gary Bakker. Edition: 1st ed. ISBN: ebook 9781921513176 Subjects: Cognitive therapy--Handbooks, manuals, etc. Behavior modification--Handbooks, manuals, etc. Behavioral assessment. Dewey Number: 616.891425 DISCLAIMER: Every effort has been made in preparing this work to provide information based on accepted standards and practice at the time of publication. The publisher, however, makes no warranties of any kind of psychological outcome relating to use of this work and disclaims all responsibility or liability for direct or consequential damages resulting from any use of the material contained in this work. Contents Acknowledgments..............................................................................................................................vii Section 1 Chapter 1 Introduction ....................................................................................................................................3 Chapter 2 Why CBT?........................................................................................................................................5 Chapter 3 A CBT Model................................................................................................................................11 Section 2 Chapter 4 The Initial Assessment ................................................................................................................23 Chapter 5 Assessment-To-Treatment Decision Pathways......................................................................35 Section 3 – Homework Prescriptions ■SELF-MONITORING Homework 1 Negative Emotion Records (NERs)..........................................................................................47 Homework 2 NERs + Coping Options ............................................................................................................52 Homework 3 NERs + Thinking Errors..............................................................................................................55 Homework 4 Challenge Diary............................................................................................................................57 Homework 5 Social Challenge Diary................................................................................................................59 ■SELF-ESTEEM, ASSERTIVENESS, SELF-EFFICACY Homework 6 25 Positives....................................................................................................................................60 Homework 7 Socialisation Messages ................................................................................................................63 Contents iii ■SELF-ESTEEM, ASSERTIVENESS, SELF-EFFICACY (continued) Homework 8 Testimonials....................................................................................................................................66 Homework 9 Personal Rights Listing ................................................................................................................67 Homework 10 ‘I’ Statements ................................................................................................................................69 Homework 11 Positive Assertiveness..................................................................................................................70 Homework 12 Locus of Control Speech Correction......................................................................................71 ■SELF-ORGANISATION/DECISION-MAKING Homework 13 Options Clarification ..................................................................................................................73 Homework 14 Decisions Book ............................................................................................................................74 Homework 15 Values Ordering/Priorities Clarification..................................................................................77 Homework 16 Values Into Goals..........................................................................................................................80 Homework 17 Goals Into Plans............................................................................................................................81 Homework 18 Self-Organisation..........................................................................................................................82 Homework 19 15-Minute Time Slots ..................................................................................................................84 Homework 20 Achievement Recording..............................................................................................................85 ■DEPRESSION MANAGEMENT Homework 21 Pleasant Events Schedule (PES) ................................................................................................86 –HANDOUT 1: Pleasant Events Schedule Self-Assessment Homework 22 PES Sublist....................................................................................................................................100 Homework 23 PES Diary......................................................................................................................................101 Homework 24 Regular Exercise..........................................................................................................................103 Homework 25 Overwhelming Sensory Experiences ....................................................................................105 iv Contents ■DEPRESSION MANAGEMENT (continued) Homework 26 Options When Suicidal..............................................................................................................107 Homework 27 Graze Foods................................................................................................................................108 ■SLEEP Homework 28 Sleep Hygiene..............................................................................................................................109 Homework 29 Dream Antidotes........................................................................................................................113 ■ANXIETY MANAGEMENT Homework 30 Worry Questions ......................................................................................................................115 Homework 31 Allocating Worry Time..............................................................................................................118 Homework 32 Relaxation Sessions....................................................................................................................120 Homework 33 Mini-Relaxers..............................................................................................................................122 Homework 34 Subjective Units of Distress (SUDS) of 7 ............................................................................125 Homework 35 Reasonable Versus Unreasonable Worries Listing..............................................................126 Homework 36 Thought-Stopping......................................................................................................................127 Homework 37 Social Phobia Self-Statements..................................................................................................130 Homework 38 Over-Breathing Experiment ....................................................................................................132 –HANDOUT 2: HV Questionnaire (Over-Breathing) Homework 39 Caffeine Reduction....................................................................................................................135 ■ANGER MANAGEMENT Homework 40 Angry Self-Talk............................................................................................................................137 Homework 41 Time-Outs....................................................................................................................................139 Contents v ■SITUATIONAL FACTORS Homework 42 Life Change Units ......................................................................................................................140 –HANDOUT 3: Recent Life Changes Questionnaire Homework 43 Reasons To Change....................................................................................................................144 Section 4 – Scripts Script 1 Self-Efficacy, Self-Esteem Restoration ........................................................................................149 Script 2 Introducing the CBT Model..........................................................................................................151 Script 3 Individualised PMCs........................................................................................................................153 Script 4 Common or Expected Prognosis................................................................................................154 Script 5 Not Just ‘Talk Therapy’ ..................................................................................................................157 Script 6 Education About Normal Anxiety, Grief, and Trauma Reactions..........................................159 References........................................................................................................................................161 vi Contents Acknowledgments Sincere thanks and gratitude go to my early clinical inspirations: To Iain Montgomery, who encouraged me to respect the evidence. To John Warren, who encouraged me to use my common sense. And to Michael Griffin, who encouraged me to try to genuinely connect with my clients. And to Michelle, who magically turned scrawl into manuscript. Acknowledgments vii SECTION 1 Introduction Why CBT? A CBT Model
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