Trial-Based Cognitive Therapy: Distinctive features

173 Pages·2016·2.004 MB·English

by  Irismar Reis de Oliveira

Trial-Based
Cognitive Therapy
Trial-Based Cognitive Therapy (TBCT) is a new model of cognitive
behaviour therapy (CBT) that organizes standard cognitive and behavioural
techniques in a step-by-step fashion, making CBT more easily mastered by
the new therapist, more easily understood by the patients, and simpler to be
implemented, whilst still maintaining flexibility and CBT’s recognized
effectiveness.
Dividing thirty key features into two parts: ‘Theory’ and ‘Practice’, this
concise book explores the principles of TBCT, explains the techniques
developed throughout TBCT therapy to change dysfunctional cognitions,
and provides a clear guide to the distinctive characteristics of TBCT.
Trial-Based Cognitive Therapy will be of interest to psychiatrists, psy-
chologists, social workers, therapists, counsellors, and other professionals
working in the field of mental health, plus those wanting to learn CBT.
Trial-Based Cognitive Therapy is part of the Distinctive Features series,
which asks leading practitioners and theorists of the main CBT therapies
to highlight the main features of their particular developing approach.
The series as a whole will be essential reading for psychotherapists,
counsellors, and psychologists of all orientations.
Irismar Reis de Oliveira, MD, PhD, is Professor of Psychiatry in the
Department of Neurosciences and Mental Health at the Federal University
of Bahia, Brazil. He is the creator of trial-based cognitive therapy and
has trained therapists in Brazil and other countries in this model. Dr. de
Oliveira also maintains a private practice and has published numerous
articles and books. He is the editor of Standard and Innovative Strategies
in Cognitive Behavior Therapy, co-editor of Integrating Psychotherapy
and Psychopharmacology: A Handbook for Clinicians, and the author of
Trial-Based Cognitive Therapy: A Manual for Clinicians.
Cognitive behaviour therapy (CBT) occupies a central position in the move
towards evidence-based practice and is frequently used in the clinical
environment. Yet there is no one universal approach to CBT and clinicians
speak of first-, second-, and even third-wave approaches.
This series provides straightforward, accessible guides to a number of CBT
methods, clarifying the distinctive features of each approach. The series
editor, Windy Dryden, successfully brings together experts from each
discipline to summarise the 30 main aspects of their approach divided into
theoretical and practical features.
The CBT Distinctive Features Series will be essential reading for psycho-
therapists, counsellors, and psychologists of all orientations who want to
learn more about the range of new and developing cognitive behaviour
approaches.
Titles in the series:
A Transdiagnostic Approach to CBT using Method of Levels Therapy by
Warren Mansell, Timothy A. Carey, and Sara J. Tai
Acceptance and Commitment Therapy by Paul E. Flaxman, J.T. Blackledge,
and Frank W. Bond
Beck’s Cognitive Therapy by Frank Wills
Behavioural Activation by Jonathan W. Kanter, Andrew M. Busch, and
Laura C. Rusch
CBASP as A Distinctive Treatment for Persistent Depressive Disorder by
James P. McCullough, Jr., Elisabeth Schramm, and J. Kim Penberthy
Cognitive Behavioural Couple Therapy by Michael Worrell
Compassion-Focused Therapy by Paul Gilbert
Constructivist Psychotherapy by Robert A. Neimeyer
Dialectical Behaviour Therapy by Michaela A. Swales and Heidi L. Heard
Functional Analytic Psychotherapy by Mavis Tsai, Robert J. Kohlenberg,
Jonathan W. Kanter, Gareth I. Holman and Mary Plummer Loudon
Metacognitive Therapy by Peter Fisher and Adrian Wells
Mindfulness-Based Cognitive Therapy by Rebecca Crane
Narrative CBT by John Rhodes
Rational Emotive Behaviour Therapy by Windy Dryden
Rational Emotive Behaviour Therapy 2nd Edition by Windy Dryden
Schema Therapy by Eshkol Rafaeli, David P. Bernstein and Jeffrey Young
For further information about this series please visit
www.routledgementalhealth.com/cbt-distinctive-features
Trial-Based
Cognitive Therapy
Distinctive Features
Irismar Reis de Oliveira
First published 2016
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2016 Irismar Reis de Oliveira
The right of Irismar Reis de Oliveira to be identified as author of this work
has been asserted by him 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.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Oliveira, Irismar Reis de, author.
Title: Trial-based cognitive therapy (TBCT): distinctive features / Irismar
Reis de Oliveira.
Description: Abingdon, Oxon ; New York, NY : Routledge, [2016]
Identifiers: LCCN 2015040438| ISBN 9781138845343 (hardback) |
ISBN 9781138845411 (pbk.)
Subjects: | MESH: Cognitive Therapy—methods.
Classification: LCC RC489.C63 | NLM WM 425.5.C6 | DDC 616.89/1425—dc23
LC record available at http://lccn.loc.gov/2015040438
ISBN: 978-1-138-84534-3 (hbk)
ISBN: 978-1-138-84541-1 (pbk)
ISBN: 978-1-315-72500-0 (ebk)
Typeset in Times
by Keystroke, Station Road, Codsall, Wolverhampton
Contents
Figures ix
Tables xi
Acknowledgments xiii
Abbreviations xv
Introduction xvii
Part 1 T HE DIsTInCTIvE THEORETICAL
FEATUREs OF TBCT 1
1 Historical development and underpinnings
of Trial-Based Cognitive Therapy (TBCT) 3
2 Core beliefs about the self, conceptualized
as self-accusations: contribution from
literature to Trial-Based Cognitive
Therapy (TBCT) 7
3 Trial-Based Cognitive Therapy (TBCT):
a 3-level, 3-phase case conceptualization
approach 11
4 Assessing cognitions: the cognitive
distortions questionnaire (CD-Quest) 17
5 The modulatory role of underlying
assumptions (UAs) 21
v
Contents
6 Separating discomfort from distress: the
color-coded symptom hierarchy (CCSH) 27
7 Resolving ambivalence 29
8 A focus on experiential techniques for
restructuring cognitions 33
9 Core beliefs about the self, conceptualized
as self-accusations 35
10 Distinguishing the inner characters:
taking distance 39
11 The “preparation for the appeal”
metaphor: building new positive and
functional core beliefs 43
12 Metacognitive awareness 45
13 TBCT and social anxiety disorder 47
14 TBCT and post-traumatic stress disorder 49
15 TBCT as a preventive approach for
adolescents in schools 51
Part 2 T HE DIsTInCTIvE PRACTICAL
FEATUREs OF TBCT 53
16 Explaining the cognitive model. Case
formulation: level 1 55
17 Assessing dysfunctional cognitions 63
18 Introducing the CD-Quest 69
19 Using the intrapersonal thought record
(Intra-TR) 73
20 Using the interpersonal thought record
(Inter-TR) 81
21 Using the trial-based participation
assessment (TBPA) to resolve guilt 85
22 Case conceptualization diagram, level 2 89
23 Using the color-coded symptom hierarchy
(CCSH): discomfort vs. distress 91
24 Resolving ambivalence and making
decisions: the consensual role-play (CRP) 93
vi
Contents
25 Case conceptualization diagram: level 3 103
26 Using Trial I to restructure dysfunctional CBs 107
27 Using Trial I to change multiple core beliefs 127
28 Using Trial I in group settings 129
29 Using Trial II to promote metacognitive
awareness 131
30 Relaxation and the sailboat metaphor 141
References 145
Index 153
vii
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Figures
3.1 TBCT case conceptualization diagram, phase 1
(CCD-1), and its 3-level cognitive components:
ATs, UAs, and CBs. Here, dysfunctional negative
CBs are predominantly active. 12
3.2 TBCT case conceptualization diagram, phase 2
(CCD-2), during therapy, and its 3-level cognitive
components: ATs, UAs, and CBs. Here, the therapist
helps the patient to deactivate the dysfunctional
negative CB and activate the new and more
functional positive CB. 14
3.3 TBCT case conceptualization diagram, phase 3
(CCD-3), at the end of therapy, and its 3-level
cognitive components: ATs, UAs, and CBs. Here,
functional positive CBs are predominantly active
relative to the functional negative CBs, now slightly
active or ready to be activated. 16
5.1 Circuit 1 shows the recycling ideation that occurs in
worry and rumination, i.e., emotions and behaviors
elicited by thoughts generate other thoughts in a
self-perpetuating mechanism. 22
ix