01 - Index

Index

Abe (case example) Action Plan dealing with negative predictions, 153–154 dealing with procrastination, 157 final check on, 189, 190–191 first therapy session, 93–96, 114 preparing for a possible negative outcome, 148–149 provision of explicit instructions, 141 setting in the evaluation session, 82–84 update and review in the first part of a session, 183–185 activity scheduling, 121, 124–126 agenda difficulties in discussing agenda items, prioritizing, 186 setting in the evaluation session, 74–75 setting in the first part of session, 181–182 setting in the first therapy session, 91–92 attributing progress to, 355–356 automatic thoughts asking for a helpful response to address, 256–257 behavioral experiment to address, 255 changing the form of telegraphic or question thoughts, 220–221 characteristics of, 211, 212, 213 core beliefs expressed as, 292 differentiating from emotions, 233–234 INDEX Note. All page numbers in italics indicate a figure or a table. difficulties in eliciting, 222, 223–224, 225 downward arrow technique, 292 identifying cognitive distortions, 254–255 looking for central themes in, 291 matching content to emotions, 235 problem solving with true thoughts, 257–258 questioning to evaluate, 243–244, 245–247, 248–249 summary of automatic thoughts, 261 Testing Your Thoughts Worksheet, 269–270 using alternative questions to evaluate, 251–252 Beck Institute case write-up case conceptualization summary, 382–383 cognitive conceptualization diagram, 45, 382 course of treatment and outcome, 384–385 historical information, 380–382 intake information, 379–380 treatment plan, 384 CBT principles of treatment, 16–24 cognitive conceptualization behavioral strategies, 41 core beliefs, 39–40 intermediate beliefs and values, 40 overview, 38–39 sequences leading to depression, 41–43 strengths, resources, and personal assets, 43–44

402 Index Abe (case example) (cont.) core beliefs identifying adaptive beliefs, 289–290 identifying dysfunctional beliefs, 291, 292 modifying dysfunctional beliefs, 309–316, 317, 318–320 overview, 39–40, 287–288 psychoeducation about, 297–300 strengthening adaptive beliefs, 304, 305, 306, 307 decision making, 327–329 depressive rumination, 274–275 difficulties in discussing agenda items, 205 emotions differentiating from automatic thoughts, 233–234 intensity of, 227 matching content of automatic thoughts to, 235 regulation of, 324 evaluation session description of a typical day, 76–77 diagnostic impression, 80 establishing expectations for treatment, 84 responding to hopelessness and skepticism, 77–78 setting goals and relating a general treatment plan, 80–82 setting the Action Plan, 82–84 setting the agenda, 74–75 summarizing and eliciting feedback, 85 excerpt from a typical CBT intervention, 8–9 final summary, check on Action Plan, and feedback, 189, 190–191 first part of a session mood check, 179–180 prioritizing the agenda, 186 setting an initial agenda, 181–182 update and Action Plan review, 183–185 first therapy session Action Plan, 114 diagnosis and psychoeducation, 96–101, 102–104 eliciting values and aspirations, 105, 106, 107–108 feedback, 113 initial agenda setting, 91–92 mood check, 89–90 reinforcing the cognitive model, 94 setting goals, 108–111 update and review of the Action Plan, 93–96 graph of expected progress, 354–355 identifying negative images, 345–346 inducing positive images, 341–344 introducing mindfulness, 278–279 introduction to, 1–2 middle part of a session, 187–188 modifying spontaneous negative images, 347, 348–350 pie chart technique, 334, 336–337 problem solving, 326–327 restructuring the meaning of early memories, 387–390 setbacks, 363 social skills and role play, 334 therapeutic relationship, 58, 63–64, 65–66 therapy notes, 262–263, 363 treatment plan Beck Institute case write-up, 384 deciding to focus on an issue or goal, 170–171 evaluation session, 80–82 initial plan, 164 therapeutic objectives, 161 Acceptance, 258–259 Acceptance and commitment therapy, 3, 323 Accountability, 152 Acting “as if,” 307 Action Plan review difficulties in, 205 discussion of, 149–150 at the end of session, 190 first part of a session, 182–185 first therapy session, 94–96 Action Plans activities and, 131 activity scheduling and, 129 anticipating and preventing problems attention to clients’ negative reactions, 145–147 changing the plan, 148 check on the likelihood of completion, examine advantages and disadvantages, 147–148 identify obstacles and do covert rehearsal, 143–145 making the plan a no-lose proposition, overview, 142–143 check on at the end of session, 190 clinical tips, 147–148, 152, 156–157 components of, 23 conceptualization of inactivity, 120 conceptualizing difficulties interfering cognitions, 153–158 interfering cognitions masked as practical problems, 158

overview, 150 practical problems, 150–153 problems related to the therapist’s cognition, 158–159 creating in the evaluation session, 82–84 encouraging clients to set, 138–139 first therapy session Abe case example, 114 end-of-session summary and, 113 review of, 94–96 setting an item to identify automatic thoughts, 102–104 identifying problems in, 371 importance of and benefits to clients, 23–24, 135–136 increasing adherence, 139–142 mindfulness, 277 preparing for a possible negative outcome, 148–149 question lists for evaluating automatic thoughts, 244 reinforcing adaptive beliefs, 311–312 reviewing. See Action Plan review session format and, 22 setting, 136 summary of, 159 treatment planning and, 167–168 types of items in, 137–138 writing down, 23–24 Active participation, 19–20 Activities rating, 129–130 types of, 131 See also Activity scheduling Activity Chart assessing predictions about mastery and pleasure, 131–133 difficulties with mood check and, 200 partially completed example chart, 122–123 rating activities and, 129–130 using, 121, 129 Activity scheduling assessing predictions of mastery and pleasure, 131–133 clinical tips, 126, 131, 133 conceptualization of inactivity, 118–120 conceptualization of lack of mastery or pleasure, 120 discussion of and case example, 121, 124–126 first therapy session, 112 importance of, 117–118 rating activities, 129–130 summary, 134 types of activities, 130 when clients resist scheduling activities, 126–129 See also Activity Chart Adaptive behaviors. See Behavioral strategies Adaptive coping techniques, rehearsing, 342–343 Adaptive (positive) core beliefs characteristics of, 31–32, 283 clinical tips, 290 identifying, 289–290 impact on schemas, 283, 284 strengthening, 303–307 Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 Adaptive mode, 284–286 Advantages–disadvantages analysis in decision making, 327–329 of tapering therapy, 358, 359 Affect, engaging in activities to lift, 137 Agendas deviating from, 207–208 difficulties in discussing items, 205–207 first part of a session prioritizing the agenda, 185–186 setting an initial agenda, 180–182 identifying problems in, 370 treatment planning and, 167, 168–169 Agenda setting difficulties in failing to contribute, 200–202 feeling hopeless and overwhelmed, rambling, 200 evaluation session, 74–75 first therapy session, 91–92 setting an initial agenda in the first part of a session, 180–182 Alcohol use, 167 All-or-nothing thinking, 253 “Alternative explanation” questions, 246 American Psychological Association, 357 Analogy, 10 Anxiety, AWARE technique, 280, 386 Arousal effect, from relaxation, 324 Aspirations Action Plans and, 140 creating an image of having achieved, 107–108 drawing conclusions about, 106–107 eliciting, 106 pie chart technique, 334, 335 Assessment, in the evaluation session, 75–80

Index

404 Index Assumptions cognitive model, 37 concept of intermediate beliefs and, 35–36 defined, 5 See also Intermediate beliefs Attitudes cognitive model, 37 concept of intermediate beliefs and, 35–36 See also Intermediate beliefs Audio-recorded therapy notes, 264 Automatic thoughts addressing thoughts that interfere with goal setting, 108–110 alternate methods to address alternative questions, 251–252 asking clients for a helpful response, 256–257 behavioral experiments, 255–256 identifying cognitive distortions, 252–255 overview, 251 self-disclosure, 256 characteristics of, 211–213 clinical tips for identifying, 101–102 cognitive conceptualization diagrams simplified diagram, 54 strengths-based diagram, 44, 45, 46 traditional diagram, 47, 48, 49–51, 53 cognitive models of CBT and, 4–5, 28–29, 37–38, 216, 217–218 conceptualization of inactivity, 118–119 conceptualization of lack of mastery or pleasure, 120 conceptualizing when cognitive restructuring is ineffective, 249–251 core beliefs expressed as, 292 defined, 5, 29 development of Beck’s CBT and, 6–7 differentiating from emotions, 232–234 disengaging from, 137 downward arrow technique, 291–292 eliciting, 215–216, 222–225 evaluating and responding to, 137 evaluating the validity of, 30 explaining to clients, 214–215 forms and types of, 216, 219–221, 239–240 identifying, 29–30, 225–226 Identifying Automatic Thoughts Worksheet, 103–104 identifying problems in identifying and selecting key thoughts, 371 identifying problems in responding to, intermediate beliefs and, 35–36, 293–294 looking for central themes in, 291 matching thought content to emotions, 234–235 monitoring, 137 overview, 210 psychoeducation about, 100–102 questioning to evaluate assessing the outcome of the process, 248–249 behavioral methods, 243 clinical tips, 245, 247 question lists, 242, 243 reasons to avoid direct challenges, 241–242 recommendations and guidelines, 243–245 Socratic questioning, 242–243 Question to Identify Automatic Thoughts handout, 225, 226 responding to importance of, 260 between sessions, 260 summary, 272 therapy notes, 261–264 using worksheets, 264–270 when a worksheet isn’t helpful enough, 270–271 selecting key thoughts to focus on, 240–241 setting an Action Plan item to reinforce the cognitive model, 102–104 summaries of evaluated thoughts, 261 summary of, 226, 259 Testing Your Thoughts Worksheet, 260 Thought Record, 260 working with true thoughts, 257–259 Avoidance description of, 331 exposure and, 331–334 regarding Action Plans, 157–158 AWARE technique, 280, 386 Beck, Aaron, 3, 6–7, 14, 56 Beck Anxiety Inventory, 89 Beck Depression Inventory–II, 89 Beck Hopelessness Scale, 89 Beck Institute for Cognitive Behavior Therapy, 7 Behavioral activation, 3 Behavioral experiments in Action Plans, 137 to address automatic thoughts, 255–256 to evaluate automatic thoughts, 243 mindfulness and testing dysfunctional beliefs, 277

modifying dysfunctional beliefs, 312–313 testing beliefs about negative emotions, Behavioral skills, practicing, 138 Behavioral strategies Abe case example, 41 psychoeducation about, 100 simplified cognitive conceptualization diagram, 54 Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 traditional cognitive conceptualization diagrams, 48, 49, 50, 52, 53 Belief Change Worksheet, 312 Belief questionnaires, 295 Beliefs adaptive, 31–32. See also Adaptive core beliefs categories of, 282 core beliefs, 30–31. See also Core beliefs dysfunctional, 32–35. See also Dysfunctional core beliefs identifying problems in responding to, 372 important concepts about, 297 intermediate, 35–36. See also Intermediate beliefs introduction to, 282–283 modifying adaptive beliefs, 303–307 importance of, 303 maladaptive beliefs, 308–321 Bibliotherapy, 138 Booster sessions, 363, 364 Breathing exercises, 324 Case conceptualization identifying problems in, 368 the therapeutic relationship and, 58 Catastrophizing, 253 CBT. See Cognitive behavior therapy CBT sessions booster sessions, 363, 364 content and format of, 174–175, 176–177 deciding to focus on an issue or goal, 169–171 helping clients identify a problematic situation, 171–173 identifying problems in processing session content, 373 identifying problems in structure and pacing, 370 importance of structured sessions, 22. See also CBT session structuring phases of treatment planning, 162–163 planning individual sessions, 166–169 self-therapy sessions, 360–361 stuck points, 374 termination. See Termination See also Evaluation session; First therapy session CBT session structuring common problems in structural parts of sessions discussing agenda items, 205–207 eliciting an update, 203–204 mood check, 197–200 overview, 197 reviewing the Action Plan, 205 setting agenda, 200–203 content and format of sessions, 174–175, 176–177 deviating from the agenda, 207–208 end of sessions, 177, 188–191 first part of sessions medications/other treatments check, mood check, 178–180 overview, 177 prioritizing the agenda, 185–186 setting an initial agenda, 180–182 specific objectives, 175, 178 update and Action Plan review, 182–185 general difficulties in, 192–197 identifying problems in, 370 importance of structured sessions, 22 middle part of sessions, 177, 186–189 when clients are distressed toward the end of a session, 208–209 CBT theoretical model, 4–5 CBT therapists Action Plans and problems related to the therapist’s cognitions, 158–159 becoming an effective therapist, 9–12 client distress toward the end of a session, 208–209 common problems in structural parts of sessions discussing agenda items, 205–207 eliciting an update, 203–204 mood check, 197–200 overview, 197 reviewing the Action Plan, 205 setting an agenda, 200–203 general difficulties in structuring sessions addressing dysfunctional cognitions, 195–197 clinical tips, 196 engaging the client, 195 interrupting the client, 194 overview, 192–193 socializing the client, 194–195 therapist cognitions, 193

Index

406 Index CBT therapists (cont.) identifying problems in the client’s views of, 369 identifying problems in the reactions of, stages of development, 11–12 CCDs. See Cognitive conceptualization diagrams Clients asking for a helpful response to address automatic thoughts, 256–257 difficulties addressing dysfunctional cognitions, 195–197 difficulties around interrupting, 194 difficulties engaging, 196 distress toward the end of a session, 208–209 introducing mindfulness, 278–279 motivating to modify dysfunctional beliefs, 300–302 socializing, 194–195, 196, 370–371 teaching to identify automatic thoughts, 225–226 Clinical tips Action Plans client’s adherence to a plan, 152 clients’ ambivalence about, 147–148 clients trying to do plans perfectly, 156–157 activity scheduling, 126 activity when clients aren’t in the moment, 133 activity when clients have maladaptive behaviors, 131 arousal effect from relaxation, 324 automatic thoughts identifying automatic thoughts, 101–102 questions to evaluate automatic thoughts, 245, 247 worksheets and automatic thoughts, 269, 270–271 core beliefs, 288–289 difficulties in goal setting, 112 eliciting values, 104–105 exposures, 333 first therapy session, 88, 90, 91, 101–102, 104–105, 112 general difficulties in structuring sessions, 196 identifying adaptive core beliefs, 290 identifying positive data, 307 intellectual-emotional role plays, 320 medication/other treatments check, 91 mood check, 90, 180, 200 pie chart technique, 337 psychoeducation about the cognitive model, 101–102 responding to hopelessness and skepticism, 77, 78–79 self-comparisons, 339 skills training, 325 summaries, 189 switching goals in treatment, 172–173 teaching clients about distressing images, therapy notes, 261, 263, 264 Cognitions identifying cognitive distortions, 252–255 identifying problems in maximizing cognitive change, 372 interfering cognitions about Action Plans, 153–158 levels of, 5 positive, 19, 183–184 See also Dysfunctional cognitions Cognitive behavioral analysis system of psychotherapy, 3 Cognitive behavioral modification, 3 Cognitive behavior therapy (CBT) additional techniques decision making, 327–329 emotion regulation, 323–324 exposure, 331–334 graded task assignments and the staircase analogy, 329–331 overview, 322–323 “pie” technique, 334–337 problem solving, 325–327 role playing, 334 self-comparisons, 337–339 skills training, 325 summary, 339 becoming an effective therapist, 9–12 cognitive model of. See Cognitive model development of Beck’s CBT, 6–7 difference between CBT and CT-R, 8 example cases, 1–2. See also Abe; Maria forms of, 3 graph of expected progress, 354–355 negative emotions and the goal of, 323 origin and overview, 3–4, 14 principles of treatment, 16–25 problems in therapy. See Problems in therapy research and CBT efficacy, 5–6 resources, 377–378 sessions. See CBT sessions; CBT session structuring theoretical model, 4–5 typical cognitive intervention, 8–9

Cognitive change, identifying problems in maximizing, 372 Cognitive conceptualization Abe case example behavioral strategies, 41 core beliefs, 39–40, 287–288 intermediate beliefs and values, 40 overview, 38–39 sequences leading to depression, 41–43 strengths, resources, and personal assets, 43–44 automatic thoughts, 28–30 beliefs, 30–35 CBT treatment plans and, 17 cognitive model and, 36–38 initiating the process, 28 intermediate beliefs, 35–36 introduction to and importance of, 26–28 Cognitive conceptualization diagrams (CCDs) importance of, 44 Strengths-Based Cognitive Conceptualization Diagram, 44–47 summary, 52–54 traditional CCD, 47–52, 53 Cognitive continuum technique, 314–316 Cognitive distortions, identifying, 252–255 Cognitive interventions, typical intervention in CBT, 8–9 Cognitive model automatic thoughts and, 4–5, 28–30, 37–38, 216, 217–218 extended models, 36–38, 216, 217–218 identifying problems in the client’s understanding of, 371 overview, 4–5 psychoeducation about, 99–102 reinforcing in the first therapy session, 94 setting an Action Plan item to reinforce, 102–104 Cognitive processing therapy, 3 Cognitive restructuring, 326–327 Cognitive therapy, 3 Cognitive Therapy of Depression (Beck et al.), Cognitive Therapy Rating Scale, 169, 366 Collaboration identifying problems in, 369 importance in CBT, 19–20 setting Action Plans collaboratively, 140–141 the therapeutic relationship and, 61–62 Collaborative empiricism, 22–23 Competence Evidence of Competence Chart, 306 Reframes of Competence Belief Chart, 310–311 Coping cards, 10–11 Coping strategies coping with difficult experiences, 348–349 rehearsing adaptive strategies, 342–343 Coping with Depression (Beck), 88 Core beliefs Abe case example, 39–40, 287–288 about others, the world, and the future, adaptive, 31–32. See also Adaptive core beliefs clinical tips, 288–289 cognitive model, 37 concept of, 30–31 defined, 5, 282 dysfunctional, 32–35. See also Dysfunctional core beliefs expressed as automatic thoughts, 292 intermediate beliefs and, 35–36 modes, 284–287 modifying adaptive beliefs, 303–307 importance of, 303 maladaptive beliefs, 308–321 origin of, 36 schemas and, 283–284, 285 simplified cognitive conceptualization diagram, 54 Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 summary, 302 traditional cognitive conceptualization diagrams, 47, 48, 49, 50–51, 53 Counseling skills, the therapeutic relationship and, 58–60 Covert rehearsal, 144–145, 150, 154 Credit lists, 138 CT-R. See Recovery-oriented cognitive therapy Cultural competency, 18–19 Daily Record of Dysfunctional Thoughts. See Thought Record “Decatastrophizing” questions, 246–247 Decision making, 327–329 Depression Abe case example, 41–43 analogizing to pneumonia, 97 development of Beck’s CBT and, 6–7 importance of modifying maladaptive beliefs, 303 presenting a diagnosis in the first therapy session, 96–97 psychoeducation about, 97–99

Index

408 Index Depressive mode, 284, 286–287 Depressive rumination, 274–275 Diagnosis identifying problems in, 368 presenting in the first therapy session, 96–97 Diagnostic impressions, 80 Diagrams, using to explain beliefs, 300 Dialectical behavior therapy, 3 Difficult experiences, coping with, 348–349 Discounting the positive, 253 Disqualifying the positive, 253 Distancing, 343–344 “Distancing” questions, 248 Downward arrow technique, 204, 291–292 Drug use, treatment planning and, 167 Dysfunctional Attitude Scale, 295 Dysfunctional cognitions CBT theoretical model and, 4–5 difficulties in addressing, 195–197 guided discovery in CBT, 22–23 identifying problems in responding to, 371–372 Dysfunctional (negative) core beliefs case example, 32–35 characteristics and categories of, 32, 33, clinical tips, 288–289, 292–293 depressive mode and categories of, 286–287 determining the origin and maintenance of, 299–300 educating clients about, 296–300 identifying, 291–293 impact on schemas, 283, 285 modifying behavioral experiments, 312–313 cognitive continuum, 314–316 deciding when to modify, 296 deciding whether to modify, 295 historical tests, 320 importance of, 303 intellectual–emotional role plays, 318–320 overview and importance of, 308–309 reframing, 310–312 restructuring the meaning of early memories, 321 Socratic questioning, 309, 310 summary, 321 using other people as a reference point, 316–317 using self-disclosure, 318 using stories, movies, and metaphors, motivating clients to modify, 300–302 Early memories, restructuring, 321, 387–390 Embedded automatic thoughts, 220 Emotional reasoning, 253 Emotion charts, 230, 231 Emotions cognitive model, 28–29, 37, 217–218 differentiating from automatic thoughts, 232–234 emotion regulation techniques, 323–324 heightening emotional responses to elicit automatic thoughts, 222 matching the content of automatic thoughts to, 234–235 overview and importance of, 227–228 rating the intensity of, 231–232 summary of, 237–238 techniques to regulate, 237 See also Negative emotions; Positive emotions Empathy, the therapeutic relationship and, 58–60 Empty-chair work, 308 Engaging clients, difficulties with, 196 Evaluation session clinical tips, 77, 78–79 conducting the assessment, 75–80 diagnostic impression, 80 establishing expectations for treatment, 84 objectives for, 72–73 overview and importance of, 71–72 setting goals and relating a general treatment plan, 80–82 setting the Action Plan, 82–84 starting the session, 74–75 structure of, 73 summarizing for the client and eliciting feedback, 85 summary of, 86 therapist activities following, 85 Evidence of Competence Chart, 306 “Evidence” questions, 245–246 Expectations, identifying problems in, 371 Experiential techniques, restructuring the meaning of early memories, 321, 387–390 Exposure monitor, 333, 334 Exposures clinical tips, 333 description of, 332–333 overview and rationale for, 331–332 Exposure therapy, 3 Feedback attention to clients’ negative reactions about Action Plans, 145–147 eliciting from clients, 60–61

eliciting in the evaluation session, 85 eliciting in the first therapy session, 113 at the end of a session, 190–191 identifying problems in, 369 Feedback Form, 115 Final summary, 189 First therapy session activity scheduling, 112 client feedback, 113 clinical tips, 88, 90, 91, 101–102, 104–105, diagnosis and psychoeducation about depression, 96–104 end-of-session summary, 112–113 identifying values and aspirations, 104–108 initial agenda setting, 91–92 medication/other treatments check, 90–91 mood check, 89–90 overview and importance of, 87–88 setting goals, 108–112 structure of, 88 therapist activities prior to, 88 update and review of the Action Plan, 92–96 Formal mindfulness meditation, 275, 276, 277, 279 Forms, negative reaction to, 197–199 Generalized Anxiety Disorder Scale (GAD7), 89 Genuineness, therapeutic relationship and, 58–60 Gestalt-type techniques. See Experiential techniques Goals Action Plans and, 140 deciding to focus sessions on, 169–171 graded task assignment and the staircase analogy, 329–331 identifying problems in accomplishing in and across sessions, 372–373 identifying problems in goal-focused orientation of sessions, 371 implementing steps toward, 137 importance in CBT, 20 setting. See Goal setting switching goals in treatment, 172–173 treatment planning to accomplish a specific goal, 163, 165 Goal setting addressing automatic thoughts that interfere with, 108–110 addressing difficulties in, 111–112 evaluation session, 80–82 first therapy session, 108–112 identifying problems in, 370 pie chart technique, 334, 335 Graded task assignment, 329–331 Graph of expected progress, 354–355 Guided discovery, 22–23, 200 Guide to Booster Sessions, 363, 364 Guide to self-therapy sessions, 361 Helpless core beliefs, 32, 33, 286–287 Historical tests, 320 Hopelessness check on client’s level of, 89 difficulty in agenda setting and, 203 responding to in the evaluation session, 77–79 Identifying Automatic Thoughts Worksheet, 103–104 Imagery and images identifying negative images, 345–346 inducing positive images, 341–345 inquiring about to elicit automatic thoughts, 224 introduction to and importance of, 340 modifying spontaneous negative images, 346–351 relaxation and, 324 strengthening core beliefs, 307 summary of, 351 synonyms for images, 346 teaching clients about distressing images, Imaginal exposure, 333 Imaginal recall, 235 Imipramine, 7 “Impact of the automatic thought” questions, 247 Inactivity, conceptualization of, 118–120 Informal mindfulness practice, 275–276, Information processing dysfunctional negative beliefs and, 34–35, using a metaphor to explain, 298–299 Intellectual–emotional role plays, 318–320 Intermediate beliefs Abe case example, 40 cognitive model, 37 concept of, 35–36 defined, 5, 282 maladaptive deciding whether to modify, 295 educating clients about, 296–300 identifying, 293–295 origin of, 36

Index

410 Index Intermediate beliefs (cont.) simplified cognitive conceptualization diagram, 54 strengthening adaptive beliefs, 303–307 Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 traditional cognitive conceptualization diagrams, 48, 49, 50, 51–52, 53 Interpretations, differentiating from automatic thoughts, 219 Interrupting clients, difficulties around, 194 Invalid conclusions, investigating, 258 Issues, deciding to focus sessions on, 169–171 Jumping to the future technique, 349–350 Labeling, 253 Life events Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 traditional cognitive conceptualization diagrams, 48, 49, 51, 53 Magnification/minimization, 253 Maladaptive intermediate beliefs. See Intermediate beliefs, maladaptive Maria (case example) Action Plan addressing practical problems, 151 anticipating and preventing problems, 143–146 daily checklist, 152 overestimation of the demands of, 155–156 tailoring to the individual, 140 addressing dysfunctional cognitions, 195–196 automatic thoughts differentiating from interpretations, eliciting, 215–216 looking for central themes in, 291 psychoeducation about, 214–215 responding to when a worksheet isn’t helpful, 270–271 specifying embedded thoughts, 220 teaching to identify, 225 concerns about tapering sessions, 358–360 core beliefs identifying dysfunctional beliefs, 293 modifying dysfunctional beliefs, 314, difficulties in agenda setting, 201–202, difficulty solving problems, 326 distress toward the end of a session, 208–209 emotions labeling negative emotions, 230–231 rating the intensity of, 231, 232 testing beliefs about, 236 graded task assignment and the staircase analogy, 329–331 interrupting the client, 194 introduction to, 2 modifying spontaneous negative images, 350–351 resistance to activity scheduling, 126–129 self-comparisons, 337–339 tension and, 212 therapeutic relationship, 66–68 treatment planning deciding to focus on an issue or goal, identifying a problematic situation, 171–173 using the Activity Chart to assess predictions of mastery and pleasure, 132–133 Mastery conceptualization of lack of, 120 using the Activity Chart to assess predictions regarding, 131–133 Medication/other treatments check, 90–91, Medication use, treatment planning and, Memories focusing on positive memories, 341–342 restructuring, 321, 387–390 Mental filter, 253 Metaphors extended trial metaphor, 308 using in CBT, 10 using to explain information processing, 298–299 using to modify dysfunctional beliefs, Mindfulness AWARE technique, 280, 386 concepts and kinds of, 273–274 depressive rumination and, 274–275 exposure to internal stimuli, 333 formal and informal practices, 275–276 introducing to clients, 278–279 self-practice and reasons to practice, 276 summary of, 280

techniques before introducing into CBT treatment, 276–277 techniques following a mindfulness exercise, 279 testing beliefs about negative emotions, Mind reading, 253 Minimization/magnification, 253 Modes adaptive mode, 284–286 defined, 284 depressive mode, 284, 286–287 Monitoring of automatic thoughts, 137 exposure monitor, 333, 334 identifying problems in monitoring clients’ understanding, 373 importance in CBT, 18 the therapeutic relationship and, 60–61 treatment planning and, 168 Mood check Abe case example, 179–180 clinical tips, 180 common problems attribution of mood change to external factors, 199 clinical tips, 200 difficulty expressing mood, 199 negative reaction to forms, 197–199 worsening of mood, 199–200 first therapy session, 89–90 opportunities created by, 178–179 treatment planing and, 167 Motivation identifying problems in, 369–370 to modify dysfunctional beliefs, 300–302 Movies changing the “movie” technique, 347 using to modify dysfunctional beliefs, 314 “Must” statements, 254 Near-termination activities, 358–360 Negative core beliefs. See Dysfunctional core beliefs Negative emotions differentiating from automatic thoughts, 232–234 dysfunctional, 227 emotion regulation techniques, 323–324 goal of CBT and, 323 heightening negative affect, 236 labeling, 229–231 list of, 230 positive functions of, 227 summary of, 237–238 testing beliefs about, 236–237 Negative images changing the “movie,” 347 following images to conclusion, 347–350 identifying, 345–346 overview, 346–347 reality testing, 350–351 substituting positive images for, 344 teaching clients about distressing images, Negative predictions, about Action Plans, 153–154 Older client–younger client role play, 390 Opposite thoughts, 224 Other people referencing to modify dysfunctional beliefs, 316–317 referencing to strengthen adaptive beliefs, 305–306 Overestimations, of the demands of an Action Plan, 154–157 Overgeneralization, 253 Pacing, 205–206, 370 Past-orientation, CBT and, 20–21 Patient Health Questionnaire (PHQ-9), 89 Periodic summaries, 188–189 Personality Belief Questionnaire, 295 Personalization, 254 Personal strengths Abe case example, 43–44 Strengths-Based Cognitive Conceptualization Diagram, 45, 46 PHQ-9. See Patient Health Questionnaire Physiological responses, heightening to elicit automatic thoughts, 222 Pie chart technique, 334–337 Pleasure conceptualization of lack of, 120 using the Activity Chart to assess predictions regarding, 131–133 PMR. See Progressive muscle relaxation Pneumonia analogy, 97 Point–counterpoint technique, 318–320 Positive cognitions emphasizing in the session, 183–184 importance in CBT, 19 Positive core beliefs. See Adaptive core beliefs Positive data clinical tips, 307 strengthening adaptive beliefs, 304, 305 Positive emotions eliciting and strengthening, 228–229 emphasizing in the session, 183–184 importance in CBT, 19 list of, 229

Index

412 Index Positive images, inducing, 341–345 Positive qualities list, 47 Positive regard, therapeutic relationship and, 58–60 Practice exercises, advice about using, 13 Preparing for Therapy Worksheet, 138, 178, Present-orientation, in CBT, 20–21 Problematic situations eliciting the meaning of, 25 focusing on positive aspects of, 345 helping clients identify, 171–173 using role play to elicit automatic thoughts, 223–224 See also Trigger situations Problem-based cognitive conceptualization diagrams, 47–52, 53 Problems in therapy conceptualizing, 366–367 overview, 365 remediating, 374–376 stuck points, 374 summary, 376 types of problems accomplishing therapeutic goals, 372–373 diagnosis, conceptualization, and treatment planning, 368 motivation, 369–370 overview, 367–368 processing session content, 373 responding to dysfunctional cognitions, 371–372 socializing the client to treatment, 370–371 structuring and pacing sessions, 370 therapeutic relationship, 369 uncovering the existence of, 366 Problem solving difficulty with, 206–207, 326 identifying problems in, 371 overview, 325 with true automatic thoughts, 257–258 when problems can’t be solved, 326–327 when problems have a low probability of occurrence, 327 “Problem-solving” questions, 248 Problem-solving therapy, 3 Procrastination, 157–158 Progress attributing to the client, 355–356 graph of expected progress, 354–355 Progressive muscle relaxation (PMR), Psychoeducation about automatic thoughts, 214–215 about depression, negative thinking, and the treatment plan, 97–99 about dysfunctional beliefs, 297–300 about the cognitive model, 99–102 importance in CBT, 21 Questions automatic thoughts framed as, 221 eliciting an intermediate belief, 294–295 to evaluate automatic thoughts “alternative explanation” questions, behavioral methods, 243 clinical tips, 245, 247 “decatastrophizing” questions, 246–247 “distancing” questions, 248 “evidence” questions, 245–246 “impact of the automatic thought” questions, 247 “problem-solving” questions, 248 question lists, 242, 243 reasons to avoid direct challenges, 241–242 recommendations and guidelines, 243–245 Socratic questioning, 242–243 using alternative questions, 251–252 to specify problems in therapy, 368–373 Questions to Identify Automatic Thoughts handout, 225, 226 Rational emotional behavior therapy, 3 Reality testing, 350–351 Recorded therapy sessions, 366 Recovery-oriented cognitive therapy (CT-R) automatic thoughts and, 213 difference between CBT and CT-R, 8 example cases, 1–2 middle part of the session, 186–187 origin and overview, 7–8 theoretical model, 4–5 update in the first therapy session, 92–94 Re-creations, using to elicit automatic thoughts, 223–224 Reenactment, 387–390 Refocusing, 323–324 Reframes of Competence Belief Chart, 310–311 Reframing, to modify dysfunctional beliefs, 310–312 Relapse. See Setbacks and relapse

Relapse prevention activities throughout therapy, 355–358 early treatment activities, 353–355 graph of expected progress, 354–355 introduction to, 353 preparing for setbacks after termination, 362–363 summary, 363–364 Relaxation techniques, 324 Reminder systems, for Action Plans, 141–142 Resilience building, 357–358 Rogerian counseling skills, 58–60 Role plays to elicit automatic thoughts, 223–224 intellectual–emotional role plays, 318–320 overview and description of, 334 restructuring the meaning of early memories, 387–390 Rules cognitive model, 37 concept of intermediate beliefs and, 35–36 See also Intermediate beliefs Rumination, 274–275 Rush, A. John, 6–7 Safety behaviors, 331 SB-CCD. See Strengths-Based Cognitive Conceptualization Diagram Schemas core beliefs and, 283–284, 285 dysfunctional negative beliefs and, 34–35 modes and, 284–287 Self, negative core beliefs about, 286–287 Self-comparisons, 337–339 Self-disclosure using in the therapeutic relationship, 63–64 using to address automatic thoughts, 256 using to modify dysfunctional beliefs, 318 Self-soothing, 324 Self-therapy sessions, 360–361 Seligman, Martin, 357 Session Notes, 175, 176–177 Setbacks and relapse preparing for after termination, 362–363 recognizing the signs of, 362 See also Relapse prevention “Should” statements, 254 Situations. See Problematic situations; Trigger situations Skepticism, responding to in the evaluation session, 77–79 Skills training in emotion regulation, 325 for relapse prevention, 356–357 Socializing the client clinical tips, 196 difficulties in, 194–195 identifying problems in, 370–371 Social skills, role play and, 334 Socratic questioning evaluating automatic thoughts, 242–243, with guided discovery, 22–23 modifying dysfunctional beliefs, 309–310 testing the validity of negative predictions, 137, 255 Solution-focused brief therapy, 111 Staircase analogy, 329–331 Stories, using to modify dysfunctional beliefs, 314 Strengths-Based Cognitive Conceptualization Diagram (SB-CCD), 44–47 Suicidality check, 89 Summaries clinical tips, 189 of evaluated automatic thoughts, 261 final summary, 189 periodic, 188–189 Tapering treatment, 358–360 Telegraphic automatic thoughts, 220–221 Termination clients’ reactions to, 362–363 early treatment activities, 353–355 near-termination activities, 358–360 preparing for setbacks after, 362–363 Testing Your Thoughts Worksheet, 260, 264, 265–266, 269–270 Therapeutic interventions failing to make, 206 identifying problems in, 373 typical cognitive intervention in CBT, 8–9 Therapeutic objectives, treatment plans and, 161 Therapeutic relationship collaboration, 61–62 counseling skills, 58–60 essential guidelines, 57–58 helping clients generalize to other relationships, 67–68 identifying problems in, 369 importance in CBT, 18 introduction to, 56–57

Index

414 Index Therapeutic relationship (cont.) managing negative reactions toward clients, 68–70 monitoring clients’ affect and eliciting feedback, 60–61 repairing ruptures, 64–67 summary of, 70 tailoring to the individual, 62 using self-disclosure, 63–64 Therapists. See CBT therapists Therapy notes about setbacks, 363 in Action Plans, 137 audio-recorded, 264 clinical tips, 261, 263, 264 composing, 261–263 making in the first therapy session, 98–99 writing down, 23–24 Thought Record, 233, 260, 264, 267–268 Time sensitivity, CBT and, 21–22 Traditional (problem-based) cognitive conceptualization diagrams, 47–52, Treatment plans to accomplish a specific goal, 163, 165 clinical tips, 172–173 cognitive conceptualization and, 17 creating, 163, 164 deciding to focus on an issue or goal, 169–171 helping clients identify a problematic situation, 171–173 identifying problems in, 368 importance of, 160 making therapy notes in the first therapy session, 98–99 phases of planning, 162–163 planning individual sessions, 166–169 relating in the evaluation session, 80–82 summary of, 173 therapeutic objectives and, 161 Treatment time, 21–22 Trial metaphor, 308 Trigger situations cognitive model, 37 psychoeducation about, 100 simplified cognitive conceptualization diagram, 54 Strengths-Based Cognitive Conceptualization Diagram, 44, 45, 46 traditional cognitive conceptualization diagrams, 48, 49, 50, 53 See also Problematic situations Tunnel vision, 254 Two-column technique, for responses to automatic thoughts, 271 Underlying assumptions. See Assumptions University of Pennsylvania, 6–7 Unlovable core beliefs, 32, 33, 286–287 Updates difficulties in eliciting, 203–204 first part of a session, 182–185 first therapy session, 92–94 Valued action/behavior, 258–259, 323–324 Values Abe case example, 40 Action Plans and, 140 eliciting, 104–105 importance in CBT, 20 pie chart technique, 334, 335 Visualization of positive outcomes for Action Plans, 142 using to elicit automatic thoughts, 223 Well-being building, 357–358 Worksheets advice about using, 13 alternatives to for responding to automatic thoughts, 270–271 clinical tips with automatic thoughts, 269, 270–271 using to respond to automatic thoughts, 264–270 Worry, AWARE technique, 280, 386 Worthlessness core beliefs, 32, 33, 286–287