Tuesday, 27 December 2011

Quick CBT (Cognitive Therapy) Quiz: How much do you know about GAD (Generalised Anxiety Disorder)?

Generalised Anxiety Disorder (GAD) is one of the most common problems you are likely to encounter as a Cognitive Therapist. Take this quick quiz to test your knowledge of it and how to treat it.
  1. Which of these is most characteristic of GAD.

  2. Not being able to stop or control worrying
    Poor appetite or overeating
    Trouble falling asleep, staying asleep or sleeping too much.
    Feeling hopeless

  3. Who says that the tolerance of uncertainty is the most central feature of GAD?

  4. Beck

  5. The main idea behind the worry decision tree (Butler & Hope) is

  6. To calculate mathematical probabilities for all worries to think more rationally
    To take action when worries are concrete but not when they are hypothetical
    To treat all worries like leaves floating down a stream
    To do something active like climbing a tree instead of worrying

  7. Adrian Wells's metacognitive approach to GAD would include

  8. To use positive thinking instead of worry
    To become active instead of worrying
    To differentiate between concrete and hypothetical worries
    To treat all worries like leaves floating down a stream

  9. Which answer below best gives rationale for "worry time".

  10. To solve all their problems in the worry period
    So they can ban worrying straight away
    So they get the message that its OK to worry
    So they can become more aware of the worrying process

  11. Which statement about GAD is most accurate

  12. GAD is just general anxiety
    The main feature of GAD is worry
    GAD is a term for what's left when no other anxiety disorder is present
    CBT can't really help with GAD

Thank you for completing the quiz. Click Grade me to see your score out of a possible 60.

Sunday, 20 November 2011

Tuesday, 15 November 2011

The Politics of Well-Being: A blueprint for 'Philosophical CBT'

The Politics of Well-Being: A blueprint for 'Philosophical CBT': Imagine being able to practice philosophy through the NHS. The idea is not as far-fetched as it sounds. In fact, therapists and counselors ...

The Politics of Well-Being: Tim LeBon on Philosophical CBT

The Politics of Well-Being: Tim LeBon on Philosophical CBT: Tim LeBon is a cognitive therapist and philosophical counselor, and the author of the book Wise Therapy . He's one of a handful of people ...

Thursday, 27 October 2011

The Politics of Well-Being: An interview by Jules Evans with Aaron Beck on CBT

The Politics of Well-Being: An interview with Aaron Beck on CBT:
  This is an interesting interview journalist and practical philosophy expert Jules Evans did with Aaron Beck, the inventor of Cognitive Behavioural Therapy (CBT), back in 2007.  Of particular interest is how Beck differentiates CT from REBT and also the tips he gives on CBT for schizophrenia. It's also noteworthy if not surprising that Beck endorses Seligman's work with children (I wonder what he thinks of positive psychology?) and , as Evans observes, how Beck is very reluctant to go beyond the facts ....

Saturday, 22 October 2011

Borkovec et al. article on GAD

There are a lot of free resources written by leading experts and here's one  I found that I wanted to share with you.

It's called

Cognitive-Behavioral Therapy for Generalized Anxiety Disorder With Integrations From Interpersonal and Experiential Therapies  

and it's written by Tom Borkovec, Michelle Newman and Louis  Castonguay


This is the abstract

After providing background information on the definition and nature of generalized anxiety disorder, this article describes cognitive-behavioral therapy (CBT) methods that have been empirically supported in the treatment of this disorder. Subsequent to this description, relevant outcome literature is briefly reviewed, along with evidence that the addition of other techniques beyond traditional CBT methods may be necessary to maximize clinical outcome. A description is then provided of an integrated interpersonal/emotional processing therapy that the authors have recently added to their CBT protocol. CBT with and without this integrated treatment is currently being evaluated in an experimental trial.


The article is now a  little out of date, but does include a good survey of CBT for GAD as understood in 2004 - for example it mentions but does not go into detail about Dugas' model focussing on intolerance of uncertainty and does not mention Wells' metacognitive approach. It does, however, go into some detail about Borkovec's own theory that worry is a form of avoidance i.e. one of the functions of worry is to avoid experiencing anxiety - a strategy that backfires and is addressed by facing the anxieties. The article also introduces the idea of integrating interpersonal concerns into CBT, a useful idea given the recent interest in Interpersonal Therapy.



Wednesday, 28 September 2011

CBT for OCD (Obsessive Compulsive Disorder)

Obsessive Compulsive Disorder (OCD) is one of the most disabling and at first sight puzzling of the anxiety disorders. Yet it is treatable, and CBT has the most impressive evidence base of all the treatments.

A new self-help book has just come out, Break Free from CBT. I went to a Paul Salkovskis workshop
at the recent BABCP conference at Guildford and was very impressed by his ideas.
The key idea to the CBT treatment for OCD can best be described in terms of Theory A and Theory B.
Theory A is what the client is already thinking. Its contents vary depending on the type of OCD, but basically it will be a varient of
Theory A: My problem is that I might get contaminated/harm someone/leave the house open. Because of this I need to avoid any contact with germs/avoid people/ repeatedly check that the door is locked.

The key insight of CBT for OCD is that theory A is the problem, and the compulsive behaviour that is meant to solve it (checking, avoidance) is also part of the problem. So we have Theory B, namely
Theory B: My problem is that  I worry that I get contaminated/ I worry that I will harm someone/ I worry that I have left the door unlocked. Because of this I need to stop doing the checking/avoiding. 

Of course it may take an OCD sufferer some time to be convinced of theory B, and the whole ethos of CBT isn't so much about convincing, more about examining the evidence. So the client will be asked to do a behavioural experiment to see which fits the data best, theory A or theory B. For example, if someone has thoughts they will harm someone, they will be asked "how often have you harmed someone before?" and "what is more likely, that you are the sort of person who harms someone, or the sort of person who has high moral standards and is worried they will harm someone?".
There is a lot more detail in the book featuring different case examples and a variety of other techniques (including ERP, exposure and response prevention, which is the more behavioural and less cognitive treatment for CBT).

 In summary, OCD is treatable, and I'd thoroughly recommend this book for sufferers and therapists alike.

Read an extract from Break Free from OCD by Challacombe, Oldfield and Salkovskis

Buy Break Free from OCD from Amazon

OCD Resources for therapists
Book Review of Break Free From OCD
Salkovskis 1985 cognitive model of OCD& formulation sheet for OCD
Salkovskis et al  vicious flowerformulation sheet for OCD
Presentation on benefit of guided self-help using CBT for OCD
OCD questionnaires including OCI and RAS
NICE guidelines on OCD

Self - help resources for OCD

OCDUK - lots of resources for those suffering from OCD and their families -especially strong on help for  children with OCD
Institute of Psychiatry  expert advice on OCD - includes  further reading suggestions
OCD Thought Record form - Thought record sheet customised for OCD
ERP logging for OCD - to record exposure and its effects
OCD Rituals Diary
OCD and Beckham - helping to take some of the stigma from OCD from the OCD Closet
6 minute video on CBT and OCD featuring Paul Salkovskis
CBT techniques for OCD -self-help page
Introduction to Overcoming OCD by Lee Brosan - a very short, clear and inexpensive guide - a good place to start.
Overcoming OCD by David Veale and Rob Wilson - another good self-help guide

Tuesday, 3 May 2011

dealing with guilt

Just published article on how to deal with guilt - getting the balance right
between challenging inappropriate or unhelpful guilt and paying heed to existential messages