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Contents

1. Introduction and overview CBT as an intervention 1 CBT as a preventative intervention 2 CBT with younger children 3 CBT with young people with learning difficulties 3 Technologically delivered CBT 4 Involving parents 5 The competencies to deliver CBT 6 Assessing competence 7 Cognitive Behaviour Therapy Scale for Children and Young People 8 CORE philosophy 12 Child centred 13 Outcome focused 14 Reflective 15 Empowering 16 2. PRECISE 19 The therapeutic alliance 19 Partnership 21 Eliciting young person and parent's understanding and views 22 Encourages the young person to participate in decision making 23 Involves young person and parent/carer in planning the intervention 24 Encourages young person to provide feedback about sessions 24 Right developmental level 25 Ensures a balance between cognitive and behavioural techniques 25 Uses simple, clear. jargon free language 26 Uses a variety of verbal and non-verbal techniques 28 Appropriately involves parents/carers 28 Courtney has anger outbursts 30 Empathy 30 Conveys interest and concern 30 Acknowledges and responds to emotional responses 32 Demonstrates a respectful, non-judgemental, caring approach 33 Empathises with parents 34 Creative 35 Tailors concepts and methods of CBT around the young person 36 Uses a range of verbal and non-verbal methods 37 Is creative in use of materials and metaphors 38 Utilises the preferred media of the young person 39 Investigation 40 Creates a process of collaborative inquiry 40 Fully involves the young person in the design of experiments 41 Helps to consider alternative explanations 42 Encourages reflection 42 Self-efficacy 43 Identifies strengths and personal resources 43 Encourages identification of helpful skills and strategies 44 Develops personal coping strategies 45 Reinforces use of new skills 46 Enjoyable and engaging 47 Uses an appropriate mix of materials and activities 47 Maintains a balance between task and relationship strengthening 47 Incorporates young person's interests into the intervention 48 Presents as positive and hopeful 49 PRECISE in practice 49 Ella's obsessional thoughts 49 Joshua's negative thinking 50 3. A: Assessment and Goals 52 Undertakes a full assessment 52 Compliments assessment with routine outcome measures 54 Negotiates goals and when progress will be reviewed 56 Identification of goals 57 Prioritisation of goals 58 Whose goals? 58 Inappropriate goals 59 Uses diaries, thought bubbles and rating scales 59 Sarah feels faint 60 Tick charts 60 Thought bubbles 61 Visualisation 62 Stories 62 Rating scales 64 Pie charts 64 Theos washing 64 Assessing motivation and readiness to change 65 Pre-contemplation 67 Contemplation 68 Preparation 69 Action 69 Maintenance 69 Relapse 69 4. B: Behavioural 71 Developing hierarchies, graded exposure and response prevention 71 Developing hierarchies 71 Graded exposure 73 Response prevention 75 John is worried about germs 76 Problems when undertaking exposure 76 Young person avoidance 76 Clinician avoidance 77 Anxiety does not come down 77 Is the young person focusing on their anxiety 77 Are parents appropriately involved 78 Uses activity rescheduling and behavioural activation 78 Activity scheduling 78 Alison feels down 79 Behavioural Activation 80 Problems with behavioural activation 80 I didn't feel like doing it 81 I did it but I don't feel any better 82 I did it but so what 82 It's not important 82 Provides a clear rationale for use of behavioural strategies 82 Identifies and implements reward and contingency plans 83 Models, uses role play, problem-solving and skills training 85 Models how to cope 85 Role-play 87 Problem solving 88 Skills training 89 5. C: Cognitions 91 Facilitates cognitive awareness 91 Cognitive content 91 Levels of cognitions 92 Uses thought records and bubbles 96 Identifies functional and dysfunctional cognitions 98 Unhelpful thoughts 98 Helpful thoughts 99 Identifies cognitive biases (thinking traps) 99 Negative filter 99 Blowing things up 100 Predicting failure 100 Being down on yourself 101 Setting yourself up to fail 101 Facilitates thought challenging and perspective taking 102 What is the evidence? 102 The 4Cs 102 What would someone else say? 103 Jaz falls out with her friend 103 Facilitates continuum work through rating scales 103 Uses mindfulness, acceptance and compassion 104 Mindfulness 104 Compassion 107 Acceptance 108 Kindness 110 6. D: Discovery 111 Facilitates discovery through the Socratic dialogue 111 The Socratic dialogue 113 Memory questions 113 Translation questions 113 Interpretation questions 114 Application questions 114 Analysis questions 115 Synthesis questions 115 Evaluation questions 115 What makes a good Socratic question? 116 Mike is worried about his cat 117 Common difficulties 120 Facilitates perspective taking 122 Perspective taking 122 Responsibility pies 123 Joshua's accident 123 Attends to overlooked information 124 Analogical comparisons 125 Testing assumed relationships 125 Marla worries she will pass germs to others 126 Evaluates cognitions thought behavioural experiments or prediction testing 127 Planning a behavioural experiment 128 Prediction testing - Caleb thinks he is a failure 129 Active experiment - Laura's social anxiety 130 Information gathering experiments - Adam's formulation 131 7. E: Emotions 134 Develops emotional literacy 134 Identifies key bodily signals 135 Body signals 135 Feeling diaries 136 William feels sad 136 Emotional logs 137 Isabella feels down 137 Develops relaxation, guided imagery, controlled breathing and calming activities 138 Progressive muscle relaxation 139 Calming imagery 141 Aisha's calming image 141 Diaphragmatic (controlled) breathing 142 Change the feeling 143 Develops physical activity, let the feelings go, emotional metaphors 144 Physical activity 144 Let the feeling go 144 Emotional metaphors 144 Emotive imagery 145 Anthony's humorous image 145 Develops self-soothing, mind games and mindfulness 146 Self-soothing 146 Mind games 147 Mindfulness 147 Talk to someone 148 8. F: Formulations 150 Provides a coherent and understandable rationale for the use of CBT 150 Links thoughts, emotions and behaviours (maintenance formulations) 152 Mini-formulations (two or three system models) 152 Rhiannon is unhappy and scared 152 Maintenance formulations 155 Naomi cuts herself 155 Four system formulations 156 Abdul's anxiety 156 Remember the strengths 158 Includes past events (onset formulations) 160 Mary's anxiety 162 Includes role of parents/carers 164 Sally's anxiety 164 Activities and goals are clearly linked to the formulation 166 Common problems 168 Difficulty identifying thoughts or feelings 168 Distinguishing between different levels of cognitions 169 Can't put the information together 170 Not sure the formulation is right 170 Can't find all the information 171 9. G: General skills 172 Prepares and brings the necessary materials and equipment 172 Manages the young person's behaviour 173 Sessions have an agenda, clear goals and structure 174 General update 175 Outcome measure update 176 Home assignment review 176 Session topic 176 Home assignment 177 Session feedback 177 Good timekeeping 178 Sessions are appropriately paced and responsive 179 Gary is worried about germs 181 Prepares for endings and relapse prevention 181 10. H: Home assignments 186 Negotiates home assignments 186 Assignments are meaningful and related to the formulation 188 Assignments are consistent with development and interests 189 Assignments are realistic and safe 191 Assignments are related to goals 193 Harry wants get fitter 193 Fatima's unhelpful thoughts 195 Assignments are reviewed and reflection encouraged 196 11. Putting it all together 199 Anxiety 199 Effectiveness 199 Rationale informing the intervention 200 Core components of CBT interventions for anxiety disorders 200 Parents 201 Important cognitions 202 Depression 202 Effectiveness 202 Rationale informing the intervention 203 Core components of CBT interventions for depression 204 Parents 205 Important cognitions 205 Obsessive Compulsive Disorder (OCD) 206 Effectiveness 206 Rationale informing the intervention 207 Core components of CBT interventions for OCD 208 Parents 209 Important cognitions 209 Post-traumatic Stress Disorder (PTSD) 209 Effectiveness 209 Rationale informing the intervention 210 Core components of CBT interventions for PTSD 210 Parents 211 Important cognitions 212 When it doesn't go right 212 Is the young person motivated to change? 213 Sam's cost of change 216 Are the young person and their family engaged with the intervention 217 Jade is anxious and depressed 219 How has the intervention been delivered 223 12. Resources 227 The chain of events 228 What happens? - negative trap 229 Four systems 230 How did this happen 231 Session rating scale 232 Scales of change 233 Anxiety intervention plan 234 Depression intervention plan 235 OCD intervention plan 236 PTSD intervention plan 237 Motivation 238 Engagement 239 Intervention delivery 240 Reflective practice 241 Cognitive behaviour therapy scale for children and young people (CBTS-CYP) 242 Beating anxiety 257 Fighting back depression 263 Controlling worries and habits 268 Coping with trauma 273 13. References 277

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