Depression is a chronic, recurring disorder that impacts children’s academic, interpersonal, and family functioning. The heritability of major depressive disorder (MDD) is likely to be in the range of 31% to 42%. This chapter begins with a brief overview of the etiology of depression. It presents a description of a cognitive behavioral therapy (CBT) intervention designed to be delivered in a group format, an individual interpersonal intervention, and an individual behavioral activation (BA) intervention that includes a great deal of parental involvement. The ACTION program is a manualized program that is based on a cognitive behavioral model of depression. There are four primary treatment components to ACTION: affective education, coping skills training (BA), problem-solving training, and cognitive restructuring. The chapter concludes with a brief discussion of universal therapeutic techniques to be incorporated into work with depressed youth regardless of the therapeutic orientation or treatment strategy.
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- Go to chapter: Evidence-Based Interventions for Major Depressive Disorder in Children and Adolescents
Eating disorders (EDs) are a complex and comparatively dangerous set of mental disorders that deeply affect the quality of life and well-being of the child or adolescent who is struggling with this problem as well as those who love and care for him or her. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for the diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or ED. Treatment of eating disordered behavior typically involves a three-facet approach: medical assessment and monitoring, nutritional counseling, and psychological and behavioral treatment. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are also evidence-based approaches to treatment for AN. The treatment of EDs should be viewed as a team effort that integrates medical, nutritional, and mental health service providers.
The baby boom cohort brings with it multiple types of substance abuse. Bisexual older adults have more co-occurring psychological problems than heterosexual older adults, older gay males, and older lesbians. An interesting finding is that immigration is contributory to older adult substance abuse. Older adults with alcohol-abuse problems do not seek help for their problems. Rather, they are often identified as having an alcohol-use problem when seeking care for other medical or psychological problems. Social workers assessing an older adult for alcohol abuse often confuse symptoms of possible alcohol abuse with dementia. Prescribing opioids and synthetic opioids to an older adult is complicated. An older adult can suffer from many forms of inner tension. Combining motivational interviewing with cognitive behavioral therapy is shown to be more effective for treating substance abuse that either therapeutic modality alone.
This chapter describes the relevance of critical thinking and the related process and philosophy of evidence-based practice (EBP) to cognitive behavior therapy and suggests choices that lie ahead in integrating these areas. Critical thinking in the helping professions involves the careful appraisal of beliefs and actions to arrive at well-reasoned ones that maximize the likelihood of helping clients and avoiding harm. Critical-thinking values, skills and knowledge, and evidence-based practice are suggested as guides to making ethical, professional decisions. Sources such as the Cochrane and Campbell Collaborations and other avenues for diffusion, together with helping practitioners and clients to acquire critical appraisal skills, will make it increasingly difficult to mislead people about “what we know”. Values, skills, and knowledge related to both critical thinking and EBP such as valuing honest brokering of knowledge, ignorance and uncertainty is and will be reflected in literature describing cognitive behavior methods to different degrees.
This chapter describes the Coping Skills Program, an innovative, school-based, universal curriculum for elementary-school aged children that is rooted in cognitive behavior theory. Rooted in cognitive behavior theory, the Coping Skills Program consists of carefully constructed metaphorical fables that are designed to teach children about their thinking; about the connections among their thoughts, feelings, and behavior; and about how to change what they are thinking, feeling, and doing when their behavior causes them problems. The chapter provides a thorough description of the Coping Skills Program and how it is implemented through a discussion of relevant research-based literature, and the theoretical underpinnings underlying this cognitive behavior approach with school-aged children. It also includes the results of preliminary testing of the Coping Skills Program. The research-based literature shows that cognitive behavior approaches are among the interventions commonly used by social workers to help young children in school settings.
Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. As is so often true for social work, the opportunity is associated with need. For social workers, in their role as advocates and clinicians, this unmet need would seem to create an obligation. This chapter argues that, if choosing to accept the obligation, social workers can become catalysts for vitally needed change within the medical field. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating Cognitive behavior therapy’s (CBT) effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients. While this chapter discusses the clinical benefits and techniques of CBT, it also acknowledges the likelihood that social work will have to campaign for its implementation in many medical settings.
This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
The clinical social worker typically interfaces with older adult clients and their families in a variety of settings, providing diverse services ranging from assessment to clinical treatment to referral. This chapter discusses the ways in which cognitive behavior therapy (CBT) techniques can be used by social workers across different milieu to assist elderly clients who may be suffering from depression. These settings include the client’s home, an inpatient or outpatient mental health facility, a hospital or medical setting, a long-term care facility, or a hospice setting. The chapter provides an overview of how cognitive behavior techniques can be integrated throughout the range of services social workers may provide to elderly clients. Clinical examples demonstrate the use of CBT in a variety of settings. For many older adult clients, issues related to the need for increasing dependence on family, friends, and paid caretakers may become the central focus of counseling.
Community-based epidemiological studies find that when grouped together, anxiety disorders are the most common mental health conditions in the United States apart from substance use disorders. Anxiety disorders are also associated with substantial impairments in overall health and well-being, family functioning, social functioning, and vocational outcomes. This chapter includes a brief description of the anxiety disorders followed by a more detailed review of the cognitive behavior interventions indicated for these conditions. Social phobia is the most common anxiety disorder in the United States. Panic attacks are sudden surges of intense anxiety that reach their peak with 10 minutes and involve at least 4 of a list of 13 symptoms. Another somewhat less common anxiety disorder is obsessive compulsive disorder. The chapter discusses the posttraumatic stress disorder (PTSD). Two anxiety management procedures, breathing retraining and deep muscle relaxation, have been subject to some level of empirical investigation for certain anxiety disorder.
- Go to chapter: Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
This chapter focuses on six maladaptive processes that underlie a wide range of emotional and behavioral problems commonly addressed by social work practitioners in the mental health field. First, it explicates how a focus on transdiagnostic processes differs from traditional views of psychopathology and accords more closely with neuroscientific evidence. Next, the chapter reviews current research in the fields of experimental psychopathology and neuroscience to detail the cognitive, emotional, and neurobiological features of these six core transdiagnostic processes: automaticity, attentional bias, memory bias, interpretation bias, suppression, and stress reactivity. Then it discusses how these processes may be assessed by clinical social workers in the field, and offer six case vignettes that depict how they manifest in human suffering and impaired psychosocial functioning. Finally, the chapter discusses mindfulness-based interventions as a means of targeting transdiagnostic processes in clinical practice.
Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.
This chapter discusses the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD) and its neurological components-especially those affecting memory, evidence-based therapies (EBTs) for the treatment of PTSD, and the implications for practice, policy, and research. Two primary predictors exist for a person developing PTSD. The first one is experiencing dissociation during the trauma. The second predictor is the person developing acute stress disorder. Specifically, neuroimaging shows how PTSD affects neurological functioning in the brain. The primary regions of the brain affected by PTSD are the medial prefrontal cortex, the left anterior cingulate cortex, the thalamus, the medial temporal and hippocampal region, and the amygdala. The different regions of the brain associated with memory encoding are: left prefrontal cortex, left temporal/fusiform, anterior cingulate, and hipocampal formation. Cognitive-behavioral therapy (CBT) has been used extensively to treat PTSD.
Social work professionals are in key roles for providing effective education, treatment, training, and services for adult survivors. This chapter helps the social workers to equip with an evidence-based treatment framework to effectively enhance their work with this population of adult survivors. A community study of the long-term impact of the sexual, physical, and emotional abuse of children concluded that a history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. There is well-established and increasing empirical evidence that cognitive and cognitive behavior therapies are effective for the treatment of disorders that are typical among adult survivors of sexual and physical abuse. The chapter presents some basic cognitive behavior therapy (CBT) strategies that social workers can use in whatever roles they play in working with the multidisordered adult survivor. There are three types of schema avoidance: cognitive, emotional and behavioral.
This chapter offers a brief and focused review of human development, with specific emphasis on cognition and emotion. It is essential that the reader distinguishes between cognitive development, cognitive psychology, and cognitive therapy. Both short-term and long-term memory improve, partly as a result of other cognitive developments such as learning strategies. Adolescents have the cognitive ability to develop hypotheses, or guesses, about how to solve problems. The pattern of cognitive decline varies widely and the differences can be related to environmental factors, lifestyle factors, and heredity. Wisdom is a hypothesized cognitive characteristic of older adults that includes accumulated knowledge and the ability to apply that knowledge to practical problems of living. Cognitive style and format make the mysterious understandable for the individual. Equally, an understanding of an individual’s cognitive style and content help the clinician better understand the client and structure therapeutic experiences that have the greatest likelihood of success.
Social workers are committed to the protection and empowerment of weak populations, of those people who are least powerful. Gradually, social work started to rely more on problem-solving methods, client-focused therapy, family theories, and, more recently, cognitive behavior theories, constructivist theories, and positive psychology developments. Clinical social work today operates in a variety of settings in the statutory, voluntary, and private sectors. Clinical social workers have always been interested in helping clients change effectively. The importance of empirical study, valid information, and intervention effectiveness has always been accentuated by the social work field’s central objectives of increasing accountability, maintaining exemplary ethics and norms, and establishing clear definitions and goals. Cognitive behavior theory emphasizes several components. First and foremost, human learning involves cognitive mediational processes. Social workers need to look for effective methods for change, and CBT methods are very promising in this respect.
Over the past 25 years there has been a growing recognition of the importance of working with families of persons with severe mental illnesses such as schizophrenia, bipolar disorder, and treatment-refractory depression. Family intervention can be provided by a wide range of professionals, including social workers, psychologists, nurses, psychiatrists, and counselors. This chapter provides an overview of two empirically supported family intervention models for major mental illness: behavioral family therapy (BFT) and multifamily groups (MFGs), both of which employ a combination of education and cognitive behavior techniques such as problem solving training. Some families have excellent communication skills and need only a brief review, as provided in the psychoeductional stage in the handout “Keys to Good Communication”. One of the main goals of BFT is to teach families a systematic method of solving their own problems.
This chapter discusses the treatment of comorbid chronic depression and personality disorders. It then discusses recent treatment advances in the cognitive behavior field relevant to this population. Recently, research has been done comparing schema therapy to Otto Kernberg’s latest model. Because of severe emotional distress, patient often experience suicidal and/or parasuicidal behaviors. The chapter explores the benefits of mode work with these particular difficulties while maintaining a therapeutic approach of connection and compassion; this alliance is crucial for the approach to be effective. It focuses on the five most common modes for those with chronic depression and personality disorders namely the abandoned/abused mode, the detached protector mode, the angry mode, the punitive mode and the healthy adult mode. The interventions described in schema mode therapy have cognitive, experiential, and behavioral components. Identification of the mode the patient is in when suicidal is essential when managing a crisis.
This chapter reviews the basic tenets of evidence-based practice (EBP), and discusses the potential applications of this model of practice and training for the field of clinical social work. It also presents some actual illustrations of its use. The chapter describes the major forms of clinical outcome studies: Anecdotal Case Reports, Single-System Designs With Weak Internal Validity, Quasi-Experimental Group Outcome Studies, Single, Randomized Controlled Trial, Multisite Randomized Controlled Trials and Metaanalyses that comprise the priority sources of information underpinning EBP. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that cognitive behavior therapy (CBT) and practice represents a strongly supported approach to social work education and practice.
Over the years, cognitive behavior therapy (CBT) has been applied to a variety of client populations in a range of treatment settings and to the range of clinical problems. This chapter provides a general overview of the cognitive behavior history, model, and techniques and their application to clinical social work practice. It begins with a brief history and description, provides a basic conceptual framework for the approach, highlights the empirical base of the model, and then discusses the use of cognitive, behavior, and emotive/affective interventions. Cognitive behavior therapy is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice.
This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.
This chapter discusses some of the critical issues surrounding culture and cognitive behavioral methods in order to better inform the advancement of culturally responsive social work practice. It focuses on one such treatment modality, cognitive behavior therapy (CBT). The chapter reviews relevant theoretical frameworks, existent empirical studies on CBT with diverse cultural groups, strengths and limitations of this modality across cultures, and suggestions for culturally responsive CBT practice, in order to better inform social work practice. While cognitive behavior therapy was developed with universal assumptions and without consideration to the diversity of the cultural contexts of consumers, it is grounded in theory that is likely to have “some universal basis across populations”. Several studies have described the use of cognitive behavior methods with gay and lesbian clients, particularly the use of rational emotive therapy, cognitive restructuring, and behavior experiments.
The treatment of the suicidal individual is perhaps the most weighty and difficult of any of the problems confronted by the clinical social worker. Some frequent comorbid pathology with suicidal behavior includes alcoholism, panic attacks, drug abuse, chronic schizophrenia, conduct disorder in children and adolescents, impulse control deficits, schizophrenia, and problem-solving deficits. Suicidal harmful behavior appears in all ages and characterizes clients in a large spectrum of life. There are four types of suicidal behavior namely rational suicider, psychotic suicider, hopeless suicider and impulsive or histrionic suicider. This chapter presents some primarily cognitive techniques for challenging suicidal automatic thoughts. Recent reports suggest that individuals suffering from alcohol or substance abuse are at an increased risk both for attempting, and for successfully completing, a suicidal act. The therapist must develop an armamentarium of cognitive techniques, and the skills to use these effectively in ways that are appropriate for each individual client.
This book represents a compilation of years of theoretical and clinical insights distilled into a specific theory of disturbance and therapy and deductions for specific clinical strategies and techniques. It focuses on an explication of the theory, a chapter on basic practice, and a chapter on an in-depth case study. A detailed chapter follows on the practice of individual psychotherapy. Using rational emotive behavior therapy (REBT) in couples, family, group, and marathons sessions is highlighted. The book commences with a note on the general theory underpinning the practice of REBT, outlines its major theoretical concepts and puts forward an expanded version of REBT’s well-known ABC framework. It then considers aspects of the therapeutic relationship between clients and therapists in REBT, deals with issues pertaining to inducting clients into REBT, and specifies the major treatment techniques that are employed during REBT. A number of obstacles that emerge in the process of REBT and how they might be overcome are noted. The book then distinguishes between preferential and general REBT (or cognitive-behavior therapy [CBT]) and specifies their differences. Individual, couples, family and group therapies are explained. The book talks about the Rational Emotive Behavioral Marathon, a highly structured procedure that is deliberately weighted more on the verbal than on the nonverbal side. The authors’ 8-week psychoeducational group for teaching the principles of unconditional self-acceptance in a structured group setting is described. The book concludes with a discussion on the concept of ego disturbance, REBT treatment of sex difficulties using the cognitive-emotive-behavioral approach, and REBT’s effectiveness with hypnosis.
- Go to chapter: Teaching the Principles of Unconditional Self-Acceptance in a Structured Group Setting
In this chapter, the author describes an 8-week psychoeducational group, in which he teaches group members the rational emotive behavior therapy (REBT) principles of unconditional self-acceptance. The author provides a brief review on the REBT concept of ego disturbance. REBT theory distinguishes between two major types of psychological disturbance: ego disturbance and discomfort disturbance. Ego disturbance occurs when a person makes a global negative evaluation of one’s total self, which in turn tends to be based on the existence of a musturbatory belief. Self-acceptance groups are based on the idea that the philosophy of unconditional self-acceptance can be taught in a structured, educational manner and can be understood by group members in a short time. People whose problems were mainly ego-related and who had previous exposure to REBT or cognitive therapy and agreed with the idea that dysfunctional beliefs are at the core of psychological disturbance.
Rational emotive behavior family therapy follows the principles and practice of rational emotive behavior therapy (REBT). REBT and cognitive-behavior therapy (CBT) have a good record as far as their basic personality hypotheses and claims for clinical effectiveness are concerned. The author began to do conjoint marital counseling and family therapy but found the techniques to be much more efficient and less time-consuming as he replaced analytical with REBT. Hassles and frustrations of living are the inevitable human condition. Parent or child one has to go along with many domestic restrictions, including room arrangements, money expenditures, meal scheduling, and a hundred other limitations. Family systems therapy tends to require an active-directive therapist who makes clear-cut interventions and who engages in a great deal of problem solving. Clients are held to be responsible for their attendance at family therapy sessions and for doing their homework assignments.
Rational emotive behavioral approach to sex counseling and therapy has a comprehensiveness that goes beyond the techniques usually employed by sex therapists attached to other schools, such as those used by psychoanalysts, behavior therapists, Reichian and bioenergetic practitioners. Rational emotive behavior therapy (REBT) employs a good amount of imaging methods in sex therapy. In treating people with sex problems, the technique of shame and guilt reduction is often valuable. As an integral part of its program of cognitive restructuring, REBT employs a great deal of bibliotherapy and recorded therapy. According to REBT, shame or self-downing constitutes the most important part of many human disturbances. In both individual and group therapy sessions the therapists give the sexually troubled clients risk-taking exercises. In REBT individual and group sessions we frequently give emotive feedback to clients.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.
The importance of the functioning of mind and the limitations of medication has encouraged some clinicians to advance the use of psychotherapy. In the present period this is mostly in the form of cognitive behavioral therapy (CBT) for schizophrenia and psychosis, and this is strongly promoted in the British Psychological Society (BPS) publication “Understanding Psychosis and Schizophrenia: Why People Sometimes Hear Voices, Believe Things That Others Find Strange, or Appear Out of Touch With Reality, and What Can Help”. Although this document has not been received without criticism, it makes some very interesting reading for us as eye movement desensitization and reprocessing (EMDR) therapists and students of the Indicating Cognitions of Negative Networks (ICoNN) model. The meta-analyses that showed the most encouraging effect sizes were looking at two groups: treatment-resistant schizophrenia, and forms of psychotherapy that were highly specific and tailored according to case formulation, targeting delusions and auditory hallucinations.
This chapter covers major depression and discusses the syndrome of depression as defined by criteria in the various versions of the Diagnostic and Statistical Manuals (DSMs) issued before the newly minted DSM-5. It considers the prevalence in time and across national boundaries. The chapter discusses the role of events and genetics in bringing on depression. It provides the link between depressive behaviors and systemic inflammation, and reviews the efficacy, and side effects for various treatments. There has been speculation that brain-derived neurotrophic factor (BDNF) might play a causal role in creating symptoms of depression. Repetitive transcranial magnetic stimulation (TMS), which involves external application of an electrode, is a Food and Drug Administration (FDA)-approved treatment for major depression. In the clinical literature, exercise has demonstrated efficacy in ameliorating major depression. Cognitive behavioral therapy is as effective as antidepressants, although it may be slower to achieve results.
- Go to chapter: Substance Use and Co-Occurring Psychiatric Disorders Treatment: Systems and Issues for Those in Jail, Prison, and on Parole
Substance Use and Co-Occurring Psychiatric Disorders Treatment: Systems and Issues for Those in Jail, Prison, and on Parole
This chapter describes how mental health and substance use interact with criminal justice involvement. It examines the common assessment and intervention strategies for co morbid mental health and substance abuse in forensic population and settings. The chapter gives a brief review of how substance use disorders co-occur with psychiatric disorders. The chapter describes prevalence of co-occurring disorders such as anxiety/depression, bipolar disorders, psychotic disorders, personality disorders, and posttraumatic stress disorder in general. It then discusses prevalence of psychiatric disorders in the prison/jail systems. The chapter also describes medication-assisted therapies for opioid use disorders and, treatment and aftercare services. It explores two of the most common types of treatments for those in the CJS, cognitive behavioral therapy (CBT) and 12-Step groups. The chapter further reviews two CBT programs, aggression replacement training and strategies for self-improvement and change.
This chapter discusses the type of group work using rational emotive behavior therapy (REBT) principles and practices. Several methods of psychotherapy, such as psychoanalysis, employ group therapy for expediency reasons. REBT distinctly uses an educational rather than a medical or psychodynamic model. REBT includes a number of role-playing and behavior modification methods that can be done during individual therapy sessions but that are more effective in group. Clients who are shy or who have interpersonal problems are particularly encouraged to join a group because it is often more therapeutic for them to work out their problems with their peers than to work on them only with an individual therapist. In cognitive-behavioral therapy in general and in group REBT in particular, the activity level of the therapist tends to be high. Group REBT and counseling especially have intrinsic disadvantages and limitations when compared to more individualized REBT proc.
Early group Eye Movement Desensitization and Reprocessing (EMDR) intervention following trauma may facilitate adaptive processing of traumatic event(s) and help prevent consolidation of traumatic memories following large-scale natural or man-made disaster. Group EMDR may also be usefully applied with homogenous groups, and where professionals are exposed to high levels of work-related stress. Writing is a useful clinical tool in narrative therapy, bibliotherapy and writing therapy. Written journaling to monitor behavior is commonly practiced between sessions of cognitive behavioral therapy. The Written Workbook Protocol allows close adherence to the EMDR Standard 3-Pronged Protocol at all steps until the end of the processing phase, when constraints of the group format come more dramatically into play. Cognitive interweaves necessary to clear potential blocks to processing are more difficult to tailor and implement in group. The potential power of “group cognitive interweaves” emerged spontaneously during multifamily group EMDR with tsunami survivors in Thailand.
This chapter helps forensic social workers (FSWs) understand how to incorporate research into their practices. It clarifies the terms associated with evidence-based practice (EBP), and demonstrates three different approaches that FSWs can use in their practice settings. The chapter focuses on clinical interventions within forensic settings. It provides a brief summary and overview of some of the intervention models used in forensic settings with established empirical support, along with a discussion of their strengths and limitations. The chapter highlights commonly used forensic intervention models such as risk-needs-responsivity models, motivational interviewing, trauma-informed care, trauma-focused cognitive behavioral therapy, schema-focused therapy, and dialectical behavioral therapy. It concludes with a case example to illustrate how to use EBP in order to ensure that FSWs are providing interventions that are the best combination of art and science.
This chapter focuses on anxiety disorders and deals with a discussion of the physiology of anxiety, including the major structures involved in the creation of a fear memory. It considers the mechanisms for extinction of conditioned anxiety. The chapter discusses the basic physiology of fear conditioning, specific anxiety disorders namely generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), and explains treatments. It then reviews the literature about how clients can talk about their fears to minimize them and how relabeling or reappraising of past events can be helpful. There is evidence suggesting that the basal ganglia, structures associated with the control of movement, are involved in the expression of OCD behaviors in subsets of those with OCD. Cognitive behavioral therapy is effective in the treatment of generalized anxiety. Selective serotonin reuptake inhibitors are also used in the treatment of anxiety disorders.
This chapter provides the reader with an awareness of key aspects of the other psychotherapies being used in schizophrenia and the other psychoses. In the Indicating Cognitions of Negative Networks (ICoNN) model, psychotic phenomena can lead us to the real pathological material of the dysfunctional memory network (DMN) that requires psychological metabolism through the use of eye movement desensitization and reprocessing (EMDR) therapy. The best evidence base for psychotherapy for psychosis and schizophrenia exists for cognitive behavioral therapy (CBT). The CBT community has merely been the best at gathering and publishing its research. Behavioral psychotherapy, which had its origins in learning theory, attributed mental disorder to faulty learning. From a pragmatic perspective this led practitioners to focus their therapeutic efforts on intervening with the psychotic symptoms, in addition to education of the family/carers, and seeking to enhance already present coping skills.
- Go to chapter: Warrior Renew: An Integrative Treatment for Military Sexual Trauma With an Emphasis on Interpersonal Factors
Warrior Renew: An Integrative Treatment for Military Sexual Trauma With an Emphasis on Interpersonal Factors
This chapter presents a case study of Isabella, who has lived through a long history of interpersonal abuse. Although the case of “Isabella” is fictitious, it is not an atypical story of a military sexual trauma (
MST) survivor, depicting interpersonal abuse across the life span, encompassing emotional, physical, and sexual abuse, and living in an ongoing context of abuse. The self-concept may take on qualities of self-blame, and internalize a sense of pending danger rendering him or her fearful, insecure, and distrustful of others. Warrior Renew was developed to address sexual trauma, specifically MST, and issues related to trauma across the life span. Warrior Renew proposes to promote improvements in interpersonal functioning by addressing affect regulation, interpersonal connectedness, and resolution of past trauma utilizing an integrated cognitive-experiential approach. Clients direct the imagery and are able to address their own unmet emotional needs.Source:
The field of family therapy has been moving ever onward toward attempting to address the complex, multidimensional, diverse, and multicultural needs of the profession. This chapter presents a summary of Systemic Cognitive-Developmental Supervision (SCDS) and integrates a case study to illustrate basic concepts and use of the SCDS supervision model. Systemic Cognitive-Developmental Supervision is a supervision model that was developed upon the same theoretical foundations as Systemic Cognitive-Developmental Therapy (SCDT). SCDS is a supervision model that is built upon the theory of SCDT and is grounded in integrative, developmental, co-constructive, holistic, and systemic assumptions. The intersecting domains of class, gender, race, ethnicity, ability, sexual orientation, spirituality, and so forth also provide important context to supervision and therapy. Although the general SCDS model provides an important framework as a beginning, value is added by a knowledge of the developing literature on culturally sensitive therapy and supervision.
Mindfulness and meditation were embedded within their religious and cultural roots, and as such they were rarely used by psychologists as interventions in a secular therapy context. In recent years there has been an emerging body of empirical research supporting both mindfulness and hypnosis interventions. Mindfulness and hypnosis have been shown to be of benefit for similar problems (i.e., stress, anxiety, pain, depression, irritable bowel syndrome), and in other research hypnosis may offer some advantages of brevity and effect on symptoms (i.e., acute and procedural pain, hot flashes, dermatological symptoms, sleep quality, habits). However, the mechanisms by which they achieve benefit may be similar in some regards (i.e., relaxation, focus of attention, awareness) and different in other aspects (i.e., hypnotizability, hypnotic state, expectancy, goal-directed suggestions). Also, studies provide substantive evidence that when hypnotherapy is integrated into standard cognitive behavioral treatment (CBT), therapeutic gains tend to be superior to CBT alone.
This chapter examines the theory of Cognitive Behavioral Therapy (CBT) and use of the theory as a model of supervision. It reviews the theory of CBT by examining a philosophical foundation, techniques and interventions, the role of the therapist, the process of change, and cultural issues. The chapter discusses the significance of utilizing a CBT approach to therapy within the supervisor-supervisee relationship. It also reviews the supervisor-supervisee relationship, looking specifically at goals and challenges, and follows with a case example. CBT can be used with adults, children, and older populations throughout an extensive continuum of mental and behavioral health diagnoses with couples, families, or individual concerns. CBT theory works to promote change in daily living. Relaxation and mindfulness techniques are used within the CBT approach to increase internal experiences and awareness and to decrease stress and tension that impact the client mentally, emotionally, and physically.
- Go to chapter: Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
This chapter discusses issues associated with specific natural disasters, generalized issues associated with most natural disasters, and evidence-based principles and practices for supporting youth following a natural disaster. La Greca highlighted three phases of recovery following natural disasters and offers evidence-based interventions associated with each phase. These include the postimpact phase, short-term recovery and reconstruction phase, and the long-term recovery phase. The chapter outlines the effects of natural disasters on children and provides an overview of strategies for supporting children and adolescents following traumatic events. Posttraumatic stress disorder (PTSD) is characterized as an anxiety reaction that emerges after witnessing or experiencing a traumatic event. The chapter summarizes three evidence-based approaches to support children in the aftermath of a potentially traumatic event, such as a natural disaster: trauma-focused cognitive-behavioral therapy (TF-CBT), mindfulness-based stress reduction (MBSR), and the Mourning Child Grief Support Curriculum (MCGC).
Pediatric bipolar disorder (PBD) has been associated with a number of negative behavioral, academic, and interpersonal outcomes for children and adolescents. It initially received a disruptive behavior disorder diagnosis. High rates of comorbid anxiety disorders have also been found in children with PBD. Psychoeducational psychotherapy (PEP) uses a biopsychosocial model and combines family therapy, psychoeducation, and cognitive behavioral therapy (CBT) techniques with the goal of helping families to better understand and manage the symptoms of PBD and coordinate more effective treatment. This chapter focuses on a description of PEP, including three key interventions of this therapeutic approach: Psychoeducation and Motto, Building a Tool Kit, and Thinking-Feeling-Doing. PEP is a manual-based treatment designed for youth with mood disorders and their caregivers, broken down into separate youth and caregiver sessions. Sessions focus primarily on psychoeducation and skills building and are delivered in individual family (IF-PEP) and multiple family formats (MF-PEP).
- Go to chapter: Evidence-Based Interventions for Obsessive-Compulsive Disorder in Children and Adolescents
The content of the obsessions and compulsions varies among individuals with obsessive-compulsive disorder (OCD); however, there are five themes that are commonly experienced across both children and adults: contamination, symmetry/ordering, forbidden or taboo thoughts, harm, and hoarding. Notably, OCD becomes more gender balanced into adolescence and adulthood. Comorbid diagnoses are common among youth with OCD. Common comorbid disorders include anxiety disorders, tic disorders, attention deficit hyperactivity disorder (ADHD), and major depressive disorder. The etiology of OCD is multidetermined with behavioral, cognitive, genetic, and biological factors being implicated. This chapter describes three successful cognitive behavioral therapy (CBT) interventions: CBT with exposure and response prevention (ERP), family-based CBT with ERP, and cognitive therapy interventions that can be used in conjunction with ERP. Treatment guidelines for pediatric OCD suggest the most efficacious treatment is CBT with ERP, either alone or in combination with pharmaco-therapy for the most severe cases.
- Go to chapter: Evidence-Based Interventions for Persistent Depressive Disorder in Children and Adolescents
Depression in children and adolescents is a serious, potentially life-threatening problem. Traditionally, depression has been diagnosed using two primary categories: major depressive disorder (MDD) or dysthymic disorder (DD). When compared with youth diagnosed with MDD, children and adolescents with persistent depressive disorder (PDD) are at increased risk for having a comorbid psychiatric disorder. The most common treatments of depression include various forms of interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and psychotropic medication. This chapter provides summary of the step-by-step implementation of IPT for depressed adolescents (IPT-A). Many youth struggle with chronic, sometimes debilitating depression for extended periods of time, leading to underachievement, secondary substance abuse, school failure and drop-out, violent or self-harming behavior, and even death by suicide. Clearly, evidence-based psychotherapeutic interventions are needed.
The therapeutic alliance works based on the idea that the social worker is a willing participant whose primary concern is to support an older client’s effort for desired change. When considering theoretical orientations to treating an older adult that are consistent with the short-term constraints found in most mental health agencies, one is faced with a multitude of theories, some extended for older adults, most created for younger adults. Cognitive behavioral therapy (CBT) and various interpersonal psychotherapies are effective for older adults, though an older adult’s response to these therapies may have a different temporal course and require modifications in technique. Constructivist theory is a conceptual framework that is foundational to existential therapy, CBT, and narrative therapy. However, for older adults, reminiscence is a strength-based strategy employed to validate a sense of intimacy with the past, to integrate the many transitions of life, and as a preparatory method for death.
This chapter addresses three categories of supervision models: developmental models, counseling theory-based models, and social role models. Clinical supervision is a core function of counselor training and development. In early stages of the supervision process, counselors use supervision to become more fully competent in all areas of professional practice, which includes theory development and utilization. Supervisors use models of supervision in a manner similar to the way counselors use counseling theories. Developmental models of supervision center around the belief that change occurs over time and that supervision will adjust supervisory interventions to align with the counselor’s evolving performance. Cognitive behavioral supervision (CBS) models represent the convergence of cognitive theories, behavioral theories, and counselor supervision. Social role models may be conceptualized as the combination of a carefully selected role and an intentional focus on a specific area.
This chapter explains the role of patient protective factors in preventing the psychological impacts of medical trauma. It discusses the strategies for screening trauma risk factors in the primary care setting, including the Medical Mental Health Screening (MMHS) inventory. The chapter also explains how to do a quick screen for medical trauma following a planned surgery or intervention using the Secondary 7-Lifestyle Effects Screening (S7-LES) tool. The patient-centered medical home model (PCMH) has evolved over the last decade as a blueprint for excellence in primary care. The Agency for Healthcare Research and Quality (AHRQ) laid the initial groundwork for the PCMH model and has garnered support from the Patient-Centered Primary Care Collaborative (PCPCC) in defining best practices that create a new paradigm in primary care. There are many variations of cognitive behavioral therapies (CBT) that can be used as effective interventions by trained mental health professionals.
- Go to chapter: Evidence-Based Interventions for Separation Anxiety Disorder in Children and Adolescents
Anxiety disorders are the most common mental health conditions to impact school-aged children. A particular diagnostic subtype termed “separation anxiety disorder” accounts for the majority of referrals seen within child and adolescent psychological service delivery systems including schools. The developmental connection between childhood separation anxiety disorder and adolescent/ adult panic disorder has also been well documented in the literature. Associated features of separation anxiety include parent-child dysfunction, school attendance difficulties, and challenges to social functioning. Biological and environmental factors play a role in the development of separation anxiety disorder. Evidence-based interventions for children and adolescents with separation anxiety disorder include cognitive behavioral therapy (CBT), family therapy, pharmacological treatments, or a combination of these biopsychosocial therapies. Parental behaviors and parenting style are associated with increased risk for childhood anxiety, including separation anxiety disorder.
- Go to chapter: Evidence-Based Interventions for Posttraumatic Stress Disorder in Children and Adolescents
This chapter presents an overview of posttraumatic stress disorder (PTSD) in childhood and adolescence, including how symptoms may present and what factors are associated with risk of developing PTSD. It provides a review of the research literature and a step-by-step guide for practice for two empirically validated treatments for youth PTSD. The symptoms of PTSD are grouped into four clusters: intrusion symptoms, avoidance symptoms, cognition and mood symptoms, and arousal and reactivity symptoms. Trauma-focused cognitive behavioral therapy (TF-CBT) was initially developed to address trauma associated with child sexual abuse and has subsequently been adapted for use with children who have experienced other trauma types. Research indicates that TF-CBT is effective in treating PTSD, depression, and related behavioral problems in children exposed to traumatic events. The chapter provides a step-by-step breakdown of TF-CBT and Prolonged Exposure for Adolescents (PE-A) interventions, including descriptions of core components and standard implementation practices.
Social anxiety disorder (SAD) is characterized by a marked fear or anxiety about social situations in which the child or adolescent perceives that he or she may be scrutinized by others. This chapter reviews the current state of treatment for youth with SAD, beginning with a brief discussion of the etiology of social anxiety, followed by an overview of the empirical support for cognitive behavioral interventions. It reviews three empirically supported interventions for social anxiety in youth, such as the Coping Cat, cognitive behavioral group therapy for adolescents (CBGT-A), and social effectiveness therapy for children and adolescents (SET-C). The Many factors, including genetic, neurobiological, cognitive, and environmental, have been implicated in the development of SAD. The most efficacious psychological treatment for SAD is cognitive behavioral therapy (CBT). Despite SAD’s pervasiveness and multiple causes, efficacious cognitive behavioral treatment exists and is effective.
Patients with sleep disorders tend to present with complaints of insomnia, excessive daytime sleepiness, or having recognized that their intra-sleep behavior is problematic. Many sleep disorders will be primarily managed through medical intervention. In the realm of sleep disorders, behavioral health specialists (BHSs) will typically find their largest role in the treatment of insomnia. Sleep disorders that present with coexistent fatigue can represent diagnostic dilemmas in primary care as up to 20” of all patients presenting to a primary care office will complain of fatigue. Some patients may benefit from an overview of normal sleep patterns, as sometimes their perception of disordered sleep is based upon an incorrect understanding of norms. The most evidence-based of the psychological therapies for insomnia are relaxation therapy, sleep restriction, stimulus control therapy, and cognitive therapy.