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Cognitive Behavioural Therapy (CBT) for Anxiety and Depression - Theory

Module description

This module will focus on common mental health disorders frequently presenting in Secondary Care services such as depression and anxiety disorders. The module aims to develop advanced skills in Cognitive Behavioural Therapy (CBT) for these disorders, improving proficiency in the fundamental techniques of CBT, and developing competencies in the specialist techniques applied to depression and anxiety disorders. Specific models, evidence base, assessment and specialist treatment strategies will be covered in workshops on a range of disorders including depression, social anxiety, post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD). The clinical workshops and tutorials will also provide a strong foundation in the evidence base for working with CBT and common mental health disorders and address the most up-to date research developments.

The module is underpinned by the Roth and Piling (2007) CBT Competency Framework for the delivery of CBT to people with depression and anxiety disorders and the national Curriculum for CBT for SMHP (NHS England and NHS Improvement, 2019).

The module is taught/supervised by BABCP-accredited CBT therapists and/or clinical psychologists, and the content is updated regularly in line with the emerging evidence base.

Module aims - intentions of the module

The aim of this module is to enable you to:

• Develop practical competency in CBT for common mental health disorders such as depression and anxiety disorders
• Develop practical skills in formulating and adapting treatment protocols in the presence of co-morbid psychosis or bipolar disorder
• Develop critical knowledge of the theoretical and research literature of CBT with common mental health disorders
• Develop an advanced knowledge and understanding of how scientific principles inform CB clinical practice
• Develop an advanced knowledge of core clinical skills necessary for CBT practice
• Develop the capacity to reflect critically on CBT theory, research and practice
• Develop skills in reflective practice that will enable you to make best use of clinical supervision in order to further your clinical skills and improve clinical practice

Through attending the related workshops, clinical skills tutorials and supervision sessions you will develop the following academic and professional skills and demonstrate knowledge, understanding and competency in the following:

• a critical understanding of the phenomenology, diagnostic classifications and epidemiological characteristics of anxiety disorders
• assessing patients for suitability for CBT with anxiety disorders constructing maintenance and developmental conceptualisations of cases of anxiety disorders
• developing CBT treatment plans for a range of anxiety disorders
• critical evaluation of theoretical evidence
• based interventions integrated within and guiding therapy with anxiety disorders
• collaboratively deriving an anxiety model with a client
• the ability to eliciting and evaluating key cognitions and images in anxiety disorders
• constructing, carrying out and evaluating behavioural experiments
• self-direction and originality in tackling and solving basic therapeutic problems with anxiety disorders
• self-direction and originality in working with co-morbidity and solving more complex therapeutic problems
• ability to deal with ending therapy and planning for long term maintenance of gains with evidence of relapse prevention plan
• self-direction and originality in tackling and solving therapeutic problems
• practise as “scientist practitioners” continuing to advance their knowledge and understanding to develop new skills with anxiety to a high level
• insightful knowledge of CBT and an ability to identify own values and beliefs in working with anxiety and CBTÃ?¢ï¿½ï¿½s application to their own lives
• making best use of supervision with anxiety disorders on the course and evidence of making use of and continuing to learn from on-going continuing professional development.
• ability to sensitively adapt CBT for anxiety disorders, and ensure equitable access of CBT taking into account cultural and social differences and values
• a working knowledge of the principles and practice, and competency in delivering high intensity psychological therapy within a stepped care system
• the ability to select and use anxiety disorder specific measures to assess outcomes and guide treatment of relevant conditions.
• a critical understanding of the phenomenology, diagnostic classifications and epidemiological characteristics of depressive disorders
• assessing patients with depression, taking into account clinical manifestations, co-morbidity, past history, present life situation, course and outcome of depression in suitability for CBT
• assessing risk factors associated with depression and the integration of risk management within treatment plans
• ability to assess suicidal risk and self-harming behaviours and
• implement practical strategies for managing suicidality and self-harm prioritising problem areas, problem solving and identifying solutions
• constructing both cognitive and behavioural development and maintenance formulations in cases of depression
• developing cognitive and behavioural treatment plans for depression
• ability to critically evaluate a range of evidence-based interventions in depression
• deriving cognitive or behavioural models with clients taking into account individual needs and preferences
• working with co-morbid presentations of depression and taking personal responsibility for clinical decision making in complex and unpredictable situations
• critical analysis (the ability to critically appraise research, literature and opinions of others, and your own work in the light of data tracking and analysis)
• problem formulation and problem solving (the ability to synthesise information from theory/literature with complex data from practical experience to make sense of experience and formulate solutions)
• reflective practice (the ability to reflect on theoretical knowledge and procedural experience and to learn from this and apply learning to practice)

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

On successfully completing the module you will be able to...

• 1. Describe in detail the phenomenology, diagnostic classifications and epidemiological characteristics of depressive and key anxiety disorders, both in general and when present with SMI
• 2. Describe and critically analyse contemporary models for depressive disorders and key anxiety disorders in SMI, their evidence bases and treatment methods derived from them
• 3. Demonstrate the technical expertise needed in the formulation of individual cases and execution of therapy methods
• 4. Assess the individual’s experience depression or anxiety disorder, both alone and in the context of SMI, taking into account clinical manifestations, co-morbidity, past history, present life situation, interpersonal and relationship functioning, and course and outcome
• 5. Assess risk factors associated with depression or anxiety and integrate risk management within treatment plans
• 6. Describe commonly used assessment measures for people with common mental health problems, including in the context of SMI, including their purpose and properties
• 7. Apply outcome measures in a way that is scientifically and therapeutically appropriate, and takes into account any difficulties the client may have in completing measures
• 8. Collaboratively construct maintenance formulations and treatment plans in cases of depression or anxiety disorder, both alone and in relation to SMI, taking into account client needs, goals, and preferences
• 9. Negotiate the end of therapy and plan for long term maintenance of gains with evidence of a relapse prevention plan
• 10. Demonstrate use of clinical judgment in order to adapt and titrate standard interventions for common co-existing disorders and integrate them into the treatment, and to decide when and how to integrate emerging evidence with current practice, and whether, when and how to work beyond the evidence base
• 11. Demonstrate a task-focused approach to intervention while being sensitive to (and being directed by) the client’s needs and capacities and tolerance of emotional content, and maintaining a consistent sense of collaboration with the client
• 12. Draw on a formulation to identify the most appropriate focus and sequence of interventions most likely achieve change, and to ensure that this sequence is congruent with the client’s perceptions of what would be most useful to them

ILO: Discipline-specific skills

On successfully completing the module you will be able to...

• 13. Understand, critically evaluate, and apply theoretical ideas and evidence relating to specific disorders outlined in Module Specific Skills
• 14. Reflect on therapeutic skills identifying areas for personal development in relation to theoretical models of change for specific disorders as outlined in Module Specific Skills

ILO: Personal and key skills

On successfully completing the module you will be able to...

• 15. Select, organise and evaluate clinical material to produce a coherent formulation
• 16. Reflect upon personal practice, set personal learning goals and monitor progress
• 17. Apply and tailor knowledge of theory and practice to the treatment of individual patients through evidence of utilisation of formulation, intervention and evaluation
• 18. Communicate understanding of theory and application to practice in written and verbal formats

Syllabus plan

Teaching is delivered in Term 3 and in term 1 of the following university year through a series of half day and whole day workshops:

• Introduction to depression, and depression within SMI (phenomenology, epidemiology, aetiology, impact, diagnosis, treatment guidelines, psychological models).
• Introduction to anxiety disorders, and anxiety disorders within SMI (phenomenology, epidemiology, aetiology, impact, diagnosis, treatment guidelines, psychological models).
• Assessment, measurement and formulation of CMHP: part 1 (general assessment and formulation of depression and anxiety disorders).
• Behavioural model of depression, part 1: accessing reward (key skills: activity scheduling, skills training).
• Cognitive model of depression, part 1: information processing biases (key skills: identifying and challenging automatic thoughts).
• Cognitive model of depression, part 2: rules for living (key skills: identifying conditional assumptions and exploring alternatives).
• Cognitive model of depression, part 3: core beliefs (key skills: identifying core beliefs and exploring alternatives).
• Behavioural model of depression, part 2: working with unhelpful secondary coping behaviours (key skills: functional analysis, identifying and enacting alternatives to avoidance and rumination).
• Behavioural Activation (Martell et al. 2010).
• Anxiety, part 1: behavioural approaches, with reference to Specific Phobias (key skills: graded exposure, applied relaxation and tension).
• Anxiety, part 2: cognitive approaches, with reference to Specific Phobias and Panic Disorder (key skills: thought testing and behavioural experiments).
• Anxiety, part 3: social phobia (additional key skills: working with longstanding beliefs, working with self-focussed attention, social context and impact of behaviour).
• Anxiety, part 4: GAD (additional key skills: working with meta-beliefs, managing worry).
• Anxiety, part 5: Single event trauma.
• Working with checking and reassurance-seeking (with reference to OCD, health anxiety, BDD).
• Multiple trauma and early abuse history.

Learning activities and teaching methods (given in hours of study time)

Details of learning activities and teaching methods

Formative assessment

Summative assessment (% of credit)

Details of summative assessment

Details of re-assessment (where required by referral or deferral)

Re-assessment notes

Two assessments are required for this module. In all cases re-assessment will be the same as the original assessment. Where you have been referred/deferred for any form of assessment detailed above you will have the opportunity to retake within four weeks from the date that feedback was provided.

If you pass re-assessments taken as a result of deferral, your re-assessment will be treated as it would be if it were your first attempt at the assessment and the overall module mark will not be capped.

If you pass re-assessments taken as a result of referral (i.e. following initial failure in the assessment), the overall module mark will be capped at 50%.

If you fail re-assessments taken as a result of referral (i.e. following initial failure in the assessment), you will be failed in the module and as a consequence you will be failed in the programme and your registration as a student of the University will be terminated.

Indicative learning resources - Basic reading

• Beck, A.T., Rush, A.J., Shaw, B.F. & Emery, G. (1979) Cognitive Therapy of Depression. New York: Guilford Press
• Clark, A. & Beck, A.T. (2010) Cognitive Therapy of Anxiety Disorders. New York: Guilford Press
• Dugas, M, & Robichaud, M. (2007) CBT for GAD. Oxford: Routledge
• Hope, D., Heimberg, R. & Turk, C. (2006) Managing Social Anxiety. Oxford: Oxford University Press
• Kozak, M & Foa, E. (1997) Mastery of OCD. Oxford: Oxford University Press
• Leahy, R. (2010) Cognitive Therapy Techniques: A Practitioner's Guide. New York: Guilford Press
• Leahy, R., Holland, S., & McGinn, L. (2011) Treatment Plans and Interventions for Depression and Anxiety Disorders 2^nd Ed..New York: Guilford Press
• Martell, C., Dimidjian, S., & Herman-Dunn, R. (2010) Behavioral Activation for Depression: A Clinician's Guide. New York: Guilford Press
• Steketee, G. & Wilhelm, S. (2006) Cognitive Therapy for Obsessive-Compulsive Disorder: A Guide for Professionals. Oakland, CA: New Harbinger Publishing Inc.
• Wells, A. (1997) Cognitive Therapy for Anxiety Disorders. Chichester: Wiley
• Zinbarg, R., Craske, D., & Barlow, D. (2006) Mastery of you Anxiety and Worry. Oxford: Oxford University Press

Journals

• Behaviour Research and Therapy
• Behavioural and Cognitive Psychotherapy
• Cognitive and Behavioural Practice
• Cognitive Therapy and Research
• International Journal of Cognitive Therapy
• Journal of Consulting and Clinical Psychology

Key words search

Psychosis, bipolar disorder, CBT, Cognitive Behavioural Therapy, CBTp, Anxiety, Depression, Personality Disorder