Overview of Systemic Teaching: D Clin Psy: University of Exeter

Overview of CBT Teaching, D Clin Psy, University of Exeter

Convenor: Dr Kim Wright ()

2016 intake: Updated August 2016

Overview

Overall learning objectives:

·  To attain a good understanding of the theory and evidence base underpinning Cognitive Behavioural therapeutic approaches, including its strengths and limitations.

·  To become familiar with core therapeutic techniques used across and within different problem areas and client groups, and to attain a basis for developing competence in these through the clinical practice elements of the programme.

·  To gain an appreciation of the place of cognitive behavioural therapy within the practice of Clinical Psychology.

·  To develop an awareness of areas for individual professional development within cognitive behavioural understanding and practice, both during training and post qualification.

The CBT teaching spans approximately 47 centrally taught sessions across the DClinPsy programme, with an additional 6 unfacilitated study sessions. In addition, CBT is covered within sessions that form part of other teaching strands.

The content of the sessions is informed by the British Psychological Society competencies for doctoral programmes in Clinical Psychology, the UCL CBT competencies frameworks, the IAPT high intensity curriculum and emerging SMI curricula and the Health Professions Council Standards of Proficiency.

The present curriculum aims to provide coverage of basic and specific competencies, with generic competencies being covered by both the CBT strand and teaching provided within the Psychological Therapies strand (Core Skills sessions) as well as the Reflective Organisational Practice strand. The CBT strand provides some coverage of the problem-specific competencies. Some elements of the problem-specific competencies are covered in other strands (such as the Adult strand), whilst some teaching on client-group specific CBT work is covered in lifespan strands (for example, using CBT when working with people with learning difficulties). Where applicable, the generic, basic, specific and problem-specific competencies addressed by each session are listed in the session descriptions below. In addition, where applicable the items from the IAPT high intensity curriculum covered by each session are listed in the session descriptions below.

The structure and delivery of the CBT teaching is informed by the requirements of the BABCP for individual accreditation as a CBT practitioner, and we provide trainees with a substantial proportion of the taught hours required by BABCP for accreditation as a CBT practitioner on an individual level. In keeping with the criteria for accreditation with BABCP, the majority of our teaching is skills-based. We note that additional requirements for individual-level accreditation specify hours of supervised practice and completed cases. Whilst this cannot be provided by the taught element of the DClinPsy course, trainees wishing to pursue secondary accreditation are encouraged to develop a portfolio of relevant clinical experience through placement-based activities with CBT practitioners.

Core Text:

Westbrook, D., Kennerley, H. & Kirk, J. (2011). An introduction to Cognitive Behavioural Therapy: Skills and applications. London: Sage. [in library]

Key supporting texts:

Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.

Beck, J.S. (2005). Cognitive therapy for challenging problems. New York: The Guilford Press.

Beck, J. S. (2011). Cognitive therapy: Basics and beyond. New York: Guilford. [in library]

Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M. & Westbrook, D. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.

Friedberg, R.D. and McClure, J. M. (2015) Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts (2nd Edition). The Guildford Press.

Fuggle, P., Dunsmuir, S., & Curry, V. (2013). CBT with children, young people and their families. London: Sage.

Kuyken, W., Padesky, C.A. & Dudley, R. (2009). Collaborative case conceptualization. New York: The Guilford Press.

Laidlaw, K. (2014) CBT for older people: an introduction. London: SAGE Publications Ltd.

Leahy, R.L., Holland, S.J. & McGinn, L.K. (2011). Treatment plans for anxiety and depression, second edition. New York: The Guilford Press.

Padesky, C.A. & Greenberger, D. (2015). Mind over mood (2nd Edition). New York: The Guilford Press.

Reinecke, M A., Datillio, F. M. and Freeman, A. (Eds) (2006) Cognitive therapy for children and adolescents (2nd Edition). The Guildford Press

Stenfert Kroese, B., Dagnan, D. & Loumidis, K. (1997). Cognitive-Behaviour Therapy for people with learning disabilities. Routledge.

Whittington, A. & Grey, N. (2014). How to become a more effective CBT therapist: Mastering metacompetence in clinical practice. Chichester, U.K.: Wiley Blackwell.

Please note: the content and ordering of some sessions may change

* denotes a session that is typically delivered on an individual locality basis. All other sessions are centrally delivered.

The following BPS doctoral competencies apply across the curriculum: GMC 2, GMC 4, PI 2, PI 3. Session-specific BPS and IAPT competencies are listed below.

YEAR 1

An introduction to the CBT model and evidence base

Learning Objectives:

·  An understanding of the history and development of CBT

·  Familiarity with cognitive and behavioural models of psychological distress

·  An introductory-level awareness of the evidence base underpinning cognitive and behavioural models

·  Knowledge of the general structure of a course of CBT

·  An awareness of the rationale for CBT as this might be explained to and understood by clients

CBT competencies:

Generic:

·  Knowledge of a model of therapy, and the ability to understand and employ the model in practice

·  Ability to foster and maintain a good therapeutic alliance, and to grasp the client’s perspective and ‘world view’

·  Knowledge of basic principles of CBT and rationale for treatment

·  Ability to explain and demonstrate rationale for CBT to client

IAPT High intensity curriculum items covered:

F1, F7

Includes skills-based practice

Assessment, measurement and goal-setting

Learning Objectives:

·  An appreciation of the rationale for conducting assessment within the CBT approach, including its contribution to the improvement of therapy and service delivery and to the therapeutic relationship

·  An understanding of the key elements of initial assessment within a CBT approach

·  An awareness of a range of assessment / measurement tools commonly used within CBT

·  An understanding of the purpose, process and collaborative nature of goal-setting within CBT

CBT competencies:

Generic:

·  Ability to foster and maintain a good therapeutic alliance, and to grasp the client’s perspective and ‘world view’

·  Ability to undertake generic assessment (relevant history and identifying suitability for intervention)

Basic:

·  Ability to implement CBT using a collaborative approach

·  Ability to agree goals for the intervention

·  Ability to use measures and self monitoring to guide therapy and to monitor outcome

Specific:

·  Ability to develop formulation and use this to develop treatment plan / case conceptualisation

IAPT High intensity curriculum items covered:

F3,F7,F8,F10,A5,D5,D6,D10,D11

BPS competencies covered:

PA 2, E 1, E 2.

Includes skills-based practice

Assessment and Formulation with young people (2 sessions)

Learning Objectives:

·  An appreciation of how the needs of younger clients impact upon the process of assessment and formulation within CBT

·  Knowledge of methods by which the assessment and formulation processes can be adapted to best meet the needs of younger clients

·  Knowledge of appropriate assessment tools / outcome measures for work with younger clients

IAPT High intensity curriculum items covered:

F3,F7,F8,F10,A5,D5

BPS competencies covered:

PA 2, E 1, PF 1, PF 5.

Basic Skills in CBT (2 sessions)

Learning Objectives:

·  An awareness of the nature and role of core skills in CBT

·  An understanding of the basic structure of a session of CBT

CBT competencies:

Basic:

·  Ability to implement CBT using a collaborative approach

·  Knowledge of basic principles of CBT and rationale for treatment

·  Sharing responsibility for session structure & content

·  Ability to adhere to an agenda

·  Ability to plan and to review practice assignments (‘homework’)

·  Using summaries and feedback to structure the session

Specific:

·  Guided discovery & Socratic questioning

IAPT High intensity curriculum items covered:

F7,F9

Includes skills-based practice

CBT Interventions with young people (2 sessions)

Learning Objectives:

·  Knowledge of the epidemiology and presentation of common mental health problems within young people

·  An understanding of issues in the use of CBT that are specific to working with younger clients

·  Awareness of means of adapting CBT for work with younger clients

IAPT High intensity curriculum items covered:

A2,A5,D1,D5,D9

BPS competencies covered:

PI 1, PF1, PF 8.

Working with parents within CBT

Learning Objectives:

·  An awareness of how parents and the family are accounted for within Cognitive Behavioural approaches to work with younger clients

·  An understanding of the role of parents within Cognitive Behavioural interventions with younger clients

·  Knowledge of means by which the process of CBT can be adapted to take into account the role of parents

BPS competencies covered:

PI 1

Phobias and exposure

Learning Objectives:

·  Knowledge of the principles underlying behavioural models of anxiety

·  Knowledge of the symptoms, phenomenology and epidemiology of phobias

·  Knowledge of the main cognitive and behavioural model of phobias and phobic avoidance

·  Familiarity with the technique of graded exposure and means of introducing and using this techniques collaboratively with clients

·  Familiarity with the techniques of identifying and challenging cognitions maintaining phobias

CBT competencies:

Basic:

·  Knowledge of basic principles of CBT and rationale for treatment

Specific:

·  Exposure techniques

Problem-Specific:

·  Phobias assessment

·  Phobias intervention

IAPT High intensity curriculum items covered:

A1,A5

BPS competencies covered:

PI 1, PF 2, PF8

Includes skills-based practice

CBT with people with learning difficulties (1 locality and 2 central sessions)

Learning Objectives:

·  An appreciation of how the needs of clients with learning difficulties impact upon the application of CBT, including the formulation stage

·  Knowledge of methods by which formulation and intervention within CBT can be adapted to best meet the needs of clients with learning difficulties

BPS competencies covered:

PI 1, PF 1, PF 8

Includes skills-based practice

Introduction to CBT for depression*

Learning Objectives:

·  Knowledge of the epidemiology and presentation of depression

·  Familiarity with a key cognitive model of depression

·  Familiarity with the evidence base for the cognitive model

·  An awareness of the key factors to take into account in the assessment of depression

CBT competencies:

Problem-Specific:

·  Depression knowledge

·  Depression Assessment

IAPT High intensity curriculum items covered:

D1,D2,D3,D4,D5,D7,D10,D14,D16

BPS competencies covered:

PI 1

Applied Relaxation*

Learning Objectives:

·  An understanding of the roles of applied relaxation and applied tension within CBT

·  Familiarity with the techniques of applied relaxation and applied tension

CBT competencies:

Specific:

·  Applied relaxation and applied tension

IAPT High intensity curriculum items covered:

A5

BPS competencies covered:

PI 1

Includes skills-based practice

Safety and Coping*

Learning Objectives:

·  Knowledge of the nature and role of safety behaviours within cognitive models

·  An understanding of how a CBT practitioner would work with safety behaviours

·  An understanding of the need to balance reduction of safety behaviours with retention of adequate means of coping within CBT

CBT competencies:

Specific:

·  Ability to identify and work with safety behaviours

IAPT High intensity curriculum items covered:

A5

CBT for Panic Disorder (2 sessions)

Learning Objectives:

·  Knowledge of the presentation and epidemiology of panic disorder

·  Knowledge of a key cognitive model of panic disorder

·  Familiarity with key techniques used in working with individuals with panic disorder from a CBT perspective

CBT competencies:

Problem-Specific:

·  Panic: Clark knowledge

·  Panic: Clark assessment

·  Panic: Clark intervention

IAPT High intensity curriculum items covered:

F1,A1,A2,A5,A6,A8,A9,A10,A11

BPS competencies covered:

PI 1, PF 1, PF 8

Includes skills-based practice

Behavioural Activation and Rumination

Learning Objectives:

·  Knowledge of the principles underlying Jacobson’s behavioural activation approach to depression

·  An understanding of how the process of assessment, formulation, intervention and evaluation in behavioural activation compare to those processes in CBT

·  Familiarity with key techniques used in Jacobson’s behavioural activation approach for depression

·  An Understanding of the role of rumination in the maintenance of depression

·  Familiarity with key techniques for working with rumination in individuals with depression

CBT competencies:

Specific: (Jacobson)

·  Depression basic knowledge

·  Depression assessment

·  Depression intervention

IAPT High intensity curriculum items covered:

D4,D9,D15

Includes skills-based practice

Activity Scheduling & Problem Solving

Learning Objectives:

·  An understanding of the role of activity scheduling within CBT

·  Familiarity with the techniques of activity scheduling

·  An understanding of the roles of problem-solving techniques within CBT

·  Familiarity with problem-solving techniques and the introduction and use of these techniques with clients

CBT competencies:

Basic

·  Problem-solving

Specific:

·  Activity monitoring and scheduling

IAPT High intensity curriculum items covered:

A5, D9,D15

BPS competencies covered:

PI 1

Includes skills-based practice

Working with Cognitive Products

Learning Objectives:

·  Knowledge of the nature and role of cognitive products within Beck’s cognitive model of depression

·  Familiarity with techniques for working with cognitive products

CBT competencies:

Problem-Specific (High intensity Intervention: Beck – Cognitive Therapy):

·  Depression knowledge

·  Depression Assessment

·  Depression Intervention

IAPT High intensity curriculum items covered:

D9,D15

BPS competencies covered:

PI 1

Includes skills-based practice

Working with Conditional Assumptions

Learning Objectives:

·  An understanding of the concept of conditional beliefs within the cognitive model

·  Familiarity with techniques for identifying and modifying conditional beliefs within CBT