An Introduction to Modern CBT E-Book

Stefan G. Hofmann

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 365

Veröffentlichungsjahr: 2011

Beschreibung

An Introduction to Modern CBT provides an easily accessible introduction to modern theoretical cognitive behavioral therapy models. The text outlines the different techniques, their success in improving specific psychiatric disorders, and important new developments in the field.

• Provides an easy-to-read introduction into modern Cognitive Behavioral Therapy approaches with specific case examples and hands-on treatment techniques
• Discusses the theoretical models of CBT, outlines the different techniques that have been shown to be successful in improving specific psychiatric disorders, and describes important new developments in the field
• Offers useful guidance for therapists in training and is an invaluable reference tool for experienced clinicians

Leseprobe

Table of Contents

Cover

Praise for An Introduction to Modern CBT

Title page

Copyright page

Dedication

About the Author

Foreword

Acknowledgment

Preface

1 The Basic Idea

The Founding Fathers

A Simple and Powerful Idea

Initiating versus Maintaining Factors

CBT in Psychiatry

Focus on Emotions

Neurobiology of Emotions

Emotion Regulation Strategies

General Approach of CBT

2 Empowering the Mind

Readiness for Change

Stages of Change

Motivational Enhancement

Assessment

General Process of CBT

Categories of Maladaptive Cognitions

General CBT Strategies

Monitoring Treatment Changes

3 Confronting Phobias

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

4 Fighting Panic and Agoraphobia

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

5 Conquering Social Anxiety Disorder

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

6 Treating Obsessive-Compulsive Disorder

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

7 Beating Generalized Anxiety Disorder and Worry

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

8 Dealing with Depression

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

9 Overcoming Alcohol Problems

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

10 Resolving Sexual Problems

Definition of the Disorder

The Treatment Model

Treatment Strategies

Adequate Stimulation

Empirical Support

11 Managing Pain

Definition of the Disorder

The Treatment Model

Treatment Strategies

Empirical Support

12 Mastering Sleep

Definition of the Disorder

The Treatment Model

Treatment Strategies

Psychoeducation

Empirical Support

References

Index

Praise for An Introduction to Modern CBT

An Introduction to Modern CBT by internationally known researcher and clinical psychologist Stefan Hofmann is exactly the right book for the busy clinician who wants to know the latest research, how it is relevant to clinical practice, and what to do with patients who need help now. Written in a clear, compelling, and caring style, this book will be invaluable for graduate students interested in the application of empirically supported approaches— and for experienced clinicians who need to know the latest innovative CBT treatments.

Robert L. Leahy, Director, American Institute of Cognitive Therapy, New York

A world leader in the treatment of social phobia, Stefan Hofmann has written the ideal introductory guide to 21st century cognitive-behavior therapy. Lucid and accessible, An Introduction to Modern CBT will be especially valuable for students and for seasoned therapists keen to learn the latest evidence-based interventions for the most common problems therapists see today.

Richard J. McNally, Professor of Psychology, Harvard University, and author of “What is Mental Illness?”

This edition first published 2012

© 2012 Stefan G. Hofmann

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Library of Congress Cataloging-in-Publication Data

Hofmann, Stefan G.

 An introduction to modern CBT : psychological solutions to mental health problems / Stefan G. Hofmann.

p. cm.

 Includes bibliographical references and index.

 ISBN 978-0-470-97176-5 (cloth) – ISBN 978-0-470-97175-8 (pbk.)

1. Cognitive therapy. I. Title.

 RC489.C63H64 2011

 616.89´1425–dc22

2011001670

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDFs 9781119973218; ePub 9781119951414; eMobi 9781119951421

To Aaron T. Beck for his ground-breaking work that has changed the field of psychotherapy forever. His therapy has helped countless of patients with debilitating mental disorders, and his theory has been an inspiration for generations of clinicians and researchers.

About the Author

Stefan G. Hofmann, Ph.D., is Professor of Psychology at the Department of Psychology at Boston University where he directs the Psychotherapy and Emotion Research Laboratory. His main research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation strategies, and cultural expressions of psychopathology. His primary area of research is on cognitive behavioral therapy and anxiety disorders. His research has been supported by the National Institute of Mental Health, the National Alliance for Research on Schizophrenia and Depression, pharmaceutical companies, and other private foundations. He has written more than 200 scientific publications and nine books. He is currently an associate editor of the Journal of Consulting and Clinical Psychology, the former editor of Cognitive and Behavioral Practice, a Board member of the Academy of Cognitive Therapy, and an advisor to the DSM-V Development Process. He also works as a psychotherapist using cognitive behavioral therapy. For more information, visit http://www.bostonanxiety.org/.

Foreword

Cognitive therapy is an evolving field. After an initially stormy adolescent period, it has now moved into the stage of maturity. Although pharmacotherapy has proven beneficial, it may have reached its limits, making it clearer that there will likely never be a “magic pill” for every psychiatric condition. Consequently, it has become apparent that psychotherapeutic interventions are needed to effectively treat the range of mental disorders.

A number of disorder-specific cognitive therapy protocols have been developed over the years. These treatments target many different problems, including pain, sleep disorders, sexual dysfunctions, depression, anxiety, and substance use, to name only a few. Despite the various specific symptom focus of these cognitive therapy protocols, they all share features that ground them within the same conceptual framework. The basic approach of cognitive therapy, which applies to virtually all mental disorders, can be separated into three parts: first, there are external triggers that activate maladaptive beliefs that subsequently lead to automatic, maladaptive thoughts; second, there is an attentional focus on these beliefs and thoughts; and third, there are maladaptive control mechanisms. For example, in the case of panic disorder, the external trigger may be feelings of heart palpitations. The person’s belief may be that the bodily symptoms are harmful and uncontrollable. In an attempt to control these feelings, the person may engage in avoidance behaviors that serve as maladaptive control mechanisms. These control mechanisms worsen the problem. As a result, the person is compelled to focus even more on the feared symptoms and engage in more avoidance behaviors that lead to the further maintenance of the problem.

A number of treatment techniques arise from the adoption of this triad in the conceptualization of mental dysfunction. For instance, the therapist can identify and evaluate maladaptive beliefs, target maladaptive control mechanisms, and address attentional focus by, for example, encouraging the person to focus his or her attention on to other, nonthreatening stimuli.

The present book has adapted these fundamental principles of cognitive therapy to a wide range of mental disorders. Although the specific treatment techniques are very specific and tailored to a particular problem and patient, all techniques are grounded on the same basic treatment model. I believe this text will be a valuable resource for therapists in training and a handy reference tool for the practicing clinician.

Aaron T. Beck, M.D.

Professor of Psychiatry

Department of Psychiatry

University of Pennsylvania

Acknowledgment

It is impossible to thank everybody who has helped me develop this book. Therefore, the list of people that follows is necessarily incomplete and arbitrary. First and foremost, I would like to thank my wife Dr. Rosemary Toomey and my sons Benjamin and Lukas for their support and love. Next, I want to thank my patients for their courage, trust, insight, and willingness to share their personal suffering, and for making me part of the healing experience. Personally witnessing the power of healing teaches more than any lecture or textbook can do, including this one. I also want to thank my teachers, friends, and collaborators who are the giants upon whose shoulders I have been standing while writing this book. These include Drs. Aaron T. Beck, Leslie Sokol, Anke Ehlers, Walton T. Roth, C. Barr Taylor, David H. Barlow, Michael W. Otto, and Richard J. McNally. Your ideas have made this world a better place. Finally, I want to thank my current students and collaborators for proofreading parts of this book, including (in alphabetical order) Dr. Idan Aderka, Anu Asnaani, Hans-Jakob Boer, Jacqueline Bullis, Michelle Capozzoli, Angela Fang, Cassidy Gutner, Dr. Angela Nickerson, and Alice (Ty) Sawyer. I am fully aware of how lucky I am for having had the privilege to work with these wonderful friends, superb mentors, excellent students, and remarkable patients.

Preface

Mind over Matter: If you don’t have a mind, what does it matter?

—Benjamin Franklin Impersonator, Boston, Massachusetts

Psychiatric disorders are common and cause a high degree of personal suffering and financial burden on society. Psychotropic drugs are common treatments for these problems. These medications are among the most successful products of a highly profitable industry.

Psychological treatments, and in particular cognitive behavioral therapy (CBT), are highly effective alternatives to drug treatments. CBT is a very simple, intuitive, and transparent treatment. It encompasses a family of interventions that share the same basic idea, namely that cognitions profoundly and causally influence emotions and behaviors and, thereby, contribute to the maintenance of psychiatric problems. The specific model and treatment techniques depend on the disorder that is targeted, and the techniques change as more is known about the targeted problem. This book will give an introduction to the modern CBT approach for some common psychiatric problems. Although CBT has become well known, there are still many misconceptions and “cognitive errors” (no pun intended) regarding this treatment, which is well on its way to becoming the dominant treatment for psychiatric disorders. My intention is to summarize the established empirically supported and efficacious CBT strategies, as well as modern and developing CBT approaches that still require validation from well-controlled clinical trials and laboratory tests.

The main message of this text is simple: CBT is a coherent model, but it is not one single approach. Because CBT is evolving and changing as more knowledge is accumulating, it is more accurate to view it as a maturing scientific discipline rather than as an assembly of specific treatment techniques. The reason for this is the strong commitment to the scientific enterprise and openness to translating and integrating new empirical findings about the psychopathology of a disorder into a working CBT model of the disorder. This is an ongoing and iterative process; for example, CBT for anxiety disorders 10 years ago looked very different from CBT for such disorders today. Although the core assumption of CBT remains the same—changes in cognitions causally predict changes in psychopathology—the specific treatment techniques have certainly changed and will continue to change as basic research on psychopathology progresses.

My hope is that this book will facilitate dissemination of CBT. Studies comparing CBT and pharmacotherapy consistently demonstrate that CBT is at least as effective as pharmacotherapy, and in many instances, CBT proves even better than the most effective medications, especially when considering the long-term effects. In addition, CBT is much better tolerated, less expensive, and associated with fewer complications than pharmacotherapy. Nevertheless, pharmacotherapy remains the standard treatment for common psychiatric problems.

There are many reasons why CBT is still struggling to be the first-line treatment, or at least the first-line alternative, for a variety of psychiatric problems. Drug companies have a vested interest in promoting and selling their medication, because a great deal of money can be made by treating people with medication, and a large number of people earn a great deal of money by developing and selling drugs: researchers who develop the drugs, researchers and sales people who work for the pharmaceutical industry, and the doctors and nurses who prescribe the drugs. In contrast, CBT is considerably less lucrative. These treatments are typically developed by psychologists as part of their research projects. If the researcher is lucky, he or she may receive a grant from the National Institute of Mental Health to test the effectiveness of the treatment. However, these grants are scarce and extremely difficult to obtain. Furthermore, the funding that is provided for those trials is a far cry from the profits of the billion dollar drug industry. My hope is that this book can help to disseminate CBT to an educated public.

Pharmacological treatments are often preferred over psychological interventions due to the stigma associated with psychotherapy. Taking a pill for a problem implies that the problem is linked to a medical condition. This also shifts the presumed reason for a problem from the patient’s behavior or maladaptive thinking to the biochemical imbalance and thereby relieves the patient from responsibility. Tying psychiatric problems to biochemical dysregulations is also consistent with the general medical model of human suffering and gives the appearance that the medication treats the root cause of the problem. Mental health care specialists know that this is far from the truth, as psychological models provide an equally (and sometimes more) plausible and scientifically validated explanation for psychiatric problems. This book will provide the readers with these contemporary psychological models.

Finally, the preference for pharmacotherapy over psychological treatments appears to be related to the erroneous assumption that pharmacotherapy has a superior scientific foundation compared with psychological treatments. Psychiatric medications undergo years and sometimes decades of research to establish safety and efficacy. These tests typically begin with animal research and later examine the effects of the drug in humans. In contrast, the process of psychological treatment development is largely unknown to the public. In this book, I aim to clarify this process and to summarize the empirical basis of psychological treatment development.

This book is primarily for the students and clinicians in training, as well as the policymakers and consumers who want to learn about effective psychological treatment options. My intention was not to write yet another self-help book. Instead, my goal was to provide a one-step practical treatment guide for some of the most common and debilitating psychiatric conditions to those who wish to learn about psychological treatment alternatives for common mental disorders. The choice of disorders covered in this text was arbitrary and many important disorders were not included, such as eating disorders, personality disorders, and psychotic disorders. Moreover, I have not compiled an exhaustive review of the CBT literature, but rather, provide the reader with snapshots of some established and developing CBT models and approaches. The book is intended to present a coherent introduction that is practically oriented and that captures some of the established as well as newer, evolving techniques of CBT. Personally, I will use this text when training and supervising clinicians and as a way to refresh my own knowledge of CBT for a particular disorder. I hope you, the reader, will do the same.

Stefan G. Hofmann, Ph.D.

Boston, Massachusetts

1

The Basic Idea

Joe

Joe is a 45-year-old car salesman. He and his wife Mary live in a suburban home just outside Boston. They have two children, ages 9 and 12. The family had been doing well financially until Joe was laid off 3 months ago. Mary had been working part-time as a receptionist for a dentist and was able to upgrade this to a full-time job once her husband was out of work. Her income is enough to make ends meet, at least for now.

Since Joe was laid off, he has been staying home. He helps to get the kids ready for school, but then goes back to bed and stays there until 1 or sometimes 2 in the afternoon. He watches TV until his kids and wife come home. Sometimes, he doesn’t even have the energy to do that. He feels worthless and believes he will never find a job again. Mary cares deeply for Joe. Although his lack of motivation has created some conflict around doing household chores and cooking, she does whatever she can to make him feel better. However, the added responsibilities are at times burdensome for Mary.

Joe is depressed. He often struggles with his mood, motivation, and energy. But this time, his depression is more severe than usual. Getting laid off from his job apparently triggered the onset of a major depression. Anyone would be upset and sad after being laid off. But in Joe’s case, the level and duration of the sadness are clearly outside the normal range. This is not the first time Joe has felt like this. Shortly after the birth of his second son, he slipped into a period of severe depression that lasted for almost a year. There was no clear trigger, aside from having a second child. He was so depressed that he even thought about suicide by hanging himself. Fortunately, he did not act on these thoughts. He has tried various medications for his depression, but he did not find them to be helpful and did not like the side effects they caused.