THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK COURSE NUMBER: COURSE TITLE: SEMESTER AND YEAR: INSTRUCTOR: OFFICE HOURS: SOWO 750 Cognitive Behavioral Therapy Spring 2012; Tuesdays 2-4:50 Marty Weems, LCSW, LCAS, CSI School of Social Work Rm. 355 Phone: 843-9161 Email: weems@email.unc.edu By appointment COURSE DESCRIPTION: This course will use the CBT framework to teach students how to move from an assessment to intervention using the model. COURSE OBJECTIVES: 1. Understand the theoretical underpinnings of CBT, including cognitive and behavioral theories. 2. Be able to conduct an assessment using the CBT model, including how to identify cognitive and behavioral patterns and link those to the current presenting problem. 3. Formulate and articulate a case using a CBT framework 4. Develop CBT skills that can be applied to clients presenting with a variety of mental health issues and from various backgrounds. 5. Create a treatment plan that demonstrates a clear link between assessment and interventions, incorporating client specific issues such as race, gender expression, SES, sexual orientation, age, religion, etc. 6. Analyze CBT’s evidence-base and applicability to clients presenting with a diverse range of issues, including different diagnoses (e.g. depressive and anxiety disorders) and diversity issues. 7. Evaluate how well CBT fits with social work values and ethics, as well as the current mental health climate, including issues of social justice like access to services. EXPANDED DESCRIPTION: This course builds on Integrated Practice’s introduction to CBT. The aim of this course is to increase a student’s conceptual understanding AND their ability to apply the model to clients with a variety of mental health issues, such as depression and anxiety disorders. Students by the end of the course should be able to conduct an assessment using a CBT framework and formulate the case so there is a clear link between the formulation and the presenting problem. Students will also have opportunities to watch and practice CBT specific skills so that they gain confidence in their ability to both recommend and use these skills in practice settings. REQUIRED TEXTS/READINGS: Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Learning cognitive-behavior therapy: An illustrated guide. Washington, D.C.: American Psychiatric Publishing, Inc. RELATED READINGS: Other required readings will be on the Sakai site for the course. TEACHING METHODS The development of a supportive learning environment, reflecting the values of the social work profession, is essential for the success of this class. A supportive learning environment is fostered by listening to the ideas and views of others, being able to understand and appreciate a point of view which is different from your own, articulating clearly your point of view, and linking experience to readings and assignments. I will appreciate your contributions to making this a safe and respectful class for learning and growth. CLASS ASSIGNMENTS Case Formulation Paper: Treatment Plan Paper: Homework: Attendance/Participation: 35% 35% 20% 10% See Appendices A & B GRADING SYSTEM H = 94-100 P = 80-93 L = 70-79 F = 69 and below POLICY ON INCOMPLETES AND LATE ASSIGNMENTS It is expected that assignments will be completed at times noted in the syllabus. If you have a situation arise that may prohibit you from completing the assignment on time, any request for delay of an assignment/exam must be approved in advance of the due date. Approved delays will not affect the grade. Any late assignments that have not been approved in advance will not be accepted. Papers are due at the start of class. If the student meets unavoidable obstacles to meeting the time frame, the student should discuss the circumstances with the instructor to determine if an initial grade of incomplete (INC) would be appropriate. I prefer not to give an incomplete grade and will give incompletes only in compliance with University policy. POLICY ON ACADEMIC DISHONESTY Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written assignments should contain a signed pledge from you stating that, "I have not given or received unauthorized aid in preparing this written work". In keeping with the UNC Honor Code, if reason exists to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for investigation and further action as required. POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES Students with disabilities that affect their participation in the course and who wish to have special accommodations should contact the University’s Disabilities Services and provide documentation of their disability. Disabilities Services will notify the instructor that the student has a documented disability and may require accommodations, Students should discuss the specific accommodations they require (e.g. changes in instructional format, examination format) directly with the instructor. POLICIES ON THE USE OF ELECTRONIC DEVICES IN THE CLASSROOM No laptops or other electronic devices are permitted in the classroom, unless you have a specific documented learning disability. Please turn off all cell phones or other devices that would disrupt the learning environment of the classroom. Course Schedule Jan. 15 Class 1 Overview of course Models Influencing CBT Jan. 22 Class 2 Introduction to CBT Homework: Psychoeducation about CBT- Provide Psychoeducation to a client using the cognitive triangle worksheet Jan. 29 Class 3 Assessment and Treatment Planning Activity: Case formulation Homework: Complete case formulation worksheet on a client (protect confidentiality) Feb. 5 Class 4 Beginning Treatment & Cognitive Strategies Activity: Working with thoughts Homework: Identify/Modify Cognitions- assist client to identify and/or modify cognitions using one of the tools we discussed in class Case Formulation Paper Due Feb. 12 Class 5 Behavioral Strategies Activity: Applying behavioral strategies Homework: Use one behavioral technique with a client Feb. 19 Class 6 Application to various settings Activity: Cumulative Practice Feb. 26 Class 7 Challenges in Treatment Treatment Plan and Critique Due COURSE OUTLINE Class 1: Introduction to course, Influential Models Introductions What is CBT? Why CBT? Class 2: Introduction to CBT Principles of CBT Role of therapeutic relationship CBT and social work Diversity and CBT Required Readings: Wright et al. Chapters 1 and 2 Muroff, J. (2007). Cultural diversity and cognitive behavior therapy. In T. Ronen & A. Freeman, (Eds.) Cognitive behavior therapy in clinical social work practice (pp. 109-146). New York, NY: Springer Publishing Company, LLC. Class 3: Assessment and Case Formulation Organization of case material Creating a case formulation Setting the stage for treatment Research on CBT Required Readings: Wright et al. Chapters 3 and 4 Gambrill, E. (2007). Critical thinking, evidence-based practice, and cognitive behavior therapy. In T. Ronen & A. Freeman, (Eds.) Cognitive behavior therapy in clinical social work practice (pp. 67-87). New York, NY: Springer Publishing Company, LLC. Class 4: Cognitive Restructuring Case formulation Paper Due Working with automatic thoughts Modifying schemas Required Readings: Wright et al. Chapters 5 and 8 Class 5: Behavioral Strategies Discussion of behavioral strategies Strategies to address anxiety and self-care Required Readings: Wright et al., Chapters 6 and 7 Class 6: Application to different populations Treatment Plan & Critique Paper Due Class choices regarding population How does CBT apply to various populations, disorders and challenges? Required Readings: Read 2 of the following that interest you the most. (Please let me know if there is topic that interests you that is not here and I can try to find it for you.) Daoud, L., & Tafrate, R.C. (2007). Depression and suicidal behavior: A cognitive behavior therapy approach for social workers. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in clinical social work practice (401-418). New York, NY: Springer Publishing Company. Gaudiano, B.A. (2005). Cognitive behavior therapies for psychotic disorders: Current empirical status and future directions. Clinical Psychology: Science and Practice, 12, 33-50. Himle, J.A. (2007). Cognitive behavior therapy for anxiety disorders. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in clinical social work practice (pp. 375-399). New York, NY: Springer Publishing Company. Malkinson, R. (2007). Grief and bereavement. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in clinical social work practice (521-550). New York, NY: Springer Publishing Company. Turkington, D., Dudley, R., Warman, D.M., & Beck, A.T. (2004). Cognitive-behavioral therapy for schizophrenia. Journal of Psychiatric Practice, 10, 5-16. Walsh, B.W. (2006). Cognitive treatment. In Treating self-injury: A practical guide. New York, NY: Guilford Press. Class 7: Challenges in treatment Homework non-completion Chronic and complex client issues. Required Readings: Wright et al., Chapters 9 & 10 Kazantzis, N., Deane, F.P., & Ronan, K.R. (2004). Assessing compliance with homework assignments: Review and recommendations for clinical practice. Journal of Clinical Psychology, 60(6), 627-641. APPENDIX A CBT CASE FORMULATION Objective: The objective of this assignment is for the student to demonstrate the ability to organize and describe case material using the CBT framework. Assignment: The student should identify a case, either from their field work or some other helping role to use for the paper. A brief summary of the case should be provided (1-2 pages) that includes the presenting problem of the case as if it were being placed in a medical chart. Please see the suggested guide that is placed under Assignments on the Sakai site. Using the case formulation form as a guide the student should write up a case formulation that uses the CBT framework to describe the essential elements in the case. In other words, how would CBT describe what is happening with the case. Why is the person feeling, thinking and behaving in the way that they present in treatment. This paper should be no more than 5 pages Grading Criteria: Criteria The student has clearly described the client and the client’s presenting issues and concerns. The student has thoroughly described the formative influences for the client that might be contributors to the current situation. The student has thoroughly described other situations or issues that might have a bearing on the client, such as class, culture or other client specific issues. Biological, genetic and medical factors have been considered. Possible Pts. 10 10 10 10 Examples of the CBT cycle are accurate and written in client friendly language Client schemas are identified 10 The working hypothesis is comprehensive and provides an accurate clinical summation of the relevant issues that are currently influencing the situation of the client using the CBT framework. The paper is well written with no errors 30 TOTAL 100 10 10 APPENDIX B CBT TREATMENT PLAN AND CRITIQUE Objective: The aim of this assignment is for student to demonstrate their ability to link their assessment and formulation to an appropriate treatment plan and using the principles of evidence-based practice, critique the plan. Assignment: Using the case from the first assignment, this assignment asks students to develop a treatment plan using the assessment and formulation developed from the first assignment. The paper does not have to be in a chart format, but all of the elements within the chart need to be included. In this assignment, students should pay close attention to linking their assessment to their interventions. The interventions should address the difficulties presented by the client as outlined in the assessment. Students should be mindful of the interventions being appropriate and feasible for the individual issues of that client, considering culture, spirituality, gender identity, class, sexual orientation, race, and ethnicity. The final section of the paper should include a brief summary of evidence that supports the use of this model for this client. Please refer to the grading criteria below. This paper should be no more than 4-5 pages. Grading Criteria: Criteria Treatment goals and objectives are written correctly using the SMART format (Can be single-spaced in an outline/bullet format) Possible Pts. 15 The goals are consistent with the CBT model 15 The treatment goals directly address the assessment and presenting problems identified in the first assignment The treatment goals pay attentive to issues of individual differences in clients. 20 There is a discussion using evidence to discuss how CBT may or may not be a good fit for this client and his/her presenting issues 30 APA formatting is correct and the paper is well written with no errors 10 TOTAL 100 10 APPENDIX C HOMEWORK ASSIGNMENTS Objective: The aim of this assignment is for students to apply and practice what they are learning in the course. Assignment: Students will complete four homework assignments; each is worth 5 points. Students are expected to apply skills in their field placement with clients, and the homework should apply to client difficulties noted in the assessment and treatment plan. Students may use course handouts and worksheets to complete the homework assignments. Students will be graded for accurateness, completeness, and self-awareness related to the implementation of skills. 1. January 22- One page synopsis of psychoeducation activity including: 1) how you presented the material to the client, 2) how it was received, 3) assessment of your strengths and weaknesses, and 4) questions for further consideration. 2. January 29- Complete the case formulation worksheet on a client and turn it in. 3. February 5- One page synopsis of cognitive strategy including: 1) why you chose this technique; 2) how you presented the material to the client, 3) how it was received, 4) assessment of your strengths and weaknesses, and 5) questions for further consideration. Turn in worksheet along with your synopsis. 4. February 12- One page synopsis of behavioral strategy including: 1) why you chose this technique; 2) how you presented the material to the client, 3) how it was received, 4) assessment of your strengths and weaknesses, and 5) questions for further consideration. Turn in worksheet along with your synopsis.