CBT Seminar #1
Identifying Thoughts and Emotions
Date: August 20, 2014
Required Reading:
Beck, J.S. (2011). Cognitive Therapy: Basics and Beyond. New York: Guilford Press
2nd ed. (pp. 137-157). Chapter 9 “Identifying Automatic Thoughts”
Beck, J.S. (2011). Cognitive Therapy: Basics and Beyond. New York: Guilford Press
2nd ed. (pp. 158-166). Chapter 10 “Identifying Emotions”
Educational Objectives:
At the end of this seminar the participant will be able to:
1) Identify common difficulties patients encounter when trying to identify thoughts and
emotions.
2) Become familiar with techniques to help patients identify and distinguish among
thoughts and emotions.
3) Recognize the reciprocal relationship between thoughts and emotions.
Questions to consider:
1) How many emotions can you name?
2) Do emotions and thoughts correspond to one another?
CBT Seminar #2
Cognitive Restructuring Strategies
Date: September 3, 2014
Required Reading:
Beck, J.S. (2011). Cognitive Therapy: Basics and Beyond. New York: Guilford Press
2nd ed. (pp. 167-186). Chapter 11 “Evaluating Automatic Thoughts”
Educational Objectives:
At the end of this seminar the participant will be able to:
1) Describe common cognitive errors
2) Describe common cognitive restructuring techniques
3) Complete an automatic thought record
Questions to Consider:
1) How does Socratic questioning facilitate the cognitive restructuring process?
2) List 5 cognitive restructuring approaches.
3) What counts as “evidence” when evaluating dysfunctional thinking?
CBT Seminar #3
Designing Effective Homework and dealing with
obstacles in CBT
Date: September 10, 2014
Required Activity:
Think of something you have been meaning to do. Write it down and commit to doing it
over the week. It can be any task large or small in their personal or professional life laundry, email a friend you’ve been meaning to contact, pay a bill, purchase something
you need, read a core curriculum reading etc.
Optional Reading:
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press
(pp. 248-268). Chapter 14 “Homework”
Educational Objectives:
At the end of this seminar the participant will be able to:
1) Discuss the rationale of assigning homework in CBT.
2) Explore different types of homework.
3) Become familiar with techniques that may enhance patients’ completion of
homework.
4) Develop approaches towards overcoming barriers when patients do not complete their
homework.
Questions to consider:
1) Why do patients not complete their homework? List ten possible reasons. <this is to
stimulate thinking – many residents jump to “resistance” very quickly>
2) Have you always completed homework or tasks that you think you “should” do? If
not, why not?
CBT Seminar #4
Behavioural Interventions in depression – Strategies to
Promote Engagement and Goal Directedness
Date: September 17, 2014
Required Activity:
Try learning about relaxation techniques by actually doing some as a scheduled activity
during the week.
Do a relaxation activity 4 times during the week for 10 minutes.
There are thousands of videos on YouTube. Here is a one from the NHS as an example:
http://www.youtube.com/watch?v=9SZ1kdBwNXo&feature=youtube_gdata_player
Optional Readings:
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of
depression. New York: Guilford Press (pp 117-141)
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press
(pp. 154-156; 197-200).
At the end of this seminar the participant will be able to:
1) To become familiar with the purpose and process of conducting behavioural
experiments in cognitive therapy.
2) To learn about a range of commonly used behavioural experiments to address typical
behavioural problems germane to the depressed state.
3) To learn strategies to address problems that may emerge before, during or following
behavioural experiments.
Questions to consider:
1) How do the goals and procedures of behavioural activation methods and behavioural
experiments differ in cognitive therapy? How does the therapist know when to select
the particular behavioural approach?
2) How does the cognitive therapist get the depressed patient to “buy in” to taking
personal risks and overcome the tendency toward ‘harm avoidance’?
3) How does the therapist work to maintain the therapeutic bond and keep the goals and
tasks of cognitive therapy on track when the patient perceives “failure” during a
behavioural experiment?
CBT Seminar #5
Cognitive and Behavioural Approaches to Treating
Panic Disorder
Dates: October 1, 2014
Required Reading:
Wells, A (1997). Cognitive Therapy of Anxiety Disorders. New York:
Wiley (pp. 98-132).
Educational Objectives:
At the end of this seminar the participant will be able to:
1) To learn how to conceptualize panic disorder within a cognitive-behavioural
framework
2) To learn the step-by-step psychological strategies to treat the disorder
3) To review the scientific literature on the use of CBT as a stand-alone treatment or in
tandem with meds
Questions to consider:
1) How does the cognitive therapist help the patient to see that panic unfolds in a
number of predictable steps that they can learn to control?
2) What are the specific cognitive and behavioural tasks that can be used to treat panic
and what is the optimal timing of these different interventions?
3) What are advantages and disadvantages to using medications in combination with
CBT when treating panic disorder?
CBT Seminar #6
LARGE GROUP SPECIAL TOPIC - CBT for
Psychosis
Date: October 8, 2014
Required Reading:
Rector, N., Beck, A. (2002). A Clinical Review of Cognitive Therapy for Schizophrenia.
Current Psychiatry Reports 4:284-292.
Educational Objectives:
At the end of this seminar the participant will be able to:
1) Become familiar with how CBT can be adapted to treat people with a major psychotic
disorder
2) Understand how CBT may be used for different symptoms: delusions, hallucinations,
negative symptoms.
3) Become familiar with some of the research in this area
Questions to consider:
1) How is cognitive restructuring utilized in schizophrenia?
2) What cognitive and behavioural strategies are used in schizophrenia that are different
than those in mood disorders?
3) How would you explain the rationale of CBT to a skeptical patient who told you that
their schizophrenia or bipolar disorder was a “chemical imbalance” and therefore
only medication was likely to have any impact?
CBT Session #7
CBT for other Anxiety Disorders
Date: January 21, 2015
Required Activity:
1. Watch an exposure for a snake phobia in the 3 clips of "Snake Phobia Treatment" at
http://www.medclip.com/index.php and develop a hypothetical hierarchy for Mariam,
imagining she came to see you for her snake phobia (hierarchy sheets available in the
toolkit)
2. Identify an anxiety of your own (e.g. dogs, heights, being assertive, giving a
presentation) and break it down into a few graded steps (e.g., looking at a photo of, being
around, and patting a dog; presenting to classmates, to professors, at grand rounds,
etc.). Select, and do, a step that you rate as 40-50 out of 100 in difficulty with 100 being
most difficult or anxiety provoking. Stick to the 40-50 level of difficulty - the goal is not
to push yourself too far but to have some experience approaching an avoided situation or
task.
Optional Readings:
Treatment Plans and Interventions for Depression and Anxiety Disorders . Leahy RL,
Holland SJ. New York: The Guilford Press; 2000. Chapter 4 pp. 113-142.
Handbook of Brief Cognitive Behaviour Therapy. Bond FW & Dryden W, Editors.
Wiley & Sons, 2002. Chapter 6: Cognitive Therapy for Generalised Anxiety Disorder,
Wells A, pp 101-116; Chapter 8: Cognitive Therapy for Social Phobia, Wells A, pp141160.
Educational Objectives:
At the end of this seminar, the participant will be able to:
1)
2)
3)
Outline a general treatment plan for specific phobias
Describe cognitive models for GAD and SP
Identify appropriate strategies for treating GAD and SP
Questions to consider:
1)
2)
When individuals present with multiple comorbid anxiety disorders, how will you
decide which symptom areas to tackle first?
If pharmacotherapy is initiated before CBT, how will this affect your CBT
treatment plan?
CBT Seminar #8
LARGE GROUP SPECIAL TOPIC - Introduction to
Mindfulness
Date: February 4, 2015
Required Reading:
Williams, M, Teasdale, J, Segal, Z & Kabat-Zinn, J (2007) Chapter Two – The Healing
Power of Awareness: Making a Shift to Freedom (pp.31-49). In Williams, Teasdale,
Segal & Kabat-Zinn The Mindful Way through Depression. New York: Guilford Press.
Optional Reading:
Segal, Z, Teasdale, J & Williams, M (2004) Mindfulness-Based Cognitive Therapy:
Theoretical Rationale and Empirical Status (pp 45-65). In Hayes, Follette, & Linehan
Mindfulness and Acceptance New York: Guilford Press.
Learning Objectives:
At the end of this seminar the participant will be able to:
Learning Objectives:
1) To develop a general understanding of what Mindfulness-Based Cognitive Therapy
and related interventions are all about
2) Have an appreciation of the current empirical status of these interventions
3) Develop an understanding of some of the fundamental theoretical underpinnings of
these interventions
Questions to consider:
How is emotional processing aided when attention is directed towards the body?
Does training in mindfulness preclude the use of cognitive strategies?
Is it unrealistic to expect therapists offering mindfulness based cognitive therapy to have
their own mindfulness practice?
CBT Seminar # 9
LARGE GROUP SPECIAL TOPIC - CBT in
Obsessive-Compulsive Disorder
Date: February 11, 2015
Required Reading:
Chapter 9: Obsessive-Compulsive Disorder. In: Cognitive Therapy of Anxiety Disorders:
A Practice Manual and Conceptual Guide. Wells A. Wiley & Sons, 1997, pp. 236-264.
Educational Objectives:
At the end of this seminar, the participant will be able to:
1) Evaluate when individuals with OCD are appropriate candidates for CBT.
2) Conceptualize how to apply CBT to common OCD presentations (ie checking,
contamination, repetition).
3) Identify appropriate strategies for common problems in treating OCD with CBT.
Questions to consider:
1)
2)
3)
How would you outline the relative benefits of CBT versus pharmacotherapy to a
new patient?
Would you continue CBT with a patient who has been poorly compliant with
homework? Why or why not?
Will you routinely offer CBT to individuals with OCD in your practice? If not,
what are your alternatives?
CBT Session #10
Identifying and Modifying Core Beliefs
Date: February 18, 2015
Required Reading:
Wright, J, H., Basco, M.R., Thase, M.E. Learning Cognitive-Behavior Therapy: An
illustrated Guide, American Psychiatric Publishing, 2006 pp 173-199 Modifying
Schemas
Educational Objectives:
At the end of this seminar the participant will be able to:
1) To understand the origin, characteristics and function of Core Beliefs and their role in
maintaining maladaptive patterns of behaviour and thinking
2) To learn when and how to work with core beliefs in therapy
3) To identify specific Core Beliefs and their relationship to Axis I
4) To identify compensatory strategies as they relate to Core Beliefs
5) To learn specific techniques including Core Belief Worksheets, the use of the
Automatic Thought record and downward arrow technique that can be applied to the
modification of core beliefs
6) To apply strategies for working with core beliefs in therapy for anxiety/depression
Questions to consider:
1) How do Core Beliefs originate?
2) How do Core Beliefs guide behaviour? How do Core Beliefs about the self, others
and the world affect patient behaviour?
3) When would you consider formally introducing Core Belief Work?
4) What difficulties may you have as the therapist in working with Core Beliefs?
CBT Seminar #11
Challenging Cases and Advanced Techniques in CBT
Date: March 4, 2015
Required Activity:
Watch: http://www.youtube.com/watch?v=Do6owMR1hSY
Keep in mind these reflective questions:
1.
As you watch the video and place yourself as the therapist, what emotions are
evoked in you? Have you experienced similar emotions/situations in therapy thus
far? How might you address them in yourself and with the patient?
2.
What are our thoughts on the author's explanation of how he interpreted the
patient's various responses?
3.
Do you feel that there were verbal/nonverbal techniques he used that were
helpful/harmful? What would you do differently? [i.e. What does the author do
with the patient that disrupts the alliance? What does the author do that appears to
maintain or enhance the alliance? What does the author do that could be
problematic in therapy?]
4.
How is the author's approach similar to or different from conventional CBT as
you understand it? What do you think are the limitations to this approach?
5.
The author of the video drew from his own personal experiences. As you reflect
on your own experiences in life, have you ever acted in a way that would be
similar in some way to personality disordered patients?
6.
What is the difference between an interpretation and a reflection?
Optional Readings:
1) Leahy, R. Overcoming Resistance in Cognitive Therapy. Guilford Press: 2003.
Chapter 12 “Using the Countertransference.”
2) Safran, J., Segal, Z. Interpersonal Process in Cognitive Therapy. Basic Books, New
York: 1990. Chapter 7 “Experiential Disconfirmation and Decentering: In-Session
Focus.”
Learning Objectives:
At the end of this seminar, the participant will be able to:
1) Appreciate the limitations of CBT
2) Appreciate some strategies for dealing with complicated problems
3) Understand the role of the therapist’s thoughts on the process of CBT
Questions to Consider:
1) What are some factors that can make a CBT case challenging?
2) How can resistance be effectively leveraged to advance the therapy in CBT?
3) What are some common forms of resistance in CBT?
CBT Seminar #12
LARGE GROUP SPECIAL TOPIC – Acceptance and
Commitment Therapy
Date: March 11, 2015
Required Readings:
Cloud, John (2006) Happiness isn’t Normal (In Time Magazine February 13, 2006).
Learning Objectives:
At the end of this seminar, the participant will be able to:
1) Distinguish the underlying philosophical and theoretical assumptions behind
traditional types of psychotherapies versus “third wave” psychotherapies
2) Formulate a basic understanding of psychopathology from an ACT perspective
3) Describe the six core therapeutic components of Acceptance and Commitment
Therapy (ACT)
Questions to consider:
How is emotional processing aided when attention is directed towards the body?
Does training in mindfulness preclude the use of cognitive strategies?
Is it unrealistic to expect therapists offering mindfulness based cognitive therapy to have
their own mindfulness practice?
CBT Seminar #13
CBT for Axis II Disorders
Date: March 18, 2015
Required Activity:
1) Watch a video on borderline personality disorder
http://www.youtube.com/watch?v=iraGmA7-9FA
2) Watch a brief discussion between Dr. Aaron Beck and Dr. Judy about the use of CBT
for personality disorders
http://www.youtube.com/watch?v=8SsojkoZ7g0
3) Read this very brief summary of DBT
http://www.dbtselfhelp.com/DBTinaNutshell.pdf
4) Review these exercises on DBT chain analysis and try one for yourself
http://ptsd.about.com/od/selfhelp/ht/fxanalysis.htm
http://www.dbtselfhelp.com/html/behavior_chain_analysis.html
Optional Reading:
Pretzer, J. and Beck, J. Contemporary Cognitive Therapy. Guilford, 2004. Chapter 14
“Cognitive Therapy for Personality Disorders”
Beck, J. Cognitive Therapy for Challenging Problems: What to do when the basics won’ t
work Guilford, 2005 Chapter 3 “When a personality Disorder Challenges Treatment”
Educational Objectives:
At the end of this seminar the participant will be able to:
1) Understand typical dysfunctional beliefs present in individuals with different
personality disorders.
2) Recognize how CBT is modified to deal with Axis II problems.
3) Appreciate how Axis I conditions are treated in CBT when they occur on the
background of Axis II difficulties.
Questions to consider:
1) How long is a course of CBT for Axis II disorders?
2) What are the pitfalls of CBT for individuals with OCPD?
3) What is meant by a “cognitive-interpersonal cycle” when talking about
personality disorders?
CBT Seminar #14
Termination and Relapse Prevention
Date: March 25, 2015
Required Reading:
SD. Hollon , M. Stewart , and D. Strunk (2006). Enduring Effects for Cognitive
Behavior Therapy in the Treatment of Depression and Anxiety, Annual Review of
Psychology, 57: 285-315.
Learning Objectives:
At the end of this seminar, the participant will be able to:
1) Discuss the pressures on the therapist that the process of termination in a time limited,
structured intervention imposes.
2) Understand the distinction between palliative versus enduring effects of treatments
for mood disorders and the relevance of this view for relapse prevention.
3) Identify 4 core CBT principles that foster patients’ self-therapy in the period posttermination.
Questions to consider:
1) How would you react to a patient’s request to continue treatment for another 10
sessions because “they are finally starting to get some traction with this model”?
2) What is the nature of emotional challenge faced by mood disorder patients in
recovery, or partial remission?
3) Have enduring treatment effects been established for somatic therapies?
CBT Seminar #15
Current Topics in CBT/Seminar Evaluation
Date: April 1, 2015
To be individualized by group