1 Argosy University, Chicago COURSE SYLLABUS PP8010 Cognitive Behavioral Therapy Wednesday 12:30-3:15pm Fall 2009 Faculty Information Faculty Name: Leah Horvath, Ph.D. Contact Information: Phone: 312-777-7681 E-Mail: lhorvath@argosy.edu Office Hours: By Appt. Short Faculty Bio: Dr. Horvath is the Associate Chair of the Clinical Psychology Program at Argosy University. She received her MS and PhD in Clinical Psychology from The University of Kentucky, with a focus on cognitive-behavioral treatments and clinical administration. She has specialized clinical training in Dialectical Behavior Therapy (DBT) – including completing her pre-doctoral fellowship in the DBT program at the Yale-New Haven Psychiatric Hospital. Dr. Horvath completed a postdoctoral fellowship in the University Counseling Service at New York University, where she specialized in the treatment of individuals with eating disorders. Her clinical areas of interest involve working in college mental health, working with adults with eating disorders or histories of trauma, and working from a DBT or mindfulness-based treatment approach. Her research interests include issues in romantic relationships, personality theory, and therapy outcome research. TA Information TA Name: Dina Karvounides Contact Information E-mail: dkarvounides@gmail.com Phone: 330-819-6987 (no calls after 10:00pm please) Course description: This course introduces the student to the major approaches and techniques for cognitive-behavioral therapy. Historical foundations, philosophical underpinnings, assessment methods, case conceptualization, intervention methods, and applications to a variety of populations and presenting problems will be addressed. Course Pre-requisites: None Required Textbooks: Cognitive Therapy: Basics and Beyond Title Author(s) Beck, Judith S. Copyright 1995 Publisher Guilford 0-89862-847-4 ISBN 2 Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice Author(s) O’Donohue, W. T., & Fisher, J.E. (Eds.) Copyright 2008 Publisher Wiley 978-0-470-22778-7 ISBN Second Edition Edition Title Title Author(s) Copyright Publisher ISBN The Case Formulation Approach to CBT Persons, J.B. 2008 Guilford 978-1-59385-875-9 In addition to these required texts, there are required journal articles and book chapters as noted in the syllabus. The book is on reserve with the library, some of these articles are available full-text online, and the remaining articles will be distributed in class. Course length: 15 Weeks Contact Hours: 45 Hours Program Outcomes: The Doctoral program in Clinical Psychology at Argosy University Chicago Campus is an APA accredited program. This program is designed to educate and train students so that they may eventually be able to function effectively as clinical psychologists. To ensure students are prepared adequately, the curriculum provides for the meaningful integration of theory, training and practice. The Clinical Psychology program at Argosy University Chicago Campus emphasizes the development of attitudes, knowledge, and skills essential in the formation of professional psychologists who are committed to the ethical provision of quality services. Specific program goals include: Goal 1: Prepare professional psychologists to accurately, effectively, and ethically select, administer, score, interpret, and communicate findings of appropriate assessment methods informed by accepted psychometric standards and sensitive to the diverse characteristics and needs of clients. Goal 2: Prepare professional psychologists to select, implement, and evaluate psychological interventions consistent with current ethical, evidence-based, and professional standards, within a theoretical framework, and with sensitivity to the interpersonal processes of the therapeutic relationship and the diverse characteristics and needs of clients. Goal 3: Prepare professional psychologists to analyze the complexity and multidimensionality of human diversity, and demonstrate the knowledge, skills, and attitudes necessary to understand diverse worldviews and the potential meaning of social, cultural, and individual differences for professional psychological services. Goal 4: Prepare professional psychologists to examine the historical context and the 3 current body of knowledge of biological, cognitive, affective, developmental, and social bases of human functioning. Goal 5: Prepare professional psychologists to critically evaluate the current and evolving body of scholarly literature in psychology to inform professional practice. Course Objective Differentiate the common and varied “world views” of various cognitive-behavioral approaches. Identify psychological phenomena and data that form the basis for assessment in CBT practice and apply CBT assessment methods. Conceptualize a therapy case from a (specific) CBT perspective Identify, define, and apply cognitive, behavioral, and cognitive-behavioral interventions Explain methods for assessing progress and outcome in CBT – empirically-based practice Identify cultural and other group and individual factors that may affect process and outcome in CBT Develop a CBT treatment plan and apply it to specific presenting problems and disorders with specific populations Articulate the research on efficacy of CBT Program Goal Goal 2 – Intervention; Goal 4 – Scientific Foundations Goal 1 Assessment Goal 2 Intervention Goal 2 Intervention Goal 1 – Assessment; Goal 5 – Scholarship Goal 3 Diversity Method of Assessment Case conceptualizations Class participation Case conceptualizations Class participation Final Project Case conceptualizations Final Project Case conceptualizations Class participation Final Project Therapy homework Case conceptualizations Class participation Final Project Goal 2 Intervention Case conceptualizations Class participation Final Project Case conceptualizations Final Project Goal 5 Scholarship Class participation Final Project Assignments: You will be graded according to the following separate assignments/criteria. 1) Class Participation and Therapy Homework (20%): You will be expected to arrive for class prepared to be an active and willing participant in classroom discussions and activities such as role plays. I will periodically assign therapy homework (like what you might ask a client to do) and you are expected to complete these and be prepared to discuss them in class. In-class participation will allow us to analyze, critique, and apply material read outside of class. Thus, you must have read all assigned material and completed all class assignments BEFORE class, and engage as an active listener/participator DURING class. Professional behavior is expected from all members. Frequent and unexcused absence, inappropriate classroom conduct, and regular lack of 4 preparation will all result in a reduced class participation grade. Two or more absences will result in the student receiving an “F” for the class. 2) Brief Case Conceptualization Write-ups (20%): 1. A brief case conceptualization write-up on one of the cases presented in class will be due at the beginning of four classes as noted in the schedule. 2. The write-up should not be more than a page or two; in the write-up, answer the following questions: 1. Presenting problem 2. How the presenting problem would be conceptualized according to the theoretical presentation discussed in the previous class session 3. Issues of diversity – either their impact on problem presentation or how these will impact your work with this individual or family, especially taking into account your own background and worldview 4. Treatment planning (inasmuch as we have discussed this in class). 3) Case Conceptualization and Treatment Plan paper (35%): As emphasized in the early classes in this course, the ability to form an accurate and comprehensive case conceptualization is critical to conducting good cognitive-behavioral therapy (as opposed to, for example, being a cognitive-behavioral technician). Using the methods described in the first few classes, please select one of your current or past clinical cases and write up your conceptualization of this case; include what you see as being the primary and secondary problems, the distal and proximal causes of these problems, maintaining variables, etc. In general, what you want this paper to address is: What do you think is going on with this person, and why? If you have not seen any clients yet, you may see me for a sample case, or you may choose a sample case from fictional (e.g., TV show, movie, book) or nonfictional (e.g.., news story) sources. Develop a treatment plan for this client. (This plan does not have to match what you actually did with the client, although hopefully there will be at least some relationship). Include within this treatment plan which interventions you would select, why, and how they relate to the case conceptualization. Selected interventions should be based on a combination of what the literature suggests is useful for the client’s particular problems and on what is suggested by your specific conceptualization. Also include within the plan what problems you might expect to arise, and how you might either address the problems so that the original treatment plan could continue, or modify treatment in response to the problems. Finally, include the methods you would use to evaluate whether treatment is working, and if there are any alternatives to these methods also worth considering. 4) Behavioral Change Project and Presentation (25%): To give you direct practice in implementing a behavioral treatment plan, you will choose some behavior of your own that you would like to change, and design and carry out a behavior modification program. 1. The goal of this project is to deepen your understanding of cognitive-behavioral techniques by applying them to yourself. Several kinds of projects are possible. For example: a stress management program, self-control projects in which you try to modify test anxiety, eating, smoking, exercise, nail-biting behavior; an assertiveness training project. 5 2. 3. 4. 5. 6. Choose something manageable given the scope of this project. I want you to be able to concentrate on all aspects of this project, so you do not want a behavior so emotionally charged that you are distracted. Please see me if you have questions about an appropriate topic. You may use a manual created for your type of behavior modification, or you may create the intervention. The intervention should have some basis in clinical literature. The extent to which this is true will vary. I encourage creativity in your project ideas and will let you know if you are too creative. As part of your approach, you must use a behavioral contract and examine your beliefs. You must get permission from the instructor to use a client other than yourself. This project should not be longer than 15 pages of text (graphs and reference list excluded). One main purpose of this paper is to help you to get in touch with the complex issues of “resistance to change.” Did you implement your program immediately and diligently? Why or why not? What were the motivational issues involved? How did you work to overcome any problems you had with your initial treatment plan? Your program should involve a serious effort—a minimum of 1 to 1 1/2 hours of homework per week. Measurement techniques may include formal assessment (e.g. the Beck Depression Inventory), SUDS scales (subjective units of distress), or behavioral measures (e.g. counting the number of times an event occurs). You must use a behavioral contract as part of your intervention. Although there is a quantitative element to the paper (i.e. graphing an outcome), I am more interested in the subjective aspect of your experience. What was it like being the client? The therapist to a client like the one you were treating (i.e. you)? How did your gender and cultural background impact the treatment? Did you experience any surprises? How did your experience inform you about the reactions of a typical client? Optionally, you may wish to share the feelings you had towards the person who assigned the original assignment (i.e. me), which is another layer of “transference”. Your final paper should include a literature review describing both the reason for intervention (such as the negative consequences of not exercising, for example) and our current knowledge regarding interventions for your particular problem, or problems similar to it; a methods section that includes a description of what you did and how you assessed what you were doing; a results section showing how it turned out; and a discussion section in which you review overall how your project went, problems that arose, what might be useful from this experience for future clients, etc. Course Policies: Approach this class as you would therapy with an individual client in terms of your professional behavior, and show your class peers respect by being on time, not checking your cell phone during class, contributing thoughtfully, and the like. It is both necessary and expected that you regularly attend class and participate in classroom activities. We cover a lot of material in a relatively short period of time. Therefore, attendance is extremely important. You are expected to come to class fully prepared. It is your responsibility to have assignments (reading, written work, etc.) completed PRIOR to attending each class. 6 An absence at any time does not relieve you of your responsibility for material covered in class, assignments, or adhering to announced deadlines. Students will take exams and hand in assignments at the required times. Plagiarism and cheating will not be tolerated and could result in failure of this course and/or academic suspension. See academic policies listed below. As with many classes, as we progress through the semester certain alterations in the syllabus may become necessary. Thus the instructor reserves the right to alter the course outline as deemed necessary. All written assignments should follow APA format. Please feel free to contact me with your concerns or questions regarding the class, either ask to speak with me after/before class, stop by my office, or e-mail me about making an appointment. Schedule, Readings & Assignments: Session & Day Topic; Assignments Due Sept. 9 Introduction; case formulations; evidence-based practice Readings (unless otherwise noted, all non-text book articles and chapters are owned by the library. Books are on reserve and the articles are full-text online) Persons, chapter 1 (What is the case-formulation approach to Cognitive-Behavioral Therapy?) Beck, chapters 1 (Introduction), 2 (Cognitive Conceptualization) Hays, P. A. (2008) Introduction: Developing culturally responsive cognitive-behavioral therapies. In P. A. Hays & G. Y. Iwamasa (Eds.) Culturally-responsive cognitive-behavioral therapy. Wash D.C.: APA Chambless, D. L. & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7-18. Chambless, D. L. & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716. Westen, D., Novotny, C., & Thompson-Brenner, H. (2004) The empirical status of empirically supported psychotherapies: Assumptions, Findings, and reporting in controlled clinical trials. Psychological Bulletin, 130, 631-663. Hofmann, S. G. (2006). The importance of culture in cognitive and behavioral practice. Cognitive and Behavioral Practice, 13(4), 243-245.*(not available 7 online – I will send it to the class). Sept. 16 Sept. 23 Cognitive theories Due: Submit target behavior for Behavior Change Project Persons, chapter 2 (Cognitive Theories and their Clinical Implications) Learning Theories Due: Brief write-up #1 Persons, chapter 3 (Learning Theories and their Clinical Implications) Beck, chapters 6 (Identifying Automatic Thoughts), 7 (Identifying Emotions), 8 (Evaluating Automatic Thoughts), 9 (Responding to Automatic Thoughts), 10 (Identifying and Modifying Intermediate Beliefs), and 11 (Core Beliefs) Premack, D. (1959). Toward empirical behavior laws: I. Positive reinforcement. Psychological Review, 66(4), 219-233. Sept. 30 Emotion Theories Skinner, B. F. (1963). Operant Behavior. American Psychologist, 18(8), 503-515. Persons, chapter 4 (Emotion Theories and their Clinical Implications) Ellis, A. (2003). Similarities and differences between Rational Emotive Behavior Therapy and Cognitive Therapy. Journal of Cognitive Psychotherapy, 17((3), 225-240. *(not available online – I will distribute in class). Oct. 7 The therapeutic relationship; the first few sessions; Due: Brief write-up #2 Ellis, A. (2004). Why Rational Emotive Behavior Therapy is the most comprehensive and effective form of behavior therapy. Journal of Rational-Emotive and Cognitive-Behavioral Therapy, 22 (2), 85-92. Persons, chapters 5 (Beginning the Therapeutic Relationship and Obtaining a Problem List and Diagnosis), 8 (The Therapeutic Relationship) Beck, chapters 3 (Structure of the First Therapy Session), 4 (Session 2 and Beyond: Structure and Format), 5 (Problems with structuring the therapy session) O’Donohue, chapter 74 (Validation Principles and Strategies) Kazdin, A. (1993). Evaluation in clinical practice: Clinically sensitive and systematic methods of 8 Oct. 14 Treatment planning; therapy progress; treatment failure treatment delivery. Behavior Therapy, 24(1), 11-45. *(not available online – I will send it to the class). Persons, chapters 6 (Developing an Initial Case Formulation and Setting Treatment Goals), 7 (Using the Formulation to Develop a Treatment Plan and Obtain the Patient’s Consent to It), 9 (Monitoring Progress), 11 (Decision Making in the Therapy Session) Beck, chapters 14 (Homework), 15 (Termination and Relapse Prevention), 16 (Treatment Planning), 17 (Problems in Therapy) Oct. 21 CBT techniques Due: Brief write-up #3 Huppert, J.D. & Abramowitz, J.S. (2003). Introduction to special series on Going beyond the manual: Insights from experienced clinicians. Cognitive and Behavioral Practice, 10, 1-2. *(not available online – I will send it to the class). Beck, chapters 12 (Additional Cognitive and Behavioral Techniques) & 14 (Homework) O’Donohue, chapters 13 (Cognitive Restructuring and the Disputing of Irrational Beliefs), 14 (Cognitive Restructuring: Behavioral Tests of Negative Cognitions), 17 (Contingency Management Interventions), 26 (Expressive Writing), 32 (Habit Reversal Training), 34 (Putting it on the Street: Homework in Cognitive Behavioral Therapy), 57 (Identifying and Modifying Maladaptive Schemas), Oct. 28 Nov. 4 CBT techniques Due: Therapy homework as assigned in prior class Mindfulness and Acceptance Based Therapies Due: Therapy homework as assigned in prior class Tompkins, M. (2002). Guidelines for enhancing homework compliance. Journal of Clinical Psychology, 58(5), 565-576. Beck, chapter 13 (Imagery) O’Donohue & Fisher, chapters 10 (Behavioral Retraining and Diaphragmatic Breathing Techniques), 23 (Distress Tolerance), 24 (Emotion Regulation), 54 (Relaxation) O’Donohue & Fisher, chapters 2 (Psychological Acceptance), 28 (Experimental Functional Analysis of Problem Behavior), 40 (Mindfulness Practice) Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125- 9 143. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How Empirically Oriented Are the New Behavior Therapy Technologies? Behavior Therapy, 35(1), 35-54. *(not available online – I will send it to the class). Nov. 11 Depression and Suicidality Due: Brief write-up #4 Harned, M. S., & Linehan, M. M. (2008). Integrating dialectical behavior therapy and prolonged exposure to treat co-occurring borderline personality disorder and PTSD: Two case studies. Cognitive and Behavioral Practice, 15(3), 263-276. *(not available online – I will send it to the class). O’Donohue & Fisher, chapters 5 (Attribution Change), 6 (Behavioral Activation for Depression) Teasdale, J. D., Williams, J. M. G., Soulsby, J. M., Segal, Z. V., Ridgeway, V. A., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623. Bottonari, K. A., Roberts, J. E., Thomas, S. N., & Read, J. P. (2008). Stop thinking and start doing: Switching from cognitive therapy to behavioral activation in a case of chronic treatment-resistant depression. Cognitive and Behavioral Practice, 15(4), 376-386. *(not available online – I will send it to the class). Nov. 18 Anxiety and PTSD Eskin, M., Ertekin, K., & Demir, H. (2008). Efficacy of a problem-solving therapy for depression and suicide potential in adolescents and young adults. Cognitive Therapy & Research, 32(2), 227-245. O’Donohue & Fisher, chapters 27 (Flooding), 6 (Behavioral Activation for Depression), 55 (Response Prevention), 69 (Systematic Desensitization) Hembree, E.A., Rauch, S.A.M., & Foa, E.B. (2003). Beyond the manual: The insider’s guide to prolonged exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 22-30. *(not available online – I will send 10 it to the class). Huppert, J.D. & Baker-Morissette, S.L. (2003). Beyond the manual: The insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10, 2-13. *(not available online – I will send it to the class). Krijn, M., and colleagues. (2004). Virtual Reality Exposure Therapy of anxiety disorders: A review. Clinical Psychology Review, 24 (3), 259-281. *(not available online – I will distribute in class). Nov. 25 Eating Disorders and Addictive Behaviors Leahy, R. (2002). Improving homework compliance in the treatment of generalized anxiety disorder. Journal of Clinical Psychology - In Session, 58, (5) 499-511. O’Donohue & Fisher, chapters 33 (Harm Reduction), 53 (Relapse Prevention) Brownell, K., Marlatt, G.A., Lichtenstein, E., & Wilson, G.T. (1986). Understanding and preventing relapse. American Psychologist, 41(7), 765-782. Marlatt, G.A., Larimer, M., Baer, J., & Quigley, L. (1993). Harm reduction for alcohol problems: Moving beyond the controlled drinking controversy. Behavior Therapy, 24(4), 461-504. *(not available online – I will send it to the class). Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114. Waldron, H. B., & Turner, C. W. (2008). Evidencebased psychosocial treatments for adolescent substance abuse. Journal of Clinical Child & Adolescent Psychology, 37(1), 238-261. Fairburn, C., Zafra, C., & Roz, S. (2003). Cognitive behaviour therapy for eating disorders. Behavior Research and Therapy, 41, (5), 509-528. *(not available online – I will distribute in class). Goebbel-Fabbri, A.E., Fikkan, J., & Franko, D.L. (2003). Beyond the manual: The flexible use of cognitive behavioral therapy for bulimia nervosa. 11 Cognitive and Behavioral Practice, 10, 41-50. *(not available online – I will send it to the class). Dec. 2 Parent Training and CBT with children Due: Final Case Conceptualization & Treatment Plan Greenberg, S. T., & Schoen, E. G. (2008). Males and eating disoders: Gender-based therapy for eating disorder recovery. Professional Psychology: Research and Practice, 39(4), 464-471. O’Donohue. chapters 47 (Parent Training), 63 (Social Skills Training) Beaver, B. (2008). A positive approach to children's internalizing disorders. Professional Psychology: Research and Practice, 39(2), 129-136. Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36(4), 567589. Dec. 9 TBA – as needed Dec. 16 Discussion of final papers Due: Behavioral Change Paper Students will present on their final projects Library All resources in Argosy University’s online collection are available through the Internet. The campus librarian will provide students with links, user IDs, and passwords. Library Resources: Argosy University’s core online collection features nearly 21,000 full-text journals and 23,000 electronic books and other content covering all academic subject areas including Business & Economics, Career & General Education, Computers, Engineering & Applied Science, Humanities, Science, Medicine & Allied Health, and Social & Behavior Sciences. 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