A clinician's guide to CBT for children to young adults : a companion to Think good-feel good and thinking good, feeling better / Paul Stallard.

1. Introduction and overview CBT as an intervention 1 CBT as a preventative intervention 2 CBT with younger children 3 CBT with young people with learning difficulties 3 Technologically delivered CBT 4 Involving parents 5 The competencies to deliver CBT 6  Assessing competence 7 Cognitive Behaviour Therapy Scale for Children and Young People 8 CORE philosophy 12  Child centred 13  Outcome focused 14  Reflective 15  Empowering 16 2.

PRECISE 19 The therapeutic alliance 19 Partnership 21  Eliciting young person and parent’s understanding and views 22  Encourages the young person to participate in decision making 23  Involves young person and parent/carer in planning the intervention 24  Encourages young person to provide feedback about sessions 24 Right developmental level 25  Ensures a balance between cognitive and behavioural techniques 25  Uses simple, clear.

jargon free language 26 Uses a variety of verbal and non-verbal techniques 28 Appropriately involves parents/carers 28  Courtney has anger outbursts 30 Empathy 30  Conveys interest and concern 30  Acknowledges and responds to emotional responses 32  Demonstrates a respectful, non-judgemental,

caring approach 33  Empathises with parents 34 Creative 35  Tailors concepts and methods of CBT around the young person 36  Uses a range of verbal and non-verbal methods 37 Is creative in use of materials and metaphors 38  Utilises the preferred media of the young person 39 Investigation 40  Creates a process of collaborative inquiry 40  Fully involves the young person in the design of experiments 41  Helps to consider alternative explanations 42  Encourages reflection 42 Self-efficacy 43  Identifies strengths and personal resources 43  Encourages identification of helpful skills and strategies 44  Develops personal coping strategies 45  Reinforces use of new skills 46 Enjoyable and engaging 47  Uses an appropriate mix of materials and activities 47  Maintains a balance between task and relationship strengthening 47 Incorporates young.

person’s interests into the intervention 48  Presents as positive and hopeful 49 PRECISE in practice 49  Ella’s obsessional thoughts 49  Joshua’s negative thinking 50 3.

A: Assessment and Goals 52 Undertakes a full assessment 52 Compliments assessment with routine outcome measures 54 Negotiates goals and when progress will be reviewed 56  Identification of goals 57  Prioritisation of goals 58  Whose goals? 58  Inappropriate goals 59 Uses diaries, thought bubbles and rating scales 59  Sarah feels faint 60 Tick charts 60  Thought bubbles 61  Visualisation 62  Stories 62  Rating scales 64  Pie charts 64  Theos washing 64 Assessing motivation and readiness to change 65  Pre-contemplation 67  Contemplation 68  Preparation 69  Action 69  Maintenance 69  Relapse 69 4.

B: Behavioural 71 Developing hierarchies, graded exposure and response prevention 71 Developing hierarchies 71 Graded exposure 73 Response prevention 75  John is worried about germs 76 Problems when undertaking exposure 76 Young person avoidance 76  Clinician avoidance 77  Anxiety does not come down 77  Is the young person focusing on their anxiety 77  Are parents appropriately involved 78 Uses activity rescheduling and behavioural activation 78 Activity scheduling 78  Alison feels down 79 Behavioural Activation 80  Problems with behavioural activation 80  I didn’t feel like doing it 81  I did it but I don’t feel any better 82  I did it but so what 82  It’s not important 82 Provides a clear rationale for use of behavioural strategies 82 Identifies and implements reward and contingency plans 83 Models,

uses role play, problem-solving and skills training 85 Models how to cope 85 Role-play 87 Problem solving 88 Skills training 89 5.

C: Cognitions 91 Facilitates cognitive awareness 91 Cognitive content 91 Levels of cognitions 92 Uses thought records and bubbles 96 Identifies functional and dysfunctional cognitions 98  Unhelpful thoughts 98  Helpful thoughts 99 Identifies cognitive biases (thinking traps) 99  Negative filter 99 Blowing things up 100 Predicting failure 100 Being down on yourself 101 Setting yourself up to fail 101 Facilitates thought challenging and perspective taking 102 What is the evidence? 102 The 4Cs 102 What would someone else say? 103  Jaz falls out with her friend 103 Facilitates continuum work through rating scales 103 Uses mindfulness, acceptance and compassion 104 Mindfulness 104  Compassion 107  Acceptance 108  Kindness 110 6.

D: Discovery 111 Facilitates discovery through the Socratic dialogue 111 The Socratic dialogue 113 Memory questions 113 Translation questions 113 Interpretation questions 114 Application questions 114 Analysis questions 115 Synthesis questions 115 Evaluation questions 115 What makes a good Socratic question? 116  Mike is worried about his cat 117  Common difficulties 120 Facilitates perspective taking 122  Perspective taking 122  Responsibility pies 123  Joshua’s accident 123 Attends to overlooked information 124  Analogical comparisons 125  Testing assumed relationships 125  Marla worries she will pass germs to others 126 Evaluates cognitions thought behavioural experiments or prediction testing 127  Planning a behavioural experiment 128  Prediction testing – Caleb thinks he is a failure 129  Active.

experiment – Laura’s social anxiety 130  Information gathering experiments – Adam’s formulation 131 7.

E: Emotions 134 Develops emotional literacy 134 Identifies key bodily signals 135  Body signals 135  Feeling diaries 136  William feels sad 136 Emotional logs 137  Isabella feels down 137 Develops relaxation, guided imagery, controlled breathing and calming activities 138 Progressive muscle relaxation 139 Calming imagery 141  Aisha’s calming image 141  Diaphragmatic (controlled) breathing 142  Change the feeling 143 Develops physical activity, let the feelings go, emotional metaphors 144  Physical activity 144  Let the feeling go 144  Emotional metaphors 144  Emotive imagery 145  Anthony’s humorous image 145 Develops self-soothing, mind games and mindfulness 146  Self-soothing 146  Mind games 147 Mindfulness 147 Talk to someone 148 8.

F: Formulations 150 Provides a coherent and understandable rationale for the use of CBT 150 Links thoughts, emotions and behaviours (maintenance formulat.

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