Cognitive Behaviour Therapy for Children and Families (Cambridge Child and Adolescent Psychiatry)

Cover......Page 1
Half-title......Page 3
Series-title......Page 5
Title......Page 7
Copyright......Page 8
Contents......Page 9
Contributors......Page 12
1 Introduction......Page 17
REFERENCES......Page 21
Part I: Developmental cognitive theory and clinical practice......Page 23
2.1 Introduction......Page 25
2.2 The theory of  CBT  as applied to adults......Page 26
2.3 Relevance of early models of cognitive development: Vygotsky and Piaget......Page 27
2.4 Varieties of meta-cognition......Page 30
2.4.2 Evaluation/appraisal  of thoughts (or statements) as being, for example, bad, clever, stupid, useless, shameful, embarrassing, mad, etc.......Page 31
2.4.4 Representation of what cognitive states are regulating another's or one's own behaviour......Page 32
2.5 ‘What cognitive developmental level is needed for CBT?’......Page 33
2.6 Conclusions......Page 37
2.8 REFERENCES......Page 38
3.1 What is a developmental approach?......Page 41
3.1.1 How is development integrated in current practice and research on CBT?......Page 44
3.2 Developmental–clinical research relevant to CBT with children: models and paradigms......Page 45
3.2.2 Attachment theory......Page 46
3.2.3 Children’s understanding of mind......Page 48
3.3.1 Core components and mechanisms of CBT......Page 50
3.3.2 Treatment context......Page 53
3.4.1 Methods and meaning of research......Page 54
3.5.1 Assessment, treatment and prevention......Page 57
3.6 Conclusions......Page 58
3.7 REFERENCES......Page 59
4.1 Psychological therapies:shared paths to success?......Page 64
4.2 Investigations of youth therapy process......Page 65
4.2.2 Therapist directiveness and client resistance......Page 67
4.2.3 Therapist warmth and facilitative conditions......Page 70
4.2.4 The therapeutic relationship......Page 72
4.3 Summary......Page 75
4.4 REFERENCES......Page 76
Part II: Engagement and assessment......Page 81
5.1 Introduction......Page 83
5.2 Models of behaviour change......Page 84
5.3 It is more than readiness that matters......Page 85
5.4 How to measure importance and confidence......Page 86
5.5 Motivational interviewing......Page 88
5.6 What is MI? principles, definitions and techniques......Page 89
5.7 Dealing with resistance......Page 91
5.8 The evidence base of MI......Page 93
5.9 Therapist behaviours of MI......Page 94
5.10 Adapting motivational strategies for working with young people in assessment and engagement for CBT......Page 95
5.11 REFERENCES......Page 97
6 Cognitive case formulation......Page 100
6.1 What is a cognitive case formulation in CBT?......Page 101
6.3 Cognitive case formulation-based or manual-based treatment for children and adolescents......Page 102
6.4 Newer approaches to cognition......Page 104
6.5 The role of the family in CBT......Page 105
6.6 A case example of a cognitive case formulation for anxiety......Page 107
6.7 The way forward......Page 112
6.8 REFERENCES......Page 113
Part III: Client groups......Page 117
7.1 Introduction......Page 119
7.2 Tensions arising out of trying to apply CBT to work with family systems......Page 121
7.2.1 Balancing competing views......Page 122
7.2.1.1 Family members’ roles in giving consent to treatment......Page 124
7.2.1.3 Working with different views of the problem......Page 125
7.2.2 Addressing family issues......Page 127
7.2.2.1 Parent as facilitator – child offered individual CBT with parent not present or infrequently seen......Page 128
7.2.2.3 Parent as client – intervention offered direct to parents in some form......Page 129
7.2.3 Promoting genuine collaboration......Page 131
7.3 Conclusion......Page 132
7.5 REFERENCES......Page 134
8.2 At what age are children able to engage in CBT?......Page 137
8.3 How often is CBT used with children under the age of 12?......Page 140
8.5 Is CBT more or less effective with younger children?......Page 141
8.6 cBt or CBT?......Page 142
8.7 Adapting CBT for use with younger children......Page 144
8.8 The role of the parent in CBT with prepubertal children......Page 146
8.9 Conclusion......Page 147
8.10 REFERENCES......Page 148
9.2.1 Diagnostic pattern......Page 152
9.2.2 Functional impairment......Page 153
9.2.3 Health needs......Page 154
9.2.6 Social and developmental impairments......Page 155
9.2.9 Treatment resistance, consent and therapeutic alliance......Page 156
9.3.1 Principles of therapeutic care......Page 157
9.4.1.1 CBT and multidisciplinary working......Page 158
9.4.1.2 CBT and unit ethos......Page 159
9.4.2.1.2 Behavioural management......Page 160
9.4.2.1.3 Social skills......Page 162
9.4.2.2.1 Conduct and hyperkinetic disorders......Page 163
9.4.2.2.4 Eating disorders......Page 164
9.4.2.2.7 Case vignette......Page 165
9.4.2.3 Potential contraindications or disadvantages of CBT treatments......Page 167
9.5 REFERENCES......Page 168
Part IV: Applications in psychosocial adversity......Page 171
10 Cognitive behavioural treatment of the emotional and behavioural consequences of sexual abuse......Page 173
10.1.1 General considerations......Page 177
10.1.3.2 Activities......Page 178
10.1.4.2 Activities......Page 179
10.1.5.1 Purpose......Page 180
10.1.6.2 Activities......Page 181
10.1.8.1 Purpose......Page 182
10.3 REFERENCES......Page 183
11.1 Introduction......Page 186
11.2 Assessment and formulation......Page 187
11.3 Transitions......Page 188
11.4 Interventions......Page 190
11.5 Parent training and counselling......Page 191
11.6 A counselling and cognitive behaviour management course......Page 193
11.6.1.3 Reassurance for the divorced person......Page 194
11.6.1.6 ‘Know yourself ’ and more hints for managing difficult childhood behaviours......Page 195
11.7 Conclusions......Page 196
11.8 REFERENCES......Page 197
Part V: Applications in specific child and adolescent psychiatric disorders......Page 201
12 Behavioural approaches to eating and sleeping problems in young children......Page 203
12.1.1.1 Classical conditioning in children......Page 204
12.1.1.5 Parental management techniques......Page 205
12.1.2.5 Loss of parental confidence about parenting......Page 206
12.1.2.9 Children’s distorted perceptions of food......Page 207
12.2.1.3 Correct misattribution of blame or guilt......Page 208
12.2.2.2 Enhancing the child’s strengths and self-confidence......Page 209
12.2.3.2 Teaching parents behavioural management skills......Page 210
12.2.3.3 Case illustration......Page 211
12.3.1.2 Classical conditioning in the parent......Page 212
12.3.2.1 Misperception of the child’s behaviour......Page 213
12.3.2.5 Parental poor self-esteem......Page 214
12.4.1.2 Correcting parents’ irrational beliefs and anxieties......Page 215
12.4.1.4 Improving parental emotional state......Page 216
12.4.2.1 Extinction......Page 217
12.4.2.3 Reinforcement......Page 218
12.4.3 Case illustration......Page 219
12.5 REFERENCES......Page 220
13 Conduct disorders in young children......Page 223
13.1 Rationale for using cognitive behaviour therapy......Page 225
13.2 Assessment for treatment......Page 226
13.4 Parent management training......Page 227
13.5 Group discussion videotape modelling for parents......Page 229
13.6 Working with individual families......Page 230
13.7 Behavioural and cognitive techniques used in working directly with the child......Page 231
13.8 Group work with children......Page 233
13.9 Liaison with schools......Page 234
13.10 Outcome......Page 235
13.11 REFERENCES......Page 236
14 Attention deficit hyperactivity disorder......Page 241
14.1 Assessment......Page 242
14.3 Comprehensive treatment of ADHD......Page 245
14.4 Behavioural interventions in the home......Page 248
14.5 Behavioural interventions in the school......Page 250
14.6 Child-focused interventions......Page 252
14.7 Medication......Page 254
14.8 Discussion......Page 256
14.9 REFERENCES......Page 257
15 Children with developmental
disabilities and their parents......Page 260
15.1 Definition......Page 261
15.2 Important components of cognitive behavioural psychotherapy......Page 262
15.3 Cognitive deficiencies versus cognitive distortions......Page 263
15.4 The cognitive triad......Page 266
15.5 The functional analysis......Page 268
15.6 Logical errors......Page 269
15.7 Cognitive techniques......Page 270
15.8 Attributional style......Page 271
15.9 Bereavement and chronic sorrow......Page 273
15.10 Specific evaluations and evidence of effectiveness......Page 274
15.12 REFERENCES......Page 275
16 Depressive disorders......Page 279
16.1.2 Cognitive models of depression in young people......Page 280
16.2 Therapist stance......Page 282
16.3.2 A typical CBT programme......Page 283
16.5.1 Developmental stage......Page 285
16.6.1 Assessment, goal setting and initial formulation......Page 286
16.6.2 Education and engagement of the child and family......Page 287
16.7 Core cognitive techniques......Page 288
16.8 Core behavioural techniques......Page 289
16.9.2 Patient factors......Page 290
16.11 The evidence base......Page 291
16.13 Acknowledgements......Page 292
16.14 REFERENCES......Page 293
17.1 Introduction......Page 297
17.2 Assessment......Page 298
17.2.1 CY-BOCS......Page 299
17.2.5 Children's Depression Inventory (CDI)......Page 300
17.3.1 Overview......Page 301
17.3.2.1 EX/RP......Page 302
17.3.2.4 Modelling and shaping......Page 303
17.3.3 A typical CBT protocol......Page 304
17.3.3.1 Course of initial treatment......Page 306
17.4.1 Empirical studies......Page 307
17.4.1.3 Durability......Page 308
17.4.1.5 Availability, acceptability and tolerability......Page 309
17.4.2 Modifiers of treatment outcome......Page 310
17.5.2 Comparative treatment trial......Page 311
17.6 Summary......Page 312
17.8 REFERENCES......Page 313
18.1 Diagnosis......Page 316
18.3 Aetiology and maintenance of child anxiety......Page 317
18.4 Integrative model for the development of anxiety......Page 319
18.5 Treatment outcome......Page 320
18.5.1 Parents in treatment......Page 321
18.5.2 Are CBT interventions for child anxiety effective in the long term?......Page 322
18.6.1 Programme structure......Page 323
18.6.2.2 Realistic or detective thinking......Page 324
18.6.2.3 Graded exposure (‘stepladders’)......Page 326
18.6.2.4 Parent management......Page 328
18.7.1 Alison (separation anxiety, specific phobia)......Page 329
18.7.2 Michael (generalized anxiety disorder and social phobia)......Page 331
18.8 REFERENCES......Page 333
19.1 Introduction......Page 336
19.2 Phenomenology......Page 337
19.4 Assessment......Page 338
19.4.1 Clinical behavioural interviews and behavioural observations......Page 340
19.4.3 Self-report measures and self-monitoring......Page 341
19.4.5 Review of attendance record......Page 342
19.4.7 Integration of assessment information......Page 343
19.5 Treatment......Page 344
19.5.1.1 Initial phase with the young person......Page 345
19.5.1.3 Concluding sessions with the young person......Page 348
19.5.2.1 Initial phase with the parents......Page 349
19.5.2.2 Implementation phase with the parents......Page 350
19.5.2.4 School-based strategies for facilitating attendance......Page 351
19.7 Acknowledgements......Page 353
19.8 REFERENCES......Page 354
20.1 Post-traumatic stress reactions in children and adolescents......Page 358
20.2 The incidence and prevalence of PTSD in children......Page 360
20.3 Behavioural and cognitive accounts of PTSD......Page 361
20.4 Assessing PTSD in children and adolescents......Page 363
20.5 Treatment......Page 365
20.6 Efficacy of treatment......Page 367
20.8 REFERENCES......Page 369
21.1 Introduction......Page 375
21.3.1 Bulimia nervosa......Page 376
21.4 A cognitive model of eating disorders in adolescence......Page 377
21.4.1 Development of eating disorders......Page 378
21.4.2.1 Individual emotional factors......Page 380
21.4.2.4 Social factors......Page 381
21.5 Assessment......Page 382
21.6.1 The phases of treatment and the role of the family......Page 383
21.6.2.1 Phase 1......Page 384
21.6.2.2 Phase 2......Page 385
21.6.3.1 Phase 1......Page 391
21.6.3.2 Phase 2......Page 392
21.6.3.3 Phase 3 – relapse prevention......Page 393
21.6.5 Case illustration......Page 394
21.8 Conclusion and implications for research......Page 395
21.10 REFERENCES......Page 396
22.1 Introduction......Page 401
22.3 Clinical description......Page 402
22.5 Medical management......Page 403
22.6.1 Predisposing and precipitating factors......Page 404
22.6.2 Perpetuating factors......Page 405
22.7 A rehabilitation programme based on CBT......Page 406
22.8 Assessment......Page 407
22.10 Rationale for treatment......Page 408
22.11 Structure......Page 409
22.14 Modifying negative and unhelpful thinking......Page 410
22.16 Tackling psychosocial problems......Page 411
22.18 Facilitating change......Page 412
22.20 REFERENCES......Page 413
23.1 Factors that influence children's social competence......Page 418
23.2 What is SST?......Page 419
22.3.1 Outcome measure......Page 421
22.3.3 Age......Page 422
23.3.4.1 Rejected children......Page 423
23.3.4.2 Social phobia......Page 424
22.3.5 Summary......Page 425
23.4.2 Deficiencies in programming for generalization......Page 426
23.5 Assessment of children's interpersonal functioning......Page 427
23.5.2.1 Behavioural observation......Page 428
23.5.2.3 Interviews......Page 429
23.5.4 Modelling and contingency management problems......Page 430
23.5.6 Summary......Page 431
23.6.2.1 Information and discussion......Page 432
23.6.2.5 Training outside the therapeutic environment......Page 433
23.6.3 Changing maladaptive cognitions......Page 434
23.6.3.3 Step 3: replace unhelpful thoughts with helpful thoughts......Page 435
23.6.4.3 Step 3: solve......Page 436
23.7 Conclusions......Page 437
23.8 REFERENCES......Page 438
24.2 Why CBT works in pain relief......Page 442
24.3.1 Distraction......Page 443
24.3.1.1 Case illustration......Page 444
24.3.2 Hypnosis......Page 445
24.4 Headaches......Page 446
24.4.2 Progressive muscle relaxation......Page 448
24.4.3 Case illustration......Page 449
24.5 Recurrent abdominal pain......Page 450
24.6 Fibromyalgia......Page 451
24.6.1 Case illustration......Page 453
24.7 Evidence for effectiveness......Page 454
24.9 REFERENCES......Page 455
25.1 Conduct disorder......Page 459
25.2 Comorbidity......Page 460
25.3.1 Child factors......Page 461
25.3.2 Family factors......Page 462
25.3.3 Peer and community factors......Page 463
25.4.1.1 Problem-solving skills training (PSST)......Page 464
25.4.1.2 Anger Coping and Coping Power Programmes......Page 465
25.4.2.1 Multisystemic therapy......Page 466
25.4.2.2 Functional Family Therapy......Page 467
25.4.2.3 Adolescent Transitions Programme......Page 468
25.4.2.4 Multidimensional Treatment Foster Care......Page 469
25.5 Summary and implications......Page 470
25.6 Acknowledgements......Page 471
25.7 REFERENCES......Page 472
26.1 Introduction......Page 475
26.2 Principles of CBT in substance use disorders......Page 476
26.3 Rationale for CBT in adolescent substance use disorders......Page 477
26.4 Assessment......Page 479
26.5.1 Theoretical model......Page 480
26.5.1.1 Case example......Page 481
26.5.2 Interventions......Page 482
26.5.2.3 Enhancing social support......Page 484
26.5.2.4.1 Example......Page 485
26.5.2.5 Management of negative affective states, urges or craving......Page 486
26.5.2.6 Relapse prevention......Page 487
26.6.1 Developmental factors unique to adolescence......Page 488
26.6.2 Developing a collaborative relationship in therapy......Page 489
26.6.3 Homework assignments......Page 490
26.7 Conclusions and recommendations......Page 491
26.8 REFERENCES......Page 492
Part VI: CBT applications in preventive interventions......Page 495
27.1 The early starter developmental pathway for serious CP......Page 497
27.2 Treatment versus prevention of CP......Page 498
27.3 Identification and screening......Page 499
27.4 Illustrative preventive interventions......Page 501
27.4.1.1.1 Elmira Home Visitation Project......Page 502
27.4.2.1.1 PATHS......Page 505
27.4.2.2.2 Seattle Social Development Project (SSDP)......Page 506
27.4.2.2.4 Linking the interests of families and teachers (LIFT)......Page 507
27.4.2.3 Core Programme Against Bullying and Antisocial Behaviour......Page 508
27.4.4 A multi-component, long-term preventive intervention: fast track......Page 509
27.5.1 Mechanisms of effectiveness......Page 510
27.5.2 Iatrogenic effects......Page 511
27.5.4 Economic analyses......Page 512
27.6 Conclusions......Page 513
27.8 REFERENCES......Page 514
Index......Page 521