Overview of CBT Teaching, D Clin Psy, University of Exeter Convenor: Dr Kim Wright ([email protected])

2014 intake: Updated August 2016 Overview Overall learning objectives:  To attain a good understanding of the theory and evidence base underpinning Cognitive Behavioural therapeutic approaches, including its strengths and limitations.  To become familiar with core therapeutic techniques used across and within different problem areas and client groups, and to attain a basis for developing competence in these through the clinical practice elements of the programme.  To gain an appreciation of the place of cognitive behavioural therapy within the practice of Clinical Psychology.  To develop an awareness of areas for individual professional development within cognitive behavioural understanding and practice, both during training and post qualification.

The CBT teaching spans approximately 47 centrally taught sessions across the DClinPsy programme, with an additional 6 unfacilitated study sessions. In addition, CBT is covered within sessions that form part of other teaching strands.

The content of the sessions is informed by the British Psychological Society competencies for doctoral programmes in Clinical Psychology, the UCL CBT competencies frameworks, the IAPT high intensity curriculum and emerging SMI curricula and the Health Professions Council Standards of Proficiency.

The present curriculum aims to provide coverage of basic and specific competencies, with generic competencies being covered by both the CBT strand and teaching provided within the Psychological Therapies strand (Core Skills sessions) as well as the Reflective Organisational Practice strand. The CBT strand provides some coverage of the problem-specific competencies. Some elements of the problem- specific competencies are covered in other strands (such as the Adult strand), whilst some teaching on client-group specific CBT work is covered in lifespan strands (for example, using CBT when working with people with learning difficulties). Where applicable, the generic, basic, specific and problem-specific competencies addressed by each session are listed in the session descriptions below. In addition, where applicable the items from the IAPT high intensity curriculum covered by each session are listed in the session descriptions below.

The structure and delivery of the CBT teaching is informed by the requirements of the BABCP for individual accreditation as a CBT practitioner, and we provide trainees with a substantial proportion of the taught hours required by BABCP for accreditation as a CBT practitioner on an individual level. In keeping with the criteria for accreditation with BABCP, the majority of our teaching is skills-based. We note that additional requirements for individual-level accreditation specify hours of supervised practice and completed cases. Whilst this cannot be provided by the taught element of the DClinPsy course, trainees wishing to pursue secondary accreditation are encouraged to develop a portfolio of relevant clinical experience through placement- based activities with CBT practitioners.

Core Text: Westbrook, D., Kennerley, H. & Kirk, J. (2011). An introduction to Cognitive Behavioural Therapy: Skills and applications. London: Sage. [in library]

Key supporting texts: Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford. Beck, J.S. (2005). Cognitive therapy for challenging problems. New York: The Guilford Press. Beck, J. S. (2011). Cognitive therapy: Basics and beyond. New York: Guilford. [in library] Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M. & Westbrook, D. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press. Friedberg, R.D. and McClure, J. M. (2015) Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts (2nd Edition). The Guildford Press. Fuggle, P., Dunsmuir, S., & Curry, V. (2013). CBT with children, young people and their families. London: Sage. Kuyken, W., Padesky, C.A. & Dudley, R. (2009). Collaborative case conceptualization. New York: The Guilford Press. Laidlaw, K. (2014) CBT for older people: an introduction. London: SAGE Publications Ltd. Leahy, R.L., Holland, S.J. & McGinn, L.K. (2011). Treatment plans for anxiety and depression, second edition. New York: The Guilford Press. Padesky, C.A. & Greenberger, D. (2015). Mind over mood (2nd Edition). New York: The Guilford Press. Reinecke, M A., Datillio, F. M. and Freeman, A. (Eds) (2006) Cognitive therapy for children and adolescents (2nd Edition). The Guildford Press Stenfert Kroese, B., Dagnan, D. & Loumidis, K. (1997). Cognitive-Behaviour Therapy for people with learning disabilities. Routledge. Whittington, A. & Grey, N. (2014). How to become a more effective CBT therapist: Mastering metacompetence in clinical practice. Chichester, U.K.: Wiley Blackwell.

Please note: the content and ordering of some sessions may change * denotes a session that is typically delivered on an individual locality basis. All other sessions are centrally delivered.

The following BPS doctoral competencies apply across the curriculum: GMC 2, GMC 4, PI 2, PI 3. Session-specific BPS and IAPT competencies are listed below.

YEAR 1 An introduction to the CBT model and evidence base Learning Objectives:  An understanding of the history and development of CBT  Familiarity with cognitive and behavioural models of psychological distress  An introductory-level awareness of the evidence base underpinning cognitive and behavioural models  Knowledge of the general structure of a course of CBT  An awareness of the rationale for CBT as this might be explained to and understood by clients CBT competencies: Generic:  Knowledge of a model of therapy, and the ability to understand and employ the model in practice  Ability to foster and maintain a good therapeutic alliance, and to grasp the client’s perspective and ‘world view’  Knowledge of basic principles of CBT and rationale for treatment  Ability to explain and demonstrate rationale for CBT to client IAPT High intensity curriculum items covered: F1, F7 Includes skills-based practice

Assessment, measurement and goal-setting Learning Objectives:  An appreciation of the rationale for conducting assessment within the CBT approach, including its contribution to the improvement of therapy and service delivery and to the therapeutic relationship  An understanding of the key elements of initial assessment within a CBT approach  An awareness of a range of assessment / measurement tools commonly used within CBT  An understanding of the purpose, process and collaborative nature of goal- setting within CBT CBT competencies: Generic:  Ability to foster and maintain a good therapeutic alliance, and to grasp the client’s perspective and ‘world view’  Ability to undertake generic assessment (relevant history and identifying suitability for intervention) Basic:  Ability to implement CBT using a collaborative approach  Ability to agree goals for the intervention  Ability to use measures and self monitoring to guide therapy and to monitor outcome Specific:  Ability to develop formulation and use this to develop treatment plan / case conceptualisation IAPT High intensity curriculum items covered: F3,F7,F8,F10,A5,D5,D6,D10,D11 BPS competencies covered: PA 2, E 1, E 2. Includes skills-based practice

Assessment and Formulation with young people (2 sessions) Learning Objectives:  An appreciation of how the needs of younger clients impact upon the process of assessment and formulation within CBT  Knowledge of methods by which the assessment and formulation processes can be adapted to best meet the needs of younger clients  Knowledge of appropriate assessment tools / outcome measures for work with younger clients IAPT High intensity curriculum items covered: F3,F7,F8,F10,A5,D5 BPS competencies covered: PA 2, E 1, PF 1, PF 5.

Basic Skills in CBT (2 sessions) Learning Objectives:  An awareness of the nature and role of core skills in CBT  An understanding of the basic structure of a session of CBT

CBT competencies: Basic:  Ability to implement CBT using a collaborative approach  Knowledge of basic principles of CBT and rationale for treatment  Sharing responsibility for session structure & content  Ability to adhere to an agenda  Ability to plan and to review practice assignments (‘homework’)  Using summaries and feedback to structure the session Specific:  Guided discovery & Socratic questioning IAPT High intensity curriculum items covered: F7,F9 Includes skills-based practice

CBT Interventions with young people (2 sessions) Learning Objectives:  Knowledge of the epidemiology and presentation of common mental health problems within young people  An understanding of issues in the use of CBT that are specific to working with younger clients  Awareness of means of adapting CBT for work with younger clients IAPT High intensity curriculum items covered: A2,A5,D1,D5,D9 BPS competencies covered: PI 1, PF1, PF 8.

Working with parents within CBT Learning Objectives:  An awareness of how parents and the family are accounted for within Cognitive Behavioural approaches to work with younger clients  An understanding of the role of parents within Cognitive Behavioural interventions with younger clients  Knowledge of means by which the process of CBT can be adapted to take into account the role of parents BPS competencies covered: PI 1

Phobias and exposure (2 sessions) Learning Objectives:  Knowledge of the principles underlying behavioural models of anxiety  Knowledge of the symptoms, phenomenology and epidemiology of phobias  Knowledge of the main cognitive and behavioural model of phobias and phobic avoidance  Familiarity with the technique of graded exposure and means of introducing and using this techniques collaboratively with clients  Familiarity with the techniques of identifying and challenging cognitions maintaining phobias CBT competencies: Basic:  Knowledge of basic principles of CBT and rationale for treatment Specific:  Exposure techniques

Problem-Specific:  Phobias assessment  Phobias intervention IAPT High intensity curriculum items covered: A1,A5 BPS competencies covered: PI 1, PF 2, PF8 Includes skills-based practice

CBT with people with learning difficulties (1 locality and 1 central session) Learning Objectives:  An appreciation of how the needs of clients with learning difficulties impact upon the application of CBT, including the formulation stage  Knowledge of methods by which formulation and intervention within CBT can be adapted to best meet the needs of clients with learning difficulties BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Introduction to CBT for depression* Learning Objectives:  Knowledge of the epidemiology and presentation of depression  Familiarity with a key cognitive model of depression  Familiarity with the evidence base for the cognitive model  An awareness of the key factors to take into account in the assessment of depression CBT competencies: Problem-Specific:  Depression knowledge  Depression Assessment IAPT High intensity curriculum items covered: D1,D2,D3,D4,D5,D7,D10,D14,D16 BPS competencies covered: PI 1

Relapse prevention and endings Learning Objectives:  Knowledge of the role of relapse prevention with CBT  Familiarity with techniques to assist relapse prevention  An awareness of how endings in therapy are approached within CBT CBT competencies: Generic:  Ability to manage endings Basic:  Ability to end therapy in a planned manner, and to plan for long-term maintenance of gains after treatment IAPT High intensity curriculum items covered: A5,D9,D15 BPS competencies covered: PI 5 Includes skills-based practice

Applied Relaxation* Learning Objectives:  An understanding of the roles of applied relaxation and applied tension within CBT  Familiarity with the techniques of applied relaxation and applied tension CBT competencies: Specific:  Applied relaxation and applied tension IAPT High intensity curriculum items covered: A5 BPS competencies covered: PI 1 Includes skills-based practice

Safety and Coping* Learning Objectives:  Knowledge of the nature and role of safety behaviours within cognitive models  An understanding of how a CBT practitioner would work with safety behaviours  An understanding of the need to balance reduction of safety behaviours with retention of adequate means of coping within CBT CBT competencies: Specific:  Ability to identify and work with safety behaviours IAPT High intensity curriculum items covered: A5

CBT for Panic Disorder (2 sessions) Learning Objectives:  Knowledge of the presentation and epidemiology of panic disorder  Knowledge of a key cognitive model of panic disorder  Familiarity with key techniques used in working with individuals with panic disorder from a CBT perspective CBT competencies: Problem-Specific:  Panic: Clark knowledge  Panic: Clark assessment  Panic: Clark intervention IAPT High intensity curriculum items covered: F1,A1,A2,A5,A6,A8,A9,A10,A11 BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice Activity Scheduling & Problem Solving Learning Objectives:  An understanding of the role of activity scheduling within CBT  Familiarity with the techniques of activity scheduling  An understanding of the roles of problem-solving techniques within CBT  Familiarity with problem-solving techniques and the introduction and use of these techniques with clients CBT competencies: Basic  Problem-solving Specific:  Activity monitoring and scheduling IAPT High intensity curriculum items covered: A5, D9,D15 BPS competencies covered: PI 1 Includes skills-based practice

CBT for depression: Working with Cognitive Products Learning Objectives:  Knowledge of the nature and role of cognitive products within Beck’s cognitive model of depression  Familiarity with techniques for working with cognitive products CBT competencies: Problem-Specific (High intensity Intervention: Beck – Cognitive Therapy):  Depression knowledge  Depression Assessment  Depression Intervention IAPT High intensity curriculum items covered: D9,D15 BPS competencies covered: PI 1 Includes skills-based practice Working with Conditional Assumptions Learning Objectives:  An understanding of the concept of conditional beliefs within the cognitive model  Familiarity with techniques for identifying and modifying conditional beliefs within CBT CBT competencies: Problem-Specific:  Depression: intervention IAPT High intensity curriculum items covered: D9,D15 BPS competencies covered: PI 1, PI 5 Includes skills-based practice

YEAR 2 Working with Core Beliefs Learning Objectives:  An understanding of the concept of core beliefs within the cognitive model  Familiarity with techniques for identifying and modifying core beliefs within CBT CBT competencies: Specific:  Ability to identify and help client modify core beliefs Problem-Specific:  Depression: intervention IAPT High intensity curriculum items covered: D9,D15 BPS competencies covered: PI 1, PI 5 Includes skills-based practice

Using Key Skills from Dialectical Behavioural Therapy (DBT) in Clinical Practice Learning Objectives:  Familiarity with some of the main transferable techniques and concepts used in DBT, as well as the theory and evidence base underpinning their use.  Awareness of the clinical situations in which it might be appropriate to use these techniques and concepts. BPS competencies covered: PI 1

Using Mindful Awareness in Clinical Practice of CBT Learning Objectives:  Familiarity with the concept of mindful awareness, and techniques that can be used to encourage this.  Knowledge of the evidence base for the use of mindful awareness as a standalone technique.  Awareness of the clinical situations in which it might be appropriate to use mindful awareness. BPS competencies covered: PI 1

Using compassion work in Clinical Practice of CBT Learning Objectives:  Familiarity with the concept of compassionate mind, and techniques that can be used to encourage this.  Knowledge of the evidence base for the use of compassion-based approaches and techniques.  Awareness of the clinical situations in which it might be appropriate to use compassion-based techniques. BPS competencies covered: PI 1

CBT and complexity (2 locality and 2 central sessions) Learning objectives:  An awareness of some of the issues involved in using CBT with clients with multiple difficulties.  Familiarity with principles commonly used by CBT therapists in working with clients with multiple difficulties.  An awareness of how evidence based practice may be maintained whilst working with clients with multiple difficulties.  An awareness of how CBT therapists can maintain the therapeutic relationship in the face of difficulties.  An understanding of how the therapeutic relationship can be used as a therapeutic tool within CBT. IAPT High intensity curriculum items covered: F13 BPS competencies covered: GMC 4 Includes skills based practice

CBT for psychosis (2 sessions) Learning Objectives:  Knowledge of the presentations and epidemiology of psychosiss  Knowledge of a key cognitive model of the positive symptoms of psychosis  Familiarity with key techniques used in working with individuals with psychosis from a CBT perspective  An awareness of particular adaptations to the standard CBT approach when working with individuals with psychosis BPS competencies covered: PI 5 Includes skills-based practice

CBT for Bipolar Disorder (2 sessions) Learning Objectives:  Knowledge of key biobehavioural and cognitive models of bipolar disorder  Familiarity with key therapeutic techniques used across therapy modalities with individuals with Bipolar Disorder, including detection and management of early warning signs.  Familiarity with key techniques used in working with individuals with bipolar disorders from a CBT perspective BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice Group Work and Psychoeducation Groups in CBT Learning Objectives:  Familiarity with the key principles in working with groups from a CBT perspective.  Knowledge of the evidence base for group based approaches in CBT.  Knowledge of the evidence base for psychoeducational groups for people with Bipolar Disorder.  Familiarity with the key components of psychoeducation groups for people with Bipolar Disorder. BPS competencies covered: PI 1 Includes skills-based practice

CBT for Social Phobia (2 sessions) Learning Objectives:  Knowledge of the presentation and epidemiology of social phobia  Knowledge of a key cognitive model of social phobia  Familiarity with key techniques used in working with individuals with social phobia from a CBT perspective CBT competencies: Problem-Specific:  Social phobia: Clark & Wells basic competencies  Social phobia: Clark & Wells assessment  Social phobia: Clark & Wells intervention IAPT High intensity curriculum items covered: F1,A1,A2,A5,A6,A8,A9,A10,A11 BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

CBT for Generalised Anxiety Disorder (GAD) (2 sessions) Learning Objectives:  Knowledge of the presentation and epidemiology of GAD  Knowledge of a key cognitive model of GAD  Familiarity with key techniques used in working with individuals with GAD from a CBT perspective CBT competencies: Problem-specific: IAPT High intensity curriculum items covered: F1,A1,A2,A5,A6,A8,A9,A10,A11 BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

CBT for Obsessive Compulsive Disorder (OCD) (2 sessions) Learning Objectives:  Knowledge of the presentation and epidemiology of OCD  Knowledge of a key cognitive model of OCD  Familiarity with key techniques used in working with individuals with OCD from a CBT perspective CBT competencies: Problem-specific:  OCD knowledge  OCD assessment  OCD intervention IAPT High intensity curriculum items covered: F1,A1,A2,A5,A6,A8,A9,A10,A11 BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

CBT for eating disorders (2 sessions) Learning Objectives:  Knowledge of the presentation and epidemiology of eating disorders  Knowledge of a key cognitive model of eating disorders  Familiarity with key techniques used in working with individuals with eating disorders from a CBT perspective BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Combined psychological therapies teaching sessions:

Year 2 Two days: Advanced Formulation Skills CBT Learning Objectives:  An understanding of both longitudinal and maintenance models of psychological distress from a CBT perspective  An awareness of what about formulation is specific to CBT and what is shared with other perspectives  An understanding of how formulation can be used in individuals presenting with complex difficulties CBT competencies Basic:  Ability to devise maintenance cycles and use this to set targets Specific  Ability to develop formulation and use this to develop treatment plan / case conceptualisation IAPT High intensity curriculum items covered: F3,F7,A5,D5 BPS competencies covered: PF 4, PF 6, PF 7 Includes skills-based practice

Year 3

Dialectical Behaviour Therapy (DBT) (two sessions) Learning objectives:  Knowledge of the theoretical background to DBT  Knowledge of the evidence base for DBT  Familiarity with the general therapeutic approach and philosophy used in DBT  Familiarity with key components of DBT  Awareness of the place of DBT within the role of a Clinical Psychologist working with client groups to whom it is relevant, and the further training necessary to practice competently in DBT BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Mindfulness Based Cognitive Therapy (MBCT) (two sessions) Learning objectives:  Knowledge of the theoretical background to MBCT  Knowledge of the evidence base for MBCT  Familiarity with the general therapeutic approach and philosophy used in MBCT  Familiarity with key components of MBCT  Awareness of the place of MBCT within the role of a Clinical Psychologist working with client groups to whom it is relevant, and the further training necessary to practice competently in MBCT BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Acceptance and Commitment Therapy (ACT) (two sessions) Learning objectives:  Knowledge of the theoretical background to ACT  Knowledge of the evidence base for ACT  Familiarity with the general therapeutic approach and philosophy used in ACT  Familiarity with key components of ACT  Awareness of the place of ACT within the role of a Clinical Psychologist working with client groups to whom it is relevant, and the further training necessary to practice competently in ACT BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Compassion Focussed Therapy (CFT) (two sessions) Learning objectives:  Knowledge of the theoretical background to CFT  Knowledge of the evidence base for CFT  Familiarity with the general therapeutic approach and philosophy used in CFT  Familiarity with key components of CFT  Awareness of the place of CFT within the role of a Clinical Psychologist working with client groups to whom it is relevant, and the further training necessary to practice competently in CFT BPS competencies covered: PI 1, PF 1, PF 8 Includes skills-based practice

Additional Year 3 workshop tbc