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Penn Psychiatry Perspective ISSUE THREE March 2013 Volume 2, Issue 3 PENN PSYCHIATRY PERSPECTIVE Perelman School of Medicine at the University of Pennsylvania | Department of Psychiatry Ask the Expert Ideas, Suggestions, Dr. Cory Newman talks about CBT in advance of his PBHMind course. and News! In this “Ask the Expert” feature, Cory F. Pennsylvania. He is a Diplomate of the Newman, PhD answers questions about key American Board of Professional Psychology We welcome your ideas, elements of Cognitive-Behavioral Therapy and a Founding Fellow of the Academy of suggestions, and news about your (CBT) to help mental health professionals Cognitive Therapy. Dr. Newman is a highly activities for stories or better understand active therapist and clinical supervisor, and announcements in Penn Psychiatry this very effective lecturer. He has served both as a Perspective, the eNewsletter of the evidence-based protocol therapist and a protocol supervisor University of Pennsylvania therapy and help in a number of large-scale psychotherapy Department of Psychiatry. Our goal them implement it outcome studies, including the National is to offer useful and interesting with patients. Institute on Drug Abuse Multi-site news to readers and highlight our Collaborative Study on Psychosocial many outstanding faculty, Dr. Newman will Treatments for Cocaine Abuse, and the programs, and services. Please cover these and Penn-Vanderbilt-Rush Treatment-of- submit your recommendations to many related Depression Project, among others. [email protected]. topics in a two-day PBHMind Dr. Newman is an international lecturer, Dwight L. Evans, MD Symposium to be held on April 5-6, 2013 having presented scores of CBT workshops Ruth Meltzer Professor and Chair – “Fundamentals of Cognitive-Behavioral and seminars across North America, as well Therapy for Depression, Anxiety, and Anger.” as in South America, Europe, and Asia. He Designed for psychologists, social workers, is the lead author on dozens of articles and therapists, psychiatrists, and other mental chapters on CBT on a wide range of healthcare practitioners, Dr. Newman’s topics, including mood disorders and PBHMind Symposium is appropriate for suicide, personality disorders, substance In this Issue early-career clinicians and as well as those abuse, and the therapeutic relationship. at any level of professional experience who He has authored or co-authored five wish to familiarize themselves with the books on CBT, including the recently Ask the Expert.......1 released volume, Core Competencies in essentials of CBT. For more information about this Symposium and details on Cognitive-Behavioral Therapy: Becoming a Cory F. Newman, PhD answers location, times, and registration, please visit Highly Effective and Competent Cognitive- questions about key elements of - http://www.pbhmind.com/cognitive- Behavioral Therapist. Dr. Newman’s honors Cognitive-Behavioral Therapy (CBT). include the Earl Bond award for therapy-symposium-13. The last day to register is Friday, March 29th, 2013. outstanding mentoring and training of News and Announcements....4 Psychiatry Residents and Fellows, the 5th Dr. Newman is the Director of the Center annual Penn Psychotherapy Professorship Upcoming Events.............................4 for Cognitive Therapy and Professor of Award for clinical expertise, and inclusion Psychology in Psychiatry at the Perelman in Philadelphia Magazine’s “Best Therapists” School of Medicine at the University of lists. The Department of Psychiatry at Penn has been a leader in the development Of of psychotherapeutic approaches. Dr. Aaron T. Beck developed CBT and Dr. www.med.upenn.edu/psych Note Edna Foa discovered prolonged exposure therapy, a form of CBT, to treat PTSD. Page 2 Ask the Expert Ask the Expert - Q&A Continued from page 1 What are the factors that have enabled cognitive-behavioral highly effective CBT practitioners stay emotionally composed therapy (CBT) to garner so much empirical support for its and try to work out their differences with their patients with efficacy? an air of good will, and with the use of constructive problem- solving. The therapists also try to conceptualize what caused The basics of CBT are grounded in principles of learning the strain or rupture in the therapeutic relationship, as this may (including social learning theory and human information provide important information about the patients’ schemas processing) that have had a firm empirical basis for decades. (core beliefs), about how the patients process interpersonal Using these principles of learning, competent CBT clinicians information, and how well they connect with others. Effective conceptualize their patients’ problems CBT therapists value working to and strengths, understanding how past improve their own interpersonal skills, experience has taught them to enact a so that they minimize episodes of certain repertoire of behaviors, to think sounding unduly demanding, in certain ways, and to experience a defensive, or critical, and maximize range of emotions in given situations. their ability to communicate a desire to Then, using positive social collaborate constructively in treatment, reinforcement and differential feed- even when (perhaps especially when) back, therapists teach their patients the therapist and patient are struggling a broader repertoire of cognitive and for answers. behavioral skills, toward the goals of greater adaptive functioning and a Please summarize some of the ways higher psychological quality of life. in which the methods of behavioral This individualized approach to human activation (BA) and rational functioning is combined with research responding (RR) help clinically on general areas of psychopathology depressed patients make significant (e.g., mood disorders, anxiety disorders, eating disorders, improvements in their functioning and quality of life. addictions, psychosis), such that CBT is adapted to meet the clinical needs of different diagnostic groups of patients, Arguably, behavioral activation and rational responding are the leading to the development of many CBT protocols that are cornerstone categories of clinical techniques in CBT for tailor made for each clinical problem area. CBT comes from depression. Behavioral activation is comprised of methods to a strong empirical tradition, thus it is routinely subjected to help patients to increase their active involvement in life by empirical tests, leading to increasingly better understanding doing things that give them more of a sense of purpose, of patients and their therapeutic needs, and ongoing advance- accomplishment, and enjoyment. Many depressed patients are ments in what CBT therapists need to provide to be most quite inactive, keeping to themselves, feeling lethargic, helpful. CBT is not static. It is continually developing as the anhedonic and under-stimulated, and thus not getting much field’s knowledge base grows. out of life, which maintains their sense of helplessness and hopelessness. CBT therapists encourage their patients to What are the key elements to a successful therapeutic generate ideas for becoming more active, step by step, even relationship? if they don’t “feel like it” at first, because “sometimes actions create a better mood.” When these patients begin to schedule As with any form of talk therapy, establishing a positive, healthy and take part in more activities (which can be as mundane and therapeutic relationship in CBT starts with the therapist basic as just taking a shower, getting dressed, and getting being a good, attentive listener who gives empathic feedback. outside for a bit), they begin to feel more of a sense of self- The therapist treats the patient as an individual (not just as a respect and empowerment, and they elicit more positive diagnostic category), such as by taking the time to learn about responses from their environment, which combat the sense of the patient’s personal history, and by showing an interest in inertia and emptiness that otherwise reinforce the depression. understanding the patient’s concerns, hopes, fears, and other Rational responding involves teaching patients to use their aspects of his or her daily life and internal world. However, the emotions as cues to identify what they are thinking that might real test of CBT therapists’ skill in creating and maintaining a be reinforcing their pessimism and low self-image. Rather than successful therapeutic relationship is in how they handle the taking these thoughts at face value, CBT therapists note that rough patches in treatment, such as when therapist and patient these are the patients’ hypotheses about themselves, their life, disagree about the diagnosis or treatment plan, or have a and their future, and that these hypotheses warrant being misunderstanding, especially when the patient is particularly evaluated for their validity and/or utility. CBT practitioners sensitive to feeling invalidated, controlled, or rejected. Here, www.med.upenn.edu/psych Penn Psychiatry Perspective - March 2013 Page 3 Ask the Expert Continued from page 2 Ask the Expert - Q&A teach their patients to ask themselves a sense of self-efficacy through active but the way you are expressing them series of questions to stimulate a more exposures and coping. may not be working out so well for you flexible repertoire of thinking patterns and others”). (i.e., to become less black-and-white; How is CBT adapted to deal with more based on objective, concrete patients who exhibit significant anger What are some of the keys to evidence; more oriented toward problems?
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