In the past decade, research from randomized clinical trials has produced strong and consistent evidence showing that cognitive-behavioral therapy (CBT) can play an important role in reducing social phobia, separation anxiety and generalized anxiety disorder (GAD) in children and adolescents (see Silverman and Berman [2001] for … Specific CBT techniques may focus on a single factor or may deliberately target multiple factors. In this case, the thought is, “I feel so awkward at … Usually, a parent or caregiver, the child, and a therapist will discuss goals and develop a treatment plan. Each child or adolescent will have a unique mix of factors implicated in the development of his/her anxiety and/or depressive disorder. Chosen specific CBT skills are indicated by numerical indicators. Once the model has been selected, the therapist should attach relevant evidence gathered during assessment to each aspect of the model. As can be seen, a picture emerges from the idiographic model of what is causing and maintaining the presenting problem for the individual. Cognitive-Behavioral Therapy for Anxiety Disorders Cognitively Focused Treatment Example of an adult thought record A sample goal, complete with standards that guide the formation of the treatment plan. Theoretically driven, context-aware case formulation Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions. Cognitive restructuring or reframing. Identify the negative thought. Reduce anxiety and improve coping skills. Consequently the amount of emphasis given to a particular skill within a treatment plan must also vary. In module-based manuals that provide greater flexibility, or in situations where the therapist is working within a general CBT framework, the sequence of selected techniques will be guided by the manual’s clinical algorithms (e.g., Chorpita 2007) or will be inferred from the direction and strength of relationships between factors identified in the case formulation. The case-formulation approach has also been shown to improve some aspects of the therapeutic alliance (Chadwick, Williams, and Mackenzie 2003); and client acceptance of a treatment rationale – one aspect of the case formulation – is related to good treatment outcome (see, e.g., Addis and Jacobson 2000). Consequently the amount of emphasis given to a particular skill within a treatment plan must also vary. In module-based manuals that provide greater flexibility, or in situations where the therapist is working within a general CBT framework, the sequence of selected techniques will be guided by the manual’s clinical algorithms (e.g., Chorpita 2007) or will be inferred from the direction and strength of relationships between factors identified in the case formulation. 2011). endstream The case-formulation approach has also been shown to improve some aspects of the therapeutic alliance (Chadwick, Williams, and Mackenzie 2003); and client acceptance of a treatment rationale – one aspect of the case formulation – is related to good treatment outcome (see, e.g., Addis and Jacobson 2000). Following thorough assessment, the therapist should select the nomothetic model that is appropriate for the presenting individual, his/her family, and the organizational setting in which treatment is being offered. 6. These strengths should be added to any written or visual representation of the case formulation in a way that emphasizes their importance – for example they can be added to the outer layer of the contextual–idiographic model. Adapted from Figure 8.2, which was adapted from Rapee (2001) and Hudson and Rapee (2004). Anxiety. Sequencing selected specific CBT techniques Diagnosis: Axis I: Generalized Anxiety Disorder, 300.02 (Active) Axis II: None V71.09 Axis III: See Medical History Axis IV: None Axis V: 60 Current Psychotropics: Paxil 10 mg PO QAM Buspirone 10 mg PO QAM Ambien CR 6.25 mg … This book is intended as a practical guide for clinicians who wish to use Cognitive Behavioral Therapy for Depression (CBT-D) with Veterans. These influences can be described within a written case formulation or, if a visual representation of the case formulation is preferred, displayed on the idiographic model as contextual layers that surround the issues identified in the model. Each of these processes is described below. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Surprisingly, though, there has been minimal research on the clinical utility and accuracy of case formulations and subsequent treatment plans, particularly with regard to child and adolescent populations. Treatment Plan Objectives ‣Focus on what needs to change to meet goals •What barriers and challenges need to be addressed •Identify a lack of resources Psychological: fear and anxiety, confused thinking, irritability, poor anger or impulse control Psychosocial: discomfort around others, social isolation, stressful The flexible therapist will revise the case formulation or the treatment plan to work directly on the parent’s reactions during exposure, through one-on-one work on his/her beliefs regarding the child’s ability to cope with risk and/or by incorporating reduction of parent involvement directly into the child’s exposure hierarchy. As can be seen, a picture emerges from the idiographic model of what is causing and maintaining the presenting problem for the individual. The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or managed. In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in Chapter 8 here, together with the reviews provided of each specific CBT technique in Chapters 12 through 19, should be used to guide the selection of appropriate techniques. Inter-rater reliability of case formulations has been found to be adequate (Kuyken, Fothergill, Musa, and Chadwick 2005), the quality of case formulations improving with therapist experience and training (Eells et al. They account for all the information gathered at any point in time, and they are updated to reflect new information as it arises. Each of these processes is described below. To devise a case formulation, a competent therapist will need to add, to the standard diagnostic and symptom severity assessment tools, a targeted assessment of the typical cognitions, behaviors, and emotions that relate to the presenting problem for the individual, as well as an evaluation of interpersonal processes between the individual and other people (e.g., parents, peers) during periods of high anxiety or low mood. Within CBT models and at the diagnostic level, avoidance is key to all forms of anxiety. Sequencing selected specific CBT techniques for depressive disorders. In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in, should be used to guide the selection of appropriate techniques. Once an initial case formulation is established, the therapist needs to convert it into a treatment plan. model (Kendall et al., 2002) was selected as an organizational framework … The flexible therapist will revise the case formulation or the treatment plan to work directly on the parent’s reactions during exposure, through one-on-one work on his/her beliefs regarding the child’s ability to cope with risk and/or by incorporating reduction of parent involvement directly into the child’s exposure hierarchy. 9Case Formulation and Treatment Planning for Anxiety and Depression in Children and Adolescents The Dual Disorder CBT Treatment of Jericah has a history of suffering from depression The current client treatment plan. Treatment Plan Meeting A Treatment Plan meeting was held today, 3/13/2012, for Anna Smith. On the basis of the case formulation, the therapist can overlay what specific CBT techniques will be used to address each component of the case formulation. Therapist flexibility in this case focuses more on the tailoring of the technique to the specific cognitions, behaviors, or situations that the client experiences. It provides a template from which an individualized treatment plan can be derived. In addition to developing the idiographic representation of the chosen model, the potential impact that socio-demographics, culture, comorbidity, and development will have on engagement with treatment and on the likelihood of experiencing common obstacles during treatment should be considered. Within CBT models and at the diagnostic level, avoidance is key to all forms of anxiety. The first-line treatment and gold standard for treating generalized anxiety disorder (GAD) is cognitive behavioral therapy (CBT). Sample Chapter: Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition Report feeling more positive about self and abilities during therapy … Alternatively, the case formulation may indicate that excessive reassurance from the parent undermines the child’s ability to learn that (s)he can cope with challenging situations. Case formulation is the process of identifying the causes, antecedents, and maintaining factors related to a client’s emotional, interpersonal, and behavioral problems. Brief CBT is particularly useful in a primary care setting for patients with anxiety and depression associated with a medical condition. Sample Treatment Plan: This is a fictitious case. Research has shown CBT is significantly more effective than all other psychological treatments for generalized anxiety disorder. The models of anxiety and depression presented in Chapter 8 are nomothetic, that is, they describe the general “laws” of how these problems arise. For example, during the implementation of in-session exposure, it may become apparent that the parent encourages flight from challenging situations at the first sign of the child’s distress, despite having been presented with psycho-education regarding the role of overprotection in child anxiety. 16 0 obj CBT involves a structured approach to solving problems in a specified number of sessions. Follow this link to a chart comparing the effectiveness of CBT to other treatments generalized anxiety … The exact nature of what we … Each factor will also vary on the strength of its association with current problems. Comprehensive CBT changes the brain as irrational thoughts and beliefs turn into rational ones. 14 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER implications of the physical examination and laboratory test results. The clinical utility of case formulation as used in a community setting with adult anxiety and depression has been examined, case-formulated treatment leading to statistically and clinically significant change, comparable to that seen in randomized controlled trials of empirically supported treatments (Persons, Roberts, Zalecki, and Brechwald 2006). The specific CBT technique that directly targets avoidance and the only skill that appears without exception in every evidence-based treatment manual for anxiety is exposure. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Learn two new ways of coping with routine stressors . Heidi J. Lyneham 2012). Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. … Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. The initial case formulation, and consequently the treatment plan, must be updated as new information is discovered and as a result of the experience implementing each specific CBT technique with the client. In manuals where there is limited flexibility in the sequencing of techniques, the presented order reflects the nomothetic understanding of the targeted disorder(s). Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or managed. In case of somewhat complicated problem, a counselor is consulted. Alternatively, the case formulation may indicate that excessive reassurance from the parent undermines the child’s ability to learn that (s)he can cope with challenging situations. Introduction Example Treatment Plan . The treatment plan can subsequently be adjusted to proactively address these potential barriers, decreasing the likelihood that the barrier will interfere with progress. Depending on the manual selected, the therapist may have limited or substantial control on the order of presentation of specific CBT techniques. The primary … In this case the treatment plan may reflect that, concurrently with the implementation of exposure, the parent would require (i) psycho-education concerning the role of excessive reassurance in his/her child’s evaluation of a situation; (ii) therapist modeling of the appropriate parent management during in-session exposure exercises; and, ultimately, (iii) parent-led in vivo exposure. We won’t necessarily work on all of these areas, but this gives you a general outline for the types of things we’ll do and the order in which we’ll approach them. Figure 9.1 Example of idiographic application of the anxiety model to the case of an 11-year-old boy. Cognitive-behavioral therapy for the treatment of depression Research studies carried out during the last decades have consistently shown that CBT is efficacious in treating adolescent mental disorders such as depression, anxiety or oppositional On the basis of the case formulation, the therapist can overlay what specific CBT techniques will be used to address each component of the case formulation. Generalized Anxiety Disorder 7-item (GAD-7) | Spitzer, Kroenke, Williams, Lowe | 2006 First, by ensuring that the therapist understands and communicates the presenting problems within the client’s personal context, it conveys hope that these problem(s) can be addressed. The clinical utility of case formulation as used in a community setting with adult anxiety and depression has been examined, case-formulated treatment leading to statistically and clinically significant change, comparable to that seen in randomized controlled trials of empirically supported treatments (Persons, Roberts, Zalecki, and Brechwald 2006). For example, successful exposure to social situations in the school playground may not be possible until an underlying deficit in social skills is addressed. Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression Author: Ricardo F. Munoz Subject: Cognitive-Behavioral Therapy (CBT) is one of the two manual-based forms of short-term psychotherapy that have been recognized as effective by the AHRQ guidelines panel. from (e.g., Rick Heimberg’s CBGT, Clark and Wells Individual CBT) should also be provided along with: (3) A summary of treatment efficacy data for these treatments (for example, a summary of treatment efficacy research on panic disorder using cognitive behavior therapy). The competent therapist must ensure that (s)he has a thorough understanding of the purpose of each specific CBT technique, so that (s)he can appropriately link it to the causal or maintaining factor(s) that it is designed to address. In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in Chapter 8 here, together with the reviews provided of each specific CBT technique in Chapters 12 through 19, should be used to guide the selection of appropriate techniques. 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