COGNITIVE BEHAVIOURAL THERAPY CASE PRESENTATION

Vandhna Sharma

July 2015

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CASE OUTLINE  Client: A.M. 15 years old. Background:

- Diagnosed with Asperger’s syndrome.

- Referred to CBT for anxiety.

 

 Impact: - “Fail to prepare, prepare to fail”

- Reliant on parents

- No friends

- Anger and aggression

  Considerations: - Overlap between ASC and anxiety

- Motivation

- Transitions

Anxiety

ASC

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CBT EVIDENCE BASE

CBT is a psychotherapeutic intervention that addresses unhelpful thoughts and behaviours, by understanding the physical and emotional impact on the individual (Wills, 2008).

The client becomes their own therapist.

More evidence for CBT than any other psychosocial intervention.

Multiple randomised control trials and meta-analyses: anxiety disorders, depression, eating disorders and substance misuse.

The evidence base for CBT with young people is growing.

NICE guidelines for social anxiety.

 

 

  

Ref: Wills, 2008; Kuyken et al., 2011; Padesky, 1993; NICE, 2012; Wilson and Branch, 2006; Department of Health (DH), 2001; National Institute for Health and Clinical Excellence (NICE), 2013; Ahrens-Eipper 2005; Muris et.al, 2008.

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THEORETICAL MODELS UTILISED

Goal setting Psycho-education work around anxiety Personalised case formulation tool – core belief Self-focused attention fuelling his worries.

Experiences

- Being different to others

- Being bullied

- Lifelong struggle to adapt to social norms. “Why cant

people just say what they mean?”

  Applied the Clark & Wells Social Phobia protocol

Ref: Greenberger and Padesky, 1995; Bieling and Kuyken, 2003; Williams

and Garland, 2002; Clark and Wells, 1995; Clark 2002.

 

People think I am

stupid

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SOCIAL SITUATIONGoing to the local shop alone

SELF-FOCUS-See myself as stupid

-Can’t make any mistakes

-Can’t draw any attention to myself

SAFETY BEHAVIOURS-Avoid paying by taking parent along

-Ignore people and say nothing-Avoid eye contact

-Head down-Parents instructed on how to

behave-Leave quickly

ANXIETY SYMPTOMS -Feeling sick

-Face goes red -Hard to speak

-Heart races-Stressed

-Fists clenched

THOUGHTS-I won’t have enough money and will get shouted at

-Everyone will see this and know I am stupid - I can’t forgive myself or forget, neither can anyone else

- I don’t look autistic so people won’t know why I messed up

Based on Wells 1997, www.getselfhelp.co.uk www.get.gg

D.C’s Social Anxiety Model

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WORK UNDERTAKEN

Thoughts/images related to his fears.

Alternate views/theories.

Practiced social situations in sessions.

Highlighted strengths.

Tracked Progress – GOALS, SRS & CORS.

Behavioural experiments.

  1/ Weekly trip to the local shop alone.

2/ Created a survey.

3/ Shifted his focus of attention.

Ref: Bennet-Levy et. al, 2004

Social Phobia Equation  

Overestimate risk

Underestimate coping ability

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OUTCOME No aggression past 6 months Better communication between family Calmer Goes to shops alone Played pool after college - unplanned Attended CAMHS Service User Forums; one on his own

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REFLECTIONS Stedmon and Dallos, 2009: Reflection is about refining therapeutic

practice by exploring results, feedback and skills Paused CBT to do psychoeducation work on ASC: NAS website and

videos Adjustment at a slower pace. More able to generate and consider alternate beliefs after doing BE.  

What would I do differently:

- ASC psychoeducation work first.

- Focused more on the behavioural aspect of CBT, which in itself leads to change in cognitions.

 

 

Refs: Bennet-Levy, 2006

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ANY QUESTIONS?

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REFERENCES  Ahrens-Eipper, S. (2005).Applying the Clark-Wells model of social phobia to children: the case of a “dictation phobia.”

Behavioural and Cognitive Psychotherapy: 34, pp. 1-4.   Bennett-Levy, J. (2006) Therapist skills: a cognitive model of their acquisition and refinement. Behavioural and

Cognitive Psychotherapy, 34, pp. 57–78. Bennet-Levy, J., Butler, G., Fennell, M.M Hackman, A., Mueller, M. And Westbrook, D. (2004) Oxford guide to

behavioural experiments in cognitive therapy: cognitive behaviour therapy: science and practice. Oxford: Oxford University Press.

Bieling, P.J. and Kuyken, W. (2003) Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice, 10(1), pp. 52-69.

Clark, D.M. & Wells, A. (1995). A cognitive model of social phobia. In R.Heimburg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds) Social phobia: diagnosis, assessment and treatment, (pp.69-93). New York: Guilford Press.

Greenberger, D. and Padesky, C.A. (1995) Mind over mood: a cognitive therapy treatment manual for clients. New York: Guilford Press.

Department of Health (2001) Treatment choice in psychological therapies and counselling. London: Department of Health.

Kuyken, W., Padesky, C.A. and Dudley, R. (2011) Collaborative case conceptualisation: working effectively with clients in cognitive-behavioural therapy. New York: Guilford Press.

Muris, P., Mayer, B., Adel, M., Roos, T., Wamelen, J. (2008). Predictors of Change Following Cognitive-Behavioral Treatment of Children with Anxiety Problems: A Preliminary Investigation on Negative Automatic Thoughts and Anxiety Control. Child Psychiatry and Human Development DOI: 10.1007/s10578-008-0116-7

National Institute of Health and Clinical Excellence (2012) Depression and anxiety – computerised cognitive behavioural therapy (CCBT): NICE guideline (TA97). London: National Institute for Health and Clinical Excellence

National Institute of Health and Clinical Excellence (2013) Social anxiety disorder: recognition, assessment and treatment. NICE Guideline (CG159) London: National Institute for Health and Clinical Excellence

Padesky, C.A. (1993) Socratic questioning: changing minds or guided discovery? A keynote address delivered at the European Congress of Behavioural and Cognitive Therapies, September 24th, London.

Stedmon, J. and Dallos, R. (2009) Reflective practice in psychotherapy and counselling. New York: Open University Press.

Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: a practice manual and conceptual guide. Chichester: Wiley Williams, C. and Garland, A. (2002) A cognitive-behavioural therapy assessment model for use in everyday practice.

Advances in Psychiatric Treatment, 8, pp.172-179. Wills, F. (2008) Skills in cognitive behaviour counselling and psychotherapy. London: SAGE Publications Wilson, R. and Branch, R. (2006) Cognitive behavioural therapy for dummies. Chichester: John Wiley & Sons, Ltd