Handouts and Resources 2021 - Royal College of ...
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…. Handouts and Resources 2021….
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SUMMARY OF THE PROBLEM
SITUATIONS
(WHAT SETS THE PROBLEM OFF)
MY THOUGHTS
(WHAT GOES THROUGH MY HEAD)
MY MY
BODY’S FEELINGS
(EMOTIONS)
REACTIONS
(PHYSICAL)
MY BEHAVIOUR
(WHAT I DO)
RESULTS
WHAT IS KEEPING THE PROBLEM GOING?
3
SUMMARY OF THE PROBLEM
SITUATIONS
(WHAT SETS THE PROBLEM OFF)
MY THOUGHTS
(WHAT GOES THROUGH MY HEAD)
MY MY
BODY’S FEELINGS
(EMOTIONS)
REACTIONS
(PHYSICAL)
MY BEHAVIOUR
(WHAT I DO)
RESULTS
WHAT IS KEEPING THE PROBLEM GOING?
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** WHAT IS COGNITIVE-BEHAVIOUR THERAPY? **
CBT Information leaflet
• CBT is a talking treatment that helps you learn more helpful ways of thinking &
reacting in everyday situations.
• C stands for ‘cognitive’ (what you think). You learn to spot when you are being
negative and self-critical. You challenge thoughts such as ‘I’m useless’ or ‘Its all
going to go wrong’ . You develop more helpful, realistic thinking habits by asking:
‘What’s the evidence this is true?’, ‘What’s another way to view this?’ or ‘How
would I advise a friend in my situation?’
• B stands for ‘behaviour’ (what you do). You might keep a daily diary of activities –
then set goals to do things that you have been avoiding, test out any fears you
have and give you a sense of achievement.
• T stands for ‘therapy’ (what you learn). CBT works best if you practice new skills
as ‘homework’. This helps you stay well in the future too.
• It is worth knowing that CBT usually helps you to deal with problems as they are
in the here and now rather than the past.
• CBT teaches you self help ways of coping for the future. It’s like learning how to
fish rather than simply being given a fish to eat.
• CBT involves you doing the hard work, guided by the professional you see. The
therapist is like a gym trainer or a football coach advising you - but you are the
one actually putting it into practice.
• It varies, but often a course of CBT lasts for between 6 and 20 sessions, for up to
1 hour every 1 or 2 weeks.
• Each session normally follows a pattern of: looking at the previous week’s
learning and homework, deciding what to cover next, agreeing on discussing one
or two problems in detail, then setting new homework (written down by you).
• CBT isn’t for everyone, but research shows it can be effective for depression,
anxiety and many other problems. It is recommended by professionals, the NHS,
and bodies such as NICE (The National Institute for Health and Care Excellence)
• If you want to know more about CBT, please look up these leaflets:
http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx
And http://www.patient.co.uk/health/cognitive-behavioural-therapy-cbt-leaflet
PBlenkiron
5Name:
Date:
PROBLEM DEFINITION
How much does this problem upset you?
0 1 2 3 4 5 6 7 8
0 = not at all
2 = slightly
4 = moderately
6 = severely
8 = very severely
How much does this problem interfere with your normal activities?
0 1 2 3 4 5 6 7 8
0 = does not interfere
2 = sometimes
4 = often
6 = very often
8 = continuously
6TARGETS 0 = Never
2 = 25% of the time
Name: 4 = 50% of the time
Date: 6 = 75% of the time
8 = All of the time
1)
How often can you achieve this target regularly and without difficulty at the moment? (Circle one)
0 1 2 3 4 5 6 7 8
2)
How often can you achieve this target regularly and without difficulty at the moment?
0 1 2 3 4 5 6 7 8
3)
How often can you achieve this target regularly and without difficulty at the moment?
0 1 2 3 4 5 6 7 8
4)
How often can you achieve this target regularly and without difficulty at the moment?
0 1 2 3 4 5 6 7 8
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WHAT A TYPICAL CBT SESSION LOOKS LIKE…
The number of CBT sessions can vary but is normally between 6 and 20.
Each session usually lasts for about 50 minutes.
They occur every 1 or 2 weeks apart.
Each session normally follows a structure as this has been shown to be more effective …
1) INTRODUCTION
“How are you?”
Brief review of the week - any key events? Update on mood. Complete and hand in any
rating scales. Get out homework.
2) ANYTHING FROM PREVIOUS SESSION
“Was there anything that you wanted to say / bothered you about our last session?
What did you get out of it?”
Encourages you to think about therapy and express any problems.
3) SET TASKS FOR TODAY
“What problems do you want to work on today?” “What do you want to get out of
this session?”
Team work (collaborative). Therapist and you agree goals and review homework. Prioritise
the most important items in case time runs out. Define problem and agree what to cover.
Include concrete examples (how will you know if we have sorted out this problem?)
4) LOOK AT HOMEWORK
“ What did you get done/ feel was useful ?”
Reinforces its value and helps you remember it. People who do homework get better
quicker. May be brief or occupy the entire session. Focus on something useful – that went
well or that highlighted a difficulty
5) DISCUSS ISSUES
Summarise and feedback, relate to general goals of therapy and continue to
learn about new ways of thinking and doing.
6) SET NEW HOMEWORK
Be clear. SMART targets. Write it down to remember!
7) FEEDBACK AND SUMMARY
“Can you summarise the most important things we covered/you learned today?” Anything
you think I got wrong or bothered you?” Write it down.
910
Cognitive Behavioural Therapy (CBT):
Session Bridging Sheet
To help you prepare and get the most out of CBT, please fill this in before your session and bring it with you:
1. What happened in our last CBT session?
What did you learn?
2. Was there anything that upset you about our last session?
3. How have you been since our last session?
4. What self-practice work have you done since our last session?
What did you learn?
5. What would you like us to focus on in today’s session?
11CBT Record Sheet
Patient name: Date: Session no:
Agenda:
Rating scales completed + scores:
Homework Review:
Work in Session (including formulation):
Homework Set:
Comments / Issues for next session:
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Activity Record
Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7-9
9 - 10
10 - 11
11 - 12
12 - 1
1-2
2-3
3-4
4-5
5-6
6-7
7-8
8-9
9 -Bedtime
Grade activities for pleasure (enjoyment) eg P = ? on a scale of 1 to 10. Grade activities for achievement (feeling of success) eg A = ? on a scale of 1 to 10
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CHALLENGING YOUR NEGATIVE THOUGHTS - A DIY GUIDE
When you feel upset, ask yourself, ‘What negative thought or picture is going through my head right
now?’ Then ask yourself one or more of the questions below….
These questions help you look at the evidence that a negative thought may not be completely true,
and consider more helpful, alternative or balanced ways of thinking about that situation. They can
also help you to fill in a thought record as ‘homework’. With practice this becomes easier and you
can learn to challenge negative thoughts in your head. You do not have to ask yourself every
question all the time. You may have a favourite question that works best for you in distressing
situations..…
• What is the EVIDENCE FOR and AGAINST this idea?
What makes me think the thought is true?
What makes me think the thought is not completely true?
• Is there an ALTERNATIVE explanation?
What’s another way to look at this?
• Consider the OUTCOME:
What’s the worst that could happen?
Would I still live through it?
What’s the best that could happen?
What’s the most realistic outcome?
• Consider the EFFECT:
What will happen if I keep telling myself the same thought?
How USEFUL is this thought? (list advantages + disadvantages)
What could happen if I changed this thought?
• PROBLEM-SOLVING:
What can practically I do now about this thought or situation
(especially if realistic or true) ?
• DOUBLE STANDARD:
What would I say to… (a friend) if they were in the same situation?
What would I have said to myself 10 years ago?
What would I say if I was the therapist? If different, what makes me so special
compared to everyone else?
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Patient Health Questionnaire - PHQ-9
Name: ___________________________ Date of Birth: _________________
Please complete and hand to the professional seeing you at your appointment.
. Write the date when you filled in the form here: __________________
Over the last 2 weeks, how often have you More
than Nearly
been bothered by any of the following problems? Not at Several half the every
(Please circle or “✔” to indicate your answer) all days days day
1. Little interest or pleasure in doing things.......……… 0 1 2 3
2. Feeling down, depressed, or hopeless.………..…… 0 1 2 3
3. Trouble falling or staying asleep, or sleeping too
much..................................................………..…….. 0 1 2 3
4. Feeling tired or having little energy......……...……… 0 1 2 3
5. Poor appetite or overeating.......................……….… 0 1 2 3
6. Feeling bad about yourself — or that you are a failure
or have let yourself or your family down………………….. 0 1 2 3
7. Trouble concentrating on things, such as reading the
newspaper or watching television.……………………….. 0 1 2 3
8. Moving or speaking so slowly that other people could
have noticed? Or the opposite — being so fidgety or
restless that you have been moving .around a lot more than
usual..............……………………………………………….. 0 1 2 3
9. Thoughts that you would be better off dead or of hurting
yourself in some way......…………………………………… 0 1 2 3
Column totals: ___ + ___ + ___
= Total Score _____
If you have been bothered by any of the problems listed above, please answer the following: How
difficult have these problems made it for you to do your work, take care of things at home, or get along
with other people?
Not difficult Somewhat Very Extremely
at all difficult difficult difficult
From the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ). The PHQ was developed by Drs. Robert L.
Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues. All rights reserved. Reproduced with permission
Continued - Please turn over…..
21GAD-7
Over the last 2 weeks, how often have you More than
been bothered by the following problems? Not Several Nearly
half the
at all days every day
(Please circle or “✔” to indicate your answer) days
1. Feeling nervous, anxious or on edge 0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that it is hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful 0 1 2 3
might happen
Column totals: ___ + ___ + ___
= Total Score ____
You can use the space below to write down any questions you have
for your appointment:
Thank you for completing this! Your answers are confidential. Please return the form
to the professional seeing you at the time you are seen for your appointment.
22Notes for Professionals
PHQ-9 Depression Severity
Guide to scores (and action) for the 9 items range 0 to 27.
0-4 = none
6-10 = mild (watchful waiting, repeat PHQ-9 at follow up)
11-15 = moderate (consider talking treatments or medication)
16-20 = moderately severe depression (start talking treatments and/or medication)
20-27 = severe depression (start talking treatments and medication, specialist input)
GAD-7 Anxiety Severity.
GAD-7 total score for the seven items ranges from 0 to 21.
0-5 mild
6-10 moderate
11-15 moderately severe anxiety
16-21 severe anxiety.
Use
Use routinely at entry to service (eg sent out with appointment letter) and follow up as appropriate
(at discretion of professional eg at 3-6 months and/or discharge from service).
Should only be used as part of a comprehensive assessment, as a guide to care, not as a
replacement for the professional’s clinical judgement.
Advantages of using rating scales
Ensure symptoms are assessed (re improved diagnosis, treatment and care pathway).
Help determine severity (symptoms and functioning).
Monitor progress.
Recommended by NICE (National Institute of Health and Clinical Excellence) – eg depression
(2009), anxiety ( 2004/2011) and common mental health disorders (2011) as part of the stepped
care approach.
Approved as free from need for copyright fees.
Recommended and used routinely by IAPT (Improving access to psychological therapies) –
allowing good communication between step 3 (high intensity CBT) and step 4 (specialist care).
Recommended by NHS as good practice. Likely to be important in future quality indicators eg PBR
Reference
NICE-indicated Treatments for Depression & Anxiety http://www.iapt.nhs.uk/silo/files/iapt-data-handbook-
appendicies-v2-word-version.doc The IAPT Data Handbook Including the IAPT Data Standard Version 2.0.1
(standards 37 & 38), 2011 http://www.iapt.nhs.uk/search/?keywords=gad+7
Paul Blenkiron
Consultant Psychiatrist
23Mental Health Information: 11 Great Self Help Websites
Mental Health Conditions:
• http://www.rcpsych.ac.uk/mentalhealthinfoforall.aspx Psychiatrists College
website: free information leaflets on common mental disorders and their treatments
• http://www.ntw.nhs.uk/pic Northumberland Tyne & Wear self help booklets
Medication:
• http://www.choiceandmedication.org/leedsandyorkpft/ Leeds & York NHS
Foundation Trust: Info leaflets on common prescribed drugs, side effects, comparing
drugs for common conditions, coming off medication
• http://www.rethink.org/diagnosis-treatment/medications/ Information on common
drugs
including link to Only the Best guide
http://www.nhs.uk/ipgmedia/national/rethink%20mental%20illness/assets/onlythebest
medication-yourguidetoantipsychoticandmoodstabilisermedication.pdf with NICE
guidelines summaries and choice eg mood stabilising medications
• http://www.rcpsych.ac.uk/pdf/NAS%20Integrated%20Physical%20Health%20Path
way%20Dec%2012.pdf Physical health pathway for SMI /Psychosis using Lester
Tool for monitoring tests for antipsychotic medication, treating cholesterol, diabetes
(professionals)
Cognitive Behaviour Therapy
• Free Web-based CBT self help programmes for depression & anxiety:
http://www.livinglifetothefull.com http://moodgym.anu.edu.au
• http://www.getselfhelp.co.uk/ More great CBT resources
• http://mindfulnessforstudents.co.uk/resources/ Mindfulness info and audio
exercises :
Workbooks
• http://www.cci.health.wa.gov.au/resources/consumers.cfm Centre for Clinical
Interventions (Google ‘cci resources’): Depression, panic, worry, health anxiety,
bipolar disorder, eating disorders, self esteem, assertiveness, perfectionism
• http://www.guilford.com/companion-site/DBT-Skills-Training-Manual-Second-
Edition/9781462516995 DBT Skills Worksheets (Linehan)
Self Help Books
• http://readingagency.org.uk/adults/quick-guides/readingwell/ Reading Well
National Books on Prescription Scheme: list of 30 key self help CBT Books endorsed
by experts and available in most English Public Libraries P BLENKIRON 2021
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Introduction to CBT 2021 Workshop Evaluation
I want to evaluate the effectiveness of this RCPsych CBT workshop.
Please answer the following questions, then detach this sheet and hand it in. It is
anonymous, but I’ve asked for your initials and some basic details so I can evaluate
the responses. I won’t reveal any names or personally identifiable information - PB.
Your name (initials only) ……..…..…… Male / Female (please circle one)
Year you qualified (eg as a doctor) ………………
Job Title, Grade & Speciality (eg WAA consultant psychiatrist in CMHT, staff grade in old age, psychologist,
CT3 trainee, GP, RMN, CPN):
……………………………………………………………………………………………………………………...
1. What did you like best about the workshop?
2. What was the most useful thing you learned today?
3. Please give one suggestion for improvement:
4. What was your score in the quiz? (be honest, it’s a baseline!) ….…/ 40
5. Using the scale below (from 1 to 10), please rate:
• This workshop (educational value & relevance) ………/10
• Your current knowledge about CBT…. before today………/10 and now ………/10
• Your practical CBT skills …. before today………/10 and now ………/10
• Your confidence as a CBT Practitioner..before today………/10 and now ………/10
…………………………………………………………………………………………………
1 2 3 4 5 6 7 8 9 10
Very Poor Poor Fair Good Very good Excellent
6. How will your practice change as a result of attending this workshop?
7. Any other comments?
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