The Science and Practice of Case Conceptualization

2008 ◽  
Vol 36 (6) ◽  
pp. 757-768 ◽  
Author(s):  
Willem Kuyken ◽  
Christine A. Padesky ◽  
Robert Dudley
Keyword(s):  
Protective Factors ◽  
Chemical Reactions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Chemical Characteristics ◽  
Case Conceptualization ◽  
New Approach ◽  
Cognitive Behavioural ◽  
Client Strengths ◽  
Over Time

AbstractCase conceptualization is a foundation of cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. This paper reviews the rationale and evidence base for case conceptualization and outlines a new approach that uses the metaphor of a case conceptualization crucible in which a client's particular history, experience and strengths are synthesized with theory and research to produce an original and unique account of clients' presenting issues. The crucible metaphor illustrates three key defining principles of case conceptualization. First, heat drives chemical reactions in a crucible. In our model, collaborative empiricism between therapist and client provides the heat. Second, like the chemical reaction in a crucible, conceptualization develops over time. Typically, it begins at more descriptive levels, later a conceptualization incorporates explanatory elements and, if necessary, it develops further to include a longitudinal explanation of how pre-disposing and protective factors influence client issues. Finally, new substances formed in a crucible are dependent on the chemical characteristics of the materials put into it. Rather than simply look at client problems, our model incorporates client strengths at every stage of the conceptualization process to more effectively alleviate client distress and promote resilience.

Supporting low intensity interventions using the telephone

2010 ◽  
pp. 275-280 ◽  
Author(s):  
Karina Lovell
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Practical Application ◽  
Low Intensity ◽  
Cognitive Behavioural ◽  
Therapy Interventions

Chapter 27 discusses LI interventions using the telephone, and aims to provide the rationale, evidence base, challenges, solutions and practical application of delivering low intensity psychological (mainly cognitive behavioural therapy) interventions by telephone.

Treatment of anxiety disorders

2020 ◽  
pp. 961-966
Author(s):  
David S. Baldwin ◽  
Nathan T.M Huneke
Keyword(s):  
Anxiety Disorders ◽  
Previous Treatment ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Physical Symptoms ◽  
Need For Treatment ◽  
Cognitive Behavioural ◽  
Choice Of Treatment ◽  
Characteristic Features

The personal and societal burden associated with anxiety disorders is considerable, but many individuals who might benefit from treatment are not recognized. Recognition relies on awareness of psychological and physical symptoms common to all anxiety disorders, and accurate diagnosis on identifying specific features of particular disorders. The need for treatment is determined by the severity and persistence of symptoms, the impact of symptoms on everyday life, the presence of coexisting depressive symptoms, and other features such as response to previous treatment approaches. Patient characteristics and patient and doctor preferences influence the choice of treatment. There is much overlap between anxiety disorders in evidence-based and effective therapies (such as the prescription of a selective serotonin reuptake inhibitor or a course of individual cognitive behavioural therapy), but there are also important differences, so it helps to be familiar with the characteristic features and evidence base for each condition.

Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury

2013 ◽  
Vol 14 (1) ◽  
pp. 5-20 ◽  
Author(s):  
Nick Alderman ◽  
Caroline Knight ◽  
Jennifer Brooks
Keyword(s):  
Brain Injury ◽  
Aggressive Behaviour ◽  
Acquired Brain Injury ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Limiting Factor ◽  
Behaviour Disorder ◽  
Behaviour Therapy ◽  
Behavioural Interventions ◽  
Cognitive Behavioural

Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.

scholarly journals Cognitive-behavioural therapy for schizophrenia: Filling the therapeutic vacuum

2003 ◽  
Vol 183 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Paul Chadwick
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Convincing Evidence ◽  
Family Work ◽  
Standard Clinical Practice ◽  
Cognitive Behavioural ◽  
Accepted Part ◽  
The Cost

When does a therapeutic intervention become an accepted part of standard clinical practice? Is it when there is sufficient research evidence? But what constitutes ‘sufficient’? What about available resources and acceptability to patients? Do we have to wait until the National Institute for Clinical Excellence pronounces? A convincing evidence base for family work in schizophrenia (Kuipers, 2000) has existed for many years but has been poorly implemented (Anderson & Adams, 1996). Will cognitive-behavioural therapy (CBT) for psychosis suffer the same fate? Which professional group will champion such an implementation? The evidence for other psychological treatments is less robust. Psychoeducation may prolong time to relapse and improve insight but at the cost of increasing suicidal ideation (Carroll et al, 1998). Personal therapy (Hogarty et al, 1997) may be of value but is contra-indicated for patients who are living alone in the community. Psychodynamic approaches are advocated (Mace & Margison, 1997) but most psychiatrists do not support their use in practice, owing to lack of evidence of efficacy.

scholarly journals Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault

2020 ◽  
pp. 135910532095079
Author(s):  
Jane Lomax ◽  
Jane Meyrick
Keyword(s):  
Sexual Assault ◽  
Psychological Health ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
First Response ◽  
Weak Evidence ◽  
Cognitive Behavioural ◽  
Trauma Processing ◽  
The Impact

Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.

Cognitive behavioural therapy with older adults: enthusiasm without the evidence?

2009 ◽  
Vol 2 (2) ◽  
pp. 75-82 ◽  
Author(s):  
Philip Wilkinson
Keyword(s):  
Older People ◽  
Methodological Quality ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Younger Adults ◽  
Behavioural Interventions ◽  
Management Interventions ◽  
Cognitive Behavioural ◽  
Cognitive Behavioural Interventions ◽  
Robust Evidence

AbstractCognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.

scholarly journals Cognitive–behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis

2015 ◽  
Vol 45 (13) ◽  
pp. 2793-2804 ◽  
Author(s):  
S. Young ◽  
M. Khondoker ◽  
B. Emilsson ◽  
J. F. Sigurdsson ◽  
F. Philipp-Wiegmann ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Adhd Symptoms ◽  
Hyperactivity Disorder ◽  
Randomized Controlled ◽  
Cognitive Behavioural ◽  
End Of Treatment ◽  
Over Time

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.MethodA total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive–behavioural therapy (CBT/MED) using theR&R2ADHDintervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.ResultsCBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.ConclusionsThe study provides evidence for the effectiveness ofR&R2ADHDand demonstrates that there are differential effects over time for ADHD symptomsversusco-morbid problems, the latter taking longer to show positive effects.

scholarly journals Therapists’ attitudes to offering eCBT in an inner-city IAPT service: a survey study

2018 ◽  
Vol 11 ◽  
Author(s):  
Susanne F. Meisel ◽  
Helena Drury ◽  
Ramesh P. Perera-Delcourt
Keyword(s):  
Inner City ◽  
Survey Design ◽  
Treatment Options ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Survey Study ◽  
Design Data ◽  
Face To Face ◽  
Psychological Therapies ◽  
Cognitive Behavioural

AbstractDespite an emerging evidence base for the efficacy of supported computerized cognitive behavioural therapy (eCBT), uptake in services has been slow. Therapists’ beliefs about eCBT may constitute a barrier to offering eCBT to clients, but little research has investigated this topic. The aim of this study was to investigate therapist attitudes towards eCBT in one inner-city Improving Access to Psychological Therapies (IAPT) service using a survey design. Data were analysed using descriptive statistics. Thirty-three therapists took part in the study. Although 97% of participants reported that they knew ‘what eCBT involves’, and 62% reported that they were ‘confident to offer eCBT to clients’, only 10% endorsed that ‘there is a strong evidence-base to support the use of eCBT’. Two-thirds of the sample believed that eCBT ‘could be effective for mild and moderate mental health difficulties’, but most participants believed that eCBT would perform ‘worse’ or ‘much worse’ than face-to-face interventions for a range of disorders. Barriers to offering eCBT related predominantly to assumptions about client expectations of therapy, and perceived lack of a therapeutic relationship. Participants identified the provision of training on eCBT for those recommending treatment options to clients as a potential solution. Results from this study highlight therapists’ attitudes to eCBT that might contribute to low uptake rates of eCBT. Particularly, misperceptions about the evidence base for eCBT may be prevalent. Appropriate training and ongoing supervision for therapists are considered as interventions that may increase acceptance of eCBT as a valid treatment option.

scholarly journals The evidence base for cognitive—behavioural therapy in depression: delivery in busy clinical settings

2003 ◽  
Vol 9 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Graeme Whitfield ◽  
Chris Williams
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Clinical Settings ◽  
Face To Face ◽  
Psychological Therapies ◽  
Department Of Health ◽  
Self Help ◽  
Cognitive Behavioural

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review documentTreatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

Hoarding disorder

2020 ◽  
pp. 1023-1030
Author(s):  
Lorena Fernández de la Cruz ◽  
David Mataix-Cols
Keyword(s):  
Mental Disorder ◽  
International Classification Of Diseases ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Hoarding Disorder ◽  
Perceived Need ◽  
Cognitive Behavioural ◽  
Classification Of Diseases ◽  
Clinically Significant

Hoarding disorder (HD) is a mental disorder that was newly included in the obsessive–compulsive and related disorders chapter of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is also planned for inclusion in the International Classification of Diseases, eleventh revision (ICD-11). Individuals meeting the diagnostic criteria for HD experience persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. This results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use, causing clinically significant distress or impairment. These symptoms must not be attributable to another medical or mental disorder. A majority of people diagnosed with HD excessively acquire items that they do not need or for which no space is available. Currently, the intervention with the strongest evidence base for HD is cognitive behavioural therapy tailored to the hoarding difficulties.

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