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COGNITIVE BEHAVIOUR THERAPY FOR
DEPRESSION IN YOUNG PEOPLE
MANUAL FOR THERAPISTS
Date: February 2010
Version: 1.0
Author(s): IMPACT Study CBT Sub-Group
Change summary: Initial (DRAFT) version
IMPACT Trial Office
Developmental Psychiatry
Douglas House
18b Trumpington Road
Cambridge
CB2 8AH
COPYRIGHT ©: Not to be copied or distributed without the Lead Author’s
permission, on behalf of the IMPACT Group
DRAFT Feb 2010 Version 1
CONTENTS
INTRODUCTION .................................................................................................................. 4 Ian M Goodyer 31/5/2016 19:48
Deleted: 13
COGNITIVE BEHAVIOURAL THERAPY AND DEPRESSION IN ADOLESCENCE ............................. 4 Ian M Goodyer 31/5/2016 19:48
What is depression? .................................................................................................. 5 Deleted: 14
What is Cognitive Behaviour Therapy? ........................................................................ 5 Ian M Goodyer 31/5/2016 19:48
Is CBT an effective treatment for young people with depression? ................................. 6 Deleted: 14
The IMPACT Trial ...................................................................................................... 7 Ian M Goodyer 31/5/2016 19:48
Deleted: 18
Ian M Goodyer 31/5/2016 19:48
PART 1 A Cognitive Behavioural Understanding of Depression ................................................. 9 Deleted: 21
The basis of Cognitive Behavioural Therapy ................................................................ 9 Ian M Goodyer 31/5/2016 19:48
1: The collaborative relationship ................................................................... 10 Deleted: 25
Collaborative empiricism ............................................................................... 11 Ian M Goodyer 31/5/2016 19:48
2: Behavioural theories of depression ...................................................................... 12 Deleted: 25
TOM ........................................................................................................ 15 Ian M Goodyer 31/5/2016 19:48
How does a behavioural model of depression apply to Tom? ........................... 16 Deleted: 25
Including parents and carers in behavioural work ........................................... 19 Ian M Goodyer 31/5/2016 19:48
3: Cognitive behavioural theories of depression ........................................................ 20 Deleted: 27
SOPHIE ....................................................................................................... 21 Ian M Goodyer 31/5/2016 19:48
How does CBT apply to Sophie? .................................................................... 22 Deleted: 27
Formation of dysfunctional assumptions ........................................................ 26 Ian M Goodyer 31/5/2016 19:48
Deleted: 27
Critical incidents ........................................................................................... 26 Ian M Goodyer 31/5/2016 19:48
Activation of assumptions ............................................................................. 26 Deleted: 27
4. Using CBT to help Sophie feel less depressed ....................................................... 26 Ian M Goodyer 31/5/2016 19:48
The formulation in CBT ................................................................................. 26 Deleted: 28
Formation of (dysfunctional)assumptions ....................................................... 28 Ian M Goodyer 31/5/2016 19:48
Critical incidents ........................................................................................... 28 Deleted: 28
Activation of assumptions ............................................................................. 28 Ian M Goodyer 31/5/2016 19:48
Formulation diagrams ................................................................................... 28 Deleted: 29
Using the formulation to guide clinical work ................................................... 29 Ian M Goodyer 31/5/2016 19:48
Psycho-education with young people ............................................................. 29 Deleted: 29
Identifying vicious cycles .............................................................................. 30 Ian M Goodyer 31/5/2016 19:48
Behavioural experiments ............................................................................... 30 Deleted: 29
Monitoring moods and feelings ...................................................................... 30 Ian M Goodyer 31/5/2016 19:48
Identifying negative automatic thoughts (NATs) ............................................. 31 Deleted: 30
Challenging negative automatic thoughts ....................................................... 32 Ian M Goodyer 31/5/2016 19:48
Learning new skills ....................................................................................... 33 Deleted: 31
Identifying assumptions ................................................................................ 34 Ian M Goodyer 31/5/2016 19:48
Cognitive restructuring ................................................................................. 35 Deleted: 32
5. Including parents and carers in CBT .................................................................... 36 Ian M Goodyer 31/5/2016 19:48
Involving parents in the assessment .............................................................. 36 Deleted: 33
Including parents in the formulation .............................................................. 36 Ian M Goodyer 31/5/2016 19:48
Working with parents to support individual CBT .............................................. 37 Deleted: 34
The parental role during therapy ................................................................... 39 Ian M Goodyer 31/5/2016 19:48
Opportunities to involve parents in therapy .................................................... 39 Deleted: 38
6. Adapting CBT for young people .......................................................................... 40 Ian M Goodyer 31/5/2016 19:48
Key developmental processes ....................................................................... 41 Deleted: 41
7. How to adapt CBT for young people .................................................................... 44 Ian M Goodyer 31/5/2016 19:48
Deleted: 45
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DRAFT Feb 2010 Version 1
Ian M Goodyer 31/5/2016 19:48
PART 2: THE INTERVENTION ............................................................................................. 48 Deleted: 49
1. Basic skills that all CBT therapists need ................................................................ 48
2. Core features of CBT .......................................................................................... 49 Ian M Goodyer 31/5/2016 19:48
3. Characteristics of CBT therapy ............................................................................ 50 Deleted: 49
4. A typical CBT programme for a depressed young person ....................................... 52 Ian M Goodyer 31/5/2016 19:48
Deleted: 50
Ian M Goodyer 31/5/2016 19:48
PART 3: APPENDICES FOR USE IN CBT FOR DEPRESSION ................................................... 58 Deleted: 51
APPENDIX A Psycho-Education ................................................................................ 59 Ian M Goodyer 31/5/2016 19:48
APPENDIX B Engagement and goal setting ............................................................... 63 Deleted: 53
APPENDIX C Emotional recognition .......................................................................... 67 Ian M Goodyer 31/5/2016 19:48
APPENDIX D Activity Schedule ................................................................................. 73 Deleted: 59
APPENDIX E Self-monitoring and detection of NATS .................................................. 79 Ian M Goodyer 31/5/2016 19:48
APPENDIX F Challenging negtive thinking ................................................................. 86 Deleted: 60
APPENDIX G Communication and interpersonal skills ................................................. 95 Ian M Goodyer 31/5/2016 19:48
APPENDIX H Social problems ................................................................................. 100 Deleted: 64
_Toc255804043 Ian M Goodyer 31/5/2016 19:48
APPENDIX I Symptomatic interventions .................................................................. 106 Deleted: 68
APPENDIX J Ending: Closure and therapy ............................................................... 115 Ian M Goodyer 31/5/2016 19:48
REFERENCES ........................................................................................................ 120 Deleted: 74
Ian M Goodyer 31/5/2016 19:48
Deleted: 80
Acknowledgements: Ian M Goodyer 31/5/2016 19:48
Deleted: 87
This manual is developed from those used in the Manchester CBT trials. Thanks are due to Ian M Goodyer 31/5/2016 19:48
workers involved with the original manuals including Alison Wood, the late Richard Harrington Deleted: 96
and Julia Rogers. Ian M Goodyer 31/5/2016 19:48
Deleted: 101
Ian M Goodyer 31/5/2016 19:48
Deleted: 108
Ian M Goodyer 31/5/2016 19:48
Deleted: 117
Ian M Goodyer 31/5/2016 19:48
Deleted: 123
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DRAFT Feb 2010 Version 1
INTRODUCTION
COGNITIVE BEHAVIOURAL THERAPY AND DEPRESSION IN ADOLESCENCE
This manual aims to outline the main principles of Cognitive Behaviour Therapy (CBT) for
depression, to describe the key therapeutic techniques of CBT, and to provide specific
information about how these may be adapted or developed for use with young people. The
manual has been specifically developed for use by therapists who are taking part in the
IMPACT Trial; Improving Mood with Psychodynamic and Cognitive Therapy. However, the
contents of the manual are intended to be of value to therapists working with young people
within a range of contexts.
The manual assumes that CBT therapists have experience of working with young people and
their families, have basic knowledge about developmental psychology and mental health, can
build and maintain a therapeutic relationship with young people, are sensitive to power
issues, boundaries and managing risk, and have a sound grounding of the principles of CBT.
We also assume that they receive regular CBT supervision and are working within the context
of a multi-disciplinary team.
In this manual we provide background information about the theory behind Cognitive
Behavioural Therapy and background information about Depression and how it is experienced
by young people. However, most of this manual is about the nuts and bolts of doing CBT
with young people. It is this that we expect most therapists to use most often. We would be
grateful for your feedback and comments, as this manual is also a work in progress. We
hope it will be a useful resource for therapists, a useful source of reassurance when therapy
is difficult, and a handy reminder of basic principles.
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