Case Formulation in Cognitive - sanjeshserv.com

1 case Formulation in Cognitive Behaviour therapy case Formulation is the core skill of every practitioner carrying out psycho- logical therapies at an advanced level. It is essential in providing an idio- syncratic understanding of individual clients and their clinical problems. In this volume, Nicholas Tarrier brings together contributions that cover many of the clinical issues that will challenge practitioners in their practice of Cognitive behaviour therapy . Each chapter serves as a practical guide to over- coming a particular clinical challenge and is grounded solidly in research evidence. Experts in each individual eld discuss how case Formulation aids clinical practice in their chosen area and demonstrate how detailed under- standing of the clinical case leads to improved therapeutic outcome. Subjects covered include: A biopsychosocial and evolutionary approach to Formulation with a special focus on shame.

2 case conceptualisation in complex PTSD. Cognitive behavioural case Formulation in complex eating disorders. This indispensable guide to formulating clinical cases will be welcomed by clinical psychologists, psychiatrists, psychiatric nurses, counsellors, social workers and students. Nicholas Tarrier is Professor of Clinical Psychology at the University of Manchester. He has pioneered the development and evaluation of Cognitive behaviour therapies for schizophrenia and other psychological disorders. case Formulation in Cognitive Behaviour therapy The treatment of challenging and complex cases Edited by Nicholas Tarrier First published 2006. by Routledge 27 Church Road, Hove, East Sussex BN3 2FA. Simultaneously published in the USA and Canada by Routledge 270 Madison Avenue, New York, NY 10016. This edition published in the Taylor & Francis e-Library, 2006. To purchase your own copy of this or any of Taylor & Francis or Routledge's collection of thousands of eBooks please go to.

3 Routledge is an imprint of the Taylor & Francis Group, an informa business Copyright 2006 selection and editorial matter, Nicholas Tarrier;. individual chapters, the contributors All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data case Formulation in Cognitive behaviour therapy : the treatment of challenging and complex cases / edited by Nicholas Tarrier.

4 P. cm. Includes biographical references and index. ISBN 1-58391-840-X (alk. paper) ISBN 1-58391-841-8 (pbk. : alk. paper). 1. Cognitive therapy . 2. Cognitive therapy case studies. I. Tarrier, Nicholas. 2006. 142 dc22 2005043532. ISBN13: 978-1-58391-840-1 (hbk). ISBN13: 978-1-58391-841-8 (pbk). ISBN10: 1-58391-840-X (hbk). ISBN10: 1-58391-841-8 (pbk). Contents List of tables and gures vii Notes on contributors xi Preface xv 1 An introduction to case Formulation and its challenges 1. NICHOLAS TARRIER. 2 Evidence-based case Formulation : is the emperor clothed? 12. WILLEM KUYKEN. 3 Formulation from the perspective of contextualism 36. CHRIS CULLEN AND HELEN COMBES. 4 Cognitive therapy case Formulation in anxiety disorders 52. ADRIAN WELLS. 5 A biopsychosocial and evolutionary approach to Formulation with a special focus on shame 81. PAUL GILBERT. 6 case Formulation in depression 113.

5 IVY M. BLACKBURN, IAN A. JAMES AND ALYSON FLITCROFT. 7 case conceptualisation in complex PTSD: integrating theory with practice 142. DEBORAH LEE. vi Contents 8 A Cognitive -behavioural case Formulation approach to the treatment of schizophrenia 167. NICHOLAS TARRIER. 9 Bipolar disorders 188. STEVEN JONES. 10 Cognitive Formulation in personality disorder 216. KATE M. DAVIDSON. 11 Cognitive -behavioural case Formulation in complex eating disorders 238. ANNA LAVENDER AND ULRIKE SCHMIDT. 12 Medically unexplained symptoms 263. RICHARD J. BROWN. 13 What about patients who can't sleep? case Formulation for insomnia 293. ALLISON G. HARVEY. 14 Self-harm 312. GARY L. SIDLEY. 15 Working with asylum seekers 330. JAKE BOWLEY. 16 Conceptualising and formulating Cognitive therapy supervision 349. PETER V. ARMSTRONG AND MARK H. FREESTON. Index 373. List of tables and figures Tables Key diagnostic features (DSM-IV) and Cognitive themes in four anxiety disorders 54.

6 Strategies for gaining and maintaining rank status in relationships (from Gilbert and McGuire 1998) 87. Ann's personal details and problem list 127. Megan's personal details and problem list 131. Megan's longitudinal conceptualisation 134. Aspects of the disorder which need to be assessed and possibly taken into consideration in CBT for psychotic patients 168. Treatment aims and methods in di erent phases of the schizophrenic illness 170. Checklist of possible prodromal symptoms (following Smith and Tarrier 1992) 202. Models of personality disorder and implications for treatment 218. Examples of techniques used in CBT for personality disorders 224. Categories of problems 233. Examples of insomnia that is comorbid with another psychological disorder or medical problem 294. Examples of useful questions for the initial case Formulation (adapted with permission from Harvey et al.)

7 2004) 302. Brief discussion of treatment outcome for the patients described in Table 308. Summary of self-harm dimensions, the underlying motivational theme, and typical negative automatic thoughts present prior to the self-harm 316. Cognitive therapy and supervision 350. Summary of important features of the case as conceptualised within the framework 363. viii List of tables and figures Figures The dysfunctional system approach to case Formulation 7. Systemic destabilisation as a result of stress and vulnerability 9. Rationale for CBT case Formulation 14. Criteria for evidence-based Formulation 15. Clinical (heuristic) decision-making: process and output in two systems (after Kahneman 2003) 20. Evidence-based guidelines for generating good enough'. CBT formulations 29. General schema model of anxiety disorders (reproduced from Wells 1997) 53. Cognitive model of panic (reproduced from Wells 1997) 56.

8 An idiosyncratic panic Formulation 60. Cognitive model of social phobia (reproduced from Wells 1997) 61. An idiosyncratic social phobia Formulation 64. Meta- Cognitive model of OCD (reproduced from Wells 1997) 66. An idiosyncratic OCD Formulation 68. Meta- Cognitive model of GAD (reproduced from Wells 1997) 70. An idiosyncratic GAD Formulation 73. A generic algorithm for case Formulation 75. Biopsychosocial and ecological interactions 84. An evolutionary and biopsychosocial model for shame (adapted for Gilbert 2002b) 99. Types of a ect-regulating systems (from Gilbert 2005a) 101. Cognitive model of depression 115. Ann's initial conceptualisation 128. Persistent PTSD (adapted from Ehlers and Clark 2000) 155. Jo's case conceptualisation (adapted from modi ed version of model of persistent PTSD (from Ehlers and Clark 2000)) 157. Amy's case conceptualisation (adapted from modi ed version of model of persistent PTSD (from Ehlers and Clark 2000)) 161.

9 Amy's hotspot chart 162. A clinical model in the CBT treatment of psychosis 176. The experience belief action con rmation cycle 177. Vulnerability-stress model (following Lam et al. 1999) 190. An instability heuristic for understanding bipolar disorder 191. Initial life chart for Peter showing self-rated mood over time 200. Formulation of depressed and agitated mood for Peter 203. Example activity and mood record for Bill 206. Prodromal signs and coping strategies for Peter 209. DSM-IV personality disorder clusters 217. Relationship between past sexual abuse, self-harm, emotion and thoughts 227. List of tables and figures ix Cognitive Formulation 232. Sarah's Cognitive behavioural Formulation 255. Karen's Cognitive behavioural Formulation 258. Clinical heuristic for formulating patients with MUS. (from Brown 2004; Sharpe et al. 1992a) 269. Formulation for Sandra 288.

10 A Cognitive model of the maintenance of insomnia: the cascade of processes depicted is proposed to apply to both the day and the night (reprinted with permission from Harvey 2002) 296. An example of a personalised version of the Cognitive model for the night (reprinted with permission from Harvey 2005) 301. Example of a maintenance Formulation illustrating the mood regulation dimension of self-harm 318. Example of a maintenance Formulation illustrating the communication dimension of self-harm 319. Example of a maintenance Formulation illustrating the self-punishment dimension of self-harm 320. Jane's full case Formulation 324. Learning process based on the Kolb cycle (1984) 356. The dynamic focus of supervision 357. Parameters of supervision 359. Primary inputs to supervision 360. Newcastle conceptual framework for Cognitive therapy supervision 366. Notes on contributors Peter V.