Cognitive Behavioural Therapy for Adolescents and Young Adults Cognitive Behavioural Therapy for Adolescents and Young Adults: An Emotion Regulation Approach provides a unique focus on therapeutic practice with adolescents and young adults, covering everything from psychological theories of adolescence to the treatment of common emotional difficulties. Beginning with a review of development through adolescence into adulthood, and the principles of CBT, this book highlights problems with traditional models of CBT for adolescents and young adults. In a fresh approach, this book separates CBT from diagnosis and grounds it instead in emotion science. Adolescents and young adults learn not about disorders and symptoms, but about emotions, emotional ‘traps’, and how they can use CBT to bring about change. There are chapters on fear, sadness, anger, emotion dysregulation, and happiness. Each chapter provides an outline of emotion science, a clear cognitive behavioural formulation (‘trap’), and evidence-based interventions. Clinicians are walked through the process using case illustrations. Cognitive Behavioural Therapy for Adolescents and Young Adults represents a transformation of CBT practice, and will become a valuable treatment manual to training and practising mental health professionals, especially psychotherapists specialising in CBT. Dr Lawrence Howells is a clinical psychologist specialising in work with adolescents and young adults. He has previously worked as clinical lead for a youth psychology team and currently works in a multidisciplinary youth mental health team. “Dr Howells’s new book, and method, reimagines CBT for the next generation. Grounded in fine-grain, intelligent clinical practice and expertise, the innovative techniques described here focus on developing a can-do mentality in young people – crucially, helping them reframe their ‘symptoms’ as normal responses to the developmental challenges of life. On the basis of cutting-edge psychological science, and with many clear case examples, Dr Howells tilts CBT on its axis to show how young people can understand their feelings, harness their latent abilities, and take back control of their futures. At a time when young people are facing unprecedented emotional challenges, Dr Howells’s powerful new re- reading of CBT is a priceless gift to give them, their families, and the professionals with whom they work.” Dr Roger Kingerlee, Consultant Clinical Psychologist, Norfolk and Suffolk Foundation Trust “This book offers a practical and refreshingly different approach to doing cog - nitive behaviour therapy (CBT) with adolescents and young adults. It is an ideal text for the therapist who is starting out in offering CBT for adolescents, as well as for the more experienced clinician who wants to refresh their knowledge and to review and reflect on their applied skills. The evidence base and theory driving the approach blends seamlessly into each chapter. A great addition to the existing CBT practitioner texts for those working with adolescents and young adults!” Dr Maria Loades, Senior Lecturer/Senior Clinical Psychologist/NIHR Research Fellow, University of Bath “As health care restructures to respond in a more timely way to the mental health needs of young people in transition from childhood to adulthood, we urgently need psychosocial interventions that are fit for purpose and transcend our artificial diagnostic frameworks. Dr Howells offers a developmentally attuned approach which is transdiagnostic and, with its primary focus on emotions, is better targeted than traditional CBT for young people. Novel therapies like this are needed as the new 12–25 system of youth mental health care takes shape in many countries. They can be enhanced through new technologies like virtual reality and online platforms but the theoretical and practical building blocks mesh well with the experience and needs of young people. This approach is likely to evolve further with feedb ack from young people themselves and experienced therapists.” Professor Patrick McGorry, Professor of Youth Mental Health at the University of Melbourne, and President of the International Association for Youth Mental Health “The term ‘paradigm shift’ is often overused. However, in the case of Lawrence Howells’ new book I believe that we are witnessing exactly that. This book gives us a really fresh approach to CBT with adolescents and young adults, at a time where effective psychological therapy approaches with this age group are more crucial than ever. Howells’ approach will help adolescents and young adults to understand a range of emotions – fear, sadness, anger, and shame – and to learn methods of bringing about change, aiming at a desired outcome of happiness and wellbeing.” Professor Jamie Hacker Hughes, Consultant Clinical Psychologist, Psychotherapist and Supervisor, and Past President of the British Psychological Society (2015–2016) “An excellent, stimulating and at times challenging addition to the literature, this book is highly recommended for both novice and experienced therapists or indeed anyone working with young people who feel that simple yet powerful models would be useful in helping them to connect with and help young people experiencing a variety of emotional issues. Highly recommended.” Dr Jon Wilson, Consultant Psychiatrist and Medical Psychotherapist at the Norfolk Youth Service. Clinical Senior Lecturer at the University of East Anglia Cognitive Behavioural Therapy for Adolescents and Young Adults An Emotion Regulation Approach Lawrence Howells First published 2018 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2018 Lawrence Howells The right of Lawrence Howells to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. 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. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. 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 Names: Howells, Lawrence, author. Title: Cognitive behavioural therapy for adolescents and young adults : an emotion regulation approach / Lawrence Howells. Description: Milton Park, Abingdon, Oxon ; New York, NY : Routledge, 2018. | Includes bibliographical references. Identifiers: LCCN 2017059367| ISBN 9781138707467 (hbk) | ISBN 9781138707474 (pbk) | ISBN 9781315201382 (ebk) | ISBN 9781351781848 (web) | ISBN 9781351781831 (epub) | ISBN 9781351781824 (mobipocket) Subjects: LCSH: Cognitive therapy for teenagers. | Adolescent psychotherapy. Classification: LCC RJ505.C63 H69 2018 | DDC 616.89/14250835 – dc23 LC record available at https://lccn.loc.gov/2017059367 ISBN: 978-1-138-70746-7 (hbk) ISBN: 978-1-138-70747-4 (pbk) ISBN: 978-1-315-20138-2 (ebk) Typeset in Times New Roman and Gill Sans by Florence Production Ltd, Stoodleigh, Devon, UK For Lucy, Taliesin, Tegan, Cassidy, and Seren Contents Acknowledgements xiii 1 Introduction 1 2 Adolescent development 5 What and when is adolescence? 6 Physical development 6 Brain development 7 Cognitive development 8 Social cognitive development 9 Identity development 10 Emotion and emotion regulation development 12 Relations with families and peers 16 Bringing it all together: theories of adolescent development 20 3 Principles of cognitive behavioural therapy (CBT) 28 History of CBT 28 Theoretical principles of cognitive behavioural therapy 29 Practical constructs of CBT 31 Evidence base 40 4 Problems with diagnosis-based CBT in adolescents and young adults 43 Problems with diagnosis 43 Problems with CBT in routine clinical practice 49