COGNITIVE BEHAVIOUR THERAPY Cognitive Behaviour Therapy: 100 Key Points and Techniques is a crisp, concise elaboration of the 100 main features of the very popular and evidence- based CBT approach within the field of psychotherapy. In recent decades CBT has been applied to an ever-i ncreasing number of problems (including anxiety disorders, substance abuse and eating disorders) and populations (children, adolescents and older people). With newly incorporated material on supervision, this exten- sively revised and updated third edition covers CBT theory and prac- tice. Divided into helpful sections, the topics covered include: • Misconceptions about CBT • Teaching the cognitive model • Assessment→case conceptualization→treatment planning • Ways of detecting and answering negative automatic thoughts (NATs) • Homework (between- session assignments) • Conducting behavioural experiments • Uncovering and restructuring intermediate and core beliefs • Relapse management • Resistance • Supervision • Third wave CBT This compact, usable book is an essential guide for psychotherapists and counsellors, both trainee and qualified, who need to ensure they are entirely familiar with the key features of CBT as part of a general introduction to the current major psychotherapies. MMiicchhaaeell NNeeeennaann is Associate Director of the Centre for Stress Management and Centre for Coaching, Blackheath, and a member of the British Association for Behavioural and Cognitive Psychotherapies. He has written and edited over 25 books. WWiinnddyy DDrryyddeenn is Emeritus Professor of Psychotherapeutic Studies at Goldsmiths College, University of London, and is an international authority on rational emotive behaviour therapy (REBT). He has worked in psychotherapy for more than 45 years and is the author and editor of over 230 books. 100 Key Points and Techniques Series Editor: Windy Dryden ALSO IN THIS SERIES: Gestalt Therapy: 100 Key Points and Techniques Dave Mann Integrative Therapy: 100 Key Points and Techniques Maria Gilbert and Vanja Orlans Solution Focused Brief Therapy: 100 Key Points and Techniques Harvey Ratner, Evan George and Chris Iveson Rational Emotive Behaviour Therapy: 100 Key Points and Techniques, 2nd Edition Windy Dryden and Michael Neenan Existential Therapy: 100 Key Points and Techniques Susan Iacovou and Karen Weixel- Dixon Person- Centred Therapy: 100 Key Points and Techniques, 2nd Edition Paul Wilkins Single- Session Therapy (SST): 100 Key Points and Techniques Windy Dryden Acceptance and Commitment Therapy: 100 Key Points and Techniques Richard Bennett and Joseph E. Oliver COGNITIVE BEHAVIOUR THERAPY 100 KEY POINTS AND TECHNIQUES THIRD EDITION Michael Neenan and Windy Dryden Third edition published 2021 by Routledge 2 Park Square, Milton Park, Abingdon Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2021 Michael Neenan and Windy Dryden The right of Michael Neenan and Windy Dryden to be identified as authors of this work has been asserted by them 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. 1st edition published in 2004 by Brunner-Routledge 2nd edition published in 2015 by Routledge British Library Cataloguing-i n- Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-i n- Publication Data Names: Neenan, Michael, author. | Dryden, Windy, author. Title: Cognitive behaviour therapy: 100 key points and techniques / Michael Neenan and Windy Dryden. Description: Third edition. | London; New York: Routledge, Taylor & Francis Group, 2021. | Series: 100 key points and techniques | Includes bibliographical references and index. Identifiers: LCCN 2020038040 (print) | LCCN 2020038041 (ebook) | ISBN 9780367680671 (hardback) | ISBN 9780367680657 (paperback) | ISBN 9781003134053 (ebook) Subjects: LCSH: Cognitive therapy. Classification: LCC RC489.C63 N45 2021 (print) | LCC RC489.C63 (ebook) | DDC 616.89/1425–dc23 LC record available at https://lccn.loc.gov/2020038040 LC ebook record available at https://lccn.loc.gov/2020038041 ISBN: 978-0-367-68067-1 (hbk) ISBN: 978-0-367-68065-7 (pbk) ISBN: 978-1-003-13405-3 (ebk) Typeset in Aldus by Newgen Publishing UK TToo LLaauurreennccee ffoorr hhiiss sstteeaaddffaasstt ssuuppppoorrtt aanndd llooyyaallttyy –– MM..  NN.. CONTENTS Preface xiii Part 1 CBT THEORY 1 1 It is not events per se that determine our feelings but the meanings that we attach to these events 3 2 Information processing becomes distorted when we experience emotional distress 6 3 An emotional disorder is usually understood by examining three levels of thinking 9 4 Thoughts, feelings, behaviour, physiology and environment are interconnected 13 5 Emotional reactions to events are viewed along a continuum 15 6 Emotional disorders have a specific cognitive content 17 7 Cognitive vulnerability to emotional disturbance 19 8 Our thoughts and beliefs are both knowable and accessible 21 9 Acquisition of emotional disturbance 23 10 Maintenance of emotional disturbance 25 11 The client as personal scientist 27 Part 2 MISCONCEPTIONS ABOUT CBT 29 12 Only articulate and intelligent clients can really benefit from CBT 31 13 CBT does not focus on feelings 33 14 CBT is basically positive thinking 36 vii viii Contents 15 CBT seems too simple 38 16 CBT is little more than symptom relief 40 17 CBT is not interested in the client’s past or childhood experiences 42 18 CBT does not make use of the relationship as a means of client change 44 19 CBT is not interested in the social and environmental factors that contribute to clients’ problems 46 20 CBT is just the application of common sense to clients’ problems 48 21 CBT is just technique- oriented 50 Part 3 CBT PRACTICE 53 GETTING STARTED 55 22 Setting the scene 57 23 Undertaking an assessment 60 24 Assessing client suitability for CBT 63 25 Structuring the therapy session 66 26 Setting the agenda 68 27 Drawing up a problem list 70 28 Agreeing on goals 72 29 Teaching the cognitive model 75 30 Developing a case conceptualization 78 31 Developing treatment plans 82 WAYS OF DETECTING NATS 85 32 Detecting NATs 87 33 Guided discovery 90 34 Using imagery 93 35 Making suggestions 95 36 In- session emotional changes 97 37 Finding the thoughts by ascertaining the client’s idiosyncratic meaning of the event 99 Contents ix 38 Focusing on feelings 101 39 Assuming the worst 103 40 Situational exposure 105 41 Role play 107 42 Analyzing a specific situation 109 43 NATs in shorthand 110 44 Symptom induction 112 45 Behavioural assignments 114 46 Eliciting key NATs from less important cognitive data 116 47 Separating situations, thoughts and feelings 119 48 Distinguishing between thoughts and feelings 122 EXAMINING AND RESPONDING TO NATS 125 49 Answering back 127 50 Weighing the evidence 130 51 Constructing alternative explanations 132 52 Identifying cognitive distortions 134 53 Looking at the advantages and disadvantages 136 54 Defining terms 139 55 Reattribution 141 56 Decatastrophizing 143 57 Exploring double standards 146 58 Modifying fearful imagery 148 59 Using behavioural experiments 150 60 Socratic questioning (a method of guided discovery) 153 61 Exaggeration and humour 156 62 Writing down alternative responses to NATs 158 HOMEWORK 161 63 Rationale for homework 163 64 Types of homework assignment 165 65 Negotiating homework assignments 169 66 Reviewing homework assignments 172