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On average, psychotherapy delivered on inpatient units produces clinical outcomes with smaller effect sizes than the same treatments in outpatient settings. The Collaborative Care CBT Milieu presents opportunities to extend the benefits of the therapeutic milieu by capitalizing on paraprofessionals who have the most interactions with patients. Mental health technicians (n = 27) were trained to use CBT strategies in daily interactions with patients on an adolescent inpatient unit. Communication about individualized CBT conceptualization and strategies were integrated into the functions of the unit across disciplines and shifts. Compared to rates of use in the year prior to training, use of physical holds was reduced by 21.25% and use of mechanical restraints was reduced by 43.98%. The Collaborative Care CBT Milieu model demonstrates the feasibility of training MHTs to work in coordination with CBT therapists and other treatment team members to provide milieu interactions consistent with traditional CBT. Training staff to apply CBT theory and strategies within their scope of practice offers a pathway to an inpatient unit with a common language, shared lens for understanding patients, and unified approach to individualized care. Further research is needed to understand how these innovations impact clinical outcomes.

Cognitive Processing Therapy (CPT) with traditional written thought records is an effective treatment for posttraumatic stress disorder (PTSD). A potential barrier to targeting trauma-related beliefs with traditional thought records is that typically the resulting behavioral avoidance from the trauma-related belief limits the experiences (i.e., evidence) which are available to draw from when evaluating a thought—there can be an absence of discrepant experiences due to avoidance. Another major approach to cognitive restructuring in the cognitive and behavioral therapies is through behavioral experiments (BE) which can be used to gather new evidence and form new experiences. Extant literature suggests there are some preliminary indications that BE may have a slight clinical advantage over traditional thought records as they are associated with a faster treatment response and better generalizing of new learning. There is also evidence that BE may have a slight advantage over traditional exposure for treating anxiety disorders. An illustrative case example of an active duty soldier with PTSD stemming from multiple combat- and non-combat-related traumas is presented. Standard CPT was modified to include BE as opposed to standard thought records to treat his PTSD. Treatment was effective as the soldier demonstrated reliable change and clinically significant change on the PTSD Checklist-5 (PCL-5). Further research is needed to better understand the role of BE in treating PTSD.

Background: Thought records are a core component of Cognitive Behavior Therapy. Over time, thought records have been modified to suit various needs or preferences. A diversity of thought records have been developed, which include differing components and cognitive change strategies. Yet, due to a lack of specificity in the literature and field, different thought records are often treated as though they are interchangeable. Limited extant literature suggests that differing thought records may have unique clinical effects. However, meta-analyzing the comparable or differing effects of the distinct extant thought records is impeded by the lack of a coding system for thought records. Objective: The current study sought to prepare a way for further understanding the differential utility and effectiveness of different iterations of thought records by creating a coding system, which is described in detail. This coding system will be used to guide future research into which thought records work best for which problems. Method: Thought records were gathered from seminal texts and solicited from the certified members of the Academy of Cognitive Therapy and the American Board of Behavioral and Cognitive Psychology. Results: In total, 110 non-identical thought records were gathered and coded into 55 unique combinations. These results demonstrate that the variability of thought records used by qualified therapists extends well beyond those found in seminal CBT texts. Conclusion: This broad diversity justifies the need for a coding system to inform future lines of research.

It is vitally important that providers treating post-traumatic stress disorder continue to stay abreast of research advances in the treatment of this disorder. This article updates the reader about advances in research in PTSD treatment in the past four years as well as the evolving recommendations of clinical practice guidelines. One of the most important developments is that trauma-focused therapy (TFT) has emerged as the first-line treatment for PTSD with pharmacologic options often being noted as second-line or adjunctive. The quality and quantity of research into the treatment of PTSD continue to grow; however, the pace of research into treatment options lags behind our understanding of the development, course, and prognosis of the disorder. The development of new research-based evidence in the treatment of PTSD, both pharmacologic and psychotherapeutic, is needed and likely to necessitate frequent updates and re-evaluations of clinical practice guidelines.

There is a great need for training in cognitive behavioral therapy (CBT) for community clinicians who work in public mental health systems where resources are low and demands are high. Researchers have found that simply attending intensive CBT workshops will not result in adherent or competent CBT being delivered, rather ongoing CBT supervision/consultation has been found to be associated with the best training outcomes. Psychotherapy-based approaches to supervision have recently received some attention for their value in providing experiential learning. What follows is a case example of a community clinician who had little previous training in CBT and following an intensive training and 16 weeks of CBT supervision had substantial gains in her CBT adherence and competency ratings. Recommendations such as the value of experiential learning are discussed.

This chapter provides the reader with a solid introduction to Socratic questioning. Specifically, Socratic questioning is defined and the value of these procedures for therapists, CBT and non-CBT alike, are illustrated. Rich, clinician-friendly case examples are used throughout this volume, beginning with this first chapter. The chapter contains an anecdote about Dr Aaron Beck that demonstrates his pragmatic nature and the flexibility of the model. The chapter concludes with two case examples of how Socratic questioning can be used to bring about lasting change.

This chapter provides the “why” for Socratic questioning. In this chapter, we have focused on reviewing why corrective learning might not happen implicitly. This has included a brief review of relevant items from the field of social psychology, an overview of the Generic Cognitive Model, an introduction to case conceptualization, and an extended case example that demonstrated both the above elements and how to address these concepts in session. This chapter is not purely theoretical/empirical. Applied material involving the formation of brief functional case conceptualizations to help identify optimal treatment targets are described. This chapter continues with rich case examples in support of the concepts presented.

In an investigation (doi:10.1016/j.cbpra.2016.04.002) of the common difficulties clinicians have when learning CBT, Socratic questioning (also called guided discovery or collaborative empiricism) was identified as the hardest skill to learn. This finding led to a reformulation of how this skillset was taught. In doing so, a four-step model was developed: (1) Focusing on Key Content; (2). Developing a Phenomenological Understanding of the Cognition; (3). Fostering a Collaborative Curiosity; (4) Summary and Synthesis. The purpose of this book is to teach this four-step model and its many applications, and to do so in a clinician-friendly manner. The revised Socratic framework is presented, including the rationale for the framework, a macro-level description of the model, an overview of the specific steps that make up the framework, and several lengthy illustrative examples. The bird’s-eye view offered in this chapter sets the stage for the next four chapters which detail each step in the framework in extensive detail. Reproducible forms that relate to the revised framework are provided.

CBT has evolved and continues to evolve rapidly. This chapter covers the integration of Socratic strategies with newer developments in the field involving third-wave cognitive behavioral therapy generally, and dialectical behavior therapy specifically. Specific examples and suggestions are made to the standard DBT therapist for the seamless integration of these procedures into their work. A common difficulty to using cognitive strategies for clients who need DBT is that they have a high level of emotion dysregulation which can make the process difficult for clinicians who do not know how to handle this presentation. This chapter will focus on using DBT strategies like emotion regulation training and the behavioral chain analysis to create the necessary conditions for the effective use of Socratic strategies. This chapter summarized Socratic strategies for working with a population that has borderline personality disorder from a DBT framework. Skills and strategies that have been presented are consistent with the DBT model and are configured in a manner to maximize the potential for successful Socratic strategies. All Socratic strategies presented are grounded in behavioral therapy and focus on fostering behavior change. New skills such as the Cognitive Chain Analysis and Socratic Dialectical Method Thought Record use DBT components and are demonstrated with clinical examples. Key elements for working with this population include using regulation strategies prior to cognitive strategies, and then connecting the outcome of the Socratic evaluation to behavior change.

There has been an increased emphasis on the implementation of cognitive behavioral therapy (CBT) to community mental health (CMH) systems due to its broad efficacy. Previous research has highlighted the importance of ongoing consultation in this process. The current study clarifies the role and process of clinical case consultation in the implementation of CBT to CMH from the consultants’ perspective. Trainers from two large-scale implementation initiatives (n = 27) were surveyed regarding their strategies used in the consultation process. Historically, researchers have focused on trainees who view relational variables as the most effective elements of consultation; however, in the current study, trainers perceived experiential learning as being the most effective consultation strategy for helping CMH clinicians learn CBT. Other aspects of consultation such as case conceptualization and practice sample review are discussed in terms of their relative perceived utility in raising CMH clinician’s competency to treat comorbid patients.

Given the preponderance of evidence supporting the efficacy of cognitive behavior therapy (CBT), there has been an increased emphasis on dissemination to community mental health systems (CMH). Trainers from two large-scale dissemination initiatives ( n = 27) were surveyed regarding the common pitfalls and difficulties encountered by CMH clinicians learning CBT. Common pitfalls were organized according to the items of the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980) and reviewed. Guided discovery was reported to be the most challenging CBT competency to learn. Qualitative methods were used to construct a grounded theory; trainer responses indicated they viewed the practice of CBT as not only a set of discrete skills, but also a way of thinking. Efforts may be needed to provide support, assistance, and resources to these CMH clinicians as they continue to build CBT competency.

The Improving Access to Psychological Therapies initiative has a reported 50 percent recovery rate. Recently, Scott published a scathing report asserting that 9.2 percent is the correct rate. This alarming assertion requires a closer look and further scrutiny of the Improving Access to Psychological Therapies. Scott’s study is fundamentally flawed in many ways; chiefly, the small ( n = 87), forensically involved, convenience sample is not representative of the Improving Access to Psychological Therapies population. Scott’s study is more a limited-scope non-representative-sampled audit (or pilot study audit) of the Improving Access to Psychological Therapies. Given the large amount of public funds involved in the project, further research and a high degree of transparency is warranted.

The following case study examines the treatment of a man who presented with ambiguous concerns related to safety. Initially, diagnosis was unclear, and a psychotic disorder was hypothesized. Through the use of functional analysis (FA), it became clear that he met criteria for Posttraumatic Stress Disorder (PTSD) and was subsequently treated using Cognitive Processing Therapy (CPT). He experienced clinically significant change as his score on the PTSD Checklist dropped from 59 to 26. This case demonstrates the utility of FA in the diagnostic process to ensure identification of key treatment targets. Also, visual methods of increasing attentional focus during cognitive restructuring are reviewed.

The Generic Cognitive Model both predates and relies on the vast research on single-diagnosis Cognitive Behavioral Therapy (CBT) protocols. In practice, CBT is a way of thinking that is driven by hypothesis testing and case formulation. Research has demonstrated that a case conceptualization-driven approach to CBT generally produces outcomes equivalent to single-diagnosis protocols. This formulation-driven approach may be most valuable when working with individuals who are not making the expected progress in response to standard protocols. Future research on training clinicians in how to develop adequate case formulations and comparing methods of transdiagnostic care, including case conceptualization-driven approaches such as The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, are warranted.

OBJECTIVE Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. METHOD Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians' work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. RESULTS Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). CONCLUSIONS Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record

This article presents the case of a mindfulness-based group therapy that was implemented in a residential treatment facility. The case presented comprised a group of adolescent males with disruptive behavior disorders. The group was designed to be appropriate for the unique demographics of the clients, with the intent to help the clients enhance and develop improved impulse control skills. The contents of the group were gathered and adapted from various mindfulness-based therapies. Attending the presented mindfulness group was found to produce increases in self-reported mindfulness skills and improvements in behavioral compliance. Recommendations are made for running similar groups.

This paper addresses the question of how to approach religiosity and psychosis within a clinical context. A clinician who is tasked with the differential diagnosis of a client who is apparently either experiencing normative religious phenomenon or psychotic symptoms faces a difficult situation—as clinicians are generally ill-prepared to address topics related to spirituality. It is important for a clinician to be culturally informed and culturally sensitive, and yet religiously-themed hallucinations and delusions are commonly observed among individuals experiencing psychosis. Recommendations are made to help inform culturally appropriate diagnosis and practice.