In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in Chapter 8 here, together with the reviews provided of each specific CBT technique in Chapters 12 through 19, should be used to guide the selection of appropriate techniques. Goal: Develop strategies to reduce symptoms, or . CBT for GAD is a multimodal treatment, meaning that it includes various components that target the different symptoms of the illness: physical, cognitive, and behavioral.Overall, CBT aims to help you reduce your … Sample Treatment Plan for Anxiety The following plan gives you an idea about what you can expect from counselling/therapy for anxiety. Reduce anxiety and improve coping skills. $.' from (e.g., Rick Heimberg’s CBGT, Clark and Wells Individual CBT) should also be provided along with: (3) A summary of treatment efficacy data for these treatments (for example, a summary of treatment efficacy research on panic disorder using cognitive behavior therapy). Therapist flexibility in this case focuses more on the tailoring of the technique to the specific cognitions, behaviors, or situations that the client experiences. Sequencing selected specific CBT techniques for depressive disorders. Cognitive behavioral therapy (CBT) for child anxiety has been shown to be maximally effective when CBT interventions are matched to the specific anxiety symptoms experienced by the individual (Eisen and Silverman 1993, 1998), and long-term efficacy has been established for a majority of individuals after a CBT program for adolescent depression that incorporated use of case formulation (Treatment of Adolescent Depression [TADS] Team 2009). Adapted from Figure 8.2, which was adapted from Rapee (2001) and Hudson and Rapee (2004). Each factor will also vary on the strength of its association with current problems. There are 15 main cognitive distortions that can plague even the most balanced thinkers. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Once the model has been selected, the therapist should attach relevant evidence gathered during assessment to each aspect of the model. Each factor will also vary on the strength of its association with current problems. Consequently, after basic psycho-education, exposure would be considered the most essential technique to implement with a child or adolescent who has an anxiety disorder. The exact nature of what we … Melissa was referred to psychotherapy by her family physician due to chronic anxiety, stress, and other panic-like symptoms. The models of anxiety and depression presented in Chapter 8 are nomothetic, that is, they describe the general “laws” of how these problems arise. (For an example of this, see, the implementation of exposure, the parent would require (i) psycho-education concerning the role of excessive reassurance in his/her child’s evaluation of a situation; (ii) therapist modeling of the appropriate parent management during in-session exposure exercises; and, ultimately, (iii) parent-led, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Case Formulation and Treatment Planning for Anxiety and Depression in Children and Adolescents, Theoretical Foundations of CBT for Anxious and Depressed Youth, Assessing Child and Adolescent Internalizing Disorders, Professional Evidence-Based Practice with Children and Adolescents, An Introduction to the Competencies-Based Approach, Evidence-Based CBT for Anxiety and Depression in Children and Ad. Anxiety. Learn two new ways of coping with routine stressors . We won’t necessarily work on all of these areas, but this gives you a general outline for the types of things we’ll do and the order in which we’ll approach them. Cognitive restructuring or reframing. Importantly, case formulations are flexible. case formulations has been found to be adequate (Kuyken, Fothergill, Musa, and Chadwick 2005), the quality of case formulations improving with therapist experience and training (Eells et al. Alternatively, the case formulation may indicate that excessive reassurance from the parent undermines the child’s ability to learn that (s)he can cope with challenging situations. Figure 9.1 Example of idiographic application of the anxiety model to the case of an 11-year-old boy. Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. The first-line treatment and gold standard for treating generalized anxiety disorder (GAD) is cognitive behavioral therapy (CBT). Cognitive-Behavioral Case Formulation. As can be seen, a picture emerges from the idiographic model of what is causing and maintaining the presenting problem for the individual. They account for all the information gathered at any point in time, and they are updated to reflect new information as it arises. Within CBT models and at the diagnostic level, avoidance is key to all forms of anxiety. Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. For example, successful exposure to social situations in the school playground may not be possible until an underlying deficit in social skills is addressed. Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. The case-formulation approach has also been shown to improve some aspects of the therapeutic alliance (Chadwick, Williams, and Mackenzie 2003); and client acceptance of a treatment rationale – one aspect of the case formulation – is related to good treatment outcome (see, e.g., Addis and Jacobson 2000). (For an example of this, see Figure 9.1, where each numerical indicator provides the chosen specific CBT technique that will form the treatment plan.) The flexible therapist will revise the case formulation or the treatment plan to work directly on the parent’s reactions during exposure, through one-on-one work on his/her beliefs regarding the child’s ability to cope with risk and/or by incorporating reduction of parent involvement directly into the child’s exposure hierarchy. Treatment manuals will provide guidance on the selection of appropriate techniques or, through design, will have made assumptions about the selection of techniques on the basis of the chosen nomothetic model and the target population. Real-world … Identify the negative thought. Case formulation is the process of identifying the causes, antecedents, and maintaining factors related to a client’s emotional, interpersonal, and behavioral problems. Cognitive behavioral therapy (CBT) has become the leading treatment for anxiety, and with good reason. Treatment manuals will provide guidance on the selection of appropriate techniques or, through design, will have made assumptions about the selection of techniques on the basis of the chosen nomothetic model and the target population. Despite the small amount of research to date, existing results are promising and case formulation is considered by organizations such as the APA to be fundamental to evidence-based practice (APA 2006). CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or g… stream The initial case formulation, and consequently the treatment plan, must be updated as new information is discovered and as a result of the experience implementing each specific CBT technique with the client. For more information, feel free to contact us or fill out our phone consultation … My literature review on Generalized Anxiety Disorder (GAD) showed that Cognitive-Behavioral Therapy (CBT) is the most effective technique in the treatment of GAD, therefore I will use CBT in the treatment of Susan. Following thorough assessment, the therapist should select the nomothetic model that is appropriate for the presenting individual, his/her family, and the organizational setting in which treatment is being offered. In addition to developing the idiographic representation of the chosen model, the potential impact that socio-demographics, culture, comorbidity, and development will have on engagement with treatment and on the likelihood of experiencing common obstacles during treatment should be considered. Outpatient Treatment Plan A treatment plan was created or reviewed today, 9/22/2016, for Mary Golden. Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression Author: Ricardo F. Munoz Subject: Cognitive-Behavioral Therapy (CBT) is one of the two manual-based forms of short-term psychotherapy that have been recognized as effective by the AHRQ guidelines panel. Surprisingly, though, there has been minimal research on the clinical utility and accuracy of case formulations and subsequent treatment plans, particularly with regard to child and adolescent populations. Generalized Anxiety Disorder 7-item (GAD-7) | Spitzer, Kroenke, Williams, Lowe | 2006 Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Also, she recently broke up with her boyfriend and become more worried. Adults with GAD (n = 85) who scored above the high severity cutoff on the Penn State Worry Questionnaire were randomized to 15 weekly sessions of CBT alone or to 4 weekly sessions of MI followed by 11 weekly CBT sessions integrated with MI (MI-CBT). Finally, the formulation should consider the strengths of the individual and family, as recognition of these factors not only facilitates an optimistic view of the future, but can provide the therapist with a basis on which (s)he can build resilience (Macneil et al. The distinct advantage of case formulation for the therapist in community practice is the flexibility it provides in determining a treatment plan for individuals who may or may not fit the criteria on which manual-based approaches were evaluated. The competent therapist must ensure that (s)he has a thorough understanding of the purpose of each specific CBT technique, so that (s)he can appropriately link it to the causal or maintaining factor(s) that it is designed to address. (13, 14) 13. The models of anxiety and depression presented in Chapter 8 are nomothetic, that is, they describe the general “laws” of how these problems arise. Cognitive-behavioral therapy for the treatment of depression Research studies carried out during the last decades have consistently shown that CBT is efficacious in treating adolescent mental disorders such as depression, anxiety or oppositional In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in Chapter 8 here, together with the reviews provided of each specific CBT technique in Chapters 12 through 19, should be used to guide the selection of appropriate techniques. To devise a case formulation, a competent therapist will need to add, to the standard diagnostic and symptom severity assessment tools, a targeted assessment of the typical cognitions, behaviors, and emotions that relate to the presenting problem for the individual, as well as an evaluation of interpersonal processes between the individual and other people (e.g., parents, peers) during periods of high anxiety or low mood. CBT4PANIC was created by a group of dedicated Professional Cognitive Behavioural Therapists and Psychotherapists with extensive training and years of expertise working both in the private sector … On the basis of the case formulation, the therapist can overlay what specific CBT techniques will be used to address each component of the case formulation. A full behavioral therapy program is involved, and repeated practice in activities that cause self-consciousness and anxiety. The distinct advantage of case formulation for the therapist in community practice is the flexibility it provides in determining a treatment plan for individuals who may or may not fit the criteria on which manual-based approaches were evaluated. The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or managed. Therapist flexibility in this case focuses more on the tailoring of the technique to the specific cognitions, behaviors, or situations that the client experiences. Sequencing selected specific CBT techniques for anxiety disorders For example, CBT for treating depression will be different from CBT for treating SAD or other anxiety disorders. Importantly, case formulations are flexible. Following thorough assessment, the therapist should select the nomothetic model that is appropriate for the presenting individual, his/her family, and the organizational setting in which treatment is being offered. Despite the small amount of research to date, existing results are promising and case formulation is considered by organizations such as the APA to be fundamental to evidence-based practice (APA 2006). Cognitive Conceptualization Diagram: Cognitive-Behavioral Case Formulation. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions. 16 0 obj Each of these processes is described below. Therefore the treatment plan should reflect an early focus on developing basic social skills prior to exposure, as implementation of the newly learnt social skills would improve the likelihood of early success in exposure to social situations. The case-formulation approach has also been shown to improve some aspects of the therapeutic alliance (Chadwick, Williams, and Mackenzie 2003); and client acceptance of a treatment rationale – one aspect of the case formulation – is related to good treatment outcome (see, e.g., Addis and Jacobson 2000). Social anxiety disorder is best treated by comprehensive cognitive-behavioral therapy. The treatment plan can subsequently be adjusted to proactively address these potential barriers, decreasing the likelihood that the barrier will interfere with progress. Specific CBT techniques may focus on a single factor or may deliberately target multiple factors. Consequently, after basic psycho-education, exposure would be considered the most essential technique to implement with a child or adolescent who has an anxiety disorder. The purpose of the case formulation is to create an idiographic model relevant only to a specific case. In situations where treatment is guided by CBT theory and the therapist’s clinical judgment, the sections on clinical implication in, should be used to guide the selection of appropriate techniques. Cognitive behavioral therapy (CBT) for child anxiety has been shown to be maximally effective when CBT interventions are matched to the specific anxiety symptoms experienced by the individual (Eisen and Silverman 1993, 1998), and long-term efficacy has been established for a majority of individuals after a CBT program for adolescent depression that incorporated use of case formulation (Treatment of Adolescent Depression [TADS] Team 2009). V9!~ƒǪ̀=ꆖlƒ :«®Ì½WÏýßJ{ç9’¨fH©t¯o&k¯O™¿ÿß®BdؒÀϕÇ8&Ä+*#2Ó#Û£˜ííù““gi Once an initial case formulation is established, the therapist needs to convert it into a treatment plan. Inter-rater reliability of case formulations has been found to be adequate (Kuyken, Fothergill, Musa, and Chadwick 2005), the quality of case formulations improving with therapist experience and training (Eells et al. Inter-rater reliability of case formulations has been found to be adequate (Kuyken, Fothergill, Musa, and Chadwick 2005), the quality of case formulations improving with therapist experience and training (Eells et al. The competent therapist must remain flexible throughout treatment. Chosen specific CBT skills are indicated by numerical indicators. For example, during the implementation of in-session exposure, it may become apparent that the parent encourages flight from challenging situations at the first sign of the child’s distress, despite having been presented with psycho-education regarding the role of overprotection in child anxiety. Specific CBT techniques may focus on a single factor or may deliberately target multiple factors. Treat or refer the patient for treatment for any medical prob-lem that … Follow this link to a chart comparing the effectiveness of CBT to other treatments generalized anxiety … First, by ensuring that the therapist understands and communicates the presenting problems within the client’s personal context, it conveys hope that these problem(s) can be addressed. Several different approaches have been devised to guide the production of case formulations (Boschen and Oei 2008; Macneil, Hasty, Conus, and Berk 2012; Persons 1989). These strengths should be added to any written or visual representation of the case formulation in a way that emphasizes their importance – for example they can be added to the outer layer of the contextual–idiographic model. The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or … Research indicates that CBT can be an effective treatment for anxiety after as few as 8 sessions, with or without any form of medication ().Due to the high prevalence of anxiety disorders (18% of adults in the United States meet criteria for an anxiety … Finally, the formulation should consider the strengths of the individual and family, as recognition of these factors not only facilitates an optimistic view of the future, but can provide the therapist with a basis on which (s)he can build resilience (Macneil et al. 2011). 9Case Formulation and Treatment Planning for Anxiety and Depression in Children and Adolescents The chosen model will either reflect a particular manualized program or should be drawn from general models of anxiety or depression, such as those provided in Chapter 8. To devise a case formulation, a competent therapist will need to add, to the standard diagnostic and symptom severity assessment tools, a targeted assessment of the typical cognitions, behaviors, and emotions that relate to the presenting problem for the individual, as well as an evaluation of interpersonal processes between the individual and other people (e.g., parents, peers) during periods of high anxiety or low mood. In determining the sequence of skills for the treatment plan, the therapist may do best to ask him-/herself what skills will be needed prior to implementing exposure and what skills may be developed concurrently with it. Selecting specific CBT techniques The purpose of the case formulation is to create an idiographic model relevant only to a specific case. •Mood and anxiety disorders are common, treatable diseases •Psychotherapy builds hope •Like much in psychiatry, we know that it works but not how it works •CBT can be an effective treatment for mood and anxiety disorders •Acknowledgements to Karen Swartz, MD! Her doctor diagnosed her with panic disorder and prescribed medication to decrease her anxiety symptoms and panic attacks. The treatment plan can subsequently be adjusted to proactively address these potential barriers, decreasing the likelihood that the barrier will interfere with progress. This involves taking a hard look at negative … ÿØÿà JFIF x x ÿá ZExif MM * J Q Q tQ t †  ±ÿÛ C Depending on the manual selected, the therapist may have limited or substantial control on the order of presentation of specific CBT techniques. In addition to developing the idiographic representation of the chosen model, the potential impact that socio-demographics, culture, comorbidity, and development will have on engagement with treatment and on the likelihood of experiencing common obstacles during treatment should be considered. Dynamic Treatment Planning The competent therapist must remain flexible throughout treatment. Example Treatment Plan . and Treatment Plan Example. Part of our behavioral health resources, this is a broad overview of our treatment plan for the treatment of anxiety. This book is intended as a practical guide for clinicians who wish to use Cognitive Behavioral Therapy for Depression (CBT-D) with Veterans. The clinical utility of case formulation as used in a community setting with adult anxiety and depression has been examined, case-formulated treatment leading to statistically and clinically significant change, comparable to that seen in randomized controlled trials of empirically supported treatments (Persons, Roberts, Zalecki, and Brechwald 2006). Case Formulation and Treatment Planning for Anxiety and Depression in Children and Adolescents. In module-based manuals that provide greater flexibility, or in situations where the therapist is working within a general CBT framework, the sequence of selected techniques will be guided by the manual’s clinical algorithms (e.g., Chorpita 2007) or will be inferred from the direction and strength of relationships between factors identified in the case formulation. In module-based manuals that provide greater flexibility, or in situations where the therapist is working within a general CBT framework, the sequence of selected techniques will be guided by the manual’s clinical algorithms (e.g., Chorpita 2007) or will be inferred from the direction and strength of relationships between factors identified in the case formulation. This can be achieved by eliciting detailed descriptions of one or two recent events that highlight the presenting concerns and by enquiring about cognitions and behavioral choices during the chosen event(s) from both the perspective of the parent and that of the child or adolescent. Meeting Start: 1:00 PM - Meeting End: 1:20 PM This was a n Initial Treatment Team Meeting. 2012). Melissa reports that her panic attacks are … For example, successful exposure to social situations in the school playground may not be possible until an underlying deficit in social skills is addressed. Sequencing selected specific CBT techniques Research has shown CBT is significantly more effective than all other psychological treatments for generalized anxiety disorder. Introduction Chosen specific CBT skills are indicated by numerical indicators. Sample Treatment Plan Update Recipient Information Provider Information Medicaid Number:123456789 Medicaid Number:987654321 Name: Jill Spratt Name: Tom Thumb, Ph.D. DOB: 9-13-92 Treatment Plan Date: 10-9-06 Treatment Plan Review Date: 3-19-07 Other Agencies Involved: Plan to Coordinate Services: Jack Horner, … Third, it can pre-empt potential barriers that may undermine treatment progress or engagement. The chosen model will either reflect a particular manualized program or should be drawn from general models of anxiety or depression, such as those provided in Chapter 8. Child Trauma Treatment Training Program Page 1 Example TF-CBT Treatment Plan and Goals Name: Date of Plan: DOB: Medical Record #: Diagnosis: Axis I 309.81 Posttraumatic Stress Disorder Axis II Axis III Axis IV Axis V GAF = Treatment Plan: 1. In determining the sequence of skills for the treatment plan, the therapist may do best to ask him-/herself what skills will be needed prior to implementing exposure and what skills may be developed concurrently with it. It can be used as an additional resource to Cognitive Behavioral Therapy for Depression in Veterans and Military Servicemembers: Therapy Manual (Wenzel, A., Brown, G. K., & Karlin, B. Each child or adolescent will have a unique mix of factors implicated in the development of his/her anxiety and/or depressive disorder. For example, Figure 9.1 applies the anxiety model presented in Chapter 8 to the case of an 11-year-old boy assessed as meeting criteria for generalized anxiety disorder and social phobia. In the past decade, research from randomized clinical trials has produced strong and consistent evidence showing that cognitive-behavioral therapy (CBT) can play an important role in reducing social phobia, separation anxiety and generalized anxiety disorder (GAD) in children and adolescents (see Silverman and Berman [2001] for … Diagnosis: Axis I: Generalized Anxiety Disorder, 300.02 (Active) Axis II: None V71.09 Axis III: See Medical History Axis IV: None Axis V: 60 Current Psychotropics: Paxil 10 mg PO QAM Buspirone 10 mg PO QAM Ambien CR 6.25 mg … Pursue treatment for con- current medical problems that may contribute to depressive and anxiety symptoms. treatment validity and a reasonable amount evidentiary support for mitigating anxiety or depression symptoms, the F.E.A.R. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Once the model has been selected, the therapist should attach relevant evidence gathered during assessment to each aspect of the model. Depending on the manual selected, the therapist may have limited or substantial control on the order of presentation of specific CBT techniques. <> In this case the treatment plan may reflect that, concurrently with the implementation of exposure, the parent would require (i) psycho-education concerning the role of excessive reassurance in his/her child’s evaluation of a situation; (ii) therapist modeling of the appropriate parent management during in-session exposure exercises; and, ultimately, (iii) parent-led in vivo exposure. endstream model (Kendall et al., 2002) was selected as an organizational framework … Report feeling more positive about self and abilities during therapy … It provides a template from which an individualized treatment plan can be derived. Many of the most popular and effective cognitive-behavioral therapy techniques are applied to what psychologists call “cognitive distortions,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016). The Dual Disorder CBT Treatment of Jericah has a history of suffering from depression The current client treatment plan. (For an example of this, see Figure 9.1, where each numerical indicator provides the chosen specific CBT technique that will form the treatment plan.). CBT4PANIC is a complete, FREE Online CBT treatment plan for anxiety & panic disorder created by professional CBT therapists. Information on comorbidity, family history, current anxiety or depression in immediate family, the client’s developmental and academic functioning, and the family’s socio-demographic and cultural environment are also needed for a comprehensive case formulation. The initial case formulation, and consequently the treatment plan, must be updated as new information is discovered and as a result of the experience implementing each specific CBT technique with the client. The specific CBT technique that directly targets avoidance and the only skill that appears without exception in every evidence-based treatment manual for anxiety is exposure. In manuals where there is limited flexibility in the sequencing of techniques, the presented order reflects the nomothetic understanding of the targeted disorder(s). CBT involves a structured approach to solving problems in a specified number of sessions. These influences can be described within a written case formulation or, if a visual representation of the case formulation is preferred, displayed on the idiographic model as contextual layers that surround the issues identified in the model. Surprisingly, though, there has been minimal research on the clinical utility and accuracy of case formulations and subsequent treatment plans, particularly with regard to child and adolescent populations. Consequently the amount of emphasis given to a particular skill within a treatment plan must also vary. Sample Chapter: Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition Consequently the amount of emphasis given to a particular skill within a treatment plan must also vary. 2011). Treatment Plan Objectives ‣Focus on what needs to change to meet goals •What barriers and challenges need to be addressed •Identify a lack of resources Psychological: fear and anxiety, confused thinking, irritability, poor anger or impulse control Psychosocial: discomfort around others, social isolation, stressful In manuals where there is limited flexibility in the sequencing of techniques, the presented order reflects the nomothetic understanding of the targeted disorder(s). Rather a combination of various techniques that depend on the manual should be followed have unique. Combination of various techniques that depend on the basis of the model has been selected the! Factor will also vary on the manual selected, the therapist may have limited or substantial control on the of... A picture emerges from the idiographic model of what is causing and maintaining presenting. 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