Summaries per chapter with the 3rd edition of Cognitive Behaviour Therapy for Children and Families by Graham & Reynolds - Bundle
What is the use of cognitive behavioural therapy for children and adolescents? - Chapter 1
What will be discussed in this book?
This book highlights the importance of cognitive behavioural therapy (CBT) in treating children and young adults who suffer from mental disorders. There is compelling scientific evidence for the effectiveness of CBT as a treatment for most mental disorders which often emerge at an early age.
Karl Popper's falsification method has had a significant impact on clinical (childhood) psychology: by falsifying hypotheses, science flourishes (as is now often done in randomized controlled trials, or RCTs). Socrates’ ideas are also still influential today: Socratic reasoning – which means that one is very critical of one's own beliefs – is central to CBT treatments.
Although few neuroscientific studies have been conducted using children and young adults with mental health problems as sample, there seems to be more and more input from this "more modern" angle. Another development focuses on new technologies in the context of the treatment of mental health problems, as new technologies (smartphones, laptops) are part of our new world. To some extent, CBT-like therapies used in adults can also be effective in treating young people (and with some flexibility as to how they are used).
What is a common criticism on CBT?
A common criticism regarding CBT is that this therapy is a simplistic representation of human behaviour and thinking, while these are very complex concepts. The authors of the book acknowledge that the complex functioning of an individual should not be underestimated, and that questionnaires – which are often used – should never be seen as a substitute for a dialogue. CBT is therefore not a wonderful medicine for all mental health problems. For some disorders (especially anxiety disorders and obsessive-compulsive disorders) it seems to be ineffective. In most cases, however, it offers at least relief – although this may also be due to nonspecific effects of therapy (such as a cooperative relationship between a psychologist and a client).
What about the development of anxiety and depression in young people? - Chapter 2
Young adults (adolescents: 12 to 17 years) have more anxiety and/or depression problems compared to children. In 50% of adults with anxiety disorders, symptoms begin before the age of 12 – and for 75% of them symptoms are visible before their 21st birthday! Although there has been a lot of research conducted on individual risk factors for mental disorders, there has been little research conducted on development of mental disorders. Therefore, this chapter looks at the biological, cognitive and social changes during adolescence that may be related to the onset of such problems. In other words, the question is: why do so many of the persistent, long-term anxiety and mood disorders start so early in development?
How is cognitive behavioural therapy (CBT) provided to children and young adults? - Chapter 3
Cognitive behavioural therapy (CBT) is a collective term for all therapies that use cognitive, behavioural and problem-solving approaches. There are many CBT techniques that can be used – in different combinations. Anyway, a CBT session always starts with psycho-education regarding the problem (diagnosis), explanation of the cognitive model and a discussion about expectations of the therapy.
Which factors are important in evaluating treatments? - Chapter 4
What works for whom, and why? In particular, a lot of research has been conducted into the question: what is the impact of a particular treatment compared to a) no treatment, and b) other types of treatments?
What is client involvement? - Chapter 5
Therapeutic involvement is essential for the effectiveness of treatments. Involvement is defined in two ways: engagement (a behavioural component: he/she does the homework, he/she shows up) and loyalty to treatment (an attitude component: how does he feel about the treatment, is there emotional investment and dedication). Both components are important for effective treatment.
What is a systematic approach in CBT? - Chapter 6
CBT is by definition a very dynamic collaborative process in which the therapist and the client jointly create insight into how the current problems have arisen and how they are maintained. This insight – the wording – is often written down, but can also be conveyed verbally. It explicitly mentions the links between the "four response systems" (cognitive, emotional, behavioural and physical) in the current problem situation and it explains how these responses are related to the underlying beliefs about the self, about others and about the world. Every stressful situation elicits a response in each of the domains.
Why is it important to involve parents/caregivers in CBT? - Chapter 7
Parental factors are often associated with the development of emotional and behavioural problems in the child. Therefore, it is essential that there is parental involvement in the (CBT) treatment of children. However, the way and the extent to which parents are involved is not always that clear. Two factors should always be taken into account: 1) The associations between parental factors and mental health problems in the child are often only modest, and 2) Studies comparing the outcomes of individual child-based CBT to family-based CBT are not always superiority of the latter. While these findings are subject to methodological limitations, it is important to be aware of the role of parental engagement in CBT.
Are most psychotherapeutic interventions suitable for people from different cultural backgrounds? - Chapter 8
In the sequel, the abbreviation BME will refer to people with a "black and minority ethnic" background. Most psychotherapeutic interventions are developed for and applied to (white) people with a Western culture: are such interventions equally suitable for, and effective in, people from different cultural backgrounds? In terms of accessibility and appropriateness of the services provided, many assistive institutions are well suited to Western culture, but not to the needs of BME populations.
What is the effect of working with the school and the broad, social context of the child? - Chapter 9
The CBT has its roots in social learning theory and is a framework in which the relationship between the cognitions, emotions and behaviours of an individual is investigated within a specific context. Children live in multiple environmental systems: family, school, sports clubs, neighbourhood children, etc. Parents and their schools play a big role in the child's life. Working with the school can therefore help to improve the effectiveness of the treatment.
What is trauma-focused CBT for sexually abused children? - Chapter 10
Sexual abuse in children is defined as the use of power (emotional, physical or psychological power) to engage a child or adolescent in behaviors in which he or she must touch or look at sexual body parts, when it is inappropriate for age, uncomfortable, or against the child's will. 1 in 4 women and 1 in 6 men experience sexual abuse before the age of 18.
How does the implementation of CBT take place in children with chronic health issues? - Chapter 11
When children suffer from chronic health conditions, they and their parents need to find a way to adapt their lives to deal with the disease. Progressive and life-limiting health problems require a lot of adaptability in every stage of the disease. Normal life is severely disrupted, because parents are often responsible for the care of their children themselves. When this is not possible, they have to be present during many hospital visits while they may have other children at home.
What is the cognitive approach for children with chronic pain? - Chapter 12
Children suffering from chronic pain experience continuous pain or recurrent pain for at least 3 months, which can fluctuate in severity, quality, regularity and predictability. Often they have had many consultations with other professionals. Many chronic pain syndromes involve back pain, abdominal pain and headaches. This chapter focuses on the last two. Chronic pain is a complex problem which, and according to the biopsychosocial model, it consists of three components that cause and maintain the pain experience: a biological component (the physical, the genes, the age, the sex, the temperament), a psychological component (anxiety, former pain experiences, learned pain behavior) and a social component (cultural influences, pain behaviors of others around you, reactions of parents and/or peers).
How does the implementation of CBT work for young people with a disorder that falls within the autism spectrum disorders? - Chapter 13
Autism spectrum disorders (ASD) are one of the most common developmental disorders that occur in childhood. It affects 1 in 91 children. The comorbidity (with, for example, an anxiety disorder) is extremely high. The core symptoms are broad and have many facets, from specific social cognitive deficiencies (such as limited theory-of-mind [ToM] skills), to pragmatic language deficiencies, and the routine repetition of (non-functional) behaviors. Nuclear symptoms are often stable over time and difficult to change using interventions. Children with less severe core symptoms, as is the case with Asperger's syndrome or PDD-NOS, have better prognosis, and better quality friendships and relationships with others compared to children with more severe symptoms.
How can eating disorders be treated? - Chapter 14
Although the majority of eating disorders – anorexia nervosa (AN) and bulimia nervosa (BN) – begin in adolescence and persist during adulthood, surprisingly little research has been conducted on the effectiveness of interventions for adolescents with eating disorders. In particular older adolescents suffer from eating disorders. Bryant-Waugh and Lask (1995) state that 10% of the children they refer to are under the age of 14.
How can we treat global anxiety problems? - Chapter 15
Anxiety disorders are the most common type of disorder that affects children and adolescents. Between 2.5% and 5% of children meet the diagnostic criteria at any given time. Anxiety disorders are associated with poor relationships with peers, increased victimhood, poor academic achievements, and disrupted family processes. The three most common anxiety disorders in children are separation anxiety disorder (SAD), social phobia, and generalized anxiety disorder (GAD). Comorbidity between these disorders is high and they are often treated in a similar way.
What is post-traumatic stress disorder (PTSD)? - Chapter 16
Experiencing a traumatic event can lead to several psychological problems, such as anxiety, depression, behavioural problems, substance abuse or post-traumatic stress disorder (PTSD). According to the DSM-IV-TR, one can be diagnosed with post-traumatic stress disorder (PTSD) if, as a result of such an event, there are persistent symptoms for at least one month (because most people spontaneously recover within about a month).
What are phobias? - Chapter 17
Children often have a fear of concrete things, such as spiders. Such specific fears often peak between 7 and 9 years of age and decrease in children 10 years and older. For some, however, their fear persists and grows into a phobia.
What is obsessive-compulsive disorder (OCD)? - Chapter 18
Obsessive compulsive disorder (OCD) is characterized by at least one irrational obsession (intrusive thoughts, images associated with a lot of stress) or compulsion (routine behaviours or mental acts that a person has to perform to feel good again), but often both are present. The first symptoms are often visible in childhood. Between 1% and 3% of children and adolescents suffer from OCD. Clinical interviews, questionnaires, mapping of the overall psychosocial functioning and functioning of the family are all part of the diagnostic process.
What are depressive disorders? - Chapter 19
3% of adolescents will experience a depressive period that meets the diagnostic criteria. Those who have experienced this are at greater risk of developing other disorders, often have recurrent depressive episodes, perform less well in school, use illegal substances earlier, are more likely to be involved in domestic violence crimes, have a greater risk of suicide, and more. According to Hyde and colleagues (2008), girls are at greater risk of depression than boys, and risk factors differ slightly between boys and girls. Some known general risk factors are an economic and/or social disadvantage, a family history in which depression is more common, recent interpersonal stressors, little social support, and conflicts within the family (Lewinsohn et al., 1999).
How can we prevent behavioural disorders with the use of CBT? - Chapter 20
Behavioural disorders are characterized by persistent antisocial behaviour in children and adolescents and occur regularly, in 5% of the population. In the DSM-IV-TR, ODD (oppositional defiant disorder) is a separate disorder; in the ICD-10, ODD is a subtype of behavioural disorders. A behavioural disorder often persists into adulthood and is related to crime, drug and alcohol abuse, and unemployment, among other things.
How can we prevent anxiety disorders? - Chapter 21
An anxiety disorder often starts in childhood or adolescence and becomes chronic if it is left untreated. 50-60% of children benefit from treatment of anxiety disorders, but a large proportion continues to experience problems. This is why there is more and more emphasis on prevention rather than the treatment of anxiety disorders. As mentioned earlier, there are three approaches for prevention: universal (for the entire population, regardless of their risk), indicated (children with symptoms, but who do not yet meet the diagnostic criteria), and selective (children at greater risk due to psychological, biological or environmental risk factors).
What are low-intensity CBT treatments? - Chapter 22
While there are several factors that hinder young people's access to CBT (such as misdiagnoses and stigmas), the biggest problem is that the demand for CBT for children is much greater than the availability of therapists. As a result, only a small proportion of needy children receive the necessary help. Low-intensity treatment methods could increase accessibility.
How can we introduce new technologies in CBT to children and adolescents? - Chapter 23
Laptops, smartphones, tablets and other technological means can no longer be imagined out of an adolescent's life, and the new generations grow up with them from an early age. It is therefore a logical approach to involve such technologies in the transmission of CBT.
How can interventions based on mindfulness be used for children and adolescents? - Chapter 24
Mindfulness-based interventions, or mindfulness training, are referred to as MFT. MFT is an umbrella term for all forms of such interventions, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). MFT for children and adolescents with psychopathology is growing rapidly and worldwide. For adults, there is a medium effect size of MFT on psychological health and stronger effect sizes for MBCT for anxiety disorders and depression. The research on (the effectiveness of) MFT for children and adolescents is still in its infancy. The studies were carried out within three psychopathologies: autism spectrum disorders (ASD), internalizing disorders (anxiety and mood) and externalizing disorders (ADHD, ODD and [other] behavioural disorders).
What are future directions? - Chapter 25
Due to the enormous growth of CBT and the developments within CBT, many more children and adolescents with mental health problems are now receiving proper treatments. However, the accessibility of CBT remains a problem and is something that still needs to be worked on in the future.
