CBT fundamentals for psychiatrists

Meet the patient

A 32-year-old man has made eleven "cardiac" presentations to the emergency department in a year. Every troponin negative, every ECG clean. He sits near the door, carries a bottle of water, and phones his wife the second his heart speeds up.[4]

He has "had CBT" — six sessions of talking about how his week went. No agenda, no homework, no experiment, nothing ever tested. He tells you therapy "doesn't work for me".[15][16]

Two exam questions are now live and you must answer both: what is actually maintaining his panic, and was what he received CBT at all? Everything below exists to answer those two.[4][15]

References16Show ledgerHide ledger

1. [1]Beck AT Thinking and depression. II. Theory and therapy Arch Gen Psychiatry, 1964.PMID 14159256
2. [2]Beck AT The evolution of the cognitive model of depression and its neurobiological correlates Am J Psychiatry, 2008.PMID 18628348
3. [3]Kovacs M, Beck AT Maladaptive cognitive structures in depression Am J Psychiatry, 1978.PMID 645943
4. [4]Clark DM A cognitive approach to panic Behav Res Ther, 1986.PMID 3741311
5. [5]Ehlers A, Clark DM, Hackmann A, et al. Cognitive therapy for post-traumatic stress disorder: development and evaluation Behav Res Ther, 2005.PMID 15701354
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8. [8]David D, Cristea I, Hofmann SG Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy Front Psychiatry, 2018.PMID 29434552
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11. [11]Wykes T, Steel C, Everitt B, Tarrier N Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor Schizophr Bull, 2008.PMID 17962231
12. [12]Kazantzis N, Whittington C, Zelencich L, et al. Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy Behav Ther, 2016.PMID 27816086
13. [13]Persons JB, Roberts NA, Zalecki CA, et al. Naturalistic outcome of case formulation-driven cognitive-behavior therapy for anxious depressed outpatients Behav Res Ther, 2006.PMID 16209865
14. [14]Kuyken W, Beshai S, Dudley R, et al. Assessing Competence in Collaborative Case Conceptualization: Development and Preliminary Psychometric Properties of the Collaborative Case Conceptualization Rating Scale Behav Cogn Psychother, 2016.PMID 25629820
15. [15]Mulkens S, de Vos C, de Graaff A, Waller G To deliver or not to deliver cognitive behavioral therapy for eating disorders: Replication and extension of our understanding of why therapists fail to do what they should do Behav Res Ther, 2018.PMID 29763767
16. [16]Hernandez Hernandez ME, Waller G Are we on the same page? A comparison of patients' and clinicians' opinions about the importance of CBT techniques Cogn Behav Ther, 2021.PMID 33475024