Module Catalogue 2024/25

Pre Requisite Comment

N/A

Co Requisite Comment

N/A

Aims

1.To develop core knowledge of the theoretical and research literature informing behavioural and cognitive models of depression
2.To develop the clinical skills needed to deliver CBT for depression based on these models
3.To achieve clinical competency in CBT for depression with specialist supervision

This module is designed to develop knowledge, skills and attitudes in the cognitive-behavioural treatment of major depression to CBT practitioner level. It is intended to improve proficiency in the fundamental techniques of CBT and support the development of competency in the specialist techniques applied to the treatment of depression. There will be a balanced emphasis on behavioural and cognitive approaches.

Cognitive-behavioural theory of depression and models of specific depression subtypes will be taught in a series of lectures. The lectures will also address the evidence-base supporting these models, covering research into basic processes and associated clinical interventions, including up-to-date developments in the field. The focus will be on Major Depressive Disorder, including reactive depression, recurrent depression, chronic depression, depression across the lifespan, and depression co-morbid with other Axis I disorders. Lectures will concentrate on developing the CBT knowledge and attitudes needed to work with people suffering from depression.

CBT assessment and specialist interventions will be covered in complementary practical workshops. The workshops will consist of role-play, experiential exercises, video and case demonstrations.
Experiential exercises will encourage self-reflection and increased self-awareness. Sessions will also incorporate a focus on therapists’ beliefs about depression. Workshops will concentrate on developing CBT intervention skills, harnessing the knowledge gained from the lectures and consolidating the personal attitudes necessary to foster effective psychotherapeutic relationships with people suffering from depression.

Trainees will take part in specialist CBT supervision groups of three with a BABCP accredited practitioner who will support the process of incorporating CBT interventions into the trainee’s therapeutic work. Trainees will be expected to make video recordings of their clinical work with depressed patients based in their normal place of work. They will need to arrange access to appropriate patients within their normal work-base or service in advance of starting the programme. They will receive intensive feedback, guidance and coaching in the clinical processes needed to treat depression using CBT. Trainee’s clinical competence will be assessed using the Cognitive Therapy Rating Scale (Revised) which will be used to provide both formative and criterion-referenced summative feedback. Trainees will be expected to have enough time to prepare before clinical sessions and to review and reflect afterwards to maximise learning from the supervisory process.
The time needed for preparation, reflection and supervision is much greater than routine clinical practice and is essential in the development of CBT competency.

Outline Of Syllabus

Knowledge and attitudes
• Phenomenology, diagnostic classification and epidemiological characteristics of major depression
• Risk assessment, mental state examination, personal, medical history relevant to major depression
• Suitability for CBT with depression: contra-indications for treatment, the role of pharmacological interventions and substance misuse, how to refer on to other agencies if unsuitable
• Fundamentals of assessment and formulation for CBT with depression
• Clinical process for depression – formulation, rationale giving, active treatment, relapse prevention
• Use of clinical measurement with depression to monitor CBT process and outcome
• The role of the therapeutic relationship in CBT with depression
• Clinical research in the treatment of major depression: clinical trials and CBT outcome studies
• Theories and experimental studies of cognitive processes in depression
• Application of theory and method to the individual case in depression
• Experiential learning: illustrating how cognitive methods with depression can be applied to the trainees’ own lives.
• Values, culture and diversity (access, ethical, professional and cultural considerations)
• Effective use of supervision in working with people with depression to enhance and regulate good practise.

Clinical skills
• Conducting assessments and collaborative formulations with depressed people
• Assessing risk, mental state, personal history and medical history relevant to depressive disorders
• Assessing and optimizing suitability for CBT with depression
• Fostering and maintaining therapeutic relationships with depressed patients
• Consolidation of core CBT skills as assessed by the Cognitive Therapy Rating Scale (Revised)
• Supporting the clinical process of CBT with depressed patients – shared formulation, rationale giving, inculcating hope, active treatment and methods of change, relapse prevention
•Helping patients overcome depressed withdrawal and goal disengagement, overly negative thinking, schema-reactivation, rumination and other forms of pre-occupation
• Effective use of supervision in working with people with depression to enhance and regulate good practice

Intended Knowledge Outcomes

Trainees will be able to:
1.Describe the phenomenology, diagnostic classifications and epidemiological characteristics of major depression and related Axis 1 disorders

2.Identify those factors predicting heightened risk of suicide, self-harm and self-neglect in cases of depression

3.Explain and discuss the full range of cognitive and behavioural processes known to maintain major depression, particularly those relating to Beck’s Cognitive Therapy (CT) and Jacobsen’s Behavioural Activation (BA) model

4.Review and evaluate the evidence-base of CBT for depression, covering both basic processes and the outcome of CB treatments

Intended Skill Outcomes

At a level of competence recognised by the BABCP, trainees will be able to use CBT to treat patients with major depressive disorders. Specifically, trainees will be able to:

1.Conduct clinical assessments for CB therapy with depressed patients, which will include:
• Identifying the presence of depressive subtypes and any co-occurring disorders
• Using standard and idiosyncratic measures appropriate to the evaluation of depression
• Identifying and discussing the merits and disadvantages of current and previous treatments, including anti-depressant medication
• Identifying the presence and effects of substance use
• Identifying the social, familial and cultural factors precipitating and maintaining major depression
• Identifying internal and external triggers of depressed mood

2.Develop case conceptualisations to form the basis of cognitive and behavioural change, which will include:
• deriving a shared personalised conceptualisation of disorders based on evidence-based treatments, specifically Beck’s Cognitive Therapy (CT) and Jacobsen’s Behavioural Activation (BA) model
• encouraging de-motivated and pessimistic patients to engage in treatment
• maintaining an empathic bond whilst retaining appropriate therapeutic optimism
• working collaboratively with a patient to develop functional analyses of their behaviour
• identifying secondary coping behaviours (such as avoidance, inactivity or rumination)
• employing cross-sectional formulations to identify key cognitive processes, e.g. the negative cognitive triad (self, others and future); processing biases such as arbitrary inference, selective abstraction
• using an understanding of self-schemas and their role in recurrent depression to alter memory biases and retrieval competition processes
• using cognitive and behavioural change methods associated with recovery from depression
• making informed choices re the sequencing of change methods
• when deviation from standard methods is employed, providing a clear rationale for such deviation

3.Foster trusting therapeutic relationships with depressed patients, which will include:
• Demonstrating genuine empathy with patient’s depression while encouraging engagement with change-oriented tasks

Clinical competence will be assessed by sampling video recordings of the trainees’ clinical work applying the Cognitive Therapy Rating Scale – Revised (CTS-R). The following aspects of CBT practice will be assessed: Agenda Setting & Adherence, Feedback, Collaboration, Pacing and Efficient Use of Time, Interpersonal Effectiveness, Eliciting Appropriate Emotional Expression, Eliciting Key Cognitions, Eliciting Behaviours, Guided Discovery, Conceptual Integration, Application of Change Methods, Homework Setting

Teaching Rationale And Relationship

Subject knowledge and understanding will be developed through:
• Small Group teaching sessions, which will introduce the phenomenology, diagnostic classification and epidemiological characteristics of major depression
• Guided self-study, to expand knowledge of the cognitive and behavioural processes known to maintain depressive disorders
• Individual tutorials and tutor feedback on draft work, to help trainees review and evaluate the evidence-base of CBT for depression, covering both basic processes and the outcome of CB treatments
• Reflective Log (initiated in the Fundamentals module), to help trainees reflect on their own moods and how they use cognitive and behavioural processes to manage them

Practical skills are developed through:
• Skill workshops, with video simulations, demonstrations and role play of the main clinical procedures used in CBT with depressed patients
• Providing CBT to depressed patients, with regular opportunities to practice clinical assessments, foster trusting therapeutic relationships, formulation and change process
• Clinical supervision, in which trainees receive regular feedback on their case conceptualisations and guidance on how to use them to form the basis of cognitive and behavioural change with their depressed patients

Assessment Rationale And Relationship

The CTS-R assessment will provide detailed feedback on specific CBT skill developments that map directly onto the knowledge, skills and attitudes outlined in the intended learning outcomes and programme aims. This is the third of four CTS-R assessments trainees receive on the programme and this provides an opportunity for skill progression to be monitored closely.

The case study and reflective report require the trainee to provide a critique of the model supporting treatment with a depressed patient and reflect on the process of using that model in therapy. It is also an opportunity to report and evidence the use of clinical skills employed in treatment and critical reflection on the process and outcome of the case. A personalised formulation of the patient’s depression will demonstrate the knowledge and skills to produce a balance of adherence to the model in question and appropriate personalised adaptation. A reflective practice section will require trainees to reflective on the personal impact on working with this case and be explicit about what has been learned from the experience.

*Note
The CTS-R is weighted 65% and the case study 35% of the total mark for this module. This ensures that across the programme assessments of clinical competence from direct contact with patients provide approximately 50% of the total mark. Within this module, the CTS-R and case study both need to be passed (even if one component is failed and the combined percentage is greater than 50).

General Notes

N/A