CBT has its origins in the 1950’s and 1960’s in behaviourism and cognitive therapy respectively. Behaviourism (or behavioural therapy) refers to interventions that specifically target unhelpful behaviours. Cognitive therapy refers to any therapy that incorporates interventions to target unhelpful thoughts or beliefs. More commonly these days, CBT refers to an approach that incorporates both cognitive and behavioural elements. Essentially, the CBT model explains the relationship between thoughts, feelings, and behaviour. The model states that it is not the event that is important but the thoughts we have about it that produces feelings that drive behaviour. Sometimes the behaviour has the effect of then reinforcing the belief. So, for example, it is not what is actually happening in someone’s back that is important when looking at prognosis, but the thoughts they are having about it such as: ‘I have a weak back’ and ‘I should protect my back’. These thoughts make them feel worried (the feelings) – which then drives them to avoid certain movements or activities, leading to deconditioning and a sensitised pain system, i.e. a back that keeps on hurting and maybe even gets worse, which then in turn reinforces the thoughts of ‘I have a weak back’ etc.

For more information on what CBT is, have a look at this paper: Grazebrook K, Garland A, Board of BABCP. What are cognitive and / or behavioural psychotherapies? Report. 2005. http://www.babcp.com/files/Public/what-is-cbt-web.pdf

Same foundations, different house. CBA is essentially a watered down version of CBT. It is not psychotherapy. When applied to physical health problems, it uses the CB model to help provide a structure for both the therapist and the patient to understand some of the vicious cycles that they have got stuck in. I wrote a document for the Physiotherapy Pain Association on the difference as part of a comprehensive competency framework for physiotherapists working with people with pain. http://ppa.csp.org.uk/documents/ppa-physiotherapy-framework-entry-level-graduate-expert-describing-values-behaviours See Appendix 1 for the difference between CBT and CBA.

Have you had any patients that do not follow your advice, or persist doing things that you perceive to be unhelpful? The CB model is great for the times when you get stuck. It gives a simple model to understand how thoughts, feelings, and behaviours are linked and the skills to then help explain these vicious cycles to the patient and work with them to break them.

You will not be asking your patients about their childhood or attempting any kind of psychotherapy. Lets leave that to the experts. Learning a CB approach is all about changing our stance from didactic to collaborative, and having some basic skills to unpick why someone might be continuing to do something that is unhelpful in the management of their condition.

You undoubtedly will. Just like every other new skill you’ve tried to apply in practice and had to abandon half way through a treatment session (whilst you try desperately to remember what the lecturer said whilst acting like you are in complete control). Hopefully the resources you will get through the course such as the laminated vicious cycles, the quick reference guide, and the patient information sheets will help. During the course I will also be giving ideas on how to continue developing your skills after the course based on the research I did during my PhD into CBA competence. I am happy to be emailed any questions and can also offer mentoring sessions as well (see here for details).

I would recommend this online register of accredited members of the British Association for Behavioural & Cognitive Psychotherapies (BABCP), which is the lead organisation for CBT in the UK and Ireland, or the Association for Rational Emotive Behaviour Therapy (AREBT). http://www.cbtregisteruk.com . If your therapist is not on this register, it does not mean that they are not perfectly qualified and experienced; it means that they have not sought accreditation as yet. Therefore this register is a useful starting point as it saves you the laborious task of checking qualifications!

We know that the biggest risk factors for a poor outcome in many long-term conditions are psychosocial such as catastrophising, low self-efficacy, and poor social support. Furthermore, we know that people can transition form acute to chronic problems because of the same psychosocial risk factors. Interventions that target these risk factors show the potential to improve outcomes and this is why CB approaches are popping up in guidelines all over the place, and commissioning bodies are starting to request that healthcare providers are trained in CB approaches. From another perspective, us healthcare professionals know loads of good stuff and really want our patients to follow our advice. But it’s not always that simple:

 

Patients are not passive recipients of information who slavishly comply with all that is recommended. They act idiosyncratically on their perceptions and respond to their therapists’ recommendations selectively– Dennis Turk, 1993, Commentary, Physical Therapy 73, 11 783-784.

Patients’ are just like us, they have lots of helpful and unhelpful beliefs, which means they are doing lots of helpful and unhelpful things as part of their self-management. Coming up with a plan of action with our patients often requires us to be able to elicit this information and then know how to tackle it. And beliefs and behaviours is the business of CBT. Lastly, I feel we have an imperative to focus on improving the self-efficacy of our patients to be able to self-manage. After all, 15.4 million people in England have a long-term health condition. Those with 3 or more long-term conditions will rise from 1.9 million in 2008 to 2.9 million in 2018 (DoH 2012, Long-term conditions compendium).

Just that you are a qualified health professional. I occasionally allow unqualified staff on in-house training, where the staff member’s supervisor will also be present on the course. Please contact me to discuss this further.

I deliver quite a few courses throughout the year as part of in-house training. I typically organise 2-3 per year that are open courses. I like my home comforts, so I tend to run these courses close to home in the beautiful Wirral.

Probably! As long as you have the facilities (see below) and I can accommodate you in my diary. Please contact me with details on how quickly you want to run the course, an idea on which months and days of the week are good, and I will get back to you with potential dates.

For the two-day course, any two consecutive days including a Friday/Saturday combination is suitable. I stopped doing Saturday/Sunday combinations a long time ago as I found attendees were too tired on the second day.

The teaching room should be large enough to seat up to 20 people comfortably and should have natural light (no internal rooms). There are several role-plays during the course where attendees will get into pairs or small groups. For this we will need ‘break out’ space otherwise it gets too noisy if we all stay in one room. This can just be space in adjoining rooms or waiting areas as long as they are vacant! If the teaching room is very large this is adequate.

The main equipment requirement is a projector with a suitable surface to project onto. Please have a second projector available in case of break down. Please also check that there is a cable to connect the projector and laptop. I will use my own laptop but would appreciate if you had a spare one available as a back up. I will need a flipchart easel, pad, and pens.

The cost is typically £2000 - £2300. This includes my lecturing fee, course materials, and my expenses. Maximum numbers on a course vary between 16-20 attendees depending on the level of experience. Let me know where you are in the country and I can give you an exact cost.

I will be running some intermediate courses – see here for more details (link to courses section). Additionally you can look at the website for the British Association for Behavioural and Cognitive Psychotherapies (BABCP) for further generic CBT training courses http://www.babcp.com/Training/Training.aspx . You can also have a look at the Oxford Cognitive Therapy Centre https://www.octc.co.uk .

There’s a few bits and bobs in the resources section. If you are looking for something specific, contact me and I’ll see if I can help.

If you are looking to increase dependency in your patients, then certainly.  Also, in the words of Edzard Ernst, you do not need a placebo to get a placebo response. Why not use evidence based treatments such as exercise and CBA, whilst optimising the chances for a placebo response as well?