CBT: Phase 2

This phase is concerned with the application of change strategies to try to help the client work towards the achievement of their goals.

Sessions in this phase (approximately sessions 4-15):

Agenda to include a target related to goal list and formulation, and review of previous tasks and setting of a new task to do between sessions (for therapist and participant)

Cognitive and/or behavioural change strategies selected on the basis of negotiation with participant (acceptability) and formulation (likelihood of success). These strategies should be selected from those indicated in the manuals (click here for the strategy list pdf).
By session 10, the aim is to have had at least one session out in the real world (e.g. a behavioural experiment)

Video Demonstrations:

The following resources consist of video excerpts of role plays filmed by PRU staff which aim to illustrate the relevant processes, principles and strategies within each phase. Where relevant, these videos are supplemented by descriptions and formulations that were shared with the ‘client’.

Setting up a behavioural experiment

Based on a shared formulation of paranoia a behavioural experiment is set up and reviewed in session.

In-session behavioural experiment

Based on a maintenance formulation of voice hearing, a behavioural experiment is collaboratively developed and carried out during the session. The experiment is aimed at testing out the beliefs: ‘the voices can harm people’ and ‘the voices are powerful’. The experiment is reviewed and the client’s conclusions are discussed.

Planning a Survey (Appearance)

Based on a maintenance formulation about distressing beliefs about the client’s appearance, the therapist and client plan a survey together. The client is distressed as he believes he looks like a freak. The aim is to test out whether other people view him in this way.

2.1 Formulation for Planning a Survey Roleplay

Reviewing a survey (appearance)

The client and therapist review the feedback from the survey which they planned together.

Reducing social isolation

The therapist and client work on increasing activity and contact with others. They explore low mood, negative thoughts and behavioural responses. They discuss what impact particular behavioural responses or activities have on low mood and draw up a list of activities the client can select from to reduce social isolation.

Discussing sleep hygiene

Based on a formulation of sleep problems, a discussion takes place about what might be maintaining the problem. The therapist and client then come up with strategies to try and help improve the clients sleep.

Utilising attentional strategies

The therapist and client carry out an experiment in session on attention focus. They then discuss how the client can use attention focus strategies to help reduce their anxiety

2.2 Formulation for Utilising Attentional Strategies Roleplay

Survey planning: Intrusive Thoughts

The client is troubled by intrusive thoughts and interprets them as meaning she is a bad person. The therapist and client plan a survey to find out more about other people’s thoughts.

Survey review: Intrusive thoughts

Follows on from the ‘Intrusive Thoughts Survey Planning’ role play which can be found here

Using evidential analysis with voice hearing

Based on a maintenance formulation, the therapist and client explore the belief ‘my voices are powerful’. They weigh up all the evidence that supports this belief, and all the evidence against. They then draw some conclusions.

Exploring alternative explanations of voices

The therapist and client generate alternative explanations to her distressing belief that the voices are an indication that she is possessed. They then draw some conclusions about her explanation.

Using worry postponement in response to voices

The therapist and client review a maintenance formulation of voice hearing. The client is spending a lot of time worrying/ruminating about the voices, which is increasing her distress. They discuss positive and negative beliefs about worry and the therapist introduces worry postponement for the client to try.

2.3 Formulation for Worry Postponement in response to voices

Formulation of voice hearing and persecutory beliefs

The therapist maps out a maintenance formulation of a recent voice hearing experience, which is related to persecutory beliefs about the Government. Based on the formulation, they discuss what they can work on to reduce her distress and help her leave the house.

1.6 Formulation of persecutory voices