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COGNITIVE THERAPY FOR CHRONIC AND PERSISTENT DEPRESSION - Richard G. Moore.pdf

COGNITIVE THERAPY FOR CHRONIC A…

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简介:本文档为《COGNITIVE THERAPY FOR CHRONIC AND PERSISTENT DEPRESSION - Richard G. Moorepdf》,可适用于自然科学领域

COGNITIVETHERAPYFORCHRONICANDPERSISTENTDEPRESSIONRichardGMooreAddenbrooke’sHospital,CambridgeandAnneGarlandNottinghamPsychotherapyUnitCOGNITIVETHERAPYFORCHRONICANDPERSISTENTDEPRESSIONTheWileySeriesinCLINICALPSYCHOLOGYRichardGMooreCognitiveTherapyforChronicandAnneGarlandandPersistentDepressionRossGMenziesObsessiveCompulsiveDisorder:andPadmaldeSilva(Editors)Theory,ResearchandTreatmentDavidKingdonTheCaseStudyGuidetoCognitiveBehaviourandDouglasTurkingtonTherapyofPsychosis(Editors)HermineLGraham,SubstanceMisuseinPsychosis:ApproachestoAlexCopello,TreatmentandServiceDeliveryMaxJBirchwoodandKimTMueser(Editors)JennyAPetrakTheTraumaofSexualAssault:Treatment,andBarbaraHedge(Editors)PreventionandPracticeGordonJGAsmundson,HealthAnxiety:ClinicalandResearchStevenTaylorPerspectivesonHypochondriasisandandBrianJCox(Editors)RelatedConditionsKeesvanHeeringenUnderstandingSuicidalBehaviour:(Editor)TheSuicidalProcessApproachtoResearch,TreatmentandPreventionCraigAWhiteCognitiveBehaviourTherapyforChronicMedicalProblems:AGuidetoAssessmentandTreatmentinPracticeStevenTaylorUnderstandingandTreatingPanicDisorder:CognitiveBehaviouralApproachesAlanCarrFamilyTherapy:Concepts,ProcessandPracticeMaxBirchwood,EarlyInterventioninPsychosis:DavidFowlerAGuidetoConcepts,EvidenceandandChrisJackson(Editors)InterventionsDominicHLam,CognitiveTherapyforBipolarDisorder:StevenHJones,ATherapist’sGuidetoConcepts,MethodsPeterHaywardandPracticeandJeniferABrightAlistofearliertitlesintheseriesfollowstheindexCOGNITIVETHERAPYFORCHRONICANDPERSISTENTDEPRESSIONRichardGMooreAddenbrooke’sHospital,CambridgeandAnneGarlandNottinghamPsychotherapyUnitCopyrightC©JohnWileySonsLtd,TheAtrium,SouthernGate,Chichester,WestSussexPOSQ,EnglandTelephone()Email(forordersandcustomerserviceenquiries):csbookswileycoukVisitourHomePageonwwwwileyeuropecomorwwwwileycomAllRightsReservedNopartofthispublicationmaybereproduced,storedinaretrievalsystemortransmittedinanyformorbyanymeans,electronic,mechanical,photocopying,recording,scanningorotherwise,exceptunderthetermsoftheCopyright,DesignsandPatentsActorunderthetermsofalicenceissuedbytheCopyrightLicensingAgencyLtd,TottenhamCourtRoad,LondonWTLP,UK,withoutthepermissioninwritingofthePublisherRequeststothePublishershouldbeaddressedtothePermissionsDepartment,JohnWileySonsLtd,TheAtrium,SouthernGate,Chichester,WestSussexPOSQ,England,oremailedtopermreqwileycouk,orfaxedto()ThispublicationisdesignedtoprovideaccurateandauthoritativeinformationinregardtothesubjectmattercoveredItissoldontheunderstandingthatthePublisherisnotengagedinrenderingprofessionalservicesIfprofessionaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbesoughtOtherWileyEditorialOfficesJohnWileySonsInc,RiverStreet,Hoboken,NJ,USAJosseyBass,MarketStreet,SanFrancisco,CA,USAWileyVCHVerlagGmbH,Boschstr,DWeinheim,GermanyJohnWileySonsAustraliaLtd,ParkRoad,Milton,Queensland,AustraliaJohnWileySons(Asia)PteLtd,ClementiLoop#,JinXingDistripark,SingaporeJohnWileySonsCanadaLtd,WorcesterRoad,Etobicoke,Ontario,CanadaMWLWileyalsopublishesitsbooksinavarietyofelectronicformatsSomecontentthatappearsinprintmaynotbeavailableinelectronicbooksLibraryofCongressCataloginginPublicationDataMoore,Richard,–CognitivetherapyforchronicandpersistentdepressionRichardGMooreandAnneGarlandpcmIncludesbibliographicalreferencesandindexISBN(Cloth)–ISBN(Paper:alkpaper)Depression,Mental–TreatmentCognitivetherapyIGarland,AnneIITitleRCM′–dcBritishLibraryCataloguinginPublicationDataAcataloguerecordforthisbookisavailablefromtheBritishLibraryISBN(hbk)ISBN(pbk)TypesetinptPalatinobyTechBooks,NewDelhi,IndiaPrintedandboundinGreatBritainbyTJInternational,Padstow,CornwallThisbookisprintedonacidfreepaperresponsiblymanufacturedfromsustainableforestryinwhichatleasttwotreesareplantedforeachoneusedforpaperproductionCONTENTSAbouttheAuthorsAbouttheAuthorsviiPrefacePrefaceixAcknowledgementsAcknowledgementsxvIntroductionTheChallengeofPersistentDepressionChapterTheCognitiveModelofPersistentDepressionChapterTheFoundationsofTherapy:TherapeuticRelationship,StyleandStructureChapterInitialAssessmentandFormulationChapterInitiatingTherapy:SocialisationandSettingGoalsChapterUsingStandardBehaviouralTechniquesChapterWorkingwithAutomaticThoughtsChapterRecognisingUnderlyingBeliefsandTheirEffectsChapterModifyingUnderlyingBeliefsChapterWorkingwithSomeTypicalThemesinPersistentDepressionChapterBeyondTherapy:PreventingRelapseandFurtheringProgressChapterDeliveringTreatmentChapterOutcomesandProcessesofTherapyviCONTENTSAppendixMeetthePatientsAppendixHandoutsforPatientsReferencesReferencesIndexIndexABOUTTHEAUTHORSRichardMooreworksasaclinicalpsychologistintheDepartmentofCognitiveandBehaviouralPsychotherapiesatAddenbrooke’sHospitalinCambridgeAfterobtaininganMAandaPhDfromtheUniversityofCambridgeandcompletinghisclinicalpsychologytrainingattheUniversityofEdinburgh,hetrainedasacognitivetherapistattheCenterforCognitiveTherapyinPhiladelphiaHehasbeenatherapistonmajorcontrolledtrialsofcognitivetherapyforrecurrentandresidualdepressioninEdinburghandinCambridgeThroughthisandhissubsequentexperienceworkingwithdepressedpatientsintheNHS,RichardhasacquiredexpertiseinprovidingcognitivetherapyforbothinandoutpatientswithchronicandrecurrentdepressivedisordersthathavenotrespondedfullytoprevioustreatmentHeisexperiencedatteachingpracticalclinicalworkshopstoprofessionalandpostgraduateaudiencesandhaspresentedresearchatanumberofmajorinternationalconferencesHeisaFoundingFellowoftheAcademyofCognitiveTherapyAnneGarlandisanurseconsultantinpsychologicaltherapiesattheNottinghamPsychotherapyUnitAftertrainingincognitivetherapyatSheffieldandOxford,AnneworkedasatherapistintwoMedicalResearchCouncilfundedtrialsinvestigatingtheefficacyofusingcognitivetherapyinthetreatmentofresidualdepressionandbipolardisorderShehasdevelopedclinicalexpertiseinthedeliveryofcognitivetherapyacrossNHSservicesettingsincludingprimarycare,communitymentalhealthteams,inpatientunitsandspecialistpsychotherapyservicesAnneisalsorecognisednationallyasacognitivetherapytrainerandclinicalsupervisorandhaspresentedcognitivetherapyskillsbasedworkshopsandacademicpapersatbothanationalandinternationallevelShewasassistantcoursedirectortotheNewcastlecognitivetherapycourseandalsocofounderoftheSalfordcognitivetherapycourseAnneisanactiveresearcherinvestigatingtheimpactofcognitivetherapytrainingandclinicalsupervisioninitiativesondevelopingclinicalcompetenciesamonghealthservicestaffSheiscurrentlyPresidentelecttotheBritishAssociationofBehaviouralandCognitivePsychotherapies(BABCP)asamemberofthepsychotherapyaccreditationsubcommitteePREFACEWhenwesetouttowritethisbook,wewantedtowriteadefinitiveworkonthetreatmentofpersistentdepressionwithcognitivetherapyForsomedisorders,thedevelopmentofcognitivetherapybasedonthecognitivemodelseemstohave‘sewnup’treatmentofthedisorderinmanycasesForexample,formanypatientswithpanicdisorder,addressingthefactorsdescribedinthecognitivemodelusingthetechniquesrecommendedresultsinremediationoftheproblemwithminimalriskofrelapseSuchanapproachtopersistentdepressionwouldbewelcomeindeedWiththispossibilityinmind,wemadeheavyweatherofdescribingcognitivetherapyforpersistentdepressionItseemedthatperhapsweweredoingexactlywhatmanypatientswithpersistentdepressiondo:havingsetoursightsonanimpossibleideal,wewerethrownbackbythedisappointmentoffailingtoliveuptoitAdifferentapproachwasneededTherefore,thebookdoesnotpresent‘theanswertochronicdepression’Rather,itdescribessomeoftheideasandexperiencesthatweresuccessfulinendeavouringtodevelopandapplythetherapywithmanypatientsovertheyearsandsomeofourinterventionsthatdidnotresultinthedesiredoranticipatedoutcomeWebelieveourdifficultyhighlightssomethingimportantaboutthenatureofpersistentdepressionFormoreacutedisorders,acquiringclinicalexperienceenablesthecliniciantohomeinontheoneortwofactorsthataremostimportantinaddressingthepatient’sproblemsWorkingwithpersistentdepression,increasingexperienceseemstohavethereverseeffectAstheclinicianseesmorepatientsorgetstoknoweachindividualbetter,theybecomemoreandmoreawareofanincreasingnumberoffactors,allofwhichseemtobecontributingtotheproblemsTheseincludenotonlyintrapersonal,cognitive,behaviouralandemotionalfactors,butalsointerpersonal,relational,environmental,biological,historicalandculturalfactorsIfthisimpressioniscorrect,wewillhavetoacceptthatnosingleapproachtothetreatmentofpersistentdepressionislikelytobeuniversallysuccessfulInpresentingacognitiveapproachtotreatment,wehavetriedtobalancefocusingoncognitionwithacknowledgingtheroleofmanyotherfactorsTherefore,weaimtoconsidertheroleofcognitionamongtheplethoraoffactorscontributingtothepersistenceofdepression,todescribehowtominimisethewaysthatallthesefactorsmayunderminexPREFACEcognitivechangeandtosuggesthowcognitivechangesmaybringaboutchangesinthewidersphereWeassumethatpatientsmightalsobenefitfrombiological,interpersonalandsocialapproachestowhichwedonotgivegreatattentionhereItwouldberemisstopresentsuchanapproachwithoutconsideringthevaluesonwhichitisbasedInworkingwithindividualswithpersistentdepression,theclinicianwillrepeatedlybefacedwithpatients’convictionthatthetherapywillnot‘work’Giventhatprevioustreatmentsreceivedbythesepatientsmayhavemetwithlittlesuccess,aconcerntodemonstratetheeffectivenessofthistreatmentmustbecentralDemonstrationsoftheeffectivenessoftherapyhaveplayedavitalpartinthedevelopmentandsuccessofcognitivetherapygenerallyTheapproachwedescribearosewithinthisframeworkofacommitmenttoimplementingtreatmentsofestablishedefficacyTheapproachwasdevelopedforuseinarandomisedcontrolledtrialofcognitivetherapyforpatientswithpersistentdepressivesymptomsfollowingtreatmentwithmedication(TheCambridge–NewcastleDepressionStudy,seePaykeletal,)AswellasdrawingonourclinicalworkintheNHS,manyoftheexamplesgiveninthisbookdrawonourexperiencesintreatingpatientsinthatstudyThebeneficialoutcomesinthatstudy(seeChapter)giveussomeconfidenceinpresentingtheproceduresweusedinthetherapyHowever,whenworkingwithpersistentdepression,thepossibilitythat,foratleastsomepatients,therapymaynotresultinthedesiredlevelofimprovementremainsalltoorealToviewtheeffectivenessoftreatmentastheonlyimportantvalueunderlyingitwouldputbothpatientandtherapistinaveryvulnerablepositionIfbothpartiesaredesperateforthetherapytowork,theresultingpressurecanevenworkagainstthechancesofimprovementAnexclusiveobsessionwithoutcome,asisoftenseeninthecurrentinterestinevidencebasedmedicine,canthereforebecounterproductiveInhisgroundbreakingworkonchronicdepression,McCullough()emphasisestheimportanceoftheopportunityintherapyforchronicallydepressedpatientstoengagewithadecent,caringhumanbeingWebelievethisvaluingofhumancareanddecencyisasimportantwhenworkingwithpersistentdepressionasconcernaboutoutcomeWithoutthelatter,professedcareanddecencycanringhollowHowever,weassumethatembracingvaluesofrespectandcarefordepressedindividuals,whatevertheoutcomeoreffectivenessoftreatment,isofparamountimportanceWehopethatourpresentationofthisapproachwillcontributetothecareanddecencyaffordedtodepressedpatients,ratherthantothecompetitivefervouroftenpresentinhealthcaresystemsThisisparticularlyimportantgiventhatthekindofproblemsweaddressinthisbookseemtobeincreasinglytypicalofthosemostcommonlyseenPREFACExiinpsychologicaltreatmentsettingsManycliniciansreportthattheyareseeingmoreandmorechronicandcomplexcasesintheirclinicsFormanypsychologicaltherapists,itseemstobesomethingofararitytoseeacaseofacutedepression,witharecentonsetfollowinglongperiodsofgoodfunctioningThismayreflectthesuccessofantidepressantmedicationinprimarycareintreatingthoseacutecases,combinedwithincreasingpublicawarenessthatdepressioncanbetreatedInattemptingtograpplewiththisfamiliarproblemofchronicityofdepression,wehavedodgedsomeoftheissuesofdefinitionalanddiagnosticcomplexityWeusethetermschronic,persistentandresistantdepressionsomewhatinterchangeablyTheessenceoftheproblemweaddressisthatpatientshavesomesymptomsofdepressionthatpersistdespitetreatmentsofknowneffectivenessandthesecontinuetointerferewithfunctioningandimpairtheindividual’squalityoflifeOneresultofthisdefinitionalimprecisionisthatpatientsconsideredtohavepersistentdepressionmayhavehadvaryingdegreesofexposuretopsychologicaltreatmentsSomemayhavehadexclusivelybiologicallybasedtreatments,othersmayhavehadvariousformsofpsychologicaltreatmentThemajoritywillnothavehadanadequatetrialofcognitivetherapyInviewofthesolidevidenceoftheeffectivenessofstandardcognitivetherapyfordepression,asdescribedbyBeckandcolleagues(),wesuggestthattheirapproachshouldremainthebasisfortherapywithpersistentcasesMuchofthematerialwepresentthereforedescribestheapplicationofstandardcognitivetherapyspecificallywithmorepersistentcasesManyofoursuggestionsforexample,relatingtotherigidityofthinkingindepressioncanbetracedbacktotheoriginalworkofBeckandcolleaguesWebelievethereismeritinreiteratingmanyaspectsoftheoriginalapproachandhighlightingtheirimportanceinthispatientgroupIntheyearssincetheapproachwasfirstdescribed,therehasbeenimportantworkindevelopingapplicationsofcognitivetherapyformorechronicdisordersMuchofthishasfocusedoninterveningatthelevelofunderlyingbeliefsWeattempttoillustratehow,inworkingwithpersistentdepression,someofthesemorenovelapproachescanbeintegratedwithstandardcognitivetherapyIndescribinghowthestandardcognitiveapproachcanberefinedandbroadened,wedonotpresentthatstandardapproachindetailReaderswhoarenotfamiliarwithitshouldseekoutBecketal(),BlackburnandDavidson()orJudyBeck’sCognitiveTherapy:BasicsandBeyond()beforegrapplingwiththeapproachdescribedhereThus,ouraimhasnotbeentorevolutionisethetheoryofpersistenceofdepressionortopresentgroundbreakingtechnicaldevelopmentsRather,itistousematerialderivedfromworkingwithmanycasesofpersistentdepressiontoshowhowexistingclinicaltheoryandtechniquescanbexiiPREFACEdevelopedandappliedintherapyWehavetriedtoconveyascloselyaspossiblethe‘flavour’ofworkingwithpeoplesufferingfrompersistentdepressionandtobeaspracticalaspossibleinsuggestinghowtheirproblemsmaybeaddressedincognitivetherapyTodothis,wehaveusedmanyclinicalexamplesdrawnfromdiscussionswithrealpatientsHowever,inordertoprotecttheirconfidentialityandtoensurethattheexamplesaregeneralisable,wehaveonlyusedexamplesofsituationsdescribedbymultiplepatientsThepatientswedescribearecomposites,eachrepresentingsomefeaturescommontoseveralpatientsthatwehaveseeninouroutcomestudyofNHSclinicsOfnecessity,themorespecificdetailsarefictionalThedialoguesarebasedonactualinterventions,amendedtoprotectconfidentialityandeditedintheinterestsofbrevityItshouldberememberedthatworkwithpatientsoftenproceedsatanevenslowerpaceandwithmoredigressionsthanillustratedhereDespitetheselibertieswithgospeltruth,webelievethatthedialogues,situationsand‘factional’characterswedescribearehighlytypicalofpatientswithpersistentdepressionseeninmanyclinicsWehopethattherapistsreadingthisbookwillrecognisesomethingoftheirpatientsinitandthatanysufferersreadingitwillrecognisesomethingofthemselvesTohelpreaderstobuildupapictureofthepatientsthatwerefertorepeatedlythroughoutthebook,wehaveprovidedbriefbiographiesofeachofthemainpatientsdescribedThepatientsforwhomsuchabiographyisprovidedareindicatedbytheirnamesbeinginitalicswhenfirstmentionedwithineachsectionoftextTheseclinicalexamplesareusedinthemainbodyofthetextinChapterstotoillustratethemodelandclinicalapplicationofcognitivetherapywithpatientssufferingfrompersistentdepressionChaptersand,coveringthecognitivemodelandtherapeuticrelationship,styleandstructure,provideaframeworkthatisessentialthroughoutthecourseoftherapyChapterstodescribethenatureofinterventionsimplementedineachofthemainphasesacrossthecourseoftherapyInsequence,wedescribeassessment,socialisingthepatientintotherapy,settinggoals,usingstandardbehaviouralandcognitivetechniques,workingwithunderlyingbeliefsandhelpingthepatientstomaintaintheirgainsbeyondtheendoftherapyChapter

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