Beck / Bannink / Geschwind Positive CBT

Individual and Group Treatment Protocols for Positive Cognitive Behavioral Therapy
2021
ISBN: 978-1-61334-578-8
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 144 Seiten

Positive CBT integrates positive psychology and solution-focused brief therapy within a cognitive-behavioral framework. It focuses not on reducing what is wrong, but on building what is right. This fourth wave of CBT, developed by Fredrike Bannink, is now being applied worldwide for various psychological disorders. After an introductory chapter exploring the three approaches incorporated in positive CBT, the research into the individual treatment protocol for use with clients with depression by Nicole Geschwind and her colleagues at Maastricht University is presented.
The two 8-session treatment protocols provide practitioners with a step-by-step guide on how to apply positive CBT with individual clients and groups. This approach goes beyond simply symptom reduction and instead focuses on the client’s desired future, on finding exceptions to problems and identifying competencies. Topics such as self-compassion, optimism, gratitude, and behavior maintenance are explored. In addition to the protocols, two workbooks for clients are available online for download by practitioners.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, counselors, coaches, and educationalists, as well as students.

Autoren/Hrsg.

Beck, Fredrike

Bannink, Fredrike

Geschwind, Nicole

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Beratungspsychologie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Verhaltenstherapie
• Sozialwissenschaften Psychologie Allgemeine Psychologie Kognitionspsychologie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Familientherapie, Paartherapie, Gruppentherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

|17|Chapter 2
Research Into Positive CBT for Depression
It is never too late to be who you might have been. George Eliot, English writer Introduction
Recent research (Craske et al., 2019; Dunn et al., 2019; Geschwind et al., 2010; Geschwind, 2011; Widnall et al., 2020) suggests that a stronger focus on positive emotions and on positive mental health may increase the effectiveness of cognitive behavioral therapy (CBT). Three arguments support this assertion: First, traditional CBT focuses primarily on reducing psychological symptoms: Treatment is deemed successful when psychopathology is in remission and residual complaints are as few as possible. However, research into clients’ perspectives shows that their definition of recovery from depression is broader. Clients find it important that they function just as well or better after treatment (compared with before the onset of the depression), and that they are optimistic and hopeful, enjoy life, and feel part of society (Demyttenaere et al., 2015; Zimmerman et al., 2006). This means that a mere decrease in symptoms is not enough for them. Reduction of psychopathology in itself does not automatically translate into higher well-being (Keyes, 2005), so a stronger focus on promoting positive emotions and positive mental health is necessary. According to the broaden-and-build theory, positive emotions contribute to both increased resilience and reduction of symptoms (Fredrickson, 2009; Garland et al., 2010). Second, in addition, even people without psychological problems pay more attention to negative rather than positive events. This phenomenon is known as negativity bias (Baumeister et al., 2001). When people are depressed, this negativity bias soon gets the upper hand (Gotlib et al., 2004). Traditional CBT may inadvertently encourage this bias by asking clients to keep track of problem situations as part of their homework, thereby focusing their attention on negative events both during and outside the therapy sessions. |18|Third, for clients with a depressive disorder, the absence of positive feelings such as pleasure and interest (i.e., anhedonia) is one of the two main characteristics of a depressive episode. The other characteristic is a depressed mood. The results of several studies have suggested that increases in positive emotions contribute more to well-being and to prevention of, and recovery from, depression than decreases in negative emotions (Geschwind, 2011; Geschwind et al., 2010, 2011; Khazanov & Ruscio, 2016). This implies that promoting positive emotions should be one of the main pillars of treatments for depressive disorders (Craske et al., 2016; Dunn, 2012). Positive CBT is ideally suited to stimulate positive feelings and positive mental health, thereby potentially making treatment for depression more efficient as well as more enjoyable for clients (and maybe also for therapists). The authors of this book set up a study to investigate whether this was indeed the case. Is treatment with positive CBT more efficient and more enjoyable, compared with traditional CBT? Client: In the beginning I thought: I’m feeling so low now. Am I supposed to pretend that nothing is going on and sit here talking about fun things? A total of 49 clients diagnosed with unipolar depressive disorder participated in the study in Maastricht, The Netherlands. They had all been referred for treatment in specialist mental health care by their GPs. After clients had given permission to participate in the study, they were randomly assigned to one of the two treatments: They either started with eight individual positive CBT sessions and then continued with eight sessions of individual traditional CBT, or the other way around. So, every client participated in the same two treatment blocks and received a total of 16 sessions of treatment. We checked whether clients experienced more improvement during positive CBT compared with traditional CBT. We asked clients to complete a number of questionnaires before the start of the treatment as well as during treatment. Clients completed these questionnaires after every fourth session. Additionally, they completed a questionnaire on depressive symptoms (the Quick Inventory of Depressive Symptoms; Rush et al., 2003) after each session. The first 12 clients also took part in an interview about how they experienced both forms of CBT. The results involved both a quantitative study (based on questionnaires), followed by qualitative research (based on interviews). For the quantitative research, we collaborated with colleagues Arnoud Arntz and Frenk Peeters. For the qualitative research, we collaborated with colleague Emke Bosgraaf, who conducted the interviews and carried out the qualitative analysis. Results of the Quantitative Study
The following findings emerged from the statistical analysis (Geschwind et al., 2019): In the first study phase of eight sessions, both treatments worked approximately equally well with regard to the reduction of depressive symptoms. However, in the second study phase of eight sessions, positive CBT worked significantly better than traditional CBT. |19|For participants who started with positive CBT and then switched to traditional CBT, the improvement stagnated during traditional CBT. For participants who started with traditional CBT and then switched to positive CBT, the improvement of depressive complaints during the second phase continued, to a similar degree, as during the first phase (see Figure 2). Additional analyses showed that significantly more clinically significant changes in depressive symptoms and negative affect occurred during positive CBT, compared with traditional CBT. “Clinically significant” means that this analysis only took into account major and relevant improvements – improvements that were not only statistically significant, but also clinically relevant. For example, depressive symptoms (scored on a scale of 0–27, with 0 representing no symptoms and 27 representing a lot of symptoms) had to be lowered by more than 7.8 points to be considered clinically significant. During positive CBT, 57% of clients experienced clinically significant improvement of depressive symptoms (averaged |20|over the first and last phase, thus irrespective of the order of positive and traditional CBT), compared with only 24% during traditional CBT. Significantly more clinically significant changes were also as measured with the Remission from Depression Questionnaire (Zimmerman et al., 2013), which captures not only decreases in depressive symptoms, but also increases in positive mental health, coping ability, functioning, life satisfaction, and sense of well-being. These clinically significant change effects were independent of the treatment phase: Positive CBT performed significantly better regarding clinically significant change on these measures than traditional CBT across both phases. For positive affect and other indicators of positive mental health, we found no statistically significant differences between the two conditions. Given that these questionnaires were administered less often than those for the depressive symptoms (every fourth session only), this may have been caused by a lack of statistical power. Across all effect sizes (for positive affect, optimism, happiness, positive mental health, and remission from depression), the effects were on average 35% larger for positive CBT than for traditional CBT (although, as mentioned, the difference was not statistically significant). We observed significantly less dropout among clients with positive CBT (three out of 24 dropped out) compared with clients who started with traditional CBT (nine out of 25). Most of the dropout in the group that started with traditional CBT took place during the first eight sessions (during traditional CBT). On the other hand, this group (with the order traditional CBT followed by positive CBT) had the best effects overall, which renders the interpretation of the results somewhat difficult. Results of the Qualitative Study
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