Current Clinical PsychiatrySeries Editor: Jerrold F. Rosenbaum

The MassachusettsGeneral HospitalHandbook ofCognitive BehavioralTherapy

Timothy J. PetersenSusan E. SprichSabine Wilhelm Editors

Current Clinical Psychiatry

Series editorJerrold F. Rosenbaum

For further volumes: http://www.springer.com/series/7634

Timothy J. Petersen • Susan E. Sprich Sabine Wilhelm Editors

The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy

Current Clinical Psychiatry ISBN 978-1-4939-2604-6 ISBN 978-1-4939-2605-3 (eBook) DOI 10.1007/978-1-4939-2605-3

Library of Congress Control Number: 2015937621

Springer New York Heidelberg Dordrecht London © Springer Science+Business Media New York 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

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Editors Timothy J. Petersen Department of Psychiatry Massachusetts General Hospital Boston , MA , USA

Sabine Wilhelm OCD and Related Disorders Program Massachusetts General HospitalHarvard Medical School Boston , MA , USA

Susan E. Sprich Cognitive-Behavioral Therapy Program Massachusetts General Hospital Boston , MA , USA

v

While, at fi rst thought, we conceptualize our therapeutic efforts as working with the patient/client to change thought, emotion, and behavior, in truth what we must do is to change, literally, rewire, the brain, to accomplish these goals. What is remarkable about our fi eld is that we now know that we can and do accomplish this with the therapeutic tools that have been developed, and that through learning and experience, effective treatment literally rewires the brain and rebalances circuits that are responsible for how we think, feel, and behave. It is incumbent on all behavioral health caregivers to learn these skills, to acquire these tools, in order to be credentialed professionals privileged to care for and to provide effective treatments for fellow humans who suffer.

This volume that my remarkable colleagues have produced is unique in that it brings together foremost clinical and research experts who all have active clinical research programs based in an academic medical center, a place that is often the court of last resort for the most challenging and complicated cases. They have offered an accessible text, both in terms of its readability and in the clarity of clinical guidance. Case examples are used in each chapter to illus-trate how the described techniques can be applied to actual patients.

The format of this volume is also unique in the CBT book world as the content spans basic skills/applications and more specialized applications and topics. Our department has endeavored to make these expertises available to all who seek to develop or enhance their clinical skills, and some readers may wish to in addition pursue our online CBT portfolio of courses for which this handbook will become the main “reading and resource” going forward. Our ultimate mission is to create a community of learners who continue to develop evidence-based practice skills and look to MGH as their education “pro-vider.” We will always be grateful for your feedback and suggestions as we pursue our mutual goal of reducing human suffering and impairment.

Jerrold F. Rosenbaum, M.D. Massachusetts General Hospital/ Harvard Medical School Boston, MA, USA

Foreword

vii

1 Introduction .................................................................................. 1 Timothy J. Petersen , Susan E. Sprich , and Sabine Wilhelm

2 Basic Principles and Practice of Cognitive Behavioral Therapy ..................................................................... 5 Amanda W. Calkins , Jennifer M. Park , Sabine Wilhelm , and Susan E. Sprich

3 Cognitive Techniques ................................................................... 15 Lauren B. Fisher and Susan E. Sprich

4 Behavioral Strategies ................................................................... 33 Anne Chosak and Lee Baer

5 Cognitive Behavioral Therapy for Anxiety Disorders .............. 43 Kristen K. Ellard and Antonia Chronopoulos

6 Cognitive Behavioral Therapy for Depression .......................... 63 Maren B. Nyer , Lauren B. Fisher , and Amy Farabaugh

7 Cognitive Behavioral Therapy for Bipolar Disorder ................ 87 Thilo Deckersbach , Lori Eisner , and Louisa Sylvia

8 Cognitive Behavioral Therapy for Obsessive–Compulsive Disorder: Theory, Assessment, and Treatment ......................... 105 Noah Chase Berman , Corinna M. Elliott , and Sabine Wilhelm

9 Cognitive Behavioral Treatment for Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin- Picking) Disorder ............................................................... 117 Nancy J. Keuthen and Aisha Usmani

10 Behavior Therapy for Tourette Syndrome and Chronic Tic Disorder ............................................................ 131 Hannah E. Reese and Aisha Usmani

11 Cognitive Behavioral Therapy for Body Dysmorphic Disorder ................................................................... 141 Jennifer L. Greenberg , Aaron J. Blashill , Jennifer Ragan , and Angela Fang

Contents

viii

12 Transdiagnostic Cognitive Behavioral Therapy for Eating Disorders..................................................................... 155 Emily K. Gray and Jennifer J. Thomas

13 Cognitive Behavioral Therapy for Adult Attention-Defi cit Hyperactivity Disorder ................................................................ 171 Susan E. Sprich and Steven A. Safren

14 Cognitive Behavioral Approaches for Schizophrenia and Other Psychotic Disorders ................................................... 183 Peter H. Marcus and Corinne Cather

15 Cognitive Behavioral Approaches for Substance Use Disorders ....................................................... 197 Julie D. Yeterian , Allison K. Labbe , and John F. Kelly

16 Cognitive Behavioral Therapy for Posttraumatic Stress Disorder ............................................................................. 211 Elizabeth M. Goetter and Luana Marques

17 Treatment of Borderline Personality Disorder ......................... 227 Rebecca Harley , Lori Eisner , Ellen Prairie , and Michelle Jacobo

18 Behavioral Medicine Strategies in Outpatient Psychiatric Settings ...................................................................... 243 Ana-Maria Vranceanu , Janna R. Gordon , Mark J. Gorman , and Steven A. Safren

19 Cognitive Behavioral Therapy with Children and Adolescents ............................................................................ 259 Aude Henin , Jamie A. Micco , Melissa Schoeller , Alexandra Boudreaux , and Dina Hirshfeld-Becker

20 Cognitive Behavioral Couple Therapy for the Treatment of Relationship Distress ............................................................... 277 Steffany J. Fredman , Philippe Shnaider , Kimberly Z. Pentel , and Candice M. Monson

21 Evaluating Strategies for Combining Pharmacotherapy with Cognitive Behavioral Therapy ........................................... 289 Meredith E. Charney , Amanda W. Calkins , Lauren S. Hallion , and Naomi M. Simon

22 Cognitive Behavioral Therapies for Chronic Depression ......... 301 John D. Matthews and James Doorley

Index ...................................................................................................... 319

Contents

ix

Lee Baer , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Noah Chase Berman , Ph.D. Department of Psychiatry, OCD and Related Disorders Program , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA

Aaron J. Blashill , Ph.D. Department of Psychiatry , The Massachusetts General Hospital , Boston , MA , USA

Alexandra Boudreaux , B.A. Child Cognitive Behavioral Therapy Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Amanda W. Calkins , Ph.D. Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA

Corinne Cather , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Meredith E. Charney , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Anne Chosak , Ph.D. Obsessive Compulsive Disorders Unit , Massachusetts General Hospital , Boston , MA , USA

Antonia Chronopoulos , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Thilo Deckersbach , Ph.D. Bipolar Clinic and Research Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

James Doorley , B.A. Department of Psychology , George Mason University , Fairfax , VA , USA

Lori Eisner , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Kristen K. Ellard , Ph.D. Bipolar Clinic and Research Program, Department of Psychiatry , Massachusetts General Hospital/Harvard Medical School , Boston , MA , USA

Contributors

x

Corinna M. Elliott , Ph.D. Department of Psychiatry, OCD and Related Disorders Program , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA

Angela Fang , M.A. Department of Psychiatry , The Massachusetts General Hospital , Boston , MA , USA

Amy Farabaugh , Ph.D. Depression Clinical & Research Program (DCRP) , Department of Psychiatry, Massachusetts General Hospital , Boston , MA , USA

Lauren B. Fisher , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

Steffany J. Fredman , Ph.D. Human Development and Family Studies , Pennsylvania State University , University Park , PA , USA

Elizabeth M. Goetter , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Janna R. Gordon , B.A. Department of Psychiatry/Behavioral Medicine Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA

Mark J. Gorman , Ph.D. Department of Psychiatry/Behavioral Medicine Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Emily K. Gray , M.D. Eating Disorders Clinical and Research Program , Massachusetts General Hospital , Boston , MA , USA

Jennifer L. Greenberg , Psy.D. Department of Psychiatry , The Massachusetts General Hospital , Boston , MA , USA

Lauren S. Hallion , Ph.D. Harvard Medical School, Anxiety Disorders Center/Center for CBT , Institute of Living , Hartford , CT , USA

Rebecca Harley , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Aude Henin , Ph.D. Child Cognitive Behavioral Therapy Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Dina Hirshfeld-Becker , Ph.D. Child Cognitive Behavioral Therapy Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Michelle Jacobo , Ph.D. Department of Psychiatry, Massachusetts General, Hospital, Boston, MA, USA

John F. Kelly , Ph.D. Department of Psychiatry, Center for Addiction Medicine , Massachusetts General Hospital , Boston , MA , USA

Contributors

xi

Nancy J. Keuthen , Ph.D. Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School, OCD and Related Disorders Clinic , Boston , MA , USA

Allison K. Labbe , Ph.D. Department of Psychiatry , Center for Addiction Medicine, Massachusetts General Hospital , Boston , MA , USA

Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA, USA

Peter H. Marcus , Psy.D. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

Luana Marques , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

John D. Matthews , M.D., M.Sc. Department of Psychiatry, Massachusetts General Hospital Harvard Medical School, Boston, USA

Jamie A. Micco , Ph.D. Child Cognitive Behavioral Therapy Program, Department of Psychiatry , Massachusetts General Hospital/Harvard Medical School , Boston , MA , USA

Candice M. Monson , Ph.D. Department of Psychology , Ryerson University , Toronto , ON , Canada

Maren B. Nyer , Ph.D. Depression Clinical & Research Program (DCRP), Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Jennifer M. Park , Ph.D. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Kimberly Z. Pentel , B.S. Department of Psychology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA

Timothy J. Petersen , Ph.D. Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA

Ellen Prairie , Ph.D. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Jennifer Ragan , Ph.D. Department of Psychiatry , The Massachusetts General Hospital , Boston , MA , USA

Hannah E. Reese , Ph.D. Department of Psychology, Bowdoin College, Brunswick, ME, USA

Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA

Steven A. Safren , Ph.D., A.B.P.P. Department of Psychiatry/Behavioral Medicine , Massachusetts General Hospital , Boston , MA , USA

Melissa Schoeller , B.A. Child Cognitive Behavioral Therapy Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Contributors

xii

Philippe Shnaider , M.A. Department of Psychology , Ryerson University , Toronto , ON , Canada

Naomi M. Simon , M.D., M.Sc. Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Harvard Medical School, Boston, MA, USA

Susan E. Sprich , Ph.D. Department of Psychiatry, Cognitive Behavioral Therapy Program , Massachusetts General Hospital , Boston , MA , USA

Louisa Sylvia , Ph.D. Bipolar Clinic and Research Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA

Jennifer J. Thomas , Ph.D. Eating Disorders Clinical and Research Program , Massachusetts General Hospital , Boston , MA , USA

Aisha Usmani , Ph.D. Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA

Ana-Maria Vranceanu , Ph.D. Department of Psychiatry/Behavioral Medicine Service , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA

Sabine Wilhelm , Ph.D. OCD and Related Disorders Program , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA

Julie D. Yeterian , M.A. Department of Psychiatry , Center for Addiction Medicine, Massachusetts General Hospital , Boston , MA , USA

Contributors

1T.J. Petersen et al. (eds.), The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy, Current Clinical Psychiatry, DOI 10.1007/978-1-4939-2605-3_1,© Springer Science+Business Media New York 2016

Psychotherapy has rich and complicated historical roots, and has evolved considerably into what we today consider generally accepted, modern forms of treatment. One of the earliest forms of psycho-therapy, developed over 2,000 years ago, was based on the principles of Buddhism and posited that mental suffering was caused by ignorance stemming from a craving for attachment. If an individual followed the “Noble Eightfold Path to Enlightenment,” this craving would be eased (The Four Noble Truths and Noble Eightfold Path, [ 1 ]). Other notable, early forms of psychotherapy, span-ning antiquity through the early nineteenth cen-tury, include Hippocrates’ focus on bringing the “four humors” into balance (Hippocrates, ca. 460

BC–ca. 370 BC [ 2 ]), emphasis on balancing the forces of Yin and Yang [ 3 ], various forms of hypnotherapy [ 4 , 5 ], and exorcism [ 6 ]. More for-malized models of “talk therapy” were not devel-oped until the late nineteenth century, when Freud and subsequent followers began their transforma-tive clinical work.

The beginning of the twentieth century marked a period of rapid growth and refi nement of psycho-therapy, with notable developments taking place in Europe and the USA. From 1900 through the end of World War II, key developments included publication of Freud’s seminal work Interpretation of Dreams [ 7 ], establishment of the American Psychological Association, opening of the fi rst mental health clinic at the University of Pennsylvania, Adler and Jung’s departure from strict Freudian views and the resulting formation of the Individual and Analytical schools of thought [ 8 , 9 ], Horney’s establishment of Neo-Freudianism [ 10 ], and publication of Carl Roger’s seminal work Counseling and Psychotherapy [ 11 ].

Signifi cant branching of theories and forms of psychotherapy occurred during the mid- twentieth century. In addition to publication of the fi rst Diagnostic and Statistical Manual of Mental Disorders (DSM; [ 12 ]), this period marked the appearance of what is known as the “fi rst wave” of evidence-based psychotherapies. As a group, these therapies were in part a rejec-tion of the perceived shortcomings of psychoana-lytic theory and techniques (e.g., overemphasis

T. J. Petersen , Ph.D. (*) Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School , 101 Merrimac Street, 10th Floor , Boston , MA 02114 , USA e-mail: tpetersen@partners.org

S. E. Sprich , Ph.D. Department of Psychiatry, Cognitive Behavioral Therapy Program , Massachusetts General Hospital , One Bowdoin Square, 7th Floor , Boston , MA 02114 , USA e-mail: ssprich@mgh.harvard.edu

S. Wilhelm , Ph.D. OCD and Related Disorders Program , Massachusetts General Hospital, Harvard Medical School , 185 Cambridge Street, Suite 2000 , Boston , MA 02114 , USA e-mail: swilhelm@mgh.harvard.ed

1 Introduction

Timothy J. Petersen , Susan E. Sprich , and Sabine Wilhelm

2

on childhood experiences as the primary cause of psychopathology, lack of standardization of techniques, absence of validated outcome mea-sures). Among the most important of these new therapies was behavioral therapy developed and codifi ed by such pioneers as Wolpe and Skinner. Behavior therapy represented a signifi cant para-digm shift in that observable events (behaviors) were the primary unit of interest and proved to be modifi able based on reinforcement strategies and contingencies [ 13 , 14 ]. Along with this core component of the “fi rst wave,” another notable progress was taking place in the development of different schools of psychotherapy including Perls’ creation of Gestalt Therapy, development of Maslow’s Humanistic Psychology, and the spawning of psychodynamic therapies and their briefer versions [ 15 – 17 ]. The “second wave” of psychotherapies, occurring in the late 1960s and 1970s, centered on a focus on cognitions as the primary drivers of affect and behavior. Rather than simply respondents to behavioral contingen-cies, human beings were viewed as engaging in active cognitive processing that had a signifi cant impact on day-to-day experience. This “sec-ond wave” was accompanied, in parallel, by the development of both social psychology and com-puter programming. Within social psychology, an emphasis on researching how people interact with each other led to the creation of attribution theory, which posits that individuals actively determine causes of others’ behavior through refl ective thought. Within the world of computer science, programming language and the concept of a “central processor of information” served as an accurate and useful model for understanding human thinking. Social psychologists addition-ally contributed to the empirical development of CBT with the advent of information processing theory. Information processing theory represented a critical paradigm shift in which humans were seen not as simply responding to external stimuli, but as active cognitive processors of information presented to them from their external world [ 18 ]. This theory helped establish thought processes or cognitions as legitimate targets for scientifi c research and therapeutic interventions. Initially this new line of thinking was met with criticism

from those solidly in the behaviorism camp as external, observable behaviors were seen by these scientists as primary in understanding the human experience.

Albert Ellis and Aaron Beck are considered to be the leaders of this second wave of psychother-apy development. Ellis created rational emotive therapy (RET; [ 19 ]). The fundamental tenet of RET is that unhealthy, self-defeating thoughts and beliefs create distress and individuals can be taught to identify and modify them. Ellis fi rmly believed that this treatment approach resulted in effective promotion of emotional well-being. The Albert Ellis Institute, still in existence, has successfully spearheaded positive RET outcome studies [ 20 ] and has provided training and certifi cation to thou-sands of psychologists. Beck, in what was argu-ably one of the most signifi cant developments in the growth of psychotherapy during this time period, created the cognitive therapy (CT) model, with a specifi c focus on how thoughts play a piv-otal role in the development and maintenance of depression. His 1979 book, Cognitive Therapy of Depression , infl uenced the fi eld in a profound manner and served as the basis for cognitive behavioral therapy (CBT) models created to treat a broad range of mental health disorders [ 21 ]. The Beck Institute in Pennsylvania continues to pro-vide training for clinicians worldwide.

Subsequent to Beck’s original 1979 publica-tion, developers of CBT treatment protocols have generously incorporated behavioral strate-gies into the overall treatment package [ 22 , 23 ]. Thus, the term CBT, as compared with CT, is a more accurate refl ection of what actually takes place during treatment—in that more behavioral strategies are now incorporated, as compared to the original CT envisioned by Beck. The relative contribution of cognitive and behavioral strate-gies to observed effi cacy of CBT has been exam-ined in a formal manner [ 23 ]. While some research suggests behavioral strategies to be the more “active” ingredient, in that they alone may produce the same positive outcomes when com-pared with the entire CBT treatment package, other research does not confi rm this fi nding [ 24 , 25 ]. At this point, the most common clinical strategy is to evaluate each patient’s individual

T.J. Petersen et al.