• Offered for Year: 2023/24

• Module Leader(s): Mr Matthew Stalker
• Lecturer: Mrs Michelle Bowen, Dr Anna Chaddock, Mr Stephen Holland, Dr Christine Blincoe

• Owning School: Psychology
• Teaching Location: Mixed Location

Semesters

Aims

1. To develop core knowledge of the theoretical and research literature informing behavioural and cognitive models of anxiety disorders

2. To develop the clinical skills needed to deliver CBT for anxiety disorders based on these models

3. To achieve clinical competency in CBT for anxiety disorders with specialist supervision

This module is designed to develop knowledge, skills and attitudes in the cognitive-behavioural treatment of anxiety disorders to CBT practitioner level. It is intended to improve proficiency in the fundamental techniques of CBT and support the development of competency in the specialist techniques applied to the treatment of anxiety disorders. There will be a balanced emphasis on behavioural and cognitive approaches.

Cognitive-behavioural theory of anxiety disorders and models of specific disorders will be taught in a series of lectures. The lectures will also address the evidence-base supporting these models, covering research into basic processes and associated clinical interventions, including up-to-date developments in the field. The disorders covered will be Specific Phobia, Panic Disorder, Agoraphobia, Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD) and Illness Anxiety Disorder (IAD). The module will also cover working with co-morbid anxiety and anxiety in the context of personality disorder . Lectures will concentrate on developing the CBT knowledge and attitudes needed to work with people suffering from anxiety disorders.

CBT assessment and specialist interventions will be covered in complementary practical workshops. The workshops will consist of role-play, experiential exercises, video and case demonstrations.
Experiential exercises will encourage self-reflection and increased self-awareness. Sessions will also incorporate a focus on therapists’ beliefs about anxiety. Workshops will concentrate on developing CBT intervention skills, harnessing the knowledge gained from the lectures and consolidating the personal attitudes necessary to foster effective psychotherapeutic relationships with people suffering from anxiety disorders.

Trainees will engage in specialist CBT supervision in groups of three from a BABCP accredited practitioner who will support the process of incorporating CBT interventions into the trainee’s therapeutic work. Trainees will be expected to make video recordings of their clinical work with anxiety-disordered patients based in their normal place of work. They will need to arrange access to appropriate patients within their normal work-base in advance of starting the programme. They will receive intensive feedback, guidance and coaching in the clinical processes needed to treat anxiety disorders using CBT. Trainee’s clinical competence will be assessed using the Cognitive Therapy Rating Scale (Revised) which will be used to provide both formative and criterion-referenced summative feedback. Trainees will be expected to have enough time to prepare before clinical sessions and to review and reflect afterwards to maximise learning from the supervisory process.
The time needed for preparation, reflection and supervision is much greater than routine clinical practice and is essential in the development of CBT competency.

Outline Of Syllabus

Knowledge and attitudes
•       Phenomenology, diagnostic classification and epidemiological characteristics of anxiety disorders
• Risk assessment, mental state examination, personal, medical history relevant to anxiety disorders
• Suitability for CBT with anxiety disorders: contra-indications for treatment, the role of pharmacological interventions and substance misuse, how to refer on to other agencies if unsuitable
• Fundamentals of assessment and formulation for CBT with anxiety disorders
• Clinical process for anxiety disorders – formulation, rationale giving, active treatment, relapse prevention
• Use of clinical measurement with specific anxiety disorders to monitor CBT process and outcome
• The role of the therapeutic relationship in CBT with anxiety disorders
• Clinical research in the treatment of anxiety disorders: clinical trials and CBT outcome studies
• Theories and experimental studies of cognitive processes in anxiety disorders
• Application of theory and method to the individual case in anxiety disorders
• Experiential learning: illustrating how cognitive methods with anxiety can be applied to the trainee’ own experience
• Values, culture and diversity (access, ethical, professional and cultural considerations)
• Effective use of supervision in working with people with anxiety disorders to enhance and regulate good practise.

Clinical skills
• Conducting assessments and collaborative formulations with people who have anxiety disorders
• Assessing risk, mental state, personal history and medical history relevant to anxiety disorders
• Assessing and optimizing suitability for CBT with anxiety disorders
• Fostering and maintaining therapeutic relationships with anxiety-disordered patients
• Consolidation of core CBT skills as assessed by the Cognitive Therapy Rating Scale (Revised)
• Supporting the clinical process of CBT with anxiety-disordered patients – shared formulation, rationale giving, active treatment and methods of change, relapse prevention
• Helping patients overcome anxious avoidance, reduce safety-seeking behaviour, re-appraise threat, danger and capacities to cope with perceived threat
• Effective use of supervision in working with people with anxiety disorders to enhance and regulate good practice

Teaching Methods

Teaching Activities

Teaching Rationale And Relationship

Subject knowledge and understanding will be developed through:

• Small Group teaching sessions, which will introduce the phenomenology, diagnostic classification and epidemiological characteristics of each anxiety disorder
• Guided self-study, to expand knowledge of the cognitive and behavioural processes known to maintain different anxiety disorders
• Individual tutorials and tutor feedback on draft work, to help trainees review and evaluate the evidence-base of CBT for anxiety disorders, covering both basic processes and the outcome of CB treatments
• Reflective Log (initiated in the Fundamentals module), to help trainees reflect on their own anxieties and how they use cognitive and behavioural processes to manage them

Practical skills are developed through:

• Skill workshops, with video simulations, demonstrations and role play of the main clinical procedures used in CBT with anxiety-disordered patients
• Providing CBT to anxiety disordered patients, with regular opportunities to practice clinical assessments, foster trusting therapeutic relationships, formulation and change process
• Clinical supervision, in which trainees receive regular feedback on their case conceptualisations and guidance on how to use them to form the basis of cognitive and behavioural change with their patients

Assessment Methods

The format of resits will be determined by the Board of Examiners

Other Assessment

Formative Assessments

Assessment Rationale And Relationship

The CTS-R assessment will provide detailed feedback on specific CBT skill developments that map directly onto the knowledge, skills and attitudes outlined in the intended learning outcomes and programme aims. The formative CTS- R feedback from the Fundamentals module precedes this summative assessment and this will support trainee progression during the initial “bench-marking” phase of CBT development when trainees learn how well their extant clinical skills map onto CBT-specific skills. A reflective review of clinical work undertaken for the summative submission provides an opportunity to draw theory/practice links and for the identification of personal strengths and areas for improvement.
The case study requires the trainee to provide a critique of the model supporting treatment with an anxious patient and reflect on the process of using that model in therapy. It is also an opportunity to report and evidence the use of clinical skills employed in treatment and critical reflection on the process and outcome of the case. A personalised formulation of the patient’s anxiety will demonstrate the knowledge and skills to produce a balance of adherence to the model in question and appropriate personalised adaptation. A reflective practice section will require trainees to reflect on the personal impact on working with this case and be explicit about what has been learned from the experience.

*Note
The CTS-R is weighted 65% and the case study 35% of the total mark for this module. This ensures that across the programme assessments of clinical competence from direct contact with patients provide approximately 50% of the total mark. Within this module, the CTS-R and case study both need to be passed (even if one component is failed and the combined percentage is greater than 50).

Reading Lists

• PSY8048's Reading List

Timetable

• Timetable Website: www.ncl.ac.uk/timetable/
• PSY8048's Timetable