One of the courses that I teach frequently for the Center for Deployment Psychology (CDP) is “Cognitive Behavioral Therapy for Depression: Working with Service Members & Veterans” (CBT-D). At CDP, we update all of our courses regularly to ensure that they’re current and fresh. With the current CBT-D workshop updates, I’m excited to be able to incorporate information from Dr. Judith Beck’s newly released third edition of Cognitive Behavior Therapy: Basics and Beyond.
In Dr. Beck’s new edition, alongside information about traditional cognitive behavioral therapy (CBT), she also includes additional content from a recovery perspective. According to the Beck Institute website, recovery-oriented cognitive therapy is a treatment approach that is designed to “promote empowerment, recovery, and resiliency in individuals with serious mental health conditions.” In CBT-D, this includes an emphasis on patients’ strengths, skills, and resources as opposed to a focus primarily on symptom presentation and psychopathology. There is an additional emphasis placed on patient’s values and aspirations, as well as a focus on experiencing positive emotion both in and out of therapy. Keeping with this shift, the book also includes two new chapters; one on the therapeutic relationship, and one on integrating mindfulness into CBT.
This shift in focus can be seen from the very beginning of the book. The second chapter, titled “Overview of Treatment” begins with a list of the general principles of CBT. When reading through the list, one of the first things that I noticed is that it now includes 14 principles, as opposed to the 10 that were enumerated in the previous edition. The newly added principles are:
In addition, there is a notable addition to the principle that describes the treatment approach as goal-oriented, to include the words “aspirational” and “values based.”
When thinking about how to incorporate this new information into our CBT-D workshop, a few areas stood out:
Cultural sensitivity is receiving increasing attention within the field of psychology. As noted in the new edition, CBT has traditionally reflected Western cultural values such as rationality, the scientific method, and individualism. However, it is important to remember that patients from different cultures may hold differing values and perspectives. Dr. Pamela Hays is a psychologist who has written quite a bit about culturally responsive CBT. When working with depressed patients, it is important to not assume that their clinical presentation is solely due to cognitive distortions or problematic behavior, but to also consider the potential impact of environmental factors (e.g., oppression, racism). In a 2009 article, she describes strategies for integrating multicultural considerations into the practice of CBT. Among others, these include things such as emphasizing culturally respectful behavior, identifying culturally related strengths, and emphasizing collaboration over confrontation. As we discuss in our workshop, this also includes taking a patient’s military affiliation into account.
By focusing on patients’ values and goals, we can help create a sense of purpose and empowerment in their lives. Having a clear vision of where they want to go can help motivate patients to commit the changes they’ll need to make in order to get there. Additionally, understanding a patient’s values can provide insight into which situations are more likely to contribute to their distress. One way to do this is to ask patients about what’s important to them in their lives and how they’d like their life to be. Cognitive restructuring, which is one of the key strategies utilized in CBT-D, is also easier if you first understand a patient’s values.
There has been an emphasis on the therapeutic alliance in CBT since its inception in the 1970s. Research has since demonstrated that a positive therapeutic alliance is correlated with positive treatment outcomes. When engaging in CBT-D it is important to maintain a relationship that encompasses the following basic qualities: warmth, empathy, and genuineness.
In our workshop we highlight multiple ways to help depressed patients become more resilient and increase their sense of well-being in our workshop. Some of these include:
Our team is excited to incorporate these (and others) new changes into our existing workshop. I look forward to seeing you at one of our future CBT-D workshops!
Editor's note: The next CBT-D training will be held on 28-29 April 2021. Registration will be available soon!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Marjorie Weinstock, Ph.D., is a Senior Military Behavioral Health Psychologist for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences at Bethesda, Maryland.
Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.
Feldman, J., Best, M., Beck, A. T., Inverso, E., & Grant, P. (2019, March 7). What is recovery-oriented cognitive therapy (CT-R)? https://beckinstitute/what-is-recovery-oriented-cognitive-therapy-ct-r/
Hays, P. A. (2009). Integrating evidence-based practice, cognitive-behavior therapy, and multicultural therapy: ten steps for culturally competent practice. Professional Psychology: Research and Practice, 40(4), 354-360.