Table Of Contentebook
THE GUILFORD PRESS
Doing CBT
Doing CBT
A Comprehensive Guide
to Working with Behaviors,
Thoughts, and Emotions
DaviD F. Tolin
THE gUilFoRD PRESS
New York London
Copyright © 2016 The Guilford Press
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Library of Congress Cataloging-i n-P ublication Data
Names: Tolin, David F., author.
Title: Doing CBT : a comprehensive guide to working with behaviors, thoughts,
and emotions / David F. Tolin.
Description: New York, NY : The Guilford Press, [2016] | Includes
bibliographical references and index.
Identifiers: LCCN 2016023931 | ISBN 9781462527076 (hardback)
Subjects: LCSH: Cognitive therapy. | BISAC: MEDICAL / Psychiatry / General. |
SOCIAL SCIENCE / Social Work. | PSYCHOLOGY / Psychotherapy / General. |
MEDICAL / Nursing / Psychiatric.
Classification: LCC RC489.C63 T65 2016 | DDC 616.89/1425—dc23
LC record available at https://lccn.loc.gov/2016023931
To Fiona, James, and Katie
Thanks for your support, for your encouragement,
and for putting up with me while I wrote this thing.
About the Author
David F. Tolin, PhD, ABPP, is founder and director of the Anxiety Disorders Center/
Center for Cognitive Behavioral Therapy at The Institute of Living–H artford Hospital
and Adjunct Professor of Psychiatry at the Yale University School of Medicine. The author
of over 150 scientific journal articles, Dr. Tolin has served as a principal investigator and
scientific reviewer for the National Institutes of Health since 2003. He is a past president
of the Society of Clinical Psychology (Division 12) of the American Psychological Associa-
tion and a recipient of awards for Distinguished Contribution to the Science of Psychol-
ogy, Distinguished Contribution to the Practice of Psychology, and Distinguished Life-
time Contribution to Psychology from the Connecticut Psychological Association.
vi
Preface
This book is for mental health clinicians of all kinds. You might be a psychologist, a social
worker, a psychiatrist, a counselor, or a member of another helping field. You might still
be in a training program, or you might be a seasoned practitioner with years or decades of
practice under your belt who is looking to sharpen your skills and expand your repertoire.
You also could work in one or more of a diverse array of clinical settings. You might
be in an outpatient private practice or clinic. You might work in a community mental
health center. You might work on a psychiatric inpatient unit or a residential treatment
program. Perhaps you work in a general medical hospital or rehabilitation center. Maybe
you’re in a school or college setting. Your typical client population could vary as well. Per-
haps you treat higher-f unctioning clients with milder psychiatric problems. Or maybe you
treat clients with more severe illness, whether acute or chronic. Maybe you work primarily
with children, or with older adults, or with the developmentally disabled.
Regardless of your level of expertise, your professional setting, or the clients you
work with, this book is intended to be useful for you. Historically, it’s been hard to find
good resources that are broad enough to be applicable to all of these practitioners, set-
tings, and clients, yet detailed enough that they can be put to actual use in practice. It’s
also been hard to find resources that have enough scientific detail to help academically
oriented readers grasp the rationale behind the ideas without losing the “how-to’s” among
the scientific jargon.
This book aims to straddle multiple lines. My hope is that regardless of your clinical
title, and whether you are a rookie or an old pro, you will find this material helpful. I am
a clinical psychologist, and much of the scientific work described in this book comes from
within the discipline of psychology. But I don’t assume you have the same background, so I
have tried to lay out the concepts in a way that people from all disciplines can use. My prin-
cipal aim is for this book to show you how to do darn good cognitive-b ehavioral therapy
(CBT) for whatever kinds of clients you work with. But I’m aware that for many readers,
this book will also serve as your introduction to this rich and interesting field, and so I
want to make sure you get the scientific understanding you need in order to appreciate
CBT from all angles: scientific, theoretical, and practical.
vi
viii Preface
We’re going to cover a lot of ground in this book. We’ll discuss how we understand
psychological problems, how we engage our clients, and a wide range of techniques that
we use to help our clients improve their lives. In addition, we’ll present a number of (ficti-
tious) clinical cases that illustrate what I’m talking about. There are numerous sidebars
that describe the science behind what we’re doing, arguments and counterarguments, and
essential points to remember. I’ll give you exercises to try on yourself so you can really
embrace key constructs and practice key techniques. I’ll introduce and define several
terms that might be new to you.
With so many different topics, it’s easy to lose sight of the forest for the trees. The
“forest” of CBT, as I see it, is this:
• Theory and technique are intertwined. As CBT practitioners, we formulate a theo-
retical understanding of why a client is suffering, and we introduce therapeutic techniques
based on that understanding. In particular, our interventions often target behavioral,
emotional, and cognitive mechanisms that are keeping the problem in place or making it
worse.
• Behavior, emotion, and thought are all different parts of an interactive process
that can function well or not so well. When that interactive process is functioning not so
well, maladaptive behaviors, emotions, and thoughts tend to exacerbate each other in a
“snowball” effect.
• Conversely, as therapists, we can use the “snowball” effect to our advantage. We
can influence the interactive process by intervening at the level of behavior, emotion, or
thought—a nd there is nearly always more than one way to help. The art and science of CBT
involve figuring out what kind of intervention will be most helpful for which client.
Whoever you are, wherever you work, and whomever you treat, you want what’s best
for your clients with psychological problems. I do, too. So how do we know what’s best?
People have been debating that issue for decades. Here’s what we know:
• First, there is no doubt that CBT can be effective for a broad range of mental disor-
ders. CBT, in various forms, has been clearly demonstrated to help clients with anxiety dis-
orders, mood disorders, compulsive disorders, substance use disorders, marital distress,
certain personality disorders, somatoform disorders and behavioral medicine concerns,
and even psychotic disorders. Furthermore, the scientific evidence tells us that CBT can
be just as effective in kids as it is in adults.
• Second, the efficacy of a lot of other forms of psychotherapy is less clear. Note that
I don’t say they’re ineffective; I’m just saying we know much less about how well they work,
and for whom they work, than we do about CBT. Certain treatments, such as interper-
sonal psychotherapy, have been shown to work for certain disorders, such as depression,
but they haven’t been demonstrated to serve as a solid foundation for a wide range of
clients with a wide range of problems the way CBT has.
• Third, we’ve discovered a lot of helpful things in psychotherapy that have little or
nothing to do with theoretical orientation. As just one example, we’ve learned much from
successful psychotherapists of all stripes about how to develop and maintain a successful
therapeutic relationship, which is critical for any treatment.
I’m a CBT therapist because, as far as I can tell, CBT is broadly the most effective per-
spective to take with most clients. And it serves as a general platform for the full range of
