Table Of Content“Josefowitz and Myran have written a tremendously useful and practical book for new and seasoned
practitioners alike. CBT Made Simple is accessible, engaging, and provides a wealth of clinical exam-
ples, resources, and applications that will be turned to time and time again. The authors’ experience
and wisdom shines through in providing guidance to help the reader apply cognitive behavioral therapy
(CBT) not only to their clients, but to learn through applications on themselves. Each chapter follows
the structure of a CBT session, and guides the reader through learning in the same way that they will
teach their clients. CBT is made simple through this elegantly written book!”
— Deborah Dobson, PhD, RPsych, adjunct professor in the department of psychology at
the University of Calgary, and coauthor of Evidence- Based Practice of Cognitive- Behavioral
Therapy; and Keith Dobson, PhD, RPsych, professor of clinical psychology at the
University of Calgary, and editor of Handbook of Cognitive- Behavioral Therapies
“This book provides a clear and structured approach to learning and practicing CBT. Nina and David
have incorporated active learning strategies, visual and auditory techniques, and lots of opportunities
to practice new skills. In addition, a wealth of resources is available online to supplement the text. This
book is an invaluable resource for therapists learning CBT for the first time, and for those more expe-
rienced who need a refresher in the core principles and practices of CBT.”
— Enid Grant MSW, RSW, senior director of Children’s Mental Health at Skylark Children,
Youth & Families
“Josefowitz and Myran’s innovative approach to teaching CBT skills engages the reader in a way that I
haven’t seen in previous books on the topic. Each chapter of the book is organized like a CBT session—
setting an agenda, presenting experiential exercises, and assigning homework. The book describes CBT
in a step- by- step, accessible way that is sure to be helpful for both new therapists and seasoned clini-
cians wanting to brush up on their skills. I highly recommend CBT Made Simple!”
— Martin M. Antony, PhD, professor of psychology at Ryerson University, and coauthor of
The Shyness and Social Anxiety Workbook and The Anti- Anxiety Workbook
“This is a program hidden in a book, which encourages an experiential approach to CBT learning.
With the additional web resources (videos, handouts) it will thoroughly engage CBT learners and
teachers. A ‘must- have’ text in the era of expanding CBT practice”
— Sanjay Rao, MD, clinical director of the Mood and Anxiety Program at Royal Ottawa
Mental Health Centre, associate professor of psychiatry at the University of Ottawa, and
executive member of the Canadian Association of Cognitive Behavioural Therapies
“Much has been written on CBT. Still there is a need— indeed a hunger— for a clear and practical
how- to book. This volume fills that need remarkably well. Its pragmatic, skill- based, experiential
approach will be extremely helpful especially for clinicians new to CBT for whom it is intended.
However, clinicians with all levels of sophistication and experience will find much to deepen their
knowledge and practice.”
— Michael Rosenbluth, MD, FRCPC, chief of the department of psychiatry at
Toronto East General Hospital, and associate professor at the University of Toronto
“CBT Made Simple offers an innovative, cutting- edge method of understanding and using CBT using
the effective adult learning model. This unique and practical resource will be of great help to clinicians
who are new to CBT, as well as those who’ve been practicing for years. I highly recommend this book!”
— Matthew McKay, PhD, psychologist and coauthor of several books, including
The CBT Anxiety Solution Workbook, Thoughts and Feelings, and Self- Esteem
C B T
made simple
A Clinician’s Guide to Practicing
Cognitive Behavioral Therapy
NINA JOSEFOWITZ, P D
h
DAVID MYRAN, MD
New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold
with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional
services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2017 by Nina Josefowitz and David Myran
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Elizabeth Hollis Hansen
Edited by Rona Bernstein
Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
We would like to dedicate this book with love to our children,
Laura, Aaron, and Daniel,
who have grown into caring, capable, and wonderful adults.
We would also like to dedicate this book to the memory of Paul Josefowitz
and his unending curiosity.
Contents
Foreword vii
Introduction 1
Part 1: CBT Foundation
1 Use CBT Theory to Understand Your Clients 6
2 Focus on Your Clients’ Problems and Strengths 25
3 Develop Goals for Therapy 46
4 Structure Your Sessions 60
Part 2: Understand Your Clients’ Problems
5 Identify Your Clients’ Feelings, Physical Reactions, and Behaviors 82
6 My Clients Have So Many Thoughts—Which Do I Focus On? 104
7 Identify Your Clients’ Thoughts 122
Part 3: Cognitive and Behavioral Interventions
8 Look for Evidence and Create Balanced Thoughts 146
9 Problem Solving—Finding a Better Way 173
10 Behavioral Activation—Action Plans for Depression 196
11 Exposure Therapy—Clients Face Their Fears 222
Part 4: CBT in Action
12 Suzanne’s and Raoul’s Therapy 246
Acknowledgments 260
Appendix: Answers to YOUR TURN! Exercises 261
References 277
Index 281
Foreword
It is fair to say that cognitive behavioral therapy (CBT) has undergone a tremendous evolution over the
past twenty-five years. Some of these changes, such as moving from a five-column to a seven-column
thought record, have been triggered by internal innovations and have helped extend CBT’s relevance
to disorders falling outside the orbit of its initial validation for depression and anxiety. Other modifica-
tions, such as focusing on strengths and balancing acceptance and change, have come in response to
external challenges from other therapy models. With all this movement in the field it can be difficult
for therapists to return to the basic elements of this approach in a way that is shorn of trends and niche
applications. On this point, in fact, I am frequently approached by trainees who are interested in learn-
ing about mindfulness-based cognitive therapy. When I ask them about their CBT background, they
say it is minimal and they don’t see much need for it. The impression I have is that they are eager to
leapfrog past the CBT essentials in order to get to the work they find more interesting. They tend to be
surprised at my response, which often runs counter to their wishes and stresses that one can’t get very
far in learning new CBT variants when the basic model is only weakly understood.
CBT Made Simple does an enviable job in providing just this type of clinically pragmatic and skill-
based grounding in CBT theory and interventions. Stemming from Nina Josefowitz and David Myran’s
two-decade-long careers as cognitive therapists, teachers, supervisors, and academics, this book exem-
plifies the best qualities of user-friendly, explicit guidance that offers valuable insights into the nuts and
bolts of CBT to all levels of learners.
For example, the decision to write this book with a structure that coheres to an actual therapy
session is highly innovative. Agendas are set, homework is assigned and reviewed, and learning covers
specific skill sets that are relevant to the material being covered. Here we see CBT at its finest. Rather
than imparting this information in a purely theoretical manner, CBT Made Simple invites the reader to
learn through doing.
Nina and David rightly argue that it is only through the experiential immersion in CBT principles
and interventions that the reader will optimize their book’s value. How much more can be learned from
giving yourself a homework assignment and monitoring its performance or even nonperformance? Or
scheduling your activities in a typical day and noticing whether life permits them to be achieved in
their predetermined order? This approach, to my mind, is what separates CBT Made Simple from many
other books touching on the same theme. It also shows how one of the metaconcepts in CBT, guided
discovery, can be brought to bear on all aspects of therapeutic learning, whether inside or outside the
actual therapy session. Readers who agree to take the plunge and work with the book in this manner
will not be disappointed.
CBT Made Simple is divided into parts that follow the different phases of CBT work and emphasize
important formulation principles along with ongoing assessment in order to ensure that the most
appropriate techniques are being employed. The early chapters focus on identifying client strengths
