Problems, Noncomplicance, and Complex Cases in Cognitive-Behavior Therapy

Topic: Cognitive Psychology
Words: 1109 Pages: 4

This chapter discusses the ways to implement the cognitive-behavior therapy (CBT) in order to decrease suicide risk. The authors state that hopelessness and negative thoughts that may lead to suicide, which can be addressed by means of engaging such patients in CBT through the recognition of their feelings and offering alternative yet realistic solutions to their cognitions (Wright, Basco, & Thase, 2017). It is critical to ensure that patients understand the core of the identified therapy, develop a commitment to treatment, and receive screening and evaluation for suicide risk. The subsequent phase of CBT is safety planning with such steps as determining warning signs, selecting coping strategies, revealing family and social contacts, and making the environment safe. The paramount idea assumed in this chapter refers to elaborating a hope kit that should be relevant for a particular patient and applying behavioral methods, be it breaking the patterns of avoidance or solving problems.

The case examples, video, and learning exercises of this chapter represent the techniques of safety planning based on the case of a patient with anxiety and depression. Such an example can be considered rather beneficial to use in practice in order to take into account all the necessary steps. The detailed interpretation of the example aloo allows for understanding the solutions offered. While the two mentioned points are evident strengths of the given chapter, its weakness is associated with a lack of guidance if a patient remains resistant to CBT: it is unclear whether to change the strategies or select another treatment tool. Therefore, it would be better of the authors discussed some steps to be adopted in case patients show avoidance or misbelief in the course of the therapy after they seemed engaged at the first stages.

The chapter focuses on cognitive restructuring as a strategy to utilize CBT in patients with chronic, severe, and treatment-resistant disorders. When standard CBT becomes ineffective, it is possible to apply the well-being therapy from the hedonic perspective, promoting personal growth, meaning identification, and self-acceptance. Furthermore, this chapter examines bipolar disorder, schizophrenia, substance abuse, and personality disorders and provides specific modifications in terms of CBT (Wright et al., 2017). The key strength of this chapter is that it translates empirical evidence into the applicable strategies that seem to be useful for both practitioners and patients. The examples of misbeliefs and delusions are also strong points as they present real-life cases and explanations. For example, the troubleshooting guide 5 identifies potential issues with pharmacotherapy adherence as one of the key characteristics of CBT in difficult cases. The references to scholarly works compose the strength of the chapter, offering readers the opportunity to reach more research insights.

As for the weakness of this chapter, it should be emphasized that the authors do not specify some barriers that may occur in the course of implementing the therapy in resistant patients. One may suggest that the opposition to treatment sessions and communicating with a psychotherapist are the most evident scenarios, yet there is no discussion of addressing them. Considering that this chapter investigates chronic and severe disorders, it would be better if the authors provided a list of complications that are most likely to appear and how practitioners should respond and adjust CBT.

The attention of this chapter is paid to a case formulation-guided approach to psychotherapeutic sessions that are devoted to addressing treatment failure along with nonadherence. Persons (2008) claims that both patients and therapists may fail to systematically and appropriately be engaged in the treatment process. A therapist’s nonadherence may be expressed in ignoring a patient’s homework and disease progress or failing to receive his or her informed consent, while patients may terminate the therapy without succeeding, cancel visits, and use sessions non-productively. The Daily Log instrument and the case formulation method are determined by the authors of the chapter as nonadherence prevention measures. Once it occurred, there are three steps to overcome it, including assessment, the conceptualization of the mechanisms that caused it, and intervention.

The second part of this chapter discusses treatment failure that is a common phenomenon among the patients with chronic and severe conditions. The authors illuminate the idea of timely failure identification and options for overcoming it. The response plan should meet the criteria of realism, applicability, and central fear fit, which can be documented in the Thought Record template provided in the chapter case example. The latter also involves hypochondriacal episode recording and the plot for determining a patient’s failure to benefit from sessions.

The critical review of this chapter reveals such a strong side as a proper structure since nonadherence and treatment failure are distinguished from each other even though they may be caused by similar factors. In addition, the point of view of Persons (2008) is well-elaborated and supported by the evidence, which shows the reliability of suggested interventions. Nevertheless, only one tool for detecting patient adherence is presented, while it would be more beneficial to speak about some alternatives so that therapists can have a choice. With regard to the relevance of the topic being examined, one may recommend including a different setting of CBT provision, such as online sessions. Considering that the latter eliminates the need to leave one’s home to visit a specialist, patient nonadherence needs further clarifications.

Over the course of CBT, therapists have to make decisions that can be focused on treating one problem in the presence of others, taking into account the compatibility of the intervention with them. In this chapter, Persons (2008) examines the idea of treating multiple health problems concurrently and coordinating the operation of multiple providers. The cooperative work of different care professionals, such as pharmacologists, group therapists, couple session providers, and others contributes to more comprehensive treatment and the increased probability of CBT success. By conducting the progress review, it is possible to determine whether a patient needs further sessions or termination of the treatment is the best option to select.

The focal strength of this chapter lies in the detailed discussion of treatment stages and associated decision-making, comprising pre-, early, and middle treatment as well as termination. The case examples are helpful in visualizing the authors’ assumptions and the flow of logics in offering one or another strategy. In particular, it is essential to ensure that patients are able to understand how they feel, refocus on positive sides, and remain assertive. The only weak point is that the chapter contains minimum figures and other visuals, which would be beneficial for using them in practice. Nevertheless, this can be easily improved by adding more tables, charts, and infographics to make the content clear, creative, and relevant to the modern needs of patients and therapists.


Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York, NY: Guilford.

Wright, J. H., Basco, M. R., & Thase, M. E. (2017) Learning cognitive-behavior therapy: An illustrated guide (2nd ed.). Arlington, VA: American Psychiatric Publishing.

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