Advances in Psychiatric Treatment (2002), vol. 8, pp. 172–179 Williams & Garland
A cognitive–behavioural therapy
assessment model for use
in everyday clinical practice
Chris Williams & Anne Garland
This is the first in a series of five papers that address how to offer practical cognitive–behavioural therapy (CBT) interventions within everyday clinical settings. Future papers will cover
identifying and challenging unhelpful thinking, overcoming
reduced activity and avoidance, offering CBT in busy clinical settings and the evidence for the effectiveness of CBT approaches.
Cognitive–behavioural therapy (CBT) is a shortterm, problem-focused psychosocial intervention. Evidence from randomised controlled trials and metaanalyses shows that it is an effective intervention for depression, panic disorder, generalised anxiety
and obsessive–compulsive disorder (Department of
Health, 2001). Increasing evidence indicates its
usefulness in a growing range of other psychiatric
disorders such as health anxiety/hypochondriasis,
social phobia, schizophrenia and bipolar disorders.
CBT is also of proven benefit to patients who attend
psychiatric clinics (Paykel et al, 1999). The model is
fully compatible with the use of medication, and
studies examining depression have tended to
confirm that CBT used together with antidepressant
medication is more effective than either treatment
alone (Blackburn et al, 1981) and that CBT treatment
may lead to a reduction in future relapse (Evans et
This article is based on material contained in Structured
Psychosocial InteRventions In Teams: SPIRIT Trainers’ Manual by Chris Williams & Anne Garland, which is available
from the authors upon request. The SPIRIT training course
offers practitioners working in busy everyday clinical
settings evidence-based training in core CBT assessment
and management skills.
al , 1992). Generic CBT skills provide a readily
accessible model for patient assessment and
management and can usefully inform general
clinical skills in everyday practice.
CBT can be offered as an integrated part of a
biopsychosocial assessment and management
approach, but there are certain situations in which
it should be particularly considered; these are
summarised in Box 1.
Box 1 Circumstances in which cognitive–
behavioural therapy is indicated
The patient prefers to use psychological
interventions, either alone or in addition to
The target problems for CBT (extreme, unhelpful thinking; reduced activity; avoidant or unhelpful behaviours) are present
No improvement or only partial improvement
has occurred on medication
Side-effects prevent a sufficient dose of
medication from being taken over an
Significant psychosocial problems (e.g. relationship problems, difficulties at work or unhelpful behaviours such as self-cutting or alcohol misuse) are present that will not be
adequately addressed by medication alone
Chris Williams is a senior lecturer in psychiatry at Gartnavel Royal Hospital (Department of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: firstname.lastname@example.org). He is President of the British Association for Behavioural and Cognitive Psychotherapies (BABCP; www.babcp.com) and a member of the Royal College of Psychiatrists’ Psychotherapy Faculty Executive. Anne Garland is a nurse consultant in psychological therapies in the Regional Psychotherapy Unit, Nottingham. She is a member of the Accreditation and Registration Committee of BABCP and is a well-known CBT trainer and researcher.
CBT assessment in everyday clinical practice
What makes CBT so effective?
Effective psychosocial interventions share certain
characteristics. They provide: a focus on current
problems of relevance to the patient; a clear
underlying model, structure or plan to the treatment
being offered; and delivery that...