COGNITIVE THERAPY FORCHRONIC AND PERSISTENTDEPRESSIONRichard G. MooreAddenbrookes Hospital, Cambridge

and

Anne GarlandNottingham Psychotherapy Unit

Innodata0470869623.jpg

COGNITIVE THERAPY FORCHRONIC AND PERSISTENTDEPRESSION

The Wiley Series in

CLINICAL PSYCHOLOGYRichard G. Moore Cognitive Therapy for Chronic

and Anne Garland and Persistent Depression

Ross G. Menzies Obsessive-Compulsive Disorder:and Padmal de Silva (Editors) Theory, Research and Treatment

David Kingdon The Case Study Guide to Cognitive Behaviourand Douglas Turkington Therapy of Psychosis

(Editors)

Hermine L. Graham, Substance Misuse in Psychosis: Approaches toAlex Copello, Treatment and Service Delivery

Max J. Birchwoodand Kim T. Mueser (Editors)

Jenny A. Petrak The Trauma of Sexual Assault: Treatment,and Barbara Hedge (Editors) Prevention and Practice

Gordon J.G. Asmundson, Health Anxiety: Clinical and ResearchSteven Taylor Perspectives on Hypochondriasis and

and Brian J. Cox (Editors) Related Conditions

Kees van Heeringen Understanding Suicidal Behaviour:(Editor) The Suicidal Process Approach to Research,

Treatment and Prevention

Craig A. White Cognitive Behaviour Therapy for ChronicMedical Problems: A Guide to Assessmentand Treatment in Practice

Steven Taylor Understanding and Treating Panic Disorder:Cognitive-Behavioural Approaches

Alan Carr Family Therapy: Concepts, Process and Practice

Max Birchwood, Early Intervention in Psychosis:David Fowler A Guide to Concepts, Evidence and

and Chris Jackson (Editors) Interventions

Dominic H. Lam, Cognitive Therapy for Bipolar Disorder:Steven H. Jones, A Therapists Guide to Concepts, MethodsPeter Hayward and Practice

and Jenifer A. Bright

A list of earlier titles in the series follows the index.

COGNITIVE THERAPY FORCHRONIC AND PERSISTENTDEPRESSIONRichard G. MooreAddenbrookes Hospital, Cambridge

and

Anne GarlandNottingham Psychotherapy Unit

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Library of Congress Cataloging-in-Publication DataMoore, Richard, 1936

Cognitive therapy for chronic and persistent depression/Richard G. Moore andAnne Garland.

p. cm.Includes bibliographical references and index.ISBN 0-471-89278-5 (Cloth)ISBN 0-471-89279-3 (Paper : alk. paper)1. Depression, MentalTreatment. 2. Cognitive therapy. I. Garland, Anne. II. Title.

RC537 .M668 2003616.852706dc21 2003006736

British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library

ISBN 0-471-89278-5 (hbk)ISBN 0-471-89279-3 (pbk)

Typeset in 10/12pt Palatino by TechBooks, New Delhi, IndiaPrinted and bound in Great Britain by TJ International, Padstow, CornwallThis book is printed on acid-free paper responsibly manufactured from sustainable forestryin which at least two trees are planted for each one used for paper production.

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CONTENTS

About the AuthorsAbout the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

PrefacePreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

AcknowledgementsAcknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Introduction The Challenge of Persistent Depression 1

Chapter 1 The Cognitive Model of PersistentDepression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Chapter 2 The Foundations of Therapy:Therapeutic Relationship, Styleand Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Chapter 3 Initial Assessment and Formulation . . 94

Chapter 4 Initiating Therapy: Socialisation andSetting Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Chapter 5 Using Standard BehaviouralTechniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Chapter 6 Working with Automatic Thoughts . . . 198

Chapter 7 Recognising Underlying Beliefs andTheir Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

Chapter 8 Modifying Underlying Beliefs . . . . . . . . . 257

Chapter 9 Working with Some Typical Themesin Persistent Depression . . . . . . . . . . . . . . . 291

Chapter 10 Beyond Therapy: Preventing Relapseand Furthering Progress . . . . . . . . . . . . . . . 319

Chapter 11 Delivering Treatment . . . . . . . . . . . . . . . . . . 341

Chapter 12 Outcomes and Processes of Therapy . . 354

vi CONTENTS

Appendix 1 Meet the Patients . . . . . . . . . . . . . . . . . . . . . . . 372

Appendix 2 Handouts for Patients . . . . . . . . . . . . . . . . . 381

ReferencesReferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397

IndexIndex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407

ABOUT THE AUTHORS

Richard Moore works as a clinical psychologist in the Department ofCognitive and Behavioural Psychotherapies at Addenbrookes Hospitalin Cambridge. After obtaining an M.A. and a Ph.D. from the Universityof Cambridge and completing his clinical psychology training at the Uni-versity of Edinburgh, he trained as a cognitive therapist at the Center forCognitive Therapy in Philadelphia. He has been a therapist on major con-trolled trials of cognitive therapy for recurrent and residual depression inEdinburgh and in Cambridge. Through this and his subsequent experi-ence working with depressed patients in the NHS, Richard has acquiredexpertise in providing cognitive therapy for both in- and out-patientswith chronic and recurrent depressive disorders that have not respondedfully to previous treatment. He is experienced at teaching practical clinicalworkshops to professional and postgraduate audiences and has presentedresearch at a number of major international conferences. He is a FoundingFellow of the Academy of Cognitive Therapy.

Anne Garland is a nurse consultant in psychological therapies at theNottingham Psychotherapy Unit. After training in cognitive therapy atSheffield and Oxford, Anne worked as a therapist in two Medical ResearchCouncil funded trials investigating the efficacy of using cognitive therapyin the treatment of residual depression and bi-polar disorder. She hasdeveloped clinical expertise in the delivery of cognitive therapy acrossNHS service settings including primary care, community mental healthteams, inpatient units and specialist psychotherapy services. Anne is alsorecognised nationally as a cognitive therapy trainer and clinical supervisorand has presented cognitive therapy skills based workshops and academicpapers at both a national and international level. She was assistant coursedirector to the Newcastle cognitive therapy course and also co-founder ofthe Salford cognitive therapy course. Anne is an active researcher inves-tigating the impact of cognitive therapy training and clinical supervisioninitiatives on developing clinical competencies among health service staff.She is currently President-elect to the British Association of Behaviouraland Cognitive Psychotherapies (BABCP) as a member of the psychother-apy accreditation sub-committee.

PREFACE

When we set out to write this book, we wanted to write a definitive workon the treatment of persistent depression with cognitive therapy. For somedisorders, the development of cognitive therapy based on the cognitivemodel seems to have sewn up treatment of the disorder in many cases.For example, for many patients with panic disorder, addressing the fac-tors described in the cognitive model using the techniques recommendedresults in remediation of the problem with minimal risk of relapse. Such anapproa