Note taking in Session

judith-beck_1024w.jpgRecently, there’s been an interesting discussion on the Academy of Cognitive Therapy listserv about the therapy notes patients take home with them to review. Here’s how I make sure a patient is able to remember important ideas we discussed in treatment, specifically the changes a patient makes in his thinking:

Generally, when I ascertain that the patient has modified his thinking during a session (e.g., following Socratic questioning, behavioral experiments, roleplaying, etc.), I’ll ask the patient for a summary. I might say:

• Can you summarize what we just talked about?
• What do you think it would be important for you to remember this week?
• What do you think the main message is?

If the patient comes up with a good summary, I positively reinforce him and ask whether he wants to write it down or if he would like me to do so. If his summary is not quite on point, I usually offer a revised version and ask the patient whether he thinks it might be helpful to remember it this latter way. If he agrees, he or I will write the summary down. At that point or later on in the session, I will ask the patient how likely it is that he will read these important therapy notes every day at home. If he’s not highly likely, I’ll ask him about what might get in the way.

I’ve found that most patients just don’t learn the skill of writing cogent summaries. They rarely write down complete ideas and they usually add in extraneous or less important material which dilutes what is really important; that’s why I’m nicely directive about what is written down. I want to be certain the patient has good notes to read this week and ten years from now, if a similar problem arises.

A Cognitive Behavioral Approach to Emotional Eating

judith-beck_1024w.jpgA therapist on a listserv I subscribe to asked for a book recommendation for her patient who struggles with emotional eating. I wrote the following reply: 

If your patient doesn’t have an eating disorder, she might try the skills in one of the CBT books I’ve written for consumers on dieting and maintenance ( People need the same skill set for resisting eating when it’s not a scheduled time to eat—regardless of whether the desire or impulse to eat has an emotional, physiological, environmental, social, or mental trigger.

For example, they need to learn how to continually motivate themselves to stick to a specific or general plan, how to label and monitor their experience without intervening with food, how to distract themselves (initially), how to accept the discomfort of not eating, how to give themselves credit to build their sense of self-efficacy, etc. Emotional eaters also need to respond to their beliefs about emotional eating. Two typical beliefs are “If I’m upset, I deserve to comfort myself with food,” and “If I’m upset, the only way I can calm down is by eating.”

I’ve found that my clients are often a bit stymied when I ask them how other people cope with distress without eating.  Of course, it’s also helpful to use a standard CBT approach—having patients respond to cognitions associated with their initial distress, do problem-solving, etc. Learning all these skills takes concentrated effort—and therapists have to decide when in treatment to focus on emotional eating, particularly if the patient has a psychiatric or psychological problem

Hong Kong: Dr. Sokol Conducts CBT Training for Nurses

Leslie Sokol, Ph.D., Director of EducationRecently, Leslie Sokol, Ph.D., our Director of Education, was invited to conduct a 5-Day intensive Cognitive Behavior Therapy (CBT) training at the Hong Kong Polytechnic’s Institute of Advanced Nursing Studies. Dr. Sokol focused on depression, anxiety, personality disorders, substance abuse, anger, group therapy, bipolar disorder, and psychosis. The multi-day training included didactic presentations and experiential learning techniques such as roleplays, video demonstrations, and case discussions.

Here are some photos from Dr. Sokol’s training:

Dr_Sokol_Hong-Kong_CBT-2009 1-Dr_Sokol_Hong-Kong-2009_Cert1 3-Dr_Sokol_Hong_Kong-CBT_2009_Cert

CBT Found to Be Clinically Effective for Depressed Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3A new study published in the Archives of General Psychiatry investigated the clinical effectiveness of cognitive behavior therapy (CBT) for older adults in primary care. A total of 204 men and women aged 65 years or older with geriatric depression were randomly assigned to one of three groups: treatment as usual (TAU), TAU plus a talking control (TC), and TAU plus CBT. The CBT and TC treatments were offered over a period of four months and participants were followed up at 10 months. Depressive levels were measured with the Beck Depression Inventory-II (BDI-II) at baseline, at four months (the end of therapy), and again at 10 months. Based on BDI-II scores per session, a significant benefit of CBT versus the TAU and TC was observed, pointing to CBT as an effective treatment for depression in older adults.

This study was the largest CBT study conducted by general practitioner of their patients.

Rewriting the Script of Flashbacks

judith-beck_1024w.jpgThere was an interesting discussion on the Academy of Cognitive Therapy listserv about rewriting the script of flashbacks. I briefly described a related technique to help patients with traumatic memories. I use imagery to help patients change the meaning of a traumatic event (rather than changing, in imagery, what actually happened during the event). First we discuss the event at an intellectual level, identifying and modifying the core belief(s) that originated or became maintained as a result of the event. Then I have the patient relive the experience, as if she were the age at which it occurred and as if it’s occurring right now. I use Socratic questioning, couched in terms her younger self would understand, to identify thoughts, emotions, and beliefs. Next I ask the younger self what is happening immediately after the trauma. Usually she has retreated to a safer place. I then ask the younger patient if it’s okay for her older self to come to this place and explain to her what has happened. I facilitate a dialogue between the younger patient and her current self. Her current self helps the younger self change the meaning of the experience. This technique seems to help patients who have changed the meaning of the event intellectually but don’t yet believe it emotionally. I learned the fundamentals of the technique back in the 1980s from David Edwards and have described it in Cognitive Therapy for Challenging Problems.

CBT for Soldiers: A personal message to professionals from Drs. Aaron and Judith Beck

Dear Colleagues,

We are trying to address a very serious problem: military personnel who need effective psychological/psychiatric treatment but who are not receiving it. To address this urgent problem, we have embarked upon a new initiative to offer partial scholarships to our Cognitive Behavior Therapy training programs for mental health professionals who treat soldiers, veterans, and their families (

Cognitive ehavior therapy (CBT) has been demonstrated in hundreds of controlled trials worldwide to be effective for a wide range of problems, including depression, suicide, post traumatic stress disorder, anxiety disorders, substance abuse, and many more.

The non-profit Beck Institute in suburban Philadelphia is recognized as one of the premiere training sites for this kind of psychotherapy. The application of cognitive therapy to the needs of our military veterans is clear. The RAND Corporation conducted a study for the military on Predicting the Consequences of PTSD, Depression and Traumatic Brain Injury. One of the study’s summary conclusions is that the capacity to provide evidence-based psychotherapies for PTSD and major depression (for example, CBT) would be important in closing the treatment gap.

We would like to bring our expertise to mental health professionals who treat soldiers, veterans, and their families. Please visit

The Becks at ABCT 2009

JSB-ATB-DB-ABCT-2009 Pictured (left) are Judith S. Beck, Ph.D., Aaron T. Beck, M.D., and Daniel T. Beck, LICSW, at the Association for Behavioral and Cognitive Therapies, each representing a different mental health discipline. Judith and Daniel are two of Aaron Beck’s four children. Daniel is a Beck Institute Extramural Supervisor, teaches CBT at several Boston area universities and institutions, and is in private practice. He organized the largest ever meeting of social workers at ABCT this year.