Trial-based cognitive therapy

Domain II · Behavioural & cognitive · de Oliveira · 2008

What it is

TBCT is a transdiagnostic, case-formulation-based development of Beck's cognitive therapy. It arranges standard cognitive and behavioural techniques into a step-by-step sequence across three cognitive levels: automatic thoughts, underlying assumptions and core beliefs. Its distinctive idea comes…

Format

• Overall shape: three levels and three phases. The 2016 book calls TBCT "a 3-level, 3-phase case conceptualization approach". Level 1 is automatic thoughts (ATs), level 2 is underlying assumptions (UAs) together with the behaviours they drive, and level 3 is core beliefs (CBs). Each phase works on…
• Typical session count and format.

Evidence status, as the guide reports it

• Ending: belief in the old CB stays low, belief in the new CB is supported by an ongoing evidence log (the appeal), and the client can run a thought record and a mini-trial without help.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• reassurance-seeking disguised as "checking".
• relaxation used as a safety behaviour to avoid feared sensations.
• the client using the hierarchy to stay at easy levels indefinitely.
• opening several trials in one session. This dilutes the experiential impact.
• self-consciousness in role-play. Start static and move to chairs once the client is engaged.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.