Trial-based cognitive therapy

1. Introduction

Version followed: Trial-Based Cognitive Therapy (TBCT) as organised in de Oliveira's books, Trial-Based Cognitive Therapy: A Manual for Clinicians (Routledge, 2015) and Trial-Based Cognitive Therapy: Distinctive Features (Routledge, 2016). The structure follows the 2016 book's published table of contents; the book text itself is not drawn on. The Trial I (trial-based thought record, TBTR) procedure follows the original 7-column description in de Oliveira (2008) and the 7-step sequence used in de Oliveira et al. (2012) and Delavechia et al. (2016). The 2012 CNS Spectrums paper uses the label "trial-based psychotherapy" in its title and "trial-based cognitive therapy" in its keywords. The sources do not say whether one name replaced the other [uncertain].

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 from Kafka's The Trial: negative core beliefs about the self are treated as self-accusations. The client brings these accusations into a simulated court case, playing defendant, prosecutor, defence attorney and juror, so the belief is examined experientially and not only intellectually. Change is thought to happen in several ways [source: de Oliveira 2008; de Oliveira et al. 2012; Delavechia et al. 2016; Routledge/Lavoisier book descriptions]:

• the client sees how much the belief depends on discounting positive evidence (the prosecutor's "yes, but" replies);
• the client reverses that discounting;
• the client gives a verdict on the evidence;
• the client builds and gathers evidence for a new, functional core belief ("preparation for the appeal");
• the client gains distance from the inner characters (metacognitive awareness, Trial II).

2. Framework

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 one level, and each phase has its own case-conceptualization diagram [source: Distinctive Features table of contents via Lavoisier; eCare course listing]. The assignment of techniques to phases below is inferred from the order of chapters 16 to 30 of the 2016 book. I have not confirmed it from the text [uncertain].

Typical session count and format.

• Pilot RCT for social anxiety disorder: 12 one-hour individual sessions over 14 weeks, following a written TBTR manual [source: Beck Institute article].
• Powell et al. (2013) delivered 10 weekly 1-hour sessions plus 2 fortnightly sessions in the last 4 weeks, 12 sessions in total. Sessions 1 to 5 covered psychoeducation on the cognitive model and cognitive distortions. Sessions 6 to 12 restructured core beliefs and built new positive beliefs [source: Powell et al. 2013]. This is the only session-by-session layout in the sources. Use it as a template for about 12 sessions, not as the full three-phase protocol [uncertain].
• A single Trial I session takes about 50 to 60 minutes and sometimes longer. It "is not necessarily repeated in subsequent sessions" [source: de Oliveira 2008; Delavechia et al. 2016].
• Formats: individual or group. The book has chapters on Trial I in groups and on TBCT as a school-based preventive approach for adolescents. Trial I can be run with empty chairs, where the client moves to a different chair for each character, or statically, with the client staying in one chair [source: Lavoisier table of contents; Delavechia et al. 2016; de Oliveira et al. 2012].

Criteria for moving between phases. The sources give no explicit criteria. Only the prerequisites for Trial I are documented [source: de Oliveira 2008]:

• the client knows the cognitive model;
• the client can identify ATs and tell thoughts apart from emotions;
• the therapeutic alliance is good;
• acute symptoms are being managed (in the 2008 case example, panic had first been reduced with interoceptive exposure).

Practical criteria [synthesis]:

• Phase 1 to phase 2: the client can complete a thought record on their own between sessions, names their typical distortions, and AT-level work is giving partial but incomplete relief. Recurring if–then rules or safety behaviours now explain why gains are not holding.
• Phase 2 to phase 3: the client can tolerate discomfort without trying to remove it, has decided to reduce key avoidance or safety behaviours, and the same self-judgement keeps appearing at the bottom of downward arrows. That self-judgement is the CB.
• 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.

3. Guiding principles

Each principle is followed by what it means in practice. Sources: de Oliveira 2008; de Oliveira et al. 2012; Delavechia et al. 2016; chapter titles of the 2016 book; Beck Institute article. Practical glosses are [synthesis] unless cited.

• Core beliefs are self-accusations. Frame the negative CB ("I'm incompetent") as a charge the client has brought against themselves, not as a fact to be argued away. That puts the client's adult judgement in charge of the verdict.
• Work level by level: ATs, then UAs, then CBs. Do not open a trial before the client can catch ATs and separate thought from emotion [source: de Oliveira 2008 prerequisites].
• Structured, step-by-step delivery. Follow the sequence of steps and record belief and emotion ratings at each step. The method is designed to be easy for new therapists to learn and for clients to understand [source: Lavoisier description].
• Experiential rather than purely intellectual restructuring. If the client says they believe the counter-evidence "only intellectually", move into role-play or chairs instead of adding more Socratic argument [source: de Oliveira 2008; book chapter 8 title].
• Measure belief and emotion as you go. Ask for percentage ratings of belief in the CB and of emotion intensity at each step. The shifts teach the client that mood follows interpretation [source: de Oliveira 2008; de Oliveira et al. 2012].
• Expose the discounting. Deliberately bring out the prosecutor's "yes, but" replies instead of avoiding them. The relapse back toward the earlier rating shows how the belief keeps itself going [source: de Oliveira 2008].
• Respect the defendant's dignity. A jury question asks which side respected the defendant's dignity. Treat any harsh, humiliating self-talk as evidence that the prosecution is unfair [source: de Oliveira 2008].
• Move blame toward a realistic share of responsibility. Use responsibility questions to shift from total self-blame to more probable, shared causes; in guilt work, convert guilt into participation and then responsibility [source: de Oliveira 2008, citing Leahy; eCare listing].
• Separate discomfort from distress. Some unpleasant feeling is unavoidable. The aim is to drop the extra suffering added by the client's appraisal of the symptoms and by their struggle against them [source: book chapter 6/23 titles; detail uncertain].
• Resolve ambivalence before asking for behaviour change. Treat "part of me wants to, part of me doesn't" as material to work through to agreement between the parts, not as non-compliance [source: chapter 7/24 titles].
• Underlying assumptions modulate how core beliefs are expressed. If–then rules and compensatory or safety behaviours keep the CB from ever being tested. Address them before or alongside CB work [source: chapter 5 title; inference uncertain].
• Take distance from the inner characters. The client is not the prosecutor. Help them notice the accusing voice as a mental event or character [source: chapter 10 and 12 titles].
• Build a new belief, not only weaken the old one. Every trial ends by naming a positive CB (upward arrow) and starting a log of supporting evidence: the appeal [source: de Oliveira 2008; Powell et al. 2013].
• Collaborative CBT basics stay in place. Use agenda, homework, a good alliance and a written formulation shared with the client [source: de Oliveira 2008; Delavechia et al. 2016 describe TBCT as Beck-based; detail synthesis].
• Do not overload the depressed client. With severely depressed clients, limit the prosecutor's list to what is necessary [source: de Oliveira 2008].

4. Intervention inventory

The inventory below lists every technique named in the 2016 book's practical chapters (16 to 30), plus the classic CT tools that the primary papers say Trial I is built from. Source status:

• The Trial I procedure is confirmed in detail from de Oliveira (2008), de Oliveira et al. (2012) and Delavechia et al. (2016).
• For the other TBCT-specific tools (Intra-TR, Inter-TR, TBPA, CCSH, CRP, Trial II, sailboat metaphor), Only the names and stated purposes are confirmed, from the book's table of contents and a training-course listing. Their step-by-step procedures are not drawn on. Their steps below are marked [uncertain] or [synthesis]. Check them against the 2015 manual before relying on them.
• All example language is illustrative unless quoted.

Phase 1: automatic-thought level

4.1 Explaining the cognitive model with the level-1 case formulation diagram

• Purpose / when: First sessions. Socialise the client to the idea that situations trigger ATs, which drive emotions, bodily reactions and behaviour, and start a shared written formulation. TBCT uses its own conceptualization diagram for this [source: chapter 16 title; eCare listing]. The exact layout of the TBCT diagram was not seen [uncertain].
• Steps [synthesis]:
  1. Ask for a recent, specific upsetting situation.
  2. Draw situation, then thought, then emotion, body and behaviour, filling the boxes with the client's own words.
  3. Show how a different thought in the same situation would give a different feeling.
  4. Leave space on the diagram for levels 2 (assumptions and behaviours) and 3 (core belief) to be filled in later.
  5. Give the client a copy.
• Example language (illustrative): "Let's put Tuesday's meeting on paper. What went through your mind just before your stomach dropped?"
• Watch for: the client collapsing thoughts into feelings ("I felt that I was useless"). Separating thought from emotion is a prerequisite for later work [source: de Oliveira 2008]. It is working when the client brings their own examples already split into thought and emotion.

4.2 Assessing dysfunctional cognitions (eliciting ATs)

• Purpose / when: Throughout phase 1, to catch the hot thought behind each emotional shift [source: chapter 17 title; de Oliveira 2008].
• Steps:
  1. When emotion shows in session, or when the client reports a distressing moment, ask what went through their mind at that moment [source: de Oliveira 2008].
  2. Get the thought in words, not as a feeling.
  3. Rate how much the client believes it and how intense the emotion is (0 to 100%).
  4. Identify which thought is "hottest" [synthesis].
• Example language (illustrative): "Right now, as you told me that, your face changed. What's going through your mind?"
• Watch for: answers given as questions ("What if they laugh?"). Help turn these into statements ("They'll laugh at me") [synthesis].

4.3 Cognitive Distortions Questionnaire (CD-Quest)

• Purpose / when: A self-report questionnaire, developed by de Oliveira's group, that rates how often and how intensely the client made a list of cognitive distortions during the past week. In TBCT it is used to assess cognitions and to teach clients to label their own distortions [source: chapter 4 and 18 titles; de Oliveira 2008 links prosecutor replies to distortions such as selective abstraction, dichotomous thinking and overgeneralisation]. The items are not reproduced here. Use the published instrument.
• Steps [synthesis, consistent with the chapter's purpose]:
  1. Introduce distortions as predictable thinking errors everyone makes.
  2. Have the client complete the CD-Quest for the past week.
  3. Review the highest-scoring distortions together and link each to a real AT from their week.
  4. Repeat it periodically to track change.
  5. From then on, ask the client to label distortions in every thought record.
• Example language (illustrative): "Your highest scores were on mind reading and all-or-nothing thinking. Let's find one example of each from this week."
• Watch for: the client using labels to attack themselves ("I distort everything, I'm hopeless"). Present distortions as habits of mind, not character flaws [synthesis]. Falling scores and spontaneous labelling show progress.

4.4 Intrapersonal thought record (Intra-TR)

• Purpose / when: Phase 1 tool for identifying and modifying negative ATs about oneself by answering a set of specific questions, aiming at a more balanced view [source: chapter 19 title; eCare listing]. The specific questions and format are not stated in the sources [uncertain]. The course listing refers to "three core tenets" without naming them.
• Steps [uncertain; generic thought-record structure as fallback, synthesis]:
  1. Situation in one or two sentences.
  2. AT, with a belief rating.
  3. Emotion, with an intensity rating.
  4. Distortion labels (from the CD-Quest).
  5. Questions testing the thought: evidence, alternatives, consequences of believing it.
  6. Balanced response.
  7. Re-rate belief and emotion.
• Example language (illustrative): "Now that you've labelled it as fortune-telling, what actually happened the last three times you predicted this?"
• Watch for: the client completing it mechanically with no shift in emotion. That is the signal that an experiential method (chairs, role-play) is needed [source: de Oliveira 2008, on "intellectual" belief].

4.5 Interpersonal thought record (Inter-TR)

• Purpose / when: Phase 1 tool for ATs in interpersonal situations, for example assumptions about what another person thinks or intends [source: chapter 20 title]. The procedure is not stated in the sources [uncertain].
• Steps [synthesis, based on standard CT for interpersonal ATs]:
  1. Record the situation and the AT about the other person ("She thinks I'm boring").
  2. Rate belief and emotion.
  3. List evidence for and against the inference.
  4. Generate alternative explanations of the other person's behaviour.
  5. Where appropriate, plan a behavioural check, such as asking or observing.
  6. Re-rate.
• Some TBCT descriptions may use role reversal, with the client speaking from the other person's chair. This is not confirmed [uncertain].
• Example language (illustrative): "If you sat in her chair for a moment, what else might explain her looking at her phone?"
• Watch for: reassurance-seeking disguised as "checking" [synthesis].

4.6 Trial-based participation assessment (TBPA, "participation grid") for guilt

• Purpose / when: For guilt over a specific event, such as a trauma, an accident or a loss. It is described as a narrative exposure technique: progressive verbal exposure to the guilt-provoking situation turns guilt into participation and then into responsibility. That responsibility is then carried into a new context linked to the client's values and commitment [source: eCare listing; chapter 21 title]. The grid's exact layout was not seen [uncertain].
• Consent and safety (exposure component):
  • Explain that retelling the event will raise distress for a while, and get explicit agreement.
  • Check that the client is stable: no acute suicidality, no active substance intoxication, no dissociation severe enough to block processing, a current safe situation.
  • Agree a stop signal.
  • Keep the pace graded.
  • Leave time to settle before the session ends [synthesis, standard exposure practice].
• Steps: Steps 1 and 2 apply the verified principle of turning guilt into participation and responsibility. Steps 3 to 7 are [synthesis] that draws on the jury's responsibility questions in de Oliveira (2008), which he adapted from Leahy.
  1. Have the client narrate the event in detail, in the first person, with distress ratings.
  2. Rate how guilty they feel (0 to 100%).
  3. List everyone and everything that contributed: people, circumstances, timing, chance, information they did not have.
  4. For each contributor, ask whether its behaviour actually caused the outcome, what a reasonable person would have done with the information available then, whether there was intent to harm, and whether this was an unusual cause.
  5. Share out the participation among the contributors, with the client's own share last.
  6. Re-rate guilt.
  7. Ask what the client's remaining share of responsibility asks them to do now, in line with their values (repair, remembrance, changed behaviour).
• Example language (illustrative): "You've given yourself 100% of the blame. Before we decide your share, let's list everyone and everything that played a part that night."
• Watch for: the client using hindsight ("I should have known"). Separate what was knowable then from what is known now [synthesis]. Also watch for real wrongdoing: the aim is proportionate responsibility and repair, not erasing it. Falling guilt ratings, together with a concrete values-based commitment, show it is working.

Phase 2: underlying-assumption level

4.7 Case conceptualization diagram, level 2

• Purpose / when: Phase 2. Add the client's conditional rules and assumptions (if–then) and the compensatory, safety or avoidance behaviours they drive to the formulation. Show how these protect against the feared CB and keep it from being tested [source: chapter 22 and 5 titles; the explanation of mechanism is synthesis].
• Steps [synthesis]:
  1. Look for themes across thought records.
  2. Find the rule by completing "If I …, then …" or by asking what the client must always or never do.
  3. List the behaviours that follow the rule.
  4. Add both to the diagram between the ATs and the not-yet-named CB.
• Example language (illustrative): "It sounds like the rule is: if I don't prepare every word, then I'll be exposed. What do you do to obey that rule?"
• Watch for: rules held as values ("I just have high standards"). Look at their cost before trying to change them.

4.8 Colour-coded symptom hierarchy (CCSH): discomfort versus distress

• Purpose / when: Phase 2. Help the client separate discomfort (unavoidable unpleasant sensations and feelings) from distress (the added suffering that comes from appraising and fighting those symptoms). It may also organise the symptoms for graded work [source: chapter 6 and 23 titles]. The colour scheme and procedure were not found [uncertain].
• Steps [synthesis]:
  1. List the client's symptoms and feared situations.
  2. Rate each for discomfort and for distress.
  3. Use a colour code the client chooses to mark which are being amplified by catastrophic appraisals and avoidance.
  4. Order them into a hierarchy.
  5. Plan graded approach tasks in which the goal is to allow discomfort while reducing distress.
• Exposure safety [synthesis]:
  • Get informed consent.
  • Screen for medical causes of bodily symptoms before any interoceptive work.
  • Be cautious in pregnancy and with cardiac, respiratory or seizure conditions.
  • Grade the steps.
  • Avoid tasks that are actually dangerous.
• Example language (illustrative): "The racing heart is the discomfort; the thought 'I'm going to collapse' and leaving the shop are what turn it into distress."
• Watch for: the client using the hierarchy to stay at easy levels indefinitely [synthesis].

4.9 Consensual role-play (CRP): resolving ambivalence and making decisions

• Purpose / when: Phase 2. Resolve ambivalence and support decisions, for example between a part of the client that knows avoidance or a safety behaviour keeps the problem going and a part that feels it must continue. The aim is agreement (consensus) between the two sides rather than one side defeating the other [source: chapter 7 and 24 titles]. The step-by-step procedure was not found [uncertain]. TBCT uses chair formats derived from Gestalt therapy elsewhere [source: Delavechia et al. 2016]. Whether CRP uses chairs was not confirmed.
• Steps [synthesis]:
  1. Name the decision and rate how strongly the client wants each option.
  2. Name the two positions, for example "the part that knows" and "the part that feels". Optionally give each its own chair.
  3. Let the feeling side speak first and fully, with the therapist validating it.
  4. Let the other side respond.
  5. Alternate until each side has acknowledged the other's concern.
  6. Ask the client to draft a decision both sides can accept, for example a smaller first step.
  7. Re-rate.
  8. Turn the decision into a behavioural experiment.
• Example language (illustrative): "Let the part that's frightened speak first. What is it trying to protect you from?"
• Watch for: a forced "rational wins" outcome with no emotional shift. Return to the frightened side's unmet concern [synthesis].

Phase 3: core-belief level

4.10 Case formulation level 3 and the downward arrow to the core belief

• Purpose / when: Start of phase 3, or whenever ATs keep coming back to the same self-judgement. Identify the negative CB that will be "on trial" and add it to the diagram [source: chapter 25 title; de Oliveira 2008].
• Steps:
  1. Take a hot AT from a recent situation.
  2. Ask repeatedly what the thought would mean about the client if it were true, until a short global statement about the self appears ("I'm vulnerable", "I'm awkward", "I'm incompetent").
  3. If the client states a CB spontaneously, skip the arrow.
  4. Circle the CB.
  5. Rate how much the client believes it and the intensity of the main emotion [source: de Oliveira 2008; Powell et al. 2013].
  6. If no CB emerges, use behavioural experiments or the continuum technique instead [source: de Oliveira 2008].
• Example language (illustrative): "Suppose it's true that you froze in that meeting. What would that say about you as a person?"
• Watch for: stopping at a feeling or a prediction instead of a statement about the self. A correctly identified CB usually brings a visible rise in emotion.

4.11 Trial I: the trial-based thought record (TBTR)

• Purpose / when: The central TBCT technique, used in phase 3. A simulated court case restructures a negative CB, conceptualised as a self-accusation. The client plays defendant, prosecutor, defence attorney and juror [source: de Oliveira 2008; de Oliveira et al. 2012; Delavechia et al. 2016].
• Prerequisites:
  • the client knows the cognitive model;
  • the client can identify ATs and separate them from emotions;
  • the alliance is good;
  • acute symptoms are under reasonable control [source: de Oliveira 2008].
• Session format: One session of about 50 to 60 minutes, which may run longer. A demonstration video can help clients understand it. After training, clients can use it as homework [source: de Oliveira 2008].
• Steps: The original 2008 sheet has 7 columns. The 2012 and 2016 studies rate belief and emotion after 7 named steps: investigation, prosecutor's plea, defence attorney's plea, prosecutor's second plea, defence attorney's second plea, jury's verdict, preparation for the appeal [source: de Oliveira 2008; de Oliveira et al. 2012; Delavechia et al. 2016]. The 2008 version is followed below, with the later appeal step added. 0. Setup. The client describes the upsetting situation in one or two sentences.
  1. Investigation (column 1). Elicit ATs, then use the downward arrow to reach the CB (4.10). Frame this as investigating the charge the client is bringing against themselves. Record the CB at the bottom of the column, circle it, and take baseline ratings of belief and emotion.
  2. Prosecutor's plea (column 2). The client, as prosecutor, lists all the evidence that seems to support the accusation. This brings the arguments that maintain the belief into the open. With severely depressed clients, keep the list to what is necessary. Re-rate.
  3. Defence attorney's plea (column 3). The client, as defence attorney, lists evidence against the accusation. Re-rate. Ratings usually fall, but the emotion may barely move if the client believes the defence "only intellectually".
  4. Prosecutor's second plea (column 4). Ask the prosecutor to reply to each defence point, which brings out the "yes, but" thoughts that discount it. Ratings typically rise back toward the column-2 level. Use this to show that mood follows interpretation, and label the distortions at work (selective abstraction, dichotomous thinking, overgeneralisation). Re-rate.
  5. Defence attorney's second plea (column 5): sentence reversion. The client copies each column-4 sentence and joins it to the matching column-3 evidence with "but", reversing the order. The negative thought now comes first and is the part being qualified. For example, "I prepared thoroughly, but I stumbled once" becomes "I stumbled once, but I prepared thoroughly" (illustrative). The client reads the reversed sentences aloud. In the 2008 study this column was not re-rated.
  6. New meaning (column 6, 2008 version). The client writes the new positive meaning that follows from the reversed sentences. Re-rate.
  7. Jury's verdict (column 7). The client, as juror, decides the case. Guiding questions [source: de Oliveira 2008]:
     • Which side was more convincing?
     • Which presented more fact-based evidence?
     • Which made fewer cognitive distortions?
     • Which respected the defendant's dignity?
     Where blame is the issue, add responsibility questions adapted from Leahy:
     • Did the behaviour actually cause the outcome?
     • What would a reasonable person have done?
     • Were there contractual obligations or conventional expectations?
     • Was there malicious intent?
     • Can responsibility be shared?
     • Was the cause unusual?
     Re-rate belief and emotion.
  8. Upward arrow to a positive CB. Ask, in de Oliveira's words, "Supposing that the defense attorney is right, what does it mean about you?" [source: de Oliveira 2008]. Record the new CB ("I am a strong person", "I am normal") and rate how much the client believes it [source: de Oliveira 2008; Powell et al. 2013].
  9. Preparation for the appeal. In session, start a record of two or three pieces of evidence from that day that support the new CB. Rate belief in the new CB. Continue it as homework (see 4.13) [source: de Oliveira 2008; de Oliveira et al. 2012].
• Example language (illustrative):
  • "Today you're going to play every role in a trial. The defendant is you, and the charge is the thought 'I'm incompetent.' First, the prosecutor: give me every piece of evidence for the charge."
  • "Now the prosecutor answers the defence. What's the 'yes, but' for that point?"
  • "Read it aloud with the 'but' the other way round, and notice what happens to the feeling."
• Watch for:
  • Ratings rising at step 4. This is expected and is used as a teaching point, not as failure.
  • A defence that the client believes only intellectually. Move to chairs, have the client speak in role, and slow the reading of the reversed sentences.
  • A verdict reached to please the therapist. Ask the juror to justify the verdict from the evidence [synthesis].
• How you know it is working: Belief and emotion should fall across the steps. Mean belief in the studies dropped from about 76 to 85% at investigation to about 18 to 27% by the verdict or appeal preparation [source: de Oliveira 2008; Delavechia et al. 2016]. The client should also be able to name a positive CB and find evidence for it during the following week.

4.12 Choosing the Trial I format: empty chair or static

• Purpose / when: Trial I can be run with empty chairs, a format derived from Gestalt therapy in which the client moves to a different chair for each character, or statically, with the client staying in one chair [source: Delavechia et al. 2016].
• Evidence on the choice:
  • Delavechia et al. (2016) found larger reductions with empty chairs on covariance analysis.
  • de Oliveira et al. (2012) found no difference between the formats.
  • Choose by the client's comfort and how much emotional engagement is needed [source: both papers; choice rule is synthesis].
• Steps [synthesis for the chair layout]: Set out chairs for the prosecutor, the defence attorney and the jury, with the defendant's seat as the client's home chair. Have the client physically move and speak in the first person as each character. The therapist stays outside the roles as facilitator or "court clerk" and records ratings.
• Example language (illustrative): "Take the prosecutor's chair. Speak as the prosecutor, to the defendant over there."
• Watch for: self-consciousness in role-play. Start static and move to chairs once the client is engaged [synthesis].

4.13 Preparation for the appeal (building the new core belief)

• Purpose / when: After every Trial I and continuing to the end of therapy. This is TBCT's metaphor for building and strengthening a new positive, functional CB, framed as gathering evidence for a future appeal [source: chapter 11 title; de Oliveira 2008; Powell et al. 2013].
• Steps:
  1. Write the new CB from the upward arrow at the top of a log.
  2. Each day, the client records two or three specific events that support it.
  3. Rate belief in the new CB weekly.
  4. Review the log at the start of each session and add evidence from the session.
  5. Use it as ready material for any later trial [source: de Oliveira 2008; the review routine is synthesis].
• Example language (illustrative): "Your lawyer is preparing the appeal. Every day this week, bring her two facts showing you are capable."
• Watch for: discounting the entries ("that doesn't count"). Treat this as the prosecutor returning and reverse the sentence. Rising ratings of the new belief show it is working.

4.14 Trial I with multiple core beliefs

• Purpose / when: Clients with more than one negative CB, for example "unlovable" and "incompetent" [source: chapter 27 title]. The procedure is not drawn on [uncertain].
• Steps [synthesis]:
  1. List the CBs.
  2. Start with the one most active in current problems or carrying the strongest emotion.
  3. Run a full Trial I on it.
  4. Start its appeal log.
  5. Hold later trials for the other CBs in separate sessions, checking whether earlier verdicts have already weakened them.
• Watch for: opening several trials in one session. This dilutes the experiential impact [synthesis].

4.15 Trial I in group settings

• Purpose / when: Delivering Trial I in groups, including school-based preventive work with adolescents [source: chapter 15 and 28 titles]. The procedure is not drawn on [uncertain].
• Steps [synthesis]:
  1. Teach the format with a demonstration, either a volunteer or a video [the demonstration-video idea is from de Oliveira 2008].
  2. Have members complete individual trial sheets.
  3. Optionally let members take the roles of prosecutor, defence or jury for a volunteer defendant, with ground rules against harsh prosecution.
  4. Collect ratings at each step.
  5. Close with each member's new CB and appeal log.
• Watch for:
  • Peers prosecuting too effectively. The therapist chairs the court and enforces the dignity criterion.
  • Shame at disclosing core beliefs in front of others. Allow written, private trials.

4.16 Trial II: promoting metacognitive awareness

• Purpose / when: Later phase 3, after Trial I. Help the client gain distance from the inner characters, recognising the accusing voice as a mental process rather than the truth or the self [source: chapter 10, 12 and 29 titles]. The procedure is not drawn on [uncertain].
• Steps: My recollection, not confirmed in any source, is that in Trial II the client takes legal action against the inner prosecutor. Check this against the 2015 manual before use [uncertain]. Distancing steps that are consistent with the stated aim [synthesis]:
  1. Name the accuser as a character ("the prosecutor").
  2. Have the client notice when the prosecutor is speaking, and say "the prosecutor is accusing me again" rather than "I am …".
  3. Review the evidence of the prosecutor's past accusations and how reliable they turned out to be.
  4. Choose how to respond to the accuser rather than obeying it.
• Example language (illustrative): "Who is speaking right now: you, or the prosecutor?"
• Watch for: the client turning distancing into suppression. The aim is noticing, not arguing every thought [synthesis].

4.17 Relaxation and the sailboat metaphor

• Purpose / when: A relaxation component presented with a sailboat metaphor [source: chapter 30 title]. Neither the content of the metaphor nor the relaxation method was found [uncertain]. Do not attribute any specific wording to de Oliveira.
• Steps [synthesis, standard relaxation practice]: Teach a brief relaxation skill such as slow breathing or progressive muscle relaxation. Practise it in session and assign daily practice. Present it as a way to sit with discomfort (4.8), not to eliminate it.
• Watch for: relaxation used as a safety behaviour to avoid feared sensations [synthesis].

5. Handling problems

The primary sources address only a few difficulties, and those are cited. Everything else in this section is [synthesis].

• The defence is believed "only intellectually" and the emotion does not move.
  • de Oliveira (2008) names this as common at column 3 and treats the prosecutor's second plea and sentence reversion as the answer.
  • Also move to the empty-chair format, which showed larger reductions in Delavechia et al. (2016) [source]. Ask the client to speak in role and in the first person, and to read the reversed sentences aloud slowly [source for reading aloud: de Oliveira 2008].
• Ratings go up at the prosecutor's second plea and the client is discouraged. This is expected [source: de Oliveira 2008]. Name it as the moment the trial shows how the belief defends itself. Then move straight to sentence reversion, and do not end a session at step 4 [synthesis].
• No core belief emerges from the downward arrow. Use behavioural experiments or the continuum technique instead [source: de Oliveira 2008]. Or return to phase 1 or 2 work and try the arrow again when a hotter situation arises [synthesis].
• Severe depression, or the prosecutor's list becomes overwhelming. Keep the prosecutor's list to what is necessary [source: de Oliveira 2008]. Also [synthesis]:
  • Cap the list at three or four items.
  • Prioritise behavioural activation and AT work before any trial.
  • Avoid running Trial I when the client is too depressed to generate defence evidence. Unanswered prosecution can reinforce the CB.
• Suicidality or self-harm. If the trial reveals hopelessness or suicidal thinking, pause the technique and carry out a standard risk assessment: current ideation, intent, plans, preparatory behaviour, history, protective factors. Collaborate on a safety plan that includes lethal-means counselling (safe storage or removal) and the client's support contacts. Do not resume trial work until risk is managed. Never leave the prosecutor's case as the last thing said in a session with an at-risk client [synthesis].
• Overwhelm or dissociation during chair work or guilt narration (TBPA).
  • Slow down and use grounding: orient to the room, feet on the floor, describe five objects.
  • Return to the defendant's chair or switch to the static format.
  • Shorten exposure segments.
  • Re-check consent and stabilisation before continuing.
• Self-consciousness or refusal of role-play. Run Trial I in static, written form first, or show a demonstration video [source for video: de Oliveira 2008]. Offer the chairs later. The static format still produced significant change [source: de Oliveira et al. 2012; Delavechia et al. 2016].
• The legal metaphor is aversive. For example, the client has had real legal proceedings, imprisonment or police trauma, or a culture or religion in which "judgement" carries heavy meaning. Discuss the metaphor openly first. Offer neutral role names such as "the critic", "the advocate" and "the fair observer", or rely on standard CT evidence-weighing. Mark any change to the role names as a departure from the protocol [synthesis].
• Non-adherence with thought records or the appeal log.
  • Find the obstacle: literacy, time, perfectionism, hopelessness.
  • Shrink the task to one entry a day.
  • Start the first entries in session [the in-session start is from de Oliveira 2008].
  • Treat "it's pointless" as a prosecutor statement to work on.
  • Use CRP-style work if the client is ambivalent about the homework itself [synthesis].
• Ambivalence about giving up safety behaviours or avoidance. This is the target of CRP (4.9). Validate the protective side, negotiate a smaller first step, and frame the step as an experiment rather than a demand [synthesis].
• Stuck at a high rating across sessions.
  • Check whether the CB is correctly identified, since the client may be trying the wrong charge.
  • Look for maintaining UAs or safety behaviours from phase 2 that are untouched.
  • Look for current circumstances that genuinely support part of the charge, such as an abusive relationship. These need problem-solving, not only restructuring.
  • Check for a comorbid condition needing other treatment, such as substance use, bipolar disorder or psychosis [synthesis].
• The client's guilt reflects genuine wrongdoing. TBPA aims at proportionate responsibility and values-based commitment, not at removing all responsibility [source for the guilt-to-responsibility aim: eCare listing]. Support repair or amends where appropriate, and consider any legal or safeguarding duties if harm to others is ongoing [synthesis].
• Rupture: the client experiences the therapist as the prosecutor. This can happen when the therapist pushes for "yes, but" replies. Explain the purpose of eliciting them before step 4, and make clear the therapist is never on the prosecution's side. Ask directly about the client's experience of the session and repair: acknowledge, adjust the pace, and give the client more control over the roles [synthesis].
• The verdict is given to please the therapist. Ask the juror to justify the verdict from specific evidence and the dignity criterion. Take a belief rating privately, written down, and accept a partial verdict, such as a lower conviction rating, as valid [synthesis].
• Relapse of the old belief after a good trial. Normalise it as "the prosecutor filing again". Review the appeal log, run a shorter Trial I on the new evidence, and move on to Trial II distancing (4.16) [synthesis].

Sources

Sources:

• Beck Institute: Trial-Based Thought Record study summary
• Oliveira IR (2008). Trial-Based Thought Record (TBTR): preliminary data… Braz J Psychiatry 30(1):12–18 (SciELO full text)
• Delavechia TR et al. (2016). Changing negative core beliefs with trial-based thought record. Arch Clin Psychiatry 43(2):31–33 (SciELO)
• Delavechia et al. (2016), USP repository PDF
• Powell VB et al. (2013). Changing core beliefs with trial-based cognitive therapy may improve quality of life in social phobia. Braz J Psychiatry 35(3):243–247 (SciELO)
• de Oliveira IR et al. (2012). Trial-based psychotherapy and the efficacy of trial-based thought record… CNS Spectrums 17(1):16–23 (abstract)
• Trial-Based Cognitive Therapy: Distinctive Features: description and table of contents (Lavoisier)
• Standard and Innovative Strategies in Cognitive Behavior Therapy (IntechOpen, chapter list only)
• eCare Behavioral Institute: TBCT continuing-education course listing (secondary)

Further reading (not drawn on):

• de Oliveira, I. R. (2015). Trial-Based Cognitive Therapy: A Manual for Clinicians. New York: Routledge.
• de Oliveira, I. R. (2016). Trial-Based Cognitive Therapy: Distinctive Features. London: Routledge (CBT Distinctive Features series). Only the table of contents was seen.
• de Oliveira, I. R. (2012). Assessing and restructuring dysfunctional cognitions; and Use of the trial-based thought record to change negative core beliefs. In I. R. de Oliveira (Ed.), Standard and Innovative Strategies in Cognitive Behavior Therapy. Rijeka: InTech. Not drawn on.
• de Oliveira, I. R., et al. (2012). Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia. Journal of Clinical Pharmacy and Therapeutics. Cited via the Beck Institute page.
• Kafka, F. (1925). The Trial (Der Process).

Not verified ([uncertain]):

• the procedures for Intra-TR, Inter-TR, TBPA, CCSH, CRP, Trial II and the sailboat metaphor;
• the CD-Quest items;
• the exact layout of the TBCT conceptualization diagram;
• the mapping of techniques to phases;
• whether "trial-based psychotherapy" has replaced "TBCT" as the name.