TIP 34 and Cognitive Behavioral Therapy: Tools for Working with Psychosis…and So Much More!

CASAT Training will be offering a workshop Foundations in Working with Psychosis on Monday, October 21, 2019 in Las Vegas, Nevada and on Monday, November 4, 2019 in Reno, Nevada. The presenter will be Stephanie Fessenden, LCSW, LMHC, LCADC, CASAC, LAADC-CA. The workshop is designed to help behavioral health providers in understanding the symptoms of psychosis, and will focus on a therapeutic approach that can be used in conjunction with a medical medication-management model. The curriculum takes a holistic approach to psychosis, addressing symptom management, healthy coping skills, and integration of the self. Cognitive Behavioral Therapy (CBT) methods are introduced as key principles in helping a person to reframe thinking and live a life of wellness and recovery. Relapse prevention with regard to psychosis will be covered, and resources will be provided, including Hearing Voices groups, the Open Dialogue approach and First Episode Psychosis programs.

The learning objectives for this workshop will help participants to:

  • Understand the nature and prevalence of psychosis
  • Understand and recognizing signs and symptoms
  • Develop tools to engage people experiencing psychosis in an effective and constructive way, including the use of CBT principles alongside a medical/medication management model
  • Understand and implement relapse prevention strategies
  • Be aware of resources and programming that incorporate the need to treat the whole person with a recovery oriented, person-centered approach

TIP 34 and Other Cognitive Behavioral Therapy Resources

As a prelude to the workshop and for those who are unable to attend, the purpose of this week’s OnDemand blog post is to provide an overview of some of the CBT resources and materials behavioral health providers can access for the treatment of psychosis. Additional conditions for which these resources may be used that are supported by research will also be highlighted.

What is Cognitive Behavioral Therapy?

CBT was initially developed by Dr. Aaron Beck and his daughter, Dr. Judith Beck. The American Psychological Association has published a document entitled What Is Cognitive Behavioral Therapy? that defines CBT as “a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness.” The core principles of CBT include:

  • Psychological problems based on faulty or unhelpful ways of thinking
  • Psychological problems with a basis in learned patterns of unhelpful behavior
  • The ability of those suffering from psychological problems to relieve symptoms and live more effectively by learning better ways of coping

CBT ultimately aims to change thinking patters by helping clients understand their current ways of thinking and behaving and by providing tools to change thinking and behavioral patterns that are causing them problems. This concept is illustrated in a diagram of the CBT “triangle.” Some of the strategies that help with this are:

  • Learning to understand how others are motivated and why they behave as they do
  • Learning problem solving skills for better coping
  • Practicing role playing to be better prepared for future interactions that could be challenging
  • Learning methods to quiet the mind and sooth the body

A more detailed overview of the strategies used can be found in The Key Principles of Cognitive Behavioural Therapy (Fenn & Byrne, 2013).

TIP 34 Background and Overview

Treatment Improvement Protocols (TIPs) are developed by the Center for Substance Abuse Treatment (CSAT), of the Substance Abuse and Mental Health Services Administration (SAMHSA) at the U.S. Department of Health and Human Services (HHS), and are the results of efforts to develop topic-specific best-practice guidelines for behavioral health providers. TIP manuals represent the consensus of a panel of clinical, research, and administrative experts who draw upon their experience and knowledge to “convey ‘front-line’ information quickly but responsibly” and provide citations for research that supports approaches. Tip manuals are updated periodically to reflect new research in the field. Research is ongoing in any field and updates to TIP manuals may not necessarily keep pace with research. TIP 34 was first published in 1999 and revised 2002, 2003, 2004, 2007, 2009, 2011, and 2012. The most current references are from 1999. TIP 34 is also a manual that focuses on a variety of brief interventions and therapies for substance abuse. CBT is covered for less than 20 pages in TIP 34, making it a good introduction and overview. Most practitioners will want to dig deeper into the topic with other resources and through continuing education as there is a great deal published about CBT. A brief search for journal articles published in peer-reviewed journals in the psychology discipline for just the last 12 months produced over 4,490 articles about CBT. Although research in theories of counseling may not change dramatically in 20 years, new research published just during the last year reveals studies on CBT applications and issues that behavioral health providers need to know about in order to apply them in the field. Just a few of the topics that have emerged since the last revision of TIP 34 in 2012 or for which the research base supporting effectiveness for the use of CBT has greatly expanded include studies on:

  • Internet-based CBT
  • Anger Management
  • Obsessive Compulsive Disorder
  • Generalized Anxiety Disorder
  • Applications in the Treatment of Children and Adolescents
  • Depression
  • Psychosis
  • Schizophrenia
  • Applications for Aging Adults
  • Mental Illness Prevention
  • Pathological and Problem Gambling
  • Smoking Cessation
  • Eating Disorders

Lastly, TIP 34 does have some excellent CBT resources and tools in the appendices:

Additional CBT Resources and Materials

One resource notably missing from the list of resources and materials in TIP 34 is the Addiction Technology Transfer Center Network (ATTC) which has over 30 general resources resulting from a search of the website, and the following four online webinars or workshops which are relevant to CBT:

A search of the Substance Abuse and Mental Health Services Administration (SAMHSA) website reveals 66 results. To highlight a few of the publications, a variety of topics are available that are relevant to CBT, such as:

Additional sources for CBT materials and other resources are:

Visit the CASAT OnDemand Resources & Downloads section for additional resources.

Additional OnDemand blog posts that mention Cognitive Behavioral Therapy (CBT) are:

Anne M. Herron, M.S., Acting Director, SAMHSA Center for Substance Abuse Treatment mentions cognitive behavioral therapy as an evidence-based treatment in her blog post Struggling With Addiction? Tips On Finding Quality Treatment (January 23, 2019).

Do you have an application of CBT that works particularly well with your clients or that hasn’t been mentioned here?

Can you add favorite CBT resources, such as books or recent articles to this list?


Beck, A. T. (1964). Thinking and depression: II. theory and therapy. Archives of General Psychiatry, 10(6), 561-571. doi:10.1001/archpsyc.1964.01720240015003

Center for Substance Abuse Treatment. Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series, No. 34. HHS Publication No. (SMA) 12-3952. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. Innovait, 6(9), 579-585. doi:10.1177/1755738012471029

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