HIGHER ORDER THINKING
Cognitive Behavioral Therapy (CBT) Case Formulation Activity
Student
School of Behavior Sciences, Liberty University
Author Note
Student
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Student
Email: [email protected]
Abstract
This paper consists of a teaching activity that incorporates higher order thinking skills (HOTS) associated with the revisions of Bloom’s taxonomy made by Anderson and Krathwohl. The teaching activity revolves around the development process of a Cognitive Behavioral Therapy (CBT) case formulation. Additionally, the active learning strategies implemented within this lesson’s activity are as follows: (1) group work that revolve around a provided case analysis, (2) discussion techniques that involve penetrating questions, and (3) think-pair-share.
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CBT CASE FORMULATION ACTIVITY 2
Keywords: teaching activity, learning activity, Bloom’s taxonomy, Cognitive Behavioral Therapy, CBT, case formulation, active learning strategies, case analysis, discussions, think-pair-share
Cognitive Behavioral Therapy (CBT) Case Formulation Activity
Every person in this world learns through their experiences. In general, experiences affect people’s thoughts and actions, and sometimes they can provide meaning to an individual’s life. Consequently, when people are placed in situations where they have to learn new things, these insights should be of value to them. In relation to this notion, Merriam et al. (2007) clearly stated that “learners must connect what they have learned from current experiences to those in the past as well as see possible future implications” (p. 162). This connection of learning must also be placed within an educational setting where adults are the students. Therefore, this paper focuses on how incorporating higher order thinking skills (HOTS) to a lesson activity in a graduate course is essential for adults to learn with meaningful insights.
Svinicki and McKeachie (2014) stated that in order for adult students to sharpen their thought process, they need to develop habits of reflection. These habits of reflections are based off experiences, successes and failures, plans and purposes, along with choices and consequences (Svinicki & McKeachie, 2014, p. 318). Consequently, when adult students develop these habits, their ability to engage in learning activities within a classroom setting can result to positive and meaningful learning outcomes relative to HOTS. Furthermore, this paper explores the development of a graduate level teaching activity that consists of learning objectives pertaining to two highest levels of thought from Bloom’s taxonomy.
Process of Development for a Learning Activity
Just like any educational setting, the first day is usually when the teacher or instructor sets the tone to establish the classroom’s environment. This is also when the teacher or instructor goes over his or her expectations of student performances that are dependent upon the level of education that he or she is assigned to teach. However, in a college classroom environment, Brookfield (2013) expressed how teachers should exercise authority by communicating with their students in a clear and transparent way (p. 25). So, for a graduate level of education, the first day of class is usually when the instructor goes over his or her syllabus that contains information about the course’s content, student learning objectives, course calendar, student tasks or assignments, etc. Therefore, this results to adult students having an idea of the direction that the course will take, along with what is clearly expected of them from their instructor.
Course Preparation for Teachers
Before the first day of a graduate level class, Svinicki and McKeachie (2014) explained how the initial step for instructors to take is to prepare student learning goals that are expressed by the course objectives (p. 6). The reason for this is because when teachers or instructors write their student learning goals down, it assists them in clearly describing what the expected student learning outcomes are within the course. Consequently, these goals will also help teachers or instructors determine what they need to do for the course (Svinicki & McKeachie, 2014).
Teacher Groundwork
As the graduate course progresses within its term, teaching techniques should have been implemented by the teacher or instructor. Once students experience these teaching techniques, they familiarize themselves with possible future steps in which their instructor plans on taking. However, before an instructor can move the class forward, he or she must design a sequence of exercises that enables him or her to judge when students are prepared to move on within the course (Brookfield, 2013, p. 37). So, for the learning activity within this paper, the teacher must ensure that students are provided with the necessary resources such as assigned textbook readings and online resources relative to the course’s content. These resources will prepare the students for the anticipated learning activity that will be described in the upcoming sections of this paper.
The Teaching Activity
The topic of this paper’s teaching activity focuses on students developing a Cognitive Behavioral Therapy (CBT) case formulation for a couple who is seeking therapy. Of course, prior to this activity, students already have background knowledge about CBT through their previous reading assignments and provided resources from the instructor. So, once students are ready to move forward with the course’s content, the teaching activity will take the direction of a problem-based learning approach. Svinicki and McKeachie (2014) explained how this approach enables the instructor to provide students with a snippet of a selected scenario and some material that students can use to solve a given issue (p. 207). Therefore, the selected scenario for this activity is based off a case study of a couple seeking therapy. It should take at least five minutes for the class to read this case study provided by Dr. Michael Regev, a registered marriage and family therapist:
John and Susan have been married for 7 years. They have two children, aged 5 and 3. John is a computer technician and Susan has been a homemaker since the birth of their first child. They live in a nice neighbourhood in one of the suburbs of a big city in Canada.
John and Susan were introduced to each other in college. They fell in love immediately and after dating for about four months, moved in together. They got married a year later. John liked Susan’s openness and sensitivity. He used to describe her as a “free spirit”, someone who could do the wildest thing on a whim. He loved her spontaneity and genuineness. Susan admired John’s brain and the way he made her laugh. She felt safe with him and believed he was very dependable. In the beginning of their relationship they got along really well and were very happy.
The first time they both started feeling that the relationship was not working well was after the birth of their first child. Initially, both wanted to have a baby and both were thrilled when their first daughter, Charlotte, was born. However, in the months following the birth they started arguing a lot about small things. Soon after, they started blaming one another for various things. Susan blamed John for not taking on a fair share of the baby’s care and house chores, and John blamed Susan for criticizing him and for always nagging him about “stupid little things”. Things had gotten so bad that they started thinking about separating. However, they still wanted to give it a try and in an attempt to mend things, they went away on a holiday, only to discover a couple of weeks after their return that Susan was pregnant again. At first they were both overwhelmed by the news, but then they talked it through and agreed that it had probably been a sign that they should stick together and raise their family. The next few months went fairly well. Susan felt that John was taking care of her and making sure she was comfortable and safe. Susan was mostly in a good mood and tried to minimize her requests from John. Things were looking up.
However, shortly after the birth of their son, Sean, they started fighting again. The tension in the house was getting worse every day. They were both very tired and drained. Susan was feeling overwhelmed with taking care of two children and she felt abandoned by John. She started begging him to come home early, or not to go to work at all. For his part, John was working more hours than ever. He often missed dinner and when he did not, he would often say he was exhausted and go to bed immediately after dinner. The bitterness and anger in the relationship grew more and more until John told Susan one day that he had rented an apartment, and was moving out. Susan was devastated. Even though she was very unhappy in the relationship, she did not expect that John would leave her. She was desperate and begged him to reconsider. They came to therapy as a “last resort”. (Regev, n.d.)
This case study will serve as information that was acquired through the couple’s intake process prior to their initial session. However, before students engage in the activity, the instructor will present an Extended Case Formulation Worksheet guide created by Ackerman (2020) and was obtained from the Positive Psychology website. The instructor will explain to the students how Ackerman (2020) created this guide with instructions on how to complete its Part A and Part B. This explanation should take no more than five minutes of class time. Additionally, for the sake of instructional guidance, the whole class will complete Part A together through a class discussion. This particular task should take no more than 20 minutes. Afterwards, the teaching activity can finally take place where students experience two highest levels of thought processes.
Critical Thought Levels of the Teaching Activity
In a college setting, depending on the course level, Svinicki and McKeachie (2014) indicated that learning goals “can be pitched at several different depths of complexity” (p. 10). However, in terms of this paper’s teaching activity, these depths of complexity reflect the levels of objectives within the revision of Bloom’s taxonomy made by Anderson and Krathwohl (Svinicki & McKeachie, 2014). Therefore, this paper’s teaching activity require students to use various types of HOTS to analyze and evaluate.
Analyze
The first highest level of thought within this paper’s teaching activity is to analyze or “subdivide content into meaningful parts and relate the parts” by differentiating, organizing, or attributing (Svinicki & McKeachie, 2014, p. 311). The learning objective for this level of thought is as follows: As a group, given Part B of the CBT case formulation guide, students will be able to categorize information provided by the case study of a couple seeking therapy through collaboration. What this means is that the whole class will be broken up into three groups. Within their assigned group, the activity requires students to participate in collaborating with each other to fulfill this learning objective.
With the use of the Extended Case Formulation Worksheet provided by Ackerman (2020), students are guided throughout their collaboration process in categorizing the information needed to complete Part B. Consequently, this activity implements the use of discussion. Svinicki and McKeachie (2014) suggested that one stimulation for discussion can start with questions (p. 42). So, prior to breaking the class up into three groups, the instructor should ask the following penetrating question to initiate the activity’s discussion portion: How does John and Susan’s automatic thoughts of their relationship problem differ from one another? Afterwards, students can begin go partake in the learning activity as a group taking no more than 25 minutes.
The Effect of Group Work Learning Activity
Throughout this learning activity, students can build on presented ideas together as a group. However, as students collaborate in order to categorize information within the provided case study, their perspectives towards the issue can be similar or different. Svinicki and McKeachie (2014) discussed how this type of situation can be positively guided through a cooperative discussion method (p. 53). Therefore, in the event that student perspectives differ during the case discussion, they can take turns in understanding each other’s point of view. When this occurs, students are still analyzing content by relating these newly presented ideas towards their own perceptions of the case study. Additionally, these differences allow students to gain a better understanding of how analyzing ideas, apart from their own, can positively impact their thought process.
At this course level, students are expected to have grasp the main concept of applying the CBT approach to the provided case study. However, the most significant student impact of learning during this activity lies within the information that has been gathered through each group’s collaboration process. Once students analyze their group’s obtained information from the case study, they are able to categorize them onto Part B of the case formulation worksheet guide. When this is done, students gain a better understanding of why a CBT case formulation is crucial to the development of a treatment process of a couple seeking therapy. Furthermore, this then entails that the learning objective for this highest level of thought, analyze, has been fulfilled.
Evaluate
The second highest level of thought within this paper’s teaching activity is to evaluate or come “to a conclusion about something based on standards/criteria” by checking, critiquing, or judging (Svinicki & McKeachie, 2014, p. 311). The learning objective for this level of thought is as follows: Through presentations, followed by a think-pair-share activity, students will be able to compare similarities and differences among the answers provided within Part B of the CBT case formulation guide with others. What this means is that each group is required to present Part B of their completed CBT case formulation worksheet and it should take at least 20 minutes of class time.
Based on the activity’s criteria of having students present what their group came up with, it exposes information that could either be similar or different from another group’s conclusion. This process enables students, in all three groups, to prepare for the anticipated discussion that will allow them to compare their answers to another. However, before the discussion begins, the instructor should ask students to reflect on the following questions:
1. Among all three group’s presentations for Part B of the case formulation guide, was there any type of information provided that differed from the answers that your group came up?
2. Relative to the CBT approach, which information seemed most common among all three group’s presentation that will significantly impact the creation of John and Susan’s treatment plan?
Students should be given at least two minutes to reflect on these questions so that they are able to share their thoughts through the active learning strategy of think-pair-share.
Think-Pair-Share
Once students gather their thoughts, they can begin to engage in a discussion with a neighboring seated individual. Svinicki and McKeachie (2014) expressed how the active learning strategy of think-pair-share does not take much of class time (p. 196). Therefore, this activity should take at least five minutes.
Svinicki and McKeachie (2014) also pointed out that through the think-pair-share activity, students begin to engage in a discussion by comparing their responses. If a disagreement occurs, students can go through the process of trying to compromise how to please both sides. However, during this process, it is the teacher’s job to listen and guide students when needed so that they can become problem solvers (Svinicki & McKeachie, 2014). Once this activity is completed, before student are dismissed, the teacher can request for them to write a short reflection. This reflection can be about how this learning activity impacted the way students understood the content that has been learned. These student reflections can be briefly explored during the beginning of the next class session.
Conclusion
This paper’s teaching activity concludes that students learn better when they interact with each other. This notion is supported by Svinicki and McKeachie (2014) as they stated that one of the “best methods of gaining clearer, long-lasting understanding” is by having someone else explain the topic to another (p. 201). Additionally, through this process, students are also able to activate critical thought levels that are associated with the revision of Bloom’s taxonomy created by Anderson and Krathwohl. The ultimate goal of this teaching activity is to incorporate various HOTS so that adult students can experience the process of learning the course content in a valuable way.
References
Ackerman, C. E. (2020). Extended case formulation worksheet. Positive Psychology.
https://positivepsychology.com/wp-content/uploads/2020/09/Extended-Case-Formulation-Worksheet.pdf
Brookfield, S. D. (2013). Powerful techniques for teaching adults. John Wiley & Sons,
Inc.
Merriam, S. B., Caffarella, R. S., & Baumgartner, L. M. (2007). Learning in adulthood:
A comprehensive guide (3rd ed.). John Wiley & Sons, Inc.
Regev, M. (n.d.). Couples counseling – case example. Dr. Regev.
https://drregev.com/counselling/couples-therapy/case-example/
Svinicki, M., McKeachie, W. (2014, 14th or later edition). McKeachie's teaching tips:
Strategies, research, and theory for college and university teachers. Cengage Learning.