cuthbertpsychology2015.files.wordpress.com · Web viewThe psychodynamic approach was all about emotions and the unconscious, therefore the psychodynamic therapy of dream analysis

C1. Approach 4: The Cognitive Approach 2: Therapy – CBT

Cognitive Therapy: Cognitive Behavioural Therapy (pg 72-73)

Thinking back to the assumptions of the approaches, what do you think the missing words are here?

The biological approach was all about biological causes of behaviour, therefore the biological therapy of chemotherapy has the aim of altering ___________________

The psychodynamic approach was all about emotions and the unconscious, therefore the psychodynamic therapy of dream analysis has the aim of altering ___________________

The behaviourist approach was all about behaviour, therefore the behaviourist therapy of systematic desensitisation has the aim of altering ___________________

The cognitive approach is all about ___________________, therefore cognitive therapies have the aim of altering ___________________.

How the cognitive approach explains mental illnessBefore we look at the therapy of CBT, it is worth looking at how the cognitive approach explains mental illness. One of the key assumptions of the cognitive approach is that behaviour can be explained by ____________ ______________ _______________. This means that the best way to understand behaviour is to investigate how an individual thinks about a situation. The cognitive approach argues that mental illness such as ________________, ___________________ or ___________________ are caused by maladaptive or negative thoughts and beliefs. It has been found that people who think negatively about the world are more likely to suffer from depression.

This type of thinking can lead individuals to pay more attention to the negative aspects of situations, and ignore the positive. The glass is always “half empty”. It can be difficult for individuals to be able to break out of this pattern of negative thinking. Beck proposed that depressed people in particular develop a pattern of negative thinking he called the Negative Cognitive Triad. This involves a negative view of the self (1), a negative view of the world (2) and a negative view of the future (3). These

three negative schemas influence the way that a person sees the world and themselves. This negative triad also makes it difficult for depressed people to be able to recall happy memories, instead focusing on unpleasant or unhappy ones.

On the diagram below, write down three things that someone with the negative triad may think

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3:2:

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These negative schemas can cause a pattern of negative thinking. A person with depression will have many automatic negative thoughts. These are thoughts that that seem reasonable to the individual, but do not reflect reality. They bias our interpretation of the world, those around us, and ourselves. Automatic negative thoughts are an example of cognitive errors.

Find the description on page 2 of the magazine article, and give an example of the types of cognitive errors.Name Description ExampleCatastrophisingMind reading

Over generalisingLabelling

We do not just have schemas about the world, we also have a self-schema. Our self-schema is all the information, thoughts and feelings that we have about ourselves. People without depression will tend to have a self-schema that is realistic and mainly positive. However, the self-schema of a person with depression or anxiety will be overwhelmingly negative. This self-schema will bias how they interpret events.

If someone has a negative self schema, what sort of beliefs might they hold about themselves?

EXTRA: Are negative automatic thoughts affecting your life? Try this quiz online: www.testandcalc.com/Self_Defeating_Beliefs/indexf2.asp

Using the information above (the cognitive triad, self schemas and cognitive errors) write a description of someone who suffers with anxiety, stress or depression. You will later be role playing a therapy session with the person you create!

AIMS

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http://www.testandcalc.com/Self_Defeating_Beliefs/indexf2.asp


The aim of CBT is to challenge the negative thoughts and replace them with constructive positive thinking that will lead to healthy behaviour. People are often unaware that they are subject to cognitive errors, or that there are problems with their thinking. The therapist will try to make these maladaptive thoughts conscious, and then by challenging them, the client will see that there is no basis for these thoughts. In theory, this should cause the problem to disappear.

How does this therapy link with the assumptions of the behaviourist approach? CBT is concerned with a range of internal mental processes including thinking,

but also attention (paying attention to negative aspects of a situation) and memory (recalling unhappy events rather than happy ones)

CBT seeks to alter the way in which we process information, so for example, people are taught to process information differently, attending to the positives or trying to recall happy memories.

CBT is also based on the assumption that mental illness is caused by faulty thinking. Therefore, by changing the thinking through cognitive restructuring, we can change the behaviour.

The cognitive approach also assumes that negative schemas are also a cause of mental illness. Therefore, in CBT the client will be helped to change these negative schemas.

MAIN COMPONENTS OF CBTRead the magazine article, and answer the following questions.

What problems have CBT been used to treat?

What is Socratic questioning, how is it used, and what is its purpose?

What aspects of CBT use cognitive principles (investigating how people think)?What aspects of CBT use behaviourist principles?What role do early life experiences have in CBT?

Dysfunctional thought diary: As homework, clients are asked to keep a diary of thoughts and feelings associated with any negative events. They have to pay particular attention to any automatic negative thoughts. For each negative thought they have to rate how much they believe this (from 0%-

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100%). They then give a rational response to this thought, and rate their belief in that. Finally, they rerate their belief in the automatic thought. E.g. Automatic negative thought: My boss hates me because I am a bad person (belief: 60%)

Rational response: My boss does not hate me. He is rude to everyone, and has had a very stressful day. Therefore, it’s nothing really to do with me. (belief: 80%)Rerated belief: My boss hates me because I am a bad person (belief: 20%)

Cognitive restructuring: The client is taught how to challenge dysfunctional automatic thoughts outside of therapy by asking themselves two questions: 1 “Where is the evidence for X?” and 2 “What is the worst that can happen if X was true.” By answering these questions, the negative thought can be replaced by more positive constructive ones.

Complete the following thought process:Automatic negative thought: I am going to fail psychology, and my life will

be over!

Question 1: ______________________________________________________________ ________________________________________________________________________________________________________________________________________________Question 2: ______________________________________________________________ ________________________________________________________________________________________________________________________________________________

Pleasant activity scheduling: Read the section on page 72. What is pleasant activity scheduling? Give an example

What is the rationale behind pleasant activity scheduling?

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Using the description you wrote on the second page of a person with an issue, role play in pairs. One person is the client; the other person is the therapist. The therapist needs to use CBT principles to help first identify and then challenge the negative thoughts held by the client. Once you have done so, write down a sample of dialogue

that demonstrates how CBT worked. EXTRA: A subtype of CBT is stress inoculation training. This is a type of CBT which is tailored specifically for dealing with stress and stress related problems. Look it up.

EVALUATION: EFFECTIVENESS

Cahill et al (2003) assessed the severity of symptoms after each therapy session of 58 patients receiving cognitive therapy for depression. By the end of the therapy which lasted 12-20 sessions, 71 percent of the patients who had completed their therapy experienced a significant reduction in their symptoms. However, only 13% of the patients who did not complete the therapy showed improvement.

David and Avelino (2003) found that CBT has the highest overall success rate of all therapies. However, Kuyken and Tsivikos (2009) suggested that as much as 15% of the effectiveness of CBT may be attributable to the competence of the therapist. This means that it may be the case that when CBT is effective it is due in part to the ability of the therapist more than the therapy itself.

Summarise how effective CBT is when compared to drug treatments (pg 73)

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What advantages might CBT have over treatments such as drugs, psychosurgery and

ECT?CBT needs to take into account individual differences. Some research suggests that

CBT may not be appropriate for individuals who have high levels of irrational beliefs or beliefs that are resistant to change. Also, an issue with CBT is that it has limited use in situations in which the person’s negative thinking is caused by very real life stressors (Simons et al, 1995). Imagine that a person seeks CBT to help with their stress. CBT can change the way that a person thinks, but what if the stress was a reasonable response to a real, stressful event.

Maybe the person has lost their job, is going through a messy divorce, or has just been diagnosed with a serious illness. Their stress or depression we could argue in this case is not a mental illness; rather it is a direct result of a stressful life event. This is a weakness of CBT; it is often argued that CBT just treats the symptoms of a mental illness rather than the cause. Someone may receive CBT for stress, but as soon as therapy is over, the cause of the stress (illness, divorce etc) is still present, and so the mental illness may return. CBT is sometimes used with schizophrenics, but is of limited use, and nearly always needs to be paired with medication. Why do you think this is?

Why could it be argued that CBT allows patients to feel “empowered” and allow people to

have “free will”? (pg 73)

Another issue with the use of CBT is cause and effect. The therapy is based on the assumption that it is the maladaptive thinking (cognitive errors, automatic negative thoughts etc.) that lead to the mental illness. Therefore, by altering the thoughts, we can change the behaviour and get rid of the mental illness. While there is little doubt that depressed people do experience the sort of negative thoughts discussed above, do the negative thoughts lead to the depression, or does the depression lead to the negative thoughts? Most of the evidence suggests that negative thoughts and attitudes are caused by depression rather than being the cause.

Lewinsohn (1981) carried out a prospective study in which negative thoughts were assessed before any of the participants became depressed. He concluded that there was no relationship between negative thought and irrational beliefs and future depression. If it is the case that negative thinking is caused by depression, and is not the cause of depression, then this undermines the whole therapy of CBT. By changing the negative

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thinking, you will not actually be treating the root cause of depression, only treating the symptoms.

EVALUATION: ETHICAL ISSUESImagine that you are depressed. You feel helpless and don’t know what to do, so you decide to undergo CBT. Your therapist says that the reason that you feel the way you do is because of your thinking, and that you can change how you think. What are the positives and negative of being told this? What about if your depression was the result of

an uncontrollable stressor?It could be argued that while CBT focuses on empowering patients to make changes to their thinking and therefore change their behaviour and emotions, it could be argued that this puts the blame for the mental illness on the patients themselves. This could cause the patient to feel worse than they already do, and reduce their self-esteem. This is a particular concern in patients with depression as they are more likely to have low self-esteem anyway, and are also more likely to already hold a number of self-critical, self-blaming thoughts. In these cases, CBT might actually make the patient’s issues worse!

Another issue with CBT is that it is up to the therapist’s judgement to decide what is and is not a rational thought. For example, look at these “irrational” thoughts below.

“I’m going to fail my exams.”“My boss hates me.”“I will never be able to get a job.”“My husband is going to leave me.”“I’m not as good as other people.”

“The future is going to be terrible.”“Nobody likes me.”“I will never find love.”“My life is over.”“My parents don’t want me.”

With a partner discuss these “irrational” thoughts. Can you think of situations or contexts when these thoughts would not be considered irrational?

What did Abrahmson (1979) suggest about people with depression?

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