Key Assumptions of The Cognitive Perspective

• Individuals who suffer from mental disorders have distorted and irrational thinking – which may cause maladaptive behaviour.

• It is the way you think about the problem rather than the problem itself which causes the mental disorder.

• Individuals can overcome mental disorders by learning to use more appropriate cognitions.

Key Assumptions of The Cognitive Approach

• Individuals who suffer from mental disorders have distorted and irrational thinking – which may cause maladaptive behaviour.

• It is the way you think about the problem rather than the problem itself which causes the mental disorder.

• Individuals can overcome mental disorders by learning to use more appropriate cognitions. If people think in more positive ways, they can be helped to feel better

These negative thoughts are unconscious and rapid responses to certain situations. They can be identified as Cognitive biases. These biases prevent the person from focusing on the positive side of life and so reinforce their negative views.

Cognitive Bias ExplanationMinimisation The bias towards minimising

success in life. Eg Attributing good exam results to luck.

Maximisation Maximising the importance of trivial failures. Thinking you’re stupid if you fail to complete a Sudoku.

Selective Abstraction Focusing on only the negative side of life and ignoring the wider picture.

All or nothing thinking A tendency to see life in terms of black and white and ignoring the middle ground; you are a success or a failure rather than good at some things but not so good at others.

Dysfunctional thinking• Awfulising: using words like 'awful’, 'terrible’, 'horrible’, 'catastrophic’ to

describe something - e.g. 'It would be terrible if …’, 'It’s the worst thing that could happen’, 'That would be the end of the world’.

• Cant-stand-it-itis: viewing an event or experience as unbearable - e.g. 'I can’t stand it’, 'It’s absolutely unbearable’, I’ll die if I get rejected’.

• Demanding: using 'shoulds’ or 'musts’ - e.g. 'I should not have done that, 'I must not fail’, 'I need to be loved’, 'I have to have a drink’.

• People-rating: labelling or rating your total self (or someone else’s) - e.g. 'I’m stupid /hopeless /useless /worthless.’

What are irrational self defeating beliefs?

• It blocks you from achieving your goals and purposes;

• It creates extreme emotions which persist, and which distress and immobilise;

• and it leads to behaviours that harm yourself, others, and your life in general.

Rational thinking = Realistic thinking

• It is based on reality - it emphasises seeing things as they really are, seeing things in perspective;

• It helps you achieve your goals and purposes; • It creates emotions you can handle; and • It helps you behave in ways which promote

your aims and survival.

Example!

It is your birthday and you are given a surprise invitation to meet your friends at lunchtime to celebrate. You are disappointed to find your best friend does not join you and gives no reason or apology.

Thoughts

Emotions

Behaviour

Irrational/negative Rational/positive

He/she is annoyed with But won’t say why you

Maybe he/she was underPressure with work etc

Hurt and upset. Perhaps you aren’t friends after all

Disappointed, but sure you’llGet together soon to celebrate

Treat him/her with cool detachment next time youmeet

Ring him/her to arrange to meet

Complete the activity about seeing your boyfriend in Starbucks with a

girl !

Cognitive Theory

• Beck and Ellis are the two psychologists most often associated with this explanation who suggested that:-

• Irrational thinking (Ellis 1962) and • The cognitive triad and errors in logic (Beck

1967)

create abnormal behaviour.

Aaron Beck• Beck believed that people who are

depressed make fundamental errors in logic

• People who have become depressed have developed negative self-schemas

• They have a tendency to view themselves, the world and the future in pessimistic ways – the triad of impairments

Beck’s Model of Depression (1979) ‘The Cognitive Triad’

• Negative Triad (3 negative Schemata)– Negative view of the self– Negative view of the world– Negative view of the future

Negative Automatic Thoughts

Beck et al (1974)Beck et al (1974)Aim: To understand

cognitive distortions in patients with depression

Aim: To understand cognitive distortions in

patients with depression

Approach: CognitiveApproach: Cognitive

Method: Clinical interviews with patients undergoing therapy

Method: Clinical interviews with patients undergoing therapy

Sample: 50 patients diagnosed with depression. 16 men and 34 women. Most middle/upper class of at least average intelligence.

Sample: 50 patients diagnosed with depression. 16 men and 34 women. Most middle/upper class of at least average intelligence.

Procedure

An independent design. Patients were compared to a group of 31 non-depressed patients undergoing therapy. They were matched for age, sex and social status.

Face to face interviews and retrospective reports of patients’ thoughts before and during the therapy session. Some patients kept diaries of their thoughts and brought them to the therapy session.

Records were kept of the non-depressed patients verbalisations.

Procedure

An independent design. Patients were compared to a group of 31 non-depressed patients undergoing therapy. They were matched for age, sex and social status.

Face to face interviews and retrospective reports of patients’ thoughts before and during the therapy session. Some patients kept diaries of their thoughts and brought them to the therapy session.

Records were kept of the non-depressed patients verbalisations.

Results

Certain themes appeared in the depressed patients that did not appear in the non-depressed. These were low self-esteem, self-blame, overwhelming responsibilities, anxiety caused by thoughts of personal danger and paranoia.

Depressed patients had stereotypical responses to situations, even when inappropriate (eg feeling inferior if a passer by did not smile at them). Depressed patients regarded themselves as inferior in intelligence, attractiveness compared to others in their social/occupational groups.

These distortions tended to be automatic, persistent and involuntary.

Results

Certain themes appeared in the depressed patients that did not appear in the non-depressed. These were low self-esteem, self-blame, overwhelming responsibilities, anxiety caused by thoughts of personal danger and paranoia.

Depressed patients had stereotypical responses to situations, even when inappropriate (eg feeling inferior if a passer by did not smile at them). Depressed patients regarded themselves as inferior in intelligence, attractiveness compared to others in their social/occupational groups.

These distortions tended to be automatic, persistent and involuntary.

Beck et al (1974)Beck et al (1974)

Albert Ellis

• Ellis argued that there are common irrational beliefs that underlie much depression, and sufferers have based their lives on these beliefs

• For example: “I must be successful, competent and achieving in everything I do if I am to consider myself worthwhile”

Ellis’ ABC model

• Ellis suggested that …

(A) an action is affected by

(B) an individual’s beliefs which results in

(C) a consequence

• If beliefs are subject to cognitive biases then they can cause irrational thinking which may produce undesirable behaviours.

Example:

Emma overhears a remark made in class ‘she really gets on my nerves’. It could have referred to anyone but Emma believes that she is unworthy and people don’t want to be friends with her. She withdraws from the friendship group and becomes more and more isolated and depressed.

Evaluation

• Depressed people undoubtedly have negative thoughts but do the negative thoughts help cause depression, or do they merely occur as a result of being depressed?

Evaluation

• This approach may succeed in changing the depressed person’s thinking, but may not discover the underlying cause of the depression.

• Past events, which have a powerful influence on the individual, are often neglected.

Evaluation • The cognitive explanation cannot account for the

physical symptoms of mood disorders

• These include aches and pains, a lack of energy, palpitations, headaches and stomach upsets. For women there may be menstrual changes. Sleep disturbance is another possible symptom. Sufferers can experience loss of appetite or weight. With bipolar depression during the manic phase the sufferer will tend to sleep very little and have increase in energy levels – how can irrational thought processes cause these symptoms?

Evaluation of the Cognitive Approach

• There is much evidence for cognitive biases and dysfunctional thinking and beliefs in depression and anxiety disorders

• Therapy based on this model can be very effective for anxiety disorders and depression

• No account of biological or genetic factors in psychopathology

• The disorder may lead to dysfunctional thinking, rather than dysfunctional thinking causing the disorder (chicken/egg)

• Takes no account of situational or environmental factors

Cognitive Therapy

• Cognitive Behaviour Therapy (CBT)• Aim – to challenge irrational and dysfunctional

thought processes

What is CBT?

• It is a way of talking about:– how you think about yourself, the world and other people – how what you do affects your thoughts and feelings.

• CBT can help people to change how they think ('Cognitive')

and what they do ('Behaviour'). These changes can help them to feel better.

• It focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve the state of mind now.

When does CBT help?

• CBT has been shown to help with many different types of problems. – Anxiety, depression, panic, phobias, stress,

bulimia, OCD, Post-Traumatic Stress Disorder, bipolar disorder and psychosis.

How does it work? • CBT can help to break the vicious circle of

maladaptive thinking, feelings and behaviour.

• When the parts of the sequence are clearly outlined and understood, they can be changed.

• CBT aims to get the person to a point where they can ‘DIY', and work out their own ways of tackling their problems.

What does CBT involve?

The SessionsMeet with a therapist for between 5 and 20, weekly, or fortnightly sessions.

Each session will last between 30 and 60 minutes.

How effective is CBT?

• CBT is effective in reducing symptoms of depression and in preventing relapse (Kuyken et al, 2007)

• It is the most effective psychological treatment for moderate and severe depression.

• It is as effective as antidepressants for many types of depression (Fava et al, 1994).

CBT and Drug Treatment

• Keller et al (2000)• Recovery rates (from depression)

– 55% drugs alone– 52% CBT alone

– 85% when used together.85% when used together.

Strengths

Client is actively involved in their recovery

CBT is not physically invasive Client learns to help

themselves, and can use the skills in new situations.

CBT works (e.g. Kuyken, Fava) Particularly when combined

with drug treatment (Keller)

Weaknesses

Clients can become dependant on their therapist, or non-cooperative

CBT is not effective for people with rigid attitudes or resistance to change,

or for people who have high stress levels in response to genuinely difficult life circumstances (depressive realism)

CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for the client.

CHANGE VIEW: 10 key facts about CBT

CChange: your thoughts and hange: your thoughts and actionsactions

VView: events from another iew: events from another angleangle

HHomework: practice makes omework: practice makes perfectperfect

II can do it: self-help approach can do it: self-help approach

AAction : don't just talk, do! ction : don't just talk, do! EExperience: test out your xperience: test out your beliefsbeliefs

NNeed: pinpoint the problemeed: pinpoint the problem WWrite it down: to remember rite it down: to remember progressprogress

GGoals: move towards themoals: move towards them

EEvidence: shows CBT can workvidence: shows CBT can work

"We are what we think. All that we are arises

with our thought. With our thoughts, we make

our world."

The Buddha