cognitive therapies

CBT goal

• to identify and challenge irrational thoughts and replace with more positive thoughts.

1)CBT: initial assessment

• CBT therapists work together to identify goals.

cognitive element: Beck

• identify negative thoughts in relation to themselves, their world and future

reality testing + homework

• hmwk encourage clients to apply what they learn in therapy to real life.

• tests accuracy of thoughts.

2) cognitive element: Ellis

• REBT (type of CBT): depression arises from how we interpret event.

extended the model to include “Disputing irrational beliefs” and “effect”.

therapists role in REBT

• structured debate with the client designed to help them see how illogical their thoughts are.

types of disputing

• logical disputing: does it make sense?

• empirical disputing: what is the evidence?

• pragmatic: is this belief helping you feel better?

3) behavioural element

• behavioural activation: therapists encourage patients to be more active.

• provides evidence of irrational nature of beliefs.

limitation - CBT not efficient for severe cases

• may not be suitable for those with severe depression.

• can impair motivation and ability to engage in cognitive demands. e.g struggle to commit to sessions/hmwk.

• alternative to use antidepressants and CBT.

• therefore not suitable for all cases

limitation - self report measures

• relies heavily on self reporting: unreliable.

• identitying negative thoughts: internal and subjective

• clients may be unable to articulate thoughts accurately especially if they are overwhelmed. some may report improvement to please therapist.

• makes it hard to evaluate the effectiveness of CBT.

limitation - Therapist-patient relationship

• success may be due to therapist - patient relationship.

• research has shown often successful outcomes is due to therapeutic alliance.

• questions whether CBT is effective because of structured techniques/offers support etc. hard to establish cause of success.