CBT therapy

assumptions: describe the computer analogy assumption

The way info is processed determines our response. Mind doesn’t passively receive info but actively process’s it like a computer. We take in info (input), change/store it (process), recall it (output).

Link: Faulty processing leads to thinking irrationally, leading to mental disorders like depression/anxiety. CBT aims to challenge the irrational thought pattern and replace it with rational ones.

Assumptions: schemas

Schemas are organised pockets of information built up via experience and influence how we respond to the world around us. Link: Beck stated depressed people have 3 negative schemas (1) themselves eg I’m a bad person (2) the world eg my life is terrible (3) future eg things won’t improve. This is called the cognitive triad. CBT aims to help client change negative schemas, resulting in changing how they respond to the world.

Assumptions: internal mental processes

Humans are info processors. Cognitive processes work together to help us make sense of/respond to the world. Internal mental processes = PALM which influence our behaviour. Link: Role of CBT therapist is to help client change perception of the world as that’s causing their illness. Can be achieved via cognitive reconstructing where therapist questions evidence for clients perception eg if a client thinks ppl hate them, therapist asks what evidence their is for this. Client will see perception is based on no evidence so internal mental processes will change.

Main component: dysfunctional thought diary

As homework, client asked to record events leading up to unpleasant emotions experienced. They record automatic negative thought associated with event + rate extent they believe thought (0-100%). Clients then asked to write rational response to automatic thought + rate belief. Finally client should re rate belief in automatic thought.

Main component: cognitive reconstructing

Once client had revealed thought pattern to therapist, can work together identifying/challenging negative thought pattern. Client may feel distrsssed about something they overheard, assuming it’s about them. CBT client is taught to challenge dysfunctional automatic thought eg, where’s the evidence for that, what’s the worst that can happen if x was. By challenging dysfunctional thoughts + replacing with constructive ones, the client can change their ways of behaving

Main component: pleasant activity scheduling

Involves asking client to plan a pleasant activity they’ll engage in each day. Something that gives a sense of accomplishment (gym) or something that breaks usual routine (eating food out of office). Engaging in pleasant activities = inducing positive emotions and focusing on new things = distraction from negative thought pattern. This is an eg of behavioural activation technique (helping clients change behaviour). Technique involves asking client to record experience, noting how they felt and specific circumstances. If didn’t go to plan, client is asked to explore why + how to change that. By taking action that moves towards a positive solution/goal, client is moved away from negative thinking/maladaptive behaviour

A03: effectiveness of CBT therapy

Strength: research edvidence

There is a large body of evidence to suggest that CBT is highly effective in treating depression and anxiety-related problems. Several studies have compared the effectiveness of CBT with drug therapy in terms of treating severed depression. For example, Jarrett et al. (1999) compared the effectiveness of CBT with antidepressants in 108 patients with severe depression. Participants were randomly assigned to either the CBT group, the antidepressants group, or the placebo group. The study lasted 10 weeks and it was found that CBT was as effective as the antidepressants and more effective than a placebo.

A03: effectiveness of CBT therapy

Strength: research evidence Kodal et al

A03: effectiveness of CBT therapy

Strength: empowerment

CBT empowers clients to develop their own coping strategies and recognises that people have free will to do this. CBT has become an increasingly popular alternative to drug therapy and psychoanalysis, particularly for people who could not cope with the determinist principles of these approaches. Partly for this reason, CBT has become the most widely used therapy by clinical psychologists working in the NHS.

A03: effectiveness of CBT therapy

Strength: therapidt competence

One factor influencing the success of CBT appears to be therapist competence. Competencies in CBT include ability to structure sessions, ability to plan and review homework, application of relaxation skills, and the ability to engage and foster good therapeutic relations. Kuyken and Tsivrikos (2009) found that therapist competence is associated with therapy outcomes. 69 depressed clients were treated by 1 of 18 CBT therapists. Competence was measured for each and those with higher competence achieved greater outcomes for their clients.

A03: effectiveness of CBT therapy

weakness: individual differences

As with all therapies, CBT may be more suitable for some people compared to others, so individual differences need to be taken into consideration when examining effectiveness. For example, CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change. It also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person’s life that therapy cannot resolve.

A03: ethics of CBT therapy

weakness: patient blame

The cognitive approach to therapy assumes that the client is responsible for their disorder. While this is a positive thing in that they are empowered to change the way they think, there are also disadvantages to this approach. For example, important situational factors may be overlooked which are contributing to their disorder, such as family problems or life events that the client is not in a position to change. Therefore, ‘blaming’ the individual for the way they think/feel/behave is not necessarily helpful because it may take other aspects of their life to change in order to help them feel better.

A03: ethics of CBT therapy

weakness: what is rational?

One ethical debate concerns who judges an ‘irrational thought’. While some thoughts may seem irrational to a therapist, resulting in the client feeling they must change them, they may in fact not be that irrational. Alloy and Abrahamson (1979) suggest that depressive realists tend to see things for what they are, and non-depressed individuals tend to distort things in a positive way (through rose- coloured glasses). They found that depressed people display the sadder but wiser effect, that they were more accurate in their estimates of the likelihood of ‘disaster’ than non-depressed people. The ethical issue is that CBT tends to discount the thoughts of depressed people which may damage self-esteem further.