Approach 4 The Cognitive Approach 4 2 THERAPY

Approach 4: The Cognitive Approach 4. 2 THERAPY: CBT

STARTER The biological approach was all about biological causes of behaviour, therefore the biological therapy of chemotherapy has the aim of altering the balance of neurotransmitters ______ The psychodynamic approach was all about emotions and the unconscious, therefore the psychodynamic therapy of dream analysis has the aim of altering emotions and things in the _______________ unconscious

STARTER The behaviourist approach was all about behaviour, therefore the behaviourist therapy of systematic desensitisation has the aim of maladaptive altering ___________ behaviour thinking The cognitive approach is all about _____, therefore cognitive therapies have the aim of maladaptive altering __________ thoughts

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 internal mental that theprocesses best way to understand behaviour is to investigate how an individual thinks about a situation. The cognitive approach argues that mental illness such as _____, stress depression ______or _______ anxiet are caused by maladaptive or y negative thoughts and beliefs.

HOW THE COGNITIVE APPROACH EXPLAINS MENTAL ILLNESS Can lead people to pay more attention to the negative aspects of situations, ignoring the positive. Beck’s Negative Cognitive Triad On the diagram, write down three things that someone with the negative triad may think 1: 2: 3:

HOW THE COGNITIVE APPROACH EXPLAINS MENTAL ILLNESS A person with depression will have many automatic negative thoughts. Thoughts 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.

HOW THE COGNITIVE APPROACH EXPLAINS MENTAL ILLNESS These are examples of automatic negative thoughts that seem reasonable to the individual, but do not reflect reality. They bias our interpretation of the world, those around us, and ourselves. Catasrophising Mind reading Over generalising Labelling

HOW THE COGNITIVE APPROACH EXPLAINS MENTAL ILLNESS Our self schema is all the information, thoughts and feelings that we have about ourselves. If someone has a negative self schema, what sort of beliefs might they hold about themselves? I am useless at everything Nobody likes me

HOW THE COGNITIVE APPROACH EXPLAINS MENTAL ILLNESS Using the information above (the cognitive triad, self schemas and cognitive errors) write a description of someone who suffers with anxiety, stress or depression. Give them one or two specific problems. E. g. They feel that they are going to fail their driving test because they fail everything. They were dumped by their girlfriend because they believe they are a bad person

AIM OF COGNITIVE BEHAVIOURAL THERAPY The aim of CBT is to challenge negative maladaptive thoughts and replace them with healthy thinking. Often people are unaware that there is anything wrong with their thinking. Change thinking, change the behaviour

AIM OF COGNITIVE BEHAVIOURAL THERAPY Links to the assumptions: CBT is concerned with internal mental processes It aims to alter how we process information Cognitive restructuring can alter behaviour Assumes that mental illness can be explained partly through schemas

MAIN COMPONENTS OF CBT Read the magazine article and answer the questions on the sheet 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?

MAIN COMPONENTS OF CBT Dysfunctional thought diary: Write down automatic negative thoughts Rate them, write a logical alternative, and then rerate 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%)

MAIN COMPONENTS OF CBT Cognitive Restructuring • Ask self two questions • “Where is the evidence for X? ” • “What is the worst that can happen if X was true. ” • Automatic negative thought: I am going to fail psychology, and my life will be over! • What would be the response to the two questions?

MAIN COMPONENTS OF CBT Read the section on page 72. What is pleasant activity scheduling? Give an example What is the rationale behind pleasant activity scheduling?

MAIN COMPONENTS OF CBT 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 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.

EVALUATION: EFFECTIVENESS Cahill et al (2003) By the end of therapy which lasted 12 -20 sessions, 71 percent of patients who had completed their therapy experienced significant reduction in their symptoms. However, only 13% of the patients who did not complete therapy showed improvement.

EVALUATION: EFFECTIVENESS David and Avelino (2003) found that CBT has the highest overall success rate of all therapies. However, Kuyken and Tsivikos (2009) up to 15% of the effectiveness of CBT may be attributable to the competence of therapist.

EVALUATION: EFFECTIVENESS Summarise how effective CBT is when compared to drug treatments (pg 73) What advantages might CBT have over treatments such as drugs, psychosurgery and ECT? Side effects? Permanence?

EVALUATION: EFFECTIVENESS Needs to take into account individual differences Not appropriate for all: high levels of irrational beliefs Simons CBT et al (1995) has limited use where mental illness is caused by a real life stressor

EVALUATION: EFFECTIVENESS Real life stressors: losing a job, divorce, illness. Stress or depression is a reasonable response to a stressful life event. This is a weakness of CBT might 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.

EVALUATION: EFFECTIVENESS 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)

EVALUATION: EFFECTIVENESS Cause and effect Depressed people do experience many negative thoughts BUT do the negative thoughts lead to the depression, or does the depression lead to the negative thoughts? Lewisohn No (1981) relationship between negative thought and irrational beliefs and future depression

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

EVALUATION: ETHICAL ISSUES Imagine 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?

EVALUATION: ETHICAL ISSUES CBT might put the blame for the mental illness on the patients themselves. Patient may feel worse than they already do, and reduce their selfesteem. Patients with depression 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. CBT might actually make the patient’s issues worse!

EVALUATION: ETHICAL ISSUES Another issue with CBT is that it is up to 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?

EVALUATION: ETHICAL ISSUES What did Abrahmson (1979) suggest about people with depression?

EXAM PRACTICE Exam corner pg 73 Therapies activity on pg 85