PSYCHOPATHOLOGY LESSON 5 THE COGNITIVE APPROACH TO TREATING

PSYCHOPATHOLOGY LESSON 5 THE COGNITIVE APPROACH TO TREATING DEPRESSION Objectives: Learn about how the cognitive model explains mental illness Learn how the cognitive approach has been applied in treatment (CBT) Practice answering therapy style questions

HOW DOES THE COGNITIVE APPROACH EXPLAIN ABNORMALITY? Abnormal behaviour is a direct result of faulty thinking.

IRRATIONAL THINKING These are specific ways in which our mind convinces us of something that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves.

POLARISED THINKING (OR “BLACK AND WHITE” THINKING). In polarised thinking, things are either “black- or-white. ” We have to be perfect or we’re a failure — there is no middle ground. You place people or situations in “either/or” categories, with no shades of grey or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure. An example abnormality would be…

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.

HOW CBT WORKS Initial therapy session: This is where the client and therapist discuss what the problem is. The therapist will use specific questioning styles to engage the client in dialogue and not allow conversation to be ‘blocked off’

Beck’s Cognitive Therapy Cognitive Behavioural Therapy • Stage 1 • Therapist & client agree on nature of problem & goals for therapy Stage 2 Therapist challenges the client’s negative thoughts Client engages in behaviour between sessions in an attempt to challenge these negative thoughts Beck Aim is for client to realise thoughts are irrational. Homework = diary kept

HOW CBT WORKS The behaviour part of therapy involves setting homework for the client to do. The therapist gives the client tasks that will help them challenge their own irrational beliefs. The idea is that the client identifies their own unhelpful beliefs and them proves them wrong. As a result, their beliefs begin to change. The patient may be asked to record their feelings, behaviours and consequences in a ‘negative thoughts diary’.

CHALLENGING DYSFUNCTIONAL THOUGHTS: • 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?

1. Lucy is suffering from depression. She finds it hard to make new friends and finds any small challenges, such as paying bills, overwhelming. How might cognitive therapy be used to help Lucy overcome depression? (4 marks) Key words: CBT, reality testing, rational thoughts, REBT, identification

2. Gregg is addicted to gambling. He bets on races almost daily and is losing a lot of money this way. He feels he cannot go on in life without the money. How might cognitive therapy be used to help Gregg overcome his gambling addiction? (4 marks) Key words: CBT, reality testing, rational thoughts, REBT, identification

II. RATIONAL EMOTIONAL BEHAVIOUR THERAPY (REBT) Ellis’ Model The therapist and client work together to find which situations cause negative reactions The therapist helps the client see a more realistic perspective More confrontational that Beck, as Ellis would engage in intense debates to challenge the client

ELLIS’ REBT (RATIONAL, EMOTIVE, BEHAVIOURAL, THERAPY) REBT is based on the premise that whenever we become upset, it is not the events taking place in our lives that upset us; it is the beliefs that we hold that cause us to become depressed, anxious, enraged, etc.

DISPUTING The goal of REBT is to help people change their irrational beliefs into rational beliefs. Changing beliefs is the real work of therapy and is achieved by therapist disputing the client's irrational beliefs. For example, therapist might ask, "Why must you win everyone's approval? " "Where is it written that other people must treat you fairly? " "Just because you want something, why must you have it? " Disputing is the D of the ABC model. When the client tries to answer therapist's questions, s/he sees that there is no reason why s/he absolutely must have approval, fair treatment, or anything else that s/he wants.

INSIGHT Albert Ellis and REBT contend that although we all think irrationally from time to time, we can work at eliminating the tendency. It's unlikely that we can ever entirely eliminate the tendency to think irrationally, but we can reduce the frequency, the duration, and the intensity of our irrational beliefs by developing three insights: We don't merely get upset but mainly upset ourselves by holding inflexible beliefs. No matter when and how we start upsetting ourselves, we continue to feel upset because we cling to our irrational beliefs. The only way to get better is to work hard at changing our beliefs. It takes practice, practice.

ACCEPTANCE Emotionally healthy human beings develop an acceptance of reality, even when reality is highly unfortunate and unpleasant.

ROLE PLAY TASK 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 – remember the specific questioning style of therapist in stage one as well as the two particular questions used in stage 3.

COGNITIVE THERAPIES Cognitive Behavioural Therapy Rational Emotive Therapy 18

RESEARCH TO SUPPORT EFFECTIVENESS OF CBT (AO 3) (P) CBT is the most effective psychological treatment for moderate and severe depression. (E) Hollan et al (2006) investigated relapse rates for moderately to severely depressed patients treated with CBT for 16 weeks. He found a 40% relapse rate for CBT 45% relapse for anti-depressants 80% for placebo (E) This shows that CBT is slightly more effective, long term than drug therapy and much better than no treatment at all. (L) This shows that CBT works and is an effective therapy for depression. However, it may be advantageous to combine both CBT with anti-depressants for maximum success.

LIMITATION OF CBT (AO 3) (P) CBT is not useful for all patients (E) For example, CBT may be unsuitable for patients who have difficulty concentrating, which can be a symptom of people suffering depression. (E) This can lead to patients becoming overwhelmed and disappointed, which strengthens depressive symptoms rather than reducing them. (L) therefore, this shows that CBT can’t be applied to everyone and is not a ‘one size fits all’ approach to treating depression.

AO 3 Include on more AO 3 point from the book Make sure you PEEL.

PLENARY Summarise CBT on your post it – include one strength and one weakness.