14) New CB Therapies

Question 1

Describe how psychological interventions were like in the past.

Answer 1

• Classical psychoanalysis took years of daily therapy
• Limited access and affordability
• Psychiatry was primitive
• No treatments for most of the mental health conditions
• Most seriously ill patients were interned into mental institutions
• Major improvements in understanding and treatment of widely prevalent disorders
  o Anxiety and depression
  o Prevalent in 25+% of population
• Modest improvements in understanding and treatment of a host of other disorders
  o E.g., OCD, trauma‐related disorders
• Combined with biological treatments – impact has been transformational

Question 2

Describe what psychological interventions are like presently

Answer 2

• Range of interventions across multiple disorders
• Psychological interventions are used widely by other disciplines
• Outstanding discoveries and insights by pioneers
• Impact of CBT – last 50 years

Question 3

Who were the early pioneers and in what ways did they contribute? (3;2)

Answer 3

• Early pioneers: Freud, Skinner, Watson
• Contributions:
• Models for psychological disorders
• Methodological: psychology as a purely objective experimental branch of natural science

Question 4

Who were the CT pioneers what did they introduce?

Answer 4

Aaron Beck and Albert Ellis

• Introduced concept that:
• Cognitive restructuring could change emotions and reduce psychopathology.
  o Acknowledged that emotions are important
  o Beliefs and schemas are what’s important

Question 5

What has the Scientist-practitioner approach contirbuted? (4)

Answer 5

• Research on learning, cognition, memory, perception
• Research in neurobiology
• Supported and refined theoretical positions
• Informed practice

Question 6

What has CBT brought in, for treatment? (7)

Answer 6

• Interoceptive exposure therapy
• Exposure with response prevention
• Treatment of mental obsessions and compulsions
• Treatment of hypochondriasis and health-related anxiety
• Enhanced CT treatments for social anxiety, especially behavioural experiment
• CBT for children
• CBT for eating disorders

Question 7

What do psychological interventions have in the future? (4)

Answer 7

• Treatment effects are modest for some disorders
  o E.g., OC and related disorders, trauma‐related disorders
• Effects are poor in some disorders
  o Addictions
  o Anorexia (intensive psych care)
  o Personality disorders (intensive psych care)
• Drop outs and relapses occur
• Some treatments are difficult to endure

Question 8

What are new developments i.e., third wave of CBT? (4)

Answer 8

• Schema therapy
• Acceptance and commitment therapy (ACT)
• Dialectical behaviour therapy (DBT)
• Meta‐cognitive therapies and Mindfulness

Question 9

Describe schema therapy

Answer 9

• Traditional CBT did not work effectively for some complex and difficult clients
• Traditional CBT focuses on automatic thoughts and conditional assumptions first, leading to alleviation of symptoms
• Some clients (e.g., BPD) have multiple and complex schema requiring longer duration therapy that target these schema.
  o Schema‐focused cognitive therapy (SFCT) (Beck et al., 2004),
  o Schema therapy (Young et al., 2003)
• Different techniques advocated e.g., schema dialogue, responsibility pies, body-image transformation, schema flashcards

Question 10

Describe Dialectical Behaviour Therapy (DBT).

Answer 10

• Comprises a broad array of cognitive and behavioural strategies
• Tailored to address problems associated with BPD, including suicidal behaviours.
• The core skills taught
  o Emotion regulation
  o Interpersonal effectiveness
  o Distress tolerance
  o Mindfulness
  o Self‐management
• Rather than aiming to test the validity of cognitions, it promotes acceptance and validation of the client’s behaviour and reality.
• The therapeutic relationship is deemed central to DBT

Question 11

Describe Mindfulness-Based Cognitive Therapy

Answer 11

• MBCT commenced as a manualised group skills training programme for clients in remission from recurrent major depression (Segal et al., 2002)
• CBT was effective
  o Not because of changes to content of negative cognitions,
  o Because it allows ‘distancing’ or ‘decentering’.
   By prompting clients to pause, identify cognitions and evaluate the accuracy or usefulness of their content, it helps them ‘stand back’ from problem cognitions.
• So, emphasis on cultivating a stance of non‐judgement and radical acceptance
• MBCT in Practice:
  o Intentional: focusing on present experience rather than processing thoughts about the past or the future
  o Regards thoughts as mental events, rather than valid reflections of reality
  o Non‐judgemental: viewing events as events, rather than ‘good’ or ‘bad’
  o Fully present: that is, experiencing the moment, which reduces cognitive and experiential avoidance

Question 12

Describe Acceptance and Commitment Therapy

Answer 12

• Therapy is based on Hayes et al.’s (2001) relational frame theory, which views psychological problems as a reflection of psychological inflexibility and experiential avoidance.
• Goal of therapy is to help clients choose effective behaviours even in the face of interfering thoughts and emotions
• Several randomised controlled studies indicating its efficacy (E.g., Zettle, 2003)
• The model has two main components:
  o acceptance and mindfulness processes and
  o commitment and behaviour change processes
• Hayes also emphasises the importance of being in the present moment, advocating the therapeutic use of mindfulness, echoing MBCT and DBT

Question 13

Summary of new therapies

Answer 13

• Meta‐cognitive stance in several interventions
• Promising empirical research that suggests that
  o Extend and improve CBT effectiveness
  o Or work better for difficult presentations
   E.g., BDP – whole range of core beliefs and conditional assumptions
• Additional research is required
• Although effects are positive, outcomes are not dramatically different
• NEED INNOVATIONS IN INTERVENTIONS
  o E.g., look at clients from a slightly different perspectives