CBT

Question 1

Assumptions applied to therapy

Answer 1

The overall assumption of the cognitive approach is that our thoughts influence our emotions and the behaviours.
Psychological disorders are due to “faulty” or “irrational” thinking.
Internal processes impact our behaviour.
It’s for the therapist to identify and modify the “abnormal” thought processes and change the client’s perception of the world which will “eliminate” their illness.
Schemas also influence how we respond to the world.
CBT can change the individual’s perception of the world by adapting and correcting their “faulty” thinking due to incorrect or irrational schemas.

Question 2

Main components

Answer 2

CBT combines both cognitive and behavioural techniques to aid their client in reaching a rational and considered conclusion to their individual problems.

Question 3

Cognitive element

Answer 3

The therapist works with the client to identify the negative thoughts that are contributing to the problem.

Question 4

Negative self - schema

Answer 4

Individuals’ prone to depression are considered to be more likely to have a negative schema about themselves.
These may be acquired in childhood but may be adjusted later in life due to other negative experiences.

Question 5

Beck’s cognitive triad

Answer 5

Negative views about oneself.
Negative views about the world.
Negative views about the future.

Question 6

Cognitive distortions

Answer 6

Selective abstraction
Minimisation
Personalisation
Arbitrary inference
Magnification
Overgeneralisation

Question 7

Selective abstraction

Answer 7

Drawing conclusions on the basis of just one of many elements of a situation.

Question 8

Minimisation

Answer 8

Downplaying the importance of a positive thought, emotion or event.

Question 9

Personalisation

Answer 9

Attributing personal responsibility for events which aren’t under a person’s control.

Question 10

Arbitrary inference

Answer 10

Drawing conclusions when there is little or no evidence.

Question 11

Magnification

Answer 11

“Making a mountain out of a molehill” – blowing things out of proportion.

Question 12

Overgeneralisation

Answer 12

Making sweeping conclusions based on a single event.

Question 13

Behavioural element

Answer 13

Therapist encourages the client to engage in reality testing, either during the session or as homework.

Question 14

Cognitive restructuring

Answer 14

The client is taught how to challenge dysfunctional automatic thoughts outside of therapy by asking themselves two questions:
“Where’s the evidence for X?”
“What’s the worst that can happen if X is true?”
By answering these questions, the negative thoughts can be replaced by more positive constructive ones.

Question 15

Pleasant activity scheduling

Answer 15

The client is asked to plan one activity that they will engage with each day over a period of time.
It could be something that gives us a sense of accomplishment or something that will involve a break from a normal routine.
Engaging with these activities will induce more positive emotions and focusing on new things will distract from negative thinking patterns.
This is an example of a behavioural activation technique – helping clients change their behaviour.
The client is asked to keep a record of the experience, noting how they felt and what the specific circumstances were.
If it didn’t go as planned, the client is encouraged to explore why and what could be done to change it.
By taking action that moves toward a positive goal and solution, the patient moves further away from negative thinking and maladaptive behaviour.

Question 16

Dysfunctional thought diary

Answer 16

As homework, clients are asked to keep a diary of thoughts and feelings associated with any negative events.
They’re asked to pay particular attention to any automatic negative thoughts.
For each negative thought they have to rate how much they believe this. (From 0 – 100%)
They then give a rational response to this thought and rate their belief in that.
Finally, they then rerate their belief in the automatic thought.

Question 17

Research support

Answer 17

There’s a large body of evidence to suggest that CBT is highly effective in treating depression and anxiety-related problems.
A number of studies have compared the effectiveness of CBT with drug therapy in terms of treating severe depression.

Question 18

Jarrett et al (1999)

Answer 18

Found that CBT was as effective as some antidepressant drugs when treating 108 patients with severe depression over a 10-week trial.

Question 19

Hollon et al (1992)

Answer 19

Found no difference in CBT when compared with a slightly different kind of antidepressant drug in a sample of 107 patients over a 10-week trial.

Question 20

Therapist competence

Answer 20

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 assignments.
Application of relaxation skills.
Ability to engage and foster good therapeutic relations.

Question 21

Kuyken and Tsivrikos (2009)

Answer 21

Claim that as much as 15% of the variance in outcomes of CBT effectiveness may be attributable to therapist competence.

Question 22

Individual differences

Answer 22

CBT may be more suitable for some people compared to others.
Therefore, individual differences need to be taken into consideration when examining effectiveness.

Question 23

Simons et al (1995)

Answer 23

CBT appears to be less suitable for people who have high levels of irrational beliefs that are both ridged 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 can’t resolve.

Question 24

Empowerment

Answer 24

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, particularly for people who couldn’t cope with the determinist principles of these approaches.
For example:
They dislike the idea that their behaviour is caused by their biological make-up / the past.
CBT has become the most widely used therapy by clinical psychologists working in the NHS.

Question 25

Patient blame

Answer 25

The cognitive approach to therapy assumes that the client is responsible for their disorder.
While this is a positive thing in that they’re empowered to change the way they think (free will), there are also disadvantages.
For example:
Important situational factors may be overlooked which are contributing to the disorder, such as family problems or life event that the client isn’t in a position to change.
Therefore, “blaming” the individual for the way they think/fee/behave isn’t necessarily helpful because it may take other aspects of their life to change in order to help them feel better.

Question 26

What is rational?

Answer 26

Who judges an “irrational” thought?
While some thoughts may seem irrational to a therapist, resulting in the client feeling they must change them, they in fact may not be that irrational.

Question 27

Alloy and Abrahamson (1979)

Answer 27

Suggest that depressive realists tend to see things for what they are, and “normal” people have a tendency to distort things in a positive way.
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 individuals.

Question 28

CBT and self-esteem

Answer 28

CBT may damage self-esteem, an example of psychological harm.