CBT - Cognitive Approach

Question 1

What are the aim of CBT ?

Answer 1

• to challenge the negative thoughts and replace with healthy thinking
• begins with an initial assessment- the client and therapist discusses the problem
• includes goal setting: the client and therapist will collaboratively create goals for their sessions and how to achieve them

Question 2

What are the main components of CBT?

Answer 2

• Dysfunctional thought diary
• cognitive restructuring
• pleasant action scheduling

Question 3

Dysfunctional thought diary - at home

Answer 3

• client must keep a record of their dysfunctional thoughts. This involves recording any events that may lead to those automatic negative emotions

Question 4

Dysfunctional thought diary- in therapy

Answer 4

• client must then record those emotions and rate how much they believe the thoughts to be true
• after this, clients must write a rational response and rate their belief of this too
• the client then will re rate their original automatic thoughts

Question 5

Cognitive restructuring

Answer 5

• involves the client and therapist collaboratively identifying and changing the automatic thought patterns
• known as ‘therapy during therapy’
• e.g. client may feel stressed about feeling that they were talked about, the therapist will teach the client to challenged their thoughts by asking questions like “where’s the evidence for this” therefore developing new rational ways of thinking.

Question 6

Pleasant activity scheduling

Answer 6

• the behavioural part of therapy
• clients plan a pleasant activity for themselves over a period of time
• e.g something that gives them the sense of accomplishment or a break from normal routine
• this will induce in positive emotions and client will move away from negative thinking (they have control)
• the client keeps a record of these activities and how it makes them feel helping with behavioural activation (changing behaviour)

Question 7

Research to support

Answer 7

S- CBT is highly effective in treating depression and anxiety related problems
E- jarret et al found that CBT was as effective as some antidepressant drugs when treating 108 patients with severe depresses over a 10 week trial
E- however Hollon et al 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
W- this suggests that CBT is still useful and commendable but it is not superior to all antidepressants.

Question 8

Therapist competence

Answer 8

S- the success of CBT is therapist competence
E- competencies in CBT include the ability to structure sessions, the ability to plan and review assignments and the application of relaxations skills etc
E- Kuyken and Tsivrikos claim that as much as 15 of the variance in outcome of CBT effectiveness may be attributes to therapist competence.
W - this suggests that therapist competence encourages clients to better themselves as they see the dedicated and skill full planning of the therapist hence why it’s a huge part of the success of CBT for clients

Question 9

Empowerment

Answer 9

S- it empowers clients to develop their own coping strategies and recognises that people have free will to do this
E- CBT has become the popular alternative to drug therapy or psychoanalysis especially for clients who would not cope with the determinist principles of the approach
E- for example the client may dislike the idea that their behaviour is caused by our biological makeup making them feel helpless.
W- for this reason, CBT has become the most widely used therapy by clinical psychologists working in the NHS as it empowers clients to look forward to the future as they can be helped.

Question 10

Ethical implications : patient blame

Answer 10

S- an ethical issue of CBT is that it assumes the client is responsible for their disorder
E- this may be a positive thing in that they are empowered to change their ways and that they have free will, but there are some disadvantages
E- 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 the position to change
W- therefore this is ethically wrong as “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

Question 11

Ethical implications : what is rational

Answer 11

S- an ethical debate of CBT is who judges what is an ‘irrational’ thought. what may seem irrational to a therapist may actually not be irrational
E- alloy and Abrahamson 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
E- they found that depressed people display the sadder but wiser effect and that they were more accurate in their estimates of the likelihood of ‘disaster’ than non depressed individuals
W- therefore the ethical issue is that CBT may damage self esteem resulting in psychological harm.