Cognitive Behaviour Therapy Flashcards
CBT aims to….
Change the maladaptive ways of thinking and behaving associated with substance or behaviour addictions.
2 indispensable elements to a CBT programme.
Functional analysis.
Skills training.
Functional analysis.
Identifies the cognitive biases that underline addictions, replacing the cognitive biases with more adaptive ways of thinking - cognitive element.
Skills training.
Helps a client to develop coping behaviours to avoid the high-risk situations that usually maintain addictions or trigger relapse (behavioural element).
Cognitive - Functional Analysis.
Client and therapist identify high-risk situations in which client is likely to gamble or use addictive substance.
Therapist reflects on what the client is thinking before, during and after such a situation.
Quality of client-therapist relationship = critical; should be warm, collaborative and responsive because therapist must challenge clients’ biased cognitions and not merely accept them.
Cognitive Reconstructing.
An initial educational element, in which therapist might give client information about nature of addiction.
Functional analysis - ongoing process.
Early phases - helps a client to identify the triggers for their addiction, vital starting point; useful later in helping a client to work out circumstances in which he or she is still having problems with coping, and what further skills training may be needed.
Behavioural - Skills training.
CBT helps client to replace strategy with more constructive ones.
Very flexible therapy, so therapist will be able to call upon a wide range of skills training techniques, starting with the basics and moving on to more individually tailored methods.
Specific skills.
CBT - focuses on wider aspects of a client’s life that are related to his/her addiction.
Assertiveness training - used to help a client confront interpersonal conflicts in a controlled and rational way instead of using avoidance, manipulation or aggression.
Social Skills.
Benefit from learning skills that help them to cope with social situations.
Therapist might begin with an explanation of reasoning behind learning a new skill.
A lack of skill = why someone relapses.
CBT - highly directive with client initially imitating therapist’s performance before eventually using skill on their own in high-risk situations.
Limitation.
P: Many clients drop out of CBT.
E: Pim Cuijpers et al (2008) note that drop-out rates in CBT treatment groups can be up to 5 times greater than for other forms of therapy.
E: This may be because CBT is a demanding therapy. In addition, clients often seek CBT initially because some life crisis caused by their addiction has driven them into therapy. Once the crisis is resolved, or doesn’t loom as large in their lives, these clients often give up therapy.
L: The high drop-out rate is a major obstacle to success of CBT in reducing addictions.
Strength.
P: It is useful in preventing relapse.
E: Most people’s experience of addiction is one of repeated relapse. CBT presents a very realistic view of recovery and incorporates the likelihood of relapse into treatment.
E: Relapse is viewed as an opportunity for further cognitive restructuring and learning rather than as a failure. It is an inevitable part of an addicted person’s life, but manageable as long as his or her psychosocial functioning improves.
L: Therefore, when clients stick with the therapy, CBT can help them to avoid relapse by maintaining a stable lifestyle.
Limitation and Strength.
P: CBT may be only effective in the short term.
E: Sean Cowlishaw et al (2012) conducted a meta-analysis of 11 dresses comparing CBT for gambling addiction with control conditions. The analysis showed that CBT had medium to very large effects in reducing gambling behaviour for periods of up to three months after treatment. But after nine to 12 months, there were no significant differences in outcome between the CBT and control groups.
E: The studies may have overestimated the benefits of CBT because they were of poor quality.
P: However, there is some high-quality research that challenges the idea.
E: Nancy Petry et al (2006) randomly allocated pathological gamblers to either a control group (Gamblers Anonymous meetings) or a treatment condition (GA + CBT). The treatment clients were gambling significantly less than the control ppts 12 months later.
E: This study has high internal validity because of the random allocation and also there were no significant differences in the extent of their gambling at the start.
Therefore, this one study (which was methodologically better) suggests that CBT is effective in reducing gambling addiction beyond the short term.
