Cognitive Behavioural Therapy

Question 1

Underlying Theory

Answer 1

• Amalgam of behavioural and cognitive interventions.
• Behavioural interventions aim to decrease maladaptive behaviours and increase adaptive ones by modifying their consequences, resulting in new learning.
• Cognitive interventions aim to modify maladaptive cognitions, self statements or beliefs.
• Basic premise that maladaptive cognitions contribute to maintenance of emotional distress and behavioural problems.
• Beck’s model posits that maladaptive cognitions include general beliefs or schemas about world, future or self.
• Consideration to specific and automatic thoughts in particular situations.
• Therapeutic strategies to change maladaptive cognitions lead to changes in emotional distress and problem behaviour.

Question 2

Techniques and Strategies

Answer 2

• To identify factors that cause, contribute to or exacerbate a particular problem
• Consider consequences of a behaviours:
  • the stimuli that are eliciting cognition, emotional and behavioural conditional responses
  • cognitions that are contributing to emotions and behaviours
  • effects of environmental and cultural contexts

Can be carried out in several different forms:

• Individual therapy
• Group therapy
• Self help book
• Computer program

Question 3

Applications

Answer 3

• Obsessive compulsive disorder (OCD)
• Panic disorder
• Post traumatic stress disorder (PTSD)
• Eating disorders
• Substance abuse

Question 4

Evidence Base

Answer 4

• Effective for cannabis and nicotine dependence but less effective for opoid or alcohol dependence
• When treating schizophrenia and psychotic disorder, CBT associated with positive outcomes, but lesser efficacy than other treatments
• Strong and weak evidence for depression could be result of publication bias (Cujipers et al, 2010)
• CBT for bipolar disorder - efficacy small to medium in short term comparison to TAU
• Limited evidence for superiority of CBT over pharmacological interventions for depression and bi-polar
• Large effect sizes for anxiety and obsessive compulsive disorder
• Medium effect sizes for social anxiety and PTSD
• Large effect sizes for treatment of anger or aggression (Saini, 2009)

Question 5

Strengths of CBT

Answer 5

• Focuses on human thought. Human cognitive abilities responsible for accomplishments and therefore problems
• Cognitive theories lend themselves to testing. When experimental studies are manipulated into adopting unpleasant assumptions or thought, they become more anxious and depression (Rumm & Litvak, 1969)
• Many people with psychological disorders have been found to display maladaptive assumptions and thoughts (Beck et al. 1983)

Question 6

Limitations of CBT

Answer 6

• Precise role of cognitive functions and processes are yet to be determined
• Cognitive model narrow in scope - broader issues need to be addressed
• Ethical issues in changing cognitions forcefully