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 contextsCan 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