Cognitive Behavioural Therapy Flashcards
Underlying Theory
- 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.
Techniques and Strategies
- 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
Applications
- Obsessive compulsive disorder (OCD)
- Panic disorder
- Post traumatic stress disorder (PTSD)
- Eating disorders
- Substance abuse
Evidence Base
- 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)
Strengths of CBT
- 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)
Limitations of CBT
- 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
CBT for depression
National Institue for Clinical Excellence (2009)
Comparison Interventions
- IPT & Pharmacotherapy
Findings
- When CBT was compared to other active psychological therapies (IPT and short-term psychodynamic psychotherapy), no clinically significant differences were found.
- Results of trials comparing CBT with antidepressant medication immediately posttreatment suggest broad equalivalence in effectiveness.
- However, after 12 months CBT appears to be more effective, with less likelihood of relapse compared to medication.Wiles, Hollinghurst, Mason & Musa (2008) - CBT
Comparison Interventions
- Clinical management plus pharmacotherapy
Findings
- CBT was found to be significantly more effective than clinical management in reducing relapse over a 6-year period following cessation of pharmacotherapy for depression.
Oei & DIngle (2008) - CBT
Comparison Interventions
- IPT and medications
Findings
- The review demonstrated that group CBT is one of the most effective treatment alternatives for depression and compared well with drug treatment and other forms of psychological therapy including individual therapy
CBT for Anxiety
Covin et al. (2008) - Meta analysis - CBT
Findings
- CBT for GAD is effective for reducing pathological worry, however, effectiveness was moderated by age.
- Younger adults responded more favourably to CBT interventions than did older adults. Despite this difference, when compared to control groups, the mean effect size of CBT for older adults was still higher.
- Therapeutic effects of CBT were maintained at 6- and 12-month follow-up.
CBT for PTSD
Bryant et al (2009) - CBT
Findings
- At post treatment and follow up, fewer participants in the prolonged exposure group had PTSD than those in any other group.
Meuser et al (2008) - CBT and TAU
Findings
- Those in the CBT group showed significantly greater improvement when compared to those in the control groups at post treatment assessments and at the 3-6 month follow up.
- The effects of CBT were strongest in participants with severe PTSD
Sjibrandij et al (2007) - CBT
Findings
- 1 week post intervention, the CT group had significantly fewer symptoms of PTSD than the comparison group
- At the 4 month follow up the difference was smaller and no longer significant
- Within the CBT group those with co-morbid depression at baseline had significantly fewer PTSD symptoms at 4 months
CBT for substance abuse
Magill & Ray (2009) - CBT - Meta analysis
Findings
- CBT demonstrated a small but statistically insignificant effect over TAU with the exception of marijuana abuse.
Stein et al (2009) - CBT (MI)
Findings
- Motivational intervention was more effective at reducing cocaine use than the assessment only control condition among those using cocaine at least 15 days a month
CBT for conduct disorder
Koegl et al (2008) - CBT
Findings
- significant within group changes were evident for the experimental and matched groups on measures of delinquent and aggressive behaviour
- Effects were larger for girls and older children
Eyberg et al (2008) - CBT - Family Therapy
Findings
- NO single intervention emerged as superior for disruptive behaviours
- However, parenting-training was recommended as the first line approach for younger children and the combination of parent and child training was recommended for older children
- For adolescents, multisystemic therapy (a combination of CBT, family therapy and pharmacotherapy)
CBT for Psychotic Disorders
National Institute for Clinical Excellence (2009) - Schizophrenia
Findings
- CBT was effective in reducing rehospitalisation rates up to 18 months posttreatment and there was also evidence indicating that length of stay in hospital was reduced. CBT was effective in reducing symptom severity both at treatment end and at 12 months follow up.
- When compared with any control or other active treatment, CBT was more effective in reducing depression. Although the evidence for CBT in relation to positive symptoms was more limited, data demonstrated some effect for hallucinations, but not for delusions.
- Family intervention appears to be an efficacious treatment for schizophrenia. Compared with standard care or other control conditions, family intervention reduced the risk of relapse at treatment end and up to 12 months posttreatment.
- Family intervention may also be effective in improving additional critical outcomes such as social functioning and disorder knowledge. When indirect comparisons were made between single family intervention and multiple
family intervention, the data suggest that only the former may be efficacious in reducing hospital admission.Geraty et al (2008) - Schizophrenia - CBT & FT
Findings
- Neither intervention had an effect on rates of remission and relapse or on days in hospital at 12-24 months
- CBT showed a beneficial effect on depression at 24 months but there were no effects for family intervention
Penn et al (2009) - CBT - Schizophrenia
Findings
- Patients who received CBT were more likely both to resist voices and to rate them as less malevolent through 12 month follow up
- CBT reduces severity of auditory hallucinations
Wykes et al (2008) - CBT - Schizophrenia
Findings
- CBT has beneficial effects on the target symptom as well as significant effects for positive and negative symptoms, functioning, mood and social anxiety
- However, there was no effect on hopelessness
