CR

Question 1

List the 4 steps to CR (Richards & Whyte, 2011).

Answer 1

1. State the rationale
2. Identify the thought, as well as any associated emotion and it’s intensity
3. Provide evidence for and against the thought
4. Identify the new thought, as well as any associated emotion and it’s intensity

(Richards & Whyte, 2011)

Question 2

Describe a key critique of CR.

Hint: To do with causation.

Answer 2

CR assumes there is a causal link between unhelpful thoughts and low mood/anxiety.

Question 3

List the 4 key principles of CR.

Answer 3

1. Note down the thought asap after the event
2. Do not write down emotions as thoughts e.g. ‘I feel sad’
3. Do not note down questions as thoughts e.g. ‘what if she thins I am stupid?’
4. Challenge the hot thought- the one associated with the most intense emotion (Greenberger & Padesky, 1993)

Question 4

When can CR help in cases of depression?

Answer 4

Individuals with depression tend to experience low levels of motivation and a lack of concentration, making them unlikely to engage fully with CR. For this reason, it is recommended that BA is used as a first line treatment for depression. Then once motivation levels have increased, the patient may be able to better engage with CR.

Question 5

It is helpful to use CR in cases where….

Answer 5

.. unhelpful thoughts are a key maintenance factor.

Question 6

Should we use CR in cases of GAD?

Answer 6

In cases of GAD, thoughts are often future-oriented, hypothetical questions which are difficult to challenge. Therefore it is advisable to use worry time instead.

Question 7

Name the study where BA was compared to BA + CR and BA + CR + CBT.

Answer 7

Jacobson et al (1996).

Question 8

What did Jacobson et al (1996) find?
What can we conclude?
What is the wider implication?

Answer 8

There were no significant differences in clinical improvement between groups.
Conclusion: Thought-challenging provides no ‘added value’ when given alongside BA.
Wider implication: Are unhelpful thoughts really a maintenance factor in depression? (Dobson & Khatri, 2000).

Question 9

Dobson and _____ (2000) argue that thought-challenging is a waste of time and money. List 3 of their arguments.

Answer 9

1. BA alone is simpler for a patient to understand and engage with, compared to BA + CR
2. BA alone saves money- organisations needn’t invest in training practitioners to give CR
3. BA alone saves time- organisations needn’t invest in the time to train practitioners to give CR

Question 10

McManus et al (2012) compared the relative efficacy of CR vs. BE in challenging beliefs. What did they find?

Answer 10

1. Both lead to clinically significant improvements relative to the control group
2. BE lead to greater belief change
3. BE lead to more immediate belief change
4. In the BE group, the new belief was more likely to be generalised to others, as well as the self.

Question 11

One challenge with CR is that patients don’t do their homework. How might we resolve this?

Answer 11

Use COM-B and problem-solving both before setting the HW and in cases where HW has not been completed.

Question 12

Another challenge with CR is that sometimes patients write down questions in the thoughts column. How might we resolve this?

Answer 12

Warn against this from the outset. If the patient returns their homework and the thoughts listed are questions, ask ‘if the answer to that question was ‘yes’, or if that worry were true, what would it mean?’ and the answer to this constitutes the thought which needs to be challenged.

Question 13

A problem sometimes experienced when doing CR is that patients might have difficulty finding evidence for/against the thought. How might we resolve this?

Answer 13

Encourage perspective-taking. E.g. Ask the patient what they would say to a friend who had that thought. Then ask the patient what a family member would say if they knew the patient had this thought. Alternatively, the practitioner could agree with the patient that they will involve a family member or friend when completing the evidence column.

Question 14

A problem occasionally experienced when doing CR is that the thought listed is actually true. What could a practitioner do in this instance?

Answer 14

1. Acknowledge the thought may be true
2. Regardless of the truth of the thought, it may be useful to look at how the thought is worded- is the patient being kind/fair to him/herself?
3. If the thought represents a problem, it may be appropriate to use problem-solving