Lecture 2 - Medical Model & CBT Flashcards
What did the Medical Model introduce?
Shift away from cultural/religious beliefs
Introduced scientific thinking regarding
understanding of psychopathology
– Given rise to large body of scientific knowledge
Based on Medicine – Psychiatry
Primary approach
– Identify biological causes
– Treat with medication/surgery
Biological Explanations of the Medical Model
Many biological explanations
– Brain abnormality
– Biochemical imbalances – neurotransmitter
imbalance
– Genetic Factors
– Physical effects of pathological activities
Problems with Medical Model
Aided development of a scientific view and
influential treatments, but…
Implies cause is always medical or
biological
Reductionist
– Reducing complex psychological and emotional
factors simply to biology
* Struggles to explain dysfunctional beliefs
characteristic of many psychopathologies
Further problems with MM
Problems with the implicit assumption
– Dysfunction vs extreme form of normal
behaviour
* AN, DP
– Impacts our views of individuals with MHPs
adding to stigmatisation
Drug Treatments
Regularly used to alleviate some of the
symptoms of psychopathologies, e.g.:
– Anti-depressant Drugs
– Antipsychotic Drugs
– Anxiolytic Drugs (Tranquilisers)
Antidepressant Drugs
Successfully developed in 1960s
– Tricyclic Antidepressants
* Increase amount of norepinephrine and serotonin available
for synaptic transmission
– Monoamine Oxidase (MAO) Inhibitors
* For those who do not respond to other antidepressants
– Also useful in treating panic disorder and bipolar depression
– Selective Serotonin Reuptake Inhibitors (SSRIs)
* Selectively affect the reuptake of serotonin
Antipsychotic Drugs
Use of effective antipsychotics
common in 1960s and 1970s
– Block dopamine receptors, helping to
reduce high levels of dopamine in the
brain
Reduce symptoms
Side effects
– E.g., blurred vision, muscle spasms,
blood disorders, cardiac problems
– Treatment adherence
Anxiolytic Drugs
Benzodiazepines
– Increasing the level of GABA at synapses in the
brain
– Usually only prescribed for short periods as risk
of dependency over a longer period of use
– Risk of abuse if available in large doses
Problems with Drug Treatments
– Medicalisation of mild psychopathology
– Long-term prescription may lead to perception of
dependence on drugs for psychological and social
functioning
– Can prevent understanding and insight into the
psychopathology
– Some evidence to suggest that may alleviate immediate
symptoms, may worsen long term course (e.g., Fava, 2003)
Can be prescribed in conjunction with
psychological therapies
Behavioural Approach
Psychopathology reflects learned reactions to
life experiences
Learning Theory
– Dysfunctional behaviour (as adaptive behaviour)
can be acquired through learning
Encompasses principles of classical and
operant conditioning
Frequently applied to explaining and treating
psychopathology
Classical Conditioning: Pavlov (1849 - 1936)
UCS food -> UCR salivation
CS + UCS -> UCR
CS -> CR
Classical conditioning applied to mental health
Trauma e.g. car accident -> UCR Fear and
UCS Anxiety
Phobic stimulus -> Fear and anxiety
Travelling in car CS CR
+ UCS
CS -> CR
Operant conditioning: Skinner (1904-1990)
- Consequences of behaviour
important - Positive reinforcement
- Negative reinforcement
- Friendly person has been
reinforced for being friendly and
visa versa
Operant conditioning applied
‘The learning of a specific behaviour or response
because that behaviour has certain
consequences’ (Davey, 2008, p.13)
For example:
– Acquisition of bizarre behaviours in Schizophrenia
(Ullman & Krasner, 1975)
– Stress-reducing or stimulant effects of nicotine, alcohol
and illegal drugs that may lead to substance
dependency (Schachter, 1982)
– Checking behaviours and OCD
Pros and cons of Behavioural Model
+ Has lead to development of
important behavioural
treatment approaches
- Neglects the cognitive
aspect of psychopathologies
E.g., dysfunctional
thinking - Psychopathologies complex,
acquired gradually over
many years
Difficult to trace
reinforcement history
Cognitive Approach
Psychopathology explained in terms of
individuals
– Acquiring irrational beliefs
– Developing dysfunctional ways of thinking
– Biased information processing
Pioneers = Ellis and Beck
Ellis (1962)
Individuals develop a set of irrational
beliefs by which they need to judge their
behaviour
– This causes emotional distress (anxiety or
depression)
Results in unrealistic demands
– Individual with anxiety:
* ‘I must be loved by everyone’
– Individual with depression:
* ‘I’m incapable of doing anything worthwhile’
Beck (1967)
Depression is a result of biases in ways of
thinking and processing information
Individuals with depression develop Negative
Schema
– Set of beliefs that tends individuals towards viewing
the world and themselves in a negative way
* Themselves: ‘I am worthless’
* The world: ‘Bad things happen to people’
* Their future: ‘I’m never going to achieve anything’
These beliefs maintain depressive thinking
Beck - Negative beliefs example
Example: You’re fired from your job
Cognition
‘How dare they!’ -> Anger
‘I am a failure. My
life is in ruins’ -> Depression
‘This is a chance to
start again’ -> Nervous but positive
Cognitive Principle
Emotional reactions, strongly influenced by cognitions
* People react differently to similar events
* Not event that determines emotion, but cognition
The ‘common sense’ model
Event -> emotion
The cognitive model
Event -> cognition -> emotion
Pros of Cognitive Approach
Applied across a broad range of MHPs
– Anxiety, Mood Disorders, paranoid thinking in
Schizophrenia (Morrison, 2001)
– Anti-social and impulsive behaviour in
Personality Disorder (Young, Klosko &
Weishaar, 2003) etc…
Successful in generating a highly influential
approach to treatment (CBT)
Cons of Cognitive Approach
– Dysfunctional thoughts might not be a cause
rather a symptom of psychopathology
– Very little insight into how dysfunctional
thoughts and beliefs develop
* Do they develop from emotional and behavioural
symptoms?
* Post hoc constructions that function to aid in
rationalisation of how an individual feels?
Cognitive-Behavioural Approach
Unhelpful cognition
‘I am worthless, incompetent, a failure’
Behavioural change
Reduced/avoided activity, unhelpful
behaviour (excessive drinking, cutting,
reassurance-seeking)
‘The Hot Cross Bun’ CBT formulation Model (Padesky and Mooney, 1990)
<-Environment->
Physical Response -> Thoughts -> Feelings -> Behaviour ->
In big circle, all affect eachother
Cognitive-behavioural Therapy (CBT) introduction
Developed out of early cognitive therapies
– Cognitive Theory
* Psychopathology manifestation of dysfunctional ways of thinking, processing and interpreting information
– Cognitive Therapy
* Address and change dysfunctional cognitive features
* Two influential cognitive therapies
– Rational Emotive Therapy (RET) (Albert Ellis, 1962)
– Beck’s Cognitive Therapy (CT) (Aaron Beck, 1967)
Rational Emotive Therapy (RET) (Ellis, 1962)
Theory
– Individuals hold implicit irrational
assumptions used as judgement
– When not met
* Emotional distress, anxiety, depression
RET
– Challenges irrational beliefs
– Replace with more rational beliefs
– Client tests out new beliefs using behavioural
exercises (REBT)
Beck’s cognitive therapy
Beck’s Theory of Depression
– Negative ‘triad’
Therapy
– Addresses schemas (beliefs)
– Deconstruct and replace schemas with more
rational schemas that do not lead to negative
interpretations
CBT
Behavioural Theory
– Assumes psychopathology acquired through
learning
Behavioural Therapies
– Developed through the use of conditioning
principles to help individual to ‘unlearn’
problematic associations
* Classical conditioning (exposure, aversion therapy)
* Operant conditioning (functional analysis, response shaping)
CBT ABC Model
A - Activating Event
-> actual event, client’s immediate interpretations of event
I
B Beliefs
-> Evaluation (rational or irrational)
I
C Consequences
-> Emotions, behaviours, other thoughts
Cognitive Therapy: Automatic Thoughts and Maladaptive Schemas (core beliefs)
AT
I should be doing better in life
MS
I must be perfect to be accepted
Cognitive Therapy: Thinking Biases
- Overgeneralisation
- Mental filter
- Discounting the positive
- Jumping to conclusions
- Magnification
- Personalisation
- Catastrophising
- Mind reading/fortune telling
Addressing Dysfunctional Cognitions
Methods:
1. Socratic questioning
2. Guided discovery
3. Examination of evidence
4. Examination of advantages and disadvantages
5. Imagery
6. Role play
7. Rehearsal
8. Homework
Questions encourage client to break through
rigid patterns of dysfunctional thinking and
to see new perspectives
Challenge accuracy and completeness of thinking in a way that acts to move
people towards their ultimate goal
Behaviour Therapy (Exposure)
Exposure Therapies
– Use principles of extinction
* Disruption of association between anxiety-provoking
cue and threatening consequence
– Expose client to stimulus that evokes distress to learn that no longer threatening:
Flooding & Systematic Desensitisation
Behaviour Therapy (Aversion)
– Attempts to condition an aversion to the
stimulus that the client is inappropriately
attracted
* E.g., Substance Misuse Disorders where taste of
alcohol paired with aversive outcome (sickness - inducing drugs)
Behaviour Therapy (Functional Analysis + Response Shaping)
Functional Analysis
– Identify consistencies between problematic
behaviours and their consequences
– Address maintaining factors through extinction
* Behaviour no longer reinforced or type of
reinforcement no longer rewarding
Response Shaping
– Encouragement of new behaviours not
occurring at a reasonable frequency
CBT tools
Activity Scheduling
* Decrease in functional ability
* Significant changes in activity levels
* Feeling overwhelmed by the resumption of
activity
* Loss of structure to daily routine
* Changes in extent to which activities
associated with pleasure or achievement
Behavioural Experiments
- get clients to carry out experiments
- Target cognitions (thoughts, assumptions testing)
- Experiment to face the situation
- Predictions
- Outcome
- What I learned
