dream analysis and CBT

• what are the main components of dream analysis

  - Dreams as wish fulfilment- The symbolic nature of dreams- Dreamwork- Role of the therapist
• what does 'dreams as wish fulfilment' mean


  - all dreams were the unconscious fulfilment of wishes that could not be satisfied in the unconscious mind because hey are unacceptable (desires of the id / repressed trauma)- dreams therefore protect the sleeper by stopping these desires from building to an unacceptable level which would threaten our sanity (anxiety/depression)- dreams allow us to express and live out some of these desires in a more acceptable waythe repression of there true desired is seen to be a source of mental and behavioural disorders, and so the therapy aims to interpret dreams to uncover the true wishes they represent
• what does the 'symbolic nature of dreams' mean


  - dream analysis works on the principle that what the dreamer recalls is is actually a symbolic representation of the truth buried in their unconscious mind- for example = female genital - caves, boxes, bottles male genitals = horses, hands, fire - latent content = hidden/real meaning (the true wishes and desires)- manifest content = the dream itself (how these desires are symbolised in the dreams we remember)- the process of changing the latent content into manifest content is called 'dreamwork', which is a type of defence mechanism.- an example is displacement. this is when the emotional significance of a dream object is separated from its real object and attached to an entirely different one. the dreamer can experience the emotion in an uncensored but safer way.
• what is a 'dream diary'


  - between therapy sessions the client may be asked to record their dreams on waking.- the manifest content of the dream is often forgotten as we get involved in the day so the client may be asked to keep the dream diary near their bed and record dreams on waking- the manifest content that is recorded in the dream diary is the basis for discussion during therapy sessions
• what is the 'role of the therapist'

  - to reverse the dreamwork process - decode the manifest content back to the latent content-Freud emphasised only trained psychologists should do this as the interpretations need to be in context with the clients life experiences - sometimes the manifest content of the dream does not actually represent some latent content.
• what is a strength of the effectiveness of dream analysis - 1

  - supports effectiveness in treating disorders such as depression and anxiety- Matt and Navarro (1997) received 63 meta analysis on the effect of psychotherapy and found that an average of 75% of clients receiving dream analysis showed improvements in the issues they were having therapy for. - this suggests DA is effective form of therapy for common mental health issues
• what is a strength of the effectiveness of dream analysis - 2

  - supports effectiveness in helping people improve their self esteem and gain greater insight into their mind- Falk and Hill compared 22 separated and divorcing women (aged 22-57yrs) in an 8 week dream interpretation groups to 12 women in control conditions in terms of changes in anxiety, depression, coping, self-esteem, and insight into their dreams- results indicate that women who participated in dream interpretation groups showed improvement compared to the control group in self - esteem and insight. - suggests its effective at helping individuals (e.g. women) adjusting to significant life changes (e.g. divorce)
• what is a weakness of the effectiveness of dream analysis.

  - its based on unfalsifiable concepts and subjective interpretations.- Freud did not support the idea of dream dictionary's as each interpretation needed to be made in the context of the individual clients situation- E.g. a cigar in a dream may represent male genitals or may simply represent a cigar depending on the context of the dream. therefore the interpretations are based on the subjective judgement of each individual therapist. - this means it is difficult to scientifically demonstrate that it is the interpretation of a dream tat leads to the effective treatment of behaviour or mental disorders. one therapists interpretation may differ significantly to another
• what is a strength of the effectiveness of dream analysis

  - does address the long term underlying cause of the psychological and behavioural problems- DA works on uncovering repressed unconscious conflicts and desires that may have occurred in early childhood, bringing them to the surface and confronting the issue should result in a long-term end to the problems they were causing later in life- this is a strength compared to other therapied such as biological and behavioural therapies which only treat the symptoms of the problem
• conclusions for dream analysis

  - there is evidence that suggests DA is effective- if DA does treat the root cause it should avoid problems such as the 'revolving door' where people have to keep returning to therapy as their symptoms reoccur- however much of the evidence is unscientific
• what are the three main components to CBT

  - engagement strategies - cognitive strategies- behavioural skills
• what is 'engagement strategies'

  - are used at the start of the therapy to create a rapport with the client and discuss any worries they have about CBT- for example, this would be essential for someone who has schizophrenia if the client is in a paranoid state then the therapist needs to gain their trust
• what is 'cognitive strategies'

  - are used to help the client identify their irrational thoughts and teach the patient strategies to challenge their disordered thoughts- e.g. dysfunctional thought diary (DTD) - a form of homework the client completes between sessions to help the client gain insight into their existing dysfunctional thought processes and recognises faulty thinking patterns for themselves- the client records the negative automatic thoughts and emotions in response to events during the week then rate how much they believe it (e.g. on a scale of 1-100)they then create an alternative more rational response to the same event and then rates how much they believed the initial negative though ( on a scale of 1-100)- after, their belief in the dysfunctional thought should have decreased
• what is cognitive restructuring

  - helps the patient to identify and challenge irrational thinking which they may have identified via the thought diary- is a collaborative process whereby the therapist works with the client to break down faulty thought patterns and rebuild them with more rational and positive ones- the therapist my use different methods to do this - empirical disputation which involves getting the patient to provide evidence to back up their thoughts
• what is 'behavioural skills'


  - training teaches the patient behaviours that will help manage their symptoms- once the dysfunctional thoughts have been broken down, the therapist then can help the client learn alternative ways of thinking about situations, and behavioural strategies to prevent the automatic faulty thoughts from kicking back in.- e.g. counting to 10 before responding to the situation- another strategy is PAS - where client should plan a pleasant activity each day during therapy. something that produces a sense of accomplishment. - it will provide pleasant emotions and distract the person from negative thoughts and it is reinforcing a more positive view of the world (helping rebuild good schemas)- the client is gradually changing their behaviour - behavioural activation - taking steps towards positive experiences takes client away from their negative thinking
• what is a strength of CBT

  - effective at treating serious psychological problems- Kuipers et al ('97) - 60 people with medication resistant schizophrenia were randomly allocated to receive CBT and standard care or standard care alone. 9 months later 50% of in the CBT condition had improved, compared to 31% in the standard care condition- furthermore, only one person in the CBT condition got worse whereas 3 got worse in the SC condition and one suicide- suggests CBT in conjunction with normal care can be very effective for treating people with Sz even when medication has failed to help. also can limit the potential for suicide
• what is a strength of the effectiveness of CBT

  - effective at modifying criminal behaviour- Ladberger and Lipsey reviewed 58 studies of CBT with offender. 20 of the studies used AM techniques and the element of anger control was significantly related to an improvement in the offenders behaviour- suggests that anger management (CBT) is successful in reducing anger and aggression which can lead to benefits for both the offenders and society as it reduces the change of them reoffending
• what is a weakness of the effectiveness of CBT

  - not effective then the 'input' is a realistic stressor- Simons argues that sometimes the cause of depression or anxiety are genuine life events such as bereavement or serious illness. CBT works on the basis that the person is processing events in a dysfuntionally negative way. however, it may not be possible to think about realistically bad situations in a more positive way. - suggests CBT is only effective in situations where the problem is the result of irrational thoughts to a not so serious event
• what is a weakness of the effectiveness of CBT

  - may not be effective for everyone as it requires commitment and motivation from the client- e.g. in treating schizophrenia Tarrier reported that 45% of his sample refused to cooperate with a CBT programme and dropped out. also, when using for criminal behaviour, some offenders do not like to reflect on their way of thinking and as such they may drop out of AM- suggests not clearly appropriate for all individuals. requires ability to commit and time and effort to process and willingness to reflect and challenge thought processes.
• conclusions for CBT


  - is still a dominant therapy use in psychology and considered effective for treating a range of mental health problems e.g. anxiety, depression- divided opinion on whether CBT is effective at treating the root cause. some argue it simply helps control irrational thinking of the disorder
• ehat are the main components of aversion therapy

  - counterconditioning-different formscovert sensitisation
• what is counterconditioning

  - client is presented with an aversive stimulus e.g. electric shock or drug = pain or feeling sick - this is repeatedly paired with the undesirable behaviour ( e.g. drinking alcohol)- client associated their undesirable behaviour (drinking alcohol) with a new negative response (feeling sick/pain)
• what are the different forms of aversive stimulus- Antabuse

  Antabuse = alcoholics - this drug affects how the body metabolises (breaks down) alcohol by blocking the action of the enzyme 'aldehyde dehydrogenase' - causes a build up of acetaldehyde, which is a toxin, that causes unpleasant physiological effects e.g. sweating, headaches this means that when a person who is taking Antabuse drinks alcohol they feel unwell within 10 mins - therefore alcohol use becomes associated with a negative reaction rather than a positive one- Antabuse stays active in the system for at least 14 days
• what are the different forms of aversive stimulus - rapid smoking

  rapid smoking = smoking- smokers sit in a room and take a puff of a cigarette every 6 seconds until they finish a specific number of cigarettes or feel sick- the person associates the unpleasant feeling with cigarettes and develops an aversion to smoking- this may be repeated over several sessions in order to make the association strong enough for the person to develop a severe aversion
• what are the different forms of aversive stimulus - electric shock therapy


  electric shock therapy = gambling addictions- a person will either take part in their usual gambling activity or watch a video of themselves or someone else engaging in their usual gambling activity whilst receiving painful electric shocks - this is intensively repeated until a negative association is created
• what is covert sensitisation

  - a unique form of AT, less commonly used- clients use their imagination rather than being exposed directly to aversive stimuli- e.g. alcoholics imagine upsetting , repulsive or frightening scenarios - clients may often be asked to imagine scenarios that get progressively worse
• what is a strength of the effectiveness of aversion therapy - 1

  - effectiveness of treating alcohol addiction with Antabuse-Neiderhoffen and Saffen (03) compared antabuse to a placebo and found that antabuse patients had a longer period of abstinence (not drinking) compared to the placebo group.- suggests the use of using antabuse to provide an unpleasant stimuli is effective at treating serious addictions such as dependency on alcohol. - however it may be that antabuse is more effective when taken alongside other 'talking' therapies.
• what is a strength of effectiveness for aversion therapy - 2


  - evidence that the use of rapid smoking is effective in treating smoking addictions- McRobbie ('07) fund that participants in the rapid smoking condition showed a significant decrease in their urge to smoke in the 24 hours, and then the week, after rapid smoking compared to a controlled group that watched an anti-smoking video- suggests rapid smoking is an effective unpleasant stimulus in using AT to break smoking addictionshowever four weeks later there were no significant difference in the amount of smoking between the two groups - therefore may only have short term benefits
• what is a weakness in the effectiveness of Aversion therapy - 1


  - may be issues with the effectiveness compared to other forms of treatment- due to unpleasant nature of treatment patients may choose to stop engaging with the aversive stimulus meaning there are likely to be issues with non compliance - therefore, the effectiveness of aversion therapy may be questioned when it comes to the long term effectiveness of antabuse
• what is a weakness of the effectiveness of aversion therapy - 2

  - it only tackles symptoms rather than the root cause- negative association may treat how the individual feels towards the focus of their addiction, but does not treat the underlying cause of the addiction e.g. genetics, personality traits - this means that while the therapy may appear to successfully cure the person of that particular addiction, the underlying problem may reoccur in the form of a different addiction or some other undesirable behaviour (known as 'symptom substitution')