Therapy

• What is the therapy of the cognitive approach?

  Cognitive behavioural therapy (CBT)
• Aim of CBT

  To challenge negative maladaptive thoughts and replace them with healthy thinking.
• Main components of CBT

  Dysfunctional thought diary

  Challenging dysfunctional thoughts

  Pleasant activity scheduling
• Dysfunctional thought diary


  Clients keep a record of events leading to any unpleasant emotion.

  Client writes down automatic negative thoughts associated with these events and rate how much they believe in them (1-100%).

  Client then writes down a rational response to the automatic negative thought and rate their belief in it (1-100%)

  Client re-rate their belief in the automatic negative thought.
• Challenging dysfunctional thoughts 


  Once the client has revealed more about their thought patterns, they work with the therapist to identify and change their dysfunctional thinking patterns.

  Client is taught to challenge dysfunctional automatic thoughts by asking themselves

  where is the evidence of X?

  what is the worst that could happen if X were true?

  By challenging these dysfunctional thoughts and replacing them with more constructive ones, clients are able to try out new ways of behaving.
• Pleasant activity scheduling

  Client plans one pleasant activity a day. This could be something that gives them a sense of achievement or something that will involve a break from normal routine. This will induce more positive emotions and will detract from negative thinking patterns. This is behavioural activation (helping clients change their behaviour). Client records the activity & how they felt. Helps them to realise that they have control over their negative thinking patterns.
• Beck


  Cognitive triad

  Represents negative schema that people with MH hold. CBT aims to challenge this.

  Negative views about the world.

  Negative views about oneself.

  Negative views about the future.
• Cahill et al (2003)


  By the end of the therapy which lasted 12-20 sessions, 71% of patients who had completed their therapy experienced significant reduction in their symptoms. Only 13% of the patients who did not complete the therapy showed improvement.
• Jarrett et al (1999)


  In comparison to drug therapy, found that CBT was as effective as some anti-depressant drugs when treating 108 patients with severe depression over a 10 week period.
• Kuyken & Tsivikos (2009)

  Found that up to 15% of the effectiveness of CBT may be due to the competence of the therapist.
• Simons et al (1995)


  Suggests that CBT appears less useful for those who have high levels of irrational beliefs, are resistant to change and those whose stress reflects realistic stress in their life that cannot be resolved by CBT.
• Ethical issues of CBT

  Patient blame

  What is ‘rational’ may be subjective

  Alloy & Abrahamson (1979) - depressive realists tend to see things for what they are.

  Cost