Cognitive assumptions and CBT.

• Cognitive - thinking/mental processes - memory, perception, attention and language.
• Perception - our outlook how we see things.
• Attention - addictive behaviour, attentional bias, too much attention more engaging.
• Introspection - how to measure internal mental processes.
• Schemas - a template, model, framework, mental processes.
• Hostile attribution bias - faulty cognitive processing, somone is a threat to you.
• Computer analogy - our mind is like a computer and the mind is like the hardware of a computer and cognitive (mental) processes is our software. Brain has an input of information from environment by senses, then process the data changing it and storing it using internal mental processes like memory and language. have an output in form of recall decisions or actions.
• Computer analogy - could explain aggressive behaviour, some have faulty cognitive processing known as hostile attribution bias, bias towards thinking the worst, if someone smiles at you (input) you think that the person is actually thinking bad thoughts (faulty processing) cognitive approach would suggest that such negative thoughts lead to aggressive behaviour (output).
• Internal mental processes - perception, memory, language and thinking, to gather and process information. these processes relate to each other and constantly work together to help individuals understand their environment. Can be measured by introspection, this techniques investigates the internal mental processes of gamblers and non-gamblers. A group of regular gamblers used more irrational verbalisations of their thought processes compared to non-gamblers.
• Internal mental processes - such as attention can be associated with addiction, people with addiction have attentional bias towards behaviour they are addicted to, so pay too much attention to cues associated with it and encourage them to keep engaging.
• Schemas - organised packets of information built up through experience and stored in our long-term memory. our dog schema is four legs, furry, bark. Schemas are usually based on past experiences but can be refined by further interactions with people and the world around us. Schemas can take different forms such as schemas for events or roles.
• Schemas - cognitive explaination of depression which suggests that depression is caused by the cognitive triad which involves a person having negative schemas about themselves the world and the future.
• Engagement strategies - used at the start of the therapy to creat a rapport with the client and discuss any worries that they may have about CBT. E.g. would be essential to someone with schizophrenia if the client is in a paranoid state then the therapist needs to gain their trust.
• Cognitive strategies - used to help the client identify their irrational thoughts and teach the patient strategies to challenge their disordered thoughts. Several different strategies the therapist might use in this process.
• Cognitive strategies - dysfunctional thought diary 1 - 'homework' client gains an insight and can recognise their faulty thinking patterns and start to consider alternative rational ways of thinking about events. They use the DTD to record negative automatic thoughts and emotions they experience in response to events during the week and how much they believe in the thought.
• Cognitive strategies - dysfunctional thought diary 2 - They then write an alternative more rational response to the same event. The client then rerates how much they would still believe in their initial negative thought so, by considering an alternative way of processing the event their belief in dysfunction should decrease.
• Cognitive restructuring - helps patients to identify and challenge irrational thinking via the thought diary. therapist works with clients to break down the faulty thought patterns and rebuild them with more rational positive ones. Can be challenging to do if negative thoughts are fixed. Could also use empirical disputation which is where the patient has to provide evidence for their thoughts.
• Behavioural skills - training teaches the patients behaviours that will help manage their symptoms. once dysfunctional thoughts had been broken down, therapist helps the client to learn alternative ways of thinking about situations and behavioural strategies to prevent automatic faulty thoughts from kicking back in. for example to count to 10 before responding to a situation.
• Behavioural strtaegies - pleasant activity scheduling PAS. behavioural part of CBT clients should plan a pleasant activity each day during therapy. this can produce a sense of accomplishment such as going for a run or a total break from routine. Will provide pleasant emotions and distract the person from negative thought, reinforcing a more positive view of the world helping to rebuild good schemas of themselves the world and the future.
• Behavioural strategies - The client gradually changing their behaviour called behavioural activation. taking steps towards positive experiences moves the client away from their negative thinking and maladaptive behaviour.
• Effectiveness


  How well something works
• Kuipers et al, 60 people with medication resistant Schizophrenia were randomly allocated CBT and standard care or standard care alone
• 9 months later 50% in CBT condition improved compared to only 31% in standard care alone condition
• Only 1 person in CBT condition got worse, 3 had got worse and one committed suicide in the standard care alone condition
• With normal care


  Can be effective for treating people with Schizophrenia where medication failed to help
• CBT


  Can limit potential suicide
• CBT is effective in improving Schizophrenia and preventing serious consequences of the condition
• Evaluation - effectiveness - is effective - method of modifying criminals behaviour, Landberger and Lipsey reviewed 58 studies of CBT with offenders, 20 used anger management techniques and the element of anger control was significantly related to an improvement in the offenders behaviour, suggests that anger management is successful in reducing anger and aggression which can have benefits for both the offenders themselves and also benefits society in helping reduce reoffending of anger related crimes.
• Evaluation - effectiveness - not effective - where the 'input' is a realistic stressor, Simons argues that sometimes the cause of depression or anxiety are genuine negative life events such as a bereavement or serious illness. CBT works on the basis that the person is procesing events in a dysfunctionally negative way, however it may not be possible to think about realistically bad situations in a more optimistic way. This suggests that CBT is only effective in situations where the problem is the result of irrational thoughts to a not-so-serious event.
• Evaluation - effectiveness - not effective - for everyone as it requires committment and motivation from the client
• In treating SZ


  • Tarrier reported that 45% of his sample refused to cooperate with a CBT programme and dropped out
• Using CBT to treat criminal behaviour


  • Some offenders do not like to reflect on their way of thinking and as such they may drop out of anger management programmes
• CBT is clearly not appropriate for all individuals as it requires the ability to commit time and effort to the process as well as having a willingness to reflect and challenge thought processes
• CBT


  Cognitive Behavioural Therapy, a dominant therapy used in clinical psychology
• Effectiveness of CBT


  • Considered effective for treating a range of mental health issues such as anxiety, depression, schizophrenia and more
  • Divided opinion as to whether it addresses the root cause of a disorder or just helps control/change irrational thinking
  • Often delivered as part of a multi-treatment programme alongside drugs to increase its effectiveness
  • More expensive in the short term but more cost effective over time when effective for individuals
• CBT is still a dominant therapy used in clinical psychology
• Evaluation - ethical issues - strength - allows patient to use free will to avoid chemical straightjacket that drugs impose. CBT gives patient control over their thoughts rather than taking drugs which control their mind and body it acknowledges the role of free will and encourages patients to take control of and change their thoughts. Therefore can be argued that CBT is ethical for treating mental disorders and more ethical than drug treatment or dream analysis as clients are not overly reliant on someone/something else to help them overcome their issues.
• Alloy and Abrahamson identified sadder but wiser effect that depressed people may see things in a more realistic way but normal people may distort things in a positive way
• Evaluation - ethical issues - strength - CBT is a therapy that empowers the individual, clients who have CBT are encouraged to realise that while they can do little about life stressors they can change the way they process life events and therefore change their behaviour/emotions as a result of this. Can be seen as ethically positive element as it can prevent feelings of helplessness during difficult times, CBT can be seen to teach 'techniques for life' that in theory can be used in the future and outside of therapy sessions if symptoms return.
• Evaluation - ethical issues - weakness - CBT is unethical due to a lack of voluntary consent for some vulnerable individuals, CBT is often used with criminals in prisons and when treating vulnerable schizophrenic patients, in many cases criminal offenders are required to take part in a anger management programme as a condition of their probation, Forced participation for vulnerable individuals would be against the ethical code of therapists and therefore it could be argued that CBT as a method of treating certain mental issues/behaviours is unethical.