Cognitive Behavioural Therapy (pg 62-63, 67)

WHAT CAUSES MENTAL ILLNESS? One of the key assumptions of the cognitive approach is that behaviour can be explained by _____________________________________. This means that the best way to understand behaviour is to investigate how an individual thinks about a situation. The cognitive approach argues that mental illness such as ________________, ___________________ or ___________________ are caused by maladaptive or negative thoughts and beliefs. It has been found that people who think negatively about the world are more likely to suffer from depression. Attribution (pg63) Yost and Weary (1996) compared depressed and non depressed students with an attribution task. They found that _____________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Similarly, Wall and Hayes (2000) found that ___________________________________ ________________________________________________________________________ ________________________________________________________________________ Becks Cognitive Triad (pg 65-66) Fill in the boxes below using the information on pg 66. Give an example of these types of thoughts.

This type of thinking can lead individuals to pay more attention to the negative aspects of situations, and ignore the positive. The glass is always half empty. It can be difficult for individuals to be able to break out of this pattern of negative thinking.

Becks Negative self-schemas (pg66) Our self schema is all the information, thoughts and feelings that we have about ourselves. If someone has a negative self schema, what sort of beliefs might they hold about themselves?

Cognitive errors (pg 2 of magazine article) These are examples of automatic negative thoughts that seem reasonable to the individual, but do not reflect reality. They bias our interpretation of the world, those around us, and ourselves. Name Catasrophising Mind reading Over generalising Labelling Description Example

Task Using the information above (attribution, the cognitive triad, self schemas and cognitive errors) write a description of someone who suffers with anxiety, stress or depression.

AIMS The aim of CBT is to challenge the negative thoughts and replace them with constructive positive thinking that will lead to healthy behaviour. People are often unaware that they are subject to cognitive errors, or that there are problems with their thinking. The therapist will try to make these maladaptive thoughts conscious, and then by challenging them, the client will see that there is no basis for these thoughts. In theory, this should cause the problem to disappear.

There are various types of CBT. We will be looking at two: Beck and Meichenbaum MAIN FEATURES BECKS CBT Read the magazine article, and answer the following questions.

What problems has CBT been used to treat?

What is Socratic questioning, how is it used, and what is its purpose?

What aspects of CBT use cognitive principles (investigating how people think)? What aspects of CBT use behaviourist principles

What role do early life experiences have in CBT? Dysfunctional thought diary: As homework, clients are asked keep a diary of thoughts and feelings associated with any negative events. They have to pay particular attention to any automatic negative thoughts. For each negative thought they have to rate how much they believe this (from 0%-100%). They then give a rational response to this thought, and rate their belief in that. Finally, they rerate their belief in the automatic thought. to

E.g. Automatic negative thought: My boss hates me because I am a bad person (belief: 60%) Rational response: My boss does not hate me. He is rude to everyone, and has had a very stressful day. Therefore, its nothing really to do with me. (belief: 80%) Rerated belief: My boss hates me because I am a bad person (belief: 20%)

Challenging dysfunctional thoughts: The client is taught how to challenge dysfunctional automatic thoughts outside of therapy by asking themselves questions such as Where is the evidence for X? and What is the worst that can happen if X was true. By answering these questions, the negative thought can be replaced by more positive constructive ones. E.g. Automatic negative thought: I am going to fail psychology, and my life will be over! Question 1: Where is the evidence that I am going to fail? I have done quite well in the last few tests the teacher has set. I should be ok if I revise. Question 2: What would be the worst thing that could happen if I fail? I would have to retake the exam, which isnt so bad. I would still be able to get a good grade.

MAIN FEATURES MEICHENBAUMS SIT Meichenbaum (1985) took CBT and adapted it to deal with stress. While he argued that you cannot avoid the causes of stress (school, job, family etc), you can adapt to cope with stress by changing the way you think about it. It is cognitive as it involves changing how a person think and behavioural as the result is to alter behaviour. Meichenbaum suggested that we can inoculate ourselves against stress in the same way that you can be protected from illnesses. Therefore, he called it Stress Inoculation Training. There are 3 stages. 1. Conceptualisation: learning to view perceived threats as problems to be solved, and to break down large stresses into smaller chunks that can then be dealt with. 2. Skills acquisition and rehearsal: Preparing how you will act including positive thinking, relaxation, social skills and using social support. The client uses coping self-statements such as Stay calm, I can deal with this, Ill make a plan of what to do, and This wont be as bad as I think it will. 3. Application: Applying what they have planned to different situations which increase in stressfulness. How could you use these 3 phases to help you inoculate yourself against exam stress? Conceptualisat ion Skills Acquisition Application

TASK In pairs Using the description you wrote on the second page of a person with an issue, role play in pairs. One person is the client; the other person is the therapist. The therapist needs to use CBT principles to help first identify and then challenge the negative thoughts held by the client. Once you have done so, write down a sample of

dialogue that demonstrates how CBT worked. FINDINGS FROM RESEARCH (pg 67) What did Cahill et al (2003) find?

What did Sandahl et al (1998) find?

David and Avelino (2003) found that CBT has the highest overall success rate of all therapies. However, Kuyken and Tsivikos (2009) suggested that as much as 15% of the effectiveness of CBT may be attributable to the competence of the therapist. This means that it may be the case that when CBT is effective it is due in part to the ability of the therapist more than the therapy itself. EVALUATION OF CBT Strengths Has been shown to be effective for a wide variety of mental illnesses It is the predominant method of therapy provided by the NHS It uses both cognitive and behavioural Weaknesses In some cases, other types of therapy (such as psychodynamic therapy) are more effective It pays little attention to early childhood experiences, and focuses instead on the

principles It is relatively quick and cheap compared to other therapies Has many real world applications

here and now It can be dependent upon the skills of the therapist who delivers the therapy Clients who do not complete a full course of CBT will often benefit little

Going further... Are negative automatic thoughts affecting your life? Try this quiz online: www.testandcalc.com/Self_Defeating_Beliefs/indexf2.asp Research into CBT being used for a social phobia http://bps-research-digest.blogspot.com/2005/02/social-phobia.html One person who was treated with SIT is Liverpool footballer Ryan Babel. What sort of stress would footballers be under, and how would SIT help them on the pitch? Pick a character from a film or TV show who exhibits maladaptive behaviour. If they were your client, how would you use CBT to help them overcome their issues?