Describe how the computer anlogy is applied in cognitive behavioral therapy
The aim of CBT is to treat behavioural or emotional disorders such as depression, schizophrenia, OCD and anger issues. CBT does this based on the model provided by the computer analogy. Most people think that it is the situations they face in life (‘input’ in the computer analogy) that cause their anger or depression (‘output’ in the computer analogy) whereas the cognitive approach believes that the faulty output is due to irrational or faulty ‘processing’.
Describe how the internal mental process is applied to cbt
Therefore, the therapy aims to challenge these dysfunctional internal mental processes and help restructure them into more realistic and positive ones. For example, in the therapy the client keeps a dysfunctional thought diary so that they, and the therapist, gain insight into their faulty mental processes. And start to challenge them. (EXT - add detail - For example, by getting the client to rate their belief in their dysfunctional thought, then writing a different more rational thought, then rerating their belief in the original thought. The amount they believe in the original thought should decrease). During cognitive restructuring, the therapist helps the client challenge their current processes and rebuild alternative ways of processing the ‘input’. (EXT - add detail - For example, the therapist may use
‘empirical disputation’ where they ask the client to provide evidence to support an overly negative thought. The client is not likely to be able to do so and start to see that their thoughts are not based on reality).
Describe how the schemas is applied in CBT
Another assumption that is applied in the therapy is that of ‘schemas’. Beck stated that people with depression often have a negative cognitive triad - a set of
irrationally negative schemas about themselves, the
world and the future. Again, through cognitive restructuring these are challenged and rebuilt. In
addition, the ‘pleasant activity scheduling’ aspect of
CBT helps the client see that the world can be a source of enjoyment. This further helps the client build more positive schemas about the world, the future and themselves.
Components of CBT - engagement strategies
Engagement strategies are used at the start of the therapy. The therapist will outline the purpose of CBT, which is to identify faulty thought processes with the aim of trying to help adiust the way clients perceive and think about situations to treat a range of disorders e.g. anxiety, depression, Sz etc. Clients are also given the opportunity to discuss any worries they may have specifically about CBT. This helps to build a good rapport between the client and therapist in order to allow for the collaborative process needed in CBT to break down faulty thought processes and rebuild into more positive rational ones to treat the disorder.
For example, this would be essential with schizophrenics in a paranoid state as part of the process of the therapist gaining their trust before challenging their distorted thinking
Components of CBT - cognitive strategies
Cognitive strategies are used to help the client identify their faulty irrational thoughts and teach the client strategies to challenge their disordered thoughts.
There are several different strategies the therapist might use in this process.
E.G Dvsfunctional Thought Diary (DTD)
This is a form of ‘homework’ which the client is asked to complete between sessions. The aim is to help the client gain insight into their existing dysfunctional thought processes and recognise faulty thinking patterns for themselves. They can then start to consider alternative rational ways of thinking about events.
The client uses the DTD to record the negative automatic thoughts and emotions they experience in response to events during the week, and how much they believe in the thought (e.g. thinking ‘I am thick’ in response to failing an exam on a scale of 1-100).
They then write an alternative more rational response to the same event (e.g. ‘l didn’t revise as thoroughly as I could have done, but I did understand it in class so maybe I failed because of a lack of preparation rather than because I’m thick’).
The client then rerates how much they still believe in their initial negative thought (again on the same scale 1-100). Hopefully, having considered an alternative way of processing the event, their belief in the dysfunctional thought should decrease. COGNITIVE RESTRUCTURING
Cognitive Restructuring Cognittve rostructuring is a technique that helps to identity and challengo irrational or maladaptive thoughts known as cognitive disscutions (Milla, Relen & Dombeak, 2015).
This component helps the patient to identify and challenge irrational thinking which they may have identified via the thought diary. This is a collaborative process whereby the therapist works with client to break down faulty thought patterns and rebuild them with more rational and positive ones.
This element can be challenging to do if negative thoughts are fixed - the therapist may need to be forthright in helping dispute thoughts.
The therapist may use different methods to achieve this; one of these is empirical disputation which involves getting the patient to provide evidence to back up heir thoughts
TENSION” - Empirical means ‘evidence-based’ so the therapist challenges e client to provide evidence to support their irrational thoughts.
For example, if the client thinks 1 am useless at everything’ the therapist will ask for evidence that they have never achieved success in anything. By failing to back up their thoughts with evidence, it helps the client understand that these thoughts are not based in reality and accept the need to change them.
Components of CBT - behavioural skills
Behavioural skills training teaches the patient behaviours that will help manage their symptoms.
Once the dysfunctional thoughts have been broken down, the therapist can then help the client learn alternative ways of thinking about situations, and behavioural strategies to prevent the automatic faulty thoughts from kicking back in. For example, to count to 10 before responding to a situation.
Another form of behavioural strategy that helps clients manage their symptoms is pleasant activity scheduling (PAS).
This is the ‘behavioural’ part of CBT. The client should plan a pleasant activity each day during therapy. It should be something that produces a sense of accomplishment (such as going for a run) or a total break from routine (e.g. going to the cinema). It will provide pleasant emotions and distract the person from negative thoughts. It is reinforcing a more positive view of the world (helping rebuild good schemas of themselves, the world and the future).
The client is gradually changing their behaviour (this process is called behavioural activation). Taking steps towards positive experiences moves the client away from their negative thinking and maladaptive behaviour.
P30
Evaluate the effectiveness of cbt at treating serious psychological disorders such as SZ
Point: Evidence shows that CBT is effective at treating serious psychological disorders such as SZ.
Evidence: Kuipers et al (‘97) - 60 people with medication resistant Schizophrenia were randomly allocated to receive CBT and standard care (medication) or standard care alone. 9 months later 50% in the CBT condition had improved, compared to only 31% in the standard care alone condition.
Furthermore, only 1 person in the CBT condition had got worse, whereas 3 had got worse and 1 committed suicide in the standard care alone condition.
Explain: This suggests CBT in conjunction with normal care can be very effective for treating people with Sz even where medication has failed to help. It can also limit the potential for suicide so it is effective at improving Sz and preventing serious consequences of the condition.
Ext = However, 50% did not benefit from CBT suggesting that it is not effective for
everyone and other therapies may need to be considered.
Evaluate the effectiveness as a method of modifying criminal behaviour
everyone and other therapies may need to be considered.
Point: CBT has also been shown to be effective as a method of modifying criminal behaviour.
Evidence: Landberger and Lipsey reviewed 58 studies of CBT with offenders. 20 of the studies used AM techniques and the element of anger control was significantly related to an improvement in the offender’s behaviour.
Explain: This suggests that anger management (CBT) is successful in reducing anger and aggression which can have benefits for both the offenders themselves and also benefits society in helping to reduce reoffending of anger related crimes.
Evaluate the effectiveness of cbt not being effective give when the input is a realistic stressor
Point: CBT is not very effective when the “input” is a realistic stressor.
Evidence: 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 processing events in a dysfuntionally negative way.
However, it may not be possible to think about realistically bad situations in a more optimistic way.
Explain: This suggests that CBT is only effective in situations where the problem is the result of irrational thoughts to a not-so-serious event.
Evaluate the effectiveness of it not being effective for everyone as it requires commitment and motivation from the client
Point: CBT may not be effective for everyone as it requires commitment and motivation from the client.
Evidence: For example in treating schizophrenia Tarrier reported that 45% of his sample refused to cooperate with a CBT programme and dropped out. Also, in terms of 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 AM programmes.
Explain: This suggests that CBT is clearly not appropriate for all individuals. It requires the ability to commit time and effort to the process, as well as having a willingness to reflect and challenge thought processes.
Effective of cbt - conclusions
- CBT is still a dominant therapy used in clinical psychology and considered effective for treating a range of mental health issues such as anxiety, depression, schizophrenia and more.
- There is divided opinion as to whether CBT is effective in treating the root cause of a disorder. Some argue it simply helps to control/change irrational thinking whereas other therapies would address the root cause e.g. dream analysis.
- CBT is often delivered as part of a multi-treatment programme alongside drugs to increase its effectiveness. Extension - Drury et al (1996) found there was a reduction in positive symptoms of SZ and a 25-50% reduction in recovery time with patients given a combination of CBT and drug therapy (antipsychotics).
- More expensive in the short term but when effective for individuals it is more cost effective over time.
Evaluating the ethical issues of cbt as it allows the patient to use their free will and avoids the chemical straitjacket that drugs impose
Point: A strength of CBT is that it allows the patient to use their free will and avoids the chemical straitjacket that drugs impose.
Evidence; This is because CBT gives the 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.
Explanation: Therefore, it can be argued that CBT is an ethical method of treating mental disorders and is more ethical than drug treatment or dream analysis as clients are not overly reliant on someone/something else to help them overcome their issues.
Evaluate the ethical issues of cbt as it can be seen as unethical and may cause psychological harm
Point: However, CBT can also be seen as unethical and may cause psychological harm
Evidence: This is because it ‘blames’ individuals for the way they think, feel and behave (even when there may be situational factors that contribute to their disorder which are largely out of the client’s control. For example, a family problem or life event). In addition to this there also needs to be consideration of who decides what is an ‘irrational thought’ - Alloy and Abrahamson identified the sadder but wiser effect, that depressed people may see things in a more realistic way whereas normal people may distort things in a positive way.
Explanation: Therefore the ethical concern is that CBT may damage the client’s self esteem by having their thoughts criticised and judged by another person. Putting full responsibility on the shoulders of somebody who may already be emotionally fragile (vulnerable) can cause psychological harm and be seen as an unethical approach to therapy.
Evaluate the ethical issues of cbt that it’s a therapy that empowers the individuals
Point: A strength of CBT is that it is a therapy that empowers the individual.
Evidence: Clients who have CBT are encouraged to realise that, while they can do little about life stressors (the ‘input’) they can change the way they process life events and therefore change their behaviour/emotions as a result of this.
Explanation: This can be seen as an ethically positive element as it can prevent feelings of helplessness during difficult times. CBT can been seen to teach ‘techniques for life’ that in theory can be used in the future and outside of therapy sessions if symptoms return.
Evaluate the ethical issues of cbt is that it’s unethical due to lack of voluntary consent for some vunrable individuals
Point: A weakness of CBT is that it is unethical due to a lack of voluntary consent for some vulnerable individuals.
Evidence: CBT is often used with criminals in prisons (anger management) and when treating vulnerable schizophrenic patients. In many cases criminal offenders are required to take part in an anger management programme as a condition of their probation.
Explanation: 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.
Conclusion of ethical issues
- Psychological therapies such as CBT are generally viewed as more ethical than biological ones (e.g. drug therapy) as they cause less harm.
*It is often seen as ethically sound as it teaches strategies that prevent feelings of helplessness - compare to e.g aversion therapy - While there are benefits to patients who have CBT (patient in control, no side effects) these need to be weighed up against the costs (Psychological harm)
