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- Overall assumption - thoughts influence emotions and behaviours that follow.
- Cognitive psychologists believe psychological disorders e.g. depression and anxiety stem from faulty or irrational thinking. If a person is to be cured of these disorders, their thinking patterns need to change.
- CBT form of therapy that relates to main assumption, works by helping change these thinking patterns as well as behaviour.
- Assumption that internal processes e.g. perception impact on our behaviour underlies the principle of CBT, role of the therapist to help the client change their perceptions of the world around them. Cognitive restructuring where the therapist questions the evidence base for the client's perceptions are not based on any real evidence, and this can elicit change.
- The assumption that schemas influence how we respond to the world around us. Aaron Beck proposed that depressed people have developed negative schemas of 3 things; themselves, the world around them and their futures (cognitive triad).
- In CBT client is helped to change these negative schemas resulting in a change in how they respond to the world around them.
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- CBT combines both cognitive and behaviourist techniques in order to help clients 'cognitive-behavioural'.
- The cognitive element - the therapist works with the client to help them identify negative thoughts that are contributing to their problems.
- The behavioural element - therapist encourages the client to engage in reality testing, either during the session or as homework.
- Both the client and the therapist play an active role in the therapy and in particular the client will have to work on various things outside of the therapeutic setting in order to aid recovery.
- Dysfunctional thought diary - as homework the clients are asked to keep a record of the events leading up to any unpleasant emotions experienced. They should then record the automatic 'negative' thoughts associated with these events and rate how much they believe in these thoughts (1-100%). Next, clients are required to write a rational response to the automatic thoughts and rate their belief in this rational response, again as a %. Finally, clients should re-rate their beliefs in the automatic thoughts.
- Cognitive restructuring - once the client has revealed more about their thought patterns to the therapist they can work together on identifying and changing negative thinking patterns. Collaboratively and is also known as 'therapy during therapy'. A client may feel distressed about something they have overheard assuming that another person was talking about them. During CBT that client is taught to challenge such dysfunctional automatic thoughts, by asking 'where's the evidence'. By challenging these thoughts and replacing them with more constructive ones, clients are able to try out new ways of behaving.
- Pleasant activity scheduling - this technique involves asking the client to plan for each day, one pleasant activity they will engage in. It could be something that gives a sense of accomplishment or something that will involve a break from a normal routine. It is thought that engaging in these pleasant activities will induce more positive emotion and that focusing on new things will detract from negative thinking patterns. Behavioural activation technique helping clients change their behaviour. Technique involves asking clients to keep a record of the experience, noting how they felt and what the specific circumstances were. If it didn't go to plan the client is encouraged to explore why and what might be done to change it. By taking action that moves toward a positive solution and goal, the patient moves further away from negative thinking and maladaptive behaviour.
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- Research support - large body of evidence to suggest that CBT is highly effective in treating depression and anxiety related problems. A number of studies have compared the effectiveness of CBT with drug therapy in terms of treating severe depression. Jarrett et al 1999 found that CBT was as effective as some antidepressant drugs when treating 108 patients with severe depression over a 10 week trial. However, Hollon et al 1992 found no difference in CBT when compared with a slightly different kind of antidepressant drug in a sample of 107 patients over a 10 week trial. This suggests that CBT is not superior to all antidepressants.
- Therpaist compentence - 1 factor influencing success of CBT - therapist compentence. Competencies in CBT include: ability to structure sessions, ability to plan and review assignments, application of relaxation skills, ability to engage and foster good therapeutic relations. Kuyken and Tsivrikos 2009 claim that as much as 15% of the variance in outcomes of CBT effectiveness may be attributable to therapist competence.
- Individual differences - as with all therapies CBT may be more suitable for some people compared to others, individual differences need to be taken into consideration when examining effectiveness. CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change. Also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person's life that therapy cannot resolve - Simons et al 1995.
- Empowerment - CBT empowers clients to develop their own coping streategies and recognises that people have free will. CBT has become an increasingly popular alternative to drug therapy and psychoanalysis, particularly for people who could not cope with the deterministic principles of these approaches. E.g. they dislike the idea that their behaviour is caused by your biological make-up/the past. Party for this CBT has become the most widely used therapy by clinical psychologists working in the NHS.
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- Patient blame - the cognitive approach to therapy assumes that the client is responsible for their disorder. Positive in that they are empowered to change the way they think, there are also disadvantages to this approach. Important situational factors may be overlooked which are contributing to their disorder such as family problems or life events that the client is not in a position to change. Therefore 'blaming' the individual for the way they think/feel/behave is not neccesarily helpful because it may take other aspects of their life to change in order to help them feel better.
- What is rational? - another ethical debate concerns who judges an 'irrational' thought. While some thoughts may seem irrational to a therapist, resulting in the client feeling they must change them, they may in fact not be that irrational. Alloy and Abrahamson 1979 suggest that depressive realists tend to see things for what they are and normal people have a tendency to distort things in a positive way. They found that depressed people display the sadder but wiser effect that they were more accurate in their estimates of the likelihood of disaster than non-depressed individuals through rose coloured glasses. The ethical issue is that CBT may damage self-esteem, an example of psychological harm.
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