Abnormality Part 5: The Cognitive Approach

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Cognitive model of abnormality

  • Cognitive aspects of psychology are those that concentrate on thinking and processing of information
  • Cognitive psychology developed partly to fill int he aps left by behaviourism
  • Model's basic assumption is that a person's thoughts are responsible for their behaviour
  • it is how a person perceives, anticipates and evaluates events rather than the events themselves which will have an impact on behaviour

Assumptions of the cognitive model

  • Psychological disorders/maladaptive behaviour are caused by faulty or irrational thoughts, perceptions or cognitions
  • it is the way you think about  a problem rather than the problem itself that causes mental disorders
  • a person can overcome thier disorder by replacing their faulty thoughts with more realistic ones.
  • Therapists are useful in helping patients to replace their faulty thoughts
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Explanations of the cognitive model of abnormality

Explanations

  • Two main psychologists - Albert Ellis (1962) and Aaron Beck (1963)
  • Faulty thoughts or perceptions are the basis of psychological disorder
  • cognitive psychologist would explain depression in terms of an overly pessimistic outlook on life
  • Beck (1967) describes the "cognitive triad" in which a depressed patient has a negative view of themselves, the world and the future
  • Seen in stress that unrealistic perceptions of stress and coping ability were treated by Meichenbaum to manage stress
  • Schizophrenia important in the cognitive approach since the symptoms are a combination of faulty perceptions and faulty thoughts
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Ellis (1962)

  • Cognitive approach assumes that emotional problems can be attributed directly to distortions in our thinking processes
  • these distortions take the form of negative thoughts, irrational beliefs and illogical errors such as polarized thinking
  • Overgeneralisation also plays a part
  • Maladaptive thoughts, it is claimed, usually take place automatically and without full awareness
  • Ellis maintaind that everyone's thoughts are rational at times and irrational at others
  • psychological problems occur only if people engage in faulty thinking to the extent that it becomes maladaptive for them and others arouned them
  • people may have inaccurate expectations which will make it more likely that they will happen: this is called the self-fufilling prophecy
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Ellis (1962) continued

  • According to Ellis when we think rationally we behave rationally and as a consequence we are happy, competent and effective
  • When we think irrationally, the result can be psychological disturbance because people become accustomed to their disturbed thoughts
  • Ellis observed that irrational thinking can often be reveleaed in the language that people use
  • Words such as "should", "ought" "must" 
  • Ellis claimed that some people tend to exaggerate or catastrophize events
  • such people fail to consider rational alternatives
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Summary of faulty cognitive processes according to

  • Overgeneralization - sweeping generalisation from a single event
  • Polarised thinking - seeing everything in black and white
  • Magnification and minimization - making too much of a detail or underplaying an important point
  • Tyranny of "should", "ought" and "must"
  • Catastrophizing - making a mountain out of a molehill
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Research into Anxiety

Newmark et al (1973) found that patients suffering clinical anxiety were more likely to suffer from negative self image

  • When asked if this statement was true: "it is essential that one be loved or approved by virtually everyone in their community" 65% of people suffering from anxiety agreed it was true 
  • 2% of a control group said this without anxiety

The Cognitive Triad and errors in Logic (Beck 1967)

  • Aaron Beck's cognitive triad has been very influential in explaining and treating clinical depression
  • Believs patients get drawn into a negative pattern of viewing themselves, the world and the future
  • combined with negative schemas and cognitive biases, these produce an inescapable cycle of negative thoughts
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The triad, biases and schemas

  • Triad involves unrealistically negative views about self, world and future
  • according to Beck this negative outlook would have originated in childhood, perhaps due to bereavement, overly critical parents or teachers etc
  • Beck believes that a depressed person has developed a negative set of schemas upon which their expectations about life are based
  • For example, may have developed a self-blame schema which makes them feel responsible for all the things in their life that go wrong or an ineptness schema that causes them to expect failure every time
  • Negative schemas are caused by cognitive biases
  • Over generalisation: an overall negative conclusion about all situations based on one, perhaps trivial event
  • Arbitrary interference: an assumption arising from no evidence at all
  • According to Beck these 3 types of cognition: views (triad) schemas and biases interact and in doing so reinforce each other eventually leading to clinical depression
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Evaluation of the cognitive model

Irrational thinking- have the issue of cause and effect. Are faulty perceptionds such as a pessimistic outlook on life a cause of depression or are they a symptom?

Research support: Lewinsohn et al (2003) followed a group of teenagers who had developed a negative pattern of thinking 

A year later, they were far more likely than the control group to have developed major depression

This would seem to suggest that the negative thinking is causing the depression as the cognitive model suggests

Behaviourists consider learning to be crucial. Faulty learning is likely to give rise to faulty thoughts and perceptions and the cognitive behavioural appraoch to treating abnormality has become popular in recent years

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Treatments based on the cognitive approach

  • Number of cognitive treatments have become popular including Beck's "cognitive therapy" and Ellis' rational emotive therapy (RET)
  • They all work in a similar way by getting the patient to recognise their distorted perception of the situation, agreeing on a more realistic approach and then putting this to practie in a real life situation

Cognitive Behaviour Therapy:

  • CBT aimed at encouraging people to examine the beliefs and expectations underlying their unhappiness and replacing irrational, negative thoughts with a more positive adaptive pattern of thinking
  • therapists and clients work together to set new goals for clients in order that more realistic and rational beliefs are incorporated into their way of thinking
  • Therapy session involvse both cognitive and behavioural elements
  • Cognitive element: therapist asks client to become aware of beliefs that contribute to depression/anxiety or are associated with general dysfunction in daily life
  • behavioural element: client and therapist decide together how the client's beliefs can be reality tested through experimentation 
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Kendall and Hammen (1998)

  • Suggested 4 basic assumptions underlying CBT
  • 1: actual events are not important. it is our interpretation of these events that is crucial. 
  • 2: thoughts, behaviours and feelings are all important all influence each other
  • 3: the therapist must help the patient/client clarify and change their interpretations of themselves and of the world, getting rid of any negative biases
  • 4: the patient must change both their thinking and their behaviour to be effective

Underlying assumption: it isn't events and the environment that create problems, it's the individuals take on them

Beck's homework: was first to adopt a fform of CBT back in the 70s. Would set his clients homework of behaving in a way they found difficult or uncomfortable

Harvey's video method: Harvey et al (2000) videotaped patients with social phobia of making public speech. Patients asked how they thought it had gone. Most showed negative interpretation biases and were pleasantly surprised to find out it had gone better than they thought when the video was replayed

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Further examples of CBT

Beck's Cognitive Therapy: Beck et al (1985). Used mainly for people with depression, is aimed at training clients to monitor situations where they make negative assumptions. Encourages them to challenge distorted thoughts and take part in activities that will help them see that such assumptions are unfounded

Meichenbaum's Stress Inoculation Model - SIT widely used in stress management training

CBT and treating schizophrenia: Beck and Meichenbaum see a role for CBT with schizophrenic patients

Exposure therapy: Gets the patient to face up to their fears by tackling safe-seeking behaviour. Tendency for people with a phobia to avoid the fear provoking situation

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Evaluation of CBT

Evidence: Butler et al (2006) collated the results from 16 meta-analyses which covered the results from over 10,000 patients. Was found that CBT was most effective in treating:

  • major depression
  • generalised anxiety disorde
  • panic disorder
  • social phobia
  • post traumatic stress disorder
  • found that CBT was effective in treating schizophrenia when used in conjunction with antipsychotic drugs
  • CBT is a combination of treatments from both behaviourists and cognitive psychology and is seen as offering a more effective treatment than either approach in isolation
  • However: already seen CBT is most effective in treating a certain category of disorder, particularly those involving anxiety and low mood
  • some have argued CBT over emphasises the importance of cognitive processes
  • reductionist approach, concentrates on behaviour interpretation of environment and maladaptive thinking, doesn't consider issues such as genetics or brain chemistry
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