Cognitive therapy tries to change unwanted or maladaptive thoughts and beliefs. Behaviourists believe that undesirable behaviours have been learned; therefore behavioural therapy aims to reverse the learning process and produce a new set of more desirable behaviours.
Stress inoculation training- Meichenbaum believed that although we cannot change the causes of stress in our life, we can change the way that we think about the stressors. Negative feeling for example "I failed to hit a deadline, people must think I'm hopeless" may lead to anxiety and depression. Positive thinking for example "My boss will still be delighted by what I've achieved" leads to more positive attitudes, reducing stress. Meichenbaum's therapy of stress inoculation training (STI) is a form of Cognitive Behavioural Therapy is developed specifically to deal with stress. You are developing a form of coping before the problem arises and that person can inoculate themselves from the "disease of stress".
The process is;
1. Conceptualisation phase (The therapist and client establish a relationship and the client are educated about the nature and impact of stress. The client is taught to view stress as a problem that needs to be solved and to break down the stress into components that can be coped with.
2. Skills acquisition phase (Coping skills are taught and practised primarily in the clinic and then gradually rehearsed in real life. Skills may include; positive thinking, relaxation, social skills, methods of attention diversion, using social support systems and time management.
3. Application phase (Clients are given opportunities to apply the newly learned coping skills in different situations, which become increasingly stressful. Various techniques may be used such as imagery (imagining how to deal with stressful situations) modelling (watching someone else cope with stressors and then imitating them) and role playing (acting out scenes involving stressors).
Strengths of SIT and Weaknesses of SIT
Effectiveness- Meichenbaum compared SIT with another form of treatment called Systematic desensitisation. Patients used SIT or desensitisation to deal with their snake phobias. Although both forms were effective with dealing with the phobia, SIT was more effective as it helped with dealing with other phobias that they were not treated for showing that SIT can inoculate against future stressors.
Time-consuming and requires high motivation- SIT requires a lot of time, effort, motivation and money. The fact it takes so much time and motivation means it will only suit a limited range of determined individuals.
Unnecessarily complex- It may be that the effectiveness of the therapy is based on certain elements rather than all of it. This means that the range of activities and time could be reduced without losing effectiveness.
Hardiness Training- the aim of hardiness training is to increase self-confidence and sense of control so that individuals can more successfully navigate change. Ways to train hardiness;
· Focusing. (The client is taught how to recognise the physiological signs of stress, such as muscle tension and increased heart rate and also how to identify the sources of this stress.
· Reliving stress encounters. (The client relives stress and is helped to analyse these situations and their response to them.)
· Self-improvement. (The insights gained can now be used to move forward and learn new techniques of dealing with stress.
Benzodiazepines- (BZ's) - The group of drugs most commonly used to treat anxiety and stress e.g. valium, which slow down the activity of the central nervous system.
· GABA is a neurotransmitter that is the body's natural form of anxiety relief. About 40% of the neurons in the brain respond on many of the neurons in the brain. It does this by reacting with GABA receptors on the outside of receiving neurons. GABA locks into these receptors which opens the channel which increases the flow of chloride ions into the neuron. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, so slows down its activity and making the person feel more relaxed.
· BZs enhance the action of GABA by binding to special sites on the GABA receptor and boosting the actions of GABA. This allows more chloride ions to enter the neuron, making it even more resistant to excitation. As a result, the brain's output or neurotransmitters are reduced and the person feels calmer.
· BZs and serotonin- Serotonin is a neurotransmitter that has an arousing effect in the brain. BZs reduce any increased serotonin activity, which then reduces anxiety.
· Sympathetic arousal- stress leads to arousal of the sympathetic nervous system and this creates raised blood pressure, increased heart rate and so on. These symptoms can lead to cardiovascular disorders.
· Beta-blockers work by reducing the activity of adrenaline and noradrenaline. Beta-blockers bind to receptors on the cells of the heart and other parts of the body that are usually stimulated during arousal.
· By blocking these receptors, it is harder to stimulate cells in the heart, so it beats slower and with less force. The results in a fall in blood pressure, and therefore less stress on the heart. The person feels less anxious and calmer.
Strengths of drug treatments
Effectiveness- Kahn et al followed nearly 250 patients over eight weeks and found that Bzs were significantly superior to a placebo. A meta-analysis of studies focusing on the treatment of social anxiety (Hildalgo et al) found that BZs were more effective at reducing anxiety than other drugs such as antidepressants.
Beta-blockers are effective in reducing anxiety in a variety of stressful situations and in sports where accuracy is more important that physical stamina (snooker and golf)
Ease of use- one the great benefits of using drugs for stress is that the therapy requires little effort from the user. You just have to remember to take the pills.
Weaknesses of drug treatments
Addiction- BZs have been recognised to become addictive as people show withdrawal symptoms even on low doses.
Side effects- side effects of BZs include "paradoxical" symptoms such as increased aggressiveness and cognitive side effects such as impaired memory and the ability to store acquired knowledge in long-term memory. Most people who take beta-blockers do not experience any side effects but some studies show a link between taking beta-blockers and development of diabetes.
Treating the symptoms rather than the problem- Drugs may be very effective at treating symptoms but the effect only lasts while a person takes the drugs. As soon as they stop taking the drugs the effectiveness ceases.