Transcript Cognitive-behavioural therapy CBT

Cognitive Behavioural
Therapy
Developed by Beck
Aim – Teach ‘clients’ to
rethink and challenge
their negative
perceptions/cognitions
Beck
Beck’s Cognitive Therapy
Cognitive Behavioural
Therapy
•Stage 1
•Therapist & client agree
on nature of problem
& goals for therapy
Stage 2
Therapist challenges
the client’s
negative thoughts
Client engages in
behaviour
between sessions
in an attempt
to challenge these
negative thoughts
Beck
Aim is for client to realise
thoughts are irrational.
Homework = diary kept
Most common
features of CBT are:
Cognitive Behavioural
Therapy
1. Client monitors
their negative,
automatic thoughts
(cognitions)
3. Client examines
evidence for
and against
their distorted
thoughts
2. Client recognises
the connection
between cognitions,
affect (mood)
and behaviour
4. Client learns to
substitute biased
cognitions for more
realistic ones
5.Client learns to
identify & alter
their beliefs that
predispose
them to
distort their
experiences
Further
developed to
include challenging
behaviour too
Cognitive Behavioural
Therapy
Usually a
series of 20
sessions
over 16
weeks
Homework
set
Thought-catching
Cognitive Behavioural
4 basic assumptions
of CBT
Therapy
Response to life
is based on interpretations
of self & world rather
than what the actual case is
Thoughts, behaviour & feelings are
interrelated & influence
each other – none are
more important than the others
Kendall
Must clarify &
change the way they
think about themselves
& world around them
Need to change
cognitions AND behaviour
Hammen
Cognitive Behavioural
Effectiveness
Therapy
Compared depressed
•Beck’s CT
patients receiving
•IPT
a range of therapies
•Tricyclics
60 pts randomly
• Placebo - no
allocated
treatment
All treatments – 16 wks
Assessed:
Assessed before,
•Symptoms of dep
•Overall symptoms &
during,
life functionin
at end & follow ups
Improvement
IPT = 55%
Drugs = 57%
CT = 51%
Placebo = 29%
Drug = fastest to
reduce symptoms
Placebo = better for
mildly dep than severely
IPT = best for social
functioning
CT = best for
dysfunctional attitudes
Elkin et al (1989)
18 mths later = only
20-30% dep free
IPT = most satisfied
with treatment
IPT & CT = able to
recognise sources of dep &
better social rels
LT = psychological
better
Relapse higher
for drugs
than CT (47% - 31%)
Cognitive Behavioural
de
Therapy
deRubeis et al (2005)
Effectiveness
Similar to Elkin
58% showed
elimination of
symptoms if CT
or drug treatment
Follow on 12 mths later by Hollon (2005) found difference in relapse rates:
31% for CT
47% for
drug treatment
76% if no
real treatment given
So CT has longer lasting effect & targets underlying problem not just
masking symptoms.
Drug treatment is purely a palliative treatment
Effectiveness
Cognitive Behavioural
Therapy
Rush (1977) –
CBT at
least
as effective
as drugs
Blackburn & Moorhead (2000)
CBT superior to drugs in
particular 1 year +
Kupfer & Frank (2001)
Most effective treatment is
A combi of
CBT & anti-depressants
Cognitive Behavioural
Therapy
Appropriateness
Successful & long lasting for many
Deals with root cause not just symptoms
No real side effects or withdrawal symptoms
Allows opportunity to use strategies in range of situations
Gives the patient some control over disorder & the power to change
Appropriate to use with depression as many symptoms are faulty cognitions
Cognitive Behavioural
Appropriateness
Therapy
Difficult to know how well a client will respond to CBT –
Simons not suitable for people with rigid attitudes
Not a quick fix – can take months to see improvement unlike drugs
Does not focus on why negative beliefs held –
may actually be based on realistic concerns
As relpase may be that negative beliefs etc
are suppressed rather than eliminated
Expensive & time consuming
People do still relapse
Cognitive Behavioural
Therapy
Take notes from textbook on p 238-9 to
expand evaluation & studies