Beck’s Cognitive Therapy

1. Beck’s Cognitive Therapy • Challenge irrational cognitions and replace them with more realistic appraisals:- therapist helps the client identify negative - keep a record of thoughts and anxieties to be revised later and negative automatic thoughts recognised- therapist draws attention to positive incidences, regardless of their triviality • REALITY TESTING: comparison of the irrational and reality

2. Behavioural techniques to encourage positive behaviour: - make a list of small goals – developing a sense of personal effectiveness- training in problem solving skills – relaxation techniques to reduce anxiety

3. Ellis & Rational-Emotive Behavioural Therapy (REBT) • Similar to Beck’s:- therapist and client work together: identify situations and negative reactions- therapist helps rationalise situations, giving a more realistic perspective- more confrontational approach – challenges the clients beliefs in debates

4. Evaluation of CBT (Cognitive-Behavioural Therapy) • CBT – structured approach – acknowledges complex cognitive processes are important in psychological disorders • Depression may be rational – it is necessary for the therapist to acknowledge this and not give the impression it is always unjustified • Effective for depression and social anxiety – evidence CBT lasts longer than antidepressant drugs exist • Less effective on phobias and more serious conditions e.g. schizophrenia

5. Evaluation of CBT (Cognitive-Behavioural Therapy) • Ignores genetic and biological factors • The idea of schemata lacks detail – no clear description of mechanism for how negative schemata develop in the first place • Less time consuming & more cost effective than psychoanalytic therapies • Avoids in depth probing – unpleasant or damaging in psychoanalysis though some may find self monitoring and analysis in CBT threatening

6. Effectiveness of Therapies Elkin et al (1989) • Several treatment centres participated • 240 patients with depression treated with CBT, psychotherapy or antidepressant drugs and placebo control group • Treatment lasted for 16 weeks

7. Findings: • Large placebo effect (35-40%) • All therapies more effective than placebo but all therapies similar • Drugs more effective in severely depressed participants • Significant factor in effectiveness of psychotherapy is the therapist • Across all groups, 30-40% did not respond

8. Additional: • 16 weeks too short – ideally 6-12 months • CBT in anxiety conditions are longer lasting than drugs (Bechdolf et al 2006) • No treatment is ever 100% effective

9. Davidson et al (2004) • 295 patients with generalised social anxiety (fear of social situations) treated with either CBT, fluoxetine (antidepressant) or combined Findings: • Overall placebo effect = 19% • All therapies effective over placebo effect • At 14 weeks, no differences between therapy groups – combination wasn’t superior • 40-50% did not respond • Drugs and CBT equally effective in treating social anxiety

10. Methodological Issues • Matched pairs for comparison • Length of study should be long enough for effects to be observed – ideally a year • Control groups:- for drugs therapy, placebo drug can be given- for psychological therapy, ‘interaction’ is used – participants talk to a therapist but no attempt to apply specific techniques are used • Measurement of improvement should be consistent and thorough across groups -questionnaires and ratings of clinical improvement (by staff who are unaware of treatment – avoids bias and investigator effects)

11. Ethical Issues • Informed consent – people with disorders may be less able to understand full consequences of treatment • Avoid psychological harm – debrief participants • If treatment are effective, control groups are being denied help • Drugs have side-effects