Discuss one or more psychological treatments for one disorder.
Cognitive Behavioural Therapy CBT is a psychotherapeutic treatment (talking therapy)
developed by Aaron Beck in the 1960s to treat depression. It is based on the cognitive
model which suggests that feelings, thoughts and actions influence behaviour and
emotional responses. CBT focuses on how the on the way that individuals process
information and how that affects their behaviour. According to Beck, psychological
problems are associated with maladaptive thinking patterns and unhealthy behaviours that
can be changed through a working relationship between the client and a therapist.
Therefore, the primary aim of CBT is to cognitively restructure thinking patterns. Cognitive
restructuring involves identifying and correcting faulty cognitions and unhealthy behaviours.
The client is encouraged to find out which thoughts are associated with depressed feelings,
and to correct them. The goal of cognitive restructuring is to identify and dispute irrational
or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking,
over- generalization, magnification, and arbitrary inferences. The therapists employ
strategies such as validity testing, which occurs when therapists ask clients to defend their
thoughts and beliefs with evidence of an experience. If the patient cannot produce objective
evidence supporting his or her assumptions the faulty nature of these beliefs is exposed. In
this way, CBT allows for patients with depression to recognise that the thoughts they
experience are irrational and maladaptive. A second aim of CBT is to enable behavioural
activation through helping clients develop effective coping strategies and problem-solving
skills. There are two key methods used by therapists to develop coping strategies. Firstly,
cognitive rehearsal occurs when the client is asked to imagine a difficult situation they have
encountered in the past, and then works with the therapist to practice how to successfully
cope with the problem. The goal is that the client would be able to transfer cognitive
rehearsal to coping with the real situation when it occurs again in the future. Additionally, to
encourage self-discovery and reinforce insights made in therapy, the therapist may ask the
patient to do ‘homework’ which can include monitoring behaviour or journaling.
A study conducted by Elkin et al 250 depressed clients were randomly assigned to one of
four treatment conditions for four months: IPT, CBT, the drug imipramine, or a placebo pill.
The sample was made up of patients from three different treatment centres located in
Pittsburgh, Washington DC and Oklahoma City. As the research was conducted in America,
an individualistic society, there is a cultural bias, and the results cannot be generalised to
those in collectivist societies. This is important to consider as those in collectivist cultures
may be specifically averse to the use of CBT because group interests take priority over that
of the individual and CBT is dependent on the willingness of the patient to communicate
personal needs. To be included in the study, patients had to meet the diagnosis of major
depressive disorder with symptoms presents at least in the two weeks previous
to the study. Patients were excluded from the study if they had any other disorder in
addition to MDD, ensuring that behaviours related to any other disorders did not influence
the results. In this way, researchers controlled for certain characteristics of the sample,
increasing internal validity. However, by excluding participants because of compounding
factors like alcoholism, personality disorders, or suicidal tendencies, the sample becomes
less representative of the general population of depressed patients.
Therefore, the findings may have limited generalisability. All treatments lasted 16 weeks.
CBT patients received 12 sessions during the first 8 weeks, followed by weekly sessions
during the second half of the study. A large number of assessments were carried out before,
during, and after the study. Three areas were assessed: symptoms, life functioning, and
functioning related to particular treatment approaches. Results suggested that there was no
difference between the effectiveness of drug treatment and CBT. This could be considered a
limitation of CBT.
Another limitation of CBT is that it is considered a directive therapy meaning that the
therapist is assessing the situation and then deciding on what the best course of action is.
The therapist is also making a judgment concerning which thoughts are acceptable.
Therefore, there is a concern about potential gender and cultural biases playing a role in the
therapy. As many societies become increasingly diverse and multicultural, the role of culture
is an important consideration in therapy. Additionally, it may be that the theory of cognitive
restructuring and coping strategies that CBT is based on is based individualistic culture and
not collectivistic. This may mean that there needs to be further emic research to determine
the extent of cross-cultural application of the therapy.
CBT has also been criticized for focusing on the symptoms of depression rather than its
causes. CBT does not address the past experience of the client, nor does it address the
potential biological nature of the disorder. This is because CBT is based on the cognitive
aetiologies of CBT which suggest that the