Using Theories in Social Work
Cognitive-Behavioural Approaches
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In order to comprehend these approaches –
what do we need to know?:
 Some necessary background– psychological concepts – about how
learning – particularly social learning takes place. First background
to behavioural, and then second CBT approaches
 Problems with simple behaviourist approaches
 Explanation of what CBT is
 Some distinctions between different types of understandings of CBT
 Some indication of where and with whom these approaches work
well – not always traditional social work settings
 Strengths and weaknesses of CBT
 Some concluding, summative thoughts
Also will help if we use some interesting case studies – I will do this at
appropriate junctures
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a)
Background to Behaviourism: Some
Psychological Concepts about Social Learning
Three main theories of social learning:
 Respondent or classical conditioning
 Operant, or instrumental, conditioning
 Social Learning Theory and modelling – more
important for CBT – as it involves focus on
cognition
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Respondent Conditioning
Presentation
of food
(Unconditioned response)
Salivation
Ringing of bell
(Conditioned response)
Switching on
on of light
Higher order
conditioning
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Classical Extinction
Conditioned
Conditioned
Stimulus
Response
Conditioned stimulus gradually disappears
when the unconditioned stimulus
is removed
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Example – Angry Driver
Dangerous Driving
incident
(original stimulus)
Paired/associated
with
Anger/Aggression
(original stimulus)
(conditioned response)
Driving
(conditioned response)
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Operant, or Instrumental, Conditioning
Anne cannot control her 7 year old, daughter Jasmine’s
behaviour without resorting to physical slaps
She has been referred to you
Anne describes how Jasmine when shopping will scream and
shout until she gets what she wants.
She takes Jasmine out of the shops…buys her
sweets…doesn’t work…..hits her legs…doesn’t work
Now resorted to buying sweets as a bribe before going out
Why do you think Jasmine’s behaviour is continuing?
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For Jasmine clearly:
 Sweets are very desirable….and so the
strong desire for them overrides any
punishment so far offered
 Rewards strong; punishment weak
 Jasmine KNOWS she will always get what
she wants in the end…….
………let’s diagrammatise an operant
understanding of what is happening here
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Operant conditioning – we don’t just learn through association with
…rather we learn behaviours as a result of the stimuli that
stimuli
immediately follows their expression
In other words we learn as a result of the consequences
of actions rather than the stimulus that precedes
them
Operant conditioning
Expression
of behaviour
(response)
Crying
Stimulus
(consequence)
Demanding
Environmental Cue
(antecedent stimulus)
Shopping
Other example of James and father
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The different uses and aims of behaviour
therapy – note focus on behaviour alone
 Tackling generalised conditioned responses – going out/get
dirty; school phobias; etc
 Aim would be extinction of generalised response – taking
child to school/park in stages – I used it with various
phobias – spider phobia
 Some kinds of behaviour are incompatible with others –
counter conditioning – associating desirable responses
with particular stimuli
 Systematic desensitisation common technique –
relaxation/personal support – e.g. transvestites/
agoraphobia/sexual therapy – reducing anxiety and
therefore premature ejaculation; enuretic children
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Ethics/politics of behavioural therapy
In the 1960s there was a fearful debate about Skinner’s work – the
behaviourist – notably in response to his book ‘Beyond Freedom &
Dignity’
Principally critics were concerned about:
 The absence of concern for ‘the mind’ – the ghost in the machine
 The potential power that conditioning gave to the therapist to shape
behaviour, and most importantly
 The potential power afforded to corporate and political power holders to
condition their workforces/populations – cf Orwell’s 1984 and Huxley’s
Brave New World
Have any of you seen Stanley Kubrick’s Clockwork Orange or read the
novel of the same name by Anthony Burgess?
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Technical efficiency cannot override moral
responsibility
 Certainly pure behavioural techniques can appear ‘nonhuman’ or inhumane
 There is a real problem as we are aware that some of
our fears have been realised in some residential token
economy, behavioural modification settings such the
Pindown scandal
 They can smack of the imposition of values – cf
manipulation
 Behavioural therapists argue that consent is always vital
– and all therapy involves similar issues of limiting user
choice – but what when consent is related to gaining
privileges?
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Background to CBT : Social Learning Theory and
Modelling
Background to these approaches can be found in the work
principally, but not exclusively, in work of Bandura (1977)
People’s learning is achieved through their perceptions and
thinking about what they experience. They learn by
copying the examples of others around them
2 sets of expectations:
 Outcome expectations – behaving in a certain way will
produce a particular outcome
 Efficacy expectations – belief that the person has the
capacity to produce successfully the behaviour necessary
for achieving the desired outcome
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Problems with basic learning theory - Bandura
 Difficult to always define what a person’s
performance expectations are without close
observation
 May have distorted view of our own efficacy – “I’m
just no good at writing essays”
 Nevertheless, we can see where the change
emphasis needs to be on reinforcement of positive
thoughts to achieve desired outcomes
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What is Cognitive Behavioural Therapy?
Let’s start with a basic observation of an emotive episode that may happen to any of us
Three elements:
A
What starts it off?
B
Beliefs about B
C
Reaction
ANTECEDENT/ACTIVATING EVENT
BELIEFS
CONSEQUENCE
Example
A
B
C
Friend passes us in street & ignores us
“I’m not worth acknowledging”; “nobody gives a s…”; “seen as
worthless as a friend…therefore as a person”
Feelings - lonely and depressed Behaviour – withdraw into self
So at root CBT is about:


How you think about yourself, the world and other people
How what you do affects your thoughts and feelings
Self Action
Unhelpful – Go home and avoid this friend and others
Helpful – get in touch and see if they are ok
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Related and building on learning theory – Cognitive
Theory and Behavioural Work - CBT
There are a range of related theories here – see Payne pp
121-123 – see also slide 19
Cognitive theory is basically suggesting that as behaviour is
affected by perception or interpretation of the environment
during learning
Inappropriate behaviour must be a misperception
The interesting issue here is that behavioural therapies or
CBT are discussing altering disorders in thinking – in the
MIND – when as we saw above initially behaviourism only
focussed on behaviour
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ABCs – Antecedent; Beliefs; Consequence
We can see that the basic tool deriving from these approaches for
practical work by psychologists & social workers is this use of A, B,
Cs
In terms of a basic tool kit that has a hands on utility – then these
behaviour therapy approaches are now widespread in
contemporary NHS and social care work
Widespread use in work on:
Stress/anxiety; depression; addictions; panic; agoraphobia & other
phobias, social phobia, bulimia, obsessive compulsive disorder; post
traumatic stress disorder and, now, in some cases schizophrenia
Huge recent investment by NHS – see below
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Classification…4 types of cognitive-behaviour
therapies – according to Scott & Dryden (1996)
 Coping Skills – 2 elements self verbalisation (instruction
to ourselves) & changes to environment e.g. stress
reduction  Problem solving – cf Perlman’s psycho-analytic work –
see life as a process of resolving life issues lock onto a
problem generate a no of solutions – get client to choose
best for them
 Cognitive restructuring – particularly used when
people are unreasonably negative – ‘awfulising’ – as
Ellis calls it in his rational-emotive beh.therapy
technique…..irrational beliefs at the root of people’s
problems e.g. lorry driver – see below
 Structural cognitive therapy – concerned with 3
‘structures’ of belief - core beliefs; intermediate beliefs or
explicit descriptions of the world; and peripheral beliefs.
The later are used as become the immediate target of 18
action but the aim is to alter the other two
Ellis’s ABCDE theory of emotions –
cognitive re-structuring
A
B
C
D
E
Activating event of situation – wife dies
unexpectedly
Beliefs – self defeating belief – “my fault should
have called GP earlier”!
Consequences – emotional/behavioural - “I
deserve to suffer/be depressed/don’t
need/deserve help
Disputation – challenge irrational belief and
replace with rational – “you did right and do not
have power over life and death.”
Evaluation – goes alongside D – so that the client
reappraises the A, B, C process
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Effectiveness of CBT
Strengths
 Evidence based practice - & examples of
success in certain contexts i.e.with
addictions & stress
 Relatively easy to use – but need to know
techniques well & have good listening &
presentational skills
 Widely applicable
 Time limited
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Possible Problems with Use of CBT:
 Can be a long process – 5 to 20 one hour sessions
 Favourable outcomes when compared to no intervention
or on subjects who select this therapy through public
advertisements – much less so on random clinical
selection
 Example - used a great deal for depression but in Nat
Inst of Mental Health Study of depression – CBT fared
less well than interpersonal therapy or GP management
with anti-depressants
 Can be difficult for some patients to verbalise their
feelings
 Does not really address the causes of problems
 Danger when CBT is used for clients that have more
complex underlying psychiatric disturbances e.g. anger
management progs in prisons
 Increasingly seen as a panacea in treating certain
conditions cheaply
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Conclusion
 Very wide influence in & around social work – particularly,
but not exclusively, in mental health settings
 Usually used by social workers in a stripped down form
around ABCs
 Fits in with task centred, focussed approaches planned,
clear agreed goals
 Many elements of the practice can show empirical
validated success
 Continues to generate some concerns due to its overly
technical rational scientific nature, certain ethical issues &
occasional inappropriate application
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