Cognitive Behaviour Models Of Abnormality Q

Describe and evaluate therapies derived from either the psychodynamic or the cognitive behavioural models of abnormality

One therapy derived from the cognitive behavioural model of abnormality is by Ellis, who established the Rational Emotive Behavioural Therapy (REBT) in the 1960s. The aims of this therapy are as follows: help the patient identify their irrational thoughts and replace them with more positive ones, which involves homework in between session in order to encourage patient’s independence; the cognitive element is when the patient is persuaded to become aware of beliefs that contribute to anxiety and depression, which involves direct questioning but the psychologist only treats these beliefs as hypotheses for where they are leading the patient; the behavioural element is when their beliefs can be reality tested via experimentation as either role plays or homework, which will help the patient to recognise the consequences of their faulty cognitions. New goals are set so that more realistic and rational beliefs are incorporated into the patient’s cognitive functioning; Ellis proposed that people can become accustomed to their disturbed thoughts, which causes anxiety and depression. The ABC model illustrates how negative and self-defeating thoughts can result in maladaptive behaviour: A is the occurrence of an unpleasant event; B is the cognitive reaction to the event; C is the state of anxiety/depression. ELLIS stated that REBT is an appropriate therapy for any psychological problem such as anxiety and depression, but no for severe disorders such as schizophrenia. Barlow and Durand also found evidence to support this, because REBT can easily be incorporated into the patient’s life unlike biological forms such as ECT and psychosurgery. HAAGA and DAVISON found that REBT is an effective form of therapy for anger, aggression and anti-social behaviour, and depression, but not as effective as systematic desensitisation. However, both of these therapies are used to treat phobias, which are positive and proves that they are both effective and appropriate in their own ways. They also suggested that it can be difficult to evaluate REBT in terms of effectiveness and appropriateness, because defining and measuring “irrational beliefs” depends on individual differences, which can cause problems when interpreting data. ENGELS examined quantitative data from 28 controlled studies, which showed that REBT is a superior form of treatment than using a placebo, and no treatment at all, so it is appropriate and effective because it does seem to work. Psychologists that use REBT tend to be more argumentative than usual and they show less concern for their patient’s well-being, which could possibly cause psychological harm for the patient. However, it does depend on individual differences because some people might prefer this type of approach. WELSH and BRANDSMA found that REBT is effective with patients who feel guilty due to their own inadequacies, and those who hold high expectations of themselves. They stated that if the psychologist is argumentative then they have the control to

persuade the patients to change their negative thoughts for the better.

Another therapy derived from the cognitive behavioural model of abnormality is stress inoculation training (SIT) by Meichenbaum, which can be likened to systematic desensitisation in the sense that he aimed to replace maladaptive thoughts with adaptive ones. For instance, positive phrases are used such as “I can succeed”. Therefore, if the negative thoughts can be reconstructed our stress will disappear. Meichenbaum suggested that it is not the situation that causes stress/anxiety, but it’s the negative way in which people deal with it. Self defeating internal dialogue occurs when people expect failure, minimise their strengths, and worry about what could go wrong, which causes stress/anxiety. Therefore, a self fulfilling prophecy is created because the person has dealt with the situation in a negative way. SIT is also known as self instruction, which is widely used in stress management training and industry. The main stages are as follows: assessment, whereby the nature of the problem is addressed and the patient is asked to give their views on how to eliminate it, and they are encouraged to relive stressful situations so that they can analyse them, which is also known as the education phase because the patient must identify the self defeating internal dialogues that lead to anxiety; stress reduction techniques are taught such as relaxation and self instruction by using realistic self coping statements, alongside breathing techniques, which are then transformed into positive statements; application and follow through when the patient imagines using the stress reduction techniques in role play, which are then applied to real life situations and can start to change maladaptive behaviour. The effectiveness of SIT can be questioned because patients could exaggerate the beneficial effects in the use of self reports, which are used to assess the effects on stress levels. A way to reduce this problem is to focus on other stress measures, for instance the level of cortisol in the blood of stressed patients is higher than normal, which is a more effective way to test the effectiveness of SIT. However, ANTONI found that SIT is effective because it reduced cortisol output and distress symptoms in HIV positive gay males. CRUESS also proved that SIT is effective because it reduced cortisol levels in women with breast cancer. GAAB studied the effects of SIT on cortisol levels for healthy participants who were exposed to an acute stressor (e.g. job interview). 50% had received SIT beforehand, and they seemed to produce less amounts of

cortisol than the controls, and also judged the situation as being less stressful, therefore SIT is an effective treatment. FOA studied female patients suffering from post-traumatic stress disorder (PTSD) who had been victims of either sexual or nonsexual assault. He compared SIT with prolonged exposure whereby the event was relived in the imagination, and found that both therapies were appropriate in reducing PTSD symptoms, but SIT was less effective in reducing anxiety and improving social adjustment. Therefore, other forms of therapy might be more effective than SIT. LEE extended Foa’s research by comparing SIT with prolonged exposure to eye movement desensitisation and reprocessing, and found that both treatments were equally effective in reducing PTSD symptoms, but SIT seemed to have fewer gains.