Lecture 14 Flashcards
List 2 explanations for apparent equivalences in therapies
True differences in effectiveness are masked by poor research
Equivalences are often explained via common factors
Discuss qualities therapists have that can improve the outcome
The therapists’ health, skill and interest in helping the patient can positively correlate with the patients’ improvement. Other factors that also have an impact include: cognitive level, establishing therapeutic alliances, having a background in short term therapy and one’s level of directiveness. Side note: therapies less than 8 sessions long are unlikely to be effective as a good working relationship between the subject and therapist is unlikely to evolve.
Describe a study that does not support the use of counselling and a study that does not support psychotherapy
Bower found that although counselling has significantly greater success short term, it has no additionally advantages long term and it does not reduce general healthcare costs.
Cuijpers found that the effects of psychotherapy on depression seem to be highly overestimated due to publication bias.
Discuss the key principles of cognitive therapy
One’s perception of something does not mean that this is reality. For example, thinking an object is dangerous when it is not.
Thus, events and situations can be interpreted differently depending on the person.
It believes that there is a situation that causes certain thinking and results in a certain emotion. Our thinking is guided by rules and assumptions. It’s all about gaining new insight, meaning old perceptions need to be challenged. This change in thinking will result in a change of emotions.
This approach is collaborative, structured, has joint responsibility, is based on a trusting relationship and is client based.
List some unhelpful thinking styles
Catastrophisation, personalisation (thinking you are responsible for a bad event), overgeneralisation and ignoring positives.
According to Beck, what is the negative cognitive triad?
Negative view of self
Negative view of personal future
Negative view of current experiences
These three things are characteristics of a depressed person.
Discuss the path to depression
What are the assumptions of the cognitive approach regarding depression?
Early experiences can cause unhelpful assumptions and beliefs to form. Then, when a critical incident occurs, these assumptions are activated, which results in negative thinking. If this escalates, then depression can develop.
Unhappiness is normal, depression is on a continuum, anti-depressants have a limited role, thinking change is key for emotional change and predispositions may exist.
List some critiques of cognitive therapy
Simplicity, only deals with the present and is sometimes described as a band-aid cure.
Discuss evidence in favour of CBT
Dobson found that 70% of clients having CBT for depression did better than the drug therapy clients.
The national institute of mental health found that CBT had the highest amount of recovery compared to pills, placebos and interpersonal psychotherapy. However, the differences were not statistically significant. Many studies have supported these findings as they consistently show that patients had significantly less relapse when CBT was used. Medication only seemed to have the most relapse and did not generally solve the problem.
Gloaguen found that on average, cognitive therapy had 15% more improvement than anti-depressants.
CBT has the greatest weight of research in favour of it for treating depression. If research does not support CBT on its own, they find that combined treatment is almost always better than medical treatment alone, for example, Cuijpers.
However, a recent study by Johnsen found that CBT is becoming less effective compared to its effectiveness in the 70s as less depressive symptoms are being reduced.
NICE reported that medication should not be administered for mild depression as the benefit cost ratio is too poor. When the depression is severe, then combined treatment should be considered as this can be more effective than each treatment on its own.
Although combined treatment is highly supported, the side effects of anti-depressants may actually negatively impact one’s ability to engage in therapy, according to Duncan.
Discuss CBT in relation to cost effectiveness
Antonuccio found that over 2 years, fluoxetine may results in costs that are 33% higher than CBT and combined treatment costs 23% more. Furthermore, it has also been found that societal costs are lower for CBT compared to drug treatment.
It has also been found that psychotherapists that are more effective, tend to favour psychotherapy alone, 74% of them in fact.
The mental health policy group claim that the amount one would spend on making CBT available on the NHS, would actually be more cost effective as less money would be wasted on incapacity benefits (when people are unable to work) and lost tax receipts.
What is a big problem with CBT?
CBT generally tests for dysfunctional attitudes but these often fail to detect depressives. This is because of the mood-state hypothesis where unhelpful assumptions are only ‘turned on’ in certain states.
Why do therapists use CBT?
They get immediate reinforcement via verbal changes in the client.
Discuss CBT in regards to mental disorders other than depression
CBT was found to be as equally as effective as behavioural therapy for OCD.
It is effective with bulimia, anxiety, anger, stress and somatoform disorders.
However, CBT was not effective in treating schizophrenia and did not reduce relapse for bipolar disorder.
Discuss Proudfoot’s study
They found that computerised CBT worked just as well, if not better than normal therapy. The computerised therapy improves depression, negative attribution and social adjustment. With anxiety, computerised treatment had better results with the more disturbed patients. This suggests that computerised treatment may be just as effective, which will allow therapy to be easier and more cost-effective.
Discuss McCrone’s study
They evaluated how cost-effective online CBT was. It was found that although online CBT was £40 more over 8 weeks, the lost employment costs were £407 lower. Therefore, overall, online CBT is more cost effective but has the same beneficial impact so it should be considered as a valuable form of psychotherapy.
