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36 Cards in this Set
- Front
- Back
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Blatt et al-
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Psychological health, skill and interest in patient well being correlated with improvement.
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Whitby 1990
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Clients may falsely attribute success to therapist.
Changeable criteria for success fosters perceived success. Distorted selection of clients (likely to do well) |
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Zeiss et al (1979)
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Effectiveness of treatment may be less to do with trained skills and more to do with a therapy placebo through positive experiences in their daily lives falsely attributed to their improved self efficacy.
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Orlinsky (1994)
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The application of intervention is important but it is also important to be emphatic, collaborative and self-congruent engagement with the client
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Lambert 1992
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Estimates of outcome variance:
40% client/ extra therapeutic factors 30% relationship factors 15% placebo/hope 15% model/ technique factors |
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Dept of health (2001)
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Effectiveness of all types of therapy depends on the patient and the therapist forming a good working relationship.
- Therapies of fewer than eight sessions are unlikely to be optimally effective for most moderate to severe mental health problems. |
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Bower et al. (2011)
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1384 randomised participants. Counselling- associated with short-term mental health improvements compared to usual care, but provides no additional advantages in the long-term.
Does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear. |
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Cuijpers (2008)
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examined effect sizes of 117 randomised controlled trials of psychotherapy for adult depression with 175 comparisons between psychotherapy and control conditions-
Effects of psychotherapy for adult depression seem to be overestimated because of publication bias. (only publish positive results, skews research) No significant differences between efficacy of different types of psychotherapy |
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“Unhelpful” Thinking Styles:
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1 "catastrophising“: assuming that the worst possible thing will have happened, or is bound to happen. For example the boss wants to see you so you assume it is to give you "the sack".
2 "jumping to conclusions“: your date is late so you assume that they don't want the relationship to continue (and that no one else likes you either). 3 "personalisation“: you assume you are directly or mostly responsible for some bad event; for example; a mother blames herself for her child's poor school report, concluding that she must be a bad mother 4 "overgeneralising“: imagining that one bad experience on one occasion will be repeated in future; for example; having felt anxious in one situation you expect to feel anxious in similar situations. 5 "ignoring the positive“: when self-criticism overwhelms recognition of your strengths. 6 "all or nothing thinking“: seeing things in absolute terms, rather than recognising complexity; seeing outcomes in terms of total success or failure |
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Beck negative cognitive triad
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Negative view of self
Negative view of personal future Negative view of current experiences |
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Criticisms of CBT
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-Simplicity
-Positive thinking -Only deals with the present -Neglects transference -Incompatible with pharmacotherapy -Band-aid cure only (DEALS WITH SYMPTOMS, NOT THE PROBLEM) |
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Assumptions in CBT
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1. assumes that it is an individual’s thoughts that lead to emotional experience in most situations.
2. assumes that those thoughts can be accessed 3. thoughts can be challenged and changed. 4. change in an individual’s thinking will lead to change in their emotional experience. |
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Dobson (1989)
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Concluded from an evaluation of research into therapy for depression that cognitive therapy clients tended to do better than 70% of drug therapy clients or individuals receiving other psychotherapies
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National institution of health, Elkin (1995)
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At 18 months-24% of clients in total met criteria for recovery and did not relapse. The separate figures for the treatment conditions were as follows;
30% in CBT. 26% in IPT. 20% in PLA-CM 19% in IMI-CM. Specifcally CBT was significantly more effective with those with severe depression in short term but IMI-CM has an effect in continued use |
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Lambert & Bergin (1994)-
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"The effects of psychotherapy were equal to, or surpassed a variety of antidepressant medications"- major meta-analytic reviews of outcome with depression.
relapse rates are typically higher for treatment with medication only" |
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Gloaguen et al (1998)
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2765 patient review,
CT compared to waiting list of placebo, CT group=29% better. CT compared to anti depressants, CT group=15% better. CT compared to misc therapies, CT group=10% better 1 year follow up compared to anti depressants suggest a preventative effect on relapse rates for CBT CBT may be the first choice for depression “cognitive modification” is the specific factor in the treatment of depression was not supported by the analvsis by Gloaguen et al. Effective ingredient-was attributed to the utilisation of several similar strategies by both CT and behaviour therapy. |
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Antonuccio 1977
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Cbt more cost effective than drugs alone
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Blatt et al. (1996)
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Psychologically orientated therapists more effective than biologically orientated ones
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NICE (2004)
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Antidepressants are not recommended for the initial treatment of mild depression, because the risk–benefit ratio is poor.
In both mild and moderate depression, psychological treatment (such as problem-solving therapy, brief CBT and counselling) of 6 to 8 sessions should be considered. severe depression-a combination of antidepressants and individual CBT should be considered as the combination is more cost-effective than either treatment on its own. |
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Teasdale (1985)
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-Individuals feeling depressed should be assisted to change their perceived controllability of depression:
1. providing-credible rationale which indicates that certain coping responses would reduce depression 2. providing-highly structured framework within in which patients can learn and practice coping responses. |
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Haaga (1991)
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depressed people do exhibit increased negativity of emotions
2 negative emotions are prevalent in all forms of depression 3 the more severe the cognitive "symptoms", the more severe the non-cognitive signs of depression 4 it could not be concluded that depressive thinking is particularly inaccurate or illogical. 5 they find "no strong evidence supporting" the causal hypotheses that thoughts lead to depression, but "at the same time it would be premature to abandon them". Shows how emotions, thoughts and non cognitive symptoms are inextricably linked rather than cognitions being primary |
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Whisman (1993)
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Even if depression is primarily biological, CBT can be similarly effective as it is in other forms of depression
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Brown (1988)
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have suggested that happy people and those in good mental health engage in three kinds of distortion of reality:
1.They have an unrealistic positive view of themselves. 2.They have exaggerated beliefs of control over events. 3. They have unrealistic optimism |
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Longmore (2007)
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“ little evidence that specific cognitive interventions significantly increase the effectiveness of the therapy.”
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Hovarth et al 2002
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quality of the patient therapist relationship is much more strongly correlated with the outcome than the therapeutic model
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Butler et al 2006
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Review of 16 meta-analyses- Large effect sizes for depressions anxiety PTSD………Moderate effect size for pain, anger…..CBT better than anti-deps for depression, CBT equivalent to behaviour therapy for adult depression and obsessive-compulsive problem
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Lynch et al (2010)
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CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse.
CBT was effective in reducing symptoms in major depression, although the effect size was small. CBT was ineffective in reducing relapse in bipolar disorder. |
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The Centre for Economic Performance’s Mental Health Policy Group (2006)
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They suggest that a course of therapy (CBT) costs £750 and pays for itself in money saved on incapacity benefits and lost tax receipts
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Meyer (2001):
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1. Psychotherapy is effective.
2. Long-term treatment is better than short-term treatment. 3. No specific treatment modality is clearly better for most disorders. 4. Medication plus psychotherapy is not usually significantly better than psychotherapy alone. 5. The curative effects of psychotherapy are often more long term than those of medication 6. The effective use of psychotherapy can reduce the costs of physical disorders 7. no clear evidence that psychologists, psychiatrists, and social workers differ in treatment effectiveness. All three of these groups are more effective than counselors or long-term family doctoring |
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Debats (1996)-
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“lead strongly to the conclusion that there is a substantial and consistent relationship between meaning in life and psychological wellbeing”.
“The feeling that one can make sense, order or coherence of one’s existence plays a crucial role in a patient’s general mental health and their gain from the psychotherapeutic treatment”. “The results challenge the prevailing notion among clinicians that meaningfulness and meaninglessness are nothing more than philosophical concepts that can be bypassed”. |
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Costello (1993)
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CBT + applied relaxation therapy was superior to non-directive therapy. Non-directive therapy had diminishing gains whereas CBT had maintained gains
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Hollen & Beck (1979)
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''schemas''- schemas of well-adjusted indivduals- allow for realistic appraisal of life events. Maladjusted individuals result in disotorted perceptions, faulty problem-solving & psychological disorders. Schematic processes of depressed individuals-characterised by a negative cognitive triad-views of self, the world (world is harsh) and future (hopeless/bleak). Principle of cognitive therapy- replace the clients presumed distorted appraisal of life events with more realistic and adaptive appraisals.
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Greenberg
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“It is possible that all the models are equally unsound scientifically but they energize therapists and provide useful fictions to activate the patients to lead somewhat more satisfying lives”
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Nabi (2013)
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It was shown that after adjusting for psychological, behavioural and biological risk factors, those who think stress is impacting their wellbeing 'a lot or extremely' face a 50 per cent greater risk of suffering a heart attack compared to those who do not think stress is having such an effect.
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Structural
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Characterised by clear changes to physiological structure
Eg. Cancer, coronary heart disease |
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Functional
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Person often reports subjective symptoms rather than observable changes
No obvious structural changes Eg. Chronic pain, chronic fatigue syndrome |
