15 terms

Frames of Reference - Cognitive Behavioural Approach

The cognitive behavioural approach assumes that a person's cognitive function and beliefs influence their behaviour, and that by helping a person dispute their irrational thoughts, they will be empowered to change their behaviour (Bruce & Borg, 2002).
What is the Cog Behavioural approach about?
Following this practice model an occupational therapist assists a person to identify and change their irrational thoughts, then take this learning and use it in real life opportunities.
An OT can use Cog Behavioural approach how?
You inquire by talking with the person about their day and everyday tasks. In doing this you encourage the person to tell you about the events and tasks which are causing them to experience extremes of emotion or blocking them from doing what they need to do. These extreme emotions can include anger, depression, phobias or anxiety. The therapist then assists the client though a process to uncover the person's irrational beliefs
How do you find out a persons cog function and beliefs?
Each person's beliefs are developed though their own life experiences. These experiences can be lived as well as watched (observational learning, vicarious reinforcement). Learning from society, and vicarious reinforcement are key aspects of Bandura's social learning theory. Bandura's theory is an important aspect of the cognitive -behavioural approach as his work helps us understand how we develop our own personal perceptions and rules of life and how we can be reinforced to make changes.
How do people develop beliefs?
Often our beliefs (shaped from life) are at an unconscious level, therefore we can be unaware that they are silently providing rules for living. For some people these rules of living develop into irrational thoughts. These thoughts can negatively affect our ability to participate in life in a healthy balanced way
What is the link between a person's cognitive function, beliefs and irrational thoughts?
Ellis summaries irrational views as "musturbatory thinking" (Bruce & Borg,2002, p.170). If your not sure what this means, go look it up. The following reflection task is going to give you examples of irrational thinking. Your task is to consider how you would re-phrase the statement to move it towards being more rational.
What is irrational thinking?
Beliefs that:
1. Distort reality

2. Are illogical
Exaggerate the badness of events
Expressed in absolute terms e.g. 'shoulds', 'must'
Make absolute judgements of people

3. Result in secure or extreme emotions that may be disabling and block your clients from achieving your goals.

Distorted beliefs develop from three possible ways of thinking.
What is Self Defeating Thinking?
i. Inferences

What is 'going on'

They provide a window to the evaluative thinking

ii. Evaluations

Go beyond the 'facts' to evaluate them in terms of what they mean to us. Evaluations are sometimes conscious, sometimes beneath awareness. Irrational evaluations consist of one or more of the four types of beliefs:

1. Demandingness

2. Awfulising

3. discomfort-intolerance

4. self/other-rating

iii. Core beliefs

Guiding a person's inferences and evaluations are their underlying, general core beliefs.

To be worthwhile as a person I must succeed at everything I do and make no mistakes.

Thing must be the way I want them to be otherwise life will be intolerable.

I must worry about things that may go wrong otherwise something terrible will happen

Discomfort and pain are unbearable and I must avoid them at all cost.
How this this look in real life? Consider this example that demonstrates the ABC Model (Ellis) in action;
Your neighbour phones and asks if you will baby-sit for the rest of the day. You had already planned to catch up with some gardening. You infer that: 'If I say no, she will think badly of me'.
You evaluate your inference: 'I couldn't stand to have her see me as selfish'.

Your inference and the evaluation that follows are the result of holding the core belief: 'To feel OK about myself, I need to be liked, so I must avoid disapproval from any source'.
You feel anxious and say yes.
What is the 'Three Levels of Thinking'?
A= Activating Event
B= Beliefs
C= Consequence
Ellis created the ABC theory. This therapy is one of the key informing theories stated within the frame of reference for the cognitive -behavioural approach. Can your remember what the A, B, C stand for?
Goals of Intervention

...the person must also alter the way she/he thinks.

The therapist aims to have the client set his/her own goals....
There are two key points captured within the goals of intervention. Can you remember them?
1. Person identifies irrational ideas

2. Demonstrates the illogical nature of these thoughts

3. Shows how these beliefs do not help

4. Uses humour and absurdity to confront

5. Explains how rational thoughts can replace these

6. Teaches the person how to decrease future irrational thoughts

Disputational Questions

Does it logically follow that because you want..., therefore you must...?

Where is written that you must...?

Where is the evidence that...?

Does this match with what is actually happening?
How do you dispute irrational thinking:
Strategies to uncover beliefs

"What were you telling yourself about (A) (the situation) to make yourself disturbed at (C) (feelings/behaviours)?

"What was going through your mind?"

"What was on your mind then?"

"What were you thinking at that moment?"

"Lets say this is true, what are you telling yourself about this?"

"What kind of person did you think you were for...?"

"... and that would mean... and therefore..."

"What does that mean about you?"

"What does it mean to you to...?"

"And what would that do?"

"And that would do what?"
What are strategies to uncover beliefs:
Cognitive behavioural strategies & occupational therapy

listening for musts
use films and visual media
2 more strategies to be used, or can be used in intervention
• Research supports use with multiple age groups and diagnostic problems, including children
• Sharing of information on intervention with clients increases awareness and understanding
• Reinforcement hierarchy (initial reinforces, symbolic, social contract) useful in realising the many levels of reinforcement that may influence behaviour
• Promotes an education/learning focus (not illness focus) ie skills are taught, person becomes their own therapist

Compatible with community settings, and health promotion
Emphasis on doing via graded activities - homework, tasks, etc
Educational models promotes treatment in groups
Primary goal of generalisation
Advantages of the cognitive-behavioural approach
• Still don't know a lot about how we think (how physiology, biology, heredity, environment and experience contribute to cognitive growth)
• This approach is limited with some people because other factors are affecting their thinking
• Difficult to define cognitive process because of the changing nature of thinking

Most research has been based on children's thinking, not adults
• Few cognitive assessment tools are developed in occupational therapy, but there are many developed for and by psychologists
• Difficult to accurately assess the impact of cognitive treatment strategies
Limitations of the cognitive-behavioural approach