There are six models of abnormality that attempt to propose treatment for psychological illnesses by viewing their nature and causes from different perspectives. One of them is the cognitive-behavioral model that concentrates on people’s thoughts and behaviors and their interplay (Comer & Comer, 2019, p. 48). The central assumption is that patients can learn how to identify, analyze, and change their core beliefs. The cognitive-behavioral model is sub-divided into two key dimensions. The behavioral dimension believes that some forms of conditioning, simple learning models, may produce maladaptive behaviors (Comer & Comer, 2019, p. 49). Researchers identified three types of conditioning: modeling, classical conditioning, and operant conditioning (Comer & Comer, 2019, p. 49). Classical conditioning is the form of associative learning when people learn to respond to the new stimuli the same way they respond to another due to their temporal proximity. For instance, children who receive painful injections from physicians may fear not only injection needles but also white lab coats.
In modeling, also known as observational learning, people learn how to respond to stimuli by observing others and copy their behaviors (Comer & Comer, 2019, p. 49). For example, when a son observes that his father is afraid of heights, he may develop a similar phobia. In operant conditioning, individuals learn how to respond by experiencing and evaluating the consequences of their performance – punishments or reinforcements (Comer & Comer, 2019, p. 49). People use to abuse alcohol or narcotic substances because it initially rewards them with pleasure and comfort.
On the contrary, the cognitive dimension explains abnormal functioning as a result of some cognitive problems. Individuals may misinterpret their experiences, make inaccurate assumptions, and adopt negative behaviors. Comer and Comer (2019) believe that abnormal functioning may also stem from illogical thinking and overgeneralization. For instance, one small adverse event of failure can make individual despair for the whole day. Regarding treatment, therapists apply various strategies to change patients’ functional ways of thinking by guiding them.
In order to address both problematic behaviors and beliefs, cognitive-behavior therapy involves a combination of techniques. This combination includes exposure therapy, an intervention under which patients are repeatedly exposed to the situations or objects they fear (Comer & Comer, 2019, p. 52). For example, an individual who fears being rejected by an audience while delivering a speech can be forced by a therapist to evaluate his/her negative social expectations. It may result in more accurate beliefs and experiencing less fear when encountering similar situations and other people.
However, abnormal behaviors and thoughts can be results rather than causes of psychological difficulties. As a result, the new wave of therapists introduced acceptance and commitment therapy (ACT) that makes individuals undertake their cognitions instead of evaluating and then changing them (Comer & Comer, 2019, p. 53). Mindfulness-based techniques are used in the form of mediation to teach patients to accept their cognitions without judgment. The main aim of such interventions is to avoid situations when individuals are troubled by their cognitions.
In one study, the objective was to evaluate the effectiveness of brief cognitive-behavioral therapy (CBT) to treat patients with schizophrenia in secondary care settings (Turkington et al., 2002, p. 523). The study hypothesized that CBT is a better option than traditional treatment of schizophrenic patients. The second hypothesis proposes that CBT may be replicated in the community by non-expert therapists and achieve comparable treatment benefits (Turkington et al., 2002, p. 523). Researches recruited 422 patients and carers to participate in a pragmatic randomized trial.
Patients with schizophrenia aged 18-65 who receive treatment in secondary care settings were divided into two major groups – CBT and TAU. (Turkington et al., 2002, p. 523). The patients and carers went through such primary measures as the Comprehensive Psychopathological Rating Scale (Asberg et al., 1978), Insight Rating Scale (David, 1990), and Burden of Care Questionnaire (Montgomery & Asberg, 1979) (Turkington et al., 2002, p. 524). In terms of secondary outcome measures, changes in schizophrenic symptoms and depression have been evaluated together with patient and carer satisfaction. The collected data was sent from six sites to the independent database for statistical analysis.
The data analysis showed no significant statistical difference between the groups regarding previous relapses and hospital stay days. According to Turkington et al. (Turkington et al., 2002, p. 524), the CBT intervention group’s mean of days in hospital was 48.53, while the TAU group had a mean of 52.01 previous hospital stays. On the contrary, statistically significant differences between groups were found in overall symptoms (CBT: 3.65 against TAU: 1.79 change score) and insights (Turkington et al., 2002, p. 524-525). In general, depression, overall symptomology, and insight were significantly inferior in the TAU group compared to the CBT group. It supports one of the hypotheses that CBT improves adherence and coping skills and reduces in-hospital stays without increasing suicidality. It was also found that CPNs who receive limited training can successfully deliver CBT intervention as they scored compatible NNT to experts (Turkington et al., 2002, p. 524-525). In terms of limitations, the TAU group was not controlled for contact time. The sample did not represent all patients with schizophrenia, and intervention did not significantly improve psychotic symptoms.
References
Comer, R. J., & Comer, J. S. (2019). Fundamentals of abnormal psychology (9th ed.). Worth Publishers.
Turkington, D., Kingdon, D., & Turner, T. (2002). Effectiveness of a brief cognitive-behavioral therapy intervention in the treatment of schizophrenia. The British Journal of Psychiatry, 180(6), 523-527. Web.