Case study based on the cognitive behavioural perspective

Aaron T. Beck, the creator of Cognitive behavioural remedy (CBT) described it as "an active, directive, time limited methodology used to take care of a number of psychiatric disorders", (Beck 1979). Beck, influenced by Albert Ellis, developed cognitive remedy in the 1960s following a realization he made while executing free connection with patients in the context of psychoanalysis when he observed that patients was not reporting certain thoughts at the fringe of awareness, thoughts which often preceded intense mental reactions. This led Beck to begin viewing mental reactions as caused by cognitions, somewhat than understanding feeling within the abstract psychoanalytic platform, (Beck 1999). Cognitive remedy rapidly became a favorite intervention strategy to examine in psychotherapy research in academics settings. CBT includes a number of therapeutic methods, such as cognitive remedy, rational-emotive psychotherapy, problem-solving interventions, and visibility. In a very restrictive definition, it indicates psychotherapeutic techniques that seek to create change in cognition as a means of influencing other phenomena appealing, such as influence or behaviour. A broader description is due to the growing consciousness that most psychotherapeutic approaches combine cognitive and behavioural elements. Days gone by 2 decades have witnessed an increasing awareness of the common things that pertain to the psychotherapeutic process which cognitive behavioural techniques show (Fava, 1998). There is certainly empirical proof that CBT works well for the treating a number of problems, including disposition, stress, personality, eating, substance abuse, and psychotic disorders. Treatment is often manualized, with specific technique-driven simple, direct, and time-limited treatments for specific psychological disorders. CBT is utilized in individual therapy as well as group configurations, and the techniques tend to be modified for self-help applications (Foa et al, 2003). The practice of CBT emphasises incidents in the "here and now", rather than considerable exploration of the client's background and particularly their years as a child.

According to the cognitive model, negative symptoms function partially as a maladaptive strategy targeted to protect people from expected pain and rejection associated with proposal in constructive activity. CBT includes interventions from restoration and empowerment moves designed to solve self-stigmatized views. Cognitive behavioral therapy for negative symptoms will depend on careful evaluation of neurocognitive performing, symptomotology, daily functioning and standard of living, beliefs, habits, and images. Examination is an ongoing process achieved through several methods, including formal methods, functional evaluation of the client's action, and self-monitoring of thoughts, images, behaviors, and thoughts (Canther, 2009).

One goal of CBT is to solve overt problems by changing cognitions and behaviours. Change in root cognitions, or schemas, is also considered quite important, both along the way of dealing with overt problems also to prevent relapse. Therefore, reliable methods for examining patients' overt problems and underlying schemas are needed. (Liese, 1995). The next formulation is based on a research study of a woman called "Cara" and has been made based on a CBT procedure. This formulation is dependant on the five P's of the process of CBT formulation as reported by Johnston & Dallas (2006); showing issues, precipitating factors, perpetuating factors, predisposing factors, and protective factors.

Presenting issues

Cara presents lots of problems such as persistent delusional beliefs with both persecutory and grandiose styles, experiencing voices, and low self-confidence. Some of her symptoms could indicate that she is suffering from paranoid schizophrenia, however insufficient information is available to get this to assumption. She discovers it difficult to relate to both her peers, and other people at work, has significantly isolated herself and it is struggling with her school work. She left her job scheduled to sense persecuted, and thinks that there is a racially discriminating conspiracy against her.

Precipitating factors

Despite no specific intervention being used to handle past stress in CBT, patients often link their computerized thoughts to earlier traumatic encounters or fear replies and discussion of this help them to comprehend the triggers because of their delusional thinking (Brakoulias, 2008). Difficult events that prompted Cara's current mental health problems include her boyfriend leaving her, her mother starting a fresh relationship, a move to Southampton, and participating in a new institution. These four precipitating factors have been summarised according to the ABC Model to assist in the procedure of understanding the actual thoughts which may have resulted in Cara's false beliefs, and assumptions have been made about likely values that she supports.

Activating event: Cara's white boyfriend leaves her

Beliefs: I am bad enough/I am inadequate for him because I'm black

Consequence: Cara isolates herself/Develops paranoid delusions about a conspiracy where many people are racially discriminating against her

Activating event: Cara's mother starts a fresh relationship

Beliefs: I am by themselves/I am abandoned

Consequence: Cara isolates herself

Activating event: Cara moves to Southampton

Beliefs: I am together/I am empty/I am unwanted.

Consequences: Cara isolates herself and detects it hard to make friends

Activating event : Cara begins attending a new middle-class school with a minority dark population

Beliefs: I am bad enough/People are racially discriminating against me/People notice me because I'm different.

Consequence: Cara isolates herself and grows paranoid delusions about a conspiracy in which many people are racially discriminating against her

Perpetuating factors

Paranoia is considered a threat belief where the person perceives that others have intentions to harm them now or in the future with little if any supporting data. These beliefs look like accompanied by significant anxiety, worry, and behavioural avoidance (Freeman & Garety, 2003). Recent types of persecutory delusions have emphasised a variety of factors that lead to the formation and maintenance of paranoid values. Paranoia appears to be largely influenced by mental, cognitive, and environmental factors (Freeman et al. , 2002). Garety and co-workers used probability reasoning jobs to demonstrate that delusional patients ''hop to conclusions'', i. e. , these individuals require less information before they choose a hypothesis (Garety, 1991). Strauss (1991) suggested that delusions may progress from less extreme thoughts and as time passes begin to diminish back into those topics again. Just as Cara has constructed bogus schema's over an extended period of time. These schema's reflect her subjective perceptions of a world in which she feels "threatened", and not an objective perspective based on proof. In terms of attributional style, people with persecutory delusions tend to display a ''personalising'' bias in which they tend to blame others somewhat than situations for negative final results (Kinderman & Bentall, 1996, 1997). In the same way Cara blames professors and pupils on her behalf poor exam results, and her work fellow workers for needing to leave her job.

Schemas, or center beliefs that underpin and cause a few of Cara's overt problems when turned on by life occurrences or situations were analyzed as perpetuating factors. Two main factors that maintain fake values or schemas from a CBT point of view would be safeness behaviours, and seeking information. Protection behaviours are those behaviours that makes a person feel safe, and in the case of Cara this means isolating herself. However, credited to limited connection with others, Cara is unable to collect research that contradict her schema's, i. e. "Many people are away to get me". By collecting only proof that support her schema's, e. g. Cara overhears a pal contacting her "odd" which confirms a fake opinion; "I am different", Cara is unable to task her very subjective perception system, or even to consider information that contradict her values. In this way false beliefs are taken care of. (Please see Appendix for a list of other perpetuating factors).

Activating event: Cara isolates herself

Beliefs: Everyone is out to get me/I am together/People notice me

Consequence: Cara will not connect to anyone so struggles to collect any research to the contrary/Cara has difficulty in making friends due to isolating herself/Cara attracts attention to herself by not interacting with other people

Activating event: Cara overhears a pal dialling her weird

Beliefs: To Cara this gives evidence for established schema's; There may be something wrong with me/There is a conspiracy against me

Consequence: Cara isolates herself even more/Cara's incorrect schema's are more established

Activating event: Cara looks for out dark-colored and Asian lady as friends

Beliefs: People discriminate against me because I am black

Consequence: By not befriending white pupils, Cara is unable to test her hypothesis

Cara's public isolation can be conceptualised as an avoidance response that serve to protect her from panic and social threat; it seems to be closely related to her paranoia and auditory hallucinations. The inclination to see hostility may be a kind of data gathering bias where there is a failure to totally focus on important aspects of situations (visual scanning; Combs et al. , 2006), or a form of the jumping to conclusions bias where decisions are created quickly (Broome et al. , 2007).

Predisposing factors

Some predisposing factors have been summarised in line with the stress-vulnerability model. (Please start to see the appendix for a quantitative description of these events. Unfortunately there is absolutely no record of how Cara responds to the situations physiologically).

Quality of events

The particular stressors for Cara contain having had a series of difficult life occurrences. Cara's father left them when she was a tiny child and she was delivered to live with relatives for long periods of time with no description. Her mother had not been able to give Cara the attention that she needed, and Cara felt more and more disconnected from her. Although the consequences of these early on happenings on Cara aren't clear, she may have sensed confused, abandoned, only and unwanted, and this could have resulted in beliefs of not being good enough which were further re-enforced when Cara suffered sexual abuse at the hands of her sibling, aged 10. Cara isolated herself, a defence system which she also uses later in life to safeguard herself. Being sexually abused by the close relative could also have led to feelings of not being able to trust anyone. A failed sexual relationship at the vulnerable age group of 14 could have further reinforced Cara's low self esteem, emotions of distrust and of sense left behind and unloved. Cara believed that this was the only person who ever realized her, which betrayal resulted in later values that everyone is "against" her. Because the man was white the partnership attracted a whole lot of negative attention, which in blend with the actual fact that he had a white partner all along led to a few of the delusional beliefs Cara developed about being racially discriminated against when moving to Southampton at age 16, and joining a school with a minority dark population. The proceed to Southampton would have triggered earlier thoughts of being together and left behind, and earlier emotions of disconnectedness with her mother who was consumed in a fresh relationship at the moment. It is at this point that Cara also started feeling timid about her personal appearance, especially her locks, and starts thinking that everyone is noticing her because she is "different", being one of just a few black pupils. She becomes paranoid, and feels that many people are mocking her behind her back again. Cara re-creates the feelings from her prior relationship to be "special" or different when she starts off believing a teacher is interacting with her non verbally, informing her that everything is likely to be ok. This demonstrates on her need for acceptance as she seems progressively more disoriented and attempts to make sense of her interior mental health turmoil. As Cara ever more begins isolating herself, believing that everyone has a conspiracy against her, she is unable to gather proof that contradict any of her false values. Instead, she seeks evidence to verify her already profound seated negative beliefs, and when her exam marks plummet she is convinced that everyone is against her. She begins hearing another, negative, words who mocks her.

Protective factors

Cara has a record of doing well academically and is also ambitious. She isolates herself when in peril as a defensive measure. Cara seeks approval, and will most likely co-operate in treatment.

Another psychological point of view that might have been used is the Friendly inequalities theory. According to the theory; "The unequal of monetary and communal resources in population is central to describing why some teams are more likely than others to seek help from subconscious services (Fryer, 1998). A social inequalities formulation recognises that people are not passive when confronted with trauma, but engage instead in counter-power resistances (White, 2004). Considering Cara's honest and socio-economic backdrop, this approach may possibly also have been effective. Cara's low self esteem, as well as her delusions relating to a racially discriminating conspiracy, and her fake opinion that "many people are against me" could be looked at from this perspective. Possessed this formulation been used attention could have been directed at the construction of interpretation and narrative, and to significant occurrences and reactions as time passes. In contrast to CBT, additional time would be spent on significant happenings that caused problems to Cara, as well as issues encircling class awareness and the way in which certain oppressive techniques have become internalised and acted on Cara's id development (Johnstone & Dallos, 2006). However, scheduled to Cara's security behaviours (i. e. isolating herself) one could argue that gathering research that contradict her false idea systems would be more fruitful. Overly figuring out with other people from the same ethnical and socio-economical backgrounds could lead to Cara collecting information that support her bogus schema's.

In summary; during her CBT treatment Cara's central beliefs and phony schema's will be challenged. The normal formulation of CBT is to see delusions as maladaptive values developed from non-psychotic antecedent factors. Therapy comprises assessing the impact of the delusions on the patient's every day tendencies and collaboratively aiding the patient alter the values both by immediately tests them and by changing associated premorbid values (e. g. , ''I am a worthless'') which may be generating the psychotic symptoms (Beck et al, 2009). It is popular that delusional values can be ameliorated by cognitive behavioural remedy (CBT). It's been proven to effectively reduce delusional conviction in roughly 50% of cured circumstances (Jakes et al. , 1999). Another analysis by Wiersma et al. (2000) discovered that cognitive behaviour remedy in patients experiencing 'reading voices' demonstrated durable results on the target symptoms of hallucinations and their burden, and also on functioning in day to day activities and social associations. This consequence of durable improvement of cognitive behavioural therapy supports other results from the books (i. e. Sensky et al. , 2000; Tarrier et al. , 1999).

However, a report on CBT by Brakoulias, et. al, 2008, found that although CBT is effective in reducing delusional conviction, there was no accompanying change in reasoning style. This would imply delusional conviction was low in patients by a process that will not involve adjustment of standard reasoning styles. Thus, CBT may action to improve reasoning in a restricted manner, pertaining and then the usual cases mentioned in sessions, whilst general cognitive biases and impairments will stay. (Brakoulias, 2008). The purpose of CBT for negative symptoms is definitely not to restore clients to their premorbid level of functioning, but rather to help them break out of the shell by mobilizing their personal and situational resources and fostering emotionally meaningful reengagement with the planet around them (Canther, 2009).

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