Practise antidepressant mechanisms, Beck's cognitive restructuring and Ellis's REBT, then apply treatment procedures and evaluate their evidence in context.
Olivia has a bipolar disorder and is receiving cognitive restructuring as therapy. In her first session she said:
'My life used to be 100% perfect! I had an amazing job and friends. I stayed up one night to research an expensive holiday. Recently everything has changed. I am not working and have no energy. No one likes me, not even my family, as I am not fun to be with. I have cancelled the holiday. Why does this keep happening to me? I feel amazing for a while and then it all changes and I am depressed again.'
Suggest how cognitive restructuring can help Olivia with both her depressive and manic episodes.
Award 3-4 marks for a detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes.
Maximum 3 marks for detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with either her depression or her manic episodes.
Award 1-2 marks for a basic suggestion with some understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes.
4
Can credit reference to type I or II bipolar.
If candidate discusses either depression or manic and not both can get 3 out of 4 marks.
No direct link to Olivia's specific symptoms 2 marks.
3(a)
Cognitive restructuring involves -
Talking therapy where the therapist asks questions and identifies the patient's irrational/illogical thinking patterns. Initially the therapist explains how the cognitive triad (self, others and future) works and the effect this has on behaviour and mood. The patient is set homework to identify their mood, thoughts and behaviour and this is discussed in subsequent sessions with the therapist. The therapist will discuss with the patient more rational and logical thoughts and help the patient to recognise the irrational thinking outside of the therapy sessions ('reality testing'). At the end of therapy, the patient will have the ability to challenge their irrational thoughts, engage in positive behaviour and increase mood. The manic episodes for someone with bipolar disorder are characterised by an overly positive view of self, world and future.
Example:
Olivia's therapist can use Olivia's description of her life to explain the cognitive triad is made up of thoughts about yourself, the world/others and the future. (1) The therapist can challenge both the manic and the depression illogical thinking and help Olivia to replace these thoughts with more rational statements about herself, the world and her future. (1) For example, no one's life is 100% perfect - a more rational view is that life can be good but doesn't need to be perfect - this will help Olivia to see herself in a more logical way and help her mania reduce. (1) For the depression, the therapist could challenge that it is unlikely that no one likes her and that she is never any fun to be around with a more realistic view that Olivia is liked by people in her life which will increase her mood. (1)
Other appropriate responses should also be credited.
Explain one strength of using cognitive restructuring therapy with Olivia.
Award 2 marks for an explanation of a strength of cognitive
restructure for Olivia.
Award 1 mark for a basic explanation of a strength of cognitive
One strength from:
- There are no side effects, unlike medication (e.g. Lithium -
mood stabiliser - feeling tired, weight gain, dry mouth,
excessive thirst, etc.)
- Effective therapy - e.g. Dobson found those who had
cognitive restructuring as opposed to drug therapy did
significantly better ( 90% versus 70% improvement in
depression symptoms).
- Long term effectiveness - teaches the patient how to
recognise automatic overly positive or overly negative
thinking and how to challenge these thoughts. The patients
can do this on their own when therapy is over.
- Cognitive therapy is shorter term and therefore cost
effective (6-12 sessions) compared to other types of
therapy (e.g. psychotherapy).
Example:
One strength of cognitive restructuring for Olivia is that it has
long-term effectiveness as Olivia will learn how to recognise her
automatic overly positive and negative thoughts. (1) Once
therapy has finished if Olivia goes back into a manic episode,
she can replace the overly positive thoughts (e.g. 'my life is
perfect') with more rational thinking (e.g. 'my life is really good,
not perfect. No one's life is perfect'). (1)
Other appropriate responses should also be credited.
2
No credit to 'will improve her mania and depression' on its own.
0 marks to long term benefits/improvements on its own. No credit to just identifying a strength.
Allow full credit for reference to research that shows effectiveness for bi-polar or depression.