Tuesday, December 9, 2008

CBT Model of Assessment

Aaron Beck, the founder of CBT, developed his theory when researching depressive illness.

This is the ‘Classic Model’ of CBT. The model shows that causes of depression come from different influences in a persons’ life. It shows how depression often develops from childhood experiences and is eventually recognized by symptoms in the adult’s later life.

Explanation of the Model:

The first box shows that there may be ‘early childhood experiences’ that affected a person. People as early as childhood can develop ‘core beliefs’. A ‘core belief’ is when a person perceives themselves in a certain way. That is, they believe certain things about themselves. For example a person may think “because my mother left us, I must be unlovable”. Or “I am worthless”. Usually ‘core beliefs’ are the ‘I’ statements we make about ourselves. [NOTE: Core beliefs commonly develop from childhood, but can develop from any other life event later in life.]

The second box shows how these experiences develop ‘dysfunctional assumptions’. This means for example if a person grows up with a bullying father, they may develop thinking patterns like “I must keep quiet, or I will make my father angry” or, “the only way to survive is to fight back”. From such experiences and changes in thinking, people then develop ‘dysfunctional assumptions’. Assumptions are like rules or standards. People make up rules to survive. In the case of the previous example, the client may develop the rule “If I keep quiet, then I won’t get hurt.” . These rules are usually expressed with a ‘if…..then…’sentence structure.

The third box shows that, as happens in most people’s lives there, are other ‘critical incidents’ that influence us. These are usually important or decisive events which influence us. For example, a marriage break down, the death of a loved one, the tsunami, or a bombing.

The fourth box shows how depression develops when the earlier dysfunctional assumptions and core beliefs then become activated by these events. That means, when what we learnt negatively about earlier events, we then use to make sense of other present events. ‘Assumptions are activated.’ For example, if a lady used to compare herself negatively to her sister in childhood, or was always compared to her sister and made to feel bad, she may develop core beliefs like ‘I am not as good as my sister’ or ‘I am inferior’. This means vulnerability is established here that she grows up feeling inferior and second best. If in her later life her marriage breaks down, because of these earlier experiences, she may then blame herself for the marriage breakdown because she believes she wasn’t a good enough wife – inferior. So, the previous assumptions about being inferior repeat themselves and become activated again in a new situation.

The fifth box shows Negative Automatic Thoughts. ‘Automatic thoughts’ are the everyday thoughts we have in the present. They are the thoughts going through our mind. They are the things we say to ourselves. For example, if I go into a room and see a nice plant I may say to myself ‘that is a beautiful plant.’ ‘Negative Automatic thoughts’ are thoughts that go through our mind because of the way we interpret events negatively or feel negatively about them. For example, if I arranged to meet someone at a shop and they are late, I may feel worried or impatient and my negative automatic thoughts might be ‘maybe she had an accident’ or ‘maybe she missed a bus’ or ‘she’s always late’. Negative Automatic thoughts are the thoughts we have about the present, but they have a link with our deeper assumptions and core beliefs. People have described them as the thoughts we have at the ‘tip of the iceberg’, but which are connected to the deeper assumptions and core beliefs ‘under the water.

A Critical incident may therefore activate old assumptions, create new ones and develop all kinds of negative automatic thoughts.

Finally, the sixth box show how depression is then maintained by these thoughts and experiences. It becomes an illness when it goes on to develop symptoms. The ‘Symptoms’ are signs or warning signs that a person has got stuck and that their life is changing negatively and that this is beginning to affect their behaviour, their level of motivation, the way they feel (moods) and their thinking and their physical reactions.

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