4. Cognitive-Behavioural Therapy [chapter]

Nima G. Moghaddam, David L. Dawson, David M. Gresswell
2015 Formulation in Action  
In this chapter, the case of Molly is formulated within a cognitive-behavioural therapy (CBT) framework. CBT is a generic term, encompassing both: (1) approaches underpinned by an assumption that presenting emotional and behavioural difficulties are cognitively mediated (A. T. Beck, 2005) or moderated (Hofmann & Asmundson, 2008) ; and (2) atheoretical bricolages of cognitive and behavioural techniques (Fennell, 1989) . This latter category may include effective therapeutic packages (perhaps
more » ... ng through mechanisms articulated in the first category) but, when theory is tacit, it becomes harder to make analytical generalisations or to extrapolate principles that could guide idiographic formulation and intervention. In contrast, the first category of approaches posits that presenting difficulties may be formulated from an assessment of individual cognitive content (thought processes and underlying beliefs) and implies that we can bring about change in presenting difficulties through change in associated cognitions. Within the expansive category of theory-linked CBT approaches, however, there remains a great deal of heterogeneity. Beyond a broadly shared assumption about the influential role of cognitions, we find that variants and developments of CBT place differential emphases on (for example): level of analysis (e.g., situational versus individual); levels of cognition (e.g., immediate thoughts versus underlying core beliefs); problem-specificity (e.g., trans-diagnostic versus disorder-specific); the relative contribution of 'non-cognitive' variables (e.g., overt behaviour, emotional experience, social context); and the particular mechanism of cognitive influence (e.g., mediational versus interactional), with some variants hypothesising complex interrelations, involving pathways between multiple cognitive 'systems'. Recent incarnations of CBT seem to place less emphasis on direct cognitive change (i.e., targeting the content, occurrence, and believability of thought processes) and greater emphasis on changing how people attend, relate, and respond to cognitions (i.e., second-order change; Hayes, Villatte, Levin, & Hildebrandt, 2011) -one such model is discussed in Chapter 5 of this volume. Given the diversity of 'CBT' approaches, and the potentially divergent implications of selecting one model over another, it is important that we specify the particular framework that we will use for the purposes of this chapter. We primarily base our approach and formulation on the theoretical model articulated by A.
doi:10.1515/9783110471014-006 fatcat:iwduprqshnaknnexkhfrbn5lpy