Critical Appraisal of Cognitive Therapy for Psychiatric Disorders

This article provides a critical appraisal of cognitive therapy for psychiatric disorders such as substance use disorder, anxiety, depression, personality disorders, and obsessive-compulsive disorders. It discusses the theory behind cognitive therapy, its effectiveness in treating various mental health problems, and its application in a case study of a patient with anxiety and depression. The article also explores the compatibility and incompatibility of cognitive therapy with Christian beliefs.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student
Name of the university
Author’s note

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Abstract
Cognitive therapy has been used successfully in several psychiatric disorders like substance use
disorder, anxiety, depression, personality disorders and the obsessive compulsive disorders. The
report spanned round the case study of Dr. House who had been suffering from anxiety and
depression has been an avid consumers of morphine, oxycodone, and methadone. His care plain
entails a cognitive therapy and social skill training. The case conceptualization initiated with the
description of the theory used, including the inventor of the theories supported by the current
literary sources. However, the second part the assignment had dealt with three techniques that
could be used in case of Dr. House. The final part of the assignment is related to the application
of spiritual support to the patient. This section has been supported by the biblical interpretation
of some of the concepts of cognitive theory that the Christian counselor often uses. This section
has also discussed about some of the cognitive therapy concepts that is contradictory to the
Christian beliefs. Finally, the work has been concluded with expected outcomes like improved
coping up skills, alcohol and drug abstinence.

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Table of Contents
CASE CONCEPTUALISATION....................................................................................................3
Intervention Plan..............................................................................................................................6
Synopsis.......................................................................................................................................6
Interventions................................................................................................................................6
Questioning..................................................................................................................................6
Reframing....................................................................................................................................7
Social skills training....................................................................................................................7
Spiritual application.........................................................................................................................7
Compatibility...............................................................................................................................8
Incompatibility.............................................................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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Case conceptualisation
The theory that has been chosen for this paper is “cognitive Therapy”. Cognitive therapy
is a type of psychotherapy that was developed independently by the American Psychiatrist Aaron
T. Beck and Albert Ellis (Grant et al., 2012). It is one of the therapeutic approaches under the
umbrella term of “cognitive behavioral therapy”.
According to Beck, feelings, thoughts and the behaviors are interrelated and individuals
can overcome their difficulties by identifying and changing the inaccurate and disruptive
thinking process, problematic behavior and the distressing emotional responses (Grant et al.,
2012). They have also stated that the dysfunctional thoughts in individuals leads to extreme
emotions, which in turn leads to maladaptive behavior.
Cognitive theory has been found to be effective for depression. Several researches have
been performed in order to understand the efficacy of cognitive theory for the conditions like
anxiety and depression. Grant et al., (2012) have performed a randomized controlled trial in
order to evaluate its effectiveness in the low functioning patients with chronic schizophrenia. In
order to the determine the efficacy an 18th month recovery oriented program was conducted for
improving the psychological and the negative symptoms in patients with schizophrenia. As per
the global Assessment scale score, significant improvement was found in the functional outcome,
motivation and the positive symptoms with cognitive therapy. Again in a metaanalysis format,
the Beck’s cognitive theory was evaluated in case of depression and the cognitive theory was
measured with the other modalities. A degree of change as found for the cognitive theory in
comparison to the other modalities, no treatment control, pharmacotherapy, behavior therapy and
other psychotherapies. The effectiveness of the therapy was not related to the length of the

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therapy . Alavi et al., (2013) have also evaluated the effectiveness of the cognitive therapy in
decreasing the suicidal ideation and the hopelessness in the adolescents with previous suicidal
attempts. As per the findings, cognitive therapies has been considered as an effective , acceptable
and appropriate treatment modality for the adolescents with a differential suicidal attempt (Alavi
et al., 2013)
Hence, it is evident that cognitive therapy can be used against several mental health
problems like anxiety, depression or suicidal ideation, personality disorders as well as eating
disorders.
The case study of Dr. House reveals that he takes drugs and the alcohol, probably to keep
away his stress and his pre-conception that drugs would be helpful to cope up with the stresses of
his personal life and relationships. It has already been stated before that cognitive theory helps
the clients to recognize the inaccurate thoughts and helps them to develop skills for coping with
habitual associated behavior towards them. Addressing and assessing the negative thoughts
paves the way to flexible ways of thinking, increased positivity and willingness to do the
activities that would be helpful to challenge his negative beliefs.
Practice of cognitive therapies needs adherence to the ethical guidelines. The main
considerations should include informed consent, exposure based out of office, autonomy of the
patients, involving the patient in the decision making process and preservation of the basic rights
of the patient (Sookman, 2015). It has been clearly stated in the case scenario, that Mr. House
struggles with his body image and strongly feels that he doesn’t need counseling. Although it is
necessary to teach Dr. House, that a patients sometimes does not understand that he is in distress
or he needs help, but it should be done without hurting his beliefs. The trend legally and morally

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will be to include the patient in the decision making of the treatments in order to nullify the
concept of paternalism.
A multicultural approaches involves the consideration of the cultural impacts on the
behavior of the multiple groups in a single context. The multicultural that has to be applied might
apply to one cultural context and might apply to the other (Hall, & Ibaraki, 2016). Hence, it is
important to determine how well Mr. House fits within the sociocultural context and then
determine how well a treatment approach can be applied.
The initial stage is the evaluation of the severity of the crisis that would help the
psychiatrist to assess some of the physical dangers to the patient after which the therapists must
determine the course of action that has to be taken (Hall, & Ibaraki, 2016). Then the patient will
be assisted to assess and mobilize his/her own strengths. Thus it can be seen that the cognitive
theories can be used for patients in crisis situation.

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Intervention Plan
Synopsis
Dr. House has been seeking counseling in order to address the problems of substance
abuse, alcohol abuse, depression, anxiety and withdrawal symptoms. House stated he uses
morphine, oxycodone, and methadone if his drug of choice is not available. He also struggles
with the body image and the to perform daily activities of living after the surgery. Dr House
hence admits that he consumes drugs in order to cope up with his leg pain and stressful life.
However, cognitive behavioral therapy and social skill training approach has been selected as the
choice of treatment for Dr House.
Interventions
The three techniques that can be used for Mr. House are as follows:-
Questioning
Socratic questioning involves the counselor to ask a series of graded question to the
patients in order to guide the thought process of the patient towards the therapeutic goal. While
questioning the therapist generally avoids a didactic style and use questions for assisting the
patient to develop new perspective (Braun et al., 2015). For example, it is evident from the case
scenario that Dr. House thinks that he is not addicted to substance, but taking them in small
amount helps him to cope up with the stress. In such a case, questions should be directed in such
a way, in order to make the patient acknowledge the fact that, drug is actually posing a harmful
effect on his health status (Braun et al., 2015). Cross questioning would probably expose the fact
that Dr. House pretends drug abstinence and recurrence.

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Reframing
Cognitive reframing can be defined as a technique that helps the patient to identify and
the dispute the irrational and the maladaptive thoughts by assisting the patient to develop more
positive alternatives (Beck et al., 2015). It is evident from the case study that Dr. House suffers
from depression due to his inability to perform the activities of daily living smoothly and he also
thinks that drug helps him to cope up with personal problems. In such a case a therapist might
ask Dr. House about the other health care problems that is arising due to his drug consumption
other than focusing on how the drug is helping him.
Social skills training
SST can be used to improve the social skills in Dr. House. It can be delivered
individually or in groups. Initially the educator should inform the patient about a particular skill,
explain how to execute ad them model the behavior (Hofmann et al., 2012). Role play involves
practicing new skills at the time in simulated situations. Correct feedback should also be taken
from the patient to help improve the social skills at the time of practice. Positive reinforcement is
used for giving rewards to the patients in improving the social skills (Williams, 2013). For
example, Dr. House can be helped to manage his personal problems by increasing the
socialization skills and assisting him to develop resilience.
Spiritual application
1. The spiritual challenge in this case is to evaluate the Dr. House’s perception for god. His
aversion to god, might pose problem in the application of ant spiritual treatment. Again, it is
necessary to know the religious beliefs of the patient.

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A Christian counselor might be contacted , who would use skills from the field of secular
psychology and counselling, where the clients are informed about the biblical truth for the errors
and the disruptive thoughts that the patients make.
Compatibility
The first compatibility of the cognitive theory with Christian belief is that cognitive theory
states that human difficulties stem form disruptive thoughts. The biblical sense of the
cognitive theory can be interpreted as “god instructs the thoughts and Satan is considered as
the father of lies and if the minds are not grounded to the truth then people might become
susceptible to the deception of Satan (Jones & Butman, 2011).
The second compatibility is related to the techniques. CBT encourages self-control in
individuals , which is in compatible to the concept that bible says; to be free of false thoughts
and to grow truly, one needs to be grounded to the truth of god (Jones & Butman, 2011).
Finally, the cognitive behavioral view of the human nature is not accurate and the biblical
interpretation of this can be stated as “Human beings are accepted by god in their
imperfection”.
Incompatibility
 The cognitive theory is embedded in naturalism and hence might not accept the concept
of god.
 Cognitive theory discourages disruptive thoughts and encourages the patient to see the
positive side of every act which contradicts with the saying : “We have all sinned and
deserve God's judgment” (Pearce & Koenig, 2013).

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 The cognitive theory discards the concept of paternalism. In Christian belief paternalistic
viewpoint might exists among the Christian counsellors.
Conclusion
The expected outcome of the treatment is that Mr. House will be able to quit drug and
alcohol constant and will be able to cope up with the withdrawal symptoms. The social skills
developed by Dr. House will help him to deal with his personal problems. Since, Dr. House is
facing difficulty with his legs after the surgery, helping his to develop physical skills might
require collaboration with an occupational therapist. A continuous monitoring will ensure that
Dr. House can perform the daily activities of living.

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References
Alavi, A., Sharifi, B., Ghanizadeh, A., & Dehbozorgi, G. (2013). Effectiveness of cognitive-
behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents
with previous suicidal attempts. Iranian journal of pediatrics, 23(4), 467-72.
Beck, A. T., Davis, D. D., & Freeman, A. (Eds.). (2015). Cognitive therapy of personality
disorders. Guilford Publications.
Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic
questioning predicts session-to-session symptom change in cognitive therapy for
depression. Behaviour research and therapy, 70, 32-7.
Grant, P. M., Huh, G. A., Perivoliotis, D., Stolar, N. M., & Beck, A. T. (2012). Randomized trial
to evaluate the efficacy of cognitive therapy for low-functioning patients with
schizophrenia. Archives of general psychiatry, 69(2), 121-127.
Hall, G. C. N., & Ibaraki, A. Y. (2016). Multicultural issues in cognitive-behavioral therapy:
Cultural adaptations and goodness of fit. The Oxford handbook of cognitive and
behavioral therapies, 465-481.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of
cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research,
36(5), 427-440.
Jones, S. L., & Butman, R. E. (2011). Modern psychotherapies: A comprehensive Christian
appraisal. InterVarsity Press.

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Pearce, M., & Koenig, H. G. (2013). Cognitive behavioural therapy for the treatment of
depression in Christian patients with medical illness. Mental Health, Religion & Culture,
16(7), 730-740.
Sookman, D. (2015). Ethical practice of cognitive behavior therapy. In The oxford handbook of
psychiatric ethics.
Williams, J. M. G. (2013). The psychological treatment of depression. Routledge.