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Models of mental disorder-The cognitive model

Put simply, the cognitive model posits that people interpret their thoughts, which in turn are the main determinants of behaviour. This stands in sharp contrast to the behavioural or disease models, which do not accommodate the cognitive mechanisms involved in behaviour and illness. For the cognitive therapist primacy is given to errors or biases in thinking and it is these dysfunctional thought patterns that create mental disorders. An important framework used by many cognitive therapists is the ABC model first described by Ellis (1962). A stands for ‘activating event’, B stands for ‘beliefs’ about the ‘activating event’, and C stands for the emotional or behavioural ‘consequence’ that follows B, given A. Thus, a person who comes across a spider (activating event) may think it harmless or dangerous (beliefs) and will either continue their usual activity or be unable to do so (consequence). While the behavioural model focuses on the fear response, or consequence in the above example, the crux of the problem according to the cognitive model rests in the beliefs that people hold. Repetitive thoughts (ruminations) can lead to persistent actions (rituals), which can prevent normal functioning. Significant change in a person’s mental health necessarily involves significant change in their cognitions .

Though the reverse of the behavioural model, the two are rarely in major conflict. Open, collaborative working partnerships are established by respective therapists, and in the case of cognitive therapy, the client is encouraged to explore their thinking patterns and consider more appropriate and adaptive thoughts that fit the evidence. Furthermore, a growing discipline of cognitive behavioural therapy has emerged in recent decades. This trend is evident also in the practice of mental health nursing. The cognitive model is the youngest of those described and it remains to be seen how it may develop and to what ends. Of contemporary interest, however, is the use of this model to manage distressing delusions, hallucinations and feelings of paranoia that people may experience in the course of a mental disorder.

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