ABSTRACT
As we saw in Part 1, behaviour has been shown to play a key role in formulation ± generally and also in speci®c contexts such as the role of withdrawal in depression and `safety behaviour' in anxiety. Cognitive therapists are open to using techniques from behaviour therapy, the main techniques being exposure therapy, graded task assignments, activity scheduling, self-monitoring, behavioural experiments and behavioural diaries (Hersen, 2002). Other behavioural methods, such as contingency management, are described by Sheldon (1995). The only real point of departure between cognitive and behaviour therapy has been the debate about whether these techniques are effective in their own right and/or as reinforcement of cognitive change: in that they discon®rm dysfunctional client cognitions during `behavioural experiments' (Rachman, 1997a). For example, the client with panic disorder often believes that the panic symptoms will drive her mad. Exposing herself to situations that have triggered panic reactions in the past and refraining from `safety behaviours' might mean that she can ®nd that she does not go mad. Repeated experiences like this may eventually discon®rm the belief. In the debate between cognitive and behaviour therapists, cognitive therapists have argued that adding cognitive elements to, for example, exposure treatments enhanced their effectiveness whereas behaviour
party its case
has that and `verbally accessible' knowledge, and, secondly, between speci®ed and generalised disorders, to understand the relative contributions of cognitive and behavioural interventions in different disorders. Verbally accessible knowledge or insight allows re¯ective techniques to be effective. Situational knowledge may, however, require a speci®c type of stimulus to provoke emotionally relevant knowledge. This is often the case in anxiety disorders, where discussion of fear experiences without some feeling of anxiety being actually present does not seem helpful (Foa & Kozak, 1986). Brewin also uses the distinction between speci®c cognitions linked to speci®c disorders: for example, the highly speci®c thinking that goes with panic (Clark, 1996) ± and the more generalised cognitions that go with generalised anxiety disorder (Wells, 1997) ± to suggest ground rules for choosing the interventions most likely to shift particular types of thinking: sometimes these may be cognitive interventions that shift behaviours and sometimes they will be behavioural interventions that shift cognitions.
