What Can Be Done to Reduce Human Error Either at Work, on the Roads, or at Home - Essay Example

FROM THE PERSPECTIVE OF COGNITIVE PSYCHOLOGY, WHAT CAN BE DONE TO REDUCE HUMAN ERROR EITHER AT WORK, ON THEROADS, OR AT HOME Cognitive Behavioral Therapy (CBT) is the term used for intense short-term psychotherapy for a range of problems including substance abuse, anxiety disorder, marital conflict, depression, fears, and personality problems. Using the tools of cognitive assessment, specific distortions are addressed by the therapist who then guides the patient in correcting thinking patterns. Essentially therapy is aimed at getting patients to interpret what they are facing today rather than childhood experiences. CBT makes the patient learn self help skills, which are practiced in 'homework' that helps in changing the way a patient thinks and feels, presently. Treatment is focused on the now and is action oriented and practical, aimed at gaining confidence in facing real life issues. Before treatment starts, self-assessment forms filled by the patient help determine what problems the patient is facing now along with history of treatment/problems. There is mutual agreement on problems to focus on and the level of symptoms. This way, progress can be tracked across treatment. There is comprehensive information on several issues available through books and other media, which the patient is advised to access. There is a lot of information on anxiety, depression and other conditions, to keep updated on. Periodic reviews to keep the treatment in perspective and to understand what is going on and the possible need to fulfill small goals for a positive outcome. Without feeling overawed, the patient is made to sense his emotions, as they are the starting point for all experience. (Perry, Tarrier, Morriss, McCarthy and Limb et al 1999) Key to this discussion is the fact that the most successful post therapy patients are those who do 'self help homework' outside of therapy to help gain self-confidence. The therapist will devise interventions and tasks to help the patient deal with negative thoughts. Unlike other therapy, Cognitive Behavior Therapy (CBT) is more structured and tries to make the most out of a session with the patient. Treatment can be more effective in correcting even manic depression because it uses homework in therapy to build self-reliance and a sense of respect (Garety and Jolley et al 2000). CBT therapists in fact help patients to think for themselves and make them feel the way they think they should - and that is, in rational agreement with the situation. Homework between sessions sorts out dysfunctional thinking and self-awareness is created. People who are willing to try out homework therapy often lose their inhibitions faster during and after treatment than those who feel unable to. For example, someone who is under depression might suffer from feelings that they are not able to socialize. Therapy would include suggestions that an attempt, may be made to go out and meet relatives or friends and progressive therapy and homework exercises in relating to other people will point the client to the direction of remission of symptoms. A simulated exercise under controlled conditions will not be so effective. (Primakoff, Epstein & Covi et al 1986) Studies have been made on the effect that self exposure homework (as in the above example) has on therapy outcome (Garety and Jolley et al 2000). The studies were made on a mix of clients with social phobia and specific phobias. Two groups were made: 'compliant' patients who completed more than 85% of homework assigned during the initial couple of months of treatment, and the 'non compliant' - those who had managed to complete less than 50% of homework tasks across the same period. The studies revealed that a good number of the compliant group showed significant improvement dealing with social phobia and depression compared to those from the non complying group. This was after 12 and 26 weeks of treatment reviews. Another experiment across a shorter duration, studied the effects of intensive homework sessions on a small group of people with symptoms of panic disorder (Barrowclough, Haddock, Tarrier, Lewis, Moring, O'Brien, Schofield and McGovern et al 2001). It was seen that a four week session of exposure to more intense doses of homework helped to stabilize panic disorder compared to the effect of normal therapy. There is reason to support the argument that homework between therapy sessions is more effective in the reduction of social paranoia (Barrowclough, Haddock, Tarrier, Lewis, Moring, O'Brien, Schofield and McGovern et al 2001). Again, group studies made on patients with obsessive compulsive disorders indicated that homework compliance was a better predictor of response to therapy (Barrowclough, Haddock, Tarrier, Lewis, Moring, O'Brien, Schofield and McGovern et al 2001). The group experienced lower severity of symptoms and more flexibility of beliefs. Homework and self exposure helped to reduce the extent of denial in patients who were viewed the self and the world with considerable negativity. As part of cognitive therapy, more skilful clinicians help the patient with an agenda for treatment and self exposure sessions or homework - but avoid being rigid in recommending any response. The reason is that life happens between sessions -and the cues for response are embedded in the unsimulated situations that real life brings. Clients may have a fight , experience the 'high' of good news like promotion at work or pregnancy or some unforeseen event for which they have not been prepared in the previous therapy session. Clients can come back to therapy sessions less sure of themselves and it can be a challenge for therapists to interrupt routine therapy sessions and engage clients with a different view on the circumstances and assign them home tasks like breathing sessions and happy experiences which help in coping with uncertainty and low self esteem (Barrowclough, Haddock, Tarrier, Lewis, Moring, O'Brien, Schofield and McGovern et al 2001). One example is a middle aged woman who saw her role as a care giver to her aging mother becoming unmanageable. She seemed not to comply with her home assignments convinced that she was not going anywhere with her own and others' happiness. She was challenged by her therapist to take more responsibility for her own happiness so she could take better care others. This helped and later home assignments strengthened her beliefs. So, in a way homework compliance can be viewed as an adjustment to life if properly discussed with patients. Homework reveals key pathology and thus opportunities for new perceptions. (Freeman et al 2007) Homework or skills learnt in treatment is a crucial component of CBT. However, its relevance is clear when seen alongside an improvement in symptoms. Studies have thrown up evidence of more effective outcome of CBT treatment with homework therapy than that without (Blackwood, Howard, Bentall and Murray et al 2001). However, many therapy session records show that homework compliance has not been measured giving a lopsided picture of its capability (Blackwood, Howard, Bentall and Murray et al 2001). As a result much of homework therapy is considered as an 'uncontrolled variable' in CBT as there is no clear measurement of its effectiveness as a process Much of this is because there is no proper measure to track how homework compliance does or does not impact patients. Therapists tend to report imprecisely on homework done or not without clearly recording the processes during assignments and the qualitative responses of each client (Bryant, Simons & Thase et al 1999). As no indicating technique has been designed, compliance may be reported inaccurately with decline in symptoms during therapy. Successful patients may not continue to take much interest in homework. Due compliance is not followed. Inaccurate reporting that clients have complied when for some time, they have not been doing so, seems to diminish the role of homework as a factor of their improvement. However, as effective contributions to the rehabilitating effects of CBT, factors influencing homework compliance are worth studying (Bryant, Simons & Thase et al 1999). The effect on therapists is to divide perceptions on the effectiveness of Home Work compliance (Dev et al 2005). Many feel that homework helps patients in applying what has been learnt in therapy classes and is therefore a catalyst for speedier recovery. Another view, like that of Murli Krishnan and mentioned by Dev, is that the increasing feeling of well being also increases homework compliance and therefore a loop of conformity is created .Yet another logical view on compliance seems to suggest that homework has no effect on depression as increasing depression seems to keep affected people away from any suggested therapy, leave alone homework. So, home assignments do really seem to be viewed differently. Measuring the effect of Homework (HW) on CBT may be imprecise as this is 'life' therapy but observations of groups can help devise qualitative tools. (Dev et al 2005) In an effort to statistically test HW and its effect on depression, two groups of patients were tested for the effects of HW compliance using statistical modeling techniques (Persons, Burns, & Perloff et al 1988). The data generated indicated a major influence that homework had on CBT therapy. Homework had the effect of vastly improving those who seriously followed homework assignments and conversely, no improvement was indicated in those who were not able to comply with homework requirements. The cause for depression regressing was largely due to the effect of homework compliance and its adaptive effects. However, a correlation between the two did not seem to be suggested. The statistical interpretation of these problems can be illustrated by the 'non recursive system' employed in statistics. This is technically explained as a system can be directed at itself through 'a circular feedback loop'. This is the most effective way by which can reduce human error either at work, on the roads, or at home (Persons, Burns, & Perloff et al 1988) These systems cannot be explained by ordinary statistical measures. Statistical modeling was used to investigate causality using two groups of patients who had completed CBT for depression. Patients and therapists both played a role in estimating homework compliance at the end of 3 months. Strong evidence was seen that HW compliance had a strong influence on therapy outcomes. Patients completing assignments consistently improved in relation to more neglectful patients. However no strong evidence was found of the causal effects of depression on homework compliance. Severely affected patients did jut as well as those who were mildly affected (Burns & Spangler et al 2000). In conclusion, it should be stated that most research delving into the influence on psychotherapy of homework has focused on the amount of homework assignments completed by patients and its influence on clinical therapy (Rees, McEvoy & Nathan et al 2005). But it is equally true that the quality of compliance is also vital because it encourages initiative outside of the therapy 'classroom. For instance, the quality effort put into home assignments concerning thought diaries was found to be directly impacting anxiety and depression symptoms: they actually declined (Rees, McEvoy & Nathan et al 2005). Bibliography: Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S. W., Moring, J., O'Brien, R., Schofield, N., McGovern, J. (2001). Randomized Controlled Trial of Motivational Interviewing. Am. J. Psychiatry 158: 1706-1713 Blackwood, N. J., Howard, R. J., Bentall, R. P., Murray, R. M. (2001). Cognitive Neuropsychiatric Models of Persecutory Delusions. Am. J. Psychiatry 158: 527-539 Bryant, Michael J. Anne D. Simons & Michael E. Thase. (1999). Therapist Skill and Patient Variables in Homework Compliance: Controlling an Uncontrolled Variable in Cognitive Therapy Outcome Research; Cognitive Therapy and Research , Vol. 23, No. 4, 1999, pp. 381-399. Curtis, D. (1999). Cognitive therapy is no better than supportive counselling. BMJ 319: 643a-643 Clare S. Rees, Peter McEvoy & Paula R. Nathan. (2005). Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy; Cognitive Behaviour Therapy Vol 34, No 4, pp. 242-247. School of Psychology, Curtin University, Australia; 2Centre for Clinical Interventions, Perth, Western Australia, Australia. David D. Burns & Diane L. Spangler. (2000) Does Psychotherapy Homework Lead to Improvements in Depression in Cognitive-Behavioral Therapy or Does Improvement Lead to Increased Homework Compliance. 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