Cognitive Behaviour Therapy for Addiction | AQA A-Level Psychology Revision

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 65 to 80 minutes

exam questions by topic 👇

1. 1AQA A-Level Psychology | Free Revision Notes
2. 2exam questions by topic 👇
3. 3Learning Objectives 🎯
4. 4Revision Notes 📚
5. 5Hints from the Examiner Reports 💡
6. 6Common Mistakes ⚠️
7. 7Exam-Style Questions ✍️
8. 8Answers and Mark Scheme

Cognitive behaviour therapy for addiction A-Level Psychology revision examines how changing thoughts and behaviour may help a person resist an addictive substance or activity. Clients identify triggers, challenge distorted beliefs and learn practical skills such as relaxation, assertiveness, refusal strategies and time management.

CBT does not simply tell someone to stop. It helps them understand the cycle maintaining their addiction and practise alternative responses for future high-risk situations. You will also evaluate motivation, dropout, long-term effectiveness and whether CBT adequately treats physical dependence. Cognitive behaviour therapy is explicitly required within the AQA Addiction specification.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

• Define cognitive behaviour therapy as a way of reducing addiction.

• Explain how triggers and high-risk situations are identified.

• Explain cognitive restructuring.

• Explain how irrational or unhelpful thoughts are challenged.

• Explain behavioural strategies including relaxation, time management, assertiveness and refusal skills.

• Apply CBT to substance and behavioural addictions.

• Explain relapse prevention within CBT.

• Evaluate CBT in terms of effectiveness, suitability, dropout and long-term outcomes.

Revision Notes 📚

Cognitive Behaviour Therapy for Addiction A-Level Psychology Revision Focus

Cognitive behaviour therapy, usually shortened to CBT, is a psychological treatment that aims to change:

• Unhelpful thoughts.

• Irrational beliefs.

• Distorted interpretations.

• Addictive routines.

• Responses to triggers.

• Coping behaviour.

The central assumption is that thoughts, feelings and behaviour influence one another.

A possible addiction cycle is:

Trigger → addictive thought → craving or emotional distress → addictive behaviour → short-term reward or relief → stronger future addiction

CBT attempts to interrupt this cycle at several points.

For example:

Stress → “I cannot cope without gambling” → urge to gamble → online gambling → temporary escape

CBT might replace this with:

Stress → “The urge will pass, and gambling will make the problem worse” → relaxation and alternative activity → reduced gambling

AQA describes CBT as focusing on changing how the addicted person thinks, identifying triggers, providing alternative thought processes and teaching coping strategies for future risk situations.

The Cognitive and Behavioural Components

The Cognitive Component

The cognitive component focuses on:

• Identifying unhelpful thoughts.

• Recognising cognitive biases.

• Examining the evidence supporting a belief.

• Considering contradictory evidence.

• Developing more realistic alternatives.

• Changing how the addictive behaviour is interpreted.

For example, a gambler may think:

“I am unusually skilled, and the next bet will recover my losses.”

CBT might challenge this by examining:

• The actual probability of winning.

• Complete records of wins and losses.

• Whether previous predictions were consistently accurate.

• The amount earned by gambling organisations from losing customers.

• Whether previous losses genuinely alter the next outcome.

The Behavioural Component

The behavioural component focuses on what the person does in response to:

• Craving.

• Stress.

• Boredom.

• Social pressure.

• Environmental cues.

• Negative emotions.

The client may learn and practise:

• Relaxation.

• Assertiveness.

• Refusal skills.

• Time management.

• Problem-solving.

• Positive self-talk.

• Role-play.

• Alternative activities.

• Avoidance or management of high-risk situations.

AQA identifies cognitive restructuring together with behavioural skills such as time management, refusal skills, assertiveness and relaxation as central CBT content.

Why CBT Combines Cognition and Behaviour

Thoughts can influence behaviour.

For example:

“I have no control over my craving.”

may make relapse more likely.

Behaviour can also influence thoughts.

For example, successfully refusing a cigarette may produce:

“I can cope without smoking.”

The two parts reinforce one another:

1. More realistic thinking supports healthier behaviour.

2. Successful behaviour increases confidence.

3. Greater confidence makes future coping more likely.

4. Repeated coping weakens the addictive routine.

CBT therefore aims to produce active psychological change rather than only suppressing symptoms.

Identifying Triggers

What Is a Trigger?

A trigger is an internal or external event associated with craving or addictive behaviour.

Triggers may be:

External

• A particular place.

• Friends who use the substance.

• A gambling application.

• A casino.

• A shop selling cigarettes.

• An advertisement.

• A work break.

• Being alone at night.

Internal

• Stress.

• Anxiety.

• Boredom.

• Anger.

• Low mood.

• Loneliness.

• Craving.

• Thoughts about reward.

AQA’s 2021 application material identifies examples such as being alone in the evening, passing a betting shop and reading stories about lottery winners.

Why Identifying Triggers Matters

If the person does not recognise what starts the cycle, the addictive behaviour may feel:

• Sudden.

• Unpredictable.

• Uncontrollable.

• Automatic.

Identifying triggers allows the person to prepare.

For example:

“I usually gamble when I am alone and bored after work.”

This insight creates several possible interventions:

• Arrange another evening activity.

• Contact a supportive person.

• Block access to gambling applications.

• Use relaxation.

• Prepare alternative self-statements.

• Reduce access to money during high-risk periods.

Trigger Analysis

The therapist and client may examine a recent addictive episode.

Question	Example answer
What happened beforehand?	I finished work and was alone
What were you feeling?	Bored and stressed
What were you thinking?	Gambling will make the evening exciting
What did you do?	Opened a betting application
What happened immediately afterwards?	I felt distracted and excited
What happened later?	I lost money and felt worse
What could be done differently?	Exercise, call someone and block the application

The purpose is to understand the whole maintaining cycle rather than blame the client.

Risk Situations

A risk situation is a circumstance in which relapse or addictive behaviour is particularly likely.

Examples include:

• Social events involving smoking.

• Being offered a drink or cigarette.

• Receiving a gambling advertisement.

• Being paid.

• Experiencing conflict.

• Being alone.

• Feeling overwhelmed.

• Having unstructured free time.

• Meeting friends associated with the addiction.

AQA’s 2024 mark scheme describes cognitive analysis as identifying risk situations before acquiring behavioural skills to manage them.

Interpersonal Risk Factors

Interpersonal factors involve other people.

Examples include:

• Peer pressure.

• Invitations to gamble.

• Conflict.

• Family modelling.

• Fear of exclusion.

• Difficulty refusing.

Intrapersonal Risk Factors

Intrapersonal factors occur within the person.

Examples include:

• Stress.

• Boredom.

• Craving.

• Irrational thoughts.

• Low self-esteem.

• Anxiety.

• Anger.

AQA’s 2025 mark scheme explicitly includes relapse prevention involving both interpersonal influences, such as peers, and intrapersonal influences, such as stress.

Cognitive Restructuring

What Is Cognitive Restructuring?

Cognitive restructuring is the process of identifying, examining and changing unhelpful or irrational thoughts.

The person learns to:

1. Notice the thought.

2. Identify its effect on feelings and behaviour.

3. Examine the evidence.

4. Challenge inaccurate assumptions.

5. Develop a more realistic alternative.

6. Practise using the alternative in a risk situation.

The aim is not unrealistic positive thinking.

The aim is accurate and useful thinking.

A Cognitive Restructuring Sequence

Stage	Example
Trigger	The gambler loses several bets
Automatic thought	“A win must be due”
Behavioural effect	Another bet is placed
Evidence supporting the belief	Wins have sometimes followed losses
Evidence against the belief	Each outcome is independent, and continued gambling has increased total loss
Alternative thought	“Previous losses do not make the next bet more likely to win”
Alternative behaviour	Stop gambling and leave the application

Automatic Thoughts

An automatic thought is a thought that appears rapidly in response to a situation.

Examples include:

• “One cigarette will not matter.”

• “I deserve a bet after today.”

• “I cannot cope with this craving.”

• “Everybody else is playing.”

• “I will be left out.”

• “I can recover the money.”

• “Gaming is the only way to escape.”

These thoughts may occur so quickly that the person initially experiences them as facts.

CBT teaches the client to pause and evaluate them.

Challenging Addictive Thoughts

Socratic Questioning

The therapist may use carefully structured questions rather than simply telling the client that they are wrong.

Questions may include:

• What evidence supports this belief?

• What evidence contradicts it?

• Have there been occasions when the belief was inaccurate?

• What would you say to a friend who held this belief?

• What is the likely short-term outcome?

• What is the likely long-term outcome?

• Is there another explanation?

• Does this thought help you achieve your goals?

The process encourages the client to reach a more balanced conclusion.

Thoughts About Gambling

Relevant distorted thoughts may include:

• Gambler’s fallacy.

• Illusion of control.

• Skill bias.

• Selective recall.

• Near-miss bias.

• Belief that losses can be chased successfully.

This links with irrational beliefs and biased gambling decisions.

Example

Original thought:

“I am a successful gambler because I remember several large wins.”

Challenge:

“How much did I stake before those wins, and what is my complete financial outcome?”

Alternative thought:

“Remembered wins do not show that I have made an overall profit.”

Thoughts About Nicotine Addiction

A smoker may believe:

• “Smoking is the only way to relax.”

• “I cannot concentrate without cigarettes.”

• “One cigarette will not restart the habit.”

• “I have no control over withdrawal.”

• “Smoking is part of my identity.”

CBT might examine:

• Whether relaxation has occurred without smoking.

• Whether smoking sometimes increases stress through withdrawal.

• What happened after previous “single” cigarettes.

• Which coping strategies have already worked.

• Whether identity can be separated from the behaviour.

Thoughts About Gaming Addiction

A person might believe:

• “Everything is better when I play.”

• “Gaming is my only escape.”

• “I have to join when friends invite me.”

• “Refusing will ruin the friendship.”

• “There is nothing else to do.”

AQA’s 2025 question used a gaming scenario involving stress, escape, boredom, competition and fear of exclusion. The mark scheme applies cognitive restructuring, relaxation, time management and refusal skills to these details.

Alternative Thought Patterns

The client develops alternatives that are:

• Realistic.

• Memorable.

• Relevant to the trigger.

• Behaviourally useful.

Examples include:

Addictive thought	Alternative thought
“I need gambling to escape stress”	“Gambling delays the problem and may add financial stress”
“A win is due”	“Previous outcomes do not guarantee the next one”
“I cannot refuse my friends”	“I can say no without rejecting the friendship”
“One cigarette will not matter”	“One cigarette may reactivate cravings and the old routine”
“I cannot tolerate this urge”	“Cravings are uncomfortable but temporary”
“Gaming is the only enjoyable activity”	“I can plan other activities that provide contact and achievement”

Alternative thoughts should lead to a practical response.

Repeating a statement without changing behaviour is unlikely to be sufficient.

Behavioural Skills

Relaxation Training

Purpose of Relaxation

Stress and anxiety may trigger addictive behaviour.

Relaxation training aims to prevent emotional arousal from building to a level where the person automatically uses the addiction as a coping response.

AQA’s 2025 mark scheme explicitly identifies relaxation training as a way of preventing the build-up of stress and anxiety that may trigger addictive behaviour.

Possible strategies include:

• Controlled breathing.

• Muscle relaxation.

• Calming routines.

• Brief mindfulness-based attention.

• Planned pauses before acting.

The examination focus is the psychological function:

Relaxation provides an alternative response to stress, reducing reliance on the addiction.

Applying Relaxation

Uma gambles whenever she becomes anxious after work.

CBT might teach Uma to:

1. Recognise anxiety as a trigger.

2. Pause before opening the gambling application.

3. Use controlled breathing.

4. Repeat an alternative thought.

5. Begin a planned non-gambling activity.

6. Review whether the urge decreased.

Relaxation should be connected with the identified trigger.

Refusal Skills

What Are Refusal Skills?

Refusal skills help the person reject invitations or opportunities connected with addiction.

The client may practise:

• Saying no clearly.

• Giving a brief reason.

• Repeating the refusal.

• Suggesting an alternative activity.

• Leaving the situation.

• Avoiding prolonged negotiation.

For example:

“No, I am not gambling tonight. Let’s do something else.”

AQA’s 2021 and 2025 mark schemes recognise refusal skills as relevant CBT strategies.

Why Refusal Skills Matter

A person may understand that the behaviour is harmful but still participate because of:

• Normative social influence.

• Fear of rejection.

• Lack of confidence.

• Habitual agreement.

• Group identity.

Refusal skills convert cognitive insight into observable behaviour.

Assertiveness Training

What Is Assertiveness?

Assertiveness involves expressing needs and decisions clearly while respecting other people.

It differs from:

• Passive behaviour, where the person gives in.

• Aggressive behaviour, where the person threatens or attacks.

• Assertive behaviour, where the person communicates firmly and respectfully.

Example:

“I have decided not to bet. Please stop sending me gambling invitations.”

Assertiveness and Addiction

Assertiveness may help the person:

• Resist peer pressure.

• Request support.

• Set boundaries.

• Ask others not to offer the substance.

• Explain their treatment goals.

• Leave high-risk situations.

AQA identifies assertiveness as a skill that may be acquired and practised within CBT.

Positive Self-Talk

What Is Positive Self-Talk?

Positive self-talk involves using prepared statements to guide behaviour in difficult situations.

Examples include:

• “I do not need to gamble.”

• “I can manage this urge.”

• “The craving will pass.”

• “I can say no.”

• “Stopping now protects my goal.”

• “One loss does not make a win due.”

AQA’s 2021 mark scheme gives “I am strong, I do not bet” as an example of positive self-talk or a mantra.

Effective Self-Talk

Effective statements are:

• Specific.

• Credible.

• Linked to the trigger.

• Rehearsed.

• Connected with an action.

Weak self-talk:

“Everything will be perfect.”

Stronger self-talk:

“The urge is temporary. I will close the application and call my friend.”

Role-Play

What Is Role-Play?

Role-play involves practising a difficult situation with the therapist or group before encountering it in real life.

Scenarios might include:

• A friend offering a cigarette.

• Colleagues suggesting a gambling session.

• Receiving an online gaming invitation.

• Passing a betting shop.

• Explaining treatment goals to family.

• Coping after a stressful event.

The client practises:

• Refusal.

• Assertive language.

• Alternative thoughts.

• Relaxation.

• Leaving the situation.

• Asking for support.

AQA’s 2021 mark scheme accepts role-play of situations in which the client does not gamble.

Feedback

The therapist may provide feedback on:

• Clarity of the refusal.

• Body language.

• Tone of voice.

• Whether the alternative thought was used.

• Whether the client remained in control.

• What could be improved.

Role-play turns an abstract strategy into rehearsed behaviour.

Limitation of Role-Play

A simulated situation may lack:

• Genuine craving.

• Social pressure.

• Financial opportunity.

• Emotional arousal.

• Real consequences.

The client may perform successfully in therapy but struggle in everyday life.

Transfer must therefore be assessed.

Time Management

Why Time Management Is Relevant

Unstructured time may increase addiction risk.

A person may gamble or game because they are:

• Bored.

• Alone.

• Lacking routine.

• Avoiding responsibilities.

• Unsure what else to do.

Time-management strategies may include:

• Planning the evening.

• Scheduling exercise.

• Arranging social contact.

• Setting work boundaries.

• Planning meals and sleep.

• Restricting screen time.

• Identifying high-risk periods.

• Preparing an alternative activity.

AQA’s 2025 mark scheme applies time management directly to boredom in an online gaming scenario.

Time Management Is Not Simply Staying Busy

The aim is not to fill every moment.

A useful plan should:

• Address the specific risk period.

• Include meaningful alternatives.

• Reduce access to the addictive activity.

• Support psychological needs such as contact, achievement or relaxation.

Problem-Solving

What Is Problem-Solving?

Problem-solving involves approaching a difficulty in a structured way.

The person may learn to:

1. Define the problem.

2. Generate possible responses.

3. Consider advantages and disadvantages.

4. Select a realistic strategy.

5. Try it.

6. Review the result.

7. Modify the plan.

AQA’s 2024 mark scheme lists problem-solving as a possible skill acquired through CBT.

Example

Problem:

“I gamble because I am worried about debt.”

Addictive response:

Gamble in the hope of winning money.

Problem-solving response:

• Calculate the debt accurately.

• Seek financial guidance.

• Restrict gambling access.

• Create a repayment plan.

• Ask for support.

• Address the problem without increasing the financial risk.

Alternative Activities

The person may be introduced to activities that replace the time or reward previously provided by addiction.

Examples include:

• Exercise.

• Social meetings.

• Hobbies.

• Volunteering.

• Structured evening routines.

• Non-gambling games.

• Education.

• Relaxation activities.

AQA’s 2021 mark scheme gives going to the gym instead of playing online poker as an example.

Functional Substitution

The replacement should serve a similar psychological function.

Function of addiction	Possible alternative
Escape from stress	Relaxation, exercise or social support
Excitement	Competitive sport or challenging activity
Social belonging	Non-addictive group activity
Boredom relief	Planned hobby or learning activity
Sense of achievement	Personal goals or structured progress
Emotional expression	Therapy or supportive conversation

An alternative is more likely to succeed if it addresses what the addictive behaviour provided.

Relapse Prevention

What Is Relapse?

A relapse is a return to addictive behaviour after a period of reduction or abstinence.

CBT recognises that completing therapy does not remove every future risk.

Relapse prevention prepares the person to:

• Recognise warning signs.

• Predict risk situations.

• Use coping strategies.

• Respond constructively to lapses.

• Seek support early.

• Avoid all-or-nothing thinking.

AQA includes relapse prevention as a component of CBT for addiction.

Lapse and Relapse

A lapse is a brief return to the behaviour.

A relapse is a more sustained return to the previous addictive pattern.

For example:

• One cigarette may be a lapse.

• Resuming daily smoking may be a relapse.

This distinction matters because a person might think:

“I have failed completely, so there is no point continuing treatment.”

CBT challenges this all-or-nothing interpretation.

An alternative is:

“This lapse shows that the situation was high risk. I can examine what happened and restart the plan.”

The Abstinence Violation Effect

A lapse may create:

• Guilt.

• Shame.

• Reduced self-efficacy.

• A sense of complete failure.

These reactions may increase the likelihood of full relapse.

CBT attempts to reinterpret a lapse as:

• Information.

• A warning sign.

• A chance to revise coping strategies.

• Evidence that one situation requires more preparation.

The key examination point is that relapse prevention encourages continued coping rather than abandoning the treatment plan.

Coping Plans

A coping plan may include:

Trigger	Warning thought	Alternative thought	Behavioural response
Friends invite me to gamble	“I will be left out”	“I can refuse gambling and suggest another activity”	Send prepared refusal message
Stress after work	“Gaming is my only escape”	“Gaming delays the stress and disrupts sleep”	Relaxation and planned exercise
Smoking cue after a meal	“I need a cigarette”	“This is a conditioned craving and it will pass”	Leave the room and use breathing
Gambling loss	“I must recover it”	“Continuing risks a larger loss”	Close account and contact support

The plan connects thinking and behaviour.

Applying CBT to Gambling Addiction

Consider this scenario:

Jacob gambles online when he is alone in the evening. He believes he is skilled at predicting sport and talks frequently about his wins while ignoring his losses. He becomes anxious when trying not to gamble.

Trigger identification

• Being alone.

• Evening time.

• Anxiety.

• Sporting events.

• Access to the betting application.

Cognitive restructuring

The therapist might challenge:

• Skill bias.

• Selective recall.

• Overestimation of winning.

• Belief that gambling is required for relief.

Jacob could examine:

• A complete record of wins and losses.

• The role of chance.

• Whether his predictions consistently outperform chance.

• How gambling organisations profit from customers.

Behavioural strategies

Jacob could practise:

• Relaxation when anxious.

• Time management in the evening.

• Blocking the gambling application.

• Alternative activities.

• Positive self-talk.

• Asking friends not to discuss betting.

Relapse prevention

Jacob could prepare for:

• Major sporting events.

• Payday.

• Gambling advertisements.

• A previous win.

• Stressful evenings.

AQA’s 2024 mark scheme similarly applies CBT to a gambler who talks about wins, ignores losses, believes they possess special skill and gambles alone in the evening.

Applying CBT to Gaming Addiction

Consider Ash’s comments from the June 2025 AQA paper:

• He feels stressed.

• Gaming helps him escape.

• He lives and works alone.

• He is bored at night.

• Friends invite him.

• He fears being left out.

Stress

CBT could teach relaxation to manage the trigger.

Escape belief

Cognitive restructuring could examine whether gaming genuinely improves the underlying problem or creates additional difficulties.

Isolation and boredom

Time-management strategies could introduce:

• Social contact.

• Exercise.

• Work-life boundaries.

• Planned evening activities.

Social pressure

Ash could practise:

• Refusal skills.

• Assertiveness.

• Suggesting a shorter or alternative social activity.

• Challenging the belief that refusing one session ruins the friendship.

The official mark scheme uses each of these links as possible application.

Applying CBT to Nicotine Addiction

Ria smokes whenever she feels stressed. She believes that cigarettes are the only reliable way to calm down and finds it difficult to refuse when colleagues offer her one.

CBT could involve:

Trigger analysis

• Stress.

• Work breaks.

• Smoking colleagues.

• Being offered cigarettes.

Cognitive restructuring

Original belief:

“Only smoking calms me down.”

Alternative thought:

“Smoking may remove nicotine withdrawal temporarily, but breathing and taking a break can reduce stress without restarting the cycle.”

Behavioural skills

• Relaxation.

• Refusal practice.

• Assertiveness.

• Leaving the smoking area.

• Alternative break routine.

• Positive self-talk.

Biological limitation

CBT does not directly reverse nicotinic-receptor adaptation or physical withdrawal.

Ria might also need medication to manage physical dependence.

Applying CBT to More Than One Addiction

CBT is flexible because its broad process can be adapted.

Addiction	Possible thoughts	Possible triggers	Possible behavioural skills
Gambling	“A win is due”	Losses, payday, casino cues	Stop plan, record outcomes, refusal
Nicotine	“I cannot relax without smoking”	Stress, coffee, peers	Relaxation, alternative break, refusal
Gaming	“Gaming is my only escape”	Boredom, loneliness, invitations	Time management, social planning
Substance use	“I cannot cope with this feeling”	Stress, cue exposure, conflict	Relaxation, problem-solving, assertiveness

The treatment should be individualised rather than delivered as one identical script.

Evaluating CBT

Strength: CBT Addresses Cognition and Behaviour

A major strength is that CBT targets more than outward addictive behaviour.

It can address:

• Distorted beliefs.

• Emotional triggers.

• Environmental risks.

• Social pressure.

• Coping deficits.

• Relapse.

This makes it broader than a therapy focused only on:

• Physical withdrawal.

• Conditioned aversion.

• External control.

For example, aversion therapy might make gambling cues unpleasant but leave the gambler’s belief in special skill unchanged.

CBT can challenge the belief and teach an alternative response.

Strength: Active Participation

The client is actively involved in:

• Identifying triggers.

• Examining beliefs.

• Developing alternatives.

• Practising skills.

• Planning for relapse.

This may increase:

• Insight.

• Self-efficacy.

• Autonomy.

• Perceived control.

AQA’s 2025 mark scheme identifies possible life-enhancing outcomes including improved control, autonomy, self-esteem, decision-making and assertiveness.

Transferable Skills

Skills learned through CBT may be useful beyond addiction.

For example:

• Assertiveness may improve relationships.

• Problem-solving may help with work or money.

• Relaxation may reduce stress.

• Time management may improve daily routines.

• More balanced thinking may support better decisions.

This gives CBT potential benefits even where complete abstinence is not immediate.

Strength: Targets Psychological Causes

Drug therapy may reduce biological withdrawal without addressing:

• Stress.

• Cognitive bias.

• Social pressure.

• Boredom.

• Beliefs about coping.

CBT can target these maintaining factors directly.

This may reduce the risk that the person returns to addiction when medication ends.

Qualification

Addiction may have biological and social causes that CBT cannot remove by itself.

It targets some psychological maintaining processes rather than every possible cause.

Strength: Relapse Prevention

CBT prepares the person for future high-risk situations rather than assuming that treatment success will continue automatically.

Relapse prevention may:

• Increase awareness.

• Improve coping.

• Prevent a lapse becoming a full relapse.

• Help the client plan for peers and stress.

• Maintain changes after formal sessions end.

This gives CBT a longer-term focus.

Strength: Evidence Can Be Used to Assess Effectiveness

AQA identifies several sources of relevant evidence:

• Petry (2006) for gambling.

• Ladouceur (2001) for pathological gambling.

• Young (2007) for internet addiction.

• Cowlishaw et al. (2012) for short-term and long-term outcomes.

• Cuijpers et al. (2008) in relation to dropout.

The supplied mark scheme does not provide the full procedures, samples or numerical findings of these studies.

Students should not invent:

• Success percentages.

• Sample sizes.

• Treatment durations.

• Follow-up periods.

• Detailed conclusions not provided by a verified source.

These studies can be identified as relevant evidence, but precise findings should be used only when accurately learned from an appropriate source.

Limitation: Short-Term Improvement May Not Last

A person may improve during therapy because:

• Support is readily available.

• Risk situations are discussed regularly.

• Motivation is temporarily high.

• Behaviour is being monitored.

• The therapist provides structure.

After therapy ends:

• Stress may increase.

• Old social groups may return.

• Cravings may continue.

• Gambling opportunities remain.

• Skills may not be practised.

• Motivation may fall.

AQA specifically identifies short-term compared with long-term effectiveness as an evaluation issue and links Cowlishaw et al. with concerns about durability.

Measuring Long-Term Effectiveness

A strong evaluation considers:

• Abstinence after treatment.

• Relapse months later.

• Reduction rather than complete abstinence.

• Improved quality of life.

• Continued use of coping strategies.

• Changes in financial or health outcomes.

Immediate self-reported improvement is not enough.

Limitation: High Dropout

CBT requires considerable effort.

The client may need to:

• Attend several sessions.

• Discuss uncomfortable experiences.

• Challenge strongly held beliefs.

• Practise skills.

• Complete monitoring tasks.

• Use strategies outside therapy.

• Continue after lapses.

Some clients may leave treatment before benefiting fully.

AQA identifies high dropout as a limitation and names Cuijpers et al. as relevant evidence.

Why Dropout Affects Research Findings

Suppose a study reports high success among clients who completed treatment.

This may exaggerate effectiveness if those clients were:

• More motivated.

• More articulate.

• Less severely addicted.

• Better supported.

• More confident.

Results for completers may not represent everyone offered CBT.

Limitation: Motivation Is Required

CBT is most suitable for clients willing to:

• Reflect honestly.

• Examine beliefs.

• Practise behaviour.

• Accept feedback.

• Prepare for relapse.

• Make changes outside sessions.

AQA’s mark schemes repeatedly identify motivation as an important requirement.

A person attending only because of:

• Family pressure.

• Court requirements.

• Employment demands.

may engage superficially without making meaningful changes.

Limitation: Verbal and Cognitive Demands

CBT requires the client to communicate and think about:

• Triggers.

• Beliefs.

• Evidence.

• Consequences.

• Alternative interpretations.

AQA identifies suitability for motivated and articulate clients as an evaluation issue.

The treatment may need adaptation for someone with:

• Limited verbal ability.

• Language barriers.

• Cognitive impairment.

• Severe concentration difficulties.

• Difficulty recognising internal thoughts.

• Acute intoxication or withdrawal.

This does not mean CBT is impossible, but a standard verbally demanding programme may be less appropriate.

Limitation: Physical Dependence May Remain

CBT cannot directly:

• Stimulate nicotinic receptors.

• Reverse neuroadaptation.

• Eliminate physical withdrawal.

• Change substance metabolism.

• Prevent every physiological craving.

A nicotine-dependent client may understand their thoughts accurately but still experience severe withdrawal.

Drug therapy may therefore be needed alongside CBT.

Combined Treatment

A combined approach could involve:

• Drug therapy for physical withdrawal.

• CBT for thoughts and coping.

• Social support for environmental risks.

• Relapse prevention for future triggers.

This is more complete than expecting one therapy to treat every part of addiction.

Limitation: Behavioural Rehearsal May Be Artificial

Practising refusal in therapy may be easier than refusing:

• Close friends.

• A high-status peer.

• A substance during intense craving.

• A gambling opportunity after a major loss.

• Gaming friends during loneliness.

Role-play may lack:

• Genuine emotion.

• Real temptation.

• Social consequences.

• Financial access.

Skills must generalise from therapy to everyday situations.

Limitation: Cognitive Change Is Difficult to Verify

A person may learn to provide the “correct” answers in therapy.

For example:

“I know previous losses do not make a win due.”

This does not prove that the belief has changed during emotional gambling situations.

The person may:

• Repeat the therapist’s language.

• Give socially desirable responses.

• Understand probability abstractly.

• Continue acting on the original bias.

Behavioural and long-term measures are needed alongside verbal reports.

Limitation: Cause of Improvement May Be Unclear

CBT contains several components:

• Therapeutic support.

• Cognitive restructuring.

• Relaxation.

• Time management.

• Assertiveness.

• Behavioural rehearsal.

• Relapse planning.

If the client improves, it may be difficult to determine which component caused the change.

Improvement could also result from:

• Motivation.

• Family support.

• Reduced access.

• Medication.

• Natural change over time.

• Expectations about treatment.

This makes the effective ingredient difficult to isolate.

Limitation: Research Samples May Be Selective

Participants in CBT research often agree to:

• Enter treatment.

• Discuss addiction.

• Attend repeated sessions.

• Complete follow-ups.

They may therefore be more motivated than people who refuse treatment.

This limits generalisation to:

• Less motivated clients.

• People with very severe addiction.

• People without stable housing or support.

• Those who leave treatment early.

Strength: Individualised Treatment

CBT can be adapted to the client’s:

• Addiction.

• Triggers.

• Beliefs.

• Social circumstances.

• Skills.

• Goals.

For example:

• A gambler may challenge cognitive bias.

• A smoker may target cue-related beliefs.

• A gamer may address boredom and exclusion.

• A substance user may develop stress-management skills.

This flexibility increases appropriateness.

Limitation of Individualisation

Highly individualised treatment can be harder to:

• Standardise.

• Replicate.

• Compare across studies.

• Deliver consistently.

Differences in therapist skill may also affect outcomes.

Cognitive Reductionism

CBT may be described as cognitively reductionist if addiction is explained mainly through irrational thoughts.

This focus has advantages:

• Thoughts can be identified.

• Beliefs can be challenged.

• Skills can be developed.

• Treatment targets can be made specific.

However, it may underestimate:

• Genes.

• Neurochemistry.

• Physical dependence.

• Reinforcement schedules.

• Social inequality.

• Availability.

• Family and peer environments.

CBT is broader than a purely cognitive treatment because it includes behavioural and social coping, but it still cannot address every level alone.

Free Will and Personal Control

CBT assumes that people can:

• Reflect on thoughts.

• Learn new skills.

• Make different choices.

• Increase self-control.

This can be empowering.

It may improve:

• Autonomy.

• Responsibility.

• Confidence.

However, placing strong emphasis on personal change could accidentally imply that relapse results from insufficient effort.

A balanced view recognises that addictive behaviour may be constrained by:

• Physical dependence.

• Stress.

• Social pressure.

• Poverty.

• Accessibility.

• Biological vulnerability.

CBT increases control without making every external condition controllable.

Ethical Considerations

CBT is generally less physically intrusive than:

• Drug therapy.

• Traditional aversion therapy.

However, ethical issues may still include:

• Discussing distressing experiences.

• Confidentiality.

• Pressure to disclose.

• Blame following relapse.

• Respect for the client’s treatment goals.

• Informed consent.

• Dependence on the therapist.

The therapist should avoid imposing personal values about what the client’s life should look like.

CBT Compared with Drug Therapy

CBT	Drug therapy
Targets thoughts and behaviour	Targets biological processes
Identifies triggers and cognitive bias	Reduces withdrawal, craving or reward
Requires active participation	May require less verbal reflection
Teaches transferable skills	Can produce relatively rapid biological effects
Has no pharmacological side effects	May cause side effects
Does not directly remove physical withdrawal	Directly targets physical dependence
Benefits may continue through learned skills	Benefits may depend on continued medication
Requires motivation and engagement	Requires adherence
Strong for psychological dependence	Strong for biological dependence

A combined approach may be most appropriate where both types of dependence are present.

CBT Compared with Aversion Therapy

CBT	Aversion therapy
Challenges thoughts and develops coping	Conditions an unpleasant response
Requires insight and reflection	Focuses on stimulus associations
Addresses triggers and relapse	Attempts to create avoidance
May improve wider life skills	More narrowly targets the addictive cue
Requires motivation and verbal engagement	May cause significant discomfort
Does not deliberately create aversion	Raises stronger protection-from-harm concerns
Can challenge cognitive bias	Does not necessarily correct irrational beliefs

This links with conditioned aversion and imagined consequences.

Is CBT Appropriate for Everyone?

CBT may be particularly appropriate when:

• Cognitive distortions are central.

• The client can identify triggers.

• The person is motivated.

• Behavioural skills can be practised.

• Psychological dependence is strong.

• Social pressure contributes to addiction.

• Relapse prevention is needed.

It may be less appropriate as the only treatment when:

• Physical withdrawal is severe.

• The person cannot engage verbally.

• Immediate medical stabilisation is required.

• Motivation is extremely low.

• The person’s environment remains highly dangerous or unstable.

Treatment selection should consider the individual rather than assuming that one intervention is universally best.

Overall Evaluation

Cognitive behaviour therapy aims to reduce addiction by changing unhelpful thoughts and teaching alternative behaviour. The client identifies internal and external triggers, examines cognitive distortions and develops more realistic thought patterns.

The behavioural component includes relaxation, assertiveness, refusal skills, positive self-talk, time management, problem-solving, role-play and alternative activities. Relapse prevention prepares the client for interpersonal influences such as peers and intrapersonal factors such as stress.

CBT has several strengths. It addresses both cognition and behaviour, encourages active participation and can provide transferable skills that improve autonomy, self-esteem and decision-making. It can also be personalised for different addictions.

However, CBT requires motivation, verbal ability and considerable effort. Dropout can be high, and short-term improvement may not remain after treatment. Cognitive change is difficult to verify, and CBT does not directly treat physical dependence or neurochemical withdrawal.

The most balanced conclusion is that CBT is particularly valuable for psychological dependence, cognitive bias and relapse prevention. For substance addictions involving strong physical dependence, it may be most effective when combined with biological treatment and social support.

Hints from the Examiner Reports 💡

Apply Every Major Part of the Stem

The June 2025 examiner report found that many students demonstrated impressive technical knowledge of CBT but struggled to apply it to Ash’s gaming addiction. Some high-level answers included no application at all.

For an applied essay, identify each relevant detail.

Stem detail	Possible CBT application
Stress	Relaxation training
Escape	Challenge the belief that addiction solves problems
Being alone	Identify a trigger and plan social contact
Boredom	Time management and alternative activities
Peer invitations	Refusal and assertiveness skills
Fear of exclusion	Challenge assumptions about friendship
Competition and fun	Find healthier replacement rewards

Name the Psychological Mechanism

Weak application:

The therapist would tell Ash to play less.

Improved application:

Cognitive restructuring would help Ash recognise that stress and being alone are triggers and challenge his belief that gaming makes everything better.

Include Both Cognition and Behaviour

Do not write only about challenging thoughts.

Include behavioural strategies such as:

• Relaxation.

• Assertiveness.

• Refusal skills.

• Time management.

• Role-play.

• Alternative activities.

Explain Cognitive Restructuring

A strong sequence is:

1. Identify the trigger.

2. Identify the automatic thought.

3. Examine supporting and contradictory evidence.

4. Develop a realistic alternative.

5. Practise a different behavioural response.

Apply Skills Precisely

Weak answer:

The person could use coping strategies.

Improved answer:

When friends invite the person to gamble, they could use an assertive refusal rehearsed through role-play, such as explaining that they will not bet but suggesting a different social activity.

Do Not Treat Relaxation as the Entire Therapy

Relaxation addresses stress and anxiety.

It does not automatically challenge:

• Gambler’s fallacy.

• Skill bias.

• Selective recall.

• Beliefs about social rejection.

Use it as one part of CBT.

Use the 2021 Gambling Application

AQA accepts:

• Identifying gambling triggers.

• Developing alternative thought patterns.

• Considering the low probability of winning.

• Assertiveness.

• Positive self-talk.

• Breathing exercises.

• Role-play.

• Replacement activities.

These elements should be connected rather than listed randomly.

Evaluate Long-Term Outcomes

Do not state only:

CBT works.

Ask:

• Are improvements maintained?

• Does relapse decrease?

• Do clients continue using the skills?

• Are conditioned cues and physical withdrawal also addressed?

AQA identifies short-term compared with long-term effectiveness as an important discussion point.

Discuss Dropout Properly

A developed point is:

CBT requires sustained effort and active engagement. Less motivated clients may leave before completing treatment, so evidence based only on completers may exaggerate effectiveness.

Be Cautious with Named Evidence

AQA identifies Petry, Ladouceur, Young, Cowlishaw and Cuijpers as potentially relevant.

The supplied mark schemes do not provide their complete methods or numerical findings.

Do not invent research details.

Compare CBT with an Appropriate Alternative

Useful comparisons include:

• Drug therapy for physical dependence.

• Aversion therapy for conditioned approach behaviour.

• Covert sensitisation for imagined aversion.

Explain which process each treatment targets.

Use Specialist Terminology

Strong terminology includes:

• Trigger.

• Cognitive restructuring.

• Automatic thought.

• Risk situation.

• Relaxation.

• Assertiveness.

• Refusal skills.

• Relapse prevention.

• Interpersonal.

• Intrapersonal.

• Self-efficacy.

Common Mistakes ⚠️

Mistake 1

Mistake: Saying CBT simply involves advising the person to stop.

Why this is incorrect:

CBT is a structured treatment involving thought and behavioural change.

How to improve:

Explain trigger identification, cognitive restructuring and coping skills.

Mistake 2

Mistake: Describing only the cognitive component.

Why this is incomplete:

CBT also develops and practises new behaviour.

How to improve:

Include relaxation, refusal, assertiveness or time management.

Mistake 3

Mistake: Describing only behavioural techniques.

Why this is incomplete:

The person’s thoughts and interpretations must also be examined.

How to improve:

Identify an automatic thought and show how it is challenged.

Mistake 4

Mistake: Saying cognitive restructuring means replacing every negative thought with a positive one.

Why this is inaccurate:

The aim is realistic, evidence-based thinking.

How to improve:

Show how evidence is considered before developing an alternative thought.

Mistake 5

Mistake: Naming a trigger without explaining how CBT responds.

Why this limits application:

Identifying the trigger is only the beginning.

How to improve:

Link it with a specific thought and coping strategy.

Mistake 6

Mistake: Giving generic application that could fit any client.

Why this loses AO2 marks:

The treatment plan must use details from the scenario.

How to improve:

Refer directly to stress, boredom, friends, time of day or the particular cognitive bias.

Mistake 7

Mistake: Saying relaxation challenges irrational gambling beliefs.

Why this is incorrect:

Relaxation manages stress or arousal.

How to improve:

Use cognitive restructuring to challenge biased beliefs.

Mistake 8

Mistake: Saying assertiveness means behaving aggressively.

Why this is inaccurate:

Assertiveness involves firm but respectful communication.

How to improve:

Give an appropriate refusal statement.

Mistake 9

Mistake: Treating a lapse as proof that CBT has failed.

Why this is too absolute:

Relapse prevention uses a lapse to improve future coping.

How to improve:

Explain how all-or-nothing thinking is challenged.

Mistake 10

Mistake: Saying CBT directly removes physical withdrawal.

Why this is incorrect:

CBT changes thoughts and behaviour rather than receptor functioning.

How to improve:

Compare CBT with drug therapy.

Mistake 11

Mistake: Claiming CBT has no side effects and is therefore suitable for everyone.

Why this is too simplistic:

CBT is demanding and may involve distress, disclosure and dropout.

How to improve:

Evaluate motivation, verbal ability and effort.

Mistake 12

Mistake: Saying high dropout proves CBT is ineffective.

Why this is incomplete:

Dropout concerns acceptability and general usefulness, while completers may still benefit.

How to improve:

Distinguish treatment efficacy from treatment completion.

Mistake 13

Mistake: Claiming short-term change proves permanent recovery.

Why this is incorrect:

Old triggers and social environments may remain.

How to improve:

Discuss follow-up and relapse.

Mistake 14

Mistake: Listing named research without accurate details.

Why this is risky:

Invented evidence weakens the response.

How to improve:

Use named evidence only when its method and findings are known securely.

Mistake 15

Mistake: Comparing therapies without making a judgement.

Why this is incomplete:

A comparison should explain suitability.

How to improve:

Conclude that CBT may suit psychological dependence, while drug therapy may be needed for severe physical dependence.

Exam-Style Questions ✍️

Question 1

What is meant by cognitive behaviour therapy as a way of reducing addiction? [2 marks]

Question 2

Explain cognitive restructuring in CBT for addiction. [3 marks]

Question 3

Explain two behavioural skills that may be taught during CBT. [4 marks]

Question 4

Niko gambles whenever he is alone in the evening. He believes that his knowledge of football makes him certain to win, and he talks frequently about successful bets while ignoring his losses.

Explain how CBT could be used to reduce Niko’s gambling. [6 marks]

Question 5

Aisha plays online games when she feels stressed and bored. She believes gaming is the only way to escape her worries. She also joins every session suggested by friends because she fears being excluded.

Explain two ways CBT could challenge Aisha’s thoughts and two behavioural strategies she could learn. [8 marks]

Question 6

Explain how relapse prevention may be used as part of CBT for addiction. [4 marks]

Question 7

Explain one difference between CBT and drug therapy as ways of reducing addiction. [4 marks]

Question 8

A hypothetical study compared gambling frequency before and after CBT.

Measure	Before CBT	After CBT
Mean gambling sessions per month	20	8
Mean craving score	18	10

Calculate the percentage reduction in mean gambling sessions. Explain one conclusion and one limitation of the findings. [6 marks]

Question 9

Explain one strength and one limitation of CBT as a way of reducing addiction. [6 marks]

Question 10

Kai says:

“I gamble whenever I am stressed. It helps me forget my problems. I usually gamble alone late at night because there is nothing else to do. My friends sometimes message me with betting tips, and I do not want them to think I am boring. I am good at gambling anyway because I remember winning lots of times.”

Discuss cognitive behaviour therapy as a way of reducing addiction. Refer to Kai’s comments in your answer. [16 marks]

Answers and Mark Scheme

Question 1

Award one mark for each of the following:

• CBT aims to identify and change unhelpful or irrational thoughts associated with addiction.

• It also teaches and practises alternative behaviour or coping strategies.

Maximum: 2 marks

Question 2

Award one mark for each linked point, up to three marks:

• The client identifies automatic or irrational thoughts connected with addictive behaviour.

• The client examines the evidence supporting and contradicting the thought.

• The therapist helps the client develop a more realistic alternative.

• The alternative thought is practised in risk situations.

• Changed thinking is intended to reduce addictive behaviour.

Question 3

Award up to two marks for each behavioural skill.

Possible answers include:

Relaxation

• The client learns breathing or another calming strategy.

• This provides an alternative response when stress triggers addiction.

Refusal skills

• The client practises saying no to addictive opportunities.

• This reduces the effect of peer pressure.

Assertiveness

• The client communicates boundaries clearly and respectfully.

• This helps them request support or resist invitations.

Time management

• The client plans high-risk periods.

• This reduces boredom and opportunities for addiction.

Role-play

• The client rehearses coping in simulated risk situations.

• Feedback helps improve future behaviour.

Alternative activities

• A healthier activity replaces the time or reward provided by addiction.

• This reduces reliance on the addictive behaviour.

Question 4

Award up to six marks for effective application:

• Niko should identify being alone in the evening as a trigger.

• His belief in guaranteed success indicates skill bias.

• Remembering wins while ignoring losses indicates selective recall.

• Cognitive restructuring could examine complete gambling records.

• The therapist could challenge the belief that football knowledge makes winning certain.

• Niko could develop an alternative thought about uncertainty and risk.

• Time management could provide planned evening activities.

• Relaxation could address urges or anxiety.

• Access to gambling could be reduced during high-risk periods.

• A relapse plan could prepare for future football events or gambling advertisements.

A full-mark answer should include both cognitive and behavioural treatment.

Question 5

Award up to two marks for each cognitive strategy and each behavioural strategy.

Cognitive strategies

• Challenge the belief that gaming is the only form of escape.

• Examine whether gaming solves the original worry or delays dealing with it.

• Challenge the belief that refusing an invitation will necessarily cause exclusion.

• Develop an alternative belief that friendship can continue without joining every session.

Behavioural strategies

• Relaxation could manage stress before gaming begins.

• Time management could provide structured evening activities.

• Assertiveness could help Aisha explain her decision to friends.

• Refusal skills could be practised through role-play.

• Alternative social activities could reduce boredom and isolation.

For full marks, the strategies must be linked directly to Aisha’s comments.

Question 6

Award one mark for each linked point, up to four marks:

• The client identifies future high-risk situations.

• These may involve interpersonal factors such as peers.

• They may involve intrapersonal factors such as stress or craving.

• The client prepares specific thoughts and behavioural coping strategies.

• A lapse is treated as information rather than complete failure.

• The treatment aims to prevent a brief lapse becoming a sustained relapse.

• Support can be sought early when warning signs appear.

Question 7

Possible answer:

CBT is a psychological treatment that changes thoughts and teaches coping behaviour, such as challenging beliefs about gambling and practising refusal skills. Drug therapy is a biological treatment that acts on receptors or neurotransmitters to reduce withdrawal, craving or reward. CBT may be more appropriate for psychological dependence and cognitive bias, whereas drug treatment may be more appropriate where physical dependence is severe.

For four marks:

• Both therapies should be accurately described.

• A direct difference should be stated.

• Credit a relevant comparison of appropriateness.

Question 8

Award up to two marks for the calculation:

Reduction=20−8=12Percentage reduction=2012​×100=60%

Mean gambling sessions decreased by 60%.

Award up to two marks for a conclusion:

• Gambling frequency decreased following CBT.

• Craving also decreased.

• The pattern is consistent with CBT reducing addiction.

• Cognitive restructuring and coping skills may have contributed.

Award up to two marks for a limitation:

• There is no control group.

• Natural change or another treatment could explain the improvement.

• The sample size is unknown.

• Mean scores may conceal individual differences.

• Gambling frequency may rely on self-report.

• The study does not provide a measure of dispersion.

• No long-term follow-up is reported.

• Reduced sessions do not prove complete recovery.

• Participants who dropped out may be missing from the results.

Question 9

Award up to three marks for one developed strength and up to three marks for one developed limitation.

Possible strength:

CBT addresses both the thoughts and behaviour maintaining addiction. The client can challenge distorted beliefs and practise relaxation, refusal and relapse-prevention skills. These strategies may transfer to future situations and increase self-efficacy and autonomy.

Possible limitation:

CBT requires considerable motivation and cognitive effort. A client must identify thoughts, communicate clearly and practise strategies outside therapy. Less motivated clients may leave treatment early, so CBT may be unsuitable for some people and evidence based on completers may exaggerate effectiveness.

Other creditworthy limitations include:

• Short-term rather than long-term effects.

• Physical dependence remaining.

• Artificial role-play.

• Difficulty verifying cognitive change.

• Selective treatment samples.

• Therapist differences.

• Cognitive reductionism.

Question 10

A high-level response should include accurate knowledge, direct application and developed discussion.

Indicative AO1 Content

• Definition of CBT.

• Interaction between cognition and behaviour.

• Identification of triggers.

• Identification of risk situations.

• Automatic thoughts.

• Cognitive restructuring.

• Challenging evidence.

• Developing alternative thought patterns.

• Relaxation training.

• Refusal skills.

• Assertiveness.

• Positive self-talk.

• Role-play.

• Problem-solving.

• Time management.

• Alternative activities.

• Relapse prevention.

• Interpersonal and intrapersonal risk factors.

• Lapse compared with relapse.

Indicative AO2 Application

• Stress is an intrapersonal trigger.

• Gambling provides escape or short-term relief.

• Cognitive restructuring could challenge whether gambling solves Kai’s problems.

• Being alone late at night is a risk situation.

• Time management could provide planned alternatives.

• Friends’ betting tips are interpersonal triggers.

• Fear of appearing boring could be challenged.

• Assertiveness and refusal skills could be practised.

• Remembering wins indicates selective recall.

• Complete records of wins and losses could challenge this bias.

• Believing he is good at gambling may indicate skill bias.

• Relaxation could be used when stressed.

• A relapse plan could prepare for messages from friends and late-night boredom.

Indicative AO3 Content

• CBT targets cognitive and behavioural maintaining factors.

• It is broader than a purely cognitive treatment.

• Skills may transfer to other areas of life.

• Increased autonomy, control, self-esteem and decision-making.

• Evidence identified by AQA, including Petry, Ladouceur and Young.

• Short-term compared with long-term effectiveness.

• Cowlishaw et al. as relevant evidence concerning durability.

• High dropout.

• Cuijpers et al. as relevant dropout evidence.

• Need for motivation.

• Need for verbal and cognitive engagement.

• Physical dependence not directly treated.

• Possible benefit of combined drug therapy and CBT.

• Role-play and skills not transferring to real situations.

• Difficulty verifying cognitive change.

• Social desirability.

• Cause of improvement being difficult to isolate.

• Selective samples of motivated clients.

• Individualisation as a strength.

• Reduced standardisation as a limitation.

• Comparison with drug therapy.

• Comparison with aversion therapy and covert sensitisation.

• Cognitive reductionism.

• Increased personal control without ignoring external constraints.

Thirteen to sixteen marks: Knowledge is accurate and generally detailed. Application is clear and sustained across Kai’s comments. Discussion is thorough and balanced, considering evidence, suitability, dropout, durability, physical dependence and alternative treatments. Specialist terminology is used effectively.

Nine to twelve marks: Knowledge is mostly accurate and application and discussion are generally effective. Some features of Kai’s comments are used, although application or evaluation may be uneven.

Five to eight marks: Some relevant CBT knowledge is present, but the answer is mainly descriptive. Application may be generic or restricted to one detail, and discussion may lack development.

One to four marks: Knowledge is very limited or confused. The answer may state only that Kai should think positively or stop gambling, with little accurate explanation, application or evaluation.

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