Lecture 8: Basic Theoretical Models of Human Functioning Used in Clinical Psychology Part III PDF

Lecture 8: Basic theoretical models of human functioning used in clinical psychology part III. Introduction to clinical psychology Anna Gabińska, Ph.D. Lecture overview  Cognitive and cognitive-behavioral model  Cognitive model  Based in information processing viewpoint.  Cognition in...

Lecture 8: Basic theoretical models of human functioning used in clinical psychology part III. Introduction to clinical psychology Anna Gabińska, Ph.D. Lecture overview  Cognitive and cognitive-behavioral model  Cognitive model  Based in information processing viewpoint.  Cognition involves the mental processes of perceiving, recognizing, judging and reasoning.  Schemas: a set of underlying assumptions rooted in experiences, values and perceived capabilities (beliefs, attributions, expectancies)  Irrational and maladaptive assumptions and thoughts  Distortions of thought processes  Beck’s cognitive therapy for depression  Ellis’s Rational Emotive Therapy  More generalized Cognitive Behavior Therapy is leading model of therapy today  Ellis – irrational belifs  Ellis believed that everyone’s thoughts were rational at times and irrational at other times.  When we think rationally, we behave rationally and we feel happy, competent and efficient.  However when we think irrationally we can develop negative or disturbed habits in our thinking which can lead to psychological disturbance (i.e. depression, anxiety)  Cognitive model - Ellis  dysfunctional thought patterns  pathology results when persons adopt illogic in response to life situations A – activating event B – belief C – consequences (emotional)  What are Automatic Thoughts? What was going through your mind?  Happen spontaneously in response to situation  Occur in shorthand: words or images  Do not arise from reasoning  No logical sequence  Hard to turn off  May be hard to articulate Negative Stressful Automatic Thoughts Situation Emotions  Core Beliefs  Core beliefs underlie and produce automatic thoughts.  These assumptions influence information processing and organize understanding about ourselves, others, and the future.  These core beliefs remain dormant until activated by stress or negative life events.  Categories of core beliefs (helpless, worthless, unlovable) Core Beliefs Automatic Thoughts Examples of Core Beliefs  Helpless core beliefs ◦ I am inadequate, ineffective, incompetent, can’t cope ◦ I am powerless, out of control, trapped ◦ I am vulnerable, weak, needy, a victim, likely to be hurt ◦ I am inferior, a failure, a loser, defective, not good enough, don’t measure up  Unlovable core beliefs ◦ I am unlikable, unwanted, will be rejected or abandoned, always be alone ◦ I am undesirable, ugly, unattractive, boring, have nothing to offer ◦ I am different, flawed, defective, not good enough to be loved by others  Worthless core beliefs ◦ I am worthless, unacceptable, bad, crazy, broken, nothing, a waste ◦ I am hurtful, dangerous, toxic, evil ◦ I don’t deserve to live  Beck - Cognitive Distortions  Patients tend to make consistent errors in their thinking  Often, there is a systematic negative bias in the cognitive processing of patients suffering from psychiatric disorders  Arbitrary inference - conclusion not supported by existing evidence  Selective abstraction - conceptualizing based on a detail  Overgeneralization- creating a rule based on only one (or few) incidents  Magnification/Minimization  Dichotomous (polarized) thinking - Interpreting in terms of extremes  Incorrect assessment of danger versus safety - sensing risk as dangerously high Beck - Cognitive Distortions ◦ Emotional reasoning - feelings are facts ◦ Anticipating negative outcomes - the worst will happen ◦ All-or-nothing thinking - all good or all bad ◦ Mind-reading - knowing what others are thinking ◦ Personalization - excess responsibility ◦ Mental filter - Ignoring the positive Beck – Cognitive Triad Beck identified three forms of negative thinking – the cognitive traid - that are typical of people with depression 1. Negative views about the future – e.g. ‘I’ll never be good at anything’ 2. Negative views about themselves – e.g. ‘I’m worthless and stupid’ 3. Negative views about the world – e.g. ‘Everyone hates me’ Cognitive Specificity Hypothesis  Psychological disorders are characterized by a different psychological profile. ◦ Depression: Negative view of self, others, and future. Core beliefs associated with helplessness, failure, incompetence, and unlovability. ◦ Anxiety: Overestimation of physical and psychological threats. Core beliefs linked with risk, dangerousness, and uncontrollability. Cognitive Specificity  Negative Triad Associated with Depression ◦ Self “I am incompetent/unlovable” ◦ Others “People do not care about me” ◦ Future “The future is bleak”  Negative Triad Associated with Anxiety ◦ Self “I am unable to protect myself ” ◦ Others “People will humiliate me” ◦ Future “It’s a matter of time before I am embarrassed”  Cognitive Conceptualization Physiology Current Automatic Thoughts Situation About self, world Feelings And others Behavior Childhood Compensatory Underlying Assumptions And Early Strategies and Core Beliefs Life Events  The Cognitive Behavioral Paradigm In a behavioral approach, subsequent research showed the importance of cognitive processes in learning, thus “cognitive” joined “behavioral” in the name of this paradigm. Cognitive behavior therapists generally have been more concerned with treatment than etiology, but a major assumption of the paradigm has been that much normal behavior—and abnormal behavior— is learned.  Working model of CBT Triggering Event Bill goes to collection Appraisal “I can never do Behavior anything right…” Avoidance; withdrawal Behavioral Inclination Bodily Sensations “I don’t want to deal with it” Low energy, disruption of “It’s too stressful to think sleep, increased fatigue about it” Thase et al., 1998  Cognitive behavioral therapy: is goal oriented and problem focused initially emphasizes the present. is educative, aims to teach the patient to be his/her own therapist teaches patient to identify, evaluate and respond to their dysfunctional thoughts and beliefs uses a variety of techniques to change thinking, mood and behavior  Etiology of Depressive and Bipolar Disorders  Genetic vulnerability: concordance rates (twins/other relative pairs) suggest there is a genetic basis for mood disorders  Neurochemical factors: correlations between these disorders and the levels of norepinephrine and serotonin  Neuroanatomical factors: reduced hippocampal volume  Inflammation: chronic, low-grade inflammation  Cognitive factors: learned helplessness, rumination, pessimistic explanatory style  Interpersonal roots: inadequate social skills  Precipitating stress: linking stress and the onset of mood disorders Interpreting the correlation between negative thinking and depression  Modern CBT Dialectical behavior therapy (DBT) Acceptance and commitment training (ACT) Mindfulness-based cognitive therapy (MBCT) Metacognitive therapy (MCT) Schema Therapy (SFT; Schema-Focused Therapy) Panic control treatments (PCT)