Overcome Your Limiting Beliefs

8 Days to End Limiting Beliefs By Dr. Steve G. Jones

This book will help you in: discovering your limiting beliefs and accept them for what they are, neutralize them and turn them into weapon and strength to attain your height and finally, start living a life free from shackle of limiting beliefs. Steve G.Jones is aware of the damage limiting beliefs can do to you which include keeping you locked in tight, immobile and helpless making you often to change how you see the world which affect your behavior, thinking and personality and so has provided the guidelines about how you can change this limiting beliefs and achieve the success you have ever desire. Though 8 days to end limiting beliefs claims that you should be out of your limiting beliefs in 8 days, it may take you longer because the application depends on the user and the situation that the user is in too. More here...

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Evidence For The Cognitive Model

The predictions of the cognitive model have been investigated in a variety of research areas including information processing, assessment of emotions and change in emotions, coping behaviours, treatment process and outcome, and developmental psychopathology. Researchers have tended to focus on a set of very specific predictions the model makes and to develop a paradigm to test those ideas. Conclusions about the cognitive model's integrity, therefore, rely on examination and review of numerous studies of specific predictions, which can be assembled into similar themes in order to draw inferences about the overall value of the model. Other reviewers have used several organizing principles to assemble their review of the literature. For instance, the first comprehensive review of the area by Haaga and colleagues (1991) specified nine specific hypotheses that could be derived from the cognitive model. Similarly, Clark et al. (1999) derived nine hypotheses from the cognitive model,...

Cognitive therapyrestructuring

Cognitive therapy identifies and modifies excessively negative appraisals of the traumatic event and or its sequelae. (5 l04) Methods include discussion of the evidence for and against the appraisals, identification of thinking errors, challenging of appraisals with behavioural tests, and imagery modification. Recent studies have shown that cognitive therapy is effective on its own, without additional exposure treatment. (100,1 2) When verbal challenging of dysfunctional beliefs was used as an additional treatment after a session of imaginal exposure, it did not lead to additional treatment gains. ( 02)

Cognitive Behavioural Model

Cognitive therapy is guided by the principle that thinking, behaviour, mood and physical state can affect each other. The cognitive model for bipolar affective disorder that we propose is largely based on the generic cognitive model for affective disorder (Beck, 1967). According to Beck's cognitive theory of affective disorder, individuals with extreme dysfunctional assumptions are prone to developing affective disorders such as depression. These assumptions are latent when the individuals are outside a mood episode. However, in the face of a congruent life event, these assumptions are activated and may lead to a mood episode such as depression. Once in a depressive state, the individual is prone to make thinking errors and to experience negative automatic thoughts. The following model is largely pragmatic and takes into account the complex picture of biological, psychological and social elements surrounding manic depression. Figure 12.1 summarises the cognitive model of bipolar...

Central characteristics of cognitive therapy

The general principles and nature of cognitive therapy have been described elsewhere. Two specific points relate to depression, as discussed below. The demands of cognitive therapy Given the nature of the disorder, cognitive therapy for depression challenges both therapist and patient. It requires active engagement from the patient (e.g. a willingness to carry out self-help assignments), yet depressed patients often lack motivation and energy. It is based on a friendly collaboration, yet depressed people often find it hard to talk and their negativity may be aversive to clinicians. It is an educational approach, using written materials, record sheets, and session audiotapes, yet depressed patients often have concentration and memory difficulties. Its stance is optimistic, yet depressed patients are often afraid (or convinced) that no change is possible. Therapists should be alert to these difficulties, understand them as aspects of the disorder rather than blaming the patient ('She...

Expectations of cognitive therapy

These may reflect general pessimism about change, especially if patients know nothing about the approach. Those who have heard or read about cognitive therapy, and are aware of outcome data, may be more optimistic, although still anxious lest it fail to help them. Others may have heard actively negative reports (e.g. that it is mechanistic and fails to address deep issues). Non-defensive discussion of expectations allows doubts and misconceptions to be addressed, as well as encouraging open-mindedness and continued frank feedback from the patient.

Cognitive Theories of Personality Disorders

It may be useful to define what is meant by the various terms cognitive theory, behaviorism, cognitive therapy, and cognitive-behavioral therapy (CBT). Theories of cognition are as old as the original foundations of psychology. Cognitive psychology was originally the study of internal mental processes. Wilhelm Wundt, a German psychologist and arguably the founder of psychology, used a method, in 1879, called introspection in which his subjects would be asked to reflect inwardly on their thought processes and respond outwardly with their observations. Hermann Ebbinghaus, also a German psychologist and Wundt's contemporary, published seminal experimental studies of learning and memory beginning in 1885. For approximately the next 4 or 5 decades, these studies would be subsumed under the rubric experimental psychology. However, there was growing discontent with the behaviorism paradigm because important mental processes such as language and grammar production, attitudes, beliefs, and...

The Cognitive Behavioural Model Of Bipolar Disorder

Overall, the cognitive behavioural model aids our clinical understanding of the psy-chopathology of bipolar disorder and the ways in which specific problems and interactions can be targeted, rather than offering aetiological clarification of this disorder. Researchers have suggested that similar cognitive structures and biases underlie both unipolar and bipolar depression (Alloy et al., 1999 Lam et al., 2000 Reilly-Harrington et al., 1999), particularly in terms of systematic attributional errors and sensitivity to failure or interpersonal rejection. Specific to individuals suffering from bipolar disorder, however, is the extreme valence shift in the content of their thinking. A cognitive model of bipolar disorder needs to integrate the variability in the stress responses of individuals. In other words, some individuals with bipolar disorder respond to stress by developing depressive symptoms, and others with the development of manic responses. The model also needs to take into...

The cognitive model of depression and case conceptualization Enduring cognitive vulnerability to depression

Cognitive therapy of depression is defined as 'an active, directive, time-limited, structured approach based on an underlying theoretical rationale that an individual's affect and behaviour are largely determined by the way in which he structures the world'.(1) The cognitive model of depression proposes that enduring cognitive Fig. 1 Cognitive model of depression. Fig. 1 Cognitive model of depression. Dysfunctional beliefs and assumptions are activated by events that match the person's particular sensitivities. So a person with negative beliefs about the self whose psychological well being depends on love and approval might become depressed after experiencing rejection. Activation of the system results in an upsurge of 'negative automatic thoughts' 'negative' in that they are associated with painful emotions, and 'automatic' in that they pop into the person's mind rather than being a product of reasoned reflection. Such thoughts are also 'distorted' that is to say, they reflect...

Are these cognitive distortions related to environmental stimuli and do these distortions have an impact on emotion and

This question is equally important because the cognitive model specifies that negative thoughts will not occur randomly, but in response to specific events that are misinterpreted by the individual. Moreover, this misinterpretation is said to fuel a cycle of negative emotions, It is important to note that the cognitive theory of depression does not suggest that depressed persons are always biased in their information processing (Segal, 1988). Rather such biases are most likely to emerge in situations that are personally relevant, and that offer a degree of ambiguity (Beck, 1967 Clark et al., 1999). Unlike the research on negativity and specificity, which often involves simple self-report, evaluation of the selective-processing hypothesis involves more laboratory-based studies. Participants in such studies are placed in a variety of specifically constructed situations, ranging from imagined scenarios in which an outcome is predicted, to performing a task and receiving feedback from...

Cognitive therapy to challenge delusions and dysfunctional assumptions

The application of cognitive therapy in the challenging of delusions and dysfunctional beliefs draws upon the approach described by Chadwick et al. (16 and builds upon the pioneering work of Chadwick and Lowe.(H) Those research groups that have been developing CBT approaches agree that engaging patients is perhaps the greatest challenge facing a therapist. It is noticeable that many individuals either never attend or do so for a few sessions and then stop. Once individuals get past the opening strategies of cognitive therapy they usually see therapy through. This pattern of high and early drop out is found in those few research trials so far carried out on cognitive-behavioural approaches to psychotic problems.(1 IM )

Cognitive therapy

Earlier studies of individual cognitive therapy suggested that it was at least as effective and acceptable as antidepressant drugs (or 'treatment as usual') in the treatment of non-psychotic outpatient unipolar depressives in primary care and hospital outpatient settings (for reviews see Hollon et al.(64) and Scott(56)). Furthermore, severity and endogenicity did not appear to be a contraindication to cognitive therapy. However, most of these studies had significant methodological flaws. The three-centre NIMH study(63) sought to overcome these. A total of 239 patients with major depression were randomly allocated to one of four treatments, imipramine with clinical management, pill placebo with clinical management, cognitive therapy, or interpersonal therapy. Treatments were undertaken by trained and supervised therapists. The primary analysis showed few differences between the active treatments. A secondary analysis which controlled for severity of depression, found that cognitive...

The Cognitive Model

At its most general, the cognitive model of depression suggests that there is a strong connection between people's construal of events, their behaviour, and their emotional state. The model postulates that incoming information from the environment is processed via meaning-making structures that result in particular interpretations for each individual, and that in depression such cognitive structures are negatively oriented in their processing and tone, generating negative emotions and problematic behaviours (Beck, 1967). The cognitive model sees the processing of information as a primary, though not necessarily causal, factor in depression. The cognitive model has its roots in two of the dominant currents of contemporary psychological thought, behaviourism and cognitivism. The developer of the cognitive model, A.T. Beck, was influenced considerably by behaviourism and learning theory, which suggested that psychopathology could be learned and did not necessarily result from repressed...

Intentionality is critical in the regulation and prediction of action

Our everyday understanding of each other's actions is in terms of mental states, such as experiencing, feeling, believing, wishing, planning, and so on and so forth. This 'folk psychology' was quite different from early experimental psychology based in principles of conditioning, but it seems on the surface at least to be more like contemporary cognitive psychology, which, as described in the first chapter, constructs explanations of behaviour inside and outside the laboratory in terms of cognitive states. We characterize mental or cognitive states in a standard way, using the technical concept of'intentionality' such

Mind as Self Fulfilling Description

The first is almost a tautology, although it seems to contradict a traditional intuition, going back to Descartes, that we know the contents of our minds immediately, without having to infer them from sense data as we do for other objects of perception. There really isn't a contradiction, but the idea of the self-model makes the tradition evaporate. When I say that I know the contents of my mind, who am I talking about An entity about whom I have a large and somewhat coherent set of beliefs, that is, the entity described by the self-model. So if you believe you have free will, it's because the self-model says that. If you believe you have immediate and indubitable knowledge of all the sensory events your mind undergoes, that's owing to the conclusions of the self-model. If your beliefs include I am more than just my body, and even I don't have a self-model, it's because it says those things in your self-model. As Thomas Metzinger (1995b) puts it, since we are beings who almost...

Emotions and affective style

A second line of research relies on direct measures of brain activity. A good example is provided by the electroencephalography ( EEG) studies of Davidson 1,5) who demonstrated that, in normal subjects, negative emotions (e.g. disgust, fear) are accompanied by a stronger right-hemisphere than left-hemisphere activation. Research findings such as these have led many authors to conclude that the right frontal areas sustain negative emotions and avoidance behaviour, while the left frontal areas are more involved in pleasant emotions and approach behaviour (for a more refined version of this theory, see Heller and Nitschke (1J ). There are good reasons to take this argument one step further and to assume that right- and left-frontal overactivation are trait-like characteristics that reflect susceptibility to avoidance-related and approach-related behaviour respectively. That is, habitual overactivation of one frontal area or underactivation of the other frontal area corresponds to certain...

Chapter References

Cognitive psychology. Appleton-Century-Crofts, New York. 62. Mineka, S. and Sutton, S.K. (1992). Cognitive biases and the emotional disorders. Psychological Science, 3, 65-9. 63. Williams, J.M.G., Watts, F.N., MacLeod, C., and Mathews, A. (1997). Cognitive psychology and emotional disorders. Wiley, Chichester. 71. Mineka, S. and Gilboa, E. (1998). Cognitive biases in anxiety and depression. In Emotions in psychopathology theory and research (ed. W.F. Flack Jr and J.D. Laird), pp. 216-29. Oxford University Press, New York. 75. Mathews, A.M., Mogg, K., Kentish, J., and Eysenck, M. (1995). Effects of psychological treatment on cognitive bias in generalised anxiety disorder. Behaviour Research and Therapy, 33, 293-303. 78. Teasdale, J.D. (1983). Negative thinking in depression cause, effect, or reciprocal relationship. Advances in Behaviour Research and Therapy, 5, 3-25. 88. Butler, G. and Mathews, A. (1987). Anticipatory anxiety and risk perception. Cognitive Therapy...

The phenomenon or process in which representational elements fuse into a coherent internal representation

Each of these questions could be tackled at multiple levels, from that of the computational theory, via the algorithms that implement the computations, down to the biological hardware that implements the algorithms. Discussion of binding in cellular neurobiology is still rather uncommon. The main focus is on the higher levels of neuronal circuits, brain systems, and cognition. At these levels, it is methodologically convenient to distinguish two types of approaches top-down or cognitive, and bottom-up or neurobiological.2 The classic top-down approach is that of the Gestalt School (Gestalt, from German for 'shape' Koffka 1935 Hochberg 1998 insight). This school of psychology, founded in Germany in the early twentieth century, has promoted the view that the nature of perceptual parts is determined by the whole, and that enquiry into the mind should consider global organization and proceed top-down. Unfortunately not much top-down analysis of the brain was possible during the formative...

Phase 5presenting The Option

As previously discussed, the time needed to process the events that have resulted in their loved one's death is different for every family depending on religious, cultural and personal beliefs, individual personalities and ways of handling grief. The best time to present the donation option will be different for every family.

What is the evidence regarding the existence of negative distortions in the thoughts of depressed individuals

The cognitive model of depression takes as its starting point the notion that it is the depressed person's moment-to-moment negative misinterpretation of an event, rather than the event itself, that leads to emotional distress (Beck et al., 1979 Clark et al., 1999). What is the empirical status of the assertion that depressed people are more likely to have negative thoughts As reviewers have done previously, we frame the questions about negative cognitions in terms of central tenets. To examine the issue of cognitive distortions, we focus on the following two specific hypotheses (1) Negativity depression is characterized by the presence of self-referent negative thinking, With regard to the first hypothesis, the large majority of studies and reviews support this notion of negativity. Since A.T. Beck's original research comparing the level of negative cognitions expressed by depressed patients during interviews to that of non-depressed psychi-atricpatients (Beck, 1967), the large...

Delineating and Decomposing Memory

Although much research on memory has focused on phenomenally decomposing memory systems, not all cognitive psychologists have accepted this agenda. A minority have focused instead on uncovering the processes or operations underlying different memory activities. This approach has the potential to produce mechanistic accounts of memory, but it confronts a serious challenge of articulating just what are the operations underlying cognitive activities such as memory. This is a serious challenge not just for memory research, but for cognitive psychology and cognitive neuroscience more generally. As I will develop in the third section of this chapter, cognitive investigators seeking to identify operations have generally either remained too close to the phenomena to be explained (drawing upon folk characterizations of mental life), or reached too low (focusing on systems made of neuron-like processing units). I suggest that neither of these approaches is sufficient to reveal the sorts of...

Objections to the proposed solution 2 Neural syntax isnt enough for semantics

As noted in the previous section Fodor's Language of Thought hypothesis is closely connected to the so-called Computational Theory of Mind, which in turn is based in the classical (von Neumann-Turing) theory of computation. According to the classical theory, computation is performed on symbol systems, physical tokens (of some kind) and strings of tokens the rules that govern their manipulation are defined in terms of shape, in terms of syntactic form only. In particular, computation is defined without reference to meaning symbols may be 'interpreted' as having meaning, as representing objects and states of affairs, but this is not essential to the definition or to the practice of computation. If this classical, 'symbolic' theory of computation is applied to cognitive psychology, the result is the so-called Computational Theory of Mind, according to which, in brief, cognitive states and processes are defined in terms of syntax, not (essentially) in terms of meaning (Fodor 1975 Newell...

Psychological processes and treatment implications

Other cognitive therapies also make significant contributions to treatment. Relapse prevention involves the teaching of cognitive and behavioural strategies for dealing with high-risk situations and mental states.(1B 9) Other cognitive-behavioural therapies, including extinction of conditioning, contingency management, community reinforcement techniques 20 and indeed Beck's cognitive therapy, (2 have been effectively applied to substance misuse. The recent very large Project MATCH (matching alcoholism treatments to client heterogenity) study of alcohol treatments compared three types of treatment and found that motivational enhancement, 12-step facilitation, and cognitive-behavioural therapy were equally effective overall, although each therapy excelled in certain subgroups. (2,23) Based on these results it seems likely that specific therapies targetted at specific issues of importance in patients with addiction are roughly equally effective overall, but that we do not yet know enough...

Mechanistic Decomposition Of Memory Into Component Processesoperations

12Kolers and Roediger described the approach Our view, transfer of training and savings methods, properly applied, constitutes a fundament upon which to construct an empirically based cognitive psychology. The techniques would be applied as measures of skills acquired in one cognitive task and expressed in performance on another. Degree of transfer from one task to the second or, as in Nelson's (1978) work, the more subtle measurement of savings, can aid in diagnosing the underlying cognitive operations. The idea is that any complex event is composed of a number of component activities, and the more alike they are, the more alike the behavior will be (Kolers & Perkins, 1975). Judicious experimentation may allow one to infer their identity (p. 443). They proceeded to talk of developing a taxonomy of trainable capabilities that can be organized in the performance of different tasks.

Helping motivation the social matrix

Treatment do no worse than those attending voluntarily. (2s) Cognitive-behavioural therapies When incentives are powerful, many newly abstinent patients are able to abstain for short periods. Others lack the skills to cope with the triggers to drinking even when their motivation to abstain has been strong. Cognitive-behavioural therapies seem to improve the coping skills of these patients. If the triggers are in social situations, assertiveness or conversation skills training can help. If the trigger is related to life problems, cognitive therapy may be effective. Other patients are helped by learning to handle frustration and criticism without anger, and to express anger instead of harbouring it. Treatment can be in groups, where the opportunity to discuss these topics with others who have similar problems is appreciated. Groups also enable learning through role playing and by modelling on others.

Defensive motivation in MDD

Certainly, no overall characterization of emotional responding in MDD is complete without a consideration of how depressed individuals respond to negative emotional stimuli. From early psychoanalytic formulations of depression to contemporary cognitive conceptualizations of this disorder, theorists have postulated that depressed individuals are characterized by a magnified response to negative stimuli. For example, cognitive theories of depression conceptualize this disorder in terms of biases in information processing, in which attention to, and or memory for, negative stimuli or environmental events are potentiated (e.g., Beck, 1967, 1976 Beck et al., 1979). Indeed, given the pervasiveness of negative thinking and negative affect in this disorder, the hypothesis that depression enhances reactivity to negative stimuli is a reasonable one.

Critical Elements Of Effective Therapeutic Communication

Be realistic in your relationships with people avoid making assumptions or judgments about your patients' behavior. If you have negative thoughts about something a patient says or does, try to keep in mind that he is an adult, responsible for making his own decisions. You do not want him to feel he must conceal anything from you. You want him to see that you will accept him for what he is you will allow him his own identity.

Theory of mind and empathy mental simulation

In the first chapter, Section 1.1.1, we noted that cognitive psychology posits cognitive states in order to explain and predict goal-directed, flexible behaviour. We went on to remark there and in Section 1.4 that folk psychology can be plausibly regarded in a similar light, as being a quasi- or proto-scientific

Cognitive vulnerability

Two types of cognitive problem are thought to make young people vulnerable to depression (a) general cognitive deficits, such as reading retardation or low intelligence, and (b) cognitive distortions, such as a negative attributional style, that are believed to be specific to depression.

Major depression with or without melancholia

The cardinal triad of symptoms of depression is as follows emotional symptoms, psychomotor symptoms, and negative beliefs. Not surprisingly, this triad is more ICD-10 requires six of the ten symptoms in Table. Negative beliefs such as 'loss of self-esteem' or 'inappropriate guilt' are the core symptoms of major depression. Inappropriate guilt is experienced as punishment for past misdeeds (prior to the current episode of depression). The prevailing element of negative beliefs is a sense of loss which is associated with lower self-esteem experienced retrospectively.(9) The symptom which discriminates best between anxiety states and major depressive disorder is guilt. (1

Looking beyond the Obvious Presuming Diagnosis Undermines the Clinical Process

An intelligent-looking undergraduate senior majoring in mathematical physics presented at the university counseling center complaining that his grades were slipping and that he felt incredibly anxious. During the clinical interview, he announced that he was much more intelligent than the other students and always received the highest grades in his mathematics and physics classes, at least until recently. Further exploration revealed that his father was a mathematical physicist at the same university, but had recently accepted the position of department chair at another institution on the opposite coast. Although intellectual testing in fact showed superior intellectual ability, it was also true that the son identified strongly with his father and greatly enjoyed the time he spent with his father, who tutored him through the most difficult problems. Several weeks into counseling, he was able to admit that he feared that without his father, he would no longer receive such high marks and...

Dysfunctional cognition

According to the helplessness model of depression,(89) vulnerability to depression derives from a habitual style of explaining the causes of life events, known as attributional style. A large body of research found that individuals suffering from depression think more negatively than healthy individuals. Specifically, depressed patients have a tendency to make internal, stable, and global causal attributions for negative events, and to a lesser extent, the attribution of positive outcomes to external, specific, and unstable causes. In other words, depressed patients have a low self-esteem.(9 Thus, when thinking about the self, past, current, and future circumstances, depressed patients emphasize the negative, and this process is likely to contribute to the perpetuation of their depressed mood. However, the role of self-esteem in depression has not yet been well established. A controversy persists as to whether low self-esteem is a consequence of depression or a vulnerability factor of...

Peer Consultation Viewing Colleagues as Other Supervisory Resources

During Jenna's second semester at the counseling center, a beginning therapist, Mark, asked her what intervention might be appropriate for a client who scored high on the trait of dependency. By misunderstanding the relationship between personality styles and personality traits, Mark was naturally looking for the single best approach. Once he understood, however, that his new case was better described as a dependent style, he was able to look deeper into the client's personality and tailor a variety of interventions to her interpersonal conduct, use of defense mechanisms, and cognitive distortions.

Psychological treatments general issues

Almost all the controlled trials of psychotherapy for depression undertaken have employed manualized therapies. The interventions share the common characteristics of being time limited (less than 20 sessions), with primary targets symptom reduction and problem resolution. Cognitive therapy, interpersonal therapy, behavioural therapy, and some models of brief dynamic psychotherapy fall into this category. The largest volume of efficacy research has focused on cognitive therapy (about 50 studies), with fewer studies (about 30 in total) of interpersonal therapy, behavioural therapy, and other dynamic therapies. Sample sizes are often smaller than desirable and many studies have methodological weaknesses including the failure to include pill-placebo control groups.

Other psychotherapies

Few high-quality studies exist on marital and family models of psychotherapy. It is clear that cognitive therapy, interpersonal therapy, and brief dynamic psychotherapy can be applied to families, groups or couples, but the only published randomized controlled trials on marital therapy mainly draw on behavioural approaches. For example, O'Leary and Beach70 demonstrated that behavioural marital therapy or cognitive therapy were both more effective than waiting-list controls in treating women with depression or dysthymia. Furthermore, Jacobson et al.(71) demonstrated an advantage for behavioural marital therapy over cognitive therapy in depressed individuals with marital discord.

Continuation and maintenance trials

The use of continuation and maintenance psychotherapy is a new concept in psychological treatment studies. In a follow-up study Blackburn et alPD offered about five sessions of cognitive therapy over the following 6 months to subjects from an acute treatment study. At 2-year follow-up, the relapse rate in patients who had received acute pharmacotherapy was significantly higher than that in patients who had received cognitive-behavioural therapy either alone or in combination with medication. Blackburn and Moore(79) allocated subjects with recurrent major depression to 16 weeks of acute treatment and 2 years of maintenance treatment which comprised either antidepressants alone, cognitive therapy alone, or antidepressants followed by maintenance cognitive therapy. All groups improved in the acute phase and there were no differences in relapse rates in the maintenance phases, suggesting that cognitive therapy may be a viable alternative to maintenance medication. Recently there have been...

Psychological treatments

Formal psychotherapy may be offered as the only treatment to individuals with milder depressions or in combination with medication in those with moderate and severe disorders. More than 20 per cent of couples report marital discord in association with depressive disorders and so marital or family approaches should always be considered as an alternative to individual therapy. Individual treatments, such as cognitive therapy, may particularly benefit milder depressions. There are a number of features that identify potentially effective psychological approaches to depression. (56) The therapy should be highly structured and based on a coherent model. It should provide the patient with a clear rationale for the interventions made and the therapy should promote independent use of the skills learned. Change should be attributed to the individual's rather than the therapist's skillfulness and the therapy should enhance the individual's sense of self-efficacy. Clearly cognitive therapy,...

Biopsychosocial Approaches

Systems change as a function of both the forces acting upon them and their own internal dynamics. The same is true for a switch from a non-depressed to a depressed state (Gilbert, 1984). There is now increasing recognition that depression is typically related to a host of interacting processes in the domains of physiological processes (genes and stress hormones), psychological processes (negative beliefs, rumination, and social withdrawal), and social factors (life events and social support) that interact over time (Akiskal & McKinney, 1975). This is depicted in Figure 6.1.

Psychological theories

Horowitz(24,) explained re-experiencing symptoms as the result of a slow process that helps the traumatized person to adjust their inner models (schemas) of the self and the world to the traumatic experience. Until this process is completed, the information related to the traumatic event is thought to be held in active memory and thus intrudes into consciousness. Similarly, Janoff-Bulman(25) proposed that traumatic events 'shatter' previously held beliefs (for instance, 'The world is a safe place'), and that post-trauma adjustment requires rebuilding basic beliefs about the self and the world. Traumatic events can not only shatter basic beliefs, but also confirm pre-existing negative beliefs.(2,26,)

Anxiety management stress inoculation

The goal of this treatment is to teach the patient a set of skills that will help them cope with stress. Examples include relaxation training, training in slow abdominal breathing, thought stopping of unwanted thoughts, assertiveness training, and training in positive thinking. (59) Anxiety management is more effective than supportive psychotherapy. In the long term it appears to be somewhat less effective than exposure treatment.(101) Relaxation treatment alone is less effective than exposure and cognitive therapy in the short and long term.(102)

Management of depressive disorders

Depression usually responds to a combined approach of antidepressant medication and cognitive therapy. Selective serotonin re-uptake inhibitors (SSRIs paroxetine, fluoxetine, sertraline) are replacing tricyclic antidepressants (dothiepin, amitriptyline, imipramine) as the first choice drugs in the treatment of depression. They are better tolerated, safer in overdose, and cause fewer side effects in the presence of physical illness. Other newer antidepressants, such as venlafaxine and mirtazapine, increase the availability of both serotonin and noradrenaline, and can be effective if there is an inadequate clinical response to one of the SSRI drugs.

Albert Ellis and Carl Rogers Finding Your Own Therapeutic Style

Although Albert Ellis was originally trained as a psychoanalyst, he is an important figure in the history of the cognitive therapy movement. His transformation is striking, as it represents a philosophical shift from that which is deep and mysterious in human nature, namely the unconscious, to that which is more or less obvious, the rational process and errors of reasoning. Enthusiasts of this approach seek elements common to all successful psychotherapies. In itself, this is a laudable beginning. However, it is doubtful that a single necessary and sufficient set of characteristics will prove uniformly effective for all mental disorders. Instead, these characteristics provide a foundation for effective therapy, against which the efficacy of specific treatments can be evaluated. We should certainly require that cognitive therapy for depression be more effective than simple warmth and empathy from a likable therapist, for example. In the same way, it would be very surprising if all...

Psychosocial treatment

Early psychological treatments for GAD consisted mostly of non-specific interventions such as supportive psychotherapy, relaxation training, and biofeedback. In general, those treatments were not very effective. More recently, treatments have been developed that specifically target cognitive (e.g. worry) and behavioural (e.g. avoidance) features of GAD. These treatments are typically administered in a dozen or so sessions, and can be conducted in group or individual formats. In controlled trials, these newer cognitive and cognitive-behavioural treatments have been more effective than no treatment or a psychological or drug placebo treatment and at least as effective as benzodiazepines (for a review, see Barlow et al.(59 ). Attrition is low (10-15 per cent), and reductions in anxiety average about 50 per cent, with gains being maintained at follow-up. Currently, the most successful treatments combine relaxation training with cognitive interventions focused on making the worry process...

Cognitivebehavioural group therapy

In this section, we describe cognitive-behavioural group therapy ( CBGT)(78) (our treatment protocol, which integrates cognitive techniques and exposure in the treatment of social phobia) and briefly review the literature supporting its efficacy. Several controlled studies have evaluated the efficacy of CBGT. In one study, 49 patients were randomly assigned to CBGT or educational-supportive group therapy a credible placebo treatment consisting of lectures, discussions, and social support. (79) Following treatment, 75 per cent of patients who received CBGT were classified as having made a significant improvement by clinical assessors, compared with 40 per cent of patients given educational-supportive group therapy. The CBGT patients also reported less anxiety before and during an individualized behaviour test than did the educational-support patients. Both groups showed similar improvement over baseline on self-report measures. At a 6-month follow-up visit, a greater number of patients...

Management of specific phobia

Several investigations suggest that tailoring treatment to individual response patterns will improve outcome. For example, patients with a profile of heightened physiological reactivity may respond preferentially to applied relaxation, while patients with a profile characterized by avoidance may respond better to in vivo exposure.(121) Patients who experience their anxiety primarily in the form of anxious thoughts may respond better to cognitive techniques than patients whose symptoms are characterized more by somatic arousal.(139)

Tensiontype headache

Physiotherapy is the treatment of choice for musculoskeletal symptoms accompanying frequent episodic or chronic tension-type headache. In stress-related illness, lifestyle changes to reduce stress, and relaxation and or cognitive therapy to develop stress-coping strategies, are the treatment mainstays. Prophylactic medication has a limited role. Amitriptyline is first-line in most cases, withdrawn after improvement has been maintained for 4-6 months. Long-term remission is not always achievable, especially in long-standing chronic tension-type headache. A pain management clinic may be the final option.

Management of anxiety and stressrelated disorders

Behaviour therapy, involving relaxation and gradual exposure to the precipitating situation, is of proven value in phobic disorders and in panic disorder when there is avoidance behaviour. A clinical psychologist should assess the patient and organise treatment if behaviour and cognitive therapy are considered appropriate. Phenelzine is a useful adjunct to psychological methods of treatment. Drug treatment is more important in spontaneous panic attacks phenelzine, imipramine, and paroxetine have been shown to be effective. There has been considerable interest in the psychological treatment of victims of accidents or disasters who are at risk of developing post-traumatic stress and other psychiatric disorders. Early intervention has been advocated but its efficacy has not been convincingly demonstrated. Cognitive therapy and exposure, preventing the development of

Blocked and ineffective defensivecoping behaviour

Van Praag (1998) suggested that certain types of depression can arise from dysregulation of the anxiety and aggression systems, and, undoubtedly, anger and anxiety are often part of depressed states. In recent years, I have been interested in the idea that, when people are in aversive situations (for example, losing control over situations, or, subject to shaming or non-supportive environments), not only are these stressful but also there is an automatic triggering of basic evolved defensive behaviours (Gilbert 2000a). There is a range of such behaviours, including fight, flight, submission, and help-seeking (Gilbert, 2000a, 2001c). Dixon (1998 personal communication, 1993) pointed out that if one arouses but then blocks the execution of a defensive response (such as flight and escape) in animals (such as rodents), one often sees passivity and immobility. Gilbert (1992) noted that LH studies in animals often involve arousing but blocking the innate defence of active escape behaviour....

Gerald M Edelman and Giulio Tononi

Consciousness has been looked on as both a mystery and a source of mystery. It is one of the main targets of philosophical inquiry, but only recently has it been accepted into the family of scientific objects that are worthy of experimental investigation. The reasons for this late acceptance are clear enough While all scientific theories assume consciousness, and while conscious sensation and perception are necessary for their application, the means to carry out objective scientific investigations of consciousness itself have only recently become available. Recent studies in neurobiology and cognitive psychology have made it possible to address a series of questions the answers to which should help resolve some of the mysteries associated with consciousness. In this article, we will focus on two of these questions (1) What are the neural mechanisms that can account for the emergence of consciousness (2) How can such neural processes account for key properties of conscious experience...

Evolution Defensive Processing And The Self

There is good evidence that many 'normal' information-processing routines have built-in biases, including biases to think more positively of one's own group and kin than outgroups and non-kin, self-serving biases, and sexual-attraction biases (Tobena et al., 1999). As noted elsewhere (Gilbert, 1998b), cognitive distortions can also be linked to a basic defensive heuristics and biases in information processing for example, better safe than sorry. Thus, if an animal hears a sound in the bushes, it may be better for it to assume a predator and run away than stay to gather the evidence. Overestimating danger may lead to the expenditure of effort by running away when one did not need to, but underestimating a danger could be fatal. Algorithms for information processing under stress are thus often based on quick, safety-first heuristics rather than logic or rationality. maintain depression by setting up maladaptive feedback cycles. Some of the therapeutic manoeuvres used when working with...

The philosophical stand that considers propositions about mental states identical to propositions about behavioural

Over the years, behaviourism has experienced fierce attacks from biological and cognitive psychology, linguistics, and philosophy (for arguments related to the insufficiency of behaviourism to account for learning, see Dickinson 1980). As noted above, behaviourism excluded itself from the biological arena in which much of the excitement of modern memory research takes place. Nevertheless, even with the recent developments in the neurosciences, behaviourism is still highly relevant to basic concepts addressed in this book. For example, the mere definition of memory raises the issue of the relevance of observable facts to inferred processes. Behaviouristic definitions of learning and memory cannot guide neurobiological research because they are not expressed in biologish. But similarly, data on ion channels and synapses cannot advance memory research unless they are expressed in a behaviourally relevant language. Skinner (1988) pointed out that 'Sherrington never saw the action of the...

Dialectic behaviour therapy

Most of the reported work with cognitive therapy in personality disorder has been open and uncontrolled, (1 24) and there have been no controlled studies apart from those of Marsha Linehan, notably a study carried out in the late 1980s in which a special form of cognitive behaviour therapy dialectical behaviour therapy was compared with the usual treatment in a group of repeatedly parasuicidal female patients with borderline personality disorder. (31) However, the main treatment outcome chosen was not resolution of the personality disorder but reduction in the frequency of self-harm episodes. The hypothesis that dialectical behaviour therapy was effective in reducing self-harm was supported. those with a history of repeated self-harm.(34) Patients were randomly assigned to treatment as usual or manualized cognitive therapy. In contrast with Linehan's treatment 31 the patients treated received only brief therapy from a six-chapter treatment manual and between two and six sessions of...

From metaphors to models historical developments in the study of biological correlates of suicidal behaviour

Over the last 30 years the modelling of suicidal behaviour has undergone a transformation through the influence of psychometrics, phenomenological psychiatry, neurobiology, epidemiology, genetics, and cognitive psychology. In addition, the emergence of the biopsychosocial approach to health problems in general, has introduced a more comprehensive, multifaceted approach to the study and modelling of suicidal behaviour. The biological study of suicide has also moved from focusing on suicidal ideation as primarily related to depression to focusing on suicidal acts as primarily related to the biology of aggression and impulsivity.

The educational component

One of the strengths of the cognitive behavioural approach (e.g., Beck et al., 1979) is that the therapist presents the client with a rationale for therapy and also presents relevant educational information, or bibliotherapy, about the problems being experienced. The booklet, Coping with Depression, was designed by Beck and his colleagues to provide information to depressed clients about the experiences they may be having, in addition to introducing the main characteristics of the cognitive approach. The booklet is handed out during the first or second session to be read for homework. The client's response to the booklet has been shown to be a good predictor of whether or not the cognitive approach is likely to be effective with that particular client (Fennell & Teasdale, 1987), such that a client who clearly disagrees or does not relate to the description of the model in any way is unlikely to do well in cognitive therapy. In such a case, the therapist might be advised to discuss...

Mental Flexibility To Adopt The Perspective Of The Other

For successful social interaction and empathic understanding in particular, an adjustment must operate on the representations elicited by the perception-action coupling mechanism. One needs to regulate one's own perspective that has been activated by the interaction with the other. Such regulation is important in modulating one's own vicarious emotion so that it is not experienced as aversive. Previous research has shown that emotion regulation is positively related to feelings of concern for the other person (e.g., Derryberry & Rothbart, 1988). In contrast, people who experience their emotions intensely, especially negative emotions, are prone to personal distress that is, an aversive emotional reaction, such as anxiety or discomfort, based on the recognition of another's emotional state or condition (Eisenberg, Shea, Carlo, & Knight, 1991). Furthermore, a complete merging or confusion of self and other is not the goal of empathy (Batson, 1987, 1991 Decety & Jackson, 2004 Hodges &...

Monitoring thoughts and feelings

One of the key problems that we noted above with the three- and the five-column techniques is that clients sometimes report that emotions come out of the blue without any prior automatic thoughts. The early cognitive therapy view of this problem was that it was merely a matter of time and of practice before such clients would be able to identify their NATs. Of course, such a strategy does run the risk that has sometimes been attributed to psychoanalytic therapies, namely, of bringing about the phenomenon rather than the phenomenon having genuine causal validity that is, cognitive therapy clients might come to experience NATs, just as Freudian patients come to have Freudian dreams and Jungian patients come to have Jungian dreams. An alternative theory that we have spelled out in our SPAARS model is that some emotions really do come out of the blue (Power & Dalgleish, 1997 1999). Although some emotional reactions follow the occurrence of

Schematic models of self and others

One of the key aims of cognitive therapy is to explore the underlying assumptions that people have of themselves and of significant others in their lives. The continued monitoring of critical situations week to week in therapy will soon provide the therapist with clear indications of the themes underlying a particular client's difficulties, information that can be supplemented with assessments of attitudes by tools such as the Dysfunctional Attitudes Scale (Weissman & Beck, 1978) and the Schema Questionnaire (Young, 1999). Let us imagine that we have a client, part of whose formulation is that he has a fear of success in competitive situations because of other people's envy that would ensue from his winning. Exploration of the origins of this schematic model might indicate that the client's father behaved in a very overbearing manner whenever there was a competitive situation in which the client was involved. The client may also back down or appear to withdraw statements in therapy in...

Associated features

Associated features include fears of ageing and death. In addition, hypochondriacs place a greater value on physical health and appearance, yet have no better health habits than non-hypochondriacal persons.( If Such patients show avoidant behaviours consistent with their cognitive distortions. (15 They may repeatedly check parts of their body for signs of disease (e.g. heart rate), or check their appearance (e.g. facial coloration) or functioning (e.g. swallowing). Some seek reassurance from medical books and related sources, while others avoid encounters with medical personnel.

Cognitivebehavioural therapy

Preliminary data suggest that cognitive-behavioural therapy (CBT) may be effective for treating BDD. Promising approaches include cognitive restructuring, exposure (e.g. exposing the defect in social situations and preventing avoidance behaviours), and response prevention (avoiding compulsive behaviours, such as mirror-checking). In a report of five patients, four improved using such approaches in 90-minute sessions for 1 day or 5 days per week (with a total of 12 to 48 sessions) 24' Techniques included having patients cover or remove mirrors, limit grooming time, and stop using make-up. Exposure techniques included going to restaurants or stores and sitting in crowded waiting rooms. Another study, which used similar techniques, found that exposure and response prevention plus cognitive techniques were effective in 77 per cent of 27 women who received this treatment in eight weekly 2-hour group sessions.(9) Subjects in the treatment group improved more than those in a no-treatment,...

Using psychological models to predict reactions to screening

Research is currently underway to examine whether cognitive-behavioural models can help to predict reactions to screening. For example, a cognitive-behavioural approach to health anxiety suggests that the extent to which a person is likely to make particularly negative interpretations of health information such as test results (and therefore to experience persistent anxiety) is likely to be determined by their pre-existing general beliefs about health, their specific beliefs about the disease which is being tested for and the test itself, and the extent to which their interpretations trigger maintaining factors such as checking or reassurance-seeking behaviours.(47) A cognitive-behavioural model of health anxiety had been applied successfully to the understanding and prediction of psychological responses to bone density screening. Three types of factor predicted distress in response to screening 2. specific negative beliefs about osteoporosis In each of the key outcome variables at...

Epidemiology and Demographics

Psychological testing on women with vulvar vestibulitis has found higher rates of introversion, somatization, and interference with sexual function. Overall levels of psychological distress, negative feelings toward sex, self-esteem, and marital satisfaction are conflicted in the literature with some studies showing no difference from matched controls and others finding opposite results. Furthermore, the order of causation remains unclear, with many authors suggesting a circular relationship of the physical condition and psychological changes.8-10

Application of counselling to specific conditions

When should counselling be offered, rather than specific psychotherapies, psychological treatments, medication, or psychiatric management Unfortunately, such a question is very difficult to answer.(4) Whilst there is high-quality outcome research linking specific therapies (e.g. cognitive therapy) to specific conditions such as depression, anxiety, and obsessive-compulsive disorder, the research for counselling models is much less clear. Depending on the settings in which they work, counsellors need to be equipped to work with clients with a range of psychological difficulties. For example, the primary care counsellor's caseload is likely to include client difficulties ranging from mild to moderate anxiety or depression to bereavement and relationship problems. However, there are some psychological difficulties for which counselling may be a more effective intervention stress-induced disorders, including adjustment disorder, grief, and trauma, postnatal depression, and relationship...

Counselling in primary care

Despite the growth and popularity of counselling in primary care, serious concerns are expressed about effectiveness and standards of training. The effectiveness of counselling in primary care has been difficult to assess because of the lack of specificity and control in studies, the diversity of patient groups, and variation in treatments 4,54* Studies have shown mixed findings, with more consistently positive results for cognitive therapy in primary care, and a generally consistent reduction in the prescription of psychotropic medication in practices with counselling services. Cape and Parnham (55 showed that the provision of practice counselling was associated with higher referral rates to clinical psychology. A number of studies have shown no difference in outcome between routine general practitioner treatment and practice counselling, patients in both groups improving however, patients are in favour of counselling and report that it helps them with a variety of psychological...

Background Previous treatment

Many depressed patients presenting for cognitive therapy have already received other treatment (most commonly antidepressant medication and counselling). The therapist should inquire about the outcome of such treatment, and what the patient makes of it. Depressed patients often conclude that the incomplete success of prior treatment means they will never improve and understandably feel hopeless about their chances with this new approach. These thoughts, once elicited, can be dealt with using straightforward cognitive-behavioural methods. Additionally, where the patient has received psychological therapy, it is often helpful to ask what they learned from it. If they feel they learned nothing, this may predispose them to approach cognitive therapy with pessimism. Alternatively, if they learned something of value, then cognitive therapy can build on this positive experience.

Distraction techniques

In severe depression, access to more positive perspectives may be blocked by depressed mood, making modifying negative automatic thoughts difficult or impossible. At the same time, patients may spend time ruminating on their difficulties, intensifying depressed mood. Learning to focus attention on the outside world (e.g. a detailed description of what the patient can see) or other mental content (e.g. remembering in detail a favourite walk), temporarily reduces the frequency of negative thoughts and improves mood. Clearly this palliative measure will not resolve the patient's problems. However, the improvement in mood it produces may facilitate more constructive thinking, as well as reinforcing the model.

Monitoring activities

Lowered activity levels and loss of interest and pleasure are often central features of depression. The goal of early behavioural interventions is to maximize engagement in activities providing a sense of pleasure and mastery. This has a direct impact on mood, and also provides an opportunity to begin countering negative thoughts that block engagement and, perhaps in a more global sense, prevent recovery (e.g. 'I can't do anything to change how I feel').

Challenging the evidence for the belief

When the therapist questions the evidence for a delusion there are two distinct but related objectives. One is to encourage to question and perhaps even to reject the evidence for his belief, and in this way perhaps to undermine the patient's conviction in the delusion itself. For some individuals challenging the evidence is a very powerful intervention and one that produces a substantial reduction in delusional conviction. However, more commonly this does not happen, but challenging evidence is still valuable in that it does impart insight into the connection between events, beliefs, affect, and behaviour. This is the second objective of challenging evidence, namely to convey the essentials of the ABC approach, i.e. that strongly held beliefs influence affect, behaviour, and cognition (i.e. interpretation) for all people. Core beliefs recruit or bias everyday inferences and automatic thoughts. However, this means that people often impose an interpretation on to events which is...

Indications contradictions and selection procedures

Currently, there is insufficient evidence to recommend a particular method of CBT for schizophrenia. Those interventions reviewed above have moved towards employing a variety of techniques as a therapeutic package. Similarly, there is insufficient evidence to determine which subgroups of patients with schizophrenia do and do not benefit from treatment, although at present personal therapy could not be recommended to people not living with their families. (7) In each of these studies a considerable number of patients initially referred for entry into the trial were excluded due to factors such as non-compliance with medication, refusal to participate, or persecutory ideation which interfered with engagement, suggesting that this treatment will not be suitable for all patients. Similarly, Kuipers et aA,(25 report that a response to CBT in their study was associated with greater cognitive flexibility concerning delusions at baseline. This suggests that the sufferer may need some small...

Cognitivebehavioural and rationalemotive couple therapy

Aaron Beck,( 9 in his cognitive-behavioural approach to couple therapy, identifies in the communication of disturbed couples many of the problems found in the thinking of depressed patients, and attempts to correct these. Thus, he tackles misunderstandings, generalizations, untested assumptions, and automatic negative thoughts by challenging assumptions, reducing expectations, relaxing absolute rules, and focusing on the positive rather than the negative.

Interpersonal Functioning

The third phase of the treatment is targeted on the interpersonal difficulties that precipitate or resulted from the disorder. This is where cognitive strategies address core beliefs and schemata. The goals for this phase of the treatment include the experience of increased self-efficacy and the rebuilding of a more solid and autonomous sense of self. This takes account of the impact of the illness, which often occurs in a developmentally critical time when self-esteem and identity are formed. It further appears that the impact of mania and depression at an early age are significant, as they dramatically affect important developmental milestones such as educational achievements, early work experience, and important interpersonal relationships. Essential cognitive structures such as dysfunctional core beliefs will probably become self-perpetuating. Examples of these beliefs include a distorted sense of autonomy or personal capability, vulnerability to harm or illness, and a sense of...

A priori threats to action and thought

The distinction between conditions favourable to action, and conditions which make action difficult to impossible, is relevant not only to psychology and clinical psychology, but also, given a certain assumption, to philosophy, specifically to the a priori theory of representation. The assumption in question is that representation essentially serves action. In terms of the cognitive-behavioural paradigm defined by this assumption there arises the prospect of profound paradox in case representation is of conditions in which action cannot proceed. The underlying logical problem is that there are conditions of reality that cannot be represented. It is possible to see from within logic the logical form or forms which psychological disorder can assume. The critical point is that thought is for the planning of action, and therefore it must represent the possibility of action if it cannot do this it undermines itself. Thought goes on, but is impossible. This defines the central, paradoxical...

The Cognitive Perspective

Writing from the perspective of cognitive therapy in Beck et al. (1990), Ottaviani argues that schizoids view themselves as observers of the world around them, not as participants. Detached from self or others and lacking in emotion, schizoids have only a paucity of automatic thoughts (p. 127) that might be identified as a basis for intervention. Moreover, schizoids do not obsess over negative feedback from others, the way an avoidant or compulsive might, for example. Instead, Ottaviani suggests that many schizoids see themselves as social misfits, but such appraisals lack any real negative impact. Because schizoids value detachment and isolation, the notion that they might be interpersonally awkward assumes the status of an incidental or offhand mental note, not a pressing concern. As such, schizoids may lack curiosity about why they are different or assume that nothing should be done about it. Consequently, they are not motivated to pursue therapeutic change. Finally, Ottaviani...

The Place of Psychology within Cognitive Science

As the science of the representation and processing of information by organisms, psychology (particularly cognitive psychology) forms part of the core of cognitive science. Cognitive science research conducted in other disciplines generally has actual or potential implications for psychology. Not all research on intelligent information processing is relevant to psychology. Some work in artificial intelligence, for example, is based on representations and algorithms with no apparent connection to biological intelligence. Even though such work may be highly successful at achieving high levels of competence on cognitive tasks, it does not fall within the scope of cognitive science. For example, the Deep Blue II program that defeated the The field of psychology has several major subdivisions, which have varying degrees of connection to cognitive science. Cognitive psychology deals directly with the representation and processing of information, with greatest emphasis on cognition in adult...

Improving the mental health skills of the primary care team Improving the skills of general practitioners

About half of GP trainees have a 6-month psychiatry hospital attachment, many of which are considered to be unhelpful for a future generalist career. (74) Many GPs have had no higher professional training in mental health and are not required to do so. Historically, continuing medical education for GPs has been based on traditional didactic educational methods which are unsuitable for learning psychiatric interviewing skills. (74,75) GPs are likely to select training by perceived rather than real need. A survey of 190 randomly selected GPs from 95 health authorities in England and Wales (74) found that 35 per cent of respondents had received mental health training in the previous 3 years and that 83 per cent of this group had found the courses useful. Respondents rated their competence in a range of mental health skills as generally average, but felt particularly confident in depression recognition with every respondent rating themselves as average or above 42.5 per cent rated...

Risk factors for depression in old age

The personality trait of neuroticism, which involves a predisposition to negative emotions, is an important risk factor at all ages. However, the elderly tend to score low on neuroticism questionnaires, consistent with the lower prevalence of depression reported in many studies.

The Debate About The Value Of Antidepressant Drugs

Whether a GP prescribes a psychotropic is influenced by her views on the advantages and disadvantages of antidepressants and anxiolytic drugs. It is well known from a number of studies that attitudes to psychotropics vary among GPs and influence their prescribing of such medication (20-22). Table 11.1 gives a summary of the most frequent criticisms and counter arguments in the antidepressant debate. Some of the points of criticism are more strongly connected to ethical values than others. For example, the first point of criticism, that antidepressants are overused, is linked with views about how people should handle their difficulties. Those critical tend to support the view that personal difficulties, like a divorce or a death of a family member, should be handled by psychosocial coping strategies, e.g. social contacts, identity changes. Of course, such a value norm can be supported by empirical hypotheses and deductions from future situations. For example, the restrictive attitude...

Specific psychotherapies

Cognitive-behavioural therapy Cognitive-behavioural therapy is effective in depressed teenagers,(39) but its value for suicidal adolescents has not been demonstrated.(23) Brent et al 23 modified the approach for depressed adolescents. The treatment comprised 12 to 16 once-weekly sessions, followed by a 6-month booster phase of monthly or bimonthly sessions. It included a psychoeducational manual about mood disorders, training to monitor and modify automatic thoughts, assumptions, and beliefs, training in more Dialectical behavioural therapy (DBT) is the only form of psychotherapy that has been shown in a randomized control trial to reduce suicidality in adults with borderline personality disorder. (49 This treatment is based on a biosocial theory in which suicidal behaviours are considered to be maladaptive solutions to painful negative emotions that also have affect-regulating qualities and elicit help from others. (S As indicated above, family discord, poor communication,...

Moral development adolescence and criminal responsibilities

Of critical importance in the assessment and treatment of young offenders is the emerging capacity of adolescents to experience guilt and shame. At its simplest, guilt involves the appreciation of responsibility for negative outcomes arising from acts of omission or commission. Shame is associated with negative feelings about the self and a perception of the self as bad or unworthy. With an evolving capacity for self-evaluation comes a recognition that there is personal choice over antisocial acts and an increasing awareness of the harm that these acts cause to others. A strong case can be made for a different approach to criminal responsibility with young people.

The Impulsive Borderline

The impulsive borderline is mixed with the histrionic or antisocial pattern. Unless constantly receiving attention, such individuals become increasingly seductive, impulsive, capricious, and irresponsible. Though most borderlines are famous for dysregulation of negative emotions, subjects with histrionic traits become even more behaviorally hyperactive and cognitively scattered, exhibiting a dysregulation of positive affects that includes frenetic gaiety, frantic gregariousness, and irrational and superficial excitement. At times, they lose all sense of propriety and judgment. Individuals with a stronger antisocial history become even more impulsive and thoughtless, both failing to plan ahead or heed the consequences of their actions as they struggle to free themselves from social constraints. At the borderline level, the strategies of the basic histrionic and antisocial patterns are simply much less successful than before. As such, they are likely to experience many disappointments,...

Different approaches to psychotherapy

Cognitive therapy versus psychoanalytically based psychotherapies There has been an increased interest in cognitive therapy and cognitive-behaviour therapy, where the emphasis is much more on the here and now and the behavioural consequences of abnormal thought patterns. (1,3) The techniques used in cognitive therapy for anxiety and depressive disorder are described in Chapter. 6.3.2 J and Chapter.6.3.2.3 respectively. The only modification that is required for their use in children is to adapt them to the developmental stage and the level of cognitive ability that the child has reached. (14) Cognitive therapy has a theoretical advantage for use in children in that its focus is more on the present and the future, in contrast to most psychoanalytically based psychotherapy. Its approach is strongly based on learning new ways of coping. Cognitive therapy is pragmatic and active rather than passive and reflective, making it generally more appropriate for the needs of younger children....

Metaanalysis Of The Efficacy Of Psychological Treatments For Depression In Older Adults

Scogin & McElreath (1994) produced the first meta-analysis of the efficacy of psychosocial treatments for late-life depression mainly in response to the National Institutes of Health (NIH) consensus statement (NIH, 1991) that suggested limited supporting evidence for psychotherapy for late-life depression. In 1997, the consensus statement was updated to take account of important new information in a range of areas pertinent to psychotherapy for depression in older adults. Lebowitz et al. (1997) concluded that cognitive-behavioural and interpersonal approaches had established evidence for treatment efficacy, and that A useful supplementary meta-analytic review to that performed by Scogin and McElreath (1994) was published by Koder et al. (1996), who evaluated cognitive therapy for the treatment of depression in older adults. Koder et al. (1996) identified seven treatment comparison studies between 1981 and 1994. Three of these seven studies favoured CBT over other treatment modalities,...

Psychological treatment

Modified cognitive therapy taking into account the level of verbal ability of the child, and teaching progressive muscle relaxation and breathing techniques with demonstration and imitation, may reduce anxiety and depression, ( ) although the effectiveness of these approaches in children with mental retardation has still to be fully established. Psychological approaches to treatment and counselling of children with mental retardation requires the therapist to be mindful of the developmental level of the child and ensure that the language used is comprehensible and that their approach is supportive and encouraging.

Summary of efficacy data

Cognitive therapy has proven efficacy as a treatment for depression in older people (Dick et al., 1996 Gatz et al., 1998 Karel & Hinrichsen, 2000 Knight & Satre, 1999 Koder et al., 1996 Laidlaw, 2001). In a broad review of the empirical evidence for the psychological treatment of depression in older adults, Gatz et al. (1998) concluded that CBT meets strict American Psychological Association criteria as a probably efficacious treatment. According to Gatz et al. (1998 13), CBT did not meet criteria as a 'well-established' treatment because 'superiority to psychological placebo has not been demonstrated with sufficiently large samples, and superiority to another treatment has not been found with sufficient consistency'. The conservative conclusion drawn by Gatz et al. (1998) may well be warranted at this stage, as too few studies have been conducted to evaluate properly cognitive therapy's efficacy. For an in-depth evaluation of the efficacy of CBT, see Laidlaw (2001). CBT has been the...

Working Psychotherapeutically With Older People

Koder et al. (1996 105) state 'The debate is not whether CT is applicable to elderly depressed patients, but how to modify existing CT programmes so that they incorporate differences in thinking styles in elderly people and age related psychological adjustment.' However, chronological age is the worst marker for determining whether therapeutic adaptations are necessary in cognitive therapy (Zeiss & Steffen, 1996).

The Self Defeating Masochistic Personality

Another way of creating a more normal masochistic personality style is by normalizing the diagnostic criteria of the DSM-III-R. Whereas individuals with the disorder seem to seek out disappointment, failure, or mistreatment (see criterion 1), those with the style do not. Whereas the disordered individual rejects or undoes the assistance of others (see criterion 2), the style tends to focus on the welfare of others before self. Whereas the disordered responds with negative emotions after positive personal events (see criterion 3), the style prefers to remain humble and resists taking public credit for accomplishments. Whereas the disordered sometimes deliberately provokes anger or rejection from others (see criterion 4), the style is charitable and deferential, sometimes to the point of indulging misbehavior. Whereas the disordered refuses pleasurable activities (see criterion 5), the style enjoys activities that fall short of self-serving hedonism. Whereas the disordered fails to...

Immunity against disconfirmation

Apart from avoidance, escape, or safety behaviours that immunize against disconfirmation, the cognitive biases discussed earlier may, of course, be relevant here. The phenomenon of emotional reasoning appears to be especially relevant to our understanding of hypochondriasis. The feared sensations are not followed by any catastrophe, but they are followed by intense anxiety. Given that anxious patients take the occurrence of anxiety as evidence for the presence of danger, beliefs may be strengthened by the very fear to which the beliefs give rise. (98) Other cognitive biases may also serve to maintain the disorder. (99 Selective attention to threat reinforces the experience of living in a threatening environment and selectively remembering negative experiences may foster hopelessness. Interpretation biases may provide subjective evidence that the disturbing beliefs are valid.

The Evolutionary Neurodevelopmental Perspective

Finally, avoidants, dependents, compulsives, and negativists are all part of the so-called anxious cluster, personalities for whom anxiety is a prominent life concern. Avoidants and dependents are alike in sharing deep feelings of personal inadequacy but differ in their response to perceived inadequacy. When threatened with feelings of helplessness, dependents seek to bind others even closer to them by increasing their submis-siveness and attempting to please others all the more. In contrast, the avoidant is often very effective in nonsocial situations the dependent is not. Avoidants run away at the first sign of negative evaluation dependents stay and try to please. Both avoidants and compulsives share performance anxiety and a fear of evaluation, which they modulate with extraordinary self-control. Compulsives, however, are usually able to sublimate their anxiety into a preoccupation with rules, details, lists, and such avoidants are more likely to simply withdraw from social...

Developing an idiosyncratic model of the patients problem

Assessment ends with the development of an idiosyncratic version of the cognitive model. In particular, therapists aim to show patients how the specific triggers for their anxiety produce negative automatic thoughts relating to feared outcomes and how these are maintained by safety behaviours and other maintenance processes. Fig. 1 A cognitive model of a patient's panic attacks. (Reproduced with permission from D.M. Clark (1996). Panic disorder from theory to therapy. In Frontiers of cognitive therapy (ed. P.M. Salkovskis), pp. 318-44. Guilford Press, New York.) Fig. 2 A cognitive model for a patient with social phobia. Fig. 2 A cognitive model for a patient with social phobia.

Observational learning

Iolab Iol Model 103

Our knowledge of IOL draws from research in multiple disciplines behavioural psychology and ethology education, developmental and social psychology and cognitive psychology and the philosophy of mind. The systematic discussion of IOL in behavioural psychology and ethology was initiated already in the nineteenth century examples from this period are provided in Darwin (1871, 1872), Romanes (1882), and Morgan (1896). Most contemporary reports on species other than humans were mostly anecdotal ( anthropomorphism). The interpretation of the factual or the alleged data was at first rather shaky. In this context, even Darwin erred he suggested that in evolution, the dog has started to bark in an attempt to imitate its talkative human master (Darwin 1872). Since then, IOL has been documented in a great variety of species, ranging from guppies and octopi, via birds and cats, to monkeys and apes (John et al. 1968 Griffin 1984 Anderson 1990 Cheney and Seyfarth 1990 Fiorito and Scotto 1992...

Depressive Personality Disorder Dsmivtr Appendix B

Or ameliorate their overly negativistic worldview. These people might even join groups of other individuals who share their pessimistic views, such as end-of-the-world cults, although many depressive people are prone to isolation. Their cheerless-ness and unhappiness tend to drive others away. When interviewed, patients with Depressive Personality Disorder are often critical of their own behavior and self-derogatory. They freely admit their feelings of guilt and remorse for their current state of affairs. As noted, these negative feelings would also extend to others, so no one would escape their negativistic and critical evaluations and judgmental scrutiny. Some evidence suggests that these chronic depressive traits are heritable and begin before early adulthood (e.g., Coolidge, Thede, & Jang, 2001). Table 5.3 lists the DSM-IV-TR diagnostic criteria for Depressive Personality Disorder.

Measures of effectiveness and outcome

Kendall, P.C. and Lochman, J. (1994). Cognitive-behavioural therapies. In Child and adolescent psychiatry modern approaches (3rd edn) (ed. M. Rutter, E. Taylor, and L. Hersov), pp. 844-57. Blackwell Science, Oxford. Spence, S.H. (1994). Practitioner review cognitive therapy with children and adolescents from theory to practice. Journal of Child Psychology and Psychiatry, 35, 1191-228. 8. Kendall, P.C. and Lochman, J. (1994). Cognitive-behavioural therapies. In Child and adolescent psychiatry modern approaches (3rd edn) (ed. M. Rutter, E. Taylor, and L. Hersov), pp. 844-57. Blackwell Science, Oxford. 13. Spence, S.H. (1994). Practitioner review cognitive therapy with children and adolescents from theory to practice. Journal of Child Psychology and Psychiatry, 35, 1191-228. 14. Kendall, P.C. (1993). Cognitive-behavioural therapies with youth guiding theory, current status, and emerging developments. Journal of Consultant Clinical Psychology, 61, 235-47.

Interruptions in the flow of thinking

Thought blocking is a sudden unintended cessation in the train of thought, experienced by the patient as 'snapping off'. After this breaking off, which may even occur in the middle of a sentence, the previous idea may be taken up again or replaced by another thought. Thought blocking occurs in organic states, in depression, and frequently in schizophrenia where it is described as part of negative thought disorder.

The use of mental techniques for assisting improving and expanding memory

Whether Aquinas was indeed capable of dictating something legible from sleep is questionable he could have appeared as if in sleep at a state of extreme concentration. This is at least an explanation that would be favoured nowadays by those scientists who doze off in research seminars and then wake up to the applause to ask a question. Naturally, information about past memory feats and mnemonists is mostly anecdotal. However, we do have data on more recent cases (Stratton 1917 Luria 1969 Hunter 1977, 1978 Thompson et al. 1993 Brown and Deffenbacher 1995). From this information, based on only a small number of mnemonists, one could draw a conclusion that there are different mnemonic strategies. Compare, for example, the patient Shereshevskii of Luria (1969), and Professor Aitken, a mathematician, mental calculator, and mnemonist (Hunter 1977). Whereas Shereshevskii's mnemonics was of the classical type (see above), using imagery and forming a rich perceptual chain to link and retrieve...

Presence and subjective credibility of pathogenic beliefs

Irrational beliefs about the outside world are common in anxiety disorders. Especially interesting are people with monosymptomatic phobia who tend, in contrast to other anxiety patients, not to suffer from comorbid pathology and who present the clearest case of irrational emotions and behaviour in otherwise healthy people. While egodystony in specific phobias is even a diagnostic criterion of DSM-IV ('The person recognizes that the fear is excessive or unreasonable'), systematic questioning using a paper-and-pencil task, without the social pressure of an interviewer, reveals that spider phobics tend to endorse highly irrational beliefs about the dangerousness of spiders. The credibility of these frightening ideas is especially high in the presence of the phobic cue. (102) Social phobics appear to have negative beliefs about their own social performance and about others, whom they believe to be more critical and rejecting than they actually are. M0.4and 105) Furthermore, prominent...

Psychosocial mechanisms

Barlow Panic Modelk

There is an extensive literature on the influences of early environmental factors on the development of anxiety and other negative emotions in children (for an integrative review, see Chorpita and Barlow(47)). Attachment theory holds that parents or other consistent caregivers serve an important function in a child's development by providing a protective and secure base from which the child can operate. Disruption of this base is hypothesized to lead initially to anxious apprehension and dependency and, if the disruption is severe, subsequently to withdrawal and depression.

The Biological Perspective

In contrast, other studies suggest minimal to no relationship between the disorders of this spectrum. For example, Maier, Lichtermann, Minges, and Heun (1994) found that paranoid personality disorder was more common in relatives of unipolar depressives than in the relatives of schizophrenia, schizoaffective, or schizophreniform disorder subjects. Similarly, studies by Kendler, Masterson, and Davis (1985) suggest a stronger genetic association between paranoid personality disorder and delusional disorder than between these and schizophrenia. Because delusions may be systematized to different depths, they are often difficult to distinguish from the cognitive distortions of the paranoid personality. Accordingly, the difference between delusional disorder, persecutory type, and the paranoid personality may be one of degree rather than kind. Though it is often said that delusional individuals lack the capacity to doubt their delusion, and paranoid personalities can admit that their beliefs...

Unanticipated contradiction between percepts or thoughts and the predictions of organized knowledge

'Surprise' is basically a sudden, significant mismatch between the actual and the expected. In brains, this is between on-line inputs (be them sensory percepts or endogenous internal representations) and off-line internal representations, i.e. memories. Definition 2 above emphasizes two additional properties (a) that the knowledge is organized, and not merely a collection of data, and (b) that such organized knowledge makes predictions about reality ( a priori, planning). These properties are explicit in the terminology of cognitive psychology. In cognitive terminology, 'surprise' is a sudden discrepancy between input and a 'cognitive schema'. 'Schemata' are structured clusters of generic knowledge, that represent situations, events, actions, or complex objects, enable the comprehension of input, and predict future outcome of action (Eyesenck and Keane 1995 those schemata that contain organized sequences of stereotypical actions are 'scripts'). When external or internal data suddenly...

The Negativistic Passive Aggressive Personality

Passive Aggressive Personality Disorder

Such individuals are often called passive-aggressive personalities. In this chapter, negativistic is the preferred designation, a newer label that captures the broader elements of the total pattern. The pattern is perhaps best understood as being both similar and opposite to the compulsive. In terms of the evolutionary model, both are ambivalent patterns that struggle mightily with issues of obedience and defiance (Rado, 1959). The negativistic pattern, however, is actively ambivalent, whereas the compulsive is passively ambivalent. As such, compulsives follow a strategy of containment, suppressing their conflicts to appear self-controlled, perfectionistic, orderly, and morally scrupulous. In contrast, negativists work out their resentments on the surrounding world, but only in indirect ways, thus symbolizing their inability to break free of ambivalence and pursue a strategy of overt opposition. such a bitch, yet whenever anything is asked of her, she immediately becomes defensive,...

Therapeutic Strategies and Techniques

Writing in Beck et al. (1990), Pretzer suggests that although borderlines exhibit many cognitive distortions, dichotomous thinking is especially prominent. An attachment figure may be seen as either totally accepting or completely condemning, for example. Because emotion and thought are so closely linked, such black-and-white appraisals lead to proportionately intense emotional reactions, throwing borderlines' lives into desperate panic and their interpersonal relationships into turmoil. The first time the subject feels ignored, his or her appraisal changes, and the attachment figure is saturated with absolute evil. Likewise, borderlines cannot feel somewhat guilty, only totally bad and worthless. Because no shades of gray exist, more adaptable reactions simply are not available. As such, a strong therapeutic alliance is particularly important, for the therapist is easily classified as completely malevolent or untrustworthy as well. Although the focus on dichotomous thinking is...

Maximizing Supervision Finding the Most Suitable Therapeutic Approach

Having learned much from her first supervisor, a psychodynamic sage, Jenna was eager to begin studying with her second supervisor, known for his knowledge of cognitive techniques. When her first client, a depressed male graduate student, scored in the narcissistic range on the MCMI-III, her new supervisor recommended that she educate the client in the principles of cognitive therapy, focusing particularly on the discovery of automatic thoughts and their connection with his self-image, which featured quickly vacillating appraisals of his ability, ranging from godlike to pathetically inadequate. After the first two sessions, however, she noticed that the client seemed increasingly condescending, apparently chaffed by her attempts. Realizing that the personality disorder was the most important factor driving his depression, Jenna suggested to her new supervisor that perhaps the automatic thoughts underlying the transference itself could be discussed as a means of synergizing the...

Capsule History of Psychology

The anatomist Ernst Heinrich Weber and the physicist and philosopher Gustav Fechner measured the relations between objective changes in physical stimuli, such as brightness or weight, and subjective changes in the internal sensations the stimuli generate. The crucial finding of Weber and Fechner was that subjective differences were not simply equivalent to objective differences. Rather, it turned out that for many dimensions, the magnitude of change required to make a subjective difference ( just noticeable difference, or jnd ) increased as overall intensity increased, often following an approximately logarithmic function, known as the Weber-Fechner Law. Weber and Fechner's contribution to cognitive psychology was much more general than identifying the law that links their names. They convincingly demonstrated that, contrary to the claim that thought is inherently impossible to measure, it is in fact possible to measure mental concepts, such as the degree of sensation produced by a...

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