Cognitive Perspectives

Question 1

Cognition

Answer 1

“the mental action or process of acquiring knowledge and understanding thought, experience, and the senses.”

Cognitive Processing
Analogous to information processing (computing)
Can be automatic and effortful

Attention
Pattern Recognition
Perception
Memory
Language
Problem-solving and decision-making
What happens when these “go wrong”

Question 2

Diagnostic Criteria for Schizophrenia

Answer 2

Taken from DSM-V

A) Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one must be 1), 2) or 3)
1) Delusions
2) Hallucinations
3) Disorganised Speech
Grossly disorganised or catatonic behaviour
Negative symptoms (e.g. avolition)

Question 3

Hallucinations

Answer 3

Sensory experience where something is perceived by sight, sound, smell, taste or touch but isn’t present

Auditory hallucinations most common – usually “external” voices
commanding, conversing or commentating

Experienced by 70% of sufferers of psychotic disorders

Visual hallucinations second most common
Abstract form – e.g. shapes and colours
Specific – perceiving a specific person

Patients can be aware that their hallucinations are not real

Question 4

Delusions

Answer 4

“Firmly held but erroneous beliefs usually involving misinterpretations of perception or experiences”

Experienced by 75% of hospitalised patients with psychotic disorder

Can be bizarre (but not always)

Logical thought processes used to support delusional beliefs despite absurdity of content

Problems integrating perceptions/experiences with existing knowledge/history

Biased information processing

Question 5

Types of Delusions

Answer 5

Persecution – belief of being spied upon/persecuted/in danger

Grandeur – belief of having fame or power

Control – belief that thoughts/feelings/actions are controlled by external forces

Reference – independent external events are referencing the individual

Nihilistic – some aspect of themselves or world has ceased to exist

Question 6

Attentional Processes

Answer 6

Attentional processes

Inability to make associations between relevant events orr making irrelevant associations.

Reflect inability to focus attention on relevant environmental aspects (underattention).

Or overattend to irrelevant aspects of the environment.

Schizophrenia sufferers shown to have deficits in the orienting response (response to a change in the environment).

For example, studies that measure Skin Conductance Responses to simple tones – schizophrenics less sensitive

Sufferers also shown to be highly distractible on cognitive tasks.

Same sort of tasks as neurocognitive disorders
Sustained Attention
Selective Attention
Divided Attention

Question 7

Cognitive Theories continued

Answer 7

Patients with schizophrenia tend to show a bias toward attributing negative life events to external causes.

Make excessively stable (cannot be changed) and global (affect everything) attributions to negative life events.

But also positive events to internal causes and negative events to external causes.

Explains high incidence of reports of persecution in sufferers.

Question 8

Bentall, R. P., & Kaney, S. (1989).

Answer 8

Used Emotional Stroop Task

Subjects required to name the colours of words as per Stroop Task

But words made up of either words related to negative affect, paranoia, strings of 0’s or neutral words

For example
Gloomy
Surveillance
00000
Luggage

Patients response times for Paranoid words sig. slower

Question 9

Cognitive Theories Ext

Answer 9

Morrison (2001) bias toward labelling a “cognitive intrusion” as threatening.
For example, normal auditory hallucination interpreted as “I must be mad”

Leads to negative mood and physiological arousal that lead to more such experiences.

Freeman et al (2002) four factors contribute to emergence and maintenance of delusions

Anomalous experience (hallucination/delusion) with no obvious explanation.

Anxiety, depression & worry creating a bias toward negative thinking and interpretation.

Reasoning bias that seek to find confirmatory evidence of their delusion.

Social factors such as isolation.

Question 10

Probabilistic Reasoning

Answer 10

Using observations and knowledge to understand an event/situation/person

Similar to inductive reasoning where logical processes that are probable rather than certain lead to conclusions

Can lead to bias in schizophrenia patients

Question 11

Theory of Mind

Answer 11

Deficits in Theories of Mind (TOM)
Ability to understand our own and others mental states.

Frith (1992) – schizophrenic sufferers thought to have a deficit in being able to infer the beliefs/attitudes/intentions of others.

Corcoran et al (1997) – jokes involving inferring the mental state of others more difficult for deluded individuals to understand

Frith & Corcoran (1996)
Six ToM stories and related questions read to 55 schizophrenia patients
Stories were either First order (a character has false belief about the world) or Second order (a character has a false belief about the belief of another character)
Also explored types of story (circumstantial, deception) and question (beliefs, predictions, explanations)

Question 12

OCD Diagnosis and Symptoms

Answer 12

Obsessions:
intrusive, repetitive and distressing thoughts, images or urges,
ego-dystonic in nature (i.e. at odds with one’s ego or self-image)
known by the obsessive individual to be the product of their own mind

Compulsions:
repetitive behaviours
or mental rituals (neutralizations)
which are performed in order to decrease the distress caused by the obsessions

Question 13

Common Subtypes of OCD

Answer 13

The content of these obsessions and compulsions varies

There are some consistent themes. These are known as subtypes or symptom dimensions

Most common include:
Checking
Doubting
Cleaning/ Contamination
Symmetry/ Ordering
Hoarding
Religious (scrupulosity)

Question 14

Common Fears

Answer 14

What do the fears in these obsessions have in common?

All relate to a fear of being responsible for harm

Question 15

The Cognitive Model of Obsessions

Answer 15

Salkovskis (1985) proposed a cognitive model of obsessions

Obsessions result from the misinterpretation of negative intrusive thoughts

Spontaneous thoughts that come into one’s mind for no apparent reason, e.g.
Sudden thought that a disaster might happen
Sudden impulse to harm someone
Sudden sexual urge

Inflated Responsibility and Dysfunctional Assumptions about one’s own thoughts play a role
Compulsions occur as a result

Question 16

Common Cognitive Themes

Answer 16

Attributions and Interpretations – how we interpret thoughts/feelings/events/bodily functions are a common theme in cognitive perspectives to psychopathology

Rumination – perhaps a common theme is a tendency to think deeply and repetitively as a general habit
Then:
Faulty Thinking = Disorder

Vicious Circles

The role of beliefs

Automatic Processing – like reading or driving a car these processes become so automatic that they happen very quickly and effortlessly, meaning they are hard to change

Question 17

Features of Depression

Answer 17

Emotional
Sadness, misery, dejection, discouraged
Close to tears, loss of sense of humour
Anxiety

Motivational
Loss of interest in hobbies, sex
Lack of initiative, social withdrawal

Behavioural
Slowness of speech and behaviour
Decreased energy, fatigue, stay in bed

Physical
Sleep disturbance (middle and terminal insomnia, hypersomnia - difficulty getting back to sleep when waking up in the middle of the night, or early, and oversleeping respectively)
Headaches, dizzy spells, indigestion, constipation, general pain

Cognitive
Negative view of the self, the world and the future – pessimism
Inability to think and concentrate or make decisions
Worthlessness, shame and guilt

Question 18

Cognitive Biases

Answer 18

Bias in thinking and information processing

Negative schema (beliefs that lean toward viewing world and self in a negative way)
Effects selection, encoding, categorisation and evaluation of events
Vicious circle
Stable, originating in early childhood, especially concerning loss
Event in later life “reactivates” negative schema

Negative Triad – self, future, the world. Self-fulfilling prophecy

Question 19

Evidence for Beck

Answer 19

Stroop task is just one example of the suggested cognitive bias
In adapted tasks the names of colours are replaced with positive, negative and neutral words (e.g. “Success”, “Failed” and “Wood”)
Subjects with depression take longer to name the colour of negative words indicating interference

Dichotic listening procedure (Ingram et al, 1994) – depressed individuals show difficulty ignoring negative words

Memory tasks – negative words, negative info about themselves

Interpretational bias – depression associated with critical self-judgement

Question 20

Learned Helplessness and Attribution Theories

Answer 20

Seligman (1974) – Research with dogs
Given unavoidable electric shocks
Trained to avoid shocks
History of shocks = couldn’t learn avoidance behaviour

In humans shock replaced with major life trauma
Led to the development of Attribution Theories of Learned Helplessness and Depression

Global-Stable attributional style vulnerability marker for depression

Question 21

Anxious Cognition

Answer 21

Features involve physical feelings and attributing those feelings to events/objects/situation in a disproportionate way

Why these might occur might not be obvious, with no object of the fear/anxiety necessarily present

Behaviour as a consequence can feed the disorder, for example…
By avoiding social situations
By avoiding the object of phobias

Worry is prominent in the diagnostic criteria

Question 22

Phobias

Answer 22

Specific type of anxiety…

Extreme, irrational fear of a specific object or situation (Gross)

Typically, the irrationality is acknowledged

Avoidance plays a key role in maintaining the phobia
E.g. If you don’t go in the shed you won’t see a spider

From a behavioural perspective this avoidance is reinforcing, but the actions still need to be explained

So cognition, or how/what the sufferer thinks about the object or situation is also important

Attempts to hide phobia can cause other detrimental effects
Shame, guilt etc.

Question 23

Agoraphobia

Answer 23

Commonly defined as fear of open spaces.

Most common phobia (60% of all patients with phobias)

Most commonly found in women

But primary fear = fear of leaving the security of the home

Secondary fear = fear of open spaces

Patient tends to be more aware of the secondary fear than the primary one, hence the definition, which also highlights the important of how we think and explain what we are feeling.

Question 24

Specific Phobias

Answer 24

The behavioural element means that pretty much anything can become a phobia

Usually follows from an unpleasant event with the object at any point on the life span but commonly in childhood

Though some phobias are argued to be hard-wired as an evolutionary development

Preparedness – the genetic preparation to fear something that may have been a threat in our evolutionary past

Question 25

PTSD

Answer 25

Began as “shell shock” in soldiers who fought in WWI

Then “Combat Fatigues” pre-1980

Before “Post Traumatic Stress Disorder” in DSM-III (1980)

Origins in the experiences of war

But other types of traumas can be the trigger

Anxiety disorder in response to extreme physical or psychological trauma outside of normal human experience

Question 26

Aspects of PTSD

Answer 26

Presence of one (or more) intrusion symptoms
Memories, dreams, flashbacks, prolonged distress & physical reactions

Memory seems to be the key

How these are reacted to make up the rest of the diagnosis

Cause almost exclusively environmental

Classical conditioning at work (the response to the original event or stimuli)

But not everyone will develop PTSD so other factors thought to be at work, such as individual differences in personal history

Diagnosis can only occur in light of a specific traumatic event, but increasing evidence to show it may not be necessary (e.g. emotional upheavals such as divorce)

Question 27

Cognitive Aspects of PTSD

Answer 27

Dual representation theory (Brewin et al, 1996):

Symptoms thought to result from a dissociation between autobiographical memory (provide context) and “snapshots” of the event itself

Verbally accessible memory system (VAM) – consciously processes

Situationally accessible memory system (SAM) – unconsciously processed

VAM thought to be impaired, therefore fear in the memory is focused on, impacting on information processing

Without the anchor of the autobiographical memory the “snapshot” are likely to return as involuntary flashbacks

Question 28

Dual Representation Outcomes

Answer 28

Dual representation theory (Brewin et al, 1996):
Completion/Integration
Recovery through habituation
Reintegration of memories and schemas

Chronic Emotional Processing
Severe and ongoing trauma, lack of support or inability to integrate
Integration not successful

Premature Inhibition of Processing
Inhibition of emotional processing of traumatic memory
Avoidance is key