Lecture 10 - theoretical frameworks and new directions

Question 1

what is the importance of theoretical frameworks in psychopathology

Answer 1

provides further insight into mechanisms and processes that contribute to the emotional disorders
provides directions for future research

Question 2

explain Beck’s model and the issue with it

Answer 2

Beck’s schema theory (also bower’s network model)

proposed mechanism of action but did not differentiate between depression and anxiety

Question 3

cognitive schemata

Answer 3

relatively enduring characteristics of a person’s cognitive organization of representations of previous experience
importance for encoding and classifying stimuli, reasoning and retrieval
part of beck

Question 4

dysfunctional schemata

Answer 4

this is what results in psychopathology according to Beck

content of the schemata varies by disorder but mechanism of action does not

Question 5

how evidence did not support beck’s framework

Answer 5

depressoina nd anxiety result in different profile of biases for attention and memory

Question 6

why did william et al 1988 develop their model and what is it called

Answer 6

integrative model

developed to explain why there should be a different pattern of results in anxiety vs depression

Question 7

integrative model principles

Answer 7

key processing components - priming vs elaboration
main source of bias in anxiety is initial automatic priming towards detection of threat related material and subsequent elaborative processing away from processing of threat
in contrat in depression main biases result from resource demnading elaborative processing

Question 8

some problems with integrative model

Answer 8

attention - evidence depression can result in attentional biases not consistent with integrative model
memory - anxiety patients can exhibit explicit memory biases - not consistent with integrative model

Question 9

name an example of multi-level models ad why we need them

Answer 9

interacting cognitive subsystems

experimental findings seem best able to fit into modesl that posit different representational levels or sub-systems

Question 10

common features of multi-level models

Answer 10

sub-systems or levels representing higher-order meaning and ones which reflect basic propositional and analogical properties of the information space
models differ in way that this is accomplished

Question 11

explain the interacting cognitive subsytstems (teasdale and barnard 1993)

Answer 11

3 sensory-proprioceptive subsystems
2 intermediate structural subsystems
2 meaning subsystems
2 affecter subsystems

Question 12

explain the propositional subsystem

Answer 12

propositions (factual statements) that are the lowest level semantic units in the system. facts are wither true or false

Question 13

explain the implicational subsystem

Answer 13

schematic models that are comprised of information from multiple subsystems - visual, body state and propositional

Question 14

combination of proposition and implicational subsystems produce…

Answer 14

emotion

Question 15

interpretation of process from clinical example

Answer 15

propositional belief that i am a failure at work is rejected
implicational belief that i am always wrong and can not figure things out for self is confirmed and therefore more depression results

Question 16

a limitation of interacting cognitive subsystems

Answer 16

distinction between propositions and implications is not always clear
more empirical evidence needed although some evidence exists (eg teasdale, taylor, cooper, hayhurt and pykel 1995)
teasdale et al 1995 found that depressed patients completed sentence stems with positive words or phrases that mapped onto high level schematic models rather than offering simple negative sentence completions

Question 17

key difference between single and multi-level theories

Answer 17

cognitive therapy - can challenge beliefs and negative thoughts at a propositional level
client rejects negative propositions but validates higher level model resulting in more depression
difference between intellectual beliefs and emotional beliefs (implicational level)

Question 18

ICS vs cognitive therapy

Answer 18

beck’s model - emotional consequence of thought (negative thought-depression)
in ICS, negative automatic thoughts consequence rather than cause of a depressive schematic model but negative thoughts can lock the system into a depression-maintaining vortex

Question 19

CARFAX model

Answer 19

model to explain mechanisms underlying OGM
functional avoidance
capture of retrieval by abstract ruminative structure
reduced executive resources

Question 20

explain functional avoidance of the CARFAX model

Answer 20

basic premise - the retrieval of general descriptions may produce less affect than the recollection of specific episodic memories
evidence - hermans et al 2005, found that individuals who retrieved memories in a less specific way also displayed a more avoidant style with respect to thoughts and feelings in general
problem - see overgeneral memory recall to positive and negative cues

Question 21

explain rumination as part of the CARFAX model

Answer 21

predominance of conceptual self-relevant infor in early stages of memory search may lead to difficulties in accessing specific memories
can view these self-representations as negative schemata
when emotional cue words used on the AMT, more likely to activate conceptual abstract info in individuals where this info is already highly accessible
therefore AMT words capture people, particulrly for those who ruminate
evidence - manipulations of rumination result in more OGM retrieval (Watknis and teasdale, 2001)

Question 22

explanation of reduced executive resources in the CARFAX model

Answer 22

generative retrieval requires use of limited executive resources
ability to retrieve specific memories in anrrative is associated with development of supervisory control functions (Fivush and Nelson, 2004)
evidence against executive account - williams and broadbent 1986 found OGM not associated with semantic fluency performance

Question 23

evidence for inhibition and OGM retrieval

Answer 23

Dalgleish et al 2007 - the key problem in retrieval of specific autobio memories is the failure to inhibit irrelevant infor leading to capture errors
demonstrated that OGM retrieval of autobio memories was correlated with errors on tasks where irrelevant material needed to be inhibited such as the emotional stroop but no tasks requiring general levels of executive resource like explicit memory tests

Question 24

vulnerability and depression - biological and cognitive factors

Answer 24

booji et al 2007 investigayed the relaptionshpi between acute tryptophan depletion (ATD) and cognitive reactivity (CR)
most models of emotionl disorders are stress-diathesis models
pre-existing vulnerability interacts with stress to produce disorder
need to look at relationship between cognitive and biological markers of vulnerability

Question 25

biological markers of depression

Answer 25

response to pharmacological challenges such as the dexamethasone/corticotropin releasing hormone (DEX-CRH) test
response to ATD (moreno et al 2000)

Question 26

psychological markers of depression

Answer 26

cognitive reactivity (segal et al 1999)
rumination (Kuehner and weber 1999)
information-processing indicies (elliot, 1998)

Question 27

actute tryptophan depletion explained

Answer 27

temporarily lowers serotonin (5-HT)
studies using this method have shown
- impaired memory consolidation (Riedel et al 1999)
- impaired emotional processing in healthy (Tunbridge et al 2003) and remitted depressed individuals (Booji et al 2005)

Question 28

serotonin (5-HT)

studies which aim to increase serotonin have shown…

Answer 28

it can facilitate the recall of positive information while impairing the detction of facial expressions of anger and fear in healthy volunteers (Harmer et al 2004)

Question 29

procedure to induce acute tryptophan depletion

Answer 29

aims to reuce Trp, a precursor to 5-HT
day 1: low Trp diet
ingestion of a mixture of all essential amino acids except Trp
results - Trp levels are reduced by 75-90%, 5-7 hours after administration and consequently 5-HT is impaired

Question 30

research from ATD studies

Answer 30

a high-dose of ATD deteriorates symptoms in around 50% of remitted depressed patients (Van Der Does, 2001)
responses to ATD may predict a recurrence of depression within 1 year (moreno et al 2000)

Question 31

cognitive reactivity

Answer 31

relates to dysfunctional schemas
it is argued that dysfunctional schemas do not dissapear during remission but become inactive
may be reactivated when a sad mood deepens
represents a feedback loop (Beck, 1967)

Question 32

how to induce cognitive reactivity

Answer 32

activate dysfucntional schemas
take dysfucntional attitude scale (DAS) at baseline
sad mood induction
DAS post induction
remitted depressed patients display higher DAS change score

Question 33

what is compassion

Answer 33

neff (2003) “ being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating their desire to alleviate one’s suffering and to heal oneself with kindness
self-compassion also involves offering non-judgemental understanding to one’s pain, inadequacies and failures, so that one’s experience is seen as part of the larger human experience

Question 34

explain the basis of MBCT

Answer 34

trains people to become more aware of body sensations, thoughts and feelings associated with depressoin
trains people to focus on here and now instead of those feelings, sensations and thoughts
acknowledge feelings but let them go

Question 35

why is an alternative to anti-depressents (paritcularly maintenance ones) important

Answer 35

adverse reactions to medications
preference not to take medications
non-adherence to taking medications
not building skills for developing resilience

Question 36

exposure therapy for phobias and anxiety disorders

Answer 36

derived from learning theory
involves designed experiences with feared stimuli
individual who has a fear of contaminated faucets guided to touch faucets without engaging in compulsive cleaning rituals

Question 37

what is being learnt in exposure therpy

Answer 37

the feared stimulus is not as harmful as expected
by repeatedly encouraging touching of feared stimulus (faucet) without safety behaviours and also the unconditioned stimulus

Question 38

problems with exposure therapy

Answer 38

half the people with OCD do not respond to exposure therapy (Homles et al 2014)
extinction learning not robust - eg may fail to generalize to new context
fear extinction - may involve inhibitory pathways from ventromedial prefrontal cortex to the amygdala
insights for treating this group may come from neuroscience and bio
using D-cycloserine (originally and anti-biotic) to enhance response to exposure therapy