Psychological approaches Flashcards
What is the definition of a mental disorder in the DSM-5?
Clinically-significant disturbances in cognition, emotional regulation, or behaviour that indicate a dysfunction in mental functioning and are usually associated with significant distress or disability in work, relationships, or other areas of functioning.
The holistic approach led to which consideration regarding the nature of psychological distress?
Psychological distress is multifactorial
- impacts several areas of someone’s life (DSM-5)
What is Sigmund Freud’s (late 19th) theory of development and organisation of personality?
> Deterministic view of human nature, as led by:
- irrational forces
- biological drives
- unconscious motivations
- > explore the unconscious
> Humans are dominated by two basic instincts
- eros (life): sexual drive, creative life force
- thanatos (death): death, destructiveness
- > we are constantly balancing these energies
How is the theory of development and organisation of personality that guides psychoanalysis used to treat psychological distress?
> Personality is shaped through sexual stages
Constant conflict between biological drives and social expectations
> Successful navigation of internal conflicts
+ Mastery at each developmental stage
= Fully mature healthy personality
> Unsuccessful navigation or fixing at stage
-> unhelpful behaviours develop
What are the psychosexual stages of the psychoanalytic model?
> Oral (birth - 1 year)
- erogenous zone: mouth
> Anal (1 - 3 years)
- erogenous zone: bowel and bladder elimination
> Phallic (3 - 6 years)
- erogenous zone: genitalia
> Latency (6 - puberty)
- dormant sexual feelings
> Genital (puberty - death)
- sexual interests mature
What are the consequences of psychological fixation at one of the psychosexual stages of the psychoanalytical model?
> Oral
- orally agressive: chewing gum and ends of pencils, …
- orally passive: smoking, kissing, oral sexual practices
- oral stage: fixation might result in a passive, gullible, immature, manipulative personality
> Anal
- anal retentive: obsessively organised, or excessively neat
- anal expulsive: reckless, careless, defiant disorganised, coprophiliac (sexual pleasure from excrement)
> Phallic
- Oedipus complex
- Electra complex
> Latency
- sexual unfulfillment if fixation occurs in the stage
> Genital
- frigidity, impotence, unsatisfactory relationships
What are the 3 elements that constitute personality, in the psychoanalytical model?
What is the relevance of dynamic equilibrium/balance?
> Id
- driven by internal basic drives and needs
- instinctual: anger, thirst, sex
- pleasure principle
- no consideration for others (and the shared reality)
- impulsive and unaware of the implications of their actions
> Ego
- start interacting with the external world
- reality principle
- goal: achieve the id’s wishes in the most realistic way
- in a healthy person, the ego is the strongest of the 3
- satisfies the need of the id
- doesn’t upset the superego
- understands the reality of every situation
> Superego
- develops by the age of 5
- moral part of us
- dictate right and wrong
-> These forces should be in a state of dynamic equilibrium
Lack of balance will cause conflict
- if Id is out of control -> impulsive
Conflict causes psychological difficulty
- if superego is too strong -> overcritical/rigid and may develop depression
Where do the id, ego and superego stand in the conscious and unconscious mind, in the psychoanalytical model?
> Ego - conscious mind / level
- small part of us
> Id and superego - unconscious mind / level
- most of what drives us dwells in the subconscious
- most of what we are and know is buried and inaccessible
- majority of our inner experiences, emotions, beliefs, feelings and impulses -> not available on a conscious level
> Preconscious level
- not regularly accessible but can be retrieved
What is the object-relations theory?
> Derived from psychoanalytic theory > Emphasis on: - interpersonal relationships - family - mother and child
> Roots in psychoanalytical principles, however:
- less emphasis on biological drives
- emphasised the significance of the mother
What is Melanie Klein’s object-relations theory?
> “Mother” of Object-relations theory
Interested in the early causes of psychosis
- first six-months are crucial to the development of the ego
> Paranoid-schizoid position
- baby is only able to relate to the mother and external world in part objects
- baby projects loving and hating feelings onto separate parts of the mother
- maternal object is divided into Bad (hated) breast: mother considered frustrating, persecutory
vs. Good (loved) breast: gratifying, loving - Splitting (clivage): good stays separate from bad
- projection allows to eject the bad, and introject the good enough experience -> basis for integration
The mother’s continued survival of the child’s attacks allows the infant to eventually progress to the depressive position
> Depressive position (what we should aspire to)
- infant can relate to objects as whole objects
- good and bad (love and hate) exist together
- Ambivalence: good and bad can coexist
- infant is aware of his destructive impulses -> fear of losing the good object -> perceives guilt -> inhibiting destructive impulses + attempts of reparation
What is Donald Winnicott’s (late 19th - 20th) object-relation theory?
What is the mother’s ‘flight insanity’?
What is the ‘good-enough mother’?
What are the steps towards the child’s and the caregiver’s individuality, and through what does that happen?
> Emphasis on the infant’s vulnerability
Caregiver needs to provide a good holding environment
> the ‘good-enough mother’
- develops heightened state of sensitivity during pregnancy
- when this passes, the mother has a ‘flight insanity’: awareness of the world outside her state of primary maternal preoccupation
- continues to provide a safe and consistent holding environment
- meets her baby’s needs on physical and emotional level
> Through play and use of transitional object
- initially the carer supports the illusion of symbiosis
- gradually and carefully allow disillusionment (including of infant’s feeling of omnipotence) by failing to adapt to the baby’s needs
- allow the child to realise their own and the caregiver’s individuality
- > with the good-enough mother, the baby develops the continuous sense of individual existence = “self”
In Donald Winnicott’s object-relation theory, when do psychological difficulties develop?
What is he criticised for?
> Psychological difficulties develop when:
- environment is not holding
- mother fails to meet the needs of the baby - failing to provide a reasonably-attuned care
- fails to protect the baby from experiencing overwhelming distress
> Winnicott sometimes criticised for putting mothers on the ‘naughty step’
- suggesting that when the environment is not holding, when the mother isn’t “good enough” -> child develops a false sense of self -> can give rise to emotional distress
What is John Bowlby’s (20th century) attachment theory?
What is the “internal working model” and how is it developed?
> Relationship with the caregiver is crucial in development of a healthy individual
Work most likely shaped by his early life:
- raised by a nanny that left when he was 4
- he speaks of grieving her as a mother figure
Working experiences prior to his psychiatry training:
- encounter with two boys
- one extremely anxious, his “shadow” (would follow him everywhere
- the other quite affectionless and prone to stealing
-> Bowlby realised common thread: lack of a reliable mother figure
> Subsequent work focused on children separated from their primary caregiver
-> “In order to grow up healthy, the child should experience a warm, intimate and continuous relationship with its mother
> Attachment
- we have an innate primary drive to “seek proximity to, and contact with, a specific figure and to do so in certain situations, notably when frightened, tired or ill”
- quality and nature of this bond is crucial for social, cognitive and emotional development
- child’s attachment experiences with primary caregiver -> development of an internal working model: cognitive framework/prototype for future relationships
What is Bowlby’s internal working model?
What are the attachment style predictions for each initial experience?
According to this model, where do the causes of psychological distress come from?
How a child is cared for in their early life will become a prototype for:
- future expectations
- how they will relate to others
- how others relate to them
Primary Caregiver’s Behavior towards child
-> child’s “working model” of itself
- Positive and loved initial experience
- > Secure attachment style: understanding of myself in relations to others:
- individuals are available
- might be caring
- I am a loveable and likeable person - Unloved and rejected initial experience
- > Avoidant attachment style
- sense that others are rejecting, not emotionally available - Inconsistent initial experience
- > Ambivalent attachement style
- insecure with ambivalence and resistance
=> Causes of psychological distress lie in the early life experience with the primary caregiver
What does the behavioural model proposes?
What are classical and operant conditioning?
> Psychology = science of behavior
Principles of learning theory to explain human behaviour
- humans learn through conditioning -> equal at birth
- environmental factors determine our behaviour
> Dysfunctional behaviours (phobia/depression) are learned
> Classical conditioning (Pavlov)
- a naturally-occurring stimulus is placed with a neutral stimulus allowing the neutral stimulus to, in time, evoke a natural reflex
Operant conditioning (Skinner)
- learner makes a connection with the consequences associated with his/her behaviour through positive and negative reinforcement and punishment
e.g. Little Albert conditioned to become fearful of neutral stimuli (learned fear of white rats through very loud noise upon presentation)
> Abnormal behaviour develops from faulty learning
- > as it is learned, it can be unlearned
e. g. depression: - environmental stressors cause a person to receive a lower rate of positive reinforcement -> lower-response contingent to positive behaviour elicits depressive behaviours
Why is behaviourism considered by some as a reductionist approach?
No reference to internal psychological processes
- it’s about what can be seen and measured
What does the cognitive model propose?
What is the cause of mental and psychological distress, according to this model and cognitive therapists?
> Behaviours matter but more importantly it’s the cognitive processes the individual goes through to evaluate an event
Cognitive model / therapists:
- cause of mental and psychological distress is a process by which individuals engage in cognitive distortions or cognitive biases
What is the CBT “Hot Cross Bun”?
> Within the environment, there is a cycle of
- thoughts
- emotions
- physical sensations
- behaviour
> Each aspect of the cycle has an impact on the others
All are interconnected in a “vicious cycle”
> 4 therapeutic interventions aiming to reduce or change at least one of them
What does the ‘ABC’ refer to in the cognitive model?
When do cognitive distortions / biases become problematic?
What are the common cognitive distortions and their associated consequence?
- Activating event
- Belief
- negative thoughts
- cognitive biases - Consequences
- emotionally drained
- negative thoughts of self, others and the world
- isolate themselves
- interpersonal struggles
> Cognitive distortions (biases) become problematic when they:
- are the default position
- inflexible
> Common cognitive distortions
- mental filter -> focus exclusively on the negative
- mind-reading -> belief of knowing what another person is thinking
- catastrophising -> infer catastrophe from a mildly negative or neutral situation
- black and white thinking -> thinking in extremes (good or bad ; right or wrong)
What is the emphasis on in Second wave CBT?
Emphasis on the content of the distortion / cognitive bias
-> in CBT, the distortion is directly challenged
What are the CBT layers of cognition?
What are core and intermediate beliefs?
What is the relation between the depth of the distorted level and the psychological distress?
- Early learning experience
- (e.g. parental criticism and rejection) - Life events
- (e.g. end of a romantic relationship) - Core beliefs
- (e.g. “I’m unlovable”) - Intermediate beliefs
- (e.g. “If I am perfect, than I will be loved”) - Negative automatic thoughts
- situation-specific
- more accessible to awareness - daily thoughts
- (e.g. “I’ll never be good enough for him”) - Depression
- (e.g. low mood, social withdrawal)
> Core and intermediate beliefs are general beliefs about ourselves
- much deeper and less available to conscious awareness
=> Distortion happens at all levels
=> The deeper the level, the more deeply-rooted the cognition -> the more entrenched the psychological distress
What does the Third wave CBT consist of?
What are the five Third wave psychotherapy treatments?
> Emphasis on new forms of behaviorism
Third wave psychotherapy treatments:
1. Acceptance and commitment therapy (ACT)
2. Behavioural activation
3. Dialectical behavioural therapy (DBT)
4. Mindfulness-based cognitive therapy (MBCT)
5. Schema therapy
-> Different approaches to the aetiology of mental illness and to how they would go about treating them
What is the Dialectical Behavioural Therapy (DBT)?
Who created it?
> A cognitive behavioural approach that emphasises the social aspect of treatment > A package treatment: - team based interventions - group work - one-to-one therapy
> Created by Dr. Masha Linehan
- to address perverse and longstanding interpersonal difficulties under the umbrella term of borderline personality disorder (BPD)
- she suffered a mental illness ; at 17 she was committed to a psychiatric institution
What is the Dialectical Behavioural Therapy (DBT) approach to mental distress?
> Primary dialectical between
- acceptance: accept clients as they are
and
- change: acknowledge that the client needs to change in order to reach his/her goal
Diathesis-stress model:
> Biological predisposition (diathesis) -> Emotional dysregulation in the child -> Great demands on the family -> Invalidation by parents through punishing or ignoring the demands -> Emotional outbursts by child to which parents attend -> Emotional dysregulation…
=> Psychological disorder is the result of a disorder-specific predisposition which lies dormant until activated by environment stressors
In dialectical behavioural therapy (DBT), what is the biosocial theory of the borderline personality disorder (BPD)?
Emotional vulnerability
- automatic nervous system reacts severely to low levels of stress
- AND takes longer than normal to return to baseline
+
Invalidating Environment
- child’s experiences are not validated by the significant others around them (e.g. punished or ignored)
= Borderline Personality Disorder - Chronic Emotion Dysregulation
- never learns to accurately label and understand one’s feelings, nor will the person learn to trust her own responses to events
- she will go from emotionally inhibited to gain acceptance, to extreme displays of emotions to have her feelings acknowledged
- > burden on the family -> this pattern of behaviour might be inadvertently reinforced by the environment (parents more likely to respond to such presentation)
- creates confusion both internally and externally
What is schema therapy?
Who created it and what does he/she proposes?
> Created by Jeffrey Young
a combination of cognitive therapy, behavioural therapy, object relations, combined into one unified systematic approach to treatment
> 5 core emotional needs
- secure attachement
- autonomy, competence, identity
- freedom of expression
- spontaneity and play
- limits and self-control
> Strive for
- connection
- understanding
- growth
J. Young, a schema is “a broad pervasive theme regarding oneself, and one’s relationship with others. It’s developed throughout childhood, and is celebrated throughout one’s lifetime. It is dysfunctional to a certain degree”
How many maladaptive schemas does Jeffrey Young proposes and what characterises them?
What are their domains?
> Up to 18 maladaptative schemas
- deeply entrenched and familiar
- people often engage in distorted cognitive processes in an attempt to cope
> 5 domains:
- Disconnection and Rejection
- abusive, traumatic childhood
- unstable family life
- rejection and humiliation
- feel different and lacking in some way
- long periods of insecurity and inconsistent parenting - Impaired Autonomy and Performance
- often over-protected and controlled as children,
- neglected or ignored
- continually undermined and made to feel incompetent
- encouraged to be dependent on others - Impaired Limits
- internal sense of control not developed
- difficulty respecting the rights of others
- families very unboundaried
- children did not have rules - Other-directedness
- experienced conditional love
- family overly concerned with appearances
- parents focused on their own needs - Over-vigilance and Inhibition
- strict parental control to gain compliance
- ever watchful - waiting for bad things to happen
- frightened of severe punishment for expressions of feelings
What is Acceptance and commitment therapy (ACT)?
What are it’s conceptions?
> Created by Hayes and Wilson
- Empirically based intervention which aims to increase psychological flexibility using a mindfulness-based approach with behaviour change strategies
> Psychological processes are often destructive (…similar to psychoanalytical ideas)
Reality of life involves:
- pain, death, lost relationships, crisis and failure
- we all face the fact that as human beings we grow old, get sick and die
- evolution shaped our minds so that we are destined to suffer psychologically (compare, evaluate and criticise ourselves)
> Modern society says ‘we should be happy’
-> we lead our lives by many unhelpful and inaccurate beliefs
