Psychotherapy
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Working with Emotion in Cognitive Behavioral Therapy
Chapter 8
Imagery Rescripting for Personality Disorders: Healing early maladaptive schemas
Patients with personality disorders (PDs) might be quite resistant to the kind of rational approach that is so prominent in most CBT.
This can be understood from schema theory. People form knowledge structures about the world that govern information processing, including the regulation of attention, information selection, and giving meaning to information.
A schema is not necessarily (fully) open to conscious inspection and its content is not necessarily restricted to verbal information.
Very early (preverbal) experiences are thought to play a role in personality development. Early attachment experiences contribute strongly to the development of schemas.
PDs are generally thought to develop as the result of an interplay between constitutional and environmental factors.
Two reasons to use imagery rescripting (ImRs) in the treatment of PDs
Imagery evokes more emotions than just talking about issues. The experimental manipulation of interpretations is strongly enhanced by having participants imagine the situation.
In many respects, the brain does not differentiate between real and imagined experiences.
Imagined experiences have highly similar brain responses to real experiences, and imagining skills is the second best option after real practice.
Imagined stimuli can act as conditioned and unconditioned stimuli, similar to real stimuli.
The basic idea of ImRs in the treatment of PDs is to activate memories of childhood events that contributed to the formation of dysfunctional schemas, re-experience the event, and imagine a different ending that better matches the needs of the child.
Through this process a change of the meaning of the original event is created, which leads to a change in the schema.
Reprocessing of experiences from childhood is the central aim.
Several aspects of ImRs are probably important in explaining why it is such a powerful technique
ImRs has not been tested extensively as an isolated technique for PDs.
But, combined it shows promising results.
Imagery of a safe place
Imagery of a safe place is an option, not a necessity.
For patients who easily experience high anxiety, it is a helpful method to help them find safety.
One can start introducing imagery work by teaching the patient to imagine a safe place, so that the patient gets used to imagery.
With a powerful image of a safe place, patients can return to that safe place at any time if the other imagery exercises evoke too high levels of negative emotions.
In cases that the patient cannot find a safe place because the world is to dangerous, it is essential that the therapist develops a strong, safe therapeutic relationship, so that safety is brought in by the therapist.
Diagnostic imagery and imagery rescripting of memories from childhood
It is not clear yet what the best approach is to introduce ImRs in the treatment of PDs.
In ImRs, an image of a childhood memory is ‘rescripted’ by having an adult person enter the scene and intervene, thus changing the script.
In the early stages of treatment of patients with PD, it is advised that the therapist enters the image and rescripts.
The following approach is suggested
General guidelines for ImRs for treating the childhood roots of PD problems
Later treatment phases: patient rescripts
Later in treatment, the therapist invites the patient to enter the scene as an adult to rescript.
First, the patient experiences the adverse event from the child’s perspective. When the moment for an intervention has come, the therapist asks the patient to step into the scene as an adult.
The therapist initially assists the patient.
After the maltreatment has stopped, the therapist asks the patient to look at the child and take care of it.
The cycle is repeated until the patient (as an adult) feels satisfied.
An important next step is to let the patient experience the whole intervention by the adult and the therapist again, but form the perspective of the child.
From the child perspective new needs may come up, and the therapist asks the patient to ask her adult self to fulfil them.
Frequency of application of ImRs
ImRs should be used repeatedly in its application to PDs.
Usually there are many childhood experiences that are related to the patients’ problems that should be addressed.
Imagery rescripting of present and future situations
ImRs can also be used to address current and anticipated problems.
This is usually in the alter phases of therapy.
ImRs can help to bring about behaviour change.
Difficulties with the application of ImRs
ImRs can be easily integrated in regular CBT, and it is a good idea to add it to the more verbal and rational CT work and to use it before the focus of treatment is on behavioural change.
Specific indications for using ImRs in the context of CBT treatment
- It is useful when patients have trouble emotionally integrating new beliefs
- There might be traumas or other adversities that the patient wants to process or that the therapist feels that processing would be helpful.
ImRs offers an excellent processing method.
- ImRs of childhood memories is most indicated in the earlier and mid-treatment phases, as the later phases of treatment should focus more on the present and future, and necessary behavioural change
There is no specific indication when ImRs work can be considered completed, although a good sign is when patients are capable of taking the lead as an adult in the rescripting and report that ImRs improves their functioning.
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M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of psychotherapy and behavior change 6th edition
Chapter 2
Methodology, design, and evaluation in psychotherapy research
Therapy researchers should make consistent use of designs in which patient, therapists, and type of treatment are independent variables and dependent variables are examined over time.
The scientists practitioner
Treatment outcome research methods within psychology developed largely from the fundamental commitment of clinical psychologists to a scientist-practitioner model for training and professional practice.
Arguably, the scientist-practitioner model provides the framework (the adaption and refinement of the methods and guidelines of science) for continuously improving the clinical services offered to clients across the globe.
Empirical evaluation of the efficacy and effectiveness of therapy is typically considered necessary before widespread utilization can be sanctioned.
The role is intended to foster service provides who evaluate their interventions scientifically and researchers who study applied questions and interpret their findings with an understanding of the richness and complexity of human experience.
For treatment outcome studies to be meaningful, they must reflect both a fit within the guidelines of science and an understanding of the subtleties of human experience and behaviour change.
The field has developed a set of criteria to be used when reviewing the cumulative literature on the outcomes of therapy.
These criteria help determine whether or not a treatment can be considered ‘empirically supported’.
Empirically supported treatments: treatments found to be efficacious when evaluated in randomized clinical trials (RCTs) with specified populations of patients.
The operational definition of empirically supported treatments focuses on the accumulated date on the efficacy of a psychological therapy.
These demonstrations of treatment efficacy often involve an RCT in which an intervention is applied to cases that meet criteria for a specific disorder and analysed against a comparison condition to determine the degree or relative degree of beneficial change associated with treatments.
The accumulated evidence comes from multiple studies whose aims were to examine the presence or absence of a treatment effect.
By accumulating evaluated outcomes, one can summarize the research and suggest that the beneficial effects of a given treatment have been supported empirically.
Even if a treatment has been supported empirically, the transport of the treatment from one setting (research clinic) to another (service clinic) represents a separate and important issue.
A researcher who addresses this issue considers the effectiveness of treatment.
This has to do with the
M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of psychotherapy and behavior change
By Lambert, M.J. (2013).
Chapter 6
The efficacy and effectiveness of psychotherapy.
Is psychotherapy efficacious?
Cohen’s d is the standardized difference between the mans of groups.
The aim of d and related statistics is to describe the magnitude of treatment response.
An effect size of 0 indicates the complete lack of differences.
An effect size of 1.0 indicates that one group, on average, is one standard deviation superior to the other group.
Meta-analysis is essentially a statistical means to test hypotheses by synthesizing the results of a set of studies addressing the same research question.
In meta-analysis an effect is calculated for each study and then aggregated. The aggregate is then tested against zero.
If an aggregate effect for treatment versus no-treatment is significantly greater than zero, it can be concluded that the treatment is more effective than no treatment.
Meta-analysis can also be used to determine whether there are moderators of the effects obtained from the various studies.
Meta-analysis can be used to identify and test moderating variables.
Broad meta-analysis of therapy efficacy
The evidence from meta-analysis indicates that the psychological, educational, and behavioural treatments studies by meta-analysis generally have positive effects.
The use of meta-analysis to summarize efficacy literature is critical for the field.
Meta-analysis are just as prone to poor methods and misinterpretations as other methods of research.
There are three main threats to their validity
Meta-analysis focused on particular disorders
Mood disorders
Numerous meta-analytic reviews suggest that patients undergoing many diverse kinds of psychotherapy for depression surpass no-treatment and wait-list control patients.
Results in treating depression have shown that most psychological treatments that have been studied produce substantial effects, in terms of symptom reduction, and increased well-being.
Psychological treatments are effective in specific populations, including adults, older adults, women with postpartum depression, and patients with both depression and general
DSM-5 Handbook of differential diagnosis
Chapter 1
Differential diagnosis step by step
If the patient is not being honest regarding the nature or severity of his or her symptoms, all bets are off regarding the clinician’s ability of arrive at an accurate psychiatric diagnosis.
Most psychiatric work depends on a good-faith collaborative effort between the clinician and the patient to uncover the nature and cause of the presenting symptoms.
Two conditions in DSM-5 are characterized by feigning
These two are differentiated based on the motivation for the deception.
The clinician’s index of suspicion should be raised when
It is useful for clinicians to become mindful of tendencies they might have toward being either excessively sceptical or excessively gullible.
Whether the presenting symptoms arise from a substance that is exerting a direct effect on the central nervous system.
Virtually any presentation encountered in a mental health setting can be caused by substance use.
The determination of whether psychopathology is due to substance use often can be difficult because although substance use is fairly ubiquitous and a wide variety of different symptoms can be caused by substances, the fact that substance use and psychopathology occur together does not necessarily imply a cause-and-effect relationship between them.
The first task is to determine whether the person has been using a
.....read moreInleiding in de gedragstherapie
Hermans, D., Raes, F., & Orlemans, H. (2018)
Fragmenten
Patiënten melden zich aan met klachten die een gedrachtstherapeut zo snel mogelijk wil concretiseren.
Een analyse op maat van de individuele patiënt maakt dat gedrag dat op het eerste gezicht bizar of gek lijkt inzichtelijk en betekenisvol wordt.
De analyse beidt vervolgens aanknopingspunten voor interventies ‘op maat van die analyse ‘op maat van’ de patiënt.
Gedragstherapeuten passen de experimentele methode en principes uit de experimentele psychologie toe op de klinische praktijk.
Twee soorten wetenschappen
Situering van de psychologie
Omdat de psychologie het menselijk handelen zelf onderzoekt heeft zij zowel een natuurwetenschappelijke als een geesteswetenschappelijke kant.
Psychologie is een gedragswetenschap.
Gedrag heeft wetmatige, mechanische aspecten maar laat zich ook begrijpen.
Gedragstherapie is sterk verbonden met de experimentele psychologie.
De opkomst van de experimentele psychologie
Wilhelm Wundt stichtte in 1879 het eerste psychologisch laboratorium.
Hierdoor kreeg de psychologie de status van een wetenschappelijke onderneming.
Dit kan binnen de mens en aan de buitenkant worden onderzocht.
Dat leidde tot het behaviourisme.
Skinner beschouwt het als zijn voornaamste taak om meer inzicht te krijgen in de wijze waarop de frequentie van een behandeling wordt beïnvloed door omgevingsvariabelen.
Gedragstherapie is ontstaan binnen het neobehaviorisme en het radicaal behaviorisme.
Het ontstond eind jaren vijftig in de vorige eeuw op meerdere manieren tegelijk.
_ Het groeide vanuit een algemene ontevredenheid met de psychoanalyse die een wetenschappelijke basis miste.
- Binnen de wetenschappelijke psychologie werd er steeds minder waarde gehecht aan introspectie als een betrouwbare wijze van kennis vergaren
- De voedingsbodem in de experimentele psychologie, en met name in de klassieke en operante conditionering
Cliëntgerichte psychotherapie: update van een veelzijdige experiëntiële benadering
Mia Leijssen (2015)
Tijdschrift Klinische Psychologie, 45
De term cliëntgericht weerspiegeld de bekommernis om in de complexiteit van het therapeutische proces steeds de cliënt als persoon centraal te stellen.
Cliëntgerichte psychotherapeuten integreren de interventiemogelijkheden naargelang de problematiek en de fase van het therapeutische proces.
in de humanistische benadering worden termen zoals psychotherapie, counseling, coaching, psychologische bergeleiding, eerstelijnszorg niet strak afgebakend.
In de praktijk gelden dezelfde werkzame processen en het is aan de hulpverlener om een gepaste afstemming te vinden in het hier en nu.
Het leidmotief is steeds: hoe kan iets terug in beweging komen? Wat is er nodig om herstel en gezonde ontwikkeling mogelijk te maken?
De basisvaardigheden uit de cliëntgerichte psychotherapie zijn
Cliëntgerichte psychotherapeuten behalen goede behandelresultaten bij mensen met uiteenlopende diagnoses.
De fenomenologische visie primeert op de diagnostische kennis van de expert die naar stoornissen speurt.
Theorieën worden in het achterhoofd gehouden terwijl cliënten vanuit een open houding worden ontmoet.
Kennis en ervaring dienen om opmerkzamer te zijn voor problemen die zich voordoen in de interactie en leveren inspiratie voor de best mogelijke behandeling.
Psychodiagnoses beschrijven niet hoe iemand is, maar besteden aandacht aan gedrag dat zich in specifieke situaties voordoet.
De therapeut let op problematische levings- en relatiewijzen.
Door empatisch in te gaan op zowel inhoud als proces maakt de therapeut begrijpelijk hoe en waarom de cliënt in bepaalde situaties moeilijkheden ondervind.
Procesdiagnoses sluiten het gebruik van kennis uit de klassieke diagnostiek niet uit.
Ziektebeelden worden gekenmerkt door specifieke belevings- en relatiewijzen waardoor de persoon in moeilijkheden komt.
Doordat procesdiagnoses de problematische belevings- en relatiewijze in het hier en nu identificeren, bieden ze aanwijzingen voor interventiemogelijkheden die een volledige behandelingscyclus kunnen omvatten.
Substromingen in de cliëntgerichte psychotherapie zijn expliciteringen en concretiseringen van helpende processen die in de cliëntgerichte basisvisie vervat zijn.
Aanvankelijk legt Rogers (1957) de nadruk op empathisch exploreren van de beleving van de cliënt als weg naar persoonlijkheidsverandering.
De heldere aanwezigheid en de onvoorwaardelijke aanvaarding van de therapeut zijn noodzakelijke condities voor de cliënt om achter zijn façade te kijken en zich te bewegen in zijn leefwereld.
Voor cliënten met emotionele, cognitieve, gedragsmatige en relationele instabiliteit is de therapeutische relatie
.....read moreGids voor Gesprekstherapie
Leijssen, M (1999)
Een therapeutische relatie
Het therapeutisch proces is altijd ingebed in de interpersoonlijke context van de relatie die de therapeut met de cliënt uitbouwt. De aanwezigheid van de therapeut is nooit neutraal. De therapeutische relatie is een middel om scheefgegroeide verhoudingen te herstellen en om de cliënt een interpersoonlijke ruimte aan te bieden waarin zijn wordingsproces opnieuw op gang komt. Om constructieve veranderingen bij de cliënt teweeg te brengen dient het relationele aanbod aan bepaalde kwaliteiten te voldoen.
Zijnswijzen die alles wat de therapeut zegt en doet inspireren zijn echtheid, empathie en onvoorwaardelijk respect. Een therapeutisch gesprek is voor de cliënt een nieuw ervaren, zowel in de relatie met de therapeut als in de relatie tot zichzelf. Dit is een gevolg van nieuwe omgangswijzen die de cliënt in de relatie met de therapeut ondervindt en in de relatie met zichzelf leert ontwikkelen.
Elke therapeut heeft een eigen uitstraling en persoonlijke kenmerken die het interpersoonlijk gebeuren kleuren. De cliënt voelt de moeilijk te omschrijven uitstraling van een therapeut aan en diens uitstraling bepaalt mede wat er wel of niet aan bod kan komen in therapie.
Eerlijk reflecteren op de eigen verschijningsvorm en onderzoeken in hoeverre eigen gedrag een veruitwendiging is van dieperliggende motieven, behoeften en zijnswijzen, is noodzakelijk om zichzelf als instrument te leren kennen. Alleen als de therapeut in contact is met zijn eigen onderliggende ervaringsstroom, kan hij een levendige en persoonlijke aanwezigheid bieden. Een therapeut die goed in contact is met de eigen ervaringsstroom, brengt energie in de relatie die stimulerend is voor het groepproces van de cliënt.
Echtheid in de therapiesessies is een dubbele gelaagdheid. Aan de ene kant is er bij de therapeut een onderliggende ervaringsstroom, die fungeert als de bodem waarop de reacties van de cliënt terechtkomen. Op die ondergrond is een bovenlaag die betrekking heeft op de interactie van de therapeut met een cliënt. Twee fasen in echtheid zijn 1) congruentie, de therapeut is in goed contact met zichzelf en kan zijn onderliggende ervaringsstroom doorvoelen. Hij is in staat te onderkennen wat er in hem bewogen wordt in relatie tot een cliënt. 2) Transparantie. De therapeut drukt uit wat er in hemzelf leeft. De echtheid van de therapeut is enerzijds door alles heen voelbaar (de cliënt ervaart dat de therapeut niets voorwend), maar is ook onopgemerkt aanwezig (de therapeut verwoordt meestal niet expliciet wat er in hemzelf omgaat terwijl de cliënt luistert).
Therapeuten hebben een ‘gedisciplineerde spontaniteit’. Of de therapeut meedeelt wat er in hemzelf omgaat hangt af van de mate waarin het relevant is voor de cliënt
Vormen van onechtheid
Er zijn verschillende
.....read moreImagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda
Arntz, A. (2012)
Journal of Experimental Psychopathology, 3(2), 190-208.
Imagery rescripting (ImRs) is a therapeutic technique addressing specific memories of earlier experiences associated with present problems. By imagining that the course of events is changed in a more desired direction, powerful therapeutic effects have been found.
ImRs is a technique used to change the meaning of emotional memories and images. With ImRs, the individual is instructed to image the memory or image as vividly as possible, as if it really happens in het here and now. Next, the individual must imagine that the sequence of events is changed in a direction that the person desires. When the patient is incapable of imagining a good outcome, the therapist rescripts the sequence, whilst the patient imagines this.
The use of ImRs is not restricted to intrusions (unwanted images) or memories that are associated with intrusions.
PTSD
ImRs seems to have been studied most in the context of PTSD, and the results are positive. But there seems to be a lack of studies investigating ImRs alone by comparing it to other effective treatments.
Social phobia
ImRs is an effective therapeutic technique for social phobia. But, studies didn’t test whether ImRs could be a complete treatment of social phobia.
Simple phobia
With simple phobia, ImRs is effective when applied alone and might enhance the effects of exposure in vivo.
OCD
ImRs might be an effective treatment for therapy-resistent OCD.
Depression
One pilot studies has promising results.
Bulimia Nervosa (BN)
ImRs might bring about a larger decrease in urges to restrict than control conditions. But, only immediate effects are known.
Nightmares
ImRs is helpful in combination with exposure, relaxation and rescripting therapy. ImRs is has not yet been addressed without the other components.
Personality disorders
ImRs is used in combination with other techniques. Dismantling studies are necessary to determine the degree to which ImRs contributes to the strong effects therapy seems to have.
Conclusions from treatment studies
ImRs can be successfully applied to any psychological problems and disorders. One session of ImRs is more effective than exploring and discussing the memories. ImRs also seems to bring about changes in a broader area than exposure.
From a methodological point of view the
.....read moreWorking with Emotion in Cognitive Behavioral Therapy
Chapter 9
Imagery Rescripting for Posttraumatic Stress Disorder.
Imagery resccripting (ImRs) is a powerful treatment with high acceptability that can be used for simple as well as complex PTSD.
The basic idea of ImRs in the treatment of PTSD is to activate the trauma memory and imagine a different ending that better matches the needs of the patient.
The facts of the original trauma memory are not forgotten or overwritten by rescripting.
The mechanism of ImRs seems to be a change in the meaning of the trauma memory, brought about by experiencing in fantasy what one needed in the situation and getting these lingering, unmet needs in fantasy. This is a change in meaning of the original unconditioned stimulus (the traumatic experience).
With US revaluation, new information is fed into the memory representation of the US. If this information is helpful, it will reduce the dysfunctional meaning of the trauma memory.
Independent of context, a trauma reminder will trigger the changed memory representation of the trauma and, if the meaning change was successful, this memory will no longer lead to dysfunctional responses.
The effects of treatment using this mechanism are not context-dependent.
Another possibility is that the expression of needs, feelings, and actions in ImRs, which were inhibited at the time, is a healing factor.
Empirical evidence
Studies of ImRs for PTSD show positive results, especially regarding dysfunctional interpretations and emotional problems.
Simple trauma
The therapist can start with gathering the usual information about the trauma.
Reliving symptoms might form a helpful focus for ImRs, as they are often central to the dysfunctional meaning the patient gave to the trauma and often represent signals of the feared catastrophe.
The meaning of the traumatic event for the patient should be explored, as well as emotions and action tendencies that were activated but could not be expressed.
In the next session, the therapist can either start ImRs directly, or do a cognitive preparation.
Important parts of the explanation of ImRs that therapist give to patients are:
Working with Emotion in Cognitive Behavioral Therapy
Chapter 8
Imagery Rescripting for Personality Disorders: Healing early maladaptive schemas
Patients with personality disorders (PDs) might be quite resistant to the kind of rational approach that is so prominent in most CBT.
This can be understood from schema theory. People form knowledge structures about the world that govern information processing, including the regulation of attention, information selection, and giving meaning to information.
A schema is not necessarily (fully) open to conscious inspection and its content is not necessarily restricted to verbal information.
Very early (preverbal) experiences are thought to play a role in personality development. Early attachment experiences contribute strongly to the development of schemas.
PDs are generally thought to develop as the result of an interplay between constitutional and environmental factors.
Two reasons to use imagery rescripting (ImRs) in the treatment of PDs
Imagery evokes more emotions than just talking about issues. The experimental manipulation of interpretations is strongly enhanced by having participants imagine the situation.
In many respects, the brain does not differentiate between real and imagined experiences.
Imagined experiences have highly similar brain responses to real experiences, and imagining skills is the second best option after real practice.
Imagined stimuli can act as conditioned and unconditioned stimuli, similar to real stimuli.
The basic idea of ImRs in the treatment of PDs is to activate memories of childhood events that contributed to the formation of dysfunctional schemas, re-experience the event, and imagine a different ending that better matches the needs of the child.
Through this process a change of the meaning of the original event is created, which leads to a change in the schema.
Reprocessing of experiences from childhood is the central aim.
Several aspects of ImRs are probably important in explaining why it is such a powerful technique
Leerboek Psychotherapie
Colijn, S., H. Snijders, M. Thunnissen, S. Bögels, & W. Trijsburg (red.).
Mindfulness en Psychotherapie.
In de afgelopen decennia is de traditionele mindfulnessbeoefening steeds meer aangepast om op seculiere wijze toegepast te kunnen worden in het westen.
Het gaat hier om de houding die men inneemt ten opzichte van disfunctionele gevoelens en gedachten.
Historie mindfulness
Mindfulness is doelbewust aandacht geven, op dit moment, zonder oordeel. Mindfulness is die aandachtskwaliteit die opmerkt zonder te kiezen en zonder voorkeur. Dit leidt tot een groter bewustzijn, helderheid en aanvaarding van de werkelijkheid op dit moment.
Mindfulness kunnen we ontwikkelen door inzichtsmeditatie. Dat is een manier van beoefening die ons in staat stelt onszelf te openen.
Mindfulness kan niet begrepen worden op intellectueel of cognitief niveau, het moet worden ervaren.
Mindfulness in de psychotherapie
Mindfulness is een vaardigheid die ons leert minder reactief te zijn op wat er in het moment gebeurt.
Het instinctieve automatische verzet wordt minder instinctief en minder automatisch. De automatische verzetsreactie wordt vervangen door gewaarzijn in het hier en nu, door helemaal bij te zijn. Dit geeft uiteindelijk een kwalitatief andere houding ten aanzien van pijn en lijden, en geeft meer keuzemogelijkheden.
Om dit te kunnen moet de diep geconditioneerde houding van automatisch verzet gedeconditioneerd worden. Dit kan alleen door intensieve training.
Een van de belangrijkste kenmerken van de training is dat het lichaam weer in aandacht wordt geplaatst. Stress, pijn en lijden ervaren we in ons lichaam.
De houding van mindfulness kenmerkt zich door:
In de training worden zowel vaardigheid als houding overgedragen.
We leren naar pijn toe te wenden in plaats van deze te vermijden. Pas dan kan je deze goed onderzoeken, waarna we kunnen kiezen er wat aan te doen.
Mindfulness-based cognitive therapy
Mindfulness-based cognitive therapy is een acht-weekse training die gebaseerd is op MBSR, met wat aanpassingen voor de specifieke doelgroep (mensen met recidiverende depressie).
De theorie is dat deze mensen een cognitieve kwetsbaarheid hebben ontwikkeld voor een sombere bui, waarbij ze gemakkelijk in oude negatieve denkpatronen terechtkomen die somberheid weer doen toenemen.
Deze patronen zijn meestal reactief en ontstaan als gevolg van experiëntiële vermijding.
Negatieve denkpatronen kunnen goed met mindfulnessoefeningen worden aangepakt.
Door te leren stil te worden en de geest te onderzoeken vanuit een niet-oordelende, open houding, wordt men zich bewust van de automatische irrationele overtuigingen en cognities die bij depressie een rol spelen.
Zo kunnen ze herkent en ontkracht worden.
Er ontstaat zo
How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective.
Holzel, B.K., Lazar, S.W., Gard, T., Schuman-Olivier, Z., Vago, D.R., & Ott, U. (2011)
Perspectives on Psychological Science, 6(6), 537-559.
Cultivation of mindfulness produces beneficial effects on well-being and ameliorates psychiatric and stress-related symptoms.
Components through which mindfulness meditation exerts its effects:
Mindfulness is nonjudgmental attention to experiences in the present moment.
Two component model of mindfulness
The practice of mindfulness meditation encompasses focusing attention on the experience of thoughts, emotions, and body sensations, simply observing them as they arise and pass away.
There is a relative paucity of theoretical reviews that consolidate the existing literature into a comprehensive theoretical framework.
Five facets of mindfulness
The combination of the following components describe much of the mechanism of action through which mindfulness works
These components interact closely to constitute a process of enhanced self-regulation.
The different components might come into play to varying degrees within any specific moment during mindfulness meditation.
Attention regulation
Many mediation traditions recommend a focused attention meditation before moving on to other types of meditations later in the learning process.
In focused attention meditation, attention is
Bewegen Richting Flexibiliteit met Acceptance en Commitment Therapie (ACT).
Jansen, G., Rinsampessy, D., van den Berg, G., and De Mey, H.
Acceptance and Commitment Therapy (ACT) is gebaseerd op de gedragsanalyse. Het gaat uit van het idee dat pijn een basiskenmerk is van het menselijk bestaan. ACT baseert zich op de aanname van destructieve nomaliteit. Dit is het idee dat gewone menselijke psychologische processen op zichzelf al kunnen leiden tot extreem disfunctionele resultaten en ongebruikelijke pathologische processen.
De golf derde generatie gedragstherapieën baseert zich op de aanname van destructieve normaliteit. Deze golf richt zich vooral op het veranderen van de context waarbinnen cognities plaats vinden. Cognities worden niet gezien als oorzaken, maar als gedrag dat wordt veroorzaakt door de leergeschiedenis van een persoon in interactie met zijn huidige omgeving (reinforcement contingenties). In de praktijk richt men zich op waar de cognities en emoties vandaan komen en waar de handvatten liggen om het gedrag van de cliënt te veranderen op weg naar duidelijke doelen. Ook wordt er niet geprobeerd om ervaringen te beïnvloeden.
ACT is een therapie waarin gedragsverandering centraal staat door het creëren van een nieuwe leergeschiedenis ofwel het veranderen van contingenties.
Herinneringen aan een pijnlijke gebeurtenis uit het (verre) verleden kunnen ervoor zorgen dat we ons in het heden niet prettig voelen. De oorzaken liggen dus in het verleden.
Een mens kan situaties vermijden waar pijn optreedt. Maar omdat de menselijke taal er via afgeleide relaties voor zorgt dat pijn ook los van de situatie gevoelt kan worden, is vermijden van situaties niet altijd functioneel.
Experientiële vermijding blijkt samen te hangen met een grote verscheidenheid aan psychopathologie. Het zou een bruikbaar begrip kunnen zijn voor een functionele classificatie van psychische problemen, omdat vele vormen van psychopathologie geïnterpreteerd kunnen worden als gevolg van ongezonde vermijdingstechnieken. Een functionele classificatie legt de nadruk op functioneel pathologische processen.
Volgens ACT zijn er een aantal processen verantwoordelijk voor het ontstaan van psychische klachten. Een van deze processen is cognitieve fusie. Hier wordt gedrag steeds meer gereguleerd door een ingewikkeld netwerk van talige relaties dat in ons hoofd bestaat, in plaats door directe ervaringen. Een fusie van gedachten leidt tot experientiële vermijding.
The development of the feighner criteria: a historical perspective
Kendler, Muñoz & Murphy (2010)
The team that developed the Feighner criteria made three key contributions to psychiatry
At the time of psychoanalysis, psychoanalysis had a negative view of psychiatric diagnosis, arguing that diagnosis in the conventional sense could be injurious to patients.
Early empirical investigations of psychiatric diagnosis showed that the probability of agreement of two psychiatrists in diagnosis mental disorders in patients hardly exceeded chance.
John Feighner came with a proposal that a paper should be published citing and reviewing those papers that clearly outlined the scientific and diagnostic bases for research in psychiatry.
He was responsible for doing ‘comprehensive literature review.. and a working outline of diagnostic criteria’ for each disorder.
Depression
The criteria for depression outlined in the Cassidy et al. article were:
The threshold of six out of ten criteria was made because ‘it sounded about right’.
The proposed Feighner criteria were very similar to those by Cassidy et al.
Four significant changes were made
Antisocial personality disorder
The starting point for the development of the Feighner criteria for antisocial personality disorder was the 19 criteria developed for sociopathic personality by Lee Robins.
Eight of the nine Feighner criteria for antisocial personality disorder had close parallels with these criteria.
Discussions in the group about the criteria were particularly concerned about avoiding confounds with poverty and drug abuse.
Alcoholism
The criteria for alcoholism were especially influenced by Guze.
Criteria were organized in five groups, symptoms from at least three of which
.....read moreEmotional processing during experiential treatment of depression
Pos, A.E., Greenberg, L.S., Goldman, R.N., & Korman, L.M. (2003)
Journal of Consulting and Clinical Psychology, 71, 1007-101
Early and late emotional processing predicts reductions in reported depressive symptoms and gains in self-esteem. Emotional-processing skill significantly improves during treatment. Late emotional processing both mediates the relationship between clients’ early emotional processing capacity and outcome.
Processes that are relevant to success in psychotherapy are working alliance, depth of experiencing, and differences in individuals’ capacity for engaging in treatment
Affect and cognition are highly integrated in automatically functioning cognitive-affective structures. These structures are important targets of treatment.
Emotional processing has been posited as important to change.
Emotion is a rapid-action meaning system that informs individuals of the significance of events to their well-being. Emotions are generated from tacit appraisals of both situations and self in relation to important needs. Being disconnected from emotion means being cut off from adaptive information.
Emotional processing is either increased or decreased emotional responding resulting from exposure to both the fear state and information inconsistent with the activated cognitive-affective fear structure.
Experiential approaches are emotional processing in a broader sense, viewing emotion as a source of adaptive information. Emotional processing is viewed as a continuum of stages 1) Clients must approach emotion by attending to emotional experience 2) Clients must allow and tolerate being in live contact with their emotions
Optimum emotional processing involves the integration of cognition and affect. Once contact with emotional experience is achieved, clients must also cognitively orient to that experience as information and explore, reflect on, and make sense of it. This includes exploring beliefs relating to experienced emotion, giving voice to emotional experience, and identifying needs that can motivate change in personal meaning and beliefs
If such exploration and reflection occur, new emotional reactions and new meanings potentially emerge that subsequently may be integrated into and change existing cognitive-affective meaning structures.
From the experiential-humanistic perspective, depression results, in part, from incomplete processing of emotional experience. Experiential treatment provides new deeper emotional processing as the important therapeutic task, goal, and change processes.
Two main avenues of intervention are used 1) Providing both an empathic, validating relationship. A collaborative alliance creates the safe environment in which clients can experience their emotions 2)Engaging in evocative, explorative, and meaning-making reflections, as well as emotionally stimulating tasks, gives clients deeper and immediate contact with emotions and helps clients make sense of them
Experiential theory predicts that to improve, clients must engage in optimal emotional processing. Emotional processing refers to the manner of processing emotional events potentially available to consciousness. Experiencing is the manner of processing experience,
.....read moreEmotion-focused Therapy
Greenberg, L.S. (2004)
Clinical Psychology and Psychotherapy, 11, 3-16
In an emotion-focused approach, emotion is seen as foundational in the construction of the self and is a key determinant of self-organisation. People have emotions and live in a constant process of making sense of emotions. Personal meaning is seen as emerging by the self-organization and explication of one’s own emotional experience. Optimal adaptation involves an integration of reason and emotion.
Therapists are emotion coaches who work to enhance emotion-focused coping by helping people become aware of, accept, and make sense of their emotional experience.
Emotion coaching is based on two phases, arriving and leaving.
A major premise of Emotion-focused therapy (EFT) is that emotion is foundational in the construction of the self and is a key determinant of self-organisation. Emotions are an adaptive form of information-processing and action readiness that orients people to their environment and promotes their well-being. Emotional intelligence involves honing the capacity to use emotions as a guide, without being a slave to them.
Emotions are important because they inform people that an important need, value, or goal may be advanced or harmed in a situation. They indicate how individuals appraise themselves and their worlds. Different action tendencies correspond to different emotions.
Emotion is a primary signalling system that communicates intentions and regulates interaction.
Emotion makes an integral contribution to information processing.
The amygdala forms emotional memories in response to particular sensations that have become associated with physical threats.
Affect infusion model holds that infusion of affect into cognition depends on the type of processing that is occurring. When processing is substantive in ambiguous, open situations, affect is most likely to influence the construction of beliefs. More controlled processing in explicit problem-solving situations is most impervious to affect infusion effects.
Cognition and memory are mood dependent.
Positive emotion improves problem solving by making thought processes more flexible, creative and efficient. It also builds resilience by undoing the effects of negative emotions. A tendency to low positive affect confers a vulnerability to depression. A stable positive affective affective style builds psychological resilience. The ability to recruit positive emotions in the face of stress is a crucial component of resilience.
Negative emotions are often useful. They draw people’s attention to matters important to their well-being. When the unpleasant emotions endure even when the circumstances that evoked them have changed, or are so intense that they overwhelm , or evoke past loss or trauma they can
.....read moreHandboek schematherapie (pp. 17-32). Theorie, praktijk en onderzoek
Vreeswijk, M., Broersen, J., & Nadort, M. (2008).
Hoofdstuk 3
Theoretisch model: schema’s, copingstrategieën en modi
Vroeg ontstane disfunctionele schema’s
Vanaf de eerste levensjaren worden ervaringen opgeslagen in ons autobiografische geheugen in de vorm van schema’s. Deze zijn de zintuigelijke waarnemingen en de ervaren emoties, handelingen en betekenis die eraan is verleend
Schema’s functioneren als filters waarmee mensen de wereld om zich heen ordenen, interpreteren en voorspellen.
De meeste mensen hebben schema’s die hen helpen zichzelf, het gedrag van anderen en gebeurtenissen in de wereld beter te begrijpen. Dit zorgt ervoor dat ze een positief zelfbeeld en een genuanceerd beeld van andere mensen ontwikkelen en om adequaat problemen op te lossen. Mensen met persoonlijkheidsproblematiek hebben disfunctionele schema’s.
Volgens Young ontstaan disfunctionele schema’s op jonge leeftijd als resultaat van de wisselwerking tussen de temperament van het kind, de opvoedingsstijl van de ouders en significante (soms traumatische) ervaringen. Disfunctionele schema’s weerspiegelen belangrijke emotionele behoeften van het kind. Zij zijn aanpassingen aan negatieve ervaringen, gebrek aan liefde en warmte en inadequate ouderlijke zorg en steun.
Hoewel disfunctionele schema’s in de vroege kinderjaren, gezien de omstandigheden, doorgaans adaptief zijn geweest, interfereren ze in belangrijke mate met goed het goed doorlopen van ontwikkelingstaken. Dit kan leiden tot voortdurende negatieve ervaringen, die ervoor zorgen dat een schema steeds meer ingesleten en rigide raakt. Hoe meer iemand op een bepaald gebied tekort is gekomen en hoe ernstiger de ervaren traumatische gebeurtenissen zijn, des te rigider en sterken hebben bepaalde overtuigingen zich geworteld en des te meer last heeft de persoon er in zijn huidige leven last van.
Schema’s zijn niet op elk moment even actief of bepalend in iemands leven. Als omstandigheden meer gelijkenis vertonen met situaties die hebben geleid tot het ontstaan van het schema, dan zal het schema ook meer op de voorgrond komen te staan.
Iemand heeft niet alleen schema’s, maar ook strategieën om er zo min mogelijk last van te hebben (copingsstrategieën).
Science and practice in cognitive therapy. Foundations, mechanisms, and applications
Chapter 5
Schema therapy
In schema therapy (ST), the basic idea is that maladaptive schemas can develop when basic emotional childhood needs are not adequately met.
The major emotional needs of children can be grouped as follows: safety and nurturance (including secure attachment), autonomy, competence and sense of identity, freedom to express needs, emotions and opinions, spontaneity and play and realistic limits and self-control.
In such needs are not adequately met, chances are great that the child develops fundamental representations of the self, of other people or the world in general, and of the meaning of emotions and needs, that are understandable in the given circumstances but are not necessarily adaptive in other circumstances.
Schemas can develop of very early experiences, before the age when verbal abilities are developed. This means that schemas need not to be verbal. The activation of the schema might become apparent primarily through bodily feelings and action tendencies.
People can differ in the way they deal with schema activation (coping style). Three groups of coping styles are distinguished: 1) Overcompensation, characterized by attempts to fight the underlying schema by pretending and behaving in the opposite manner 2) Avoidance, characterized by various kinds of situational, cognitive, and emotional avoidance manoeuvres so that full activation of the schema is avoided 3) Surrender, characterized by giving in to the schema.
Schema mode results form an activated schema through the model that coping style at the moment.
ST may be used between 20 and 200 sessions, depending on the severity of the disorder and the aims of treatment.
Limited reparenting is the idea that the therapist offers the patient a relationship during therapy that offers at least a partial antidote to what went wrong in important childhood relationships. The therapist tries to offer direct corrective experiences for emotional needs that were not adequately met during childhood-notably, safe attachment, guidance, stimulation of autonomy, and realistic limits. This should be offered within professional boundaries and should never lead to therapists transgressing personal limitations.
Limited reparenting also involves creating frustration by confronting patients with, for instance, lack of discipline, just as real parenting does. During therapy, the therapist gradually changes the therapeutic stance, increasingly stimulating the patient’s autonomy and responsibility in the later phase of treatment. ST therapist tend to be more open about their feelings about the patient and use personal disclosure more often if it is deemed to be helpful for the client.
Coping modes might block the access to vulnerably child modes that are associated with the childhood memories.
These
Current psychotherapies
Chapter 2
Psychoanalytical psychotherapies
Psychoanalysis is a distinctive form of psychological treatment, and a model of psychological functioning, human development, and psychopathology. There is a host of different theories and treatment models that have developed over more than a century.
Certain basic principles that tend to cut across different psychoanalytic perspectives are 1) an assumption that all human beings are motivated in part by wishes, fantasies, or tactic knowledge that is outside of awareness (unconscious motivation), 2) an interest in facilitating awareness of unconscious motivations, thereby increasing choice, 3) an emphasis on exploring the ways in which we avoid painful or threatening feelings, fantasies, and thoughts, 4) an assumption that we are ambivalent about changing and an emphasis on the importance of exploring this ambivalence, 5) an emphasis on using the therapeutic relationship as an area for exploring clients’ self-defeating psychological processes and actions (both conscious and unconscious), 6) an emphasis on using the therapeutic relationship as an important vehicle of change, 7) an emphasis on helping clients to understand the way in which their own construction of their past and present plays a role in perpetuating their self-defeating patterns.
The unconscious
Rational understanding of the factors motivating our actions often proves inadequate. The unconscious is an area of physic functioning in which impulses and wishes, as well as certain memories, are split off from awareness. This occurs either because the associated affects are too threatening or because the content of the impulses and wishes themselves are learned by the individual to be unacceptable through cultural conditioning.
Many contemporary psychoanalysis no longer conceptualize the unconscious in precisely the same way that Freud did. Some still content that there is a hypothetical psychic agency that keeps aspects of experience deriving from the more primitive, instinctually based aspect of the psyche out of awareness. Others argue that it is problematic to speculate about the nature of hypothetical psychic agencies.
Common threads through the differing perspectives are the premises that our experience and actions are influenced by psychological processes that are not part of our conscious awareness and these unconscious processes are kept out of awareness in order to avoid psychological pain.
Fantasy
People’s fantasies play an important role in their psychic functioning and the way in which they relate to external experience, especially their relationships with other people. These fantasies vary in the extent to which they are part of conscious awareness, ranging from daydreams and fleeting fantasies of the edge of awareness to deeply unconscious fantasies that trigger psychological defences. Fantasy serves a number of psychic
.....read moreResearch on the treatment of couple distress
Lebow, J. L., Chambers, A. L., Christensen, A., Johnson, S. M. (2012)
Journal of Marital & Family Therapy, 38, 145-68
Couple distress continues to number along the most frequently encountered difficulties.
Couple distress has a strong relation to an individual’s level of mental and physical problems. It may have a causal role in the generation and maintenance of individual psychopathology. The presence of diagnoses and relationship distress is circular, each begets the other.
The effects of relationship distress are also salient throughout the family system. It also leads to poorer treatment outcome in the treatment of disorders.
There have emerged a number of well-validated measures of couple functioning.
Studies show that most couple therapy has an impact, with about 70% of cases showing positive change.
Integrative behavioural couple therapy (IBCT) includes aspects of private experience (such as emotions) and emphasizes concepts such as acceptance and mindfulness in addition to the typical cognitive-behavioural strategies. It focuses on broad themes in partners’ concerns and puts a renewed emphasis on a functional analysis of behaviour. IBCT emphasizes emotional acceptance as well as behavioural change and creates joint awareness of the difficult patterns couples get into and an emotional distance from those patterns so that couples can look at them more objectively. It emphasizes contingency-shaped change, in which change occurs by exposing partners to new experiences that create contingencies that shape new behaviour.
In IBCT, there is no delay in focusing on long-standing issues. This may account for the slow, but continual increase in satisfaction.
Behavioural couple therapies produce substantial improvements in even seriously and chronically distressed couples. Those improvements are maintained for a substantial portion of the couples for 5 years after treatment termination. Potentially important variables that may predict response to treatment are arousal and language during difficult problem-solving discussions.
Emotionally focused couple therapy (EFT) is a couple intervention that is based
.....read morePsychometric perspectives on diagnostic systems
D. Borsboom (2008)
Journal of clinical psychology
Four conceptualizations of the relation between symptoms and disorders as utilized in diagnostic systems are: 1) A constructivist perspective, disorders are conveniently grouped sets of symptoms. 2) A diagnostic perspective, disorders are latent classes underlying the symptoms. 3) A dimensional perspective, symptoms measure latent continua. 4) A causal systems perspective, disorders are causal networks consisting of symptoms and direct causal relations between them
The movement standardization has not been paralleled by theoretical advances in understanding the conceptual and psychometric underpinnings of diagnostic systems in general.
The central question in this article is: What is it that a researcher, who uses the DSM classification, really does?
The researchers that uses the DSM for classification constructs classes of people based on a convenient grouping of symptoms into syndromes. The classification system of the DSM is seen as relatively arbitrary, which renders the resulting classes of people socially constructed kinds rather than naturally existing ones. The concept of a disorder is a socially constructed kind in the sense that it is implicitly defined by a convenient grouping of key attributes. The concept that describes the group does not identify a homogenous group of people. The label is merely useful to delineate a group of people who share some key attributes, but does not ‘cut nature at its joints’.
Constructivist conceptualizations does not imply that the whole process of diagnosis and the results of scientific research on mental does orders, are also arbitrary. For instance, the symptoms of depressing hang together reliably, in the sense that they are moderately positively correlated, so the syndromes constructed out of them have a sense of reliability as well. The higher the intercorrelations between a set of measures, the higher internal consistency will be. People may respond to treatment with a reliable change of symptoms while they suffer from very different conditions.
Constructivist deny that a group of symptoms is anything more than just that, a group of symptoms. A constructivist accepts that a set of symptoms may have high internal consistency, but denies that they all measure the same latent variable (unidimensionality). Internal consistency is nothing more than a summary statistic of the intercorrelations between a set of variables, and these correlations may come from everywhere and nowhere. Any set of positively correlated variables will show high internal consistency if run through the relevant
.....read moreHet KOP-model. Een manier van denken, kijken en werken.
Rijnders, P., & Heene, E. (2015).
Directieve Therapie, 35(1), 15-64
Het KOP-model is bedoeld om de duur van de behandeling te verkorten, en om de participatie van de patiënt in het behandelproces te vergroten. De nadruk ligt hierbij op de copingsstijl van de cliënt. Ook wordt er aandacht besteed aan de context en wordt het systeem van de cliënt actief betrokken bij de probleemanalyse en de behandeling.
In het KOP-model wordt ervan uit gegaan dat met enige uitleg, steun en coaching cliënten goed in staat zijn hun problemen zelf aan te pakken en op te lossen.
Het KOP-schema is een hulpmiddel om gevoelens en reacties te ordenen en terug te brengen tot overzichtelijke eenheden. Deze zijn: 1) Van welke klachten heeft iemand last? (K), 2) Waar zijn de mogelijke oorzaken of uitlokkende omstandigheden? (O), 3) In hoeverre is er sprake van een persoonlijk aandeel in de klachten? (P).
Het KOP-model gaat ervan uit dat er een relationeel verband is tussen de omstandigheden en de kenmerken van een onderzoeksobject. We moeten de aard van het individu kennen. Dit bied een kans om de cliënt, als zij dat wenst en ertoe in staat is, bij de opzet en uitvoering van zijn behandeling te betrekken. Dit draagt in belangrijke mate bij aan het succes van een behandeling.
Het KOP-model heeft een drietal belangrijke elementen. 1) De cliënt wordt uitgenodigd en gestimuleerd om op te treden als ‘co-therapeut’ Hiervoor is het belangrijk te vragen hoe omstandigheden door haar worden beleeft en hoe ermee wordt omgegaan. 2) De erkenning van, en de aandacht voor, de centrale rol van individuele kenmerken van de persoon. Het is belangrijk om vast te stellen wat de aard van de relatie is tussen een gebeurtenis en hoe de cliënt geneigd is daarmee om te gaan. 3) Het helpen van de cliënt om opnieuw of beter gebruik te maken van zijn reflectieve vermogen. Het helpt cliënten te beseffen dat ze in staat zijn keuzes te maken, en in voor hen lastige situaties alternatief gedrag aan te wenden of te ontwikkelen.
De uitwerking van P uit het KOP-schema wordt gestart met een zo concreet mogelijke beschrijving van de relevante kenmerken van de persoon van de cliënt. Dit gebeurt met behulp van de ‘balans’. Dit is een continuüm
.....read moreA guided self-help intervention in primary care to improve coping and mental health: an observational study
Rijnders, P., Heene, E., van Dijk, M., van Straten, A., Hutschemaekers, G., & Verbraak, M.J.P.M. (2016).
European Journal for Person Centered Healthcare, 4(2), 281-288
The administration of treatments through self-help materials can help to reduce the complexity of psychotherapy and the length and the amount of therapist contact and might therefore reduce costs.
The self-help program is suitable for the treatment in primary care of patients with different mental health problems. This program is based on the idea that maladaptive coping is a transdiagnostic factor for psychopathology.
This intervention is characterized as follows.
It is structured, simple and brief
The manifestations of mental functioning and mental disorders are explained with the formula: S = L x C. The clarification of this formula helps the patient discover how mental problems (S: symptoms) arise as a consequence of the combination of life events (L) and inadequate coping strategies (C).
The patient uses a manual during the course of treatment. This manual contains information as well as homework assignments. These are typically presented as charts, which the patient has to fill in at home. Through the homework patients reach better understanding of the peculiarities of his or her situation.
It focuses on coping and hence self-efficacy
Coping expresses the behavioural and psychological strategies people employ to master, tolerate or reduce stress. Maladpative coping strategies are associated with psychopathology and are considered to be transdiagnostic. In the program coping strategies are characterized in terms of habitual reaction patterns and seen as the core element. The treatment aims to teach patients a new way to confirm or adapt their coping strategy.
It uses a stepwise approach
The treatment as a whole consists of three steps. These are: 1) shared problem definition and defining targets, 2) behaviour change, and 3) relapse prevention.
It stresses shared decision making
The patient’s problems are sorted out while using an outline. The patient and therapist discuss which components of the problem belong to which portion of the outline. During the discourse, the therapist explains how the elements in the outline are interconnected. As soon as the interconnectedness among S, L and C becomes clear, the patient and therapist discuss which elements of the problem need modification and which strategies will serve to activate new coping behaviour.
It includes monitoring of treatment progress
Objective information about mental functioning of the patient is obtained at the start and during
.....read moreHow does EMDR work?
Hout, van den, M. & Engelhardt, I. (2012).
Journal of Experimental Psychology, 3 (5), 724-738.
Eye movement desensitisation and reprocessing (EMDR) is an effective treatment for alleviating trauma symptoms. Eye movements or other ‘dual tasks’ are necessary for this. Bilateral situation is not needed. It is important that the dual task taxes working memory.
Eye movement desensitisation (EMDR) is used to treat posttraumatic stress disorder. A crucial part of the producer involves the patient recalling traumatic memories while simultaneously making horizontal eye movements Increasingly, these eye movements have been replaced by other intermitted bilateral stimulation.
The procedure of EMDR involves: 1) Volunteers recall unpleasant memories for a few seconds. they rate those memories in terms of vividness and emotionality. 2) They recall those memories for a second, longer time, while making eye movements by visually tracking a white circle that moves from side to side on a computer screen. 3) After a break, the memory is recalled under the same conditions as the first time and is again rated in terms of vividness and emotionality.
Hypothesis 1: EMDR works by recalling aversive memories and eye movements do not contribute anything
Studies show that: eye movement matter, the effects cannot be explained by exposure alone.
Hypothesis 2: EMDR works by stimulating ‘Interhemispheric communication’
Research dismisses this hypothesis.
Hypothesis 3: EMDR works by taxing working memory during recall
When simultaneously do two tasks that each tax WM, the tasks compete for the limited capacity of working memory. During recall, a memory becomes ‘labile’, events during recall influence how the memory is restored and may be recalled in the future. The ‘recall + eye movements’ combination will lead to ‘imagination deflation’.
Other tasks
An implication of the working memory theory is that not only eye movements, but any task should attenuate the vividness and hence the emotional tone of the memory. This has been found.
According to the working memory theory, all emotional memories should lose their
.....read moreHow Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action.
Ramon Landin-Romero, R., Moreno-Alcazar, A. ,Pagani , M., Amann, B. (2018).
Frontiers in Psychology
EMDR is a structured eight-phase approach using standardized procedures to address the past, present, and future aspects of a traumatic memory. The traumatic memory is composed of a set of multi-sensory images, negative cognitions, negative emotions, and related unpleasant physical sensations. The EMDR therapy standard protocol includes the following preparation steps. These are: 1) History and treatment plan 2) Preparation phase with an introduction to the EMDR protocol and development of coping strategies 3) An assessment phase with visualization of an image of the traumatic incident, identification of beliefs, and emotions associated with the disturbing event, rating of disturbance recalling the traumatic incident, and rating the validity of preferred cognitions of the client. 4) The desensitization and reprocessing. The client focuses on a dual attention stimulus, while holding in mind the image, thoughts and/or sensations associated with the disturbing memory Following each brief set of bilateral stimulation, the client is asked to identify the associative information that was elicited. 5) Incorporate and strengthen a positive cognition to replace the negative cognition associated with the trauma 6) The body scan to reprocess any remaining bodily sensations. 7) The client is guided through relaxation techniques designed to re-establish emotional stability if distress has been experienced, and for use between sessions. 8) Re-evaluation, identifying outcomes from the prior session
The completion of EMDR requires attention, self-consciousness, autobiographical semantic memory, and metacognition to successfully identify the potential dysfunctional processes underlying the traumatic memory.
Evidence for the efficacy of EMDR in PTSD and other comorbid disorders
EMDR is recognized as a treatment for PTSD.
The adaptive information processing model
The adaptive information processing model postulates that humans have an innate information processing system that assimilates new experiences and stores them into existing memory networks in an adaptive state. These networks link the thoughts, images, emotions, and sensations associated with experiences. According to the model, pathology arises when new information is inadequately processes and then stored in a maladaptive mode in the memory networks, along with associated distorted thoughts, sensations and emotions.
External stimulation similar to the adverse experience can trigger sensations and images from the traumatic event so that the person re-experiences feelings or bodily sensations. If these memories remain unprocessed, they become the basis of the symptoms of PTSD. When the memories are adequately processed, symptoms can be eliminated and integrated. EMDR can assist in processing the
.....read moreIn this magazine, everything you need for the course DSM-5 and psychotherapy is bundled.
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