This is a magazine about clinical psychology
This is a summary of Abnormal Psychology by Kring, Davison, Neale & Johnson. This summary focuses on clincal psychology and mental health. Discussed are etliolgies of disorders and treatments.
This is a magazine about anxiety and mood disorders
This is a magazine about Sexology.
Useful video's to broaden your knowledge
Questions to practice your knowledge
Dit is een magazine over het vak psychodiagnostiek aan de uva. Het vak wordt gegeven in het tweede jaar van de studie psychologie en gaat over het stellen van diagnoses.
Vragen voor het eerste en het tweede blok
This is a bundle about the ussage and efficacy of psychotherapy. This bundle contains the literature used in the course 'DSM-5 and psychotherapy' at the third year of psychology at the University of Amsterdam.
Dit is een samenvatting van het boek DSM-5 voorbij! Persoonlijke diagnostiek in een nieuwe GGZ van J. van Os. Deze samenvatting hoort bij de cursus 'DSM-5 en psychotherapie' van het derde jaar psychologie op de UvA.
De eerste drie hoofdstukken van het boek zijn gratis, maar de rest is voor Joho-supporters. Dit kost 5 euro per jaar, en dan heeft u toegang tot alle Joho-samenvattingen.
This is a video about trauma and addiction from the youtube series 'crash course'
This is a video about schizophrenia and dissociative disorders from the youtube series 'crash course'
This is a video about eating and body dysmorphic disorders from the youtube series 'crash course'
This is a video about personality disorders from the youtube series 'crash course'
This is a video about sex and psychology of the series 'crash course'
Introduction and historical overview - summary of chapter 1 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)
Clinical psychology
Chapter 1
Introduction and historical overview
Introduction
Psychopathology: the field concerned with the nature, development, and treatment of mental disorders.
Continually developing and adding new findings.
Sigma: the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness.
Stigma has four characteristics:
The treatment of individuals with mental disorders throughout recorded history has not generally been good, and this has contributed to their stigmatization.
Mental illness remains one of the most stigmatized of conditions in the twenty-first century.
Mental disorder is one disorder that contains several characteristics.
Four key characteristics that any comprehensive mental disorder definition ought to have:
No single characteristic can fully define the concept.
Mental disorder is usually determined based on the presence of several characteristics at one time.
Personal distress
A person’s behavior may be classified as disordered if it causes him or her great distress.
But not all mental disorders cause distress.
And not all behavior that causes distress is disordered.
Disability
Impairment in some important area of life.
Disability alone cannot be used to define mental disorder. Not all disorders involve disability.
Other characteristics that might, in some circumstances, be considered disabilities, do not fall within the domain of psychopathology.
Violation of social norms
In the realm of behaviors, social norms are widely held standards that people use consciously or intuitively to make judgments about where behaviors are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable.
Behavior that violates social norms might be classified as disordered.
This is not enough for defining mental disorder. It is too broad and too narrow.
And social norms vary across cultures and ethnic groups.
Dysfunction
Harmful dysfunction. Has a value judgment and a objective component (dysfunction).
A judgment
Current paradigms in psychopathology - summary of chapter 2 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 2
Current paradigms in psychopathology
Introduction
Science is a human enterprise that is bound by scientists’ human limitations.
Paradigm: a conceptual framework or approach within a scientist works.
A paradigm as profound implications for how scientist operate at any given time.
Three paradigms that guide the study and treatment of psychopathology
Factors that cut across all the paradigms:
Almost all behavior is heritable to some degree.
Despite this, genes do not operate in isolation from the environment. Through the life span, the environment shapes how our genes are expressed, and our genes also shape the environment.
Nature via nurture.
Without the environment, genes could not express themselves and thus contribute to behavior.
Genes: the carriers of genetic information.
The number of genes is not important. The sequencing, or ordering, of these genes as well as their expression is what makes us unique.
What genes do matters more than the number of genes we have. Genes make proteins that in turn make the body and the brain work.
Gene expression: some proteins switch, or turn, on and off other genes.
Polygenic: several genes turning themselves on and off as they interact with a person’s environment is the essence of genetic vulnerability.
We do not inherit mental illness from our genes. We develop mental illness trough the interaction of our genes with our environment.
Heritability: the extent to which variability in a particular behavior in a population can be accounted for by genetic factors.
Shared environment factors: those things that members of a family have in common, such as parents’ marital status.
Nonshared environment (or unique environment) factors: those things believed to be important in understanding why two siblings from the same family can be so different.
Nonshared environmental experiences have much more to do with the development of mental illness than the shared experiences.
Behavior genetics
Behavior genetics: the study of the degree to which genes and environmental factors influence behavior.
Genotype: the total genetic makeup of an individual, consisting of inherited genes. The genotype cannot be observed outwardly.
Phenotype: the totality of observable behavioral characteristics.
The genotype should not be viewed as a static entity. Genetic programs are quite flexible.
The phenotype changes
Diagnosis and assessment - summary of chapter 3 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 3
Diagnosis and assessment
Introduction
Diagnosis can be the first major step in good clinical care.
Having a correct diagnosis will allow the clinician to describe base rates, causes, and treatment.
Hearing a diagnosis can help a person understand why certain symptoms are occurring.
Two concepts that play a key role in diagnosis and assessment:
Reliability
Reliability: consistency of measurement.
Validity
Validity: whether a measure measures what it is supposed to measure.
Unreliable measures will not have good validity.
Reliability does not guarantee validity.
The diagnostic system of the American psychiatric association: DSM-5
Diagnostic and Statistical Manual of Mental Disorders (DSM).
Multiaxial classification system forces the diagnostician to consider a broad range of information.
Axis:
Removal oaf the multiaxial system
The multiaxinal system developed for DSM-IV-TR is removed in DSM-5.
In place of the first three axes clinicians are simply to note psychiatric and medical diagnoses.
Organizing diagnoses by causes
DSM-5 defines diagnoses entirely on the basis of symptoms.
In the DSM-5, the chapters are reorganized to reflect patterns of comorbidity and shared etiology.
Enhanced sensitivity to the developmental nature of psychopathology
Childhood diagnoses
.....read more Research methods in psychopathology - summary of chapter 4 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 4
Research methods in psychopathology
Introduction
Theory: a set of propositions meant to explain a class observations.
Hypotheses: expectations about what should occur if a theory is true.
The case study
Case study: recording detailed information about one person at a time.
The case study can be used:
The correlational method
Variables are measured as they exist in nature.
Psycho-pathologist will rely on correlational methods when there are ethical reasons not to manipulate a variable.
Comparison of people with and without diagnoses can be correlational as well.
Measuring correlation
Statistical and clinical significance
A statistical correlation is unlikely to have occurred by chance.
A non-significant correlation may have occurred by chance, so it does not provide evidence for an important relationship.
A statistical finding is usually considered significant if the probability that it is a chance finding is 5 less in 100. p<0.05.
In general, as the absolute size of the correlation coefficient increases, the result is more likely to be statistically significant.
The significance is also influenced by the number of participants in the study.
Clinical significance: whether a relationship between variables is large enough to matter.
Problems of causality
Correlational method does not allow determination of cause-effect relationship.
Epidemiology: the study of the distribution of disorders in a population.
Focuses on three features of a disorder
Epidemiological studies are designed to be representative of
.....read more Mood disorders - summary of chapter 5 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 5
Mood disorders
Mood disorders involve disabling disturbances in emotion.
The DSM-5 recognizes two broad types of mood disorders:
Depressive disorders
The cardinal symptoms of depression include profound sadness and/or an inability to experience pleasure.
Physical symptoms of depression are also common
Social withdrawal is common.
Major depressive disorder
Major depressive disorder (MDD)
DSM-5 criteria
Persistent depressive disorder (Dysthymia)
People wit dysthymia are chronically depressed, more then half of the time for at least 2 years. They feel blue or derive little pleasures from usual activities and pastimes.
DSM-5 criteria for persistent depressive disorder (dysthymia)
Anxiety disorders - summary of chapter 6 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 6
Anxiety disorders
Introduction
Anxiety: apprehension over an anticipated problem (future)
Fear: a reaction to immediate danger
Both anxiety and fear can involve arousal, or sympathetic nervous system activity.
Anxiety and fear are both adaptive.
In some anxiety disorders, the fear system seems to misfire. A person experiences fear at a time when there is no danger in the environment.
Anxiety creates a U-shape curve with performance.
Anxiety disorders as a group are the most common type of psychiatric diagnosis.
Phobias are particularly common
For each anxiety disorder, several criteria must be met for a DSM-5 diagnoses to be made:
Each disorder, though, is defined by a different set of symptoms related to anxiety or fear.
Anxiety disorders:
Specific phobias
A specific phobia: a disproportionate fear caused by a specific object or situation.
The person recognizes that the fear is excessive, but still goes to great lengths to avoid the feared object or situation.
Specific phobias tend to cluster around a small number of feared objects and situations.
The DSM categorizes specific phobias according to these sources of fear.
A person with one type of specific phobia is very likely to have another type of specific phobia as well. There is high comorbidity of specific phobias.
DSM-5 criteria:
Social anxiety disorder
Social anxiety disorder: a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
The problems caused by it tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias.
Social anxiety disorder generally begins during adolescence. For some, though, the symptoms first emerge during childhood.
Without
Obsessive-compulsive-related and trauma-related disorders - summary of chapter 7 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 7
Obsessive-compulsive-related and trauma-related disorders
OCD is defined by repetitive thoughts and urges (obsessions) as well as an irresistible need to engage in repetitive behaviors or mental acts (compulsions)
Body dysmorphic disorder and hoarding disorder have symptoms or repetitive thoughts and behaviors.
For all three conditions, the repetitive thoughts and behaviors are distressing, feel uncontrollable, and require a considerable amount of time.
For the person with these conditions, the thoughts and behaviors feel unstoppable.
These syndromes often co-occur.
Clinical descriptions and epidemiology of the obsessive-compulsive and related disorders
Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions.
Obsessions: intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and often appear irrational to the person experiencing them.
For people with OCD, obsessions have such force and frequency that they interfere with normal activities.
People with obsessions may also be prone to extreme doubts, procrastination, and indecision.
Compulsions: repetitive, clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring.
Even though rationally understanding that there is no need for this behavior, the person feels as something dire will happen if the act is not performed.
The sheer frequency with which compulsions are repeated may be staggering.
Commonly reported compulsions:
OCD tends to begin either before age 10 or else in late adolescence/early adulthood.
Slightly more common among women than men.
The pattern of symptoms appears to be similar across cultures.
High comorbidity.
DSM-5 criteria for Obsessive-compulsive disorder
Dissociative disorders and somatic symptom- related disorders - summary of chapter 8 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 8
Dissociative disorders and somatic symptom- related disorders
Introduction
Both types of disorders are hypothesized to be associated with stressful experiences, yet symptoms do not involve direct expressions of anxiety.
Dissociative and somatic symptom-related disorders tend to be comorbid.
The DSM-5 includes three major dissociative disorders:
The dissociative disorders are all presumed to be caused by a common mechanism, dissociation. Which results in some aspect of cognition or experience being inaccessible consciously.
Dissociation and memory
Psychodynamic theory suggests that in dissociative disorder traumatic events are repressed.
In this model, memories are forgotten because they are so aversive.
Memory for emotional relevant stimuli is enhanced by stress, while memory for neutral stimuli is impaired.
Dissociative disorders involve unusual ways of responding to stress.
Extremely high levels of stress hormones could interfere with memory formation.
In the face of severe trauma, memories may be stored in such a way that they are not accessible to awareness later when the person has returned to a more normal state.
Dissociative disorders are considered an extreme outcome of this process.
Dissociative amnesia
The person with dissociative amnesia is unable to recall important personal information, usually information about some traumatic experience.
The holes in memory are too extensive to be explained by ordinary forgetfulness.
The information is not permanently lost, but it cannot be retrieved during the episode of amnesia, which may last for as short a period as several hours, or as long as several years.
The amnesia usually disappears as suddenly as it began, with complete recovery and only a small change of recurrence.
Most of the memory loss involves information about some part of a traumatic experience.
More rarely the amnesia is for entire events during a circumscribed period of distress.
During the period of amnesia, the person’s behavior is otherwise unremarkable, except that the memory loss may cause some disorientation.
In a more severe sub-type of amnesia, fugue, the memory loss is more extensive.
The person not only becomes totally amnesic but suddenly leaves home and work.
Recovery is usually complete, although it takes various amounts of time.
After recovery, people are fully able to remember the details of their life and experiences,
Schizophrenia - summary of chapter 9 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 9
Schizophrenia
Schizophrenia: a disorder characterized by disturbances in thought, emotion and behavior.
>1% prevalence
Slightly more men than women.
Sometimes develops in childhood, but usually appears in late adolescence or early adulthood
people with schizophrenia typically have a number of episodes of their symptoms and less severe but still debilitating symptoms between episodes.
The range of symptoms in the diagnosis of schizophrenia is extensive, although people with schizophrenia typically have only some of these problems at any given time.
No single essential symptom must be present for a diagnosis of schizophrenia.
Researchers divided symptoms in three
DSM-5 criteria of schizophrenia
Positive symptoms
Positive symptoms comprise excesses and distortions, such as hallucinations and delusions.
For the most part, acute episodes of schizophrenia are characterized by positive symptoms.
Delusions
Delusions: beliefs contrary to reality and firmly held in spite of disconfirming evidence.
Common symptoms in schizophrenia.
Delusions take several forms including:
Delusions are also found in other diagnoses,
Hallucinations and other disturbances of perception
Hallucinations: sensory experiences in the absence of any relevant information for the environment.
More often auditory than visual.
Negative symptoms
The negative symptoms of schizophrenia consists of behavioral deficits.
Include:
Negative symptoms tend to endure beyond an acute episode and have profound
.....read more Substance use disorders - summary of chapter 10 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 10
Substance use disorders
Prevalence adolescents: 9,3 to 10 percent.
Addiction: a more severe substance use disorder that is characterized by having more symptoms, tolerance, and withdrawal, by using more of the substance than intended, by trying unsuccessfully to stop, by having physical or psychological problems made worse by the drug, and by experiencing problems at work or with friends.
Tolerance: indicated by either:
Withdrawal: the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount.
DSM-5 criteria for substance use disorder
Alcohol use disorder
Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly.
Liver enzymes that metabolize alcohol can account to a small extent for tolerance. The central nervous system is responsible as well.
Tolerance results from changes in the number or sensitivity of GABA or glutamate receptors. Withdrawal may result because some neural pathways increase their activation to compensate for alcohol’s inhibitory effects in the brain.
Alcohol use disorder is often part of polydurg abuse.
Polydrug abuse: abusing ore than one drug at a time.
Alcohol and nicotine are cross-tolerant; nicotine can induce tolerance for the rewarding effects of alcohol and vice versa.
Consumption of both drugs may be increased to maintain their rewarding effects.
Prevalence and cost of alcohol abuse and dependence
No yet prevalence estimates.
Especially frequent among college-age adults.
Binge drinking: having five drinks in a short period of time
Heavy-use drinking: having five drinks on the same occasion five or mire times in a 30-day period.
Among college students, binge drinking and heavy-use prevalence rates are 43,5 and 16 percent.
Binge drinking can have serious consequences
More men than women have problems with alcohol, though
.....read more Eating disorders - summary of chapter 11 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 11
Eating disorders
Anorexia nervousa
DSM-5 criteria for anorexia nervousa
Amenorrhea: loss of menstrual period
Two types of anorexia nervosa:
Typically begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.
Lifetime prevalence: less than one percent
10 time more frequent in women than in men.
Suicide rates are quite high for people with anorexia
Physical consequences of anorexia nervosa
Self-starvation and use of laxatives produce numerous undesirable biological consequences in people with anorexia nervosa.
Prognosis
Between 50 and 70 percent of people with anorexia eventually recover.
Recovery often takes 6 to 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved.
Anorexia nervosa is a life-threatening illness.
Bulimia nervosa
DSM-5 criteria for bulimia nervosa
Involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
Binge has two characteristics:
Bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss.
The diagnoses in such a case is anorexia nervosa, binge-eating/purgning type.
The key difference between anorexia and bulimia is weight loss.
People with bulimia do not lose a
Sexual disorders - summary of chapter 12 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 12
Sexual disorders
Sexual dysfunctions are defined by persistent disruptions in the ability to experience sexual arousal, desire, orgasm, or by pain associated with intercourse.
Paraphilias are defined by persistent and troubling attractions to unusual sexual activities or objects.
Definitions of what is normal or desirable in human sexual behavior vary with time and place.
Culture influences attitudes and beliefs about sexuality.
Gender and sexuality
Women tend to be more ashamed of any flaws in their appearance than do men, and this shame can interfere with sexual satisfaction.
For women, sexuality appears to be more closely tied to relationship, status, and social norms than for men.
Among women with sexual symptoms, more than half believe their symptoms are caused by relationship problems. Men are more likely to think about their sexuality in terms of power than are women.
There are many parallels in men’s and women’s sexuality.
The sexual response cycle
Four phases in the human sexual response cycle
Sexual dysfunctions
Sexuality usually occurs in the context of an intimate personal relationship.
Our sexuality shapes at least part of our self-concept.
When sexual problems emerge, they can wreak havoc on our self-esteem and relationships.
Clinical descriptions of sexual dysfunctions
The DSM-5 divides sexual dysfunctions into three categories:
Separate diagnoses are provided for men and women.
The diagnostic criteria for all sexual dysfunction specify that dysfunction should be persistent and recurrent and should cause clinically significant distress or problems with functioning.
A diagnoses of sexual dysfunction is not made it the problem is believed to be due entirely to a medical illness or another psychological disorder.
Many people with problems in one phase of the sexual cycle will often report problems in another phase. Some of this may just be a vicious circle.
Sexual problems in one person may lead to sexual problems in the partner.
Disorders involving sexual interest, desire, and arousal
DSM-5 criteria for Male hypoactive sexual desire disorder
DSM-5 criteria for Erectile disorder
DSM-5 criteria for Female sexual interest/arousal disorder
Disorders of childhood - summary of chapter 13 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 13
Disorders of childhood
Most theories of childhood disorder, consider childhood experience and development critically important to adult mental health.
Before making a diagnosis of a particular disorder in children, clinicians must first consider what is typical for a particular age.
Some childhood disorders are unique to children.
The more prevalent childhood disorders are often divided into two broad domains,
Children and adolescents may exhibit symptoms form both domains.
Across cultures, externalizing behaviors are consistently found more often among boys and internalizing behaviors more often among girls, at least in adolescence.
Childhood disorders involve an interaction of genetic, neurobiological, and psychological factors.
Clinical descriptions, prevalence, and prognosis of ADHD
DSM-5 criteria for attention-deficit/hyperactivity disorder
Although children with ADHD are usually friendly and talkative, they often miss subtle social cues.
Children with ADHD can know what the socially correct action is in hypothetical situations but be unable to translate this knowledge into appropriate behavior in real-life social interactions.
DSM-5 includes three specifiers to indicate which symptoms predominate
The combined specifier comprises the majority of children with ADHD.
A difficult differential diagnosis is between ADHD and conduct
.....read more Late life and neurocognitive disorders - summary of chapter 14 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 14
Late life and neurocognitive disorders
As we age, physiological changes are inevitable, and there may be emotional and mental changes as well.
Many of these influence social interactions.
The problems experienced in late life
Mental health is tied to the physical and social problems in a person’s life.
No other have more of these problems than the elderly.
As people age, the quality of depth of sleep declines.
Sleep apnea: a disorder in which a person stops breathing for seconds to minutes during the night. Increase with old age.
Several problems are evident in the medical treatment available during late life.
Research methods in the study of aging
Three kinds of effects:
Two major research designs
The DSM criteria are the same for older and younger adults.
The process of diagnoses must be considered with care. DSM criteria specify that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or medication side effects.
Clinicians must be extremely careful to consider the interactions between physical and psychological health.
Estimating the prevalence of psychological disorders in late life
Persons over age 65 have the lowest overall prevalence of mental disorders of all age groups.
Mot people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier.
Why so low?
Methodological issues in estimating the prevalence of psychopathology
Personality disorders summary of chapter 15 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 15
Personality disorders
The personality disorders are a heterogeneous group of disorders defined by problems in forming a stably positive sense of self and with sustaining close and constructive relationships.
People with personality disorders experience difficulties with their identity and their relationship in multiple domains of life, and these problems are sustained for years.
Their personality problems are evident in cognition, emotion, relationships, and impulsive control. The symptoms of personality disorders are pervasive and persistent.
The DSM-5 approach to classification
In the DSM-5, the 10 different personality disorders are classified in three clusters, reflecting the idea that these disorders are characterized by:
Many people with psychological disorder will also experience a personality disorder.
Comorbid personality disorder are associated with more severe symptoms, poorer social functioning, and worse treatment outcomes for may conditions.
Diagnostic reliability
Using structured interviews and multiple informants can improve reliability.
Comorbidity
Personality disorders tend to be comorbid with each other.
Alternative DSM-5 model for personality disorders
Reducing the number of personality disorders, incorporating personality trait dimensions, and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
Two types of dimensional scores
Key strengths:
Alternative DSM-5 criteria for Personality disorder
Odd/eccentric cluster includes:
Paranoid personality disorder
DSM-5 criteria for Paranoid personality disorder
Introduction to clinical psychology In this magazine, you can find the information you need for the first year course introduction to clinical psychology in the study psychology at the uva.
Clinical psychology
This is a magazine about clinical psychology
A contemporary learning theory perspective on the etiology of anxiety disorders: It’s not what you thought it was - a summary by an article by Mineka, & Zinbarg 
A contemporary learning theory perspective on the etiology of anxiety disorders: It’s not what you thought it was
Article by: Mineka, S. & Zinbarg, R. (2006)
American Psychologist, 61, 10-26
Individuals with specific phobias show intense and irrational fears of certain objects or situations that they usually go to great lengths to avoid.
Vicarious conditioning of fears and phobias
Strong and persistent phobias can be learned rapidly through observation alone.
Sources of individual differences in the acquisition of fears and phobias
Many individuals who do undergo traumatic experiences do not develop phobias. From a diathesis-stress perspective, such findings are expected. There seems to be a modest genetically based vulnerability for phobias. This genetic vulnerability may well be mediated through genetic contributions to fear conditioning, which may in turn be mediated through personality variables such as high treat anxiety that also seem to serve as vulnerability factors, affecting the speed and strength of conditioning.
Differences in life experiences among individuals can also strongly affect the outcome of conditioning experiences. Such experiential factors may serve as vulnerability (or invulnerability) factors for the development of phobias. The relevant differences in life experiences may occur before, during, or following a fear-conditioning experience, and they can act singly or in combination to affect how much fear is experienced, acquired, or maintained over time.
Impact of prior experiences
Latent inhibition demonstrates that simple prior exposure to a conditioned stimulus (CS) before the conditioned and unconditioned stimulus (US) are ever paired together reduces the amount of subsequent conditioning to the CS when paired with the US.
A person’s history of control over important aspects of his or her environment is another important experiential variable strongly affecting reactions to frightening situations. A greater sense of mastery and control may lead to a more readily adaption to frightening events and novel anxiety-provoking situations.
Impact of contextual variables during conditioning
Several different features of conditioning events themselves have a strong impact on how fear is acquired. Having control over a traumatic event (such as being able to escape it) has a major impact on how much fear is conditioned to CSs paired with that trauma. Far less fear is conditioned when the aversive event is escapable than when it is not.
Impact of postevent variables
Different kinds of experiences that people can have following conditioning affect the strength of the conditioned fear that is maintained over time. A person who is exposed to a more intense traumatic experience (not paired with the CS) after conditioning of a mild fear is likely to show an increase in
.....read more Maximizing exposure therapy: An inhibitory learning approach - a summary of an article by Craske, Treanor, Conway, Zbozinek & Vervliet Maximizing exposure therapy: An inhibitory learning approach
An article by: Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014).
Behaviour Research and Therapy, 58, 10-23
In a Pavlovian conditioning model, a neutral stimulus (conditional stimulus, CS) is followed by an aversive stimulus (unconditional stimulus, US). After a number of parings, the CS will come to elicit anticipatory fear reactions (conditional response, CR). The CR is presumed to depend upon the CS becoming a reliable predictor of the US. An association is posited between the memory representations of the CS and the US such that presentations of the CS will indirectly activate the memory of the US.
One powerful way to reduce conditional fear reactions is through extinction, in which the CS is repeatedly presented in the absence of the US.
Inhibitory learning is regarded as being central to extinction, although additional mechanisms, such as habituation, are likely to be involved. Inhibitory learning models mean that the original CS-US association learned during fear conditioning is not erased during extinction, but rather is left intact as new, secondary inhibitory learning about the CS-US develops, specifically that the CS no longer predicts the US.
The amygdala, which is particularly active during fear conditioning, appears to be inhibited by cortical influences identified as occurring from the medial prefrontal cortex as a result of extinction learning. After extinction, the CS possesses two meanings: 1) Its original excitatory meaning (CS-US). 2) an additional inhibitory meaning (CS-no US)
Even though fear subsides with enough trials of the CS in the absence of the US, retention of at least part of the original association can be uncovered by various procedures, which each one showing a continuing effect of the original excitatory association after extinction. 1) Conditional fear shows spontaneous recovering. 2) The strength of the CR increases in proportion to the amount of time since the end of extinction. 3) Renewal of conditional fear occurs if the surrounding context is changes between extinction and retest 4) Fear extinction appears to be specific to the context in which extinction occurs 5) Reinstatement of conditional fear occurs if unsignaled (or unpaired) US presentations occur between extinction and retest. 6) Rapid reacquisition of the CR is seen if the CS-US pairings are repeated following extinction
Tackling maladaptive memories through reconsolidation: From neural to clinical science - a summary of an article by Elsey& Kindt (2017).Tackling maladaptive memories through reconsolidation: From neural to clinical science
By: Elsey, J. W. B. & Kindt, M. (2017).
Neurobiology of Learning and Memory, 142, 108-117
Memory reactivation can induce a labile period, during which previously consolidated memories are sensitive to change, and in need of restabilization. This is reconsolidation.
Memory labilization appears to result from the interplay of learning history, reactivation, and individual differences.
The dominant model of memory formation proposes that memories transition from a short-term and relatively unstable trace to a more persistent long-term form.
This transition from short-term memory to long-term memory is consolidation.
Consolidation is thought to be mediated by protein synthesis dependent synaptic changes.
Protein synthesis inhibitors (PSIs) prevent the expression of long-term memory when administered shortly after learning.
Once consolidated, memories appear insensitive to protein synthesis inhibition, and can prove highly recalcitrant to attempts at modification.
Reactivation of a memory can render it vulnerable to amnestic interventions.
Protein synthesis inhibition shortly after reactivation can prevent the later expression of long-ter memory.
Under certain conditions, a consolidated memory can be brought into a labile state by reactivation, during which the memory trace can be modified or even disrupted.
This labile state requires restabilization in a manner similar to consolidation.
The reactivation-induced period of lability is temporary.
The amnesia for auditory fear conditioning could be induced by the systemic administration of propranolol, timed to coincide with memory reactivation.
The blockade of beta-adrenergic receptors by propranolol is believed to indirectly inhibit protein synthesis by halting noradrenaline-stimulated CREB phosphorylation in the amygdala.
The disruption of reconsolidation by pharmacological means has been proven effective in both non-human animals and humans under controlled laboratory settings.
Reconsolidation is most reliably induced by memory reactivations that in some way add to or indicate the need to update the memory.
Memory expression appears to be unnecessary for inferring memory reconsolidation.
NMDA receptor activation is necessary for the labiliation of a fear memory trace upon reactivation.
AMPA receptors are crucial for the expression of that memory.
These two processes are dissociable.
It is the prediction error, not the absence of reinforcement, that is necessary for the destabilizaiton of conditioned fear memories.
For the translation of reconsolidation-based research into clinical practice, simply generating a fear response or reactivating a patient’s memory may not trigger reconsolidation of the target memory trace.
An optimal reactivation session should involve some kind of prediction error.
Prediction errors could
Is depression an adaptation? - summary of an article by NesseIs depression an adaptation?
Article by: Nesse, R. M. (2000)
Archives of General Psychiatry, 57, 14-20
In difficult situations, pessimism and lack of motivation may give a fitness advantage by inhibiting certain actions, especially:
Here are three causes for manifestations of disease
Correcting a defect is almost always useful, but blocking a defence can be harmful.
Depression is painful and interferes with normal function.
Other useful capacities such as pain, nausea and fatigue, are also aversive and disruptive.
Their very aversiveness is likely a product of natural selection, probably because they promote escape and avoidance of situations that decrease fitness.
From that perspective, the intrinsic aversiveness of most low mood and depression suggest that they may be related to defence.
The epidemiology of mood disorders.
If depression were rare, and had symptoms unrelated to the experiences of most people, this would suggest it was a disease unrelated to any defence.
But this issn’t the case.
There is no point of rarity in the distribution that can differentiate pathologic from non-pathologic depression.
The incidence of depression is highest at the ages where reproductive value peaks, a pattern characteristic of few diseases.
Defences are regulated by cues associated with situations in which they are useful, defects are not.
The regularity of the relationship between loss and negative affect and the proportionality of low mood to the magnitude of a loos imply that mood is regulated.
The relationship of depression to events is less consistent. This suggests that many depressive episodes are not defences.
Signalling benefits of several kinds have been attributed to low mood or
.....read more Genotype–environment correlations: Implications for determining the relationship between environmental exposures and psychiatric illness - summary of an article by Jaffee and PriceGenotype–environment correlations: Implications for determining the relationship between environmental exposures and psychiatric illness
By: Jaffee, S. R., & Price, T. S. (2008)
Psychiatry, 7, 496–499
Psychological risk factors for psychiatric illness are moderately heritable.
This has two implications
There are three types of genotype-environment correlation
These forms of genotype-environment correlation differ from gene-environment interaction (GxE), which refers to genetic differences in sensitivity to particular environmental effects.
Twin and adoption studies demonstrated that putative environmental measures are heritable.
These include many environments that are associated with psychiatric illness, including:
The weighted heritability of these environments ranges from 6 to 39%, with most ranging from 15 to 35%.
When a study involves child twins reporting their experiences, genetic influences on the putative environment reflect the extent to which the child’s genetic propensities elicit or evoke that experience.
When studies involve samples of adult twins reporting their experiences, genetic influences on the putative environment reflect the extent to which the adult’s genetic propensities modify or create that experience.
Environments are heritable because genotype influences the behaviours that evoke, select, and modify features of the environment.
Environments less amenable to behavioural modification tend to be less heritable.
Molecular studies measure genotype directly.
It may be possible to identify specific genotypes that correlate with environmental variables.
The subjective experience of emotion: A fearful view - summary of an article by LeDoux and Hofmann (2018)The subjective experience of emotion: A fearful view.
LeDoux, J. E. & Hofmann, S. G (2018)
Current Opinion in Behavioral Sciences, 19, 67–72.
doi:10.1016/j.cobeha.2017.09.011.
The subjective emotional experience, the feeling, is the essence of an emotion.
Objective manifestations in behaviour and in body or brain physiology are, at best, indirect indicators of these inner experiences.
The most direct way to assess conscious emotional feelings is through verbal self-report.
Because behavioural and physiological responses are important contributors to emotions, and the circuits underlying these are highly conserved, studies of animals have an important role in understanding how emotions are expressed and regulated in the brain.
Scientific assessments of inner experiences require some form of self-reporting.
People can typically give either a verbal or a nonverbal report of information to which they have introspective access, but cannot provide a verbal report of information that is only processed non-consciously.
Verbal self-report remains the gold standard in studies of consciousness.
It is most suitable for assessing the content of immediate experiences rather than remembered experiences.
It is less useful for assessing the motivations underlying actions.
The neuro-Darwinian Approach: subjective fear is an innate state of mind inherited from animal ancestors
Darwin defined emotions as innate ‘states of mind’ that humans have inherited from animal ancestors, and that, when aroused, cause the expression of so-called emotional behaviours.
Neuroscience proponent
Views emotions as subjective feelings that emerge from a subcortical neural circuit that is highly conserved across mammals, including humans.
The circuit is centered on the amygdala and related subcortical areas.
The amygdala circuit, when activated by a threat to well being, both gives rise to fearful feelings and controls innate behaviours and supporting physiological responses that help the organism defend against harm.
Cognitive elaboration of subcortical fear by higher-cortical prefrontal circuits makes possible introspection and verbal reports of fear in humans. The core of fear is the inherited mental state arising from the subcortical circuit.
Problematic for this view is the evidence suggesting that the experience of fear is not embodied in the amygdala.
The amygdala can respond to threats without the person knowing the threat is present and without feeling fear.
Also, fear can be experienced when the amygdala is damaged.
Social anxiety disorder: A critical overview of neurocognitive research - a summary of an article by Cremers & RoelofsSocial anxiety disorder: A critical overview of neurocognitive research.
Cremers, H. R., & Roelofs, K. (2016).
WIREs Cognitive Science, 7, 218-232
doi: 10.1002/wcs.1390
Social anxiety disorder is a common disorder characterized by a persistent and excessive fear of one or more social or performance situations.
Behavioural inhibition is one of the early indicators of social anxiety and may advance into a certain personality structure and the development of maladaptive cognitive biases.
Several large-scale brain networks related to emotion, motivation, cognitive control, and self-referential processing have been identified, and are affected in social anxiety.
Social anxiety is also characterized by increased cortisol response and lower testosterone levels.
These neuroendocrine systems are related to altered connectivity patterns.
Social anxiety disorder (SAD) is characterized by a persistent fear of one or more social or performance situations with exposure to unfamiliar people or to possible scrutiny by others.
A person with SAD fears that he or she will act in a way that will be humiliating or embarrassing.
Expose to the feared situations almost invariably provokes anxiety.
Social situations are either avoided or endured with intense anxiety or distress.
The diagnosis of SAD requires that the condition interferes substantially with the person’s normal routine.
Research on personality traits and the development of social anxiety stresses the dimensional nature of social anxiety.
Traits related to emotional processing, much as neuroticism and extraversion are critical.
The heritability of social anxiety can, to a large extend, be explained by the heritability of these personality traits.
The relationship between personality factors and (social) anxiety development may be interpreted in a merely probabilistic manner.
Personality traits may simply capture some aspects of (social) anxiety and therefore naturally show covariation.
A three-factor solution for social anxiety
Such factors just pertain to the population, not the individual.
Developmental and cognitive models
Behavioural inhibition (BI): a temperamental trait referring to reactions of a child when confronted with novel situations and unfamiliar people.
One of the earliest developmental indications of social anxiety.
During the course of a child’s development, social anxiety may progress from such initial behavioural indicators, to increasing levels of self-consciousness and
.....read more Hormones and psychiatric disorders - summary of part of Why zebras don't get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated by SapolskyWhy zebras don't get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated
By: Sapolsky, R. M. (2004).
New York: Henry Holt.
As the master gland, the brain can experience or think of something stressful and activate components of the stress-response hormonally.
Some of the hypothalamus-pituitary-peripheral gland links are activated during stress, some inhibited.
Two hormones vital to the stress-response released by the sympathetic nervous system:
Another important class of hormones in the response to stress are called glucocorticoids.
These are steroid hormones secreted by the adrenal gland.
Back the epinephrine activity up over the course of minutes to hours.
Because the adrenal gland is basically witless, glucocorticoid release must ultimately be under the control of the hormones of the brain.
When something stressful happens or you think a stressful thought, the hypothalamus secretes an array of releasing hormones into the hypothalamic-pituitary circulatory system that gets the ball rolling.
The principal such releaser is CRH (coticotropin releasing hormone).
A variety of minor players synergize with CRH
Withing fifteen seconds, CRH triggers the pituitary to release ACTH (corticotrpin) in the bloodstream.
ACTH reaches the adrenal gland and (in a few minutes) triggers glucocorticoid release.
Together, glucocorticoids and the secretions of the sympathetic nervous system (epinephrine and norepinephrine) account for a large percentage of what happens in your body during stress.
In times of stress, your pancreas is stimulated to release a hormone called glucagon.
Glucocorticoids, glucagon, and the systematic nervous system raise circulating levels of the sugar glucose.
These hormones are essential for mobilizing energy during stress.
Other hormones are activated as well.
The pituitary secretes prolactin, which plays a role in suppressing reproduction during stress.
Both the pituitary and the brain secrete endorphins and enkephalins, which help blunt pain perception.
The pituitary secretes vasopressin (antidiuretic hormone), which plays a role in the cardiovascular stress response.
Various hormonal systems are inhibited during stress
The secretion of various reproductive hormones such as estrogen, progesterone, and testosterone are inhibited.
Hormones related to growth are also inhibited.
As are the secretin of insulin.
A few complications
Fight or flight response is a way of conceptualizing the stress-response as preparing the body for that sudden burst of energy demands.
This might be different in females.
In most species, females are typically less aggressive than males, and having dependent young often precludes the option of flight.
Some suggest that the female stress-response is about
Cortisol stress reactivity across psychiatric disorders: A systematic review and meta-analysis - summary of an article by Zorn. et al (2017)Cortisol stress reactivity across psychiatric disorders: A systematic review and meta-analysis
Zorn, J. V., Schür, R. R., Boks, M. P., Kahn, R. S., Joëls, M., & Vinkers, C. H. (2017)
Psychoneuroendocrinology, 77, 25–36.
doi:10.1016/j.psyneuen.2016.11.036
The hypothalamus-pituitary-adrenal (HPA) axis and its end product cortisol are essential for an adequate response to stress.
A dynamic cortisol response, marked by a rapid rise and decline in cortisol levels following stress, is thought to be adaptive and to facilitate adequate coping with perceived threats in the environment.
Changes in cortisol stress reactivity may increase susceptibility to the negative effects of stress.
Prolonged, excessive or insufficient activation of the HPA axis may lead to changes in the brain and may subsequently result in the development of psychiatric disorders.
There are sex-specific changes in cortisol stress reactivity for MDD and anxiety disorders.
Women with current MDD or an anxiety disorder exhibit a blunted cortisol stress response compared with healthy controls.
Men with current MDD or SAD show an elevated cortisol response.
For schizophrenia, the cortisol response to psychosocial stress is blunted in both male and female patients.
Influence of sex and sex hormones
Sex is an important factor when studying cortisol stress reactivity across psychiatric disorders.
Women in the luteal phase of the menstrual cycle have a similar cortisol response as men, while women in the follicular phase, menopause and those using oral contraceptives show blunting of the cortisol response.
Higher testosterone levels were associated with lower cortisol responses in men and higher progesterone levels had the same effect in women.
Despite the rise of sex hormones in response to acute stress, baseline levels of testosterone, estradiol and progesterone could partially explain sex differences in cortisol stress reactivity.
The cortisol stress response as a resilience marker
There is a dynamic cortisol stress response in relation to psychiatric illness.
The response was altered in patients with current MDD or an anxiety disorder.
Recurrent episodes of MDD change the cortisol response more permanently.
Women with current MDD or an anxiety disorder exhibit a blunted cortisol response to psychosocial stress compared to healthy controls.
Male patients with current MDD or SAD show an elevated cortisol response to psychosocial stress.
Cognitive theories of emotion - summary of chapter 3 of Cognition and emotion: form order to disorderCognition and emotion: form order to disorder
Power, M & Dalgleish, T (2015)
Chapter 3
Cognitive theories of emotion
Two main groups of theories
The starting point for the theories to be presented is an attempt to provide a cognitive account of normal emotions.
Zajonc argued that the initial procession of stimuli assesses the affective tone of the stimulus as positive or negative, safe or threatening, and that ‘cognitive’ processes occur subsequent to this affective processing.
Dimensions
There have been several related proposals that have focused on dimensions such as valance and arousal.
Subsequent theories have divided up the dimensions of valence and arousal.
Gray argued that the arousal system is in fact two separate systems
Watson argued that the Valence dimension should be divided into two separate orthogonal dimensions, one of which is positive and the other negative (instead of bipolar)
Although studies of self-reported emotion and affect have been taken to support the dimensional structure of emotion (with most support for two separate dimensions of Valence and Arousal), there are a number of short-comings of these studies in relation to measurement problems.
Basic emotions
Basicness means that there is a small handful of core human emotions.
This provides a framework within which to divide up, integrate and organize the confusion of our emotional experience.
Also provides a way into other important approaches to emotions (such as evolution) and the foundations for a bridge between the study of human emotions and research into the emotional experiences of other species.
The concept of emotion includes an event, a perception or interpretation, an appraisal, physiological change, a propensity for action, and conscious awareness.
Emotion as a paradigm could embrace overt
.....read more Cognitive theories of emotional disorder - summary of chapter 4 of Cognition and emotion: from order to disorderCognition and emotion: from order to disorder
Power, M. & Dalgleish, T. (2015).
Chapter 4
Cognitive theories of emotional disorder
There are a number of influential cognitive approaches toe motion that have their starting points to be disorders of emotion.
Cognitive approaches to the emotional disorders have typically focused on a specific disorder.
This carving up of the emotional disorders can lead to a false sense of disjointedness between the emotions in comparison to the more over-arching theories.
Learned helplessness
The role of perceived non-contingency plays an important role in the theory of learned helplessness.
The original theory focused on the key features of passivity and helplessness in the face of future events characteristic of depression.
Reformulated learned helplessness
Abramson added Weiner’s attribution theory to the original learned helplessness approach.
Although helplessness continued to be seen to arise from the perception of uncontrollability, the subsequent effects were now seen to depend both on the type and the importance of the event experienced, together with the explanation that the individual produced for the cause of the event.
The explanatory style dimensions focused on three of Weiner’s attributional dimensions
The combination of these dimensions led to the proposal that the emotional, motivational and cognitive deficits seen in depression could be accounted for by a particular set of attributions following the occurrence of a negative event.
The crucial type of attribution style that is identified as a vulnerability factor for depression is if the individual makes internal-stable-global attributions for the causes of negative events and external-unstable-specific attributions for positive events.
An internal attribution for a negative event leads to low self-esteem, especially if other individuals are perceived not to be helpless in such a situation (personal helplessness).
The additional stable and global attributions for negative evens add to the chronicity and the generality of the deficits observed in depressed individuals.
It is possible that depressogentic implicit attributional tendencies are not being detected by the routine
.....read more A cognitive approach to panic - summary of an article by Clark (1986)A cognitive approach to panic
Clark, D. M. (1986).
Behaviour Research and Therapy, 24, 461-470.
Within this cognitive model, panic attacks are said to result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those involved in normal anxiety responses but also include other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are.
A panic attack consists of an intense feeling of apprehension or impending doom which is of sudden onset and which is associated with a wide range of distressing physical sensations. Panic attacks occur in both phobic and non-phobic anxiety disorders.
It is proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those which are involved in normal anxiety responses. The misinterpretation is perceiving these sensations as much more dangerous as they really are.
A wide range of stimuli can provoke a panic attack. These stimuli can be external and internal. If these stimuli are perceived as a threat, a state of mild apprehension results. This state is accompanied by a wide range of body sensations. If these anxiety-produced sensations are interpreted in a catastrophic fashion, a further increase in apprehension occurs, which produces a further increase in body sensations.
In the case of an ‘out of the blue’ panic attack, the trigger often seems to be the perception of a bodily sensation which itself is caused by a different emotional state or for example caffeine.
Other sensations than bodily sensations can also play a role in panic, particularly as triggering stimuli. Like the interpretation of mental processes.
Modification of information processing biases in emotional disorders: Clinically relevant developments in experimental psychopathology - summary of an article by Baert, Koster and de Raedt (2011)Modification of information processing biases in emotional disorders: Clinically relevant developments in experimental psychopathology
Baert, S., Koster, E. H. W., De Raedt, R. (2011)
International Journal of Cognitive Therapy, 4, 208-222
Experimental psychopathology has provided abundant evidence to suggest information-processing biases in anxiety and depression.
Cognitive bias modification (CBM) procedures are specifically designed to modify dysfunctional processing for those circumstances where patients are depleted form intentional control to override the bias. Through repeated practice, CBM intends to alter former biases and automate new, more adaptive cognitive processes. It holds potential in the treatment of anxiety and depression.
Research on information-processing in emotional disorders has predominantly been guided by the cognitive schema theory proposed by Beck and Bower’s associative network theory.
Beck’s cognitive schema theory.
Information-processing is guided by schema’s, defined as memory structures which, based on previous experiences, contain and organize information about the self, the world, and the future These schema’s are thought to bias encoding of information. Specific information processing biases at the level of attention, interpretation, and memory mediate incoming information and subjective experience. Eventual experience is considered to be the product of both bottom-up processing of the environment as well as top-down processing involving selection, abstraction, interpretation and elaboration. In the case of anxiety and depression, emotional information-processing will influence experience in a negative way, causing maladaptive emotional responses. These negative experiences further reinforce the maladaptive schemas.
It is thought that the active ingredients of cognitive behavioural therapy (CBT) act through modification of maladaptive cognition. Mostly, these techniques work by identifying maladaptive beliefs and negative thoughts and substituting these more adaptive ideas. CBT emphasizes the presence and content of schema-incongruent information that disconfirms former beliefs, which subsequently leads to new experiences that evoke or strengthen more adaptive schema’s.
The reciprocal influence between CBT and information processing bias has received scare attention. Information-processing biases may act as a barrier in CBT.
Information processing biases often act involuntarily and occur outside of conscious awareness. Although a change in controlled processing can lead to a change in automatic processing, this would require fulfilment of a least two crucial conditions. These are: 1) Using effortful control in situations of stress and negative mood. But, cognitive resources might not be sufficiently available. And 2) The individual must be motivated to do so. One possible direction is to include procedures modifying biases that are out of the patient’s voluntary control.
.....read more Attention - summary of (part of) chapter 2 of Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatmentCognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment
Harvey, A., G., Watkins, E., Mansell, W., Shafran, R. (2004)
Chapter 2
Attention
Out experience at any one point is dominated by some stimuli at the expense of others.
Selective attention is a process by which specific stimuli, within the external and internal environment, are selected for further processing.
Further processing may be reasoning, thought, or the generation of a plan of action. These processes are not to be confused with selective attention itself.
Selective attention is the internal filtering of stimuli. S
Attentional bias: a systematic tendency to attend (or avoid attending) to a particular class of stimuli.
The processes of selective attention have been divided into
This might be a continuum.
Most everyday behaviours are triggered, and often maintained, in an automatic manner such that they free up resources and thereby maximize the efficiency with which we operate the world.
Self-focused attention is an awareness of self-referent, internally generated information that stands in contrast to an awareness of externally generated information derived through sensory receptors.
Self-focused attention includes awareness of
Self-report measures
Asking people.
Self-report measures index how much the individual reports attending to the stimulus identified.
Advantages
Drawbacks to self-report
The emotional stroop task
It has been proposed that the participants’ selective attention to the content of
.....read more Thought - summary of (part of) chapter 5 of Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatmentCognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment
Harvey, A., G., Watkins, E., Mansell, W., Shafran, R. (2004)
Chapter 5
Thought
Metacognitive processes and beliefs: those concerned with the appraisal, monitoring or control of thinking itself
Intrusions are spontaneous, unwanted, unbidden, uncontrollable and discrete thoughts, images, or urges that are attributed to internal origins.
Many intrusive thoughts involve memories.
Intrusions are normal and universal.
What distinguishes normal form abnormal intrusions is that clinical intrusions tend to be experienced as more intense, more uncomfortable, and less controllable.
Patients differ in their appraisals and responses to intrusions compared to controls.
They tend to view them as more meaningful and important, and are more likely to act in response to them.
Two particular responses to intrusions are unhelpful
Forms of intrusions
Intrusions can occur in the form of
Images
Images are contents of consciousness that possess sensory qualities. They usually provide a perceptual-like analogue of some or all of the sensory aspects of a real-world experience.
Images are particularly potent at evoking emotional and physiological responses and at influencing the development of coping plans and the implementation of behaviour.
Verbal thoughts and images each influence and lead onto the other.
Urges
An urge is the internal experience of a desire to perform a particular act.
They can be induced by exposure to the object of the desire, contextual cues associated with the behaviour, emotional triggers and imagining performing an action or imagining a desired outcome.
The majority of psychological disorders are characterized by disorder-specific intrusive thoughts.
Intrusive thoughts are triggered by conditioned associations at either a sensory or a meaning level.
Stimulus or response cues associated with the content of the intrusion can trigger the intrusion.
One response to an intrusive thought is to further dwell on the subject matter of the intrusion, trying to work through or resolve it.
This is likely if the intrusion is
Anxiety disorders in children and adolescents: Nature, development, treatment and prevention - summary of chapter F1 of e-Textbook of Child and Adolescent Mental Health. IACAPAP e-Textbook of Child and Adolescent Mental Health.
J. M. Rey (2018)
Chapter F.1
Anxiety disorders in children and adolescents: Nature, development, treatment and prevention.
In the child and adolescent fields, there is a more common tendency to examine disorders as a whole.
Externalizing disorders are disorders in which people act out inner conflict or emotions. Internalizing disorders reflect problems with the self.
The core feature of anxiety disorders is avoidance. In most cases, this includes overt avoidance of specific situations, places or stimuli. It may also involve subtle forms of avoidance such as hesitancy, uncertainty, withdrawal, or ritualized actions. The key difference between specific disorders is the trigger for this avoidance. The avoidance is generally accompanied by affective components of fearfulness, distress or shyness. Some children may have difficulty verbalising these emotions.
Anxiousness occurs due to an expectation that some dangerous or negative event is about to occur. In identifying the anxious child, it is crucial to determine that the avoidance occurs due to an expectation of some form of threat. All of the anxiety disorders will involve an anticipation of threat, which may take the form of worry, rumination, anxious anticipation, or negative thoughts. The key differences between disorders lie in the content of these beliefs. In addition to the beliefs, behaviours and emotions, anxious children will often report a range of associated physical complains reflecting heightened arousal. These are rarely specific to a given disorder.
Physical symptoms that are common among anxious children include: Headaches, stomach aches, nausea, vomiting, diarrhoea, and muscle tension. It is common for many anxious children to have difficulty with sleep.
Anxiety-related disorders
Children with obsessive compulsive disorder (OCD) report repetitive and intrusive thoughts, images or urges, often accompanied by repeated characteristic actions or behaviours with the goal of reducing anxiety. The mental components commonly focus on some expected threat or danger, although sufferers from some forms of OCD might focus more one a sense of disgust and a belief that certain actions simply ‘feel right’. When a threat expectation exists, the corresponding rituals are generally aimed at preventing or undoing the expected danger.
Many children are unable to clearly describe their beliefs and motivations.
Post-traumatic stress disorder involves a constellation of symptoms of heightened arousal, intrusions, detachment, and avoidance that occur following a severe event. Post-traumatic stress disorder is relatively infrequent in childhood.
School refusal
School refusal is not a formal diagnosis.
School refusal is not an anxiety disorder and may be motivated by many factors aside from anxiety.
.....read more Depression in children and adolescents - summary of chapter E.1 of Textbook of Child and Adolescent Mental HealthIACAPAP e-Textbook of Child and Adolescent Mental Health.
J. M. Rey (2018)
Chapter E.1
Depression in children and adolescents
Prevalence varies depending on the population, the period considered, informant, and criteria used for diagnosis. Most countries concur that about 1 to 2% of pre-pubertal children and about 5% of adolescents suffer from clinically significant depression at any one time. The cumulative prevalence (accumulation of new cases in previously unaffected individuals) is higher.
Gender and culture
The ratio of depression in males and females is similar in pre-pubertal children. It becomes about twice as common among females during adolescence.
Burden of illness
Depression poses a substantial burden to the individual suffering from this disorder and the society at large. Interpersonal relationships are particularly likely to suffer when someone is depressed. Depression is likely to progress into a chronic, recurring disease if not treated.
The burden of depression is increased because it appears to be associated with behaviours linked to other chronic diseases, although the nature of this association is unclear.
Depressed patients can display symptoms of depression at any age. The pattern varies slightly according to developmental stage.
Age at onset does not seem to define separate depressive subgroups. Earlier onset is associated with multiple indicators of greater illness burden in adulthood across a wide range of domains.
Adolescents often have a reactive affect and can, with effort, hide their symptoms.
Course
Clinical depression in youth follows a recurring course. An episode of depression in clinically referred patients last 7 to 9 months on average, but it can be shorter in non-referred community samples. Depressive episodes are, on average, a spontaneously remitting illness. Recurrence is high even after treatment.
Predictors of recurrence include: poorer response to treatment, greater severity, chronicity, previous episodes, comorbidity, hopelessness, negative cognition style, family problems, low socioeconomic status, and exposure to abuse or family conflict
Different types of depression may have implications for treatment and prognosis.
The etiology of depression is complex, multifactorial, and the object of much academic argument.
Depression in youth appears to be the result of complex interactions between biological vulnerabilities and environmental influences. Biological vulnerabilities may result from children’s genetic endowment and form prenatal factors. Environmental influences include children’s family relationships, cognitive style, stressful life events, and school and neighbourhood characteristics.
Comorbidity is the simultaneous occurrence of two or more distinct illnesses in the one individual. Depression comorbid with other disorders frequently in children and adolescents.
Berkson effect: comorbidity is particularly the cause in clinical settings because the likelihood of referral is a function of the combined likelihood of referral for each disorder individually.
Patients with comorbid disorders show greater impairment than those with a single diagnosis. It is also associated with worse adult outcomes.
Psychiatric disorders that often
.....read more Interpersonal processes in social phobia - summary of an article by Alden & Taylor (2004)Interpersonal processes in social phobia
Alden, L. E., & Taylor, C. T. (2004)
Clinical Psychology Review, 24(7), 857-882
Social phobia involves anxiety-related symptoms and is an interpersonal disorder. It is a condition in which anxiety disrupts the individual’s relationships with other people.
Social anxiety is conceptualized and measured in somewhat different ways across various domains.
Interpersonal models share the assumption that good social relationships contribute to psychopathology. The self-perpetuating interpersonal cycle means that we tend to expect people in the present to treat us in the same way that people have in the past and we tend to repeat the behavioural strategies we learned to handle those earlier events. Our behaviour exerts a pull on other people that tends to evoke responses that maintain our social assumptions, expectations, and behavioural patterns.
Dysfunctional patterns are the result of an ongoing interaction between the individual and the social environment. This is a social developmental process that begins early and continues throughout the lifespan. Our relationships shape our sense of self and others.
People with social anxiety disorder have fewer social relationships than other people.
Social anxiety is associated with a variety of dysfunctional strategies in relationships, including strategies of non-assertiveness and avoidance of emotional expression and conflict. Socially anxious people also reported over-reliance on others.
Even when people with social anxiety develop relationships, they view those relationships as less intimate, functional and satisfying than do people without social anxiety.
Socially anxious people behave in ways that lead to negative social outcomes. People with social phobia may establish negative interpersonal cycles between themselves and others in which they adopt behavioural strategies that evoke negative reactions.
Behavioural patterns
The behaviours most commonly associated with social anxiety are: low social skill, non-assertiveness, visible anxiousness and some studies also found differences between socially anxious and non-anxious people on specific anxiety-related micro behaviours
Socially anxious individuals can appear less skilful and more anxious than other people.
Other researchers report evidence of critical or angry behaviour in socially anxious samples.
Others’ reactions
People with psychological problems often
.....read more Interpersonal processes in depression - summary of an article by James, Hagan & Joiner (2013)Interpersonal processes in depression
James, J. L., Hagan, C. R., & Joiner, T. E. (2013)
Annual Review of Clinical Psychology, 9, 355-377
Humans have an intrinsic need for social connection, so it is crucial to understand depression in an interpersonal context.
Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases the risk for future depression.
Depression impacts how individuals interact with people in their environment. Some symptoms of depression are inherently likely to produce interpersonal distress and impairment. These symptoms could help maintain the current episode and create a troubled interpersonal context that could potentially trigger future episodes of depression.
Depression is persistent disorder within acute episodes.
Differences have been identified are in: the amount of facial expression (more animated facial expressions to express sadness in depressed individuals), eye contact (less in depressed individuals), posture (depressed individuals hold their head downward and engage in more self-touching), non-verbal gestures (less in depressed individuals). The extent to which people demonstrate these deficits had been linked to the severity of their depressive state.
Following treatment or the remission of a major depressive episode, these behavioural features of depression tend to show improvement.
While communicating and interacting with others, depressed individuals have been found to speak more slowly and with less volume and voice modulation. Their voices have been perceived more negatively. They also produce a lesser number of social interpersonal actions. When they do interact, they tend to be much more negative in their chosen topics and self-disclosure negative feelings.
Depression is associated with social skills deficits. The social skills deficits that have been linked with depression may be a product of the basic behavioural features and communication behaviours that are associated with depression.
Social skills impairments have been viewed as more state-like than trait-like. Social skills deficits operate as a vulnerability to depression that only becomes problematic in the presence of a significant stressor.
The relationship between social skill deficits and later depression is mediated by the presence of relations with others.
.....read more Familial and social environments in the etiology and maintenance of anxiety disorders - summary of an article by Hudson & Rapee (2009)Oxford handbook of anxiety and related disorders
Hudson, J. L., & Rapee, R. M. (2009)
Familial and social environments in the etiology and maintenance of anxiety disorders.
Factors in the individual’s environment are likely to provide understanding of why one vulnerable individual may develop anxiety disorder and another may not. It is an individual’s specific environment (non-shared) that accounts for the most environmental influence.
Individuals with specific genetic vulnerabilities may elicit particular environments. Individuals at genetic risk who are exposed to a relevant environmental factor may show an increased morbidity.
Parenting
There is a link between avoidance of threatening stimuli and the maintenance of anxiety disorders. Parenting behaviours that serve to accommodate or enhance avoidant strategies are likely to impact on the maintenance of anxiety disorders. They may also contribute to the development of anxiety disorders in individuals with an existing anxious vulnerability.
There is a positive relationship between the anxiety disorders and parenting that is controlling, overprotective, or lacking in autonomy granting. The ultimate consequence of overprotective parenting is that the child avoids potentially threatening situations and is prevented from potentially learning the situation is not as dangerous as predicted or she or he is able to exert some control in the situation.
There is some evidence that parenting high in negativity and rejection and low in warmth is also associated with anxiety disorders.
Temperamental factors interact with parent behaviour and play a role in eliciting overprotective parenting. An anxious child may elicit increased involvement and help from their environment. This increased help will serve to decrease the child’s autonomy and increase avoidance of novel anxiety-provoking situations and ultimately maintain the child’s vulnerability to anxiety.
Overprotection/control and rejection/negativity may reduce the child’s opportunity to approach novel situations and to experience confidence and independence.
Parents of anxious children are more likely to support avoidant responding to ambiguously threatening stimuli.
Summary
The key parenting variables that have been associated with anxiety disorders are parenting that is: overprotective/controlling and lacking autonomy granting, negative and lacking warmth and parenting that enhances the child’s avoidance of ambiguously threatening situations. These parenting variables are of most importance in the context of a temperamentally vulnerable child.
Family environment
There are a number of more general facets of the family environment that may be of interest in the development of anxiety disorders. These are cohesion, inter-parental conflict and stressful and negative family environments
There
.....read more Anxiety and mood disorders, uva
In this magazine, you can find what you need to excell at anxiety and mood disorders in the third year of psychology at the uva.
Anxiety and mood disorders 
This is a magazine about anxiety and mood disorders
Clinical psychologyThis is a magazine about clinical psychology
Methodology, design, and evaluation in psychotherapy research - a summary of chapter 2 of Bergin and Garfield’s Handbook of psychotherapy and behavior change 
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
The efficacy and effectiveness of psychotherapy - summary of chapter 6 of Bergin and Garfield’s Handbook of psychotherapy and behavior change By Lambert, M.J. 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
Differential diagnosis step by step - summary of chapter 1 of DSM-5 Handbook of differential diagnosisDSM-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 more Gedragstherapie - samenvatting van fragmenten uit inleiding in de gedragstherapieInleiding 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 - samenvatting van een artikel van Leijssen (2015)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 more Een therapeutische relatie - samenvatting van een artikel uit Gids voor Gesprekstherapie van Leijssen (1999)Gids 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 more Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda - summary of an article by Arntz (2012)Imagery 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 more Imagery Rescripting for Posttraumatic Stress Disorder - a summary of chapter 9 of Working with emotion in cognitive behavioural therapy Working 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:
Imagery Rescripting for Personality Disorders: Healing early maladaptive schemas - summary of chapter 8 of Working with Emotion in Cognitive Behavioral TherapyWorking 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
Mindfulness en Psychotherapie - samenvatting van een artikel uit Leerboek psychotherapieLeerboek 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 - summary of an article by Holzel, Lazar, Gard, Schuman-Olivier, Vago and Ott (2011)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) - summary of an article by Jansen, Rinsampessy, van den Berg en de MeyBewegen 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 - a summary of an article by Kendler, Muñoz & Murphy (2010) 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 more Emotional processing during experiential treatment of depression - summary of an article by Pos, Greenberg, Goldman & Korman (2003)Emotional 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 more Emotion-focused Therapy - a summary of an article by GreenbergEmotion-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 more Theoretisch model: schema’s, copingstrategieën en modi - samenvatting van hoofdstuk 3 uit handboek schatherapieHandboek 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).
Schema therapy - summary of chapter 5 of Science and practice in cognitive therapy. Foundations, mechanisms, and applicationsScience 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
Psychoanalytical psychotherapies - summary of chapter 2 of Current psychotherapiesCurrent 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 more Articlesummary with Research on the treatment of couple distress by Lebow a.o. - 2012Research 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 more Psychometric perspectives on diagnostic systems - summary of an article by Borsboom (2008)Psychometric 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 more Het KOP-model. Een manier van denken, kijken en werken - samenvatting van een artikel van Rijnders & Heene (2015)Het 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 more A guided self-help intervention in primary care to improve coping and mental health: an observational study - summary of an atricle by Rijnders et al. (2016)A 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 more How does EMDR work? - summary of an article by Hout, & Engelhardt (2012)
How 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 more How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action - summary of an atricle by Landin-Romero et al (2018)How 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 more DSM-5 and psychotherapy - uvaIn this magazine, everything you need for the course DSM-5 and psychotherapy is bundled.
Clinical psychologyThis is a magazine about clinical psychology
Positie van DSM: Heden en verleden - samenvatting van hoofdstuk 1 van DSM-5 voorbij!DSM-5 Voorbij!
Hoofdstuk 1
Positie van DSM: heden en verleden
De DSM-5 staat voor de vijfde editie van de Diagnostic and Statistial Manual of Mental disorders.
Hierin staan alle mogelijke diagnosen die psychiaters gebruiken.
Het is een verzameling van categoriale diagnosen die voortdurend worden bijgesteld en die worden uitgedeeld aan telkens nieuwe generaties patiënten.
De DSM-3 brak met eerdere versies. Eerder versies hingen de psychoanalytica aan, en het uitgangspunt van een stoornis als reactie op de omgeving. Ook was er in de DSM-3 minder zicht voor onderliggende zaken.
De DSM-3 had een impliciete hersenreductionistische visie.
Het aantal stoornissen nam toe.
DSM-4 en 5 zijn niet meer dan verbijzonderingen van de algoritmen van de derde versie.
Veel mensen hebben iets te zeggen over de DSM.
Psychische klachten zijn zo goed als zichtbaar.
Iedereen is expert op het gebied van psychiatrie (omdat iedereen wel eens symptomen meemaakt).
De identiteit van mensen wordt gevoed door hun ervaringen, maar de psychiatrische diagnostiek probeert het te reduceren tot een label en –impliciet- een abstract en onbewezen breinprobleem.
De patiënt kan in verwarring komen en denken dat de medicatie een instrument is om zijn identiteit te veranderen.
Principes van de psychiatrische diagnostiek - samenvatting van hoofdstuk 2 van DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 2
Principes van de psychiatrische diagnostiek
Dingen waar diagnostiek in de psychiatrie niet voor is bedoelt:
Hier worden drie hoofdcriteria besproken waaraan een goed diagnostisch systeem aan in de psychiatrie aan dient te voldoen.
Het kan verwarrend zijn als er in de GGZ geen enkele vorm van gemeenschappelijke taal is.
Naast het unieke verhaal van de patiënt is het noodzakelijk om met elkaar een vorm van communicatie af te spreken, een gemeenschappelijke taal vast te stellen.
Diagnostiek kan worden gezien als de verbinding tussen het verhaal van de patiënt, en een formele uitspraak over zorgbehoeften en behandelindicaties.
Als er een taal is van diagnostische formuleringen, kunnen psychotherapie en psychofarmacologie worden gebruikt op een manier die zodanig generaliseerbaar is dat hulpverleners opleiding kunnen ontvangen over wanneer welke behandeling toegepast moet worden, voor hoelang en onder welke voorwaarden.
Diagnostiek kan worden beschouwd als het medisch instrument on menselijk lijden te objectiveren en te rubriceren, zodanig dat ordening ontstaat in het kader van een therapeutisch model.
Diagnostiek is waardevol indien ze informatie verschaft over de zorgbehoeften in het therapeutisch model, en voorspellende waarde heeft met betrekking tot het beloop van de klachten, de prognose.
Is het nuttig voor de patiënt?
Het is belangrijk dat de patiënt zich in de diagnose herkent.
Nuttig voor de patiënt impliceert in de psychiatrische praktijk dat de diagnose bruikbare informatie geeft, binnen de context van het verhaal van de patiënt.
Diagnostische informatie wordt bruikbaar als deze aanwijzingen geeft over
Dit kan alleen als er een verband is tussen de diagnose en de zorgbehoeften van de patiënt.
Elke patiënt heeft een unieke mix van zorgbehoeften, dus met een diagnose alleen kom je niet ver, deze classificeert alleen.
Ook zijn zorgbehoeften niet specifiek voor een bepaalde diagnose.
Het echte proces is niet het zoeken naar het best passende label, maar
.....read more Principes van behandeling in de GGZ - samenvatting van hoofdstuk 3 van De DSM-5 voorbij!De DSM-5 voorbij!
Hoofdstuk 3
Principes van behandeling in de GGZ
In de behandelprincipes van de GGZ zit een worsteling.
Het persoonlijke, kwalitatieve proces in de behandeling wordt aangeduid met het woord ‘herstel’, en gaat over het vinden van een zinvol bevredigend bestaan met een psychiatrische aandoening.
Herstel is van belang bij elk psychisch syndroom.
Het is vooral van belang bij kwetsbaarheid die voor langere duur tot expressie komt in iemands leven.
Het proces kent een aantal fasen
Bij herstel gaat het om zaken als het ontwikkelen van het eigen levensverhaal, autonomie en empowerment, hoop op verandering en erkenning van de eigen ervaringsdeskundigheid binnen en buiten de GGZ.
De attitude van de professional wordt van groot belang geacht in het begeleiden van het proces van herstel.
Bij dit proces past een professional die
De kwantitatieve benadering is gebaseerd op de gedachte dat patiënten aandoeningen hebben die kunnen worden geclassificeerd volgens de systematiek van de DSM, gesteund door objectieve wetenschappelijke bevindingen.
Op basis van kwantitatieve vergelijkingen bepaald de professional welke zorg zijn individuele patiënt met krijgen en voor hoe lang.
Het effect van de behandeling is mede afhankelijk van de therapietrouw van de patiënt.
De professional is hier dominant.
De professional kan moeite hebben dingen goed uit te leggen.
Zijn diagnosen goed uit te leggen?
Elke professional geeft een eigen invulling van de definitie-kwestie.
Hierdoor schieten zij de bedoelde ‘DSM taal’ voorbij.
Het belang van de diagnose is discutabel.
De fase van het kwalitatieve proces waarin de patiënt zich bevind is belangrijker dan de diagnose.
Hoe solide
.....read more Mijn ervaringen met de making of the DSM-5 - samenvatting van hoofdstuk 4 van DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 4
Mijn ervaringen met de making of the DSM-5
De verschillende DSM-werkgroepen zijn opgezet rond a priori-diagonstische groepen.
De deliberaties van de werkgroepen van de DSM zijn een vorm van hogere groepsdynamica, de uitkomst hangt in groet mate af van het proces in de groep en de interacties tussen individuen.
De groepen werken op basis van consensus waardoor verandering moeilijk is.
Na de debat kwam eruit dat de DSM-5 net zoals de DSM-4 het zou moeten doen met ouderwetse diagnostische criteria, gebaseerd op westers-etnocentrische symptoombeschrijvingen.
De vragen waren
Met psychische syndromen is er sprake van een veelheid van verschillende symptomen, die allemaal dimensioneel en categoriaal kunnen worden uitgedrukt.
Het grootste voordeel van de dimensionele diagnose is dat ze direct verwoordt hoeveel last de patiënt heeft van de voor hem relevante symptomen.
Dit geeft meer informatie over de zorgbehoeften dan de categoriale diagnostiek.
Ook heeft iedere patiënt een unieke combinatie van symptoomscores: hierdoor kun je niet stereotyperen.
Het zou criteria en hokjes-denken veranderen naar denken in gradaties en veranderlijkheid.
Toch zegen de andere werkgroepen de dimensionele diagnose niet zitten.
Het maakt het moeilijk met de verzekeringen en psychologen waren bang dat e minder geld voor hun patiënten kregen.
Sommige DSM-commissies stemden om psychopathologie niet zozeer als categorieën of symptoomscores te zien, maar als levende netwerken van op elkaar inwerkende ervaringen.
Dit gaat uit van het idee dat psychische klachten elkaar beïnvloeden in de loop van de tijd, en dat iedere persoon na verloop van tijd zijn eigen unieke kluwen van klachten ontwikkeld.
Iedereen bouwt allengs zijn unieke kluwen van symptomen, in respons op veranderingen in de omgeving. Het kan nuttig zijn deze kluwen in kaart te brengen zodat de mensen er meer grip op kunnen krijgen.
Dit systeem heeft het niet gehaald om in de DSM te komen.
Een risicosyndroom is dat je niet de ziekte zelf
.....read more Na de marktwerking: DSM-gewijs snoeien van de GGZ - samenvatting van hoofdstuk 6 van DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 6
Na de marktwerking: DSM-gewijs snoeien van de GGZ
De GGZ is overgelaten op de marktwerking.
Net als de introductie van de marktwerking zonder inhoudelijke voorstudie of wetenschappelijke consultatie was uitgevoerd, zo werd ook een berg van ad hoc-maatregelen uitgestort over de GGZ om het risico voor zorgverzekeraars te beperken. Dit was zonder serieuze poging om de gevlogen voor patiëntenzorg en hulpverlening eerst in kaart te brengen.
Het effect: meer onderbehandeling van degenen die de zorg het meest nodig hebben en grote verwarring in het veld.
Een aantal van de ad-hoc maatregelen.
Hierdoor wordt overbehandeling niet aangepakt en onderbehandeling erger.
Een andere maatregel was gedwongen participatie aan het grootste kwantitatieve onderzoek in de historie van de Nederlandse GGZ.
Er ontbreken harde criteria om de kwaliteit van de GGZ-aanbieder te beoordelen.
De beleidsmedewerkers bedachten een nationale, verplichte dataverzameling bij patiënten, op basis waarvan uit te maken zou zijn wie goede en wie slechte zorg levert.
Het ‘benchmarken’ van instellingen en behandelaars.
Stichting Benchmark GGZ (SBG) werd bekostigd door de zorgverzekeraar.
De zorgverzekeraars dwongen de GGZ-instellingen in heel Nederland om bij hun patiënt materiaal op symptoomniveau te verzamelen en over te dragen.
Het idee is dat de behandelaar dat toch al doet via de Routine Outcome Monitoring (ROM), waarbij de klachten van patiënten met een symptoomlijst voor en na behandeling systematisch in kaart worden gebracht zodat de behandelaar op gezette tijden kwantitatieve feedback creëert over hoe het met de patiënt gaat over verloop van tijd.
Dit is echter maar één van de informatiebronnen die de behandelaar gebruikt bij het plannen van de behandeling.
De ROM kan geen reductie van de symptomen laten zien, terwijl de patiënt wel beter is geworden (door bijvoorbeeld omgaan met klachten).
Groepsvergelijkingen op basis van ROM-data zijn alleen zinvol in een zeer lokale context die de behandelaar in kwestie door en door kent.
ROM-data geeft geen informatie over de veelheid van variabelen die de individuele variatie in de behandelresponse veroorzaken, anders dan het effect
DSM-isatie van de GGZ - samenvatting van hoofdstuk 7 van DSM-5 voorbij!DSM-5 voorbij!
Hoofstuk 7
DSM-isatie van de GGZ
De toenemende nadruk op de diagnosen van de DSM is de psychiatrie gaan verkokeren en opgesplitst in subspecialisaties, zo’n beetje op het niveau van de hoofstukken van de DSM.
Dit geld ook voor de academische psychiatrie.
De richtlijnen zijn sterk verankert in de DSM-diagnostiek en mede gebaseerd op de spookdiagnosen van het categoriale denken.
Er wordt gedaan alsof elke ‘stoornis’ zijn aparte domein van super-specialistisch denken en zorg nodig heeft (geen oog meer voor transdiagnostiek).
Het gevolg van toenemende specialisering is een afname in generalistisch werken en daarmee ook een afname in algemene/generalistische competentie.
De organisatie binnen en tussen instellingen is georganiseerd langs diagnostische lijnen, waarbij het behandelaanbod versnipperd en vaak ongelijk verdeeld wordt over de verschillende onderdelen.
Dit geld ook in de academische wereld.
Het web van belangen rond de DSM-5 - samenvatting van Hoofdstuk 8 van DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 8
Het web van belangen rond de DSM-5
Belangen:
DSM en onderzoek: Wetenschap of waan van de dag? - samenvatting van Hoofdstuk 9 uit DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 9
DSM en onderzoek: Wetenschap of waan van de dag?
Twee zaken die beïnvloeden hoe de relatie van het brein en psychopathologie wordt gezien
Er wordt gedacht dat psychische stoornissen zijn terug te voeren op duidelijke onderliggende pathologische veranderingen in het brein.
Inmiddels begint men te erkennen dat dit concept niet beschouwd kan worden als valide wetenschappelijk uitgangspunt voor onderzoek en behandeling.
Het meest gebruikte paradigma in biologische psychiatrie is dat van de case control-studie.
Deze is gericht op het vinden van verschillen tussen ‘ziek’ en ‘normaal’.
Dit is een zwak paradigma, want als onderzoekers een groep patiënten nemen en een hoop vergelijkingen doen met een groep ‘supernormale’ controlepersonen komt er altijd wel wat uit.
De combinatie van hoge (technologische) kwaliteit en lage (conceptuele) kwaliteit van het onderzoek leidt tot een interessant fenomeen.
Het technologische vernuft overschaduwt de conceptuele zwakheid en men wordt opgewonden van het type onderzoek.
Neurocratie is het fenomeen van de technologische ‘wow’-factor die het beeldvormend onderzoek in de psychiatrie steevast oproept, waardoor inherente conceptuele zwakheden verhuld blijven achter de belofte die voortvloeit uit de significante vooruitgang in de basale neurowetenschap en de spectaculaire vooruitgang in technologische innovatie van het onderzoeksinstrumentarium.
De esthetische kritiekloze fascinatie voor hersenplaatjes van patiënten in de psychiatrie lijkt voort te komen uit twee factoren
De opbrengst van het breinmodel is gering.
Het is een model van de patiënt als ziek brein in plaats van de patiënt als drager van ervaringen.
Het basisgeloof: de dichotomie van biologisch versus psychosociaal
Er bestaat een informele hypothese die aan het onderzoek van psychische klachten ten grondslag ligt
De dichotomie.
Als het biologisch is is het niet sociaal en vice versa.
Dit is niet bewezen (en niet
Deconstructie van DSM-diagnosen tot menselijke variatie - samenvatting van hoofdstuk 10 van DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 10
Deconstructie van DSM-diagnosen tot menselijke variatie
Bij een kleine minderheid van patiënten met een diagnose schizofrenie is er sprake van een ongunstig beloop.
Er is sprake van stereotypering op basis van een DSM-label omdat de eigenschap van de uitzondering (zeer slecht beloop) wordt overgedragen op de hele groep.
De naam schizofrenie is een metafoor voor een gespleten persoonlijkheid, ook al heeft het er niets mee te maken.
Dit maakt het dat het ziektebegrip wordt geassocieerd met slechtheid.
Dit wordt weerspiegeld in de media.
Een stigmatiserende naam in het professionele classificatiesysteem kan voor complicaties zorgen, nog los van de klachten van stereotypering die patiënten ervaren in de maatschappij.
De confrontatie met een label dat andere mensen als beschamend ervaren kan resulteren in het overnemen van negatieve verwachtingen door de persoon zelf.
Het woord syndroom verwijst in de geneeskunde naar de situatie dat mensen een mix hebben van verschillende klachten, waarbij het niet duidelijk is of er sprake is van één onderliggende ziekte-entiteit of van meerdere onderliggende ziekten, of dat er misschien geen enkele specifieke ziekte-entiteit ten grondslag ligt aan de symptomen.
De symptomen zelf en hun onderlinge verbanden bepalen het beeld.
Dit past beter bij schizofrenie.
Een voordeel van een nieuwe naam met syndroom is dat het niet meer het pessimistische beeld uitdraagt van een deficitaire toestand maar in plaats daarvan ene beeld geven van kwetsbaarheid en plasticiteit (mogelijkheid tot verandering).
Dit geeft al hoop op verbetering.
Ondanks een naamverandering alleen blijft de rest van het DSM systeem hetzelfde.
Als je iets een naam geeft gaat dat ding, of het nou bestaat of niet, een eigen leven leiden.
Heel veel gezondheidsklachten kun je uitdrukken in termen van zowel een ziektecategorie als een dimensie van variatie.
Je kunt zeggen dat het arbitrair is om et kiezen voor normale variatie (dimensies) of voor het abnormale (categorieën)
Misschien is het handig te kijken naar wat het meest nuttig is.
In de praktijk van de geneeskunde is het nuttig om met gezondheidsklachten om te gaan in een flexibele mix van benaderingen.
De diagnose van de vragende wijs - samenvatting van hoofdstuk 11 uit DSM-5 voorbij!DSM-5 Voorbij!
Hoofdstuk 11
De diagnose van de vragende wijs
Psychopathologie gaat over menselijke variatie. Daarnaast hoort diagnostiek persoonlijk (idiografisch), functioneel (relevant voor verandering in psychische functies) en nuttig (informatief voor zorgbehoeften) te zijn.
Professionele diagnostiek moet ruimte bieden voor het fasegebonden proces van adaptatie en het kwalitatieve proces dienen.
De beste bescherming tegen overmatig leunen op de broze kennis van de diagnose-cum-richtlijn combinatie is te halen uit de vragende opstelling.
Empowerment is het proces waardoor mensen meer invloed verwerven over beslissingen en acties die van invloed zijn op hun gezondheid.
De beste manier om het vigerende hokjesdenken te vervangen door een ander concept is je af te vragen wat je zelf zou willen als je patiënt was.
We hebben een gemeenschappelijke taal nodig rond het vaststellen van zorgbehoeften en toepassen van behandelingen. Hierbij dient de nomothetische component van de diagnostiek (patiënten in hokjes stoppen) geminimaliseerd te worden en de idiografische component (factoren beschrijven die uniek zijn voor de cliënt) gemaximaliseerd.
In de diagnostische fase willen mensen niet uitsluitend gereduceerd worden tot de optelsom van algoritmische oplossingen van experts, maar ook een persoonlijke forumlering van hun lijden waar ze iets mee kunnen.
De persoonlijke forumlering dient zo te zijn opgesteld dat het de weg wijst naar eigenaarschap van de cliënt, in de wetenschap dat het proces van herstel moet uitmonden in de constructie van het eigen verhaal en het inzicht dat kwetsbaarheid weliswaar aanpassing vereist, maar niet in de weg hoeft te staan van betekenisvol zijn.
Gezondheid is het proces van adaptatie en zelfmanagement. De diagnose moet zich hierop focussen.
Open vragen, zonder preconcepties van hokjes, zijn nodig om de persoonlijke diagnose, en daarmee de weg naar het persoonlijke verhaal, mogelijk te maken.
Vragen is menselijk
Als we een vragende diagnostiek aannemen dan zal dat een boodschap geven en hulpverleners en patiënten een instrument aanreiken dat samenwerking beter mogelijk maakt.
Hierdoor geef je de patiënt, als drager van ervaringen, meer gewicht. Er wordt namelijk open gestaan voor het verhaal van de cliënt door het stellen van open vragen.
De kunst is om de vragen zo te stellen dat mensen het gevoel hebben dat ze serieus worden genomen. Dit werkt ‘empowerend’.
De
.....read more Vraag 1: wat is er met je gebeurt? - samenvatting van hoofdstuk 12 uit DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 12
Vraag 1: wat is er met je gebeurt?
Iemand belangstellend vragen wat de reden is van het geobserveerde lijden is een van de meest basale interpersoonlijke interacties.
Mensen hebben behoefte te vertellen wat hen is overkomen. Het is een goede manier om mensen iets van hun algemene stress, angst, en pijn te laten kanaliseren in de geruststellende aanwezigheid van een hulpverlener.
Ook een persoonlijke psychische crisis ontstaat om een reden. Alle psychische klachten hebben te maken met veranderingen in de omgeving, en dit geld ook voor herstel.
Hierom is het logisch mensen te informeren naar de situationele context van de crisis, en om daaruit met elkaar te gaan werken. Dit gebeurt niet als enkel DSM-symptomen worden uitgevraagd.
Symptomen ontstaan bij een ongunstige balans tussen kwetsbaarheiden weerbaarheid, klachten dienen daarom begrepen te worden in het perspectief van de recente en minder recente geschiedenis en de impact daarvan op kwetsbaarheid en weerbaarheid.
Het zoeken naar een reden is de eerste stap naar een oplossing.
Vraag 2: wat is je kwetsbaarheid en je weerbaarheid? - samenvatting van hoofdstuk 13 uit DSM-5 voorbij!DSM-5 voorbij!
Hoofdstuk 13
Vraag 2: wat is je kwetsbaarheid en je weerbaarheid?
Kwetsbaarheid is het peilgebied van de tweede vraag.
Hoe hebben de omstandigheden de kwetsbaarheid van de persoon geprikkeld? Hoe zijn symptomen ontstaan (uit de kwetsbaarheid?).
Symptomen geven aan in welke hoek kwetsbaarheid zich manifesteert.
Symptomen ontstaan wanneer kwetsbaarheid niet langer kan worden gecompenseerd met weerbaarheid.
Indicatoren van kwetsbaarheid en weerbaarheid bieden de basis om de balans te kunnen verschuiven van teveel kwetsbaarheid en te weinig weerbaarheid naar minder kwetsbaarheid en meer weerbaarheid.
Expressie van kwetsbaarheid kan aangeduid worden in termen van impact of psychische functies.
Symptomen zijn van belang om tot een diagnostische formulering van de onderliggende kwetsbaarheid en weerbaarheid te komen. Ze dienen te worden beschreven als een dimensionele variatie, omgevingsreactiviteit, impact van symptomen op elkaar en relatie met psychische functies.
In de nieuwe diagnostiek is er sprake van een belangrijke persoonlijke component.
Diagnostiek vraagt een gedegen analyse van indicatoren van kwetsbaarheid en weerbaarheid. Dit is voor de professional en om iets terug te kunnen geven aan de cliënt.
Inzicht in de patronen van kwetsbaarheid en weerbaarheid is de eerste stap om er grip op te krijgen en er verandering in aan te brengen.
Symptomen vergen altijd een nadere persoonlijke analyse om er van te leren.
Met instrumenten waarmee je kwetsbaarheid en weerbaarheid inzichtelijk worden kun je wat aan je symptomen doen.
Diagnostiek is idealiter niet alleen persoonlijk, maar geeft ook informatie over de ernst van de klachten (dimensionele diagnose), hoe de symptomen reactief zijn op de omgeving in het dagelijks leven (ecologisch) en interfereren met psychische functies (functioneel).
Met zelfkwantificatie worden mensen hun eigen diagnostische instrument en daarmee een actieve participant in het diagnostisch proces. Zij verzamelen zelf de data op ecologische wijze.
Zelfkwantificatie kan bijvoorbeeld via een app waarin een paar keer per dag vragen worden beantwoord over psychische ervaringen, gedragingen, omgevingen activiteiten.
Uit de data van zelfkwantificatie zijn belangrijke aanwijzingen te halen voor de verdere behandeling. Dit is in de zin dat de patiënt zelf
.....read more Waar wil je naar toe en wat heb je nodig? - samenvatting van hoofdstuk 14 en 15 uit DSM-4 voorbij!DSM-5 voorbij!
Hoofdstuk 14
Vraag 3: waar wil je naar toe?
Deze vraag legt de focus op de fase van het proces van adaptatie en zelfmanagement waarbij de hulpverlener en patiënt samen proberen te bepalen op welk punt de patiënt zich bevindt en hoe eventueel stappen naar een volgende fase gemaakt kunnen worden.
Het geeft diagnostiek een langetermijnperspectief van herstel.
Hoofdstuk 15
Vraag 4: Wat heb je nodig?
Psychische klachten hebben behandeling nodig op het moment dat er sprake is van een zorgbehoefte.
Het is belangrijk de informatie uit eerdere vragen te vertalen naar concrete zorgbehoeften, op basis waarvan de behandeling kan worden ingericht.
Een diagnose zonder vertaling naar zorgbehoeften is incompleet.
DSM-5 and psychotherapy - uvaIn this magazine, everything you need for the course DSM-5 and psychotherapy is bundled.
Clinical psychologyThis is a magazine about clinical psychology
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