Psychoanalytical psychotherapies - summary of chapter 2 of Current psychotherapies

Current psychotherapies
Chapter 2
Psychoanalytical psychotherapies

Introduction
Basic concepts
History
Personality
Psychotherapy
Applications

Introduction

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.

Basic concepts

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 functions, including the need for regulation of self-esteem, the need for a feeling of safety, the need for regulating affect, and the need to master trauma.

because fantasies are viewed as motivating our behaviour and shaping our experience, exploring and interpreting clients’ fantasies is viewed as an important part of the psychoanalytic process.

Primary and secondary processes

Primary process is a raw or primitive form of psychic functioning that begins at birth and continues to operate unconsciously throughout the lifetime. In primary process, there is not distinction between past, present and future. Different feelings and experiences can be condensed together into one image of symbol, feelings can be expressed metaphorically, and the identities of different people can be merged. Primary processes can be seen operating throughout childhood and adulthood in dreams and fantasy, as well as more consistently in individuals suffering from acute psychosis.

Secondary process is the style of psychic functioning associated with consciousness. It is logical, sequential and orderly, and the foundation for rational, reflective thinking.

Defenses

A defense is an intra-psychic process that functions to avoid emotional pain by pushing thoughts, wishes, feelings, or fantasies out of awareness. These are: 1) Intellectualization, an individual talks about something threatening while keeping an emotional distance from the feelings associated with it. 2) Projection, a person attributes a threatening feeling or motive he is experiencing to another person. 3) Reaction formation, someone denies a threatening feelings and proclaims he feels the opposite. 4) Splitting, an individual attempts to avoid his or her perception of the other as good from being contaminated by negative feelings or he or she may split the representation of the other into two different images.

Splitting may be commonly used by infants so that they are able to feel safe with their mother. The ability to integrate the good and bad representations of the mother might be a developmental achievement that requires the ability to tolerate ambivalent feelings about the mother. Clients who have more severe psychological disturbances might never achieve this ability as adults, so the client experiences dramatic fluctuations in his or her perceptions and feelings toward others.

Transference

Freud observed that it was not uncommon for clients to view him and relate to him in ways that were reminiscent of the way they viewed and related to significant figures in their childhood. They were ‘transferring’ a template from the past onto the present situation.

The development of transference is an indispensable part of the psychoanalytic process. By reliving the past in the analytic relationship, the client provides the therapist with an opportunity to help him develop an understanding of how past relationships were influencing the experience of the present in an emotionally immediate way.

One- versus two-person psychologies

Two-person psychology is a perspective in which therapist and client are viewed as co-participants who engage in an ongoing process of mutual influence at both conscious and unconscious levels. This implies that the therapist cannot develop an accurate understanding of the client without developing some awareness of her own ongoing contribution to the interaction.

Other systems

One difficulty with comparing psychoanalysis to other systems of psychotherapy is that psychoanalysis is not just form of therapy, it is a worldview.

Reasons for the declining fortunes of psychoanalysis are: the tendency for psychiatry to become increasingly biological, the rise of the cognitive-behavioural tradition and growing emphasis on evidence-based treatment, a negative public reaction to an attitude of arrogance, insularity, and elitism that came to be associated with the psychoanalytic tradition, and psychoanalysis have been guilty of a lack of receptiveness to valid criticism and empirical research. Many of these problems emerged as a result of various historical, cultural and social-political forces that shaped the development of psychoanalysis, but are not intrinsic to it.

Many of these problematic features of psychoanalysis have diminished in the last two decades as a result of internal reforms and modifications that have taken place within the psychoanalytic tradition. Many people on the broader mental-health field and the general public are unaware of these changes.

The current marginalization of psychoanalysis is attributable not only to valid criticism but also to the unhealthy contemporary cultural biases.

History

Precursors

Freud’s development of psychoanalytic theory and practice was influenced by a number of cultural and intellectual trends and scientific models that dominated European circles in the late 19^th and early 20^th centuries. Two of these influences were exposure to developments in French neurology and psychiatry that explored the role that the splitting of conscious played in psychopathology, and a collaboration with Breuer, who talked with clients.

Freud came to believe that hysterical symptoms were the result of suppressed emotions that had been cut off at the time of trauma, and that these emotions expressed themselves in the form of physical symptoms.

Beginnings

Freud encouraged clients to ‘say everything that comes to mind without censoring’, which was the origin of free association. Free association is a technique in which clients are encouraged to attempt to suspend their self-critical function and verbalize thoughts, images, associations, and feelings that are on the edge of awareness.

There was an evolving conception of the goals of psychoanalysis. One of the important goals of psychoanalysis involved the pursuit of truth.

From seduction theory to drive theory

Seduction theory means that sexual trauma always lies at the root of psychological problems. Over time, Freud abandoned this theory and began to focus on the role that sexual instincts play in the developmental process. He theorized that rudimentary sexual feelings are present even during early infancy and give rise to sexually related wishes and fantasies that are pushed out of consciousness because they were experienced as too threatening. Often the recovered memories of sexual trauma are actually the product of reconstructed fantasies rather than real sexual trauma.

Freud’s growing emphasis on unconscious fantasy opened the way to a deeper appreciation of the complex nature of psychic life that was not always obvious to the everyday observer. His evolving perspective involved tracing the chain of the client’s associations in order to help formulate hypotheses about childhood fantasies and wishes that had been covered over and disguised.

Freud came to believe that all thinking and action were fuelled by a type of psychic energy that is linked in a complex way to sexuality. He developed a motivational model that held that psychic energy (libido) could be activated by both external and internal stimuli, which in turn produces an organismic sense of tension or ‘unpleasure’. Maintaining psychic energy at a constant level was biological imperative. Once psychic energy became activated it needed to be discharged, which restored psychic equilibrium and was experienced as pleasure. This could take place in a variety of ways. The psychobiological push to repeat experiences that become associated with tension reduction is the pleasure principle. The general model of motivation is known as drive theory.

Freud theorized that the process of psychological development was linked to the biological process of sexual development (psychosexual theory).

The trend within today’s psychoanalysis is to replace psychosexual theory with a model of motivation that is more consistent with contemporary developments in emotion theory and research and the affective neurosciences.

Jung, Bleuler, and the Zuric psychoanalytic society

Bleuler and Jung accounted findings using Freud’s theories about the nature of consciousness. Jung’s published articles were well received by the mainstream psychiatric community. At the same time, a number of psychiatrists at the Burgholzli clinic began to experiment with the use of treatment methods that they had gleaned from Freud’s writings.

The development of structural theory and ego psychology

Structural theory distinguish between three psychic agencies. These are : 1) Id, the aspect of the psyche that is intrinsically based and present from birth. It presses for immediate sexual gratification. 2) Ego, which gradually emerges out of the id and functions to represent the concerns of reality. The ego evaluates the suitability of the situation for satisfying one’s instinctual desires, and it allows the individual to delay instinctual gratification or find other ways of channelling instinctual needs in a socially acceptable form. It mediates between the demands of the id and the superego.3) Superego, the psychic agency that emerges through the internalization of social values and norms. Some are conscious, others not.

One goal of analysis traditionally has been to help individuals become more aware of the overly harsh nature of their superegos so that they become less self-punitive.

The development of object relations theory in Britain

Object relations theory in concerned with the way in which we develop internal representations of our relationships with significant others.

The British system has formally institutionalized the existence of three different psychoanalytic traditions.

Current status

Toward psychoanalytic pluralism in North America

The US formally recognized the existence of only one psychoanalytic tradition. Ego psychology centred firmly around Freud’s structural theory later refinements.

American ego psychology gradually consolidated into an orthodoxy that is classical psychoanalysis. Classical psychoanalysis was characterized by an adherence to certain core theoretical premises as well as specific technical guidelines. The core theoretical premises included an adherence to Freud’s drive theory of motivation and to his psychosexual model of development.

Classical psychoanalysis viewed transference as a projection of the client’s unconscious dynamics. The key mechanism of change was theorized to involve the process of gaining insight into one’s own unconscious conflicts.

Technical guidelines specified that therapists should: strive to maintain anonymity, attempt to remain neutral and avoid gratifying the client’s immediate wishes.

Theorists diverging too far from mainstream ego psychology tended to become marginalized. In some cases, they started their own school of thought. Two of these are Interpersonal psychoanalysis (It is impossible to understand the individual apart from the context of relations with others) and relational psychoanalysis (placed emphasis on the instinctual need for human relatedness).

The culture created a fertile climate for changes within the psychoanalytic world.

Contemporary ego psychology had involved into modern conflict theory. Conflict theory emphasizes the centrality in human experience and the action of ongoing conflict between unconscious wishes and defences against them. There is a more pragmatic emphasis on principles of technique and practice, and there are efforts to develop an overarching model of the human psyche.

Kleinian and Lacanian traditions in Europe and Latin America

Lacanian argued the our identity is forged out of a misidentification of ourselves with the desire of the other. There is a lack from the self, and this stems from the fact that our experience cannot be communicated without the medium of language. The processes of symbolizing our experience through language results in a distortion of this experience.

Personality

There is no one psychoanalytic theory of personality.

Theories of personality

Conflict theory

Beginning with Freud, intra-psychic conflict has been viewed as playing a central role in the development of the individual’s specific personality. Different personality or character styles can be understood as resulting from the compromise between specific underlying core wishes and characteristic styles of defence that are used to manage these wishes.

Object relations theory

Object relations perspectives on personality theorize that internal representations influence the way in which people perceive others, choose particular types of people with whom to establish relationships, and shape their relationships in an ongoing fashion through their own perceptions and actions.

Attachment theory is a model of object relations. To maintain proximity to the attachment figure, infants develop representations of their interactions with their attachment figures that allow them to predict what type of actions will increase the possibility of maintaining proximity.

Object relations theory assumes that internal models are shaped by a combination of these real experiences with unconscious wishes and fantasies and other intra-psychic processes that are not reality based.

Klein theorized that people are born with instinctual passion related to both love and aggression and that are linked to unconscious fantasies and images about relationships with others. These exists before any actual encounter and serve as the scaffolding for the perception of others. Klein believed that infants experience their own aggression as intolerable, and therefore need to fantasize that this aggression originates in the other. Projective identification is the intra-psychic process through which feelings that originate internally are experienced as originating from the other. The unconscious fantasies are internal objects. To retain some perception of the other as potentially good, infants unconsciously split the image of the other.

Fairbairn theorizes that internal objects are established when the individual withdraws from external reality and create a type of internal reality as a substitute. These fantasized relationships become important building blocks for one’s experience of the self because the self is always experienced in relationship to others. But, attempts to control significant others by developing fantasized relationships with them, rather than real ones, are only partially successful.

Developmental arrest models

Developmental arrest models theorize that psychological problems emerge as a result of the failure of caregivers to provide a ‘good enough’ or optimal environment. As a result, the normal developmental process becomes arrested.

The infant begins in a state of omnipotence, believing that her or his wishes make things happen and that the mother will satisfy all of his or her needs. Over time, the mother will fail the infant, and the infant begins to lose her or his experience of omnipotence and to experience a distinction between his or her reality and fantasies. If the mother is too unresponsive, the infant will become overadapted to the needs of the other and develop a false self. The infant might grow up to feel alienated from himself, resulting from the subjective experience of lack of inner vitality. If the process by which the infant’s sense of omnipotence is frustrated takes place in a sufficiently gradual fashion, the infant can come to accept the limitations of the other without being traumatized.

To develop a cohesive sense of self, the developing child requires caregivers who are able to provide adequate mirroring or attunement to his or her needs.

Psychotherapy

Theory of psychotherapy

What is psychoanalytic theory?

Psychoanalysis is a form of treatment with certain defining characteristics. Psychodynamic therapy are forms of treatment that are based on psychoanalytic theory but lack some of the defining characteristics of psychoanalysis.

Psychoanalysis is long term, intensive, and open ended. It is characterised by a specific therapeutic stance that involves 1) an emphasis on helping clients to become aware of their unconscious motivation. 2) Refraining from giving the client advice or being overly directive. 3) Attempting to avoid influencing the client by introducing one’s own belief and values. 4) Maintaining a certain degree of anonymity by reducing the amount of information one provides about one’s personal life or one’s feeling and reactions in the session. 5) Attempting to maintain the stance of the neutral and objective observer. 6) A seating arrangement in which the client reclines on a couch and the therapist sits upright and out of view of the client.

Many psychoanalysis no longer make such rigid distinctions between psychoanalysis and psychoanalytic treatment.

The therapeutic alliance

Freud emphasized the importance of establishing a good collaborative relationship with the client. Greenson emphasized that the caring, human aspects of the therapeutic relationship play a critical role in allowing the client to benefit from psychoanalysis. According to Bordin, the strength of the alliance depends on how much the client and therapist agree about the tasks and goals of therapy and on the quality of the relational bond between them. The tasks of therapy consists of the specific activities that the client must engage in to benefit from treatment. The goals of therapy are general objectives toward which the treatment is directed. The bond refers to the degree of trust the client has in the therapist and the extent to which he or she feels understood. Bond, task, and goal components of the alliance influence each other.

Transference

Transference is the client’s tendency to view the therapist in terms that are shaped by his or her experiences with important caregivers and other significant figures who played important roles during developmental processes. Early experiences establish schemas that shape the perception of people in the present.

The therapeutic relationship provides an opportunity for the client to bring the memory of the relationship with the parent from the past to life through the relationship with the therapist. This provides the therapist with an opportunity to help clients gain insight into how their experiences with significant figures in the past have resulted in unresolved conflicts that influence their current relationships.

Countertransference

The therapist’s countertransference is the totality of his or her reactions to the client. It can be useful therapeutically, but is not without potential dangers.

Resistance

Resistance is the tendency for an individual to resist change or act in a way that undermines the therapeutic process. It is the way in which defensive processes manifest in the therapy session and interfere with the therapist’s goals or agenda. Emphasis has been placed on the self-protective aspects of resistance.

Inter-subjectivity

As the two-person psychology perspective grows in influence, some analytic thinkers find that conceptualizing the psychotherapy situation in terms of the client’s perspective and the therapist’s perspective is incomplete. The meeting of two minds is thought to produce a new, emergent product, the analytic dyad. Understanding in psychotherapy derives out of the dialogue between therapist and client through which meaning is constructed.

Mitchell says that this processes allows the client to gradually learn that human relationships are flexible, and that it is possible to recognize the potential validity of the other persons’ perspective without feeling demolished or invalidated.

Pizer describes the therapy session as an ongoing negotiation about the meaning of substance reality.

It is conceptualized that transference-countertransference can be understood in terms of an ongoing implicit and explicit negotiation about what is taking place in the therapeutic relationship. This might play a role in helping the client develop the capacity for inter-subjectivity. This is the ability to hold onto one’s own experience while at the same time beginning to experience the other as an independent centre of subjectivity.

Enactment

Because client and therapist are always influencing one another at both conscious and unconscious levels, they inevitably end up playing complementary roles in relational scenarios of which neither is fully aware. Both client’s and therapist’s relational schemas will influence these scenarios. The process of collaborating in the exploration of how each of them is contributing to these scenarios provides clients with an opportunity to see how their own relational schemas contribute to the enactment, and for playing out new scenarios with other persons, contributing to a modification of their current schemas.

We are influenced by complex nonverbal communications from others that are difficult to decode and humans are never fully transparent to themselves.

Process of psychotherapy

Empathy

The most fundamental intervention is empathy. The ability to identify with our clients and immerse ourselves in their experience is critical in the process of establishing an alliance, it is a central mechanism of change and of itself.

Interpretation

An interpretation has traditionally been conceptualized as the therapist’s attempt to help clients become aware of aspects of their inter-psychic experience and relational patterns that are unconscious. It is the therapist’s attempt to convey information that is outside of the client’s awareness.

The accuracy of an interpretation is the extent to which an interpretation corresponds with a ‘real’ aspect of the client’s unconscious functioning. The quality or usefulness of an interpretation is the sense that the client can make use of the interpretation as part of the change process. Three aspects of this are timing, depth and empathic quality.

Clarification, support and advice

Many contemporary psychoanalytic therapists find that support, reassurance, and advice can play vitally important roles in the change process. A willingness on the therapist’s part to give advice, especially when asked for it, is consistent with reducing the power imbalance because we are ‘playing our cards straight up’.

Termination

A well-handled termination can play a vital role in helping clients consolidate any gains that have been made. Poorly handled terminations can negatively affect the treatment process.

Ideally, the decision to terminate is made collaboratively by client and therapist and marks the end of a treatment that has been helpful and satisfying.

The therapist needs to strike a balance between on one hand trying too hard to hold on to a client who wants to terminate, and on the other, failing to adequately explore the client’s underlying motivations for terminating.

When the process of exploring the client’s desire to leave treatment does lead to a final decision to terminate, it is useful to establish a contract to meet for a certain number of final sessions and thus provide an opportunity to terminate in a constructive fashion.

Mechanisms of psychotherapy

Making the unconscious conscious

Change often involves making the unconscious conscious. Changes involves becoming aware of our instinctual impulses and related unconscious wishes and then learning to deal with them in a rational or reflective fashion. By becoming aware of our unconscious wishes and our defences against them, we increase the degree of choice available to us.

Emotional insight

The primary vehicle for making the unconscious conscious is through the use of verbal interpretations that give the client insight into the unconscious factors that are shaping his or her experience and actions. Emotional insight is combining the conceptual with the affective so that the client’s new understanding has an emotionally immediate quality to it and is not relegated to the realm of intellectual understanding that has no impact on his or her daily functioning.

One of the key ways of increasing the possibility that the insight will be emotional is through the use of transference interpretations that lead the client to reflect on his or her immediate experience of the therapeutic relationship.

Creating meaning and historical reconstruction

People often come to therapy with varying degrees of difficulty in the construction of meaningful narratives about their lives.

Psychoanalytic practice provides culturally normative psychological or psychoanalytic explanations for symptoms and emotional pain. It adds an additional dimension of creating meaning through a process of co-constructing an idiosyncratic narrative that is tailored to the client’s unique history and psychology.

The process of constructing a viable narrative account of the role that one’s childhood experiences played in contributing one’s problems can decrease the experience of self-blame.

The process of exploring and clarifying one’s own values and engaging in a meaningful dialogue with the therapist can help clients reorient themselves and develop a more refined sense of what is meaningful to them. This often involves becoming more aware of and articulating the nuances of one’s emotional experience in the context of the relationship with the therapist.

Increasing and appreciating the limits of agency

As clients gain a greater appreciation of the connections between their symptoms, their way of being, and their own contributions to conflictual patterns, they come to experience a greater degree of choice in their lives and experience themselves as agents rather than victims. This growing awareness must be experientially based. The client must also come to appreciate and accept the limits of agency.

Containment

Containment involves attending to our own emotions when working with clients and cultivating the ability to tolerate and process painful or disturbing feelings in a non-defensive fashion.

Children and clients imagine that unacceptable feelings belong to the caregiver or therapist, and they exert subtle pressures that evoke the dissociated feeling in the other. Children need their parents to help them process raw emotional experience and learn to tolerate, symbolize, and make sense of the experience.

Rupture and repair

An ongoing process of interactive disruption and repair in infant and mother communication, plays an important role in the normal developmental process by helping the infant develop a form of implicit relational knowing that represents both the self and other as capable of repairing disruptions in relatedness.

The therapist’s inevitable failures provide opportunities for working through in a way that helps the client to begin to bring him or herself into the relationship in a way that is experienced as real.

Applications

Who can we help?

Psychoanalysis (when conceptualized in a rigid fashion) is most appropriate for clients who are neurotic, who have a relatively high level of ego strength and cohesiveness, and the capacity for self-reflection.
When conceptualized more flexible it can be useful to a wide range of clients.

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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 6^th edition
Chapter 2
Methodology, design, and evaluation in psychotherapy research

Guiding principles
Empirically supported treatment(s)
Design considerations
Procedural considerations
Measurement considerations
Data analysis
Reporting

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.

Guiding principles

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.

Empirically supported treatment(s)

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

Generalizability
Feasibility
Cost-effectiveness of the therapeutic

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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.

The effectiveness of psychotherapy
Do patients make changes that are clinically meaningful?
Cost offset
Does therapy exceed placebo?
Do patients maintain their gains?
How much therapy is necessary?
Sudden gains and related patterns of change
Do some patients get worse?
Does efficacy research generalize to practice?
Comparison and causative factors
Common factors and outcome
The search for larger effects
Conclusions

The 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

File drawer problem
The tendency for studies with small or no effects to never be published
The garbage in, garbage out problem
Mixing poor-quality and high-quality studies
The apples and oranges problem
Combining studies of very different phenomena

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

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Differential diagnosis step by step - summary of chapter 1 of DSM-5 Handbook of differential diagnosis

DSM-5 Handbook of differential diagnosis
Chapter 1
Differential diagnosis step by step

Step 1: rule out malingering and factitious disorder
Step 2: rule out substance etiology (including drugs of abuse, medications)
Step 3: rule out a disorder due to a general medical condition
Step 4: determine the specific primary disorders
Step 5: differentiate adjustment disorders from the residual other specified or unspecified disorders
Step 6: establish the boundary with no mental disorder
Differential diagnosis and comorbidity

Step 1: rule out malingering and factitious disorder

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.

Malingering
When the motivation is the achievement of a clearly recognizable goal
Factitious disorder
When the deceptive behaviour is present even in the absence of obvious external rewards

The clinician’s index of suspicion should be raised when

There are clear external incentives to the patient’s being diagnosed with a psychiatric condition
The patient presents with a cluster of psychiatric symptoms that conforms more to a lay perception of mental illness rather than to a recognized clinical entity
The nature of the symptoms shift radically form one clinical encounter to another
The patient has a presentation that mimics that of a role model
The patient is characteristically manipulative or suggestible

It is useful for clinicians to become mindful of tendencies they might have toward being either excessively sceptical or excessively gullible.

Step 2: rule out substance etiology (including drugs of abuse, medications)

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

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Gedragstherapie - samenvatting van fragmenten uit inleiding in de gedragstherapie

Inleiding in de gedragstherapie
Hermans, D., Raes, F., & Orlemans, H. (2018)
Fragmenten

Inleiding achtergrond
Experimentele psychologie
De oorsprong van gedragstherapie
De grondslagen van de gedragstherapie
Inleiding integratie van nieuwe ontwikkelingen
Nieuwe ‘therapieën’ in het gedragstherapeutisch veld
Nieuwe ‘theorieën’ in het gedragstherapeutisch veld
Experimentele cognitieve psychologie: kernconcepten
Relational frame theory: kernconcepten
Integratie van theoretische kaders
Inleiding – de empirische cyclus
De empirische cyclus
De empirische cyclus binnen de gedragstherapie

Inleiding achtergrond

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.

Experimentele psychologie

Twee soorten wetenschappen

Natuurwetenschappen
Maken gebruik van de experimentele methode
De samenhang kan herhaald worden en exacte controle is mogelijk
Geesteswetenschappen
Over alles wat door mensen is gemaakt
Men zoekt naar verbanden
De experimentele methode is hier niet mogelijk
Herhaling is niet mogelijk en exacte controle ook niet
Gericht op begrijpen

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.

De oorsprong van gedragstherapie

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

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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

Inleiding
Procesdiagnostiek
De reflectieve benadering of klassieke rogeriaanse psychotherapie
De experiëntiële benadering met focussen en emotiegerichte therapie
De interactionele benadering of interpersoonljike therapie
De existentiële benadering of zingevingstherapie

Inleiding

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

Empathie
Acceptatie
Echtheid

Procesdiagnostiek

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.

De reflectieve benadering of klassieke rogeriaanse psychotherapie

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

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Een therapeutische relatie - samenvatting van een artikel uit Gids voor Gesprekstherapie van Leijssen (1999)

Gids voor Gesprekstherapie
Leijssen, M (1999)
Een therapeutische relatie

Inleiding
Echtheid
Empathie
Onvoorwaardelijk respect

Inleiding

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.

Echtheid

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

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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.

Abstract
Introduction
Treatment studies
Studies into mechanisms
Research agenda

Abstract

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.

Introduction

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.

Treatment studies

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

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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.

Introduction
Rationale for ImRs
Application with PTSD
When and how to use ImRs for PTSD

Introduction

Imagery resccripting (ImRs) is a powerful treatment with high acceptability that can be used for simple as well as complex PTSD.

Rationale for ImRs

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.

Application with PTSD

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 is a more powerful way than talking to change traumatic memories and the associated meaning and emotion
During a traumatic event it is natural that all kinds of needs, emotions, and action tendencies are triggered, but they usually cannot be fully actualized.
It

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Imagery Rescripting for Personality Disorders: Healing early maladaptive schemas - summary of chapter 8 of Working with Emotion in Cognitive Behavioral Therapy

Working with Emotion in Cognitive Behavioral Therapy
Chapter 8
Imagery Rescripting for Personality Disorders: Healing early maladaptive schemas

Introduction
Rationale for ImRs
Empirical evidence
Application with PDs
When and how to use ImRs in CBT of PDs

Introduction

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

The nonverbal (feeling) aspects of dysfunctional views call for techniques that can address the nonverbal content of underlying schemas directly
The influences of early childhood experiences on the formation of dysfunctional schemas call for techniques that address these early experiences

Rationale for ImRs

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

Reattribution
Patients start to attribute what has happened to other causes than they did when they were a child
Emotional processing
Difficult experiences from childhood are usually not emotionally processed in patients with PD.
ImRs helps them to feel more comfortable with emotions and to process them. This changes the basic dysfunctional views of patients about emotions.

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Mindfulness en Psychotherapie - samenvatting van een artikel uit Leerboek psychotherapie

Leerboek Psychotherapie
Colijn, S., H. Snijders, M. Thunnissen, S. Bögels, & W. Trijsburg (red.).
Mindfulness en Psychotherapie.

Inleiding – theoretische achtergrond
Kernconcepten
Universele therapiefactoren
Centrale interventies
Tijdsperspectief

Inleiding – theoretische achtergrond

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:

Niet-oordelen
Niet-streven
cceptatie
Loslaten
Frisse blik
Vertrouwen
Geduld
Compassie en mildheid

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

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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.

Abstract
Definition of mindfulness
Need for a theoretical framework
Components of mindfulness mediation
Reappraisal
Exposure, extinction and reconsolidation
Change in perspective on the self
Integration
Self-compassion

Abstract

Cultivation of mindfulness produces beneficial effects on well-being and ameliorates psychiatric and stress-related symptoms.

Components through which mindfulness meditation exerts its effects:

Attention regulation
Body awareness
Emotion regulation
Change in perspective on the self

Definition of mindfulness

Mindfulness is nonjudgmental attention to experiences in the present moment.

Two component model of mindfulness

The regulation of attention in order to maintain it on the immediate experience
Approaching one’s experiences with an orientation of curiosity, openness, and acceptance, regardless of their valence and desirability.

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.

Need for a theoretical framework

There is a relative paucity of theoretical reviews that consolidate the existing literature into a comprehensive theoretical framework.

Five facets of mindfulness

Observing
Attending to or noticing internal and external stimuli
Describing
Noting or mentally labelling these stimuli
Acting with awareness
Attending to one’s current actions, as opposed to behaving automatically or absentmindedly
Nonjudging intter experience
Refraining from evaluation of one’s sensations, cognitions and emotions
Non-reactivity to inner experience
Allowing thoughts and feelings to come and go, without attention getting caught in them

Components of mindfulness mediation

The combination of the following components describe much of the mechanism of action through which mindfulness works

Attention regulation
Body awareness
Emotion regulation
- Reappraisal
- Exposure, extinction, and reconsolidation
Change in perspective on the self

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

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Bewegen Richting Flexibiliteit met Acceptance en Commitment Therapie (ACT) - summary of an article by Jansen, Rinsampessy, van den Berg en de Mey

Bewegen Richting Flexibiliteit met Acceptance en Commitment Therapie (ACT).
Jansen, G., Rinsampessy, D., van den Berg, G., and De Mey, H.

Introductie
Derde generatie cognitieve gedragstherapie
Pijn en lijden
Eperiëntiële vermijding en functionele classificatie
De zes hoekstenen van ACT

Introductie

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.

Derde generatie cognitieve gedragstherapie

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.

Pijn en lijden

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.

Eperiëntiële vermijding en functionele classificatie

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.

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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)

Abstract
The historical context
The development of the criteria
The influence of the Feighner criteria

Abstract

The team that developed the Feighner criteria made three key contributions to psychiatry

The systematic use of operationalized diagnostic criteria
The reintroduction of an emphasis on illness course and outcome
An emphasis on the need, whenever possible, to base diagnostic criteria on empirical evidence

The historical context

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.

The development of the criteria

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 patient has made at least one statement of mood change
The patient had any six of the ten following special symptoms
- Slow thinking
- Poor appetite
- Constipation
- Insomnia
- Feels tired
- Loss of concentration
- Suicidal ideas
- Weight loss
- Decreased sex interest
- Wringing hands
- Pacing
- Over-talkativeness
- Press of complatins

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

Constipation was dropped
Feelings of self-reproach or guilt were added
Insomnia was expanded to sleep difficulties
Anorexia and weight loss were combined into one item

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

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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

Abstract
Introduction
Discussion

Abstract

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.

Introduction

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,

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Emotion-focused Therapy - a summary of an article by Greenberg

Emotion-focused Therapy
Greenberg, L.S. (2004)
Clinical Psychology and Psychotherapy, 11, 3-16

Abstract
Emotion in human functioning
A dialectical-constructivist view: integrating biology and culture
Emotion coaching
Principles of working with emotion
Emotion regulation
Emotion transformation

Abstract

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.

Emotion in human functioning

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

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Theoretisch model: schema’s, copingstrategieën en modi - samenvatting van hoofdstuk 3 uit handboek schatherapie

Handboek schematherapie (pp. 17-32). Theorie, praktijk en onderzoek
Vreeswijk, M., Broersen, J., & Nadort, M. (2008).
Hoofdstuk 3
Theoretisch model: schema’s, copingstrategieën en modi

Praktijk
Beschrijving van de schema’s
Copingstrategieën
Schemamodi

Praktijk

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).

Beschrijving van de schema’s

Emotionele verwaarlozing
Verlating/instabiliteit
Wantrouwen en/of misbruik
Sociaal isolement/vervreemding
Minderwaardigheid/schaamte
Sociale ongewenstheid
Mislukking
Afhankelijkheid/onbekwaamheid
Kwetsbaarheid voor ziekte en gevaar
Verstrengeling/kluwen
Onderwerping
Zelfopoffering
Goedkeuring en erkenning zoeken
Emotionele geremdheid
Meedogenloze normen/overmatig kritisch
Negativiteit en pessimisme
Bestraffende houding
Zich rechten toeeigenen
Gebrek aan zelfbeheersing/zelfdiscipline

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Schema therapy - summary of chapter 5 of Science and practice in cognitive therapy. Foundations, mechanisms, and applications

Science and practice in cognitive therapy. Foundations, mechanisms, and applications
Chapter 5
Schema therapy

Cognitive model
Clinical application
Research

Cognitive model

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.

Clinical application

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

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Psychoanalytical psychotherapies - summary of chapter 2 of Current psychotherapies

Current psychotherapies
Chapter 2
Psychoanalytical psychotherapies

Introduction
Basic concepts
History
Personality
Psychotherapy
Applications

Introduction

Basic concepts

The unconscious

Fantasy

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Articlesummary with Research on the treatment of couple distress by Lebow a.o. - 2012

Research 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

Epidemiology
Advances in assessment
Meta-analytic and effectiveness studies
Integrative behavioural couple therapy
Emotion-focused therapy
Couple therapy for specific couple difficulties
Treatment of DSM axis I and axis II disorders with couple therapy
Process studies
Principles of couple therapy
Conclusion

Epidemiology

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.

Advances in assessment

There have emerged a number of well-validated measures of couple functioning.

Meta-analytic and effectiveness studies

Studies show that most couple therapy has an impact, with about 70% of cases showing positive change.

Integrative behavioural couple therapy

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.

Summary of findings on IBCT and future outlook

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.

Emotion-focused therapy

Emotionally focused couple therapy (EFT) is a couple intervention that is based

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Psychometric perspectives on diagnostic systems - summary of an article by Borsboom (2008)

Psychometric perspectives on diagnostic systems
D. Borsboom (2008)
Journal of clinical psychology

Abstract
Introduction
The constructivist view
The diagnostic view
The dimensional view
Measurement of causality
Disorders as causal systems

Abstract

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

Introduction

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 constructivist view

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

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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

Introductie
KOP: het theoretische concept
De balans: reflectie, relativering, uitzichten en ontwikkeling
Het KOP-model in de praktijk: het behandelproces in vijf stappen

Introductie

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.

KOP: het theoretische concept

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 balans: reflectie, relativering, uitzichten en ontwikkeling

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

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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

Introduction
The treatment intervention: ‘from symptoms to solutions’

Introduction

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.

The treatment intervention: ‘from symptoms to solutions’

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

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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.

Abstract
History and effects of EMDR
A model of EMDR
Positive memories
Prospective memory and flash-forwards
How do we know if and how much working memory is taxed?
Low working memory capacity? Benefits from EMDR
Inverted U
The effect of beeps
Mindfulness and mindful breathing

Abstract

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.

History and effects of EMDR

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.

A model of EMDR

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.

Positive memories

According to the working memory theory, all emotional memories should lose their

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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

From EMD to EMDR: the standard EMDR therapy protocol
Discussion

From EMD to EMDR: the standard EMDR therapy protocol

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

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DSM-5 and psychotherapy - uva

In this magazine, everything you need for the course DSM-5 and psychotherapy is bundled.

Supporting content:

DSM-5 voorbij! - Een samenvatting

Psychotherapy

Year 3 of psychology at the uva

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Clinical psychology

This is a magazine about clinical psychology

Supporting content:

Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition) - a summary

Anxiety and mood disorders

Sexology - uva

Psychodiagnostiek, UVA

Psychotherapy

DSM-5 voorbij! - Een samenvatting

Trauma and addiction video

Schizophrenia and dissociative disorders video

Eating disorders video

Personality disorders video

Sex and psychology

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Introduction

Basic concepts

History

Personality

Psychotherapy

Applications

Guiding principles

Empirically supported treatment(s)

The effectiveness of psychotherapy

Step 1: rule out malingering and factitious disorder

Step 2: rule out substance etiology (including drugs of abuse, medications)

Inleiding achtergrond

Experimentele psychologie

De oorsprong van gedragstherapie

Inleiding

Procesdiagnostiek

De reflectieve benadering of klassieke rogeriaanse psychotherapie

Inleiding

Echtheid

Abstract

Introduction

Treatment studies

Introduction

Rationale for ImRs

Application with PTSD

Introduction

Rationale for ImRs

Inleiding – theoretische achtergrond

­­Abstract

Definition of mindfulness

Need for a theoretical framework

Components of mindfulness mediation

Introductie

Derde generatie cognitieve gedragstherapie

Pijn en lijden

Eperiëntiële vermijding en functionele classificatie

Abstract

The historical context

The development of the criteria

Abstract

Introduction

Abstract

Emotion in human functioning

Praktijk

Beschrijving van de schema’s

Cognitive model

Clinical application

Introduction

Basic concepts

Epidemiology

Advances in assessment

Meta-analytic and effectiveness studies

Integrative behavioural couple therapy

Emotion-focused therapy

Abstract

Introduction

The constructivist view

Introductie

KOP: het theoretische concept

De balans: reflectie, relativering, uitzichten en ontwikkeling

Introduction

The treatment intervention: ‘from symptoms to solutions’

Abstract

History and effects of EMDR

A model of EMDR

Positive memories

From EMD to EMDR: the standard EMDR therapy protocol

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