Anxiety- and mood disorders
- 3328 keer gelezen
Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment
Harvey, A., G., Watkins, E., Mansell, W., Shafran, R. (2004)
Chapter 5
Thought
Metacognitive processes and beliefs: those concerned with the appraisal, monitoring or control of thinking itself
Intrusions are spontaneous, unwanted, unbidden, uncontrollable and discrete thoughts, images, or urges that are attributed to internal origins.
Many intrusive thoughts involve memories.
Intrusions are normal and universal.
What distinguishes normal form abnormal intrusions is that clinical intrusions tend to be experienced as more intense, more uncomfortable, and less controllable.
Patients differ in their appraisals and responses to intrusions compared to controls.
They tend to view them as more meaningful and important, and are more likely to act in response to them.
Two particular responses to intrusions are unhelpful
Forms of intrusions
Intrusions can occur in the form of
Images
Images are contents of consciousness that possess sensory qualities. They usually provide a perceptual-like analogue of some or all of the sensory aspects of a real-world experience.
Images are particularly potent at evoking emotional and physiological responses and at influencing the development of coping plans and the implementation of behaviour.
Verbal thoughts and images each influence and lead onto the other.
Urges
An urge is the internal experience of a desire to perform a particular act.
They can be induced by exposure to the object of the desire, contextual cues associated with the behaviour, emotional triggers and imagining performing an action or imagining a desired outcome.
The majority of psychological disorders are characterized by disorder-specific intrusive thoughts.
Intrusive thoughts are triggered by conditioned associations at either a sensory or a meaning level.
Stimulus or response cues associated with the content of the intrusion can trigger the intrusion.
One response to an intrusive thought is to further dwell on the subject matter of the intrusion, trying to work through or resolve it.
This is likely if the intrusion is considered to be personally important.
The recurrent thinking, in response to a negative intrusion, could result in worry or rumination.
Worry: a chain of thoughts and images, negatively affect-laden and relatively uncontrollable.
Rumination: dysfunctional, redundant, repetitive, and stereotypical thinking
Worry and rumination often involve self-focused attention.
Definite transdiagnostic processes
Evidence suggests that recurrent negative thinking is an important process that is common across all of the psychological disorders.
As such, recurrent negative thinking meets the criteria for a definitive transdiagnostic process.
Different types of recurrent thinking
There is an debate to whether worry and rumination only differ in the content of the recurrent thinking or whether they involve related but distinct processes.
Obsessions are more likely to be visual images, are less realistic, more involuntary, easier to dismiss, and less distracting.
An egosyntonic thought is consistent with the individual’s beliefs and values.
An egodystonic thought is not acceptable within the person’s beliefs.
The egodystonic quality of the intrusions is the hallmark of obsessions and appears to discriminate obsessive intrusions from worrisome or ruminative intrusions.
There are enough similarities between obsessions and worry to consider them as lying on the same continuum and sharing many of the same appraisals and strategies.
Causal role of recurrent thinking
Prospecitive studies
Rumination predicts future symptoms.
Experimental studies
Studies suggest that recurrent thinking may play a causal role in the maintenance of psychological disorders.
Theoretical issues
The content of recurrent thinking may differ between the disorders to reflect the particular current concerns of each disorder (and each individual patient).
Recurrent thinking has been conceptualized as an attempt at problem solving and as a self-regulatory attempt to try resolve unfulfilled goals.
Recurrent thinking, whether it is useful problem solving or unhelpful rumination, will persists until the goal is attained or the goal is discarded.
Functional recurring thinking
Recurrent thinking can be helpful in resolving goals and solving problems.
It is useful for problem solving if it is appropriate, focused on real, objective concerns and relatively brief.
Whether recurrent thinking about a problem becomes functional or not may depend on the manner in which a person approaches the problem.
Positive orientation, encompassing confidence in one’s ability to solve the problem, is associated with better outcomes.
Recurrent thinking may be functional in emotional processing.
Emotional processing: a process whereby emotional disturbances are absorbed and decline to the extent that other experiences and behaviour can proceed without disruption.
Elaboration and focus on an upsetting event is a critical aspect of emotional processing.
What determines functional versus dysfunctional recurrent thinking?
One factor that seems important in the use of worry and rumination seems to be the beliefs that people hold about the utility of this strategy in response to intrusive thoughts or problems.
Another factor is how easy it is to solve the problem and the ode of the recurrent thinking, as well as the learning (conditioning) associated with the recurrent thinking.
Insoluble problems
The problem that people are attempting to resolve may be an important determinant of the duration and helpfulness of recurrent thinking.
Problem solving may become stuck in rumination if the problem chosen is not easily soluble or amenable to intervention.
Mode of processing
The mode of thinking used during attempts at working through or solving problems.
Both worry and rumination involve more verbal thinking and less visual imagery.
Cognitive avoidance theory: verbal worrying reduces the amount of aversive imagery associated with emotional concerns, thus minimizing the physiological and emotional responses to such concerns. This inhibits emotional processing.
By minimizing the physiological and emotional response to difficulties, verbal worrying will prevent emotional processing, which requires sufficient activation of an emotional response to upsetting memories or events to be successful.
Worry and rumination are associated with a more abstract and less concrete style of thinking.
Problem descriptions are less concrete for worry-related problems.
An abstract-conceptual style of thinking is characteristic of the spontaneously occurring phenomenology of rumination.
The reduced concreteness theory of worry: the increased abstract thinking found in worry reduces visual imagery and hence reduced physiological and emotional response because abstract thoughts evoke imagery with less vividness, speed and ease.
This reduced concreteness also explains impaired problem solving within worry and rumination.
Conditioning
The tendency to worry or ruminate could be further maintained by higher-order conditioning.
Recurrent thinking
Three interventions may be particularly effective for reducing negative recurrent thinking
Several potential approaches for achieving the first two
Join with a free account for more service, or become a member for full access to exclusives and extra support of WorldSupporter >>
This is a bundle with information about anxiety- and mood disorders.
The bundle is based on the course anxiety- and mood disorders taught at the third year of psychology at the University of Amsterdam.
There are several ways to navigate the large amount of summaries, study notes en practice exams on JoHo WorldSupporter.
Do you want to share your summaries with JoHo WorldSupporter and its visitors?
Main summaries home pages:
Main study fields:
Business organization and economics, Communication & Marketing, Education & Pedagogic Sciences, International Relations and Politics, IT and Technology, Law & Administration, Medicine & Health Care, Nature & Environmental Sciences, Psychology and behavioral sciences, Science and academic Research, Society & Culture, Tourisme & Sports
Main study fields NL:
JoHo can really use your help! Check out the various student jobs here that match your studies, improve your competencies, strengthen your CV and contribute to a more tolerant world
3262 |
Add new contribution