Behaviorism- An approach to psychology that limits itself to the description of relationships between observable environmental events and ensuring observable behaviour of organisms in the environment. (thinking is seen as a black box) - These types of psychologists believe that there is thinking (black box) but that it is irrelevant to the outcome. - They refer to this thinking, or black box as “inner state” Stimulus- First link, or input Antecedent- Natural/ less controlled event that proceeds output Response- The output of a controlled experiment Behaviour- Output when it is more natural Intervening Variables- The thing(s) we can’t see, Black Box (eg: thoughts) Classical Conditioning- Type of learning that happens unconsciously (Automatic conditioned response is paired with a stimulus that was neutral before) (eg: Pavlov bell when presenting dogs with food) - Conditioned stimulus- a learned reaction - Unconditioned stimulus- Naturally causes a response without conditioning Operant Conditioning- Reward and punishment conditioning (eg: Dogs get a treat when he sits) Little Albert Study- Conditioned a baby to be afraid of small furry animals - Example of fear conditioning Puzzle Boxes- Used ability to measure intelligence, Placed a cat in a box that must press a leaver to open the box, escapes, and get food Connectionism- Trial and error learning Law of Effect- More likely to repeat actions that lead to positive consequences Contingency learning- 1) Situation/Discriminative stimulus/Antecedent 2) Response/Behaviour 3) Effect/Reinforcer/Consequence Types of consequences Increase Something Decrease something + Add something - Remove/take away - + Positive reinforcement – Something is added and behaviour changes - Negative reinforcement- Something is taken away and behaviour changes - + Added or Take away – Something is added or taken away + Positive punishment – Something is taken away and behaviour stops - Negative punishment – Something is taken away and behaviour stops Punishment- Something that stops behaviour from occuring Reinforcer- Something that changes behavior (causing them to behave the way you want) - Primary - Appetitive stimuli- Sex, food, drink - Averse stimuli- Bitter taste, pain - Secondary - A paired reinforcer- Bell for dogs food 1 Factor theory- Reinforcement and punishment lie at different ends of a single continuum 2 Factor theory- Reinforcement and punishment are distinct and operate on behaviour in different ways 3 Term Contingency - The difference in this theory is that the consequence is also taken into consideration - Ex: Stimulus -> Response -> Effect - This shows that when a reward is presented after a behaviour, that behaviour is more likely to be repeated Behaviour graphs (Reinforcement schedules) VR- Variable ratio- Reinforcement is given on average (eg: VR5 on average every 5 times) VI- Variable interval- Reinforcement given on average after a certain amount of time FR- Fixed ratio- Reinforcement is given on exact ratio (eg: FR2 Every second time) FI- Fixed interval- Reinforcement given exactly a certain amount of time after the action (eg: coffee machine takes 1 minute to brew coffee after pressing button) Extinction- Stopping the reinforcements (takes longer for extinction to occur when the rewards are variable Neobehaviourism- formed latent learning (Learning that is latent, or concealed. Occurs from exposure to stimuli without reinforcement) Latent learning- the subconscious retention of information without reinforcement or motivation (Seen as stimulus-stimulus (ss) learning in cognitive model) (Seen as stimulus-response (sr) learning in operant model) Cognitive Psychology- The scientific study of the mind as an information processor (Inside the black box) Hypothetical constructs- The black box thinking (occurs between input and output) - Cognitive domains (functions)- perception, language, attention, learning, memory, decisions, problem solving, reasoning, action - Cognitive structures (forms & representations)- Images, Symbols, Knowledge, Interpretations, Appraisals, Rules, Schema, Beliefs, - Cognitive processes (operations & transformations)- Association, comparison, discrimination, categorization, storing, evaluating, encoding, retrieval - - Cognitive domains are the functions. Ex: perception, attention, learning Cognitive structures are used to then interpret what the cognitive domains are able to see. This means that when you perceive something, or pay attention you then need to use this information. (ex: knowledge, concepts, form images, symbols or schemas, rules, sounds attached to letters, letters being put together to form words) Cognitive processes involves using the information we have now transformed in a way that can help us (ex: using the knowledge we have to compare or distinguish between two things Schema- An organized abstract representation of knowledge about a particular sitatuion or thing - We have them to help us make quick decisions, judgements Role Schema- We expect people performing a certain role to have certain attributes (eg: doctor to be smart) Self-Schema- The perception we have of ourselves Cuteness Schema- Evidence suggests we are all born with this (eg: puppies, babies) Analysis by Synthesis Model- Feature analysis occurs automatically and is guided by our schemas. Mediation- Another term for the “black box” Introspectionists: Tried to uncover the black box thinking. How it worked and what outcomes it was responsible for. Blind Spot- Where the optic nerve takes the visual information into our brain is a complete blind spot Challenges interpreting sensory information - Incomplete information - Too much raw data - Must first extract what is important/dangerous Vision- Only sense that has a dedicated lobe of the brain (occipital lobe) - In the brain only things we see with both eyes are interpreted as 3-D - Vision from left eye goes to right hemisphere (and vice-versa) - Thalamus (Lateral Geniculate Nuclei (LGN)) receives the info and sends it to other parts of the brain Retina- Has rods and cones that allow us to see - Rods- For low light. Not sensitive to colour - Cones- For normal light. Sensitive to colour. (Found in Fovea) Occipital lobe - 1) Vision is hierarchical (simple properties processed first) - 2) Vision is modular (specific parts are dedicated to certain types of information) V1- Primary visual cortex V2 V3 V4- Colour vision V5- Motion Visual Pathways 1) Dorsal stream- Top of brain, “where” stream, 3-D vision, V5 is involved - The dorsal stream is proposed to be involved in the guidance of actions and recognizing where objects are in space. Also known as the parietal stream, the "where" stream, or the "how" stream, this pathway stretches from the primary visual cortex (V1) in the occipital lobe forward into the parietal lobe. It is interconnected with the parallel ventral stream (the "what" stream) which runs downward from V1 into the temporal lobe. 2) Ventral stream- Bottom of brain, “what” pathway, facial recognition, V4 involved - The ventral stream is associated with object recognition and form representation. Also described as the "what" stream, it has strong connections to the medial temporal lobe (which stores long-term memories), the limbic system (which controls emotions), and the dorsal stream (which deals with object locations and motion) Attention- The mechanism we use to select what to further analyze (people with depression pay more attention to negative things) - Selects: loud, bright, attention grabbing, novel things, changes - Right parietal cortex is crucial Spotlight metaphor- Highlights one piece of information to further analyse Selection Methods - Exogenous (bottom up)- auto-allocation based on properties of stimuli - Endogenous (Top down)- things you actively choose to focus on Bottom-up processing begins with the retrieval of sensory information from our external environment to build perceptions based on the current input of sensory information. - Habitual information processing Top-down processing is the interpretation of incoming information based on prior knowledge, experiences, and expectations - How we intentionally control our thinking Inattention blindness- When we focus our attention on one thing it is hard to see others Visuo-spatial neglect- Damage to the right parietal regions causes people not to be able to see anything on the left. They feel that their vision is the problem, but they are just not able to pay attention to things on the left Representational neglect- Not able to recall from memory a full image Attention in the brain - Parietal cortex was the most important part - Right parietal cortex side is used for sustained attention (dorsal stream) Sustained attention- Paying attention to the same thing for a sustained period of time Neglect task- Draw a line and see if they are able to see the whole thing or if they can only see one side of it. (ask them to mark the middle of the line and see if they mark near one side) Cancelation task- Ask the patient to cancel out (cross out) all of one type of shape and see if they use the whole sheet, or just focus on one side of it Representational neglect- Ask the patient to remember somewhere he has been (local town square) and ask them to describe everything they can. If they are not able to describe on part of the Working memory- Can be measured with digit span repeating numbers back (sometimes in reverse) (New name for short-term memory) Modal model (outdated now) 1) Sensory stores 2) Short term stores (sts) 3) Long term stores (lts) Long term memory- Does not rely on short term memory - Stress hormones can help us remember Phonological store (Verbal working memory)- Uses left parietal Visio Spatial (Spatial working memory)- Uses right parietal (v1) Central executive - Decides which info should be stored and which storage it goes into - Inspects, transforms and manipulates info being held in stores Implicit memory- long term memories that we can’t describe or define, but we have them Explicit memory 1) Episodic- (Events and experiences) This is a memory of actual events, not just the event recall. What, Where, When (uses medial temporal lobe and hippocampus) 2) Semantic- (facts) Just the information you have learned, without experiencing an event. Best learned through repetition Episodic Memory - Linked to how we see ourselves - Losing this is the first symptom of dementia - Remembering is a system of reconstructing - We can recall untrue events as well as true Mirror drawing task- Showed us that even though the patient was not able to recall doing the test before, he got better every day after practice (shows that learning is happening even when the brain is damaged) Emotions- Something that causes a change in equilibrium (internal or external) - Requires a stimulus - a complex reaction pattern, involving experiential, behavioral and physiological elements Neuroscience behaviour (emotion) - Events are first interpreted and then tended to by the nervous system - Part of our survival instincts - Emerge in response to reward (anything an animal will work for) and punishment (anything an animal will work to avoid) events Social Construct Perspective- Emotions are socially constructed - One criticism is that across culture we share many of the same emotions It is debatable whether emotions cause bodily changes, or bodily changes cause emotions B.F. Skinner believes that emotions are useless and just hurt our state of mind and blood pressure Overall most psychologists believe emotions are positive Functions of emotions - Prepare for action (endocrine response) - Generate autonomic response - Motivation - Show our emotions to others (rotten food, bad smell, smile) - Helps us remember/learn from events - Survival - Can hinder us (sadness, depression, seeing other people suffer) Studying emotions- Must be able to provoke them - Facial expression (eyes have been shown to show emotions better than face) - Imbed stimuli in everyday events (being accepted, rejected, winning money) Mood Inductions- changing someone’s mood (can be done with music) Conditioned fear- Can be caused without having direct contact with the thing. Parents can instill this in their kids Flashbulb memories- Memories of events that can be remembered very vividly (eg: sept 11) Weapon focus effect- Observers of a crime focus so much on the weapon (survival instinct) that they do not remember the person Mood congruent memory- Related to the mood we are currently in Mood-dependent memory- More likely to recall memories when we are in the same mood as we were when we experienced them Attention Control- Higher attention control is better to keep the mind focused and causes less mental health issues. (studies have shown we can improve this) Cognitive reappraisal/restructuring- Changes the way we think about something and can help us get over mental health issues (eg:ptsd) Extinction learning- When we are repeatedly presented something we are afraid of we become less afraid. Can also be useful watching someone else interact with it Memory re-scripting- Intentionally changing out memory. We can slightly alter how we remember events (Beck did this) - Type A: Modifying a memory and associated emotions - Type B: Regulating negative emotions Effects of emotions - Memory- When an event elicits an emotion we are more likely to remember it - Learning- We can learn better when presented a reward (happy) - Attention- People with depression will focus on sad things. We also pay more attention to things that could be of danger Attitudes- (Concrete/Specific) positive or negative evaluations of objects and subjects (gives us fast answers to things) (ex: person, car, group) - Can be very negative in some situations (racism, stigmas) Some kids will avoid peers who’s parents have mental health problems Values- (Abstract/General) concepts that we think are important (ex: justice, fairness, beliefs) Social identity- can be expressed by pour attitudes and represents the culture we were raised in Types of attitudes 1) Mere exposure- the more you are exposed to something the more you will like it 2) Learning- rewards and punishments shape our attitudes 3) Culture- the culture we are raised in shapes out attitudes (interdependent vs dependent) 4) Stereotypes Psychosis - 20% of people experience multiple cases in their life, but it is very rare for someone to develop the disorder - Clinically psychotic patients are more likely to relate events to themselves than to situations or by chance - Therapy has been able to help many people Elaboration likelihood model - 2 ways we process information (Our motivation to what we are experiencing dictates which route we use) - 1) Central route- deep processing (detailed info with calculations 2) Peripheral route- simple and shallow (ex: impulse purchases) Implicit attitudes- attitudes that we have but we are not sure how we got them Heuristics- Simple rules we use to form our attitudes with little effort - Chess- impossible to have a “winning strategy’ but capturing their Queen gives us a better chance. - Lets us make fast decisions, but they are not always accurate - Can lead to addiction because it makes us think winning is easier than it really is Gambling- 70% of people in the UK gamble once a year. People who make decisions based more off heuristics have the highest rate of addiction Cognitive distortions- When we feel that we are in control we are happier. Ex: near misses (near wins) in a gambling game makes us more sure we will win soon. (near misses cause a very similar brain reaction as wins) Gamblers fallacy- After a run of black on the roulette wheel people are more sure red will be the next number even though the odds remain the same. Appraisal- A set of psychological interpretations of an event (related to how we interpret events, and influenced by our attitudes and emotions) James-Lang Theory of emotions- Our emotions change as a result of changes in the body (ex: We cry and then we feel sad) Cannon & Bard theory of emotions- Emotions do not necessarily change when the body changes (ex: the body does not get scared when we exercise just because we start sweating) Schanter & Singer- Combined the 2 theories of emotions and studied them - They found that emotions are caused by the appraisal of the changes in the body - They injected people with adrenaline to study them and found 1) when there is no reason for an arousal state they will try to determine what has caused it 2) When they know why they have a high state of adrenaline they won’t look for other possible reasons 3) In many situations people do not understand the reason for changes to body state Social cognition- How we process, store and apply information about other people and social situation. This is something that is lacking in people with down syndrome. Empathy- Is being able to see what other people are experience and relating to it. This means that you have to be able to read people’s facial expressions and make judgements based on their tone of voice. This is difficult for people with down syndrome because of the broken mirror theory. They are not able to mirror other people’s emotions. Theory of mind: Sally-Anne test: They tested for theory of mind with this test. They got Sally-Anne to leave the room and then moved her book, when she came back they asked people where she would look first. The people with theory of mind said she would look where she had left it first, whereas the people without theory of mind said that she would look where the researchers had moved it first. Mirror neurons- These are motor neurons that are believed to be responsible for learning by watching someone else complete a task. This means that while we are watching someone else do something these neurons are firing in the same way they would be if the person was doing the task themselves. (One thing that must be noted is that there has to be another system operating at the same time that tells the person that they are not the one performing the task. Actor-observer effect- We tend to blame others for the mistakes they make, while we blame the situation for the mistakes we make. Autism Spectrum Disorder (ASD)- A neurodevelopment condition - Often accompanied with: Epilepsy, intellectual disability, Anxiety, depression, ADHD, sleep and eating problems - 2-4x more males than females diagnosed - Effects 1% of people - Causes deficits in: Social-emotional-reciprocity, nonverbal communication, developing, maintaining and understanding relationships - Usually diagnosed before 3 Triad of impairments: (ASD) Mind-blind- Children with autism don’t track the mental states of others Scary bridge experiment- Men crossed a scary bridge and then were asked questions by a good looking female. After she gave them her number. The men that were scared while crossing the bridge were more likely to contact her. This is because they don’t understand why their level of arousal was high, only that it was when they were speaking to her. Coping- The ability to menage stress and demands Lazarus’ Cognitive-motivational theory - We experience and event, then we appraise it and judge the relevance and congruency (if it matches what we expect) - After the primary appraisal we then decide what caused it (blame yourself, blame others, blame the world) Interpretations- The mood we are currently in determines how we will interpret events that we are experiencing Cognitive bias modification (CBM)- Directly targets dysfunctional thoughts by using quick and repeated low level information - Reinforces positive adaptive processing style 10-25% of older people have had an hallucination Social cognition- The process people use to navigate and make sense of their social world - 3 assumptions - 1) Always seeking consistency - 2) People are naïve scientists (trying to understand) - 3) People are cognitive misers (save their effort) - two pillars - 1) Cognitive psychology- we use our existing knowledge to make assumptions - 2) Social psychology- how we make sense of social stimuli Theory of mind- Social judgements, understand other peoples thoughts/ decisions/ motives (allows us to have empathy) Sally-Anne test- As young people age, they develop theory of mind Mirror neurons- Fire we when perform, or observe an action (motor neurons) - First recorded in Macat monkeys - They play a role in social cognitive processes (related to neurological and psychiatric disorders) - The way we have been able to study these is by scanning the brain when watching someone else perform a task. Also by being able to learn to perform a task after watching other people perform it Self-other distinction- When using these mirror neurons we must have a way to know if it is us or someone else experiencing the event. Attributions- regarding something as being caused by a person or a thing - We use our stereotypes to make these quickly - We prefer when people live up to our assumptions of them Fundamental Attribution error- We attribute behaviour to the person more often than judging the whole scenario it took place in. (judge person instead of situation) Actor-observer effect- We attribute our own failures to the situation, while attributing other’s failures to them as a person Autism- Neurodevelopmental condition (usually diagnosed through behaviour) - Impaired social and communication skills - ASD Diagnosis criteria- Persistent deficits in social communication and social interactions. Struggle with relationships. Lack of non-verbal communication Autism theories 1) Social motivation- Don’t find social stimuli such as faces and voices interesting or rewarding. Causes them not to learn about the social world around them. Early signs of this are lack of interest. james 2) Broken mirror theory- They have unhealthy mirror neurons. This causes them not to have empathy for others. They don’t realise that others are “like them” 3) Theory of mind (mind blindness)- Can’t understand others may think differently to them. Struggle to form relationships because they don’t understand other people. Take things very literally. The tests for this have come up with many false positives (not all autistic people fail this either) Mentalising- Unconscious: eye gazing/ tracking. Conscious: Deliberately focusing WEEK 5 First wave- First wave CBT differs radically from psychoanalysis, the years-long and empirically weak method of addressing neuroses pioneered by Sigmund Freud. First wave CBT uses the principles of operant learning and classical conditioning. First wave CBT went no further than basic learning and conditioning paradigms. Based on empirical, research-based science, first wave CBT was used in the 1940s as a short term treatment for cases of depression and severe anxiety which were endemic in veterans returning from World War II. - This is behaviour therapy and was created by B.F. Skinner There was a British and an American approach Seeks to change behaviour rather than treat emotional disturbance Methods: Operant conditioning and reinforcement Setting: psychiatric and other long-stay institutions Goal: reduction in Challenging behaviours (eg: self harm, shouting, aggression) and encouraging desired behaviour. American Functional assessment screening tool (FAST)- the method used to detect the undesirable behaviour. ABC Charts - Conducted by someone with frequent interaction with the patient - Requires careful training and constant record keeping Modifying behaviour with ABC approach: 1) Antecedent’s approach- Remove the person from the original stimulus that is causing the issue 2) Behaviour approach- Provide the person with new skills and tools to convey their displeasure. (these tools and skills can later be transferred to other situations) 3) Consequence approach- Remove the link between the behaviour and the outcome (unless the behaviour cannot be ignored) Treatment rules for exploring agitation- Lists behaviours and then possible reasons for such behaviours. From here possible solutions are offered Premack’s principal - Behaviours chosen frequently are reinforcing - Frequently chosen behaviours can be used to reinforce/ alter other behaviours - Eg: Being allowed to sit down only when working causes people to work more, and later for people to sit around less Token Economies (popular post 1970’s) - Requiring a token as a reward (immediately at the time of the good behaviour) - Tokens can be spent on something they want - 5 basic components: 1) Nature + value of tokens must be understood 2) Accurate + transparent way to earn tokens 3) Must be able to spend tokens 4) Rules must be clear 5) Consistency British Methods- classical conditioning, extinction, de-conditioning Targets- Addressing neurosis, fear and anxiety Original reason- Tried to help soldiers returning from WWII with shell shock Deconditioning- Pairing a feared stimulus with a non-feared one Systematic exposure- Exposure over time (little by little) Observation and modeling- Watching others react in a positive way to something you are afraid of and learning from this that it is not scary. Objective measures (psychophysiology)- Physical response measured (eg: heart rate, blood pressure) Reciprocal Inhibition- Impossible to be nervous and afraid while carrying out behaviours of relaxation and fearlessness. Systematic desensitization - Start by performing easy tasks related to the fear stimulus and wait for response - Allow the patient to experience the anxiety and understand that it will reduce on its own - While the anxiety is becoming present the patients are trained in relaxation techniques In vitro- Imagining a stimulus that causes fear while training to be relaxed In vivo- Having the fear stimulus presented while training to be relaxed Social learning theory (Albert Bandura) - Deconditioning by observation- reduced fear by watching other people experience it - Bobo doll experiment: Used to study childrens aggression. The kids would watch adults play with the doll and they would mimic similar behaviour when it was there turn - This also works for being afraid of something. Watching a parent that is scared of a stimulus can cause the child to be afraid as well Escape/ Avoidance- Distancing yourself from unpleasant events Active avoidance- Leave an even that could be bad Passive avoidance- Not entering into a situation all together Maladaptive- Avoiding situations or having a fear of them when they are highly unlikely (ex: fear of snakes in England) Mowrer’s 2-factor theory of avoidance learning - Fear is internal and unavoidable - Criticisms of this theory: Fear is not necessary for avoidance to continue. Desensitizing fear by exposure only works if the person is no longer afraid. Animals can learn to avoid without an aversive stimulus Classical conditioned fear response- Conditioning someone to be afraid of something by pairing it with something they are already afraid of. Safety behaviour- Causes maladaptive behaviour and leads to long term reliance without ever getting rid of the fear and anxiety Behavioural Psychotherapy- Covers all the behavioural treatment of mental health disorders - Came from Pavlovian and operant learning theory Second Wave- Second wave cognitive behavioral therapy came from Aaron Beck’s cognitive therapy. Based on the cognitive model, it states that people are more negatively affected by their automatic thoughts and patterns of thought about negative events than the events themselves. As well, situations can create automatic physiological reactions, like an increase in heart rate, perspiration or blood pressure, that can be interpreted cognitively as an awareness of perceived danger when there is in reality no threat at all. Simply put, our assumptions and presumptions control us and our reactions far more than events themselves. Everything we experience gets interpreted through cognitive filters. - This wave of cognitive therapy started with depression - Was founded by Beck (and also Ellis with his rational emotive therapy) Hamlet’s cognitive model - Situation Thought Emotions and actions Cognitive Behavioural Therapy - Adaptive (coping) skills- requires learning new methods to cope and assumes our current skills aren’t good enough or make things worse - Problem solving- finding new ways to see a problem and then exploring new ways to deal with it - Cognitive Restructuring- identify and change maladaptive thinking patterns Cognitive triad: The self, the future, the world Negative Automatic thoughts (NATs) - Anxiety, depression, anger, guilt - They are all believable, negative towards self and unhelpful Becks Cognitive Model - All or nothing thinking- categorizing all things as either good or bad, leaving no room for the grey area - Mental filtering (selective abstraction)- always confirms your cognitive bias while highlighting failure and ignoring success - Magnification + Minimization- magnifying the negative and minimizing the positive - Catastrophizing- illogical leap from a small negative to something extremely bad - Personalising- thinking events you have little or no control over are all your fault - Overgeneralising- drawing definite conclusions with only partial information - Emotional reasoning (labelling)- We thing that what we feel must be true (ex: you fail one thing and label yourself as a failure) Original model- More general model (Hot cross bun) Schemas Cognitive therapy (in practice) - Aim- to improve real life function - Cognitive model is explicit from the beginning - Letting the client fill in his real life examples - Fixed term (number of sessions) - Structured classes with lesson plan - Scientific approach- 1) Best guess (hypothesis) 2) Look for evidence that the model is accurate 3) Client tests accuracy of perceptions and expectations - Client is engaged to find their own answer - Client is given homework Cognitive distortion- A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as depression and anxiety Techniques for CBT - Understand and recognize cognitive distortions (help to acknowledge when you’re making incorrect assumptions) 3 column thought record 1) Situation (who, what, where0 2) Feeling/Emotion (0-100 scale) 3) Automatic thought (before or after feeling) 5 column thought record 1) Situation (who, what, where0 2) Feeling/Emotion (0-100 scale) 3) Automatic thought (before or after feeling) 4) Evidence that supports the “hot thought” 5) Evidence that doesn’t support the “hot thought” - After rating thinking about the evidence around the hot thought the client is asked to re-rate their mood. This is useful because it forces the client to confront the situation The survey- Get opinions/ feedback on hot thought/ important belief Behavioural experiment - Do something different Observe outcomeNew information (after experiment compare results to original prediction) Downward arrow technique Statement 1 o Prompt/probe Statement 2 o What would it mean if? Statement 3 o Why does that bother you? Statement 4 Psychotherapy- An approach to help someone overcome mental/physical problems - Behavioural, humanistic, psychoanalysis - Based on established psychological principals Best review of evidence- Systematic reviews/ meta-analysis Challenges of randomized control trials - Consistent treatment - Consistent therapists - Cannot always be blind - Not as blind or black and white as with pills Evidence based psychotherapy - The levels of evidence that are applied when evaluating psychotherapy are: The evidence of the foundational principals and The evidence that it’s effectiveness - Some things that need to be considered here are: economic and ethical concerns - Systematic review Sumarises evidence Allows us to draw evidence based recommendation Can identify groups in evidence Combining evidence can draw our attention to possible new hypothesis Grading of Recommendations, Assessements, Development and evaluation (GRADE) 4- High 3-Moderate 2- Low 1-Lowest Meta Analysis - Statistical approach by combining many findings to draw an overall conclusion. - Standard effect size: continues carriable (eg: BDI-II rating scale), must be able to compare them Risk Ratio- Recover/Relapse measure. Relative likelihood a patient will show the event outcome in an active group vs a control group. - Ex: 30% active group recovered, 10% control group recovered = 3.0 risk ratio Five (5) R’s of outcome 1) Response- severity decrease by 50% (most common) 2) Remission- no longer being diagnosed as depressed (must be sustained) 3) Recovery- sustained remission (6-12 months) 4) Relapse- Return of symptoms 5) Recurrence- Relapse after full recovery Depression treatment - Has shown that treatment by medication is better than CBT for people with severe depression - - Residual therapy - Executive functions- (collectively referred to as executive function and cognitive control) are a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals. Executive functions include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory control, working memory, and cognitive flexibility. Higher-order executive functions require the simultaneous use of multiple basic executive functions and include planning and fluid intelligence (e.g., reasoning and problem-solving) Executive (control) processes- Necessary to us to be able to carry out all other processes - Allows us to set out lives up in a way that is convenient - Juggling tasks - Ex: keeping an eye on water to boil, while talking to a friend and ignoring the noise of the radio, while also thinking about your schedule tomorrow Task switching- Moving your attention around to ensure you’re attending to the things that need it 1) Attention 2) Inhibition- preventing ourselves from paying attention to things that will distract us from what we need to do 3) Planning- switching between working and long term memory to ensure we can make plans o Script: the actions and their order become prescripted (we only need to use significant brain power to plan things if they do not follow our script) Brain Regions: Prefrontal cortex- very large and well connected. Feedback information through backwards pathways. Last region of brain to reach maturity (around 20 years) Dysexecutive syndrome- Results from damage to the prefrontal cortex. - Causes people to change their behaviour in a bad way - Don’t conform to social norms - Distractibility - Not able to make plans Go/ No Go task- Press a button when you see a number, unless it is the one that they said not to press (Inhibition trial) Stop trial- Tests out inhibition not to move eyes when we are told to stop Stroop test- When the words are written in the colour they spell vs. another colour Hannah stuck in a bus door - Hannah and her mom thought she was going to die - When she is asked to recall she has a poor memory of it and gets very upset - When she has to get on a bus she becomes distressed (higher heart rate, sweating) - This fear has caused problems with her social life as she does not go out as often - She met criteria for PTSD - Cognitive processes that were altered (More alert to danger of buses, fragmented memory of the trauma) PTSD Diagnosis criteria - A) Exposure to a trauma - B) At least one intrusion symptom associated to the event and occurring after the event (flashbacks, distressing memories, nightmares) - C) Avoidance symptoms (activity, places, people, certain thoughts) - D) Negative alteration in cognitions and mood (not remember part of the event, getting negative beliefs, struggling more with relationships - E) Alterations in arousal and reactivity - Must be present for at least 1 month John the post graduate student - He is starting to think he sees encrypted messages and that people are following him - He has psychosis (could be Schizophrenia, bipolar or severe depression) - Psychosis symptoms- Hallucinations, delusions Beads task- To measure delusions - Shown 2 jars (one with more yellow than black, and vice versa) - The person is told the conductor has chosen one of the jars. - They are allowed to request as many beads as they would from the jar like before guessing which jar, he selected - People with psychosis require fewer beads as they have a tendency to “jump to conclusions” Joe (The 40 year old female) - Not performing everyday tasks as well which is leading to arguments with husband - Her sadness is starting to affect her family - She keeps remembering only sad things Major depressive disorder (criteria) - Must have 5 or more of theses symtoms (and must be present every day) - Low mood, Anhedonia (loss of interest in almost all activities), weight loss or gain, Insomnia, fatigue, feeling worthless/ guilt, indecisiveness, recurrent thoughts of death, diminished concentration, fatigue, loss of energy, psychomotor retardations ICD-10 (UK) & DSM-5 (USA)- The standards for diagnosing mental health conditions Over general memory- Linked to depression - Memories that are not specific 10 year old Dylan - Frequently shouting and swearing and fighting - His parents were abusive and he is in foster care - Attendance in school is poor - Runs away from home Attention to threat (bias)- More likely to think that things are threatening them Hostile intent (bias)- More likely to think that when people do things their aim was to harm them Metacognition- thinking about thinking - Peoples beliefs about their own thinking processes - Second-order form of consciousness - Thoughts about: 1. Our own subjective states - Thinking about how we are feeling o Ex: thinking that we are sad, but not sure why 2. Our self-concepts o We may not accurately think about ourselves (we usually have a positive bias) 3. How we think others perceive uso We try to confirm or disconfirm our thinking o Meta-stereotypes- How we think others feel about groups we belong too 4. How cognitive processes work in general Folk theories- broad group of metacognitions (a type of group stereotypes) Self-discrepancy theory- 3 important ways we think about ourselves 1) Who we are- our ‘so called’ actual self 2) Who we want to be- What we aim for in the future 3) Who we think we should be- things we think we should do (the person we think we should be) - The more realistic we are with out goals (the smaller the discrepancy) the happier we tend to be. Affective forecasting- Act of predicting how our emotions and actions will unfold over time - Eg: get divorced, how long will I be sad? - Win the lottery, How long will I be happy? - Durability bias- overestimate the duration of the feeling (positive or negative) - Intensity bias- overestimate how intense the feelings will be Worry- Chain of thoughts and images that negatively affect us, relatively uncontrollable - What if I don’t have enough money to pay rent, I will have to ask my parents, they will be disappointed, they wont trust me anymore, Next month my landlord will kick me out - Linked to anxiety - About the future Rumination- Process of thinking preservatively about ones feelings and problems instead of the specific content of thoughts - Why do I always overanalyse everything, when it’s silent I say stupid things, why do I say things, why do I analyse these things, other people don’t do this - Linked to depression - About the past - Linked to over general thinking Response style theory of rumination - Prolongs depression through: - 1) enhanced negative feeling - 2 Interfering with problem solving - 3)Interfering with Instrumental behaviour - 4) Eroding social support (family and friends will give up over time) Interpretation bias-Our bias that is related to how we interpret information Cognitive model as a hypothesis 1) Therapy- therapeutic intervention 2) Target- intervening variable (transformed by an input) 3) Outcome- therapeutic change Cause- The action that leads to and is responsible for the change Mediation- The variable that explains the relationship between the event and the outcome (can be a partial mediator as well, only describes part of it) Mechanism- critical process responsible for change Dysfunctional Attitude Scale (DAS)- published by Weismann and Beck in 1978. Originally comprising 100 items, it was developed into two 40-item versions-- the DAS-A and DAS-B. - A 24-item version of the DAS-A was proposed by McPower and colleagues in 1994, here at the IOPPN - Now it is two reliable subscales, one relating to perfectionism and performance achievement, and the second to dependency Dysfunctional attitudes - Depressed people have 50% more dysfunctional attitudes - e measures of dysfunctional assumptions can account for approximately a quarter to one-third of the variability in depression, - CBT has helped reduce this reliable measure dysfunction assumptions- level is higher in people with depression than people who are not depressed, and that severity of depression is associated with the level of dysfunctional assumptions held CBT not suitable for: - People with anxiety disorder - People with personality disorder - People that do not agree with the way it is conducted or the research behind it Third wave psychotherapies- Based on recognizing and changing their maladaptive thinking - Conscious, top down thinking - Address the thinking style more than the specific cognitions - Rumination focused therapy - Metacognitive therapy - Schema therapy - Mindfulness therapy - Acceptance and commitment therapy Rumination- Style of repetitive thinking (especially about oneself and ones world) - Depressive Rumination- Normally used to define unproductive thinking that does not stop (constantly repeated) o Content is negative o Has negative valence (emotionally disturbing) o Outcomes are negative (thinking this will or won’t happen for the worse) o Nature of thinking is abstract/general (not concrete or context specific) Rumination Focused Cognitive Behavioural Therapy (RRCBT) - Promotes solution for depression - Was largely founded at KCL - Focuses on how it happens - Uses record keeping and self-monitoring to understand why they self-ruminate Mindfulness (meditation) - Came from eastern Buddhist traditions - Mindfulness based stress reduction (MBSR) - Has been used to treat major depression - Skills- 1) Train attention to be present and understand things that are happening in our world (being present). 2) Trains us to notice habitual reactions to stressful and adverse events (no expectation to change the thought). 3) Encourages an attitude that is flexible and curious about the world (without judging it) Mindfulness Based Cognitive Therapy (MBCT) - 8-week, 2 hour sessions - Has been shown to have less severe relapse - - Dual-process model- a psychological framework that postulates two modes of information processing which diff er in the extent to which individuals engage in eff ortful thought about message content Core techniques for CBT 1. Cognitive restructuring or reframing. ... 2. Guided discovery. ... 3. Exposure therapy. ... 4. Journaling and thought records. ... 5. Activity scheduling and behavior activation. ... 6. Behavioral experiments. ... 7. Relaxation and stress reduction techniques. ... 8. Role playing. Moderators- A moderator is a variable that affects the strength of the relation between the predictor and criterion variable. Moderators specify when a relation will hold. It can be qualitative (e.g., sex, race, class…) or quantitative (e.g., drug dosage or level of reward)
