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вторник, 16 юни 2009 г.

The Psychotherapy as an applied field in Cognitive Psychology

Applied Cognitive Psychology

The Psychotherapy as an applied field in Cognitive Psychology

Psychology is interdisciplinary field by presumption. Each subdivision in the broad psychological field is normal up to the degree to provide advancement in certain area of interest. Every psychological domain is just a branch in the bigger tree of the all encompassing knowledge about the human knowledge, intelligence. Cognitive psychology, neuro – psychology, clinical psychology, humanistic psychology, transpersonal psychology, psychodynamic psychology, social psychology, so on, are only different approaches toward the human psyche. The important point here is that if each branch is viewed as separate and detached from the others independent field – then it would represent merely immensely incomplete, partial, narrowed and crippled point of view regarding the man’s cognition.
In order to have the whole picture, we need the entire knowledge of each and everyone approaches and psychological branches. All of the psychological subdivisions originally stem from the same cognitive system, they are being studied by the same cognitive system (metacognition) using different methods according to the concrete approach and this very cognitive system depicts the studied subject – the human cognition, according to the contrivances employed by every distinctive psychological branch.

As a matter of fact – nowadays scholars from very different fields of science more and more realize the impossibility to continue their researches without interconnection and integration with the others scientific areas – because each scientific domain: physics, chemistry, mathematics, biology, psychology, artificial intelligence, astronomy, quantum physics, so on, so forth – represents solely a small particle of the interdependently functioning indivisible whole. The only division is within the imperfect human mind, unable to encompass the whole knowledge – but all changes, all evolves. The human mind develops its cognitive abilities in a degree unknown before – and realizes the need of integration between the scientific fields. Of course, each scholar has his specific interests in one or several scientific areas – but the novel here is that more and more the scientists manage to expand ones mind up to the degree to grasp the main discoveries of every scientific branch and thus to observe the whole picture of the human knowledge. And of course, this viewpoint widening starts with the expanding ones knowledge within the scientific field of primal interest.

Regarding contemporary psychology: It is still very young science – I can compare all the psychological branches with bunch of adolescents, barely entering upon the new stage of puberty. Just like every teenager, every branch claims confidently he has best understanding of the human mind, denies the achievements and the immense wisdom of the millenniums old psychology of the ancients, even denies the existence of this ancient psychology and rediscovers the wheel through its own stumbling.

One very promising field in the modern psychology is the “Cognitive psychology”. It paces confidently to the secrets of human knowledge abilities, grounding its advancement on the stable experimental ground. Cognitive psychology is extremely wide field, working with the core processes and capbilities such as memory, attention, perception, learning, knowledge presentation – modeling, etc. Cognitive psychology is open minded discipline, attracting inventive, brave and free thinking researchers with different interests in many directions. Highly scientific by nature, cognitive psychology does not neglect the other psychological approaches, such as clinical, social, behavioral, humanistic, psychodynamic, etc, but puts them on scientific base and raises their findings and paradigmatic theories on higher degree of representational models, terminology and understanding.

Psychotherapy as an applied Cognitive Psychology

Psychotherapy is by itself extremely broad field and consists of about 300 psychotherapeutic approaches, originating from various areas: behaviorism, clinical psychology, psychodynamic psychology, religion and different holistic systems, eastern philosophy, developmental psychology, neurosciences, linguistics, art – theatre, drawing, dance, sociology and social psychology (systems interactions), evolutionary psychology etc.
The psychotherapist could derive from wide area of academic education, preferably, but not mandatory from humanistic sciences. Further on, the prerequisite for being psychotherapist is passing long (4-10 years), demanding (financially and as a personal development) post graduate study in one of the psychotherapeutic approaches, each of them closely connected and stemming from one of the scientific areas or psychological schools mentioned above.

One of the most successful, rapid and scientifically based psychotherapeutic approaches is the “Cognitive psychotherapy”. It uses the cognitive paradigm and represents the mental processes and disorders in the language of the cognitive science / psychology.

Cognitive Therapy is a type of psychotherapy developed by psychiatrist Aaron T. Beck in the 1960s. Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his clients perceived and interpreted and attributed meaning — a process known scientifically as cognition — in their daily lives was a key to therapy. Albert Ellis was working on similar ideas from a different perspective, in developing his rational emotive behavior therapy. Beck initially focused on depression and developed a list of "errors" in thinking that he proposed could cause or maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives). Cognitive therapy seeks to identify and change "distorted" or "unrealistic" ways of thinking, and therefore to influence emotion and behavior.
Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders and problems. He also introduced a focus on the underlying "schema" — the fundamental underlying ways in which people process information — whether about the self, the world or the future. Treatment is based on collaboration between client and therapist and on testing beliefs.
The new cognitive approach came into conflict with the behaviorism ascendant at the time, which denied that talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioral responses. However, the 1970s saw a general "cognitive revolution" in psychology. Behavioral modification techniques and cognitive therapy techniques became joined together, giving rise to cognitive behavioral therapy. The term is sometimes used interchangeably with cognitive therapy, since cognitive therapy has always included some behavioral components, but advocates of Beck's particular approach seek to maintain and establish its integrity as a distinct clearly-standardized kind of cognitive behavioral therapy.

Further on the “Schema focused approach” was developed by the former psychoanalyst and A. Beck’s pupil Jeffrey Young in his “Schema focused cognitive therapy”, emphasizing on the early years engraved cognitive schemas and the cognitive reconstruction:

Early Maladaptive Schemas
Schema Domains















































Of course, here we can not present the entire therapeutic approach, but we can have a glimpse on its basic key positions:

What is the origin of early maladaptive schemas?
The three basic origins are:
1. Early childhood experiences.
2. The innate temperament of the child.
3. Cultural influences.
It is believed that the combination of these three lead to early maladaptive schemas.

What type of early childhood experiences lead to the acquisition of schemas?
The child who does not get his/her core needs met. The child needed affection, empathy and guidance but didn’t get it etc (neglecting parenting style).
The child who is traumatised or victimised by a very domineering, abusive, or highly critical parents (authoritarian parenting style).
The child who learns primarily by internalising the parent’s voice. Every child internalises or identifies with both parents and absorbs certain characteristics of both parents, so when the child internalizes the punitive punishing voice of the parent and absorbs the characteristics they become schemas.
The child who receives too much of a good thing. The child who is overprotected, overindulged or given an excessive degree of freedom and autonomy without any limits being set. (Overprotective, overindulgent parenting style)
Therefore Early Maladaptive Schemas began with something that was done to us by our families or by other children, which damaged us in some way. We might have been abandoned, criticized, overprotected, emotionally or physically abused, excluded or deprived and, consequently, the schema becomes part of us. Schemata are essentially valid representations of early childhood experiences, and serve as templates (frames, scripts) for processing and defining later behaviors, thoughts, feelings and relationships with others. Early maladaptive schemas include entrenched patterns of distorted thinking, disruptive emotions and dysfunctional behaviors. These schemata become fixed when they are reinforced and/or modeled by parents.
Long after we leave the home we grew up in, we continue to create situations in which we are mistreated, ignored, put down or controlled and in which we fail to reach our desired goals.
Schemata are perpetuated throughout one’s lifetime and become activated under conditions relevant to that particular schema.
It is important to realize that schemas can be functional or dysfunctional and are core cognitive constructs in what is typically referred to as our personality style. For example, someone may have a schema of personal incompetence, from which his or her actions are consistently interpreted as “not good enough". Someone else may have a schema of mistrust, from which all interpersonal actions by others are seen as suspicious. A third person may have a dependency schema and feel unable to function alone without help. Even when presented with evidence that disproves the schema, individuals distort data to maintain its validity.
Some schemas are developed in the preverbal period and therefore the most central core early maladaptive schemas are the ones developed in the preverbal stage. It is these preverbal schemas that tend to be entrenched and absolute, whilst the later ones tend to be conditional.
Early maladaptive schemas are typically unconditional themes (entrenched beliefs and feelings) held by individuals, which are often linked to the individual’s self-concept and that of the environment. Because of this concept, together with the fact that schemata begin so early in life, people feel secure in knowing who they are and what their world is like. This sense of secureness and predictability is comfortable and familiar, making it difficult to change without therapy.

How are schemas maintained?
Once a childhood pattern is established we tend to repeat it over and over. Freud called this ’repetition compulsion'. It refers to the universal tendency of individuals to repeat in their lives distressing or even painful situations without realizing they are doing so, or even understanding they are bringing about the recurrence and repeating in their current situations the worst times from the past. Somehow people manage to create, in adult life, conditions remarkably similar to those that were so destructive in childhood. An example is a woman who took emotional care (self-sacrifice or subjugation) of her father who was emotionally depriving. Later in life the tendency could be to go after a man who in one way was unavailable or emotionally unstable, unaware of the similarity with her father. A schema is all the ways in which we recreate these patterns.
The above example explains why individuals are likely to be drawn to partners where there is a high degree of chemistry, as this triggers their schemas, even when they are not objectively healthy for them. People with (EMS) tend to be drawn to partners who trigger their core schemas and that maladaptive partner selection is another strong mechanism through which schemas are maintained.
There are three broad coping styles, which ultimately reinforce the schemata through avoiding experiencing painful emotions associated with schema activation. These coping styles are processes that overlap with the psychoanalytical concepts of resistance and defense mechanisms:
Schema surrender – everything the person does to keep the schema going, by remaining in the situation and doing things to keep the schema going, e.g. if someone has a defectiveness schema and they stay in a relationship with someone who has criticized them, they are surrendering to the schema, they are staying in the situation but allowing themselves to be criticized thus enhancing the schema.
Schema avoidance is avoiding the schema either by avoiding situations that trigger the schema or by psychologically removing yourself from the situation so you don’t have to feel the schema. An example of avoidance might be the person with a mistrust schema who avoids making friendships because of the fear of being hurt or taken advantage of. This action only tends to reinforce the belief when others pick up the coolness and distance themselves.
Schema overcompensation is an excessive attempt to fight the schema by trying to do the opposite of what the schema would tell you to do. So if someone has a subjugation schema, they might rebel against the people who are subjugating them. If the overcompensation is too extreme it ultimately backfires and reinforces the schema. A form of overcompensation is externalizing the schema, by blaming others and becoming aggressive. Another way can be achieving at a very high level, whereby, a person who feels defective works 80 hours a week to overcompensate.
The Schema-Focused model of treatment is designed to help people break these maladaptive coping styles which perpetuate negative patterns of thinking, feeling and behaving, so that individuals can get their core needs met.
Cognitive Research into Trauma
The EMDR (Eye Movement Desensitisation and Reprocessing – Rapid eye movement technique, used to unlock the encapsulated repressed traumatic long term memories) processing of traumatic events is supported by the latest Cognitive Neuroscience Model. According to Dual Representation Theory (DRT), proposed by Professor Chris Brewin, (University College London), the situationally accessible memory system (SAM), which is located in the emotional part of the brain called the amygdala, interferes with hippocampal function, disrupting encoding in Verbally Accessible Memory (VAM). It is this impairment in VAM that accounts for increased intrusions. EMDR plays a critical role in transferring information from the non-hippocampally (amygdala) dependent SAM memory store to the hippocampally-based VAM and completing the processing of the trauma.
In terms of DRT, dissociation can be thought of as impairing the formation of a normal autobiographical narrative. This phenomenon can be witnessed in minor traumas such as panic attacks, whereby, the client misinterprets the physical sensations of panic in a catastrophic fashion, without checking out checking out the negative interpretation, which maintains the panic. EMDR can often be used to process early negative memories, and help weaken early maladaptive beliefs which appear resistant to change.

Cognitive Distortions:
All-or-nothing thinking: Seeing things in black-or-white categories that exist on a continuum.
Mental Filter: Dwelling on a single negative detail, instead of seeing the whole picture.
Over-generalization: Seeing one negative event as a never-ending pattern of 'always', or 'never'.
Jumping to conclusions: Interpreting things negatively when there is no evidence to support it.
- Mind reading: Guessing the content of someone else's thoughts, without checking it out.
- Fortune-telling: Predicting the future in a negative way, without any supporting evidence.
Discounting the positive: Positive experiences are dismissed, as 'not counting'.
Magnification: Magnifying ones problems and shortcomings, or minimizing one's positive qualities.
Imperative statements: Rigid, absolute demands about oneself, others or the world taking the form of should, must, ought, have to, or awfulising, catastrophising, leading to "' I can't stand it".
Emotional reasoning: Assuming negative emotional thinking reflects reality. i.e. '"I feel it".
Labelling: Attaching a negative label to an action i.e. I'm a failure, instead of, I made a mistake.
Personalisation: Holding oneself responsible for an event outside one's control.
Tunnel vision: Seeing only the negative aspects of a situation.
Research has shown that specific patterns of thinking are associated with a wide range of emotional and psychological problems. These negative or extreme thought patterns have frequently become so habitual that they are experienced as automatic and go unnoticed by the individual.
Cognitive Restructuring
Cognitive Therapy treats emotional problems by changing or restructuring maladaptive patterns of thought. Clients are taught how to uncover and re-examine these negative beliefs, and replace them with more adaptive ways of viewing life events. Through this process, clients learn self-help techniques that can produce rapid symptom shifts, solve current life problems, and improve self-esteem. These negative patterns of thought are called negative automatic thoughts and can be thought of as automatic representations of deeper cognitive structures - schemas.

Decision making in psychotherapy
Cognitive psychotherapy is the most scientific and empirically studied psychotherapeutic method. It utilizes the already existing knowledge of the other methods, but heightens up their approaches and terminology up to more structural degree of presentation. Moreover, cognitive psychotherapy introduces numerous paradigmatic and practical innovations distinguishing it from all the rest of therapies.
Cognitive schemas – cognitive schemas are concept of the symbolic cognitive modeling. In the topic view of the mentality, as it is seen in the psychodynamic psychology, cognitive schemas would represent the concept of “ID”. These schemas subliminally take part in all human choices and decisions. They are like unconscious cognitive filter through which we take our decisions. One can take adequate and appropriate decision up to the degree he has realized and worked through his cognitive schemas so that he can see the circumstances via clear “eye glasses”.
Automatic rules and thoughts – in cognitive science automatic thoughts represent procedural declarative long term memory. In psychodynamic psychology automatic ruled and thoughts correlate to the topic construct of super – ego (pre – consciousness) – censure resulting from the early years – product of the cognitive schemas.

Metacognition – it is the ability to observe one’s own cognition, affects and behavior.
In psychoanalyses this ability is attributed to the Self – feeling of oneself, the integrative cognitive principle, the leader of the mental processes. In the analytical psychology (C. Jung) it is also called Self. In transpersonal psychology metacognition is named inner Self, inner observer, the witness within, the controller. What is of paramount importance here is the ability of the metacognition to observe consciously, change and guide the cognitive processes, which is of huge importance regarding all mental abilities distinguishing us as an intelligent creatures. Metacognition plays enormous role in the course of psychotherapy, providing stable inner integrative pillar, converging all the rest of the cognitive abilities around itself and thus forming healthy strong mental structure.
Metacognition is the core cognitive construct in the process of decision making. It is the Decision Maker itself.


1. Fear and the Human Amygdala. Ralph Adolphs,’ Daniel Tranel,’ Hanna Damasio1s2 and Antonio R. Damasio1’2
‘Department of Neurology, Division of Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City,
Iowa and ‘The Salk Institute for Biological Studies, La Jolla, California
2. Age of Onset in Different Phobias. Lars-Goran Ost
Psychiatric Research Center, University of Uppsala, Sweden
3. A Contemporary Learning Theory Perspective on the
Etiology of Anxiety Disorders. It’s Not What You Thought It Was. Susan Mineka Northwestern University
Richard Zinbarg Northwestern University and The Family Institute at Northwestern University
S. RACHMAN. Psychology Department, Institute of Psychiatry, De Crespigny Park. London
SE5 8AF, England
5. http://www.schematherapy.com/ ; http://www.beckinstitute.org/Library/InfoManage/Guide.asp?FolderID=198&SessionID={86173AE3-77EA-447E-A43E-F79DE94DBC64}

Author: Orlin Baev

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