Transcript Meta-cognitive model - University of Sussex

Cognitive approaches to
understanding emotional
disorders
Dr. Frances Meeten
[email protected]
Who am I?
 Mechanisms of worry
 Embodiment of emotion
 MBCT for older people
OVERVIEW: Learning outcomes
- Understand cognitive explanations of two common
psychopathologies
 A cognitive model of depression
 Cognitive model of anxiety
 Meta-cognitions in anxiety
 Intolerance of uncertainty in anxiety
 The utility of examining cognitive processes across
disorders
MEDICAL MODEL
SOCIAL VARIABLES
Biological causes of
psychopathology
Socio-economic status,
geographical factors
COGNITIVE MODEL
Dysfunctional ways of thinking
generate psychopathology
symptoms
Diagram taken from:
http://www.stress.org/placebos-andpsychosomatic-disease-part-2/
MAJOR DEPRESSION
Prevalence:
World Health Organization (WHO) projections indicate that
depression will be the highest ranked cause of disease burden
in developed countries by the year 2020.
Characterisation according to the Diagnostic and statistical manual (DSM - IV-TR, APA, 2000):
Behavioural features
Inertia
Lack of energy
Physical features
Cognitive features
Insomnia
Depressed mood
Weight loss/gain
Negative beliefs about the world
Motivational features
Hopelessness
Diminished interest in activities
Beck’s Cognitive theory of depression
(Beck, 1967)
Aaron T. Beck
Cognitions (thoughts and beliefs) shape one's
behaviours and emotions.
Maladaptive cognitions precede and cause
psychological disorders.
Beck (1967): 3 main levels of thinking in onset,
maintenance, and exacerbation of depression.
Depressive
self-schemas
Maladaptive
beliefs/assumptions
Negative automatic
thoughts (NATS)
Schemas
Schema: Cognitive patterns used to categorise experiences and events
Mental plans that are abstract and that serve as guides for action, as structures for
interpreting information, as organised frameworks for solving problems.
(Reber, A. S. 1985: The Penguin Dictionary of Psychology. Penguin Books)
Depressive Schema
A structure such as a schema can be adaptive as it
speeds processing, but it can be maladaptive when
information is selectively encoded and retrieved i.e.
negative information at the expense of positive or
neutral information.
Depressive self-schemas result in a negative understanding
of the world and negative core beliefs e.g. ‘I am inept’
 E.g. Evans et al. (2005)
Core beliefs
Core beliefs that are organised within the negative self-schema influence
the development of dysfunctional beliefs. (Dozois & Beck, 2008)
Intermediate dysfunctional beliefs:
Often ‘all or nothing’ or ‘if/then’ beliefs that are contingent on selfworth.
“If I do not do as well as other people, then I am inferior”
Individuals with negative core beliefs often generate compensatory
strategies and rules e.g. “I must always succeed in everything I do”
Activation of depressotypic self-schemas and negative core beliefs
result in:
Cognitive errors/biases
And
Negative automatic thoughts
Cognitive biases
Systematic biases in thinking in depression maintain the
individual’s belief in the validity of negative concepts (Beck, 1967)
e.g.
Extreme thinking: All or nothing type thoughts i.e. “I am a terrible
person”
Selective attention: Selectively remembering a negatively biased version
of events.
Arbitrary inference: Drawing a specific conclusion in the absence of
evidence. “I only did well in the test because they probably made it
easier this year”
Negative Automatic Thoughts
- NATs are spontaneous and occur effortlessly and frequently.
- NATs influence emotions , behaviours, and physiological
responses.
- NATs occur spontaneously and are often left unchecked or
unchallenged , which makes a depressed individual feel more
negative and more depressed.
iveronicawalsh.wordpress.com
The cognitive triad
Three major cognitive patterns that lead an individual to
perceive themselves, the world, and the future in a negative
way.
SELF
Attribute failure to self
Attribute success to others
www.savagechickens.com
Negative automatic thoughts (NATS) often take this form
FUTURE
Current difficulties will continue
indefinitely.
Problems are timeless
WORLD
Interpretation of everyday
experiences in a negative way.
Failures are global
Early experience
• e.g. rejection
and criticism
from parents
Negative core
beliefs/schemas
Beck’s cognitive model
From Dozois & Beck (2008)
• I am
incompetent
Negative life event
Activation of
schema
Cognitive biases
• Nothing ever goes
right for me
Negative automatic
thoughts
Depression
Maintenance process for depression
Increased
hopelessness
Loss of
pleasure/achievement
Depressed
Mood
More negative view
of self
Negative cognitive biases
and symptoms e.g.
fatigue/poor concentration
Reduced activity
Nothing changes
Reduced coping
From: Westbrook, Kennerley, & Kirk (2007)
Negative cognitive biases
Beck suggested that a depressive schema served to maintain
negative cognitions and information processing biases.
STROOP TASK (e.g. Gotlib & McCann, 1984) - Name the colour of the word.
 GREEN
HAPPY
PAIN
 RED
 SUN
 LOSS
 YELLOW  LAUGHTER
 SORROW
People who are depressed are more likely to show greater attentional bias to
negative information.
Summary: A cognitive model of depression
Summary: Beck’s cognitive theory of
depression has highlighted how maladaptive
thinking can shape the way we perceive
ourselves and the world around us. Cognitive
biases influence our thoughts, behaviours,
and belief systems.
GENERALISED ANXIETY DISORDER
(GAD)
Excessive anxiety and worry lacking closure (Davey,
1994; Davey & Levy, 1998; Wells, 1995)
Long chains of negative thought: ‘What if ?’
questioning style
(Davey & Levy, 1998; Vasey & Borkovec, 1992)
Endemic negative mood
(Startup & Davey, 2001; Vasey & Borkovec, 1992).
We all worry…. But what is it that leads people
into pathological worrying that interferes with
their ability to get on with daily life?
www.cartoonstock.com
 Uncertain about the future?
 Unable to cope with life stresses?
 Unable to see the ‘brighter side’?
 Finds that worrying is helpful?
COGNITIVE MODELS OF ANXIETY
There are a number of cognitive models of anxiety.
We will discuss two:
1. Well’s (1995) Metacognitive model of worry and generalised
anxiety disorder (GAD).
2. Intolerance of Uncertainty (IU) in worry and generalised
anxiety disorder (GAD) (Koerner & Dugas, 2006; Ladouceur,
Gosselin, & Dugas, 2000).
Metacognitive model (Wells, 1995, 2006)
Meta-cognition refers to the knowledge and beliefs we have about
our cognitive system – the way we appraise things, regulate our
own thoughts.
Dysfunctional beliefs about our own thoughts (cognitions) are the
basis for the development and maintenance of clinical problems
e.g. anxiety/depressive rumination.
Metacognitive model (Wells, 2006)
 Makes the distinction between positive (type 1) and negative (type 2) beliefs
about worrying (Wells, 2006).
Type 1 worrying: Positive metacognitive beliefs
• Worry as a coping strategy
“If I worry a negative event – I will be prepared”
“ If I worry about all possibilities – I will avoid failure”
• Changes in mood/emotion
Type 2 worrying
• Negative beliefs about worry: Worry is uncontrollable, worry is
harmful
“Worrying is uncontrollable – I will lose my mind because
of worrying”
• Associated with pathological worrying
 Wells (1997) views
Negative cognitions
or beliefs about
worry as critical in
GAD.
 In meta-worry a
person will appraise
their worry thoughts
as being
uncontrollable and
dangerous
Figure 1. Cognitive model of GAD. From Cognitive Therapy of Anxiety Disorders: A
Practice Manual and Conceptual Guide (p.204), by A. Wells, 1997, Chichester, UK: Wiley.
Copyright 1997by John Wiley and Sons, Ltd.
Evidence? Some examples…
Individuals with GAD endorse significantly greater levels of negative
beliefs concerning the uncontrollability and danger of worry than other
groups (Cartwright-Hatton & Wells, 1997).
Meta-worry beliefs distinguished GAD individuals from individuals
without GAD. Thus there is a relationship between negative
metacognitions and GAD (Wells, 2005).
Summary of metacognitive model of anxiety
High worriers (including people with GAD) hold beliefs about worrying.
Positive beliefs about worry e.g. worrying is a useful task to undertake
(not necessarily pathological).
Negative beliefs about worry e.g. worrying in uncontrollable and harmful
Negative beliefs about worry result in avoidance behaviours, which
maintain maladaptive beliefs.
Intolerance of uncertainty model
(Dugas, Gosselin, Ladouceur, 2001, Koerner & Dugas, 2006))
Intolerance of uncertainty (IU) is a dispositional characteristic and
those who experience IU find uncertainty stressful, upsetting, they
think being uncertain about the future is unfair and that
unexpected events are negative and should be avoided (Buhr &
Dugas, 2002) .
IU promotes heightened sensitivity to ambiguous or innocuous
thoughts or situations resulting in processing biases towards
uncertainty and the perception of uncertainty as threatening.
Model of GAD based on Intolerance of Uncertainty
Dugas, Gagnon, Ladouceur, Freeston (1998)
1. IU
exacerbates
“what if
questions”
about worry
2. Individuals
with GAD
hold positive
beliefs about
worry
3. Worriers have
poor
Problem solving
confidence and
appraisals
4. Cognitive
avoidance means
threatening
material is not
processed – which
serves to maintain
worry
Figure from: Dugas, Gagnon, Ladouceur, Freeston (1998)
What’s the evidence?
Correlational evidence: Individuals with high IU appraise ambiguous situations as
more disconcerting than those with low IU (Koerner & Dugas, 2008).
Experimental evidence: Manipulating tolerance to uncertainty increases worrying
when tolerance is low e.g. Ladouceur et al. (2000) and Meeten et al. (2012).
Are the two models of GAD compatible?
IU and positive beliefs about worry: IU may perpetuate worry through a
number of positive beliefs about worry
1. Worrying is adaptive: It helps problem solve and increases
motivation
2. Worry dampens emotional reactions by preparing you for
surprise/disappointment
3. Worry shows positive aspects of your personality i.e. you are caring…
(Koerner & Dugas, 2006)
Summary
IU is a higher order process thought to directly affect
worry.
There is a positive correlation between high IU and
pathological worry and reducing IU has been found
to reduce worry.
One way in which IU is thought to exacerbate and
maintain worry is through positive beliefs about the
usefulness of worry.
Cognitive processes across psychological
disorders:
A transprocess model
Co-occurrence of
psychological disorders
Psychological disorders are more similar
than different in terms of the cognitive
behavioural processes that maintain
them
(Harvey et al., 2004)
Information processing
biases in depression and
anxiety
Attentional biases in
depression and anxiety
Dysfunctional ways of
thinking generate
psychopathology
symptoms
SUMMARY
1. What does the cognitive model seek to explain?
Dysfunctional ways of thinking generate
psychopathology symptoms.
2. Beck’s cognitive model of depression
Three levels of ‘thinking’ depressive schemas,
maladaptive beliefs, and NATs.
3. Cognitive models of anxiety
Meta-cognitive model: Type 1 and type 2 worries
IU in worry: IU directly affects worry and indirectly
affects positive beliefs about worry.
5. Cognitive processes across psychological disorders
References
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Depression
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper and Row. Republished as: Beck, A. T.
(1970). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press (Beck’s model of depression)
Dozois, D.J.A. & Beck, A.T. (2008). Cognitive schemas, beliefs, and assumptions. In K.S. Dobson & D.J.A. Dozois (Eds.), Risk factors in
depression. London Academic Press. (Available online via ScienceDirect).(Nice explanations of main factors of cognitive model of
depression)
Evans, J., Heron, J., Lewis, G., Araya, R., & Wolke, D. ( 2005 ). Negative self-schemas and the onset of depression in women: A
longitudinal study . British Journal of Psychiatry , 186 , 302 – 307 . (evidence that negative self-schemas are a risk for onset of
depression)
Gotlib, Ian H.; McCann, C. Douglas (1984). "Construct accessibility and depression: An examination of cognitive and affective factors".
Journal of Personality and Social Psychology 47 (2): 427–439.
Ingram, E. (2003). Origins of cognitive vulnerability to depression. Cognitive Therapy and Research, 27, 77-88. (Examination of how
depressive self-schemas may develop).
Westbrook, D. Kennerley, H. & Kirk, J. (2007). An introduction to Cognitive Behaviour Therapy: Skills and application. Sage. London
Anxiety
• Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: psychometric properties of the English version. Behaviour Research
and Therapy, 40, 931-945
• Cartwright-Hatton, S. & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates.
Journal of Anxiety Disorders, 11, 279-296.
• Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized Anxiety Disorder: A preliminary test of a conceptual model.
Behaviour Research and Therapy, 36, 215-226.
• Koerner, N., & Dugas, M. J. (2006). A cognitive-affective model of generalized anxiety disorder: the role of intolerance of uncertainty. In G.
C. L. Davey, & A. Wells (Eds.), Worry & psychological disorders: Theory, assessment & treatment (pp. 201-216). Chichester: John Wiley and
Sons, Ltd. (Overview of a cognitive model of IU)
• Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: The role of intolerance of
uncertainty. Cognitive Therapy and Research, 32, 619-638. (Experimental paper looking at appraisals by those with high IU)
• Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model
of worry. Behaviour Research and Therapy, 38, 933-941.
• Meeten, F., Dash, S., Scarlet, A. & Davey, Graham (2012). Investigating the effect of intolerance of uncertainty on catastrophic worry and
mood. Behaviour Research and Therapy, 50 (11). pp. 690-698. ISSN 1873-622X
• Wells, A. (1995) Meta-cognition and worry: A cognitive model of generalised anxiety disorder. Behavioural and Cognitive Psychotherapy,
23, 301-320.
• Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.
• Wells, A. (2006). Metacognitive Therapy for Worry and Generalized Anxiety Disorder. In: G.C.L. Davey & A. Wells (Eds.). Worry and
Psychological Disorders: Assessment and Treatment. Chichester, UK: Wiley. (Very clear overview of the metacognitive model of GAD and