Eliminating Your Limiting Beliefs

Ho'oponopono Certification

The Ho'oponopono Certification will teach you some fundamental strategies that will help you do away with all the negative energies. By so doing, you will become a positive person, leading a positive life as well. The program is a creation of two individuals, Dr. Joe Vitale and Mathew Dixon. The former is an actor and has featured in many books, apart from being a professional in the implementation of the law of attraction in ensuring people lead better lives. Mathew is an influential healing musician. The two individuals teamed up to modernize the Ho'oponopono strategy in the program. The program was established following a thorough research and tests. It is a step by step guide that will ensure you successfully let go of your cognizant and intuitive memory, bringing to an end all your problems. The program consists of 8 eight videos, each taking 40 minutes. These videos will explain each and every detail of the program to ensure that you fully understand all the necessary techniques. There is no reason to hesitate. Purchase it today transform your life for good. Read more here...

Hooponopono Certification Summary

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My Hooponopono Certification Review

Highly Recommended

Recently several visitors of websites have asked me about this manual, which is being promoted quite widely across the Internet. So I bought a copy myself to figure out what all the publicity was about.

All the modules inside this e-book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Cognitive Therapy Focusses on Cognition and Behaviour

The cognitive model of emotional disorders is central to every aspect of cognitive therapy the formulation, intervention planning and change processes. Thus, the therapist seeks to understand the client's presenting problems in terms of maladaptive beliefs and behaviours and develops an intervention plan that will effect changes in the presenting problems through changes in beliefs and behaviours. When successes and difficulties are encountered in the therapeutic process these are formulated in terms of maladaptive beliefs and behaviours, and therapy proceeds accordingly.

Cognitive Therapy is Based on a Cognitive Formulation of the Presenting Problems

Cognitive therapy distils cognitive theories of emotional disorders to the understanding of particular cases through the case formulation method. A skilled cognitive therapist aims to understand presenting problems in terms of cognitive theory while maintaining the 'essence' of the presenting problems for a particular individual. To the scientist-practitioner cognitive therapist, individualised case formulation is the heart of good practice (Tarrier & Calam, 2002). The process of clinical formulation has been described as' the linchpin that holds theory and practice together' (Butler, 1998), serving as a clinical tool that practitioners use as a framework for describing and explaining the problems that individuals may present with in cognitive therapy (Bieling & Kuyken, 2003). A case formulation should guide treatment and serve as a marker for change and as a structure for enabling practitioners to predict beliefs and behaviours that might interfere with the progress of therapy. It...

Cognitive Therapy Aims to Enable Clients to Identify Evaluate and Respond to Maladaptive Thoughts Beliefs and Behaviours

The change process in cognitive therapy involves clients learning to recognise how their thoughts, feelings and behaviours are related to one another and how they are implicated in the presenting difficulties. Clients then go on to learn how to actively evaluate and respond to maladaptive thoughts and behaviours. Early phases of cognitive therapy involve the therapist in an active and educative role middle phases involve much more of a joint problem-solving stance with later stages involving clients essentially 'running their therapy'. Placing the client in this active role of evaluating problematic patterns of thought and behaviour serves the parallel functions of increasing a sense of hope and mastery.

Cognitive Therapy Draws on a Wide Range of Cognitive and Behavioural Techniques to Change Thinking Beliefs Emotions and

The development of cognitive therapy over several decades has drawn on other therapeutic modalities, the extensive accumulated clinical expertise of cognitive therapists, increasingly sophisticated and fine-tuned theory and a large body of research. This has led to the development of a wide range of cognitive and behavioural therapeutic strategies on which a cognitive therapist can potentially draw. The main cognitive approaches involve teaching clients to be able to identify, evaluate and challenge cognitive distortions (such as all-or-nothing thinking) and maladaptive beliefs ('I have to be upbeat and bubbly at all times to be liked'). The main behavioural approaches involve increasing positively reinforcing behaviours (for example, behaviours that are pleasurable and generate a sense of mastery in people diagnosed with depression) and extinguishing or replacing negative behaviours (such as 'safety behaviours' that maintain a fear in people diagnosed with an anxiety disorder).

Cognitive Therapy is Structured

Cognitive therapy has evolved a structured format that enables the therapist and client to work in the most efficient and effective way. The structure remains constant throughout therapy making therapy more transparent and understandable for both therapist and client. Having outlined what distinguishes cognitive therapy, we aim to convey a sense of how cognitive therapy proceeds in practice. We will outline a typical therapy session, as well as a typical progression for therapy as a whole. We will conclude with a case example, illustrating this process. The interested reader is referred to J. Beck (1995) for a comprehensive overview of cognitive therapy in practice.

Cognitive Therapy In Practice

A typical cognitive therapy session involves checking how the client has been doing, reviewing the previous session, setting an agenda, working through the agenda items, setting homework, reviewing summarising the session and eliciting feedback. It begins with the therapist and client negotiating an agenda or list of topics that they agree to work on in that session. This involves ensuring the agenda is manageable, prioritising the items and linking them to the therapy goals. The therapist will usually ask the client for a brief synopsis of the time since they last met and as far as possible will try to enable a linking of both positive and negative experiences to thoughts and behaviours. For example, a client who reports feeling less depressed may go on to link this to returning to work and having less time to ruminate. A session would then review the homework from the previous session, again seeking to link progress or lack of progress to the therapy goals. For example, an...

The Structure of Cognitive Therapy Behavioural Techniques Cognitive Techniques and Homework

Cognitive therapy is made up of a range of therapeutic approaches (Figure 2.3). The first class of therapeutic approaches focus on the client's behaviour. The rationale is that for some people behaviour monitoring, behavioural activation and behavioural change can lead to substantive gains. For example, people with more severe depression often become withdrawn and inactive, which can feed into and exacerbate depression. They withdraw and then label themselves as 'ineffectual', fuelling the depression. By focussing on this relationship and gradually increasing the person's sense of daily structure and participation in masterful and pleasurable activities the person can take the first steps in combating depression (Beck et al., 1979). Other behavioural strategies include scheduling pleasurable activities, breaking down large tasks (such as finding employment) into more manageable graded tasks (buying a newspaper with job advertisements, preparing a resume ), teaching relaxation skills,...

Training And Supervision In Cognitive Therapy

Developing these skills requires training and supervision. Our experience suggests several goals for cognitive therapy trainers and supervisors. A first goal is to develop therapists' formulation skills, so that interventions have a clear rationale (Bieling & Kuyken, 2003 Needleman, 1999). Novice therapists often use cognitive therapy techniques without a clear basis in a cognitive formulation of the person's presenting problems. Learning formulation skills involves learning the technical aspects of a case formulation system, the cognitive theories that underpin it and having a good understanding of how this relates to the client's personal world. A second goal is to enable trainees to develop skills in collaborative empiricism. Trainees are encouraged to learn how to work with their clients to formulate hypotheses, carry out experiments, note and analyse the outcome of experiments, and through this process facilitate client cognitive and behavioural change. When done well this is...

Cognitive Therapy Areas Of Application

The last few decades have seen cognitive therapy adapted for mood, anxiety, personality, eating and substance misuse disorders. As well as these formal psychiatric disorders, cognitive therapy has been adapted for relationship problems and the psychological aspects of a range of medical disorders. Most recently cognitive therapy has been applied to the problem of anger generally and its manifestations in conflict specifically, while colleagues, mainly in England, have applied cognitive therapy to people with psychosis. A thorough review of these applications is beyond the scope of this chapter, but a brief overview is provided for the main areas of application. Interested readers may wish to follow up the references describing these adaptations and the following excellent reviews of evidence-based psy-chotherapies (Compas et al, 1998 De Rubeis & Crits-Cristoph, 1998 Fonagy et al., 2002 Kazdin & Weisz, 1998 Rector & Beck, 2001).

Cognitive Therapy for Affective Disorders

The first full description of a cognitive therapy format was cognitive therapy for depression (Beck et al., 1979). There have been numerous randomised clinical trials that support the efficacy and effectiveness of cognitive therapy for depression, across a variety of clinical settings and populations (for review, see Clark, Beck & Alford, 1999 De Rubeis & Crits-Cristoph, 1998 Dobson, 1989 Robinson, Berman & Neimeyer, 1990). In outpatient trials, effect sizes are considerable compared to no treatment controls, with about half of the intent-to-treat patients showing full recovery (Hollon & Shelton, 2001). Some studies suggest cognitive therapy has particular relapse prevention effects (see, for example, Evans et al., 1992). More recently there have been important developments for recurrent and severe depression (McCullough, 2000) and for the prevention of depression relapse in individuals at high risk by virtue of their history of recurrent depression (Jarrett et al., 2001 Segal,...

Cognitive Therapy for Anxiety Disorders

Cognitive therapy has been adapted for the full range of anxiety disorders generalised anxiety disorder (Beck & Emery with Greenberg, 1985) panic disorder (Clark, 1986 Craske & Barlow, 2001) social phobia (Heimberg & Becker, 2002) and obsessive-compulsive disorder (Frost & Steketee, 2002 Salkovskis, 1985). For generalised anxiety disorder, Chambless & Gillis (1993) computed effect sizes across five studies in which cognitive therapy was compared with one of several control conditions non-directive therapy (Borkovec & Costello, 1993) or waiting list (Butler etal., 1987, 1991). Substantial effect sizes (1.5-2) at post-test and follow up suggest that cognitive therapy is an efficacious intervention for generalised anxiety disorder. A review of 12 trials of cognitive therapy for panic suggested that 80 of patients achieved full remission at the end of treatment (Barlow & Lehman, 1996). De Rubeis & Crits-Christoph (1998) reviewed 11 outcome studies of cognitive therapy for panic disorder....

Cognitive Therapy for Personality Disorders

The 1990s saw several developments of cognitive therapy for personality disorders. Beck, Freeman & Davis (2003) adapted traditional cognitive therapy for each of the DSM-IV personality disorders. Layden et al. (1993) developed a more in depth adaptation for borderline personality disorder, and Linehan (1993) developed a more integrative behavioural-cognitive Zen Buddhist approach for this client group. Meanwhile, Young developed a schema-focussed cognitive therapy for personality disorders, which emphasises the importance of underlying schema change in this group (Young, 1994 Young, Klosko, & Weishaar, 2003). Several preliminary effectiveness studies suggest that these approaches produce significant symptom changes in people diagnosed with personality disorders (Kuyken et al., 2001, Linehan etal., 1999 Linehan, Heard & Armstrong, 1993). It is premature to comment on whether these are evidence-based interventions although several large-scale trials are currently under way.

Cognitive Therapy for Eating Disorders

Only more recently has cognitive therapy been adapted for eating disorders (Vitousek, 1996). In their review of eight outcome studies, Compas et al. (1998) concluded that cognitive therapy for bulimia nervosa meets criteria for an efficacious approach, although effectiveness research suggests that on average only 55 are in full remission at follow up. A recent multi-site study has broadly replicated these findings (Agras et al., 2000). It is premature to comment on cognitive therapy for anorexia nervosa as, although several adaptations have been suggested (Vitousek, Watson & Wilson, 1998), there is very limited research attesting to its efficacy or effectiveness to date.

Cognitive Therapy for Substance Misuse

There is a large body of research on psychosocial interventions for substance misuse, but cognitive therapy for substance abuse disorders is a more recent development (Beck et al., 1993 Marlatt & Gordon, 1985 Thase, 1997) and to date the evidence base for cognitive therapy as a preferred treatment choice is weak. The largest study in this area assigned 1 726 people with alcohol-abuse problems to cognitive therapy, a facilitated 12-step programme or motivational interviewing. Improvements were observed in all groups but, contrary to the study's hypotheses, there was no evidence that treatment matching improved outcomes or that any one intervention achieved improved outcomes (Allen et al., 1997). Evidence for cognitive therapy's evidence base with other substance abuse problems is decidedly mixed.

Cognitive Therapy for Psychosis

The last decade has seen an exciting development in cognitive therapy approaches for psychosis (Chadwick, Birchwood, & Trower, 1996 Fowler, Garety, & Kuipers, 1995 Morrison, 2002). While outcome research in this area is limited, a range of efficacy and effectiveness studies suggests that cognitive therapy is efficacious in the treatment of positive symptoms and that changes are maintained at follow-up (Garety et al., 1994 Kuipers et al., 1998 Rector & Beck, 2001 Tarrier et al., 1993).

Cognitive Therapy in Health Psychology Settings

A cognitive model of stress examines the role of beliefs in illness and proposes that aperson's beliefs about illness determine both emotional reactions to illness health and to health behaviours (Beck, 1984 Pretzer, Beck & Newman, 1989). This formed the basis for forms of cognitive therapy for a range of problems in health psychology and behavioural medicine, including pain, HIV AIDS, cancer, heart disease and health-related behaviours like exercise and smoking. For example, a link has been established between anger and hostility and coronary heart disease (Emmelkamp, & Van Oppen, 1993). Cognitive therapy to reduce anger and hostility therefore suggests a way of reducing the rates of heart disease. R. Beck and Fernandez (1998) analysed 50 studies, over two decades, incorporating 1 640 angry subjects treated with cognitive therapy. Using meta-analysis, it was found that cognitive therapy had a mean-effect size of 0.70, which indicated that the average individual treated with cognitive...

Cognitive Therapy for Different Populations and in Different Settings

Given the common features of cognitive therapy and these widely differing areas of application, it is not surprising that cognitive therapy has evolved in several different formats to ensure it is acceptable and effective to a range of groups of people (children, adolescents, adults, older adults and people with learning disabilities), in different therapy formats (self-help, individual, couples, families, groups, organisations) and across different levels of service delivery (primary, secondary and tertiary care). There is increasing interest in cognitive therapy for children, in part because the approach appears acceptable to children and adolescents and pragmatic in these service settings (Friedberg & McClure, 2001). A comprehensive review of the outcome literature for children and adolescents suggests that cognitive therapy is effective for generalised anxiety, simple phobias, depression and suicidality (Fonagy et al., 2002 Kazdin & Weisz, 1998). As with adult populations, the...

Cognitive Psychology Has Not Succeeded in Making a Significant Contribution to the Understanding of the Human Mind

Cognitive psychology is not getting anywhere that in spite of our sophisticated methodology, we have not succeeded in making a substantial contribution toward the understanding of the human mind A short time ago, the information processing approach to cognition was just beginning. Hopes were high that the analysis of information processing into a series of discrete stages would offer profound insights into human cognition. But in only a few short years the vigor of this approach was spent. It was only natural that hopes that had been so high should sink low. (Glass, Holyoak & Santa, 1979, p. ix)

The Assumption That Cognitive Psychology Has Epistemological Import Can Be Challenged

Only the assumption, that one day the various taxonomies put together by, for example, Chomsky, Piaget, Levi-Strauss, Marx, and Freud will all flow together and spell out one great Universal Language of Nature would suggest that cognitive psychology had epistemological import. But that suggestion would still be as misguided as the suggestion that, since we may predict everything by knowing enough about matter in motion, a completed neurophysiology will help us demonstrate Galileo's superiority to his contemporaries. The gap between explaining ourselves and justifying ourselves is just as great whether a programming language or a hardware language is used in the explanations. (Rorty, 1979, p. 249)

The Evidence Base For Cognitive Therapy Ct And The Comparison Of Behaviour Therapy And Cognitive Therapy

A systematic review by Abramowitz (1997) found no significant difference between behaviour therapy and cognitive therapy. In a further RCT Cottraux (2001) found a similar response rate following behavioural and cognitive therapy. Obsessive cognitions changed with BT and CT. Few studies have tried to investigate whether cognitive therapy and ERP share a psychological mechanism or achieve the same results through different mechanisms. Van Oppen et al. (1995) showed that there was no difference on the Irrational Beliefs Inventory or YBOCS obsessions or compulsions subscales between the groups treated with cognitive therapy or ERP. However they used cognitive therapy that included behavioural experiments and the reality is that treatments will rarely be purely behavioural or cognitive. Freeston etal. (1997) showed that cognitive-behavioural treatment was effective for patients with only obsessive thoughts who completed treatment. However there was a significant drop-out rate.

Cognitive Behavioural Therapy Rationale

Cognitive behavioural therapy for depression, rather than referring to a single system of therapy, now more accurately describes a range of practices derived from the original work by Aaron Beck (Beck et al. 1979), focusing on the thinking patterns and associated emotional, behavioural and physiological systems operating within the depressed individual. Problematic schema, acquired in and reflecting the course of development are retained into later life and can be triggered by thematically congruent events. Such triggering events are argued to lead to characteristic negative automatic thoughts, thinking errors and erroneous or negatively biased (Power & Dalgleish, 1997) information processing and associated behavioural, emotional and physiological responses. The first goal of CBT is the identification of any such systematic errors and the second is the modification of thinking and reasoning patterns to replace them with evidence-based and rationale alternatives, thus facilitating...

Cognitive Therapy For The Personality Disorders

Cognitive therapy was first developed as a treatment for depression and the anxiety disorders (A. T. Beck, 1976 A. T. Beck, Emery, & Greenberg, 1985 A. T. Beck, Rush, Shaw, & Emery, 1979). According to this model, emotional disorders can be understood in terms of the biases in thinking that are activated with, for example, depressed individuals predisposed toward seeing events in terms of loss, failure, and depletion, and anxious individuals viewing events in terms of threat that is imminent. These biases are related to the latent schemas or models of reality through which information is filtered, in a manner that continually reinforces the biased model of thinking. Beck and his colleagues (A. T. Beck et al., 2003 Pretzer & Beck, in press) have extended the schematic processing model to an understanding of personality disorders. Influenced by the ego analysts such as Alfred Adler (1924 1964), Karen Horney (1945, 1950), Harry Stack Sullivan (1956), and Victor Frankl (1992) the...

The Cognitive Model

At the heart of cognitive therapy lies a deceptively simple idea. Perceptions of ourselves, the world and the future shape our emotions and behaviours. What and how people think profoundly affects their emotional well being. As Shakespeare's Hamlet put it' is nothing either good or bad, but thinking makes it so . . . ' From this principle comes the idea that if we evaluate and modify any dysfunctional thinking, we can profoundly affect our emotional Figure 2.1 Factors involved in the development of evidence-based cognitive therapy. Salkovskis (2002). Reprinted with permission. Figure 2.1 Factors involved in the development of evidence-based cognitive therapy. Salkovskis (2002). Reprinted with permission. This central feature of cognitive therapy is based on two broader assumptions. First, that a broader bio-psycho-social context is implicated in the development and maintenance of emotional disorders. Cognitive therapy theorists and researchers have themselves emphasized different...

Cognitive Therapies

Adapted versions of the cognitive therapies are being used increasingly with people with ID. It had been considered by earlier writers that methods for cognitive therapy would have to be adapted considerably in order to be understood clearly by individuals with mild ID (Kroese, 1997). However, more recent research suggests that with minor adaptations, simplification and so on, assessment and treatment are extremely similar to those seen in mainstream therapy. Dagnan & Sandhu (1999) used an adapted version of the Rosenberg Self-esteem Scale (Rosenberg, Schooler & Scoenbach, 1989) and the Gilbert & Allen (1994) Social Comparison Scale in a study of the impact of social comparison and self-esteem on depression in people with mild intellectual disabilities. Psychometric analysis of these scales indicated a factor structure that is consistent with the factor structure of the original scales when used in the mainstream population and a good level of internal and test re-test reliability....

The Health Belief Model

The HBM has provided a useful framework for investigating health behaviors and has been widely used. It has been found to successfully predict a range of behaviors. For example, Janz and Becker (1984) found that across 18 prospective studies, the 4 core beliefs were nearly always significant predictors of health behavior (82, 65, 81, and 100 of studies report significant effects for susceptibility, severity, benefits, and barriers, respectively). Harrison et al (1992), in a review with more stringent inclusion criteria, reported that susceptibility and barriers were the strongest predictors of behavior. Some studies have found that these health beliefs mediate the effects of demographic

Examples Of The Evidence Base

One of the most famous and most expensive therapy outcome studies was the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program, which will be considered in order to illustrate the problems that have arisen from the general failure to find differential effectiveness of therapy outcome (see Elkin et al., 1989 Elkin, 1994) but also to illustrate other issues about the evidence base. This trial was the largest of its kind ever carried out. There were 28 therapists working at three sites eight therapists were cognitive-behavioural, 10 were interpersonal therapists, and a further 10 psychiatrists managed two pharmacotherapy conditions, one being imipramine plus 'clinical management', the second being placebo plus 'clinical management'. Two-hundred-and-fifty patients meeting the criteria for major depressive disorder were randomly allocated between the four conditions. The therapies were manualised and considerable training and supervision...

Good Therapeutic Relationship is Necessary but Not Sufficient for Effecting Change

Cognitive therapists, like other therapists, aim to provide an empathic, warm, genuine and respectful context in which to work. Given the focus of cognitive therapy, they should be particularly skilled at seeing the world from their clients' perspective (accurate empathy) while holding a realistic perspective in the face of what may be quite distorted thinking. Cognitive therapists explicitly model a hopeful, collaborative and problem-solving stance.

General Versus Specific Habits

Studies, the habitual quality of negative self-thinking was pitted against the content of such thinking. Having negative self-thoughts every now and then is part of a healthy mental life, e.g., being self-critical at times, learning from past mistakes, or being aware of one's weaknesses. However, when negative self-thoughts occur frequently and automatically they may become dysfunctional. Verplanken et al (2007) indeed found that the mental habit component of negative self-thinking accounted for unique variance in explicit and implicit measures of self-esteem. Similar results were found in a longitudinal study over 9 months on anxiety and depression, even after controlling for traditional vulnerability measures such as previous symptoms, dysfunctional attitudes, and negative life events. Habitual negative thinking has also been found important in the more specific area of body image. Dissatisfied body image thinking is an increasing problem and is particularly associated with eating...

Cognitive Psychologists Construe the Abstract Mechanisms Underlying Behavior

The task of the cognitive psychologist is a highly inferential one. The cognitive psychologist must proceed from observations of the behavior of humans performing intellectual tasks to conclusions about the abstract mechanisms underlying the behavior. Developing a theory in cognitive psychology is much like developing a model for the working of the engine of a strange new vehicle by driving the vehicle, being unable to open it up to inspect the engine itself

Common Approaches To Neuropsychological Evaluation

The fixed battery approach falls at the extremes of fixed test selection, standardized administration, and actuarial interpretation. It is best exemplified by the Halstead-Reitan Battery (4). The process, or hypothesis-testing, approach emphasizes qualitative aspects of neuropsychological functions, which are found in developmental and cognitive psychology. Champions of the process approach promote testing the limits with patients and assessing the component processes of cognition, rather than relying exclusively upon summary scores. In other words, the process approach views critically how a task is solved and how the solution unfolds over time, rather than the achievement score quantifying the quality of the end product.

Medical Decision Making

Chronic pain, a common treatment target for behavioral medicine practitioners, provides a final example of the relevance of the neu-rocognitive examination to medical decision making. In their review of executive functions, self-regulation, and chronic pain, Solberg et al (2009) propose a model in which executive functions and associated decrements in self-regulation cause and maintain chronic pain disorders. Specifically, the cognitive, emotional, social, behavioral, and physiological challenges associated with chronic pain are more poorly managed in the context of poor executive function. Optimally designed chronic pain interventions may therefore require components aimed at improving executive functions and self-regulatory capacity, such as cognitive techniques and physical activity.

Conceptualization Measurement and Analysis of Negative Affective Risk Factors

Since long before the inception of behavioral medicine as a scientific field, negative emotions have been described as contributing to the development and course of serious physical illness. A substantial and growing body of research now supports this hypothesis (Smith and MacKenzie, 2006 Steptoe, 2007a Suls and Bunde, 2005). Among the specific negative affects studied, anger and related constructs (e.g., hostility) have the longest history of research, especially in cardiovascular disease (Chida and Steptoe, 2009 see Chapter 13). More recently, depression has emerged as a major research focus as a risk factor for the development and adverse course of physical illness (Nicholson et al, 2006 Steptoe, 2007b). Anxiety and related constructs (e.g., worry) are increasingly documented as having similar effects (Roy-Byrne et al, 2008 Suls and Bunde, 2005). Whether studied as symptoms of emotional distress, diagnosed mood or anxiety disorders, or related personality traits, it is increasingly...

Methods of Measurement

The vast majority of studies of negative emotions as risk factors for poor health outcomes rely on self-reports of anxiety, depression, or anger. This approach assumes that participants are willing and able to provide generally accurate descriptions of their emotional functioning. Even interview-based assessments (e.g., structured diagnostic interviews) rely heavily on what participants are willing and able to report. A small but growing literature suggests that self-reports of these risk factors have less predictive utility than do other methods, such as ratings provided by significant others (c.f., Smith et al, 2008). Hence, reliance on self-reports could produce an underestimate of the importance of negative affective risk factors. Here again, design and implementation of optimal interventions would be facilitated by attention to basic issues in measurement.

Established Coronary Disease

Colleagues (2002) found that scores on the Cook Medley scale were an independent risk factor for recurrent events in postmenopausal women. Denollet and Brutsaert (1998) found that anger was one of several negative emotions conferring excess risk in MI patients. There have been some negative studies, however (e.g., Frasure-Smith and Lesperance, 2003), other researchers have observed the effect only under certain conditions. For example, two studies (Angerer et al, 2000 Boyle et al, 2004) found some hostility measures to be predictive while others were not, and Boyle and colleagues (2005) observed a stronger effect in younger patients. Although the picture painted by the literature is not completely clear, it is highly probable that hostility does convey increased risk of future coronary events in those with established disease. The exact conditions and aspects of hostility that maximize that risk are yet to be established.

Questionnaires Selfmonitoring and Observation of Behaviour

When the therapist and patient have determined what behaviour needs to change, it can be useful to have the patient complete a self-monitoring diary to elucidate the conditions under which the behaviour occurs. Such diary registrations can illuminate crucial associations between problem behaviour and critical events (antecedents and consequences of the problem behaviour). It is important to tailor the registration forms to the individual needs of the patient. In general, during the self-monitoring phase, patients are asked to record date and time, the situation they are in, their emotion and its intensity, the presence of any physical sensations, their automatic thoughts and the occurrence of the problem behaviour. In contrast to cognitive therapy, where diaries are used as a means of changing cognitions, in behaviour therapy diaries are used as an assessment instrument to enhance the problem analysis (see Figure 4.1) and the evaluation of treatment. In this respect, it can also be...

Positive Meaning Focused and Spiritual Coping

For example, people report both negative emotions and positive emotions during stressful periods (e.g., Andrykowski et al, 1993 Norekv l et al, 2008). There is some basis for holding that positive emotions per se can have beneficial effects on health (Folkman and Moskowitz, 2000, 2004 Frederickson et al, 2000), though evidence is mixed (Pressman and Cohen, 2005, see Chapter 14).

Social And Procedural Context

Control processes and how they are organized, or whether there are distinct mechanisms for different kinds of memories. Much of cognitive psychology has focused on identifying the component parts of systems such as decision making, attentional control, and memory, among other topics. This has been approached in two major ways by trying to identify behavioral dissociations in performance between different processes, and by trying to identify the similarities in performance between different processes. The logic of both approaches can also be applied to measures of brain activation.

Coping and Health Behavioral Pathways

For example, smoking, alcohol and drug use, and casual sex are common ways to self-sooth, or regulate emotions, when under stress (cf. Cohen et al, 1991 Holahan et al, 2003 Horowitz and White, 1991). Such activities may reduce negative feelings over the short term, thereby serving as emotion-focused coping. However, they ultimately can have adverse effects on health.

Species of the Unconscious

Preparatory to my critical assessment of the psychoanalytic enterprise, let me emphasize the existence of major differences between the unconscious processes hypothesized by current cognitive psychology, on the one hand, and the unconscious contents of the mind claimed by psychoanalytic psychology, on the other (Eagle, 1987). These differences will show that the existence of the cognitive unconscious clearly fails to support, and even may cast doubt on, the existence of Freud's psychoanalytic unconscious. His so-called dynamic unconscious is the supposed repository of repressed forbidden wishes of a sexual or aggressive nature, whose reentry or initial entry into consciousness is prevented by the defensive operations of the ego. Though socially unacceptable, these instinctual desires are so imperious and peremptory that they recklessly seek immediate gratification, independently of the constraints of external reality. Freud did not seem to take seriously the possibility that cognition...

Problemsolving Skills Training

Problem orientation, during which patients explore their personal attitude towards problems. The most important aspects are that the patients learn to recognize their negative feelings as signals of problems and learn to distinguish between problems over which one can exert personal control (such as arguments) versus those where one can not (such as cancer).

An unkind note on sociobiology or evolutionary psychology

By some peculiar coincidence, the behaviors that evolution has found most adaptive correspond to the stereotypes of womanly and manly that are, at least tacitly, dominant among the American white, protestant middleclass (see e.g. Garcia, 1983 Sprecher et al., 1987 Gagnon and Simon, 2002, for a discussion of social prejudice or stereotypes). There is no reason to make a sociological or cultural analysis of this fact here. This is a task for social scientists. Nevertheless, it may be convenient to remember that explanations in terms of final cause or purpose, teleological explanations, such as those behind the sex differences mentioned above, are always arbitrary. There exists a myriad of possible answers to the questions of 'why ' and 'what for ' are men more promiscuous than women. The answer we choose is inevitably determined by our personal beliefs. If we believe that male promiscuity indeed is adaptive, we can always create an evolutionary argument for that. Evolutionary arguments...

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Rationale for Assessment of Psychosocial Constructs

One issue that has been strongly debated in the literature on psychosocial factors and health is whether assessments include measures of clinical diagnoses (e.g., major depressive disorder, panic disorder) or measures of symptom severity or both. Within the context of studying the health impact of negative emotions and personality, questions have been raised as to whether assessment of symptoms without assessment of clinical conditions is sufficient. An example is the assessment of depressive symptoms versus major depressive disorder (i.e., clinical depression). The initial studies examining whether depression was linked to increased morbidity and mortality were conducted within psychiatric populations, so an early emphasis in the literature was on clinically diagnosed depression. However, because it is uncommon to have time or resources to complete clinical interviews within the context of large, population-based studies, much of the epidemiologic research on the relation of...

Toward A New Classification Of Personality Disorders

In contrast to the large number of specific features detailed by Parker et al. (2002) that appear more suitable to Step 2, Livesley (1998, 2001) proposed that review of the clinical literature on personality disorders reveals two major features of dysfunction that can be used to elegantly and parsimoniously define personality disorder (Step 1). He suggested that personality disorder could be clinically defined by chronic interpersonal dysfunction and problems with self or identity. The former is characterized by pervasive abnormalities in social functioning, including failure to develop adaptive relational functioning, impairments in cooperative and prosocial relational capacity, and instability and poor integration of mental representations of others and relationships. Such deficits often give rise to interpersonal relationships marred by deleterious vicious circles (Millon, 1996), self-fulfilling prophecies (Carson, 1982), and maladaptive transaction cycles (Kiesler, 1991). Self...

Stress and Personality

Several cognitive models of adaptation and coping with stress have been proposed. These models postulate different cognitive strategies that may be preferred by people with different personalities. An earlier model of this sort is Byrne's (1961) repression-sensitization conception of a continuum representing different responses to stress. Information-avoidance behaviors are at the repression end of the continuum, and information-seeking behaviors at the sensitization end. Another cognitive model of coping is Folkman and Lazarus's (1980) distinction between problem-focused and emotion-focused strategies. A problem-focused strategy consists of obtaining additional information to actively change a stressful situation, whereas an emotion-focused strategy is concerned with employing behavioral or cognitive techniques to manage the emotional tension produced by stressful situations. Rather than focusing on one strategy, most people employ a combination of the two. Although Folk-man,...

Intention Versus Action

One of the common reasons given by people who do not go for screening tests is that they did not get round to it (Seeff et al, 2004 Shields and Wilkins, 2009 Waller et al, 2009). Seeing a doctor who recommends cancer screening may act as a prompt to overcome this inertia, but this barrier is still cited by women in countries with organized screening programs (who receive a personal invitation) so prompting may be insufficient to encourage some women to be screened. In these situations the intention to be screened may be there, but translation of this intention into behavior never occurs. A review of research into the intention-behavior gap suggests this is the case for a significant proportion (around 40 ) of individuals (Sheeran, 2002). A recent study in the context of CRC screening showed that while psychosocial predictors were strongly associated with intention to be screened, factors relating to life difficulties (e.g., SES, stress and social support) played a larger role in...

Is EMDR a Power Therapy

Rosen et al. (1998) describe EMDR as a 'power therapy' (Figley, 1997), and group it together with therapies such as thought field therapy (Callahan, 1995), trauma incident reduction (Gerbode, 1989), and emotional freedom techniques (Craig, 1997). Rosen et al. say 'These Power Therapies appeal to popular healthcare models with an emphasis on tapping energy points.' Poole, De Jongh & Spector (1999), however, respond that the theoretical foundations of these procedures linked together have no common ground whatsoever. Eye movement desensitisation and reprocessing incorporates well-established therapeutic principles of exposure, cognitive restructuring and self-control procedures, and should be viewed as part of an overall treatment process, rather than a 'one-off' treatment method. They also point out that none of the other procedures mentioned had been evaluated by any properly controlled randomised studies, whereas EMDR had been evaluated by several.

Parenting and Family Environments

Along with absence of the father, family environments prone to discord and lacking in close interpersonal relationships have been of interest, in part, due to their association with girls' early pubertal development, which in turn increases the likelihood of a number of adolescent health outcomes, including problems of mood and conduct, early sexual activity, and teen pregnancy (Ellis, 2004). In twin studies, measures of family conflict and family cohesion show modest to moderate genetic influence, with weighted mean heritabilities in the Kendler and Baker (2007) review of 30 and 24 , respectively (Plomin et al, 1988, 1989 Jacobson and Rowe, 1999 Jang et al, 2001). In one other twin study, Krueger et al (2003) reported on the heritability of a retrospective measure of perceived cohesion versus conflict in the family environment derived from multiple environmental scales. The 16 of variance in this measure that could be attributed to heritable variation, moreover, was fully explained...

Comparison Of Psychological And Drug Treatments And Combinations Of Treatment

One study showed a significantly greater improvement in obsessions with behavioural therapy plus the selective serotonin reuptake inhibitor drug fluvoxamine, compared to behavioural therapy plus placebo tablet (Hohagen et al., 1998). O'Connor et al. (1999) found that a combination of cognitive behavioural therapy and medication seemed to potentiate treatment efficacy. However other studies have not shown any additional benefit of combining behavioural therapy or cognitive therapy with a serotonin reuptake inhibitor drug, compared to using any of the three treatments alone (De Haan et al., 1997 Kobak et al., 1998 Van Balkom et al., 1998). De Haan et al. (1997) compared ERP, cognitive therapy, ERP plus fluvoxamine and cognitive therapy plus fluvoxamine and found no differences in efficacy between the four treatments. They found that a short-term positive response is a good predictor of long-term effect. However one-third of non-responders at post-treatment (16 weeks) had also become...

Prototype Diagnosis Of Personality

The late 1970s and 1980s saw a flurry of research applying the prototype concept to the classification of psychopathology and, particularly, PDs. Cantor and Mischel (1977) found evidence for prototype-based memory for personality features (introversion extraversion) similar to the memory processes identified in cognitive psychology for simpler, nonsocial categorization tasks. Research by Horowitz and colleagues (Horowitz, Post, French, Wallis, & Siegelman, 1981 Horowitz, Wright, Lowenstein, & Parad, 1981) examined the extent to which prototypes could be identified and cases could be classified by expert and nonexpert raters based on the extent of prototypicality of the case. Several studies found that prototypes can be reliably generated and rated by clinicians (e.g., Blashfield, 1985 Livesley & Jackson, 1986 Sprock, 2003).

Difficulties In Assessing Outcome Research

With these caveats in mind we will proceed to examine the evidence base for psychological therapies in the treatment of personality disorder. Recent systematic reviews (Bateman & Fonagy, 2000 Bateman & Tyrer, 2002 Binks et al., 2006 Perry, Banon & Ianni, 1999 Roth & Fonagy, 2005 Roy & Tyrer, 2001 Shea, 1993) have varied in their inclusiveness. For reasons of space the following section is limited to consideration of large-cohort and controlled studies in which patients were selected on the basis of Axis II disorders, treatments were clearly described and adequate measures were used. The approaches considered are dynamic psychotherapy, cognitive therapy, interpersonal group psychotherapy, behaviour therapy and dialectical behaviour therapy delivered through outpatient, day hospital or inpatient programmes. Therapeutic communities will be briefly considered at the end, together with treatment programmes for personality disordered offenders.

Chronic Negative Affect

Links between negative emotional states and health outcomes may result from chronic or recurring engagement of biological stress regulatory systems. Negative emotional states have been tied to heightened biological stress responses, including evidence of stronger autonomic response to stressful circumstances (e.g., Matthews et al, 1996) and stronger hypothalamic-pituitary-adrenocortical (HPA) responses to stress (e.g., Chorpita and Barlow, 1998 Flinn and England, 1997). Studies also suggest links between negative emotions and reduced heart rate variability (e.g., Kawachi et al, 1995), implicating potential compromises in parasympathetic functioning in these relations. Intense, chronic, or recurring biological responses to stress may, thus, represent one pathway by which a harsh early environment exerts adverse effects on adult health outcomes (McEwen, 1998 Repetti et al, 2002), effects that may be mediated, at least in part, by negative emotional states.

Early Adversity and Health Outcomes Tests of the Model

That a harsh family environment was related to negative emotions and to obesity, which in turn predicted blood pressure as well as change in blood pressure. Low childhood SES directly predicted change in systolic blood pressure as well. The strength of these pathways did not vary by race or gender. Thus, the findings suggest that socioemotional factors contribute to biological mechanisms that may underlie the impact of early family environment on the development of elevated blood pressure. Two important caveats deserve mention. First, the effects revealed in these tests of the model were modest in size. One reason is that genetic factors are strong contributors to these outcomes, and they could not be measured in this data set. Second, the fact that participants reconstructed their early family environment and that these studies were retrospective rather than prospective raises the possibility that negative emotions themselves color reconstruction of family environment. Accordingly,...

Aging Related Outcome Frailty

In addition, various cross-sectional reports have linked depressive symptoms to aspects of frailty. However, cross-sectional associations are hard to interpret since frailty status itself could result in increased feelings of depression and mood changes. For certain aspects of the frailty syndrome, longitudinal associations with depression have been confirmed as well. Persons with high depressive symptoms have shown a larger 4-year decline in walking speed (Penninx et al, 1998) and a larger decline in muscle strength (Rantanen et al, 2000). In addition to negative emotions, Ostir and colleagues (2004) found that positive affect could significantly reduce the onset of frailty, which adds to a growing positive psychology literature showing that positive affect is protective against the functional and physical decline associated with frailty (see Chapter 14).

Asian Pacific Islander Americans

Not permit Asian and Pacific Island women to enter this country, combined with the detention of Japanese-Americans in concentration campus during World War II, left a reservoir of negative feelings in some members of the Asian-American community. Be that as it may, Asian-Americans are perhaps the best example of how the United States can still be a land of opportunity for immigrants who are skilled and motivated to work and save.

Evidencebased Psychotherapy With Older People

Despite an increasing awareness of the importance of anxiety disorders in older people there still remains a limited number of systematic studies examining psychotherapy for anxiety in later life (Gatz et al., 1998 Nordhus & Pallesen, 2003 Stanley & Beck, 2000 Woods & Roth, 1996). This paucity of systematic studies is all the more surprising given the evidence supporting cognitive therapy as a treatment of choice for panic disorder and phobic disorders (Laidlaw et al., 2003). There are many more papers published that comment on King & Barrowclough (1991) developed a series of individual case studies to evaluate CBT's effectiveness as a treatment for late-life anxiety. The study was a naturalistic one as reflects the pilot nature of interventions being evaluated. Many of the participants were prescribed medication at a stable dose during their participation in the study. Outcome was impressive as seven out of 10 patients benefited from CBT. King & Barrowclough (1991) used standard...

Influence of the Judge

Were jurors swayed by the judges' hints Data on this issue are somewhat fuzzy. Although the judges' biases in summing up were closely associated with the results of most cases, jurors' verdicts occasionally did not agree with the judges' apparent inclinations. So, for example, 9 of jurors who believed that the judge favored conviction reported that their jury opted to acquit. Of jurors who perceived a mild bias in favor of conviction, 13 decided to acquit. These data suggest that at least some juries are able to resist the influence of the judge's perceptions if those perceptions are counter to their own. However, some juries went against their personal beliefs and convicted or acquitted because the judge favored that particular verdict.

Autonomic Balance and Health

Autonomic imbalance, in which one branch of the ANS dominates over the other, is associated with a lack of dynamic flexibility and health. Empirically, there is a large body of evidence to suggest that autonomic imbalance, in which typically the sympathetic system is hyperactive and the parasympathetic system is hypoactive, is associated with various pathological conditions (Sztajzel, 2004). In particular, when the sympathetic branch dominates for long periods of time, the energy demands on the system become excessive and ultimately cannot be met, eventuating in death. The prolonged state of alarm associated with negative emotions likewise places an excessive energy demand on the system. On the way to death, however, premature aging and disease characterize a system dominated by negative affect and autonomic imbalance.

The Assumptive Beliefs And Explanatory Worldviews

Why are these personal beliefs so critical to the maintenance of psychological well-being And, why, if violated, do they create such havoc within an individual's psyche The answer appears to be twofold First, as noted earlier, these personal beliefs serve to reduce anxiety and uncertainty in a world where much must be taken for granted. Second, these worldviews serve as substitutes for actual physical and psychological protection mechanisms, thus their extreme importance ontogenetically. This notion is consistent with the existence of a biological mandate to make sense of the world.

Cognitive Behaviour Therapy

The cognitive behavioural approach, with its success in the management of depression and anxiety disorders (Department of Health, 2001), soon turned its focus to schizophrenia. It had the advantage of collaborative relationship and shared formulation of the patient's problem based on common sense. Most importantly, it de-stigmatised psychosis by giving due importance to the patient's perspective (Kingdon & Turkington, 1994) on the experience of psychosis - the sufferer now had a say. Cognitive behavioural and family work could all be woven into the work with the individual (Kuipers, 2000). There is evidence that the gains made through cognitive therapy are durable at least in the medium term (Sensky et al., 2000). However, adequate evidence does not exist to support the view that CBT can reduce relapse rates in schizophrenia except when a specific focus is taken on relapse prevention (Gumley et al., 2003). This can be explained by the fact that patients enrolled in the majority of CBT...

Phenotypic variation in human female reproductive development

Environmental adversity, including economic hardship and marital strife, compromise the emotional well-being of the parent and thus influence the quality of parent-child relationships (Repetti et al., 2002). High levels of maternal stress are associated with increased parental anxiety, less sensitive childcare (Dix, 1991 Goldstein et al., 1996), and insecure parental attachment (Goldstein et al. 1996 Vaughn et al., 1979). Parents in poverty or other environmental stressors experience more negative emotions, irritable, depressed, and anxious moods, which lead to more punitive parenting (Belsky, 1997a Conger et al., 1984 Fleming, 1999 Grolnick et al., 2002). The greater the number of environmental stressors (e.g., lesser education of parents, low income, many children, being a single parent), the less supportive the mothers are of their children such mothers are more likely to threaten, push, or grab them, and display more controlling attitudes. Fleming (1988) reported the anxiety of...

Studies Of Psychological Treatments In Bipolar Disorders

For BP have focussed on psychoeducational models, the three most well-researched manu-alized psychological approaches - interpersonal social rhythms therapy (IPSRT), cognitive therapy (CT) and family focused therapy (FFT) - or techniques derived directly from these manualized therapies. The latter are used primarily to improve medication adherence or to teach recognition of prodromes and relapse prevention techniques. Cognitive Therapy Cognitive therapy

Overview of Brain Changes inMDD

The cognitive model of depression (Beck, 1961) posits that stressful life events activate cognitive vulnerability and the depressive state develops, resulting in the depressive phenotype that is characterized by increased negative emotion processing (i.e., negative bias) and impaired emotional control (e.g., emotional responses that are too intense or prolonged). Extensive behavioral evidence supports this model, revealing that depressed individuals (1) focus more on negative stimuli and less on positive stimuli (Mogg et al, 1995 Scher et al, 2005), (2) are less easily distracted from negative emotion processing (Ellenbogen et al, 2002 Lyubomirsky et al, 1998 Siegle et al, 2002 Wenzlaff and Bates, 1998), (3) show heightened stress hormone levels such as cortisol that may have deleterious effects on the brain (Sapolsky, 2000), and (4) Functional neuroimaging studies have identified the brain structures that process negative emotions (Adolphs, 2002) and a neural network that is involved...

Behaviour Therapy Rationale

Behaviour therapies for depression are underpinned by learning theory as a means of explaining the decline into and resolution of the depressive state and are primarily aimed at engaging or re-engaging the patient in pleasurable and consequently positively reinforcing behaviours. Relative to psychotherapy, behaviour therapy concentrates more on behaviour itself and less on a presumed underlying cause. The basic premise of behavioural treatments is that depression is a learned response in light of low rates of positively reinforcing behaviours and insufficient positive reward from routine behaviour. The aim therefore is to increase the reward experience through behavioural activation. Interventions combine skills based learning such as relaxation skills and problems solving with distress tolerance for negative emotions. Behavioural marital therapy progresses through three stages, employing social learning, behavioural change and cognitive techniques. The initial phase concentrates on...

Criteria For Evaluating The Outcome Of Treatment

Kazdin (1994) and Lambert &Hill (1994) emphasise that measures of outcome should be of proven reliability and validity and should be sensitive to change. Kazdin (1994) and Roth & Fonagy (1996) note that several measures are probably necessary to represent all aspects of patients' wellbeing. However, it is then necessary to make sure that change in only a few of several measures is not the result of chance variation. Subjects should be assigned at random to treatments and procedures should be conducted for comparison. Their characteristics, including diagnoses and demographic measures, should be reliably recorded to ensure that the groups are comparable, especially if the samples are small. A sufficiently large number of subjects should be recruited to ensure that the design has sufficient power to reject the null hypothesis if it is false. Studies that meet all these standards are very rare. The outstanding example has been the multicentre trial of cognitive therapy for depression...

Bloodinjury And Injection Phobia

Not addressed Three Groups one session of cognitive therapy, or dental information, waiting list Negative cognitions decreased in credibility and frequency in all groups. Cognitive therapy showed greatest change but was not superior in frequency of cognitions on follow-up. Dental Anxiety declined most rapidly with cognitive therapy Two groups massed spaced cognitive therapy and relaxation

Cognitive And Behavioural Therapies

Over the past decade, a number of studies have examined the efficacy of psychological (mostly cognitive-behavioural) treatments for social anxiety disorder. The most commonly investigated treatments have been in vivo exposure (with or without the addition of cognitive restructuring techniques), social skills training, and relaxation training. The International Consensus Group on Depression and Anxiety's 'Consensus Statement on Social Anxiety Disorder' concluded that there is good evidence for the efficacy of exposure-based cognitive-behavioural interventions for social anxiety (Ballenger et al., 1998). Accordingly, these interventions receive the bulk of our attention in this review. Treatments that combine exposure techniques and cognitive restructuring are by far the most extensively researched psychosocial interventions for social anxiety disorder. Cognitive models of social anxiety disorder (see, for example, Beck, Emery & Greenberg, 1985 Clark & Wells, 1995 Rapee & Heimberg,...

Social Anxiety In Children And Adolescents

An intervention called Social Effectiveness Therapy for children (SET-C) has been developed to treat socially anxious preadolescent children (ages 8 to 12) (Beidel, Turner & Morris, 1996). It was adapted from the adult SET programme (Turner et al., 1994b) and comprises separate group social skills training and individual exposure sessions for 12 weeks. A unique aspect of this treatment is that each child is paired with a non-anxious peer helper to assist in interactions in age-appropriate social outings. Parent involvement is limited to assistance with conducting the structured interaction homework assignments. Cognitive restructuring is not a fixed component of SET-C because the authors believe that children in Piaget's concrete operational stage may not endorse catastrophic negative thoughts during socially stressful situations. Cognitive-Behavioural Group Treatment for Adolescents Cognitive-behavioural group treatment for adolescents with social anxiety disorder (CBGT-A) (Albano et...

Documentng Effective Treatment

By contrast, concern about theory of causes and mechanisms of disorder and change had been emphasized by psychoanalysis during its heyday in the first part of the twentieth century. The concept of defenses, for example, was invoked to explain cognitive distortions. Instead of targeting the distortions themselves, as would be done in cognitive-behavioral therapy (CBT), the psychoanalytic idea was to get rid of the underlying need to defend (e.g., projection) by dealing directly with that which was defended against. Once the underlying (theoretical) cause was addressed, the derivative pathology (e.g., distorted cognition) was expected to remit. Focus on the symptom itself was said to be vulnerable to symptom substitution. For example, changes in the distortion (projection) would be replaced by another distortion (e.g., denial), unless the underlying issue was successfully resolved.

The Discrete Formal Symbol Is the Basis of All Systems of Thought

The notion of a discrete atomic symbol is the basis of all formal understanding. Indeed, it is the basis of all systems of thought, expression or calculation for which a notation is available No one has succeeded in defining any other type of atom from which formal understanding can be derived. Small wonder, then, that many of us are reluctant to dispense with this foundation in cognitive psychology under frequent exhortations to accept symbols with such varied intrinsic properties as continuous or analogue properties. (Pylyshyn, 1984, p. 51)

Strategies For Intervention

A reasonable goal for Axis II patients is schematic reinterpretation, assisting patients in reducing the impact of the schema, and helping them understand and reinterpret events in more functional ways (A. T. Beck et al., 2003). This often leads to some degree of schematic modification patients are able to view themselves, others, and the world in a more realistic and functional way. Since cognitive therapy with personality disorders usually requires many months, the clinician should be realistic about the goals that can be accomplished.

Socialization To Schemafocused Work

An essential component of cognitive therapy treatment is to educate patients as to the rationale for treatment and the expectation that they will engage in active self-help assignments. The clinician recognizes that treatment is likely to take longer than the treatment of patients with straightforward depression and anxiety disorders. Treatment will also be more demanding for both patients and therapists, and the very nature of the disorder will pose roadblocks to change. The initial focus of treatment is amelioration of Axis I symptoms, if present. When starting to work on Axis II issues, it is useful to provide patients with a description and rationale for schema-focused work, such as the one shown in Table 24.3 (which can be simplified or adapted as needed). Another way that people avoid their schemas whatever those schemas are is by emotional escape and avoidance. This can involve behaviors such as drinking too much, using drugs to dull your feelings, binge eating, or even acting...

Theoretical Formulations

The cognitive model of GAD developed by Adrian Wells is based on a distinction between two types of worry Type 1 worries, which concern everyday events and bodily sensations, and Type 2 worries, which are focused on the act of worrying itself and reflect both positive and negative appraisals of worrisome activity (Wells, 1999). There is evidence that the content of Type 1 worries is very similar to normal worries (Craske et al., 1989) and that GAD is associated in particular with Type 2 worries. The theory proposes a particular sequence of events. Once triggered, the worry cycle persists initially through the activation of positive Type 2 worries (positive metacognitions such as 'worry helps me cope', 'worry prevents bad things happening'), which in turn increase the accessibility of, and sensitivity to, threat-related information and lead to more intense worrying. The balance of appraisal then shifts to predominantly negative Type 2 worries ('my worries are uncontrollable', 'I could...

Case Example

Thomas attended 16 therapy meetings over eight months. Initially meetings were weekly, but later meetings were biweekly and then monthly. The steps in cognitive therapy were (1) education about social anxiety, depression and the cognitive model to normalise Thomas's experience, (2) diary keeping of thoughts, feelings and behaviour across a range of upsetting situations to help Thomas further understand his beliefs and their role in his psychological difficulties, (3) reducing avoidance of feared situations in graded homework assignments and (4) testing and challenging hypothesised conditional and core beliefs. In terms of his presenting problems, Thomas responded well to cognitive therapy's pragmatic 'here-and-now' approach. Thomas identified the following strategies from cognitive therapy as helpful in managing his social anxiety (1) the solicitous use of self-disclosure, (2) 'what-if' thinking (asking yourself 'What would be so terrible if the feared consequences really did happen...

Future Directions

We predict that the period to 2030 will see a range of exciting developments in cognitive therapy research and practice. In the area of outcome research, the most obvious area for advancement is where promising initial research suggests that cognitive therapy may prove to be an evidence-based approach personality disorders, anorexia nervosa and substance misuse. Here efficacy and effectiveness research is urgently needed to establish whether people with these complex mental health problems can be helped through cognitive therapy. Similarly, psychotherapy outcome research is needed to examine how cognitive therapy fares when it is adapted to different populations (for example, older adults) and to different service settings (such as primary care). In a climate of managed health care, evidence-based practice and practice guidelines, researchers, practitioners and policy makers are increasingly asking the question 'What works best for whom ' Beyond the comparative outcome studies, this...

Knowing The Patient

Each patient may have very different available resources, support systems, and personal beliefs all affect the clinician's ability to carry out the therapeutic plans. It is inconceivable that one therapeutic regimen will be useful for all patients. It will be almost impossible to develop a rational treatment plan without knowing the complete needs of a patient. To meet

Foraging

The order of experiences also appears to play a role in event timing. A kind of first impression among animals, called side bias, sometimes confounds psychophys-ical results (Ha et al., 1990). Side bias generally refers to some unknown force controlling the animal's behavior. Experimenters typically make an effort to remove these animals from the analyses. Nonetheless, every animal may experience this kind of bias with variable time reinforcement schedules. Large initial rewards could lead to particularly strong cognitive bias. A series of large rewards might also instill a memory of a rare event that keeps the animal coming back. Exactly how the temporal sequence of events establishes memory biases is still an open question.

What Is Health

Nonetheless, some broad hypotheses can be posed in principle. As suggested earlier, the typical view of the relationships among stress, coping, and health begins with adverse events leading to negative emotions, with physiological components or concomitants. If the distress is intense, prolonged, or repeated, disruption of one or more physiological systems may develop. The disruption then affects disease outcomes, directly or indirectly. From this view, effective coping acts largely to minimize initial stress arousal and to influence how intense and prolonged the negative emotions are. Coping that is ineffective or maladaptive can worsen the response, resulting in sustained distress and accompanying physiological responses.

Medical Futility

Denise's case raises issues for each type of argument. At the level of clinical care for an individual, caregivers would be prudent to use a clinical approach such as that described by Block and Billings (1994) to explore her reasons for requesting physician-assisted death, to assure adequate palliative care, and to address psychological issues. Caregivers and patients may then need to explicitly discuss deontological issues that place personal beliefs squarely in the providerpatient relationship. The difficulty may be in having explicit discussions about a practice that is currently illegal in most places. Physicians will probably continue to deliberate in silence and occasionally act on the basis of professional conscience. If Denise persists in her desire for physician-assisted death, she may turn to a patient advocacy group. Like other issues in which public and professional opinions are polarized, such as abortion, the ethics of physician-assisted death may be overtaken by its...

The Emdr Procedure

The third phase is named the 'assessment' phase. During this phase the first memory to be reprocessed is targeted. A visual image or picture that represents the worst part of the traumatic memory is elicited. Next a negative belief or cognition associated with the identified picture is elicited. This negative belief needs to be meaningful in the present as well as in the old memory. Next a positive or preferred belief or cognition is elicited that the client would like to be able to believe. This positive belief is then rated on the 'validity of cognitions' (VOC) scale (Shapiro, 1989), which is a seven point semantic differential scale from disbelief to full belief. The emotions associated with the targeted memory are identified and the disturbance level in relation to the traumatic incident is rated on the SUD scale (Wolpe, 1958). Finally physical sensations and their location in relation to the targeted traumatic memory are elicited. Each stage of this assessment stage is very...

Bayesian inference

As mentioned above, Bayesian methods require the definition of prior probabilities, and the choice of priors is crucial. Inference is based on a combination of evidence from the observed data and pre-existing beliefs. If strong priors are chosen, the resulting activation maps may reflect prior beliefs more than the story told by the data. If one does not want to impose such beliefs, then it is possible to use noninformative priors. This is an approach taken by some neu-roimaging applications, for example, FSL, which implements a fully Bayesian approach towards multi-subject analysis with non-informative priors (Woolrich, 2004). For the single-level model this leads to parameter estimates that are equivalent to those obtained using classical inference. Without informative priors, it is unclear whether the Bayesian approach confers an advantage over the classical approach, although the ability to specify priors makes the Bayesian framework more flexible. Another way to choose

Gender Differences

Women also fall in love in different ways than men. Men tend to fall in love faster, to fall out of love more slowly, and, because they have no one in whom to confide, suffer more from a breakup (Hill, Rubin, & Peplau, 1976 Rubin, Hill, Peplau, & Dunkel-Schetter, 1980). Men also tend to be more romantic than women, believing in love at first sight, that there is one true love for them, and that love is magical and incomprehensible. In contrast, women tend to be more cautious and pragmatic about love relationships, emphasizing financial security as much as passion, that there are many people with whom they could be equally happy, and that love cannot conquer all differences or problems (Peplau & Gordon, 1985). Women are more likely than men to experience both the agony and the ecstasy of love and to disclose both their positive and negative feelings about a relationship (Jourard, 1971). When men share their views, they are more likely to discuss their strengths

Treatment

Cognitive Therapy Three CT techniques have been described challenging obsessional thoughts, thought stopping and challenging negative automatic thoughts. Patients can be taught to monitor the obsessional thoughts and then learn how to replace them with more helpful thoughts or learn to challenge the belief in the thoughts by employing rational counter claims. In thought stopping patients are taught to say a cue word, such as 'stop', to disrupt a chain of obsessional thoughts. The patients can also be instructed to picture a positive image after saying the cue word. The third technique uses Beckian principles to challenge the negative automatic thoughts that result from the obsessional intrusive thoughts, rather than targeting the obsessional thoughts. The patients are helped to consider alternative, less threatening explanations. Cognitive Behavioural Therapy for Obsessions Salkovskis, Forrester & Richards (1998) has devised a cognitive-behavioural treatment for obsessions. In...

Summary

Obsessive compulsive disorder is a disabling and often chronic disorder. Behavioural therapy is largely successful for treatment completers. Developing a therapeutic alliance and using motivational techniques are extremely important. Cognitive therapy has not shown clearly that it adds anything to behavioural therapy but may have a role in improving engagement in therapy and in improving outcome by treating co-morbid disorders. Medication is effective for many but symptoms commonly recur when medication is stopped.

Referrals

Over the course of the patient's illness, nurses need to continually assess the need for referrals to supportive resources. A primary care doctor is necessary to treat other medical conditions unrelated to the tumor such as high blood pressure, hyperlipidemia, or diabetes. Patients with psychosocial impairments or cognitive impairments may benefit from referral to a neuropsychiatrist, psychologist, counseling, or cognitive therapy. Physical therapist can provide gait training, durable medical equipment, and assistive devices such as canes, walkers or braces. Physical therapy can improve weakness, loss of coordination, and endur

Behaviour Therapy

Other studies have adapted the Linehan model of DBT delivery in different ways. Evans et al. (1999) conducted an RCT (N 34) to assess the efficacy of manualised DBT and cognitive therapy (MACT) for treatment of outpatients who met criteria for Cluster B personality disorders and had made a parasuicide attempt in the past 12 months. Individuals were assigned to MACT or TAU and assessed at six months. The rate of parasuicide was significantly lower in the MACT group, and self-ratings of depression also showed significantly more improvement in this cohort.

Counselling

The authors include a list of the 92 papers included in their meta-analysis of counselling. A quick review of these references shows that the studies in the meta-analysis included the following counselling techniques anger management, assertiveness training, social skills training, exposure treatment for obsessive compulsive disorder, desensitisation, relaxation training, cognitive therapy, group cognitive behaviour therapy, shaping, reinforcement of non-depressed behaviours and implosion. Hence, the possibility that the apparent effectiveness of counselling was due largely to the inclusion of traditional behaviour therapy cannot be excluded. At this time we must conclude that there are very limited data to support the use of counselling with people with intellectual disabilities.

Conclusions

Although there is the beginning of an evidence base for cognitive therapy with people with intellectual disabilities, especially for anger management, it is much more limited. The possibility that the effects of cognitive therapy merely reflect the behavioural procedures contained in most treatment packages labelled 'cognitive therapy' has yet to be addressed (Sturmey, 2004). There is currently no convincing evidence base to support the use of counselling or sensory therapies with people with intellectual disabilities.

Dental Phobia

The studies of phobic patients in Table 20.1 show that exposure to video displays of patients receiving dentistry can reduce anxiety under test conditions. That has enabled subjects to accept one invasive dental procedure according to verifiable records in three studies (Bernstein & Kleinknecht, 1982 Harrison, Berggren & Carlsson, 1989 Jerremalm, Jansson & Oest, 1986). The studies that have tested cognitive therapy (De Jongh et al., 1995 Ning & Liddell, 1991) provide no evidence that the patients were more able to accept dental treatment even though improvements in anxiety on standard measures were recorded. Hypnosis, which is popular among dentists, has been examined in very few controlled studies. Moore et al. (1996) compared hypnotherapy plus graded exposure to dentistry, systematic desensitisation, group therapy and a waiting-list control group. The subjects in all treatments showed a greater reduction in anxiety than the control group but half those who received hypnosis failed...

Flying Phobia

Three sessions exposure to external stimuli, exposure to anxiety symptoms, cognitive therapy, control group Four groups one session exposure, five sessions exposure, five sessions cognitive therapy, waiting list Fear Survey Schedule (FSS), Fear of Flying Scale (ad hoc for present study) rating scales for expected anxiety, negative thoughts rating scale, Behavioural Test (BT), heart rate

Hypertension

The impact of antihypertensive medication on coronary heart disease has been less than expected, however, most likely because of the influence of adverse side effects and poor compliance. There has led to renewed interest in the non-pharmacological management of hypertension, with the aim of reducing stress by focusing on cognitive and behavioural stress coping strategies and reducing sympathetic arousal. Psychological interventions to date have tended to focus on either one or a combination of biofeedback, relaxation and stress-management techniques. An early meta-analysis purporting to assess the efficacy of cognitive behavioural techniques for hypertension included biofeedback, meditation and relaxation as forms of CB therapies, concluding that there was a lack of support for such interventions (Eisenberg et al., 1993). However, Linden and colleagues have suggested that there is such a varied interpretation of the term 'stress management', ranging from transcendental meditation to...

Modifying Schemas

The cognitive approach to personality disorders incorporates many of the traditional cognitive therapy techniques used for the treatment of depression and anxiety (A. T. Beck et al., 1979, 1985 J. S. Beck, 1995 Leahy, 2003). However, the cognitive therapy of personality disorders also emphasizes case conceptualization of personality, developmental material, experiential techniques, impasses in the therapeutic relationship, and roadblocks in therapy. We next turn to specific interventions to accomplish these goals.

Spider Phobia

Studies of recall and perceptual bias in spider phobia have been contradictory (Cameron, 1997). Disgust and fear evoked by spiders are largely independent of one another (Smits, Telch & Randall, 2002 Thorpe & Salkovskis, 1995) even though both decline with brief exposure (Smits, Telch & Randall, 2002 Thorpe & Salkovskis, 1997). Disgust as well as fear is, therefore, probably worthy of attention. Many people with spider phobia are also afraid, in the presence of spiders, of being unable to move, of making a fool of themselves, screaming and feeling faint (Thorpe & Salkovskis, 1995). Responses on measures that address these beliefs improve with brief exposure coupled with cognitive therapy, a change that is correlated with a reduction in fear (Thorpe & Salkovskis, 1997). However, it is not clear if cognitive therapy was necessary for that. Trials in adults and children (Table 20.4) show, without exception, that exposure to live spiders, usually in a graded manner, produces improvement...

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