Week 10 - Cognitive - Behavioural Models

Recap – Multiple Risk and Protective Factors

  • Genetic Predisposition
      - Polygenic nature of predispositions affects multiple genes.
      - Pleiotropy describes the phenomenon where one gene may influence multiple traits.

  • Multiple 'Hits' from Environment across Lifespan
      - Toxins: Includes both chemical and biological agents that may contribute to mental health issues.
      - Social Determinants: Factors such as economic stability, education, social context, and healthcare that may play a significant role.

  • Social Support: Importance of relationships and community as protective factors against psychopathology.

Recap – Additional Considerations

  • Multiple risk and protective factors do not manifest in every individual case.

  • Just because factors are present does not mean psychopathology will result.

  • Developmental Perspectives:
      - Multifinality: Refers to the same starting point leading to different outcomes.
      - Equifinality: Different starting points leading to the same outcome.

  • Complex Interactions: Multiple factors interact with each other, creating unique outcomes for each individual.

  • Transdiagnostic Approach: Understanding mental health issues across diagnostic categories can be beneficial.

Recap - Mechanisms of Psychopathology

  • Biological Mechanisms
      - Brain development issues that may alter functioning.
      - Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis can lead to stress-related disorders.
      - Neuroinflammation may play a role in certain psychological disorders.

  • Social Mechanisms
      - Can be considered biological in a sense; influences emotions and social information processing.
      - Impact of discrimination on mental health and social interaction.
      - Belonging, companionship, and social support influence psychological resilience.

  • Psychological Mechanisms: Need for further elaboration on specific cognitive and emotional factors impacting mental health.

Cognitive-Behavioural Models Lecture

  • Lecture Structure:
      - Origins of cognitive-behavioural models.
      - Components constituting these models.
      - Example mechanisms and evidence behind cognitive-behavioural models, including transdiagnostic mechanisms.

First Wave: Behavioural Theory

  • Learning Theory: Emphasizes that experiences shape behaviour.
      - Conditioning is performed through rewards and reinforcement leading to generalised behaviours.

  • Examples of Theories:
      - Mowrer’s Two Factor Theory (1947): This theory of anxiety suggests that fears are acquired and then maintained through avoidance behaviours.
      - Lewinsohn's Behavioural Model of Depression: Explores the relationship between behaviour and depression.
      - Seligman’s Learned Helplessness (1967): Discusses how past experiences can lead individuals to feel powerless in future situations.
      - Bandura’s Social Learning: Focuses on learning through observation of others, enhancing the understanding of behavior acquisition.

Empirical Testing and Application of Behavioral Theory

  • Empirical Basis: Theory is grounded in evidence and has practical applications in treatment.

  • Example Therapies:
      - Effective methods like exposure therapies allow individuals to confront their fears and can lead to unlearning behaviours.

Second Wave: Cognitive-Behavioural Theory

  • The central consideration was how people interpret situations and how these perceptions impact their behavior.

  • Information-Processing Biases:
      - Beliefs shape expectations and experiences, can be dysfunctional or maladaptive.

Beck’s Cognitive Model of Depression

  • Developmental Experiences: Adverse experiences lead to negative attitudes and beliefs about self, world and future

  • Cognitive Vulnerability: Activation of these negative beliefs by stressors, leading to engrained patterns over time.

  • Generic Cognitive-Behavioral Model:
      - genetic and physiological predisposition

    • Explains why beliefs are linked to emotional disorders and connects back to the discussion of risk factors.
        - Example belief: “I am worthless” or “If I don’t let people in, they won’t know I’m worthless.”

Principles of Cognitive-Behavioural Therapy (CBT)

  • Identification of Dysfunctional Thoughts: The aim is to change these thoughts effectively.

  • Structure and Protocol:
      - CBT is time-limited, manualized, and should be personalized based on the individual's needs and the specific psychopathology.

  • Importance of collaboration: Therapists actively engage with clients rather than applying CBT without consideration of individual needs.

Disorder-Specific Cognitive-Behavioural Models

  • Mechanisms differ depending on clinical presentations; psychopathology uniqueness comes from the specific beliefs involved.

  • The focus on disorder-specific models helps understand and treat various mental disorders better.

Context for Disorder-Specific Models

  • Early theories were broad

  • Historical theories such as psychodynamic theory and classical/operant conditioning have paved the way for current diagnostic practices reinforced by the DSM.

  • Research and treatment frameworks are often based on the assumption of specific risk factors and causes.

Seminal Disorder-Specific Models

  • Example constructs include:
      - Safety Behaviors: Engagement in behaviours to mitigate perceived social danger.
      - Appraisal of Situations: How processing of self and social environments interact to create anxiety.
      - Triggers and Threat Assessment: Internal and external stressors leading to perceived threats and anxiety responses.

Example of OCD Mechanisms

  • Early Experiences and Critical Incidents: Creating vulnerabilities leading to OCD, individual feels responsible for a certain event (responsibility beliefs)

  • Neutralising Behaviors: Visible (cleaning) or covert (internal checking) actions taken to address intrusive thoughts.

  • Safety Strategies: Behavioural avoidance, use of medication, or other means used to suppress intrusive thoughts.

  • Attention Biases: Cognitive processing that focuses excessively on potential threats.

Evidence for Responsibility Beliefs in OCD

  • Higher responsibility beliefs correlate with increased symptoms in OCD but not necessarily in other mental health conditions.

  • Efficacy of Cognitive-Behavioural Therapy: CBT targeting responsibility beliefs can effectively diminish OCD symptoms.

Transdiagnostic Responsibility Beliefs

  • Responsibility beliefs are not exclusive to OCD, showing relevance across various psychopathologies like anxiety and psychosis, with mixed evidence for depression.

Third Wave: Transdiagnostic Cognitive-Behavioural Models

  • Symptoms and Heterogeneity: Early symptoms across disorders may not be specific; co-morbidities are common, heterogeneity within diagnoses

  • Shared Characteristics: Recognition of common features that exist across different diagnoses leading to dimensional approaches in psychological understanding.

HITOP Framework

  • A dimensional approach to psychopathology comparing spectra of disorders with the traditional DSM diagnostic categories.

  • Categories include General Psychopathology, Eating Disorders, and various Anxiety Disorders among others.

Trans diagnostic CBT

Transcends diagnostic boundaries

  • addresses common maintaining processes

  • Evidence for effectiveness

Direction of Future Research in Cognitive-Behavioural Models

  • Discussion of effectiveness and application in real-world contexts, emphasizing the need for both specificity and integrative approaches.

Advantages of Cognitive-Behavioural Models

  • Continuous redefinition and an integrative approach ensure models remain relevant.

  • Hypotheses derived from these models are testable, leading to evidence-based practice.

  • The development of CBT showcases its adaptability to various clinical needs.

  • Emerging trans diagnostic evidence- broadly applied

Disadvantages of Cognitive-Behavioural Models

  • Potential neglect of biological and social factors influencing mental health; social determinants may limit individual’s capacity for change.

  • Not all individuals respond positively to CBT; therapy trials sometimes lack focus on underlying mechanisms.

  • Questions about whether transdiagnostic research is truly comprehensive and applicable across diagnoses.

Summary of Key Points

  • The association of cognitive-behavioural mechanisms with various psychopathologies, the influence of early experiences on cognitions and behaviours, and the existence of numerous disorder-specific cognitive-behavioural models.

  • The potential effectiveness of both disorder-specific and transdiagnostic cognitive-behavioural therapies.

Reading List

  • Essential Reading:
      - Miegel, F. et al. (2022) - Dysfunctional beliefs shared between OCD and anxiety disorders.
      - Mitchell, R. et al. (2020) - Examining inflated responsibility beliefs in OCD.

  • Recommended Reading:
      - Schaeuffele, C. et al. (2024) - Overview of transdiagnostic cognitive behavioural therapies.
      - Spinhoven, P. et al. (2014) - Longitudinal study on experiential avoidance in emotional disorders.

  • Further Reading:
      - Callaghan, T. et al. (2024) - Perfectionism and its relationship with depression and anxiety.
      - McEvoy, P. M. et al. (2019) - Factors influencing associations with intolerance of uncertainty.