HD 3700 1st Edition Lecture 24 Outline of Last Lecture I Psychotherapy II Varieties of Psychotherapy III Hamlet confronts Gertrude Outline of Current Lecture I Beck s Great Discovery Automatic Thoughts II A Common Sense Approach To Feelings And Conflicts III The CBT Revolution IV Case Study Nick V CBT and SCZ Current Lecture I Beck s Great Discovery automatic thoughts The thesis that the special meaning of an event determines the emotional response forms the core of the cognitive model of emotions and emotional disorders the meaning is encased in a cognition a thought or an image Sometimes the cognition may consist simply of a connotation or value judgment such as awful or wonderful It is a commonplace observation that a particular emotion may have no connection to the external circumstances at the time If we are daydreaming or ruminating our emotion is generated by the content of the reverie or ideas rather than by an external stimulus Finally if we distort a situation grossly our emotional response is consistent with the distortion rather than with the factual aspects of the situation The cognitive model of emotions is derived initially from reports of introspective observations of thoughts and feelings Second the relation of though to feeling is determined Third generalizations are made regarding what kinds of thoughts or meanings lead to which emotions Beck was a psychotherapist trained in the Freudian model of the mind o This model was dynamic and could be at least used to explain the uncanny parts of who we are He gets his patients to tell them what they re thinking as they re lying on the couch He trained his patients to associate in a subtle way about their past but They weren t telling him their automatic thoughts by which they evaluated themselves at the time or other worries about their self Beck s idea There is this whole stream of associations that no one is looking at Automatic thoughts generate in part our understanding of the world The classical psychoanalytic model of emotions is far more complex Reduced to simple terms the sequence is as follows a stimulus or event occurs and arouses an unconscious wish or impulse Since the wish is generally unacceptable to the person its incipient emergence into consciousness poses an internal threat If he is unable to ward off the taboo impulse through the use of a defense mechanism he experiences anxiety or guilt For example according to Freud s concept of the Oedipus complex a young boy responds to the sight of his mother the stimulus with an unconscious sexual impulse directed toward her If the wish threatens to break into consciousness the boy feels anxious because of possible punishment from his rival the father The psychoanalytic and behavioral models skirt the common conceptions of why a person becomes sad glad afraid or angry The cognitive approach however brings the whole matter of arousal of emotion back within the range of common sense observation By sorting out the specific meanings of events this approach draws together many diverse or dissimilar situations that lead to the same emotional response Although at times the specific conditions for the arousal of a particular emotion may seem too obvious to warrant fine grained analysis they are crucial to the development of the generalizations These generalizations in turn serve as the basis for understanding emotional disorders such as depression mania anxiety neurosis and paranoid states II A common sense approach to feelings and conflicts Beck s theory o Becks theory is a theory of the preconscious focusing on an underlying stream of consciousness o Freud emphasized the guilt and anxiety stirred by taboos o Segal s position our associations are rich and simultaneous on a conscious level which allows for rational thought automatic thoughts judging our selves can direct our associations to create art our associations can come to us unbidden and they do determine our emotional experience o Beck focuses on one aspect of a mind Freud on another o All therapy really about directing attention to associations and challenging them or supporting them or reframing them or helping the person accept them o Example teenage girl who is jealous of her friend who has a boyfriend but doesn t want to feel that way o I don t want to feel this way my defenses are not keeping these thoughts from consciousness o Mature ambivalence you can have these thoughts but still be happy for them at the same time o Capacity to tolerate the conflict of thoughts is a sign of psychological health Beck s Model of Emotion o Feelings are generated by thoughts interpretations of present or anticipated events o These feelings make sense if you simply take them at face value o You don t need to assume that unconscious feelings are triggering defenses and anxiety o Sadness is about loss anger is about feeling that one is in danger or has been treated unfairly anxiety is about the fear that something will happen that one can t control o But unconscious feelings contribute to consciousness too Beck does not take this into consideration Because of Beck s Model o Therapy is much more like teaching Help patients to look at their automatic thoughts to challenge and replace them with other that are more realistic and you can dispense with long term psychoanalytic therapy o Therapy involves homework Patients keep records of their distorted thoughts the feelings they generate and come in to discuss ways to reframe or revise their interpretations of reality o Therapy is short term 12 sessions is the goal o Dreams childhood transference are irrelevant o A developmental model of childhood is unnecessary Prof Segal thinks this is a huge mistake on the part of CBT CBT says you have schemas that lead to distorted thoughts III The CBT Revolution Primary tools of CBT o Patients and therapists agree to a contract citing ultimate goals o Patients fill out baseline measures of depression and anxiety using selfreport measures o Therapists assign homework daily journals describing events triggering automatic thoughts linked to depressed or anxiety thoughts o Setting specific goals using exposure therapy to help patients face frightening events or challenges o Ongoing evaluation of depressive and anxiety symptoms using questionnaires As a mode of therapy CBT o Works best with high functioning verbal patients It was developed using college students o Focuses on specific symptoms of depression and anxiety and can be very effective