HD 3700 1st Edition Lecture 24Outline of Last LectureI. PsychotherapyII. Varieties of PsychotherapyIII. Hamlet confronts Gertrude Outline of Current LectureI. Beck’s Great Discovery: Automatic ThoughtsII. A “Common Sense” Approach To Feelings And ConflictsIII. The CBT RevolutionIV. Case Study: NickV. CBT and SCZCurrent LectureI. 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 particularemotion may have no connection to the external circumstances at the time. If weare 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 introspectiveobservations of thoughts and feelings. Second, the relation of though to feeling isdetermined. Third, generalizations are made regarding what kinds of thoughts (ormeanings) 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 aparticular 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 statesII. 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 consciousnesso Freud emphasized the guilt and anxiety stirred by tabooso 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 experienceo Beck focuses on one aspect of a mind, Freud on anothero All therapy really about directing attention to associations and challenging them or supporting them or reframing them or helping the person accept themo Example: teenage girl who is jealous of her friend who has a boyfriend but doesn’t want to feel that wayo I don’t want to feel this way—my defenses are not keeping these thoughts from consciousnesso Mature ambivalence—you can have these thoughts but still be happy for them at the same timeo Capacity to tolerate the conflict of thoughts is a sign of psychological health- Beck’s Model of Emotiono 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 thoughtsIII. The CBT Revolution - Primary tools of CBTo Patients and therapists agree to a contract citing ultimate goals.o Patients fill out baseline measures of depression and anxiety using self-report 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 challengeso Ongoing evaluation of depressive and anxiety symptoms using questionnaires.- As a mode