Overview Of Clinical Cognitive Psychology Essay, Research Paper
Title: Overview of Clinical Cognitive PsychologySubject: Cognitive PsychologyType: Research PaperAcademic Level: CollegeContent: Overview of clinical cognitive psychology Description: Write a description of clinical approach emphasizing theoretical underpinnings. Any activity requiring thought involves cognition. Relatively recently there has arisen a school of thought within psychology in general and (however strange it might at first seem) behaviorism in particular called cognitive psychology. It seems strange that this subdiscipline would identify itself with a method that ignored or denied the existence of internal thought processes. A perhaps overly simple definition of cognition is information processing . A better definition for our purposes is: a special purpose device whose special purpose is adaptation to the environment (Medin and Ross, 1992) . In much the same way as animals are models of their environments, our cognition is a schema of our experience. Buddhism teaches that there are aggregates of consciousness e.g. being conscious of the sounds of the rain–consciousness arising from hearing. If our life is the creation of our mind (Mascaro 35) , and we can alter how we think and feel about different things!, we can effectively change everything about our individual experience; even if the circumstances of our life are beyond our control. There is no objective reality…you say tomato, I say tomaaato… The jist of this paper will be to examine some of the theoretical underpinnings of clinical cognitive psychology, especially in its relation to what shall be called negative affect –specifically anxiety, panic disorder and its companion, depression. Although there is an increasing body of evidence for a genetically transmitted neurochemical abnormality that is episodically manifested in sudden surges of autonimoc arousal and fear (as well as depression and more generalized anxiety) (McNally, 1990) , for the sake of this paper, the role of environmental factors will be stressed as the cause and enduring cognitive substructures the maintenance of anxiety disorders. So how does panic disorder from phobic anxiety, or is there really such a clear distinction? The nature of panic attacks, where the person is suddenly and very unexpectedly gripped by terror accompanied by feelings of imminent death or sudden insanity, often accompanied by tachycardia and shortness of breath is commonly differentiated from phobic anxiety by the very suddenness of its occurrence and the apparent lack of antecedent. In the case of phobic anxiety, the cause of the anxiety is generally known: fear of final exams for instance. In an attempt to differentiate between panic and more generalized anxiety it should be pointed out that panic attacks were previously thought of as being the manifestations of intense generalized anxiety disorder (Barlow, 1988). There is now a clearer distinction: that panic can be defined more clearly as involving feelings of physical harm, whereas anxiety tends to involve the fear of being hurt in another way–usually being rejected o!r humiliated. Something which further complicates things is the fear of experiencing another period of intense anxiety. This could take on a life of its own apart from the cause that started with the original experience (this idea is central to the work of A.T. Beck and its implications in depression will be reviewed later). The nature of panic is that it is usually not precipitated by anything specific. There is an interesting theory which demands more attention: that panic is really the Catastrophic misinterpretation of bodily sensations (McNally, 1990) . This could mean interpreting tachycardia as an impending heart attack. It is important to note that a panic attack usually occurs after the detection and possible subsequent misinterpretation of such a sensation. This misinterpretation also need not be conscious: in patients who experience recurrent attacks, catastrophic misinterpretations may be so fast and automatic that patients may not be aware of the interpretive process (Clark, 1988). This contrasts with the view that emotion results from the conscious labeling of unexplained physiological arousal (Schacter and Singer, 1962) . The explanations of these sensations as something other than impending doom does little to dispel their unsettling effects. To know intellectually !that what you are experiencing is not a heart attack or that you have suddenly gone insane does not make the sensation any less real. This would seem to lend credence to psychological theories of panic attacks which postulate that the condition is caused by factors that are not strictly biochemical. A common theme in the cognition of panickers is the anticipated loss of control immediately before onset of a panic attack. This indicates a strong psychological component, although this is not to say that anticipatory cognition does not arise from a sudden biochemical change. This does however point to a strong psychological component in the etiology and maintenance of panic disorder. It has been shown that such cognitive-therapeutic measures as applied relaxation, breathing control and systematic exposure to feared bodily sensations can alleviate panic attacks (Barlow, Craske, Cerny & Klosko, 1989; Beck, 1988; Ost, 1988; Salkovkis, Jones & Clark 1986). A persistent cultural (and philosophical) dualism that is losing sway is that mind and body are commonly thought of as independent of one another. The interrelationship between the two is being taken into account more and more and it might behoove us to think of the whole organism instead of isolated problems. What these therapies prove is that by attenuating oneself with ones body one can learn to avoid these misinterpretations of bodily sensations. In the course of human evolution it was probably advantageous to experience some anxiety: being physiologically aroused in the presence of a saber tooth tiger probably conferred an advantage, just as being a little more on-edge and therefore more alert while driving has its advantages today. But when these feelings become attached to a particular situation where there is no necessity for them they are maladaptive.
An interesting characteristic of anxiety is that the person who is experiencing it often knows there is little to fear in the situation that triggers the anxious response. Phobic and obsessive symptoms arise as a reaction to anxiety and represent an insufficient attempt to ward off danger (Barlow, 1988). The prevalence of anxiety is extremely widespread. One study indicated that from 30-40% of the population sufficiently suffered from anxiety that clinical intervention would have helped (Shepherd, Cooper, Brown & Kalton 1966). Another interesting feature of anxiety is that, unlike depression, which will usually abate, anxiety disorders tend to be chronic and even if successfully treated are present to some degree (Noyes & Clancy 1976; Noyes, Clancy, Hoenk & Slymen 1980). So maybe because anxiety is so ingrained and essential it must have an enormous effect on our lives and our cognitions. Exactly how anxiety effects cognition has been the focus of much research. One such study looks at how self preoccupation and attention effect anxiety. The researchers found that how well people perform, how anxious they feel in certain situations and their levels of physiological arousal are powerfully influenced by self-related thoughts (Saranson, 1988). This does much to explain phobic anxieties as they are mostly related to seeing the self in some kind of negative light and perhaps more often than not focusing too much critical attention on the self and not enough on the external environment. The notion that anxious people are predisposed to pick up on threat cues has also been investigated. It is postulated that a bias favoring threat cues during perceptual search is an enduring feature of individuals prone to anxiety, rather than a transient consequence of current mood state alone (Mathews; May; Mogg; Eyensck, 1990). So the individual who feels threatened by, say, authority figures is only that much more likely to spot that figure in a crowd. Whereas the person who only has cause to fear that same figure in a given situation will allocate attention in that situation alone and not apart form it. This might help distinguish an anxiety disorder from a normal expression of anxiety. Still another study involving anxiety and cognition addressed a specific phobic anxiety (social anxiety) and the recall of interpersonal information. In this study, the subjects interacted socially with someone, under varying degrees of social-evaluative threat, and were then, after the interaction asked to recall specific information about the person to whom they were speaking and what they were speaking about. This study found that socially anxious people recalled less and made more errors in recall than non-anxious subjects. Not surprisingly evaluative anxious subjects reported greater self-focused attention during the interaction. High self-focused attention was associated with superior recall for non-anxious subjects (Hope, Heimberg and Klein 1990). This lends weight to cognitive formulations of social anxiety. Depression is a disease. It has alternately been considered an indulgence of the weak or a sort of romantic affliction of artists and poets: a fitful strain of melancholy will ever be found inseparable from the perfection of the beautiful (Poe, 1931) . The reality is not at all romantic. Everyone to some degree or other has experienced sadness or melancholy, but at its worst depression can be as debilitating as any somatic illness. This horror is virtually indescribable, since it bears no relation to normal suffering. In depression, a kind of biochemical meltdown, it is the the brain as well as the mind that becomes ill–as sick as any other besieged organ. The sick brain plays tricks on its inhabiting spirit. Slowly overwhelmed by the struggle, the intellect bursts into stupidity. All capacity for pleasure disappears and despair maintains a merciless drumming. The smallest command of daily life, so amenable to the healthy mind, lacerates like a blade (Styron, ! 1990) . The prolific cognitive psychologist A.T. Beck has formulated a model for the maintenance of depression where information processing can become interlocked in vicious cycles, processing only a limited range of recurrent themes…such processing reflects attempts to resolve discrepancies in situations where centrally important goals can neither be attained nor relinquished (Beck, 1976) . The basic idea here is that after an episode where an individual becomes depressed they continue to think negatively . This pattern he calls the Negative Cognitive Triad : a negative view of the self (perceived as deficient, inadequate or unworthy); the world (interactions with the environment are seen as representing defeat or deprivation); and of the future (current difficulties will continue indefinitely) (Beck, 1967, 1976). Beck defines cognition as any ideation with verbal or pictorial content .Criticisms of this or any other purely cognitive view are that negative thinking may be a consequence of depression rather than an antecedent to it. Another criticism is that this perspective doesn t pay adequate attention to environmental factors in the etiology of depression. This view also recognizes one level of meaning, and has difficulty in distinguishing between hot and cold –emotional and intellectual cognitions. A further problem with Beck s hypothesis is that it assumes that all people share the same background–people who are depressed are more likely to produce unpleasant memories which they recall when they take a measure of affect such as the Beck Depressive Inventory or similar barometers of mood. Methods employed by clinical psychologists often follow the zeitgeist and in todays atmosphere of computer technology and cyber-everything it is not surprising that cognitive methods of treatment are very popular. As has been shown, there are identifiable cognitive components to psychological malaise and the methods employed by clinical cognitive psychologists to treat them prove beneficial.