Cognitive Behavioural Processes Across Disorders
Lecture 1: Avoidance Theme
Avoidance as a trans-diagnostic process in psychopathology
Avoidance as trans-clinical school target
Existential therapy
• Existential givens: the unknown/uncertainty and concomitant anxiety as surrounding
human being
• Absence of ultimately solid foundation of our meaning systems (and thus, voices)
• = ultimate meaninglessness
• = freedom (and responsibility)
• Death [ existential givens —> anxiety —> defense mechanisms ]
• Freedom —> responsibility for choices given to others (individuals, institutions, fate,
god)
• Death —> (i) specialness, (ii) ultimate rescuer
Types of avoidance
• Overt escape/avoidance: when “an individual does not enter (=avoidance), or
prematurely leaves (=escape), a fear-evoking situation”
• Safety behaviour (‘within-situation safety-seeking behaviour’): overt or covert
avoidance/prevention of feared outcomes
• Sucking mints to ‘prevent’ vomiting
• Distracting oneself when in presence of fear cues (self-deception; psychoanalytic
defences)
Problem with avoidance (control)
• Doesn’t work
• Maintains/increases negative a ect
• Cannot learn that danger cue (e.g., dog) is actually safe
• Rebound e ect
• Narrows/prevents life
Avoidance in social anxiety
• Safety behaviours contributes to likelihood of feared outcome occurring
• Socially anxious vs. Not anxious groups
• Condition: elicit safety behaviour or not
• DV: discussion; safety behaviours of ‘short duration’ + ‘low intimacy/disclosure’
• DV: confederate liking of participant
Avoidance in depression
• Measures
• Beck depression inventory
• Cognitive-behavioural avoidance scale
• “I try not to think about problems in my personal relationships”
• “I quit activities that challenge me too much”
• Reward assessed through daily diary and reward probability Index (e.g., “there are a
lot of activities I might enjoy, but they just don’t seem to happen”)
• **decreased availability of reward (both measures) mediated relation
between avoidance and depression
ff ff
, Avoidance in PTSD
• Mental defeat: “perceived loss of psychological autonomy, accompanied by the sense
of not being human any more” —> challenges the person’s sense of worthiness and
competence
• I mentally gave up
• Avoidance/safety behaviours
• Avoid people who remind you of situation; avoid unfamiliar places or situations
• Try to distract yourself from distressing thoughts
• Sleep with lights or radio on
Avoidance prevents treatment bene t
Approach as trans diagnostic process
• Exposure therapy works for anxiety disorders
• Behavioural activation therapy
What changes when facing what is feared?
Exposure —> fear tolerance
• Administer CO2 (similar to panic symptoms) to anxiety sensitive subjects
• Acceptance exposure vs. Control (relaxation breathing) vs. No instructions
• DV: How long avoid subsequent CO2 challenges?
Exposure —> self-e cacy
• Bene ts predicted by self-e cacy, even when controlling for anticipated and actual
anxiety
• But reduced anxiety did not predict more approach when controlling for self-e cacy
Lecture 2: Memory
A selection of memory processes
1. Selective memory
2. Overgeneral memory
3. (Freudian) repression vs avoidance
1. Selective memory
Memory processes
1. Encoding — information enters (perception, interpretation)
2. Storage (consolidation) — formation memory traces / representation of event
3. Retrieval — what people call
“remembering”
Intentional vs unintentional
fi ffi ffi fi ffi
, Types of memory
“Conscious” — declarative explicit memory
“Unconscious” — non declarative memory, e.g.,
• Associative learning (conditioning)
• Procedural memory — tying shoelaces, riding your bike
• Priming = things that you just experienced make processing of similar things easier
Cues are important
Successful remembering (recall, cued recall, recognition)
Depends on the interplay between encoding and retrieval
Encoding speci city: a cue is e ective when it is speci cally encoded
During retrieval:
• The more a cue matches circumstances during encoding, the greater the probability
of recall
• Environmental details; interpretation (current concerns); (mood)state
Mood congruency/dependency
• Mood congruent memory: selective encoding or retrieval of information with a ective
tone matching current a ective state. E.g., depressed mood — recall negative events
• Mood(state) dependent memory: increased likelihood of retrieving material that was
encoded in a particular mood state. E.g., money hidden in manic state — found when
manic, not when depressed.
Example of explicit memory bias
Face recognition in depressed patients vs controls.
Depressed patients recognise happy faces less and
recognise sad faces more than the control groups do.
Transdiagnostic nature of selective memory
Explicit tests:
• Some evidence for bias in depression, eating
disorder, substance disorder
• Related to current concerns
Implicit memory:
• Not so clear, mixed evidence
• Distinction perceptual/conceptual processing
important?
Transfer appropriate processing
Successful remembering depends on the overlap between processes at encoding and
test
Two types:
• Conceptual (meaning)
• Perceptual (features)
2. Overgeneral memory
Two types of declarative memory
Di erent types of “knowing”
ff
fi ff ff fi ff
Lecture 1: Avoidance Theme
Avoidance as a trans-diagnostic process in psychopathology
Avoidance as trans-clinical school target
Existential therapy
• Existential givens: the unknown/uncertainty and concomitant anxiety as surrounding
human being
• Absence of ultimately solid foundation of our meaning systems (and thus, voices)
• = ultimate meaninglessness
• = freedom (and responsibility)
• Death [ existential givens —> anxiety —> defense mechanisms ]
• Freedom —> responsibility for choices given to others (individuals, institutions, fate,
god)
• Death —> (i) specialness, (ii) ultimate rescuer
Types of avoidance
• Overt escape/avoidance: when “an individual does not enter (=avoidance), or
prematurely leaves (=escape), a fear-evoking situation”
• Safety behaviour (‘within-situation safety-seeking behaviour’): overt or covert
avoidance/prevention of feared outcomes
• Sucking mints to ‘prevent’ vomiting
• Distracting oneself when in presence of fear cues (self-deception; psychoanalytic
defences)
Problem with avoidance (control)
• Doesn’t work
• Maintains/increases negative a ect
• Cannot learn that danger cue (e.g., dog) is actually safe
• Rebound e ect
• Narrows/prevents life
Avoidance in social anxiety
• Safety behaviours contributes to likelihood of feared outcome occurring
• Socially anxious vs. Not anxious groups
• Condition: elicit safety behaviour or not
• DV: discussion; safety behaviours of ‘short duration’ + ‘low intimacy/disclosure’
• DV: confederate liking of participant
Avoidance in depression
• Measures
• Beck depression inventory
• Cognitive-behavioural avoidance scale
• “I try not to think about problems in my personal relationships”
• “I quit activities that challenge me too much”
• Reward assessed through daily diary and reward probability Index (e.g., “there are a
lot of activities I might enjoy, but they just don’t seem to happen”)
• **decreased availability of reward (both measures) mediated relation
between avoidance and depression
ff ff
, Avoidance in PTSD
• Mental defeat: “perceived loss of psychological autonomy, accompanied by the sense
of not being human any more” —> challenges the person’s sense of worthiness and
competence
• I mentally gave up
• Avoidance/safety behaviours
• Avoid people who remind you of situation; avoid unfamiliar places or situations
• Try to distract yourself from distressing thoughts
• Sleep with lights or radio on
Avoidance prevents treatment bene t
Approach as trans diagnostic process
• Exposure therapy works for anxiety disorders
• Behavioural activation therapy
What changes when facing what is feared?
Exposure —> fear tolerance
• Administer CO2 (similar to panic symptoms) to anxiety sensitive subjects
• Acceptance exposure vs. Control (relaxation breathing) vs. No instructions
• DV: How long avoid subsequent CO2 challenges?
Exposure —> self-e cacy
• Bene ts predicted by self-e cacy, even when controlling for anticipated and actual
anxiety
• But reduced anxiety did not predict more approach when controlling for self-e cacy
Lecture 2: Memory
A selection of memory processes
1. Selective memory
2. Overgeneral memory
3. (Freudian) repression vs avoidance
1. Selective memory
Memory processes
1. Encoding — information enters (perception, interpretation)
2. Storage (consolidation) — formation memory traces / representation of event
3. Retrieval — what people call
“remembering”
Intentional vs unintentional
fi ffi ffi fi ffi
, Types of memory
“Conscious” — declarative explicit memory
“Unconscious” — non declarative memory, e.g.,
• Associative learning (conditioning)
• Procedural memory — tying shoelaces, riding your bike
• Priming = things that you just experienced make processing of similar things easier
Cues are important
Successful remembering (recall, cued recall, recognition)
Depends on the interplay between encoding and retrieval
Encoding speci city: a cue is e ective when it is speci cally encoded
During retrieval:
• The more a cue matches circumstances during encoding, the greater the probability
of recall
• Environmental details; interpretation (current concerns); (mood)state
Mood congruency/dependency
• Mood congruent memory: selective encoding or retrieval of information with a ective
tone matching current a ective state. E.g., depressed mood — recall negative events
• Mood(state) dependent memory: increased likelihood of retrieving material that was
encoded in a particular mood state. E.g., money hidden in manic state — found when
manic, not when depressed.
Example of explicit memory bias
Face recognition in depressed patients vs controls.
Depressed patients recognise happy faces less and
recognise sad faces more than the control groups do.
Transdiagnostic nature of selective memory
Explicit tests:
• Some evidence for bias in depression, eating
disorder, substance disorder
• Related to current concerns
Implicit memory:
• Not so clear, mixed evidence
• Distinction perceptual/conceptual processing
important?
Transfer appropriate processing
Successful remembering depends on the overlap between processes at encoding and
test
Two types:
• Conceptual (meaning)
• Perceptual (features)
2. Overgeneral memory
Two types of declarative memory
Di erent types of “knowing”
ff
fi ff ff fi ff
