Kazi, A., Freund, B., & Ironson, G. (2008). Prolonged Exposure Treatment for Posttraumatic Stress Disorder following the 9/11 attack with a person who escaped from the Twin Towers. Clinical Case Studies, 7, 100-116.
This article chronicles the progress of one 9/11 survivor through the cognitive-behavioral therapy intervention of prolonged exposure (PE) therapy to address her PTSD and depressive symptomatology. This treatment consists of (1) imaginal exposure, and (2) in vivo exposure. It is designed to elicit emotional processing until the detrimental traumatic memories and avoidances have habituated (desensitized). After 15 sessions this client improved 75% as measured by a composite index. However, there was residual symptomatology 6 months after therapy ended but measures remained sub-clinical. Progress through treatment can be seen as waxing and waning, but trending towards improvement. Still, in this type of therapy clients must be stressed before they are to feel better. With the prevalence of PTSD at 8% in the US population, clinicians are calling more and more for effective treatment regimes. PE may be a promising candidate.
Showing posts with label Cognitive Psychology. Show all posts
Showing posts with label Cognitive Psychology. Show all posts
Thursday, July 10, 2008
Sunday, March 2, 2008
The Emotionally Engaged Analyst
Miller, M.L. (2008). The Emotionally Engaged Analyst: Theories of affect and their influence on therapeutic action. Psychoanalytic Psychology, Vol. 25, No. 1, 3-25.
The article provides a review of affect theories and how they relate to therapy. As Dahl mentions, "the absence of a coherent psychoanalytic theory of emotions is truly remarkable, given clinician's nearly universal belief in the centrality of emotions in every patient's life and treatment".
Two broad categories have predominated thus far. One is the cognitive appraisal theory of emotion which holds that emotions are the conscious or unconscious cognitive appraisal of an arousing stimulus. These cognitive evaluations are formed by assimilating the current event into a stored schema that represents earlier experiences in similar circumstances. Schemas may be processed in subsymbolic, nonverbal symbolic, and verbal symbolic modes. If we are to represent and understand emotional experiences, subsymbolic processes must be integrated with symbolic processes. This idea forms the basis for therapy: enable the patient to metabolize unformulated subsymbolic experiences of emotion into meaningful feelings.
The second category encompasses so-called functional and discrete theories of emotion. These theories hold that the brain is more an emotional organ than a cognitive one, and emotions are seen as a hierarchy of embedded regulatory functions necessary for the automatic adaptive survival of the organism. Emotions are orchestrated in response to significant changes perceived in the internal or external milieu, and responses are executed subcortically. Cortical involvement occurs after subcortical emotional processes have begun; this may later influence the execution of the underlying emotional processes by providing the informational context of the body, the self, and the environment. Feelings, the mental representations of ongoing regulatory processes, do not initiate these emotional processes but are instead the product of them. These theories view the essence of change in psychoanalytic treatment as the remodeling of the nonconscious procedures through which the person adapts to his or her environment.
The dynamic systems theory of emotion, a recent theoretical addition, can be viewed as a combination of the cognitive appraisal schema of emotion and the discrete/functional models of emotion with an emphasis on social interaction. In this model, emotions should be seen not as discrete states of being or constructed interpretive programs but as ongoing, continuous processes influencing and being influenced by the complex context in which they occur. Emotions emerge as three critical component systems (the subcortical arousal system, the cortical interpretive system, and the motor system) dance together. In so doing, emotions, meanings, and actions are continuously modified and negotiated. Viewed in the context of social interaction, another three-way interaction can be seen to take place between each person's own emotional processes, those of the person he or she in interacting with, and the emotional character of the interaction itself. Although all of these components within the individual and without can interact with one another in an infinite number of ways, they have a tendency to self-organize into a finite number of stable patterns which tend to repeat under particular conditions and ultimately define the different emotional states and state transitions a system can take. The goal of therapy is then to engender systemic change, to perturb the system appropriately into allowing transformations in the emotional experience of the client. In a truly interactive system, with multiple internal and external factors contributing to the individual's emotional experience, as one component within the system changes, all other components adjust to that change. As such, the analyst's emotional participation is viewed as an essential component.
The article provides a review of affect theories and how they relate to therapy. As Dahl mentions, "the absence of a coherent psychoanalytic theory of emotions is truly remarkable, given clinician's nearly universal belief in the centrality of emotions in every patient's life and treatment".
Two broad categories have predominated thus far. One is the cognitive appraisal theory of emotion which holds that emotions are the conscious or unconscious cognitive appraisal of an arousing stimulus. These cognitive evaluations are formed by assimilating the current event into a stored schema that represents earlier experiences in similar circumstances. Schemas may be processed in subsymbolic, nonverbal symbolic, and verbal symbolic modes. If we are to represent and understand emotional experiences, subsymbolic processes must be integrated with symbolic processes. This idea forms the basis for therapy: enable the patient to metabolize unformulated subsymbolic experiences of emotion into meaningful feelings.
The second category encompasses so-called functional and discrete theories of emotion. These theories hold that the brain is more an emotional organ than a cognitive one, and emotions are seen as a hierarchy of embedded regulatory functions necessary for the automatic adaptive survival of the organism. Emotions are orchestrated in response to significant changes perceived in the internal or external milieu, and responses are executed subcortically. Cortical involvement occurs after subcortical emotional processes have begun; this may later influence the execution of the underlying emotional processes by providing the informational context of the body, the self, and the environment. Feelings, the mental representations of ongoing regulatory processes, do not initiate these emotional processes but are instead the product of them. These theories view the essence of change in psychoanalytic treatment as the remodeling of the nonconscious procedures through which the person adapts to his or her environment.
The dynamic systems theory of emotion, a recent theoretical addition, can be viewed as a combination of the cognitive appraisal schema of emotion and the discrete/functional models of emotion with an emphasis on social interaction. In this model, emotions should be seen not as discrete states of being or constructed interpretive programs but as ongoing, continuous processes influencing and being influenced by the complex context in which they occur. Emotions emerge as three critical component systems (the subcortical arousal system, the cortical interpretive system, and the motor system) dance together. In so doing, emotions, meanings, and actions are continuously modified and negotiated. Viewed in the context of social interaction, another three-way interaction can be seen to take place between each person's own emotional processes, those of the person he or she in interacting with, and the emotional character of the interaction itself. Although all of these components within the individual and without can interact with one another in an infinite number of ways, they have a tendency to self-organize into a finite number of stable patterns which tend to repeat under particular conditions and ultimately define the different emotional states and state transitions a system can take. The goal of therapy is then to engender systemic change, to perturb the system appropriately into allowing transformations in the emotional experience of the client. In a truly interactive system, with multiple internal and external factors contributing to the individual's emotional experience, as one component within the system changes, all other components adjust to that change. As such, the analyst's emotional participation is viewed as an essential component.
Saturday, December 1, 2007
Sex Differences in Jealousy
Buunk, B.P., Angleitner, A., Oubaid, V., & Buss, D.M. (1996). Sex Differences in Jealousy in Evolutionary and Cultural Perspective: Tests From the Netherlands, Germany, and the United States, Psychological Science, 7, 359-363.
In the 1992 article “Sex differences in jealousy in evolutionary and cultural perspective”, Buunk et al. suggested that women typically find emotional infidelity to be more distressing than sexual infidelity, whereas men are bothered more than women by sexual infidelity. The article leapt to the conclusion that these results supported hypotheses of jealousy offered by evolutionary psychology, a field which believes behavior evolves in a species if it is (or was) somehow adaptive. C.R. Harris & N. Christenfeld (HC) reacted to the article with “Gender, Jealousy, and Reason” which provided an alternate explanation for how such data might appear.
The experiment of the 1992 Buunk et al. article was replicated by HC during their subsequent study, reaching similar results. Both studies revealed that men demonstrate greater anguish to sexual than to emotional infidelity of their partner, whereas women grow more upset to emotional infidelity. However, HC were skeptical of the conclusions drawn by Buunk et al. – namely that the gender differences in sexual jealousy shown across geography and cultures was necessarily in support of an evolutionary psychology explanation.
In order to combat such conclusions, HC posed some additional questions to their respondents. First, they explicitly asked if they discovered that their partner was engaging in sexual intercourse with someone else, how likely did they think that their mate would be in love with this person. Conversely, they also asked respondents to imagine they discovered their mate was in love with someone else and to indicate how likely they believed their partner would also be engaging in sex with this other person.
The results concluded that men think that sex implies love for their partners more so than women, whereas women think that love implies sex more so than men. Given this extra data, one would find it reasonable to conclude, as a woman, that emotional infidelity also implies sexual infidelity. Essentially a double whammy, likely signifying both emotional and sexual infidelity, emotional infidelity is thus logically more troubling to a woman and might account for the uniqueness of results across genders.
Suggesting that men and women may instead show differences in their interpretations of the evidence of infidelity, HC challenged the foundational conclusions of Buunk et al. Although applying evolutionary psychology models may be provocative and convincing, HC showed that cognitive explanations may be equally plausible. Thus, one should exercise caution when interpreting the results of such a study of jealousy.
In the 1992 article “Sex differences in jealousy in evolutionary and cultural perspective”, Buunk et al. suggested that women typically find emotional infidelity to be more distressing than sexual infidelity, whereas men are bothered more than women by sexual infidelity. The article leapt to the conclusion that these results supported hypotheses of jealousy offered by evolutionary psychology, a field which believes behavior evolves in a species if it is (or was) somehow adaptive. C.R. Harris & N. Christenfeld (HC) reacted to the article with “Gender, Jealousy, and Reason” which provided an alternate explanation for how such data might appear.
The experiment of the 1992 Buunk et al. article was replicated by HC during their subsequent study, reaching similar results. Both studies revealed that men demonstrate greater anguish to sexual than to emotional infidelity of their partner, whereas women grow more upset to emotional infidelity. However, HC were skeptical of the conclusions drawn by Buunk et al. – namely that the gender differences in sexual jealousy shown across geography and cultures was necessarily in support of an evolutionary psychology explanation.
In order to combat such conclusions, HC posed some additional questions to their respondents. First, they explicitly asked if they discovered that their partner was engaging in sexual intercourse with someone else, how likely did they think that their mate would be in love with this person. Conversely, they also asked respondents to imagine they discovered their mate was in love with someone else and to indicate how likely they believed their partner would also be engaging in sex with this other person.
The results concluded that men think that sex implies love for their partners more so than women, whereas women think that love implies sex more so than men. Given this extra data, one would find it reasonable to conclude, as a woman, that emotional infidelity also implies sexual infidelity. Essentially a double whammy, likely signifying both emotional and sexual infidelity, emotional infidelity is thus logically more troubling to a woman and might account for the uniqueness of results across genders.
Suggesting that men and women may instead show differences in their interpretations of the evidence of infidelity, HC challenged the foundational conclusions of Buunk et al. Although applying evolutionary psychology models may be provocative and convincing, HC showed that cognitive explanations may be equally plausible. Thus, one should exercise caution when interpreting the results of such a study of jealousy.
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