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Lecture from 3/3/2016

by: Rachel Onefater

Lecture from 3/3/2016 76884

Rachel Onefater

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Lecture 15
Dr. George Howe
Class Notes
Psychology, clinical, community, research
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This 7 page Class Notes was uploaded by Rachel Onefater on Thursday March 3, 2016. The Class Notes belongs to 76884 at George Washington University taught by Dr. George Howe in Spring 2016. Since its upload, it has received 21 views. For similar materials see PSYC4201W in Psychlogy at George Washington University.


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Date Created: 03/03/16
Prevention: Can we change appraisals or schemas before problems develop?   → interventions that focus on schemas and appraisals, but there are also other things going on in  that area  *NOTE: action is involved because we use behaviors to cope with stress     Possible selves   • Oyserman’s possible selves intervention      Targeting schemas   • Cognitive reappraisal: (def.)if we are in a stressful situation, if we interpret it in one way, we  may have greater emotional response  – Changing an emotional response be reinterpreting the meaning of a situation   • Example:  I was let go from my job without explanation;   → it must be because I’m not good at what I do ​ VS​. → I was let go from my job without  explanation; later I checked with my old co­workers and they told me that my whole division  was eliminated, so I know it didn’t have anything to do with my competence   Appraisal: This negative event occurred because something occurred in the external world, and  not in something internal→ There is an overgeneralization in self­blame(first appraisal)     Expressive writing and reappraisal   • Jamie Pennebaker ­­Social Psychology­­Surveys  – Early studies found those who had disclosed a traumatic event to others had better health than  those who did not.​ Are traumatic events associated with health?   Q: Is there something that is just about expressing what is going on that influences our health  – Theorized that merely writing about event would relieve stress and improve health   Testing effects of expressive writing     Experiment: Pennebaker & Beall (1986)   – 46 Intro psych students   – Randomly assigned to four different conditions, 4 sessions of writing about:   1. Trivial topic (describe your shoes as objectively as possible)­­each day it was a different  trivial thing  2. Trauma emotions (describe feelings during a personally upsetting experience, ​ but  nothing about the event​ )   3. Trauma facts (describe upsetting event in detail, ​but nothing about  feelings­OBJECTIVITY) ​  4. Trauma combination (describe event and feelings)       Differences in writing   • Trauma focused conditions:   – More personal   – Topic previously not discussed   – Emotion and combination revealed more emotion   *Found that trauma focused conditions were considered more personal  *55­75% of topics were ones that were previously not discussed  *NOTE: Emotional and combination of the two reported that people reported more emotion  Suggests that people writing in trauma experiences that involve description of a lot of the  emotional experience going on    Differences in health outcomes   • Trauma­combination group had no increase in health center visits over year, compared to other  three groups who showed increases   • Better self­reported health in groups that focused on expressing emotions  *Control group: Substantial increase in the visits. Trauma combination, you and no increase AT  ALL in the group that was both emotion and experience  → how much did you think of the study over time    Pennebaker Interpretation​ : When we have some kind of very upsetting event, and we don’t talk  about it, we are actually doing some active suppression(i.e. White Bear Study) If you don’t think  about it, it becomes bottled up inside.     Critical thinking moment:   Limitations?   → They did not get completely consistent findings, finding for one group is saying that  self­reports and the emotional expression cannot be accurate  → Small group of people, all intro to Psych Students    Do these findings replicate?   • Frattaroli (2006) Meta­analyzed 146 studies(average): ​ could there be difference within these  effects? Is there variability within this number?   • Overall: modest positive effect on   – Psychological health(often depression/anxiety)   – Physiological responses   – Reported health   – Health behaviors   • Stronger for:   – Participants with physical health problems, history of trauma or stressors, non­college  students(college student may have fewer health problems because they are younger)   – Disclosure was at home, private, and didn’t require release of writing to the  investigator(suggests there is something about privacy, and expressing in a safe place)   – Writing over 3 or more sessions, at least 15 minutes, about more recent events, and about  previously undisclosed events​(in disclosing the event, seem to have more of an impact)    Why does it work?   • Alparone et al (2015) (How to Remember study: ​ A​lparone­​Anxiety)  • Randomly assigned 70 Italian undergrads to write about:   – Thoughts and feelings about the most traumatic experience in your life.   – Daily activities in cold and neutral fashion   • Measured frequency of “cognitive mechanism” words in writings reflecting   – Cause – Insight   • Assessed anxiety before intervention and 4 months later     Testing mediation   • Mediation   – Changes in supposed cause lead to changes in outcome through their impact on some  intermediate factor   – Alparone interprets this as “progress in the linguistic organization of the narrative”   → is change in words actually related to change in anxiety?     Other evidence   • Changes in cognitive reappraisal   – Park & Blumberg (2002): found improvement in appraisal content up to four months later  (controllability, threat)   • Creation of more coherent narrative or story about the event   – Smyth et al (2001) had people write coherent stories or make a fragmented list of thoughts,  feelings, sensations: narrative group had fewer PTSD­related avoidance at followup)   → Actually the content of the story that people tell that matters  → Rather than have people just write stories, they assessd people to either write it out in  narrative form, or list the thoughts, feelings, and sensation that you had at that time  → if you tell it in a coherent fashion , you have more POSITIVE EFFECTS!    Critical thinking moment: Limitations?   From schemas to “possible identities”   → Expressive writing having an impact on organizational thinking  i.e. Humans think in stories which is helpful in how we develop narratives  • Daphna Oyserman   • Identity­based motivation theory (IBM): we think about ourselves and form schemas about the  world and ourselves, and it is a much bigger picture view of who we are. Who am I, what is the  concept of who I am.   → Our self­concepts are not necessarily singular, unilateral concepts of who we are, they are  rather multi­faceted, and involve identities in particular context, past, current, or future identities  – Our self concepts are multifaceted, and include a range of past, current, and future identities  – We construct identities “on the fly”, depending on the situation   – We are motived to act in ways congruent with our currently activated identities   • Oyserman & Destin (2010): “Consider an eighth grader whose self­concept, sampled across  multiple contexts, includes the following identities: “I am a girl whose parents are from Mexico.  I used to want to play violin. I hate school. This coming year, I expect to get As and be really  popular. I want to become a doctor. I am afraid I might end up poor, unemployed, or homeless.”   → We interpret difficulty differently depending on the situation  Example: If you hate school and you are asked to solve a problem on the board, it is difficult  because it cannot be changed, but if you like school, your inability to solve a problem can be  fixed/helped, and it can be seen as more of a motivational factor.    Targeting possible identities   • Oyserman et al (2006)   • Randomized field trial of school­based program   • 264 Detroit middle schoolers, mostly African American or Latina/o   • Assigned to either regular elective class or intervention class    Program components   • Group classroom intervention to build peer support for possible identities   • Discussion of range of adult possible identities using familiar photos   • Focus on negative forces and possible setbacks, emphasizing overcoming of obstacles   • Timelines into the future, to tie current and future identities together   • Focus on developing specific strategies to move towards future identities   → R​ esults   • Changes in targeted mediators: (changes in possible selves)  – Feared off­track possible selves (drugs, gangs, delinquency)   → Starting to understand what affects it would have in the future. Intervention actually increased  their awareness on off­track identities  – Balance in expected (“passing 8th grade”) and feared (“having to repeat grade”) possible selves  – Plausibility of possible selves (number of possible selves, range of strategies)   • Mediated impact on school and mental health outcomes up to 2 years later  → intervention influence people's plausible identities, reported more strategies, and influence  balanced, and specific targets in the cognitive realm fit, and up to two years later, there were  effects in reducing classroom behavior problems, absences, homework etc.  Critical thinking moment: Limitations?     Treatment: can we change appraisals or schemas to help resolve problems?   The three waves of CBT   • First wave: change behavior : reinforcement schedules, learn skills, and mold skills to be better  • Second wave: change thoughts: ​ Changing content of thoughts, and how you think, and  challenging that   • Third wave: attend to experiences, change how we respond to our thoughts   Second wave: “standard CBT” :  • Albert Ellis and Aaron Beck   • Cognitive restructuring:(def.) therapeutic activities that lead  people to learn how to challenge  irrational thoughts and cognitive distortions  – Learning to identify and challenge “irrational or maladaptive thoughts”, also known as  cognitive distortions     Efficacy of CBT?   • Johnson & Friborg (2015) Meta­analyzed 70 trials of CBT for depression   → No more ​ all­or­nothing​,black and white​ , and “I should..” thinking!  – Strong, consistent effects, but effects seem to bediminishing in newer studies​ (can only  speculate)  1. Found a lot of evidence for very strong and existence effects  2. CBT does not necessarily win out against other treatments for different effects  3. Look to see if those effects were consistent over time      Effects across all studies by time   Why?   • Doesn’t appear to be due to differences in severity of condition or use of more rigorous study  designs   • Speculations:   – Such studies are extremely ​difficult or impossible to use double­blinding​  (where both  treatment staff and patients are unaware of which intervention they get).   → Easier to do double blind with medication, but you can’t do that here because people  understand what is going on, and what of the things is understanding and if you appraise that  treatment is likely to be helpful, particularly in mental health, it is helpful!  *NOTE: Giving people hope that things will get better, and this influence the positive impact of  treatment   – Possible that part of CBT effect is “placebo effect”, and this has diminished over time     Does CBT work through changing schemas or appraisals?   • Shimotsu et al (2014)  • Group cognitive behavior therapy with 46 Japanese outpatient adults focusing on:   – Relationship between thoughts and emotions(tied together)   – Explanation of cognitive distortions   – Cognitive restructuring strategies (challenging dysfunctional thoughts)   • Administered dysfunctional attitudes scale before and after   → ​Findings   • Reductions in three subscales from pre to post  → This is consistent with the interpretation that there is an effect, but it is missing a control  group!   *NOTE: There are very few studies testing mediation effects     Third wave CBT   • Stephen Hayes (Acceptance and Commitment Therapy)   • Marcia Linehan (Dialectical Behavior Therapy)   • Zindel Segal (Mindfulness Based Cognitive Therapy)  → Focuses a lot more on people's sense of their internal experiences and how they are attending  to and experiencing thought processes as they go along, esp. with mindfulness    Acceptance and commitment therapy (ACT)   • ACT developed by Stephen Hayes   • Several components in model of psychopathology From Hayes, Luoma, Bond, Masuda, &  Lillis (2006) Therapeutic components     From Hayes, Luoma, Bond, Masuda, & Lillis (2006)   Acceptance as a form of mindfulness   • Mindful awareness of unwanted thoughts or feelings, without judgment   – Acceptance of “demons” without attempting to fight them   – Requires practice and repetition   – Development of mindfulness skills help   • Notice similarity to:   – Directed review of memories related to PTSD   – Exposure therapies for severe anxiety     When I find myself in times of trouble Mother Mary comes to me speaking words of wisdom,  let it be ­­ Paul Mccartney, John Lennon    Effectiveness of ACT as a therapy?   • Recent review (Smout et al, 2012):   • Evidence from randomized clinical trials comparing ACT to treatment­as­usual   • Strong enough to meet clinical guidelines for:   – Pediatric chronic pain   – Obsessive­compulsive disorder   – Anxiety disorders including social anxiety, generalized anxiety    Summary   • CBT and third wave versions all have evidence for efficacy in treating depression and anxiety   • For CBT, evidence that changing appraisals, schemas, or cognitive distortions is the active  ingredient is still limited   • And evidence for the mechanisms of ACT on other mindfulness based interventions is even  more lacking 


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