Beck introduced ‘the cognitive triad’ which is 3 beliefs which cause Depression and affect each other. They are unrealistic negative views about the self, the future and the world. According to beck, this negative outlook would have derived from the individual’s childhood perhaps due to bereavement, overcritical parents or even teachers. Essentially, he believes that a depressed person has developed a negative set of schemas on which their expectations about life are based on. For example, in Anna’s case, she may have developed a self-blame schema which makes her feel responsible for all the things in her life that go wrong or even an ineptness schema which causes her to expect failure every time.
Our psychodynamic psychologists assume that all behaviour can be explained in terms of the inner conflicts of the mind. The belief that our behaviour and feelings as adults are rooted from our childhood experiences and that all behaviours have a cause and a meaning that it is all determined. It is important to recognise that we may not be able to understand behaviours using question and answer techniques, as the individual may not always be aware of what is troubling them. It is necessary to explore a little further in trying to interpret behaviour on the assumption that the behaviour is in some way a symptom of what is going on in the unconscious.
When Anna feels upset and becomes very overwhelmed with her emotions, she may start to wonder why she feels like this. Even when she is unsure to why she is feeling low, she was want answers and therefore could end up making up things which lead to negative thinking.
The treatment that psychodynamic psychologists would offer Anna would be psychotherapy. They would aim to make conscious her unconscious thoughts and motivations thus gaining insight. The psychoanalysis therapy will release any repressed emotions and experiences. A psychologist would ask Anna to lie down on a couch for example to be able to relax. They would sit behind Anna and take down notes while asking her to talk about her dreams and any childhood memories. They would want her to remember and recognise the positive memories and thoughts that were once visible to her to encourage her conscious mind to believe that there is possibility for positivity.
A therapist employing psychoanalytic techniques may work with Anna to identify unconscious beliefs which may underlie or maintain the problems such as in the case of a child who may have learnt that feelings and thoughts were to be brushed under the carpet.
However, both treatments have its limitations. Cognitive behaviour therapy will not suit everyone. An individual will be required to be very committed and persistent in tackling their health problem with the help of their therapist. It can be considered as hard work as it involves taking the individual out of their comfort zone to be able to tackle situations and this can often be seen as very challenging for some people.
Psychotherapy can become a very lengthy process and requires many sessions before the individual can begin to feel a difference. This therapy will also not be for everyone as for this therapy to take place; the therapist and the client will need to build a trusting relationship. Some people cannot open up very easily to people and can take a very long time before they even say anything relevant to the therapy which will just make it very time consuming and pointless.
“Ethel’s daughter, Jane came to into the clinic to urge help from one of our psychologists for her mother. Ethel has agoraphobia which has led her to become very isolated and feeling very depressed. Jane stressed the severity of this issue, as she is able to see how much this phobia has dominated her mother’s life. She is worried that her mother will never leave the house and become very poorly and will not want to seek help.”
Our behaviourist psychologists assume that behaviour is learned and shaped by the environment. They believe behaviour is determined by past events i.e. operant/classical conditioning. The prior stimulus and response situation (which has been reinforced by reward or discouraged via punishment) determines how you respond to a situation in the present and later in the future. The principles of classical conditioning can be applied to everyday life in even the most practical way. A method which is commonly used to help change an individual’s phobic behaviour uses a method of treating acquired fears which is called systematic desensitisation. This method begins by creating a hierarchy of fear.
In Ethel’s case, her fear is going out. Behaviourist psychologists would ask Ethel to create a list of aspects with going outside of her house. For example, walking out onto the street being her least feared aspect and being around lots of people outside being her most feared.
The principle of this procedure is to help Ethel to achieve a state of relaxation. The aim is to replace the fear with a relaxed frame of mind. An image will be shown to her of her least feared situation as she is encouraged to relax until she is able to view it without feeling a sense of fear or anxiety. This can often take more than one session. When the least feared situation has been satisfactorily overcome, Ethel will be able to move onto the next situation at the next level, working on relaxing until they are able to view that situation without a trace of fear or level of anxiety. This treatment gets repeated over a period of time until the final most feared situation can be faced without Ethel feeling any worry.
Our cognitive psychologists would help Ethel by offering her cognitive behaviour therapy to help desensitise anxiety through exposure to feared situations. The therapy is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour. It aims to break this cycle and find new ways of thinking that can help you behave in a more positive way. The therapist will identify a feared situation for Ethel and try to shift a more positive thought that the situation although being unpleasant, is not fatal to her and will pass. Cognitive behaviour therapy is usually combined with exposure therapy so the therapist will set relatively modest goals at the beginning of the treatment like just going to a local shop. As Ethel becomes more confident over time, the goals set will become more challenging such as going to a larger supermarket for example.