Psychodynamic & Cognitive Perspectives on Psychopathology.pptx

Presentation on psychodynamic and cognitive perspectives in the field of psychology

1. Psychodynamic & Cognitive Perspectives on Psychopathology Presented by: Yashi Goel, M.Phil Clinical Psychology Trainee, ABVIMS & Dr. Ram Manohar Lohia Hospital, Delhi Supervised by: Ms. Satyam, HOD, Clinical Psychology, ABVIMS & Dr. Ram Manohar Lohia Hospital, Delhi

2. Fun Fact Freud was inspired by the theory of thermodynamics and used the term psychodynamics to describe the processes of the  mind  as flows of  psychological energy  ( libido  or psi ) in an organically complex  brain. The principle of conversation states that "the total amount of energy in any given physical system is always constant, that energy quanta can be changed but not annihilated, and that consequently when energy is moved from one part of the system, it must reappear in another part." This principle is at the very root of Freud's ideas, whereby  libido , which is primarily seen as sexual energy, is transformed into other behaviours . 

3. Introduction Psychodynamic theory (sometimes called  psychoanalytic theory ) explains personality in terms of unconscious psychological processes (for example, wishes and fears of which we’re not fully aware), and contends that childhood experiences are crucial in shaping adult personality. Topography model- conscious, preconscious and unconscious The three aspects of personality- Id, Ego and Superego By 1906, Freud had developed his theories of the underlying processes that caused mental illness and therefore could classify various disorders such as neuroses, character disorders, perversions and psychoses based on their psychopathology.

4. Theory of Neurosis Freud’s early formulations of neurosis can be traced to his propositions about hysteria by observing and modifying Breuer’s work. Hypothesized that mental illness was the consequence of previously forgotten sexual experience or sexual seduction of a child in his early development by an adult. Maternal deprivation can prove to be devastating to the ego’s integrative capacities; lack of adequate introjections and identifications either due to deprivation or excessive indulgence may hinder the ego from mediating between instincts and environmental forces, thus impacting drive discharge . A lack of the capacity to discharge drives such as aggression may lead to their turning inwards, causing self –destruction or may lead to their inhibition. When ego has been weakened, a traumatic event later in life can threaten survival , especially when combined with external conditions such as exhaustion or toxic conditions that may break the ego’s defenses. Disappointments, frustrations or adult strivings may awaken infantile longings that need to be dealt with through symptom formation of regression   While reduction of tension and conflict is the primary gain of neurotic illness, secondary gain is obtained by the ego in the form of evoking pity, sympathy and material gains.

5. Conversion Hysteria:   D efense against over intense libidinal stimulation by means of a transformation or conversion of psychic excitation into physical symptoms. As a consequence various alterations occur in the motor functions and sensations. Phobias: P hobias represent a displacement of conflict arising from increasing sexual excitation attached to an unconscious object, onto an object or situation outside the ego system. Case study- Little Hans Obsessional Neurosis: defensive regression to the early stages of development with the use of maladaptive defense mechanisms such as isolation of affect, undoing, displacement, and reaction formation. OCD symptoms result because of repressed mental processes, wishes, and desires, which went out via substitution or conversion. person with OCD uses isolation of affect, in which superego removes affect from the anxiety-provoking idea. Thus, the idea gets weakened but still remains in the consciousness. However, the affect becomes free and by using symbolic associations, attaches itself to other neutral ideas through displacement. Hence, such neutral ideas or thoughts become anxiety-provoking and in turn lead to the formation of obsessions. The defense mechanism of undoing leads to the formation of compulsions in order to prevent feared consequences of obsessive thoughts ideas or impulses. Case study- Rat Man

6. Mood Disorders According to Freud, depressive states involve the introjection of a lost love object, and the redirection of the ambivalence originally directed towards the object against the internalized object. Book- Mourning and Melancholia (1917) - explained that the loss could result due to death or disappointment of a loved object. Freud noted that mourning is precipitated by actual external object loss. However, in melancholic depression, the ego itself is impoverished having experienced an internal loss- blow to the self esteem- ego is perceived as poor and empty, deserving reproach and attack from the superego. The depressive dilemma is anger towards the lost love object- anger is turned inwards. Adulthood- failure to live upto one’s own standards or meet specific goals – awakens feelings of loss of the object’s love- diminished self esteem.

7. Theory of Psychosis- Freud’s explanation Freud postulated that paranoia was an unconscious projection of intense and overwhelming homosexual impulses which were unconsciously denied by the patient. Freud later described psychosis as a result of narcissism - result of incapacity for emotional interest in other people and things (trauma) R edistribution of libido that is normally devoted to object love - energy from impoverished object relationships is excessively invested in the self – break with reality P sychotic symptoms such as delusions, hallucinations and disorganization were rudimentary efforts on the part of the patient to reconstitute or substitute for lost relationships with external objects

8. Theory of Psychosis- Psychoanalytic perspective Arieti (1974)- psychotic symptoms are not random or meaningless phenomena, but rather rich, symbolic expressions of the patient’s inner world . Hallucinations and delusions are concrete representations of abstract ideas, wishes, and conflicts- develop in response to an overwhelming and intolerable self-image. CONCRETIZATION   and  PERCEPTUALIZATION Perceptualization refers to the process of transforming abstract concepts into specific sensory perceptions ( e.g. patients who think poorly of themselves may smell a foul odor emanating from their body; the rotten self-perception becomes the rotten body that smells) In the absence of sensory perceptions (e.g. in patients who experience delusions without hallucinations), concretization is used- for example , patients project onto the outside world their self-condemnation and come to believe that others are targeting them . Negative symptoms can be interpreted similarly. The typical schizophrenic defense is withdrawal- strategy intended to shield patients from the painful consequences of social contact .

9. Psychodynamic therapy for Psychosis Dr. Ruffalo (2019)- Patients with schizophrenia generally come to treatment fearful and anxious, just as they are fearful and anxious of any interpersonal contact. E arly stages of therapy must be focused on relaying to patients a sense that they are no longer alone in the world—every effort must be made by the therapists to form a connection with the patient- basic trust As therapy proceeds, therapists may begin to offer interpretations regarding the nature and meaning of patients’ symptoms. May not be helpful at first but gradually, patients start understanding the possibility of these interpretations. The formation of symptoms is discussed as an attempt to resolve a painful and untenable situation . Patients are taught that psychotic symptoms are often preceded by a change in one’s emotional state , and that it is possible to catch themselves in this  listening attitude   before the occurrence of the symptom.

10. Cognitive Perspective Pioneers- Albert Ellis- ABC model; REBT and Aaron Beck- wanted to verify aspects of psychoanalytic theory- investigated the thoughts and dreams of depressed individuals, looking for signs of repressed hostility. Instead, he discovered a prominent theme of defeat and a pervasive negative bias. Basic tenets of Beck’s theory- A utomatic distorted and dysfunctional patterns of thinking, N egative views of self, world, and future (the cognitive triad), Clinically troublesome cognitive distortions are often triggered by adverse life events, yet are maintained by fixed perceptual rules or schemata, Schemata (develop early in life, shaped by life experiences) provide the basis for organizing, categorizing, evaluating, and judging new experiences and recollections of past events.

11. Cognitive Biases

12. Origins of Beck’s theory of depression

13. Cognitive Triad in Depression

14. Anxiety Anxiety is evoked when individuals are concerned about their vulnerability to physical or psychological harm and are consequently impelled to avoid, escape, or appease. Fight-or-flight responses become overreactive to stimuli induced by catastrophic thoughts about the risk of rejection, embarrassment, diminished life circumstance, injury, or death itself. In some respects, anxiety can be construed as the temporal flip side of depression ; anxiety is about what one might lose in the near future, whereas depression is about what one believes one has already lost.

15. Risk Resource Model of Anxiety Increased anticipation of risk along with perceived low resources lead to fight or flight response, and increased physiological arousal, thereby reinforcing a heightened sense of risk and vulnerability

16. Cognitive Model for Panic Disorder (Clark, 1986)

17. Personality Disorders Dysfunctional beliefs and maladaptive schemas For example, an individual with dependent personality disorder believes that he or she cannot function without the help of someone else, the individual with avoidant personality disorder believes that problems will go away if he or she ignores them, and the individual with narcissistic personality disorder maintains that he or she is deserving of special considerations above those of others. Interestingly, in borderline personality disorder , patients are often double-bound by their own internally contradictory beliefs. A typical example is the patient who simultaneously believes, I am vulnerable if someone gets close to me and I expect to be abandoned, and this will devastate me. Schemas shape behavioral strategies. For example, the individual with paranoid personality disorder acts in a guarded, hostile manner, waiting to defend him- or herself from harm and preparing to counterattack at any time. His or her belief that people cannot be trusted, so I must be wary at all times reinforces this behavioral pattern. Similarly, the individual with obsessive-compulsive personality disorder adheres to a rigid schedule and an inflexible way of doing things, believing, I can only feel a necessary sense of control if I do things a certain way and never deviate.

18. Eating Disorders Anorexia and Bulimia are characterized by a constellation of maladaptive beliefs that encourage patients to continue their unhealthy eating patterns, while discouraging them from trying to modify their eating behavior so as to make it more normative. For example, the anorexic patient will often maintain faulty beliefs such as “It is virtuous to go without eating for long periods of time” and “ If I can get my weight down to [unspecified abnormally low figure], I will be happy and everything will be okay ”. Additionally, individuals with anorexia illustrate the problems associated with all-or-nothing thinking quite strikingly by expressing the belief that any increase in their eating will necessarily lead to excessive eating and obesity. They also demonstrate perceptual distortions in viewing themselves as fat when others see them as thin- being pleased with their sick-looking appearance. B ulimic patients have maladaptive beliefs such as “ I cannot tolerate feeling full, thus I must vomit to get rid of this awful feeling ” and “I can eat anything and everything I want, as long as I have the opportunity to vomit without anyone knowing about it”.

19. CBT Formulation (Christopher Fairburn)

20. Cognitive Triad For Delusional Beliefs TYPE OF DELUSION VIEW OF SELF VIEW OF OTHERS (THE WORLD) VIEW OF FUTURE Paranoid Vulnerable (inferior, defective, socially undesirable) Powerful, threatening; others are harmful, hostile and malevolent Hopeless, uncertain Jealous Unworthy, unappealing Distrustful, exploitative; actions of others are intentional Hopeless Control Weak, powerless, helpless Powerful, omnipotent, omniscient. Largely determined by others. Somatic Vulnerable to harm and illness Dangerous, threatening, infectious Characterized by suffering Guilt Self-loathing Punishing Doomed Grandiose Special, important (inadequate) Unrewarding; others are inferior Optimistic, hopeful Magical thinking Capable, possess powers and abilities (inadequate) Others are vulnerable to powers Controllable, predictable Referential (positive form) Important (inadequate) Others are powerful, knowledgeable, and “tuned in” Hopeful

21. Cognitive distortions seen in Psychosis

22. THANK YOU! This Photo by Unknown Author is licensed under CC BY-SA