Attachment & Cognitive Therapy

Patricia M. Crittenden, Ph.D.

Patricia M. Crittenden, 2005

Four Growing Points

1. Symptoms: diagnoses & treatment 1. Emphasis on cognitive rational & verbal processes 1. Model of psychological functioning & psychopathology 1. Evaluation of harmful effects of psychotherapy
Patricia M. Crittenden, 2005

Symptoms
Distress = patients perspective Diagnosis = professionals perspective Self-protective strategies Behaviors can serve many functions
Patricia M. Crittenden, 2005

Symptoms, cont
50%+ failure rate 1 year post-CT Focus on symptom vs. reason for symptom Competence with danger vs. competence with safety Strengths approach vs. vulnerability
Patricia M. Crittenden, 2005

Cognition & Affect

Cognition Temporal, causal contingencies Verbal generalizations about contingencies: core beliefs Affect Response to intensity of sensory stimulation Somatic & psychological feelings: images

Patricia M. Crittenden, 2005

Cognitive Memory Systems

Procedural Memory
Reflexive, sensorimotor schema Preconscious Learned from experienced consequences Re-active

Semantic memory
Verbalized procedural contingencies When/then & if/then and (distorted) absolute forms Borrowed Should & ought to do

Patricia M. Crittenden, 2005

Affective Memory Systems

Imaged memory
Possibility of danger Fight, flight, freeze Bodily arousal and feeling anxious Pro-active

Connotative language
Brings images to mind Elicits feeling in listener
Patricia M. Crittenden, 2005

Integrative Memory Systems

Episodic memory
Cognitive-affective integration Learned at about 3 years Dependent upon a dialogue Biased by what parents will talk about

Reflective integration
Permits information to be corrected Is slow Done best under safe conditions
Patricia M. Crittenden, 2005

Memory Systems
Temporal Order (Cognition) Procedural Semantic Episodic Reflective Integration
Patricia M. Crittenden, 2005

Intensity (Affect) Imaged Connotative Language

Dispositional Representation
Relation of self to context Each different DR disposes behavior differently Each highlights some aspect of the problem, but obscures some other

Patricia M. Crittenden, 2005

Arousal Scale
1. Anxiety
Pain Sexual Desire Fear Anger Desire for comfort

2. Comfort 3. Depression

Patricia M. Crittenden, 2005

Boredom Tiredness Sleep Unconsciousness

Transformations
Sensory stimulation Transformations of information Dispositional representations Enacted behavior
Patricia M. Crittenden, 2005

The only information that we have is information about the past

whereas

The only information that we need is information about the future.

Patricia M. Crittenden, 2005

Transformations of Information
True Erroneous Omitted Distorted Falsified
Patricia M. Crittenden, 2005

True

False Cognitive Integration of Cognitive and Affective Information Affective

Patricia M. Crittenden, 2005

Type of Transformation of Information

True Cognitively Organized

Integrated True Cognition-True Affect

Affectively Organized

Type of Transformation of Information

Cognitively Distorts by Simplification

Affectively Distorts by Simplification Omits Cognition

Omits Affect

False Cognitive Integration of Cognitive and Affective Information Affective

Patricia M. Crittenden, 2005

True Cognitively Organized

Integrated True Cognition-True Affect

Affectively Organized

Type of Transformation of Information

Adaptive in Safe Contexts, but Otherwise Maladaptive Cognitively Distorts by Simplification Omits Affect Adaptive in Dangerous Contexts, but Otherwise Maladaptive

Adaptive in Safe Contexts, but Otherwise Maladaptive Affectively Distorts by Simplification Omits Cognition

Adaptive in Dangerous Contexts, but Otherwise Maladaptive

Increasing Risk of
Mental Health Problems

Increasing Risk of
Mental Health Problems

False Cognitive Integration of Cognitive and Affective Information Affective

Patricia M. Crittenden, 2005

True Cognitively Organized

Integrated True Cognition-True Affect

Affectively Organized

Type B
Balanced/ Secure

Reserved
Adaptive in Safe Contexts, but Otherwise Maladaptive Type of Transformation of Information

Reactive
Adaptive in Safe Contexts, but Otherwise Maladaptive

Type A
Cognitively Distorts by Simplification Omits Affect Defended/ Disengaged (Anxious Avoidant)

Type A+/C+
Unintegrated Cognitive/Affect

Type C
Coercive/ Enmeshed (Anxious Ambivalent)

Affectively Distorts by Simplification Omits Cognition

Various Compulsive A+ Strategies

Various Coercive C+ Strategies

Adaptive in Dangerous Contexts, but Otherwise Maladaptive

Increasing Risk of Adaptive in Dangerous Contexts, but Otherwise Maladaptive

Mental Health Problems

Increasing Risk of

Type A+C+
Psychopathy AAnti@ Integrated False Cognition-False Affect

Mental Health Problems

False Cognitive Integration of Cognitive and Affective Information Affective

Patricia M. Crittenden, 2005

Treatment Outcomes
There could be harmful effects Cognitive & affective strategies are psychological opposites They might need opposite treatments

Patricia M. Crittenden, 2005

Ideas from Attachment Theory

The importance of understanding the self-protective function of symptoms. The strategic organization of all persons, patients included. The importance of affect. The structure of human psychological organization as consisting of two opposite processes and their integration - with patients rarely displaying integration.

Patricia M. Crittenden, 2005

Ideas from Attachment Theory

The possibility that treatments may have different effects on people with similar symptoms, but opposite psychological organizations. The important of therapists knowing both the organization of each patient and also the effects on psychological functioning of each treatment technique that they employ. The importance of the therapist being, uniquely for each patient, a transitional attachment figure who helps to create enough safety and comfort for change to be explored.
Patricia M. Crittenden, 2005

This talk can be down-loaded from: www.patcrittenden.com

Patricia M. Crittenden, 2005