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7/15/2019 Attachment Cognitive Therapy
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Attachment & Cognitive Therapy
Patricia M. Crittenden, Ph.D.
© Patricia M. Crittenden, 2005
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Four Growing Points
1. Symptoms: diagnoses & treatment
1. Emphasis on “cognitive” rational & verbal
1. Model of psychological functioning &
psychopathology
1. Evaluation of harmful effects of psychotherapy
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Symptoms
• Distress = patient’s perspective
• Diagnosis = professional’s perspective
• Self-protective strategies
• Behaviors can serve many functions
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Symptoms, con’t
• 50%+ failure rate 1 year post-CT
• Focus on symptom vs. reason for
• Competence with danger vs. competence
with safety
• Strengths approach vs. vulnerability© Patricia M. Crittenden, 2005
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“Cognition” & Affect
Cognition
• Temporal, causal contingencies
• Verbal generalizations about contingencies: core
Affect
• Response to intensity of sensory stimulation• Somatic & psychological feelings: images
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“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
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“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
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Integrative Memory Systems
• Episodic memory
– Cognitive-affective integration – Learned at about 3 years
– De endent u on a dialo ue
– 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
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Memory SystemsTemporal Order
(Cognition)
⇓⇓⇓⇓Procedural
⇓⇓⇓⇓
Intensity
(Affect)
⇓⇓⇓⇓Imaged
⇓⇓⇓⇓
eman c onno a ve anguage
⇓⇓⇓⇓
Episodic⇓⇓⇓⇓
Reflective Integration© Patricia M. Crittenden, 2005
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Dispositional Representation
• Relation of self to context
• Each different DR disposes behavior
eren y
• Each highlights some aspect of the
problem, but obscures some other
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Arousal Scale1. Anxiety
• Pain
• Sexual Desire• Fear
• Anger
• es re or com ort2. Comfort
3. Depression
• Boredom• Tiredness
• Sleep
• Unconsciousness© Patricia M. Crittenden, 2005
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Transformations
Sensory stimulation
⇓⇓⇓⇓
Transformations of information
⇓⇓⇓⇓
Dispositional representations
⇓⇓⇓⇓
Enacted behavior
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The only information that we haveis information about the past
whereas
The only information that we needis information about the future.
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Transformations of
Information
• True
•
• Omitted
• Distorted• Falsified
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i o n o f I n f o r m a t i o n
True
T y p e o f T r a n s f o r
m a t
False
Integration of Cognitive and Affective Information AffectiveCognitive
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Cognitively Distorts
by Simplification
Integrated
True Cognition-True
Affect Affectively
Organized
Cognitively
Organized
Affectively Distorts
by Simplification
I n f o r m a t i o n
True
Omits Affect
T y p e o f T r a n s f o r m a t i o
n o
False
Integration of Cognitive and Affective Information AffectiveCognitive
© Patricia M. Crittenden, 2005
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Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Cognitively Distorts
by Simplification
Integrated
True Cognition-True
Affect Affectively
Organized
Cognitively
Organized
Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Affectively Distorts
by Simplification
f I n f o r m a t i o n
True
Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive
I ncreasing Risk of
Mental Health
Problems
I ncreasing Risk of
Mental Health
Problems
Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive
T y p e o f T r a n s f o r m a t i o n
False
Integration of Cognitive and Affective Information AffectiveCognitive
© Patricia M. Crittenden, 2005
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Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Cognitively
Integrated
True Cognition-True
Affect
Type C Coercive/
Enmeshed
Type ADefended/
Disengaged
Type A+ /C +Unintegrated
Type BBalanced/
Secure
Affectively
Organized Cognitively
Organized
ReactiveReserved Adaptive in Safe
Contexts, but
Otherwise Maladaptive
Affectively Distorts
by Simplification
r m a t i o n
True
Omits Affect
Distorts
by Simplification
Adaptive in
DangerousContexts, but
Otherwise Maladaptive AAnti@ Integrated
False Cognition-False Affect
Various Coercive
C + StrategiesVarious Compulsive
A+ Strategies
(Anxious Ambivalent)(Anxious Avoidant) Cognitive/Affect
Type A+C +
Psychopathy
I ncreasing Risk of
Mental Health
Problems
I ncreasing Risk of
Mental Health
Problems
Adaptive in
Dangerous
Contexts, but
Otherwise Maladaptive
T
y p e o f T r a n s f o r m a t i o n o f
I n f
False
Integration of Cognitive and Affective Information AffectiveCognitive
© Patricia M. Crittenden, 2005
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7/15/2019 Attachment Cognitive Therapy
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Treatment Outcomes
• There could be harmful effects
• Cognitive & affective strategies are
psyc o og ca oppos es
• They might need opposite treatments
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Ideas from Attachment Theory• The importance of understanding the self-protective
function of symptoms.
• The strategic organization of all persons, patientsincluded.
• The importance of affect.
• The structure of human psychological organization asconsisting of two opposite processes and their integration - with patients rarely displaying integration.
© Patricia M. Crittenden, 2005
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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
psychological functioning of each treatment techniquethat they employ.
• The importance of the therapist being, uniquely for each
patient, a transitional attachment figure who helps tocreate enough safety and comfort for change to beexplored.
© Patricia M. Crittenden, 2005