attachment cognitive therapy

7/15/2019 Attachment Cognitive Therapy

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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

1. Model of psychological functioning &

psychopathology

1. Evaluation of harmful effects of psychotherapy




Symptoms

• Distress = patient’s perspective

• Diagnosis = professional’s perspective

• Self-protective strategies

• Behaviors can serve many functions




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



“Cognition” & Affect

Cognition

• Temporal, causal contingencies

• Verbal generalizations about contingencies: core

Affect

• Response to intensity of sensory stimulation• Somatic & psychological feelings: images




“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




“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




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




Memory SystemsTemporal Order

(Cognition)

⇓⇓⇓⇓Procedural

⇓⇓⇓⇓

Intensity

(Affect)

⇓⇓⇓⇓Imaged

⇓⇓⇓⇓

eman c onno a ve anguage

⇓⇓⇓⇓

Episodic⇓⇓⇓⇓

Reflective Integration© Patricia M. Crittenden, 2005



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




Arousal Scale1. Anxiety

• Pain

• Sexual Desire• Fear

• Anger

• es re or com ort2. Comfort

3. Depression

• Boredom• Tiredness

• Sleep

• Unconsciousness© Patricia M. Crittenden, 2005



Transformations

Sensory stimulation

⇓⇓⇓⇓

Transformations of information

⇓⇓⇓⇓

Dispositional representations

⇓⇓⇓⇓

Enacted behavior




The only information that we haveis information about the past

whereas

The only information that we needis information about the future.




Transformations of

Information

• True

•

• Omitted

• Distorted• Falsified




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




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





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



by Simplification

f I n f o r m a t i o n

True

Adaptive in

Dangerous

Contexts, but


I ncreasing Risk of

Mental Health

Problems

I ncreasing Risk of

Mental Health

Problems

Adaptive in

Dangerous

Contexts, but


T y p e o f T r a n s f o r m a t i o n

False





Adaptive in Safe

Contexts, but


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



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


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





Treatment Outcomes

• There could be harmful effects

• Cognitive & affective strategies are

psyc o og ca oppos es

• They might need opposite treatments




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.




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.




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