Neuroscientific based therapy of dysfunctional cognitive overgeneralizations caused by stimulus overload with an "emotionSync" method

Abstract

One of the basic assumptions of cognitive behavioral therapy is that cognitions influence internal reactions – such as emotions – to external events. Cognitions are possibly dysfunctional.

Dysfunctional cognitions may be overgeneralizations. They are unreflected generalizations about oneself, other people and how the world is. Dysfunctional cognitions become psychological strains and can result in a variety of mental disorders (depression, e. g.).

This paper describes a psychotherapeutical method for treating and changing negative emotions related to dysfunctional cognitions. This method – called emotionSync – is guided by methods of cognitive behavioral therapy, especially exposure therapy. During this therapy, the dysfunctional cognition is treated and new functional ones are learned to enable new behavioral choices. A theory for both pathogenesis and treatment of mental disorders is generated on a neuroscientific basis. It thus takes part in building a bridge between psychotherapy and neuroscience. Already existing links between psychotherapy and neuroscience are critically discussed.

To empirically evaluate the method three studies were conducted. Two studies examined the efficacy of the method on a subjective level. In the first study a one dimensional measurement tool (emotional valence). 52 subjects participated in this study. In the second study a validated multidimensional questionnaire was used („Mehrdimensionale Befindlichkeitsfragebogen (MDBF)" (Multidimensional mood questionnaire) by Steyer, Schwenkmezger, Notz und Eid (1997)). 50 subjects participated in this study.

For both the one dimensional measurement tool as well as the three subscales of the MDBF after invention the change was highly significant (p<0.001). Very large effect sizes and analyses of the individual changes satisfy criteria for the clinical relevance of the intervention. A follow-up in study 2 showed lasting effects of the therapy after three months. Possible critical points of design and analysis of both studies are intensively discussed.

The third study generated hypotheses for evaluating the therapy on a neuroscientific level. Electromyographic activity, skin resistance, respiratory frequency and heart rate turn out to be promising parameter for evaluating the method on a neuroscientific, objective level.

The main conclusion is that for this scope empirical evidence suggests effectiveness of this method on a psychological level – operationalized by valence of emotion and multidimensional mood measurements – and is promising for the evaluated parameters on a neuroscientific level. The methods used for collecting empirical data are critically reflected based on the criteria for evidence-based medicine. Possible further developments of the methods are discussed. The effectiveness of the intervention is discussed in comparison with other psychotherapeutical and pharmacological methods.

Table of Contents

Abstract

List of Figures

Table Index

List of Abbreviations

Acknowledgement

Introduction

1.1 Overview

1.2 Problem Definition

1.3 Aim

1.4 Structure of the work

Basics of the analysis – specialization

2.1 Overview of the history of psychotherapy

2.1.1 The origins of psychotherapy

2.1.2 The development of modern Psychotherapy

2.2 Methods of Psychotherapy

2.2.1 Cognitive Behavioural Therapy

2.2.2 Methods of Stimulus Confrontation

2.3 Pschotherapy and Neuroscience

2.4 The neuroscientific Approach of this Work

2.4.1 Basics – the Electrical and Neuronal Approach of this Work

2.4.2 Electrical Stimulation

2.5 Learning and Unlearning

2.5.1 Learning

2.5.2 Unlearning

2.6 Development of the emotionSync-Method (clapSync)

Questioning and Methodology

3.1 Introduction

3.2 Subjective Level

3.2.1 Study 1

3.2.2 Study 2

3.3 Physiological level

3.3.1 Scientific Questions

3.3.2 Implementation

3.3.3 Measuring Instrument and Parameter

3.3.4 Methodological Critique

Results

4.1 Presentation of Results

4.1.1 Presentation of Results on the Psychological Level

4.1.2 Presentation of Results on the Physiological Level

4.2 Subjective Level

4.2.1 Study 1

4.2.2 Study 2

4.3 Physiological Level

Critical Reflection of the Results

5.1 Overview and Introduction

5.2 Methodological critique

5.2.1 Statistics

5.2.2 Sample

5.2.3 Study Design

5.2.4 Manualization

5.2.5 Phases of clinical Examination

5.3 Further Developments

5.3.1 Further Development regarding other Sense Channels

5.3.2 Further Development regarding other Disorders

5.3.3 Further Development as a Psychotherapy Method

5.3.4 Further Development of Quality Management Measures

5.3.5 Further Development regarding neuroscientific Evaluation

5.3.6 Further Study Options

5.4 Comparison to other Therapy Methods

5.4.1 Comparison to other Psychotherapy Methods

5.4.2 Comparison to pharmacological Therapy Methods

5.5 Outlook

5.6 Conclusion

Afterword

Bibliography

Annex

Annex A – Therapy Manual: clapSync as a Method of treating dysfunctional Cognitions

Explanation

Therapist-Client-Relationship

Structure of Intervention

Annex B– Case Studies

Case Study 1

Case Study 2

Anhang C – Curriculum Vitae

List of Figures

Figure 1: Schematic presentation of learning processes

Figure 2: In In electrical engineering two principles of erasure are known: two energies overlap (a) or a stimulus is increased until an abrupt abortion is achieved (b). In case of classic habituation the energy is increased and then decreases again (red line). In case of the methods presented here, the energy is increased up to a maximum and then an abrupt abortion is achieved.

Figure 3: Design of a typical therapy setting, sessions normally took place in twos (client and therapist), sometimes in threes (client, therapist and recording person). A recording person was available upon express request and with the consent of the participant, but was seldomly requested. In larger seminar rooms, private areas were separated with the help of partitian walls.

Figure 4: Scale for the evalutation of the valence in stuy 1.–10 stands for maximum negative and +10 for maximum positive.

Figure 5: The measuring instrument used for the generaion of hypotheses

Figure 6: The test setup

Figure 7: The average (n=52) valence of the emotion before the intervention (time t0), after therapy of the dysfunctional cognition (time t1) and after learning of a functional cognition (time t2). The error bars indicate the standard error.

Figure 8: (a) Scatter Plots (blue) of the individual values before the intervention (time t0) and after therapy of the dysfunctional cognition (time t1). (b) Scatter Plots (blue) of the individual values afer therapy of the dysfunctional cognition (time t1) and after learning of a functional cognition (time t2). Shadows indicate identical values. The red points mark the border where no change takes place. Points above this border indicate an improvement, below the border a deterioration. The numbers within the points mark the number of test persons with identical values.

Figure 9: The value of the subscale GS of the MDBF before the intervention (time t0), after the intervention (time t1) and after three months (time t2). The error bars indicate the standard error. „*** means of utmost significance (p<0.001; see chapter 4.1.1), „n. s. is the abbreviation for non-significant.

Figure 10: The values of the subscale WM of the MDBF before the intervention (time t1) and after three months (time t2). The error bars indicate the standard error. „*** means of utmost significance (p<0.001; see chapter 4.1.1), „n. s. is the abbreviation for non-significant.

Figure 11: The values of the subscale RU of the MDBF before the intervention (time t0), after the intervention (time t1) and after three months (time t2). The error bars indicate the standard error. „*** means of utmost significance (p<0.001; see chapter 4.1.1), „n. s. is the abbreviation for non-significant.

Figure 12: (a) individual change on the scale GS between measuring time t0 (before the intervention) and t1 (afer the intervention). (b) individual changes on the scale GS between measuring time t0 (before the interventon) and t2 (after three months). The red line marks values remaining equal at both measuring times. The yellow lines mark the 95%-confidence interval. Reliable changes only take place outside of the yellow area (1), values between the two yellow lines are regarded as no change. Values above the upper yellow line mean reliable improvements, values below the lower yellow line mean reliable deteriorations. Both groups can be further divided, depending on whether the values were below the values of the normal population before and above or below the values of the normal population after (blue lines). Group 2 was below the average value before the intervention. After the intervention/after three months the values of group 2 improved reliably, but are still below the average. Group 3 was below the average before the intervention and is above the average after the intervention/after three months. Group 4 was already above the average and further improved until the second measuring time. Group 5 was above the average before the intervention, deteriorated reliably until the second measuring time but remained above the average. Group 6 was above the average at the first measuring time and deteriorated below average until the second measuring time. Group 7 was below the average at the first measuring time and further deteriorated reliably.

Figure 13: (a) individual changes on the scale WM between measuring time t0 (before the intervention) and t1 (after the intervention). (b) individual changes on the scale WM between measuring time t0 (before the intervention) and t2 (after three months). For interpretation see figure 12.

Figure 14: (a) individual change on the scale RU between measuring time t0 (before the intervention) and t1 (after the intervention). (b) individual change on the scale RU between measuring time t0 (before the intervention) und t2 (after three months). For interpretation see figure 12.

Figure 15: (a) Percentual group membership under consideration of the criteria for clinical relevance (see figure 12 – 14 and chapter 4.2.2.4) for the difference between time t0 and t1. (b) percentual group membership under consideration of the criteria for clinical relevance (see figures 12 – 14 and chapter 4.2.2.4) for the difference between times t0 and t2.

Figure 16: (a) The middle difference of the scale value between time t0 and t1. (b) The middle difference of the scale value between time t0 and t2. Error bars indicate the standard error. „*** means of utmost significance (p<0.001; see chapter 4.1.1), „n. s. is the abbreviation for non-significant.

Figure 17: Results of the physiological examination. The blue boxes mark the three examined intervals: before the intervention, during the intervention and after the intervention. Explanations see text.

Table Index

Table 1: Overview of the procedures and their terms (according to Neudeck and Wittchen, 2005)

Table 2: criteria for the scientific recognition of psychotherapy methods and psychotherapy procedures according to the WBP (WBP, 2010). Criteria for the evaluation of the methodological quality, the internal and external validity are available (WBP, 2010).

List of Abbreviations

Acknowledgement

I thank Professor / UCN Dr./UCN Karl Nielsen and Professor / UCN Dr./UCN Nandana Nielsen for their open, far-sighted way of helping and appreciating people. They are pioneers for the positive change in teaching and learning in the Faculty of Psychology. I also thank Dr. Claudia Wilimzig, Dr. Götz Wilimzig, Monika Pfaff, Stephanie Konkol, Fabian Müller, Torsten Seelbach AFNB, Peter Manns, Tanja Geppert and all my wonderful clients for their loving help and support. Many thanks also to my most important teacher, Klaus Grochowiak, who taught me the philosophical perspective. This also includes Frank Farrelly, who gave me love and humour.

The big thanks goes to my dear wife, Heidi and my children Ann Sophie and Maximilian. I thank Steve Jobs (Apple) for his memorable statements (his words have inspired me):

Apple Think Different Advertising Campaign (1997 – 2002)

Here’s to the crazy ones.

The misfits.

The rebels.

The troublemakers.

The round pegs in the square holes.

The ones who see things differently.

They’re not fond of rules.

And they have no respect for the status quo.

You can quote them, disagree with them, glorify or vilify them.

But the only thing you can’t do is ignore them.

Because they change things.

They push the human race forward.

And while some may see them as the crazy ones,

We see genius.

Because the people who are crazy enough to think

they can change the world,

Are the ones who do

Quelle: Spot Think Different von Apple-Weblinks:

http://www.youtube.com/watch?v=Rzu6zeLSWq8,

http://www.youtube.com/watch?v=nmwXdGm89Tk

http://www.youtube.com/watch?v=Ypp09Hq7T9g

http://de.wikipedia.org/wiki/Think_Different

1. Introduction

1.1 Overview

In this chapter (section 1.2) the central concepts of this work, as mentioned in the title, are defined and briefly explained. On this basis, the need for action leading to this work is derived and described. Subsequently, the objectives of this work are presented (Section 1.3) and the structure of the work outlined (Section 1.4).

1.2 Problem Definition

This work deals with the development and empirical examination of a (psycho) therapeutic approach. For psychotherapy, there are many different definitions, as there is a great variety of psychotherapy methods (a good overview is provided in Pritz, 2008), which makes an exact definition of psychotherapy more difficult (Van Deurzen-Smith & Smith, 1996). The presumably oldest definition comes from Anna O., one of the classicals clients of the early psychoanalysis who described Breuer's therapy as talking cure (Breuer and Freud, 1895). Corsini and Wedding (2000) argued the pessimistic view that psychotherapy can not be defined with precision (interestingly, this is missing in the newer version (Corsini and Wedding, 2011)). Similarly, Raimy (1950) found psychotherapy as an undefined method applied with unpredictable results to unspecific problems. There may be agreement that psychotherapy has developed beyond this.

Here, some characteristics of psychotherapy are to be listed, which does not mean that they always apply to all forms of therapy (see Corsini and Wedding, 2000). The following characteristics are given for the following examples: Strotzka (1978), Baumann, Hecht and Mackinger (1984), Wittchen, Hoyer, Fehm, Jacobi and Junge-Hoffmeister (2011), Hautzinger and Pauli (2009) and Kanfer and Schmelzer (2005) Serious psychotherapy suggested:

a purposeful change process,

is consciously planned and systematic

is carried out with psychological means

of psychological and stressful problems

current, scientifically based knowledge in theory and practice

methods whose principle effectiveness is valid for the relevant purpose

aims at a reduction or reduction of the symptoms

is variable in its objectives according to the respective problem constellation

It is also important that it is an interaction between at least two human beings and the therapeutic relationship is given great importance.

Psychotherapy is frequently equated with psychology in everyday language usage (Van Deurzen-Smith & Smith, 1996). Psychology is the scientific occupation of thinking, feeling, perception and behaviour and is defined as:

The science of behaviour (everything that accounts for an organism) and the mental processes (subjective experiences that we tap into behaviour). The key word of this definition is science. (Myers, 2008, p. 8).

The focus of psychology today is on empirical research, which is very strongly theorized (cf Myers, 2008, Gerrig and Zimbardo, 2008). Psychologists carry out basic research (see Myers, 2008). In classical psychology, basic research and applied psychology are separated (see Myers, 2008).

The fields of applied psychology include clinical psychology, which is most closely linked to psychotherapy within psychology, since it deals with the research topic of mental disorders and psychological aspects of somatic disorders (Wittchen and Hoyer, 2011a, 2011b, 2011c, Baumann et al Perrez, 1998).

These include research, diagnostics, etiology, conditional analysis, classification, epidemiology and therapy / intervention (Wittchen and Hoyer, 2011a; Baumann and Perrez, 1998). It is characteristic that it has close relations with other scientific