Fertig
Consistency theoretical case conception and therapy planning: Assumes that...
…people strive to satisfy their psychological needs
…mental disorders are caused by non-satisfaction
…the importance of motivational goals must be understood
Definition: Incongruence/ DIscordance und inconsistency
INCONGRUENCE: lack of satisfaction of motivational goals (Inkongruenz)
DISCORDANCE: incompatibility of two or more simultaneously activated motivational tendencies (Diskordanz)
INCONSISTENCY: competition between basic needs; basic needs not fulfilled (Inkonsistenz)
Conclusion – Core assumption of consistency theory
Core assumption is…
…that our psychological system is designed to strive for consistency and avoid inconsistency, therefore has a broad basis in scientific research findings.
Psychological Disorders in light of the Consistency Theory
Components (psychological disorders) are activated when motivational goals are activated but cannot be achieved
Autonomous arousal
All involved neural “circuits,” not just those for inconsistency reduction, are better wired—individual components can activate the entire disorde
With good wiring, disorder patterns can be triggered even without the presence of current incongruence
Disorder is decoupled from current inconsistency tension
Conclusions for Psychotherapy: Consistency theory
Do not support the patient in pursuing goals that are not consistent with their overarching personal goals
Therapy goals do not automatically result from the disorder
The patient should set goals that are consistent with their needs
Correlation between incongruence and clinical measures
Incongruence questionnaire correlates r = .87 with subjective well-being (N > 1000)
When people succeed in achieving their motivational goals, they feel good.
Consequences of changing incongruence
Incongruence can be influenced
Mental disorders result from failed inconsistency regulation
Psychological: predominantly avoidance goals, high level of incongruence
Genetic: increased readiness to react to incongruence with prolonged autonomic arousal (conditions for expression!)
Physiological: stress response (glucocorticoidlevels); sensitized amygdala, hippocampus, orbitofrontal cortex
Emotional dysregulation
Short-term reduction of inconsistency
=> Inconsistency is both CAUSE and EFFECT
Conclusion for Psychotherapy: Paradoxical conclusion
The most important causes of mental disorders lie in early childhood, but looking back into the past does not help to change their underlying causes.
Change can only be brought about by real experiences in the present, that transform the neural structures, established at that time, into new ones.
Perspectives on psychotherapeutical intervention
Consistency improvement through disorderoriented treatment: Disorder perspective
Correlation: mutual relationship; positive feedback process
Disturbances are themselves a source of inconsistency
Correlation between decrease in psychopathological symptoms and decrease in incongruence: r = .64
Manuals for psychotherapeutic intervention
Consistency improvement through satisfaction of basic need during the psychotherapeutic process: Process perspective
- Session outcome = how the patient experiences the session
- Therapy outcome = end of therapy (based on many hourly outcomes)
The extent to which needs are satisfied during therapy sessions contributes more to a productive outcome than the way in which the respective problems are addressed.
Assessment of session outcome
Sum score based on the following items from the patient session questionnaire:
- Today I feel that we have really made progress in therapy
- Today the various options for solving my problems have become clearer to me
- I now feel more capable of handling situations that I previously did not feel up to
- I believe that I can now behave more in the way I would like to
- I feel that I understand myself and my problems better
- I believe that I am increasingly able to solve my problems on my own
- Today I became aware of connections that I had not seen before
- After today’s session, I am determined to tackle the problems we discussed
Activation of resources – positive feedback loop
Activation of resources – positive feedback loop
Cognitive-Experiential Self-Theory (CEST; Epstein 2012)
- Main therapeutic goal: To support patients immediately within and outside therapy in finding opportunities to fulfill their basic needs in a constantly changing environment.
- Assessment processes: rational-intentional AND emotional-holistic
Broaden and Build Theory (Fredrickson 2004)
- Positive emotions expand attention, the cognitive search area becomes larger, and more diverse problem-solving attempts are attempted (broaden).
- Diverse abilities and skills are practiced.
- Stepping stone for further competence acquisition (build).
Activation of resources and Outcome
Interpretation?
Resource activation must be actively addressed by the therapist, as patients are unable to take on this responsibility themselves.
Consistency improvement through treatment of individual sources of inconsistency
Incongruence analysis
Level of incongruence
- Indicators: high comorbidity, number of treatment concerns, score on the incongruencequestionnaire
Sources of incongruence
- Unfavorable current living conditions
- Unfavorable relationships
- Unfavorable relationshipbehavior
- Unfavorable consistency maintenance mechanisms
- Unfavorable cognitions
- Excessively pronouncedavoidance patterns
- Underdeveloped or dormant approach schemas
- Motivational conflicts
Perspective – Behavioural Medicine
Behavioural Medicine… …is the interdisciplinary field of work in which health and disease mechanisms are researched, taking into account psychosocial, behavioral, and biomedical sciences, and the empirically tested findings and methods are applied in prevention, diagnosis, treatment, and rehabilitation.
Risk and protective factors, e.g., sense of coherence (resource!)
Summary and conclusions for psychotherapy
- From the Consistency Theory of psychological events different levels of intervention can be derived
- Inconsistency, incongruence, discordance are motivators of behaviour, inconsistency strives to be resolved
- Reducing incongruence leads to improved well-being, reduced symptoms, etc.
- Motivational intervention strategies can reduce resistance and focus on cooperation with and autonomy of patients
- Successful resource activation during therapy sessions makes a positive outcome more likely
- The relationship with the therapist can serve as a resource
- During a therapy session, the extent of resource activation should always exceed that of problem activation.
Consistency -theoretical model of psychological functioning
(Konsistenztheoretisches Modell psychischen Geschehens )
Grundbedürfnisse
Kontrollbedürfnis
Lustgewinn/ Unlustvermeidung
Bindungsbedürfnis
Selbstwerterhöhung
Bonding patterns
- Secure bonding behavior
- Insecure bonding and avoidant relationship behavior
- Insecure bonding and ambivalent relationship behavior
- Insecure bonding and disorganized/disoriented relationship behavior
Effects of neglect
- In approximately one-third of children aged 11 to 20 months, avoidance and negative emotions
- In preschool age: differences in play behavior, social contact behavior, balance and fluency of communication, autonomy, self-confidence
- The foundation for motivational schemas is laid early in life
- Feedback confirming schemas is likely
- The attachment style of the mother and grandmother predict the attachment style of the child in 81% and 75% of cases, respectively
Interaction mother-child
A child's innate temperament can have an unfavorable influence on attachment experiences
Mothers of highly irritable infants are less sensitive and provide less stimulation
Greater likelihood of an insecure attachment style
Training to improve maternal sensitivity
- Experimental group: significantly more securely attached children than in the control group
Conclusion: Attachment/bonding experiences are not inevitable (genes, caregiver)
Unfavorable cycles can be broken with targeted measures.
Need for bonding: Experiments with monkeys: Early bonding experiences
Two groups:
1. Plenty of food, mothers spent a lot of time with their young
2. Periods of plenty alternated with periods of food scarcity; mothers had to search for food
Periods began at 3 months of age / duration: 14 weeks
Baby monkeys in group 2 showed less exploratory and playful behavior in new environments
Experiments with monkeys (Rhesusaffen): Long term effects of early stress
After 3 years:
- Stronger response to Noradrenalin, weaker response to 5HT/ Serotonin
- At age 4: Significantly elevated CRF (Corticotropin releasing factor ) levels in cerebrospinal fluid
- Long-term increased susceptibility to stress
Bonding style and differential gene expression
Low expression of the serotonin transporter gene (5- HTT) leads to reduced serotonergic function
Study with rhesus monkeys: it was expected that those with less functional alleles would have less 5-HT in their CSF
Result: only in those who grew up without a mother
Less “favorable” genetic makeup can be completely offset by environmental influences
Baby monkeys distributed among surrogate mothers:
- 1. “Super mothers” (optimal bonding behavior)
- 2. Mothers with average bonding behavior
Result:
- Less 5HT plus average mother = at-risk children
- Less 5HT plus super mother = normal development
CAVE:
Animal experiments cannot be 1:1 transferred to humans, but can generate / inspire hypotheses
=> Bonding style is not inherited, but results from bonding experiences.
Early childhood experiences and stress tolerance : Owaga et al 1994
Young rats separated from their mothers for 15 minutes every day for 3 weeks during the nursing phase
Alone in another cage
Measurable stress response
For 21 days
Adult rats: less fearful in new surroundings, lower hormonal stress response, good HHNA feedback
Stress inoculation
CAVE:
Animal experiments cannot be 1:1 transferred to humans, but can generate / inspire hypotheses
Violations of the need for bonding
Incongruence experiences:
... lead to
- intense negative emotions
- feelings of lack of control
poor emotional regulation
Early/middle childhood: fewer positive life experiences
Fewer positive experiences in memory, reducing the likelihood of future positive experiences and vice versa
Positive feedback process
Positive experiences of control
Self-esteem-enhancing experiences
Positive emotions
Early positive experiences with regard to the basic need for attachment lead to the satisfaction of other basic needs
Overall positive development and good mental health.
Stable tendencies toward approach
If needs are not satisfied: stable tendencies toward avoidance
Consequence:
- Predominance of avoidance tendencies
- Permanent conflicts between approach and avoidance tendencies
Conclusion/ Hypothesis
People with an insecure attachment style are more likely to experience mental health issues in adulthood.
Secure bonding – good mental health:
Percentage of people with secure attachment in population and clinical context
- Approximately 60% of the population securely attached
- Clinical samples: 10%
Bonding styles in stationary PT
N = 528 stationary psychotherapy
Conclusion – basic need for bonding
Secure bonding fosters psychological resilience – positive feedback cycle
In the population of people with psychological disorders those with other than secure bonding style constitute the vast majority
Almost all psychotherapy patients were unable to satisfactorily fulfill their basic need for bonding in relationships that were important in their lives.
Unfavorable bonding styles can be addressed and changed
Treatment goals - general
Treatment goals - specific disorders
Conclusions for psychotherapy: Bonding and treatment goals
Bonding patterns influence reactions to stress, emotion regulation, automated perceptual readiness, avoidance reactions, etc.
Not quickly or easily changeable (medication, only cognitive schema therapy)
Relapse likely with disorder-specific intervention alone
Need for control and orientation
Need for control, control, control expectations, control beliefs
Need for control:
- Current control
- Wide scope for action
Own behavior leads to results
- Rotter (1966): positive control beliefs
- Bandura (1977): positive self-efficacy expectations
Satisfying the need for control reduces the level of incongruence
Incongruence always activates the need for control
Incongruence with avoidance goals is more difficult to control than approach incongruence
Consequences of controllable incongruence
= Motor of psychological development
- Stress / Strain that you believe you can cope with (controllable)
- Challenge
- Stress initially causes non-specific arousal
- During prolonged stress: release of cortisol (via activation of the hypothalamic-pituitary-adrenal axis)
- Adrenergic stimulation makes the brain more receptive to learning
- New connections can be easily established
- New networks help to cope with the situation in the future
- These “networks” correspond to new behaviors
Incongruity is positive as long as it remains controllable
Effects of high internal control conviction
- More self-confidence
- Higher life satisfaction
- Better well-being
- Higher stress resistance
- High expectations of control have a protective value and are an important component of mental health.
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Lernkarten
Consistency -theoretical model of psychological functioning
(Konsistenztheoretisches Modell psychischen Geschehens )
Grundbedürfnisse
Kontrollbedürfnis
Lustgewinn/ Unlustvermeidung
Bindungsbedürfnis
Selbstwerterhöhung
Bonding patterns
- Secure bonding behavior
- Insecure bonding and avoidant relationship behavior
- Insecure bonding and ambivalent relationship behavior
- Insecure bonding and disorganized/disoriented relationship behavior
Effects of neglect
- In approximately one-third of children aged 11 to 20 months, avoidance and negative emotions
- In preschool age: differences in play behavior, social contact behavior, balance and fluency of communication, autonomy, self-confidence
- The foundation for motivational schemas is laid early in life
- Feedback confirming schemas is likely
- The attachment style of the mother and grandmother predict the attachment style of the child in 81% and 75% of cases, respectively
Interaction mother-child
A child's innate temperament can have an unfavorable influence on attachment experiences
Mothers of highly irritable infants are less sensitive and provide less stimulation
Greater likelihood of an insecure attachment style
Training to improve maternal sensitivity
- Experimental group: significantly more securely attached children than in the control group
Conclusion: Attachment/bonding experiences are not inevitable (genes, caregiver)
Unfavorable cycles can be broken with targeted measures.
Need for bonding: Experiments with monkeys: Early bonding experiences
Two groups:
1. Plenty of food, mothers spent a lot of time with their young
2. Periods of plenty alternated with periods of food scarcity; mothers had to search for food
Periods began at 3 months of age / duration: 14 weeks
Baby monkeys in group 2 showed less exploratory and playful behavior in new environments
Experiments with monkeys (Rhesusaffen): Long term effects of early stress
After 3 years:
- Stronger response to Noradrenalin, weaker response to 5HT/ Serotonin
- At age 4: Significantly elevated CRF (Corticotropin releasing factor ) levels in cerebrospinal fluid
- Long-term increased susceptibility to stress
Bonding style and differential gene expression
Low expression of the serotonin transporter gene (5- HTT) leads to reduced serotonergic function
Study with rhesus monkeys: it was expected that those with less functional alleles would have less 5-HT in their CSF
Result: only in those who grew up without a mother
Less “favorable” genetic makeup can be completely offset by environmental influences
Baby monkeys distributed among surrogate mothers:
- 1. “Super mothers” (optimal bonding behavior)
- 2. Mothers with average bonding behavior
Result:
- Less 5HT plus average mother = at-risk children
- Less 5HT plus super mother = normal development
CAVE:
Animal experiments cannot be 1:1 transferred to humans, but can generate / inspire hypotheses
=> Bonding style is not inherited, but results from bonding experiences.
Early childhood experiences and stress tolerance : Owaga et al 1994
Young rats separated from their mothers for 15 minutes every day for 3 weeks during the nursing phase
Alone in another cage
Measurable stress response
For 21 days
Adult rats: less fearful in new surroundings, lower hormonal stress response, good HHNA feedback
Stress inoculation
CAVE:
Animal experiments cannot be 1:1 transferred to humans, but can generate / inspire hypotheses
Violations of the need for bonding
Incongruence experiences:
... lead to
- intense negative emotions
- feelings of lack of control
poor emotional regulation
Early/middle childhood: fewer positive life experiences
Fewer positive experiences in memory, reducing the likelihood of future positive experiences and vice versa
Positive feedback process
Positive experiences of control
Self-esteem-enhancing experiences
Positive emotions
Early positive experiences with regard to the basic need for attachment lead to the satisfaction of other basic needs
Overall positive development and good mental health.
Stable tendencies toward approach
If needs are not satisfied: stable tendencies toward avoidance
Consequence:
- Predominance of avoidance tendencies
- Permanent conflicts between approach and avoidance tendencies
Conclusion/ Hypothesis
People with an insecure attachment style are more likely to experience mental health issues in adulthood.
Secure bonding – good mental health:
Percentage of people with secure attachment in population and clinical context
- Approximately 60% of the population securely attached
- Clinical samples: 10%
Bonding styles in stationary PT
N = 528 stationary psychotherapy
Conclusion – basic need for bonding
Secure bonding fosters psychological resilience – positive feedback cycle
In the population of people with psychological disorders those with other than secure bonding style constitute the vast majority
Almost all psychotherapy patients were unable to satisfactorily fulfill their basic need for bonding in relationships that were important in their lives.
Unfavorable bonding styles can be addressed and changed
Treatment goals - general
Treatment goals - specific disorders
Conclusions for psychotherapy: Bonding and treatment goals
Bonding patterns influence reactions to stress, emotion regulation, automated perceptual readiness, avoidance reactions, etc.
Not quickly or easily changeable (medication, only cognitive schema therapy)
Relapse likely with disorder-specific intervention alone
Need for control and orientation
Need for control, control, control expectations, control beliefs
Need for control:
- Current control
- Wide scope for action
Own behavior leads to results
- Rotter (1966): positive control beliefs
- Bandura (1977): positive self-efficacy expectations
Satisfying the need for control reduces the level of incongruence
Incongruence always activates the need for control
Incongruence with avoidance goals is more difficult to control than approach incongruence
Consequences of controllable incongruence
= Motor of psychological development
- Stress / Strain that you believe you can cope with (controllable)
- Challenge
- Stress initially causes non-specific arousal
- During prolonged stress: release of cortisol (via activation of the hypothalamic-pituitary-adrenal axis)
- Adrenergic stimulation makes the brain more receptive to learning
- New connections can be easily established
- New networks help to cope with the situation in the future
- These “networks” correspond to new behaviors
Incongruity is positive as long as it remains controllable
Effects of high internal control conviction
- More self-confidence
- Higher life satisfaction
- Better well-being
- Higher stress resistance
- High expectations of control have a protective value and are an important component of mental health.
Consequences of uncontrollable incongruence
- Uncontrollable stress (e.g., child abuse)
- Further increase in arousal/glucocorticoid release
- Damages the hippocampus
- Also damages the cortex; previously acquired behaviors may be erased
- Destabilization
- Everything that reduces inconsistency is intensified
- System is preoccupied with itself, not with coping with the environment
- The state triggered by the stressor is learned = FEAR
- System is on defense, BIS is activated - especially ventromedial and dorsolateral part of the RIGHT prefrontal cortex
- Anticipatory fear (= constant altertness)
Conclusion – basic need for orientation and control
If satisfied, then:
- Better overall development
- More resilient, stress-resistant, healthier
- Early positive experiences of control lead to more positive life experiences later on
Conclusions for Psychotherapy: Need for control and orientation
- Positive control experiences
- Make the procedure as transparent as possible
- Show understanding of the problem
- Point out what the patients can do themselves
=> Resources oriented procedure
Need for selfesteem enhancement (Selbstwerterhöhung)
- Alfred Adler (1927): Overcoming feelings of inferiority is the most important source of motivation for humans
- Specific human need
- Self-esteem regulation requires self-awareness and the ability to reflect
- Self-image develops through interaction with other people
- Interaction consists largely of verbal communication
- Self-esteem reactions are highly subjective
Influence on self-esteem
- Early experiences of attachment and control
- Development of a negative self-image and poor self-esteem
- Frequent self-deprecating behavior
- Motivational patterns are primarily focused on avoidance
- Resistance to closeness; experiences that boost self-esteem are lacking
Self-esteem and health
=> Tredn towards increased self-esteem
- Healthy people tend to have illusions of self-esteem (and control)
- People describe themselves more positively than average (driving!)
- Positive attributes are used to compare oneself with others
- Positive information about oneself is remembered better and processed faster than negative information
Exception: depressed patients and people with low self-esteem
Self-esteem and health: Interaction of unsatisfied basic needs
Rejection and bullying by peers during adolescence correlate with depression and self-deprecation. (Alsaker & Olweus, 2003)
Violation of self-esteem is part of a chain of negative developments – originating in unfulfilled needs for bonding and control/orientation.
Patients with mental disorders often have low self-esteem (interaction!).
Model of context-dependent processing of difficult thoughts
“Self-compassion” as a protective factor against events that threaten self-esteem; resource!
Conclusion - self-esteem enhancement
Assessment of self-esteem
- Often based on unrealistic assessments
- Often above average
- May be realistic in patients with mental disorders (e.g., depression)
- Negative impact on mental health
Conclusions for Psychotherapy: Need for selfesteem enhancement
Therapists do not need to strive for an absolutely realistic selfimage of the patient
Self-esteem-enhancing behavior must be supported, even if it seems somewhat exaggerated
Self-esteem enhancement triggers more positive feelings than is objectively justified
However, individuals are in a better state
Self-compassion has a positive effect on emotional state
=> Resources oriented procedure
Gain of pleasure / avoidance of discomfort
The good-bad evaluation is a constantly active driver of psychological processes
Emotional evaluation of stimuli occurs automatically (unconscious process)
Intrinsic motivation (enjoy doing something)
Current perception and goals are aligned – FLOW experience (Csikszentmihalyi, 1990)
Automatic activation of approach and avoidance tendencies (BAS vs BIS)
Approach / Avoidance
Positive words are assigned to the correct category more quickly during arm flexion (approach) and negative words during arm extension (avoidance). (Neumann and Strack, 2000).
Interpretation: Mental processes run more smoothly and quickly when the good-bad evaluation is compatible with the approach-avoidance behavioral orientation.
Approach Goals
- Easy to determine whether it has been achieved
- Positive emotions
- The path to the goal can be divided into small steps
- Positive emotions when sub-goals are achieved
- You can focus on the goal
- The effectiveness of the action can be determined immediately
- Can be pursued with intrinsic motivation
Avoidance Goals
- Require constant monitoring
- Distracted rather than focused attention
- Accompanied by negative emotions
- Can never be fully achieved
- You can never be sure that danger will not arise from another, unexpected source
- You must always be alert
- Activated avoidance goals tie up attention and are accompanied by anxious tension
- No efficient goal pursuit possible
- No real satisfaction of needs
Approach/avoidance goals
Not significantly correlated with each other (separate systems)
FAMOS – Questionnaire for analyzing motivational schemas (Gross Holtforth and Grawe, 2000)
Records approach and avoidance goals
Avoidance goals inhibit approach activity
Avoidance and well-being
- n=260 (90 male)
- Students of Psychology (undergraduate)
- Mean age = 19.5 (18-39)
- List of personal goals (Personal Goals Questionaire)
- Filling out a questionnaire on well-being (pre-post; Positive-/Negative Affect Scale; Delighted-Terrible Scale)
- Questionnaire on Stressors (Life event check list) and social desirability (Impression Management Scale)
Avoidance personal goals were a positive predictor of life stressors (independent of social desirability and basic personality traits)
Avoidance dominance
Consequences for PT:
Decrease in the strength of avoidance goals
Can avoidance goals be changed?
FAMOS – pre-post comparison, N=87, effect size = 1.06
Strong effect, as motivational goals are stable characteristics
Change in motivational goals correlates with changes in other measures of therapeutic success
Conclusion - Pleasure gain / Avoidance of discomfort
Pleasure gain and avoidance of discomfort implies constant evaluation and are drivers of behaviour
Approach goals are easy to identify
Avoidance goals
- require constant monitoring of effectiveness
- Are linked to psychological distress / disorders
- can be changed
Conclusions for Psychotherapy: Avoidance/ approach
When the avoidance system is activated, mental activity is oriented toward avoidance
Negative evaluations are promoted
When the approach system is activated, other processes oriented toward approach and positive evaluation run more smoothly
(Natural) treatment of negative experiences – priming in favor of the avoidance system
Therapist must activate the approach system
