Intervention: Consistency theory

…people strive to satisfy their psychological needs

…mental disorders are caused by non-satisfaction

…the importance of motivational goals must be understood

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)

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. 

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 

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

Incongruence questionnaire correlates r = .87 with subjective well-being (N > 1000)

When people succeed in achieving their motivational goals, they feel good. 

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

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.

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

• 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.

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

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).

Interpretation?

Resource activation must be actively addressed by the therapist, as patients are unable to take on this responsibility themselves.

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

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!)

• 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.

Kontrollbedürfnis

Lustgewinn/ Unlustvermeidung

Bindungsbedürfnis

Selbstwerterhöhung

• Secure bonding behavior
• Insecure bonding and avoidant relationship behavior
• Insecure bonding and ambivalent relationship behavior
• Insecure bonding and disorganized/disoriented relationship behavior

• 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

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. 

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 

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

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.

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

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 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:

1. Predominance of avoidance tendencies
2. 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.

• Approximately 60% of the population securely attached
• Clinical samples: 10%

N = 528 stationary psychotherapy

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

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, 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

= 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

• 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.