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Introduction to the cognitive approach in psychology. Explanation and evaluation of this approach.

The Cognitive Approach in psychology is a relatively modern approach to human behaviour that focuses on how we think, with the belief that such thought processes affect the way in which we behave (other approaches take other factors into account, such as the biological approach, which acknowledges the influences of genetics and chemical imbalances on our behaviour).

What it is and where the cognitive approach came from

1. Stimulus (External Factor)
2. affects:
3. Response (Human Behavior)

There is some dispute as to who created the cognitive approach, but some sources attribute the term to the 1950s and 1960s, with Ulric Neisser’s book Cognitive Psychology, which made allusions of the human mind working in a similar fashion to computers. The approach came about in part due to the dissatisfaction with the behavioural approach, which focused on our visible behaviour without understanding the internal processes that create it. The approach is based on the principle that our behaviour is generated by a series of stimuli and responses to these by thought processes.

Comparison to other approaches

Cognitive (meaning “knowing”) psychologists attempt to create rules and explanations of human behavior and eventually generalise them to everyone’s behaviour. The Humanistic Approach opposes this, taking into account individual differences that make us each behave differently. The cognitive approach attempts to apply a scientific approach to human behaviour, which is reductionist in that it doesn’t necessarily take into account such differences. However, popular case studies of individual behaviour such as HM have lead cognitive psychology to take into account ideosynchracies of our behaviour. On the other hand, cognitive psychology acknowledges the thought process that goes into our behaviour, and the different moods that we experience that can impact on the way we respond to circumstances.

Key Assumptions

• Human behaviour can be explained as a set of scientific processes.
• Our behaviour can be explained as a series of responses to external stimuli.
• Behaviour is controlled by our own thought processes, as opposed to genetic factors.

Evaluation of the Cognitive Approach

Biological Approach-Orientated Treatment

Electric shock treatment, or ECT, is one of the more controversial of psychological treatments, perhaps seconded only by lobotomy. Its origins, and effect in treating depression and obsessions, are quite surprising…

It was at the start of the 20th century when doctors believed that epileptic seizures were effective in preventing schizophrenia that attempts were made to cure the condition by actually inducing fits in patients. So, how were they induced?

In Germany, Manfred Sakel used insulin to lower the blood sugar levels of patients at the Lichterfelder sanitarium, causing patients to fall into comas and experience convulsions. Some patients experienced positive effects, and Sakel published his results and his method was used more widely. But it wasn’t until 1938 that Cerletti and Bini discovered that electric charges could be used to induce seizures.

ECT Today

Modern ECT treatment is more humane than its original form: many patients’ seizures resulted in broken bones and other injuries, so today patients are given anaesthetics so that they are not awake through the treatment. Muscle relaxants are also used so that the main visible signs of the experience are twitching of facial muscles.

The original treatment involved applying half-second shocks through two electrodes at either side of the forehead. Modern treatment applies the shock to a less active part of the brain.

What is it used for and is it effective?

Modern ECT is humane, but concerns remain as to the ethics of such a treatment that bypassed freewill and normal behavior. However, it has been found to be effective in the treatment of severely depressed patients who have not benefitted from conventional drug treatments and therapy. Fink (1985) found 60% effectiveness among psychotic depressives, but it doesn’t get to the cause of the problem; altering only the biology of patients, and psychologists are still unsure as to exactly why ECT works.

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications�chiefly the selective serotonin reuptake inhibitors (SSRIs)�the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs�and other newer medications that affect neurotransmitters such as dopamine or norepinephrine�generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn’t helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects on page 13) may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for at least 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust. Never stop taking an antidepressant without consulting the doctor for instructions on how to safely discontinue the medication. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.

Medications of any kind�prescribed, over-the counter, or borrowed�should never be mixed without consulting the doctor. Other health professionals who may prescribe a drug�such as a dentist or other medical specialist�should be told of the medications the patient is taking. Some drugs, although safe when taken alone can, if taken with others, cause severe and dangerous side effects. Some drugs, like alcohol or street drugs, may reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants.

Antianxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they are not effective when taken alone for a depressive disorder. Stimulants, such as amphetamines, are not effective antidepressants, but they are used occasionally under close supervision in medically ill depressed patients.

Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor.

Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one is small. If a person has preexisting thyroid, kidney, or heart disorders or epilepsy, lithium may not be recommended. Fortunately, other medications have been found to be of benefit in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol®) and valproate (Depakote®). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Other anticonvulsants that are being used now include lamotrigine (Lamictal®) and gabapentin (Neurontin®): their role in the treatment hierarchy of bipolar disorder remains under study.

Most people who have bipolar disorder take more than one medication including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Side Effects

Antidepressants may cause mild and, usually, temporary side effects (sometimes referred to as adverse effects) in some people. Typically these are annoying, but not serious. However, any unusual reactions or side effects or those that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are:

• Dry mouth�it is helpful to drink sips of water; chew sugarless gum; clean teeth daily.
• Constipation�bran cereals, prunes, fruit, and vegetables should be in the diet.
• Bladder problems�emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
• Sexual problems�sexual functioning may change; if worrisome, it should be discussed with the doctor.
• Blurred vision�this will pass soon and will not usually necessitate new glasses.
• Dizziness�rising from the bed or chair slowly is helpful.
• Drowsiness as a daytime problem�this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

The newer antidepressants have different types of side effects:

• Headache�this will usually go away.
• Nausea�this is also temporary, but even when it occurs, it is transient after each dose.
• Nervousness and insomnia (trouble falling asleep or waking often during the night)�these may occur during the first few weeks; dosage reductions or time will usually resolve them.
• Agitation (feeling jittery)�if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
• Sexual problems�the doctor should be consulted if the problem is persistent or worrisome.

Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John’s wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John’s wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Because of the widespread interest in St. John’s wort, the National Institutes of Health (NIH) conducted a 3-year study, sponsored by three NIH components�the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. The study was designed to include 336 patients with major depression of moderate severity, randomly assigned to an 8-week trial with one-third of patients receiving a uniform dose of St. John’s wort, another third sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, and the final third a placebo (a pill that looks exactly like the SSRI and the St. John’s wort, but has no active ingredients). The study participants who responded positively were followed for an additional 18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall functioning was better for the antidepressant than for either St. John’s wort or placebo. While this study did not support the use of St. John’s wort in the treatment of major depression, ongoing NIH-supported research is examining a possible role for St. John’s wort in the treatment of milder forms of depression.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John’s wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions.

Some other herbal supplements frequently used that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.

psychology news

Beginning in the 1960s, a movement called anti-psychiatry claimed that psychiatric patients are not ill but are individuals that are misfits in society, and therefore put into asylums. Adherents of this movement often refer to the myth of mental illness, after Dr. Thomas Szasz’ controversial book, The Myth of Mental Illness.

Origins of anti-psychiatry

The term ‘anti-psychiatry’ was first used by David Cooper in 1967, though opposition to either psychiatry in general, or its practices, predates this coinage; surrealism’s opposition to psychiatry predates it by decades. Leading lights of the anti-psychiatry movement included Thomas Szasz and R. D. Laing, both psychiatrists. Other critics of psychiatry often associated with the anti-psychiatry movement include Dr. Peter Breggin and Jeffrey Moussaieff Masson, a psychoanalyst who uncovered evidence that Sigmund Freud had suppressed observations of child sexual abuse. Civil libertarianism has opposed psychiatry or abuses of psychiatry on constitutional or other legal grounds. Among popular movements against psychiatry are the Psychiatric survivors movement, persons charged with abuse based on repressed memories, political prisoners of totalitarian regimes, and certain documenters of the Nazi holocaust. The latter point out that systematic euthanasia of people in German institutions in the 1930s provided the institutional, procedural, and doctrinal origins of racial mass murder of the 1940s. The Nuremberg Trials convicted a number of physicians, mostly psychiatrists, who held key positions in both eras of Nazi murder. A sermon against the earlier practice by Bishop August Clemens Graf von Galen of Münster delivered on August 3, 1941 is credited with inspiring a group of young medical students to publish anti-Hitler pamphlets in 1942 and 1943 in the name of White Rose.

Cooper was a Marxist, and indeed there has been a great challenge to conventional theories of psychiatry from Western believers in Marxism, but the anti-psychiatry movement is by no means homogenous ideologically, and Szasz approached anti-psychiatry from a civil libertarian perspective and challenged Cooper’s Marxist beliefs.

Many of their criticisms derived from the inhumane treatment of mental patients, either through the damaging effects of long-term institutionalisation or the use of specific interventions given without informed consent. Electroconvulsive therapy, or ECT, has been used to sedate and punish difficult psychiatric patients, rather than for therapeutic purposes. Others contend that even accepted therapeutic practices remain instruments of social control. Punitive use of “treatment”, including ECT, isolation, and restraint has diminished, but is still widely documented to occur. (There has been a resurgence of ECT research and treatment in the past decade, for treatment of a wide range of mental illnesses including severe depression, but many things about ECT are still poorly understood, including exactly how ECT works, and opponents of the practice allege that ECT causes brain damage and has killed several patients on whom it was used, some without their consent.)

Observation of the abuses of psychiatry in the Soviet Union also led to questioning of the validity of the practice of psychiatry in the West. (In particular, the diagnosis of political dissidents in the Russian Soviet Federated Socialist Republic (RSFSR) with sluggishly progressing schizophrenia, when compared to four different types of schizophrenia recognized in the West, led some to question the existence of schizophrenia.) The alleged practice of the United States Secret Service, endorsed by the agency, of attempting to get involuntarily committed those it perceives (its critics would have it, perceives or claims it perceives) to be a danger to its protectees, rather than because of their mental illness, is claimed by some to come closest to these Soviet practices.

Others object to psychiatry not on these grounds, but on the grounds of the fact that the body of information making up the discipline consists mostly of vague and non-falsifiable hypotheses, or, worse, hypotheses not testable without resorting to unconscionable and inhumane experiments on human beings. As Karl Popper noted, if it isn’t falsifiable, it isn’t empirically testable–and if it is not empirically testable, it is not science at all.

During the 1970s the anti-psychiatry movement acquired sufficient respectability to advocate restraint from the worst abuses prevalent in Psychiarty. Jurists such as David Bazelon brought legal force and stature to anti-psychiatry sentiments. Still, in the modern therapeutic culture with pharmaceuticals promising relief from all that ails, those who question the ethics and efficacy of psychiatric practice are far from mainstream.

Arguments against anti-psychiatry

The discovery of evidence suggestive of biological and genetic bases for some mental illnesses has eroded support for the more extreme claim among portions of the anti-psychiatric movement that mental illness is more a social label than a biological disorder, but such claims persist.

Anthropological studies have claimed that roughly equivalent percentages of people in a variety of cultures, some very different to modern Western culture, develop a disease recognised by that culture as such, with similar symptoms to schizophrenia, and subsequent medical examination of afflicted individuals show similar physical abnormalities as schizophrenics. However, the lower rates of diagnosis for the forms of schizophrenia accepted in the West in Western Europe than in the United States of America, has led some to question the criteria for diagnosis, and even that in some cases schizophrenia is deliberately misdiagnosed in the United States as a means of political or philosophical repression. DSM-IV-TR also notes that there is “a far higher incidence [of schizophrenia] for second generation African Caribbeans living in the United Kingdom.” The form of treatment also may vary according to suspect criteria; young black males in the United States are disproportionately prescribed high doses of “anti-psychotic” medication, and blacks are disproportionately subjected to involuntary commitment.

Many people diagnosed with a mental illness or illnesses, and many of those who have family members or close friends who have been diagnosed with mental illness find the views of the anti-psychiatry movement contrary to their own experience with mental illness. They believe that mental illness produces real and terrible suffering which psychiatry and social treatment programs have been effective in relieving. One of their strongest advocates is Dr. E. Fuller Torrey. Torrey maintains that psychiatry diagnoses “normal” people. He also believes in the forcible medication and confinement of those he believes have genuine neurological problems.

Thomas Szasz points out that one of implications of the argument that mental illness does not exist must be that the insanity defense must be abolished. He insists that someone who has killed someone under the influence of psychosis should be fully criminally responsible for this actions. This position is regarded as inhumane by many people. However despite perceptions caused by sensationalist news stories, most people with psychiatric labels suffer violence by others more than they commit violence.

Modern anti-psychiatric views

Some who are active in anti-psychiatry have not gone so far as to challenge the illness of psychiatric patients but merely challenged the practice of involuntary commitment from a legal or civil liberties perspective. Many people argue that even if it is sometimes necessary to detain a few people with extreme mental illnesses behind bars, that society is far too eager to lock up people with minor mental illnesses. The growing practice in the UK and elsewhere of “care in the community” was instituted partly in response to those concerns. On June 22, 1999, the United States Supreme Court ruled in Olmstead v. L.C., against unnecessary confinement of people with disabilities, including the mentally ill, in institutions.

A wide concern is of over-diagnosis. Again, advocates argue that while serious mental illness does exist, currently people are diagnosed as mentally ill, and sometimes detained in mental hospitals, when they are (or their speech or behaviour is) merely different (or said to be different) from the prevailing attitudes of their society. There have been allegations that teenagers are particularly susceptible to improper involuntary commitment, and indeed in a few cases bounty hunters have even been used to take them to private psychiatric hospitals against their will. The treatment of patients in private psychiatric hospitals, chiefly teenagers, has been the subject of investigations by (U.S.) state attorneys general.

A few individuals have criticized some state statutes in the United States that provide for involuntary commitment, for being unconstitutional as they violate the First, Fourth or Fifth Amendments. They argue that in those cases in which the writing or behaviour of the individual examined by a psychiatrist who will possibly be certified as being in need of treatment forms the basis for the diagnosis, the deprivation of liberty which will result if the individual is so found will actually be a result of his speech or writing, and testimony taken while in custody, in violation of the United States Constitution.

In 1998 Szasz and others staged the Foucault Tribunal on the State of Psychiatry in Berlin (named for the philosopher Michel Foucault who wrote books in 1954 and 1988 about the nature of madness and its treatment). This tribunal reached what could be said to be a preordained verdict — that, among other things, “We demand the abolition of the ‘mental patients laws as a first step toward making psychiatry accountable to society.”

Many of the premises of anti-psychiatry have been adopted by psychologists working to treat mental disorders without medication, including sexual addiction counselor, Joe Zychik.

One organization often confused with the anti-Psychiatry movement is the Citizens Commission on Human Rights (CCHR), founded in 1969 by the Church of Scientology and Dr. Thomas Szasz. CCHR has used the considerable financial resources of Scientology to wage media campaigns against various psychiatrists, psychiatric organizations, and pharmaceutical companies (especially Eli Lilly). Dr. Breggin and other prominent figures and organizations in the anti-psychiatry movement have emphatically denounced efforts to associate them with Scientology, from which they are completely independent and, often as not, vehemently opposed. The prominence of Dr. Szasz – a co-founder of the CCHR – within the anti-psychiatry movement adds to this confusion.

While flooding can be used to deal with physical phobias, its real value has come in the field of dealing with the victims of severe trauma. Flooding has an established record in combating and relieving post traumatic stress disorder, and there are preliminary reports that it is extremely effective in helping the victims of rape and sexual assault and abuse work through their traumas. By being forced to relive the original trauma repeatedly in a safe setting, the patient is able to reconnect their emotions to the event and live through them. Until they are able to do that, they can’t let go of the fear.

In this setting, flooding shares some points with guided visualization – except that the goal is to invoke and sustain fear rather than hide from it. Flooding takes place in a physically comfortable setting, where the patient is encouraged to talk through the traumatic experience over and over until they can do so without experiencing physical symptoms. The role of the therapist is to monitor the patient physically, and to guide them through their memories without allowing them to escape from them.

Flooding is an extremely intense form of therapy, and is usually recommended as a last resort. Because the patient is forced to relive traumatic incidents without any neutralization to help them cope with the emotions, it can provoke further trauma. Because of this, it’s very important that each patient be carefully evaluated before deciding to use flooding, and that the therapist be trained in using the technique.