L8 - Cognitive models and cluster C

Question 1

Cluster C has (3) + prevalence

Answer 1

1. avoidant PD - 2,7%
2. dependent PD - 0,8%
3. obsessive-compulsive PD - 3,2%

overall cluster C prevalence is 5%

Question 2

Avoidant PD (4/7)

Answer 2

1. Avoiding occupational activities involving significant interpersonal contact
   
   • General tendency to avoid emotions + other kinds of thoughts and behaviors also
2. Unwilling to get involved with people unless certain kind of acceptance
   
   • Due to fear of being critisized or fear of embarrassing themselves
   • Unless certain kind of acceptance: unless there is a certain kind of person there that they like - even then it is difficult
3. Restraint within intimate relationships
   
   • Even then scared to show vulnerable side and difficulties - counterparts react to this by withdrawing and this confirms that their relationship is not that important
   • Keeps these relationships shallow
4. Preoccupied with fears of receiving criticism or rejection in social situations
5. Social inhibition new interpersonal situations
6. Feelings of inferiority
   
   • Not only social skills - also generally other topics
   • Also believe that others will criticise them
7. Reluctant to take personal risks or to engage in any new activities

Question 3

What may be possible challenges during treatment? (2)

Answer 3

• Scared of being critisized
• Scared of trying new therapy homework exercises

Question 4

what we see in therapy (7)

Answer 4

• High amounts of stress
  
  • Depression, substance use, somatic symptoms, chronic mental health issues, sleep problems
• Strong focus on own fear and sress
• Isolation from friends, colleagues, romantic partners
  
  • Lower social support
• Negative impact on (academic) career
• Self-fulfilling prophecy?
• NSSI
• Similarities AVPD and BPD
  
  • Fear of being critisized and betrayed/left behind

Question 5

Etiology - AVPD (5)

Answer 5

• Low degree of (healthy) emotional expression in family
• Conflict avoidance in family
• Avoidant modeling by parents
• Ridicule by parents and rejection - emotional abuse
• (preoccupied)-avoidant attachment

Question 6

how is AvPD different from SAD (2)

Answer 6

AVPD
- preoccupation with fear of social rejection continues even after someone becomes close (not the case for SAD)
- no risk taking in various life areas and situation (for SAD its only social situations)

Question 7

two hypotheses about AVPD and SAD’s relatedness

Answer 7

1. continuum hypothesis = AVPD is a severe form of nongeneralized and generalized SAD
2. qualitatively different disorders hypothesis = AVPD and SAD(s) are completely different disorders

Question 8

evidence for the continuum hypothesis

Answer 8

• Complaints DO present as more severe
• this hypothesis means that everyone with AVPD also has SAD or GAD
  - between 40-88% also have SAD
  - but PD is also present without SAD

Question 9

support for qualitative differences hypothesis (6)

Answer 9

• AVPD patients do not recognize the situational fear response of SAD
• Feelings of inferiority and passivity is much stronger + fear of abandonment
  
  • AVPD general avoidance strategy and inferiority, in SAD more related to specific attributes
• Feared social situations
  
  • all interpersonal situations AVPD vs. performance SAD
• AVPD more strongly related to introversion, openness, agreeableness
• Clinical experience: AVPD more early experiences of isolation and early onset. SAD has a later onset
• Restraint: in SAD, anxiety lessens as relationship develops

Question 10

Dependent (5/8)

Answer 10

1. Difficulty making daily decisions advice and reassurance
   
   • E.g., what to make for dinner, where to go for holiday etc.
   • It has to show in all kinds of situations and especially the small daily ones
2. Needs someone else to take over major life areas
3. Difficulty disagreeing with others
   
   • Can become a dangerous pattern in an intimate relationships - feeling trapped in a relationships
4. Difficulty starting projects on their own
5. Go to great lengths to obtain support from others
6. Feeling uncomfortable or helpless when alone
7. Searches for new relationship after one ends
   
   • Can be a romantic relationship or platonic one
   • Can become proactive during this time, whereas other times seen more as passive
8. Unrealistic preoccupation with being alone and unable to care for themselves

Question 11

what may be possible challenges during treatment?

dependent

Answer 11

Dependent pattern shown in therapeutic relationship as well
- e.g., patients may try to shift all responsibility for decisions and changes to the therapist
- Problematic as the point is to make them more independent

Question 12

Etiology/general discussion - DPD (5)

Answer 12

• Linked to authoritarian and overprotective parenting
• Not always passive!
• Important to distinguish Emotionval vs. functional dependency
  
  • Emotion-wise they are fine - able to cope with their emotions to a certain extent
  • Emotion dependency seen more in BPD while a functional dependency is more DPD
• Cultural differences?
  
  • Individualistic vs. collectivistic?
  • How is dependency seen, is it necessarily a problem in e.g., collectivistic cultures - take into account whether it is truly outside the norm
• Gender bias
  
  • More diagnoses in females
  • Is the DSM Written from a masculine perspective?
  • Reporting bias in the definition of the disorder itself? Easier diagnosed in females?
    seen as stereotypical behavior for women

Question 13

Obsessive-compulsive PD (4/8)

Answer 13

1. Preoccupation with details, rules, schedules, organization
   
   • E.g., making lists, notes - preoccupation more with the notes and lists themselves rather than their content
2. Perfectionism that interferes with the task completion
   
   • Prevents a task from being finished - its seen as never good enough
3. Devotion to work and productivity to the exclusion of leisure activities and friendships
   
   • E.g., being really preoccupied with a certain hobby and not being comfortable for example going on a holiday
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics or values
5. Unable to discard worn-out or worthless objects
   
   • Thinking that this thing may have some use to me in the future
6. Reluctant to delegate tasks
7. A miserly spending style
   
   • E.g., the GP registering spendings of goods that were under 1€
8. Rigidity and stubbornness
   - E.g., refusing to go on a holiday because you already planned a coffee date

Question 14

What may be possible challenges during treatment?
(3)

Answer 14

• Lack of insight?
• Urge to be in control
• Rigidity and stubbornness contributing to treatment efficacy

Question 15

characteristics OCPD (4)

Answer 15

• Extremely rational
• Workaholics
  
  • Traits valued by society
• Relatively few patients seek help for OCPD
• Overcompensation coping (or surrender to this fear of not being in control?)
  
  • E.g., for the need to be in control

Question 16

Etiology - OCPD (7)

Answer 16

• Lack of emotional expresion
• Lack of relaxation, fun, playtime
• Rigid rules, in exchange for love
• Punitive parenting style –> avoiding punishment
• Oveprotection
• Emphasis on achievements, rules, production
• Too much responsibility in early life - parentification

Question 17

The pilot study from UvA, why does DPD show better treatment outcomes compared to the other two after treatment?

Answer 17

Experience the successes of being independent after treatment - small successes aggravating over time

Question 18

cognitive models

Schema definition

Answer 18

Knowledge representation of the self, others, the world and relationships

Question 19

schemas can be external and internal

Answer 19

• Explicit: can be verbalized
• Implicit: Non-verbal knowledge, such as attachment representations
  There are different levels

Question 20

schemas originate in childhood, they can be early maladaptive schemas (EMA)

Answer 20

• As a child you do not have much knowledge about the world –> childish interpretations
• An aversive environment contributes to a schema that is representative
• They were adaptive once (represented actual environment) -> in adulthood is unrepresentative and you can understand this but your schema still activates

Question 21

explain the structure of beliefs (3)

Answer 21

• core beliefs
• I am worthless
• conditional beliefs
• If I say something weird, then other’s will judge me
• strategic beliefs
• these often manifest in DSM symptoms
• e.g., avoidance in order to not be judged

Question 22

give 2 reasons why schemas are maintained and difficult to change?

Answer 22

• assimilation
• inclusion in already existing schema, sometimes adjusted (dominant process=easy to do because requires no change to existing schema) - preserves them
• accomodation
• adjustment of schema according to new information (difficult to achieve)

Question 23

schemas influence information processing by (3)

Answer 23

• Attention and selection of information
• Interpretation of information
• Memory

–> how we respond to the world

Question 24

study about interpretation bias: procedure

Answer 24

Procedure:

• 10 scenarios
• e.g., you experienced smt unpleasant yesterday and you cannot let go of the thoughts avout what has happenes
• forced response:
  (1) there is no one to comfort be (BPD)
  (2) I need help, I canot solve this on my own (DEP)
  (3) I need to control my thoughts andfeelings, otherwise it will go wrong (OCP)
• open response
• e.g., what would you feel, what would you think, what would you do?
• ratings of believability/credibility

Question 25

study about interpretation bias: results

Answer 25

for every PD their forced choices matched their open responses except for OCPD - e.g., OC responses were not chosen most by OCPD patients - social desirability? perchance - maybe the OC reposnses are relatively healthy looking choices compared to others

Question 26

Conclusions cognitive models (4)

Answer 26

* PDs are characterized by: - Specific sets of ‘beliefs’ - Specific cognitive biases (also implicit) * Schemas cause cognitive processes and maintain personality disorders * No direct causal evidence yet * Cognitive model useful for experimental research and translation to practice and treatment!

Question 27

What are the three essential features of Avoidant Personality Disorder (AvPD) as described in the source material? (3)

Answer 27

a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluations by others

Question 28

Explain one key difference between Social Phobia (SP) and Avoidant Personality Disorder (AvPD) as discussed in the context of their diagnostic similarities.

Answer 28

AVPD is better characterized as an aversion to intimacy in relationships. Although they share symptoms like shyness, AvPD often represents a more severe and pervasive form of social avoidance.

Question 29

What role do childhood experiences, particularly abuse and parental behavior, play in the development of AvPD according to research mentioned in the text?

Answer 29

a strong connection between childhood abuse (sexual, physical, and emotional) and low parental affection/nurturing with the development of AvPD. --> These adverse early experiences can shape an individual's personality and coping skills, contributing to the disorder.

Question 30

How does the "catastrophizing" tendency of individuals with AvPD impact their lives and potential for change?

Answer 30

leads individuals with AvPD to automatically assume "worst-case scenarios" and inappropriately characterize minor problems as catastrophic events. This often results in them withdrawing from many life events and activities, including maintaining adequate employment, hindering beneficial change.

Question 31

Why do individuals with AvPD often struggle to form intimate romantic relationships, despite potentially desiring affection?

Answer 31

they fear being shamed or ridiculed, which leads them to exhibit restraint. -> often fantasizing about ideal ones instead.

Question 32

What are the essential features of Dependent Personality Disorder (DPD) (3) and when does it typically begin?

Answer 32

a pervasive and excessive need to be taken care of, combined with clinging behavior and fears of separation. This disorder typically begins in early adulthood.

Question 33

List three environmental factors believed to contribute to the development of DPD + extra

Answer 33

* exposure to authoritarian or overprotective parents * chronic physical illness during childhood * experiencing separation anxiety during childhood. -> Parental behaviors like neglect or abusiveness can also reinforce dependent traits.

Question 34

How does DPD typically manifest in the workplace, particularly regarding initiative and task performance?

Answer 34

avoid initiating tasks, believing others are more capable, and may present themselves as inept to avoid independent work. They struggle with decisions and may volunteer for unpleasant tasks to secure support, and they often rely on others for career choices, potentially leading to job dissatisfaction.

Question 35

Describe two characteristic behaviors or traits typically exhibited by individuals with OCPD regarding their work or leisure activities

Answer 35

* excessive devotion to work * at the expense of leisure activities -> this happens even when economically unnecessary

Question 36

How do individuals with OCPD typically express their anger or frustration, and why might they avoid direct expression?

Answer 36

* do not express it directly * rumintate about it for hours -> increases their frustration they consider anxiety or frustration more appropriate than anger

Question 37

How does OCPD's impact on psychosocial functioning differ from most other mental disorders, particularly in terms of career and wealth?

Answer 37

OCPD has an inconsistent relationship with psychosocial functioning. While it can significantly interfere with social and romantic relationships, it has also been positively correlated with higher educational attainment, career success, and wealth.

Question 38

What is the observed relationship between OCPD and anorexia nervosa, and what childhood traits are considered risk factors?

Answer 38

consistent and strong linkage between OCPD and anorexia nervosa, with OCPD's overcontrolled quality predicting worse outcomes in eating disorders. Childhood traits reflecting OCPD, such as perfectionism and rigidity, are identified as significant risk factors for the later development of eating disorders.

Question 39

Discuss two implications of the cognitive model of PDs for clinical practice and treatment

Answer 39

1. provides a clear framework for clinicians to conceptualize a patient's problems by linking developmental history to dysfunctional schemas 2. normalizes conditions by describng PDs in terms of changeable cognitive structures