INTERACTING COGNITIVE SUBSYTEMS AND ANXIETY

1. INTERACTING COGNITIVE SUBSYTEMS AND ANXIETY Dr Nick White Chartered Clinical Psychologist

2. THE SUBSYSTEMS AND THEIR INTERACTIONS

5. The Meaning Subsystems(The Central Engine of Cognition) • The Propositional Subsystem Deals with specific meanings that have a truth value • The Implicational Subsystem Deals with high level, abstract meaning - a holistic sense of the way things are

6. Different Levels of Meaning • Thoughts do not necessarily lead to anxiety • Anxiety is not necessarily caused by thoughts • Anxiety = re-generation of threat-related implicational schematic models

7. Clinical treatment • The treatment aim in anxiety problems = preventing regeneration of threat-related implicational models • Similar anxiety symptoms can be maintained by different processes in different individuals • Different disorders can be maintained by the same processes

8. Propositional-Implicational interlock • Implicational subsystem has output to the propositional subsystem and vice-versa • Propositional-implicational interlock may act as a feedback loop • New or discrepant information is not attended to

9. The Sensory Subsystems • Acoustic Subsystem Processes basic information regarding the nature of sounds eg pitch, volume • Visual Subsystem Processes basic information about light, such as wavelength • Body State Subsystem Processes internal sensory information eg temperature, tension, arousal

10. Sensory subsystems and anxiety • The sensory subsystems have a direct input to the implicational subsystem • Acoustic and visual stimuli in PTSD • Body state feedback loop and anxiety

11. The role of the environment • The environment determines what external information is available to the system • Factors in the environment may maintain threat-related schematic models • Role for problem solving or family therapy

12. TRANSFORMATION PROCESSES AND MEMORY RECORDS

13. Processing within each subsystem

14. Key features of ICS information processing • Only information from one input data stream can be processed at any one time (selective attention) • The transformation processes learn to use heuristics to process information (biased processing) • The system is geared towards reducing discrepancies in the information it is processing eg. present state vs goals

15. Development of anxiety • Initially in the infant certain stimuli are ‘hard-wired’ to produce an anxiety response • Anxiety becomes generalised to other stimuli or situations as the implicational system learns the co-occurring regularities • Tendency to re-create previous familiar schematic models

16. Pattern completion • The formation of schematic models is influenced by the memory record • A similar process happens in word recognition • eg. L _ B _ R _ L P _ N _ C

17. Pattern completion • Each experience of anxiety leads to an increased chance of future re-generation of threat related implicational level schematic models • So new information can be ‘missed’ and treated as irrelevant by the system

18. Buffered processing

19. Buffered processing • Buffered processing is more efficient • It facilitates the integration of new unfamiliar information in the data pattern • The central engine of cognition can be in one of three buffering modes at any one time

20. Central engine of cognition buffering modes • 1) Mindless emoting Neither propositional nor implicational subsystem in buffered mode. Individual is focussed on their affective reactions • 2) Conceptualising/doing Propositional subsystem in buffered mode. Impersonal detached thoughts about the self as object. Goal oriented thinking • 3) Mindful experience/being Implicational subsystem in buffered mode. Non-evaluative awareness of subjective experience. Most likely to lead to implicational schematic model changes

21. Buffered processing and anxiety • The buffer will tend to switch to a relevant subsystem in order to problem solve discrepancies in information processing • Worrying = Propositional buffering • In some anxiety states with a focus on physiology the buffer will be on processing in the body state subsystem

22. ICS INFORMED GROUP CBT

23. ANXIETY GROUP PROGRAMME SESSION ONE: INTRODUCTION/ OUTLINE OF GROUP PROGRAMME SESSION TWO: UNDERSTANDING WHAT HAPPENS IN ANXIETY What is anxiety? Outline of the CBT model. SESSION THREE: ANXIETY MANAGEMENT Relaxation and distraction Anxiety management techniques – advantages and disadvantages SESSION FOUR: AGENDA SET BY GROUP SESSION FIVE: SAFETY BEHAVIOURS AND BEHAVIOURAL EXPERIMENTS SESSION SIX: AGENDA SET BY GROUP

24. ANXIETY GROUP PROGRAMME SESSION SEVEN: THOUGHTS AND ANXIETY/ THOUGHT CHALLENGING I Identifying thoughts Thinking biases and attention Alternative explanations SESSION EIGHT: THOUGHT CHALLENGING II Evidence and logical reasoning SESSION NINE: AGENDA SET BY GROUP SESSION TEN: WORRYING AND MINDFULNESS SESSION ELEVEN: AGENDA SET BY GROUP SESSION TWELVE: SUMMARY, FEEDBACK AND GOODBYES Review of goals and taking things forward

25. Disrupt feedback loops • Anxiety Management • Distraction • Relaxation techniques • Breathing techniques • Effect likely to be only temporary unless repeatedly done • May integrate a sense of mastery or self-efficacy into the schematic models generated

26. The influence of output on input • Change the environment or how the individual interacts with it • This may facilitate a change in incoming information • To change behaviour it is often necessary to move the buffer, to enable the individual to switch out of ‘doing’ mode

27. Propositional level work • Thought challenging may be effective at altering elements of schematic models • Mainly aimed at helping clients to learn to move the buffer • Propositional level work could reinforce a propositional buffering mode

28. Re-populating the memory records • To prevent relapse the memory records must be re-populated with new memories of more adaptive schematic models • This can partly be achieved through repeated behavioural experiments or more prolonged behavioural change • Create alternative schematic models that are then activated by the same incoming information

29. Moving the buffer • Worrying vs mindfulness • Attentional control skills • Help individual to learn to move the buffer to the implicational subsystem

30. CMHT ANXIETY GROUP AVERAGE SCORES – HADS ANXIETY SUBSCALE

31. MODERATE ANXIETY GROUP AVERAGE SCORES – HADS ANXIETY SUBSCALE

32. drnickwhite@hotmail.com