Behavioural experiments in depression How to prevent patients from - - PowerPoint PPT Presentation

Behavioural experiments in depression – How to prevent patients from disregarding positive information?

• Dr. Tobias Kube

University of Koblenz-Landau Department of Clinical Psychology and Psychotherapy Pain and Psychotherapy Research Lab

Lack of updating negative beliefs in depression Cognitive immunisation as a mechanism of persistent negative beliefs Psychotherapeutic strategies to inhibit cognitive immunisation and to facilitate belief update

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OVERVIEW

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

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THE PROBLEM OF LACK OF UPDATING NEGATIVE BELIEFS

Department of Clinical Psychology and Psychotherapy

“You have made great progress!” I am still feeling miserable Tobias Kube Pain and Psychotherapy Research Lab

One possible positive outcome of a behavioural experiment is that a negative belief of the patient is positively disconfirmed Therapists assume that this disconfirmation of patients’ beliefs leads to an update of beliefs However, many patients stick to their beliefs and do not update them despite disconfirmatory evidence

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THE PROBLEM OF LACK OF UPDATING NEGATIVE BELIEFS

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

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THE PROBLEM OF LACK OF UPDATING NEGATIVE BELIEFS: EVIDENCE FOR DEPRESSION

Department of Clinical Psychology and Psychotherapy

* F(1,113) = 5.414; p = .022; ɳ²p = 0.046

1 MDD = Major Depressive Disorder

Kube, Rief, … & Glombiewski (2019) Psychological Medicine

Generalised performance expectation

Provision of unexpectedly positive feedback

3 3,5 4 4,5 5 5,5 pre post

individuals with MDD healthy individuals

* 1

Tobias Kube Pain and Psychotherapy Research Lab

Similar effects have been found for areas other than performance, e.g.:

Failure to revise negative interpretations of social situations after novel positive information (Everaert et al., 2018; Liknaitzky et al., 2017) Updating beliefs about future life events (Garrett et al., 2014; Korn et al., 2014)

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THE PROBLEM OF LACK OF UPDATING NEGATIVE BELIEFS: EVIDENCE FOR DEPRESSION

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

Cognitive immunisation = reappraisal of disconfirming information such that beliefs become “immune” to learning from new experiences Some examples: Unexpectedly positive performance feedback

“This was a particularly easy test, everyone could have done this“ “This test seems invalid, so perhaps I was not as good as indicated“

Unexpectedly positive social interaction:

“This person had to be nice to me in this situation” “This person was just pretending to like me. In fact, she does not like me”

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COGNITIVE IMMUNISATION AS A MECHANISM OF PERSISTENT NEGATIVE BELIEFS

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

Cognitive immunisation is regarded as a specific cognitive mechanism underlying the persistence of dysfunctional beliefs From a clinical point of view, it should be aimed to prevent patients from using cognitive immunisation strategies to devalue unexpectedly positive information gained from a behavioural experiment → increase the likelihood of belief update

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HOW TO HANDLE COGNITIVE IMMUNISATION THERAPEUTICALLY?

Department of Clinical Psychology and Psychotherapy

Belief

Disconfirmatory information

Belief update

Tobias Kube Pain and Psychotherapy Research Lab

Cognitive immunisation is regarded as a specific cognitive mechanism underlying the persistence of dysfunctional beliefs From a clinical point of view, it should be aimed to prevent patients from using cognitive immunisation strategies to devalue unexpectedly positive information gained from a behavioural experiment → increase the likelihood of belief update

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HOW TO HANDLE COGNITIVE IMMUNISATION THERAPEUTICALLY?

Department of Clinical Psychology and Psychotherapy

Belief

Disconfirmatory information

Belief update Cognitive immunisation Persistent belief

Tobias Kube Pain and Psychotherapy Research Lab

Cognitive immunisation is regarded as a specific cognitive mechanism underlying the persistence of dysfunctional beliefs From a clinical point of view, it should be aimed to prevent patients from using cognitive immunisation strategies to devalue unexpectedly positive information gained from a behavioural experiment → increase the likelihood of belief update

10

HOW TO HANDLE COGNITIVE IMMUNISATION THERAPEUTICALLY?

Department of Clinical Psychology and Psychotherapy

Belief

Disconfirmatory information

Belief update Cognitive immunisation Persistent belief Therapeutic intervention

Tobias Kube Pain and Psychotherapy Research Lab

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COGNITIVE IMMUNISATION CAN BE INHIBITED

Department of Clinical Psychology and Psychotherapy

Sample: 113 people with major depression Comparison of three strategies aimed at inhibiting the use of cognitive immunisation strategies and facilitating expectation update Particularly the strategy aimed at increasing the value of the positive feedback by providing additional information (“INFORMATION”) about the test effectively boosted expectation change

Generalised performance expectation

3,5 4 4,5 5 5,5 6

pre post

INFORMATION RECALL ATTENTION CONTROL

Kube, Glombiewski, … & Rief (2019) Journal of Affective Disorders F(3, 109)=3.758; p=0.013; ɳ²p=0.094

Tobias Kube Pain and Psychotherapy Research Lab

• Mr. G.‘s expectation: “When I talk to other people they will think I’m incompetent”

Possible behavioural experiment: Talk to other people and see what happens Therapist‘s concern: Patient would negatively reappraise possible positive outcome

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INHIBITION OF COGNITIVE IMMUNISATION: CLINICAL EXAMPLE

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

Inhibition of cognitive immunisation:

A priori discussion: “How would we have to design the behavioural experiment so that you find the information gained from it credible?”

• Mr. G.: „…

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INHIBITION OF COGNITIVE IMMUNISATION: CLINICAL EXAMPLE

Department of Clinical Psychology and Psychotherapy

Tobias Kube Pain and Psychotherapy Research Lab

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THERAPEUTIC STRATEGIES TO INHIBIT COGNITIVE IMMUNISATION

Department of Clinical Psychology and Psychotherapy

Kube, Glombiewski, & Rief (2019), Verhaltenstherapie; Kube, Rief, & Barsky (under review)

When to use it? Strategy Before engaging in a behavioural experiment A priori specification of valid belief-disconfirming information that can be gained from the behavioural experiment Shift the patient’s attentional focus to potential belief disconfirming experiences After receiving unexpectedly positive information Consider repeating the behavioural experiment in other situations/contexts to increase its validity Increase the value of disconfirmatory positive information by emphasising its relevance and credibility Discuss the generalisability of the unexpectedly positive information

Tobias Kube Pain and Psychotherapy Research Lab