Marked differences in core beliefs about self and others, between sociotropy and autonomy: personality vulnerabilities in the cognitive model of depression

Although low self-esteem is common in clinical populations, a cognitive conceptualization of the problem and an integrated treatment programme deriving from that conceptualization are as yet lacking. The paper proposes a cognitive model for low self-esteem, deriving from Beck's model of emotional disorder. It outlines a treatment programme which integrates ideas and methods from cognitive therapy for depression, anxiety and more recent work on schemas or core beliefs. The model and treatment are illustrated with an extended case example.

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The Omnipotence of Voices

The British Journal of Psychiatry ◽

10.1192/bjp.164.2.190 ◽

1994 ◽

Vol 164 (2) ◽

pp. 190-201 ◽

Cited By ~ 462

Author(s):

Paul Chadwick ◽

Max Birchwood

Keyword(s):

Cognitive Therapy ◽

Cognitive Model ◽

Affective Responses ◽

Auditory Hallucinations ◽

Adaptive Behaviour ◽

Core Beliefs ◽

Drug Resistant ◽

Cognitive Approach ◽

Voice Activity

We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices - fear, reassurance, engagement and resistance - reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either ‘benevolent’ or ‘malevolent’. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31 % of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and, unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.

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Sociotropy, Autonomy and Emotional Symptoms in Patients with Major Depression or Generalized Anxiety: The Mediating Role of Rumination and Immature Defenses

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165716 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5716

Author(s):

Ruth Martínez ◽

Carmen Senra ◽

José Fernández-Rey ◽

Hipólito Merino

Keyword(s):

Anxiety Symptoms ◽

Generalized Anxiety ◽

Depression And Anxiety ◽

Multiple Mediation ◽

Emotional Symptoms ◽

Personality Dimensions ◽

Emotional Context ◽

Personality Vulnerabilities ◽

Sociotropy And Autonomy

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.

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