INTERACTING COGNITIVE SUBSYTEMS AND ANXIETY

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INTERACTING COGNITIVE SUBSYTEMS AND ANXIETY

• Dr Nick White
• Chartered Clinical Psychologist

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• THE SUBSYSTEMS AND THEIR INTERACTIONS

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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

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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

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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

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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

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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

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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

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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

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• TRANSFORMATION PROCESSES AND MEMORY RECORDS

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Processing within each subsystem
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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

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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

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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

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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

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Buffered processing
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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

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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

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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

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• ICS INFORMED
• GROUP CBT

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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

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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

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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

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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

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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

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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

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Moving the buffer

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

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CMHT ANXIETY GROUP AVERAGE SCORES HADS ANXIETY
SUBSCALE
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MODERATE ANXIETY GROUP AVERAGE SCORES HADS
ANXIETY SUBSCALE
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drnickwhite_at_hotmail.com