CBT: Cognitive Behavioral Therapy

woodbrainby Jen L’Insalata

In most psychotherapeutic environments the term CBT is tossed around all the time. CBT in research; my insurance providers prefer CBT; CBT; CBT; CBT. So what is this CBT stuff? CBT is short for cognitive behavioral therapy and essentially addresses both thoughts and the underlying emotions that influence behavior. This is achieved by bringing together components of both cognitive therapy and behavioral therapy is a direct and effective manner.

Behavior Therapy

Behavior therapy is centered on the concept that human behavior serves a function and results from stimuli within the individual’s environment. Behaviors result in response to environmental stimuli and behavioral patterns result from the reinforcement or punishment received from the interaction between the individual and their particular environment. The psychosociocultural viewpoint encompasses a wide range of therapeutic strategies that aim to change the environmental factors that stimulate maladaptive behaviors (Wedding, & Corsini, 2014).

Cognitive Therapy

Cognitive theory is a theory of personality in which individuals respond to life events cognitively, motivationally, and behaviorally. An individual perceives, interoperates, and assigns meaning to particular life events. Maladaptive behaviors and affects are caused due to the misinterpretation of stimuli, situations, and events. Cognitive therapy aims to adjust the way the individual processes incoming information by examining the individual’s belief about their self, the world, and others (Wedding, & Corsini, 2014).

Five Concepts That Add Dimension

Both behavior and cognitive therapy recognize that personality is consistent and an individual’s response to environmental stimuli can be predicted. Behavior therapy acknowledges five core domains from which personality can be assessed. Behavior therapy teaches flexibility within an individual’s personality domains and introduces healthy coping mechanisms and responses for environmental stimuli (Wedding, & Corsini, 2014).

Cognitive therapy recognizes schemas to explain and predict responses to environmental stimuli and situational cues.  A network of affective, motivational, and behavioral schemas known as modes asses and interoperate situations. Some modes are rooted in instinct and are referred to as primal modes. Primal modes are often ridged, automatic, and absolute. Primal thinking leads to maladaptive behavior. Cognitive therapy teaches a client to consciously override primal modes through means of deliberate thinking and problem solving (Wedding, & Corsini, 2014).

Behavior therapy focuses on the behaviors and actions that are conditioned responses to external stimuli. Cognitive therapy focuses on the affect and mental interpretation of a particular stimuli (Zaretsky, Segal, & Fefergrad, 2007). Due to similarities, behavior therapy and cognitive therapy are often combined in a treatment known as cognitive behavioral therapy. CBT targets the bias mental interpretations acknowledged in cognitive therapy and teaches the client to regulate emotions causing maladaptive behaviors (Harvey, Bélanger, Talbot, Eidelman, Beaulieu-Bonneau, Fortier-Brochu, & … Morin, 2014).

CBT is often used as a primary treatment for depression and mood disorders.  By leveraging a client’s awareness of the changes in their cognition, (Zaretsky, Segal, & Fefergrad, 2007) treatment techniques encompassing mindfulness, relaxation, meditation, exposure, (Wedding, & Corsini, 2014) and modeling teach the client ways to regulate their affect and reduce symptoms (Zaretsky, Segal, & Fefergrad, 2007).

When addressing depression, cognitive therapy addresses the client’s negative views of one’s self, their experiences, and future. A client’s interpretation of their environment is often bleak and the client maintains a pessimistic bias toward themselves and their future. Motivational symptoms appear such as a lack of energy and sometimes paralysis that inhibits the completion of everyday life tasks. Increasing activity and social exposure combined with combating negative interpretations of situations are used to alleviate the cognitive components of depression (Wedding, & Corsini, 2014).

Behavior therapy addresses the conditioned response to stimuli. Behaviors increase due to reinforcement (Wedding, & Corsini, 2014). Maladaptive coping strategies and behaviors continue to reinforce depressive behaviors. Treatments focused on positive social exposure and activity work to reinforce positive experiences for the depressed individual and reduce exposure to negative experiences such as isolation. Exposure to positive stimuli aids in reinforcing non-depressive behaviors (Ryba, Lejuez, & Hopko, 2014).

Modeling behaviors occurs when an individual observers others in a sociocultural environment. Anxiety or phobias are maladaptive behaviors that can be learned through modeling abuse (Wedding, & Corsini, 2014). If an individual observes a social fear or anxiety about a particular situation, it is likely to be interoperated as a truth. An individual may model the anxious or phobic behavior learned from observation.

Behavior therapy addresses the hyperarousal brought on by anxiety and phobia by combining exposure and relaxation training. Practicing relaxation techniques while exposed to environmental stimuli helps alleviate the physical stress and tension associated with phobia and anxiety. Cognitive therapy teaches an individual to reevaluate the particular stimuli and interoperate it as less threatening (Wedding, & Corsini, 2014).

Substance abuse is often coupled with depression and anxiety. The recognition of psychosocial factors maintain the maladaptive belief and subsequent behaviors are addressed by combining cognitive and behavioral therapies (Harvey, Bélanger, Talbot, Eidelman, Beaulieu-Bonneau, Fortier-Brochu, & … Morin, 2014). Substance abuse may begin as a molded socioenvironmental behavior and become reinforced through positive social experiences. Reinforcement of addictive behaviors may be reinforced when a client engages in self-medication to alleviate depression and anxiety symptoms.

Stimulus control is a behavioral technique that can be used to help individuals with substance abuse issues and addiction. Principles of classical conditioning state that conditioned cues illicit behavioral responses.  Stimulus control aims to correct the problems associated with a particular stimuli (Wedding, & Corsini, 2014). For example, a client may associate a place or event with the acquisition and consumption of substances. Clients are encouraged to avoid places and situations which are cues for their addiction.

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References

Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. ISBN: 9781285083711.

Zaretsky, A., Segal, Z., & Fefergrad, M. (2007). New developments in cognitive-behavioural therapy for mood disorders.Canadian Journal of Psychiatry, 52(1), 3-4. Retrieved from http://search.proquest.com.library.capella.edu/docview/222807541?accountid=27965

Harvey, A. G., Bélanger, L., Talbot, L., Eidelman, P., Beaulieu-Bonneau, S., Fortier-Brochu, É., & … Morin, C. M. (2014). Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: A randomized controlled trial. Journal Of Consulting And Clinical Psychology, 82(4), 670-683. doi:10.1037/a0036606

Ryba, M. M., Lejuez, C. W., & Hopko, D. R. (2014). Behavioral activation for depressed breast cancer patients: The impact of therapeutic compliance and quantity of activities completed on symptom reduction. Journal Of Consulting And Clinical Psychology, 82(2), 325-335. doi:10.1037/a0035363

Stress!!!!

mental-illnesses-disorders-drawn-real-monsters-toby-allen-thumb640
Artwork by Toby Allen
By Jen L’Insalata

Stress has been cited for many adverse physical and mental health conditions and is linked to the proliferation of non-communicable disease epidemics in recent years. During the 1800’s most deaths were related to poor sanitary and hygienic conditions. Most deaths were attributed to outbreaks of cholera, Influenza, typhoid, and tuberculosis spread through unsanitary drinking water (Shern, Blanch, & Steverman, 2016).

In the 21st century, public health is still at risk. The US ranked 36th out of 194 for life expectancy in 2012 with the vast majority of deaths related to obesity, coronary heart disease, lung disease, and substance abuse. Most contemporary chronic illness has its roots in stress and it is estimated that nearly half of Americans will develop resulting mental health and addiction issues at some point during their lifetime (Shern, Blanch, & Steverman, 2016).

It is widely understood that a combination of genetic predisposition coupled with environmental influence shape over all human development. Many alterations in genetic material correlate with environmental stressors. In other words, genetic mutation and expression is strongly influenced by the environments which people are exposed to.

While manageable stress is considered important for healthy human development, toxic stress is not. Frequent, intense, and prolonged exposure to adversity including but not limited to physical and emotional abuse or violence, neglect, and economic hardship account for the source of much toxic stress. Acute or chronic exposure to traumatic events including death and sexual abuse also fall into the toxic stress category as does the persistence of less sever stressors including family instability and income insecurity (Shern, Blanch, & Steverman, 2016).

Stress alters development   over the course of a lifetime. Prenatal exposure to stress impacts developing structures of the fetus leading to adverse effects on memory and cognition. Early childhood stress often results in diminished behavioral, emotional, and impulse control. Individuals exposed to toxic stress during late adolescence and early adulthood develop a heightened fear response and are hyper responsive to stress stimuli (Shern, Blanch, & Steverman, 2016). Additionally, stress amplifies the aging process on both the brain and the body as a whole.

Stress causes structural remodeling of the brain and weakens neuro-connections within in the brain. Exposure to stress activates stress hormones and raises cortisol levels. Persistent elevation of cortisol levels increases the adverse effects on the connective structures within the amygdala; a structure commonly linked to cognitive and emotional regulation (Shern, Blanch, & Steverman, 2016 & Pagliaccio, Luby, & … Barch, 2015).

Genetic mutations occur throughout the short alleles of the serotonin transport promoter and produced heightened monoamine oxidise A activity. Heightened activity along the Hypothalamic-Pituitary-Adrenal Axis greatly effects the monoamine/serotonin structures and leads to additional cortisol release. It is the relationship between cortisol and amygdala connectivity that is believed to be a foundational component of internalizing pathology (Pagliaccio, Luby, & … Barch, 2015).

Internalizing pathology such and depression and anxiety contribute additional stress to an individual’s life. Symptoms of both disorders have dehabilitating effects on one’s ability to function in a socioeconomic capacity and produce feeling of dependency on unhealthy relationships and substances. Thus the cycle of stress, cell malfunction, and disorder is perpetuated.

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Resources

Pagliaccio, D., Luby, J. L., Bogdan, R., Agrawal, A., Gaffrey, M. S., Belden, A. C., & … Barch, D. M. (2015). Amygdala functional connectivity, HPA axis genetic variation, and life stress in children and relations to anxiety and emotion regulation. Journal Of Abnormal Psychology, 124(4), 817-833. doi:10.1037/abn0000094

Shern, D. L., Blanch, A. K., & Steverman, S. M. (2016). Toxic stress, behavioral health, and the next major era in public health. American Journal Of Orthopsychiatry, 86(2), 109-123. doi:10.1037/ort0000120

 

A Brief Overview of Neurons and Neurotransmission

neuronsJen L’Insalata

Preston, O’Neal, & Talaga (2013), presented the comparison of neural transmission to a telephone switchboard. In many ways, that analogy is accurate since neurotransmitters are essentially messages being sent from one nerve to another. Neurons utilize electrical and chemical stimulation to communicate and ultimately control human behavior.

To understand how transmissions are passed between neural pathways, one must first understand the basic structure of a nerve cell. The main body of the nerve cell or neuron is known as the soma. Its shape differs depending on its specific function but is contains the structures universal to all cells such as the nucleus, mitochondria, and cytoplasm. The axon is a slender tube like structure that emanates from the soma. It is often covered by a myelin sheath which aids in the conduction of information from one neuron to another; known as an action potential. Terminal buttons are the end points of axons which secrete hormones known as neurotransmitters. To do this an action potential must travel down the axon and reach the terminal buttons. The neurotransmitter either excites or inhibits the action potential allowing it to continue or cease its communication with the neighboring neuron. The dendrites of the neighboring neuron receive the transmission from the terminal button across a fluid filled gap called a synapse. The dendrite resembles the branches of a tree and allow the transmission to continue along the neural pathway (Carlson, 2014. & Saladin, 2012).

 

Neural transmission and action potentials are governed by the balance of positively and negatively charged ions such as sodium, potassium, and chloride. Polarization of the intracellular fluid by salutatory conduction and diffusions allows the transmission of the action potential down the length of the axon until it reaches the terminal buttons. If the action potential is strong enough at the terminal button, synaptic vesicles containing neurotransmitters are able to bind with the presynaptic membrane of the terminal button. This membrane essentially separates the end of the terminal button from the synaptic cleft. The synaptic vesicle is then able to release the neurotransmitter across the intracellular fluid which fills the gap, or synapse, between the terminal button and the opposing dendrite (Carlson, 2014. & Saladin, 2012).

 

Neurotransmitters are transported from the cell body to the terminal button by sac-like structures called vesicles. The vesicles bind to the membrane of the terminal button ans create tiny opening from which the neurotransmitter is released from the presynaptic neuron. Neurotransmitters are then ale to cross they synapse and bind with receptors on the dendrites of the postsynaptic neuron facilitating communication. While some neurotransmitters bind with the receptor sites on the post synaptic neuron, others are destroyed, or reabsorbed by the terminal button of the presynaptic neuron (Reed, Carlson, Quale, 2016).

 

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Resources

Carlson, N. R. (2014). Foundations of behavioral neuroscience (9th ed.). Boston, MA: Pearson. ISBN: 9780205940240.

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2013). Handbook of clinical psychopharmacology for therapists (7th ed.). Oakland, CA: New Harbinger. ISBN: 9781608826643.

Reed, L., Carlson, L, Quale, S. (2016). Capella University Neurotransmission Retrieved from http://media.capella.edu/course media/PSY7330/animation/transcript.htm1

Saladin. K.S. (2012). Anatomy and Physiology: The Unity of Form and Function. 6th ed. Mcgraw-Hill. New York, NY. ISBN978-0-07-337825-1.

A General Diagnostic Understanding: Schizophrenia and Related Psychotic Disorders

schizophreniaJen L’Insalata

Schizophrenia is a psychotic disorder characterized by the disruption of an individual’s sense of self and perception. Psychotic symptoms manifest in the form of auditory, visual, and sensational hallucinations, disordered or delusional thoughts, and disruptions in language and communication. An individual with schizophrenia is not always incoherent. Most individuals experience periods of active symptoms and symptom remission, while many experience at least one period of relapse (NIMH, 2009).

Schizophrenia is sometimes confused with having a split of multiple personality which are characteristic of another disorder. Diagnosing in an emergency room setting can be difficult as symptoms manifest differently in varying individuals. Involuntary hospitalization can only occur legally if a professional witnesses psychotic behavior which can take the form of the vocalization of delusional thoughts (NIMH, 2009).

295.90 (F20.9) Schizophrenia is characterized by delusions, hallucinations, disorganized speech that is easily derailed or incoherent, grossly disorganized or catatonic behavior, and negative symptoms including flat affect and diminished emotional expression. The symptoms must be severe enough to impact normal day to day function such as interpersonal relationships and self-care (APA, 2013). In an emergency room scenario it may be difficult to assess the impact of the symptoms on education and employment. It may be easier to visually assess the appearance of the individual to gather the extent of the symptoms on daily functionality. Schizophrenia can be distinguished from other psychotic disorders based on severity and length of duration of the symptoms. In schizophrenia the symptoms persist continuously for six months and meet the full diagnostic criteria for at least one month. If the duration and severity of the symptoms is less than the diagnostic criteria, a diagnosis of schizophrenipform disorder may be more appropriate. Additionally, if the active phase of psychosis includes depressive symptoms, a diagnosis of schizoaffective disorder may be warranted (APA, 2013).

Schizoaffective Disorder is similar to schizophrenia and symptoms include hallucinations, delusions, disorganized thought, and negative symptoms. In addition to the psychotic features present, individuals with schizoaffective disorder also exhibit features of depressive disorders and bipolar disorders. Coding for schizoaffective disorder is based on the mood episodes exhibited. 295.70 (F25.0) Schizoaffective Disorder, Bipolar type indicated there is a manic phase to the mood disturbances indicative of bipolar disorder. In 295.70 (F25.1) Schizoaffective Disorder, Depressive type, the individual experiences mood symptoms congruent with major depressive disorder (APA, 2013).

298.8 (F23) Brief Psychotic Disorder is characterized by the presence of delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behavior. Symptoms last for at minimum, one day and at maximum, one month. Typically the onset is sudden and an individual goes from a non-psychotic to a psychotic state within two weeks. The differentiation between Brief psychotic disorder and other forms of psychotic disorder focuses on the length of time and onset of the symptoms. If the symptoms last longer that one month, the diagnosis of schizophrenipform disorder is more appropriate. Additionally, individuals who experience brief psychotic disorder do not meet the full DSM criteria for schizophrenia and show no disturbance in mood or affect. Individuals who experience brief psychotic disorder do not often show negative symptom that are common in schizophrenia. If mood congruent symptoms are present, schizoaffective disorder is a more appropriate diagnosis (APA, 2013).

The exact cause of schizophrenia is still unknown. It is believed that there is genetic, biological, and environmental links that correspond with the disorder and provide risk factors. Schizophrenia shows a genetic component and runs within families. Having a first degree relative with schizophrenia increases a person’s likelihood to develop the disorder themselves. Environmental factors such as exposure to prenatal viruses, malnutrition, and complications during birth also increase the risk of schizophrenia (NIMH, 2009). According to the diathesis stress model, individuals inherit a high or low genetic risk for schizophrenia. Varying psychosocial factors throughout the lifespan such as stressors and experiences influence the trajectory and development of the disorder (U.S. Department of Health and Human Services, 1999).

Several genes have been linked to schizophrenia and individuals with schizophrenia have a higher rate of gene mutation than healthy individuals. Brain physiology also differs in individuals with schizophrenia. Ventricles in the center of the brain are often larger in schizophrenic patients and individuals have decreased amounts of gray matter than healthy individuals. Genes that code for the chemicals associated with the development of higher brain function, neurotransmitters such as dopamine and glutamine are also effected which cause changes to the neuropathways that develop during puberty (NIMH, 2009).

Individuals with schizophrenia who receive treatment have a better outcome than individuals who do not. One halt to two thirds of individuals who receive treatment recover or show significant improvement over time (U.S. Department of Health and Human Services, 1999). Treatment for schizophrenia includes both psycho-pharmisudical and psychotherapeutic interventions that focus on eliminating the symptoms and developing coping strategies.

During the 1950’s antipsychotics were developed to treat schizophrenic symptoms. This first generation of antipsychotics consisted of medications including Chlorpromazine (Thorazine), Haloperidol (Haldol), Perphenazine (Etrafon, Trilafon), Fluphenazine (Prolixin), and Clozapine (Clozaril). Each individual responds to treatment differently, however Clozapine appeared to be most effective in the most varied cases. Clozapine also had a side effect that reduced white blood cell count requiring patients using the medication to receive blood screening every two weeks (NIMH, 2009).

During the 1990’s a second generation of antipsychotics were developed that had reduces side-effects. These include Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone (Invega); which are more commonly prescribed today. Side effects to antipsychotics may include drowsiness, dizziness, blurred vision, rapid heartbeat, sensitivity to the sun, and skin rashes. In women, menstrual problems may occur. Additional side effects may be physical in nature and long term use of antipsychotics may cause loss of neuromuscular control. Once a compatible antipsychotic is found patients may see improvements in as little a few days, with an overall reduction in psychotic symptoms in as little as six weeks (NIMH, 2009).

In addition to pharmisudical treatment, psychotherapy is important to an individual’s recovery.  Therapy provides prosocial, interpersonal, vocational skills, and education that helps prevent relapse of symptoms. Family and community based therapy helps to build a support system that also helps improve the individual’s prognosis. Psychosocial and Cognitive Behavioral Therapy address the disruptive thoughts and perceptions that are symptomatic of schizophrenia. CBT helps develop coping skills that allow the individual to test the legitimacy of their delusions or hallucinations and implement healthy behavioral alternative to actin on such thoughts. Prosocial components address areas of daily self-care, occupational, and educational skills that help schizophrenic patients live healthy and functioning lives (U.S. Department of Health and Human Services, 1999, & NIMH, 2009).

Schizophrenia effects men and woman and displays cultural equality, however not all symptoms manifest the same. Misdiagnosis can occur if the culture to which a patient differs from that of the diagnosing clinician.  Many cultural sub groups participate in religious experiences where hearing voices or seeing vision is acceptable. In other cultures, affect and avoidance can be misinterpreted as paranoia or other negative symptoms. It is important to understand the culture from which an individual comes from to determine if the symptoms are due to psychosis or cultural misinterpretation (U.S. Department of Health and Human Services, 1999, & NIMH, 2009).

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. ISBN: 9780890425558.

National Institute of Mental Health. (2009). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Retrieved from http://profiles.nlm.nih.gov/ps/access/NNBBHS.pdf

Theories of Moral Development

moral
Jen L’Insalata

Morality is often defined as an individual’s ability to judge and understand what is right and wrong and then to act in accordance to what they judge to be right. An individual’s moral and belief system influence their behaviors. Behaviors aligned with personal beliefs and morals help to build self-concept and self-esteem (Broderick, & Blewitt, 2010).

A child’s early sense of morals are influenced by a system of rewards and punishment established by the caregiver. Young children will act in accordance of with the egocentric self to meet the standards of their primary caregiver and avoid punishment. Perspective-taking improves and parental established morals give way to a conscience that intertwines emotions, cognition, and behavior (Broderick, & Blewitt, 2010).

Despite cultural and religious influences on morality, there are several universal component that establish good morals. Generally speaking, morality take into account the concern for others, a sense of justice and fairness, honesty and trustworthiness, and self-control (Broderick, & Blewitt, 2010). Feelings of morality and actions are often at a conflict and moral conduct appears to be determined more by situational assessment then by moral reasoning (Broderick, & Blewitt, 2010).

Several theories surrounding moral development exist. Freud discussed in his Psychoanalytic Theory that infants and young children are driven by the impulses of the self-serving id. The superego emerges and establishes a source of morals around preschool age (Broderick, & Blewitt, 2010). Freud believed these morals stemmed from an internalized system of rewards and punishments driven by parental conflict. Around the age of three, vague sexual desires toward the parent of the opposite sex and leads to an internal conflict and competition with the parent of the same sex. The solution to this conflict is to identify with the dominant same sex parent in order to be like them and satisfy this sexual longing (Broderick, & Blewitt, 2010). Morals are established by imitating the same sex parent’s actions.

Later research has failed to support Freud’s Psychoanalytic predictions. Finding show that children as young as eighteen to twenty-four months are capable of understanding empathy. This is inconsistent with Freud’s timeline for the emergence of the id ego and superego (Broderick, & Blewitt, 2010). Toddlers do however preform pro-social actions as a willingness to comply with the authority of their parents. The Psychoanalytic Theory associates this compliance with a fear of the same sex parental conflict. This concept contradicts research establishing that secure attachment and warm affectionate parental styles forester pro-social behavior and moral development (Broderick, & Blewitt, 2010).

Cognitive Theories of moral development center on the works of Piaget, Kohlberg, and Gilligan and emphasize changes in logical thinking at the core of moral development. Piaget theorized that there are three stages to moral development, premoral, heteronomous, and autonomous (Broderick, & Blewitt, 2010). In studies, Piaget presented children with moral dilemmas and asked them to assess the behavior of the protagonist or the rules of a game. During the premoral stage, infants have no concern for rules and often make up their own rules to serve an egocentric purpose. Around age five, children enter the heteronomous stage and view morals and rules through a realist perspective. They view rules at concrete and never to be broken. Violation of rules requires immediate justice and punishment. During middle childhood socialization and perspective-taking abilities become more refined. The child transitions into the autonomous stage and views morals as a social agreement to promote fairness. Rules can be modified and amended to serve a higher social purpose (Broderick, & Blewitt, 2010).

Kohlberg expanded on Piaget’s theory and assessed moral development beyond childhood into adulthood. Kohlberg based much of his work off philosophical concepts of morality referenced in Plato’s The Republic (Jorgensen, 2006) which morality is centered on justice. Utilizing unconventional philosophical scenarios, Kohlberg established three levels of moral reasoning each broken into stages. The preconventional level corresponds with Piaget’s heteronomous stage and established that children follow rules to avoid punishment and judgment from a superior authority during stage one. During stage two, children follow rules to serve their own interest, however may include the interests of others (Broderick, & Blewitt, 2010).  The conventional level is reached during adolescence and young adulthood. In stage three, social relationships become moral motivators and shared interests trump personal interest. Stage four focuses on social and societal order. Morals and behaviors at this stage are motivated by contributions to society, responsibility, and laws (Broderick, & Blewitt, 2010).  The postconvetional levels focus on universal standards of justice, democratic principles, and individual rights. Stage five establishes a moral social contract and is reached around adulthood. Stage six takes a more theoretical approach and addresses abstract concepts of social justice (Broderick, & Blewitt, 2010).

Research supports both Piaget and Kohlberg and shows that children indeed pay attention to the consequences and punishments surrounding moral violations and older children pay more attention to the intent of the protagonist to establish moral basis (Broderick, & Blewitt, 2010).  However finding show that children have a greater capacity for focusing on intentions and moral reasoning then given credit in the theories of Piaget and Kohlberg. Studies also show that preschoolers are able to differentiate between an intentional lie and a mistake and judge the liar more harshly (Broderick, & Blewitt, 2010).  Piaget believed that children believed all rules to be handed down from a superior authority. Children do however show a philosophical understanding of the difference between moral rules, conventional rules, and cultural rules. Children have the capacity to view cultural rules as arbitrary, but adhere more strictly to personal self-governed rules (Broderick, & Blewitt, 2010). Thus demonstrating that children have the understanding moral context.

Gilligan often criticized Kohlberg stating that his description of moral reasoning focused primarily on cerebral components of justice, ignoring the care and concern involved in moral reasoning (Jorgensen, 2006). Gilligan argued that morals developed on different trajectories for males and female. Women are more inclined to introduce sympathy, empathy and compassion into moral reasoning, whereas males utilize justice as an emphasis for moral reasoning (Broderick, & Blewitt, 2010).  This feminine viewpoint has earned Gilligan criticism question her bias in her approach to moral reasoning (Jorgensen, 2006).

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References:

Jorgensen, G. (2006). Kohlberg and Gilligan: duet or duel?. Journal Of Moral Education, 35(2), 179-196. doi:10.1080/03057240600681710

Broderick, P. C., & Blewitt, P. (2010). The life span: Human development for helping professionals (3rd ed.). Boston, MA: Allyn & Bacon. ISBN: 9780137152476

Freud and Attachment

boy and gearsJen L’Insalata

Freudian psychoanalytic theory presents concepts which have shaped and influenced many aspects of the field of psychology. Much of Freud’s theory was developed from observations and case studies of many of his own patients. He is often criticized for a lack of experimental investigation and hypothesis testing throughout his theory and an over emphasis placed on psychosexual components (Feist, Feist, & Roberts, 2013). Yet despite the criticism, Freudian psychoanalysis explores ways in which unconscious motivations influence personality and behavior and still maintains relevancy in psychological practice today.

Freud explored how unconscious motivations influence emotional states, personality and outward manifestations of behavior. According to Freud, such motivation have root in past experience (Feist, Feist, & Roberts, 2013). In essence behavior is shaped by an unconscious struggle to reduce emotional tensions caused by our past traumas.

A core component of psychoanalytic theory emphasizes maladaptive coping mechanisms such as defense mechanisms and repression (Feist, Feist, & Roberts, 2013). Individuals who experience trauma often utilizes maladaptive defense mechanisms to reduce psychological tension. Often, individuals suffering from severe PTSD repress memories of the traumatic event. This is a temporary solution which allows the individual to function in immediate aftermath. According to Freud, manifestations of the unconscious repression manifest in recurrent dreams commonly experienced by individuals suffering from PTSD (Feist, Feist, & Roberts, 2013). Psychoanalytic theory can be applied in the treatment of severe trauma as the individual begins to bring the unconscious to light and acknowledge their past experiences.

Attachment theory places emphasis on the earliest of childhood experiences and emphasizes ways in which infants form bonds with their caregivers. As much of Feud’s theory relies heavily on early childhood and past experiences, concepts of personality and behavior manifestations focus heavily on such bonds. Freud believed that attachment centered on a child’s identification with the same sex parent and their desire to be with the opposite sex parent. Freud theorized that these unconscious sexual desires manifested in overcoming what he called the Oedipus and Electra complex (Feist, Feist, & Roberts, 2013). Successful resolution of the unconscious sexual motivators in such complexes allow for secure attachment bonds to parents and healthy interpersonal relationships in the future.

Although the Oedipus and Electra complex are highly discredited, Freud’s theory paved the way for his contemporaries to explore the relationship between healthy and secure attachments to caregivers. Early childhood attachments are viewed as an underlying component in many theories on healthy human functioning and interpersonal behavior. Attachment theory serves as a heavily emphasized component in developmental and behavioral psychology.

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References

Feist, J., Feist, G. J., & Roberts, T. (2013). Theories of personality (8th ed.). New York, NY: McGraw-Hill.