Pavlov and Associationism

How effective psychological treatments work: mechanisms of change in cognitive behavioural therapy and beyond

BACKGROUND

Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however.

AIMS

In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment.

METHOD

The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general.

CONCLUSION

Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.

Cortical activation during Pavlovian fear conditioning depends on heart rate response patterns: An MEG study

In the present study, we examined stimulus-driven neuromagnetic activity in a delayed Pavlovian aversive conditioning paradigm using steady state visual evoked fields (SSVEF). Subjects showing an accelerative heart rate (HR) component to the CS+ during learning trials exhibited an increased activation in sensory and parietal cortex due to CS+ depiction in the extinction block. This was accompanied by a selective orientation response (OR) to the CS+ during extinction as indexed by HR deceleration. However, they did not show any differential cortical activation patterns during acquisition. In contrast, subjects not showing an accelerative HR component but rather unspecific HR changes during learning were characterized by greater activity in left orbito-frontal brain regions in the acquisition block but did not show differential SSVEF patterns during extinction. The results suggest that participants expressing different HR responses also differ in their stimulus-driven neuromagnetic response pattern to an aversively conditioned stimulus.