Continuity and Discontinuity cognitive science and psychotherapeutic perspectives

Continuity and Discontinuity: cognitive science and psychotherapeutic perspectives. Isabel Clarke Consultant Clinical Psychologist.

What I hope to cover: • Outline the discontinuity hypothesis • Ground this in cognitive theory • Implications for therapy – – Third Wave Cognitive therapy – my additions to CBT for psychosis • Wider Vision of the person

Instead of psychosis and spirituality, I propose two ways of operating in the world: • The everyday • The transliminal Both of these are available to all human beings. THE DISCONTINUITY exists between these two states.

The Everyday • Ordinary • Clear limits • Access to full memory and learning • Precise meanings available • Separation between people • Clear sense of self • Emotions moderated and grounded The. Transliminal • Numinous • Unbounded • Access to ordinary knowledge/memory is patchy • Connections abound - or all is meaningless • Self: lost in the whole or supremely important • Emotions: swing between extremes or absent

Looking at this cognitively • Two complementary approaches • Kelly’s Personal Construct Theory • Interacting Cognitive Subsystems (Teasdale and Barnard).

Constructs • Are based on past experience/memory • New experience is filtered through our constructs • They colour and help to define our world • Each person’s construct system is unique to them.

Transliminal Experience = operating Beyond the Construct System • No means of anticipating or discriminating • A state without boundaries • Both/and - two contradictory things can be simultaneously valid

Beyond Constructs and Boundaries • Liberating; ecstatic; one with the universe – BUT • Mind is no longer private • Open to any influence or “insertion” • Loss of the construct “safe/dangerous” - danger can come from anywhere. • The boundary between inner and outer is lost.

Interacting Cognitive Subsystems: Teasdale & Barnard 1993. • An information processing model of cognition, developed through extensive research into memory and limitations on processing. • 9 subsystems, each with its own type of coding. • Some deal with sensory perception - auditory and visual • Some deal with language processing • There are two higher order systems: the propositional and the implicational.

Interacting Cognitive Subsystems. Body State subsystem Implicational Memory Auditory ss. Visual ss. Propositional subsystem Propositional Memory Verbal ss.

Important Features of this model • Our subjective experience is the result of two higher order processing systems interacting – neither is in overall control. • Each has a different character, corresponding to “hot” and “cool” cognition. • The IMPLICATIONAL Subsystem manages emotion – and therefore relationship. • Presumabley, the verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self.

Two Ways of Knowing • Good everyday functioning = good communication between implicational/relational and propositional • At high and at low arousal, the relational ss becomes dominant • This gives us a different quality of experience – one that is both sought and shunned. • Managing that good communication is key – Teasdale was a pioneer in introducing Mindfulness to CBT.

I suggest • Both ways of encountering reality are equally valid • Both are intrinsically incomplete • Human beings have always honoured the transliminal • Made space for the sacred.

Advantages of this model • It clarifies the characteristics of the transliminal; – both/and, not either/or – paradox – numinosity • It brings psychosis into the realm of universal human experience • It helps to explain common psychotic experiences, such as: – thought insertion – distortions in the sense of self • It raises interesting questions around scientific enquiry into the transpersonal.

“Third Wave” Cognitive Therapies • Developments in CBT as it tackles personality disorder, psychosis etc. • Therapeutic relationship important • Past history is significant • Change lies not so much in altering thought to alter feeling, but in altering the person’s relationship to both thought and feeling • Mindfulness is a key component. • Role of mindfulness in managing the threshold between the two ways of knowing.

“Third Wave” – term coined by Hayes (Acceptance & Commitment Therapy) • Kabat-Zinn. Applied mindfulness to stress and pain. • Segal, Teasdale & Williams. Mindfulness Based Cognitive Therapy (relapse in depression. ) • Linehan. Dialectical Behaviour Therapy (BPD) • Chadwick. Mindfulness groups for voices. • Hayes

Parallel Developments in other modalities • Bateman and Fonagy – Mentalisation. Promotes theory of mind, collaboratively and through skills training. • Developments in Cognitive Analytic Therapy for severe personality disorders.

DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND EMOTION REASONABLE WISE MIND IN THE PRESENT IN CONTROL

Working with Psychosis using the Discontinuity Model • Managing arousal – the transliminal is accessible at both high and low arousal • Validate the experience • Validate the feeling • Persuasion to join “shared reality” • “Sensitivity” – normalisation based on Claridge’s work on schizotypy.

The Relational Mind • Developmentally, we make sense of ourselves only in relation to others. • We grow, and are moulded, through relationship – all relationship. • The self sufficient, atomistic, mind is an illusion • Our verbal, propositional ss. sets a limit on what we can know precisely • We can reach out in relationship beyond that limit.

Web of Relationships In Rel. with earth: non humans etc. primary care-giver In Rel. with wider group etc. Self as experienced in relationship with primary caregiver Sense of value comes from rel. with the spiritual

• Spiritual Crisis Network. www. spiritualcrisisnetwork. org. uk My website (publications) www. scispirit. com/Psychosis_Spirituality/ Chris Clarke Ed. 2005. ” Ways of Knowing: science and mysticism today”. Exeter: Imprint Academic. Clarke, I. Ed. (2001) Psychosis and Spirituality: exploring the new frontier. London: Whurr.