1. INTERACTING COGNITIVE SUBSYTEMS AND ANXIETY
Dr Nick White
Chartered Clinical Psychologist

2. THE SUBSYSTEMS AND THEIR INTERACTIONS

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. TRANSFORMATION PROCESSES AND MEMORY RECORDS

13. Processing within each subsystem

14. 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

15. 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

16. 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

17. 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

18. Buffered processing

19. 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

20. 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

21. 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

22. ICS INFORMED
GROUP CBT

23. 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

24. 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
Review of goals and taking things forward

25. 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

26. 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

27. 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

28. 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

29. Moving the buffer Worrying vs mindfulness Attentional control skills
Help individual to learn to move the buffer to the implicational subsystem

30. CMHT ANXIETY GROUP AVERAGE SCORES – HADS ANXIETY SUBSCALE

31. MODERATE ANXIETY GROUP AVERAGE SCORES – HADS ANXIETY SUBSCALE