Table of Contents
LIST OF FIGURES
LIST OF TABLES
LIST OF ABBREVIATIONS
1.1. Theoretical Background
1.1.1. Grawe's Universal Working Mechanisms of Psychotherapy
1.1.2. Dysfunctional Beliefs
1.1.3. The Aha-Experience
1.2. Aim of the Present Study
1.3. Research Questions
1.3.1. Influence of Implicit Self-Esteem on Aha-Experiences
1.3.2. Influence of Aha-Experiences on Implicit Self-Esteem
2.2.1. Stimulus Selection
2.3. Implicit Association Test
2.4. General Procedure
2.5. Statistical Tests
3.1. Descriptive Values
3.2. Hypothesis 1
3.3. Hypothesis 2
4.1. Interpretation of Results
4.2. Limitations and Implications for Research and Practice
LIST OF FIGURES
Figure 1 Exclusion of Candidates in the Selection of Participants
Figure 2 Procedure of the Rethink-Paradigm
Figure 3 IAT Procedure
LIST OF TABLES
Table 1 Hypotheses for Research Question 1
Table 2 Hypotheses for Research Question 2
Table 3 Descriptive Values of the Variables
LIST OF ABBREVIATIONS
Abbildung in dieser Leseprobe nicht enthalten
This study is part of a pioneering project examining aha-experiences regarding dysfunctional beliefs using the Rethink-paradigm designed for this purpose. Findings stemming from problem-solving research lead us to consider aha-experiences as beneficial for motivational clarification, a working mechanism of psychotherapeutic change. The present study examines interactions of implicit self-esteem and therapeutically relevant aha-experiences in participants that have no history of psychological disorders. Lower self-esteem was shown to be associated with experiencing more aha-moments regarding dysfunctional beliefs but this moderate effect fell short of becoming significant. A small, non-significant effect was found for the number of aha-experiences being associated with a decline in self-esteem. Given the limitations of the present study, future research should be carried out to satisfactorily answer the question of how aha-experiences influence implicit self-esteem and to examine whether aha-experiences are superior to other clarification processes in bringing about therapeutic change.
Keywords: aha-experience, implicit self-esteem, dysfunctional beliefs, Rethink-paradigm, motivational clarification, psychotherapy
Diese Studie ist Teil einer ersten Serie an Studien, die Aha-Erlebnisse bei dysfunktionalen Einstelllungen untersucht. Dabei wird das eigens zu diesem Zweck konzipierte Rethink- Paradigma verwendet. Befunde aus der Problemlösungsforschung sprechen dafür Aha- Erlebnisse als vielversprechend für motivationale Klärung, ein Wirkfaktor psychotherapeutischer Veränderung, zu sehen. Die vorliegende Studie untersucht Zusammenhänge zwischen impliziten Selbstwert und therapeutisch relevanten Aha- Erlebnissen bei Teilnehmenden, bei denen eine aktuelle oder vergangene psychische Erkrankung ausgeschlossen ist. Es konnte gezeigt werden, dass ein niedriger Selbstwert mit mehr Aha-Erlebnissen bei dysfunktionalen Einstellungen einhergeht. Dieser moderate Effekt wurde jedoch nur knapp nicht signifikant. Es wurde ein kleiner, nicht signifikanter Zusammenhang zwischen der Anzahl der Aha-Erlebnisse und einen Abfall des Selbstwerts gefunden. In Anbetracht der Limitationen der vorliegenden Studie sollte sich zukünftige Forschung der ungeklärten Frage des Einflusses von Aha-Erlebnissen auf impliziten Selbstwert widmen, sowie untersuchen inwiefern Aha-Erlebnisse anderen Klärungsprozessen darin überlegen sind, therapeutische Veränderung zu bewirken.
Schl ü sselw ö rter: Aha-Erlebnis, impliziter Selbstwert, dysfunktionale Einstellungen, Rethink- Paradigma, motivationale Klärung, Psychotherapie
Have you ever had the feeling of a light bulb being switched on in your head when suddenly something becomes clear for the first time? If so, you have experienced what has come to be known as an aha-experience or eureka-experience in scientific literature. Aha- experiences have been mainly studied in cognitive psychology for problem-solving tasks. McCrea (2010) also judges them to be “theoretically well-defined from a sociocognitive and neural perspective” (p. 30). Even though renowned psychotherapy researchers, such as Klaus Grawe advocate integrating knowledge gained from other psychological disciplines in order to further improve psychotherapy (Grawe, 2004), the aha-experience has so far not been studied regarding its relevance for psychotherapy. This is the case despite evidence gained in problem-solving research leading one to regard it as promising. Therefore, the present study examines aha-experiences regarding dysfunctional beliefs, which has not been done apart from theses of our institute (e.g. Kuhl, 2016).
To account for differential treatment outcomes when using the same standardized, evidence-based methods (Ehrlich & Lutz, 2014), psychotherapy research has, since the 1990s increasingly focused on individual patient characteristics and their interaction with therapeutic methods and working mechanisms (Lutz & Rubel, 2014). In line with this understanding, this study will look at how self-esteem as a characteristic highly relevant for psychotherapy interacts with the experiencing of therapeutically relevant aha-moments.
1.1. Theoretical Background
1.1.1. Grawe's universal working mechanisms of psychotherapy.
The more intentionally and systematically universal working mechanisms, the mechanisms causing therapeutic change, are implemented, the more successful therapy should be (Grawe, 2004). This calls for continuous research of the processes of these mechanisms and methods to bring them about. Findings stemming from problem-solving research lead us to consider aha- experiences as beneficial for motivational clarification, one of these working mechanisms.
In hundreds of studies, psychotherapy has been shown to be effective for a wide range of mental health conditions across the life span (Caspar, 2014; Hunsley, Elliot, & Therrien, 2013). Because therapeutic concepts and techniques can be very different, one might be surprised that comparisons of different forms of therapy show only moderate differences in efficacy (Luborsky et al,, 2002; Luborsky, Singer, & Luborsky, 1975; Smith & Glass, 1977).
One way to account for this seemingly implausible finding is to attribute it to the effects of universal working mechanisms, which are seen to be responsible, to a large extent, in producing outcome in psychotherapy. These mechanisms are complex processes which influence cognitive, affective, motivational, and behavioral components. They likely have such a great effect, that the changes attributable to factors specific to certain forms of therapy are often not large enough for differences in efficacy between them to be detected (Grawe, 2004, p. 18).
Grawe's (2004) model of universal working mechanisms is likely the most comprehensive and theoretically well-founded, based on hundreds of studies, and developed and improved in the course of over three decades of his psychotherapy research. He sees therapeutic success as depending on the realization of universal working mechanisms in any case, regardless of intention. They are always realized in some way, more or less successfully,
thus effectively explaining therapeutic change across schools of therapy as well as a part of the variation in therapeutic outcomes. A further part of this variation should be clarified by the interaction of patient characteristics with the implementation of working mechanisms and techniques. In order to improve the therapeutic process, more knowledge of how to best implement universal working mechanisms in therapy is necessary, as well knowledge how to strategically best fit them to individual characteristics of the patient. Grawe (2004) proposes five working mechanisms which will be outlined in the following.
1. A therapeutic relationship, in which the therapist is viewed as trustworthy and competent, is the motivational foundation from which all other mechanism take hold. If ideally realized, the patient will feel safe to and have more capacity available to be able to focus their attention on inner experiences and difficult issues even if it is uncomfortable. The therapeutic relationship interplays with other working mechanisms, for example, in that the patient will likely behave according to their habitual relationship patterns, allowing for an identification of unconscious motivation and opportunities for corrective and mastery experiences.
2. Resource activation means viewing every already existing characteristic of the patient and their life situation as a potential resource, in order to utilize them for the therapeutic process and improve the patient's well-being.
3. The working mechanism of problem actuation refers to looking for or creating situations in therapy in which problems can be experienced in a maximally realistic way. This includes involving as many modalities as possible in order to change problematic experience and behavior. The therapist must especially ensure that the patient is emotionally involved. The underlying assumption, based on the structure of memory, is, that only what is currently experienced can be changed.
4. In the working mechanism of mastery, patients receive active help for the mastery of their problems, thus better realizing their intentions. In successfully dealing with their problems, they experience an increase in self-efficacy leading to further mastery experiences independent of therapy, in which they continuously feel more competent and in control and achieve a greater fulfillment of needs and goals.
5. In motivational clarification, the patient gains more understanding of the motives behind their experience and behavior. In better understanding the experience and behavior maintaining their disorder, they are more likely to be able to change it. Of course, understanding the negative impacts of one's behavior is a step towards wanting to and being able to change it, but it does not suffice. This is because experience and behavior are, to a large extent, determined by implicit motives. Thus, without insight into why one acts the way one acts or feels the way one feels, there is no appropriate conscious behavior, including beneficial cognitions, available to change the problematic experience or behavior. Therefore, the implicit motives must first be brought into consciousness, resulting in a deeper understanding of one's own intentions and motives, such as values and fears, to then be able to voluntarily control behavior effectively with this knowledge. Understanding a process helps change the process. Of course, problem actuation also plays a role here.
But why is it so hard to clarify one's motives, to bring implicit motives into consciousness? This is due to the consistency principle, the most primary of the five needs stated by Grawe, which prevents conflicting content from gaining access into consciousness. Consistency in consciousness is a prerequisite for mental functioning. Conscious inconsistency causes a large amount of tension, a very unpleasant mental state. When incompatible motives remain implicit however, they give rise to experience and behavior that prevent the fulfillment of other needs and goals and maintain disorders.
In therapy, the avoidance of the conflicting motives entering consciousness can be overcome by the patient's strong intention to understand combined with the therapist directing the patient's attention towards the previously unconscious content. This is, nonetheless, accompanied by increased tension, but now the conflicting motives underlying problematic experience and behavior can be analyzed. In explicitly clarifying motives, the patient is able to see the conflict from new angles which ideally leads to a restructuring and integration of content that was previously conflicting, thus resolving tension more profoundly than banning content from consciousness and paving the way to more beneficial experience and behavior.
Additionally, gaining clarity is in itself a need-fulfilling experience as it addresses the need for orientation and control. What is more, clear intentions may lead to behavior, cognition, perceptions and emotions more in line with them, which results in overall better need fulfillment; the other needs stated by Grawe being the need for self-enhancement or protection of self-esteem, the increase of pleasure/avoidance of pain, the attachment need, and the consistency principle mentioned earlier. Motivational clarification also builds a foundation from which to experience mastery. The Aha-experience holds potential to aid and accelerate the successful realization of motivational clarification, which will be further elaborated in Chapter 1.1.3.
1.1.2. Dysfunctional beliefs.
Since motivational clarification is usually applied to dysfunctional beliefs, Aha-experiences regarding dysfunctional beliefs should be considered those most relevant for psychotherapy. Beliefs determine how events are perceived and interpreted, which in turn leads to certain experience or behavior (Ellis, 1991). They can be seen as the cognitive manifestation of motives such as values, goals (Ellis, 1991), evaluations, wishes and fears (Grawe, 2004). Beliefs maintaining experience and behavior in conflict with goals or sustaining disorder s are seen as dysfunctional (Ellis, 1991). It is important to mention, that while dysfunctional beliefs are especially common and wellresearched for psychological disorders, they are also present in healthy individuals, as demonstrated, for example, by Hautzinger, Joormann, and Keller (2005).
Psychological disorders can be seen as conditions resulting from an interlocked complex of mental processes, of which cognitive processes are only one aspect (Ellis, 1991; Grawe, 2004). But due to the interplay of these processes, changing one aspect may pave the way for change (Grawe, 2004). Because psychotherapy mainly involves talking, it focuses on verbal representations of experience and behavior (Grawe, 2004). Therefore, identifying, scrutinizing and changing dysfunctional beliefs is an important part of motivational clarification in many forms of therapy, for example cognitive therapy (Beck, 1979) and rational-emotive therapy (Ellis, 1991). The patient may not be fully aware of these dysfunctional beliefs but attention can be directed towards them (Beck, 1979; Ellis, 1991; Grawe, 2004). They are not necessarily internally verbalized before being expressly formulated during therapeutic procedures.
Methods of motivational clarification often aim to replace dysfunctional beliefs with more beneficial beliefs on a profound level (Gerlach, 2014; Jacob & Potreck-Rose, 2004). However, the psychotherapeutic setting is very different from the patient's everyday life in which problems are present and relies mainly on talking, thus focusing on explicit processes. Addressing only explicit processes through verbal representation may lead to little outcome regarding changes in experience and behavior, because implicit processes, which play a substantial role in the causation of experience and behavior, are likely to remain unchanged (Grawe, 2004). Aha-experiences may extend the range of possible methods involving more implicit processes when working on dysfunctional beliefs in psychotherapy, in order to bring about lasting change.
1.1.3. The aha-experience.
Insight is an important part of the working mechanism of motivational clarification. Accounts of motivational clarification or cognitive restructuring, however, do not specify how insight comes about. Insight can occur gradually, with can be visualized as slowly dimming up a light, or suddenly in a aha-moment, such as switching a light on (Danek, Fraps, von Müller, Grothe, and Öllinger, 2014).
Among others, Kuhl (2016) and Kummerant (2015) have shown, using the Rethink- paradigm also applied in the present study, that aha-experiences indeed occur when confronted with dysfunctional beliefs. The aha-experience contrasts with analytic and gradual problem solving strategies, in that it relies on nonconscious processes, not conscious reasoning (McCrea, 2010) and refers to the subjective experience of a new understanding (Schulte, 2005).
According to Danek et al. (2014)'s overview of the relevant literature, there is little agreement on a definition of the concept apart from the fact that a “solution suddenly pops into mind” (p. 2). Danek et al. (2014) therefore systematically explored the phenomenology of the aha-experience both through quantitative ratings of commonly proposed dimensions and through qualitative report of the experience. Their results show positive affect as the most important dimension and support that the experience involves emotions to a much greater extent than cognitions. The previously postulated factors suddenness, surprise (an idea comes to mind unexpectedly), and certainty of the solution are also supported by their results. The factor of impasse, also called idling or incubation phase, was shown to be less important to the concept as previously supposed and they cast doubt whether it should be used as a defining feature. They also observed a release of tension while having an aha-experience, and suggest adding it as a defining feature. McCrea (2010) furthermore characterizes the aha- experience as leading to an accurate and deep understanding of something which is often associated with a shift of paradigms. This aspect especially demonstrates the importance ahaexperiences may have on dysfunctional beliefs, which will become more clear in the following description of how aha-moments come about.
Clearly, the confrontation with a problem is a prerequisite for an aha-experience (Danek et al., 2014; Schulte, 2005). In this context “problem” can be loosely defined as a perception that invalidates previous assumptions leading to cognitive inconsistency and thereby to tension (Danek et al., 2014; Schulte, 2005). Thus being confronted with a personal dysfunctional belief can be seen as a problem that may lead to an aha-experience. For one thing, in coming to see the belief as dysfunctional and for another thing, in seeing it as false or coming up with a more beneficial alternative belief.
Having encountered a problem, both the explicit and implicit systems of information processing may become active in finding a solution in order to eliminate the inconsistency. Conscious cognitive constraints may be very pervasive, hindering explicit processes from representational restructuring of the problem complex necessary to arrive at an appropriate solution (Danek et al., 2014).
In comparison to the explicit system, the implicit system works much more associatively and can also draw on knowledge the individual is not conscious of. This can lead to the discovery of crucial details that conscious approaches are likely to miss. Because implicit processes take up less mental capacity than explicit processes, much greater masses of information can be restructured into new understandings (McCrea, 2010). When the product of this restructuring suddenly becomes conscious, the subjective experience of this moment is the actual aha-experience.
A profound representational change has occurred (Danek et al., 2014), which is experienced as a qualitative change (Grawe, 2004; Schulte, 2005). Because the problem is solved, the aha-experience is characterized by tension relief which results in positive affect. Because the new understanding was created by implicit processes, the individual is to a large extent unable to recall how they arrived at the solution or why they feel sure it is correct (Danek et al., 2014).
For the present study we included the following well-supported characteristics in the definition of the aha-experience given participants of our experiment: suddenness, unexpectedness, obviousness, certainty, and contrast to declarative, stepwise processing with inability to describe the process.
The present study wishes to take into account not only aha-moments accompanying solutions participants generated themselves, but also aha-experiences that follow stimulus presentation, as such situations are also relevant to psychotherapy. It is conceivable that the presentation of an answer may trigger restructuring in the same way, resulting in an ahaexperience. While the design of the majority of studies concerning aha-experiences involve the generation of an answer, stimulus based aha-experiences have also been researched (Kuhl, 2016; Kummerant, 2015; Luo & Niki, 2003).
Aha-experiences may be superior towards the success of motivational clarification compared to other, gradual means of gaining insight. According to Grawe (2004) “change itself materializes in the moment of the actual experiencing” (p. 75). Because aha-experiences are just that, the moment of experiencing a new understanding, more change and more lasting change in experience and behavior should be expected to follow in comparison to understanding gained without the direct conscious experience of this understanding.
Beneficial memory effects attributable to aha-experiences found in problem-solving research support this claim. Danek, Fraps, von Müller, Grothe, and Öllinger (2013) found that aha-experiences lead to a facilitation of later recall of the solution. They state that the effect has been shown for verbal as well as visual material. Aha-experiences have also been shown to facilitate transfer to new, similar problems (Knoblich, Ohlsson, Haider, & Rhenius, 1999). While it is not certain whether these results are transferable to aha-experiences regarding dysfunctional beliefs, this might be the case, as the aha-experience should lead to a well- integrated representation persisting over time regardless of the type of problem. New understandings accompanied by an aha-experience should be immediately better ingrained because they have arisen from implicit processes and have emotional as well as cognitive components, which is thought to increase processing depth (Grawe, 2004).
Not only may aha-experiences have the potential for more profound change in less time due to the factors mentioned above, they may also speed up the process of motivational clarification by giving a rationale for quick improvement. According to Grawe (2004), a consistent treatment rationale plays an important role in therapeutic success by way of inducing expectations. He states that giving patients a plausible rationale for rapid improvement and applying methods consistent with this rationale can lead to more rapid improvements. So far, most therapies have imparted that understanding takes time and have lacked an explanation to plausibly state otherwise (Grawe, 2004).
Aha-experiences may also increase motivation for therapy beyond inducing the expectation of quick change. Danek et al. (2014) found a feeling of heightened motivation for solving further similar problems in participants that had experienced an aha-moment, an effect which could also be used to motivate patients in therapy. However, this effect may be attributable not to aha-experiences themselves, but to evaluative processes occurring after the actual aha-experience.