Theoretical Components Of The Model

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Cognitive therapy is based on a contemporary understanding of the relationships among thought, emotion, and behavior. It presumes that individuals are constantly and automatically appraising the situations they encounter and that these "automatic thoughts" (immediate, spontaneous appraisals) play a central role in eliciting and shaping an individual's emotional and behavioral response to a situation. For example, if I arrive on time for an appointment with my physician and am kept waiting for a long time, i might interpret this event in a variety of ways. I could conclude "This shows how little I matter," or "This

* A number of different cognitive and cognitive-behavioral approaches to therapy have been developed in recent years. While these various approaches have much in common, there are important conceptual and technical differences among them. To minimize confusion, the specific approach developed by Aaron T. Beck and his colleagues (Beck, Rush, Shaw, & Emery, 1979) is referred to as cognitive therapy whereas the term cognitive-behavioral will be used to refer to the full range of cognitive and cognitive-behavioral approaches.

Table 9.1

Common Cognitive Distortions

Dichotomous thinking: Viewing experiences in terms of two mutually exclusive categories with no shades of gray in between. For example, believing that you are either a success or a failure and that anything short of a perfect performance is a total failure.

Over-generalization: Perceiving a particular event as being characteristic of life in general rather than as being one event among many. For example, concluding that an inconsiderate response from your spouse shows that she doesn't care despite her having showed consideration on other occasions.

Selective abstraction: Focusing on one aspect of a complex situation to the exclusion of other relevant aspects of the situation. For example, focusing on the one negative comment in a performance evaluation received at work and overlooking the positive comments contained in the evaluation.

Disqualifying the positive: Discounting positive experiences that would conflict with the individual's negative views. For example, rejecting positive feedback from friends and colleagues on the grounds that: "They're only saying that to be nice" rather than considering whether the feedback could be valid.

Mind-reading: Assuming that you know what others are thinking or how others are reacting despite having little or no evidence. For example, thinking: "I just know he thought I was an idiot!" despite the other person's having given no apparent indications of his or her reactions.

Fortune-telling: Reacting as though expectations about future events are established facts rather than recognizing them as fears, hopes, or predictions. For example, thinking: "He's leaving me, I just know it!" and acting as though this is definitely true.

Catastrophizing: Treating actual or anticipated negative events as intolerable catastrophes rather than seeing them in perspective. For example, thinking: "What if I faint?" without considering that while fainting may be unpleasant or embarrassing, it is not terribly dangerous.

Maximization/Minimization: Treating some aspects of the situation, personal characteristics, or experiences as trivial and others as very important independent of their actual significance. For example, thinking: "Sure, I'm good at my job, but so what, my parents don't respect me."

Emotional reasoning: Assuming that your emotional reactions necessarily reflect the true situation. For example, concluding that since you feel hopeless, the situation must really be hopeless.

"Should" statements: The use of "should" and "have to" statements that are not actually true to provide motivation or control over your behavior. For example, thinking: "I shouldn't feel aggravated. She's my mother, I have to listen to her."

Labeling: Attaching a global label to yourself rather than referring to specific events or actions. For example, thinking: "I'm a failure!" rather than "Wow, I blew that one!"

Personalization: Assuming that you are the cause of a particular external event when, in fact, other factors are responsible. For example, thinking: "She wasn't very friendly today, she must be mad at me," without considering that factors other than your own behavior may affect the other individual's mood.

Theoretical Components of the Model 171

shows how poor he is at managing his time," or perhaps "This shows how busy he is." My interpretation of the long wait shapes my emotional and behavioral responses. When an individual's interpretation of the situation is accurate, emotional and behavioral responses are likely to prove to be appropriate and adaptive. When the situation is misinterpreted, the individual's responses are more likely to prove dysfunctional.

According to cognitive therapy, each of us interprets experiences on the basis of beliefs and assumptions we acquired through previous experience. These include unconditional core beliefs, or schemas, such as "I don't count," conditional beliefs such as "If I speak up for what I want, no one will take me seriously," and interpersonal strategies such as "To get what I want, I have to make people take me seriously." These beliefs and assumptions lie dormant until a relevant situation arises and then automatically become active and shape the individual's responses when a relevant situation is encountered. This often occurs without the individual's being aware of his or her beliefs and assumptions.

Another aspect of cognition that can contribute to misperceptions of situations is the errors in reasoning that cognitive therapy refers to as cognitive distortions. These errors in logic (see Table 9.1) can seriously distort interpretations of events and amplify the impact of beliefs and assumptions. To continue our previous example: If I am prone to "dichotomous thinking," I will be more likely to react as though being kept waiting reveals total disregard for my feelings. This, in turn, elicits a much stronger reaction than would be elicited by a more moderate evaluation of the situation.

While the cognitive model assumes that the individual's automatic thoughts shape his or her emotional response to the situation, we also hypothesize that the individual's emotional state has important effects on cognition (see Figure 9.1). A large body of research has demonstrated that affect tends to influence both cognition and behavior in mood-congruent ways (Isen, 1984). For example, a number of studies have demonstrated that even a mild, experimentally induced depressed mood biases perception and recall in a depression-congruent way (Watkins, Mathews, Williamson, & Fuller, 1992). If negative automatic thoughts tend to elicit a depressed mood and a depressed mood biases cognition in a depression-congruent way, this sets the stage for a self-perpetuating cycle in which a depressed mood increases the likelihood of negative automatic thoughts, these negative thoughts

Beliefs and Assumptions

Automatic Thoughts

External Events

Biased Perception and Recall

Automatic Thoughts

Responses of Others

InterpersonE Behavior

Responses of Others

Figure 9.1 Cognitive-Interpersonal Cycle.

elicit more of a depressed mood, the increasingly depressed mood further biases cognition, and so on. This type of self-perpetuating cycle can perpetuate a mood and the mood's biasing effect on perception and recall until something happens to disrupt the cycle.

The cognitive model does not simply assert that dysfunctional cognitions cause psychopathology. We view cognition as an important part of the cycle through which humans perceive and respond to events and thus as having an important role in pathological responses to events. However, we view cognition as part of a cycle and as a promising point for intervention, not as the cause of psychopathology.

As shown in Figure 9.1, cognitive therapy's model is not exclusively cognitive. Rather, the cognitive model focuses on the interplay among cognition, affect, and behavior in psychopathology. The individual's beliefs and assumptions and his or her cognitive distortions shape perception of events, and the interpretation of those events shapes the individual's emotional response and interpersonal behavior, but the cycle does not end here. A person's interpersonal behavior influences the responses of others, and their responses can, in turn, result in experiences that influence the individual's beliefs and assumptions. For example, if I passively tolerate being kept waiting and my physician makes no comment about my wait, the fact that he did not apologize for keeping me waiting is likely to reinforce my conclusion that he has no regard for my feelings. However, if I comment about the long wait and my physician explains why i was kept waiting so long in a way that shows consideration for my feelings, this response may lead me to different conclusions. When an individual interacts with others in ways that elicit responses that reinforce his or her beliefs and assumptions, those beliefs and assumptions are likely to be persistent.

How does cognitive therapy's view of psychopathology apply to understanding personality disorders? If we examine the individual's momentary interpretations of events and the assumptions under which they operate, the cognitive perspective helps us understand his or her reactions in specific situations, but this does not explain the persistence of dysfunctional behavior. if we consider the way in which moods bias cognition in mood-congruent ways, we can understand how a disturbed mood and dysfunctional cognitions can persist during a particular episode, but it does little to explain the broad, persistent patterns of dysfunctional cognition and behavior that are observed in individuals diagnosed with personality disorders. However, if we also consider the impact of self-perpetuating cognitive-interpersonal cycle such as described previously, this provides one way of understanding how dysfunctional behavior can be so persistent and resistant to change.

For example (continuing the scenario discussed previously), if I conclude that my physician has no regard for my feelings and believe that I have to make people take me seriously, I am likely to react strongly to his lack of punctuality. If he responds to my tirade in a way that leaves me feeling that he understands my dissatisfaction and is taking me seriously, I am likely to be satisfied for the time being but this also reinforces my conviction that I have to make people take me seriously. If he responds in a way that leaves me feeling that he is not taking me seriously, this reinforces my conviction that "I don't count" and I am likely to redouble my efforts to make him care. If my efforts to make him care end with his refusing to continue as my physician or with my stomping out angrily, this reinforces my conviction that "I don't count" and "If I speak up for what I want, no one will take me seriously." Once one of these cognitive-interpersonal cycles is established, the individual's beliefs and assumptions tend to bias his or her perception of events. Experiences that should contradict his or her assumptions are overlooked, discounted, or misinterpreted. At the same time, his or her interpersonal behavior results in experiences that seem to confirm the dysfunctional beliefs.

The cognitive and interpersonal processes that occur in individuals who qualify for Axis II diagnoses are the same as occur in any other nonpsychotic, neurologi-cally intact individual except that, in individuals with Axis II diagnoses, strongly self-perpetuating, dysfunctional cognitive-interpersonal cycles have evolved. The cognitive view of personality disorder, is that this term is the label currently used to refer to individuals with pervasive, self-perpetuating cognitive-interpersonal cycles that are dysfunctional enough to come to the attention of mental health professionals (Pretzer & Beck, 1996).

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