Judith Beck (1995, p. 1) defines the Cognitive Model of emotional disorders as follows: “…the cognitive model proposes that distorted or dysfunctional thinking (which influences the client’s mood and behaviour) is common to all psychological disturbances.”
There are many misunderstandings about the role of cognition in psychotherapy, for example:
The notion that cognition is disconnected from emotion. The reality is that, except in the case of specifically abstract thought, they are intimately connected – think of the panic that instantly accompanies the thought/belief “I’m having a heart attack”.
The notion that working with cognition is somehow optional in psychotherapy practice. In fact, given that the term “cognition” refers to something very central to human experience, namely the constant processing of information that informs our responses to our world, it should feature very strongly as a focus for therapeutic change. As Aaron Beck has remarked, "If beliefs do not change, there is no improvement. If beliefs change, symptoms change.” (American Psychological Association, 108th Convention, Washington DC, August 4-8, 2000).
However, the misunderstanding I mainly want to explore in this month’s blog is the idea that cognition is superficial and shallow. The truth is that it is deep and multi-layered; below I describe the various layers where we can see cognitive processes acting.
The most basic level of information-processing is the matter of where we direct our Attention. We are only cognitively and emotionally affected by a particular aspect of our environment to the extent that we notice it, pay attention to it. A socially anxious person, for instance, tends to notice and attend to the expressions on people’s faces, scanning for any possible signs of disapproval; an alcoholic notices where the drinks are kept.
A particular focus of attention such as the above can then trigger relevant Self-talk/Automatic Thoughts. The socially anxious person might be thinking “They don’t like me, maybe I said something stupid”; the alcoholic might be thinking “I’ll never get through the evening without a drink.” Aaron Beck describes his discovery of Automatic Thoughts which “…appeared to emerge automatically and extremely rapidly…prior to experiencing the emotions” (1976, p. 33). Such automatic thoughts, which clients are normally unaware of, but which they can be trained to become more aware of, make sense of the troublesome feelings which immediately follow them. The socially anxious person’s automatic thoughts (ATs) will make them more anxious and self-conscious; the alcoholic’s AT’s will increase their craving.
However, we don’t all have the same ATs about the same situations, so our individual ATs must be influenced by certainly underlying Assumptions/Rules. These are less accessible to present-moment phenomenological awareness than ATs, but can be deduced from the way we habitually respond to situations, cognitively, emotionally and behaviourally. For instance, if the socially anxious person tends to agree with everything that other people say (like the Paul Whitehouse character in the 90s BBC TV sketch comedy “The Fast Show”), we can deduce that amongst their underlying assumptions/rules are things like “no one must dislike me” and “no one will dislike me if I don’t disagree with anyone.” Typical human Cognitive Distortions such as Emotional Reasoning, Black-and-White Thinking and Catastrophisation are also found at this level.
At a deeper level again we find our Core Beliefs/Schemas, as described in a previous blog (“A Client with a Past: Schema-based Case Formulation” - 2 June 2010):
Our earlier learning experiences leave us with deeply held ways of viewing the world, ourselves, and others, ‘templates’ through which we process current experience, and which therefore tend to be self-perpetuating and rigid in nature... These templates can be called Schemas; their contents (e.g. “I’m unlovable”, “Men can’t be trusted” etc) can be called Core Beliefs.
Core Beliefs are more unconditional than Assumptions, as the examples above show.
And finally, in a recent blog on Evolutionary Psychology at
http://psychotherapeuticnaturalism.blogspot.com/2011/03/trials-and-themes-what-makes-humans.html
I discussed the concept of “THEMAs”:
Evolutionary psychology sees human life, like that of any organism, as consisting of strategic attempts to maximise our success along various key axes, such as mating, care-giving, satisfying appetites etc… There is no definitive list (yet) of these motivational axes, but I have put together a list for myself for practical use in the therapy context, which probably covers the main areas… I find it useful to call these major themes in human life “THEMAs” (Typically Human Evolved Motivational Axes). Themas can be seen as analogous to schemas, but operating at an even deeper level, in the way that they structure our lives without us being aware of the fact most of the time. Schemas operate at the level where we are not generally aware how much they structure our experience as individuals. Themas operate at the level where we are not even generally aware how much they structure our experience as a species.
… I list below what I see as the main Themas using the mnemonic “PASTMARKS”.
Parenting
Attachment
Safety
Territory
Mating
Affiliation
Reciprocity
Kinship
Status
So there may be more to cognition than meets the eye – hopefully this has given you food for thought!
References
Beck, A.T. (1976) Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.
Beck, J. (1995) Cognitive Therapy: Basics and Beyond. New York: Guilford Press.
