Becks continuity hypothesis

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Main points Beck advanced what he calls his "continuity hypothesis" as early as 1976, when he published Cognitive Therapy and the Emotional Disorders. What he means by this phrase is that human behaviors can be placed at various points along a continuum instead of being divided sharply into "normal" and "pathological" behaviors. Beck's interest in evolutionary biology allows him to situate the continuity hypothesis within the larger framework of human evolution, and thus to describe dysfunctional attitudes and behaviors as potentially adaptive. He uses the example of a graduate student who fails an examination:

Although it is important to realize that anger [directed at the examiners] and anxiety are potentially adaptive reactions, they can become maladap-tive when we exaggerate the degree of danger or the magnitude of an offense. The student who exaggerates his vulnerability during an oral examination may find that his mind goes blank and he performs just as badly as he feared he would.

The theoretical account of personality disorders in Cognitive Therapy of Personality Disorders discusses the origin of these Axis II syndromes in terms of "evolutionary-based strategies" that may have been necessary for survival in prehistoric times but are no longer adaptive in contemporary societies. The diagnosis of a personality disorder may reflect only a "bad fit" between a given individual and our present "highly individualized and technological society," rather than a clear-cut instance of untreatable psychopathology. Or, as Beck puts it in Prisoners of Hate, "The most hypersensitive reactors among us are destined to receive a psychiatric diagnosis, which serves as a mandate to receive help in moderating the exaggerated reactions."

Beck applied his continuity hypothesis to consciousness itself as well as to emotions and behaviors. Speaking in a 1991 interview, Beck openly disagreed with Freud's notion of "a thick concrete wall of repression" separating conscious thinking and feeling from unconscious wishes and drives. "Now my own notion is that consciousness is on a continuum. Some things are more conscious than others and some are less conscious When you drive your car, you're [ordinarily] not conscious of every single move you're making, but if you're focusing on it, then you do become aware of what you're doing." Otherwise stated, for Beck consciousness is not a unitary or either/or condition, but a flexible set of responses to the environment.

Explanation Beck's continuity hypothesis has systematic as well as practical consequences. In terms of his system of thought, the continuity hypothesis provides a bridge between schemas and cognitions on the one hand and what Beck calls automatic thoughts on the other. Beck's concept of automatic thoughts, which he defines as "brief signals at the periphery of consciousness," grew out of his early work with depressed patients. One patient undergoing treatment in 1959, when Beck was still practicing traditional psychoanalysis, reported a secondary succession of thoughts that occurred while he was free-associating and angrily criticizing Beck. The thoughts concerned feelings of guilt for verbally attacking the therapist. Beck was intrigued by the patient's account of his internal monologue and began asking other patients if they had thoughts during therapy sessions that they had not mentioned. On the basis of their replies, he elaborated his notion of automatic thoughts.

In practical terms, Beck's continuity hypothesis is helpful to many patients in that it removes some of the feelings of shame and social stigma that many associate with a psychiatric diagnosis. Instead of being placed on one side of a categorical wall that separates a patient from "normal" people, he or she can think of therapy as helping him or her to move along a continuum from a more to a less extreme position on the continuum. Interestingly, many of the strategies recommended to people in therapy for dealing with the stigma attached to mental disorders are essentially cognitive techniques.

Examples Beck's continuity hypothesis is the basis of a technique that some cognitive therapists refer to as the continuum technique. It is used specifically to challenge all-or-nothing thinking. Cognitive Therapy of Personality Disorders includes an example of this technique with a patient diagnosed with paranoid personality disorder. The patient was a radiologist who had an all-or-nothing view of competence; in his own words, a person was either completely "good at what he does" or a total "screw-up." The therapist began by asking the patient to describe a competent person, and then a "screw-up." He made a list of the qualities the patient associated with competence, such as "doing hard tasks well," "being relaxed while doing them," "catching and correcting mistakes," and "knowing one's limits," and a second list of their opposites. The therapist then drew a linear scale marked from "0" to "10," and asked the patient to rate himself on the continuum for each of the qualities he associated with competency. The radiologist quickly realized that he did not see himself as very relaxed at any time, and that neither he nor anyone else can function at their peak all the time. As the patient's view of competency became less polarized, the therapist then extended the continuum technique to his view of other people as either "completely trustworthy" or "totally malevolent, just like [his] family." Gradually the patient began to recognize that people, like skills, are not all-or-nothing packages, and he began to apply the continuum technique for himself to a range of social as well as occupational situations.

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