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Emotions in cognitive therapy

Main points Beck has been criticized for paying insufficient attention to the role of emotions in treating mental disorders, although he did devote a full chapter in his landmark Cognitive Therapy of Depression to The Role of Emotions in Cognitive Therapy. One important function of emotions in cognitive therapy is that they help patient and therapist to target core symptoms for the work of therapy rather than being distracted by relatively superficial issues. A strong emotional reaction during the initial interview and history-taking is usually evidence that the therapist has touched on a core problem. Beck also recommended the use of several techniques, including imagery work, sensory awareness, and flooding, as ways to identify the patient's core issues. His interest in these techniques goes back to his treatment of depressed Korean War veterans in the 1950s. A second function served by the patient's expression of emotions during cognitive therapy sessions is stress relief, in that...

Training in cognitive therapy

Training in cognitive therapy is available to students in graduate programs in social work, clinical psychology, and psychiatric nursing as well as for medical students and practicing psychiatrists. About 20 of the 197 accredited programs in clinical psychology in the United States offer coursework in cognitive therapy. The Beck Institute The Beck Institute, which was founded in 1994 and is presently directed by Judith Beck, offers a range of training programs and workshops for mental health professionals, as well as a speakers' bureau and videoconferences. An extramural distance learning program is available for clinicians working outside North America. Books, audiotapes, and other multimedia presentations on cognitive therapy can also be ordered through the Institute. Professional organizations The Academy of Cognitive Therapy (ACT) was established in 1999 after a three-year process of consultation that involved the directors of 36 different training programs in cognitive therapy....

Depression and Cognitive Therapy

Cognitive theory and cognitive therapy originated in Beck's observation and treatment of depressed patients. Originally trained in psychoanalysis, Beck observed that his patients experienced specific types of thoughts, of which they were only dimly aware, that they did not report during their free associations. Beck noticed that these thoughts were frequently followed by an unpleasant effect. Further, he noted that as the patients examined and modified their thoughts, their mood began to improve. At the time of the emergence of the cognitive model, the treatment world was dominated primarily by the psychoanalytic model (with its heavy emphasis on the unconscious processes) and to a lesser extent by the behavioral model (with its emphasis on the behavioral processes, to the exclusion of thought). The psychoanalytic model was under attack, primarily because of a lack of careful empirical support. In contrast, behavior therapists were actively demonstrating the efficacy of their...

Associationism Cognitive Theory and Neuropsychology

The goal of a theory of memory is to explain the structures (analogous to hardware) and the processes (analogous to software) that make the system work. Explaining how such a complex system works is a massive undertaking. Many attempts have taken the form of large-scale theories, which seek to deal with all major operations of the memory systems. The major theories of memory are associationism and theories from cognitive psychology and neuropsychology. The theories differ primarily in views of the retention and retrieval functions of memory. They also differ in terms of their conception of memory as active or passive. Cognitive theory emphasizes studying complex memory in the real world it is concerned with the ecological validity of memory studies. Most of this work stems from the research of Sir Frederic C. Bartlett, who was not satisfied with laboratory emphasis on artificial memory, but rather chose to study what he called meaningful memory. Meaningful memory, he said in his book...

Applied Research in Cognitive Psychology

Consider next the topic ofdecision making, an area ofresearch in cognitive psychology loaded with practical implications. Everyone makes scores of decisions on a daily basis, from choosing clothing to match the weather to selecting a college or a career objective. Psychologists Amos Tversky and Daniel Kahneman are well known for their research on decision making and, in particular, on the use of heuristics. Heuristics are shortcuts or rules of thumb that are likely, but not guaranteed, to produce a correct decision. It would seem beneficial for everyone to appreciate the limitations ofsuch strategies. For example, the availability heuristic often leads people astray when their decisions involve the estimating of probabilities, as when faced with questions such as, Which produces more fatalities, breast cancer or diabetes Which are more numerous in the English language, words that begin with k or words that have k as the third letter Experimental subjects typically, and incorrectly,...

Practice of cognitive therapy

Cognitive therapy is a highly structured form of short-term therapy. Practitioners who have been trained at the Beck Institute or have passed the certification examination of the Academy for Cognitive Therapy (ACT) follow a standard format for treatment, which will be outlined below. Standardization is an important feature of cognitive therapy, as Judith Beck explains who practice some form of cognitive therapy. As of late 2002 there were about 350 accredited cognitive therapists in the United States. Other practitioners are graduates of doctoral programs approved by the ACT (10 as of early 2004) or have trained at centers for cognitive therapy in New York, Atlanta, Cleveland, Huntington Beach, California, or Oxford, England, but have not yet taken the ACT's certification examination. Many therapists in the United States, however, practice eclectic or integrative therapy, using techniques derived from psychodynamic psychotherapy or other orientations as well as cognitive therapy. A...

Cognitive factors personality characteristics and core beliefs

Further support to the important role played by these overlapping concepts is provided by the findings of Fortune et al. (1997) with a group of people living with psoriasis. Whilst, they found only a modest association between visibility and distress, their analyses revealed that stress resulting from anticipating negative reactions from others accounted for more of the variance in disability scores than any other disease-related factor. This finding is lent further support by qualitative research which suggests 'social vulnerability' is a key concern for those living with a skin condition (Thompson et al., 2002 Wahl et al., 2002). Further, quantitative evidence is provided by Leary et al. (1998) and Kent and Keohane (2001) who made use of the Brief Fear of Negative Evaluation Scale (FNE Leary, 1983) and found that this conceptually-related factor moderated the degree of distress experienced. Papadopoulos et al. (1999b) and Kent (2002) have also found heightened levels of...

Cognitive Therapy

Type of psychology Psychotherapy Field of study Cognitive therapies Cognitive therapy holds that emotional disorders are largely determined by cognition, or thinking, that cognitive activity can take the form of language or images, and that emotional disorders can be treated by helping patients modify their cognitive distortions. Treatment programs based on this model have been highly successful with depression, panic disorder, generalized anxiety disorder, and other emotional problems. Cognitive therapy, originally developed by Aaron T. Beck (born in 1921), is based on the view that cognition (the process of acquiring knowledge and forming beliefs) is a primary determinant of mood and behavior. Beck developed his theory while treating depressed patients. He noticed that these patients tended to distort whatever happened to them in the direction of self-blame and catastrophe. Thus, an event interpreted by a normal person as irritating and inconvenient, for example, the malfunctioning...

Cognitive psychology

Another movement in psychology undoubtedly played a big role in shaping Bandura's opinions. In the 1950s, cognitive psychology began moving to the There are several reasons why cognitive psychology became so popular in the mid-twentieth century. One was the growing dissatisfaction with behaviorism. Another was the advent of modern linguistics, which shed new light on how people learn and use language. Yet another was the birth of computer science, which led scientists to ponder the difference between human thought and machine intelligence. Around the same time, developmental psychologists such as Jean Piaget aroused new interest in the way human mental abilities unfold as children mature. Meanwhile, innovative research on verbal learning and memory gave rise to fresh insights about how memory works. All of these developments helped focus attention on the crucial role of thought processes. Of course, such processes are at the core of Bandura's ideas about how people learn and function....

Newer cognitive approaches

As its name implies, social-cognitive theory is at its best when it comes to describing social and cognitive factors. It does a particularly good job of explaining the social situations in which complex behaviors are learned and the cognitive processes by which people decide whether or not to imitate those behaviors. Bandura and his followers argue that cognitive processes are especially important to study and Social-cognitive theory arose as a reaction to behaviorism and, to a lesser extent, psychoanalytic theory. Bandura was very successful at breaking free from these earlier viewpoints. Yet critics argue that the pendulum may have swung too far in the opposite direction. Some claim that social-cognitive theory goes too far in downplaying the role of reinforcement and conditioning in affecting behavior. Others complain that the theory ignores the emotional and unconscious aspects of personality. Still other critics fault social-cognitive theory for oversimplifying cognition as well....

Selfefficacy and explanatory style

Cognitive psychology continues to evolve. As already noted, one research-oriented branch has merged with neuroscience. Another branch, with closer ties to clinical practice, has turned its attention to the cognitive styles that characterize different people. Explanatory style is the name usually given to the set of cognitive variables that describe how a person habitually interprets the events in his or her life. One example of an explanatory style is optimism versus pessimism. Although optimism is different from high perceived self-efficacy, the two concepts have some features in common.

Role of the therapist

Main points Beck describes cognitive therapy as a collaborative enterprise or collaborative empiricism. What he means by these expressions is that the therapist works together with the patient to uncover the specific underlying assumptions that trigger the patient's emotional pain and motivational difficulties. The patient brings what Beck calls raw data to the therapeutic relationship, while the therapist offers guidance in collecting appropriate data and using them in therapy. The therapist is not regarded as an expert who knows the patient's mind better than she does herself the patient is asked and expected to correct the therapist if he has misunderstood her. Beck emphasizes that the distorted cognitions involved in mental disorders are often idiosyncratic and cannot be deduced automatically from the event that has brought the patient into therapy.

Managed care and evidencebased practice

Cognitive therapy has enjoyed renewed popularity in the early twentieth-first century because of its cost-effectiveness and long-term benefits. The rise of managed care and subsequent pressures for cost containment in the treatment of psychiatric disorders have made cognitive therapy the dominant model of psychotherapy in the United States. According to a 2002 article in the Washington Post, this dominance has caused resentment among psychoanalysts and practitioners of psychodynamic therapy. The reporter concluded, Therapists feel they are being railroaded into a single school of therapeutic thinking the one supported by managed care companies, which care less about patients than about holding costs down.

Inadequate account of human emotions

A second common critique of cognitive therapy is that it focuses on cognition to the point of discounting the role of emotions in effecting change during psychotherapy. Other critics maintain that cognitive therapy is rationalistic in the sense of making a detached or common-sense attitude toward life as the implicit goal of therapy. Cognitive therapy does not, however, regard intellectual insight by itself as sufficient to bring about change, nor does it hold that all emotional distress is caused by dysfunctional thinking. A related objection to cognitive therapy's approach to the emotions is that it encourages people to trivialize painful feelings or reinterpret them in inappropriately positive ways. One commentator refers to David Burns's popular book Feeling Good as an example of this reductionism, quoting Burns on the proper way to grieve for someone's death

Realitybased depressions

For example, a person who belongs to a socially marginalized group, or who has been severely disfigured in an accident, or has a physical handicap is not necessarily being illogical or irrational for feeling pessimistic about his or her future. In addition, some well-conducted studies have challenged Beck's hypothesis that depressed people are more prone to cognitive distortions that nondepressed people. In 1979, Lauren Alloy and Lyn Abramson of the State University of New York at Stony Brook performed a series of experiments that indicated that depressed subjects judged themselves and their circumstances more accurately than those who were not depressed. This postulate is sometimes known as depressive realism. Other studies carried out between 1979 and the mid-1990s also found that most people's self-understanding is not only inaccurate but skewed in an overly positive direction. In general, most people assume they have a greater degree of control over their lives...

Becks continuity hypothesis

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 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...

Superficial view of major life changes

The short-term focus of cognitive therapy has led some observers to argue that its practitioners underestimate the hard work and suffering involved in major life changes. An example might be a junior college faculty member who recognizes that she is not going to get tenure in spite of an excellent record of publications and enthusiastic evaluations as a teacher. The external circumstances may include departmental politics, cutbacks in the number of tenured positions, older professors who do not wish to retire at the usual age, and many others. The instructor will have to make cognitive changes in the way she views herself, the world, and her place in it, but these changed cognitions are far more fundamental than correcting misperceptions or recognizing logical fallacies. In sum, major life transitions require more than merely cognitive alterations. As one of Beck's critics has put it, Courage, endurance, and the acquisition of humility may also have something to do with making the...

Inadequate utilization of the therapistpatient relationship

A frequent criticism of cognitive therapy in its early years was that it neglected the therapeutic relationship as a locus of, or impetus for, change. Most researchers who took this position were either psychoanalysts or Another factor that has led to a reappraisal of the therapeutic relationship in cognitive therapy is the extension of cognitive approaches to the treatment of the Axis II personality disorders. In contrast to Beck's straightforward statement in 1979 that cognitive therapists do not make interpretations of unconscious factors in therapy, the second edition of Cognitive Therapy of Personality Disorders makes explicit reference to the significance of the transference relationship The patient's emotional reactions to the process of therapy and the therapist are of central concern. Always alert but not provoking, the therapist is ready to explore these reactions for more information about the patient's system of thoughts and beliefs. It should be noted, however, that the...

Structures of human cognition

Beck defines cognitive therapy as an active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders . . . . based on an underlying theoretical rationale that an individual's affect and behavior are largely determined by the way in which he structures the world. According to Beck, the cognitive organization of the human mind consists of various levels of verbal or pictorial events that vary among themselves in terms of Schemas. Schemas are cognitive structures based on a network of core beliefs established by a person's early learning experiences. They operate below the level of conscious awareness, and are dormant until they are activated or triggered by specific events. The schemas then serve as filters or screens that determine the person's interpretation of the event. Schemas form interlocking sets that Beck calls systems. In cognitive therapy, it is a system that governs the sequence of events that begins with the person's reception and...

Simplistic and techniqueoriented

One of the most common criticisms of cognitive therapy is that it is superficial and consists of a cookbook or mechanical approach to psychotherapy. This line of criticism gathered force after 1979, when Beck published Cognitive Therapy of Depression. The book offered therapists an explicit description of the course of therapy, from a discussion of the structure of the therapeutic interview and a session-by-session outline of the treatment of a depressed patient to explanations of therapeutic homework and ways to focus on target symptoms. Beck's critics, however, used the book to argue that cognitive therapy is too technique-oriented, focuses too narrowly on short-term symptom reduction, underestimates the level of skill required to be a competent therapist, and oversimplifies the complexity of patients' problems. The cost-control emphasis of managed care has intensified this particular criticism of cognitive therapy. Practitioners of psychodynamic therapy in particular have...

Recent discoveries in cognitive science

That were made in the 1980s and 1990s do not support Beck's notion of a close relationship between cognitions and emotions. The first such discovery was made in the course of so-called split-brain research. Split-brain research refers to studies carried out with epileptic subjects who have had a commissurotomy. In this procedure, the neurosurgeon cuts the corpus callosum, a band of tissue that carries nerve impulses between the two cerebral hemispheres, in order to control the patient's seizures. The researchers discovered that the human mind is not a unified entity, but consists of modules operating independently of one another. The parts of the brain that govern emotional states may have little to do with the parts that process information. What split-brain studies indicate is that consciousness cannot be an exact mirror of what is going on in the brain. Yet consciousness plays a central role in the theories underlying cognitive therapy. Another area of research that raises...

Selfhelp groups and bibliotherapy

Another historical factor that has favored the growth of cognitive therapy since the 1970s is the rapid proliferation of self-help groups and the growing popularity of self-help books. Bibliotherapy, or the use of books to help people solve problems or train themselves in such techniques as those used in cognitive therapy, has become widely used since it was first discussed in the early 1980s. In addition, the Twelve Steps of Alcoholics Anonymous (AA) and similar groups (Al-Anon, Overeaters Anonymous, Gamblers Anonymous, etc.) have been described in the psychiatric literature as a form of cognitive restructuring that helps uncover the distortions of stinkin' thinkin' and the emotional problems associated with addictions. Beck has contributed to the self-help movement both theoretically and practically. His theoretical contribution lies in his emphasis on the collaborative aspect of the therapist patient relationship and the therapist's role in teaching the patient techniques for...

Behaviorist criticisms

The earliest criticisms of Beck's work came from behaviorist psychologists, particularly Joseph Wolpe and B. F. Skinner, on the grounds that cognitive therapy is a form of mentalism, which may be defined as the belief that mental processes are autonomous and cannot be explained by an organism's behavior. Behaviorists have also criticized Beck for departing from basic science in his use of self-report paper-and-pencil questionnaires and his inability to demonstrate that cognitions are anything more than conditioned behaviors. Behaviorist critiques of Beck since the 1970s have generally focused on the uneasy relationship between cognitive therapy and behavior therapy. Most criticisms of cognitive therapy, however, have come from practitioners of psychoanalysis and psychodynamic psychotherapy.

Principal Publications

Cognitive Therapy and the Emotional Disorders. New York International Universities Press, 1976. Cognitive Therapy of Depression. New York The Guilford Press, 1979. Cognitive Therapy in Clinical Practice An Illustrative Casebook. London and New York Routledge, 1989. Cognitive Therapy with Inpatients Developing a Cognitive Milieu. New York Guilford Press, 1992. Cognitive Therapy of Substance Abuse. New York Guilford Press, 1993. The Integrative Power of Cognitive Therapy. New York and London Guilford Press, 1998. Scientific Foundations of Cognitive Theory and Therapy of Depression. New York John Wiley, 1999. Cognitive Therapy of Personality Disorders, 2nd ed. New York The Guilford Press, 2004. Early depression studies Beck developed cognitive therapy almost by accident in the course of his growing discontent with Freudian psychoanalysis. As a practicing therapist, Beck was aware that academic psychologists whose work he respected questioned Freud's account of depression because of the...

Historical Context

Edward Tolman was one of the early converts to behaviorism and like Watson, rejected the notion of introspection and inner processes for determining behavior. He was firmly committed to working only with those behaviors that were objective and accessible to observation. Tolman is recognized as a forerunner of contemporary cognitive psychology, and his work had a great impact, especially his research on problems of learning. Some of his core principles were later used by Skinner and other behaviorists.

Previous dominance of the psychoanalytic model

Beck's dissatisfaction with the psychoanalytic method and his gradual divergence from Freudian presuppositions resulted in a period of professional isolation and some loss of grant funding. He later remarked, One colleague at Penn told me cognitive therapy was like treating malaria with an electric fan. During this period Beck relied primarily on his wife and on Gerald Davison, a psychologist at the State University of New York at Stony Brook, for feedback and support. Another source of encouragement was Albert Ellis, who had also begun his career in therapy as a psychoanalyst, become disenchanted with the Freudian mainstream, and developed his own form of psychotherapy-rational-emotive behavioral therapy or REBT. Ellis first wrote to Beck in 1963 after reading one of his articles in the Archives of General Psychiatry. The two men have continued to communicate with each other and exchange ideas ever since. Beck even underwent a session of REBT with Ellis, hoping to cure his lifelong...

Marriage and family

Beck's daughter Judith became a clinical psychologist and presently serves as director of the Beck Institute for Cognitive Therapy and Research in Bala Cynwyd, Pennsylvania, which was founded in 1994. She has published several books of her own on cognitive therapy and oversees training programs for cognitive therapists at the Institute.

In the classroom

Teachers who understand Piaget know that the very young student learns through trial and error and needs access to a diversity of objects for manipulation. As the child becomes older and has progressed into the concrete-operational stage, a teacher influenced by Piaget's theories will know to present the child with problems of classification, ordering, location, and conservation. Teachers facilitate cognitive development by providing activities that engage learners, challenge their existing beliefs, and stimulate adaptation to new levels of understanding. Teachers applying Piaget's insights will make the learning environment interesting with support for exploratory activity and peer interactions, and keep the focus on projects that require solutions to reallife, practical problems.

Historical Overview

The scientific study of psychology is a much more recent development, however. Many historians date the birth of modern psychology from the founding of the first experimental psychology laboratory by Wilhelm Wundt in 1879. As a science, then, psychology is still relatively young. Yet, over the course of little more than 120 years, it has managed to make a tremendous impact on both the academic world and society at large. Psychology has given rise to influential schools of thought ranging from psychoanalysis to behaviorism, and from Gestalt psychology to cognitive psychology. Lewin soon developed his own theory, known as field theory, first published in 1935. It stood out from earlier approaches that had focused single-mindedly on either internal mental processes or external rewards and punishments. Instead, Lewin's theory stressed the interaction of the person and the environment. In this way, it anticipated some popular approaches of the late twentieth century, such as Bandura's...

Case studies

The case studies that follow illustrate both the broad application of the principles underlying cognitive therapy and their accommodation to different DSM-IV diagnoses. Cognitive therapy in treating depression Beck's Cognitive Therapy of Depression presents a summary of a typical course of cognitive therapy requiring 2004 Publishes Cognitive Therapy of Personal Disorders, second edition. Cognitive therapy in treating wife battering Beck discusses the case of R, whom he describes as a typical wife batterer, in Prisoners of Hate. R was abused by his parents in his childhood and teased by other boys in his peer group. He viewed the world as filled with antagonistic people lying in wait for an opportunity to pounce on him. Although R had a comfortable relationship with his wife most of the time, any criticism from her or pressure to do chores around the house would activate his dysfunctional beliefs that mild pressure from her meant total domination, and that criticism meant rejection and...


Effectiveness of cognitive therapy Beck's research orientation is reflected in the fact that cognitive therapy is commonly regarded as the most rigorously studied kind of talk therapy, according to one report. As of late 2002, cognitive therapy had been evaluated in at least 325 clinical trials. The Beck Institute conducts ongoing research projects, its most recent being an examination of the effects of stress reactivity and coping style on depressed patients being treated with cognitive therapy. Judith Beck and one of her associates at the Beck Institute published a study in 2000 of 14 meta-analy-ses of the effectiveness of cognitive therapy. Their findings may be briefly summarized as follows Comparison of cognitive therapy with antidepressant medications. Cognitive therapy was found to be somewhat superior to medications in the treatment of unipolar depression in adults. Follow-up studies a year after the end of treatment indicated, however, that only 30 of the patients treated...

Treatment Approaches

Ture, and that they interpret their experiences in a distorted fashion so as to support these pessimistic views. A related cognitive model of depression is that of Martin E. P. Seligman. He argues that depression results from the perception that one is helpless or has little or no control over the events in one's life. Seligman has shown that laboratory-induced helplessness produces many of the symptoms of depression. Cognitive therapy for depression, which Beck described in 1979, aims at helping depressed patients identify and then change their negative and inaccurate patterns of thinking.

Sources for Further Study

Shaw, and G. Emery. Cognitive Therapy of Depression. 1979. Reprint. New York Guilford Press, 1987. Summarizes the cognitive theory of depression and describes how this model can be applied in the treatment of depressed patients. Beutler, Larry E., John F. Clarkin, and Bruce Bongar. Guidelines for the System See also Bipolar Disorder Cognitive Behavior Therapy Cognitive Therapy Depression Diagnosis Drug Therapies Mood Disorders Suicide.

Theoretical and Methodological Approaches

To understand cognitive psychology, one must be familiar not only with the relevant questions the topic matter of the discipline but also with the approach taken to answer these questions. Cognitive psychologists typically employ an information-processing model to help them better understand mental events. An assumption of this model is that mental activities (the processing of information) can be broken down into a series of interrelated stages and scientifically studied. A general comparison can be made between the information processing of a human and a computer. For example, both have data input into the system, humans through their sense organs and computers via the keyboard. Both systems then translate and encode (store) the data. The computer translates the keyboard input into electromagnetic signals for storage on a disk. People oftentimes translate the raw data from their senses to a linguistic code which is retained in some unique human storage device (for example, a...

Changing the Patients Mind

The goal of cognitive therapy is to assist the patient to evaluate his or her thought processes carefully, to identify cognitive errors, and to substitute more adaptive, realistic cognitions. This goal is accomplished by therapists helping patients to see their thinking about themselves (or their situation) as similar to the activity of a scientist that they are engaged in the activity of developing hypotheses (or theories) about their world. Like a scientist, the patient needs to test his or her theory carefully. Thus, patients who have concluded that they are worthless people would be encouraged to test their theories rigorously to determine if this is indeed accurate. Further, in the event that the theories are not accurate, patients would be encouraged to change their theories to make them more consistent with reality (what they find in their experience). A slightly different intervention developed by Beck and his colleagues is to help the patient identify common cognitive...

Therapeutic Techniques

Finally, cognitive therapy has been applied to a variety of psychological disorders with striking success. For example, studies from seven independent centers have compared the efficacy of cognitive therapy to antidepressant medication, a treatment of established efficacy. Comparisons of cognitive therapy to drugs have found cognitive therapy to be superior or equal to antidepressant medication. Further, follow-up studies indicate that cognitive therapy has greater long-term effects than drug therapy. Of special significance is the evidence of greater sustained improvement over time with cognitive therapy. Cognitive therapy has been successfully applied to panic disorder, resulting in practically complete reduction of panic attacks after twelve to sixteen weeks of treatment. Additionally, cognitive therapy has been successfully applied to generalized anxiety disorder, eating disorders, and inpatient depression.

Clinical Data Raising the Problem of Hemispheric Asymmetries in Emotional Processing

Damaged patients to disruption of a center for negative emotions located in the right hemisphere. sis of a different hemispheric specialization for positive and negative emotions has been restricted to the level of emotional expression by Davidson 24,25 , who, in the most recent version of this model, assumes that only the generation (and not the comprehension) of positive and negative emotions may be lateralized to the anterior parts of the left and of the right hemisphere, respectively. In any case, a critical analysis of these new models requires a more theoretically motivated approach to the emotional system, its organization and its relationships with the cognitive system. An illustration of the theoretical grounds necessary to understand the recent developments of studies on hemispheric asymmetries in emotional representation will therefore be discussed next.

Relationships Between the Automatic Controlled and the Unconscious Conscious Dichotomies

Coming back from the methods to the theoretical models, we can say that the debate on unconscious processes took a new turn in the 1960s and 1970s, with the end of behaviorism and the advent of a strong, scientifically based cognitive psychology, since information processing models necessitated unconscious processing stages 72 . In particular, a basic distinction was introduced in research on attention, between automatic vs. conscious 73 or automatic vs. controlled 74 information-processing,

Quality of Life Assessment

- An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a wideranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their

Clinical Considerations

It is clear that psychotherapy today cannot do without the emotional participation of the therapist in the interaction with the patient. The state referred to variously as identification, empathy, sharing, syntony, tuning in, mirroring, or resonance holds top rank in this therapeutic process. This does complicate the therapist's task, but at the same time it raises thorny methodological problems in research, especially when negative emotions are involved-as so often in pathological processes-from which not only the patient but the therapist too tends to keep their distance.

Negative Cultural Stereotypes

In spite of these scientific data, many heterosexuals (especially men) still harbor negative feelings about homosexuality. This phenomenon is called homophobia. Some of this fear, disgust, and hatred is attributable to the incorrect belief that many homosexuals are child molesters. In fact, more than 90 percent of pedophiles are heterosexual. Another source of homophobia is the fear of acquired immunodeficiency syndrome (AIDS). This deadly, sexually transmitted disease is more easily transmitted through anal intercourse than through vaginal intercourse and thus has spread more rapidly among homosexuals than heterosexuals. Education about safe sex practices, however, has dramatically reduced transmission rates in homosexual communities.

Ongoing sociocultural factors

Acquiring a skin condition in later life can also be distressing and attract negative reactions from others. Adolescence is a particularly sensitive time for the development of self-concept (see Richardson, 1997, above). Experiencing distress on acquiring a skin condition later in life has been hypothesised (Kent & Thompson, 2002) to be related to either the confirmation of existing predisposing underlying negative beliefs, or to discrepancies arising between existing positive self-beliefs and actual self, as predicted by self-discrepancy theory (Higgins, 1987). As such, the personal value (appearance schemas) one previously attributed to one's appearance may be a critical factor for some in dictating the degree of discrepancy and the consequential distress experienced.

Intelligence and Environment

Theories of intelligence are still grappling with the issues of defining its nature and composition. Generally, newer theories do not represent radical departures from the past. They do, however, emphasize examining intelligence in relation to the variety of environments in which people actually live rather than to only academic or laboratory environments. Moreover, many investigators, especially those in cognitive psychology, are more interested in breaking down and replicating the steps involved in information processing and problem solving than they are in enumerating factors or settling on

Impact Of Travel On Relationships

Passengers who have been abroad for extended periods may find returning home a stressful experience and as demanding as arriving in any 'new' unfamiliar environment, a phenomenon referred to as 'reverse culture shock'. Homesickness can also lead to emotional arousal. This may be characterised by obsessional thoughts about home and negative thoughts about the new environment, accompanied by low mood. Travellers should acknowledge their nostalgia and develop skills to ensure that they achieve appropriate social support. They should, however, endeavour to create involvement with and a degree of commitment to the new environment, and should engage in physical activity. Travellers should ensure that they develop an awareness of likely 'high-risk' situations that are likely to evoke feelings of homesickness (van Tilburg et al., 1996). Similarly, travellers who return from long periods abroad often feel a longing for the country they have left, causing significant levels of stress....

Repression A Cognitive Neuroscience Approach

In this chapter, I review a program of research that I have been pursuing now for over a decade that may reconcile these dissociated views. A central strategy I have pursued has been to consider how repression might be understood in terms of mechanisms that are widely studied in cognitive psychology and cognitive neuroscience. To this end, I have focused on a well-specified question what are the mechanisms by which human beings willfully control awareness of unwanted memories, when confronted with reminders to them Although my colleagues and I view this question through the lens of cognitive psychology, the situation bears a strong resemblance to repression. Thus, a better understanding of memory control may provide both the theoretical and empirical grounding necessary to make repression a scientifically tractable problem. The resulting theory may not be identical to Freudian repression, but it clearly speaks to the situations characterized by Freud. First, I describe our general...

Respondent Conditioning and Reinforcement

Ated with the experience evoke unsettling feelings. The person reduces the unpleasant feelings by avoiding bodies of water. In this example, negative feelings are conditioned according to Pavlovian principles. The avoidance reaction is maintained by (negative) reinforcement and involves instrumental learning. Virtually all the previous examples can be analyzed similarly.

On the Distinction Between Suppression and Repression

If Erdelyi's scholarship and historical analysis are correct, this suggests that the psychoanalytic field may need to reconsider the distinction between repression and suppression, at least to the extent that it is intended to reflect Freud's views. Moreover, Erdelyi's analysis suggests that work with the think no-think procedure fits Freud's ideas of repression well. This certainly seems true from Freud's own statements. If so, then work with the think no-think procedure provides a tractable way to scientifically evaluate the existence and properties of repression, laying the groundwork for a theoretical synthesis of this idea with well-established constructs within the field of cognitive psychology and cognitive neuroscience.

Which Therapy Is Best

Researchers approach the question of which therapy is best in the context of specific disorders. No one therapy is recommended for every disorder. For instance, behavior therapy has proven to be highly successful with phobias, cognitive therapy shows good results with depression, and a trial of medication is usual for schizophrenia and bipolar disorder.

Integrated Approaches

Chemtob, Tolin, van der Kolk, and Pitman (2000a) outline the EMDR process in an eight-step process. Step one includes taking a patient's history, and, in addition to traditional clinical assessment, the EMDR clinician identifies trauma memories considered suitable targets for treatment. In the next stage, preparation, information about EMDR is provided, along with the teaching of coping skills for general functioning, for dealing with emergent traumatic material, and for keeping perspective when the trauma is reactivated. Following the preparation stage, in the assessment stage, the patient is asked to bring together the components of the traumatic memory in a structured manner (p. 141), including identifying distressing images, negative thoughts, and alternative positive thoughts rating the validity of the positive thoughts rating the subjective level of distress and identifying physical sensations as they occur. The fourth stage of the procedure is identified as desensitization and...

Types of Support and Link These Types with Network Members

By the third session, members may understand that the group members, in effect, provide support to each other. During this session, members will learn to identify different types of support and who the most appropriate provider is for a particular type of support. A first exercise may have members discuss a situation in which they needed or sought support from someone in their network over the previous week. Each situation can be discussed in terms of whom they called upon (i.e., brother, spouse, friend, social services), what specific help was needed (type of support), and what the outcome was (support provided, not provided). Ask members to say how they felt when they asked for and received the help. In this session, it may be helpful to acknowledge that sometimes asking for help evokes shame or anger or other negative emotions from the recipient. These feelings must be dealt with. The facilitator may discuss ways of handling these negative emotions. For example, when there is...

Evolution of Theoretical Development

During the 1970's, psychology had grown increasingly cognitive. This development was reflected in Bandura's 1977 book Social Learning Theory, which presented self-efficacy theory as the central mechanism through which people control their own behavior. Over the following decade, the influence of cognitive psychology on Bandura's work grew stronger. In Social Foundations of Thought and Action, he finally disavowed his roots in learning theory and renamed his approach social cognitive theory. This theory accorded central roles to cognitive, vicarious, self-reflective, and self-regulatory processes. Social learning social cognitive theory became the dominant conceptual approach within the field of behavior therapy. It has provided the conceptual framework for numerous interventions for a wide variety of psychological disorders and probably will remain popular for a long time. Bandura, its founder, was honored with the Award for Distinguished Scientific Contributions to Psychology from...

Integration Of Neuropsychology Into Psychiatric Research

Although both psychiatry and neuropsychology are concerned with the identification of abnormal behavioural patterns, historically there has been surprisingly little interaction between the two disciplines. The development of neuropsychology under the influence of pioneers such as Luria, Reitan, Halstead and Rey began in the 1950s and 1960s at a time when academic psychiatry was moving away from biological theories towards social and psychoanalytical models of mental functioning. While in psychiatry unconscious conflicts and social pressures were given priority over the CNS as causes of morbidity, neurobiologists had begun to question the notion of equipotentiality which had assumed that higher mental functions were diffusely represented throughout the cortex. Thus the way was opened for the integration of early models of information processing derived from experimental research in cognitive psychology. Clinical neurology also provided the cases of highly localized cerebral lesions...

Stress Reduction and Coping

Research with twins has found that temperament is largely inborn however, any individual can choose to be more optimistic, generous, and patient. Norman Cousins is often cited as an example of a person who decided to change his outlook and mental state in order to preserve his life. He had read Selye's The Stress of Life (1956), which describes how negative emotions can cause physical stress and subsequent disease. Cousins, who had a rare and painful illness from which he was told he would likely never recover, decided that if negative emotions could harm one's health, then positive emotions could possibly return one's health.

Study and Measurement

Although the study of thought did not originate in psychology, cognitive psychology is primarily dedicated to the study and measurement of thought processes. cognitive psychology Cognitive psychologists study many processes basic to human nature and everyday life. Mental processes are central to who people are, what they do, and how they survive. In cognitive psychology, the study of thought necessitates its measurement. For example, much effort has been put forth in cognitive psychology to study how people understand and process information in their environment. One popular approach is to use the idea of a human information-processing system, analogous to a computer. Computers are information-processing devices that use very specific instructions to achieve tasks. A computer receives input, performs certain internal operations on the data (including memory operations), and outputs certain results. Cognitive psychologists often use the information-processing metaphor in describing...

Transference and the Unconscious

Freud was also the first to understand and describe the concept of transference, the patient's positive or negative feelings that develop toward the therapist during the long, intimate process of analysis. These feelings often relate to earlier ones that the patient has had for significant others namely, mother, father, or sibling. The analysis of transference has become extremely important to neo-Freudian analysts, particularly as it relates to the treatment of borderline and other personality disturbances.

Two Clinical Vignettes

Since his brother, who was two-and-a-half years younger than he, had died about 10 years before, he found that saying his name out loud enabled him to urinate. He was devoted to his brother and was aware of no negative feelings towards him. He was heartbroken when he died. His younger brother had been chroni

Horowitzs Cognitive Analytic Approach

The next phase of treatment involves helping the patient improve his or her future coping style. These words are italicized because this treatment approach addresses the patients functioning in response to both current and anticipated stressors on the part of the patient-realistic or otherwise. It is explained that thoughts about the event or events are being inhibited and can be experienced in a dose-by-dose approach with specific controls rather than global inhibitions (Horowitz, 2001, p. 193) being utilized to cope. As defensive functioning is reduced, negative emotions will emerge but within the context of tolerable limits. If these experiences are too overwhelming, Horowitz (2001) suggests adding desen-sitization procedures for relaxation and self-control. Maladaptive defenses should give way to more consciously controlled and adaptive controls. Defensive operations such as inhibition of thought, suppression of emotion, distortion of reality,

Compare Alexithymia And Coping Style Between People With Ms And Other People

Altabe, M., & Thompson, J.K., (1996). Body image a cognitive self-schema construct. Cognitive Therapy and Research, 20, 171-193. Cash, T.F., & Labarge, A.S. (1996). Development of the appearance schemas inventory a new cognitive body-image assessment. Cognitive Therapy and Research, 20, 37-50. Leventhal, H., Diefenbach, M., & Leventhal, E. (1992). Illness cognition using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 143-163. Papadopoulos, L., Bor, R., & Legg, C. (1999b). Coping with the disfiguring effects of vitiligo a preliminary investigation into the effects of cognitive-behavioural therapy. British Journal of Medical Psychology, 72, 385-396.

The Self as a Regulator of Individual Processes

Albert Bandura, the American founder of social cognitive psychology, conceptualizes the person as part of an interactive triad consisting of individual, behavior, and environment. Like radical behaviorism, social cognitive theory assumes that all human behavior is ultimately caused by the external environment. However, Bandura also describes individuals as having cognitions with which they regulate their own behavior, through the establishment of guiding performance standards. His idea of the self-system consists of internal motivations, emotions, plans, and beliefs which are organized into three processes self-observation, judgmental processes, and self-reaction. In self-observation, the individual consciously monitors his or her own behavior and describes it. Through judgmental processes, values are placed on the observations, according to personal standards internalized from past experience and comparisons to others. The self-reaction is the self-system's way of punishing,...

Sleep Disorders Narcolepsy

Dream Disorders

Sturzenegger and Bassetti collected the dream reports of 57 narcolep-tics with cataplexy and compared them with those from patients with nonnarcoleptic hypersomnia and from normal controls 56 . The dreams of narcoleptics more often included such contents as flying, being chased, crawling in a tube, monsters and the presence of persons in the patient's room (sensed presence). Moreover, dream reports from narcoleptics contained more negative emotions such as sorrow, anger, fear, guilt, disgust and disdain. No link was found between emotions in the dreams and emotions triggering cataplectic attacks.

Psychological Models of Abnormality

A cognitive model, stemming from American psychologists Albert Ellis and Donald Meichenbaum, American psychiatrist Aaron Beck, and others, finds the roots of abnormal behavior in the way people think about and perceive the world. People who distort or misinterpret their experiences, the intentions of those around them, and the kind of world where they live are bound to act abnormally. The cognitive model views human beings as thinking organisms that decide how to behave, so abnormal behavior is based on false assumptions or unrealistic situations. For example, Sally Smith might react to getting fired from work by actively searching for a new job. Sue Smith, in contrast, might react to getting fired from work by believing that this tragedy is the worst possible thing that could have happened, something that is really awful. Sue is more likely than Sally to become anxious, not because of the event that happened but because of what she believes about this event. In the...

Cognitive and Behavioral Treatments

Aaron Beck and Marjorie E. Weishaar (1989) provide an excellent definition of cognitive therapy Cognitive therapy is based on a theory of personality which maintains that how one thinks largely determines how one feels and behaves. The therapy is a collaborative process of empirical investigation, reality testing, and problem solving between therapist and patient. The patient's maladaptive interpretations and conclusions are treated as testable hypotheses. Behavioral experiments and verbal procedures are used to examine alternative interpretations and to generate contradictory evidence that supports more adaptive beliefs and leads to therapeutic change. (Beck & Weishaar, 1989, p. 229) Cognitive-behavioral therapy. For our purposes, CBT can be understood as any treatment that utilizes any combination of either behavior therapy or cognitive therapy. Most therapies from this perspective appear to be more CBT than either pure behavioral or cognitive. Some pioneers...

Cognitive Behavioral Therapies for PTSD

Cognitive Therapies Cognitive therapy Cognitive Therapies Traditional cognitive therapy was developed for treating depression, but adaptations for Anxiety Disorders and PTSD have been developed (Clark, 1986 Frank et al., 1988 Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998). Rothbaum et al. (2000a, b) report that cognitive therapy for PTSD has been shown to be effective for reducing posttraumatic symptoms in two well-controlled studies. Cognitive therapies are combined with exposure therapy. Its unique contribution is to focus on the identification and modification of target core dysfunctional cognitions (Moore, Zoellner, & Bittinger, 2004, p. 132). These dysfunctional cognitions and cognitive processes include disruptions in Janoff-Bulman's (1992) fundamental assumptions about a safe and meaningful world (Moore, Zoell-ner, & Bittinger, 2004, p. 130). Disruptions in Epstein's four beliefs that the self is worthy, people are trustworthy, the world is benign, and the world...

Theoretical Influences

An initial exposition of social learning theory was presented in Bandura and Richard H. Walters's text Social Learning and Personality Development (1963). This formulation drew heavily on the procedures and principles of operant and classical conditioning. In his later book Principles of Behavior Modification, Bandura placed much greater emphasis on symbolic events and self-regulatory processes. He argued that complex human behavior could not be satisfactorily explained by the narrow set of learning principles behaviorists had derived from animal studies. He incorporated principles derived from developmental, social, and cognitive psychology into social learning theory.

Psychosocial impact of skin diseases

Feelings of anxiety, uncertainty and helplessness are often cited by dermatology patients as accompanying the diagnosis of their skin condition. Without the knowledge of when or how the condition will develop, the patient may be left wondering about what behaviours or actions might be contributing to its progression. Moreover, dermatology patients experience heightened self-consciousness, which, in turn, has negative implications for interpersonal interactions and relationships. Research has shown that self-consciousness is a common reaction amongst acne patients (Kellett & Gilbert, 2001). Papadopoulos et al. (1999b) found a significantly high frequency in irrational, negative thoughts among vitiligo patients.

Role of the Clinical Psychologist in Thyroid Cancer

Following referral, the clinical psychologist would offer the patient a comprehensive assessment. On the basis of assessment the patient may be offered a course of therapy (e.g. cognitive therapy, interpersonal therapy, brief psychotherapy). If therapy is not deemed appropriate, advice on management may be offered to the referrer. Psychological therapy would be based on the patient's idiosyncratic needs, but may focus on preparing for and coping with treatment re-establishing roles following treatment overcoming depression addressing marital and sexual difficulties living with ongoing surveillance and threat of recurrence.

Structural Psychotherapy

Structural psychotherapy is a cognitive behavioral approach that derives from the work of two Italian mental health professionals, psychiatrist Vit-torio Guidano and psychologist Gianni Liotti. These doctors are strongly persuaded by cognitive psychology, social learning theory, evolutionary episte-mology, psychodynamic theory, and cognitive therapy. Guidano and Liotti suggest that for an understanding ofthe full complexity ofan emotional disorder and subsequent development ofan adequate model ofpsychotherapy, an appreciation of the development and the active role of an individual's knowledge of self and the world is critical. In short, in order to understand a patient, one must understand the structure of that person's world. Guidano and Liotti's therapeutic process utilizes the empirical problemsolving approach of the scientist. Indeed, the two suggest that therapists should assist patients in disengaging themselves from certain ingrained beliefs and judgments and in considering...

Clinical Approaches to Memory Disorders

Visual cues, such as tying a string around one's finger or knotting one's handkerchief, are traditional and effective ways to improve prospective memory. Cognitive psychology has demonstrated the importance of emotional factors how and why something is learned to the effectiveness of memory. It has provided the research base to demonstrate the effectiveness of study strategies such as the SQ3R (survey, question, read, recite, review) technique. Cognitive theory has also shown that metamemory, a person's knowledge about how his or her memory works, may be important for the improvement of memory. Associationism, cognitive psychology, and neuropsychology can each explain some of the structures and processes involved in these and other real-world problems, but it seems as though none of the theories is sufficient by itself. Memory is such a complex phenomenon that it takes all the large-scale theories and a number of smaller-scale ones to comprehend it. The truth probably is that...

Models of Emotional Lateralization Based on the Componential and Hierarchical Organization of Emotions

The comprehension and expression of emotions through the facial or vocal channels of emotional communication have been extensively investigated both in brain-damaged patients (BDP) and in normal subjects (see 31, 32 for reviews). Studies conducted in BDP have consistently shown that patients with right-sided lesions are often impaired in recognizing emotions expressed through tone of voice and or facial expression and in the capacity to express emotions with the prosodic contours of speech or through expressive facial movements 33, 34 . On the other hand, investigations conducted in normal subjects (see 35 for review) have allowed a better testing of the hemispheric specialization hypothesis and have tended to give more support to the right hemisphere dominance than to the different hemispheric specialization hypothesis. They have, indeed, usually confirmed the general dominance of the right hemisphere for communication of both positive and negative emotions. Results of these...

Stigma and Discrimination

Finally, the most insidious form of stigma may exist within persons with mental illness themselves. When society reduces access to good jobs, and staff people give subtle or overt messages of doubt about a person's ability to perform on the job, these negative beliefs can be internalized (Rehab Brief, 1993). This self stigma may be the hardest form of stigma to detect and is often the most difficult form of stigma to overcome (Ritsher, Otilingam, & Grajales, 2003 Ritsher & Phelan, 2004).

Cognitive and Stress Theories

A different approach to understanding depression has been put forward by cognitive theorists. According to Aaron Beck, in Cognitive Therapy and the Emotional Disorders (1976), cognitive distortions cause many, if not most, of a person's depressed states. Three of the most important cognitive distortions are arbitrary inference, overgeneralization, and magnification and minimization. Arbitrary inference refers to the process of drawing a conclusion from a situation, event, or experience when there is no evidence to support the conclusion or when the conclusion is contrary to the evidence. For example, an individual concludes that his boss hates him because she seldom says positive things to him. Overgeneralization refers to an individual's pattern of drawing conclusions about his or her ability, performance, or worth based on a single incident. An example of overgeneralization is an individual concluding that he is worthless because he is unable to find his way to a particular address...

Basic Principles of Behavior and Cognitive Behavioral Therapy

Cognitive therapy is built on an information-processing model of psychology, viewing pathology as a consequence of systematic biases in the processing of information. (See Chapter 5 for more detail on cognitive models of PTSD.) In essence, the mediating role of thinking between stimulus and behavior is the critical point of change and alteration in cognitive therapy. Errors in thinking and the processing of information, be it environmental or more internal in nature, are the targets of therapy. Many different concepts and terms are used to characterize and describe thinking and dysfunctional cognitions in cognitive therapy, such as schemas, automatic thoughts, conditional assumptions, mal-adaptive cognitions, and cognitive distortions. Different classes of mental disorders are characterized by a specific type of cognitive errors. For example, depression is characterized by a negative view of self, the world, others, current experience, and the future. Panic Disorder is characterized...

Introduction and Overview of Treatment

The chapters that follow will introduce both psychological interventions in the classic sense and psychobiological interventions such as psychopharmacolog-ical interventions. With the ultimate goals of removing or at least reducing symptoms and their sequelae, each intervention can be understood in terms of the level of biopsychosocial functioning it operates on. For example, pharmacological treatment may operate at the level of neurochemical processes in the brain, but it still seeks to relieve one's subjective sense of vigilance and fear. Cognitive therapy may operate on the level of unconscious and automatic thought processes and content. The former operates at the most fundamentally reduced level and the latter at a more abstract and psychological level. Each level of therapy carries with it at least two sets of goals, the specific goals relevant to the model of treatment (thoughts, chemicals, behavior, etc.) and the broad goals of cure or reduction of PTSD.

Psychosomatics and the Future

Cognitive and health psychologists have, particularly since the 1970's, tried to determine the degree to which cognitive psychotherapy interventions can boost immune system functioning in cancer patients. They have also used behavioral and cognitive therapy approaches to alter the attitudes and behaviors of people who are prone to heart disease and strokes, with considerable success. In the near future, they can be expected to focus their efforts on two major fronts. The first will involve further attempts to identify the psychological factors which might increase people's propensity to develop psychosomatic disorders. The second will involve continuing efforts to develop and refine the therapeutic interventions intended to reduce the damage done by psychosomatic disorders, and possibly to prevent them entirely.

Quantum Psychology and the New

In cognitive therapy this is called mind reading. Simply put, if I believe nobody likes me, I project that you don't like me, and then I act as if this mind reading were the truth. Often times, people as children develop this cognitive distortion as a way to handle their parental situation. Mind-reading Mommy's or Daddy's wants could certainly help a child to please them and survive. The child learned that mind reading and pleasing an alcoholic or abusive parent might be a way to keep the peace. Unfortunately, as the child becomes an adult he takes this mind reading with him on automatic. The adult, with this mechanism running, will mind read, unknowingly, the present-time situation, as if it were the threatening past.

Cytokines in depression and anxiety

There is mounting evidence that both depression and depressive symptoms can induce immune dysregulation by the production of proinflammatory cytokines including IL-6 (Maes et al., 1998). Similar responses in chronic anxiety with the production of IL-6 and reduced IL-2 receptor production (which is an essential cytokine to counter infection) was deemed a factor in increased URTI episodes (Ravindran, 1995). Persistent elevation of pro-inflammatory cytokines may lead to chronicity in disease, poor healing and increased disability (Leventhal et al., 1998). It seems, therefore, that negative emotions can directly affect the immune system to up or down regulate the response via inflammatory cytokines. This affects not only immediate reaction to the challenge of infection, but also the mechanisms of inflammatory disease.

Physiological Basis of Memory

Theories of learning and memory have been of great concern to philosophers and psychologists for a long time. They have formed a major part of the history of psychology. Each of the theories has been ascendant for a time, but the nature of theory building requires new conceptions to compensate for perceived weaknesses in currently accepted theories and models. Associationism was the principal theory of memory of stimulus-response psychology, which was dominant in the United States until the mid-1950's. Cognitive psychology evolved from Gestalt psychology, from Jean Piaget's work on developmental psychology, and from information-processing theory associated with the computer, and was extremely important during the 1970's and 1980's. Neuropsychology developed concurrently with advanced technology that permits microanalysis of brain functioning. It has resulted in an explosion of knowledge about how the brain and its systems operate.

Research On Coping And Adjustment Among African Americans

Gil, Williams, Thompson, and Kinney (1991) found that among patients with sickle cell disease, negative thinking and passive adherence were associated with more severe pain, less activity, and distress. These passive coping strategies were also associated with more health care services utilization. The results of this study suggest that passive adherence to prescribed treatments and rehabilitation regiments is not always good. The person should assume some degree of control over his or her treatment. Control over treatment within the medical and rehabilitation environment is likely to be especially difficult for some African Americans, who may feel intimidated by higher-status professionals. However, these skills can be learned, and strategies for gaining these skills will be discussed in chapter 8.

Automatic Thoughts and Schemata

Two concepts of particular relevance to cognitive therapy are the concepts of automatic thoughts and schemata. Automatic thoughts are thoughts that appear to be going on all the time. These thoughts are quite brief only the essential words in a sentence seem to occur, as in a telegraphic style. Further, they seem to be autonomous, in that the person made no effort to initiate them, and they seem plausible or reasonable to the person (although they may seem far-fetched to somebody else). Thus, as a depressed person is giving a talk to a group of business colleagues, he or she will have a variety of thoughts. There will be thoughts about the content of the material. There is Beck has suggested that although automatic thoughts are occurring all the time, the person is likely to overlook these thoughts when asked what he or she is thinking. Thus, it is necessary to train the person to attend to these automatic thoughts. Beck pointed out that when people are depressed, these automatic...

Depression Research

Many research projects since the 1970's have examined the effectiveness of cognitive and behavioral treatments of depression. Beck and his colleagues have demonstrated that cognitive therapy for depression is superior to no treatment whatsoever and to placebos (inactive psychological or medical interventions which should have no real effect but which the patient believes have therapeutic value). In addition, this research has shown that cognitive therapy is about as effective as both antidepressant medications and behavior therapy. Similarly, Lewinsohn and others have shown the effectiveness of behavior therapy on depression by demonstrating that it is superior to no treatment and to placebo conditions.

Working memory

Cognitive psychology is that branch of psychology concerned with human mental activities. A staggering array of topics fit under such a general heading. In fact, it sometimes seems that there is no clear place to end the catalog of cognitive topics, as mental operations intrude into virtually all human endeavors. As a general guideline, one might consider the subject matter of cognitive psychology as those mental processes involved in the acquisition, storage, retrieval, and use of information.

Cognitive Contexts

In the 1950's, a number of forces came into play that led to the reemer-gence of cognitive psychology in the United States. First, during World War II, considerable research had been devoted to human-factors issues such as human skills and performance within, for example, the confines of a tank or cockpit. After the war, researchers showed continued interest in human attention, perception, decision making, and so on, and they were influenced by a branch of communication science, known as information theory, that dealt abstractly with questions of information processing. The integration of these two topics resulted eventually in the modern information-processing model, mentioned above. Working memory emerged as an important theoretical construct in the 1980's and 1990's. Everyday cognitive tasks such as reading a newspaper article or calculating the appropriate amount to tip in a restaurant often involve multiple steps with intermediate results that need to be kept in mind temporarily...

Smiths Chapter

Having said that, it is important to recognize that such arguments are rarely, if ever, resolved by critical experiments in the muddy scientific waters that are experimental cognitive psychology. On the one hand, the structure of the arguments does not necessarily afford critical experimental tests. Smith argues, for example, that preparatory attention is not always evoked (but must be for successful prospective remembering), and that it is not necessarily accessible to awareness, even when it is operating. So awareness cannot be, by this argument, a criterion for attention allocation. On the other hand, interpretation of empirical results depends on a number of auxiliary assumptions in both cases, and these assumptions are difficult to disentangle from the tests themselves. It is difficult to prove that automatic cue detection has not occurred, because the costs Smith bases her study on are at best


As the concept of a direct, simple linkage between environment and behavior became unsatisfactory in the late twentieth century, the interest in altered states of consciousness helped spark new interest in consciousness. People are actively involved in their own behavior, not passive puppets of external forces. Environments, rewards, and punishments are not simply defined by their physical character. There are mental constructs involved in each of these. People organize their memories. They do not merely store them. Cognitive psychology, a new division of the field, has emerged to deal with these interests.

Treatment Methods

A second effective approach to the treatment of depression can be found in cognitive therapy. It has become clear that altering cognitions and behavior in a cognitive behavioral format can relieve an ongoing episode of depression and may reduce the likelihood of relapse further than the use of psychopharmacology alone. Thus, cognitive processes are, at a minimum, reasonable targets of intervention in the treatment of many depressed patients. In addition, cognitive therapy appears to work well at decreasing depressive symptomatology even in the context of ongoing marital discord. Thus, for many depressed patients, interventions targeted at altering dysfunctional, negative automatic thoughts are likely to be useful.

Physical Access

Another necessity for physical access is that the patient be able to actually get and use the therapy, meaning in most instances a prescription from a doctor, a local pharmacy or mail-order service, and a means to pay. The prescription requirement obviously means that a physician or other licensed prescriber must agree that the patient needs the therapy. The pharmacy must stock the medicine or be willing to get it. Some prescribers will not prescribe, and some pharmacies will not dispense, a necessary medicine or amount of medicine. Chronic severe pain and the opiate drugs used for it are common examples of this problem, especially for terminally ill patients who may require unusually high dosages. Another example is ethically or politically controversial treatments, e.g., morning-after contraceptives that are already on the market but which some health professionals will not recommend, prescribe, or dispense because of their personal beliefs or values. Finally, the patient must learn...

Visceral responses

An emotion is avalenced experience that is felt with some degree of intensity, involves a person's interpretation of the immediate situation, and is accompanied by learned and unlearned physical responses. Emotions are transitory states, and they have five characteristics. First, emotions are experiences, not specific behaviors or thoughts. Although thoughts can sometimes lead to emotions, and behaviors can sometimes be caused by emotions, an emotion is a personal experience. Second, an emotional experience has valence, meaning that the emotion has a positive or negative quality. Because emotions have valence, they often motivate people toward action. People tend to seek activities, situations, and people that enhance their experience of positive emotional states, and they tend to avoid situations that are connected with the experience of negative emotions.

Assessment Measures

In addition to measures of specific emotions, researchers have developed methods for assessing emotional intensity. Emotional intensity refers to the strength with which a person experiences both positive and negative emotions. It has been found that people who are emotionally intense report a feeling of well-being as exuberance, animated joy-fulness, and zestful enthusiasm. On the other hand, people who score low on a measure of emotional intensity experience a state of well-being as serenity, contentment, tranquil calmness, and easygoing composure.

Gender Schema

Gender-schema theory is a way of explaining gender-identity formation, which is closely related to the cognitive developmental approach. The concept of a schema or a general knowledge framework comes from the field of cognitive psychology. Sandra Bem proposed that each person develops a set of gender-linked associations, or a gender schema, as part of a personal knowledge structure. This gender schema filters and interprets new information, and as a result, people have a basic predisposition to process information on the basis of gender. People tend to dichotomize objects and attributes on the basis of gender, even including qualitites such as color, which has no relevance to biological sex.


Social cognition is not only thinking about the contents of someone else's mind. The automatic translation of the folk psychology-inspired boxology-endorsed by functionalism and by some quarters in cognitive science-into newly formed brain modules specifically dedicated to mind-reading abilities should be carefully scrutinized. Looking for the brain location of intentions as such might not be the best epistemic strategy for revealing what social cognition really is. A more promising and potentially fruitful strategy lies in the integration of multiple approaches (from genetics and molecular biology all the way up to neu-rophysiology, brain imaging and cognitive psychology) to the study of the role played in social cognition by the sensorimotor systems of primate brains.

Cluster B

Tive and negative feelings about significant people in their lives. This behavior is referred to as splitting and may contribute to the emotional instability displayed by these people. People with BPD often engage in self-destructive behavior, such as self-mutilation, suicidal acts, or drug abuse. Those with BPD report chronic feelings of emptiness.

Group therapy

Specifically, CBT is gaining credibility as a psychological treatment in the management of skin condition. Data from the studies reviewed are generally supportive of its efficacy as an approach, which can be used as an adjunct to medical care (Ehlers et al., 1995 Papadopoulos et al., 1999 Fortune et al., 2002, 2004). Findings have shown that cognitive techniques produced reductions in the frequency of cognitions concerning itching, catastrophizing cognitions (Ehlers et al., 1995), and in beliefs about the consequences and the emotional causes of disease, and were maintained at 6 month and at 1-year follow-up. Research has also shown that relaxation is an important component of CBT and it has proved most effective in decreasing anxiety levels among dermatology patients (Ehlers et al., 1995 Zacharie et al., 1996). These data suggest that high anxiety levels often observed in these patients can be reduced with treatment and that treatment effects can be maintained even after a 1-year...

Personality Types

Also noted that people with certain personality characteristics are more likely to develop cancer, are more likely to develop fast-growing cancers, and are less likely to survive their cancers, whatever the cause. These personality characteristics include repression of strong negative emotions, acquiescence in the face of stressful life situations, inhibition, depression, and hopelessness. Encounters with uncontrollable stressful events appear to be particularly related to the development or course of cancer. In addition, some research suggests that not having strong social support systems may contribute to the development or affect the outcome of cancer.


Because the hyperreactivity of the Type A behavior pattern is thought to be at least partially genetically based, there are probably some limits on what can be done to reduce the incidence of coronary heart disease resulting from physiological hyperreactivity. There is, however, much that can be done in other areas. Persons who are prone to such disorders can be taught to exercise properly, eliminate unhealthy dietary practices, and reduce or quit smoking. Of particular interest to psychologists is the opportunity to help these individuals by teaching effective coping strategies, stress management, values training, behavior modification to control Type A behaviors, and cognitive control of depression and other negative emotions. Efforts by psychologists to help the Type C personality might focus on as-sertiveness training and altering the person's belief that it is not appropriate to display strong negative emotions, such as anger or frustration. Teaching the Type C person to fight...


The self is a term that is widely used and variously defined. It has been examined by personality theorists as a central structure. Social cognitive psychology has explored the individual and interpersonal processes that influence such dimensions as self-systems, self-concept, self-consciousness, and self-efficacy. Recent research has challenged psychology to rethink its concept of the self.

Hormonal Treatments

If treatment is unsuccessful with a SRI or a second-line psychotropic agent, hormonal therapies should be considered. Spironolactone, a diuretic and steroid antagonist, has been shown to reduce premenstrual bloating, weight gain and negative emotions. Oral contraceptives are frequently used for treatment of mild to moderate premenstrual symptoms. There are several open trials supporting the efficacy of an oral contraceptive containing drospirenone, a progestogen that is also an analogue of spironolactone, for moderate to severe premenstrual symptoms.

Child Abuse

Finally, alterations in self-concept or self-perception require treatment to focus on techniques that help children connect to immature and inaccurate self-perceptions that they hold (Friedrich, 1996, p. 113). Initially, the focus may be on identifying and understanding feelings and emotions followed by activities and techniques designed to boost self-efficacy and a sense of competency, sometimes referred to as mastery tasks. Michael White suggests a technique called externalizing the problem in which the child learns to talk about him- or herself instead of as him- or herself. Finally, various cognitive techniques are used to address distorted cognitions.

Goal Setting

We can also set cognitive and affective goals, along with behavioral or action-oriented goals. For example, an affective goal may be to decrease one's negative thinking pattern following an aversive situation. If I don't get a job, I will be able to control my anxiety (affective goal) and not view myself as worthless (cognitive goal). As with behavioral self-efficacy, strategies can be used to increase cognitive and affective self-efficacy by identifying cognitive and affective goals (Maddux & Lewis, 1995). Cognitive and affective subgoals, along with behavioral subgoals, can be used to reach larger goals. For example, one affective subgoal may be to repeat an affirmation to oneself each day. Another may be to think about a pleasant experience whenever one starts to feel anxious.

Assessing Risk

Beck and his colleagues developed the Hopelessness Scale in 1974 to assess an individual's negative thoughts of self and future. In many theories of suicide, an individual's sense of hopelessness is related to risk for suicide. Beck and others have demonstrated that hopelessness in depressed patients is a useful indicator of suicide risk. For example, in 1985, Beck and his colleagues reported a study of 207 patients who were hospitalized because of suicidal thinking. Over the next five to ten years, fourteen patients committed suicide. Only one demographic variable, race, differed between the suicide and nonsuicide groups Caucasian patients had a higher rate of suicide (10.1 percent) than African American patients (1.3 percent). Of the psychological variables assessed, only the Hopelessness Scale and a measure of pessimism differed between suicide victims and other patients. Patients who committed suicide were higher in both hopelessness and pessimism than other...

Quantum Exercise

I'd like you to develop an image, or let an image come to you, of a spiritual, religious, or political symbol. Notice what positive or negative feelings you have about the symbol. Then expand your awareness and find the emptiness prior to the emergence of that symbol. Let another symbol come up into your awareness. Notice the image, good or bad, and find the empty space that symbol came from. Now let another symbol come up to your awareness. Notice the energy, and find the empty space that

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