Vol V, No. 1, 2005 6

5.1

Cognitive Behavior Therapy: evidence and new directions

Psychotherapy is a diffuse, complex, multi-faceted undertaking. It has been practiced and investigated for decades and much of the literature could be summarized as, “It all depends...” That is, after thousands of studies and generations of theorizing, few interventions derived from theory appear to be uniquely successful and none account for the major source of variance in client change. From the beginning, it has based its theory, practice, and research on the medical model, both for historical and professional status reasons. Freud was a physician and only after the Second World War did psychologists begin conducting psychotherapy in significant numbers in the United States. In addition, because the practice and the professional training standards for psychologists were established at that time with powerful assistance from the U.S. Veterans Administration Medical Centers, educational and training parity with physicians was important. Thus, the doctorate (at that time the Ph.D.) was set by the American Psychological Association as the entry-level degree for practice in the United States. I will use two recent and important books to demonstrate the complexity and the equivocal results of psychotherapy theory, research, practice as well as its promise for the amelioration of human distress.

Cognitive psychology research as a tool for developing new techniques in cognitive behavioral therapy. A clinical example

Cognitive behavioral therapy (CBT) is based on the premise that human psychological problems stem from maladaptive cognitions. One of the most important tools used in CBT is cognitive restructuring that aims to change maladaptive cognitions and replace them with more adaptive ways of information processing. However, maladaptive thinking patterns are sometimes so strong and automatic that they tend to persist and bias the process of acquiring new adaptive ones. The goal of this article is to illustrate the development and implementation of two cognitive techniques for blocking the impact of mental contamination during cognitive restructuring by using fundamental research findings from cognitive psychology. After a brief introduction concerning relevant aspects in the literature, we describe two techniques hypothesized to control mental contamination: (a) the rational anticipation technique and (b) the incompatible information technique. The final section of the article focuses on illustrating the implementation of these techniques based upon a clinical case conceptualization.

The role of irrational beliefs in the rational emotive behavior theory of depression

In the REBT theory of psychopathology major depression is associated with the endorsement of irrational beliefs. The present pilot study aims to extend the investigation of the major assumptions of the theory, by using a measure of IB (ABS2) that has good discriminant validity, allows the discrete evaluation of irrationality, rationality, demandingness, self-downing, frustration tolerance and awfulizing, and has been validated for the Romanian population. Subjects with major depression, subclinical dysphoria and controls were compared with regards to IBs. Results confirm that clinical depression is indeed accompanied by irrationality. Also, some IBs have been found to be associated with subclinical depressive symptoms.

Positive emotions and irrational beliefs. Dysfunctional positive emotions in healthy individuals

Since negative affect has been in the focus of attention for the entire history of psychotherapy, time has now come to turn towards cognitive factors involved in mild disturbances of positive affect. This article focuses on dysfunctional positive emotions and how they relate to evaluative cognitions and arousal. One of the basic assumptions of the rational emotive behaviour therapy (REBT) theory of emotions is that irrational beliefs lead to both positive and negative dysfunctional emotions. To date there is no empirical data investigating dysfunctional positive emotions and their relations to different types of irrational beliefs in healthy individuals. 35 subjects participated in this study. They were asked to recall a positive event in two conditions: a) pre-goal attainment condition, prompted by the instruction of recalling an event when a cue primed the anticipation of goal attainment and b) post-goal attainment condition prompted by the instruction of recalling an event and their reactions after they have met an important goal. After each experimental condition, participants completed questionnaires assessing, pre-goal and post-goal attainment positive emotions, arousal, dysfunctional positive inferences, context inappropriateness of the emotional experience, evaluative cognitions, and the ABS II scale-Romanian version. Results indicate that subjects high on demandingness have higher levels of pre-goal attainment emotions than low demanding subjects when they meet their goals, and possibly a higher level of post-goal positive emotions, when they anticipate attaining a personal goal. Also it seems that state and trait demandingness have different relations with positive emotions. We suggest that dysfunctional positive emotions can be differentiated by the context in which they are experienced, and that there are two types of dysfunctional positive emotions: a) post-goal attainment dysfunctional positive emotions referring to high levels of pre-goal attainment positive emotions after achieving personal goals, and b) pre-goal attainment dysfunctional positive emotions referring to high levels of post-goal attainment positive emotions when anticipating and moving towards goal attainment. Correlation analysis has revealed relations between evaluative cognitions, dysfunctional inferences, arousal, and dysfunctional positive emotions. Implications for positive emotions research and psychotherapy are discussed.

Demanding brain: between should and shouldn’t

Albert Ellis’ cognitive theory of emotions makes a major distinction between positive and negative demandingness and preferences, but up to now there is no scale that makes this distinction evident. The main goal of this study is to validate this distinction by showing that positive and negative evaluative beliefs are separately associated with two distinct motivational brain systems: the approach/withdrawal systems. Participants (N=46) were tested with a modified version of the ABS II scale, allowing the distinction between positive and negative evaluative beliefs; subsequently they completed the BIS/BAS scales (Carver & White, 1994). Results show that positive demandingness and irrationality, but not preferences, strongly correlate with approach system sensitivity (BAS scores), while negative demandingness and irrationality, but not preferences, strongly correlate with withdrawal system sensitivity (BIS scores). This study suggests that individuals tend to develop positive and negative demandingness depending on the approach/withdrawal motivational systems sensitivity. Implications for emotional reactions and therapy are also discussed.

A search for “hot” cognitions in a clinical and a non-clinical context: appraisal, attributions, core relational themes, irrational beliefs, and their relations to emotion

Two studies examine the hypothesized status of appraisal, attribution (study 1 only), core relational themes (study 2 only), and irrational beliefs (both studies) as proximal antecedents of emotions. In our studies, which looked at 4 pairs of functional and dysfunctional negative emotions (i.e., concern/anxiety, sadness/depression, remorse/guilt, annoyance/anger), 125 undergraduate students (study 1) and 60 psychotherapy patients reported on their appraisals, attributions, core relational themes, irrational beliefs, and emotions during past encounters with various negative events. Congruent with Smith & Lazarus’ (1993) appraisal theory, and Ellis’ (1994) cognitive theory of emotions, the results of our studies indicate that emotions (both functional and dysfunctional negative emotions) are associated with both appraisal and core relational themes, while only dysfunctional feelings are associated with irrational beliefs; the impact of attributions on emotions is mediated by appraisal. Also, irrational beliefs are strongly associated with appraisal; while demandingness (DEM) is to a higher degree associated with primary appraisal, awfulizing/catastrophizing, low frustration tolerance, and global evaluation of human worth (including self-downing) are to a higher degree associated with secondary appraisal. Dysfunctional emotions seem to involve primary appraisal associated with DEM, while functional emotions involve primary appraisal associated with preferences. These findings support to the status of appraisal, core relational themes and irrational beliefs as the proximal cognitive antecedents of emotion, and the status of irrational beliefs as discriminating factors between functional and dysfunctional emotions.