Monday, July 16, 2012

The Cognitive Model

Cognitive Therapy is based on the so-called cognitive model - a theory that conceptualizes emotions and behaviors as resulting from the content of people's thoughts. Instead of seeing situations as triggers for emotions and behaviors, thoughts are seen as the mediator between situation and reaction.

All of us have thoughts rattling around in our heads all of the time. After all, the brain's job is to think. We are not aware of all of these thoughts - if we were, we would never be able to focus on anything! And, not all of our thoughts are "true" or "accurate" - that is not a natural property of the human brain.

When we experience... well, anything, triggers a series of "automatic thoughts" - whatever words or images begin running through our minds. We may be aware of these thoughts...but we may not. According to the cognitive model, these thoughts produce our emotions and behaviors (of which we are more likely to be aware).

A starting point of CBT is often teaching clients to identify automatic thoughts. In fact, some symptom improvement can happen very quickly when a client starts to identify automatic thoughts. This happens because identifying the thoughts begins to unearth cogntive distortions. By recognizing distortions and ceasing to accept distorted thoughts as Truth, they lose some of its power over emotions and actions.

The cognitive model does not stop there, however. It asks: where are these automatic, distressing and/or distorted thoughts coming from? The answer provided by the cognitive model is that automatic thoughts arise from another category of thoughts: beliefs.

We all develop beliefs about ourselves, other people, and the world we live in, beginning in early childhood. Some of these beliefs are so fundamental to how we view...everything...that we see them as absolute truths. The cognitive model calls these "core beliefs." We may not be consciously aware of our core beliefs - they are kind of like the water fish swim in. However, they have a significant impact (like water does for fish): situations can activate core beliefs, which then shape our perception and interpretation of the situation. In fact, we tend to filter incoming information to accept information that fits the core belief, while discounting anything that contradicts our belief.

The way that core beliefs influence our perception, interpretation, and response to a situation is through what is called "intermediate beliefs." This category includes our attitudes, assumptions, and rules. Attitudes are evaluative statements ("It would be terrible if..."), assumptions tend to be "if...then..." statements, and rules are "shoulds" (or musts, or oughts). These intermediate beliefs arise from core beliefs, either as logical extensions thereof, or as attempts to cope with a painful core belief (often that one is inadequate and/or unloveable): I am inadequate so I need to work harder than everyone else. I am unloveable, so I should expect rejection. Etc.

If CBT begins with automatic thoughts, it's only a matter of time before beliefs start popping up. Themes may start to appear among automatic thoughts that cause distress. Some thoughts may even be direct expressions of a belief. These beliefs then become the substance of therapy - evaluating their usefulness (pros/cons), examining evidence for and against, and considering possible modification or replacement of unhelpful beliefs. Of course, this is not nearly as easy as it sounds, but a full description of the process is beyond the scope of this post.

So, this, then, is the cognitive model: early life experiences shape core beliefs, which give rise to intermediate beliefs. A given situation activates relevant beliefs, resulting in automatic thoughts, which in turn shape emotions and behaviors. Changing automatic thoughts can lessen distressing emotions and maladaptive behaviors, while changing core beliefs can prevent the automatic thoughts in the first place.

Do you buy into the cognitive model? How do you use it, or why do you not? What seems useful and less useful about it?

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