Th e original formulation of the model underlying cognitive therapy has its roots in the philosophy of Immanuel Kant (1781/1929), who argued that the mind actively
categorizes and organizes information to create representations of the external world.
Kant also introduced the concept of schemas and stated that these cognitive templates or “spectacles” fi lter reality. Th is thinking was foundational to the development of the cognitive sciences and ultimately to the cognitive psychotherapies (Nevid, 2007). Th e conceptual foundation of cognitive therapy may also be attributed to the cognitive revolution that took place in psychology during the 1950s and 1960s (Beck, 2005).
Particularly infl uential to cognitive theory were the writings of George Kelly (1955) and Albert Ellis (1962).
In the 1960s, Beck was interested in validating various psychoanalytic concepts to make them more accessible to the scientifi c community. He made depression the focus of his research. Rather than fi nding evidence supportive of the psychoanalytic formu- lation that depression was a result of anger turned inward, Beck instead documented themes of rejection, defeat, deprivation, and sensitivity to failure in the thoughts and dreams of depressed individuals. Beck also noticed that depressed mood was typically preceded by very rapid negative thoughts and that by helping people to become aware of these thoughts, test their validity, and modify unhelpful cognitions, their depression would improve (Beck, 1967, 1976). Th is research spawned the beginning developments of cognitive therapy (Beck, Rush, Shaw, & Emery, 1979).
Originally developed for the treatment of depression, cognitive therapy has now been applied successfully to a number of psychiatric conditions, including anxiety disorders (Beck et al., 1985), psychosis (Beck, Rector, Stolar, & Grant, 2008), personality disorders (Beck, Freeman, Davis, and Associates, 2004), substance abuse and dependence (Beck, Wright, Newman, & Liese, 1993), bipolar disorder (Basco & Rush, 2005), couples distress (Beck, 1988), and crisis management (Dattilio & Freeman, 1994). Th roughout these developments, there has been a consistent emphasis on how unrealistic cognitive appraisals have a negative impact on one’s emotions and behaviors.
According to Beck’s model (Beck, 1963, 1964, 1967; Beck et al., 1985; Beck et al., 1979; Clark, Beck, & Alford, 1999) the cognitive appraisal of internal or external stimuli infl uences subsequent emotional states and behavioral repertoires. Specifi c cognitive models have been developed for various forms of psychopathology, but they typically rely on the basic framework originally proposed by Beck. At a general level, this frame- work posits a taxonomy of cognition, ranging from “deeper” cognitive structures to more surface-level cognitions (Dozois & Beck, 2008; Garratt, Ingram, Rand, & Sawalani, 2007). Specifi cally, three main levels of cognition are emphasized in this theory: (a) schemas; (b) information processing and intermediate beliefs (including dysfunctional rules, assumptions, and attitudes); and (c) automatic thoughts.
At the crux of the Beck’s cognitive model is the construct of the schema. Schemas have been defi ned in many diff erent ways, with some researchers emphasizing their content (e.g., core beliefs; Young, Klosko, & Weshaar, 2003) and others focusing on both their propositional and organizational properties (e.g., Dozois, 2007; Dozois et al., 2009; Ingram, Miranda, & Segal, 1998). Th e notion of a well-organized cognitive struc- ture of stored information and memories that forms the basis of core beliefs about self
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has long been featured in the cognitive model. Kovacs and Beck (1978), for instance, defi ned schemas as cognitive structures of organized prior knowledge, abstracted from past experience, that infl uence the screening, coding, categorization, and assessment of incoming stimuli and the retrieval of stored information.
Schemas are adaptive in the sense that they allow individuals to process information in a highly effi cient manner. However, there can also be a “hardening of the categories”
(Kelly, 1963) such that assimilation dominates over accommodation (Piaget, 1947; 1950).
As such, self-schemas may become negatively biased, maladaptive, rigid, and self- perpetuating.
According to Beck, maladaptive self-schemas develop during early childhood and become increasingly consolidated when subsequent experiences are assimilated (Beck et al., 1979; Kovacs & Beck, 1978). Poor early attachment experiences and other adverse events (e.g., childhood maltreatment) are some of the early predictors of the develop- ment of a negative or maladaptive belief system (Lumley & Harkness, 2009; Gibb, Abramson, & Alloy, 2004; Ingram, 2003). Th e activity of the schema, which may be quiescent for a number of years, is later activated by adverse circumstances (often resem- bling hardships in childhood, such as loss or rejection). Th e activated schemas may then bias which information is attended to and encoded and how information is retrieved and interpreted (Beck et al., 1979; Dozois & Beck, 2008).
Schemas have often been discussed in the literature as though they are synonymous with dysfunctional beliefs, underlying assumptions or even core beliefs. Th eoretical revisions and empirical research have contributed to a clearer diff erentiation of these constructs (Beck, 1996; Dozois & Dobson, 2001b; Ingram et al., 1998; Teasdale, 1996).
Ingram et al. (1998), for example, argued that the schema concept encompasses cognitive propositions (i.e., the actual content of information that is stored in memory; namely, core beliefs and assumptions) as well as the organization and structure of that informa- tion. Th e core beliefs that are organized within an individual’s self-system are deep and absolutist statements (e.g., “I am unlovable,” “I am incompetent,” “I am worthless”) that are often not directly articulated (Garratt et al., 2007).
Core beliefs that are organized within the self-schema infl uence the development of another level of thinking, namely processing biases and intermediate beliefs (Beck et al., 1979; Clark et al., 1999). Th is may be represented as attention, memory, or interpreta- tional biases. For instance, individuals with anxiety disorders often believe that they are vulnerable and that the world is a dangerous place. Such individuals attend selectively to threat-pertinent information at the expense of information that is inconsistent with threat or information that suggests one has suffi cient resources for dealing with it. An individual with tendencies toward aggression may attend to and encode information that is consist- ent with his or her pre-existing beliefs that others are malicious or that it is a “dog-eat-dog world.” Situations in which negative events are ambiguous with regard to intent are often interpreted as being due to untoward intent (i.e., a hostile attribution bias; see Crick
& Dodge, 1994). Someone vulnerable to depression, on the other hand, may have an underlying belief that he or she is unlovable. Th is belief may become especially powerful
and reifying when negative life events occur that trigger this negative schema. Such an individual may then selectively attend to and recall information that is consistent with this negative view of self (e.g., paying attention to cues that are suggestive of being unlovable and minimizing information that is inconsistent with that belief ).
Biased thinking may also be evident in faulty interpretations, “if-then” statements, and inaccurate causal attributions (Dozois & Beck, 2008). To illustrate, an individual may believe that making a mistake is equivalent to complete failure, or that his or her self-worth is contingent upon acceptance and approval from others. Th ese dysfunctional attitudes may also be expressed as contractual contingencies (e.g., “If I fail at work, then I am a failure as a person;”see Kuiper & Olinger, 1986). Individuals adhering to such a belief may not experience emotional distress provided that they believe they are meet- ing their idiosyncratic criteria for self-worth (e.g., performing adequately at work). Yet adopting this rule will result in emotional distress when the contractual contingency is not met. Consequently, vulnerable individuals often generate personal rules and com- pensatory strategies (Young et al., 2003) for coping with negative core beliefs (e.g., “I must succeed in everything I do”).
Th e activation of an individual’s self-schema, and ensuing information process- ing biases, is also evident in more surface-level cognition, or what are referred to as automatic thoughts. Automatic thoughts pertain to the fl ow of positive and negative thoughts that run through an individual’s mind each day and are not accompanied by direct conscious deliberation. Some researchers have argued that it is the relative balance of positive to negative automatic thoughts, rather than the absolute frequency of nega- tive thoughts, that is functional or dysfunctional (e.g., Schwartz & Garamoni, 1986; for a review, see Clark et al., 1999). Automatic thoughts are often about oneself, the world, and the future—what Beck (1967) called the “cognitive triad.” Although such thoughts are more superfi cial and proximal to a given situation than are other levels of cognition, they are functionally related to one’s deeper beliefs and schemas and seem to arise associatively as diff erent aspects of one’s core belief system are activated.
Cognition is the primary focus of Beck’s theory; however, this model does not sim- ply state that cognitions cause emotions and behaviors. Instead, it is acknowledged that these variables are interrelated. Several related cognitive models have been advanced to characterize this interaction, and recent adaptations of Beck’s model (e.g., the inclusion of modes) have taken into account the complex interplay among cognitive and aff ective systems (e.g., Beck, 1996, 2008; Teasdale & Barnard, 1993). Th e cognitive model main- tains, however, that “the nature and function of information processing (i.e., the assign- ment of meaning) constitutes the key to understanding maladaptive behavior” (Alford
& Beck, 1997, p. 11).
In addition to understanding cognition in psychopathology from the perspective of levels (from schematic structure to information processing to automatic thoughts), Beck’s model also emphasizes content-specifi city (Alford & Beck, 1997; Clark et al., 1999). Th at is, diff erent patterns of cognition are purported to relate to specifi c clinical syndromes. Indi- viduals who are depressed, for instance, are theorized to have core beliefs, dysfunctional
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attitudes, and automatic thoughts related to themes of personal loss, deprivation, and failure (Beck et al., 1979). In contrast, individuals with clinically signifi cant anxiety tend to overestimate the probability of risk while simultaneously underestimating their resources for coping with potential threats. Th eir thoughts focus on themes of the self as vulnerable, the world as dangerous, and the future as potentially catastrophic (Beck et al., 1985). A per- son with paranoid personality disorder believes that others are malevolent, untrustworthy, abusive, and deceitful (Beck, Freeman, Davis, and Associates, 2004). On the other hand, an individual who experiences problems with substance abuse may have a set of core be- liefs that emphasize the self as inept, weak, trapped, or helpless. Such individuals may also engage in permission-giving beliefs (e.g., “I will just use one more time, then I will stop”) and hold particular beliefs about strategies for coping (e.g., “If I use, I can handle things better”) and about the inability to resist urges (e.g., “Even if I stop using, the craving will continue indefi nitely;” Ball, 2003).