followed by a decrease as the thought is repeated until it becomes boring (Freeston, et al., 1997). Attempts to suppress emotions (or thoughts) confi rm the belief that emotions cannot be tolerated, similar to the confi rmation of beliefs about suppressing intrusive thoughts. Acknowledging repeatedly that one has an emotion—by enhancing conscious acceptance—is a form of exposure to recognizing, accepting, and tolerating the emo- tion, and disconfi rms the belief that an emotion must be eliminated lest the individual go insane.
per se or the mediating mechanisms involved. For example, it is not clear if emotional schema therapy is as eff ective as traditional cognitive or behavioral models, nor is there evidence as to which kinds of patients and problems would be particularly amenable.
However, the empirical data thus far suggest that emotional schemas play a mediating role in a variety of pathological states and processes, and may therefore help bridge the apparent divide between the diff erent “waves” in CBT. For example, the putative role of emotional schemas in mediating mindfulness, acceptance, experiential avoidance, and anxiety suggests that mindfulness and acceptance may aff ect how emotions are inter- preted and, thereby, result in a reduction of anxiety. Similarly, modifying beliefs about emotions may obviate the reliance on worry as a strategy to avoid emotions, thereby modifying the metacognitive factors underlying the process of worry. It may be that the various theoretical approaches described in the current volume each contain an element of the important truth that pathological processes interact iteratively and simultane- ously, and that no one model captures the entire “truth.”
FUTURE DIRECTIONS
One of the diffi culties in predicting the future is being anchored in the present. It is un- likely that psychodynamic theorists in 1960 would have been able to predict accurately the cognitive revolution that gained momentum in the 1970s. And it is equally unlikely that cognitive theorists in the 1990s would have predicted the rise in popularity of ACT, DBT, or MBCT in recent years. While acknowledging the value of these contributions, a recent meta-analysis suggests that so-called “third wave” approaches have yet to establish effi cacy equivalent to more established cognitive-behavioral interventions (Öst, 2008). Of course, science is continually advancing, and the much-needed research to meet the stringent criteria of “empirically supported studies” for these approaches may soon be available.
One trend that seems to be gaining some momentum is focused on transdiagnostic processes that appear to transcend specifi c categorical approaches to psychopathology (Barlow et al., 2004; Harvey, Watkins, Mansell, & Shafran, 2004). Th e newer cognitive models of psychopathology now focus both on the content of schematic processing and on the individual’s evaluation of the process of thinking. For example, recent approaches to cognitive therapy for schizophrenia include both consideration of the content of delusional thinking (and how this content functions) and also on metacognitive aware- ness of the nature of intrusive thinking or delusions (Beck, et al., 2009). Similarly, the role of avoidance, and strategies and beliefs that contribute to avoidance, appears to have gained signifi cance among cognitive therapists. Th e key question—perhaps from a cognitive perspective—is what is learned (or not learned) through avoidance? Indeed, extinction and exposure involve some “cognitive” mediation, insofar as they change expectancies. Perhaps current controversies pitting “experience” against “cognition”
will turn out to be similar to the unnecessary dichotomization of emotion and think- ing in the classic debates between Zajonc and Lazarus (Lazarus, 1982; Zajonc, 1984).
For some, the “chicken or egg” question may never be reconciled, although for others the either/or framing of the question is unnecessary. Indeed, the irony in resolving the
“debate” between the primacy of one over the other approach may be resolved by invok- ing a much-maligned, but newly resurrected, concept that has gained respectability in neuroscience—namely, unconscious processing (Bargh, Gollwitzer, Lee-Chai, Trötschel,
& Barndollar, 2001; Gray, 2004; Hassin, Uleman, & Bargh, 2005). Perception and cat- egorization can occur outside the realm of conscious awareness and can have emotional impact. Th us, the dichotomy between thinking and feeling may be reconciled if we include nonconscious thinking—that is, nonconscious thinking may result in emotional responses.
Humans are arguably the only animal with the capacity for metacognitive awareness, perhaps accounting for the complexity of the pathology that emerges from their trouble- some theories of mind and their reliance on worry as a coping strategy (Geary, 2005).
However, research in neuroscience suggests that diff erent areas and functions of the brain are activated when the individual employs diff erent strategies for emotion regula- tion, in some cases relying primarily on the hippocampus and amygdala (Bottom-Up) while in other cases (Top-Down Processes) relying on the prefrontal cortex and related areas (Cahn & Polich, 2006; Lazar, et al., 2000; Quirk, 2007). Future research, utilizing neuroimagining technologies such as fMRI, may help clarify how mediating processes of acceptance, mindful awareness, cognitive restructuring, metacognitive processes, and emotional schemas are refl ected in diff erent (or similar) brain functions.
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