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The understanding of delusions, while historically focused on neuropsychological deficits, can be approached from the same cognitive perspective as that applied to other forms of psychopathology. The cross-sectional analysis of delusional thinking shows several cognitive characteristics: egocentric bias (irrelevant events are construed as self-relevant); externalizing bias (strong internal sensations or symptoms are attributed to external agents); and intentionalizing bias (other people’s behaviors are believed to be based on intentions—usually malevolent—towards the patient). In addition, defective reality testing precludes reevaluation and rejection of erroneous conclusions. Consequently, cognitive distortions such as selective abstraction, overgeneralization, and arbitrary inferences are prevalent. From a developmental perspective, grandiose delusions appear to arise from earlier daydreams of glory, serving as a compensation for feelings of loneliness, inadequacy, and inferiority. The daydreams become increasingly real to the patient until they become overt delusions. Persecutory delusions typically begin as a fear of retaliation or discrimination. Because of attentional bias, these fears receive pseudoconfirmation until they become fully formed beliefs that preempt normal information processing and displace more realistic beliefs.
- Go to article: Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy
Aaron T. Beck’s Cognitive Therapy (CT) and Albert Ellis’ Rational Emotive Behavior Therapy (REBT) are compared. A major difference between these therapies is that CT is an empirically based therapy and REBT is philosophically based. The origins and subsequent development of the therapies are reviewed with this difference highlighted. Comparisons between CT and REBT practice are made regarding attitudes toward client beliefs, use of guided discovery, types of cognition addressed, and the nature of the client-therapist relationship. The scientific foundations of CT are summarized in terms of the specificity of its conceptual models, the construction of targeted treatment protocols, and empirical findings that support both CT conceptualizations and treatments.
- Go to article: Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
These authors appreciate Ellis’ clarification that he encourages REBT therapists to use many of the same principles and methods used by CT therapists. His assertions that many of these elements are done more frequently or thoroughly in REBT than in CT are best evaluated by objective observers via empirical analysis of therapy transcripts, session videotapes, and treatment manuals. Such research would have particular value if it linked therapy methods with treatment outcome and relapse prevention for particular problems. In this regard, Ellis’ recommendation that REBT become more empirical is welcome. Also, these authors clarify the distinction they make between the terms philosophical and philosophically-based; empirically responsive and empirically-based. Finally, the authors applaud Ellis’ major contributions to the field.
This article elaborates on the construct of dysfunctional vulnerability schemas in Obsessive-Compulsive Disorder (OCD)(Sookman & Pinard, 1995,1999; Sookman, Pinard, & Beauchemin, 1994). These schemas are conceptualized as a central mechanism of excessive threat appraisals proposed to be the predominant cognitive problem in anxiety (Beck, 1996; Beck & Clark, 1997). Four domains of beliefs are hypothesized to comprise vulnerability in OCD: Perceived Vulnerability; View of/Response to Unpredictability, Newness, and Change; View of Strong Affect; and Need for Control. A study carried out with 111 subjects indicated that OCD patients more strongly endorsed these beliefs compared with patients with other anxiety disorders, mood disorders, and normal controls. The discriminant function derived from these four belief domains was effective in classifying OCD patients and other subjects into their respective groups. The results support the inclusion of dysfunctional vulnerability beliefs in cognitive assessment and treatment of OCD.
The poor reality testing and the thinking disorder in schizophrenia may be attributed to a deficiency in cognitive resources related to the neurobiological deficiencies. Recent therapy and research have demonstrated that, far from being a bizarre psychologically incomprehensible phenomenon, schizophrenia can be understood within our conventional conception of human nature. This humanizing trend is especially evident in the cognitive approaches to this disorder. Research has established that there is a continuum from normal experiences of paranormal beliefs, hallucinations, thinking problems, and withdrawal to their counterpart in schizophrenia. The kinds of biases in schizophrenia are also evident in common social problems such as prejudices and ethnocentrism as well as in interpersonal strife. Dysfunctional attitudes about attachment and performance in schizophrenia form the infrastructure for persecutory delusions and negative symptoms, respectively. Grandiose delusions, on the other hand, are shown to be an overcompensation for a sense of loneliness, inferiority, and vulnerability.
- Go to article: Stability and Change of Sociotropy and Autonomy Subscales in Cognitive Therapy of Depression
Sociotropy and autonomy have been demonstrated to be a diathesis for depression as well as predictors of treatment outcome. There are few studies, however, that have investigated whether these vulnerability factors change with cognitive therapy (CT) and are associated with outcome in CT. Also, it appears that the autonomy construct may have both positive and negative content and it is important to examine these two aspects of autonomy in treatment. In this study, depressed outpatients (N = 149) were followed from intake to the 12th session of CT. The treatment outcome variables included depression (Beck Depression Inventory), hopelessness (Beck Hopelessness Scale), and sociotropy and autonomy (Sociotropy-Autonomy Scale [SAS]). Using a repeated measures analysis, depression symptoms and hopelessness decreased significantly over time. Both subscales of sociotropy, preference for affiliation and fear of criticism and rejection, were positively associated with depression at intake, and decreased significantly over time in those who responded to treatment. However, independent goal attainment, one subscale of autonomy, increased significantly over sessions and was associated with treatment response. The second subscale of autonomy, sensitivity to others’ control, demonstrated no change. The results suggest that independent goal attainment may be an indicator of psychological health. Implications for future research using the SAS and its subscales in treatment and vulnerability research are described.