Cognitive theories of emotional disorder - summary of chapter 4 of Cognition and emotion: from order to disorder

Cognition and emotion: from order to disorder
Power, M. & Dalgleish, T. (2015).
Chapter 4 
Cognitive theories of emotional disorder

Introduction

There are a number of influential cognitive approaches toe motion that have their starting points to be disorders of emotion.

Cognitive approaches to the emotional disorders have typically focused on a specific disorder.
This carving up of the emotional disorders can lead to a false sense of disjointedness between the emotions in comparison to the more over-arching theories.

Seligman’s learned helplessness theory

Learned helplessness

The role of perceived non-contingency plays an important role in the theory of learned helplessness.
The original theory focused on the key features of passivity and helplessness in the face of future events characteristic of depression.

Reformulated learned helplessness

Abramson added Weiner’s attribution theory to the original learned helplessness approach.
Although helplessness continued to be seen to arise from the perception of uncontrollability, the subsequent effects were now seen to depend both on the type and the importance of the event experienced, together with the explanation that the individual produced for the cause of the event.

The explanatory style dimensions focused on three of Weiner’s attributional dimensions

• Internal-external or locus
  Whether the cause is seen to be due to something about the individual (internal) or due to something about other people or circumstances (external)
• Stable-unstable
  Whether the cause is due to something that would recur future similar events
• Global-specific
  Whether the cause influences only one area of the individual’s life or many

The combination of these dimensions led to the proposal that the emotional, motivational and cognitive deficits seen in depression could be accounted for by a particular set of attributions following the occurrence of a negative event.

The crucial type of attribution style that is identified as a vulnerability factor for depression is if the individual makes internal-stable-global attributions for the causes of negative events and external-unstable-specific attributions for positive events.
An internal attribution for a negative event leads to low self-esteem, especially if other individuals are perceived not to be helpless in such a situation (personal helplessness).
The additional stable and global attributions for negative evens add to the chronicity and the generality of the deficits observed in depressed individuals.

It is possible that depressogentic implicit attributional tendencies are not being detected by the routine questionnaire methodology.
The links between style and emotion can be weak correlational ones.

Hopelessness theory

Hopelessness theory is a reformulation of helplessness theory.
The key differences is that hopelessness requires only the occurrence of negative events rather than uncontrollable events.
The main outcome is hopelessness rather than helplessness. This places the emphasis on negativity.

Hopelessness makes some adjustments to the combinations of the attributional dimensions and their consequences.
Low self-esteem is now seen to derive from an internal-stable-goal attributional style.
A combination of stability and globablity is seen to lead to generality and chronicity of depressive deficits.  

Beck’s cognitive therapy

Cognition is not the cause of emotional disorders, but it is part of a stet of interacting mechanisms that include biological, psychological, and social factors.

There are two main components to the theory from which the general therapeutic approach is derived

• The types of cognitive structures that underlie the emotional disorders
• The types of cognitive processes that are involved in the onset and maintenance of these disorders.

Beck’s model of depression
Early experience à Formulation of dysfunctional assumptions à Critical incidents à Activation of assumption à Negative automatic thoughts à depression

The type of knowledge representation that cognitive therapy focuses on is schemas.
Schemas are seen to be units in which memories, thinking and perception are organised.
These schemas are in part derived from past experience, but are not passive representations of that experience. Activation of part of the schema leads to activation of the whole schema. Information not represented in the input will be filled in according to operative ‘default’ values.
The patterning of self-schemas and significant-others schemas, which is based on past experience, will provide a starting point from which current relationships and experiences are viewed.

In relation to specific emotional disorders, certain groups of dysfunctional schemas are likely to be characteristic.

• Depression
  Schemas reflect cognitive triad that focuses on negative views of the self, the world and the future

Between episodes of emotional disorders, Beck proposed that dysfunctional schemas are inactive and lie dormant.
They become activated only when appropriate matching stressors occur.
Part of the reason for this proposed latency of dysfunctional schemas has been to immunise the theory against failure to find elevated levels of dysfunctional attitudes and automatic thoughts during recovery.

But, it seems unlikely that such important concerns for the individual become inactive.
Alternative possibilities are that the dysfunctional schemas remain active but that during recovery the individual is able to inhibit the outcomes of such processing if it is negative, or if the outcomes of processing are positive these are consciously acceptable to the individual.
Another possibility is that the traditional view of schemas is too simplistic to capture the type of high-level representation system necessary within cognition-emotion systems.

The effect of activation of dysfunctional schemas is that they produce negative automatic thoughts which the individual believes.
Unlike healthy individuals, who can normally dismiss such thoughts, depression-prone individuals may seek further evidence in support of such negative thoughts and beliefs.
This evidence-seeking includes the logical distortions of thinking.

• Magnification
  Negative material related to the self
• Minimisation
  Positive material related to the self
• Personalisation
  Taking the blame for anything negative

The outcome of these distorted processes, in combination with other biases such as for memory, is that the depressed individual maintains a negative view of the self and thereby remains depressed.

Two main points to raise about this view of cognitive processes

• The approach implies that normal thinking is logical and rational
  But whether or not this is true remains unresolved
  The differences between normal and depressive thinking may be less that of logical versus illogical thinking and more that of positively biased versus negatively biased processes
• It presents a view of self-concept in depression that is monolithic and negative
  One puzzle to which cognitive therapy fails to provide an adequate answer is how the self-concept switches form being negative during an episode of depression to being positive during recovery

Clark’s adaptation of cognitive therapy for panic

The key theme in both Beck’s general approach to anxiety and in Clark’s application of the approach to panic disorder is that the individual is considered to be prone to the detection of threat or danger in both the external and the internal environment.
The catastrophic misinterpretation of the environment maintains the high level of distress experienced in a panic attack. It may also lead the individual to become hypervigilant for particular bodily sensations and likely to avoid situations or activities that produce similar sensations.
Despite the avoidance, the hypervigilance will still lead the individual to detect small physical sensations, which push the individual into a vicious circle.

Williams, Watts, MacLeod and Mathews (1988, 1997)

The network theories of Bower and the schema theory of Beck predicted that a wide range of cognitive biases should be found in emotional disorders.
There is a failure to find such global biases.

Williams proposed an empirically based model in which cognitive biases were specific to specific emotional disorders.
Williams took as theoretical starting point the distinction between

• Priming
  An automatic stage of processing in which the stimulus may be linked with its representation in long-term memory
• Elaboration
  Subsequent strategic or resource-demanding processes

In the case of anxiety disorders, Williams propose that automatic priming processes are biased towards the detection of anxiety-relevant stimuli or situations.
Although initial priming or automatic processes are biased towards the detection of threat in anxiety, subsequent elaborative processes are biased away from the processing of threat.

The main cognitive biases evident in depression are resource-demanding elaborative ones that are most apparent in mnemonic tasks.

The strength of the framework presented by Williams et al is that it provided a focus for the dissatisfaction for global cognitive biases.
But, Williams provides a starting point rather than an aetiological theory.

Teasdale and Barnard

The interaction cognitive subsystems (ICS) approach is an exemplar of one of a class of multi-level, multi-system approaches which, can provide accounts of a variety of cognitive skills and processes.
The link between cognition and emotion is not easily pinned down in such models, because the relationship is seen as complex and interactive.

Nine cognitive subsystems in Teasdale and Bernard’s ICS approach

• Sensory related
  • Acoustic subsystem  
  • Visual subsystem
• Central subsystems
  • Morphonolexical
  • Propositional
  • Implicational
  • Object
• Affector subsystems
  • Articulatory
  • Body state
  • Limb subsystems

These subsystems process information partly in parallel and partly sequentially according to the type of task and other requirements acting on the overall system

In relation to emotion, the key subsystems are the propositional and the implicational subsystem.
The units of representation in propositional subsystems do not have truth values in themselves but are merely names about which noting is asserted.
Only when included in larger units do the units become propositional and they are either true or false.
The higher-level semantic representations at the implicational level in ICS are referred to as ‘schematic models’.
Schematic models combine information for a variety of sources.

Four of the key sub-systems involved in the occurrence of emotion in the ICS approach

• Visual subsystem
• Implicational subsystem
• Propositional subsystem
• Body state subsystem

In the ICS approach, emotion is the result of the combination within the implicational subsystem of outputs form a number of cognitive subsystem.

In ICS, automatic thoughts may be the consequence rather than the cause of depressive schematic model at the implicational level, though in turn these negative thoughts may serve to lock the system in a depression-maintaining loop.

Teasdale and Barnard argue that much of the challenging of negative thoughts and beliefs in standard cognitive theory occurs at the propositional level and may often ignore the higher level implicational meaning. This can make the depression worse.

A focus on the implicational level of meaning would suggest that an important issue for a client might be a need to discover things for himself and that a focus on the therapeutic relationship in relation to this and other issues might be well warranted.

• Intellectual beliefs
  Meanings at the propositional level
• Emotional beliefs
  Propositional articulations of schematic models at the implicational level

The information held at the two levels need not be consistent.

The central distinction between the propositional and the implicational levels of meaning may not be as clear-cut in practice as it appears.

Social-cognitive theories

In social-cognitive theories of psychopathology it is argued that vulnerability to emotional disorders cannot solely be located in factors internal to the individual nor in factors that are solely external.
There is a complex interaction between the internal and the external.
There is a type of diathesis-stress model in which an external stressor is problematic for an individual with a relevant vulnerability.

Social-cognitive theories of depression

Social-cognitive theories of depression focus on a number of related proposals

• The vulnerable individual has a high level of investment in one particular role or goal
• The individual may pursue this role or goal, with considerable success
• The occurrence of a severe event which matches the role or goal thematically, and which thereby threatens it, increases the likelihood of depression
• The influence of social-cognitive factors is seen to be the strongest for first episodes of unipolar depression, but the repeated experience of adversity and depression may lead to a sense of ‘defeat’ in which the individual disinvests in all domains, including those which were previously overinvested
• Most theories identify a number of other vulnerability or protective factors
  • Whether or not the individual has a close confiding relationship
  • Issues such as self-esteem and self-concept
  • Attributional style
  • Dysfunctional attitudes
  • Coping
  • Emotion regulation strategies

Weak points of social-cognitive theories of depression

• There has been poor agreement over the measurement of social factors
• Social-cognitive models often appear to hedge their bets over whether they are models of the onset of disorders, of the maintenance of disorders, of the recovery from disorders, or of relapse of disorders
• The models are often poor at explaining how vulnerability factors arise in the first place
• Social-cognitive accounts of depression are well in advance of equivalent accounts of other disorders

Miscellaneous theories of emotional disorders

Emotional processing

Emotional processing is used in reference to how an individual processes stressful events.

The proposal is that it is inevitable that unpleasant events will occur to an individual at one time or another, but the consequences of such events are normally satisfactory processed.
Evidence of normal emotional processing is provided 

• Emotional disturbance has occurred
• The disturbance eventually declines in strength
• There is a return to routine behaviour

In abnormal grief reactions, there is a failure in this normal sequence, which is likely to result from a failure of emotional processing.
A number of indices by which these failures can be identified

• The presence of direct signs
  • Obsessions
  • Disturbing dreams
  • Unpleasant intrusive thoughts
  • Inappropriate expressions of emotion
  • Behavioural disruptions
  • Pressure of talk
  • Hallucinations
  • Return of the fear after a period of absence
• Indirect signs
  • Subjective distress
  • Fatigue
  • Insomnia
  • Anorexia
  • Inability to direct constructive thoughts
  • Preoccupations
  • Restlessness
  • Irritability
  • Resistance to distraction

What types of emotion modes are needed to account for the observation that individuals may fail to process stressful events.
We can consider a cognitive conflict model in which the unwanted material is inhibited because it conflicts with core self-beliefs, important goals and plans, or important beliefs about significant others.
The more dramatic or severe the stressful event, the greater the impact on the individual’s beliefs, goals and plans. Denial causes clinical worry.
A cognitive account of limited attentional resources may have to be allocated in order to maintain cognitive and behavioural avoidance.

Summary

• Several types of theories point to the key role that significant events play in the emotional disorders.
  It is not simply that such events occur, but rather the types of explanation that individuals make.
  Dysfunctional explanations are more likely to occur the more negative or severe the event is.
  The focus should be on
  • The causes of events
  • How an individual perceives the consequences
  • How the events impact on important domains or areas of investment
  • And so on
• Most models are diathesis-stress models in which a pre-existing vulnerability factor has interacted with subsequent stressors to produce the particular disorder
  It seems more likely that we will need different models and different weightings of factors to account for the onset of a first episode of an emotional disorder, maintenance and recovery, relapse, and future recurrence
• An adequate cognitive account of emotion requires at least two levels of semantic representation
• Emotional thinking should not be equated with irrational thinking.
• Theories that have predicted global cognitive biases or that have searched for global vulnerability factors in the emotional disorders need to be revised. More specific biases are implicated.
• The idea of loops and locked systems has become more evident in models of the emotional disorders
• The cognitive and social-cognitive theories have highlighted the importance of social factors in the emotional disorders
• An adequate model of mental functioning must be able to account for a range of inhibitory phenomena in relation to emotion.