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Towards An Experimental Cognitive Science of CBT
Towards An Experimental Cognitive Science of CBT
Towards An Experimental Cognitive Science of CBT
www.elsevier.com/locate/bt
(incidental) rule learning, and consequently it was depression-prone individuals. Rumination thus has
argued that interference due to rumination (repetitive two adverse consequences specific to vulnerable
self-related ideation) is unlikely to explain the rapid individuals: it reactivates existing negative thought
abandonment of old learning in depression. There is patterns and makes personal interpretations of new
now little doubt, however, that rumination is an ambiguous events more likely. One way to prevent
important risk factor in prolonging episodes of these consequences could be to strengthen incom-
depression (Lyubomirsky & Nolen-Hoeksema, patible (i.e., less self-related) habits of thought.
1995). Recent research has begun to shed light on In addition to self-focus, however, the more
the critical cognitive operations underlying rumina- damaging (brooding) component of rumination
tion and how these can be changed. includes a self-judgmental aspect (e.g., Why do I
Four papers in this special issue address this and have problems that others don't have?). In the
related topics. Rumination as commonly assessed is present issue, Gortner, Rude, and Pennebaker
not a unitary process but rather includes some (2006) go on to speculate that one way to reduce
components that are more toxic than others. Along brooding and encourage less judgmental thinking
with others, Joorman, Dkane, and Gotlib (2006) (e.g., reflection) might be to use expressive writing.
argue that it is content described as “brooding” Previously depressed students were assigned to 3 to
(e.g., self-evaluative analysis), as opposed to “re- 4 sessions of expressive writing about personal
flection” (which can include problem-solving events that they found most emotionally disturbing
attempts), that has deleterious consequences. or writing about nonemotional everyday events. Six
Brooding was indeed found to be more associated months later, those in the expressive writing group
with depression than was reflective content, and— reported significantly fewer depressive symptoms.
more importantly in the present context—brooding Extent of improvement was associated with reduc-
was also more associated with attention to faces tions in reported brooding, but (contrary to
with sad (or happy) rather than neutral expressions expectation) not with increased reflection. Further-
and with memory for negative self-related words. more, those who initially reported suppressing their
Thus, a self-report measure of repetitive self- emotions also improved more following expressive
evaluative thought content was related to objective writing. This fits our common sense idea that
measures of attention to and memory for emotional people who overly suppress their feelings may profit
information. The interesting question then arises: from expressing them more but does not explain
Are these relationships causal, and if so, in which why this should be so. It seems likely that expressive
direction? For example, could ruminative content be writing encourages processing emotional events in a
maintained by biases in underlying selective pro- nondestructive way, perhaps by interfering with an
cesses that make it difficult to disengage from otherwise habitual judgmental self-focus and allow-
negative self-related thoughts? Understanding direc- ing a more objective perspective to be taken. But the
tions of possible causation in this respect could have exact mechanism by which vulnerability to depres-
important implications for choosing the most sion was reduced remains unclear and how this
appropriate targets for therapeutic modification. happens can only be discovered in future research.
As noted above, rumination (and specifically its For now, however, the finding again points to the
so-called “brooding” component) is characterized notion that cognitive habits having negative emo-
by an analytic focus on the self. Interestingly, tional consequences can be weakened by practicing
however, this only leads to adverse emotional incompatible ways of processing the same material.
consequences in those already disposed to depres- A final paper on rumination in this issue (Moberly
sion. Why should this be so? Hertel and El-Messidi & Watkins, 2006) also distinguishes between types
(2006) suggest that the self-focused content in of mental content, labeled in this case “abstract-
rumination has greater adverse effects in depres- evaluative” versus “concrete-process” focused
sive-prone individuals because they have developed (Watkins & Teasdale, 2004). The former (evalu-
the habit of thinking about negative aspects of ative) content seems to map fairly well onto
themselves. Self-focus thus guides them along brooding, sharing with it a focus on self-evaluative
already familiar mental paths. In the first experi- implications and having similar adverse effects in
ment described here, Hertel and El-Messidi confirm depression. The latter (concrete) content is less
that a brief period of self-focused thought can have easily identified with reflection, as it is said to
more negative emotional effects for those already include moment-to-moment perception of feelings
prone to depression. Even when no differential (e.g., What am I feeling right now?). However, like
mood changes were seen (in a second experiment), reflection, it can be self-focused while lacking in
self-focus had more persisting effects on the evaluative content and does not lead to negative
interpretation of new ambiguous information in emotional consequences. Indeed, it seems possible
cognitive science of cbt 317
that this type of thinking about feelings is related to biases are a cause rather than just a consequence of
that induced by expressive writing and could offer emotional vulnerability.
an explanation for its beneficial effects (if, for In the study by Mackintosh et al. (2006),
example, a focus on the experience of feelings volunteers practiced accessing either the positive
discourages self-evaluative judgments about them). or the negative meaning of ambiguous descriptions
In support of this notion, experimentally inducing and then returned the next day for testing. Despite
this type of thought content following a failure the delay, and for half of the participants a change
experience prevented the adverse emotional effects of environmental setting, they continued to inter-
otherwise seen in ruminative and depressive-prone pret new descriptions in a manner congruent with
individuals (Watkins & Teasdale, 2004). their prior experience in training. More strikingly,
In the present study, Moberly and Watkins (2006) those previously trained to access the more negative
adopted the general approach developed by meaning of ambiguous descriptions reported more
MacLeod and his colleagues (Mathews & anxiety in response to a stressful video than did the
MacLeod, 2002), in which processing style is comparison group. These data raise the possibility
experimentally manipulated rather than varying that similar methods could be used to induce more
naturally between individuals or selected groups. positive processing biases in vulnerable individuals
Critically, such an approach allows for more and thus protect them from the adverse conse-
definitive causal conclusions about the effect of a quences of stressful life events.
specified processing style (or mode) on emotion and In previous work using these experimental induc-
emotional vulnerability. In the present study parti- tion methods, Holmes and Mathews (2005) found
cipants were allocated to think about a series of both that changes in anxiety during training to induce a
positive and negative personal events in different negative bias depended critically on the use of
ways: either concretely (e.g., imagine the details of imagery rather than on the verbal meaning of texts.
what is happening) or in an evaluative manner (e.g., Although it has long been supposed that images have
think about the implications), with each condition more powerful emotional effects than do verbally
reinforced by related questions. After a contrived mediated representations, surprisingly, supporting
failure experience, reductions in positive affect were evidence for this claim has been lacking. In the
greater for those in the evaluative group, albeit only present paper, Holmes et al. (2006) go on to show
for participants reporting high levels of rumination. that the superior effect of imagery applies equally to
Although this study only involved students, it does the effectiveness of training on positive emotionality.
suggest that training to focus on the present In addition to imagery having greater effects of
experience of feelings, rather than on their implica- positive feelings during training, it also led to more
tions, could decrease vulnerability to depression (cf. positive interpretations of ambiguous event descrip-
Teasdale et al., 2000). tions encountered later. Imagery is, of course, widely
used in CBT for anxiety disorders, but the present
Experimental Modification of Processing Style results support the possibility of wider applications,
including positive retraining in mood disorders.
The effect of training cognitive processing style is
The paper by Hirsch et al. (2006) builds on
also the central topic of the next two papers to be
evidence based on methods similar to those just
discussed (Mackintosh, Mathews, Yiend, Ridge-
described and also makes a wider point: If
way, & Cook, 2006; Holmes, Mathews, Dalgleish,
psychological disorders are associated with not
& Mackintosh, 2006) and is also highly relevant to
just one but several characteristic types of cognitive
the last one (Hirsch et al., 2006).1 The issues
content and process, how might they influence each
addressed by Mackintosh et al. include the persis-
other? And could such mutual influences serve to
tence of such experimental training and the extent to
amplify their total effect, thereby creating particu-
which it can influence later emotional vulnerability.
larly strong effects on emotional vulnerability?
These issues are critically relevant to the question of
Existing cognitive models make such assumptions
whether induced processing style persists as do
implicitly (for example, the cognitive model of social
naturally occurring biases and whether processing
phobia; Clark & Wells, 1995), but this hypothesis is
made more explicitly in the present paper. Specifi-
cally, it is proposed that biased interpretations can
1
It will not have escaped the alert reader's attention that the influence the content of mental imagery, which has
present writer is a co-author of the last three papers discussed. I especially powerful effects on emotion (as noted
hope that any positive processing bias on my part is not too
apparent in this discussion, but in any event it should not detract
above). In reciprocal fashion, imagery content can
from the credit due to the main authors, who have contributed far powerfully influence the interpretations made of
more than I have. emotionally ambiguous events. As Hirsch et al.
318 mathews
point out, mutual influences of this type are subclinical anxiety? Journal of Experimental Psychology:
probably quite common and perhaps can be General, 130, 681–700.
Gortner, E. M., Rude, S. S., & Pennebaker, J. W. (2006).
harnessed in therapy, for example, by targeting Benefits of expressive writing in lowering rumination and
one cognitive process in order to change another. depressive symptoms. Behavior Therapy, 37, 292–303.
Hertel, P. T., & El-Messidi, L. (2006). Am I blue? Depressed
Conclusions mood and the consequences of self-focus for the interpre-
Despite the disparate content of these papers, tation and recall of ambiguous words. Behavior Therapy,
37, 259–268.
several important unifying themes emerge from Hirsch, C., Mathews, A., & Clark, D. (2006). Imagery and
them. In particular, they are all concerned with interpretations in social phobia: Support for the combined
identifying underlying cognitive processes that are cognitive biases hypothesis. Behavior Therapy, 37,
thought to maintain emotional disorders. This 223–236.
approach does not ignore reportable cognitive Holmes, E. A., & Mathews, A. (2005). Mental imagery and
emotion: A special relationship? Emotion, 5, 489–497.
content, such as repetitive emotional thoughts and Holmes, E. A., Mathews, A., Dalgleish, T., & Mackintosh, B.
images, but this content is viewed as being (2006). Positive interpretation training: Effects of mental
influenced by other cognitive processes that are imagery versus verbal training on positive mood. Behavior
not usually accessible for conscious report. The Therapy, 37, 237–247.
causal role of these processes, and of the content Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and
maladaptive components of rumination? Diagnostic speci-
they influence, can then be investigated by manip- ficity and relation to depressive biases. Behavior Therapy,
ulating them in experimental studies. In this way we 37, 269–280.
can move beyond merely describing the cognitive Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-
operations that characterize certain disorders to- focused rumination on negative thinking and interpersonal
wards finding the optimal ways of changing them. problem solving. Journal of Personality and Social Psychol-
ogy, 69, 176–190.
Not only does this allow investigation of their Mackintosh, B., Mathews, A., Yiend, J., Ridgeway, V., &
causal role in emotional vulnerability, but it should Cook, E. (2006). Induced biases in emotional interpreta-
eventually lead to new methods of treatment. tion influence stress vulnerability and endure despite
I began by anticipating that some readers of this changes in context. Behavior Therapy, 37, 209–222.
special issue may be uncomfortable with the Mathews, A., Fox, E., Yiend, J., & Calder, A. (2003). The face
of fear: Effects of eye gaze and emotion on visual attention.
emphasis on underlying cognitive processes within Visual Cognition, 10, 823–836.
experimental studies of volunteers rather than on Mathews, A., & MacLeod, C. (2002). Induced processing
observable behaviors and clinical symptom change. biases have causal effects on anxiety. Cognition and
However, as I hope is now clear, the experimental Emotion, 16, 310–315.
approach used here often does employ behavioral Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability
to emotional disorders. Annual Review of Clinical Psychol-
measures (e.g., decision latencies or response accu- ogy, 1, 167–195.
racy), and the methods of modification employed Moberly, N., & Watkins, E. (2006). Processing mode influences
are in many ways surprisingly close to the learning the relationship between trait rumination and emotional
origins of Behavior Therapy. Control over destruc- vulnerability. Behavior Therapy, 37, 281–291.
tive cognitive habits can be achieved, not only by Oatley, K., & Johnson-Laird, P. N. (1987). Towards a cognitive
theory of emotions. Cognition and Emotion, 1, 29–50.
discussion and instructions, but via training that Ree, M., & Harvey, A. (2006). Interpretive biases in chronic
involves repeated practice serving to strengthen insomnia: An investigation using a priming paradigm.
incompatible positive alternatives. Results so far Behavior Therapy, 37, 237–247.
may seem fairly far removed from actual clinical Teasdale, J., Segal, Z., Williams, J. M., Ridgeway, V., Soulsby, J.,
application, but I believe they show that we have & Lau, M. (2000). Prevention of relapse/recurrence in major
depression by mindfulness-based cognitive therapy. Journal
made measurable progress towards providing CBT of Consulting and Clinical Psychology, 68, 615–623.
with the cognitive science base it needs. van den Elzen, J., & MacLeod, C. (2006). Facilitated cognitive
disengagement in depression. Behavior Therapy, 37, 304–313.
Watkins, E., & Teasdale, J. D. (2004). Adaptive and maladap-
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