Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
can develop, persist, and recur as a result of cognitive struc- tures called “schemas.” Beck, Rush, Shaw, and Emery (A.T. Beck et al., 1987) describe a schema as “the basis for molding data into cognitions (defined as any verbal or pictorial content )” (pp. 12-13). According to Beck and colleagues (A.T. Beck et al., 1987), depression can be understood via schemas, cogni- tive errors, and the cognitive triad (i.e., negative views of self, the tendency toward interpreting experiences negatively, and holding negative thoughts of the future). In this theory, the presence of schemas can be a predisposing factor in the devel- opment of depression (Barlow, 2021). Briefly, a schema may become activated by a circumstance related to the schema or through the schema’s association with other activated schemas. The types of circumstances generally understood to trigger schemas can be conceptualized as stressors, the experience of which ranges from a single traumatic event to daily occur- rences. Beck’s theory suggests that depression is triggered when dysfunctional schemas are activated, giving rise to negative cognitions and information processing patterns that precipitate depression (Leahy, 2006). For example, a person’s dysfunc- tional belief or schema, “I must be loved to be worthwhile,” may be triggered by processing an external, stressful life event such as the ending of an intimate relationship. The “I must be loved to be worthwhile” schema may not generally be active. Still, when the person’s partner terminates their relationship (a stressful event), this belief may become activated, and thus the person is more susceptible to depression. This concept is similar to that of a diathesis-stress model in that it suggests that vulnerability to depression is influenced by the develop- ment of cognitive schemas resulting from stressful events in the individual’s past (Leahy, 2006). Understanding the treatment of psychopathology from a cognitive model requires attention to cognitions and cogni- tive patterns. Cognitions include thoughts, beliefs, attitudes, assumptions, expectations, standards, images, goals, memories, and perceptions. Several models of cognitive theory exist, bor- rowing their origins from those discussed previously. However, the overarching premise of cognitive therapy is that specific cognitions (e.g., maladaptive beliefs, irrational thoughts, dys- functional schemas, and problematic information processing) likely lead to emotional distress and behavioral difficulties. Thus, modification of cognitions and cognitive patterns is required to effect change. OVERVIEW OF COGNITIVE THERAPY At its most basic level, cognitive therapy is based on the con- cept that an individual’s perceptions shape their behavior and emotional experience. In other words, it is not necessarily the events in an individual’s life that affect behavior and moods but how they perceive them. The cognitive model reflects the view that the way an individual interprets (or appraises) an event or situation determines, in part, their resulting emo- tions and behavior. The cognitive model also addresses how an individual processes information and how it informs their subsequent action plan. In this way, information processing and the development of a belief structure that guides behavior
can be seen as an active, goal-directed process, which is central to survival (A.T. Beck & Weishaar, 2018). Interpreting events and circumstances is an enduring process that allows individuals to develop a sense of meaning from their experiences (Messer & Kaslow, 2019). Schemas, belief systems, and cognitive patterns present the individual with challenges that may have been at once adaptive or accepted in the individual’s past environment or circumstances (Freeman et al., 2004). These beliefs and assumptions persist, mediate an individual’s response to specific events or stimuli, and render the individual “sensitive” to particular external and internal stressors. Such beliefs and assumptions cause the individual to selectively attend to and recall information consistent with their belief system and to overlook information inconsistent with their belief structure (Messer & Kaslow, 2019). As a result, the individual may behave so that their belief system is rein- forced through maladaptive coping (or behavioral) responses. An example of this process concerns a person who holds the belief that he is unlovable. As a child, developing this belief may have assisted the client in managing painful or unpredict- able interactions with his parents (e.g., through cognitive or behavioral avoidance). This belief persists, and as an adult, he continues to withdraw socially to avoid the emotional pain of expected rejection and rarely, if ever, seeks new social interac- tions or experiences. The information processing bias results in the maladaptive coping response of avoidance, reinforcing his belief that he is unlovable. He selectively attends to the fact that no one interacts with him and interprets this as support for his belief that he is of no interest to others but overlooks the fact that his behaviors (the maladaptive coping response of avoidance/isolation) may actually be a primary reason no one is interacting with him. Cognitive therapy focuses on understanding how his belief system interferes with his ability to see current events realistically and serves as a biased filter through which he sees himself, the world, and his future (i.e., the cognitive triad). Cognitive therapy addresses dysfunctional thoughts as well as dysfunctional thought patterns. Many terms, concepts, defini- tions, and phrases describe these cognitions and patterns of thinking. Before the approach to and techniques of cognitive therapy can be discussed, it is necessary to define such fac- tors. Reading literature in cognitive therapy to gain a clear understanding of these issues can be somewhat confusing due to inconsistencies in semantics; depending on the literature, many terms addressing these concepts are used interchange- ably (as in the case of schema and core belief ) or may also be distinctly defined (such as underlying assumptions ). Such terms and concepts include schema, core belief, intermediate belief, automatic thoughts, underlying assumptions, underlying mechanisms, irrational beliefs, dysfunctional beliefs, and so on. For an introductory course on cognitive therapy, the main message to appreciate is that all of these terms, in one way or another, are intended to reflect problematic cognitions, cogni- tive patterns, or cognitive processes. Schema has been defined
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