Good Article on Cognitive Therapy

Article 63
October 31, 1990

Some Reflections on Cognitive Therapy

Cognitive Therapy is a helping methodology that is well known, experimentally verified as effective (particularly in cases of depression), well thought of, and successful. It has much in common with viewing, but there are also some important differences. In this article, I will attempt to outline the most significant differences and similarities. An examination of these may provide a learning opportunity, both for cognitive therapists and for metapsychologists.

Cognitive therapists assert that there is a close relationship amongst thoughts (called "cognitions"), emotions, and behavior. This relationship is reflected in the names that the two major schools of cognitive therapy have adopted. The school led by Aaron T. Beck is called "Cognitive-Behavioral Therapy" and the one led by Albert Ellis is called "Rational-Emotive Therapy". Although these two schools arose independently, their proponents came to realize that they were very similar both in theory and practice, and so collectively they became referred to as "Cognitive Therapy".

Theory of Cognitive Therapy

According to the theory of Cognitive Therapy, events that occur in the physical world ("activating events") do not directly cause any particular emotions or behavior. Emotions and behavior result from the "cognitions" that are "triggered" by activating events. If, for instance, you harbor the "cognition" (or belief) that it would be unbearable if everyone did not like you, then you become upset when someone gives evidence that he does not like you. If you do not have such a belief, not being disliked in a particular instance will probably not upset you.

Correcting Thoughts

The role of the cognitive therapist is to correct the client's "cognitions" (belief system) into one that will not tend to result in negative feelings when certain activating events occur. If I have decided that it is OK if not everyone likes me, I won't be upset when some people don't. In Cognitive Therapy, clients are encouraged to examine their beliefs critically and to eliminate those that are distorted, irrational, counterfactual, or "maladaptive". The result is an elimination of many negative feelings.

Behavioral Challenging

Behavioral prescriptions can also play an important role in Cognitive Therapy. By acting in certain ways, the client can, as it were, do a "scientific experiment" to see if certain beliefs are or are not really accurate. This is called "behavioral challenging". If, for instance, the client believes that it would be perfectly awful and unconfrontable for him to be rejected by a woman, this belief can be readily tested by a real-life "experiment". Albert Ellis illustrates how this worked in his own case. Originally, Ellis was very shy around women. He resolved to rid himself of this hangup by assigning to himself the task of going to a park and talking to the first fifty women he saw and asking each of them out on a date. All fifty refused, but Ellis learned that he had not at all been annihilated by the experience. He then felt much more secure about dealing with women in social situations.

For people who have an excessive fear of disapproval, Ellis prescribes a "shame attacking exercise". The client is told to go out on the street and go up to the first fifty people he meets and say, "I just got out of the local insane asylum. What year is it?" The client rapidly learns that he can survive being looked down on.
In Cognitive Therapy, then, there are two basic approaches:

1. Modify thoughts by spotting irrationalities in them.
2. Use behavioral challenges to modify assumptions.

The resultant change in beliefs leads to an improvement in the client's emotional state.

Similarities Between Cognitive Therapy and Viewing

As mentioned above, there are several important points of similarity between Cognitive Therapy and Viewing:

• One of the important points of similarity between Cognitive Therapy and viewing is that each is based on a person-centered viewpoint. The cognitive therapist is concerned with the world as it appears to the client and with helping the client make adjustments to his own world of experience.
• Although Cognitive Therapy is officially a form of psychotherapy, it is, like viewing, essentially educational in its approach.
• Cognitive Therapy, like viewing, is an organized, systematic activity with a well-articulated theory, a well-defined goal, and a well-defined point at which success has been achieved -- the point at which the client feels better.
• Both Cognitive Therapy and metapsychology see a definite relationship amongst behavior, thought, and emotion, and in both disciplines various approaches have been designed with this relationship in mind.

Differences Between Cognitive Therapy and Viewing

There are, however, a few pieces missing from the picture that Cognitive Therapy presents.

The Effect of Emotion on Behavior and Thought

One significant omission is the effect that emotion can have on thought and behavior. Those of us who are familiar with the Emotional Scale and the Table of Attitudes realize that certain kinds of thoughts and behaviors (coping strategies) are characteristic of certain points on the Emotional Scale. An enthusiastic person characteristically thinks thoughts like, "I'm in control!", "Everything's great!" And he behaves in an effective manner. An angry person tends to think things like: "Those bastards! I'm going to get them." And his behavior is overtly destructive toward others.

If we view thought, behavior, and emotion as a triad (like the Communion and Power Triads), it seems valid to say that we can address this triad by starting at any one of its three legs. Cognitive Therapy deals with two of the legs (behavior and thought) but omits the possibility of going after the difficulty from the third leg: emotion. If one can eliminate a negative emotion or otherwise move a person upward on the Emotional Scale, his thoughts and behavior will tend to straighten themselves out. In fact, this leg of the triad is often the easiest one to address in viewing, using such techniques as Traumatic Incident Reduction (TIR), Unblocking, upset handlings, or list assessments.
In the Communication Exercises (CE's) -- particularly CE's 1-3 -- one can learn how to spot when an activating event is occurring, and how to prevent or avoid the emotional or behavioral response that would otherwise take place. Similarly, by using the Cognitive Therapy technique of examining one's thought processes and correcting them, one can get some distance from one's negative emotions and destructive behavior and thus achieve a degree of control over them.
But it is even better to have additional techniques for eliminating altogether the tendency for these negative thoughts, emotions, and behavior to be "triggered" (restimulated) in the first place. Viewing contains many such techniques, particularly TIR.

Explaining the "Triggering" Effect

This brings to light another important missing element in the theory and practice of Cognitive Therapy: nowhere is it explained just how an activating event can trigger a distorted thought. Cognitive Therapy is correct in observing that such triggerings (restimulations) occur, but it does not explain how or why they occur. The metapsychological theory of the Traumatic Incident Network (Net) does explain restimulation, and that explanation paves the way for TIR, a method for definitively handling the tendency to be restimulated.

Beliefs vs. Intentions

In its term, "cognition", Cognitive Therapy conflates the ideas of "belief" (or, in metapsychological terms, "fact") and "intention", which are, in reality, two very different things. You can change a person's beliefs by reasoning and demonstrations, but when you start dealing with intentions, you have entered a far different territory, one that should be recognized as different.

According to Cognitive Therapy, emotions are entirely determined by "cognitions" and the events that activate them. If one did not think it was terribly important to please others, one would not be upset when others are displeased. Now, "It is important to please others," sounds like a pure belief, but in actual fact it expresses a desire: the desire to please others. In asking a client to change that "cognition", a cognitive therapist is, in fact, asking for more than a mere shift in beliefs. He is actually asking for a change in or a weakening of one of the client's desires. Obviously, if the client did not desire to please others, he would not be upset at not pleasing them. So for any event that is emotionally distressing to a client, one could, in theory, find the desire that is frustrated by that event (and there certainly will be such a desire), and then advise the client to change or discontinue that desire.
More specifically, the cognitive therapist makes a distinction between needs and wishes ("wants"). It is OK to wish for something but (in most cases) not really OK to feel one needs something. As mentioned in JOM Article 62 "Needs and Wishes", a need is a desire for something the absence of which would cause pain, whereas a wish is a desire for something the absence of which would not necessarily cause pain. The cognitive therapist tries to convince the client that things he thinks are needs are actually only wishes. It may indeed be possible, using demonstrations, behavioral challenging, and reasoning, to convince someone that something he had priorly thought of as a need is actually only a wish. If a person learns that he can, in fact, receive criticism without being overwhelmed, then he will realize that he does not really have a need for approval, only a wish for it.
Still, it is not always easy to convince someone that something they regard as a need is really only a wish. You may obtain intellectual agreement, but for the client to realize this on a feeling level -- i.e., for the desire not to be actually felt as a need anymore -- it is necessary to reduce a great deal of charge, and this requires methods that are not found in Cognitive Therapy. Argumentation alone will usually not suffice. As we have learned, desires and intentions are highly charged and central elements of a person's case. A person will not have fully handled them until he has completed the Core Curriculum.

Differences in the Session Environment

There is a set of differences between viewing and Cognitive Therapy that does not necessarily come to light merely from reading books about the two subjects but which is abundantly obvious from watching actual sessions. Viewing is a highly prescribed action that operates under a strict set of rules that (amongst other things) prohibit any evaluation, interpretation, or invalidation. Each action done in a viewing session, each utterance of a facilitator, is completely determined by the session agenda and by the rules that govern the specific procedure being used. Nothing is left informal or up to the "intuition" of the therapist. Most cognitive therapists, on the other hand, do not recognize the value of the formality and the strictness of the rules under which viewing operates. So they engage freely in evaluation and invalidation, and it even becomes a part of the method to dispute with the client about his "cognitions". The cognitive therapist is free (sometimes even obligated) to offer his own opinions. The result is the creation of a counterproductive degree of dependency on the therapist and unsafeness in the therapeutic space.

I don't feel that evaluation or invalidation are at all necessary to achieving the aims of Cognitive Therapy. It should be relatively simple to construct a set of questions and procedures that would elicit the realizations about needs vs. wishes that Cognitive Therapy seeks to bring about. We already have certain procedures, such as Data Correction and Concept Clearing, that address fixed and false ideas. We might well be able to learn additional useful approaches by studying the methods of Cognitive Therapy. These methods should be even more effective when done under the Rules of Facilitation and in a formal session environment.
Cognitive Therapy is one of the most successful, coherent, and systematic helping methodologies available today. By using some of the methods of Cognitive Therapy in conjunction with the vast armamentarium of procedures we already have, and in a safe, formal session environment, we may be able to improve our ability to help our viewers.

Frank A. Gerbode, M.D.
Director, IRM