The most basic tenet of cognitive clinical models is that cognitions mediate the relation between events that people experience and the emotions that they feel. A passage from Dickens aptly illustrates this keystone of cognitive models of emotional disorders and other psychopathology. It clearly conveys the fact that individuals can radically differ from each other in the ways that they privately explain and understand different characteristics of the same stimulus event:
"Oh, you cruel, cruel boy, to say I am a disagreeable wife!," cried Dora. "Now, my dear Dora, you must know that I never said that!" "You said I wasn't comfortable!" said Dora. "I said the housekeeping was not comfortable!" "It's exactly the same thing!" cried Dora. And she evidently thought so, for she wept most grievously. (Dickens, 1979, p. 616)
The basic precept of cognitive models of emotional disorder, then, is that a person's emotional responses to a situation are influenced by the interpretation (or appraisal) the person makes of its meaning (e.g., Fridja, 1987; Lazarus, 1991; Ortony, Clore, & Collins, 1988; Roseman, Spindel, & Jose, 1990). People's appraisals are not simple mirrorlike reflections of the elements of objective reality. Hence, it is not only a particular situation that determines the way people feel or emotionally respond, but also the special meaning that is subjectively constructed by the person that is important. It is just as important that the situation (absolute reality) does not directly determine how the person feels or responds. The same guiding principle applies to stimuli that are perceived within the interior of the person (e.g., physical sensations, thoughts, emotions) as to stimuli that are found in the external environment.
Cognitive models are also based on the general idea that there is a continuity of normal and abnormal cognitive processes. For instance, Beck (1991) stated that "the [cognitive] model of psychopathology proposes that the excessive dysfunctional behavior and distressing emotions or inappropriate affect found in various psychiatric disorders are exaggerations of normal adaptive processes" (p. 370). Thus, it is quite simple to apply the presuppositions of cognitive models to emotional disorders such as depression and panic disorder, or related ones such as eating disorders. For example, triggering events such as a social rejection or a small increase in body weight are construed by some individuals as a small setback; others perceive them as no less than decisive evidence of utter failure and personal defect. In addition, some people exhibit relatively characteristic or stable patterns in the ways in which they appraise emotion-provoking stimuli (e.g., Abramson et al., 1978; Riskind, Williams, Gessner, Chros-niak, & Cortina, 2000; Weiner, 1985). The bottom line is that habitual differences in the manner in which people interpret particular kinds of events can affect their future risk for developing particular kinds of emotional disorders.
The cognitive factors conceived to be important in emotional disorders can include both distal phenomena that were present before the disorder, and proximal phenomena that occur very close to, or even during, the episode of disorder and its symptoms (Abramson, Metalsky, & Alloy, 1989). Distal cognitive factors are normally relatively enduring cognitive predispositions to respond to stressful situations in maladaptive ways (e.g., dysfunctional attitudes or explanatory styles). They are higher in generality (or abstraction) as well as more distal to future episodes of disorders than proximal cognitions, which are more transitory or specific thoughts or mental processes that occur very close to, or even during, the episode of disorder. And, proximal cognitions (e.g., specific thoughts or images) are typically produced when individuals process the meaning of a stressful event in any situation through the filter of the underlying cognitive vulnerability.
Today, most cognitive models presuppose that the outcomes resulting from cognitive vulnerabilities depend on interactions with environmental precipitants. Some good examples of precipitants include stressful life events, early childhood traumas, faulty parenting, or medical injuries. In other words, the models incorporate a vulnerability-stress paradigm in which it is recognized that psychological disorders are caused by an interaction between predisposing (constitutional or learned) and precipitating (environmental) factors. These factors can trigger the development of emotional disorders or psychological problems for certain individuals (e.g., see Alloy, Abramson, Raniere, & Dyller, 1999), but the specific degree and even direction of the response can differ enormously from one person to another. For example, some individuals seem to be relatively "resilient" and often overcome the difficulties that accompany stressful events (e.g., Hammen, 2003); others seem overwhelmed by even minor problems. Thus, precipitating events are particularly likely to produce emotional disorders among individuals who have a preexisting cognitive vulnerability to the disorders.
Most individuals in stressful situations do not develop clinically significant disorders. Moreover, the specific disorder that emerges for different individuals is not determined just by the precipitating stress alone (i.e., precipitating stresses do not just occur in conjunction with any one clinical disorder). For example, stressful events are elevated in depression (Brown & Harris, 1978; Paykel, 1982), bipolar disorder and mania (see chap. 4, this vol.; Johnson & Roberts, 1995), anxiety disorders (Last, Barlow, & O'Brien, 1984; Roy-Byrne, Geraci, & Uhde, 1986), and even schizophrenia (Zucker-man, 1999). In light of these findings, cognitive vulnerability-stress models are offered to help account for not only who is vulnerable to developing emotional disorder (e.g., individuals with a particular cognitive style), and when (e.g., after a stress), but to which disorders they are vulnerable (e.g., depression, eating disorder, etc.).
The earliest vulnerability-stress models (e.g., Meehl, 1962) emphasized constitutional biological traits (e.g., genetic traits) as vulnerabilities. But, this approach was quickly expanded in terms of cognitive vulnerabilities, personality factors, and interpersonal strategies (e.g., Abramson et al., 1989; Blatt & Zuroff, 1992; D. A. Clark, Beck, & Alford, 1999; Ingram, Miranda, & Segal, 2001; Joiner, Alfano, & Metalsky, 1992; Rachman, 1997; Riskind, 1997; Robins, 1990). Researchers in the cognitive tradition favor the term vulnerability to diathesis, because the former term embraces the idea of learned and modifiable predispositions, instead of immutable genetic or biological traits (e.g., Just, Abramson, & Alloy, 2001).
Beck's (1967,1976) theory was the earliest to expound a cognitive vulnerability-stress interaction. Beck postulated that whether or not individuals possess an enduring cognitive predisposition to emotional disorders depends on if they have acquired maladaptive knowledge structures or schemata during the course of childhood. These schemata are internal frameworks, constructed of attitudes, beliefs, and concepts that individuals use when they interpret past, present, and future experiences. Because they influence the ways in which they interpret and initially experience events, schemata moderate the idiosyncratic subjective meaning and thus the impact of stressful events. These cognitive schemata promote maladjustment when they are poorly grounded in social reality or are otherwise dysfunctional. Hence, individuals with maladaptive schemata are more likely to make dysfunctional interpretations of stressful events that increase vulnerability to emotional disorders. Once they have made such appraisals (e.g., of failures as personal defects), a series of changes in mental processes are initiated that can culminate—by way of changes in the contents of thinking and information processing—in depression or anxiety. Thus, in Beck's cognitive model, emotional disorders result from a combination of predisposing, environmental, and developmental factors that lead individuals to engage in dysfunctional thinking and information processing.
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