The conceptual framework presented in Fig. 1.1 depicts several distinct features of the prototypical cognitive vulnerability model of emotional disorders and other psychological problems. Such cognitive models generally share the assumption that there are a series of causal chains by which enduring vulnerabilities develop and (with relevant stressor combinations) become converted into the emotional disorders or problems. These causal chains commence with earlier life experiences (e.g., faulty attachment relationships, childhood traumas, modeling) that lead individuals by means of developmental pathways to develop cognitive vulnerabilities. Once cognitive vulnerability factors have coalesced and are put into play or are activated, they alter the individual's responses and are seen as serving schematic processing functions (e.g., D. A. Clark, Beck, & Alford, 1999). That is, the cognitive vulnerabilities represent a mental mechanism that shapes the individual's selective processing, attention, and memory,
and molds changes in the concomitant contents of the individual's thinking (i.e., the ideation, imagery, or "automatic" thoughts").
Although a vulnerability-stress interaction is a central feature of cognitive vulnerability models, there are many possible variations. First, the triggering conditions that are hypothesized to precipitate symptoms or episodes of disorder may be both "public" and "private" events. Public events include achievement failures, disruptions of interpersonal relationships, or collectively evident threats to well-being. Private events include unusual bodily sensations, unwanted thoughts, or traumatic memories.
Thus, the putative cognitive vulnerability that influences the risk of emotional disorder can be represented by a depressive inferential style (see chap. 2, this vol.), a cognitive network of negative self-referent cognition (chap. 3, this vol.), a looming cognitive style (chap. 7, this vol.), or a tendency to catastrophically misinterpret the meaning of experienced bodily sensations (see chap. 8, this vol.). In this conceptual framework, the output is represented by the emotional disorder or symptoms that result from the interaction between the precipitating event and cognitive vulnerability.
A critical element of many cognitive models is that specific biases of information processing and proximal cognitions are assumed to differ with different disorders (Beck & D. A. Clark, 1997; J. M. G. Williams et al., 1988). For example, the bias in social phobia is for information relevant to the threat of public humiliation, and is accompanied by proximal thoughts like "I'll make a fool of myself" (see chap. 10, this vol.). The specific bias in panic disorder is for information relevant to unusual bodily sensations that might signal impending heart attacks or other feared calamities, and is accompanied by thoughts such as "I'm having a heart attack" (see chap. 8, this vol.). Such "disorder-specific" information-processing biases are presumably instigated when cognitive vulnerabilities (the distal factors) are put into play or engaged that were present long before the symptoms or episode. Hence, the specific vulnerability hypothesis of cognitive models is that the vulnerabilities to different disorders can dramatically differ. The mental processing biases can in turn be seen as penetrating a range of basic information processes (e.g., selective attention, encoding, and retrieval in memory, interpretation).
The stages of processing and specific subject matter that are implicated, however, depend on the particular cognitive models and disorders. For example, in some models, the primary disorder-specific bias in anxiety is in selective attention for threatening stimuli, whereas the primary bias in depression is in the elaboration in memory of negative information during encoding (e.g., J. M. G. Williams et al., 1988). In general, the basic idea of disorder-specific content and biases has been an impetus for considerable research on cognition in emotional disorders.
Several additional factors may also influence the net effects of the cognitive vulnerability, by reason of having power to either inhibit or intensify reactions to precipitating stresses. As Fig. 1.1 shows, some factors (e.g., social support, an intimate relation with a spouse or lover, effective coping mechanisms) are often seen in cognitive models as operating as protective factors that work against the development of disorders (e.g., Brown & Harris, 1978; S. Cohen & Wills, 1985; Panzarella, Alloy, & Whitehouse, 2004). For example, even when cognitively vulnerable individuals are exposed to stress, the presence of certain protective factors may shield them from disorders, or reduce the likelihood they will develop psychological problems. Such factors can be either transitory, "providential" factors (e.g., fortuitous, but temporary, social support during stress), or quite stable (e.g., lifelong relationships). Sometimes they can be unidentified by researchers or even unknown. In contrast, exacerbatingfac-tors are additional stresses or factors that worsen an emotional disorder after it has already been acquired. Examples include stressful life events (e.g., further medical illnesses, psychological problems, or negative affect expressed by others) that impinge on individuals subsequent to the onset of their emotional disorders.
It seems that individuals become more supersensitive or defenseless to the impact of negative events, and therefore cope less well, once a psychological disorder such as a depressive episode (Hammen, 1991) has been acquired. Such an observation invites comparisons to the weakened state of people who are medically ill. Taken collectively, this line of reasoning suggests that even when individuals have equivalent vulnerability-stress combinations, they can still differ in their trajectories of disorder owing to differences in protective and exacerbating factors.
Finally, as Fig. 1.1 indicates, vicious cycles involving bidirectional causal links (and feedback loops) with disorder-related behaviors can also contribute to the onset, maintenance, or recurrence of disorders. Under the pressure of the stress and intense symptoms, for example, cognitively vulnerable individuals tend to engage in various maladaptive self-protective or compensatory behaviors. In instances of depression, individuals often have a heightened inclination to engage in reassurance seeking from others (Joiner, Alfano, & Metalsky, 1992). Individuals who are depressed also contribute to the occurrence of self-generated life events (e.g., creating interpersonal conflicts or excessive demands) that can maintain and exaggerate their depression (Hammen, 2003). In instances of anxiety disorders, individuals often engage in cognitive avoidance strategies that can include worry, thought suppression, or wishful thinking (see chap. 7, this vol.). Here, avoidance behaviors can be relatively subtle, such as looking away from the faces of others to avoid seeing imagined rejection. In this way, compensatory avoidance behaviors often insidiously enforce and maintain the erroneous beliefs as well as the symptoms of the emotional disorder (e.g., beliefs about the likelihood of rejection; see D. M. Clark & Wells, 1995).
According to cognitive models, emotional disorders persist as long as the cognitive components of the disorders are active, and improve when they are altered (see chap. 9, this vol.). Furthermore, temporary relief is produced by changes in proximal cognitive components of the disorder, whereas durable improvement requires changes of the underlying cognitive vulnerability factors.
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