The Role of Affect in Cognitive Therapy

A lot of people have the impression that CT de-emphasizes emotion or that CT aspires to use rational thinking to eliminate emotion but this is not the case at all. The basic Cognitive model hypothesizes that the individuals immediate, spontaneous appraisal of the situation elicits emotional responses. If I appraise the situation as presenting a significant amount of risk or danger, I will experience anxiety/fear.

However, the model is not linear. It also asserts that mood biases cognition in a mood-congruent way. If I am anxious, I will tend to be more vigilant for signs of danger, will attend selectively to stimuli associated with danger, and will be inclined to have a lower estimate of my ability to cope with the situation.

We argue that cognition influences mood and mood influences cognition. (This is discussed a variety of different places, the reference which I can think of at the moment of Pretzer & Beck, 1996)

CT was initially developed as a treatment for depression and when we are working with a depressed individual, we typically are trying to decrease the intensity of their depressed mood. Thus we may well help the client learn to identify dysfunctional negative thoughts which contribute to the depressed mood and help him or her learn to replace them with more realistic cognitions (Rational Responses) in order to alleviate the depression.

When we use cognitive interventions to alleviate a depressed mood, this is not because we believe that one should always be rational or that one should eliminate emotion. Rather, when treating depression, decreasing the intensity of the client1s depressed mood is one of the treatment goals. When treating other problems, we have other goals and may or may not try to decrease the intensity of the emotion involved. In treating anxiety disorders, we typically focus on helping the individual face their fears and tolerate anxiety rather than avoiding it as a means to decrease their anxiety in the long run. In treating anger problems, we may work to decrease the intensity of inappropriate anger or we may focus on helping the individual acknowledge their anger and handle it more adaptively (usually more assertively). In treating Obsessive-Compulsive Personality Disorder we may need to spend a fair amount of time and energy helping the client to recognize and verbalize emotions (see Pretzer & Hampl, 1994). One of the recent advances in treating Borderline Personality Disorder is the idea that increasing the individuals awareness of their emotions and their tolerance for emotion may be important (see Linehan, 1993; Farrell & Shaw, 1994).

I would argue that sometimes we should help clients use cognitive and behavioral techniques to decrease the intensity of affect. On other occasions we need to help clients to tolerate their affect and cope with it more effectively. On yet other occasions we need to help clients face their affect rather than avoiding it. Still other clients need to learn to value their emotions and become more aware of them.

Finally, in trying to figure out how discussions of affective processing fit with CT, it is important to remember that we define cognition broadly. We are thinking of more that just the verbal thoughts of which one is consciously aware. When we talk of cognition, we include many forms of information processing including verbal thoughts which one is not aware of and non-verbal thought such as mental imagery. Much of what is discussed in terms of affective processing we would consider to be cognition.

For example, when a snake phobic sees a snake and has a strong emotional and physiological response but denies having experienced any thoughts. We don1t see this as proof that the affect is occurring without any cognitive mediation. In fact, I would argue that cognition is inherent in recognizing the stimulus as a snake and categorizing it as dangerous. There are a variety of ways in which this could occur without the individual reporting the occurrence of thoughts. There may have been verbal thoughts (such as - OH MY GOD A SNAKE! It will bite me!-) which the individual did not notice and therefore cannot report. There may have been visual images (such as an image of a large snake lunging forward with an open mouth) rather than verbal thoughts. There may have been abstract propositional thought equating snakes and danger. I would not rule out the possibility that affect can sometimes occur without being elicited by cognition but I do not see this happening a lot in my clinical practice. I do encounter a great many occasions where clients are initially unaware of the cognitions which play a role in their problems.

• Farrell, J.M. & Shaw, I.A. (1994). Emotional awareness training: A prerequisite to effective cognitive-behavioral treatment of borderline personality disorder. Cognitive & Behavioral Practice, 1, 71-91.
• Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
• Pretzer, J. & Beck, A.T. (1996). A cognitive theory of personality disorders. In: J.F. Clarkin & M.F. Lenzenweger (Eds.) Major Theories of Personality Disorder. New York: Guilford.
• Pretzer, J. & Hampl, S. (1994). Cognitive behavioural treatment of obsessive compulsive personality disorder. Clinical Psychology and Psychotherapy, 1, 298-307.

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