The Cognitive Model

2.3.2.1. What is It?

As noted earlier, the idea of people being machines was a key feature of behaviorism and other
schools of thought in psychology until about the 1960s or 1970s. In fact, behaviorism said
psychology was to be the study of observable behavior. Any reference to cognitive processes
was dismissed as this was not overt, but covert according to Watson and later Skinner. Of course,
removing cognition from the study of psychology ignored an important part of what makes us
human and separates us from the rest of the animal kingdom. Fortunately, the work of George
Miller, Albert Ellis, Aaron Beck, and Ulrich Neisser demonstrated the importance of cognitive
abilities in understanding thoughts, behaviors, and emotions, and in the case of psychopathology,
they helped to show that people can create their own problems by how they come to interpret
events experienced in the world around them. How so?

2.3.2.2. Maladaptive Cognitions

Irrational or dysfunctional thought patterns can be the basis of psychopathology. Throughout this
book, we will discuss several treatment strategies that are used to change unwanted, maladaptive
cognitions, whether they are present as an excess such as with paranoia, suicidal ideation, or
feelings of worthlessness; or as a deficit such as with self-confidence and self-efficacy. More
specifically, cognitive distortions/maladaptive cognitions can take the following forms:

 Overgeneralizing – You see a larger pattern of negatives based on one event.

 What if? – Asking yourself what if something happens without being satisfied by any of
the answers.
 Blaming – Focusing on someone else as the source of your negative feelings and not
taking any responsibility for changing yourself.
 Personalizing – Blaming yourself for negative events rather than seeing the role that
others play.
 Inability to disconfirm – Ignoring any evidence that may contradict your maladaptive
cognition.
 Regret orientation – Focusing on what you could have done better in the past rather than
on making an improvement now.
 Dichotomous thinking – Viewing people or events in all-or-nothing terms.

For more on cognitive distortions, check out this website: http://www.goodtherapy.org/blog/20-

cognitive-distortions-and-how-they-affect-your-life-0407154

2.3.2.3. Cognitive Therapies

According to the National Alliance on Mental Illness (NAMI), cognitive behavioral
therapy (CBT) “focuses on exploring relationships among a person’s thoughts, feelings and
behaviors. During CBT a therapist will actively work with a person to uncover unhealthy
patterns of thought and how they may be causing self-destructive behaviors and beliefs.” CBT
attempts to identifying negative or false beliefs and restructure them. They add, “Oftentimes
someone being treated with CBT will have homework in between sessions where they practice
replacing negative thoughts with more realistic thoughts based on prior experiences or record
their negative thoughts in a journal.” For more on CBT, visit: https://www.nami.org/Learn-
More/Treatment/Psychotherapy. Some commonly used strategies include cognitive restructuring,
cognitive coping skills training, and acceptance techniques.

First, cognitive restructuring (also called rational restructuring) involves replacing maladaptive
cognitions with more adaptive ones. To do this, the client must be aware of the distressing
thoughts, when they occur, and their effect on them. Next, the therapist works to help the client
stop thinking these thoughts and to replace them with more rational ones. It’s a simple strategy,
but an important one. Psychology Today published a great article on January 21, 2013 which
described 4 ways to change your thinking through cognitive restructuring. Briefly, these
included:

1. Notice when you are having a maladaptive cognition such as making “negative
predictions.” They suggest you figure out what is the worst thing that could happen and
what other outcomes are possible.
2. Track the accuracy of the thought. For instance, if you believe ruminating on a problem
generates a solution then write down each time you ruminate and then the result. You can
generate a percentage of times you ruminated to the number of successful problem-
solving strategies you generated.
3. Behaviorally test your thought. As an example, if you think you don’t have time to go to
the gym then figure out if you really do not have time. Record what you do each day and
then look at open times of the day. Explore if you can make some minor, or major,
adjustments to your schedule to free up an hour to exercise.
4. Examine the evidence both for and against your thought. If you do not believe you do
anything right, list evidence of when you did not do something right and then evidence of
when you did. Then write a few balanced statements such as the one the article suggests,
“I’ve made some mistakes that I feel embarrassed about but a lot of the time, I make good
choices.”

The article also suggested a few non-cognitive restructuring techniques to include mindfulness
meditation and self-compassion. For more on these
visit: https://www.psychologytoday.com/blog/in-practice/201301/cognitive-restructuring

A second major strategy is to use what is called cognitive coping skills training. This strategy
involves teaching social skills, communication, and assertiveness through direct instruction, role-
playing, and modeling. For social skills, therapists identify appropriate social behavior such as
making eye contact, saying no to a request, or starting up a conversation with a stranger and
examine whether the client is inhibited from engaging in the behavior due to anxiety. For
communication, the therapist can help determine if the problem is with speaking, listening, or
both and then develop a plan the client can use in various interpersonal situations. Finally,
assertiveness training aids the client protect their rights and obtain what they want from others.
Treatment starts with determining situations in which assertiveness is lacking and generating a
hierarchy of assertiveness opportunities. Least difficult situations are handled first, followed by
more difficult situations, all while rehearsing and mastering all the situations present in the
hierarchy. For more on these techniques, visit http://cogbtherapy.com/cognitive-behavioral-
therapy-exercises/.

Finally, acceptance techniques can be used to reduce a client’s worry and anxiety. Life involves
a degree of uncertainty and at times we need to just accept this uncertainty. However, many
clients, especially those with anxiety, have difficulty tolerating uncertainty. Acceptance
techniques might include weighing the pros of fighting uncertainty against the cons of doing so.
The cons should outweigh the pros and help the client to end the struggle and accept what is
unknown. Chances are the client is already accepting the unknown in some areas of life and
identifying those can help them to see why it is helpful to accept uncertainty which may help
them to do so in more difficult areas. Finally, the therapist may help the client to question
whether uncertainty necessarily leads to a negative end. The client may think so, but reviewing
the evidence for and against this statement will show them that uncertainty does not always lead
to negative outcomes which can help to reduce how threatening uncertainty seems.

2.3.2.4. Evaluating the Cognitive Model

The cognitive model made up for an obvious deficit in the behavioral model – overlooking the
importance of our thoughts and the role cognitive processes play in our feelings and behaviors.
Right before his death, Skinner (1990) reminded psychologists that the only thing we can truly
know and study is observable behavior. Cognitive processes cannot be empirically and reliably
measured and so should be ignored. Is there merit to this view? Social desirability states that
sometimes people do not tell us the truth about what they are thinking, feeling or doing (or have
done) because they do not want us to think less of them or to judge them harshly if they are
outside the social norm. In other words, they present themselves in a favorable light. If this is
true, how can we really know what they are thinking? The person’s true intentions or thoughts
and feelings are not readily available to us or are covert, and so do not make for good empirical
data. Still, cognitive-behavioral therapies have proven their efficacy for the treatment of OCD
(McKay et al., 2015); perinatal depression (Sockol, 2015); insomnia (de Bruin et al., 2015),
bulimia nervosa (Poulsen et al., 2014), hypochondriasis (Olatunji et al., 2014), and social anxiety
disorder (Leichsenring et al., 2014) to name a few. Other examples will be discussed throughout
this book.