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Anxiety Disorders
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Depression: Depression & Related Conditions

Psychological Explanations: Part II

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

Cognitive Beliefs:

So far, we have discussed two psychological variables that influence whether or not someone is likely to experience anxiety. These are perceived control and cognitive appraisals. However, these two variables are actually a reflection of a person's beliefs about themselves and the world around them. The relationship between a person's individual, unique beliefs about an event, and their responses to that event, is central to Rational Emotive Behavioral Therapy (REBT). This particular type of cognitive therapywas developed by Albert Ellis. According to Ellis (1997), the specific stressors in a person's environment do not directly cause their emotional reactions, or problematic behavior. Instead, unhealthy responses are the result of a person's unique beliefs. These beliefs include not only beliefs about the event itself, but also beliefs about one's ability to cope with, and/or tolerate negative events.

cognitive word collageInterestingly, our beliefs about a particular situation, and our beliefs about our ability to cope with it, are not necessarily haphazard. Instead, our understanding of a particular situation is often influenced by underlying attitudes and "core beliefs" about ourselves, and the world around us. Core beliefs refer to organizing principles we use to understand and interpret the events in our environment. According to Aaron T. Beck, the one of the principal founders of cognitive therapy, each of us form strongly held, core beliefs about ourselves, others, and the world around us. Although these core beliefs fundamentally influence our appraisal of an event, we are often unaware of these beliefs. Therefore, we do not realize their impact on our everyday lives. Unfortunately, these core beliefs may not always represent an accurate portrayal of the situation at hand. These beliefs can cause us to experience undue emotional distress. Cognitive therapy seeks to bring these core beliefs in awareness, and to challenge the accuracy of those beliefs. For more information about cognitive theory and associated therapies please refer to that section.

Cognitive Distortions:

Generally, our beliefs are usually not evaluated in terms of their objective validity. The common expression, "You're entitled to your beliefs" reflects this acceptance. However, some beliefs can lead to distorted thoughts. These thoughts in turn may lead to distressing emotions and maladaptive behavior. According to Beck and Emery (1985), people are prone to make certain types of cognitive "errors" in their appraisals across various situations in their lives. This is particularly true for people with anxiety disorders. These thinking errors are often called cognitive distortions.

There are many different types of cognitive distortions that may affect anxiety. However, two of the most common are:

1. the overestimation of threat; and,
2. the underestimation of one's ability to cope with the threat.

The overestimation of threat commonly refers to the beliefs an individual holds about the perceived probability, or certainty, of an event's occurrence. This type of cognitive distortion is often called "fortune-telling" (e.g., "I will get lost when I am driving"). A related cognitive distortion refers to catastrophic prediction, which is a heightened or exaggerated sense of perceived harm. It is also called "catastrophizing." "It will horrible if I get lost." "I will be in grave danger."

It is not hard to imagine that if someone already overestimates the danger of a situation, they are likely to underestimate their ability to cope with it. The cognitive distortion of overestimation of threat, often leads to a second distortion of underestimating one's ability to cope with it. "I will never be able to find my way home." "I will be helpless and I can't tolerate that." This is similar to the concept of primary and secondary appraisal discussed in the previous section. Unfortunately, this combination of cognitive distortions will most likely result in a disproportionate amount of anxiety relative to the actual situation. At the same time, these distortions increase the odds of engaging in maladaptive behaviors (i.e., avoidance). The avoidance of challenging or stressful situations blocks the development of coping skills. For instance, if you avoid going to unfamiliar locations you cannot develop problem-solving skills such as asking for directions or using a map. Avoidance also prevents any opportunity to refute the distorted belief. Therefore, its effect is to strengthen cognitive distortions. For instance, suppose I believe I will always get lost. If I never go anywhere, I cannot refute this belief. By never traveling on my own, I will never have the opportunity not to get lost. For more information about cognitive distortions, review the Cognitive Theory and Therapy Section.

The Importance of Psychological Vulnerabilities

Taken together, our beliefs affect the way we experience, and respond to, a potentially threatening situation. In general, the greater the gap between our estimation of threat, and our estimated abilities, the greater the likelihood we will experience anxiety. Because these beliefs have such a powerful influence, cognitive therapy seeks to create an awareness of these cognitions, and to challenge their accuracy. Interestingly, in clinical practice we often see individuals who, despite their initial belief about their inability to cope with a situation, are often quite good at problem-solving solutions to threatening situations. In addition, when coached to challenge their cognitive distortions, people are able to accurately reevaluate the probability of catastrophic outcomes.

These thoughts and beliefs may have been formed from past experiences. Nonetheless, they operate in the present and subsequently influence our current behavior. This recognition forms the fundamental premise of anxiety disorder treatment. It is possible to treat anxiety symptoms in the present, regardless of prior experiences, or strongly held beliefs and assumptions that were formed in the past. The idea of focusing on the "here-and-now" is one of the main tenets underlying the many useful techniques of cognitive-behavioral therapy (CBT). This type of therapy is often considered the "gold standard" of anxiety disorder treatment.

Simply stated, CBT is based on the premise that people's dysfunctional thinking and behavioral patterns contribute to the development and maintenance of an array of difficulties. These difficulties range from daily stress, to full-blown psychological disorders. Consequently, the main goal of CBT is help individuals change problematic beliefs and thinking patterns while learning to engage in more adaptive behaviors. These changes relieve a person's symptoms, and to restore their quality of life. In a sense, by treating the symptoms in the present, the therapist and therapy participant are chipping away at the psychological vulnerability that was formed in the past.