Cognitive theories of emotional disorder

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MATHEWS (1988, 1997)










In the vast colony of our being there are many different kinds of people, all thinking and feeling differently.

(Fernando Pessoa)

The cognitive theories presented in Chapter 3 took "normal" emotions as their starting point. However, there are a number of influential cognitive approaches to emotion that have taken their starting points to be disorders of emotion rather than normal emotions themselves. These theories will form the focus of the present chapter.

In contrast to theories of normal emotion, cognitive approaches to the emotional disorders have typically focused on a specific disorder such as depression or anxiety rather than attempting broader accounts of a range of emotional disorders. This carving up of the emotional disorders can lead to a false sense of disjointedness between the emotions in comparison to the more over-arching theories that were considered in Chapter 3. Fortunately there are signs that recent theories may buck this trend, although for at least two different reasons. First, the sheer success of a theory in its own domain may lead it, in the tradition of the great empire builders, to cross into adjoining territories; thus, the success of Beck's theory of depression has led to its fruitful extension to other areas such as anxiety, schizophrenia, and personality disorders. Second, there are signs that the increasing cross-fertilisation between cognitive psychology and clinical psychology may lead to more general theories of emotional disorders rather than theories that are tied to one specific disorder; we will examine the approach of Williams et al. (1988, 1997) as an example of this trend. However, we will not attempt to examine every cognitive theory of every emotional disorder, but will leave many of these until the appropriate chapters in the second part of this book. The theories that we will discuss will be chosen for what we see as their potential to be applied more widely than they may have been so far.

If, in our examination of normal theories of emotion, we detected the possibility of integration, for example between cognitive and psychodynamic approaches (e.g., in the increasing interest in unconscious processes) or between cognitive and social approaches, we can also find these integrative forces within recent theories of emotional disorders. For example, an increasing number of approaches to depression look to the interaction of social and cognitive factors to explain its occurrence (e.g., Rottenberg & Gotlib, 2004); thus, it is well recognised that depression is more likely to occur if an individual experiences a severe negative life event, but not every individual who experiences such events becomes depressed. Although the modern interest in the interaction between social factors such as life events and internal cognitive factors such as self-esteem can be traced to the work of researchers such as Brown and Harris (1978), from a broader integrative and historical perspective we should also note Freud's 1917 work, Mourning and Melancholia. In this paper, Freud proposed that significant losses (i.e., life events in modern terminology) occur both in the normal state of mourning and in the disorder of melancholia, but in melancholia vulnerable individuals in addition turn their anger against the self (a possible mechanism that would lead to "low self-esteem"). The moral is that, although the wheel may simply have turned full circle in the search for integrative approaches, we should now be in a position to take these approaches further.

One general criticism that we offered in Chapter 3 of cognitive theories of normal emotions was that these theories often provided inadequate accounts of how emotional disorders might be explained within their frameworks. However, in relation to theories of emotional disorders, we can identify the opposite problem: How do theories of emotional disorders account for normal emotions? Are disordered emotions simply greater amounts of emotion X, which last for longer? Or does the disordered variant include some additional factor that is not present in the normal form, such that disorder is qualitatively different from order? In answer to these questions, most of the theories that we will consider are members of the class of so-called diathesis-stress models. That is, many of the theories identify a long-standing vulnerability factor, such as a particular attributional style, a particular group of dysfunctional schemas, particular attentional or mnemonic biases, or whatever, which in the context of an appropriate stress leads to the emotional disorder in question. It must be noted, though, that the diathesis-stress accounts have been better worked out for some disorders than others; for example, whereas strong evidence is available for diathesis-stress accounts of depression, the picture is less clear for the anxiety disorders (see Chapter 6).

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