Academic journal article Journal of Cognitive Psychotherapy

Facilitating Cognitive-Emotional Congruence in Anxiety Disorders during Self-Determined Cognitive Change: An Integrative Model

Academic journal article Journal of Cognitive Psychotherapy

Facilitating Cognitive-Emotional Congruence in Anxiety Disorders during Self-Determined Cognitive Change: An Integrative Model

Article excerpt

The treatment of the multiple dimensions of anxiety requires a multimodal therapy. To facilitate the congruence between cognition and emotion, a synthesis of cognitive restructuring, progressive self-relaxation training, and concentration skills training is presented as an integrative model applied to inpatient Vietnam combat veterans with PTSD (Post-Traumatic Stress Disorder) during the process of self-determined cognitive change. Using a cognitively oriented frame-work, the model provides procedures that identify important propositional beliefs, transform the personal meaning of these beliefs, pair beliefs/self-talk with a state of wellbeing to facilitate cognitive-emotional congruence, and operationalize beliefs into observable behavior. Emphasis is placed on the rationale, clinical integration, and application of the various components within a cognitively oriented approach.

A cognitive mediational approach that endeavors to help the individual change by modifying the internal dialogue alone may not change the emotional or behavioral experience of the individual. Cognitive-emotional dissonance occurs when the individual attempts to apply rational thinking yet still experiences old familiar feelings. Known more popularly as the discrepancy between the "head and the heart," the resistance to more adaptive ideas, to more functional attitudes may be the result of the person not knowing how to change more than the self-limiting thoughts: "I learned to tell myself I deserve to be forgiven. I believe I deserve to be forgiven. My Vietnam buddies say they would forgive me for my actions, but I don't feel forgiven."

This article presents an integrative approach to facilitate cognitive and emotional congruence by blending elements of cognitive restructuring, progressive selfrelaxation, and concentration skills training in the treatment of anxiety. There is increasing interest in the development of integrated models combining elements of cognitively oriented approaches with relaxation procedures (Dendato & Diener, 1986; Corder, Whiteside, & Haizlip, 1986; Griffiths, 1985; Hillenberg, 1985; Tolman & Rose, 1985; Hazaleus, 1984; Meichenbaum, 1977), however, many of these models structure the treatment variables in a linear sequence. The program presented emphasized a synthesis rather than a sequence of the elements of cognitive restructuring, progressive self-relaxation, and concentration-skills training to expand upon the primary clinical tasks of a cognitively oriented approach. This synthesis sought to: a) increase the individual's capacity to shift and focus cognitive attention; b) increase the individual' s capacity to produce a relaxation response; and c) pair a new, more adaptive cognition or proposition/self-talk with the self-induced state of relaxation in an attempt to facilitate cognitive and emotional congruence during the process of self-determined cognitive change. The program, Choosing to Change, was employed on five separate occasions as a treatment group on a 90-day specialized inpatient treatment unit designed to treat post-traumatic stress disorder (PTSD) in Vietnam combat veterans.1 It was one of many ongoing treatment groups set in a therapeutic community that included didactic presentations and interactional therapies, and it served in an ancillary role to groups that dealt directly with the trauma of the veterans' military experience. The presentation of the program will, we hope, be of heuristic value and stimulate interest in controlled study.

There are an increasing number of cognitive theorists and others who are questioning the primary and unifying principle of cognitive mediational theories that proclaim that the principal determinant of emotion, behavior, and motivation is entirely the product of the internal dialogue of conscious thinking. Mahoney (1980) and Yesavage (1980) review the arguments for considering unconscious processes as contributing factors, concluding that they are probably more important than has been previously acknowledged by cognitive-behavioral theorists. …

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