Academic journal article American Journal of Psychotherapy

Cognitive Regulatory Control Therapies

Academic journal article American Journal of Psychotherapy

Cognitive Regulatory Control Therapies

Article excerpt

Cognitive regulatory control processes play an essential but typically unap- preciated role in maintaining mental health. The purpose of the current paper is to identify this role and demonstrate how cognitive-behavioral and related techniques can compensate for impairments. Impaired cognitive regulation contributes to the overly intense emotional states present in anxiety disor- ders, depression, and personality disorders; progression of adaptive hypoma- nia to mania; expression of psychosis in the conscious and awake state; dominance of immature defense mechanisms in borderline and other person- ality disorders. A wide variety of standard (monitoring, reappraisal, response inhibition, relaxation training) and more novel (suppression therapy, willful detachment, cost-benefit analysis, normalization, mature defense mechanism training) cognitive-behavioral and related techniques can be applied to compensate for cognitive regulatory control impairments, and their success probably aligns with this capacity.

KEYWORDS: cognitive regulation; cognitive behavioral therapy; psychosis; mania; mood disorders; anxiety disorders; personality disorders

INTRODUCTION

Regulation is essential to healthy functioning. Cells free of regulation transform into cancer, uncontrolled immune system responses fail against pathogens and attack the host in the case of autoimmune conditions, and well-regulated homeostatic mechanisms are required to maintain physio- logical parameters such as temperature and blood pressure within the range required for survival. While the role of regulatory control is well established in regards to biological functioning, its application to psycho- logical functioning is very limited. Given that regulatory control is essential for biological functioning, and that psychological and biological activity are tightly linked, it follows that such control must play a crucial role in maintaining the integrity of psychological functioning. Mental illness to a great extent can be conceptualized as the failure of cognitive regulatory control processes to maintain psychological homeostasis. For example, there is solid evidence that amygdala based fear/anxiety responses are regulated by prefrontal cortex (PFC)-amygdala connectivity, typically ensuring that exaggerated anxiety reactions are attenuated to promote adaptive functioning (Goldin, 2009; Goldin, Manber, Halimi, Canli, & Gross, 2009; Larson, Schaefer, Siegle, Jackson, Anderle, & Davidson, 2006). The PFC represents the brain's master controller accounting for a third of the human cortex, and with uncontrollable acute and chronic stress its functioning is diminished impairing regulation (Arnsten, 2009; Arnsten, 2011). When cognitive regulatory control functioning is inade- quate, psychological disturbances arise.

Cognitive-behavioral techniques are well established in the treatment of many mental health conditions, including anxiety disorders, depression, and to a lesser extent, psychosis (Barlow, 2005; Beck, 2005). These techniques lend themselves well to the task of compensating for inade- quate cognitive regulation because they focus on dysfunctional thoughts and the behaviors following from these thoughts. Their effectiveness probably equates with how well they compensate for impaired cognitive regulatory control, although these techniques are not typically framed in this fashion. In the present paper the role that deficient cognitive regula- tory control plays in mental health issues will be discussed, and the ability of cognitive-behavioral and related techniques to compensate for deficits will be shown. Some of these techniques are highly familiar, forming the basis of cognitive-behavioral therapy (CBT), while others are more unique, being designed to address specific cognitive regulatory control deficits.

ANXIETY DISORDERS

Cognitive activating appraisals underlie emotional responses (Lazarus, 1991; Lazarus, 1984; Clore & Ortony, 2000). …

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