Academic journal article Journal of Evidence-Based Psychotherapies

Cognitive-Emotional Equation: The Relationship between Irrational Cognitive Processes, Cognitive Contents and Specific Emotions. Evidence from a Sample of Breast Cancer Radiotherapy Patients

Academic journal article Journal of Evidence-Based Psychotherapies

Cognitive-Emotional Equation: The Relationship between Irrational Cognitive Processes, Cognitive Contents and Specific Emotions. Evidence from a Sample of Breast Cancer Radiotherapy Patients

Article excerpt

Abstract

The present exploratory study investigated the interrelations among irrational cognitive processes, cognitive contents and specific emotions in breast cancer patients undergoing radiotherapy. The data were collected during a randomized clinical trial investigating a cognitive behavioral therapy intervention for breast cancer women undergoing radiotherapy. Intervention group participants had to complete 2 worksheets (in which they described their thoughts and emotions) per every week of intervention. The content of the worksheets was coded into 3 categories: irrational cognitive processes, cognitive contents and emotions. Coding was based on Rational-Emotive Behavior Theory. The irrational cognitive processes most frequently exhibited by these patients were low frustration tolerance (82.3% of the patients), demandingness (79.4%), and catastrophizing (76.5%). The cognitive contents most frequently exhibited were comfort (88.2% of the patients) and fairness (67.6%). The most commonly experienced negative emotions were anxiety (73.5%) and anger (70.6%). Self-downing was a predictor for depression (OR=2.33, p<.010), while other-downing was a predictor for anger (OR=7.27, p<.001). A significant interaction was found between irrational cognitive process and cognitive content such that catastrophizing (p<.017), low frustration tolerance (p<.010) and selfdowning (p<.005) predicted anger only in the context of fairness. Irrational cognitive processes may not function in the same way for different contents and knowing the elements of the content-process-emotion equation can be useful and informative in tailoring short-term, effective interventions.

Keywords: Rational-Emotive Behavior Theory, irrational cognitive processes, cognitive contents, emotions

Introduction

Breast cancer is the second leading cause of cancer death in women (American Cancer Society [ACS], 2013). Radiotherapy is one of the treatment modalities prescribed for women with breast cancer, and has been shown to improve survival after breast surgery (Vinh-Hung & Verschraegen, 2004). While medically effective, this treatment is also associated with aversive symptoms and side effects (Binkley et al., 2012; Schnur, Ouellette, Bovbjerg, & Montgomery, 2009) and there is available evidence showing that during the course of radiotherapy treatment, approximately 30-50% of women experience moderate to severe levels of emotional distress (Browall et al., 2010; Knobf & Sun, 2005; Schnur et al, 2009b; Sollner, Maislinger, Konig, Devries, & Lukas, 2004; Stiegelis, Ranchor, & Sanderman, 2004).

The literature points to a diversity of psychological interventions designed to relieve the emotional distress of cancer patients (Jacobsen et al., 2006). In the context of radiotherapy for breast cancer patients, Rational Emotive Behavior Therapy, a form of Cognitive Behavioral Therapy, was found to be effective in reducing emotional distress (Schnur, David, Kangas, Green, Bovbjerg, & Montgomery, 2009).

Rational Emotive Behavior Therapy (REBT) was developed by Albert Ellis (Ellis, 1962; Ellis, 1994), and it has since then flourished and become extremely popular. The theory behind this form of therapy asserts that the relationship between undesirable events (e.g., undergoing radiotherapy for breast cancer) and emotional consequences (e.g., anxiety) is mediated by the individual's belief system, with a particular focus on irrational beliefs (Ellis, 1962, 1994; Walen, DiGiuseppe, & Dryden, 1992).

According to REBT theory, irrational beliefs are defined as evaluative beliefs that are not empirically supported, non-pragmatic and/or illogical. Emotions that follow irrational beliefs about negative events are called dysfunctional negative emotions (e.g., anxiety, depression, guilt, anger) (Ellis, 1994). The purpose of REBT is to reduce dysfunctional negative emotions and to replace them with functional emotions by replacing the irrational beliefs with rational beliefs (Ellis, 1962, 1994; Neenan & Dryden, 1999; Walen, DiGiuseppe, & Dryden, 1992). …

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