Cognitive Errors in Cognitive Behavioral Therapy: A Survey of Researchers and Practitioners and an Assessment of the Face Validity of the Cognitive Error Rating Scale
Milman, Evgenia, Drapeau, Martin, Journal of Evidence-Based Psychotherapies
Constructs such as Cognitive Errors (CE) and other types of cognition are crucial to the advancement of Cognitive Behavioral Therapy (CBT) theory, practice and research. However, much ambiguity remains surrounding the characterization and manifestation of CEs and other types of cognitions (e.g., Kwon & Oei, 1994). In response to this, Drapeau and Perry (2008) developed the Cognitive Errors Rating Scale (CERS) which has the potential to clarify some of this ambiguity and to provide a means of assessing the manifestation of CEs. The present study first investigated whether the ambiguity surrounding the characterization and manifestation of cognition types translates from CBT literature to the experience of researchers and practitioners. An online survey (n=128) indicated that this ambiguity is, in fact, not evident to researchers and practitioners. Demographic variables, including identity as a researcher versus practitioner, attitude toward manual use, and experience in practice, affected participants' assessment of the need for and the benefit from the provision of consensual definitions for cognition types in CBT theory. The study also examined the face validity of the CERS. Results showed that the CERS has strong face validity. The research implications of these findings are discussed.
Keywords: cognitive errors, cognitive distortions, measurement, assessment, Cognitive Error Rating Scale, CERS, face validity, cognitive behavioral therapy, CBT
In conceptualizing psychopathology and its treatment, Cognitive Behavioral Therapy (CBT) scholarship has postulated the existence of a type of cognition referred to as a cognitive error (CE). Despite the fact that CEs are central to the field of CBT, there is variation in the approaches that have been taken to defining and characterizing CEs. As a result, answers to questions such as "what makes a CE a CE? or "what, if anything, differentiates a CE from an automatic thought or a schema?" differ from one scholar to the next (e.g., Kwon & Oei, 1994). For example, some have characterized CEs as distorted cognitive processes and distinguished them from automatic thoughts which are understood to be the cognitive products of distorted cognitive processes (e.g. Hollon & Kriss, 1984; Kwon & Oei, 1994). Others define CEs and related constructs using a surface versus deep criterion, which represents the degree to which a cognition is accessible to awareness. In this context, both CEs and automatic thoughts are believed to be accessible to awareness (i.e. on the surface) and are distinguished from schemas which are considered inaccessible to awareness (i.e., deep; e.g., Kwon & Oei, 1994; Leahy, 2000).
Researchers and theorists appear to take for granted different terms and characterizations of CEs. This variation has created inconsistency and uncertainty in the field of CBT (Kwon & Oei, 1994). For instance, when given examples of various types of CEs, independent judges are unable to reliably differentiate between them (Krantz & Hammen, 1979). As a result, of the two adult CE measures in existence, the Cognitive Bias Questionnaire acts only as a general gauge of thought distortion rather than a measure of specific types of CEs (Krantz & Hammen, 1979). Similarly, the Cognitive Error Questionnaire (Lefebvre, 1981) probes only four of the dozens of CEs described by CBT theorists (e.g., Dobson, 2010; Leahy, 2000; Sacco and Beck, 1995). Furthermore, measures presumed to target types of cognitions other than CEs are not exclusive of CEs. For example, according to the thought type characterizations presented by Sacco and Beck (1986), item 23 on the Automatic Thoughts Questionnaire (ATQ; Hollon and Kendall, 1980), "I can't do anything well," appears to be both negative thought content characteristic of an automatic thought and distorted thought processing (i.e., over-generalizing) characteristic of a CE. Likewise, item 14 on the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978), "If I fail partly, it is as bad as being a complete failure," is both stable thought content characteristic of a dysfunctional attitude and distorted thought processing (i. …