The Recovery-Oriented Cognitive Therapy (CT-R) Difference: Activating Positive Cognitions Rather than Deactivating Negative Cognitions

The Recovery-Oriented Cognitive Therapy (CT-R) Difference: Activating Positive Cognitions Rather than Deactivating Negative Cognitions


This recent article by Dr. Aaron T. Beck describes the biological underpinnings of an individual’s responses to various situations, and how these responses can create cognitive biases that may influence an individual’s personality and potential psychological disorders. It then explains a recent shift in psychology, from centering therapy on the correction of negative symptoms and maladaptive adaptations to a holistic approach to understanding an individual and activating their personality. This humanistic, positive approach is a cornerstone of our Center for Recovery-Oriented Cognitive Therapy (CT-R), where we work with individuals given a diagnosis of a serious mental health conditions on the path to recovery.

I view personality in terms of two overarching sectors: the positive (appetitive) and negative (aversive). These two sectors include domains such as cognitions/attitudes and affect. For convenience, I will be mainly referring to the affects for labeling purposes. The negative or aversive affects are useful to human behavior but are occasionally related to biases and can cause transient problems. In general, the negative affects can be divided into anxiety, depression or anger. The relevant automatic thoughts have to do with danger, defeat or disempowerment/devaluation, respectively. When the individual overreacts to a situation, it is often because of a negative cognitive bias and the individual interprets a situation as negative when it is actually neutral or positive. The tendency to misinterpret is, to a certain extent, a carry-over from the hunter-gatherer society or “the wild.” For example, preparedness for any danger or threat was adaptive. Another difficulty in everyday life has to do with the intensity of the affect, which to some extent is also carried over from the wild, where such an intense reaction may be preservative of life. Thus, in everyday life, there is a certain percentage of false negatives (experiencing an exaggerated negative affect that does not fit the external situational demands).

Most individuals manage to navigate alongside these biases and either live with them or correct them. Many individuals are able to use reasoning (as earlier described by Stoic philosophers). A similar mechanism is found in defeat/sadness or depression. The anger-arousing situation has to do with circumstances interpreted as disempowering or devaluing. While these may temporarily cause hurt, as in the case of defeat, they are in this case bound by anger and a wish to punish the offender. This reaction occurs in individuals who do not feel a heightened sense of insecurity and feel strong enough in relation to the offender to retaliate. The appetitive sector (which will be described in more detail at a later date) has to do with positive affect. Individuals are programmed to do things that will bring them satisfaction or pleasure. However, when this drive becomes too strong, it can lead to addiction.

Thus, the mechanisms of momentary anxiety are transformed into anxiety disorders, the setbacks leading to sadness when expanded and exaggerated with bias lead to depression, and anger and the wish to retaliate leads to aggressive or violent behavior. The neuroses represent an extension and magnification of the transient reactions. The syndromes may also occasionally arise from the continual repetition of the transient reactions. Not only do these transient reactions become extended overtime, but they also become more extreme. There are often other things going on. For example, the persistence of a syndrome can lead to a drastic drop in self-esteem or empowerment. The individual regards himself or herself as a failure or helpless.

Until recently, the therapeutic approach across the span of psychopathology has been directed towards the “symptoms” and specifically a reduction in various cognitive patterns, negative affect and maladaptive behavior patterns. In recent years, however, the attention of many psychotherapists has shifted from looking at the obliteration of negative symptoms or the overt correction of various misinterpretations to a broader, more cross-diagnostic approach that aims to view individuals holistically and activate the total personality. In their work with individuals with serious mental health conditions, Paul Grant and Ellen Inverso have led the way in trying to activate these broad aspects of personality, such as being effective, valuable, a good person, independent, etc. We have observed that when individuals became engaged in activities of their own choosing such as washing the dishes or folding the laundry, they became animated and their overall functioning, sense of self-worth and altruism improved, among other factors. Thus, after a discrete action or experience, members of an individual’s care team would assist the individual in drawing conclusions regarding the meanings of the experience, what the experience says about them (for example, that they are kind, worthwhile or courageous), and what the experience denotes about how the individual can relate to others. This focusing on meaning tends to activate the entire person—a top-down approach. These positive interactions with the clinical staff also help reverse the stigma imposed by the clinical staff. It is important to note that this approach is ultimately directed at cognitions, just as traditional cognitive therapy approaches are. However, the critical difference in CT-R is the emphasis on activating positive cognitions (and a relative de-emphasis on deactivating negative cognitions).

The post The Recovery-Oriented Cognitive Therapy (CT-R) Difference: Activating Positive Cognitions Rather than Deactivating Negative Cognitions appeared first on Beck Institute for Cognitive Behavior Therapy.

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