The Status of Cognitive Change in Cognitive Therapy and Other Therapies

In this article, we analyze the nature of cognitive therapy and explore the likelihood of cognitive processes in other forms of therapy. In minimalist terms, cognitive therapy may often distill down to (1) acknowledging the apparent reality with which the individual is contending, and (2) providing an optional perspective-often the other side of the reversible illusion. Moreover, all therapies may be effective to the degree they promote cognitive change, although cognitive therapy alone explicitly attempts to accentuate cognitive mechanisms of action. Also, frequent suggestions that performance experiences are necessary for cognitive change may be overstated. Finally, the implications of applying some of the criteria for scoring fidelity of cognitive behavior therapy to other therapies, and the utility of importing ideas from social cognition research on two routes of persuasion and cognitive change, are discussed. The current special issue has discussed up to now the advantages of a partnership between cognitive therapy and behavioral, physiological, and developmental perspectives. This leads us to a new question: Why don't we use a cognitive frame of reference to understand what could be happening in other forms of therapy? A risk exists, of course, of overextending cognitive perspectives. On this note, Stephen J. Gould (1991) has compared scientific theories to "spectacles of the mind" (p. 264). He has pointed out that the spectacles can limit what we can see. Taking a cue from Gould, psychologists may need to periodically switch to new spectacles and ways of looking on clinical issues. But before we try this, it might behoove us to really see other psychotherapies through cognitive lenses to a greater degree than we ordinarily do (Alford & Norcross, 1991; Beck, 1991). SO, WHAT COGNITIVE CHANGES TAKE PLACE IN CT OR OTHER THERAPIES? At least six key points about cognitive change and therapy can be enumerated here:. 1. The first point is that, to some degree, cognitions reflect the basic ambiguity inherent in reality itself. As illustrated by the reversible illusion in Figure 1, people can often see more than one alternative reality in any stimulus domain. In this case, they can see an old woman, or a young woman, but not both simultaneously. The perception of meaning we have about reality at any time is necessarily selective. Furthermore, as we know, from contemporary cognitive and social cognitive research (e.g., Fiske & Taylor, 1984), people are quite capable at finding "realistic" evidence to justify their alternative realities, whatever their realities are. In this sense, we might call reality itself a kind of reversible illusion (see Cacioppo, Berntson, & Klein, 1992). A specific example might be helpful here. A recent study by Marx, Williams, and Claridge (1992) found that depressed subjects seemed to have difficulties in the more rudimentary or "cognitive" phases of problem-solving- in generating or identifying effective strategies. In current terms, depressed people may see the part of the reversible illusion that involves problems and difficulties they may face in the future-the holes that face them in the future, but not the way out of the holes. In contrast, nondepressed individuals may better see the way out of the holes they face. Interestingly, anxious subjects in the Marx et al. study were in between depressed subjects and normals, and appeared to know what had to be done but had difficulty performing the behaviors. 2. In minimalist terms, cognitive therapy may often distill down to two vital elements: First, acknowledging the apparent reality with which the individual is contending; and second, providing an optional perspective-often the other side of the reversible illusion (see Figure 2). The patient comes to take an expanded perspective, and to know, or cognize, reality in a different way- seeing resources and safety factors now as well as risks, or seeing positive attributes in the self as well as negatives. …