Cognitive Modification of Cognitive Dysfunctions and Distortions in a Learner
Cognitive Modification of Cognitive Dysfunctions and Distortions in a Learner
This chapter presents Professor Reuven Feuerstein's ideas concerning the mediation and modifiability of cognition, with specific focus on the contribution, identification, and modification of cognitive functions in relation to Professor Aaron Beck's idea of cognitive distortions in the field of counseling and psychotherapy. Specifically, it outlines how the two ideas of cognitive dysfunctions and cognitive distortions are integrated and applied in the cognitive modification of cognitive dysfunctions and cognitive distortions in the learner.
Learning problems can be ameliorated by various approaches. This chapter presents a cognitive modifiability approach that integrates Reuven Feuerstein's concept of cognitive dysfunction and Aaron Beck's concept of cognitive distortion, with the purpose of modifying learners' beliefs and thinking. Specifically, the relationship between cognitive dysfunctions and cognitive distortions will be explored, and will be followed by a discussion on the strategies and techniques in the assessment and modification of cognitive dysfunctions that are related to cognitive distortions. Finally, a case illustration will be used to highlight how cognitive dysfunctions mediation techniques can be applied in modifying a learner's cognitive distortions in thinking and belief systems.
RELATIONSHIP BETWEEN COGNITIVE DYSFUNCTIONS AND COGNITIVE DISTORTIONS
There is a growing interest in applying Reuven Feuerstein's theories of structural cognitive modifiability (SCM), mediated learning experience (MLE), and cognitive functions and dysfunctions beyond their traditional areas. One new area of application is to explore how cognitive dysfunctions contribute to the formation of cognitive distortions. Cognitive functions have been defined as “process variables that are themselves compounds of native ability, attitudes, work habits, learning history, motives, and strategies” (Arbitman-Smith, Haywood, & Bransford, 1984). Furthermore, cognitive functions underlie internalized, representational, and operational thought, but they are not equivalent to operations and contents of thought. In other words, they can be considered as prerequisites of thinking and learning (Feuerstein, Hoffman, Egozi, & Shachar-Segev, 1994). Hence, they are important factors to consider in the conceptualization of learning problems.
In contrast to the cognitive map in the SCM theory, which describes the task, experience, or mental act of the individual, cognitive functions refer to the characteristics or attributes of the person (Falik & Feuerstein, 1990; Feuerstein & Rand, 1997). Falik and Feuerstein (1990) suggested that cognitive functions can “serve as an operational capacity or style, at a given moment of time and as more enduring behavioral characteristic” (p. 147). In other words, cognitive functions refers to the complex manner in which an individual engages in functions supporting the cognition in the way the individual: (1) approaches, receives, and perceives the information in the environment (Input Phase or Level); (2) process, elaborate, make sense, and work on (e.g., analyze, synthesize) the information (Elaboration Phase or Level); and then finally (3) uses, responds, reacts, or acts on the information (Output Phase or Level). In relating cognitive functions to the theory of mediated learning experience, deficient cognitive functions or cognitive dysfunctions are due to a lack of, or insufficient, mediated learning experience (Feuerstein, Rand, Hoffman, & Miller, 1980). Cognitive dysfunctions are responsible for, and reflected in, poor cognitive performance in general (Feuerstein, Rand, Hoffman, & Miller, 1980). In particular, they have been hypothesized to be responsible for poor performance on traditional, standardized intelligence tests (Feuerstein, Rand, & Hoffman, 1979).
Structurally, cognitive functions can be organized into three mutually interactive phases (Feuerstein, Rand, Hoffman, & Miller, 1980) or levels (Feuerstein, Feuerstein, & Schur, 1997) of the mental act—input, elaboration, and output. Hence, the focus of this section is to present the results of working with (i.e., assessing and mediating) clients' cognitive functions by comparing, contrasting, and analyzing their cognitive distortions based on the different cognitive dysfunctions that can occur during the three phases of the mental act.
Cognitive distortion is a construct that was developed by Aaron Beck and his associates based on their work with psychiatric patients. Cognitive research suggested that many psychiatric clients tend to make consistent cognitive errors in their thinking (especially with automatic thoughts—thoughts that are perceived as though they arise by reflex—without any prior reflection or reasoning), known as cognitive distortions (Beck, 1967; Beck, 1976; Beck, 1995), which eventually got “stored” in cognitive structures or cognitive schemas. Based on the research of typical thematic cognitive content of the clients' verbalizations and narratives of presenting problems, a typology of cognitive distortions was developed (Beck, 1967). This initial typology of cognitive distortions was later expanded by Beck and others in subsequent research and clinical practice (e.g., Beck, 1976; Beck, Rush, Shaw, & Emery, 1979; Beck, 1995; Burns, 1998; Corey, 2005; Persons, Davidson, & Tompkins, 2001; Seligman, 2001; Sharf, 2004).
Figure 6.1 shows the diagrammatic depiction of the relationships among cognitive distortions of negative cognitive schemas (beliefs) and automatic thoughts, cognitive dysfunctions, and affective-motivational factors. Note that cognitive dysfunctions and cognitive distortions are reciprocally related. Developmentally, it is assumed that specific cognitive dysfunctions contribute to the formation of certain cognitive distortions. Once formed, cognitive distortions can also have a “top-down” influence on the operations of cognitive functions. Table 6.1 presents a summary of the possible relationship between certain cognitive dysfunctions and the formation of certain cognitive distortions, whether it is at the automatic thoughts level or the schemata (belief) level.
DEFICIENT COGNITIVE FUNCTIONS: INPUT PHASE
The input phase represents the components of processes that are involved in the perception and registration of information (Feuerstein, Feuerstein, & Schur, 1997) or the way in which experience is taken in (response to stimuli) (Falik & Feuerstein, 1990). Hence, impaired cognitive functions affecting the input phase will include those impairments that are related to the quantity and quality of information gathered by the individual when confronted by a given task, problem, issue, object, or experience (Feuerstein, Feuerstein, & Schur, 1997; Feuerstein, Rand, Hoffman, & Miller, 1980). The severity of these impairments at the
|Cognitive Dysfunctions||Cognitive Distortions|
|1. Blurred and sweeping perception||1. Focus on the negative or “doom and gloom,” tunnel vision|
|2. Unplanned, impulsive, and unsystematic exploratory behavior||2. Jumping to conclusions|
|3. Lack of, or impaired, receptive verbal tools and concepts which affect discrimination||3. Absolutist thinking; all-or-nothing, all-or-none, black-and-white, dichotomous, or polarized thinking|
|4. Lack of, or impaired, temporal orientation||4. Always statements; always-and-never thinking|
|5. Lack of, or deficient need for, precision and accuracy in data gathering||5. Deletions; distortion; magnification; minimization|
|6. Lack of, or impaired, capacity for considering two sources of information||6. Filtering, mental filter, selective abstraction|
|1. Inadequacy in experiencing the existence of an actual problem and subsequently defining it||1. Disqualifying or discounting the positive|
|2. Inability to select relevant, as opposed to irrelevant, cues in defining a problem||2. Personalization, self-reference or selfblame|
|3. Lack of orientation toward the need for logical evidence as an interactional modality with one's objectal and social environment||3. Emotional reasoning; overgeneralization; negative prediction, catastrophizing or fortune telling|
|4. Lack of, or restricted, inferentialhypothetical thinking||4. Arbitrary inference|
|5. Lack of, or impaired, strategies for hypothesis testing||5. Not checking inferences|
|Cognitive Dysfunctions||Cognitive Distortions|
|6. Non-elaboration of certain cognitive categories because the necessary labels either are not part of the individual's verbal inventory on the receptive level or are not mobilized at the expressive level||6. Labeling, inexact labeling, mislabeling|
|1. Egocentric communicational modalities||1. Should statements; imperatives|
|2. Lack of, or impaired, need for precision and accuracy in communicating one's response||2. Labeling, inexact labeling, mislabeling|
input level may also affect the functioning of the levels of elaboration and output (Feuerstein, Feuerstein, & Schur, 1997).
Blurred and Sweeping Perception
Blurred and sweeping perception is one of the foremost listed cognitive dysfunctions affecting information processing during the input phase. According to Feuerstein, Rand, Hoffman, and Miller (1980), blurred and sweeping perception is “attributable neither to the peripheral limitations of the perceptual processes nor to the way certain stimuli are sensed, but rather to the manner in which things are perceived” (p. 76). In other words, the perception of stimuli is affected by the blurredness or oversight of the various dimensions that define the perceived stimuli, above and beyond the problems at the sensory level. This is also known as a top-down processing problem rather than a bottom-up processing problem. Specifically, some characteristics of the blurredness and sweeping perception include poverty of details or their lack of clarity, a poor quality of sharpness, an imprecise definition of borders, and an incompleteness of the information necessary for proper discrimination and description. Finally, three main factors contribute to such a deficiency in perception, namely, inappropriate speed, inappropriate focusing, and inappropriate or limited need system. Blurred and sweeping perception is hypothesized to be implicated in a number of cognitive distortions, for example, Focus on the Negative or Doom and Gloom and Tunnel Vision.
Focus on the negative or doom and gloom. Focusing on the negative is one common cognitive distortion found in individuals with psychological problems. This is the distortion of selectively attending to negative information; alternatively it is known as the “glass-half-empty” view of the world.
Tunnel vision. In this cognitive distortion, the individual only sees the negative aspects of a situation, or the individual is oblivious to positive information—analogous to seeing the world though a dark tunnel. One example of such cognitive distortions is in this client's presenting complaint concerning her son: “He can't do anything right. He's lazy and not good in his studies.” For these two cognitive distortions, the cognitive dysfunction of blurred and sweeping perception appears to play an important contributing role to their formation. It appears that when one either focuses on the negative dimension of a stimulus (event, individual, situation, etc.) or ignores the positive dimension of a stimulus, one is said to be lacking in a clear and complete perception, resulting in the cognitive distortions of focusing on the negative and tunnel vision.
Unplanned, Impulsive, and Unsystematic Exploratory Behavior
Unplanned, impulsive, and unsystematic exploratory behavior is the result of a cognitive dysfunction which renders the client unplanned, impulsive, and unsystematic in dealing with events, situations, or problems in life. Even though the three components of poor planning, impulsivity, and disorganization are often seen together, impulsivity plays the major role in the contribution to the formation of a particular cognitive function, known as Jumping to Conclusions.
Feuerstein, Rand, Hoffman, and Miller (1980) distinguished between three types of impulsivity, namely, (1) Biorhythmical Impulsivity; (2) Motoric Impulsivity; and (3) Cognitive, Conceptual, or Epistemic Impulsivity. Of these three types of impulsivity, the epistemic impulsivity has the most relevant and direct relationship to the cognitive distortion of Jumping to Conclusions.
Jumping to conclusions. This refers to the process of drawing hasty and unwarranted conclusions or making a negative interpretation even though there are no definite facts that convincingly support the premature conclusion. This also suggests the lack of seeing the need for additional data to produce the proper answer, solution, or conclusion (Feuerstein, Rand, Hoffman, & Miller, 1980). An example of such a cognitive distortion can be seen in this client's remarks about his spouse: “My wife must be having an affair. Someone saw her hanging around her male colleague late that night after the meeting is over.”
Lack of, or Impaired, Receptive Verbal Tools and Concepts Which Affect Discrimination
The lack of or impaired receptive verbal skills (e.g., labels, tools, concepts), which affect discrimination (Feuerstein, Rand, Hoffman, & Miller, 1980), may contribute to the formation of these cognitive distortions.
Absolutist thinking. Absolutist Thinking involves viewing an event or situation in absolute terms or within absolute categories, without considering the possibilities of something in-between on a continuum.
All-or-nothing thinking, all-or-none thinking, black-and-white thinking, dichotomous thinking, or polarized thinking. All these cognitive distortions are specific variants of Absolutist Thinking. They involve seeing the world, events, or situations in only two categories, or categorizing experiences in one of two (either/or) extremes, instead of on a continuum, like all-or-none terms, black and white terms (rather than in shades of gray), as either all good or all bad. An example of such cognitive distortions is found in this client's utterance: “I will either succeed or fail. There is no other way out of this situation.”
As we can see from the descriptions of the cognitive distortions, not having or having fragile ability to apply more accurate and less extreme alternative categories or verbal labels to the stimuli or problem encountered at the input level can lead to the negative cognitive distortions of Absolutist Thinking and All-or-Nothing Thinking, which in turn may affect information processing at the elaborational level and output level.
Lack of, or Impaired, Temporal Orientation
According to Feuerstein, Rand, Hoffman, and Miller (1980, p. 85), “the lack of temporal orientation and the inaccurate use of temporal concepts affect the individual's capacity to use the data registered by him in an accurate and well defined way. This cognitive dysfunction may lead to the formation of the cognitive distortions of Always Statements and Always-and-Never Thinking. In the cognitive distortions of Always Statements and Always-and-Never Thinking, there appears to be an inappropriate use of the temporal concepts of “Always” and “Never.”
Always statements. Always Statements refer to the making of “Always” Statements when it is not appropriate or accurate. For example, “I am always unlucky!”
Always-and-never thinking. Seeing oneself as always doing something wrong, something bad always happened to oneself, and seeing oneself as never going to be happy are results of Always-and-Never Thinking. For example, “Jason is the only man who makes me happy, but he left me. I will never be happy again.”
Lack of, or Deficient Need for, Precision and Accuracy in Data Gathering
This cognitive dysfunction is especially relevant in the development of several cognitive distortions. In fact, there appears to be a one-to-one correspondence between this cognitive dysfunction and certain cognitive distortions elaborated below.
Specifically, Feuerstein, Rand, Hoffman, and Miller observed two categories of imprecision in their work (1980, p. 86): (1) Missing Data;and (2) Distorted Data. Missing Data is related to the general cognitive distortion of Deletions, while Distorted Data is related to the general cognitive distortion of Distortions.
Deletions. Deletions refer to the tendency to disqualify or delete positive events, for example, “I got two ‘Cs’ and one ‘B’ for my examinations; therefore I did not do well at all.”
Distortions. Distortions refer to the distortion of data, such as in Magnification or Minimization.
Magnification. Magnification consists of blowing out of proportion or magnify, exaggerate, or inflate the importance or magnitude of unfortunate or negative events, negative information, problems, tasks; to enlarge small events to a point of great significance; or make mountains out of molehills; or exaggerate the importance of personal flaws, imperfections, shortcomings, fears, or mistakes. One example of magnification is: “This is a horrible mistake that I made; there will be terrible consequences.”
Minimization. Minimization is the opposite of magnification. This is a type of cognitive distortion in which one minimizes, underestimates, or devalues positive information, one's good or positive points, desirable qualities, performance, achievement, or ability. For example, thinking that one's recent successes or achievements are really not successes or achievements at all: “There is not really anything to be happy about!”
Lack of, or Impaired, Capacity for Considering Two Sources of information at Once
This cognitive dysfunction is reflected in dealing with data in a piecemeal fashion rather than as a unit of organized facts. The importance of using two or more sources of information is considered by many thinkers to be an important cornerstone of deep and thorough thinking. In emphasizing the importance of this cognitive function, Feuerstein, Rand, Hoffman, and Miller (1980, p. 88), posits that using two or more sources of information at once as a unit of organized facts is a “prerequisite of thinking because it is the basis of all relational thought processes. Two elements must be used as sources of data in comparative behavior and whenever a problem is confronted. In fact, no problem can be experienced as such unless an incompatibility of data stemming from two or more sources is identified and confronted.” Hence, not considering multiple sources of information at once, as a unit of organized facts, can contribute to the formation of certain cognitive distortions, such as, Filtering, Mental Filter, or Selective Abstraction.
Filtering, mental filter, or selective abstraction. This refers to the perception of a situation on the basis of a detail taken out of context—abstracting a detail out of context, ignoring other information, and thus, missing the significance of the total situation. Specifically, it involves individuals selectively abstracting the parts of their experiences that reflect upon their flaws and ignoring evidence of their competencies; or focusing only on negative details of events, thereby rejecting the positive features of one's experiences; or selectively abstracts and dwells on the negative details from events and ignores their positive features; or picking out a single negative detail and dwelling on it exclusively, so that one's vision of all of reality becomes darkened, like the drop of ink that discolors a beaker of water. Thus, one bases one's self-esteem on perceived weaknesses and failures, rather than on positive features, or on a balance of accomplishments and shortcomings. Such a problem can be illustrated by this client's complaint concerning his supervisor's job evaluation of him that actually contains both positive and negative comments but client focuses only on the negative: “I made so many mistakes. I did not do a good enough job.”
DEFICIENT COGNITIVE FUNCTIONS: ELABORATION PHASE
The elaboration phase represents the components of processes that are involved in the storage and retrieval of data and information (Feuerstein, Feuerstein, & Schur, 1997) or the ways in which what is experienced is processed and integrated into existing experience (personalization and subjective experiencing) (Falik & Feuerstein, 1990). Hence, impaired cognitive functions affecting the elaboration phase or level will include those impairments that impede the efficient use of available data and existing cues (Feuerstein, Feuerstein, & Schur, 1997; Feuerstein, Rand, Hoffman, & Miller, 1980).
Inadequacy in Experiencing the Existence of an Actual Problem and Subsequently Defining It
This cognitive dysfunction of inadequacy or lack of awareness in experiencing, recognizing, understanding, and defining the actual problem involves (1) “the inability of the individual to grasp the disequilibrium existing in a given situation;” and (2) “not attending to appropriate cues,” or inadequate data gathering (Feuerstein, Rand, Hoffman, & Miller, 1980, pp. 89–90).
One of the most extreme outcomes of being unable to adequately experience the existence of the actual problem is to define the problem in solely negative terms, to the extent of changing positive aspects of the situation to negative aspects, leading to Disqualifying or Discounting the Positive.
Disqualifying or discounting the positive. This means ignoring or devaluing positive evidence, events, experiences, and information; or converting neutral or positive events into negative ones; or rejecting positive evidence, events, experiences, accomplishments, deeds, or qualities by insisting they “don't count” for some reason or other. An example is dismissal of congratulations for a job well done by thinking and saying, “Oh, it's no big deal. Anyone could have done it.” Other examples include “This so called success was only a fake.” and “The compliment you gave was unwarranted.”
Inability to Select Relevant Cues in Defining a Problem
This cognitive dysfunction refers to the lack of discrimination between the relevant and irrelevant cues or units of information (Feuerstein, Rand, Hoffman, & Miller, 1980). Selecting and dwelling on irrelevant cues about oneself can result in Personalization, which is sometimes referred to as Self-Reference or Self-Blame.
Personalization, self-reference, or self-blame. This refers to the propensity or tendency to relate external events to themselves, even when there is no basis for making this connection, for example, seeing one-self as the cause of some negative external event which in fact one was not primarily responsible for. Or attributing external events to oneself without evidence supporting a causal connection. Or the tendency to interpret events in terms of their personal meaning, resulting in the over personalization of events. Moreover, more plausible explanations were not even considered. This cognitive distortion can exist in at least three forms, varying in the degree of severity. First, the most extreme forms of personalization involve psychotic individuals who consistently interpret events totally unrelated to them as though they were caused by them or directed against them. Second, the less extreme forms of personalization involves neurotic individuals who tend to overestimate the degree to which events are related to them and to be excessively absorbed in the personal meanings of particular happenings. Finally, the least extreme, but quite common form of personalization is found in the tendency to compare oneself with other people. For example, a man waved to a friend along a busy walkway. When he did not receive a greeting in return, he concluded, “I must have done something to offend him.”
Lack of Orientation Toward the Need for Logical Evidence as an Interactional Modality with One's Objectal and Social Environment
The lack of need for logical evidence not only results in imprecise and incomplete data (Feuerstein, Rand, Hoffman, & Miller, 1980), but also results in at least three types of cognitive distortions—Emotional Reasoning, Overgeneralization, and Negative Prediction (Catastrophizing or Fortune Telling).
Emotional reasoning. This is the mistaken belief that everything one feels must be true, ignoring or discounting evidence to the contrary—believing that something is true because it feels that way, paying no attention to contradictory evidence; or basing reasoning on emotions (i.e., reason from how one feels). In other words, one interprets feelings and events on the basis of emotions rather than dispassionate evaluation, or assuming that one's negative emotions necessarily reflect the way things really are. Examples include: (1) “I feel it, therefore it must be true.” (2) “If I feel guilty, it must be because I've done something really wrong.” (3) “Because I feel inadequate, I am inadequate.”
Overgeneralization. Overgeneralization refers to the unjustified abstraction of a general rule from one or a few isolated incidents or experiences and applying it too broadly and to unrelated situations. It can also refer to drawing sweeping conclusions that are not justified by the evidence. For example, it can be a pattern of drawing a sweeping negative conclusion about ability, performance, or worth on the basis of a single incident. Finally, it can refer to the belief that if a negative event occurs, it is likely to recur in similar situations. That is, one interprets a single negative event as foreshadowing an endless series of negative events or seeing a single negative event as a never-ending pattern of defeat. Or it is the irrational tendency to believe that what has happened has always occurred in the past or will always occur in the future. This cognitive distortion is exemplified by such statements as: “This is always happening to me;” “This will always happen;” “All men are alike. I'll always be rejected.”
Negative prediction, catastrophizing or fortune telling. This involves the error of drawing conclusions, usually about the future, that involves exaggerated horrendous outcomes, such as predicting the future negatively without considering other likely outcomes or possibilities. It can also involve the error of predicting the future on the basis of the present. This is often a problem because the view of the present is distorted, so the view of the future then becomes distorted as well. For example, “This is disastrous. My life is over.”
Lack of, or Restricted, Inferential—Hypothetical Thinking
Inferential-hypothetical thinking refers to the use of inference and hypothesis in thinking, a thinking process commonly found in scientific work. The standards for proper inferential-hypothetical thinking include gathering proper evidence before making an inference or a hypothetical conclusion. Hence, the lack of, or restricted use can result in Arbitrary Inference.
Arbitrary inference. This involves drawing conclusions about a situation, an event, or an experience about someone or something without supporting evidence, or on the basis of insufficient or irrelevant information, or even in the face of contradictory evidence. For example, the working mother who concludes after a particularly busy day, “I'm a terrible mother.”
Lack of, or Impaired, Strategies for Hypothesis Testing
The ability to develop proper strategies for hypothesis testing is considered an important cognitive function (Feuerstein, Rand, Hoffman, & Miller, 1980). Lack of or impairment in this cognitive function can lead to the cognitive distortion of Not Checking Inferences.
Not checking inferences. Not checking the inferences we make about our world can be a problem resulting from the lack of, or impaired, strategies for hypothesis testing. For example, most people would agree that the validity of the belief that “you cannot change the way you think, feel, or act” can only be tested by trying to change the way one thinks, feels, or acts.
Non—elaboration of Certain Cognitive Categories Because the Necessary Labels Either are Not Part of the Individual. s Verbal Inventory on the Receptive Level or are Not Mobilized at the Expressive Level
The lack or impairment of this cognitive function (Feuerstein, Rand, Hoffman, & Miller, 1980) can lead to the cognitive distortions of Labeling, Inexact Labeling, or Mislabeling.
Labeling, inexact labeling, or mislabeling. This is an extreme form of a number of cognitive distortions mentioned earlier, such as all-or-nothing thinking and overgeneralization. It involves describing an event with language that is highly colored and emotionally loaded, to the extent of being inflammatory. For example, instead of describing one's error, one attaches a negative, extreme, global/broad, and unjustified label to oneself or others. You may label others. Then you feel that the problem is with that person's “character” or “essence” instead of with their thinking or behavior. You see them as totally bad. Some examples of such inappropriate labels are “I'm a born loser.” and “He's a blur octopus.”
DEFICIENT COGNITIVE FUNCTIONS: OUTPUT PHASE
The output phase or level represents the components of processes that are involved in the formulation and shaping of the thinking product (Feuerstein, Feuerstein, & Schur, 1997) or the ways in which knowledge or experience is communicated or expressed (Falik & Feuerstein, 1990). Hence, impaired cognitive functions affecting the elaboration phase or level will include those impairments that impede the efficient use of available data and existing cues (Feuerstein, Feuerstein, & Schur, 1997;Feuerstein, Rand, Hoffman, & Miller, 1980).
Egocentric Communicational Modalities
Feuerstein, Rand, Hoffman, and Miller (1980) refers to egocentric communicational modalities as the “impairment of communication output as a consequence of the way in which an individual regards his partner with whom he is involved in a transaction” (p. 99). They further argue that egocentric communication is a “function of a lack of differentiation, which does not allow the individual to see his partner as different from himself.” It is possible that with extreme lack of differentiation and isolation, the impairment of communication output can also occur intrapersonally, besides interpersonally. One possible cognitive distortion that results from such extreme egocentric communication is Should Statements, or Imperatives.
Should statements, or imperatives. These statements entail operating from a set of inflexible, indisputable rules and unrealistic expectations about how everyone, including yourself, should act, behave and how life should be. This means that the individuals create personal imperatives or self-commandments—“shoulds,” “shouldn'ts,” “musts,” “oughts,” “have tos,” etc. from an egocentric perspective by telling oneself that things should be the way one hoped or expected them to be. One criticizes oneself or other people with “shoulds” or “shouldn'ts,” etc. When directed against oneself, one may can feel depressed, guilty, and frustrated. When directed toward others, one may feel anger, frustration, and resentment. Examples are “I should visit my family every time they want me to;” and “They should be nicer to me.”
Lack of, or Impaired, Need for Precision and Accuracy in Communicating One's Response
This is similar to the cognitive dysfunction of non-elaboration of certain cognitive categories. When the necessary labels either are not part of the individual's verbal inventory on the receptive level or are not mobilized at the expressive level, the lack or impairment of this cognitive function (Feuerstein, Rand, Hoffman, & Miller, 1980) can lead to Labeling, Inexact Labeling, or Mislabeling.
This process of analyzing clients' cognitive distortions based on cognitive dysfunctions (see Table 6.1) revealed three important issues for future research. First, there are some cognitive distortions (e.g., labeling, inexact labeling, or mislabeling) which can be the result of more than one type of cognitive dysfunction. This means that cognitive distortions can be “supported” by a number of cognitive dysfunctions, just as in the case of cognitive operations.
Second, it appears that there are cognitive dysfunctions (e.g., impaired spatial orientation; impaired conservation of constancies; lack of spontaneous comparative behavior; narrowness of the mental field; lack of, or restricted, interiorization of one's behavior; impaired planning behavior; episodic grasp of reality; blocking; trial-and-error responses; impaired verbal tools for communicating adequately elaborated responses; difficulties in projecting virtual relationships; deficiency of visual transport; and impulsive acting-out behavior) which are not related to any of the existing known cognitive distortions. This suggests the possibility that there may be undiscovered cognitive distortions that can be analyzed using these remaining cognitive dysfunctions. Third, it appears that not all of the cognitive distortions discovered by cognitive therapists can be analyzed based on cognitive dysfunctions (e.g., mind reading; moralistic value judgments). Hence, there is room for future research to discover additional cognitive dysfunctions that are based on these cognitive distortions.
STRATEGIES AND TECHNIQUES IN THE ASSESSMENT OF COGNITIVE DYSFUNCTIONS
In the assessment of cognitive dysfunctions related to cognitive distortions, it is helpful to mention that the assessment approaches for both cognitive dysfunctions and cognitive distortions differ traditionally. Assessment of cognitive dysfunctions has been traditionally performed using dynamic assessment or DA (e.g., Feuerstein, Rand, Haywood, Kyram, & Hoffman, 1995; Tzuriel, 2001; Tzuriel, 2003a; Tzuriel, 2003b). In contrast, assessment of cognitive distortions traditionally has been implemented using clinical interview (e.g., Beck, 1995) and self-report questionnaire (e.g., Beckham, Leber, Watkins, Boyer, & Cook, 1986; Hollon & Kendall, 1980; Weissman, 1980).
It is therefore proposed that there are three possible routes in the assessment of cognitive dysfunctions related to cognitive distortions:(1) Cognitive Dysfunction—Cognitive Distortion Route; (2) Cognitive Distortion—Cognitive Dysfunction Route; and (3) Mixed Route. First, in the Cognitive Dysfunction—Cognitive Distortion Route, the psychologist can use the DA method to determine the specific cognitive dysfunctions embedded in the client's cognitive structure. Alternatively, Falik and Feuerstein (1990) also suggested the possibility of reviewing a cognitive dysfunctions list together with the client as a way of assessing for cognitive dysfunctions. A clinical interview, reviewing the cognitive distortion list, or possible administration of a cognitive distortion questionnaire can then follow administration of the dynamic assessment.
In the second approach (i.e., Cognitive Distortion—Cognitive Dys-function Route), the psychologist interviews, reviews the cognitive distortion list, or asks the client to complete the cognitive distortion questionnaire, followed by the dynamic assessment of the cognitive dysfunctions. In the third approach, the mixed route points to the possibilities of developing assessment methods for both cognitive dysfunctions and cognitive distortions, using each other's traditional approach. For example, one possibility lies in the assessment of cognitive dysfunctions using the clinical interview. Similar to the test-mediation-retest format in the dynamic assessment, the psychologist can interview the client about his or her life problems, followed by mediation, and then a re-interview. Hence, in this case, the life problems become the test items instead of the usual test items in the dynamic assessment battery.
STRATEGIES AND TECHNIQUES IN THE MODIFICATION OF COGNITIVE FUNCTIONS
Traditional cognitive therapy approaches the problem of cognitive distortions through three related main approaches (e.g., Beck, 1995). First, cognitive distortions can be targeted for intervention directly. For example, clients can be educated about the different cognitive distortions embedded in thinking errors or beliefs. Providing clients with a list of common cognitive distortions and teaching them how to identify and reduce the use of certain cognitive distortions in relation to their thoughts and beliefs is one strategy. After the clients are familiar with the list of cognitive distortions, the two indirect approaches of working with cognitive distortions can be mobilized via either modifying automatic thoughts or beliefs, in which cognitive content is distorted resulting in psychological problems.
The approach of modifying cognitive distortions based on cognitive dysfunctions is different from those three common cognitive therapy approaches. This cognitive dysfunction approach is indicated when clients are slow to respond to the usual cognitive interventions because of highly resistant cognitive distortions. Hence, modifying cognitive dysfunctions first before using the three traditional cognitive therapy approaches may help to sidetrack the difficulties associated with highly resistant cognitive distortions.
The modification of cognitive dysfunctions related to cognitive distortions can be approached via traditional cognitive dysfunction techniques such as the following (Feuerstein & Rand, 1997; Feuerstein, Rand, Hoffman, & Miller, 1980; Haywood, 1993; Skuy & Mentis, 1999; Tzuriel, 2000; Wong, 2003; Wong & Seng, 2001):
- Mediation based on cognitive functions
- Mediation based on challenging or requiring justification
- Mediation based on phases
- Mediation based on process questioning
- Mediation based on focusing
- Mediation based on directives and instructions
- Mediation by emphasizing order, predictability, system, and sequence
- Mediation by emphasizing strategies
- Mediation by emphasizing rules, principles, formulas, and generalizations
- Mediation based on timing
- Mediation based on MLE criteria
- Mediation based on MLE categories
The counseling transcript below illustrates the application of those cognitive dysfunctions mediation techniques in working with a learner to modify her cognitive distortions in thinking and belief systems:
|Client:||I'm a failure. I can't even pass my preliminary examinations. How can I even pass my “A” Levels [Cognitive distortions: Jumping to Conclusions and Labeling; Cognitive dysfunction: Unplanned, impulsive, and unsystematic exploratory behavior].|
|Psychologist:||Wait a minute [Mediation based on timing]. Before you jump to conclusions about who you are and your belief about not passing your “A” levels, let us examine the different issues you raise in a more systematic and objective manner [Mediation by emphasizing order, predictability, system, and sequence].|
|Psychologist:||I hear that you have two pressing concerns, that is your need for success and the concern about passing the “A-level” examinations. Let us explore each of these needs one at a time [Mediation by emphasizing order, predictability, system, and sequence]. For example, let us take the need for success first. You said that you are a “failure.” Just as one bee does not make a swarm, just by failing an examination cannot determine whether one is a “success” or a “failure.” Do you think it is a reasonable assumption to make?|
|Client:||Yes, I can see your point. Failing one examination does not really make me a “failure.”|
|Psychologist:||Can you think of another way we could apply this principle to your other need of passing the “A-level” examination? [Mediation by emphasizing strategies]|
|Client:||Do you mean to say that just by failing my prelims does not really mean that I will fail my “A levels?”|
|Psychologist:||Yes! And to further convince you that this principle works [Mediation by emphasizing rules, principles, formulas, and generalizations], let us list out things that support and do not support the statement that failing examination does not mean you are a failure, and failing one examination does not mean that you will fail another examination [Mediation based on challenging or requiring justification].|
Cognitive distortions have been implicated in the development of various problems. Most of the work on cognitive distortions has been related to their identification in the cognitive content of automatic thoughts and beliefs, as well as the modification of these thoughts and beliefs with such cognitive distortions. This chapter examines the relationship between these cognitive distortions and cognitive dysfunctions through a qualitative analysis. It is proposed here that the development of cognitive distortions can be explained via the lack, or the impairment, of certain cognitive functions. The qualitative analysis of known cognitive distortions using known cognitive dysfunctions revealed that most of the cognitive distortions can be explained by the lack, or the impairment, of certain cognitive functions, especially at the input phase and elaboration phase, which may ultimately affect the output phase. With the establishment of the linkage between these cognitive distortions and cognitive dysfunctions, the identification and modification of cognitive distortions via cognitive dysfunctions are made possible. The availability of an additional route to modify cognitive distortions can be indicated in cases where traditional cognitive interventions targeting the automatic thoughts and beliefs encounter difficulties. Moreover, linkage between cognitive distortions and cognitive dysfunctions also provide a deeper understanding of how cognitive distortions operate at the cognitive process level, in addition to the usual understanding of cognitive distortions at the cognitive content level. This linkage also allows the use of cognitive dysfunctions to conceptualize various types of problems. Comparing the relative utility and efficacy of modifying cognitive distortions via modifying cognitive dysfunctions versus the other three routes—automatic thoughts, intermediate beliefs, and core beliefs—may be the next step in understanding the different ways in which cognitive distortions can be differentially modified so that clients' problems can be solved or attenuated.
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Cognitive Modification of Cognitive Dysfunctions and Distortions in a Learner
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