Cognition, Mental Representations and Embodied Emotions

8/13/2019 Cognition, Mental Representations and Embodied Emotions

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the effectiveness of the treatment process (McEachrane 2003 , 82). However, it isproblematic (and circular) to hold that empirical studies can provide satisfactoryevaluation of all the underlying key assumptions.

Philosophy can indeed make a valuable contribution here because, as will be

made clear, CT rests on certain philosophical assumptions (McEachrane 2003 ;Lacewing 2004 ; Whiting 2006 a) that have a long history (Butera 2011 ). This paperwill assess these philosophical assumptions and argue that due to several aws, CTmust be revised. In the nal section of the paper, a way will be sketched in whichthese aws could be corrected in a manner that would not only secure philosophicalaccuracy but also result in an account that is better suited to explaining some of thecognitive, emotional, and bodily characteristics in affective disorders. Furthermore,the conceptual adjustment might lead to improvements in the treatment protocolsand the empirical testing of the protocols.

2 The Philosophy of CT

The two primary historical factors that led to the emergence of CT were thecognitive revolution in psychology, on the one hand, and the growing dissatis-faction with both stimulusresponse psychology and psychoanalysis on the other(Dobson and Dozois 2010 ). At the same time, theoretical psychology began toacknowledge the existence of inner mental maps (Holmes 2010 ; Westen 2005 ).

Partly due to these factors, the 1950s and early 1960s saw an increasing emphasis onthe role of cognitive processes in psychiatric disorders (Beck and Alford 2009 , 232).Albert Ellisconsidered by many to be, along with Aaron Beck, the father of CTpresented a theory of emotional dysfunction in the 1950s that has become animportant premise of CT. The so-called ABC model of emotional disturbance wasmeant to describe how cognitive processing (as opposed to the environment)inuenced emotional and behavioral reactions. While CT underwent numerousmodications over the ensuing four decades, its genera l point remains that mentaldisorder is intrinsically linked to cognitive disturbance. 4

From this outlook, depression is conceptualized as a disorder of thought (Beck and Alford 2009 , 208, 239) and the pathological affective disturbance can beregarded as the consequence of the way individuals view themselves and theirenvironments (Ibid., 231). The primary causal factor in the development of depression is the activation of idiosyncratic cognitive patterns that divert thinkinginto specic channels that deviate from reality (Beck and Alford 2009 , 243; Wells2000 , 34). A central claim is that depression is characterized by inaccuracies ininformation processing that therapy aims to correct (Beck and Alford 2009 ; Clark

4 The idea of an underlying cognitive disturbance serves as a point of departure for many other and lesswidespread approaches like Ellis rational emotive behavior therapy (REBT), and, to a lesser degree, forthe more recent acceptance and commitment therapy (ACT) and for some of the so-called third waveapproaches (Dobson and Dozois 2010). Also, other directions that either place greater emphasis onmetacognitive interventions or attempt to insert positive distortions into cognitive processes to a certaindegree still remain within the cognitive paradigm.

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et al. 1999 ). As Judith Beck ( 1995 , 2), one of the currently most inuentialproponents of this approach, notes:

The therapist seeks in a variety of ways to produce cognitive changechange

in the patients thinking and belief systemin order to bring about enduringemotional and behavioral change.

Additionally, Aaron Becks cognitive-content specicity hypothesis postulatesthat depression has a distinctive cognitive prole that is characterized by thoughtsfocused on incompetence, failure, or worthlessness (Clark et al. 1989 , 1990 ;Szentagotai et al. 2008 ). As we shall see in the next section, these negativelydistorted thoughts and beliefs emerge from the activation of negative and morefundamental belief-systems that are stored in long-term memory.

2.1 Schemas and Automatic Thoughts

A central characteristic of CT is a distinction between fundamental beliefs orschemas and something like second-order thoughts called automatic thoughtsthat emerge on the basis of schemas. These schemas begin developing in childhoodand they contain beliefs which are understandings that are so fundamental anddeep that [patients] often do not articulate them, even to themselves (Beck 1995 ,16). Schemas are depicted as stored bodies of knowledge containing fundamentalbeliefs which are regarded by the person as absolute truths, just the way things

are (Ibid.) Schemas interact with incoming information and help shapeexperience (Beck and Alford 2009 , 255; Williams et al. 1997 ).Dysfunctional schemas are thought to be causative elements in the development,

maintenance, and recurrence of a variety of mental disorders such as depression.The schemas of depression-prone individuals are considered to be dysfunctionalbecause they contain beliefs about self and world that are rigid and unrealisticallynegative (Kovacs and Beck 1978 ; Beck 1983 ; Hammen 1997 ; Epp and Dobson2010 ; Blatt 2004 ). CT maintains that depressed individuals possess negativelybiased cognitive schemas that reect past experiences, and organize and structurenew experiences. In the case of numerous and signicant early negativeexperiences, negatively biased schemas (Im vulnerable, I am worthless, orthe world is dangerous) may develop which inuence the preferential processingof information. Over time, these schemas often become unconditionally acknowl-edged as truths (Wells 2000 ), in the sense that they are not seen as contingentconstruals to which alternatives are possible. It is on the background of such aspectsthat Charland ( 2006) has argued that depression assumes the character of acognitive module. 5

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This hypothesis has been put forward by Charland ( 2006 ), who argues that a good theoreticalformulation and defence of this hypothesis can be found in Aaron Becks well-known cognitive theory of depression (2006, 221). Charlands point that the emotional system is marked by a susceptibility todevelop a modular structure (Ibid., 225) may be right, but it is unclear whether this can in any way furtherour understanding of emotional disturbances. We would still have to explain why emotional systems insome individuals and not others are aficted. CT provides an explanation for this, but one that does notclearly sustain the modularity hypothesis.

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Cognitive theory maintains that while schemas are mostly not readily accessible toconsciousness, they are both expressed in and activated by automatic thoughts (Alfordand Beck 1997 , 1617). Schemas become apparent to both the patient and therapist asthey identify the consistencies or themes that run through the automatic thoughts.

Cognitive training is supposed to make people able to catch the automatic thoughtsthat follow an event and trigger the emotional response (Beck 1976 , 26; Beck andAlford 2009 ). Beck ( 1995 , 14) notes that when reading her book on cognitive therapy,such automatic thoughts could be: This is just too hard. Im so dumb. Ill nevermake it as a therapist. Automatic thoughts are the situation specic actual words orimages that go through a persons mind (Beck 1995 , 16). The most emotion-elicitingautomatic thoughts are thought to consist of some kind of mental representationinvolving actual words; the authors also note that mental imagery can elicit the sameeffect. But importantly, such mental imagery is also thought of as being conceptually

structured (e.g., Beck and Alford 2009 , 26, 3738).Overall, the relationship between core beliefs, automatic thoughts, and emotional

distress is viewed in the following way: experienceis interpreted within the framework of schemas, which lead to specic automatic thoughts that, in turn, generate specicemotions. Consequently, therapy seeks to determine the content of such maladaptiveinformation processing strategies. The aim is to capture automatic thoughts thatallegedly elicit emotions in the moment and, on that basis, to explore the underlying,general belief-schemas that these thoughts express. Then the attempt is made tochange the semantic information that such emotion-eliciting thoughts contain and

modify the content of basic schemas (Beck et al. 1979 ; Beck and Alford 2009 ). Thepatient is encouraged to logically challenge and test thoughts against reality, both insession and as in-between-sessions homework (Milton 2008 , 104), and to createsubstitute representations that help restore positive mood states. In this framework,once the correction is achieved and consistency with intersubjectively valid standardsis attained, these schemas can no longer trigger the unpleasant emotional disturbances.

3 Assessing the Underlying Assumptions of CT

After this brief outline, I want to isolate underlying assumptions on which CT isbased. These assumptions can be categorized into two groups, relating tophilosophical issues of mental representation and introspection on the one hand(3.13.3 ) and emotion and cognition on the other ( 3.43.5 ). The assumptions are asfollows: Thoughts are mentally represented ( 3.1 ), words are the vehicles of thought(3.2 ), we have direct access to our thoughts ( 3.3 ), cognition constitutes/causesemotions ( 3.4 ), and schemas constitute the fundament of our thinking ( 3.5 ). In thefollowing, they will be tested one by one.

3.1 Thinking that P. Non-representational, Explanatory, Expressiveand Transparent Uses

In the CT literature, cognition is depicted as essentially involving internalconversations and inner speech, in which we constantly talk silently to


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ourselves (Sheldon 1995 , 150151). Accordingly, the automatic thoughts thataccompany experience are described as on-going automatic self-statements(Hollon and Kendall 1980 ; Freeman et al. 1989 , 2005 ), cognitive self-talk (Safrenet al. 2000 , 328), internal exclamations (Newman 2006 , 212), or as a running

commentary (Mulhern et al., 38). While the talk of statements, exclamations,speech, or commentary indicate that in CT, thinking implies the representationof propositional content, other authors spell this out more explicitly. In their recentbook on CT and depression, Gilson et al. ( 2009 ), 128) speak of automatically arisingthoughts as self-talk sentences. Riskind ( 2006 , 63) maintains that automaticthoughts are consciously accessible verbal thoughts and pictorial images. Beck (1995 , 16) concurs, arguing that automatic thoughts are actual words or imagesthat go through a persons mind and that the therapist should aim to capture (Ibid.,88). 6

As these examples demonstrate, CT posits a very strong conceptual link betweencognitive events and mental representations andakin to the RepresentationalTheory of Mind (Sterelny 1990 ) from the philosophy of cognitive scienceregardsrepresentations as the vehicles that drive our thinking and carry mental content.However, CT also maintains that there is a representation of propositional contentinvolved. In a concrete therapeutic encounter, this means that the report of thepatient in the form of I thought that P is understood as entailing the representationof propositional content, which the patient can catch. In other words, there is ageneral assumption that thought involves conscious mental representation and a

more specic assumption that mental representations are speech-like, that is,structurally isomorphic with spoken language (words are the vehicles of thought). Ishall rst deal with the more general assumption.

As the following conceptual examination shall make clear, the generalassumption that thought involves conscious mental representation is awed andpotentially damaging to a precise understanding of the patients self-reporting. Ishall introduce a couple of conceptual distinctions and argue that the formula Ithink/thought that P can convey different meanings depending on whether it is usedin a non -representational (3.1.1), explanatory (3.1.2), expressive (3.1.3), ortransparent (3.1.3) manner.

(3.1.1) In order to demonstrate a non-representational use, I want to drawattention to the crucial distinction between thinkin g and having thoughts (seeMcEachrane 2003 ; Malcolm 1972 ; Davidson 1987 ).

7The fact that we sometimes

use the verb think in a transitive manner and, thus, imply that it has a propositionalobject seems to mislead the CT to think that thinking involves the representationof a propositional content. However, in everyday language, saying that a person

6 To avoid misunderstandings, it is important to recall that mental imagery is also thought to beconceptually structured (e.g., Beck and Alford 2009 , 26, 3738).7 Several of Malcolms connecting ideas have been contested (for instance by Davidson), but the aspectthat I emphasize here is not really controversial. For instance, while Davidson (2001, 97100) criticizesspecic aspects and implications of Malcolms idea (specically the question of attributing of thinkingto animals), he similarly argues that we should not conceive of thinking as having representations beforethe minds eye and urges us to give up the idea that thoughts require mental objects (Davidson1987 , 456).

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thought that P does not imply that he thought of P, or that P occurred to him in histhoughts. Let us look at some examples. When I enter my sons classroom to pick him up, it sometimes takes a while until I spot him among the many childrenwearing the same uniform. When I nally do, I am surely aware of my seeing him,

but in general, the thought that is my son does not occur in my thoughts. Thisobservation is also valid from a third-person perspective. When a cab driver stopshis car at an intersection because the light is red, he is cognitively aware of the lightbeing red, but the thought the light is red does not necessarily occur in his mind. Inother words, our speaking of thinking does not necessarily entail that we representpropositional content: he thought that p does not entail the formula, the thoughtthat p occurred to him. Regarding having thoughts as the prototype of thinkingis bought at the expense of mistakenly taking grammatical form to be the index of psychological reality.

If this is right, if he thought that P can mean something different than theformula the thought that P occurred to him then there is a risk that the CTinformed practitioner will misinterpret the patient. However, the picture is evenmore complex, as there are yet other intelligible uses of the formula I thought thatP that carry different meanings.

(3.1.2.) It is perfectly intelligible to use the sentence I thought that P in anexplanatory way, which not only does not involve mental representations, but whichcannot even be considered as involving reporting on actually occurred thoughts. Asnoted, when we say that the cab driver thinks that the light is red, this need not

involve positing that there is a particular representation going through his mind.Rather, we attribute thoughts to him and use the term thinking to describe andexplain the situation in question in a way that makes sense of his actions. In otherwords, when we attribute the thought to the cab driver we do not necessarilydesignate some mentally represented entity, but rather the situation that he is in. AsDan Hutto ( 2008 , 433) notes, we use such sentences to ll in the content clause,but this is only a convenient way of denoting the situation that it is directed at non-contentfully. Also, when asked to explain why he stopped, the cab driver maysimply tell us I thought the light was red. But in that case, he would not bereporting on words or images represented in his mind, rather, he would beexplaining his experience of the situation and his reaction in a particular way, whichinvolves some kind of awareness of the light being red. When listening to hisexplanation, unless we are given further information, under normal circumstanceswe cannot assume that he is reporting on thoughts that actually occurred to him.

(3.1.3.) There is in our everyday language yet another non-representational wayin which it is entirely intelligible to use the sentence I thought that P. We may useit an expressive way, which is neither about reporting on thoughts or explainingactions, but about expressing emotions. In order to see this, let us imagine thatMalcolms car driver is involved in a serious car accident right after stopping at thered light. When a concerned friend or therapist later asks him what went through hishead in that life-threatening situation, he may very well reply, I thought I was goingto die. But what does his answer mean? It is rather unlikely that he means that thethought I thought I was going to die or a particular image with the same contentpassed through his mind. Instead, his utterance might very well convey the manner


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entertaining thoughts that do not include words or propositions. 10 This is furthersustained by ontogenetic considerations about, on the one hand, the acquisition of concepts and words, and thinking on the other. It seems relatively straightforwardthat in order to learn a language, the young child must be able to reect on and

hypothesize about the meanings and correct applications of the words that she hears.To be able to achieve this, however, the child needs to be able to possess certainconcepts and entertain thoughts. This conceptual point is supported by empiricalevidence showing that thinking and the possession of concepts precede theacquisition and mastery of words (Hespos and Spelke 2004 ; Bloom 2000a , b).

Still, a CT theorist could counter this in several ways. One way would be to arguethat these mainly phenomenologically-based ndings miss the target becausepositing that words are the vehicles of thoughts is a theoretical matter aboutsubpersonal phenomena. But this objection would fail, because CT needs to assume

that the relevant mechanisms are available for conscious thought.A second, and more successful, way would be to argue that these empirical

results are in principle compatible with CT. CT could simply relax its claim, andmaintain that not all, but in a good deal of cases, words are involved in our thinking.This move would as such not be devastating for CT, but it would introduce furtherinsecurities. CT would have to specify whether and why automatic thoughts belongto the realm of thinking that involves representing propositional content. Also, giventhat CT maintains that patients have to learn to identify automatic thoughts, it wouldhave to be claried how the patient would identify thoughts that involve words and

further distinguish between automatic and non-automatic ones. However, there isanother critical problem that is more damaging to CT. I want to argue that even if we assume that the patient reliably identies automatic thoughts involving words,we need to distinguish between those cases in which these words have a constitutiveor merely an accompanying role. As I will show in the following, while theconstitutive story is very difcult to establish, it is nevertheless the one that CT bothassumes and needs to assume .

3.2.1 Words: Constitutive or Accompanying Role?

Consider the following example. Our cab driver is a rather unorganized man, whooften forgets to lock the door of his car in spite of knowing that the city he lives inhas exceptionally high rates of car theft. Both his employer and his wife haveunsuccessfully warned him several times that if he continues his forgetful habit, it isonly a matter of time until he will have his car stolen. One day, returning to the car

10 In these studies, normal subjects wore a paging device, which would randomly beep throughout theday. Somewhat similar to patients in a CT informed therapy session, the subjects participating in thesestudies were asked to stop and record the thoughts that they had during the activation of the device. What

subjects report is that besides inner speech and visual imagery, they also experience unsymbolized butdeterminate thoughts - such as wondering whether or not to purchase a particular item in a supermarket -in the absence of any visual imagery or inner speech (Heavey and Hurlburt 2008 , 802). Moreover, theauthors have detected a signicant negative correlation between inner speech and unsymbolized thinking.This means that individuals have a relatively stable propensity towards different thinking patterns. Thosewho report frequent cognitive activity in which words and proposition constitute the vehicles of theirthoughts have at the same time relatively few instances of unsymbolized thinking.

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park from his lunch break, the unlocked car is gone. The rst thought that comes tohis mind is, I had that coming.

Now, the rst issue I want to demonstrate with this example is that it is difcultto tell whether the proposition involved (the resounding words I had that coming)

can be said to constitute the cab drivers thinking. When the thought resounds, hemay likely be imagining telling the episode to his wife or employer. In that case, it isquestionable whether the resounding words I had that coming are the indispensiblevehicles of his thought. But in case he is imagining himself speaking, then theresounding words have an accompanying role, simply adding a meta-level to histhinking (see Davies 1998 ). This would be both consistent with the conceptualanalysis presented earlier ( 3.1 ) and also with the view that words and language arenot necessary for thought, but only for meta-level thought (Smith 1998 , 407). Thepoint is that without further evidence, there is no obvious reason to assume that the

resounding words constitute his thinking.In support of this, one may make a stronger argument: when the cab driver

hears himself inwardly uttering I had that coming we cannot even securelyassume that he is aware of a genuine mental episode of thinking. Byrne ( 2011 , 115)compares inwardly and outwardly uttered sentences and argues that the outerutterance is not itself an episode of thinking, but something produced by such anepisode; likewise, if there were ( ) an inner utterance it wouldnt be an episode of thinking either. Thus, using Byrnes idea, we could argue that what the cab driveris really aware of when he hears himself inwardly uttering I had that coming is

not the thinking process itself, but rather its product. Byrnes reections usefullycomplement the arguments presented earlier, but his position is stronger than theone I am trying to defend. While he subscribes to the view that inwardly-utteredwords cannot be taken to constitute the vehicles of thought, Byrne seems to denythat they can be parts of the thinking itself. My suggestion is more modest,maintaining that at least in some of those cases in which words resound in ourheads, the words in question only play an accompanying role in our thinking, ratherthan constituting it. 11 Also, I am not claiming that it cannot be claried whether aresounding thought has an accompanying or constitutive role. Rather, the point isthat it would take exactly the kind of (not insignicant) interpretative effort that CTwants to avoid (see more on direct versus interpretative retrieval in 3.3).

A CT theorist might reply that it does not really matter whether the resoundingthought constitutes or merely accompanies thinking. She might remind us that whatreally matters is that these thoughts are generated by a (negative) schema and thatthey can be used to detect that schema. Nonetheless, this objection is not entirelyconvincing. If one assumes that the resounding thought in question merelyaccompanies thinking, then it is doubtful whether it would necessarily or even justreliably reveal underlying schemas. Here is why.

11 The view that thinking does not necessarily involve words is less bold than the idea that not allthinking may involve concepts. The latter view has been put forward by Bermudez (2003), emphasizingnon-conceptual processes of representation that are not constrained by the range of concepts possessed bythe cognitive agent. Similarly, Evans ( 1982 ) has written about the possibility that cognitive activity mayinvolve non-conceptual content.


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Let us imagine that our cab driver felt depressed and consulted a CT-informedtherapist. When talking about the episode when his car was stolen, the therapist askshim What went through your mind? He replies: I had that coming. Now let usassume that the words in question (we are now assuming that they resound) play a

merely accompanying and not constitutive role. The difculty we then face is asfollows: If the resounding thought only accompanies thinking, for example, if he isthinking by imagining himself speaking about the episode, then it is an instantiationof thinking that is located at a higher level of thought, and the connection to anunderlying schema becomes more uncertain. Put differently, it then becomesimplausible to think that the thought necessarily (or even reliably) reveals or reectsan underlying schema. So in order to avoid potential misunderstandings, and tomaximize the reliability of the CT therapists judgment, it is safer if the therapistonly infers an underlying schema in cases in which the resounding thought has a

constitutive role.

3.3 We have Direct Access to our Thoughts

Besides the CT conjecture about the vehicles of thought, the idea that patients cancatch (Beck; JS Beck) the precise wording of their automatic thoughts relies onan additional assumption. That is, the assumption about a vehicle of thought iscomplemented by an assumption about access to our thoughts. Recall that thepatient is instructed not to interpret, but to simply observe introspectively and report

the actual words that go through her mind. This is something that patients usuallyhave to get used to: Until they have learned to recognize these thoughts, manypatients report interpretations , which may or may not reect the actual thoughts(Beck 1995 , 88 emphasis in original). This, however, relies on the assumption thatwe must have direct (unmediated, non -interpretative) introspective access to ourthoughts. If the claims and recommendations of CT are coherent, then CT has torely on the assumption that by introspection we can bring our thoughts intoawareness directly that is, unaltered, unpolluted by any process of interpretation.To be clear, the point is not that CT assumes that there are completely unpollutedthoughts. Evidently, CT maintains that thoughts are polluted, namely by theunderlying schemas. My point is, rather, that CT assumes that the introspectiveretrieval brings thoughts into awareness unpolluted by any additional process of interpretation .

One major aw in the assumption of direct access is that it neglects the authorityand agency that we entertain towards our mental states. When we bring aspects of our mental life to consciousness, we are not merely something like an expert witnessof our mental states. Rather, the identity of a given inner entity depends on ourinterpreting it by applying conceptual and descriptive resourcesa process thatinvolves a stance of agency (Moran 2001 , 4; 42). Bringing into play both theissue of the constituting agency of the person and the dynamic relation betweenrst-person reection and mental life, Moran ( 2001 , 28) shows that acquiringknowledge of our inner life is not a perception-like and relatively neutral epistemicundertaking of an expert witness, but a process that has specic, formativeconsequences for the object of introspective retrieval. In such a process, we do not

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merely report, but, rather, shape (pollute) and sometimes co-constitute the state inquestion. Thus, in those cases in which answering the question Do you think thatP? involves an introspective p rocess, the introspection shapes and alters the contentin question (Moran 2001 , 40). 12 Mental states are far from being independent and

stable entities that await introspective discovery. Rather, they are polluted byintrosp ect ion as mental states are dynamically intertwined with our rst-personalagency. 13

The CT theorist might obj ect that I am attributing a view to CT that is strongerthan what it needs to assume. 14 She could relax the claim and concede that there isalways some kind of interpretation involved. She could argue that CT only needs toassume that introspective reports of the patient can sometimes, or in principletruthfully reect how the patient feels. However, this would be too imprecise. Recallthat according to CT, affective states (how the patient feels) do not necessarily

reect the underlying schemas. While it is important to know how the patient feels,bear in mind that in CT, it is not so much the way the person is feeling that is takento reveal insight about the schemas. Rather, and crucially, CT maintains that it is theautomatic thoughts (which cause the emotions) that really offer the relevant insight.Therefore, the CT theorist must embrace more than the simple and trivial claim thatintrospective reports can sometimes accurately reect how a person is feeling.

There is, however, another way in which the CT theorist could acknowledge therole of interpretation and relax the relevant claim. She could argue that CT onlyneeds to assume that introspective reports of the patient can sometimes, or in

principle, truthfully reect the patients automatic thoughts. There is somethingright about this objection. Surely, some reports are more accurate than others. Butthis is also a quite substantial concession that introduces signicant uncertaintiesinto the therapeutic setting. How is the patient or the therapist to decide whether areport is more direct in the sense of involving a minimal amount of interpretation?Given such insecurities, under what circumstances is it warranted to infer anunderlying schema? Thus, while it is in principle possible for the CT theorist toconcede the role of interpretation and relax the relevant claim, this would be boughtat relatively high price.

12 It should be noted that Morans view of rst-personal agency is weaker than constitutivist views, suchas the one defended by Crispin Wright.13 Of course, this goes for both symbolized and unsymbolized thought. But it is even morestraightforward that we cannot be said to have direct access to our unsymbolized thoughts. Carruthers(2009 ) has criticised Hulburts understanding, suggesting that when prompted by the beep, subjects turntheir mindreading systems on their own behavior and circumstances , often enough interpretingthemselves as entertaining a specic thought. The point that Carruthers tries to convey is thatunsymbolized thoughts are in the periphery of our awareness in a way that making sense of themnecessarily involves some kind of self-interpretation. But independent of Carruthers pointwhichdepends on a certain conceptualization of the mindit does seem rather unproblematic to hold that sinceneither the content nor the vehicles of unsymbolized thinking are of propositional nature, ourcommunicating their content will always be indirect, involving some kind of translation into words andpropositions. Of course, none of this commits me to the idea that we do not have a direct or unmediatedunderstanding of our unsymbolized thoughts. The point so far is merely that our communicating theircontent will always be indirect.14 I thank an anonymous reviewer for putting forward this objection.


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3.4 Cognitions Cause and/or Constitute Emotions

After having considered the assumptions of CT that relate to the topics of cognition,mental representation and introspection, the focus of the remaining part of this

section will be on cognition and emotions. The rst point that I shall make is thatCT subscribes to a general cognitivist view of emotions, which explains the emotionby attitudes directed at a proposition, while bodily feelings are in no way essential(see de Sousa 2010 ). A central assumption of CT is that emotional disturbances likefeelings of guilt, anxiety, and despair in depression can be traced back to a specicconstellation of thoughts and beliefs. Within the general view of depression as adisorder of thought (Beck and Alford 2009 , 208, 239), it is possible to identify inCT both the claim (a) that thoughts, beliefs, or judgments cause emotions and(b) that they constitute emotions.

(a) As to the causal claim, Beck and Alford explicitly maintain that the affectivedisturbance, in such forms as low mood and anxiety is the consequence of cognitive activity (Ibid., 231): the typical depressive affects are evoked by theerroneous conceptualizations (Ibid., 209). In all, there is primarily a disorder of thought with resultant disturbance affect and behaviour in consonance with thecognitive distortions (Beck and Alford 2009 , 208). While it is indisputably the casethat sometimes emotions are caused by cognitive activity, the CT picture oncausation is too crude. First, we must remember that non-cognitive causal factorscan trigger emotions. For instance, anxiousness can be caused by an excessive

consumption of beverages that are rich in caffeine, just as feeling sad may be theoutcome of consuming alcohol or fatigue (Prinz 2004 ). Second, given the enormousamount and variety of processes covered by the term cognition, it is rather obviousthat not every token cognitive activity is necessarily efcacious. It is possible tohold a relevant belief or judgment while not being in the matching emotive state(Robinson 2005 , 26). The cab driver may believe that leaving the car unlocked isdangerous, while not fearing that the car might be stolen. Third, even in the case of causally efcacious cognitive activity, the picture is much more complex than whatis depicted in CT. For instance, the same judgment with the same propositionalcontent may sometimes generate anger, but sometimes anxiety or sorrow, or even adispassionate shrug of the shoulders. In all, the CT claim that affective disturbancesare caused by cognitive activity is very problematic.

(b) A CT defender may object and argue that CT does not really need the causalaccount for its aims. Instead, it only has to claim that emotions are constituted bythoughts, beliefs, or judgments. According to the view that emotions are constitutedby thoughts, beliefs, or judgments, the anger I feel toward a friend of mine simply isthe judgment that he has wronged me, while my embarrassment is identical with my judgment of being in an awk ward situation (Solomon 1976 , 187; Neu 2000 ;Nussbaum 2001 ; Marks 1982 ).15 Subscribing to the constitutional view, the CTtheorist may claim that if emotions are constituted by thoughts, beliefs, or

15 Of course, some positions are slightly more complicated. For instance, in order to be able to attributeemotions to infants and animals, Nussbaum ( 2001 ) allows for some propositions to be preverbal.However, this redenition may result in a very vague concept of propositions (de Sousa 2004).

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judgmen ts, then modication in the judgment will ipso facto generate a change of emotion. 16 The CT theorist could argue that the constitution view would beconsistent with the CT idea that clients should be corrected when describing theirexperiences by using I feel Beck et al. ( 1979 ), 37). Therapists are instructed to

help patients translate I feel into I think or I believe (Beck et al. 1979 ; Beck 1995 ; Beck and Alford 2009 ). For example, the patient might say: So, during thecourse of the day, driving into work, being at work, I was just in a nervous state. Notin extreme panic, but just in a nervous state. A feeling of, like, I dont know if Iwant to stay here or if I want to go (Scott et al. 1991 , 18). The therapist answersand translates the patients report into a cognitive vocabulary: You had automaticthoughts like I dont know if I want to go or stay at work? (Ibid., 18).

There are several ways in which the CT theorist could esh out a constitutiveview (see Debes 2009 ). The strongest version holds that emotions both are

evaluative judgments (reductive identity) and that they are type-identiable by thecontent of those judgments or beliefs. Slightly less strong, she could claim thatemotions are both essentially constituted (though not exhausted) by evaluative judgments or beliefs and type-identiable by the content of those judgments orbeliefs. In the weakest version, she could claim that emotions are essentiallyconstituted (though not exhausted) by evaluative judgments or beliefs, thoughwithout being differentiated by their cognitive contents.

As I see it, CT only needs to assume the weakest version of the constitutionviewa move that would save it from a great deal of problems. CT may thus grant

that emotions are not necessarily type-identiable by the evaluative, propositionalcomponent involved, or that the emotion is identical with or exhausted by theevaluative component (for a critique see Ben-Zeev 2004 ; Goldie 2000 ). Nonethe-less, the weakest view is also vulnerable to severe criticism. One very simpleproblem for this view is that possessing particular judgments is neither necessarynor su fcient for having an emotional state (Stocker and Hegeman 1992 ; Tappolet2003 ).17 In other words, it is possible to be in an emotional state without holding therelevant judgment. For instance, feelings of fear toward some object do notnecessarily involve assenting to the object being dangerous (Goldie 2000 ; Ben-Zeev 2000 ; Elster 2003 ). In addition, the body of work on affect programs bypsychologists like P. Ekman and R.B. Zajonc and philosophers like DeLancey

16 Matthew Ratcliffe has righty pointed out (personal communication) that CT does not actually need tocommit to the strong cognitivist view that beliefs precede emotions and that emotions are themselvescognitive states. Instead, it could maintain that emotions entail evaluations, but resist the nal assumptionthat these evaluations are judgments (or beliefs involving propositional content), and settle with the viewthat changes in belief can inuence emotions. However, while this would indeed be an alternative, it isnevertheless not endorsed in CT. A speculative answer as to why, could be that it would weaken thepositions of CT. But also, even if CT theorists would take this option, CT would still be susceptible to therest of the criticism in this paper.17 Additionally, research in neuroscience indicates that affective responses can and do operate prior toand without the involvement of cognitive processing. Emotions can be experienced without cognitiveprocessing and they actively inuence such processes (LeDoux 1996; Damasio 1994 /2006; 1999). In thiscontext, cognition is taken to denote thinking activity, and not merely simply any processing of information about the world (which would include perception). Such evidence is in contradiction with theassumption of a cognitivist view of emotions in which changes in belief precede emotional changes.


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(2002 ), DArms and Jacobson ( 2003 ) and Prinz ( 2004 ) contains substantial evidenceabout the automated and non-cognitive nature of emotional response systems. Thus,even the weakest notion of the constitution view is susceptible to substantialcriticism.

The issues raised in (a) and (b) have implications for our context. For instance, aclient reports about her horrible day at work where she suffered feelings of inferiority and constantly felt outperformed by her co-workers. When asked whatshe was thinking, her answer is I felt so stupid and worthless. Typically, thetherapist would correct her, and encourage her to say instead I thought I was stupidand worthless, either bec ause this thought is regarded as causing or as constitutingthe emotional experience. 18 However, given that thoughts need not necessarily standin either causal or constitutional relation to emotional states, this patients emotionalexperience does not have to involve her thinking that she is stupid and worthless.

But if this is right, the strategy might be misleading and lastly ineffective. First, itmay be misleading to persuade the patient to switch to using cognitive vocabulary.For example, it may very well be that the utterance I felt so stupid and worthless isexpressive (in the sense dened in 3.1 and thus not a report) and conveys aconfusing emotional experience that she underwent. In that case, her originaldescription is the more accurate one, and the correction may take her further awayfrom the original experience. Second, in cases of this type, the translation into acognitive vocabulary and the attempt to neutralize the relevant thought is unlikely tobe effective and result in relief.

It is important to emphasize that nothing I have said entails denying thatcognitions may cause or constitute certain emotions and emotions disturbances.Sometimes this may very well be the case. However, in order to make out whetherthis is the case, it is of utmost importance to provide a more profound interpretationof the reports, taking into account a variety of contextual elements. This adds to thecomplexity of the interpretational task as (very roughly) laid out in Sect. 3.1.

3.5 Cognitive Schemas Constitute the Fundament of our Thinking

Cognitive theory rightly maintains that experience does not take place in a worldthat is neutrally disclosed, but in one where we always already are anchored by ourcognitive schemasstored bodies of fundamental, background beliefs that interactwith the incoming information and shape and frame experience (Beck and Alford2009 , 255; Williams et al. 1997 ). The schemas constitute the tacit background of experience and the framework of intentional experience. What CT also says is thatin depression-prone individuals this interpretive framework is unrealisticallynegatively biased, resulting in catastrophic interpretations of an occurring situation.At the same time, the relevant schema rationalizes the catastrophic interpretation.

Thus far, this idea calls into mind Wittgensteins work on certainty and hinge-propositions (Wittgenstein 1969 ). He famously argued that at the fundament of our

18 Beck (et al. 1979, 37) specically emphasizes that clients should be corrected when describing theirexperiences by using I feel. Rather, therapists are instructed to help patients translate I feel into Ithink or I believe (Beck et al. 1979; Beck 1995; Beck and Alford 2009).

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world-relation, there are certain types of beliefs (hinge-propositions), which makeup a rather permanent backdrop of certainty (Ibid., 115, 150, 283, 472477) thateven skeptics must rely on. What is special about these beliefs is that they do notalways rely on justication by other beliefs: they are immediately warranted,

epistemically basic, and the certainty we connect to them does not stem from theirrole within our framework of beliefs.

However, discussing Wittgensteins use of the term hinge-proposition alsosheds light on some of the challenges that the idea of cognitive schemas face.Looking closer on Wittgensteins hinge-proposition s reveals that these are notclearly propositional and belief-like as other beliefs, 19 and, therefore, some arguethat hinge-propositions are linked to and embedded in practice (Moyal-Sharrock 2003 ; Varga 2012 ). The background that frames everyday experience and therealness that usually characterizes experience is not merely grounded in beliefs but,

rather, in our practical relation to the world revealed in our patterns of actions.While hinge-propositions on this interpretation are themselves embedded insomething more fundamental, we might start suspecting an analogous case withcognitive schemas. While the level of practice is undoubtedly a part of thebackground of experience and thinking, what I want to add here is that cognitiveschemas are also embedded in tacit background emotions . As we shall see, for anadequate understanding of the activation pattern of cognitive schemas, we need totake into account this embeddedness.

3.5.1 Background Emotions

Very roughly, background emotions are inconspicuous background states that areless intense then what we usually co nsider as moods (Damasio 1999, 341 ; Lane andNadel 2000 ; Ratcliffe 2005 ; 2008 ).

20As with being in a mood, we only have a

subtle awareness of a background emotion, but when prompted, we are usually ableto report on its quality instantly. Matthew Ratcliffe has provided an excellentphenomenological study of such subtle emotions that include the feeling of beingon top of things, being strong and full of energy, being in danger, or beingdistant and cut off from the world (Ratcliffe 2005 , 2008 , 2010 ).

These emotions not only colour our experience, but have far more important rolesto play. Similar to the way in which Martin Heidegger has famously describedmoods, they disclose to us our Being-in-the-world as a whole and createframeworks of signicance that structure our experience and make it possible for usto direct ourselves towards something (Heidegger 1963 , 172). Such tacitbackground states bestow the world with a sense of practical signicance. Roughly,one may say that these fundamental emotions frame experience and provide anaffective background orientation by constituting a space of signicant possibilitiesthat afford certain actions. For instance, the subtle feelings of being on top of

19 Some of his examples are not propositional, like the certainty of the sense of ownership of body parts.20 As Damasio ( 1994/2006 ) has expressed it, a background feeling is not the Verdi of grand emotion,nor the Stravinsky of intellectualized emotion but rather a minimalist in tone and beat, the feeling of lifeitself, the sense of being.


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cognition. Rather, they fundamentally shape cognition and tacitly structure and co-constitute experience. Taking this seriously, we may argue that this also means thatbackground emotions to a certain extent constitute the framework in which thecognitive schemas occur. This view can be additionally supported by phenomeno-

logical and empirical arguments. Let us see how.First, this view squares easily with the relevant phenomenology. For instance,

having a background emotion that is characterized by general anxiousness towardsthe world usually comes with a propensity towards holding certain basic beliefsabout oneself and the world, as vulnerable to dangers that one tends to seeeverywhere. Or, more moderately, we can say that such a background emotionamplies those past experiences in which such vulnerability to dangers has beenconrmed. At the same time, when having such a background emotion, one isspecically susceptible to feelings of fear that one otherwise would be able to

regulate and to hinder from guiding action. Additional evidence for the embedd-edness of beliefs and schemas in background emotions comes from psychopathol-ogy. Ratcliffe ( 2005 , 2008 ) has argued that pathologically altered backgroundemotions that lack certain qualities may lead to delusional beliefs.

If this is right, then it is plausible that the background beliefs or schemas that CTconsiders to cause the pathological emotional episodes are not simply there asbrute facts regulating our inner life at the fundament of our world-relation. Instead,their presence and impact are themselves dependent on the background emotionsthat frame them. This view is additionally conrmed by the work of Teasdale and

Barnard ( 1993 ). These authors note that one problem with the CT assumption thatvulnerability to depression depends on individuals underlying dysfunctionalbackground beliefs is that it has not been demonstrated that vulnerab le individualsremain committed to these beliefs once their depression has remitted. 24 Thus, oncethe patients no longer suffer from the affective disturbances in depression, therelevant negative or dysfunctional background beliefs cease to be active or existent.Therefore, the evidence shows that rather than being enduring characteristics of vulnerable individuals, such beliefs are habitually mood-state dependent (Teasdale1993 ; Teasdale and Barnard 1993 ).

If it is correct that schemas are themselves embedded in background emotions,than this has serious consequences that CT needs to take into account. For instance,it needs to be taken into consideration that schemas in depression may in themselvesnot be dysfunctional, but rather intelligibly embedded in a particular (dysfunctional)background emotion. In other words, their dysfunctional nature may stem from theirbeing embedded in a particular background emotion. But then, CT needs toaccommodate that the adequate explanation of the dysfu nctional response patternsmust take into account such non-cognitive aspects. 25 In addition, another

24 For a philosophical critique of their account see Charles 2004 paper Emotion, Cognition and Action.25 Whiting ( 2006 a, b) has rightly argued that there are some cases in which the explanation of dysfunctional response patterns must be non-cognitive. He has noted that sometimes our thoughts depictor represent the world accurately, but our emotional response is inappropriate or out of control, in whichcase it may be inadequate to aim at cognitive alterations. I am making a related point here, but note thatthe point of departure is very different. In each case that Whiting depicts, experience starts withrepresentations that then elicit certain evaluations and/or emotional responses. The view that I am


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consequence is that the therapeutic alteration of such patterns and the alleviation of the emotional disturbance may consist in working with the (background) emotionsthemselves instead of focusing on cognitions. Of course, the identication of cognitive schemas is an important step toward mapping the cognitive landscape of

the patient, itself a vital instrument of psycho-education. However, its value issomewhat limited if the role of background emotions is not taken into consideration.

4 Towards a More Precise CT

So far, this paper has mainly been concerned with testing the underlyingphilosophical assumptions of CT, but it has also pointed out where CT needsrevision and what such revision should best entail. Such revision is likely to be

extensive. On the one hand, it would involve correcting assumptions about cognitiveprocesses, mental state attributions, mental representations, and backgroundemotions. On the other hand, it would involve paying less attention to the contentof mental representations and more to the role of interpretation. Such revision willnot only secure philosophical accuracy, but may also help provide an account that isbetter suited to explain some of the cognitive, emotional, and bodily manifestationsin affective disorders. Furthermore, the revised account could still count as sort of CT, since none of the arguments presented here deny that beliefs have an importantrole to play in depressive states. Indeed, beliefs can and do contribute to sustaining

background emotions, and the fact that fundamental beliefs arise in the context of background emotion does not mean that they cannot affect them.In the remainder of the paper, given the constraints of space, I will make

admittedly tentative suggestions of how a corrected CT would have severaladvantages and could provide the basis for a more precise understanding of patientsutterances in a therapeutic encounter. First, upon such a correction, the bodilyaspects of depression could be accounted for in a more adequate and direct manner(a). Second, some of the described problems that CT runs into could be avoided (band c). Let us see how.

(a) As noted earlier, CT is in striking contradiction with the embodied nature of background emotions, since it regards the bodily aspects of emotions and affectivedisturbances, like somatisation and motor retardation, as (at best) secondarycompared to automatic thoughts and fundamental beliefs (Beck and Alford 2009 ,244). However, the bodily experience is not only an inextricable part of the emotionitself, but sometimes it is the most salient feature of it. In that case, focusing on thebodily changes may help reveal the background emotion that one is going through.For instance, parallel to low moods, depressive patients often complain about motorretardation and about general states of all-encompassing bodily uneasiness in whichthe body feels object-like and conspicuous (Fuchs 2003 , 2005 ; Ratcliffe 2009 ). An

Footnote 25 continuedstressing is different in that I take representation to already be imbued with an embodied backgroundemotion. Such a point of departure leads into a different explanation, but one that is compatible withWhitings account.

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advantage of such a changed view is that complaints about motor retardation orbodily conspicuousness, and the tacit quality of the low emotional experience,need neither be understood as distinct phenomena, nor in causal terms. Thebackground low emotion in which everything is permeated by a sense of

meaninglessness and lack of possibilities, and the object-like and conspicuous senseof the body (through which we usually actualise those possibilities), may simply bedifferent sides of the same experience.

In the corrected view, such bodily feelings need not be distinguished from alteredexperiences, and we need not say that it is beliefs formed on the basis of experiencesthat slow down the body. If we understand the changed bodily feeling as a part of the altered experience, then in some cases the emotional experience of beingirrevocably disconnected, cut off and alienated can become more conscious byfocusing on the bodily side of the experience. This may specically apply to patients

that are more comfortable with talking about bodily disturbances rather thanemotional ones.

(b) On the background of several points throughout the paper, it seems clear thata correction of CT would also have to involve allocating a different position forautomatic thoughts. First, as seen in Sect. 3.1 ., the awed general assumption mustbe abandoned that thought always involves conscious mental representation.Besides this general point, special attention should be paid to the fact that a thoughtor a belief need not be constitutive of an emotion but might simply be expressive of it. Automatic thoughts could, in such a changed picture, be understood as

expressions of a negatively altered background emotion that makes the horizon of possible experiences shrink into a locked atmosphere, characterized by a loss of meaningful practical possibilities. In this case, it is clear that if the therapist seeks tochange the vocabulary and reduce the utterance of the patient I feel worthless tosome kind of belief, then important aspects of a complex experience are lost. I feelworthless might harbour a much more complex relation to self and world thancertain beliefs about the state of things. Referring to feelings might just be the mostadequate means of expression of the transformation in the overall sense of being inthe world rather than a change in belief. We have to keep in mind that suchalteration encompasses a range of subtly different predicaments and it might beextremely difcult to convey it in terms of concrete differences in how things look.So while CT would attempt reduce I feel worthless to a distorted belief, in thecorrected view, the same utterance might gure as a useful characterization of thealtered background structure of experience. It may express that the world no longeroffers the usual possibilities for activity, in the sense that possibilities for interactionthat are inaccessible to the self, appear easily accessible to others. It may expressalterations in the space of possibilities that involve feelings and thoughts of irrevocable isolation. A correct and nuanced understanding of such utterances mayalso be the rst step towards working with the background emotions themselvesinstead of focusing on cognitions.

(c) Besides this loss, we have also seen how CTs intention to identify automaticthoughts and to correct and translate affective utterances in a cognitive vocabularycan lead to a variety of severe misunderstandings, which can be assumed to have anegative impact on the therapeutic outcome. A common problem is that if a patient


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is unable to identify explicit automatic thoughts resounding in her mind, theconclusion of CT is typically that they are simply not conscious enough. Thisconclusion is in striking contradiction to the patients awareness of her distress,which may then lead her to seek even harder, thus increasing the chance of a false

recollection. It is already the case that due to the specic way of questioning and thepower of the therapeutic encounter, clients do at times falsely recollect automaticthoughts (Power 2002 , 2009 ). However, if some of the assumptions of CT arerevised in the way indicated in this paper, then the problem of falsely recollectedautomatic thoughts might be reduced to a minimum.

5 Conclusion

Undeniably, the cognitive conceptualization of emotions and affective disorders hasled to a variety of theoretical, empirical, and therapeutic advances. However, giventhat CT constitutes the predominant paradigm in the understanding of affectivedisorders and psychotherapy, and given that the therapist more or less explicitlyeducates the patient to consent to this theory (psycho-education), it is important toassess the philosophical assumptions on which it is based. Therefore, this papercontained the identication and the assessment of basic assumptions, relating tophilosophical issues of mental representation and introspection on the one hand(3.13.3 ), and emotion and cognition on the other ( 3.43.5 ). The general conclusionwas that the philosophical basis of CT needs to be revised, and over the last pagesthe attempt was undertaken to briey sketch how this could be achieved and whatadvantages a corrected view would hold. Of course, much further work is needed.One interesting possibility to make progress would be to explore how mysuggestions could be combined with models that work with multi-level accounts of emotion such as in Power ( 2009 ) and Power and Dalgleish ( 1999 ). In any case, thehope is that some of these thoughts may contribute to providing a clinically usefulframework with which the emotional disorders can be understood.

Acknowledgments I would like to thank Matthew Ratcliffe, Daniel D. Hutto, George Graham, Achim

Stephan, Stephan Blatti, Remy Debes, Luvell Anderson, Shaun Gallagher, Jennifer Radden and ananonymous referee for valuable comments and criticism.

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Cognition, Mental Representations and Embodied Emotions

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