Self-esteem

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Self-esteem 

 

Self-esteem is an individual's subjective evaluation of their own worth. Self-esteem encompasses beliefs about oneself (for example, "I am unloved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) defined it by saying "The self-concept is what we think about the self; self-esteem, is the positive or negative evaluations of the self, as in how we feel about it."

Self-esteem is an attractive psychological construct because it predicts certain outcomes, such as academic achievement, happiness, satisfaction in marriage and relationships, and criminal behavior. Self-esteem can apply to a specific attribute (for example, "I believe I am a good writer and I feel happy about that") or globally (for example, "I believe I am a bad person, and I feel bad about myself in general"). Psychologists usually regard self-esteem as an enduring personality characteristic (trait self-esteem), though normal, short-term variations (state self-esteem) also exist. Synonyms or near-synonyms of self-esteem include many things: self-worth, self-regard, self-respect, and self-integrity.

History

The concept of self-esteem has its origins in the 18th century, first expressed in the writings of David Hume, the Scottish enlightenment thinker, shows the idea that it is important to value and think well of yourself because it serves as a motivational function that enables people to explore their full potential.

The identification of self-esteem as a distinct psychological construct has its origins in the work of philosopher and psychologist, geologist, anthropologist William James (1892). James identified multiple dimensions of the self, with two levels of hierarchy: processes of knowing (called the 'I-self') and the resulting knowledge about the self (the 'Me-self'). The observation about the self and storage of those observations by the I-self creates three types of knowledge, which collectively account for the Me-self, according to James. These are the material self, social self, and spiritual self. The social self comes closest to self-esteem, comprising all characteristics recognized by others. The material self consists of representations of the body and possessions and the spiritual self of descriptive representations and evaluative dispositions regarding the self. This view of self-esteem as the collection of an individual's attitudes toward oneself remains today.

In the mid-1960s, social psychologist Morris Rosenberg defined self-esteem as a feeling of self-worth and developed the Rosenberg self-esteem scale (RSES), which became the most-widely used scale to measure self-esteem in the social sciences.

In the early 20th century, the behaviorist movement minimized introspective study of mental processes, emotions, and feelings, replacing introspection with objective study through experiments on behaviors observed in relation with the environment. Behaviorism viewed the human being as an animal subject to reinforcements, and suggested placing psychology as an experimental science, similar to chemistry or biology. As a consequence, clinical trials on self-esteem were overlooked, since behaviorists considered the idea less liable to rigorous measurement. In the mid-20th century, the rise of phenomenology and humanistic psychology led to renewed interest in self-esteem. Self-esteem then took a central role in personal self-actualization and in the treatment of psychic disorders. Psychologists started to consider the relationship between psychotherapy and the personal satisfaction of persons with high self-esteem as useful to the field. This led to new elements being introduced to the concept of self-esteem, including the reasons why people tend to feel less worthy and why people become discouraged or unable to meet challenges by themselves.

In 1992 the political scientist Francis Fukuyama associated self-esteem with what Plato called thymos - the "spiritedness" part of the Platonic soul.

As of 1997 the core self-evaluations approach included self-esteem as one of four dimensions that comprise one's fundamental appraisal of oneself - along with locus of control, neuroticism, and self-efficacy. The concept of core self-evaluations as first examined by Judge, Locke, and Durham (1997), has since proven to have the ability to predict job satisfaction and job performance. Self-esteem may be essential to self-evaluation.

Self-esteem in public policy

The importance of self-esteem gained endorsement from some government and non-government groups starting around the 1970s, such that one can speak of a self-esteem movement. This movement can be used as an example of promising evidence that psychological research can have an effect on forming public policy. The underlying idea of the movement was that low self-esteem was the root of the problem for individuals, making it the root of societal problems and dysfunctions. A leading figure of the movement, psychologist Nathaniel Branden, stated: "[I] cannot think of a single psychological problem – from anxiety and depression, to fear of intimacy or of success, to spouse battery or child molestation – that is not traced back to the problem of low self-esteem".

Self-esteem was believed to be a cultural phenomenon of Western individualistic societies since low self-esteem was not found in collectivist countries such as Japan. Concern about low self-esteem and its many presumed negative consequences led California assemblyman John Vasconcellos to work to set up and fund the Task Force on Self-Esteem and Personal and Social Responsibility in California in 1986. Vasconcellos argued that this task force could combat many of the state's problems - from crime and teen pregnancy to school underachievement and pollution. He compared increasing self-esteem to giving out a vaccine for a disease: it could help protect people from being overwhelmed by life's challenges. 

The task force set up committees in many California counties and formed a committee of scholars to review the available literature on self-esteem. This committee found very small associations between low self-esteem and its assumed consequences, ultimately showing that low self-esteem is not the root of all societal problems and not as important as the committee had originally thought. However, the authors of the paper that summarized the review of the literature still believe that self-esteem is an independent variable that affects major social problems. The task force disbanded in 1995, and the National Council for Self-Esteem and later the National Association for Self-Esteem (NASE) was established, taking on the task force's mission. Vasconcellos and Jack Canfield were members of its advisory board in 2003, and members of its Masters' Coalition included Anthony Robbins, Bernie Siegel, and Gloria Steinem.

Theories

Many early theories suggested that self-esteem is a basic human need or motivation. American psychologist Abraham Maslow included self-esteem in his hierarchy of human needs. He described two different forms of "esteem": the need for respect from others in the form of recognition, success, and admiration, and the need for self-respect in the form of self-love, self-confidence, skill, or aptitude. Respect from others was believed to be more fragile and easily lost than inner self-esteem. According to Maslow, without the fulfillment of the self-esteem need, individuals will be driven to seek it and unable to grow and obtain self-actualization. Maslow also states that the healthiest expression of self-esteem "is the one which manifests in the respect we deserve for others, more than renown, fame, and flattery". Modern theories of self-esteem explore the reasons humans are motivated to maintain a high regard for themselves. Sociometer theory maintains that self-esteem evolved to check one's level of status and acceptance in ones' social group. According to Terror Management Theory, self-esteem serves a protective function and reduces anxiety about life and death.

Self-esteem is important because it shows us how we view the way we are and the sense of our personal value. Thus, it affects the way we are and acts in the world and the way we are related to everybody else.

Carl Rogers (1902-1987), an advocate of humanistic psychology, theorized the origin of many people's problems to be that they despise themselves and consider themselves worthless and incapable of being loved. This is why Rogers believed in the importance of giving unconditional acceptance to a client and when this was done it could improve the client's self-esteem. In his therapy sessions with clients, he offered positive regard no matter what. Indeed, the concept of self-esteem is approached since then in humanistic psychology as an inalienable right for every person, summarized in the following sentence: 

“

Every human being, with no exception, for the mere fact to be it, is worthy of unconditional respect of everybody else; he deserves to esteem himself and to be esteemed.

”

Measurement

Self-esteem is typically assessed using self-report inventories. 

One of the most widely used instruments, the Rosenberg self-esteem scale (RSES) is a 10-item self-esteem scale score that requires participants to indicate their level of agreement with a series of statements about themselves. An alternative measure, The Coopersmith Inventory uses a 50-question battery over a variety of topics and asks subjects whether they rate someone as similar or dissimilar to themselves. If a subject's answers demonstrate solid self-regard, the scale regards them as well adjusted. If those answers reveal some inner shame, it considers them to be prone to social deviance.

Implicit measures of self-esteem began to be used in the 1980s. These rely on indirect measures of cognitive processing thought to be linked to implicit self-esteem, including the Name Letter Task. Such indirect measures are designed to reduce awareness of the process of assessment. When used to assess implicit self-esteem, psychologists feature self-relevant stimuli to the participant and then measure how quickly a person identifies positive or negative stimuli. For example, if a woman was given the self-relevant stimuli of female and mother, psychologists would measure how quickly she identified the negative word, evil, or the positive word, kind.

Development across lifespan

Experiences in a person's life are a major source of how self-esteem develops. In the early years of a child's life, parents have a significant influence on self-esteem and can be considered the main source of positive and negative experiences a child will have. Unconditional love from parents helps a child develop a stable sense of being cared for and respected. These feelings translate into later effects on self-esteem as the child grows older. Students in elementary school who have high self-esteem tend to have authoritative parents who are caring, supportive adults who set clear standards for their child and allow them to voice their opinion in decision making.

Although studies thus far have reported only a correlation of warm, supportive parenting styles (mainly authoritative and permissive) with children having high self-esteem, these parenting styles could easily be thought of as having some causal effect in self-esteem development. Childhood experiences that contribute to healthy self-esteem include being listened to, being spoken to respectfully, receiving appropriate attention and affection and having accomplishments recognized and mistakes or failures acknowledged and accepted. Experiences that contribute to low self-esteem include being harshly criticized, being physically, sexually or emotionally abused, being ignored, ridiculed or teased or being expected to be "perfect" all the time.

During school-aged years, academic achievement is a significant contributor to self-esteem development. Consistently achieving success or consistently failing will have a strong effect on students' individual self-esteem. Social experiences are another important contributor to self-esteem. As children go through school, they begin to understand and recognize differences between themselves and their classmates. Using social comparisons, children assess whether they did better or worse than classmates in different activities. These comparisons play an important role in shaping the child's self-esteem and influence the positive or negative feelings they have about themselves. As children go through adolescence, peer influence becomes much more important. Adolescents make appraisals of themselves based on their relationships with close friends. Successful relationships among friends are very important to the development of high self-esteem for children. Social acceptance brings about confidence and produces high self-esteem, whereas rejection from peers and loneliness brings about self-doubts and produces low self-esteem.

Adolescence shows an increase in self-esteem that continues to increase in young adulthood and middle age. A decrease is seen from middle age to old age with varying findings on whether it is a small or large decrease. Reasons for the variability could be because of differences in health, cognitive ability, and socioeconomic status in old age. No differences have been found between males and females in their development of self-esteem. Multiple cohort studies show that there is not a difference in the life-span trajectory of self-esteem between generations due to societal changes such as grade inflation in education or the presence of social media.

High levels of mastery, low risk taking, and better health are ways to predict higher self-esteem. In terms of personality, emotionally stable, extroverted, and conscientious individuals experience higher self-esteem. These predictors have shown us that self-esteem has trait-like qualities by remaining stable over time like personality and intelligence. However, this does not mean it can not be changed. Hispanic adolescents have a slightly lower self-esteem than their black and white peers, but then slightly higher levels by age 30. African Americans have a sharper increase in self-esteem in adolescence and young adulthood compared to Whites. However, during old age, they experience a more rapid decline in self-esteem.

Shame

Shame can be a contributor to those with problems of low self-esteem. Feelings of shame usually occur because of a situation where the social self is devalued, such as a socially evaluated poor performance. A poor performance leads to higher responses of psychological states that indicate a threat to the social self namely a decrease in social self-esteem and an increase in shame. This increase in shame can be helped with self-compassion.

Real self, ideal self, and dreaded self

There are three levels of self-evaluation development in relation to the real self, ideal self, and the dreaded self. The real, ideal, and dreaded selves develop in children in a sequential pattern on cognitive levels.

• Moral judgment stages: Individuals describe their real, ideal, and dreaded selves with stereotypical labels, such as "nice" or "bad". Individuals describe their ideal and real selves in terms of disposition for actions or as behavioral habits. The dreaded self is often described as being unsuccessful or as having bad habits.
• Ego development stages: Individuals describe their ideal and real selves in terms of traits that are based on attitudes as well as actions. The dreaded self is often described as having failed to meet social expectations or as self-centered.
• Self-understanding stages: Individuals describe their ideal and real selves as having unified identities or characters. Descriptions of the dreaded self focus on a failure to live up to one's ideals or role expectations often because of real world problems.

This development brings with it increasingly complicated and encompassing moral demands. This level is where individuals' self-esteems can suffer because they do not feel as though they are living up to certain expectations. This feeling will moderately affect one's self-esteem with an even larger effect seen when individuals believe they are becoming their dreaded selves.

Types

High

Pyramid of Maslow.

People with a healthy level of self-esteem:

• Firmly believe in certain values and principles, and are ready to defend them even when finding opposition, feeling secure enough to modify them in light of experience.
• Are able to act according to what they think to be the best choice, trusting their own judgment, and not feeling guilty when others do not like their choice.
• Do not lose time worrying excessively about what happened in the past, nor about what could happen in the future. They learn from the past and plan for the future, but live in the present intensely.
• Fully trust in their capacity to solve problems, not hesitating after failures and difficulties. They ask others for help when they need it.
• Consider themselves equal in dignity to others, rather than inferior or superior, while accepting differences in certain talents, personal prestige or financial standing.
• Understand how they are an interesting and valuable person for others, at least for those with whom they have a friendship.
• Resist manipulation, collaborate with others only if it seems appropriate and convenient.
• Admit and accept different internal feelings and drives, either positive or negative, revealing those drives to others only when they choose.
• Are able to enjoy a great variety of activities.
• Are sensitive to feelings and needs of others; respect generally accepted social rules, and claim no right or desire to prosper at others' expense.
• Can work toward finding solutions and voice discontent without belittling themselves or others when challenges arise.

Secure vs. defensive

A person can have high self-esteem and hold it confidently where they do not need reassurance from others to maintain their positive self-view, whereas others with defensive high self-esteem may still report positive self-evaluations on the Rosenberg Scale, as all high self-esteem individuals do; however, their positive self-views are fragile and vulnerable to criticism. Defensive high self-esteem individuals internalize subconscious self-doubts and insecurities, causing them to react very negatively to any criticism they may receive. There is a need for constant positive feedback from others for these individuals to maintain their feelings of self-worth. The necessity of repeated praise can be associated with boastful, arrogant behavior or sometimes even aggressive and hostile feelings toward anyone who questions the individual's self-worth, an example of threatened egotism.

The Journal of Educational Psychology conducted a study in which they used a sample of 383 Malaysian undergraduates participating in Work integrated learning (WIL) programs across five public universities to test the relationship between self-esteem and other psychological attributes such as self-efficacy and self-confidence. The results demonstrated that self-esteem has a positive and significant relationship with self-confidence and self-efficacy since students with higher self-esteem had better performances at university than those with lower self-esteem. It was concluded that higher education institutions and employers should emphasize the importance of undergraduates' self-esteem development.

Implicit, explicit, narcissism and threatened egotism

Implicit self-esteem refers to a person's disposition to evaluate themselves positively or negatively in a spontaneous, automatic, or unconscious manner. It contrasts with explicit self-esteem, which entails more conscious and reflective self-evaluation. Both explicit self-esteem and implicit self-esteem are subtypes of self-esteem proper.

Narcissism is a disposition people may have that represents an excessive love for one's self. It is characterized by an inflated view of self-worth. Individuals who score high on narcissism measures, Robert Raskin's 40 Item True or False Test, would likely select true to such statements as "If I ruled the world, it would be a much better place." There is only a moderate correlation between narcissism and self-esteem; that is to say that an individual can have high self-esteem but low narcissism or can be a conceited, obnoxious person and score high self-esteem and high narcissism.

Threatened egotism is characterized as a response to criticism that threatens the ego of narcissists; they often react in a hostile and aggressive manner.

Low

Low self-esteem can result from various factors, including genetic factors, physical appearance or weight, mental health issues, socioeconomic status, significant emotional experiences, peer pressure or bullying.

A person with low self-esteem may show some of the following characteristics:

• Heavy self-criticism and dissatisfaction.
• Hypersensitivity to criticism with resentment against critics and feelings of being attacked.
• Chronic indecision and an exaggerated fear of mistakes.
• Excessive will to please and unwillingness to displease any petitioner.
• Perfectionism, which can lead to frustration when perfection is not achieved.
• Neurotic guilt, dwelling on or exaggerating the magnitude of past mistakes.
• Floating hostility and general defensiveness and irritability without any proximate cause.
• Pessimism and a general negative outlook.
• Envy, invidiousness, or general resentment.
• Sees temporary setbacks as permanent, intolerable conditions.

Individuals with low self-esteem tend to be critical of themselves. Some depend on the approval and praise of others when evaluating self-worth. Others may measure their likability in terms of successes: others will accept themselves if they succeed but will not if they fail.

The three states

This classification proposed by Martin Ross distinguishes three states of self-esteem compared to the "feats" (triumphs, honors, virtues) and the "anti-feats" (defeats, embarrassment, shame, etc.) of the individuals.

Shattered

The individual does not regard themselves as valuable or lovable. They may be overwhelmed by defeat, or shame, or see themselves as such, and they name their "anti-feat". For example, if they consider that being over a certain age is an anti-feat, they define themselves with the name of their anti-feat, and say, "I am old". They express actions and feelings such as pity, insulting themselves, and they may become paralyzed by their sadness.

Vulnerable

The individual has a generally positive self-image. However, their self-esteem is also vulnerable to the perceived risk of an imminent anti-feat (such as defeat, embarrassment, shame, discredit), consequently, they are often nervous and regularly use defense mechanisms. A typical protection mechanism of those with vulnerable self-esteem may consist in avoiding decision-making. Although such individuals may outwardly exhibit great self-confidence, the underlying reality may be just the opposite: the apparent self-confidence is indicative of their heightened fear of anti-feats and the fragility of their self-esteem. They may also try to blame others to protect their self-image from situations that would threaten it. They may employ defense mechanisms, including attempting to lose at games and other competitions in order to protect their self-image by publicly dissociating themselves from a need to win, and asserting an independence from social acceptance which they may deeply desire. In this deep fear of being unaccepted by an individual's peers, they make poor life choices by making risky decisions.

Strong

People with strong self-esteem have a positive self-image and enough strength so that anti-feats do not subdue their self-esteem. They have less fear of failure. These individuals appear humble, cheerful, and this shows a certain strength not to boast about feats and not to be afraid of anti-feats. They are capable of fighting with all their might to achieve their goals because, if things go wrong, their self-esteem will not be affected. They can acknowledge their own mistakes precisely because their self-image is strong, and this acknowledgment will not impair or affect their self-image. They live with less fear of losing social prestige, and with more happiness and general well-being. However, no type of self-esteem is indestructible, and due to certain situations or circumstances in life, one can fall from this level into any other state of self-esteem.

Contingent vs. non-contingent

A distinction is made between contingent (or conditional) and non-contingent (or unconditional) self-esteem.

Contingent self-esteem is derived from external sources, such as what others say, one's success or failure, one's competence, or relationship-contingent self-esteem. 

Therefore, contingent self-esteem is marked by instability, unreliability, and vulnerability. Persons lacking a non-contingent self-esteem are "predisposed to an incessant pursuit of self-value". However, because the pursuit of contingent self-esteem is based on receiving approval, it is doomed to fail. No one receives constant approval and disapproval often evokes depression. Furthermore, fear of disapproval inhibits activities in which failure is possible.

"The courage to be is the courage to accept oneself, in spite of being unacceptable. . . . This is the Pauline-Lutheran doctrine of 'justification by faith.'" Paul Tillich

Non-contingent self-esteem is described as true, stable, and solid. It springs from a belief that one is "acceptable period, acceptable before life itself, ontologically acceptable". Belief that one is "ontologically acceptable" is to believe that one's acceptability is "the way things are without contingency". In this belief, as expounded by theologian Paul Tillich, acceptability is not based on a person's virtue. It is an acceptance given "in spite of our guilt, not because we have no guilt".

Psychiatrist Thomas A Harris drew on Tillich for his classic I'm OK – You're OK that addresses non-contingent self-esteem. Harris translated Tillich's "acceptable" by the vernacular OK, a term that means "acceptable". The Christian message, said Harris, is not "YOU CAN BE OK, IF", It is "YOU ARE ACCEPTED, unconditionally".

A secure non-contingent self-esteem springs from the belief that one is ontologically acceptable and accepted.

Importance

Abraham Maslow states that psychological health is not possible unless the essential core of the person is fundamentally accepted, loved and respected by others and by her or himself. Self-esteem allows people to face life with more confidence, benevolence, and optimism, and thus easily reach their goals and self-actualize.

Self-esteem may make people convinced they deserve happiness. Understanding this is fundamental, and universally beneficial, since the development of positive self-esteem increases the capacity to treat other people with respect, benevolence and goodwill, thus favoring rich interpersonal relationships and avoiding destructive ones. For Erich Fromm, the love of others and love of ourselves are not alternatives. On the contrary, an attitude of love toward themselves will be found in all those who are capable of loving others. Self-esteem allows creativity at the workplace and is a specially critical condition for teaching professions.

José-Vicente Bonet claims that the importance of self-esteem is obvious as a lack of self-esteem is, he says, not a loss of esteem from others, but self-rejection. Bonet claims that this corresponds to major depressive disorder. Freud also claimed that the depressive has suffered "an extraordinary diminution in his self-regard, an impoverishment of his ego on a grand scale....He has lost his self-respect".

The Yogyakarta Principles, a document on international human rights law, addresses the discriminatory attitude toward LGBT people that makes their self-esteem low to be subject to human rights violation including human trafficking. The World Health Organization recommends in "Preventing Suicide", published in 2000, that strengthening students' self-esteem is important to protect children and adolescents against mental distress and despondency, enabling them to cope adequately with difficult and stressful life situations.

Other than increased happiness, higher self-esteem is also known to correlate with a better ability to cope with stress and a higher likeliness of taking on difficult tasks relative to those with low self-esteem.

Correlations

From the late 1970s to the early 1990s many Americans assumed as a matter of course that students' self-esteem acted as a critical factor in the grades that they earned in school, in their relationships with their peers, and in their later success in life. Under this assumption, some American groups created programs which aimed to increase the self-esteem of students. Until the 1990s, little peer-reviewed and controlled research took place on this topic. 

Peer-reviewed research undertaken since then has not validated previous assumptions. Recent research indicates that inflating students' self-esteems in and of itself has no positive effect on grades. Roy Baumeister has shown that inflating self-esteem by itself can actually decrease grades. The relationship involving self-esteem and academic results does not signify that high self-esteem contributes to high academic results. It simply means that high self-esteem may be accomplished as a result of high academic performance due to the other variables of social interactions and life events affecting this performance.

"Attempts by pro-esteem advocates to encourage self-pride in students solely by reason of their uniqueness as human beings will fail if feelings of well-being are not accompanied by well-doing. It is only when students engage in personally meaningful endeavors for which they can be justifiably proud that self-confidence grows, and it is this growing self-assurance that in turn triggers further achievement."

High self-esteem has a high correlation to self-reported happiness; whether this is a causal relationship has not been established. The relationship between self-esteem and life satisfaction is stronger in individualistic cultures.

Additionally, self-esteem has been found to be related to forgiveness in close relationships, in that people with high self-esteem will be more forgiving than people with low self-esteem.

High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. One exception is that high self-esteem reduces the chances of bulimia in females.

Neuroscience

In research conducted in 2014 by Robert S. Chavez and Todd F. Heatherton, it was found that self-esteem is related to the connectivity of the frontostriatal circuit. The frontostriatal pathway connects the medial prefrontal cortex, which deals with self-knowledge, to the ventral striatum, which deals with feelings of motivation and reward. Stronger anatomical pathways are correlated with higher long-term self-esteem, while stronger functional connectivity is correlated with higher short-term self-esteem.

Criticism and controversy

The American psychologist Albert Ellis criticized on numerous occasions the concept of self-esteem as essentially self-defeating and ultimately destructive. Although acknowledging the human propensity and tendency to ego rating as innate, he has critiqued the philosophy of self-esteem as unrealistic, illogical and self- and socially destructive – often doing more harm than good. Questioning the foundations and usefulness of generalized ego strength, he has claimed that self-esteem is based on arbitrary definitional premises, and over-generalized, perfectionistic and grandiose thinking. Acknowledging that rating and valuing behaviors and characteristics is functional and even necessary, he sees rating and valuing human beings' totality and total selves as irrational and unethical. The healthier alternative to self-esteem according to him is unconditional self-acceptance and unconditional other-acceptance. Rational Emotive Behavior Therapy is a psychotherapy based on this approach.

"There seem to be only two clearly demonstrated benefits of high self-esteem....First, it increases initiative, probably because it lends confidence. People with high self-esteem are more willing to act on their beliefs, to stand up for what they believe in, to approach others, to risk new undertakings. (This unfortunately includes being extra willing to do stupid or destructive things, even when everyone else advises against them.)...It can also lead people to ignore sensible advice as they stubbornly keep wasting time and money on hopeless causes"

 

False attempts

For persons with low self-esteem, any positive stimulus will temporarily raise self-esteem. Therefore, possessions, sex, success, or physical appearance will produce the development of self-esteem, but the development is ephemeral at best.

Such attempts to raise one's self-esteem by positive stimulus produce a "boom or bust" pattern. "Compliments and positive feedback" produce a boost, but a bust follows a lack of such feedback. For a person whose "self-esteem is contingent", success is "not extra sweet", but "failure is extra bitter".

As narcissism

Life satisfaction, happiness, healthy behavioral practices, perceived efficacy, and academic success and adjustment have been associated with having high levels of self-esteem (Harter, 1987; Huebner, 1991; Lipschitz-Elhawi & Itzhaky, 2005; Rumberger 1995; Swenson & Prelow, 2005; Yarcheski & Mahon, 1989). However, a common mistake is to think that loving oneself is necessarily equivalent to narcissism, as opposed for example to what Erik Erikson speaks of as "a post-narcissistic love of the ego". A person with a healthy self-esteem accepts and loves himself/herself unconditionally, acknowledging both virtues and faults in the self, and yet, in spite of everything, is able to continue to love her/himself.

In narcissists, by contrast, an " uncertainty about their own worth gives rise to...a self-protective, but often totally spurious, aura of grandiosity" – producing the class "of narcissists, or people with very high, but insecure, self-esteem... fluctuating with each new episode of social praise or rejection." Narcissism can thus be seen as a symptom of fundamentally low self-esteem, that is, lack of love towards oneself, but often accompanied by "an immense increase in self-esteem" based on "the defense mechanism of denial by overcompensation." "Idealized love of self...rejected the part of him" that he denigrates – "this destructive little child" within. Instead, the narcissist emphasizes their virtues in the presence of others, just to try to convince themself that they are a valuable person and to try to stop feeling ashamed for their faults; such "people with unrealistically inflated self-views, which may be especially unstable and highly vulnerable to negative information,...tend to have poor social skills."

Phobia

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Phobia

 

Phobia
The fear of spiders is one of the most common phobias
Specialty	Psychiatry, clinical psychology
Symptoms	Fear of an object or situation
Complications	Suicide
Usual onset	Rapid
Duration	More than six months
Types	Specific phobias, social phobia, agoraphobia
Causes	Unknown, some genetic effects
Treatment	Exposure therapy, counselling, medication
Medication	Antidepressants, benzodiazepines, beta-blockers
Frequency	Specific phobias: ~5% Social phobia: ~5% Agoraphobia: ~2%

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object or situation. The phobia typically results in a rapid onset of fear and is present for more than six months. The affected person goes to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the feared object or situation cannot be avoided, the affected person experiences significant distress. With blood or injury phobia, fainting may occur. Agoraphobia is often associated with panic attacks. Usually a person has phobias to a number of objects or situations.
Phobias can be divided into specific phobias, social phobia, and agoraphobia. Types of specific phobias include those to certain animals, natural environment situations, blood or injury, and specific situations.^[1] The most common are fear of spiders, fear of snakes, and fear of heights. Occasionally they are triggered by a negative experience with the object or situation. Social phobia is when the situation is feared as the person is worried about others judging them. Agoraphobia is when fear of a situation occurs because it is felt that escape would not be possible.

It is recommended that specific phobias be treated with exposure therapy where the person is introduced to the situation or object in question until the fear resolves. Medications are not useful in this type of phobia. Social phobia and agoraphobia are often treated with some combination of counselling and medication. Medications used include antidepressants, benzodiazepines, or beta-blockers.

Specific phobias affect about 6–8% of people in the Western world and 2–4% of people in Asia, Africa, and Latin America in a given year. Social phobia affects about 7% of people in the United States and 0.5–2.5% of people in the rest of the world. Agoraphobia affects about 1.7% of people. Women are affected about twice as often as men. Typically onset is around the age of 10 to 17. Rates become lower as people get older. People with phobias are at a higher risk of suicide.

Classification

Most phobias are classified into three categories and, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), such phobias are considered sub-types of anxiety disorder. The categories are: 

1. Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes lead to panic attacks. Specific phobia may be further subdivided into four categories: animal type, natural environment type, situational type, blood-injection-injury type.

2. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or PTSD (post traumatic stress disorder) related to a trauma that occurred out of doors.

3. Social phobia, also known as social anxiety disorder, is when the situation is feared as the person is worried about others judging them.

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their panic reaction. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of pain, and shortness of breath.

Specific phobias

A specific phobia is a marked and persistent fear of an object or situation. Specific phobias may also include fear of losing control, panicking, and fainting from an encounter with the phobia. Specific phobias are defined in relation to objects or situations whereas social phobias emphasize social fear and the evaluations that might accompany them.

The DSM breaks specific phobias into five subtypes: animal, natural environment, blood-injection-injury, situation and others. In children, blood-injection-injury phobia and phobias involving animals, natural environment (darkness) usually develop between the ages of 7 and 9, and these are reflective of normal development. Additionally, specific phobias are most prevalent in children between ages 10 and 13.

Social phobia

Unlike specific phobias, social phobias include fear of public situations and scrutiny, which leads to embarrassment or humiliation in the diagnostic criteria. 

Causes

Environmental

Rachman proposed three pathways to acquiring fear conditioning: classical conditioning, vicarious acquisition and informational/instructional acquisition.

Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model). When an aversive stimulus and a neutral one are paired together, for instance when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well. In behavioral terms, this is described as a conditioned stimulus (CS) (the room) that is paired with an aversive unconditioned stimulus (UCS) (the shock), which leads to a conditioned response (CR) (fear for the room) (CS+UCS=CR). For instance, in case of the fear of heights (acrophobia), the CS is heights such as a balcony on the top floors of a high rise building. The UCS originates from an aversive or traumatizing event in the person's life, such as almost falling down from a great height. The original fear of almost falling down is associated with being in a high place, leading to a fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost falling down) leads to the CR (fear). This direct conditioning model, though very influential in the theory of fear acquisition, is not the only way to acquire a phobia.

Vicarious fear acquisition is learning to fear something, not by a subject's own experience of fear, but by watching others reacting fearfully (observational learning). For instance, when a child sees a parent reacting fearfully to an animal, the child can become afraid of the animal as well. Through observational learning, humans can to learn to fear potentially dangerous objects—a reaction also observed in other primates. In a study focusing on non-human primates, results showed that the primates learned to fear snakes at a fast rate after observing parents’ fearful reactions. An increase of fearful behaviours was observed as the non-human primates continued to observe their parents’ fearful reaction. Even though observational learning has been proven effective in creating reactions of fear and phobias, it has also been shown that by physically experiencing an event, chances increase of fearful and phobic behaviours. In some cases, physically experiencing an event may increase the fear and phobia more so than observing a fearful reaction of another human or non-human primate. 

Informational/instructional fear acquisition is learning to fear something by getting information. For instance, fearing electrical wire after having heard that touching it causes an electric shock.

A conditioned fear response to an object or situation is not always a phobia. To meet the criteria for a phobia there must also be symptoms of impairment and avoidance. Impairment is defined as being unable to complete routine tasks whether occupational, academic or social. In acrophobia, an impairment of occupation could result from not taking a job solely because of its location at the top floor of a building, or socially not participating in a social event at a theme park. The avoidance aspect is defined as behaviour that results in the omission of an aversive event that would otherwise occur, with the goal of preventing anxiety.

Mechanism

Regions of the brain associated with phobias

 

Beneath the lateral fissure in the cerebral cortex, the insula, or insular cortex, of the brain has been identified as part of the limbic system, along with cingulated gyrus, hippocampus, corpus callosum and other nearby cortices. This system has been found to play a role in emotion processing and the insula, in particular, may contribute through its role in maintaining autonomic functions. Studies by Critchley et al. indicate the insula as being involved in the experience of emotion by detecting and interpreting threatening stimuli. Similar studies involved in monitoring the activity of the insula show a correlation between increased insular activation and anxiety.

In the frontal lobes, other cortices involved with phobia and fear are the anterior cingulate cortex and the medial prefrontal cortex. In the processing of emotional stimuli, studies on phobic reactions to facial expressions have indicated that these areas are involved in processing and responding to negative stimuli. The ventromedial prefrontal cortex has been said to influence the amygdala by monitoring its reaction to emotional stimuli or even fearful memories. Most specifically, the medial prefrontal cortex is active during extinction of fear and is responsible for long-term extinction. Stimulation of this area decreases conditioned fear responses, so its role may be in inhibiting the amygdala and its reaction to fearful stimuli.

The hippocampus is a horseshoe-shaped structure that plays an important part in the brain's limbic system because of its role in forming memories and connecting them with emotions and the senses. When dealing with fear, the hippocampus receives impulses from the amygdala that allow it to connect the fear with a certain sense, such as a smell or sound.

Amygdala

The amygdala is an almond-shaped mass of nuclei that is located deep in the brain's medial temporal lobe. It processes the events associated with fear and is linked to social phobia and other anxiety disorders. The amygdala's ability to respond to fearful stimuli occurs through the process of fear conditioning. Similar to classical conditioning, the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response that is often seen in phobic individuals. In this way, the amygdala is responsible for not only recognizing certain stimuli or cues as dangerous but plays a role in the storage of threatening stimuli to memory. The basolateral nuclei (or basolateral amygdala) and the hippocampus interact with the amygdala in the storage of memory, which suggests why memories are often remembered more vividly if they have emotional significance.

In addition to memory, the amygdala also triggers the secretion of hormones that affect fear and aggression. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, which prepares the individual to move, run, fight, etc. This defensive "alert" state and response are known as the fight-or-flight response.

Inside the brain, however, this stress response can be observed in the hypothalamic-pituitary-adrenal axis (HPA). This circuit incorporates the process of receiving stimuli, interpreting it and releasing certain hormones into the bloodstream. The parvocellular neurosecretory neurons of the hypothalamus release corticotropin-releasing hormone (CRH), which is sent to the anterior pituitary. Here the pituitary releases adrenocorticotropic hormone (ACTH), which ultimately stimulates the release of cortisol. In relation to anxiety, the amygdala is responsible for activating this circuit, while the hippocampus is responsible for suppressing it. Glucocorticoid receptors in the hippocampus monitor the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing CRH.

Studies on mice engineered to have high concentrations of CRH showed higher levels of anxiety, while those engineered to have no or low amounts of CRH receptors were less anxious. In people with phobias, therefore, high amounts of cortisol may be present, or alternatively, there may be low levels of glucocorticoid receptors or even serotonin (5-HT).

Disruption by damage

For the areas in the brain involved in emotion—most specifically fear— the processing and response to emotional stimuli can be significantly altered when one of these regions becomes lesioned or damaged. Damage to the cortical areas involved in the limbic system such as the cingulate cortex or frontal lobes have resulted in extreme changes in emotion. Other types of damage include Klüver–Bucy syndrome and Urbach–Wiethe disease. In Klüver–Bucy syndrome, a temporal lobectomy, or removal of the temporal lobes, results in changes involving fear and aggression. Specifically, the removal of these lobes results in decreased fear, confirming its role in fear recognition and response. Bilateral damage to the medial temporal lobes, which is known as Urbach–Wiethe disease, exhibits similar symptoms of decreased fear and aggression, but also an inability to recognize emotional expressions, especially angry or fearful faces.

The amygdala's role in learned fear includes interactions with other brain regions in the neural circuit of fear. While lesions in the amygdala can inhibit its ability to recognize fearful stimuli, other areas such as the ventromedial prefrontal cortex and the basolateral nuclei of the amygdala can affect the region's ability to not only become conditioned to fearful stimuli but to eventually extinguish them. The basolateral nuclei, through receiving stimulus info, undergo synaptic changes that allow the amygdala to develop a conditioned response to fearful stimuli. Lesions in this area, therefore, have been shown to disrupt the acquisition of learned responses to fear. Likewise, lesions in the ventromedial prefrontal cortex (the area responsible for monitoring the amygdala) have been shown to not only slow down the speed of extinguishing a learned fear response but also how effective or strong the extinction is. This suggests there is a pathway or circuit among the amygdala and nearby cortical areas that process emotional stimuli and influence emotional expression, all of which can be disrupted when an area becomes damaged.

Diagnosis

It is recommended that the terms distress and impairment take into account the context of the person's environment during diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a social situation, is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and impairment within the individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. It is recommended that proximity to, and ability to escape from, the stimulus also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the doors open).

Treatments

There are various methods used to treat phobias. These methods include systematic desensitization, progressive relaxation, virtual reality, modeling, medication and hypnotherapy.

Therapy

Cognitive behavioral therapy (CBT) can be beneficial by allowing the person to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings, with the aim that the person will realize that his or her fear is irrational. CBT may be conducted in a group setting. Gradual desensitization treatment and CBT are often successful, provided the person is willing to endure some discomfort. In one clinical trial, 90% of people were observed to no longer have a phobic reaction after successful CBT treatment.

CBT is also an effective treatment for phobias in children and adolescents and has been adapted for use with this age. One example of a CBT program targeted towards children is the Coping Cat. This treatment program can be used with children between the ages of 7 and 13 to treat social phobia. This program works to decrease negative thinking, increase problem-solving and provide a functional coping outlook in the child. Another CBT program was developed by Ann Marie Albano to treat social phobia in adolescents. This program has five stages: Psychoeducation, Skill Building, Problem Solving, Exposure and Generalization and Maintenance. Psychoeducation focuses on identifying and understanding the symptoms. Skill Building focuses on learning cognitive restructuring, social skills and problem-solving skills. Problem Solving focuses on identifying problems and using a proactive approach to solving them. Exposure involves exposing the adolescent to social situations in a hierarchical approach. Finally, Generalization and Maintenance involves practising the skills learned.

Peer-reviewed clinical trials have demonstrated that eye movement desensitization and reprocessing (EMDR) is effective in treating some phobias. Mainly used to treat post-traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.

Another method used to treat people with extreme phobias is prolonged exposure, in which the person is exposed to the object of their fear over a long period of time. This technique is only tested when a person has overcome avoidance of, or escape from, the feared object or situation. People with slight distress from their phobias usually do not need prolonged exposure to their fear.

Systematic desensitization

A soldier stomping his foot to put out the fire rising up his leg during military fire-phobia training

A method used in the treatment of a phobia is systematic desensitization, a process in which the people seeking help slowly become accustomed to their phobia, and ultimately overcome it. Traditional systematic desensitization involves a person being exposed to the object they are afraid of overtime, so that the fear and discomfort do not become overwhelming. This controlled exposure to the anxiety-provoking stimulus is key to the effectiveness of exposure therapy in the treatment of specific phobias. It has been shown that humor is an excellent alternative when traditional systematic desensitization is ineffective. Humor systematic desensitization involves a series of treatment activities that consist of activities that elicit humor with the feared object. Previously learned progressive muscle relaxation procedures can be used as the activities become more difficult in a person's own hierarchy level. Progressive muscle relaxation helps people relax their muscles before and during exposure to the feared object or phenomenon. 

Participant modeling, in which the therapist models how the person should respond to fears, has been proven effective for children and adolescents. This encourages people to practice the behaviour and reinforces their efforts. In a manner similar to systematic desensitization, people with phobias are gradually introduced to their feared objects. The main difference between participant modelling and systematic desensitization involves observations and modelling; participant modelling encompasses a therapist modelling and observing positive behaviours over the course of gradual exposure to the feared object.

Virtual reality therapy is another technique that helps phobic people confront a feared object. It uses virtual reality to generate scenes that may not have been possible or ethical in the physical world. It offers some advantages over systematic desensitization therapy. People can control the scenes and endure more exposure than they might handle in reality. Virtual reality is more realistic than simply imagining a scene—the therapy occurs in a private room and the treatment is efficient.

Medications

Medications can help regulate apprehension and fear of a particular fearful object or situation. Antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act on serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, people may be prescribed an antidepressant. Sedatives such as benzodiazepines may also be prescribed, which can help people relax by reducing the amount of anxiety they feel. Benzodiazepines may be useful in acute treatment of severe symptoms, but the risk-benefit ratio is against their long-term use in phobic disorders. This class of medication has recently been shown as effective if used with negative behaviours such as alcohol abuse. Despite this positive finding, benzodiazepines are used with caution. Beta blockers are another medicinal option as they may stop the stimulating effects of adrenaline, such as sweating, increased heart rate, elevated blood pressure, tremors and the feeling of a pounding heart. By taking beta-blockers before a phobic event, these symptoms are decreased, making the event less frightening.

Hypnotherapy

Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias. Through hypnotherapy, the underlying cause of the phobia may be uncovered. The phobia may be caused by a past event that the person does not remember, a phenomenon known as repression. The mind represses traumatic memories from the conscious mind until the person is ready to deal with them. Hypnotherapy may also eliminate the conditioned responses that occur during different situations. People are first placed into a hypnotic trance, an extremely relaxed state in which the unconscious can be retrieved. This state makes people more open to suggestion, which helps bring about desired change. Consciously addressing old memories helps individuals understand the event and see it in a less threatening light. 

Epidemiology

Phobias are a common form of anxiety disorder, and distributions are heterogeneous by age and gender. An American study by the National Institute of Mental Health (NIMH) found that between 8.7 percent and 18.1 percent of Americans suffer from phobias, making it the most common mental illness among women in all age groups and the second most common illness among men older than 25. Between 4 percent and 10 percent of all children experience specific phobias during their lives, and social phobias occur in one percent to three percent of children and adolescents.

A Swedish study found that females have a higher number of cases per year than males (26.5 percent for females and 12.4 percent for males). Among adults, 21.2 percent of women and 10.9 percent of men have a single specific phobia, while multiple phobias occur in 5.4 percent of females and 1.5 percent of males. Women are nearly four times as likely as men to have a fear of animals (12.1 percent in women and 3.3 percent in men) — a higher dimorphic than with all specific or generalized phobias or social phobias. Social phobias are more common in girls than in boys, while situational phobia occurs in 17.4 percent of women and 8.5 percent of men.

Society and culture

Terminology

The word phobia comes from the Greek: φόβος (phóbos), meaning "aversion", "fear" or "morbid fear". The regular system for naming specific phobias to use prefix based on a Greek word for the object of the fear, plus the suffix -phobia. However, there are many phobias irregularly named with Latin prefixes, such as apiphobia instead of melissaphobia (fear of bees) or aviphobia instead of ornithophobia (fear of birds). Creating these terms is something of a word game. Such fears are psychological rather than physiological in origin and few of these terms are found in medical literature. In ancient Greek mythology Phobos was the twin brother of Deimos (terror). 

The word phobia may also refer to conditions other than true phobias. For example, the term hydrophobia is an old name for rabies, since an aversion to water is one of that disease's symptoms. A specific phobia to water is called aquaphobia instead. A hydrophobe is a chemical compound that repels water. Similarly, the term photophobia usually refers to a physical complaint (aversion to light due to inflamed eyes or excessively dilated pupils), rather than an irrational fear of light.

Non-medical use

A number of terms with the suffix -phobia are used non-clinically to imply irrational fear or hatred. Examples include:

• Chemophobia – Negative attitudes and mistrust towards chemistry and synthetic chemicals.
• Xenophobia – Fear or dislike of strangers or the unknown, sometimes used to describe nationalistic political beliefs and movements.
• Homophobia – Negative attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay, bisexual or transgender (LGBT).

Usually these kinds of "phobias" are described as fear, dislike, disapproval, prejudice, hatred, discrimination or hostility towards the object of the "phobia".

Cognitive therapy

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Cognitive_therapy

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working collaboratively with the therapist to develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A tailored cognitive case conceptualization is developed by the cognitive therapist as a roadmap to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

 

 

History

Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his patients perceived, interpreted and attributed meaning in their daily lives—a process scientifically known as cognition—was a key to therapy. Albert Ellis had been working on similar ideas since the 1950s (Ellis, 1956). He called his approach Rational Therapy (RT) at first, then Rational Emotive Therapy (RET) and later Rational Emotive Behavior Therapy (REBT).

Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders and problems. He also introduced a focus on the underlying "schema"—the fundamental underlying ways in which people process information—about the self, the world or the future.

The new cognitive approach came into conflict with the behaviorism ascendant at the time, which denied that talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioral responses. However, the 1970s saw a general "cognitive revolution" in psychology. Behavioral modification techniques and cognitive therapy techniques became joined together, giving rise to cognitive behavioral therapy. Although cognitive therapy has always included some behavioral components, advocates of Beck's particular approach seek to maintain and establish its integrity as a distinct, clearly standardized form of cognitive behavioral therapy in which the cognitive shift is the key mechanism of change.

Precursors of certain fundamental aspects of cognitive therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Beck's original treatment manual for depression states, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers".

As cognitive therapy continued to grow in popularity, the Academy of Cognitive Therapy, a non-profit organization, was created to accredit cognitive therapists, create a forum for members to share emerging research and interventions, and to educate consumer regarding cognitive therapy and related mental health issues.

Basis

Therapy may consist of testing the assumptions which one makes and looking for new information that could help shift the assumptions in a way that leads to different emotional or behavioral reactions. Change may begin by targeting thoughts (to change emotion and behavior), behavior (to change feelings and thoughts), or the individual's goals (by identifying thoughts, feelings or behavior that conflict with the goals). Beck initially focused on depression and developed a list of "errors" (cognitive distortion) in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives).

As an example of how CT might work: Having made a mistake at work, a man may believe, "I'm useless and can't do anything right at work." He may then focus on the mistake (which he takes as evidence that his belief is true), and his thoughts about being "useless" are likely to lead to negative emotion (frustration, sadness, hopelessness). Given these thoughts and feelings, he may then begin to avoid challenges at work, which is behavior that could provide even more evidence for him that his belief is true. As a result, any adaptive response and further constructive consequences become unlikely, and he may focus even more on any mistakes he may make, which serve to reinforce the original belief of being "useless." In therapy, this example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and patient would be directed at working together to explore and shift this cycle.

People who are working with a cognitive therapist often practice the use of more flexible ways to think and respond, learning to ask themselves whether their thoughts are completely true, and whether those thoughts are helping them to meet their goals. Thoughts that do not meet this description may then be shifted to something more accurate or helpful, leading to more positive emotion, more desirable behavior, and movement toward the person's goals. Cognitive therapy takes a skill-building approach, where the therapist helps the person to learn and practice these skills independently, eventually "becoming his or her own therapist."

Cognitive model

The cognitive model was originally constructed following research studies conducted by Aaron Beck to explain the psychological processes in depression. It divides the mind beliefs in three levels:

• Automatic thought
• Intermediate belief
• Core belief or basic belief

In 2014, an update of the cognitive model was proposed, called the Generic Cognitive Model (GCM). The GCM is an update of Beck's model that proposes that mental disorders can be differentiated by the nature of their dysfunctional beliefs. The GCM includes a conceptual framework and a clinical approach for understanding common cognitive processes of mental disorders while specifying the unique features of the specific disorders. 

Consistent with the cognitive theory of psychopathology, CT is designed to be structured, directive, active, and time-limited, with the express purpose of identifying, reality-testing, and correcting distorted cognition and underlying dysfunctional beliefs.

Cognitive restructuring (methods)

Cognitive restructuring involves four steps:

1. Identification of problematic cognitions known as "automatic thoughts" (ATs) which are dysfunctional or negative views of the self, world, or future based upon already existing beliefs about oneself, the world, or the future
2. Identification of the cognitive distortions in the ATs
3. Rational disputation of ATs with the Socratic method
4. Development of a rational rebuttal to the ATs

There are six types of automatic thoughts:

1. Self-evaluated thoughts
2. Thoughts about the evaluations of others
3. Evaluative thoughts about the other person with whom they are interacting
4. Thoughts about coping strategies and behavioral plans
5. Thoughts of avoidance
6. Any other thoughts that were not categorized

Other major techniques include:

• Activity monitoring and activity scheduling
• Behavioral experiments
• Catching, checking, and changing thoughts
• Collaborative empiricism: therapist and patient become investigators by examining the evidence to support or reject the patient's cognitions. Empirical evidence is used to determine whether particular cognitions serve any useful purpose.
• Downward arrow technique
• Exposure and response prevention
• Cost benefit analysis
• acting 'as if’
• Guided discovery: therapist elucidates behavioral problems and faulty thinking by designing new experiences that lead to acquisition of new skills and perspectives. Through both cognitive and behavioral methods, the patient discovers more adaptive ways of thinking and coping with environmental stressors by correcting cognitive processing.
• Mastery and pleasure technique
• Problem solving
• Socratic questioning: involves the creation of a series of questions to a) clarify and define problems, b) assist in the identification of thoughts, images and assumptions, c) examine the meanings of events for the patient, and d) assess the consequences of maintaining maladaptive thoughts and behaviors.

Socratic questions are the archetypal cognitive restructuring techniques. These kinds of questions are designed to challenge assumptions by:

• Conceiving reasonable alternatives:

‘What might be another explanation or viewpoint of the situation? Why else did it happen?’

• Evaluating those consequences:

‘What’s the effect of thinking or believing this? What could be the effect of thinking differently and no longer holding onto this belief?’

• Distancing:

‘Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what would I tell them?’ 

Examples of socratic questions are:

• ‘Describe the way you formed your viewpoint originally.‘
• ‘What initially convinced you that your current view is the best one available?‘
• ‘Think of three pieces of evidence that contradict this view, or that support the opposite view. Think about the opposite of this viewpoint and reflect on it for a moment. What's the strongest argument in favor of this opposite view?‘
• ‘Write down any specific benefits you get from holding this belief, such as social or psychological benefits. For example, getting to be part of a community of like-minded people, feeling good about yourself or the world, feeling that your viewpoint is superior to others', etc Are there any reasons that you might hold this view other than because it's true?‘
• ‘For instance, does holding this viewpoint provide some peace of mind that holding a different viewpoint would not?‘
• ‘In order to refine your viewpoint so that it's as accurate as possible, it's important to challenge it directly on occasion and consider whether there are reasons that it might not be true. What do you think the best or strongest argument against this perspective is?‘
• What would you have to experience or find out in order for you to change your ‘mind about this viewpoint?‘
• Given your thoughts so far, do you think that there may be a truer, more accurate, or more nuanced version of your original view that you could state right ‘now?‘

False assumptions are based on ‘cognitive distortions’, such as:

• Always Being Right: “We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.”
• Heaven’s Reward Fallacy: “We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.”

Types

Cognitive therapy

based on the cognitive model, stating that thoughts, feelings and behavior are mutually influenced by each other. Shifting cognition is seen as the main mechanism by which lasting emotional and behavioral changes take place. Treatment is very collaborative, tailored, skill-focused, and based on a case conceptualization.

Rational emotive behavior therapy (REBT)

based on the belief that most problems originate in irrational thought. For instance, perfectionists and pessimists usually suffer from issues related to irrational thinking; for example, if a perfectionist encounters a small failure, he or she might perceive it as a much bigger failure. It is better to establish a reasonable standard emotionally, so the individual can live a balanced life. This form of cognitive therapy is an opportunity for the patient to learn of his current distortions and successfully eliminate them.

Cognitive behavioral therapy (CBT)

a system of approaches drawing from both the cognitive and behavioral systems of psychotherapy.

Unlike Psychodynamic approaches, CBT is transparent to the individual receiving services. At the end of the therapy, an individual will often have learned the cognitive therapy skills well enough to "be their own therapist," decreasing dependence on a therapist to provide the answers. 

Application

Depression

According to Beck's theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence; children and adolescents who experience depression acquire this negative schema earlier. Depressed people acquire such schemas through a loss of a parent, rejection by peers, bullying, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounters a situation that resembles the original conditions of the learned schema in some way, the negative schemas of the person are activated.

Beck's negative triad holds that depressed people have negative thoughts about themselves, their experiences in the world, and the future. For instance, a depressed person might think, "I didn't get the job because I'm terrible at interviews. Interviewers never like me, and no one will ever want to hire me." In the same situation, a person who is not depressed might think, "The interviewer wasn't paying much attention to me. Maybe she already had someone else in mind for the job. Next time I'll have better luck, and I'll get a job soon." Beck also identified a number of other cognitive distortions, which can contribute to depression, including the following: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization.

In 2008 Beck proposed an integrative developmental model of depression that aims to incorporate research in genetics and neuroscience of depression. This model was updated in 2016 to incorporate multiple levels of analyses, new research, and key concepts (e.g., resilience) within the framework of an evolutionary perspective.

Other applications

Cognitive therapy has been applied to a very wide range of behavioral health issues including:

• Academic achievement
• Addiction
• Anxiety disorders
• Bipolar disorder
• Low self-esteem
• Phobia
• Schizophrenia
• Substance abuse
• Suicidal ideation
• Weight loss

Criticisms

A criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.