Figure 3.1

The cognitive–behavioral model of emotional distress. From Evidence-Based Practice of Cognitive–Behavioral Therapy (p. 44), by D. J. G. Dobson and K. S. Dobson, 2009, New York, NY: Guilford Press. Copyright 2009 by Guilford Press. Reprinted with permission.

According to the cognitive model, individuals possess cognitive structures, which are a composite of both formal (semantic) and personal (autobiographical or episodic) knowledge and experience. Various terms have been used to refer to these structures, but the most common are beliefs and schemas. Within the cognitive model, schemas are seen as both reactive, in that they respond to and incorporate new information, and proactive, in that they influence which types of situations a person might be willing to enter, the information that is attended to in different situations or contexts, and even the range of experiences an individual is able to have.

Because the schema construct is broad, there have been efforts to identify the possible content of schemas in various disorders. For example, in an early article about depression, A. T. Beck, Rush, Shaw, and Emery (1979) discussed the cognitive triad, which consists of beliefs about the self, the world, and the future. They went on to specify typical or characteristic beliefs that a depressed person has in each of these three domains. Specifically, they suggested that depressed persons view themselves as “losers,” that they are “helpless” in the world, and that the future is “hopeless.” Over time, this model has been presented in various ways. Figure 3.2 depicts one version of an elaborated cognitive model of depression (Blackburn, James, & Flitcroft, 2006). As can be seen there, core beliefs and schemas interact dynamically with critical incidents or triggers to activate assumptions or behavior rules, as well as automatic thoughts, which then lead to the symptoms of depression.

Figure 3.2

Cognitive model of depression. From Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases (p. 121), by N. Tarrier, 2006, New York, NY: Routledge. Copyright 2006 by Routledge. Reprinted with permission.

Key schemas have been similarly identified in other disorders, such as the idea that the world is “dangerous” in anxiety disorders (A. T. Beck & Emery, 1985) or that other people are “hostile” for people with anger problems (A. T. Beck, 1999). Figure 3.3 presents a general cognitive model for panic disorder (D. M. Clark, 1986; Wells, 2006), Figure 3.4 represents a model for insomnia (Harvey, 2006), and Figure 3.5 is a model for anorexia nervosa (Lavender & Schmidt, 2006). Models either have been or are being developed for a wide range of other disorders and clinical problems (Tarrier, 2006).

Figure 3.3

Cognitive model of panic. From “A Cognitive Model of Panic” by D. M. Clark, 1986, Behavior Research and Therapy, 24, p. 465 and Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases (p. 58), by N. Tarrier, 2006, New York, NY: Routledge. Copyright 2006 by Routledge. Adapted with permission.