According to the cognitive model of psychopathology, maladaptive beliefs about oneself, others, and the world are the main factors contributing to the development and persistence of various forms of mental suffering. Therefore, the key therapeutic process of Cognitive Behavioral Therapy (CBT)—a therapeutic approach rooted in the cognitive model—is cognitive restructuring, i.e., a process of revision of such maladaptive beliefs. In this paper, I examine the philosophical assumptions underlying CBT and offer theoretical reasons to think that the effectiveness of belief revision (...) in psychotherapy is very limited. This is the case, I argue, because the cognitive model wrongly assumes that our body of beliefs is unified, while it is in fact fragmented. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

Cognitive theory (CT) is currently the most widely acknowledged framework used to describe the psychological processes in affective disorders like depression. The purpose of this paper is to assess the philosophical assumptions upon which CT rests. It is argued that CT must be revised due to significant flaws in many of these philosophical assumptions. The paper contains suggestions as to how these problems could be overcome in a manner that would secure philosophical accuracy, while also providing an account that is (...) better suited to explaining some of the cognitive, emotional, and bodily manifestations of affective disorders. (shrink)

In this essay the author argues that, in a restricted sense, we can decide to believe certain propositions. It is conceded that acquiring a belief is not a basic action and possibly not even an action at all. However, this does not entail the impossibility of decisions to believe since not everything we can decide to do is a basic action. In fact, we can often decide to be in a certain state of affairs. Although beliefs normally aim at truth, (...) there are cases in which we can voluntarily seek or avoid irrational states of affairs and thereby influence our attitudes. Bearing this in mind, situations in which we can talk of decisions to belief can be construed easily. (shrink)

The author outlines a number of reasons why morally inappropriate attitudes may give rise to concerns about fitness to practise. He argues that inappropriate attitudes may raise such concerns because they can lead to harmful behaviours , and because they are often themselves harmful . He also outlines some of the challenges that the cultivation and assessment of attitudes in students raise for medical educators and some of the ways in which those challenges may be approached and possibly overcome.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 13.3 (2007) 251-253MuseSearchJournalsThis JournalContents[Access article in PDF]Taming the Beast WithinDavid PugmireKeywords cognition, emotion, therapy, depressionI agree with Whiting and others that there can be more to emotions than the cognitive attitudes that inform them, including valuational attitudes. Emotion can also be awakened without these. For that matter, feeling can actually fly in the face of thought. I suggest that despite this, however, even recalcitrant emotions (...) might be more responsive to cognitive intervention than Whiting allows. This could be important, particularly where more sure-fire noncognitive therapies are lacking. The therapeutic interest of a person's cognition is not wholly dispelled, even in the hard cases Whiting brings to our attention.Whiting's challenge to cognition-based therapy for emotional (and related) problems is not to the principle on which such therapy is based, but to the scope of that principle. He concedes that many emotional responses crucially depend on how their host represents the things affecting him. However, Whiting thinks these form but one type of case. In other cases, this picture is misleading and cognition-based therapy more apt to be futile. There are, he thinks, cases in which what is dysfunctional about an emotional response or attitude partly consists in the very fact that it is resistant to the appropriate cognitions. Thus, the way a person feels can be strikingly at odds with what the person actually thinks and resistant to the influence of reforms in that. This is one of the reasons for thinking that emotion is not always the creature of cognition, either causally or conceptually.1The general fact that emotional responses can arise from noncognitive sources and remain in the thrall of these is of interest partly because the emotional aspects of at least some mental disorders might involve this. Where this was so, the question would arise as to what these sources variously were and what therapies, if any, they might respond to. Whiting's paper concentrates on the theoretical stage setting that would generate these challenges. That it generates them is part of the interest of his paper.Whiting's examples of noncognitively sourced emotional feelings are various in kind: alcohol-induced sadness, coffee-induced edginess, stress anxiety, and endogenous and opaque responses such as pedophilic excitation. Presumably there are other, less obviously or mundanely chemically sourced responses. And to these might be added the experience of other people's emotion. There is a direct affective vulnerability to the manifestations of emotion in others: The intimidating glare, infectious sadness or joy, and so on. (That is, we respond with feeling to the very expression of emotion, emotion as it is shown to us, sometimes as directed at us, and this is not the same as thoughts we have about others' emotions, to which we may also, of course, be susceptible emotionally.) But what is of clinical interest is not response episodes that reflect happenstance (too much coffee, catching sight of a snake underfoot), but more [End Page 251] chronic emotional dispositions. And there are numerous prima facie candidates for these to add to Whiting's examples of pedophilic arousal and depression (e.g., phobias, mood swings, anxiety, flatness, proneness to runaway anger). Some, of course, would query how far our noncognitive (or precognitive) vulnerabilities really extend. Appearances can deceive, and the relation of emotional response to cognition can be subtle. Where emotion seems at odds with thought and resistant to changes in it, this can still owe to the presence of controlling thoughts that are concealed, even from the affected person. Pivotal thoughts may elude a particular confused person, or they may be tacit, as yet unrecognized. It is possible to be self-deceived, mistaken about what one believes, where, for instance, one is subject to wishful thinking about what one really believes ("The fool hath said in his heart that there is no God"). And this raises the whole question of what "cognition," "thought," or "represents" actually can mean. These are umbrella terms for a variety of possible attitudes. Except for behaviorists, what one is... (shrink)