Behavioral-Cognitive Inhibition Theory: Conceptualization of Posttraumatic Stress Disorder and Other Psychopathology Disorders
Nenad Paunovic
.
DOI: 10.4236/psych.2010.15044   PDF    HTML     10,469 Downloads   29,099 Views   Citations

Abstract

A comprehensive and behaviorally formulated theory for psychopathology disorders termed as behavioral-cog- nitive inhibition theory is presented. It constitutes an integration and re-formulation of several influential psy- chological theories of psychopathology and empirical findings in imagery research. According to the behavioral-cognitive inhibition theory the development of PTSD and other psychopathology disorders are due to the development of dysfunctional respondent-functional-appraisal memories. The maintenance of psychopathology disorders is due to a continuous retrieval of dysfunctional respondent-functional-appraisal memories, to inhibit- tion of incompatible respondent-functional-appraisal memories, and to current dysfunctional appraisals and behaviors. Dysfunctional and incompatible respondent-functional-appraisal memories consist of respondent, discriminative, behavioral response, appraisal and consequence memory elements. It is proposed that the recovery from PTSD and other psychopathology disorders is accomplished when (a) strong enough matching incompatible respondent-functional-appraisal memories are retrieved in the same circumstances as dysfunctional respondent-functional-appraisal memories, (b) dysfunctional respondent-functional-appraisal memories become inhibited by incompatible respondent-functional-appraisal memories, and (c) new incompatible or functional contingencies are encoded, stored and become effective incompatible respondent-functional-appraisal memories. Concrete examples of respondent-functional-appraisal memory elements in emotional and personality disorders are presented. In addition, incompatible respondent-functional-appraisal memory elements are presented. Fur- thermore, central hypotheses of the behavioral-cognitive inhibition theory are formulated and important issues are discussed.

Share and Cite:

Paunovic, N. (2010). Behavioral-Cognitive Inhibition Theory: Conceptualization of Posttraumatic Stress Disorder and Other Psychopathology Disorders. Psychology, 1, 349-366. doi: 10.4236/psych.2010.15044.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Amdur, R. L., Larsen, R., & Liberzon, I. (2000). Emotional processing in combat-related posttraumatic stress disorder: A comparison with traumatized and normal controls. Journal of Anxiety Disorders, 14, 219-238.
[2] American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Author.
[3] Arntz, A., Tiesema, M., & Kindt, M. (2007). Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. Journal of Behavior Therapy and Experimental Psychiatry, 38, 345-370.
[4] Arntz, A. & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37, 715-740.
[5] Baldwin, J. D. & Baldwin, J. I. (2001). Behavior principles in everyday life, 4th edition. New Jersey: Prentice Hall.
[6] Barlow, D. H. (2002). Anxiety and its disorders. New York: Guilford Press.
[7] Barrett, P. M., Rapee, R. M., Dadds, M. M., & Ryan, S. M. (1996). Family enhancement of cognitive style in anxious and aggressive children. Journal of Abnormal Child Psychology, 24, 187-203.
[8] Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
[9] Beck, A. T., Rush, A. J., Shaw B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
[10] Benight, C. & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129-1148.
[11] Brewin, C. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765-784.
[12] Brewin, C. R., Dalgleish, T, & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychology Review, 103, 670-686.
[13] Brewin, C. R., Watson, M., McCarthy, S., Hyman, P., & Dayson, D. (1998). Intrusive memories and depression in cancer patients. Behaviour Research and Therapy, 36, 1131-1142.
[14] Chorpita, B. F. & Barlow, D. H. (1998). The development of anxiety: The role of control in the early environment. Psychological Bulletin, 124, 3-21.
[15] Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, 5-27.
[16] Cloitre, M., Cohen, L. R. & Koenen, K. C. (2006). Treating survivors of childhood abuse: Psychotherapy for the interrupted life. New York: Guilford Press.
[17] Cloitre, M., Cohen, L.R., & Scarvalone, P. (2002). Understanding revictimization among childhood sexual abuse survivors: An interpersonal schema approach. Journal of Cognitive Psychotherapy: An International Quarterly, 16, 91-111.
[18] Cloitre, M. & Rosenberg, A. (2006). Sexual revictimization. In V.M. Follette and J.I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (pp. 321-361). New York: Guilford Press.
[19] Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.
[20] Dalgleish, T. (2004). Cognitive theories of posttraumatic stress disorder: The evolution of mul-ti-representational theorizing. Psychological Bulletin, 130, 228-260.
[21] Davey, G. C. L. An expectancy model of laboratory preparedness effects. Journal of Experimental Psychology: General, 121, 24-40.
[22] Day, S., Holmes, E. A., & Hackman, A. (2004). Occurrence of imagery and its link with early memories in agoraphobia. Memory, 12, 416-427.
[23] Ehlers, A. (1993). Somatic symptoms and panic attacks: A retrospective study of learning experiences. Behaviour Research and Therapy, 31, 269-278.
[24] Ehlers, A. & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.
[25] Ehlers, A., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress, 11, 457-471.
[26] Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re-experiencing in posttraumatic stress disorder: Phenomenology, theory and therapy. Memory, 12, 403-415.
[27] Ehlers, A., Hackmann, A., Steil, R., Clohessy, S., Wenninger, K., & Winter, H. (2002). The nature of intrusive memories after trauma: The warning signal hypothesis. Behaviour Research and Therapy, 40, 995-1002.
[28] Ehlers, A., Mayou, R. A., & Bryant, B. (1998). Psychological predictors of chronic PTSD after motor vehicle accidents. Journal of Abnormal Psychology, 107, 508-519.
[29] Engelhard, I. M., van den Hout, M. A., Arntz, A., & McNally, R. J. (2002). A longitudinal study of “intrusion-based reasoning” and posttraumatic stress disorder after exposure to a train disaster. Behaviour Research and Therapy, 40, 1415-1424.
[30] Foa, E. B. & Kozak, M. J. (1986). Emotional processing of fear: expo-sure to corrective information. Psychological Bulletin, 99, 20-35.
[31] Foa, E. B., Riggs, D. S., & Gershuny, B. S. (1995). Arousal, numbing, and intrusion: Symptom structure of PTSD following assault. American Journal of Psychiatry, 152, 116-120.
[32] Foa, E. B. & Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive behavioral therapy for PTSD. New York: Guilford Press.
[33] Foa, E. B., Steketee, G, & Rothbaum, B. O. (1989). Behavioral-cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155-176.
[34] Follette, W. C. & Naugle, A. E. (2006). Functional analytic clinical assessment in trauma treatment. In V.M. Follette and J.I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (pp. 17-33). New York: Guilford Press.
[35] Gilbert, P. & Irons, C. (2005). Compassionate mind training, for shame and self-attacking, using cognitive, behavioral, emotional and imagery interventions. In P. Gilbert (Ed.), Compassion: Conceptualizations, research, and use in psychotherapy (pp. 263-325). London: Brunner-Routledge.
[36] Grunert, B. K., Smucker, M. R., Weis, J. M., & Rusch, M. D. (2003). When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD. Cognitive and Behavioral Practice, 10, 333-346.
[37] Grunert, B. K., Weis, J. M., Smucker, M. R., & Christianson, H. F. (2007). Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury. Journal of Behavior Therapy and Experimental Psychiatry, 38, 317-328.
[38] Hackmann, A., Clark, D. M., & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38, 601-610.
[39] Hackmann, A. & Holmes, E. A. (2004). Reflecting on imagery: A clinical perspective and overview of the special issue of memory on mental imagery and memory in psychopathology. Memory, 12, 389-402.
[40] Hackmann, A., Surawy, C., & Clark, D. M. (1998). Seeing yourself through others eyes: A study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 3-12.
[41] Holmes, E. A., Arntz, A., & Smucker, M. R. (2007). Imagery rescripting in cognitive behavior therapy: Images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 297-305.
[42] Holmes, E. A., Grey, N., & Young, K.A.D. (2005). Intrusive images and “hotspots” of trauma memories in posttraumatic stress disorder: An exploratory investigation of emotions and cognitive themes. Journal of Behavior Therapy and Experimental Psychiatry, 36, 3-17.
[43] Hoover, C. F. & Insel, T. R. (1984). Families of origin in obsessive-compulsive disorder. Journal of Nervous and Mental Disease, 172, 207-215.
[44] Hunt, M., Bylsma, L., Brock, J., Fenton, M., Goldberg, A., Miller, R., Tran, T., & Urgelles, J. (2006). The role of imagery in the maintenance and treatment of snake fear. Journal of Behavior Therapy and Experimental Psychiatry, 37, 283-298.
[45] Keane, T. M., Zimering, R. T., & Caddell, J. M. (1985). A behavioral formulation of posttraumatic stress disorder. Behavior Therapist, 8, 9-12.
[46] Kohlenberg, B. S., Tsai, M., & Kohlenberg, R. J. (2006). Functional analytic psychotherapy and the treatment of complex posttraumatic stress disorder. In V.M. Follette and J.I. Ruzek (Eds.), Cogni-tive-behavioral therapies for trauma (pp. 173-197). New York: Guilford Press.
[47] Kubany, E. S. & Manke, F. P. (1995). Cognitive therapy for trauma-related guilt: Conceptual bases and treatment outlines. Cognitive and Behavioral Practice, 2, 27-61.
[48] Kubany, E. S. & Ralston, T. C. (2006). Cognitive therapy for trauma-related guilt and shame. In V.M. Follette and J.I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (pp. 258-289). New York: Guilford Press.
[49] Kuyken, W. & Brewin, C. R. (1995). Autobiographical memory functioning in depression and reports of early abuse. Journal of Abnormal Psychology, 104, 585-591.
[50] Laor, N., Wolver, L., Mayes, L. C., Gershon, A., Weizman, R., & Cohen, D. J. (1997). Israeli pre-school children under Scuds: A 30-month follow-up. Journal of American Academy of Child and Adolescent Psychiatry, 36, 349-356.
[51] Last, C. G., Barlow, D. H., & O’Brien, G. T. (1984). Precipitants of agoraphobia: Role of stressful life events. Psychological Reports, 54, 567-570.
[52] Lazarus, R. S. & Folkman, S. (1984). Stress, ap-praisal, and coping. New York: Springer Publishing Compa-ny.
[53] Lee, D. A. (2005). The perfect nurturer: A model to develop a compassionate mind within the context of cognitive therapy. In P. Gilbert (Ed.), Compassion: Conceptualizations, research, and use in psychotherapy (pp. 326-351). London: Brunner-Routledge.
[54] Lewinsohn, P. M., Hoberman, H. M., Teri, L., & Hautzinger, M. (1985). An integrative theory of depression. In S. Reiss and R.R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 331-359). Orlando, FL: Academic Press.
[55] Lieberman, A. F. & Amaya-Jackson, L. (2005). Reciprocal influences of attachment and trauma: Using a dual lens in the assessment and treatment in infants, toddlers, and preschoolers. In L. Berlin, Y. Ziv, L. Amaya-Jackson and M.T. Greenberg (Eds.), Enhancing early attachments: Theory, re-search, intervention, and policy, pp. 120-126. New York: Guilford Press.
[56] Litz, B. T. (1992). Emotional numbing in combat-related post-traumatic stress disorder: A critical review and reformulation. Clinical Psychology Review, 12, 417-432.
[57] Litz, B. T., Orsillo, S. M., Kaloupek, D. & Weathers, F. (2000). Emotional processing in posttraumatic stress disorder. Journal of Abnormal Psychology, 109, 26-39.
[58] Loftus, E. F. (2003). Our changeable memories: Legal and practical implications. Nature Reviews: Neuroscience, 4, 231–234.
[59] Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: W.W. Norton & Company.
[60] Martin, G. & Pear, J. (2007). Behavior modification: What it is and how to do it. New Jersey: Prentice Hall.
[61] Miller, M. W. & Litz, B. T. (2004). Emotional-processing in posttraumatic stress disorder II: Startle reflex modulation during picture processing. Journal of Abnormal Psychology, 113, 451-463.
[62] Mogg, K., Bradley, B. P., Williams, R., & Mathews, A. M. (1993). Subliminal processing of emotional information in anxiety and depression. Journal of Abnormal Psychology, 102, 304-311.
[63] Mueser, K. T., Rosenberg, S. D., & Rosenberg, H. J. (2009). Treatment of posttraumatic stress disorder in special populations: A cognitive restructuring program. Washington, DC: American Psychological Association.
[64] Najavits, L. M. (2001). Seeking safety: A treatment manual for PTSD and substance abuse. New York: Guilford Press.
[65] Nolen-Hoeksema, S., Girgus, J. S., & Seligman, M. E. (1992). Predictors and consequences of childhood depressive symptoms: A 5-year longitudinal study. Journal of Abnormal Psychology, 101, 405-422.
[66] Ohanian, V. (2002). Imagery rescripting within cognitive behavior therapy for bulimia nervosa: An illustrative case report. International Journal of Eating Disorders, 31, 352-357.
[67] Osman, S., Cooper, M., Hackmann, A., & Veale, D. (2004). Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory, 12, 428-436.
[68] Ozer, E. J. & Weiss, D. S. (2004). Who develops posttraumatic stress disorder? Current Directions in Psychological Science, 13, 169-172.
[69] Paunovic, N. (1999). Exposure counter-conditioning (EC) as a treatment for severe PTSD and depression with an illustrative case. Journal of Behavior Therapy and Experimental Psychiatry, 30, 105-117.
[70] Paunovic, N. (2002). Prolonged exposure counterconditioning (PEC) as a treatment for chronic post-traumatic stress disorder and major depression in an adult survivor of repeated child sexual and physical abuse. Clinical Case Studies, 1, 148-169.
[71] Paunovic, N. (2003). Prolonged exposure counterconditioning as a treatment for chronic posttraumatic stress disorder. Journal of Anxiety Disorders, 17, 479-499.
[72] Power, M. J. & Dagleish, T. (1997). Cognition and emotion: From order to disorder. Hove, England: Psychology Press.
[73] Rachman, S. J. (1976). The passing of the two-stage theory of fear and avoidance: Fresh possibilities. Behaviour Research and Therapy, 14, 125-131.
[74] Rachman, S. J. (1977). The conditioning theory of fear acquisition: A critical examination. Behaviour Research and Therapy, 15, 375-387.
[75] Resick, P. A. & Schnicke, M.K. (1993). Cognitive processing therapy for rape victims: A treatment manual, Newbury Park, CA: Sage Publications.
[76] Roemer, L., Litz, B. T., Orsillo, S. M., & Wagner, A. W. (2001). A preliminary investigation of the role of strategic withholding of emotions in PTSD. Journal of Traumatic Stress, 14, 149-156.
[77] Salkovskis, P. M., Shafran, R., Rachman, S., & Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: Possible origins and implications for therapy and research. Behaviour Therapy and Research, 37, 1055-1072.
[78] Scheeringa, M. S. & Zeanah, C. H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14, 799-815.
[79] Shear, K. & Frank, E. (2006). Treatment of complicated grief: Integrating cognitive-behavioral methods with other treatment approaches. In V.M. Follette and J.I. Ruzek, Cogni-tive-behavioral therapies for trauma (pp. 290-320). New York: Guilford Press.
[80] Smith, P., Perrin, S., Yule, W., & Clark, D. M. (2009). Posttraumatic stress disorder: Cognitive therapy with children and young people. Florence: Routledge.
[81] Smucker, M. R. & Dancu, C. V. (1999). Cognitive-behavioral treatment for adult survivors of childhood trauma: Imagery rescripting and reprocessing. New Jersey: Jason Aronson, inc.
[82] Smucker, M. R., Dancu, C., Foa, E. B., & Niederee, J. L. (1995). Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy, 9, 3-17.
[83] Somerville, K., Cooper, M., & Hackmann, A. (2007). Spontaneous imagery in women with bulimia nervosa: An investigation into content, characteristics and links to childhood memories. Journal of Behavior Therapy and Experimental Psychiatry. 38, 435-446.
[84] Spahic-Mihajlovic, A. S., Crayton, J. W., & Neafsey, E. J. (2005). Selective numbing and hyperarousal in male and female Bosnian refugees with PTSD. Journal of Anxiety Disorders, 19, 383-402.
[85] Speckens, A. E. M., Hackmann, A., Ehlers, A., & Cuthbert, B. (2007). Imagery special issue: Intrusive images and memories of earlier adverse events in patients with obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 38, 411-422.
[86] Taylor, S. (2006). Clinician’s guide to PTSD: A cognitive-behavioral approach. New York: Guilford Press.
[87] Tarrier, N., Sommerfield, C., & Pilgrim, H. (1999). Relatives' expressed emotion (EE) and PTSD treatment outcome. Psychological Medicine, 29, 801-811.
[88] Terr, L. C. (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry, 148, 10-20.
[89] Watkins, R. (2008). Depressive rumination – Investigating mechanisms to improve treatment. Workshop at the 1st international conference of Forum Lundense: What makes therapy work? Towards a science of cognitive, emotional, and behavioural change, Lund, Sweden.
[90] Wheatley, J., Brewin, C. R., Patel, T., Hackmann, A., Wells, A., Fisher, P., & Myers, S. (2007). I’ll believe it when I can see it”: Imagery rescripting of intrusive sensory memories in depression. Journal of Behavior Therapy and Experimental Psychiatry, 38, 371-385.
[91] Wild, J., Hackman, A., & Clark, D. M. (2007). When the present visits the past: Updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38, 386-401.
[92] Wild, J., Hackmann, A., & Clark, D. M. (2008). Rescripting early memories linked to negative images in social phobia: A pilot study. Behavior Therapy, 39, 47-56.
[93] Wolpe, J.(1995). Reciprocal inhibition: Major agent of behavior change. In W. Donahue and L. Krasner (Eds), Theories of behavior therapy, pp. 23-57, Washington, DC: American Psychological Association.
[94] Young, J. E., Klosko, J. S. & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.