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Key points
- Evidence from fMRI/lesion studies suggests that anxiety/depression engender contradiction between perfectionist demands and reality perception.
- Such conflicts in the premises of the person's practical reasoning network generate somatosensory threat feelings.
- These feelings are conceptualized in terms of linguistic acts of catastrophizing, damning, and thinking that "I can't".
- A logic-based cognitive-behavioral therapy (LBT) can key into the premises of such self-defeating reasoning.
The human brain is hardwired to seek consistency; when persistent, unresolved internal contradictions arise between people's everyday decisional premises, it can generate mental stress that manifests in mental dysfunction. This post briefly describes the process by which this can happen.
Many mental disorders are a result of perceived contradictions between reality and a perfectionist demand. The conflict between such premises feels threatening to the client leading to linguistic expression of the threatening feeling using language with a strong negative valence (“This is awful.” “I am worthless.”) The latter negative conceptualization serves to sustain and amplify the negative feeling and to generate further feelings of powerlessness, which is then expressed in further disempowering language (“I can’t”).
Some major forms of mental disorder of this nature include many types of anxiety disorder including obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder. They also include mood disorders such as major depressive disorder.
From a neurological perspective (Inzlicht et al, 2015, Porcaro et al, 2012), these disorders arise as a result of a cognitive (logical) conflict in the executive region of the brain (ventromedial prefrontal cortex, orbital frontal cortex, dorsolateral prefrontal cortex, etc.), which is involved in practical decision-making (Cohen, 2018). Effectively, this cortical region “hijacks” the subcortical region of the brain (the amygdala-hypothalamic-pituitary-adrenal axis) (Hiser & Koenigs, 2018). This is the opposite process to that arising in disorders such as PTSD, phobias, and addictive disorder, where the subcortical region of the brain “hijacks” the cortical region, so-called bottom-up control (Nicholson et al., 2017).
For example, the process involved in some anxiety disorders may be schematically illustrated as follows:
1. Perfectionistic Demand for Certainty (“I must be certain about the outcome of my action”)
2. “Reality judgment (“I am not certain; I might screw up”)
3. Catastrophizing (“It would be horrible if I screwed up”)
4. Can’tstipation (“I can’t do it”)
In a depressive disorder, the process may be schematically illustrated as follows:
1. Perfectionistic Existential Demand (“Bad things must never happen to me”)
2. Reality Judgment (“Something bad happened to me”)
3. Global Damnation (“The world is a horrible place’)
4. Can’tstipation (“I can’t stand to live in the world”)
Remarkably, in each case, premises 1 and 2 contradict, which generates a threatening somatosensory feeling linguistically expressed in premise 3, which in turn generates a feeling of powerlessness, which is linguistically expressed in premise 4.
The importance of unpacking this cognitive-affective process is of inestimable value in treating clients. It provides a way to key into clients' belief systems and network of somatosensory feelings, thereby allowing the client to be appropriately treated. Essentially, the goal of treatment is to help resolve the contradiction between premises 1 and 2 by helping the client to give up her perfectionist demand.
Because logic-based therapy (LBT), the form of rational-emotive behavior therapy (REBT) I have formed (Cohen, 2022, 2020, 2019, 2018, 2016), provides a framework for keying into the above logical progression in practical decision-making, it is a useful approach to helping clients who suffer from such disorders. I have elsewhere (Cohen, 2022) discussed in detail how such a logic-based form of cognitive-behavioral therapy can be used to treat a number of mental disorders as well as everyday anxiety and emotional stress.
References
Cohen, E.D. (2022). Cognitive-behavioral Interventions for self-defeating thoughts: Helping clients overcome the tyranny of "I Can't." London: Routledge.
Cohen, E.D. (2020). The Psychoanalysis of Perfectionism: Integrating Freud’s Psychodynamic Theory into Logic-Based Therapy. International Journal of Philosophical Practice, 6.1, 15-27.
Cohen, E.D. (2019). Making peace with imperfection: Discover your perfectionism type, end the cycle of criticism, and embrace self-acceptance. Oakland, CA: Impact Publishers.
Cohen, E.D.(2018). Use of logic-based therapy to encode emotional reasoning on the ventromedial prefrontal cortex. Trauma Psychology. American Psychological Association. https://traumapsychnews.com/2018/07/use-of-logic-based-therapy-to-encod…
Cohen, E.D. (2016). Logic-based therapy for everyday emotions. Lanham, MD: Lexington Books.
Hiser, J. & Koenigs, M. (2018). The Multifaceted Role of the Ventromedial Prefrontal Cortex in Emotion, Decision Making, Social Cognition, and Psychopathology. Biological Psychiatry, 83(8), 638-647. https://koenigslab.psychiatry.wisc.edu/wp-content/uploads/2018/03/1-s2…
Inzlicht, M., Bartholow, B. D., & Hirsh, J. B. (2015). Emotional foundations of cognitive control. Trends in Cognitive Sciences, 19(3), 126–132. https://doi.org/10.1016/j.tics.2015.01.004
Nicholson, A.A., Friston, K.J., Zeidman, P. et al. (2017). Dynamic causal modeling in PTSD and its dissociative subtype: Bottom-up versus top-down processing within fear and emotion regulation circuitry. Human Brain Mapping. 38(11), 5551-5561. https://pubmed.ncbi.nlm.nih.gov/28836726/
Porcaro, C., Medaglia, M. T., Thai, N. J., Seri, S., Rotshtein, P., & Tecchio, F. (2014). Contradictory reasoning network: an EEG and FMRI study. PloS one, 9(3), e92835. https://doi.org/10.1371/journal.pone.0092835
