“It made me stressed”

By Martin J. Turner & Andrew G. Wood

In rational emotive behavioural therapy (REBT), it has long been held that in the generation and regulation of emotion, cognitive mediation and cognitive change is paramount. Both cognitive mediation and cognitive change are foundational to CBTs like REBT, and many individuals undergoing CBT learn the A x B = C framework. This is where thoughts (B) about the situation (A) underpin emotions (C), not the situation or the thoughts alone in isolation.

“They made me really angry”, or “it made me anxious” are just some examples of ‘A-C thinking’ (i.e., Adversity – Consequence). A-C thinking is used to capture the idea that the situation alone causes emotion. On the contrary, the term ‘B-C thinking’ (Beliefs – Consequences), is used to express cognitive mediation, which does not exclude the influence of A, but places B and the centre of emotion reactivity. That is, people believe their emotions are a result of the interaction between the situation and their own thoughts.

In emotion science, the terms A-C and B-C thinking are uncommon, instead captured by the concepts of stimulus-response (S-R) and cognitive mediation (C-M). An S-R viewpoint reflects A-C thinking, and a C-M viewpoint reflects B-C thinking. An S-R viewpoint of emotion indicates that emotions are the result of external events, and thus for emotional change to take place, the situation must change. This is a less favourable viewpoint, because of the myriad of things in life we cannot change, and the tendency to reinforce situational avoidance (i.e., avoiding a situation to not evoke a particular emotional response). A C-M viewpoint of emotion is advantageous because it allows greater volition over emotion regulation due to malleability of the content of conscious thought. A C-M viewpoint indicates that emotion results from cognition about events, and thus for emotional change to take place, cognitive change must take place. Even within uncontrollable situations, evidence indicates that cognitive change is a superior emotion regulation strategy. Thus, a person with a C-M viewpoint would not need to avoid a situation, instead, altering their cognitions to feel differently about a difficult situation.

Unsurprisingly then, second wave CBTs, especially rational emotive behaviour therapy (REBT), focus largely on cognitive change in relation to Beliefs (B), rather than the situation (A) and consequences (C). In other words, rather than changing the situation or directly modulating the emotion, the individual restructures their cognitions, to bring about emotion change. This has the advantage of giving the client some volition over their emotional reactivity, because they can learn to execute cognitive change with autonomy, thus exercising, some emotional responsibility. Cognitive change boasts empirical support within emotion regulation literature, and is the backbone of prominent psychotherapies. 

With the clients we work with, helping them to understand cognitive mediation is often a light bulb moment and a vital part of an intervention. Psychological change, and thus effective therapeutic outcomes are predicated on the understanding that psychological change is indeed possible, and the client is the one who can drive this change. That is, clients are able to reach the conclusion that irrespective of the circumstance in which they find themselves, they can strongly and meaningfully influence how they feel and then react to difficult situations.

Clearly, an important yet overlooked mechanisms for effective practice, there is one factor which has limited our ability to understand the extent to which the client endorses cognitive mediation, or not; the lack of a valid psychometric measure. We can measure maladaptive schema, irrational beliefs, cognitive distortions etc, but until now we haven’t been able to measure fundamental (i.e., superordinate) beliefs in cognitive mediation.

So with colleagues, we developed the cognitive mediation beliefs questionnaire, or the CMBQ for short. Be published this in the journal Psychotherapy Research, which includes two constructs:

  1. Stimulus-Response (SR) generation beliefs (emotions are caused by events alone)
  2. Cognitive-Mediation (CM) change beliefs (changes in cognition lead to emotion change.

To develop the measure we undertook a rigorous item development process, and completed a litany of psychometric validation statistical analyses. We arrived at a 15-item scale. We wanted to know whether the CMBQ is related to other prominent markers of emotion regulation and emotion reactivity, so we conducted some additional studies alongside the questionnaire development.

We found that participants who reported greater scores in S-R beliefs (emotions are caused by events alone) also reported poorer emotional regulation tendencies, poor mental health, and more persistent, intense, and sensitive emotional reactivity (that’s a bad thing). We found the reverse for C-M beliefs (changes in cognition lead to emotion change).

Participants who reported greater scores in C-M beliefs also reported better emotional regulation tendencies, greater mental health, and less persistent, intense, and sensitive emotional reactivity (that’s a good thing).

In other words, those who endorsed the viewpoint that changes in cognition lead to emotion change reported a more adaptive psychological health profile. Why is this important? It means that in our work using CBTs, like REBT, we can encourage clients to understand and endorse the idea that they can influence their emotions by using cognitive change. We can discourage and weaken their assertion that emotions are caused by events alone. We can help them to develop the volitional viewpoint that they can have a say in how they emote, and thus, how they experience the world. Ultimately, we then (as practitioners) are able to monitor, and have confidence in making the assertions, that S-R beliefs are less favourable for psychological health in comparison to C-M beliefs.

It is really important to mention that the message here is not that, when an individual experiences an unpleasant or unwanted emotion, that it is all their fault or that they are wholly responsible for experiencing that emotion. There are of course situational events that strongly influence our emotions, but even in situations where the event is highly evocative and stressful, it could be argued that perceiving that emotion change can take place by changing the way one thinks, provides some tangible volition over emotion.  For example, no matter how adaptive one’s cognitions are, if one were to be treated unfairly, they may still legitimately experience anger. Yet, their endorsement of S-R or C-M beliefs may dictate the intensity, frequency, and functionality of the anger. Along a spectrum, we know that some can respond with annoyance and assertiveness, whilst others may experience rage.

Interventions that target cognitive change (e.g., second wave CBTs), should first encourage C-M change beliefs, and discourage S-R generation beliefs. Practitioners could help the people they work with to first understand that they can have a strong influence on their emotions, by managing their thoughts about life events, prior to teaching cognitive change techniques such as cognitive reappraisal.

It is early days for the CMBQ and the concepts nested within it, but over the coming months and years we will test the CMBQ in various samples, using various methods, to see what it can tell us about emotion regulation and emotion reactivity. Ultimately, we hope to better delineate the precise mechanisms that underpin emotion regulation and reactivity, that we know to be of central importance for the cultivation of mental health and performance.

You can access the CMBQ here: https://www.researchgate.net/publication/348621653_15-item_CMBQpdf

You can access the paper here: https://www.tandfonline.com/doi/abs/10.1080/10503307.2020.1871524

You can contact the lead researcher here: m.turner@mmu.ac.uk

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