Cognition, Emotion, and Psychopathology: Theoretical, Empirical, and Clinical Directions

Neuropsychiatric research and theory owe a great deal to the field of cognitive psychology, which has made impressive strides in the empiric investigation of a variety of processes involved in mind/brain functioning in both normal and disordered states. This volume is an edited collection in tribute to Andrew Mathews, an influential figure in the cognitive psychology of negative emotions and emotional disorders, particularly anxiety states, widely known for his work on cognitive biases in anxiety. The body of the text is preceded by a prologue about Mathews’ career written by a long-time colleague and friend, T.D. Borkovec, which places Mathews’ work in the context of the development of cognitive-behavioral therapy, as well as of cognitive psychology. Indeed, the mutually enriching relations between theory, research and clinical practice outlined in this history of Mathews’ career are reflected in the content of the book itself, which is divided into theoretical, empirical and clinical sections. A second prologue by the volume’s editor, Jenny Yiend, admirably accomplishes the tasks promised in its title, “Introduction and Synthesis.” Its section on emergent themes is particularly helpful, drawing the reader’s attention to the prominence of such topics as cognitive control, avoidance, contextual factors, and the differentiation of discrete emotions in the volume’s various contributions, which have built upon the work of Mathews and others.

The section entitled Theoretical Approaches begins with a chapter by Susan Mineka. Integrating animal work on the avoidance response, and its possible implications for cognitive avoidance, with the literature on worry by Borkovec and others, she develops a model of generalized anxiety disorder that includes a potential role for paradoxical effects of the punishing consequences of worry in its pathologic perpetuation in generalized anxiety disorder. Michael W. Eysenck’s chapter focuses on the relationships between cognitive biases, both attentional and interpretive, trait anxiety, and repression. The author updates his previously proposed model of anxiety to include a possible role for biphasic processing of stimuli by repressors, as an explanation for the discrepancies between their cognitive biases (as traditionally measured), self-reported anxiety, and physiologic and behavioral responses to stressful conditions. Karin Mogg and Brendan P. Bradley describe a cognitive-motivational perspective on anxiety that gives primacy to evaluative, rather than attentional, biases in the generation of anxiety. They also discuss the possible cognitive mechanisms underlying attentional biases, in the context of a vigilance-avoidance hypothesis that bears some relation to Eysenck’s description of biphasic processing in repressors.

The second section of the book, entitled Empirical Directions, begins with a chapter by Paula Hertel that describes studies extending the effects of training threat-related interpretive biases to performance on a subsequent test of remembering. She discusses the implications of this work for understanding memory biases in anxiety versus depression, and argues for the primacy of cognitive habits, rather than emotional state, in causing mood-congruent memory. Anne Richards discusses the background and implications of her work on anxiety and the resolution of ambiguity, paying particular attention to the roles of automatic versus strategic processing as well as context effects in the production of mood-congruent interpretations of stimuli. In a chapter whose content is perhaps more familiar to neuropsychiatrists, Andrew D. Lawrence, Fionnuala C. Murphy, and Andrew F. Calder review the neuropsychological/neurobehavioral and functional neuroimaging literatures on fear and disgust, and find convincing evidence, within both, of a double dissociation between those emotions. This review is followed by a thoughtful discussion of its implications for various models of emotion. Colin MacLeod, Lynlee Campbell, Elizabeth Rutherford and Edward Wilson review evidence for a causal contribution of attentional and interpretive bias to the mediation of anxiety vulnerability. Literatures reviewed include relevant research on treatment, development, and emotional prediction, as well as, most importantly, studies examining the emotional impact of directly manipulating patterns of selective processing. Finally, Jenny Yiend and Bundy Mackintosh, former students and ongoing collaborators of Andrew Mathews, describe the new directions of their joint work, delineating empirical and theoretical aspects of various methods of bias induction and their effects, over time, on processing, mood, and vulnerability to stress. The chapter includes a review of preliminary work on the development of induction methods for possible use in treatment, showing promising results for both attentional and interpretive techniques.

The third and final section of the book, entitled Clinical Perspectives, discusses research and theory from a clinical perspective. The initial chapter, by Jonathan D. Huppert and Edna B. Foa, presents an approach to social anxiety disorder that integrates Mathews and MacKintosh’s concepts of anxiety with the authors’ own work on emotional processing theory, which utilizes a model of “fear structures” consisting of associated representations of stimuli, responses, and their interpretations. They posit that therapeutic emotional processing occurs when information incompatible with the pathologic elements of a fear structure is incorporated into such a structure in the setting of its activation – a process hampered by the presence of cognitive biases. Colette R. Hirsch and David M. Clark discuss the role of negative mental self-imagery in social phobia, and its implications for treatment. J. Mark and G. Williams describe the phenomenon of over-general autobiographical memory in depression. They delineate its relation to affective state, ruminative thinking, and maintenance of affective symptoms, and discuss its relevance to treatment. John D. Teasdale outlines the development of, and theory behind, mindfulness-based cognitive therapy, a welcome addition to the volume given the recent prominence of this treatment. He describes the therapeutic impact of changing the style, rather than content, of patients’ dysfunctional processing, and reports the results of clinical trials in patients with a history of depression. In a final chapter, Gillian Butler delineates areas of difficulty in clinical practice that merit further research.

Overall, this volume serves as an excellent overview of evolving approaches to the understanding and treatment of emotional dysfunction within the field of cognitive psychology. In addition, it provides an interesting glimpse of the way in which one person’s intellectual and personal qualities can shape a field of inquiry. If the approaches described within it can at times seem curiously detached from the larger neuroscientific literature, this does not represent a weakness of its authors, but a reminder of the importance of cross-disciplinary exposure for all those interested in the workings of the mind and brain.

Dr. Epstein is Associate Professor of Clinical Psychiatry and Associate Director of the Division of Neuropsychiatry in the Department of Psychiatry, Weill Medical College of Cornell University, New York, NY.