Erkenn DOI 10.

1007/s10670-013-9484-x

Cognition, Representations and Embodied Emotions: Investigating Cognitive Theory

Somogy Varga

Received: 20 July 2012 / Accepted: 27 March 2013 Springer Science+Business Media Dordrecht 2013

Abstract 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 signicant aws 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.

1 Introduction In recent years there has been a reawakened philosophical interest in the topic of emotion and its relationship to cognition and mental representation. While this interest has resulted in the emergence of a dynamic eld that is characterized by interdisciplinary research, relatively little philosophical attention has been devoted to the conditions in which emotions are disordered. Nevertheless, such attention could result in a mutual enrichment. Relevant knowledge from psychopathology could inform and correct philosophical inquiry, while psychological and psychiatric theories could benet from a philosophical assessment of some of their core assumptions (Varga 2011, 2012). In this paper, an attempt will be made to work towards such a mutual enrichment by assessing the foundations of the inuential cognitive theory (CT) as defended by Beck et al. CT is probably the most commonly used theoretical approach to understanding the psychological processes involved in affective disorders and to conceptualize the adequate psychotherapy. Alford and Beck (1997, 4142) claim
S. Varga (&) Department of Philosophy, University of Memphis, 327 Clement Hall, Memphis, TN 38152, USA e-mail: svarga@memphis.edu

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CT is of both practical and explanatory value: The purpose of cognitive theory is to provide conceptual tools for effective action or practice in such clinical contexts. It also explicates the factors or processes responsible for the development, maintenance, correction, and prevention of psychopathology. I should note that what I outline here is the most inuential and canonical version of CT, as espoused by founding fathers like Beck and others. There are of course approaches to CT that deviate from the canonical version and it is therefore possible that some of these might not subscribe to all of the assumptions that I deal with. Consequently, the critique and corrections I put forward have broad applicability, although there might be versions of CT that will not be vulnerable to all of the concerns that I raise. In CT, emotional disturbances like those in depression are thought to be a result of an inaccurate cognitive mind-set or an inadequate way of thinking about self and world (Beck 1967; Beck and Alford 2009; Wells 2008, 2), as a matter of faulty information processing or distorted and dysfunctional beliefs (Bracken and Thomas 2008, 86). Maladaptive cognition is thus given a causal role in depression (Kuyken et al. 2005, 114; DeRubeis et al. 2008). CT is the theoretical foundation of so-called Cognitive Therapy,1 which is promoted as the therapy of choice for many emotional disturbances and constitutes the predominant paradigm of psychotherapy in the treatment of depression (Epp and Dobson 2010; Holmes 2001; Ghaemi 2007). In CT-informed therapy, the aim is to alter depressive cognitive styles by challenging and modifying irrational and dysfunctional thought. Of course, a proponent of CT could respond to the rst aim of this paperto philosophically evaluate CTby saying that, instead of philosophical assumptions, it is rmly based on scientic principles (Padesky and Beck 2003; Dryden et al. 2010, 226277 in Dobson 2010, 262).2 Such a proponent may remind us that CTbased therapy is currently the rst-option treatment for diverse conditions because it has been successfully formalized in comprehensive therapeutic manuals and has been positively evaluated in randomized controlled trials (Epp and Dobson 2010; Hollon and Beck 2004; Roth and Fonagy 2005).3 However, there might be an epistemological misconstruction in such a strategy that neglects the fact that in many cases the boundary between scientic and philosophical issues cannot be drawn sharply. While generating numerous testable hypotheses, scientic theories emerge in paradigms that always involve untestable or circular assumptions. Consequently, it is unproblematic to say that empirical studies can prove that people suffering from, or vulnerable to, depression have a propensity to assess themselves, the situations they encounter, and their relations to other people in a certain way. Also, it is equally unproblematic to hold that empirical studies can help to evaluate
1

Cognitive therapy is the application of cognitive theory to the individual (Beck and Alford 2009, 300). Also: we do not believe that the therapy could be applied effectively without knowledge of the theory (Beck et al. 1979, 4).

Indeed, Padesky and Beck have critiqued other approaches (for example, Ellis rational emotive behavior therapy REBT) for representing a more philosophical approach, while pointing out the more scientic base of CT (Padesky and Beck 2003).

In recent years, however, there has been an increase in discussion about the effectiveness of such an approach, especially in terms of clinical improvement and protection against relapse (Brewin 2006; Roth and Fonagy 2005).

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the effectiveness of the treatment process (McEachrane 2003, 82). However, it is problematic (and circular) to hold that empirical studies can provide satisfactory evaluation of all the underlying key assumptions. Philosophy can indeed make a valuable contribution here because, as will be made clear, CT rests on certain philosophical assumptions (McEachrane 2003; Lacewing 2004; Whiting 2006a) that have a long history (Butera 2011). This paper will assess these philosophical assumptions and argue that due to several aws, CT must be revised. In the nal section of the paper, a way will be sketched in which these aws could be corrected in a manner that would not only secure philosophical accuracy but also result in an account that is better suited to explaining some of the cognitive, emotional, and bodily characteristics in affective disorders. Furthermore, the conceptual adjustment might lead to improvements in the treatment protocols and the empirical testing of the protocols.

2 The Philosophy of CT The two primary historical factors that led to the emergence of CT were the cognitive revolution in psychology, on the one hand, and the growing dissatisfaction with both stimulusresponse psychology and psychoanalysis on the other (Dobson and Dozois 2010). At the same time, theoretical psychology began to acknowledge the existence of inner mental maps (Holmes 2010; Westen 2005). Partly due to these factors, the 1950s and early 1960s saw an increasing emphasis on the role of cognitive processes in psychiatric disorders (Beck and Alford 2009, 232). Albert Ellisconsidered by many to be, along with Aaron Beck, the father of CT presented a theory of emotional dysfunction in the 1950s that has become an important premise of CT. The so-called ABC model of emotional disturbance was meant to describe how cognitive processing (as opposed to the environment) inuenced emotional and behavioral reactions. While CT underwent numerous modications over the ensuing four decades, its general point remains that mental disorder is intrinsically linked to cognitive disturbance.4 From this outlook, depression is conceptualized as a disorder of thought (Beck and Alford 2009, 208, 239) and the pathological affective disturbance can be regarded as the consequence of the way individuals view themselves and their environments (Ibid., 231). The primary causal factor in the development of depression is the activation of idiosyncratic cognitive patterns that divert thinking into specic channels that deviate from reality (Beck and Alford 2009, 243; Wells 2000, 34). A central claim is that depression is characterized by inaccuracies in information processing that therapy aims to correct (Beck and Alford 2009; Clark

The idea of an underlying cognitive disturbance serves as a point of departure for many other and less widespread approaches like Ellis rational emotive behavior therapy (REBT), and, to a lesser degree, for the more recent acceptance and commitment therapy (ACT) and for some of the so-called third wave approaches (Dobson and Dozois 2010). Also, other directions that either place greater emphasis on metacognitive interventions or attempt to insert positive distortions into cognitive processes to a certain degree still remain within the cognitive paradigm.

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et al. 1999). As Judith Beck (1995, 2), one of the currently most inuential proponents of this approach, notes: The therapist seeks in a variety of ways to produce cognitive changechange in the patients thinking and belief systemin order to bring about enduring emotional and behavioral change. Additionally, Aaron Becks cognitive-content specicity hypothesis postulates that depression has a distinctive cognitive prole that is characterized by thoughts focused on incompetence, failure, or worthlessness (Clark et al. 1989, 1990; Szentagotai et al. 2008). As we shall see in the next section, these negatively distorted thoughts and beliefs emerge from the activation of negative and more fundamental belief-systems that are stored in long-term memory. 2.1 Schemas and Automatic Thoughts A central characteristic of CT is a distinction between fundamental beliefs or schemas and something like second-order thoughts called automatic thoughts that emerge on the basis of schemas. These schemas begin developing in childhood and they contain beliefs which are understandings that are so fundamental and deep that [patients] often do not articulate them, even to themselves (Beck 1995, 16). Schemas are depicted as stored bodies of knowledge containing fundamental beliefs which are regarded by the person as absolute truths, just the way things are (Ibid.) Schemas interact with incoming information and help shape experience (Beck and Alford 2009, 255; Williams et al. 1997). Dysfunctional schemas are thought to be causative elements in the development, maintenance, and recurrence of a variety of mental disorders such as depression. The schemas of depression-prone individuals are considered to be dysfunctional because they contain beliefs about self and world that are rigid and unrealistically negative (Kovacs and Beck 1978; Beck 1983; Hammen 1997; Epp and Dobson 2010; Blatt 2004). CT maintains that depressed individuals possess negatively biased cognitive schemas that reect past experiences, and organize and structure new experiences. In the case of numerous and signicant early negative experiences, negatively biased schemas (Im vulnerable, I am worthless, or the world is dangerous) may develop which inuence the preferential processing of information. Over time, these schemas often become unconditionally acknowledged as truths (Wells 2000), in the sense that they are not seen as contingent construals to which alternatives are possible. It is on the background of such aspects that Charland (2006) has argued that depression assumes the character of a cognitive module.5
5

This hypothesis has been put forward by Charland (2006), who argues that a good theoretical formulation and defence of this hypothesis can be found in Aaron Becks well-known cognitive theory of depression (2006, 221). Charlands point that the emotional system is marked by a susceptibility to develop a modular structure (Ibid., 225) may be right, but it is unclear whether this can in any way further our understanding of emotional disturbances. We would still have to explain why emotional systems in some individuals and not others are aficted. CT provides an explanation for this, but one that does not clearly sustain the modularity hypothesis.

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Cognitive theory maintains that while schemas are mostly not readily accessible to consciousness, they are both expressed in and activated by automatic thoughts (Alford and Beck 1997, 1617). Schemas become apparent to both the patient and therapist as they identify the consistencies or themes that run through the automatic thoughts. Cognitive training is supposed to make people able to catch the automatic thoughts that follow an event and trigger the emotional response (Beck 1976, 26; Beck and Alford 2009). Beck (1995, 14) notes that when reading her book on cognitive therapy, such automatic thoughts could be: This is just too hard. Im so dumb. Ill never make it as a therapist. Automatic thoughts are the situation specic actual words or images that go through a persons mind (Beck 1995, 16). The most emotion-eliciting automatic thoughts are thought to consist of some kind of mental representation involving actual words; the authors also note that mental imagery can elicit the same effect. But importantly, such mental imagery is also thought of as being conceptually structured (e.g., Beck and Alford 2009, 26, 3738). Overall, the relationship between core beliefs, automatic thoughts, and emotional distress is viewed in the following way: experience is interpreted within the framework of schemas, which lead to specic automatic thoughts that, in turn, generate specic emotions. Consequently, therapy seeks to determine the content of such maladaptive information processing strategies. The aim is to capture automatic thoughts that allegedly elicit emotions in the moment and, on that basis, to explore the underlying, general belief-schemas that these thoughts express. Then the attempt is made to change the semantic information that such emotion-eliciting thoughts contain and modify the content of basic schemas (Beck et al. 1979; Beck and Alford 2009). The patient is encouraged to logically challenge and test thoughts against reality, both in session and as in-between-sessions homework (Milton 2008, 104), and to create substitute representations that help restore positive mood states. In this framework, once the correction is achieved and consistency with intersubjectively valid standards is attained, these schemas can no longer trigger the unpleasant emotional disturbances.

3 Assessing the Underlying Assumptions of CT After this brief outline, I want to isolate underlying assumptions on which CT is based. These assumptions can be categorized into two groups, relating to philosophical issues of mental representation and introspection on the one hand (3.13.3) and emotion and cognition on the other (3.43.5). The assumptions are as follows: Thoughts are mentally represented (3.1), words are the vehicles of thought (3.2), we have direct access to our thoughts (3.3), cognition constitutes/causes emotions (3.4), and schemas constitute the fundament of our thinking (3.5). In the following, they will be tested one by one. 3.1 Thinking that P. Non-representational, Explanatory, Expressive and Transparent Uses In the CT literature, cognition is depicted as essentially involving internal conversations and inner speech, in which we constantly talk silently to

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ourselves (Sheldon 1995, 150151). Accordingly, the automatic thoughts that accompany experience are described as on-going automatic self-statements (Hollon and Kendall 1980; Freeman et al. 1989, 2005), cognitive self-talk (Safren et al. 2000, 328), internal exclamations (Newman 2006, 212), or as a running commentary (Mulhern et al., 38). While the talk of statements, exclamations, speech, or commentary indicate that in CT, thinking implies the representation of propositional content, other authors spell this out more explicitly. In their recent book on CT and depression, Gilson et al. (2009), 128) speak of automatically arising thoughts as self-talk sentences. Riskind (2006, 63) maintains that automatic thoughts are consciously accessible verbal thoughts and pictorial images. Beck (1995, 16) concurs, arguing that automatic thoughts are actual words or images that go through a persons mind and that the therapist should aim to capture (Ibid., 88).6 As these examples demonstrate, CT posits a very strong conceptual link between cognitive events and mental representations andakin to the Representational Theory of Mind (Sterelny 1990) from the philosophy of cognitive scienceregards representations as the vehicles that drive our thinking and carry mental content. However, CT also maintains that there is a representation of propositional content involved. In a concrete therapeutic encounter, this means that the report of the patient in the form of I thought that P is understood as entailing the representation of propositional content, which the patient can catch. In other words, there is a general assumption that thought involves conscious mental representation and a more specic assumption that mental representations are speech-like, that is, structurally isomorphic with spoken language (words are the vehicles of thought). I shall rst deal with the more general assumption. As the following conceptual examination shall make clear, the general assumption that thought involves conscious mental representation is awed and potentially damaging to a precise understanding of the patients self-reporting. I shall introduce a couple of conceptual distinctions and argue that the formula I think/thought that P can convey different meanings depending on whether it is used in a non-representational (3.1.1), explanatory (3.1.2), expressive (3.1.3), or transparent (3.1.3) manner. (3.1.1) In order to demonstrate a non-representational use, I want to draw attention to the crucial distinction between thinking and having thoughts (see McEachrane 2003; Malcolm 1972; Davidson 1987).7 The fact that we sometimes use the verb think in a transitive manner and, thus, imply that it has a propositional object seems to mislead the CT to think that thinking involves the representation of a propositional content. However, in everyday language, saying that a person
6

To avoid misunderstandings, it is important to recall that mental imagery is also thought to be conceptually structured (e.g., Beck and Alford 2009, 26, 3738). Several of Malcolms connecting ideas have been contested (for instance by Davidson), but the aspect that I emphasize here is not really controversial. For instance, while Davidson (2001, 97100) criticizes specic aspects and implications of Malcolms idea (specically the question of attributing of thinking to animals), he similarly argues that we should not conceive of thinking as having representations before the minds eye and urges us to give up the idea that thoughts require mental objects (Davidson 1987, 456).

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thought that P does not imply that he thought of P, or that P occurred to him in his thoughts. Let us look at some examples. When I enter my sons classroom to pick him up, it sometimes takes a while until I spot him among the many children wearing the same uniform. When I nally do, I am surely aware of my seeing him, but in general, the thought that is my son does not occur in my thoughts. This observation is also valid from a third-person perspective. When a cab driver stops his car at an intersection because the light is red, he is cognitively aware of the light being red, but the thought the light is red does not necessarily occur in his mind. In other words, our speaking of thinking does not necessarily entail that we represent propositional content: he thought that p does not entail the formula, the thought that p occurred to him. Regarding having thoughts as the prototype of thinking is bought at the expense of mistakenly taking grammatical form to be the index of psychological reality. If this is right, if he thought that P can mean something different than the formula the thought that P occurred to him then there is a risk that the CT informed practitioner will misinterpret the patient. However, the picture is even more complex, as there are yet other intelligible uses of the formula I thought that P that carry different meanings. (3.1.2.) It is perfectly intelligible to use the sentence I thought that P in an explanatory way, which not only does not involve mental representations, but which cannot even be considered as involving reporting on actually occurred thoughts. As noted, when we say that the cab driver thinks that the light is red, this need not involve positing that there is a particular representation going through his mind. Rather, we attribute thoughts to him and use the term thinking to describe and explain the situation in question in a way that makes sense of his actions. In other words, when we attribute the thought to the cab driver we do not necessarily designate some mentally represented entity, but rather the situation that he is in. As Dan Hutto (2008, 433) notes, we use such sentences to ll in the content clause, but this is only a convenient way of denoting the situation that it is directed at noncontentfully. Also, when asked to explain why he stopped, the cab driver may simply tell us I thought the light was red. But in that case, he would not be reporting on words or images represented in his mind, rather, he would be explaining his experience of the situation and his reaction in a particular way, which involves some kind of awareness of the light being red. When listening to his explanation, unless we are given further information, under normal circumstances we cannot assume that he is reporting on thoughts that actually occurred to him. (3.1.3.) There is in our everyday language yet another non-representational way in which it is entirely intelligible to use the sentence I thought that P. We may use it an expressive way, which is neither about reporting on thoughts or explaining actions, but about expressing emotions. In order to see this, let us imagine that Malcolms car driver is involved in a serious car accident right after stopping at the red light. When a concerned friend or therapist later asks him what went through his head in that life-threatening situation, he may very well reply, I thought I was going to die. But what does his answer mean? It is rather unlikely that he means that the thought I thought I was going to die or a particular image with the same content passed through his mind. Instead, his utterance might very well convey the manner

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in which he experienced being in the dangerous situation, feeling frightened and passive. In other words, in this case his utterance I thought I was going to die is not explaining (or at least not only explaining) but expressing the terrifying emotional experience that he underwent. Thus, his voiced thought might very well have been the rst time these words actually occurred to him. (3.1.4.) The last meaning connected to the formula I thought that P that I want to mention can be referred to as the transparent use. Recall that in CT, it is assumed that the proper answer to the question of the therapist Do you think that P? involves an introspective process that aims to detect pre-existing thoughts. However, it is perfectly intelligible to attribute thoughts to ourselves without turning inward at all. Indeed, in many cases where we think that we arrive at a certain self-ascription of a mental entity by inwardly attending (introspection), we are in fact attending outward to those aspects of the world that our mental states are about. That is, sometimes we simply acquire knowledge about our minds and arrive at self-ascriptions by looking outward. The question Do you think that P? may be transparent to a corresponding question about the world, which can be answered by considering reasons that count for or against P itself (Evans 1982; Moran 2001). It is perfectly intelligible to attribute thoughts to ourselves without turning inward at all. Given the CT framework, the therapist may easily mistake this utterance as a direct, introspectively achieved report about the patients inner life. The analysis provided so far has established a couple of interlinked points. It became clear that when somebody uses the formula I thought that P, we are not warranted in assuming that the relevant thought was mentally represented to him or her. Further complicating matters, we have established that using this formula does not even necessarily entail that the person is reporting on thoughts at all. He may just as well be explaining actions, expressing emotions (see also section (e)) or forming beliefs. If the points made here are correct, then the CT-informed therapist might in numerous cases wrongly infer the existence of a corresponding internally represented propositional content and severely misunderstand the meaning of the patients report. At least in some situations, the excessive focus on thoughts as mental representations and the neglect of situational and bodily dimensions may preclude a precise understanding of what the patient is saying. Importantly, what I have said in this section entails no knock-down argument against the general idea that thinking may involve mental representations. The points I have put forward are compatible with the view that in some cases mental representations are indeed constitutive of our thinking.8 But they also show that in
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For additional support for the arguments made here we could draw on recent discussions in the philosophy of cognitive science, where non-representationalist approaches to cognition are increasingly popular (Keijzer 1998; Hutto 1999; Wheeler 2005; Gallagher 2005; Dreyfus 2004; Varga in press). Nonrepresentationalist arguments often draw on continental phenomenology and nd support by empirical, cognitive-scientic cognition. But we might also consider a possible objection the CT theorist might use, inspired by representationalist replies to the non-representationalist challenge. Could the CT theorist not relax her main claim and argue that CT merely provides inferences to the best explanation about subpersonal phenomena? To see why this strategy is not available for the CT theorist, we have to recall that CT is not merely explanation oriented, but aims to change cognitive and emotional phenomena. Therefore, CT has to assume that automatic thoughts and schemas are not subpersonal, but accessible to consciousness.

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order to secure a precise understanding of the report of the patient, the CT assumption that automatic thoughts are internally represented in a way that we can catch them must be corrected. In order to see whether this is possible, we need to ask: is it the case that CT needs to (is logically compelled to) assume the view? Does CT need maintain that all thinking is reducible to having thoughts? In short, nothing of what I have said implies that CT is logically compelled to subscribe to such hard-nosed representational view. Thus, CT could in principle choose to relax this view signicantly, maintaining that only thinking only sometimes involves the representation of propositional content. However, without further arguments, this move would also render CT question begging. If the CTinformed therapist cannot assume that thoughts involve the representation of propositional content, then more needs to be said as to how she would pick out the right automatic thoughts. At this point, I can only gesture towards a solution, which I see as connected to more focus on interpretation. What the formula I think/ thought that P really means, whether it involves representation of propositional content, and whether thinking is applied in an expressive, explanatory, or transparent manner will to a large extent rst become intelligible if the whole communicative situation, the context, the tone of voice, and bodily language is taken into account. In other words, accommodating the criticism would require that CT put more emphasis on interpretation. 3.2 Words are the Vehicles of Thought Different versions of the idea that thinking occurs in a kind of inner speech involving words are not unfamiliar in philosophy.9 In CT, the claim that thinking involves representations is paired with the idea that that symbols like words and propositions are the vehicles of a persons thought. Recall that in CT, cognition is understood in terms of an ongoing internal conversation, inner speech, or as a running commentary to experience (see 3.1). Thoughts are described as involving self-talk sentences that are consciously accessible (Gilson et al. 2009; Riskind 2006). It is on such a background assumption that CT-theorists instruct practitioners to convey to their patients that it is of utmost importance to recognize and capture the precise wording of their automatic thoughts (Beck and Alford 2009, 311; Beck 1995, 16 and 88). In order to assess the accuracy of the assumption that all thinking involves words, we may draw on several sources. First, we may draw on empirical ndings to counter the phenomenological claim in CT about actual words or images that go through a thinking persons mind. In several studies, Hurlburt and Heavey (Hurlburt 1990, 1993; Heavey and Hurlburt 2008; Hurlburt and Heavey 2002; 2004; Hurlburt and Akhter 2008) demonstrate that we frequently think in an unsymbolized manner,
For instance, Gilbert Ryle refers to thinking as internal monologue or silent soliloquy (Ryle 1949, 28), while Plato writes that the soul when thinking appears to me to be just talkingasking questions of herself and answering them, afrming and denying. I say, then, that to form an opinion is to speak, and opinion is a word spoken, - I mean, to oneself and in silence, not aloud or to another Recently, Carruthers (1996, 5051, 2009) has subscribed to a related view maintaining both that thoughts occur in the form of imaged conversations and that we have introspective access to them. However, in his account, Carruthers also reserves a place for the so-called mentalese.
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entertaining thoughts that do not include words or propositions.10 This is further sustained by ontogenetic considerations about, on the one hand, the acquisition of concepts and words, and thinking on the other. It seems relatively straightforward that in order to learn a language, the young child must be able to reect on and hypothesize about the meanings and correct applications of the words that she hears. To be able to achieve this, however, the child needs to be able to possess certain concepts and entertain thoughts. This conceptual point is supported by empirical evidence showing that thinking and the possession of concepts precede the acquisition and mastery of words (Hespos and Spelke 2004; Bloom 2000a, b). Still, a CT theorist could counter this in several ways. One way would be to argue that these mainly phenomenologically-based ndings miss the target because positing that words are the vehicles of thoughts is a theoretical matter about subpersonal phenomena. But this objection would fail, because CT needs to assume that the relevant mechanisms are available for conscious thought. A second, and more successful, way would be to argue that these empirical results are in principle compatible with CT. CT could simply relax its claim, and maintain that not all, but in a good deal of cases, words are involved in our thinking. This move would as such not be devastating for CT, but it would introduce further insecurities. CT would have to specify whether and why automatic thoughts belong to the realm of thinking that involves representing propositional content. Also, given that CT maintains that patients have to learn to identify automatic thoughts, it would have to be claried how the patient would identify thoughts that involve words and further distinguish between automatic and non-automatic ones. However, there is another critical problem that is more damaging to CT. I want to argue that even if we assume that the patient reliably identies automatic thoughts involving words, we need to distinguish between those cases in which these words have a constitutive or merely an accompanying role. As I will show in the following, while the constitutive story is very difcult to establish, it is nevertheless the one that CT both assumes and needs to assume. 3.2.1 Words: Constitutive or Accompanying Role? Consider the following example. Our cab driver is a rather unorganized man, who often forgets to lock the door of his car in spite of knowing that the city he lives in has exceptionally high rates of car theft. Both his employer and his wife have unsuccessfully warned him several times that if he continues his forgetful habit, it is only a matter of time until he will have his car stolen. One day, returning to the car
In these studies, normal subjects wore a paging device, which would randomly beep throughout the day. Somewhat similar to patients in a CT informed therapy session, the subjects participating in these studies were asked to stop and record the thoughts that they had during the activation of the device. What subjects report is that besides inner speech and visual imagery, they also experience unsymbolized but determinate thoughts - such as wondering whether or not to purchase a particular item in a supermarket in the absence of any visual imagery or inner speech (Heavey and Hurlburt 2008, 802). Moreover, the authors have detected a signicant negative correlation between inner speech and unsymbolized thinking. This means that individuals have a relatively stable propensity towards different thinking patterns. Those who report frequent cognitive activity in which words and proposition constitute the vehicles of their thoughts have at the same time relatively few instances of unsymbolized thinking.
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park from his lunch break, the unlocked car is gone. The rst thought that comes to his mind is, I had that coming. Now, the rst issue I want to demonstrate with this example is that it is difcult to tell whether the proposition involved (the resounding words I had that coming) can be said to constitute the cab drivers thinking. When the thought resounds, he may likely be imagining telling the episode to his wife or employer. In that case, it is questionable whether the resounding words I had that coming are the indispensible vehicles of his thought. But in case he is imagining himself speaking, then the resounding words have an accompanying role, simply adding a meta-level to his thinking (see Davies 1998). This would be both consistent with the conceptual analysis presented earlier (3.1) and also with the view that words and language are not necessary for thought, but only for meta-level thought (Smith 1998, 407). The point is that without further evidence, there is no obvious reason to assume that the resounding words constitute his thinking. In support of this, one may make a stronger argument: when the cab driver hears himself inwardly uttering I had that coming we cannot even securely assume that he is aware of a genuine mental episode of thinking. Byrne (2011, 115) compares inwardly and outwardly uttered sentences and argues that the outer utterance is not itself an episode of thinking, but something produced by such an episode; likewise, if there were () an inner utterance it wouldnt be an episode of thinking either. Thus, using Byrnes idea, we could argue that what the cab driver is really aware of when he hears himself inwardly uttering I had that coming is not the thinking process itself, but rather its product. Byrnes reections usefully complement the arguments presented earlier, but his position is stronger than the one I am trying to defend. While he subscribes to the view that inwardly-uttered words cannot be taken to constitute the vehicles of thought, Byrne seems to deny that they can be parts of the thinking itself. My suggestion is more modest, maintaining that at least in some of those cases in which words resound in our heads, the words in question only play an accompanying role in our thinking, rather than constituting it.11 Also, I am not claiming that it cannot be claried whether a resounding thought has an accompanying or constitutive role. Rather, the point is that it would take exactly the kind of (not insignicant) interpretative effort that CT wants to avoid (see more on direct versus interpretative retrieval in 3.3). A CT theorist might reply that it does not really matter whether the resounding thought constitutes or merely accompanies thinking. She might remind us that what really matters is that these thoughts are generated by a (negative) schema and that they can be used to detect that schema. Nonetheless, this objection is not entirely convincing. If one assumes that the resounding thought in question merely accompanies thinking, then it is doubtful whether it would necessarily or even just reliably reveal underlying schemas. Here is why.
11 The view that thinking does not necessarily involve words is less bold than the idea that not all thinking may involve concepts. The latter view has been put forward by Bermudez (2003), emphasizing non-conceptual processes of representation that are not constrained by the range of concepts possessed by the cognitive agent. Similarly, Evans (1982) has written about the possibility that cognitive activity may involve non-conceptual content.

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Let us imagine that our cab driver felt depressed and consulted a CT-informed therapist. When talking about the episode when his car was stolen, the therapist asks him What went through your mind? He replies: I had that coming. Now let us assume that the words in question (we are now assuming that they resound) play a merely accompanying and not constitutive role. The difculty we then face is as follows: If the resounding thought only accompanies thinking, for example, if he is thinking by imagining himself speaking about the episode, then it is an instantiation of thinking that is located at a higher level of thought, and the connection to an underlying schema becomes more uncertain. Put differently, it then becomes implausible to think that the thought necessarily (or even reliably) reveals or reects an underlying schema. So in order to avoid potential misunderstandings, and to maximize the reliability of the CT therapists judgment, it is safer if the therapist only infers an underlying schema in cases in which the resounding thought has a constitutive role. 3.3 We have Direct Access to our Thoughts Besides the CT conjecture about the vehicles of thought, the idea that patients can catch (Beck; JS Beck) the precise wording of their automatic thoughts relies on an additional assumption. That is, the assumption about a vehicle of thought is complemented by an assumption about access to our thoughts. Recall that the patient is instructed not to interpret, but to simply observe introspectively and report the actual words that go through her mind. This is something that patients usually have to get used to: Until they have learned to recognize these thoughts, many patients report interpretations, which may or may not reect the actual thoughts (Beck 1995, 88 emphasis in original). This, however, relies on the assumption that we must have direct (unmediated, non-interpretative) introspective access to our thoughts. If the claims and recommendations of CT are coherent, then CT has to rely on the assumption that by introspection we can bring our thoughts into awareness directlythat is, unaltered, unpolluted by any process of interpretation. To be clear, the point is not that CT assumes that there are completely unpolluted thoughts. Evidently, CT maintains that thoughts are polluted, namely by the underlying schemas. My point is, rather, that CT assumes that the introspective retrieval brings thoughts into awareness unpolluted by any additional process of interpretation. One major aw in the assumption of direct access is that it neglects the authority and agency that we entertain towards our mental states. When we bring aspects of our mental life to consciousness, we are not merely something like an expert witness of our mental states. Rather, the identity of a given inner entity depends on our interpreting it by applying conceptual and descriptive resourcesa process that involves a stance of agency (Moran 2001, 4; 42). Bringing into play both the issue of the constituting agency of the person and the dynamic relation between rst-person reection and mental life, Moran (2001, 28) shows that acquiring knowledge of our inner life is not a perception-like and relatively neutral epistemic undertaking of an expert witness, but a process that has specic, formative consequences for the object of introspective retrieval. In such a process, we do not

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merely report, but, rather, shape (pollute) and sometimes co-constitute the state in question. Thus, in those cases in which answering the question Do you think that P? involves an introspective process, the introspection shapes and alters the content in question (Moran 2001, 40).12 Mental states are far from being independent and stable entities that await introspective discovery. Rather, they are polluted by introspection as mental states are dynamically intertwined with our rst-personal agency.13 The CT theorist might object that I am attributing a view to CT that is stronger than what it needs to assume.14 She could relax the claim and concede that there is always some kind of interpretation involved. She could argue that CT only needs to assume that introspective reports of the patient can sometimes, or in principle truthfully reect how the patient feels. However, this would be too imprecise. Recall that according to CT, affective states (how the patient feels) do not necessarily reect the underlying schemas. While it is important to know how the patient feels, bear in mind that in CT, it is not so much the way the person is feeling that is taken to reveal insight about the schemas. Rather, and crucially, CT maintains that it is the automatic thoughts (which cause the emotions) that really offer the relevant insight. Therefore, the CT theorist must embrace more than the simple and trivial claim that introspective reports can sometimes accurately reect how a person is feeling. There is, however, another way in which the CT theorist could acknowledge the role of interpretation and relax the relevant claim. She could argue that CT only needs to assume that introspective reports of the patient can sometimes, or in principle, truthfully reect the patients automatic thoughts. There is something right about this objection. Surely, some reports are more accurate than others. But this is also a quite substantial concession that introduces signicant uncertainties into the therapeutic setting. How is the patient or the therapist to decide whether a report is more direct in the sense of involving a minimal amount of interpretation? Given such insecurities, under what circumstances is it warranted to infer an underlying schema? Thus, while it is in principle possible for the CT theorist to concede the role of interpretation and relax the relevant claim, this would be bought at relatively high price.
12 It should be noted that Morans view of rst-personal agency is weaker than constitutivist views, such as the one defended by Crispin Wright. 13 Of course, this goes for both symbolized and unsymbolized thought. But it is even more straightforward that we cannot be said to have direct access to our unsymbolized thoughts. Carruthers (2009) has criticised Hulburts understanding, suggesting that when prompted by the beep, subjects turn their mindreading systems on their own behavior and circumstances , often enough interpreting themselves as entertaining a specic thought. The point that Carruthers tries to convey is that unsymbolized thoughts are in the periphery of our awareness in a way that making sense of them necessarily involves some kind of self-interpretation. But independent of Carruthers pointwhich depends on a certain conceptualization of the mindit does seem rather unproblematic to hold that since neither the content nor the vehicles of unsymbolized thinking are of propositional nature, our communicating their content will always be indirect, involving some kind of translation into words and propositions. Of course, none of this commits me to the idea that we do not have a direct or unmediated understanding of our unsymbolized thoughts. The point so far is merely that our communicating their content will always be indirect. 14

I thank an anonymous reviewer for putting forward this objection.

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3.4 Cognitions Cause and/or Constitute Emotions After having considered the assumptions of CT that relate to the topics of cognition, mental representation and introspection, the focus of the remaining part of this section will be on cognition and emotions. The rst point that I shall make is that CT subscribes to a general cognitivist view of emotions, which explains the emotion by attitudes directed at a proposition, while bodily feelings are in no way essential (see de Sousa 2010). A central assumption of CT is that emotional disturbances like feelings of guilt, anxiety, and despair in depression can be traced back to a specic constellation of thoughts and beliefs. Within the general view of depression as a disorder of thought (Beck and Alford 2009, 208, 239), it is possible to identify in CT both the claim (a) that thoughts, beliefs, or judgments cause emotions and (b) that they constitute emotions. (a) As to the causal claim, Beck and Alford explicitly maintain that the affective disturbance, in such forms as low mood and anxiety is the consequence of cognitive activity (Ibid., 231): the typical depressive affects are evoked by the erroneous conceptualizations (Ibid., 209). In all, there is primarily a disorder of thought with resultant disturbance affect and behaviour in consonance with the cognitive distortions (Beck and Alford 2009, 208). While it is indisputably the case that sometimes emotions are caused by cognitive activity, the CT picture on causation is too crude. First, we must remember that non-cognitive causal factors can trigger emotions. For instance, anxiousness can be caused by an excessive consumption of beverages that are rich in caffeine, just as feeling sad may be the outcome of consuming alcohol or fatigue (Prinz 2004). Second, given the enormous amount and variety of processes covered by the term cognition, it is rather obvious that not every token cognitive activity is necessarily efcacious. It is possible to hold a relevant belief or judgment while not being in the matching emotive state (Robinson 2005, 26). The cab driver may believe that leaving the car unlocked is dangerous, while not fearing that the car might be stolen. Third, even in the case of causally efcacious cognitive activity, the picture is much more complex than what is depicted in CT. For instance, the same judgment with the same propositional content may sometimes generate anger, but sometimes anxiety or sorrow, or even a dispassionate shrug of the shoulders. In all, the CT claim that affective disturbances are caused by cognitive activity is very problematic. (b) A CT defender may object and argue that CT does not really need the causal account for its aims. Instead, it only has to claim that emotions are constituted by thoughts, beliefs, or judgments. According to the view that emotions are constituted by thoughts, beliefs, or judgments, the anger I feel toward a friend of mine simply is the judgment that he has wronged me, while my embarrassment is identical with my judgment of being in an awkward situation (Solomon 1976, 187; Neu 2000; Nussbaum 2001; Marks 1982).15 Subscribing to the constitutional view, the CT theorist may claim that if emotions are constituted by thoughts, beliefs, or
15 Of course, some positions are slightly more complicated. For instance, in order to be able to attribute emotions to infants and animals, Nussbaum (2001) allows for some propositions to be preverbal. However, this redenition may result in a very vague concept of propositions (de Sousa 2004).

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judgments, then modication in the judgment will ipso facto generate a change of emotion.16 The CT theorist could argue that the constitution view would be consistent with the CT idea that clients should be corrected when describing their experiences by using I feel Beck et al. (1979), 37). Therapists are instructed to help patients translate I feel into I think or I believe (Beck et al. 1979; Beck 1995; Beck and Alford 2009). For example, the patient might say: So, during the course of the day, driving into work, being at work, I was just in a nervous state. Not in extreme panic, but just in a nervous state. A feeling of, like, I dont know if I want to stay here or if I want to go (Scott et al. 1991, 18). The therapist answers and translates the patients report into a cognitive vocabulary: You had automatic thoughts like I dont know if I want to go or stay at work? (Ibid., 18). There are several ways in which the CT theorist could esh out a constitutive view (see Debes 2009). The strongest version holds that emotions both are evaluative judgments (reductive identity) and that they are type-identiable by the content of those judgments or beliefs. Slightly less strong, she could claim that emotions are both essentially constituted (though not exhausted) by evaluative judgments or beliefs and type-identiable by the content of those judgments or beliefs. In the weakest version, she could claim that emotions are essentially constituted (though not exhausted) by evaluative judgments or beliefs, though without being differentiated by their cognitive contents. As I see it, CT only needs to assume the weakest version of the constitution viewa move that would save it from a great deal of problems. CT may thus grant that emotions are not necessarily type-identiable by the evaluative, propositional component involved, or that the emotion is identical with or exhausted by the evaluative component (for a critique see Ben-Zeev 2004; Goldie 2000). Nonetheless, the weakest view is also vulnerable to severe criticism. One very simple problem for this view is that possessing particular judgments is neither necessary nor sufcient for having an emotional state (Stocker and Hegeman 1992; Tappolet 2003).17 In other words, it is possible to be in an emotional state without holding the relevant judgment. For instance, feelings of fear toward some object do not necessarily involve assenting to the object being dangerous (Goldie 2000; BenZeev 2000; Elster 2003). In addition, the body of work on affect programs by psychologists like P. Ekman and R.B. Zajonc and philosophers like DeLancey
16 Matthew Ratcliffe has righty pointed out (personal communication) that CT does not actually need to commit to the strong cognitivist view that beliefs precede emotions and that emotions are themselves cognitive states. Instead, it could maintain that emotions entail evaluations, but resist the nal assumption that these evaluations are judgments (or beliefs involving propositional content), and settle with the view that changes in belief can inuence emotions. However, while this would indeed be an alternative, it is nevertheless not endorsed in CT. A speculative answer as to why, could be that it would weaken the positions of CT. But also, even if CT theorists would take this option, CT would still be susceptible to the rest of the criticism in this paper. 17 Additionally, research in neuroscience indicates that affective responses can and do operate prior to and without the involvement of cognitive processing. Emotions can be experienced without cognitive processing and they actively inuence such processes (LeDoux 1996; Damasio 1994/2006; 1999). In this context, cognition is taken to denote thinking activity, and not merely simply any processing of information about the world (which would include perception). Such evidence is in contradiction with the assumption of a cognitivist view of emotions in which changes in belief precede emotional changes.

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(2002), DArms and Jacobson (2003) and Prinz (2004) contains substantial evidence about the automated and non-cognitive nature of emotional response systems. Thus, even the weakest notion of the constitution view is susceptible to substantial criticism. The issues raised in (a) and (b) have implications for our context. For instance, a client reports about her horrible day at work where she suffered feelings of inferiority and constantly felt outperformed by her co-workers. When asked what she was thinking, her answer is I felt so stupid and worthless. Typically, the therapist would correct her, and encourage her to say instead I thought I was stupid and worthless, either because this thought is regarded as causing or as constituting the emotional experience.18 However, given that thoughts need not necessarily stand in either causal or constitutional relation to emotional states, this patients emotional experience does not have to involve her thinking that she is stupid and worthless. But if this is right, the strategy might be misleading and lastly ineffective. First, it may be misleading to persuade the patient to switch to using cognitive vocabulary. For example, it may very well be that the utterance I felt so stupid and worthless is expressive (in the sense dened in 3.1 and thus not a report) and conveys a confusing emotional experience that she underwent. In that case, her original description is the more accurate one, and the correction may take her further away from the original experience. Second, in cases of this type, the translation into a cognitive vocabulary and the attempt to neutralize the relevant thought is unlikely to be effective and result in relief. It is important to emphasize that nothing I have said entails denying that cognitions may cause or constitute certain emotions and emotions disturbances. Sometimes this may very well be the case. However, in order to make out whether this is the case, it is of utmost importance to provide a more profound interpretation of the reports, taking into account a variety of contextual elements. This adds to the complexity of the interpretational task as (very roughly) laid out in Sect. 3.1. 3.5 Cognitive Schemas Constitute the Fundament of our Thinking Cognitive theory rightly maintains that experience does not take place in a world that is neutrally disclosed, but in one where we always already are anchored by our cognitive schemasstored bodies of fundamental, background beliefs that interact with the incoming information and shape and frame experience (Beck and Alford 2009, 255; Williams et al. 1997). The schemas constitute the tacit background of experience and the framework of intentional experience. What CT also says is that in depression-prone individuals this interpretive framework is unrealistically negatively biased, resulting in catastrophic interpretations of an occurring situation. At the same time, the relevant schema rationalizes the catastrophic interpretation. Thus far, this idea calls into mind Wittgensteins work on certainty and hingepropositions (Wittgenstein 1969). He famously argued that at the fundament of our
18 Beck (et al. 1979, 37) specically emphasizes that clients should be corrected when describing their experiences by using I feel. Rather, therapists are instructed to help patients translate I feel into I think or I believe (Beck et al. 1979; Beck 1995; Beck and Alford 2009).

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world-relation, there are certain types of beliefs (hinge-propositions), which make up a rather permanent backdrop of certainty (Ibid., 115, 150, 283, 472477) that even skeptics must rely on. What is special about these beliefs is that they do not always rely on justication by other beliefs: they are immediately warranted, epistemically basic, and the certainty we connect to them does not stem from their role within our framework of beliefs. However, discussing Wittgensteins use of the term hinge-proposition also sheds light on some of the challenges that the idea of cognitive schemas face. Looking closer on Wittgensteins hinge-propositions reveals that these are not clearly propositional and belief-like as other beliefs,19 and, therefore, some argue that hinge-propositions are linked to and embedded in practice (Moyal-Sharrock 2003; Varga 2012). The background that frames everyday experience and the realness that usually characterizes experience is not merely grounded in beliefs but, rather, in our practical relation to the world revealed in our patterns of actions. While hinge-propositions on this interpretation are themselves embedded in something more fundamental, we might start suspecting an analogous case with cognitive schemas. While the level of practice is undoubtedly a part of the background of experience and thinking, what I want to add here is that cognitive schemas are also embedded in tacit background emotions. As we shall see, for an adequate understanding of the activation pattern of cognitive schemas, we need to take into account this embeddedness. 3.5.1 Background Emotions Very roughly, background emotions are inconspicuous background states that are less intense then what we usually consider as moods (Damasio 1999, 341; Lane and Nadel 2000; Ratcliffe 2005; 2008).20 As with being in a mood, we only have a subtle awareness of a background emotion, but when prompted, we are usually able to report on its quality instantly. Matthew Ratcliffe has provided an excellent phenomenological study of such subtle emotions that include the feeling of being on top of things, being strong and full of energy, being in danger, or being distant and cut off from the world (Ratcliffe 2005, 2008, 2010). These emotions not only colour our experience, but have far more important roles to play. Similar to the way in which Martin Heidegger has famously described moods, they disclose to us our Being-in-the-world as a whole and create frameworks of signicance that structure our experience and make it possible for us to direct ourselves towards something (Heidegger 1963, 172). Such tacit background states bestow the world with a sense of practical signicance. Roughly, one may say that these fundamental emotions frame experience and provide an affective background orientation by constituting a space of signicant possibilities that afford certain actions. For instance, the subtle feelings of being on top of
19 20

Some of his examples are not propositional, like the certainty of the sense of ownership of body parts.

As Damasio (1994/2006) has expressed it, a background feeling is not the Verdi of grand emotion, nor the Stravinsky of intellectualized emotion but rather a minimalist in tone and beat, the feeling of life itself, the sense of being.

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things, or being in danger may have us in its grip to the extent that it permeates the cognitive and evaluative aspects of our experience (Ratcliffe 2005, 2008). Such background emotions structure the pool of meaningful possibilities and shape practical comportment. Somebody feeling on top of things will have a propensity towards holding certain beliefs about herself and the world, for instance, seeing herself invincible and the world as a place in which her plans can be effortlessly realized. But in addition to such an orienting role, Damasio (1994) points out that background emotions also enable the proper functioning of cognitive and deliberative skills. He draws on neurological phenomena that cannot be fully explained within the traditional framework that assigns primacy to cognitive approaches. One of Damasios conclusions is that background emotions constitute something like the context in which cognition takes place. Drawing on Damasios work, Matthew Ratcliffe has argued that background emotions are essentially embodied, which also means that the way the body feels and how the world is experienced (as the inhabited space of possibilities) are not two different things, but rather two inextricable aspects of the same experiential structure (Ratcliffe 2005, 49; also Drummond 2004, 115).21 The space of possibility for experience is constituted by bodily potentialities, so that an altered feeling in the body is at the same time a change in the space of possibility.22 For instance, the background emotion feeling low is both characterized by the way in which the world appears, namely as lacking attractive affordances, and the way the body feels: slow and heavy. Meier and Robinson (2005) have found empirical evidence that supports such a view. On the basis of these results, referencing a study of simple vertical selective attention tasks, they argue that emotional states like feeling down are intrinsically linked to specic bodily postures (like looking down).23 The most important point emerging here is that embodied background emotions are not just adding some emotional color to objects that are already present through
At this point we depart from Damasios theoryone that only acknowledges the role of the body in the form of somatic markers. Many have critiqued this view for thinking in dualistic terms and separating mental and somatic aspects, and for envisaging emotions as representational events taking place in the brain (Spackman and Miller 2008; Gallagher 2005).
22 Phenomenologists (and more recently enactivist approaches to cognition [Noe 2004]) have emphasized that the lived body is not just an object of experience, it also has a decisive role in structuring experience and the range of possibilities that we perceive. For instance, integral to experiencing an object, there is a perceived range of salient possibilities. When looking at the laptop in front of me, it appears as something that could be worked on and manipulated in certain ways. Such clusters of experiential possibilities make up the horizons of objects, which are not only perceived visually but above all feel like bodily potentialities. In the perception of an object, there is a bodily sense of being able to reveal hidden features of the object and to be able to act upon it in various ways. So the body is not only the matching part of ordered horizons, but also indissociable from such horizons. At the same time, the body is of central relevance to background emotions. Its role is not exhausted by its relation to specic horizons of possibilities of particular entities; it also relates to the world-horizon of pre-givenness that, for Husserl, allows individual entities to appear in the rst place (Husserl, Hua VI, 146, 267). 23 21

Some additional supporting evidence can be found in the work of Lakoff and Johnson (1999) and Johnson (1987), who suggest that emotional experiences are usually expressed by employing bodily and spatial metaphors. It is easy to see that positive emotions typically refer to high vertical positions. When experiencing positive emotions we tend to speak of feeling up or high, while we speak of feeling down or low when undergoing negative emotion.

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cognition. Rather, they fundamentally shape cognition and tacitly structure and coconstitute experience. Taking this seriously, we may argue that this also means that background emotions to a certain extent constitute the framework in which the cognitive schemas occur. This view can be additionally supported by phenomenological and empirical arguments. Let us see how. First, this view squares easily with the relevant phenomenology. For instance, having a background emotion that is characterized by general anxiousness towards the world usually comes with a propensity towards holding certain basic beliefs about oneself and the world, as vulnerable to dangers that one tends to see everywhere. Or, more moderately, we can say that such a background emotion amplies those past experiences in which such vulnerability to dangers has been conrmed. At the same time, when having such a background emotion, one is specically susceptible to feelings of fear that one otherwise would be able to regulate and to hinder from guiding action. Additional evidence for the embeddedness of beliefs and schemas in background emotions comes from psychopathology. Ratcliffe (2005, 2008) has argued that pathologically altered background emotions that lack certain qualities may lead to delusional beliefs. If this is right, then it is plausible that the background beliefs or schemas that CT considers to cause the pathological emotional episodes are not simply there as brute facts regulating our inner life at the fundament of our world-relation. Instead, their presence and impact are themselves dependent on the background emotions that frame them. This view is additionally conrmed by the work of Teasdale and Barnard (1993). These authors note that one problem with the CT assumption that vulnerability to depression depends on individuals underlying dysfunctional background beliefs is that it has not been demonstrated that vulnerable individuals remain committed to these beliefs once their depression has remitted.24 Thus, once the patients no longer suffer from the affective disturbances in depression, the relevant negative or dysfunctional background beliefs cease to be active or existent. Therefore, the evidence shows that rather than being enduring characteristics of vulnerable individuals, such beliefs are habitually mood-state dependent (Teasdale 1993; Teasdale and Barnard 1993). If it is correct that schemas are themselves embedded in background emotions, than this has serious consequences that CT needs to take into account. For instance, it needs to be taken into consideration that schemas in depression may in themselves not be dysfunctional, but rather intelligibly embedded in a particular (dysfunctional) background emotion. In other words, their dysfunctional nature may stem from their being embedded in a particular background emotion. But then, CT needs to accommodate that the adequate explanation of the dysfunctional response patterns must take into account such non-cognitive aspects.25 In addition, another
24 25

For a philosophical critique of their account see Charles 2004 paper Emotion, Cognition and Action.

Whiting (2006a, b) has rightly argued that there are some cases in which the explanation of dysfunctional response patterns must be non-cognitive. He has noted that sometimes our thoughts depict or represent the world accurately, but our emotional response is inappropriate or out of control, in which case it may be inadequate to aim at cognitive alterations. I am making a related point here, but note that the point of departure is very different. In each case that Whiting depicts, experience starts with representations that then elicit certain evaluations and/or emotional responses. The view that I am

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consequence is that the therapeutic alteration of such patterns and the alleviation of the emotional disturbance may consist in working with the (background) emotions themselves instead of focusing on cognitions. Of course, the identication of cognitive schemas is an important step toward mapping the cognitive landscape of the patient, itself a vital instrument of psycho-education. However, its value is somewhat limited if the role of background emotions is not taken into consideration.

4 Towards a More Precise CT So far, this paper has mainly been concerned with testing the underlying philosophical assumptions of CT, but it has also pointed out where CT needs revision and what such revision should best entail. Such revision is likely to be extensive. On the one hand, it would involve correcting assumptions about cognitive processes, mental state attributions, mental representations, and background emotions. On the other hand, it would involve paying less attention to the content of mental representations and more to the role of interpretation. Such revision will not only secure philosophical accuracy, but may also help provide an account that is better suited to explain some of the cognitive, emotional, and bodily manifestations in affective disorders. Furthermore, the revised account could still count as sort of CT, since none of the arguments presented here deny that beliefs have an important role to play in depressive states. Indeed, beliefs can and do contribute to sustaining background emotions, and the fact that fundamental beliefs arise in the context of background emotion does not mean that they cannot affect them. In the remainder of the paper, given the constraints of space, I will make admittedly tentative suggestions of how a corrected CT would have several advantages and could provide the basis for a more precise understanding of patients utterances in a therapeutic encounter. First, upon such a correction, the bodily aspects of depression could be accounted for in a more adequate and direct manner (a). Second, some of the described problems that CT runs into could be avoided (b and c). Let us see how. (a) As noted earlier, CT is in striking contradiction with the embodied nature of background emotions, since it regards the bodily aspects of emotions and affective disturbances, like somatisation and motor retardation, as (at best) secondary compared to automatic thoughts and fundamental beliefs (Beck and Alford 2009, 244). However, the bodily experience is not only an inextricable part of the emotion itself, but sometimes it is the most salient feature of it. In that case, focusing on the bodily changes may help reveal the background emotion that one is going through. For instance, parallel to low moods, depressive patients often complain about motor retardation and about general states of all-encompassing bodily uneasiness in which the body feels object-like and conspicuous (Fuchs 2003, 2005; Ratcliffe 2009). An
Footnote 25 continued stressing is different in that I take representation to already be imbued with an embodied background emotion. Such a point of departure leads into a different explanation, but one that is compatible with Whitings account.

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advantage of such a changed view is that complaints about motor retardation or bodily conspicuousness, and the tacit quality of the low emotional experience, need neither be understood as distinct phenomena, nor in causal terms. The background low emotion in which everything is permeated by a sense of meaninglessness and lack of possibilities, and the object-like and conspicuous sense of the body (through which we usually actualise those possibilities), may simply be different sides of the same experience. In the corrected view, such bodily feelings need not be distinguished from altered experiences, and we need not say that it is beliefs formed on the basis of experiences that slow down the body. If we understand the changed bodily feeling as a part of the altered experience, then in some cases the emotional experience of being irrevocably disconnected, cut off and alienated can become more conscious by focusing on the bodily side of the experience. This may specically apply to patients that are more comfortable with talking about bodily disturbances rather than emotional ones. (b) On the background of several points throughout the paper, it seems clear that a correction of CT would also have to involve allocating a different position for automatic thoughts. First, as seen in Sect. 3.1., the awed general assumption must be abandoned that thought always involves conscious mental representation. Besides this general point, special attention should be paid to the fact that a thought or a belief need not be constitutive of an emotion but might simply be expressive of it. Automatic thoughts could, in such a changed picture, be understood as expressions of a negatively altered background emotion that makes the horizon of possible experiences shrink into a locked atmosphere, characterized by a loss of meaningful practical possibilities. In this case, it is clear that if the therapist seeks to change the vocabulary and reduce the utterance of the patient I feel worthless to some kind of belief, then important aspects of a complex experience are lost. I feel worthless might harbour a much more complex relation to self and world than certain beliefs about the state of things. Referring to feelings might just be the most adequate means of expression of the transformation in the overall sense of being in the world rather than a change in belief. We have to keep in mind that such alteration encompasses a range of subtly different predicaments and it might be extremely difcult to convey it in terms of concrete differences in how things look. So while CT would attempt reduce I feel worthless to a distorted belief, in the corrected view, the same utterance might gure as a useful characterization of the altered background structure of experience. It may express that the world no longer offers the usual possibilities for activity, in the sense that possibilities for interaction that are inaccessible to the self, appear easily accessible to others. It may express alterations in the space of possibilities that involve feelings and thoughts of irrevocable isolation. A correct and nuanced understanding of such utterances may also be the rst step towards working with the background emotions themselves instead of focusing on cognitions. (c) Besides this loss, we have also seen how CTs intention to identify automatic thoughts and to correct and translate affective utterances in a cognitive vocabulary can lead to a variety of severe misunderstandings, which can be assumed to have a negative impact on the therapeutic outcome. A common problem is that if a patient

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is unable to identify explicit automatic thoughts resounding in her mind, the conclusion of CT is typically that they are simply not conscious enough. This conclusion is in striking contradiction to the patients awareness of her distress, which may then lead her to seek even harder, thus increasing the chance of a false recollection. It is already the case that due to the specic way of questioning and the power of the therapeutic encounter, clients do at times falsely recollect automatic thoughts (Power 2002, 2009). However, if some of the assumptions of CT are revised in the way indicated in this paper, then the problem of falsely recollected automatic thoughts might be reduced to a minimum. 5 Conclusion Undeniably, the cognitive conceptualization of emotions and affective disorders has led to a variety of theoretical, empirical, and therapeutic advances. However, given that CT constitutes the predominant paradigm in the understanding of affective disorders and psychotherapy, and given that the therapist more or less explicitly educates the patient to consent to this theory (psycho-education), it is important to assess the philosophical assumptions on which it is based. Therefore, this paper contained the identication and the assessment of basic assumptions, relating to philosophical issues of mental representation and introspection on the one hand (3.13.3), and emotion and cognition on the other (3.43.5). The general conclusion was that the philosophical basis of CT needs to be revised, and over the last pages the attempt was undertaken to briey sketch how this could be achieved and what advantages a corrected view would hold. Of course, much further work is needed. One interesting possibility to make progress would be to explore how my suggestions could be combined with models that work with multi-level accounts of emotion such as in Power (2009) and Power and Dalgleish (1999). In any case, the hope is that some of these thoughts may contribute to providing a clinically useful framework with which the emotional disorders can be understood.
Acknowledgments I would like to thank Matthew Ratcliffe, Daniel D. Hutto, George Graham, Achim Stephan, Stephan Blatti, Remy Debes, Luvell Anderson, Shaun Gallagher, Jennifer Radden and an anonymous referee for valuable comments and criticism.

References
Alford, A., & Beck, A. T. (1997). The integrative power of cognitive therapy. New York: Guilford Press. Beck, A. T. (1967). Depression: Clinical, experimental and theoretical aspects. New York: Hoeber. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press. Beck, A. T. (1983). Cognitive therapy of depression: New perspectives. In P. J. Clayton & J. E. Barrett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265284). New York: Raven Press. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford. Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatments (2nd ed.). Philadelphia: University of Pennsylvania Press. Beck, A. T., Rush, A. J., Shaw, B. F., et al. (1979). Cognitive therapy of depression. New York: Guilford Press.

123

Cognition, Representations and Embodied Emotions Ben-Zeev, A. (2000). The subtlety of emotions. Cambridge: MIT Press. Ben-Zeev, A. (2004). Emotions are not mere judgments. Philosophy and Phenomenological Research LXVIII, 2, 450457. Blatt, S. J. (2004). Experiences of depression: Theoretical, clinical, and research perspectives. Washington, DC: American Psychological Association. Bloom, P. (2000a). How children learn the meanings of words. Cambridge: MIT Press. Bloom, P. (2000b). Children think before they speak. Nature, 430, 410411. Bracken, P., & Thomas, P. (2008). Cognitive therapy, cartesianism, and the moral order. In R. House & D. Lowenthal (Eds.), Against and for CBT. Towards a constructive dialogue? (pp. 86100). PCCC: Hereforshire. Brewin, C. R. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765784. Byrne, A. (2011). Knowing that I am thinking. In A. Hatzimoysis (Ed.), Self-Knowledge (pp. 105124). Oxford: OUP. Butera, G. (2011). Thomas aquinas and cognitive therapy: An exploration of the promise of the thomistic psychology. Philosophy, Psychiatry, and Psychology, 17(4), 347366. Carruthers, P. (1996). Language, thought and consciousness: An essay in philosophical psychology. Cambridge: Cambridge University Press. Carruthers, P. (2009). How we know our own minds: The relationship between mindreading and metacognition. Behavioral and Brain Sciences, 32(2), 121138. Charland, L. C. (2006). The cognitive modularity of emotions. Canadian Journal of Philosophy 32, 213228 (Eds. L. Faucher, & C. Tappolet). Charles, David. (2004). Emotion, cognition and action. Royal Institute of Philosophy Supplement, 55, 105136. Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientic foundations of cognitive theory and therapy of depression. New York: Wiley. Clark, D. A., Beck, A. T., & Brown, G. (1989). Cognitive mediation in general psychiatric outpatients: A test of the cognitive content-specicity hypothesis. Journal of Personality and Social Psychology, 56, 958964. Clark, D. A., Beck, A. T., & Stewart, B. (1990). Cognitive specicity and positive-negative affectivity: Complementary or contradictory views on anxiety and depression? Journal of Abnormal Psychology, 99, 148155. DArms, J., & Jacobson, D. (2003). The signicance of recalcitrant emotions (or, anti-quasijudgmentalism). Philosophy, 52, 127145. Damasio, A. (1994/2006). Descartes error: Emotion, reason, and the human brain. New York: G.P. Putnams Sons. Damasio, A. (1999). The feeling of what happens: Body and emotion in the making of consciousness. New York: Harcourt Brace and Co. Davidson, D. (1987). Knowing ones own mind. Proceedings and Addresses of the American Philosophical Association, 60(3), 441458. Davies, M. (1998). Language, thought, and the language of thought (Auntys own argument revisited). In P. Carruthers & J. Boucher (Eds.), Language and thought (pp. 226247). Cambridge: Cambridge University Press. de Sousa, R. (2004). Sex, drugs and Mahler. Reections on Martha Nussbaums. Upheavals of Thought. Rretrieved on March 2013 from http://homes.chass.utoronto.ca/*sousa/UPHEAVALS-APA.pdf. de Sousa, R. (2010). Emotion. In E. N. Zalta (Ed.), The stanford encyclopedia of philosophy. URL http://plato.stanford.edu/archives/spr2010/entries/emotion/. Debes, R. (2009). Neither here nor there: The cognitive nature of emotion. Philosophical Studies, 146(1), 127. DeLancey, C. (2002). Passionate engines. New York: Oxford University Press. DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9, 788796. Dobson, K. S. (Ed.). (2010). Handbook of cognitive behavioural therapies. NY: Guilford Press. Dobson, K. S., & Dozois, D. J. A. (2010). Historical and philosophical bases of the cognitive- behavioral therapies. In K. S. Dobson (Ed.), Handbook of cognitive behavioural therapies (pp. 238). NY: Guilford Press.

123

S. Varga Dreyfus, H. L. (2004). A phenomenology of skill acquisition as the basis for a Merleau-Pontian nonrepresentationalist cognitive science. http://web.archive.org/web/20061216075452/ist-socrates. berkeley.edu/*hdreyfus/pdf/MerleauPontySkillCogSci.pdf. Drummond, J. J. (2004). Cognitive impenetrability and the complex intentionality of the emotions. Journal of Consciousness Studies, 11(1011), 109126. Dryden, W., David, D., & Ellis, A. (2010). Rational emotive behavior therapy. In K. S. Dobson (Ed.), Handbook of cognitive behavioural therapies (pp. 226276). NY: Guilford Press. Elster, J. (2003). Emotion and action. In R. C. Solomon (Ed.), Thinking about feeling: Contemporary philosophers on emotions. Oxford: Oxford University Press. Epp, A. M., & Dobson, K. S. (2010). The evidence base for cognitive-behavioral therapy. In K. S. Dobson (Ed.), Handbook of cognitive behavioural therapies (pp. 3973). NY: Guilford Press. Evans, G. (1982). The varieties of reference. Oxford: Oxford University Press. Freeman, A., Simon, K. M., Beutler, L. E., & Arkowitz, H. (Eds.). (1989). Comprehensive handbook of cognitive therapy. New York: Plenum. Freeman, A., et al. (2005). Encyclopedia of cognitive behavior therapy. New York: Plenum Publishing. Fuchs, T. (2003). The phenomenology of shame, guilt and the body in body dysmorphic disorder and depression. Journal of Phenomenological Psychology, 33, 223243. Fuchs, T. (2005). Corporealized and disembodied minds: A phenomenological view of the body in melancholia and schizophrenia. Philosophy, Psychiatry & Psychology, 12, 95107. Gallagher, S. (2005). How the body shapes the mind. Oxford: Oxford University Press. Ghaemi, S. N. (2007). Feeling and time: The phenomenology of mood disorders, depressive realism, and existential psychotherapy. Schizophrenia Bulletin, 7(33), 122130. Gilson, M., Freeman, A., Yates, J., & Morgillo Freeman, S. (2009). Overcoming depression: A cognitive therapy approach therapist guide. NY: OUP. Goldie, P. (2000). The emotions: A philosophical exploration. Oxford: Clarendon Press. Hammen, C. (1997). Depression. Hove: Erlbaum. Heavey, C. L., & Hurlburt, R. T. (2008). The phenomena of inner experience. Consciousness and Cognition, 17, 798810. bingen: Niedermeyer. Heidegger, M. (1963). Sein und Zeit. Tu Hespos, S. J., & Spelke, E. S. (2004). Conceptual precursors to language. Nature, 430, 453456. Hollon, S. D., & Beck, A. T. (2004). Cognitive and cognitive behavioral therapies. In M. J. Lambert (Ed.), Bergin and Garelds handbook of psychotherapy and behavior change (5th ed., pp. 447492). New York: Wiley. Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4, 383395. Holmes, J. (2001). All you need is CBT. British Medical Journal, 324, 288294. Holmes, J. (2010). Psychoanalysis and CBT: Conuence of theory, watershed in practice. In D. Loewnethal & R. House (Eds.), Critically engaging CBT (pp. 1832). NY: McGraw-Hill. Hurlburt, R. T. (1990). Sampling normal and schizophrenic inner experience. New York: Plenum Press. Hurlburt, R. T. (1993). Sampling inner experience in disturbed affect. New York: Plenum Press. Hurlburt, R. T., & Akhter, S. A. (2008). Unsymbolized thinking. Consciousness and Cognition, 17, 13641374. Hurlburt, R. T., & Heavey, C. L. (2002). Interobserver reliability of descriptive experience sampling. Cognitive Therapy and Research, 26, 135142. Hurlburt, R. T., & Heavey, C. L. (2004). To beep or not to beep: Obtaining accurate reports about awareness. Journal of Consciousness Studies, 11, 113128. Hutto, D. D. (1999). Cognition without representation. In A. Riegler, M. Peschl, & A. von Stein (Eds.), Understanding representation in the cognitive sciences: 33 does representation need reality?. New York: Kluwer Academic/Plenum Publishers. Hutto, D. D. (2008). Limited engagements and narrative extensions. International Journal of Philosophical Studies, 16(3), 419444. Johnson, M. (1987). The body in the mind: The bodily basis of meaning, imagination, and reason. Chicago: University of Chicago Press. Keijzer, A. F. (1998). Doing without representations which specify what to do. Philosophical Psychology, 11(3), 269302. Kovacs, M., & Beck, A. J. (1978). Maladaptive cognitive structures in depression. American Journal of Psychiatry, 135, 525533.

123

Cognition, Representations and Embodied Emotions Kuyken, W., Watkins, E., & Beck, A. (2005). CBT for mood disorders. In G. Gabbard, J. Beck, & J. Holmes (Eds.), Oxford textbook of psychotherapy (pp. 111126). Oxford: OUP. Lacewing, M. (2004). Emotion and cognition: Recent developments and therapeutic practice. Philosophy, Psychiatry and Psychology, 11(2), 175186. Lakoff, G., & Johnson, M. (1999). Philosophy in the esh: The embodied mind and its challenge to western thought. New York: Basic Books. Lane, R. D., & Nadel, L. (2000). Cognitive neuroscience of emotion. Oxford: OUP. LeDoux, J. E. (1996). The emotional brain. New York: Simon & Schuster. Malcolm, N. (1972). Thoughtless brutes. Proceedings and Addresses of the American Philosophical Association, 46, 520. Marks, J. (1982). A theory of emotion. Philosophical Studies, 42, 227242. McEachrane, M. (2003). Capturing emotional thoughts. The philosophy of cognitive-behavioral therapy. In Y. Gustafsson, C. Kronqvist, & M. McEachrane (Eds.), Emotions and understanding: Wittgensteinian perspectives. Palgrave Macmillan, pp. 80101. Meier, B. P., & Robinson, M. D. (2005). The metaphorical representation of affect. Metaphor and Symbol, 20, 239257. Milton, J. (2008). Psychoanalysis and cognitive behaviour therapy: Rival paradigms of common ground? In R. House & D. Lowenthal (Eds.), Against and for CBT. Towards a constructive dialogue? (pp. 101117). Hereforshire: PCCC. Moran, R. (2001). Authority and estrangement: An essay on self-knowledge. Princeton NJ: Princeton University Press. Moyal-Sharrock, D. (2003). Logic in action: Wittgensteins logical pragmatism and the impotence of scepticism. Philosophical Investigations, 26(2), 125148. Neu, J. (2000). A tear is an intellectual thing: The meaning of emotions. Oxford, New York: Oxford University Press. Nussbaum, M. (2001). Upheavals of thought: The intelligence of emotions. Cambridge: Cambridge University Press. Newman, C. F. (2006). Substance abuse. In L. Leahy (Ed.), Contemporary cognitive therapy: Theory, research, and practice (pp. 206227). New York: Guilford. Padesky, C. A., & Beck, A. T. (2003). Science and philosophy: Comparison of cognitive therapy (CT) and rational emotive behavior therapy (REBT). Journal of Cognitive Psychotherapy: An International Quarterly, 17, 211224. Power, M. (2002). Integrative therapy from a cognitive behavioural perspective. In J. Holmes & A. Bateman (Eds.), Integration in psychotherapy. Oxford: OUP. lise Psicolo gica, 27(2), 127141. Power, M. (2009). Cognitive psychopathology: The role of emotion. Ana Power, M., & Dalgleish, T. (1999). Two routes to emotion: Some implications of multi-level theories of emotion for therapeutic practice. Behavioural and Cognitive Psychotherapy, 27, 129141. Prinz, J. (2004). Gut reactions: A perceptual theory of emotion. New York: Oxford University Press. Ratcliffe, M. (2005). The feeling of being. Journal of Consciousness Studies, 12(810), 4360. Ratcliffe, M. (2008). Feelings of being: Phenomenology, psychiatry and the sense of reality. Oxford: Oxford University Press. Ratcliffe, M. (2009). Understanding existential changes in psychiatric illness: The indispensability of phenomenology. In M. Broome & L. Bortolotti (Eds.), Psychiatry as cognitive neuroscience (pp. 223244). Oxford: Oxford University Press. Ratcliffe, M. (2010). The phenomenology of mood and the meaning of life. In P. Goldie (Ed.), Oxford handbook on emotion (pp. 349371). Oxford: Oxford University Press. Riskind, J. H. (2006). Cognitive theory and research on generalized anxiety disorder. In R. L. Leahy (Ed.), Contemporary cognitive therapy: Theory, research, and practice (pp. 6285). New York: Guilford. Robinson, J. (2005). Deeper than reason: Emotion and its role in literature, music, and art. Oxford, UK: Oxford University Press. Roth, A., & Fonagy, P. (2005). What works for whom? A critical review of psychotherapy research. New York: The Guilford Press). Ryle, G. (1949). The concept of mind. Chicago: University of Chicago Press. Safren, S. A., Heimberg, R. G., et al. (2000). Differentiating anxious and depressive self-statements: Combined factor structure of the anxious self-statements questionnaire and the automatic thoughts questionnaire-revised. Cognitive Therapy and Research, 24(3), 327344.

123

S. Varga Scott, J., Williams, J. M., & Beck, A. T. (1991). Cognitive therapy in clinical practice: An illustrative casebook. New York: Routledge. Sheldon, B. (1995). Cognitive-behavioural therapy: Research, practice and philosophy. London: Routledge. Smith, B. C. (1998). On knowing ones own language. In C. Wright, B. C. Smith, & C. Macdonald (Eds.), Knowing our own minds (pp. 391428). Oxford: Clarendon Press. Solomon, R. (1976). The passions: Emotions and the meaning of life. Indianapolis: Hackett Publishing Company. Spackman, M. P., & Miller, D. (2008). Embodying emotions: What emotion theorists can learn from simulations of emotions. Minds and Machines, 18(3), 357372. Sterelny, K. (1990). The representational theory of mind. Oxford: Blackwell. Stocker, M., & Hegeman, E. (1992). Valuing emotions. Cambridge: Cambridge University Press. Szentagotai, A., David, D., et al. (2008). Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis. Psychotherapy (Chic) 45(4), 523538. Tappolet, C. (2003). Emotions and the intelligibility of akratic action. In S. Stroud, & C. Tappolet (Eds.), Weakness of will and practical irrationality (pp. 97120). Oxford: Clarendon Press. Teasdale, J. D. (1993). Emotion and two kinds of meaning: Cognitive therapy and applied cognitive science. Behavioral Research and Therapy, 31(4), 339354. Teasdale, J. D., & Barnard, P. J. (1993). Affect, cognition and change: Remodelling depressive thought. Hove: Lawrence Erlbaum Associates. Varga, S. (2011). Pretence, social cognition and self-knowledge in autism. Psychopathology, 44, 4552. Varga, S. (2012). Depersonalization and the sense of realness. Philosophy, Psychology and Psychiatry, 19(2), 103113. Varga, S. (in press). Frames of cognition. Cognitive Systems Research Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester, UK: Wiley Wells, A. (2008). Metacognitive therapy: A practical guide. New York: Guilford. Westen, D. (2005). Implications of research in cognitive neuroscience for psychodynamic psychotherapy. In G. Gabbard, J. Beck, & J. Holmes (Eds.), Oxford textbook of psychotherapy (pp. 443448). Oxford: OUP. Wheeler, M. (2005). Reconstructing the cognitive world. Cambridge: The MIT Press. Whiting, D. (2006). Why treating problems in emotion may not require altering eliciting cognitions. Philosophy, Psychiatry, and Psychology, 13(3), 237246. Whitting, D. (2006). Some more reections on emotions, Thoughts, and Therapy. Philosophy, Psychiatry, & Psychology, 13(3), 255257. Williams, J. M., Watts, F. N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and emotional disorders (2nd ed.). Chichester: John Wiley & Sons. Wittgenstein, L. (1969). In G. E. M. Anscombe & G. H. von Wright (Eds.), On Certainty (trans: Anscombe, G. E. M., & Paul, D.). Oxford: Blackwell.

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