ABCs of Cognition, Emotion, and Action and controversy in cognitive neuroscience

[SWM]

Abstract
It has been over 35 years since Albert Ellis first formulated his ABC model of human disturbance, and 70 years since Woodworth described the SOR (Stimulus - Organismic response - emotional and behavioral Response) mechanism of human behavior, an early ancestor of Ellis' theory. While the ABC model has made a great impact on the development and current popularity of cognitive-behavior therapy, it has also been at the center of significant controversy in cognitive neuroscience over the past three decades. In this article, we address the main controversies from our somewhat radical perspective, and provide a simple example that we utilize clinically with our patients to help them gain quick and meaningful insight into this ABC model of their own emotions. We support our position with a brief overview of the neuropsychological mechanisms involved in emotional reactions and the psychoneuroimmunological implications of this perspective. Finally, we will present the basic rules for healthy thinking as put forth by Maultsby and modified by Simonton, and discuss their clinical role in the treatment of patients with life threatening diseases and challenges concerning spiritual/religious/philosophical/existential issues.

Controversies Surrounding the ABC Model
Albert Ellis, considered by many the father of cognitive therapies, originally formulated his ABC model of human disturbance in order to describe the manner in which our environment impacts our emotional and behavioral reactions. Simply put, Ellis (Ellis, 1962) argued that human beings for the most part create their own emotional consequences. From his perspective, when a highly charged emotional consequence (C) follows a significant activating event (A), it might seem that A causes C. Yet, in actuality, emotional consequences are largely created by (B), the individual’s belief system. (A), filtered through (B), leads to (C). Ellis’model was consistent with the underlying assumption of Stoic philosophy -- that facts (A) do not upset (C) people, people upset (C) themselves with the view (B) that they take of those facts (A). The model was proven to be scientifically valid by psychosomatic research of Grace and Graham as well as Luria (Graham et al., 1962; Luria, 1968). This ABC model became the basic foundation for most cognitive therapies and has gone through many modifications over the past 30 years, (Beck, 1989; DeSylvestri, 1989; Dryden, 1984; Grieger, 1986; DiGiuseppe, 1986; Lazarus, 1976; Maultsby, 1984; Wessler, 1984) and even Ellis (Ellis, 1994) has criticized his original model for being oversimplified because it omitted salient information about the human experience.

Of these numerous theoretical revisions, we consider Maultsby's A-b,C model of attitude-controlled emotive and motoric reactions as the most accurate for explaining how salient (attitude-controlled, nonverbal, and supraconscious) information triggers emotional and motoric responses (Maultsby 1984). Based on psychophysiological research of Razran (Razran, 1949) Maultsby extended the traditional ABC model to a more comprehensive and clinically usful A-b,C model. Maultsby argues that an individual experiences an event and reacts instantly, without having the time to think consciously about the process that is taking place. As with any learning, this instantaneous reaction is created through the repetitive pairing of the same (A)s with the same (B)s and the same (C)s. A simple example of this is a beginning typist who has had to learn the positions of all the keys and the proper fingering, and consciously "talk herself through" each typing exercise, pairing the same (A)s with (B)s to get (C)s. At first, the typist has to accurately perceive the letter to be typed (A) and consciously consider which key to press with which finger (B), so that the correct letter appears on the page (C). Usually, the errors far outnumber the successes. With each mistake that is made, they typist has a mild negative emotion, but each triumph also elicits a mild positive emotion. As the number and frequency of those positive emotions increase through practice and the accurate pairings of (A)s and (B)s with (C)s, the typist gradually develops a "typing attitude" and is soon able to copy an entire page without even a single mistake. Moreover, the need for conscious thought disappears and success occurs seemingly automatically, accompanied by a sense that it simply "feels right". This sense becomes the bridge from the antecedent event (A) to the consequence (C), and the conscious evaluative process that Ellis identified at (B) is replaced by a superconsionscious attitude. In the typing example, there is no identifyable belief at (B), as the ABC model would argue, but it is clear that something happens between (A) and (C). If not, this would suggest that the letters on the page to be copied caused the letter to be correctly typed, which is clearly a form of magical thinking! (for detailed discussion, see Maultsby 1984, pp 50-68 or Polish edition, 1992 pp 57-76).

This model also contradicts those authors who "follow a phenomenological tradition, and argue that thought, emotion and action are structurally and functionally inseparable" (Muran, 1991; Guidano and Liotti, 1983; Mahoney, 1988; Safran and Greenberg, 1988). In Muran's terminology we instead fall into the "associationist/behavioral" camp and "argue for clear, conceptually discrete definitions of the constructs of the ABC model, which would allow for reliable and valid measures of these constructs". Furthermore we fall into a more radical wing for reasons that will become clearer as we proceed. While we agree with Ellis that perceptive (A), inferential/evaluative (B), and affective/motoric (C) processes cannot be experienced by an individual in isolation due to the instantanious character of neurological processing, we argue for a causal, mutually dependent relationship between cognitions (thoughts, beliefs and attitudes) and emotional responses, in that emotional responses only in an appropriate cognitive context can motivate us to specific actions. As Maultsby put it, "with our cognitions (B - thoughts, beliefs and attitudes) we create, maintain and eliminate all our emotional feelings (C) about events (A)" (Maultsby, 1984 - slightly paraphrased).

In addition to debating the ability of humans to experience perception, cognition, emotion, and action as separate entities, the phenomenologists also argue that because more clinically important cognitive content is best accessed in affectively aroused states (Safran and Greenberg, 1982,1986; Bower, 1981; Teasdale, 1983), it is further evidence that the (B)s and (C)s in the ABC model are really the same phenomenon. As both theorists and practitioners of cognitive-behavior therapies, we agree that most effective work is done when the patient is experiencing intense negative emotions and concede that this state may sometime be more difficult to elicit in the office during a scheduled session than in the actual crisis situation. We believe, however, that intense emotional expression occurs because a person is actually thinking those disturbing beliefs, not the other way around. More often than not, a patient in the office setting is naturally avoiding getting into emotional distress, therefore resists thinking distressing thoughts, and works hard to create more tolerable thoughts instead. On some level they know that if they sincerely re-experienced those disturbing thoughts in your office, they would get as upset as in original crisis. Furthermore, anyone who has effectively worked using cognitive methods with people in intense emotional distress knows that as soon as the patient sincerely begins to think healthier thoughts, his or her affect quickly follows. We agree that affect colors perceptive and inferential/evaluative functions, but in our understanding this new affect also becomes a new activating event (A), about which we have new beliefs (B), which in turn may create new emotion or change the intensity of original affect.

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