Theory of Psychopathology

Core Problem Processes

From an ACT / RFT point of view, while psychological problems can emerge from the general absence of relational abilities (e.g., in the case of mental retardation), a primary source of psychopathology (as well as a process exacerbating the impact of other sources of psychopathology) is the way that language and cognition interact with direct contingencies to produce an inability to persist or change behavior in the service of long term valued ends. This kind of psychological inflexibility is argued in ACT and RFT to emerge from weak or unhelpful contextual control over language processes themselves, and the model of psychopathology is thus linked point to point to the basic analysis provided by RFT. This yields an accessible and clinically useful middle level theory bound tightly to more abstract basic principles.

A core process that can lead to pathology is cognitive fusion, which refers to the domination of behavior regulatory functions by relational networks, based in particular on the failure to distinguish the process and products of relational responding. In contexts that foster such fusion, human behavior is guided more by relatively inflexible verbal networks than by contacted environmental contingencies. This is fine in some circumstances, but in others it increases psychological inflexibility in an unhealthy way. As a result, people may act in a way that is inconsistent with what the environment affords relevant to chosen values and goals. From an ACT / RFT point of view, the form or content of cognition is not directly troublesome, unless contextual features lead this cognitive content to regulate human action in unhelpful ways.

The functional contexts that tend to have such deleterious effects are largely sustained by the social / verbal community. There are several. A context of literality treats symbols (e.g., the thought, “life is hopeless”) as one would referents (i.e., a truly hopeless life). A context of reason-giving bases action or inaction excessively on the constructed “causes” of one's own behavior, especially when these processes point to non-manipulable “causes” such as conditioned private events. A context of experiential control focuses on the manipulation of emotional and cognitive states as a primary goal and metric of successful living.

Cognitive fusion supports experiential avoidance -- the attempt to alter the form, frequency, or situational sensitivity of private events even when doing so causes behavioral harm. Due to the temporal and comparative relations present in human language, so-called “negative” emotions are verbally predicted, evaluated, and avoided. Experiential avoidance is based on this natural language process – a pattern that is then amplified by the culture into a general focus on “feeling good” and avoiding pain. Unfortunately, attempts to avoid uncomfortable private events tend to increase their functional importance – both because they become more salient and because these control efforts are themselves verbal linked to conceptualized negative outcomes – and thus tend to narrow the range of behaviors that are possible since many behaviors might evoke these feared private events.

The social demand for reason giving and the practical utility of human symbolic behavior draws the person into attempts to understand and explain psychological events even when this is unnecessary. Contact with the present moment decreases as people begin to live “in their heads.” The conceptualized past and future, and the conceptualized self, gain more regulatory power over behavior, further contributing to inflexibility. For example, it can become more important to be right about who is responsible for personal pain, than it is to live more effectively with the history one has; it can be more important to defend a verbal view of oneself (e.g., being a victim; never being angry; being broken; etc) than to engage in more workable forms of behavior that do not fit that that verbalization. Furthermore, since emotions and thoughts are commonly used as reasons for other actions, reason-giving tends to draw the person into even more focus on the world within as the proper source of behavioral regulation, further exacerbating experiential avoidance patterns. Again psychological inflexibility is the result.

In the world of overt behavior, this means that long term desired qualities of life -- values -- take a backseat to more immediate goals of being right, looking good, feeling good, defending a conceptualized self, and so on. People lose contact with what they want in life, beyond relief from psychological pain. Patterns of action emerge and gradually dominate in the person’s repertoire that are detached from long term desired qualities of living. Behavioral repertoires narrow and become less sensitive to the current context as it affords valued actions. Persistence and change in the service of effectiveness is less likely.