Immunity against disconfirmation

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It is perfectly possible that a large number of people develop irrational beliefs of the types discussed above, but the vast majority are quick to reject them and do not present for mental health care. However, that would make the question even more compelling for those who do seek help. Why do these patients fail to reject problem-related beliefs that are logically and/or empirically untenable or extremely dysfunctional?

Behavioural processes seem to be involved in irrational fear. The conviction that a particular situation predicts harm motivates avoidance and escape of that situation. This deprives the patient of the opportunity to experience the fact that the feared situation is innocuous. In traditional behavioural accounts of fears and phobias, avoidance and escape were also seen as maintaining factors. Escape and avoidance were held to reduce anxiety immediately, and this anxiety reduction was thought to reinforce avoidance. From the present cognitive stance, this view appears not to be entirely correct. Patients do not avoid because otherwise they will become anxious, but because they believe that harm will be inflicted if they do not avoid. Thus avoidance maintains anxiety disorders because it prevents disconfirmation of fear-related beliefs. Likewise, depressed patients seem to behave in ways that tend to confirm their dysfunctional beliefs and they do not engage in activities that might yield disconfirming information. Depressed patients who believe that they are unlovable tend to isolate themselves, and the lack of social interaction is likely to be interpreted as further evidence for their belief.

Feared situations can be avoided but, as indicated above, some beliefs relate to internal events. Some patients fear internal events like bodily sensations (e.g. panic patients or hypochondriacs) or intrusions (e.g. obsessive-compulsive patients), and such internal events cannot be avoided. Panic patients have experienced hundreds of attacks attended by feared sensations but not followed by the catastrophe that they believe to be predicted by these sensations. Likewise, obsessive patients have typically experienced hundreds or thousands of intrusions without the feared outcome materializing. Why do these patients not give up their beliefs in the light of such clear and personally experienced contradicting evidences?

The phenomenon of safety behaviour, which appears to be functionally equivalent to avoidance and escape, may be relevant here. Once the feared situation is encountered and the patient believes harm is about to occur, he or she may try to prevent this. For instance, panic patients may sit down and try to relax in order to prevent cardiac failure. The non-occurrence of a heart problem may then be attributed not to the harmlessness of palpitations, but to the effectiveness of sitting down and relaxing. The rituals by which obsessive-compulsive patients respond to intrusions seem to serve the same function; predicted harm is prevented by some safety operation.

Apart from avoidance, escape, or safety behaviours that immunize against disconfirmation, the cognitive biases discussed earlier may, of course, be relevant here. The phenomenon of emotional reasoning appears to be especially relevant to our understanding of hypochondriasis. The feared sensations are not followed by any catastrophe, but they are followed by intense anxiety. Given that anxious patients take the occurrence of anxiety as evidence for the presence of danger, beliefs may be strengthened by the very fear to which the beliefs give rise. (98) Other cognitive biases may also serve to maintain the disorder. (99 Selective attention to threat reinforces the experience of living in a threatening environment and selectively remembering negative experiences may foster hopelessness. Interpretation biases may provide subjective evidence that the disturbing beliefs are valid.

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Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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