Blog – Beck Institute for Cognitive Behavior Therapy

Brittany, John, BA & Aaron T. Beck, MD

This post contains part three and the conclusion of a five part article. Please see the introduction and parts one and two.

Part 3: Case Studies

The pathways of the biases and the treatment involving the
activation of the adaptive mode is best seen in case studies of individuals who
are treated with Recovery-Oriented Cognitive Therapy.

In one case, a 40-year-old man became progressively depressed over a period of three months following his failure to obtain a prestigious award in his academic field. He expressed that he had invested much of himself in the attempt to achieve the award and was “nothing” because he had not received it.  This is typical all-or-nothing thinking observed in depressed patients who experience failure. The sequence in this individual’s thinking was: the event (failure to receive the award) → cognition (“I am a failure; I am nothing”) → affect (sadness) + motivation (desire to withdraw) → behavior (avoidance).  When questioned about his investment in his work, he responded that the only thing important to him was being successful in his field. When questioned about investments outside of work, he responded, “In the back of my mind, I have always wanted to be a good parent.” He recalled during childhood that his father was an overworked salesman who spent minimal time at home and even less with the children. As a child, he vowed he would not be the same way.  In a subsequent interview he expressed that he felt great about coaching his daughter’s softball team. As the interviews progressed, he spent more of his time attempting to fulfill his aspiration of being a good parent and socializing and spending more time with his friends and his wife. As he became more active as a parent, spouse, and friend, his depression improved. This case illustrates what is commonly found in individuals with similar issues, namely, that they are so driven in their competition with their friends or colleagues to achieve highly, that they abandon their true aspirations. While he was striving for awards, the patient could not be satisfied because he was neglecting key values that centered around his family. Once the aspirations are identified and become actualized, individuals like this tend to have a more balanced life and obtain more satisfaction from their family, friends, and extracurricular activities.

In a second case, a 35-year-old individual was diagnosed
with schizophrenia and was living at home with his parents. Since early
childhood, the individual operated below par in his studies. His self-esteem
was wrapped around his notably poor performance at school and lack of friends
throughout his adolescence. Around the age of 17, he fell in love with another
student in his class. This relationship persisted for approximately one year
(although it is not clear whether his classmate shared his feelings). The
individual’s self-esteem was elevated during the course of the relationship. He
felt disappointed when the object of his affection broke off their
relationship. At this point, he withdrew from other people.  The withdrawal tendencies of became cemented.
For the past 15 years, the individual lived at home and was chronically
amotivated. His parents tried to get him engaged with friends, but he rebelled
against their suggestions. The clinician who worked with him on a once-a-week
basis found that their sessions were fruitless. The client was disengaged and
quite passive in therapy. At one point, however, he began to see another
clinician who observed that he had fancy shoes. She introduced the topic of
fashion into their conversations and the individual became animated. The
clinician honestly professed a lack of knowledge about fashion. She asked
questions so he could teach her. This led to a collaborative decision to visit
a department store.  At the store, the
individual was transformed. Previously he had been regressed, often listening
to voices. While he was at the store, he became active, discussing fashion with
a sale person. He moved into an adaptive, sociable mode. His self-esteem became
elevated and his belief “I can be sociable” became activated.

The clinician used this transformation to steer the
conversation toward the future. The individual identified his aspiration to
make friends and to get a job in fashion. His parents observed this change and
encouraged the pursuit of new friends. With the clinician’s guidance, he
eventually formed a club which met periodically to discuss changes in fashion.
In the end, the individual had developed the belief “I can make good friends
and am sociable.”

Conclusion

Self-esteem plays a critical role in the development of
self-image and the subsequent actions taken to become the best version of
oneself. A healthy self-esteem may protect individuals from the development of
neuroses and predict their adjustment to external events. We have previously
addressed the importance of a strong “fit” between the internal desires and
external circumstances in the Theory of Modes (Beck, Finkel, and Beck, 2020)
and in this paper we propose an updated model that is inclusive of the
interaction of self-esteem with the four dominant modes.

Cognitive biases serve to protect the self-esteem in
everyday behaviors, but when cognitive biases become maladaptive, the
self-esteem becomes vulnerable to opposition. In the gain mode, an excessive
amount of self-esteem leads to a cycle of reward seeking and mania. The loss
mode results in withdraw and isolation to protect the self-esteem. The threat mode
produces escapism to maintain the self-esteem. And in situations of perceived
offense, there is a counterattack to restore slight to self-esteem or sense of
vulnerability.

We present two cases demonstrating how the fluctuations of
self-esteem contribute to the onset of the emotional disorders and suggest that
the treatment for these disorders involves getting the individual engaged in
activities that bolster the self-esteem and provide connectivity. By promoting
the self-esteem by targeting areas of interest and expertise, the individual’s
aspirations can be targeted for future growth and development, activating the
adaptive state and regulating future dips or increases in self-esteem.

Citation:

John, B., Beck, A. T. (2021, June 24). Application of Self-Esteem to the Theory of Modes: A Summary. Beck Institute for Cognitive Behavior Therapy.
The post Application of Self-Esteem to the Theory of Modes: A Summary (Part 3 & Conclusion) appeared first on Beck Institute for Cognitive Behavior Therapy.
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June 28, 2021 – 6:02 pm /Max Hayes
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