My Thesis Prospectus

Part of my absence the last few months has been my initial work on my thesis. After much work with my primary thesis advisor, this is the mostly-finished prospectus:

Embodying Cognitive-Behavioral Therapy of Depression:
A Phenomenological Critique of Aaron Beck

Cognitive-behavioral therapy (hereafter CBT) is one of the dominant therapeutic paradigms in our time. With its focus on cognition, however, CBT virtually ignores the body and its role in human existence. My thesis will be a philosophical critique of CBT through the question of the body’s role in human existence. While it is admitted that CBT is a clinical and not a philosophical discipline, I believe that every method in every discipline is grounded by (sometimes implicit) philosophical theories and that an examination of those theories should be a vital aspect of psychology (Gadamer, 1960/1989; Slife & Williams, 1995). I will focus on Aaron Beck’s CBT model and will use depression as the target psychological phenomenon by which to compare Beck’s model with my phenomenological alternative. My analysis will primarily be informed by Maurice Merleau-Ponty’s phenomenology of embodiment. This thesis is not meant as a refutation of CBT, but an attempt to find those structures of active embodiment that essentially undergird and give meaning to cognition as understood by CBT.

The first section of the thesis, essentially the first chapter, will be my literature review of CBT followed by a brief look at the body’s place within that literature. Aaron Beck’s (1976) cognitive-behavioral therapy combines cognitive psychology’s focus on meaning with behaviorism’s theory of learning (Rupke, Blecke, & Renfrow, 2006). Beck (1976) proposed that “[p]sychological problems…result from commonplace processes such as faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, and not distinguishing adequately between imagination and reality” (p. 20). The behavioral aspect of cognitive-behavioral therapy provides a theory of learning and action. Psychological disorders develop when we habitually pair objects, people, events, and actions to certain values, beliefs, and/or consequences (Farmer & Chapman, 2008). With this understanding, depression is grounded in various beliefs: “I am unworthy,” “I am/life is hopeless,” or the unrealistic and ultimately futile belief that “I must be perfect” (Riso & Newman, 2003). These beliefs are “maladaptive schemas” through which the depressed person interprets the events in their lives, essentially filtering out those things that don’t cohere with the belief and emphasizing those things that do. The goal of the therapist, then, is to help the patient correct their maladaptive schemas through vigilant reflection and evaluation of their beliefs, reality testing, and the development of cognitive skills to similarly evaluate and work past future maladaptive schemas, possibly supplemented by medication (Beck, Emery, & Greenberg, 1985, Chapter 11).

The body is rarely mentioned in works on CBT. Naturally, the body is implied in the very notion of behavior and one can easily find discussions of the brain in relation to the usefulness of medication. Beyond these, the most prevalent use of the body is in reference to the “body image”: “one’s perceptions, attitudes, and experiences related to one’s body, especially his or her physical appearance” (Cash & Hrabosky, 2003, p. 255). The body, then, can be said to have a two-fold significance in CBT: first, it is the physical (what I will call the objective) body; second, it is the body as represented in the mind (what I will call the cognitive body).¹

The second part of the thesis will be an extended exposition of Merleau-Ponty’s phenomenology of embodiment. The first chapter will be a discussion of Merleau-Ponty’s notions of “form” in Structure of Behavior (1942/1963) and the figure-ground structure of experience in Phenomenology of Perception (1945/1958). These concepts form the background from which to understand the motile structure of the body. The second chapter will be an analysis of the arguments and evidences given by Merleau-Ponty and others (e.g., Gallagher, 2005) for the “body schema” —“a global, practical, and implicit notion of the relation between our body and things, of our hold on them…[a] system of possible movements, or ‘motor projects’” (Merleau-Ponty, 1962/1964, p. 5)—in contrast to the “body image” of either objectivistic or cognitive models of the body. The final chapter of this section will be an analysis of the temporal structure of embodiment, including the encultered nature of embodied action and experience (Ingold, 2000; Bourdieu, 1980/1990).

The final section will consist of an analysis of depression through Merleau-Ponty’s phenomenology of embodiment. It will attempt to answer the following questions: how is depression situated within the motile body? What is the relation between the temporal structure of embodiment and the most common symptoms of depression? Why is it important to examine depression by way of the objects that we interact with in an embodied way? How does the above account for the success of cognitive-behavioral therapy? Finally and tentatively, what potential therapeutic techniques can help in developing a therapeutic approach geared to the motile body?

Notes:
1. Bennett and Hacker (2003) point to a propensity within cognitive science and neuroscience to equate the brain with the whole person. Though pertinent to the issues discussed in this thesis, neural reductionism is not going to be explicitly addressed, though I believe the critique I will give can also apply to this approach.

References

Beck, A. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

Beck, A., Emery, G., and Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.

Bennett, M., and Hacker, P. (2003). Philosophical foundations of neuroscience. Oxford: Blackwell.

Bourdieu, P. (1980/1990). The logic of practice (R. Nice, Trans.). Stanford: Stanford University Press.

Cash, T., and Hrabosky, J. (2003). The effects of psychoeducation and self-monitoring in a cognitive-behavioral program for body-image improvement. Eating Disorders 11(4), 255-270.

Farmer, R., and Chapman, A. (2008). Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action. Washington, DC: American Psychological Association.

Gadamer, H-G (1960/1989). Truth and method (J. Weinsheimer & D. Marshall, Trans.). New York: Continuum.

Gallagher, S. (2005). How the body shapes the mind. Oxford: Clarendon Press

Ingold, T. (2000). The perception of the environment: Essays in livelihood, dwelling and skill. New York: Routledge.

Merleau-Ponty, M. (1942/1963). The structure of behavior (A. Fisher, Trans.). Pittsburgh: Duquesne University Press.

Merleau-Ponty, M. (1945/1958). Phenomenology of perception (C. Smith, Trans.). London and New York: Routledge & Kegan Paul.

Merleau-Ponty, M. (1962/1964). An unpublished text (A. Dallery, Trans.). In The primacy of perception (pp. 3-11). Evanston, IL: Northwestern University Press.

Riso, L., and Newman, C. (2003). Cognitive therapy for chronic depression. Journal of Clinical Psychology, 59(8), 817-831.

Rupke, S., Blecke, D., and Renfrow, M. (2006). Cognitive therapy for depression. American Family Physician, 73(1), 83-86.

Slife, B., and Williams, R. (1995). What’s behind the research: Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: SAGE Publications.