“Remarkable addition to increasing CBT’s effectiveness in one of its most

challenging areas: dealing with the low frustration tolerance that leads to
addictive behavior or avoidance of uncomfortable tasks that block people from
achieving their goals. It clearly demonstrates, with case examples, how to
identify the self-defeating thoughts, ‘I can’t stand it,’ ‘this is too hard and
uncomfortable,’ ‘it’s hopeless’ and replace them with counter-messages that
increase motivation and the likelihood of overcoming emotional blocks to
behavioral change. A brilliant book and a truly outstanding expansion of the
literature on increasing client motivation.”
Janet Wolfe, PhD, former executive director of the
Albert Ellis Institute and professor at New York University,
currently running a private therapy and consulting practice in New York City

“I highly recommend Dr. Elliot D. Cohen’s book, Cognitive-Behavior Interventions for

Self-Defeating Thoughts: Helping Clients to Overcome the Tyranny of ‘I Can’t.’ An
innovative, scholarly, philosophic, logic-based approach for cognitive-behavioral
therapists. Addresses common self-defeating emotional problems, including low self-
esteem, anger, intrusive thoughts, phobias, depression, and more!”
Dr. Michael R. Edelstein,
co-author of Three Minute Therapy

“Your new client wants freedom from anxiety, depression, anger, and toxic
relationships. However, your client also believes, ‘I can’t make the personal changes
I want to make.’ Philosopher Elliot D. Cohen tells how therapists can help clients
find and refute such self-defeating fictions by refining their logic-based thinking
skills in ways that can also strengthen reason-related neural networks. He integrates
key parts of the philosophical, neuroscience, and psychological literature on
cognitive, emotion, and behavior systems. His philosophical counseling system is
compatible with Albert Ellis’ comprehensive rational emotive behavioral therapy
and allied, evidence-based cognitive-behavioral approaches. Among his many
contributions, Dr. Cohen skillfully shows how to help people disentangle
themselves from self-defeating belief systems well beyond what you’d generally
find in psychotherapy reference books. That is what makes this book a critical read.”
Dr. Bill Knaus, former director of Postdoctoral Training,
Institute for Advanced Study in Rational Emotive Therapy
(Albert Ellis Institute), and author or co-author of 25 books, including The Cognitive
Behavioral Workbook for Anger

“Long before CBT, Albert Ellis fashioned a cognitive-emotive-behavioral

approach that conditioned our current age of therapies. Elliot D. Cohen has
philosophized this approach with his Logic-Based Therapy and virtue ethics,
which has generated a worldwide movement. This volume is a marriage
between applied psychology, logic, and what philosophy has to contribute to
the behavioral sciences.”
Prof. Jon Mills, PsyD, PhD, ABPP,
Adelphi University
Cognitive-Behavior
Interventions for
Self-Defeating Thoughts

Integrating Cognitive Behavior Therapy (CBT) with a logic-based

restructuring of Rational Emotive Behavioral Therapy (REBT), this book
provides therapists with a guide for addressing self-defeating thoughts and
behaviors.
Cohen explores how the tyrannical use of the words “I can’t” creates
and sustains many commonplace behavioral and emotional problems. It
shows how cognition and affect are intimately connected, demonstrating
how cognitive-behavioral interventions help clients to address both their
feelings and irrational ideas. Each chapter explores a specific problem,
including low frustration tolerance, obsessiveness, risk avoidance, phobias,
intolerance to criticism, dependent personalities, and much more. The
theories developed throughout are integrated with practice sections and
session transcripts that focus on the application of these theories for the
treatment of clients who have self-destructive linguistic habits. Cohen also
provides resource materials including reflection activities, bibliotherapy,
meditation, and step-by-step guidance.
This book is essential reading for mental health professionals looking for
novel techniques of using CBT, life coaches, positive psychology coaches,
counselors, and academic and clinical researchers who work with CBT.

Elliot D. Cohen, Ph.D., is president of the Logic-Based Therapy &

Consultation Institute, with training centers in the United States, India, and
Taiwan. He is a professor at Florida State College of Medicine, Ft. Pierce
Regional Campus, and a professor and department chair at Indian River
State College.
Cognitive-Behavior
Interventions for
Self-Defeating Thoughts
Helping Clients to Overcome the
Tyranny of “I Can’t”

Elliot D. Cohen
First published 2022
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 Elliot D. Cohen
The right of Elliot D. Cohen to be identified as author of this work has
been asserted by him in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and
recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this title has been requested

ISBN: 978-0-367-46073-0 (hbk)

ISBN: 978-0-367-46071-6 (pbk)
ISBN: 978-1-003-02673-0 (ebk)

Typeset in Bembo
by MPS Limited, Dehradun
Albert Ellis began a philosophical revolution in psychotherapy,
seeing that science and humanities were joined at the hip. This
work is a part of that revolution.
Contents

Preface xi
Acknowledgments xiv

Introduction 1

PART I
Overcoming “I Can’t” in Self-Defeating Reasoning:
A Logic-Based Cognitive-Behavioral Approach 9

1 Logic and Language 11

2 Capacity Disavowals in Syllogism Chains 23
3 Guiding Virtues and Their Uplifting Philosophies 37
4 Applying Philosophies in a Cognitive-Behavioral Plan 47

PART II
Neurological Correlates 59

5 Neuropsychology of a Logic-Based Therapy 61

6 Neuropsychology of Guiding Virtues and Their
Philosophies 84

PART III
Overcoming Common Types of Capacity Disavowal 95

7 Risk-Avoidant Capacity Disavowals 97

x Contents
8 Low-Frustrative Capacity Disavowals 127
9 Blame-Based Capacity Disavowals 157
10 Phobic Capacity Disavowals 188
11 Hyper-Egoic Capacity Disavowals 214
12 Dependent Capacity Disavowals 247
13 Obsessive Capacity Disavowals 278
14 Key Hypotheses of a Logic-Based Therapy 305

Index 312
Preface

The theory I present in this book is one I have been refining since 1985, a
version of Rational-Emotive Behavior Therapy (REBT) that I call Logic-
Based Therapy (LBT), with particular application to various self-destructive
uses of the words, “I can’t.” These words can be perilous for clients who
believe they “can’t” exercise their own judgment and end up slaves to others;
who tell themselves they “can’t” take risks and end up keeping themselves
from moving forward; who find it beyond their capacity to sit still and forego
immediate gratification to enjoy long-term gains; who tell themselves (or
their therapists) that they just can’t stop ruminating about “horrible ideas”;
who narcissistically believe they are the arbiters of reality and “can’t stand”
disagreement or correction by others; or who blame things on other people
or events and then proclaim with a false sense of incapacity that they “can’t”
help feeling as they do. These uses of “I can’t” keep clients in a perpetual
never-never-land of painful feelings and behavioral responses that destroy
their personal and interpersonal happiness.
These self-stultifying words do not float about in thin air, however. They
are supported by an edifice of irrational linguistic actions (“speech acts”) that
lead one to finally say, “I can’t.” It is this “leading to,” the logical gymnastics
(chains of inferences) many unhappy people go through to deduce their
disavowal of capacity, that I have tried to unpack. To accomplish this goal, I
have used a litany of resources gleaned from clinical observations, existing
literature, and studies in neuroscience.
I believe the present book is a testament to the future of psychotherapy, for
it is a future that is increasingly being influenced by groundbreaking discovery
in neuropsychology and neuroscience. I have therefore incorporated a large
amount of neuropsychological research on emotion and cognitive processing,
both meta-analyses of current literature as well as important research findings
based largely on functional magnetic resonance imagery (fMRI) studies. And I
have attempted to link these studies with the emotional language and
underlying negative feelings that appear to drive many and sundry behavioral
and emotional problems.
The present approach harnesses philosophy to help people feel and do
better. So, it is edifying that neuroscience has provided some insights that
xii Preface
reveal how the language of philosophy can be good for the psyche. But not
just philosophy meandering about—philosophy cast in language that is
uplifting and has the potential to illuminate a client-friendly road to virtue:
such aspirational goals as Courage, Authenticity, Patience, Temperance,
Unconditional Self and Other-Acceptance, Prudence, and more.
Throughout this book I have capitalized the words referring to these
virtues in attempting to capture their exalted, lofty, aspirational status. For it
is their association with human excellence that can help clients overcome
the complacency that keeps them in a state of denial of their freedom and
responsibility.
While Albert Ellis, who invented REBT in 1955, did not describe his
approach as virtue-based, running through his theory is a commitment to
promoting human happiness through virtuous living. For example, the terms
“Unconditional Self-Acceptance” and “Unconditional Other Acceptance” are
his words, which I have adopted in the present work. These ideas are ideals,
abstract goals, character traits to be internalized and cultivated, cognitively and
behaviorally. In short, they are “guiding virtues.”
From its inception, REBT has stood out from other CBT approaches by
virtue of its emphasis on the evaluative nature of cognitions that drive self-
defeating emotions and behavior, for example, demandingness, catastrophizing,
and damnation. Indeed, any analysis of what goes on when a human being flies
into a rage, or goes into a deep dark depression, could not be grasped without
keying into the negative valance of such emotions.
While inductive overgeneralizations (“Everyone hates me,” “I will never
find another lover”) and other forms of unjustified, empirical report play a
key role in driving a person to become depressed (or anxious), such reports,
alone, are impotent in leading to such devastating emotions without the
person pronouncing himself a “failure” or “loser”; writing off his existence as
“meaningless” or “a waste”; denouncing the world as a “terrible place”; rating
an event as “awful,” “or “the worst that could happen”; or demanding that
such undesirable things “must” or “should” not happen. Negatively rating or
evaluating the world, an event, or oneself, through the use of negatively
charged language, is an essential aspect of the processing of negative emotions.
Clients make logical inferences when they process emotions. Here I am not
speaking about largely prewired responses to an environmental stimulus
perceived to be dangerous, such as bear fear. I am speaking instead about
emotions that have neurological correlates in cortical brain structures (not
primarily subcortical ones such as the amygdala), for example, guilt, depression,
anxiety, and anger. This book examines these “cognitive” emotions in the
light of neuropsychology and effectively demonstrates that the long-held
dichotomy between affective psychotherapies and cognitive ones is a false
dichotomy.
In sum, the approach presented in this book is eclectic, providing a
coherent and systematic synthesis of logic, language, philosophy, virtue
 Preface xiii
theory, and neuroscience; aiming at helping clients overcome self-
destructive, freedom-debilitating, responsibility-denying uses of “I can’t.”
On a personal note, Albert Ellis always encouraged me to expand on the
philosophical and logical roots of his theory. In 2007, about a week before
he passed, I visited him while he was in the hospital. I vowed to him that I
would spend my life building on the edifice of REBT. The present work is
my latest attempt to honor this commitment, and the legacy of this
magnanimous person who helped millions through his therapy and kind
nature.
Acknowledgments

The multiprong task of research and development for this book has occupied
a large chunk of my life during the COVID-19 pandemic. This has been an
exceptional time in my long professional career, as no doubt it has been for
others. It has required shifting from in-class instruction to working remotely
online. The transition was edifying. Fortunately, my clinical practice was
already online, currently consisting mainly in conducting sessions globally
with practitioners-in-training in the modality addressed in this book. In my
capacity as a clinical ethicist, I have also devoted many hours during the
pandemic working on a hospital ethics committee and a COVID-19 task
force to address the issue of allocation of scarce medical resources such as
ventilators. As such, I am much indebted to my editor, Sarah Gore, at
Routledge, who understood my situation and gave me additional time to
complete this book.
I am indebted to my wife, Gale S. Cohen, a licensed mental health
counselor and professor, with whom I shared ideas and received exceptionally
useful feedback. I am also indebted to her for her generosity and patience
during the long hours I spent working on this project.
I am also indebted to the reviewers who provided useful guidance that
helped shape the direction of this book.
Last and not least, I am indebted to my canine companion, a Coton de
Tulear, who faithfully stayed by my side for many hours each day, offering
occasional licks, while I worked away on this book, conducting online
sessions, meeting with colleagues and students, and teaching synchronous
online courses. His Unconditional Acceptance during these long hours felt
good, and no doubt helped me to do better.
Introduction

This book presents a logic-based, highly philosophical, virtue-oriented

version of the world’s first type of CBT developed in 1955 by Albert Ellis,
which he called Rational-Emotive Behavior Therapy (REBT) (Ellis &
Maclaren, 2005). The unique feature of Ellis’ theory has been its emphasis
on evaluative language, especially terms such as “must,” “ought,” and
“should” in addition to self-downing terms such as “failure” and “loser.”
Such words, Ellis correctly surmised, have the power to promote self-
defeating negative emotions including anxiety, depression, guilt, and anger.
Fast forward to 2021 and there have been a vast amount of functional
magnetic resonance imaging (fMRI) studies in neuropsychology that have
confirmed Ellis’ hypothesis. As discussed in subsequent chapters, such
words have the power to amplify and sustain the negative valence attached
to the objects (or persons) to which they are applied, for example, to
oneself, as in “I’m a loser”; or to amplify and sustain self-destructive feel-
ings, as in “I must never fail.” In fact, there is now evidence that such
linguistic expressions gain their emotive potency (capacity to arouse, ex-
press, and amplify positive/negative valence) by virtue of their association
with interoceptive feelings (awareness of physiological changes in the body)
generated by somatosensory brain structures such as the insular cortex,
anterior cingulate cortex, and somatosensory cortices (Pace-Schott, 2019;
Cromwell et al., 2020; Siddharthan, 2018; Saxbe et al., 2013; Burin et al.,
2014). This emotive vocabulary is, in turn, used to perform speech acts
(Austin, 1975) such as demanding and damning, which, in turn, lead to self-
destructive conclusions about how to think, feel, and act.

Capacity Disavowals
In so doing, these speech acts drive further self-destructive speech acts,
especially disavowals of one’s capacity to exercise freedom and accept responsibility
for the ways in which one thinks, feels, or acts. Language used to perform these
freedom-dissuading, responsibility-denying speech acts include “I can’t” or “I’m
unable to” (or other synonymous terms). These linguistic disavowals, in turn, keep
clients in vicious cycles of self-defeating thoughts, feelings, and actions.
2 Introduction
The use of the term “disavowal” captures the idea that saying “I can’t” is
an act of repudiation, denial, or refusal to accept freedom and responsibility.
In other writings, especially in the self-help genre, I have used the term
“can’tstipation” or “can’t stipating oneself ” to convey this idea. In my
experience, clients generally find the latter terms quite memorable—if not
also amusing. At the same time they also have a negative association with an
undesirable condition (inability to excrete), which, in my clinical ob-
servations over many years of using this term with clients, seems to have
practical value in creating a negative association with saying, “I can’t.” So, I
have included some instances of the latter in some practice sections of this
book (see below). However, for purposes of explicating the theory, I have
found the term “disavowal” or “capacity disavowal” (as dry as they may be)
to be more serviceable.

Overview of this Book

Part 1 of this book provides the specifications of a logic-based cognitive-
behavior therapy (LBT) by which clients’ reasoning leading to “I can’t”
(capacity) disavowals can be exposed and addressed using virtue theory and
philosophy. More specifically, it presents a model for construing the cog-
nitive process that drives emotional experiences and their expression, as
applied to capacity disavowals. This model proceeds by articulating a form
of deductive reasoning process consisting of a chain of evaluative (or
practical) syllogisms terminating in a capacity disavowal; and it shows how
to help clients identify and refute self-defeating speech acts expressed in
such cognitive chains. It then expands on conventional CBT interventions
by providing a set of virtues, backed by uplifting philosophical ideas, as
aspirational goals for overcoming the latter disavowals.
Then, in part 2, the book explores key neurological correlates that track
client’s self-defeating syllogism chains, and further demonstrates how the
virtue-based, philosophical aspects of the theory presented in part 1 track
neurological processes associated with cultivation of positive cognitive-
behavioral changes, which can help to reverse the negative valence of the
latter chains. Indeed, the theory presented in this book is a product of
clinical investigation and alignment with neuropsychological findings that
have both confirmed and directed the current state of the theory and its
practice.
In light of Parts 1 and 2, each chapter in Part 3 addresses a particular type
of capacity disavowal. Chapter 7 addresses risk-avoidant disavowals, which
involve refusal to accept capacity to take risks, including rational ones.
Chapter 8 addresses low-frustrative disavowals, which sustain clients’ dis-
position toward immediate gratification and perceived incapacity to tolerate
things that are unpleasant. Chapter 9 addresses blame-based disavowals,
which involve blaming external objects (people, events, etc.) for their
negative feelings instead of taking responsibility for them. Chapter 10 treats
 Introduction 3
phobic disavowals, which deny freedom and responsibility for intense,
irrational fears, thus allowing them to be sustained. Chapter 11 treats
hyper-egoic disavowals, which involve clients’ refusal to accept freedom and
responsibility for their intolerance to criticism or disagreement by others.
Chapter 12 involves dependent disavowals, which involve clients denying
freedom and responsibility for making their own decisions. Chapter 13
treats obsessive disavowals, which sustain the perceived incapacity to stop
unwanted thoughts.

Practice Sections
Included in the book chapters are practice-oriented sections that illustrate
the technical concepts and methodologies that are introduced. Many of
these are dialogs depicting sessions between a client and therapist, which are
intended to show how the technical ideas covered in the chapter can be
applied or explained within the counseling setting in ordinary language that
is accessible to a wide range of clients with the cognitive skills to benefit
from a CBT approach.

Influences on the Theory Advanced Here

As mentioned, the type of CBT presented here is a highly philosophical,
virtue-oriented variant of REBT. Ellis was himself a strong believer in the
efficacy of philosophical ideas to help clients overcome irrational thinking
(Ellis, 1990). This was quite evident in his use of Stoic philosophy, espe-
cially Epictetus’s idea that events themselves do not upset people; that what
upsets them, instead, is their value judgments about events. He also cor-
rectly perceived the importance of the Buddhist idea that people suffer
because they stubbornly cling to things that are impermanent, for instance,
demanding that they not suffer loss or be inconvenienced. Such perfec-
tionistic demands go to the root of much of the self-destructive behavioral
and emotional tendencies clients have, including their self-stultifying,
freedom-disabling capacity disavowals.
This book, accordingly, takes such philosophies seriously. Moreover, it
brings in many other philosophical ideas that can be useful in helping clients
overcome their behavioral and emotional problems, from traditional areas of
philosophy including ethics, epistemology, metaphysics, and social and po-
litical philosophy; from Plato and Aristotle to Sartre, Camus, Heidegger,
Kierkegaard, and Nietzsche. The utility of using philosophical ideas to help
clients reframe their self-disturbing views arises from my work as a philo-
sophical counselor where I have used a version of the theory presented here,
called Logic-Based Therapy (LBT), to help clients address their everyday
problems of living (Cohen, 2016; Cohen, 2013). This approach is among the
most prominent versions of philosophical counseling in the world. The
version of CBT presented here represents the latest iteration of LBT.
4 Introduction
Feelings and Cognition in a Logic-Based Approach
The keynote of the latter logicized version of CBT is that clients upset
themselves by deducing self-defeating conclusions from irrational premises.
For example, a client may make himself angry by deducing a damning
conclusion about someone from a premise damning miscreants. As sug-
gested in this book, such (deductive) reasoning does not cause the client’s
negative emotion (anger); it largely comprises it.
As discussed in Chapter 5, the neurological correlates of such “emotional
reasoning” are changes in the prefrontal cortex including the “executive
center” (ventrolateral prefrontal cortex), which is associated with practical
(evaluative) reasoning (Cohen, 2018; Fellows & Farah, 2007) and emo-
tional language comprehension (Burin et al., 2014); somatosensory struc-
tures associated with interoceptive feelings; ventral striatum associated with
reward of purposeful behavior; and limbic structures such as the amygdala
and hypothalamus, associated with responding to threats.
Phenomenologically, such reasoning is experienced as a flow of images and
associated interoceptive feelings, the latter feelings having a negative valence in
negative emotions, and a positive valence in positive emotions (Bechara
et al., 2000). These feelings, in turn, drive emotive language (for example,
“awful” or “wonderful”), which expresses what is experienced, and am-
plifies its negative or positive valence through speech acts such as catastro-
phizing or jubilating (Maddock et al., 2003; Seto & Nakao, 2017). For
example, an interoceptive feeling of disgust arising from a “gut” (abdom-
inal) interoceptive feeling can be expressed in the linguistic act of self-
damnation, which may, in turn, generate further feelings such as a global
feeling of unworthiness (Nummenmaa et al., 2018; Critchley & Garfinkel,
2017; Paulus, 2010).
What is remarkable about the latter hypothesis is its unmasking of a
misconception that has fueled past criticism of cognitive-behavior ap-
proaches to psychotherapy, namely that the latter set of theories do not
address the affective (feeling) side of therapy (Corey, 2009, p. 308). In fact,
an analysis of emotional reasoning informed by contemporary neu-
ropsychology reveals that the cognitive processes occurring during human
emotional experiences are themselves comprised of affective elements,
specifically, interoceptive feelings. As such, the attempt to bifurcate affect
and cognition in CBT is not a reasonable possibility and the criticism that it
does so is therefore equally unreasonable. To the contrary, a theory of CBT
that resonates with the neurological processes occurring during emotional
experiences proceeds by helping clients key into their feelings, especially
those that drive irrational thinking, and to work diligently to reverse the
negative polarity of these feelings through cognitive-behavioral tools.
Among these tools are rational-emotive imagery, forms of meditation, and
forms of cognitive reframing.
 Introduction 5
Three Interdependent Levels of Cognitive Processing
Accordingly, there are three levels of cognitive processing that occur during
an emotional experience: linguistic, phenomenological, and neurological.
Each is summarized and illustrated below:

1. Logico-linguistic: Tracks the logical progression of speech acts terminating

in a capacity disavowal. (“As I must always be right, if others don’t
agree with me, it’s awful; and, therefore, I can’t stand it”)
2. Phenomenological level: Tracks the flow of feelings and images. (“As I feel a
need to always be right, I feel threatened by others who disagree with
me, and then feel powerless over tolerating them.”)
3. Neurological level: Tracks the neurological activity during the cognitive-
emotive process. (The medial prefrontal cortex triggers an interoceptive
felt need for agreement which, in conflict with perceptual imagery of
disagreement by others, triggers a further interoceptive feeling of being
threatened, which engages the amygdala, which, in turn, engages the
hypothalamic-pituitary axis, which further intensifies the feeling of the
emotional body state.)

In Part 3 of this book, all three of these levels are discussed and their sy-
nergistic relationships explored. Given the incredibly complex nature of the
human brain, I have attempted to avoid anatomical details I believed were
not expressly relevant, or which might detract from the purpose of the
present study, notably, capturing the general neurological landscape un-
dergirding the interplay of phenomenal and logico-linguistics of discourse.

Guiding Virtues and Their Philosophical Interpretations

One of the distinctive features of the approach presented here is the in-
troduction of “guiding virtues” to aid in reversing the negative polarity
mentioned previously. These virtues provide affective counters, goals, and
ideals, toward which to aspire; for example, Courage to counter phobic
disavowal; Empathy to counter hyper-egoic disavowals; and Serenity in-
stead of obsessive disavowal.
These virtues are subject to a myriad of interpretations; from diverse
philosophical perspectives including religious, moral, existential, episte-
mological, and metaphysical frames of reference. For example, from one
existential perspective, that embraced by Jean-Paul Sartre, Courage in-
volves not living in “bad faith” (lying to oneself) and instead accepting
responsibility by acting in the face of anxiety. From another existential
perspective, that of Nietzsche, Courage lies in overcoming adversity, for it
is suffering that “ennobles” and gives meaning and purpose to life. On one
ethical perspective, that of Plato, Courage involves not being afraid to ask
questions, to challenge popular dogma and the status quo, even if it meets
6 Introduction
with the disapproval of others. Finally, on one metaphysical outlook, that of
Buddhism, possessing Courage entails “letting go” instead of “clinging” to
material things that are, by their nature, impermanent.
As such, while some clients may resonate with one interpretation of a
virtue, other clients may resonate with another. Thus, some clients may
find the latter Buddhist interpretation to be uplifting, others may find
Nietzsche more uplifting. So, the CBT therapist is there to help the client
choose her own philosophy and to apply it in pursuing her guiding virtue.
This does not require giving the client a philosophy lesson or naming
particular philosophers. From a therapeutic perspective, the choice of a
philosophy is based on what works for the client, not what works for the
therapist. Thus, a philosophically enlightened (and enlivened) CBT keeps
in its toolchest a rich assortment of (not necessarily consistent) potentially
uplifting philosophical ideas.
It is also not necessary that the CBT therapist be a trained philosopher to
use such a philosophical approach. Indeed, philosophies may be gleaned
from numerous sources; from songs with pithy lyrics ripe for the occasion,
to novels and films that exemplify a philosophically enlightened manner of
aspiring to reach a guiding virtue (for example, a film about Courage to
overcome adversity or a novel about how a self-doubter reframes her vision
of the meaning of life). Accordingly, this book provides some appropriate
examples of such sources for overcoming particular disavowals; and it also
includes others in the respective sections on bibliotherapy.
A philosophy may be grist for a client’s adoption if it has “uplifting”
potential to promote the intended guiding virtue; reverse the negative po-
larity of a targeted interoceptive feeling and the self-defeating speech act it
drives; is internally consistent; and does not itself commit any speech act
generative of self-destructive emotions or behavior such as demanding per-
fection, damnation, oversimplifying reality, or distorting probabilities.1 For
example, a low-frustrative client may find that the imagery attaching to a
Buddhist philosophy produces an inner feeling of freedom from the felt need
for immediate gratification. This philosophy may, in turn, help the client to
overcome a perfectionistic demand for immediate gratification, and promote
his guiding virtue of Patience. Moreover, this (internally consistent) philo-
sophy may redirect attention away from the client’s own suffering to other
people’s suffering, hence reducing, rather than promoting, a tendency to
catastrophize about not receiving immediate gratification.

Person-Centered Orientation
Although Ellis believed emphasis on the therapist–client relationship could
create client dependence on the therapist, LBT underscores the importance
of the therapist–client relationship as model of the guiding virtues it
promotes. These virtues include Unconditional Positive Acceptance,
Authenticity, and Empathy. Consistent with Rogerian counseling (Rogers,
 Introduction 7
1995), these virtues are important for promoting client trust and, accord-
ingly, comfort in disclosing personal information pertinent to helping cli-
ents identify and overcome disavowals that sustain self-destructive patterns
of thought, feeling, and behavior. This is especially important in the first
step of LBT in which the client provides information essential to helping
the client formulate her emotional reasoning.

Six-Step Methodology
The cognitive-behavior interventions advanced here for overcoming cli-
ents’ capacity disavowals proceed methodologically in six integrated, pro-
gressive steps or stages. They are as follows:

1. Identify the client’s primary syllogism chain leading to a self-destructive

capacity disavowal.
2. Expand the syllogism chain (identifying upper and lower tiers of the
chain).
3. Identify and refute self-defeating speech acts in the chain.
4. Identify the (applicable) guiding virtues.
5. Find a set of uplifting philosophies.
6. Construct a cognitive-behavioral plan to apply the philosophies.

These steps are consistently applied in Part 3 of this book in treating the
distinct forms of capacity disavowals addressed. The concepts they embody
are addressed in Parts 1 and 2, starting with the concepts of “speech act”
and “primary syllogism” in Chapter 1.

Note
1 These and other such fallacious linguistic acts are presented in Chapters 1 and 2.

References
Austin, J.L. (1975). How to do things with words (2nd ed.). Harvard University Press.
Bechara, A., Damasio, H., & Damasio, A.R. (2000). Emotion, decision making and the
orbitofrontal cortex. Cerebral Cortex, 10(3), 295–307. https://doi.org/10.1093/
cercor/10.3.295
Burin, D.I., Acion, L., Kurczek, J., Duff, M.C., Traine, D., & Jorge, R.E. (2014). The
role of ventromedial prefrontal cortex in text comprehension inferences: Semantic
coherence or socio-emotional perspective? Brain and Language, 129, 58–64. https://
doi.org/10.1016/j.bandl.2013.12.003
Cohen, E.D. (2013). Theory and practice of logic‐based therapy: Integrating Critical thinking
and philosophy into psychotherapy. Cambridge Scholars Publishing.
Cohen, E.D. (2016). Logic‐based therapy and everyday emotions. Lexington Books.
8 Introduction
Cohen, E.D. (2018). Use of logic-based therapy to encode emotional reasoning on the
ventromedial prefrontal cortex. Trauma Psychology, 13, 2. https://
www.printfriendly.com/p/g/WiKXXd
Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Cengage.
Critchley, H.D. & Garfinkel, S.N. (2017). Interoception and emotion. Current Opinion
in Psychology, 17, 7–14. https://doi.org/10.1016/j.copsyc.2017.04.020
Cromwell, H.C., Abe, N., Barrett, K.C., Caldwell-Harris, C., Gendolla, G.H.E.,
Koncz, R., & Sachdev, P.S. (2020). Mapping the interconnected neural systems
underlying motivation and emotion: A key step toward understanding the human
affectome. Neuroscience & Biobehavioral Reviews, 113, 204–226. https://doi.org/10.101
6/j.neubiorev.2020.02.032.
Ellis, A. & Maclaren, C. (2005). Rational-emotive behavior therapy: A Therapist’s Guide
(2nd ed.). Impact Publishers.
Ellis, A. (1990). The Philosophical basis of rational-emotive therapy (RET). International
Journal of Applied Philosophy, 5(2), 35–41. https://doi.org/10.5840/ijap1990525
Fellows, L.K. & Farah, M.J. (2007). The role of ventromedial prefrontal cortex in
decision making: Judgment under uncertainty or judgment per se? Cerebral Cortex,
17(11), 2669–2674. https://doi.org/10.1093/cercor/bhl176
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activation by emotional words: fMRI evidence from a valence decision task. Human
Brain Mapping, 18, 30–41. https://doi.org/10.1002/hbm.10075
Nummenmaa, L., Hari, R., Hietanen, J.K., & Glerean, E. (2018). Maps of subjective
feelings. Proceedings of the National Academy of Sciences, 115(37), 9198–9203. https://
doi.org/10.1073/pnas.1807390115
Pace-Schott, E.F., Amole, M.C., Aue, T., Balconi, M., Bylsma, L.M., Critchley, H.,
Demaree, H.A., Friedman, B.H., Gooding, A.E.K., Gosseries, O., Jovanovic, T.,
Kirby, L.A.J., Kozlowska, K., Laureys, S., Lowe, L., Magee, K., Marin, M.F.,
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VanElzakker, M.V. (2019). Physiological feelings. Neuroscience & Biobehavioral
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806–812. https://doi.org/10.1093/scan/nss075
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(2018). WordNet-feelings: A linguistic categorisation of human feelings. arXiv, 1–21.
https://arxiv.org/abs/1811.02435v1
Part I

Overcoming “I Can’t” in
Self-Defeating
Reasoning: A Logic-
Based Cognitive-
Behavioral Approach
1 Logic and Language

In 1955, philosopher J. L. Austin delivered a set of lectures at Harvard later

published under the title, “How to Do Things with Words” (Austin, 1975).
These lectures pointed out a different way to perceive the use of natural
language. Instead of seeing the primary use of language as making true or
false statements, Austin focused on how it could be used to do things—to
perform various speech acts, from marrying a couple, bequeathing one’s
property to one’s heirs, naming a ship, and casting a bet, to making a
promise. Thus, in saying “I promise,” under certain conditions (for ex-
ample, being in a position to keep it), one does not simply make a statement
that is either true or false. Rather, one actually does something with words,
namely make a promise, which can, in turn, have various practical con-
sequences, including legal ones in some cases. This emphasis on the per-
formative use of language has been key to the development of the first
cognitive-behavior therapy (CBT).

Self-Disturbing Speech Acts

At about the same time Austin was delivering his lectures at Harvard (in
Cambridge, MA), psychologist Albert Ellis (in New York City) was
working out the details of his “Rational Therapy,” which was to provide
the first ever version of CBT. In discussing the origins of his psychother-
apeutic approach in his 1962 classic, Reason and Emotion in Psychotherapy,
Ellis summed up what has become a cornerstone of his version of CBT,
which he later called, Rational-Emotive Behavior Therapy (REBT):

I had finally … at least to my own satisfaction, solved the great mystery

of why so many millions of human beings not only originally became
emotionally disturbed, but why they persistently, in the face of so much
self-handicapping, remained so. The very facility with language which
enabled them to be essentially human—to talk to others and to talk to
themselves—also enabled them to abuse this facility by talking utter
nonsense to themselves: to define things as terrible when, at worst, these
things were inconvenient and annoying. (p. 21; emphasis in original)
12 Logic-Based Cognitive-Behavioral Approach
Importantly, Ellis italicized the word “define” to suggest that people do
something linguistically to upset themselves, namely define things as terrible
rather than as inconvenient or annoying. In 1961, in Ellis and Harper’s A
New Guide to Rational Living, the authors state, “[P]recisely because we tell
ourselves … catastrophizing sentences, we almost immediately begin to feel
anxious” (p. 10). Further, they go on to state:

Misery … consists of two fairly distinct parts: (1) desiring, wishing, or

preferring that you achieve some goal or purpose and feeling
disappointed and irritated when you do not achieve it; and (2)
demanding, insisting, commanding, and urgently necessitating that
you achieve this goal or purpose and feeling bitter, enraged, anxious,
despairing, and self-downing when you do not. (p. 77)

In “part 2” (which the authors indicate accounts for the self-defeating

negative emotions), we find a list of speech acts—“demanding, insisting,
commanding, and urgently necessitating,” which, along with “catastro-
phizing” and “damning,” provide insight into some key speech acts that
human beings perform to emotionally disturb themselves.
More specifically, the above-mentioned speech acts each comprise classes
of speech act with different types. Table 1.1 identifies, describes, and illus-
trates some common types of demanding perfection examined in this book.1
The term “must” is used in Table 1.1 to illustrate most (but not all) the
respective types of demanding perfection. Within the category of moti-
vational language (Cromwell et al., 2020; Siddharthan, 2018), the latter
term appears to be rooted in a feeling of necessity: an interoceptive (so-
matic) feeling of need. For instance, phenomenologically, the client who
demands that he must always be right feels a need to always be right.
As illustrated in the cases of existential and treatment perfectionism in
Table 1.1, other terms, such as “should” (or “ought”) may also be used to
demand perfection (“Bad things should never happen”; “Others should
never deceive me”). The latter should-demands differ from must-demands,
however. For example, while the “must” in must-demands expresses a felt
need, the “should never” expressed in “Bad things should never happen”
and “Others should never deceive me” appears to express an automatic, gut
feeling of wrongfulness or unfairness, or, following one tradition in moral
philosophy, what may be called a “deontological feeling” (Cropanzano
et al., 2017; Manfrinati et al., 2013; Greene et al., 2001).
Such a feeling appears to present as an “intuition” about the inherent
wrongfulness or unfairness of something, that is, a nondiscursive (non-
inferential), interoceptive, deontological feeling about the thing in question
(Cushman et al., 2006; Manfrinati et al., 2013). Thus, a demand that bad
things should never happen appears to express such an intuition.
Importantly, the latter demand resembles a must-demand by virtue of
making an absolutistic (exceptionless or unconditional) demand. Words such
 Logic and Language 13
Table 1.1 Speech Acts of Demanding Perfection (Cohen, 2019a)

Type of Demanding Definition Example

Perfection

Outcome Certainty Demanding certainty about the “I must be certain I

outcomes of one’s actions.
Existential Certainty Demanding certainty that bad
things won’t happen to oneself
or one’s loved ones.
Moral Certainty Demanding certainty that one
won’t do (morally) bad things.
Treatment Demanding that others always
treat one fairly.
Existential Demanding that the world not
contain bad things.
Performance Demanding that one not make
mistakes that could reflect
badly on what others may
think.a
Hedonic Demanding immediate (or fast)
gratification.
Epistemic Demanding that reality be just
what one says it is.
Approval Demanding the affection,
confidence, or approval of
others as a condition of one’s
own self-worth.
won’t fail.”
“I must always be certain
that bad things won’t
happen.”
“I must be certain I won’t
do something wrong.”
“Others should never
deceive me.”
“Bad things like pandemics
should never happen.”
“I must not fail to do what
is expected of me.”
“I must get what I want
immediately.”
“I must always be right.”
“I must always get the
approval of others.”

Note
a This type of perfectionism is usually deduced from approval perfectionism. For details, see
Chapter 12 on dependent capacity disavowals.

as “never” or “always” are intended to linguistically express this dimension

of deontological feelings: like felt needs, they feel absolute. Of course, it
makes no sense to demand that bad things never happen because one has no
control over this, and there is no practically significant chance of such
things not ever (or almost ever) happening. Thus, both must-demands and
should-demands appear to feel equally compelling (phenomenologically) to
the person making the demand. For, in either case, what is being demanded
feels equally non-negotiable.
Table 1.2 identifies, describes, and illustrates some common damning
speech acts.
Words to perform speech acts of self-damnation such as “loser” or
“worthless” appear to be associated with feelings of unworthiness.2 Terms
to damn others such as “piece of shit” or “stupid asshole” appear to be
associated with feelings of anger.3 Terms such as “terrible place,” to per-
form global damnation are associated with a feeling of hopelessness.4 Terms
such as “not worth living” or “sucks” to perform existential damnation are
associated with a feeling of whole-life devaluation.5
14 Logic-Based Cognitive-Behavioral Approach
Table 1.2 Damning Speech Acts (Cohen, 2016)

Type of Damning Definition Example

Self-Damning Condemning or largely “I’m a total loser.”

devaluating the worth of “I’m not completely
oneself as a person. worthless, but damn
close.”
Damning Others Condemning or largely “He’s a piece of shit.”
devaluating the worth of others “He might not be the worst
as persons. person in the world but
he’s a stupid asshole.”
Global Damning Condemning or largely “The world is a terrible
devaluating, the value of the place.”
world. “Mostly shit happens.”
Existential Damning Condemning or devaluating one's “My life is not worth
life or existence as a whole. living.”
“My life mostly sucks.”

Table 1.3 identifies, describes, and illustrates two types of catastrophizing.

For instance, pretemporal catastrophizing is often performed by clients
who are risk-avoidant or who have phobias.6 The words, “awful,” “hor-
rible,” and “terrible” are commonly associated with this type of catastro-
phizing and with intense feelings of fear including that of mortal danger, as
in panic attacks.7
Post-temporal catastrophizing is often performed by clients who tend to
blame their feelings on the bad things happening in the world, or on other
people, and is associated with feelings of depression or hopefulness, or anger.8
The treatment of CBT in this book, which is based on Ellis’ Rational-
Emotive Behavior Therapy, keeps this original focus on the role of lin-
guistic activities in creating emotional disturbances. In fact, the influence of
language on the emotions can be traced back to ancient times, particularly
in the writings of Stoic philosopher, Epictetus, whom Ellis credits for
providing a foundation for REBT. Epictetus (2003) stated

Table 1.3 Catastrophizing Speech Acts—While Pre-temporal Catastrophizing Tends to

Support Anxiety, Post Temporal Tends to Support Depression

Type of Definition Example

Catastrophizing

Pre-temporal Negatively evaluating the future “If I lose my job, it would be

by magnifying the risk (or
probability) of an extremely
bad outcome.
Post-temporal Negatively evaluating
something that has happened
by exaggerating its badness.
awful—I would probably
never find another job and
end up on the street.”
“Now that I lost my job, I
might as well be dead.”
 Logic and Language 15
It is not the things themselves that disturb men but their judgments
about these things. For example, death is nothing dreadful, or else
Socrates too would have thought so, but the judgment that death is
dreadful, this is the dreadful thing. When, therefore, we are hindered,
or disturbed, or grieved, let us never blame anyone but ourselves, that
means, our own judgments. (p. 260)

So, according to Epictetus in the act of negatively judging or evaluating

something (for example, rating death as “dreadful”), a person makes himself
upset. However, while seeming straightforward, this incredibly powerful
insight is subject to interpretation; for the relation embedded in “making
oneself upset” can be treated as a logical or causal relation. Roughly, ac-
cording to the former approach, the act of judging something to be dreadful
is part of a logical process whereby one decides to upset oneself by reasoning
irrationally. According to the latter approach, the act of judging something
to be dreadful causes one to become upset. Which approach is embraced can
have profound implications for the theory (and practice) of CBT.
Ellis embraced the causal approach, thereby influencing the development
of CBT in the direction of an empirical science, that is, one that looks for
causal relations. In contrast, the approach taken in this book makes epistemic
justification (how to rationally justify one’s judgments and behavior), the
cornerstone of CBT (Cohen, 2019b). Ellis’ causal approach is based on his
“ABC theory.”

Ellis’ ABC Theory

As Ellis (1962) discloses in his description of the origins of REBT, as a
practicing psychoanalyst, he was originally influenced by Sigmund Freud’s
psychoanalytic approach, which viewed human beings as largely causal
products of their childhood experiences. Accordingly, while Ellis was
among the first psychoanalysts to challenge the psychoanalytic approach
with its emphasis on the past, he did not abandon its causal etiological roots.
Like Freud, he still viewed clients’ mental disorders as the causal products of
events in their lives; however, unlike Freud, he believed that clients were
also active contributors to this causality through their present (unrepressed)
cognitive contributions. In this regard, Ellis’ model contained three psy-
chological points that account for human cognition and behavior
(Ellis, 1985):

A: Activating event
B: Belief
C: behavioral and emotional Consequence

According to the “ABC theory,” the events at point A do not directly

cause the behavioral and emotional consequences at point C. Rather,
16 Logic-Based Cognitive-Behavioral Approach
the latter consequences are jointly caused by the events at point A along
with beliefs at point B. For example, a person is not made (caused) to
become depressed at point C merely by being divorced at point A.
Instead it is the divorce, together with what the person tells himself at point B
(“I’m the world’s biggest loser!”), which causes the depression. This
model is causal because the depression is a consequence of a jointly suf-
ficient set of causal conditions (the divorce at A and the self-damning
belief at B).
A causal relation is a relation between two events, the first being the
cause of the second (the effect). The relation is inductive, that is, established
empirically. For example, it is observed that people who experience divorce
and catastrophize about it, become, or tend to become, depressed.
However, while this may be true, this analysis does not capture the actual
thought process that a client goes through in becoming depressed. Moreover,
it suggests that the depression is distinct from the set of beliefs that causes it.
Thus, showing the client that his divorce at A and belief at B is causing his
depression at C does not capture entirely what the client is going through
psychologically during the depression.
By contrast, on the epistemic or logic-based model developed in this
book, the depression is not distinct from the set of beliefs undergirding it.
Further, on this model, the logical inferential process internal to the
emotion tracks neurological changes in regions of the brain that modulate
emotions as well as phenomenological shifts (shifts in consciousness). This
model starts with the premise that consciousness is intentional.

The Intentionality of Emotions

In the previous example, the client is depressed about the divorce. During
the depression, the divorce exists phenomenologically as an intentional
aspect of consciousness. More generally, emotions have intentional objects
(Husserl, 2001). So, one is angry about something that someone else did.
One feels guilty about having done something one perceives to be mo-
rally wrong. One is anxious about possible, negative consequences of a
future event (Cohen, 2016). In this phenomenological sense, it means
that the divorce is not related to the depression as cause to effect. It is,
instead, the object of consciousness in the depression, not necessarily its
cause. This is because intentional objects themselves need not be causes
of the conscious states of which they are objects. For example, one can
be angry about something that never happened and thus it could not
possibly be causing the anger. In the case of the divorce, the actuality of
the divorce is not causal, and the client could simply imagine that his
wife divorced him, or falsely think that she intends to divorce him, and
still be depressed or anxious about the inexistent intentional object
(Cohen, 2005).
 Logic and Language 17
Emotions as Complex Linguistic Activities
Further, in experiencing emotions, people rate or evaluate their intentional
objects or some aspect of their intentional objects (Cohen, 2016). For
example, in being depressed about the divorce, the client may be rating it as
“the worst thing in the world,” and, in so doing, catastrophize about it.
Phenomenologically, emotions can be defined according to their intentional
objects and ratings. Table 1.4 provides some examples of cognitive defi-
nitions (Cohen, 2016).
Such definitions succinctly capture what is going on referentially and
linguistically during an emotion. The rating activity undertaken by enga-
ging in each emotion captures the (nondescriptive) speech act, or perfor-
mative aspect of the emotion while the intentional object captures the
descriptive (reportative) activity. This underscores that one does not merely
have an emotion; that is, it does not just happen to someone. Rather, an

Table 1.4 Definitions of Some Troublesome Emotions Using O+R

Emotion Intentional Object Rating

Anger An action. Strong, negative rating of the

action itself or the person who
did it.
Guilt A moral principle, which Strong condemnation of the
you perceive yourself to perceived violation or yourself.
have violated.
Shame An action or state of yours. Perception of others to be
strongly, negatively morally
judging you, your action, or
state; on the basis of which
perceived judgment you also
strongly, negatively morally
judge yourself, your action, or
state
Depression An event or state of affairs. Strong, negative rating of this
event or state of affairs, on the
basis of which you persistently,
over a period of time, bleakly
rate yourself, your own
existence, or the world as
worthless or hopeless.
Grief The loss of a loved one. Strong, negative rating of this loss
on the basis of which you
intermittently bleakly perceive
your own existence.
Anxiety A possible future state of Strong, negative rating of this
affairs. perceived possibility such that
you also perceive a need to
ruminate about it.
18 Logic-Based Cognitive-Behavioral Approach
emotion, or, more appropriately, the act of emoting, involves a complex lin-
guistic performance undertaken vis-à-vis an intentional object. Table 1.4

Constructing the Client’s Primary Syllogism

Like any other form of intentional behavior, such emotive linguistic acts tend
to be based on reasons for undertaking them. By “reasons” I am not referring
to subconscious motivation, although this does not mean that such motivation
does not also occur. Instead, the sense of “reason” here is that of “justifica-
tion” or train of logical thinking or argument to justify the act. Further, as
discussed below, in identifying the intentional object and rating of an emo-
tion, it is also possible to construct the evaluative reasoning process that comprises
the linguistic performance involved in emoting. This approach—that of
constructing the reasoning process involved in emoting—is what I mean by
the logical approach to “making oneself upset,” as distinguished from the causal
approach taken by Ellis, discussed previously.
One type of human reasoning that can represent this emotive process
across a diverse field of emotions is deductive reasoning. This is a form of
reasoning in which one set of meaningful strings of symbols (the premises)
necessitates (or logically entails) a further meaningful string of symbols (the
conclusion). By “necessitates” (or “entails”) I mean that, the transformation,
or inference, from the first string of symbols to the second is entirely a function
of linguistic rules, and therefore does not depend upon the use of sense per-
ception vis-a-vis the external world (Cohen, 2009). This does not mean that
the meaning or interpretation of the strings of symbols manipulated a priori is
not gleaned empirically. Indeed, confirmation of the existence (or in-
existence) of intentional objects depends on sense perception.
Modus ponens is the most basic linguistic rule for making deductive in-
ferences. The deductive inference rule simply states,
From the set of premises [(If p then q & p] infer the conclusion q
where p and q are placeholders for semantically meaningful strings of
symbols. For example, the following inference proceeds according to the
modus ponens inference rule:
(First Premise) If it rains, then there are clouds.
(Second Premise) It’s raining.
(Conclusion) There are clouds.
Linguistically, the above inference is purely descriptive or reportative. The
first premise describes a sufficient condition for clouds, namely rain.
The second premise reports that it is raining; and the conclusion reports that
there are clouds. Such an inference generated from the modus ponens rule
performs a complex linguistic activity of reporting an event (it’s raining)
along with the activity of describing a causal law (if it rains, then there are
clouds), and then deducing a further report (there are clouds) from these
premises. Such an inference may therefore be appropriately referred to as a
 Logic and Language 19
reportative syllogism because its primary function is to report the conclusion it
deduces. The term “syllogism” refers to a deductive argument with just two
premises (Cohen, 2009).
In contrast, the complex logic-based activity performed in emoting is not
purely descriptive or reportative. While it also uses modus ponens as its in-
ference rule, emoting also includes performance of evaluative speech acts. Its
modus ponens inference rule proceeds according to the following instantia-
tions of p and q:

From [(If O then R) and O] infer R

where O represents the emotion’s intentional object and R its rating
(Cohen, 2016). For example, recall the case of the depressed client dis-
cussed earlier. Where O is “My wife divorced me (against my wishes)” and
R is “I’m the world’s biggest loser,” the following inference is generated
from the above inference rule:

Primary Syllogism:

(Emotional Rule) If my wife divorced me then I’m the world’s biggest loser.

(Report) My wife divorced me.

(Conclusion) Therefore, I’m the world’s biggest loser.

The above syllogism is an example of the client’s primary syllogism (Cohen,

2016). It is “primary” or “basic” in the sense that it is constructed out of the
O & R elements the therapist first gleans from the client’s responses to the
therapist’s open-ended questions posed to elicit the client’s O and R (see
below “Practice” section). In further challenging the client to support his
premises, a multitiered syllogism chain may be generated from the primary
syllogism. This aspect of helping the client to construct the evaluative
reasoning process underlying his emotion is addressed in Chapter 2.
In the example of a primary syllogism, the central purpose of the client’s
complex linguistic activity is not merely to report something but rather to
damn himself. In the first premise, the client accepts a rule that gives him
permission to damn himself if his wife divorced him against his wishes. This
premise is therefore appropriately called an emotional rule because it is the
rule the client uses to upset himself about the divorce.9 In the second
premise, the client makes a report and files it under the rule (makes a report that
confirms the antecedent of his rule); and, following modus ponens, the client
then, in his conclusion, proceeds to damn himself about having been di-
vorced by his wife. As such, the primary function of the client’s complex
linguistic activity is to damn himself for the divorce, which defines a pri-
mary cognition embodied in the client’s depression (see rating column of
definition of depression in Table 1.4).
20 Logic-Based Cognitive-Behavioral Approach

Box 1.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism

To construct this primary syllogism, the therapist gathers the client’s intentional
object (O) and rating (R) by asking open-ended questions. At this stage of therapy,
the therapist is nonconfrontational and nondidactic. Authenticity, Unconditional
Positive Client Acceptance, and Empathy are key virtues for success in eliciting
the O & R from the client. Here is how the therapeutic dialogue might proceed at
this juncture:

Therapist (T): So what’s going on?

Client (C): Last week my divorce was finalized.
T: I see. So how do you feel about that?
C: I didn’t want this divorce. She was the one who wanted
out of the marriage. I have been very depressed about it.
T: So, you are depressed about your wife divorcing you against
your wishes?
C: Yes, now that it’s final. [Here, the client confirms the
therapist hypothesis about the client’s O.]
T: So, on a bad scale of 0 to 10, just how bad is it that
your wife divorced you against your wishes?
C: It’s definitely a 10.
T: That’s pretty bad!
C: Yes, it really is.
T: Is this negative rating also a rating of yourself or just of
your wife’s divorcing you? In other words, are you
thinking anything negative about you, or just how
shitty it is that she divorced you?
C: Well, I mean, she divorced me, for God sake! I must
be the world’s biggest loser! [Here, the therapist elicits
the client’s R.]
T: So, is this how you are reasoning? If your wife
divorced you against your wishes, then you are the
world’s biggest loser. And, since she did, in fact,
divorce you (your divorce was just finalized), you
must then be the world’s biggest loser?
C: Yes, that’s exactly what I’m thinking.
 Logic and Language 21
Aristotle appears to have been the first to observe the intimate nexus
between emotions and so-called “practical” or “evaluative syllogisms”
(syllogisms in which the conclusion performs an evaluative speech act).
According to Aristotle, “anger and sexual appetites and some other such
passions,” are “under the influence (in a sense) of a rule and an opinion
[report]” (Aristotle, 1941, bk. 7, chap. 3, 1041). With this brief statement,
Aristotle introduced a crucial ingredient to a logic-based theory of CBT,
one that could constructively be applied to Ellis’ REBT in lieu of his “ABC
theory.”

Notes
1 More exactly, the types of perfectionism included in Table 1.1 drive the types of
capacity disavowals addressed in Part 3 of this book.
2 See Chapter 12.
3 See Chapter 9.
4 See Chapter 9.
5 See Chapter 13.
6 See respectively, Chapters 7 and 10.
7 See Chapter 10.
8 See Chapter 9.
9 Just how such a rule figures in the emotional process is considered in the discussion in
Chapter 5 on neurological correlates of evaluative syllogisms.

References
Aristotle. (1941). Nicomachean ethics. In R. McKeon (Ed.), The basic works of Aristotle.
Random House.
Austin, J.L. (1975). How to do things with words (2nd ed.). Harvard University Press.
Cohen, E.D. (2005). Metaphysics of logic-based therapy. International Journal of
Philosophical Practice, 3(1).
Cohen, E.D. (2009). Critical thinking unleashed. Rowman & Littlefield.
Cohen, E.D. (2016). Logic-based therapy and everyday emotions. Lexington Books.
Cohen, E.D. (2019a). Making peace with imperfection: Discover your perfectionism type, end the
cycle of criticism, and embrace self-acceptance. Impact Publishers, Inc.
Cohen, E.D. (2019b). Epistemology of logic-based therapy. International Journal of
Philosophical Practice, 4(1), 48–61. https://doi.org/10.5840/ijpp2019513.
Cromwell, H.C., Abe, N., Barrett, K.C., Caldwell-Harris, C., Gendolla, G.H.E.,
Koncz, R., & Sachdev, P.S. (2020). Mapping the interconnected neural systems
underlying motivation and emotion: A key step toward understanding the human
affectome. Neuroscience & Biobehavioral Reviews, 113, 204–226. https://doi.org/10.101
6/j.neubiorev.2020.02.032
Cropanzano, R.S., Massaro, S., & Becker, W.J. (2017). Deontic justice and organiza-
tional neuroscience. Journal of Business Ethics, 144, 733–754. https://doi.org/10.1007/
s10551-016-3056-3
Cushman, F., Young, L., & Hauser, M. (2006). The role of conscious reasoning and
intuition in moral judgment: Testing three principles of harm. Psychological Science, 17,
10821089. https://doi.org/10.1111/j.1467-9280.2006.01834.x
Ellis, A. (1962). Reason and emotion in psychotherapy. Citadel Press.
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Ellis, A. (1985). Expanding the ABC’s of rational-emotive therapy. In M.J. Mahoney &
A. Freeman (Eds.), Cognition and psychotherapy (pp. 313–323). Plenum Press.
Ellis, A. & Harper, R.A. (1961). A new guide to rational living. Prentice-Hall, Inc.
Epictetus. (2003). Encheiridion. In F.E. Baird & W. Kaufmann (Eds.), From Plato to
Derrida (4th ed.).
Greene, J.D., Sommerville, R.B., Nystrom, L.E., Darley, J.M., & Cohen, J.D. (2001).
An fMRI investigation of emotional engagement in moral judgment. Science,
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Husserl, E. (2001). The shorter logical investigations. Routledge.
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lemmas and moral principles: When emotion and cognition unite. Cognition and
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Siddharthan, A., Cherbuin, N., Eslinger, P.J., Kozlowska, K., Murphy, N.A., & Lowe, L.
(2018). WordNet-feelings: A linguistic categorisation of human feelings. arXiv, 1–21.
https://arxiv.org/abs/1811.02435v1
2 Capacity Disavowals in
Syllogism Chains

Chapter 1 introduced the construct of a primary syllogism. Such evaluative

syllogisms may also be linked to other evaluative syllogisms in a successive
chain, thereby increasing, sustaining, or modulating the emotional force of
a previous syllogism in the chain; or obstructing the working through of the
emotional problem.1 This potentially self-destructive process often involves
a successive chain of syllogisms terminating with a syllogism that uses the
term, “I can’t,” or equivalent term (“I cannot,” “I’m unable,” “I can never,”
“I couldn’t,” etc.).

Negative Emotion Syllogism Chains

Evaluative syllogisms using the term “I can’t,” or its cognates, are often
deduced from other, prior-tier syllogisms that use other disempowering lan-
guage such as “awful,” “loser,” or “must not.” These chains tend to track
intense negative emotions, such as anxiety, guilt, anger, and depression.

Disavowals of Freedom Using “I Can’t”

The illocutionary force (Austin, 1975; Searle, 1969), that is, the specific speech
act performed by using the term “I can’t” in the context of such self-
destructive, negative emotions is a form of capacity disavowal. More exactly,
in performing the linguistic act in question, a person thereby refuses to accept
his capacity to control his behavior, emotions, volitions, impulses, or cog-
nitions, and thereby abnegates her freedom and responsibility to choose.
Part 3 of this book treats seven commonly dysfunctional types of capacity
disavowal. They are divided into behavioral, emotional, impulsive, voli-
tional, and cognitive according to the type of dysfunctionality, for example,
the perceived incapacity to control one’s behavior. As will be evident from
subsequent discussion of underlying neurology (see Chapter 5), there are
also salient neurological dysfunctions in areas of the brain that process these
different activities. For example, impulsive dysfunctions, as classified here,
are largely rooted in the limbic system (“lower” forebrain), thus driven by
so-called “bottom-up” control; whereas cognitive dysfunctions are largely
24 Logic-Based Cognitive-Behavioral Approach
rooted in the prefrontal cortex (“upper” forebrain), thus driven by so-
called, “top-down” control (Ochsner et al., 2009; Lumen, n.d.).
This classification should not be taken to mean that the areas of the brain
responsible for behavior, emotion, cognition, volition, and impulse act
independently of each other. They do not. All areas of the brain have both
input and output capacity; thus, signals originating in the lower forebrain
(such as the amygdala) transmit to the upper forebrain (such as the ven-
tromedial cortex), and conversely.
I use the term “impulsive” as distinct from the term “volitional.” The latter
more generally refers to the will or willpower, whereas the former to physical
desires such as for food or sex, or to aversions such as phobias. Willpower
appears to refer to executive (prefrontal) control. For example, “I don’t have
the willpower to control my sexual appetite” means that I cannot exercise
rational (prefrontal) control over my sexual impulses (amygdala). Willpower is
not necessarily “top-down” control, however, since one part of the upper
forebrain may be thought incapable of controlling another part; for example,
“I cannot exercise [executive] control over the thoughts I am having.”
The term “I can’t stand it” (or its synonyms) likewise refers to incapacity
to exercise cognitive control. Use of such volitional capacity disavowals can
cut across the four other major areas of human control: emotional, cog-
nitive, behavioral, and impulsive. That is, capacity disavowals can apply to
emotions (“I can’t stand to feel so depressed”), cognition (“I can’t stand
these intrusive thoughts”), behavior (“I can’t stand this job”), and impulsion
(“I can’t stand to be so afraid”). Still, some forms of capacity disavowals
seem to be primarily focused on the perceived incapacity to maintain
cognitive control. This appears to be true in hyper-egoic disavowals, which
I have classified below as a form of volitional disavowal.
Table 2.1 summarizes each type of capacity disavowal examined in
this book.
Each of these seven capacity disavowals typically figure in a complex set
of speech acts inside a syllogism chain. For example, in the case of the
divorced client discussed in Chapter 1, the chain of syllogisms that sustains
his self-damnation may include a behavioral capacity disavowal such as
refusing to accept his capacity to “go on” with his life, say by trying to find
someone else or exploring new possibilities as a single person.

Syllogism Chain 1

(Emotional Rule) If my wife divorced me then I’m the world’s

biggest loser.
(Report) My wife divorced me.
(Conclusion 1) Therefore, I’m the world’s biggest loser.
(Disavowal Rule) If I’m the world’s biggest loser, then I can’t go on
with my life.
(Conclusion 2) Therefore, I can’t go on with my life.
 Capacity Disavowals in Syllogism Chains 25
Table 2.1 Types of Capacity Disavowals Addressed in This Book

Type of Capacity Category Dysfunction Illustration

Disavowal

1. Risk-Avoidant Behavioral Obstructs taking rational “I can’t afford to take

risks risks.”
2. Low-Frustrative Behavioral Creates and sustains low “I can’t stand (don’t
frustration have patience for)
tolerance (LFT) difficult things.”
3. Dependent Behavioral Creates and sustains “I can’t make my own
dependency on others decisions.”
4. Blame-based Emotional Keeps one in a constant “I can’t help being
state of emotional stress pissed by that nasty
comment.”
5. Phobic Impulsive Sustains intense “I can’t stand being in
irrational fear crowded places.”
6. Hyper-egoic Volitional Sustains self-defeating, “I can’t stand it when
inflated ego-centeredness others disagree
with me.”
7. Obsessive Cognitive Sustains unwanted or “I can’t get that
painful thoughts horrible thought
out of my mind.”

Notice how, in Syllogism Chain 1, Conclusion 1 becomes a premise of a

further syllogism, from which, in combination with the Disavowal Rule, the
client deduces Conclusion 2. In this way, the client sustains his self-
damnation by deducing Conclusion 2, which disavows his capacity to
move on.
By a disavowal rule, I mean an inference rule that validates an inference
to a conclusion performing a capacity disavowal. In this book I have grayed
out such rules because they are not usually challenged by logic-based
therapists. For example, it would not be helpful to ask, “Why does being
the world’s biggest loser mean you can’t go on with your life?” Whereas it
would be helpful to challenge the client’s act of damning himself as “the
world’s biggest loser” in the first place, or to challenge the client’s capacity
disavowal that he “can’t” go on with his life.
From an existential psychotherapeutic perspective, in saying “I can’t” the
client is (linguistically) acting in “bad faith” (Sartre, 2007, 47–48) since he is
thereby refusing to accept his freedom and responsibility to choose.
Inasmuch as the client disavows his capacity to go on with his life, he gives
himself an excuse to remain in a depressed state; for “should” implies “can,”
so, if he “can’t,” there is no point in telling himself what he “should” do
differently.
Accordingly, a logic-based approach provides a model that can uncover
the chain of evaluative syllogisms and complex set of speech acts the client
may be using to block the requisite acceptance of freedom and responsi-
bility to make constructive changes. In the present case, the deduction of
26 Logic-Based Cognitive-Behavioral Approach
the “I can’t” rests on an emotional rule that associates an unwanted divorce
with being a total failure. But does going through an unwanted divorce
truly make one “the world’s biggest loser”? It may feel like it to the client;
but why would it feel so bad in the first place?
The emotional rule in this case may itself be a deduction from even further
premises in the client’s belief system. A therapist can check for this by asking
the client why he thinks that the unwanted divorce makes him a total failure.
And suppose the client responds, “I failed to make my marriage work.” This,
in turn, generates a further syllogistic tier of the syllogism chain:

Syllogism Chain 2

(Emotional Rule 1) If I failed to make my marriage work then

I’m the world’s biggest loser.
(Report 1) If my wife divorced me then I failed to make my
marriage work.
(Conclusion 2/Emotional Rule 2) Therefore, if my wife
divorced me, then I’m the world’s biggest loser.
(Report 2) My wife divorced me.
(Conclusion 2) Therefore, I’m the world’s biggest loser.
(Disavowal Rule) If I’m the world’s biggest loser, then I can’t go on
with my life.
(Conclusion 3) Therefore, I can’t go on with my life.

So now it seems clearer why the client is taking the divorce so hard, for in
Report 1 he is associating divorce with having failed to make his marriage
work, and therefore experiences an intensely negative feeling of inadequacy at
the thought of the divorce, and is therefore inclined, in Emotional Rule 1,
in Syllogism Chain 2 above, to rate himself in superlatively negative terms.2
But is it true that going through an unwanted divorce means one was
(causally) responsible for the divorce?

Reportative Fallacies in Negative Emotion Syllogism Chains

As a factual report, Report 1in Syllogism Chain 2 requires empirical evidence
to be worthy of accepting. Clearly, this premise is an unconfirmed hy-
pothesis. For example, another explanation is that the two were simply
incompatible. So, a logic-based CBT therapist also needs to investigate
client’s inductive judgments, that is, reports that make empirical general-
izations, predictions, causal judgments, explanations of facts, and observa-
tional claims. Because the complex speech acts clients make to upset
themselves depend on such reportative premises, CBT therapists can
challenge these premises to help clients give up such self-destructive acts. It
is therefore helpful for CBT therapists to have background in inductive
logic to enable them to expose such potential “weak links” in clients’
 Capacity Disavowals in Syllogism Chains 27
3
syllogism chains, and, accordingly, to help clients refute them. While there
is a large body of literature on inductive logic,4 Table 2.2 provides three
commonplace classes of inductive fallacy that can infect clients’ negative
emotion syllogism chains.
However, it is simply not enough for the therapist to demonstrate to the
client that the hypothesis in Report 1 in Syllogism Chain 2 is false; for
instance, that he did not cause the marriage to fail and that there were
conditions beyond his control responsible for it. For, what if he really was
(largely) responsible for the marriage failing? It is also important for clients
to be able to cope with negative empirical realities. This means that a logic-
based CBT account that focuses exclusively on the reportative premise in
clients’ reasoning is likely to ill-prepare the client for undesirable empirical
eventualities. In contrast, a robust CBT approach that takes seriously (and
does not just pay lip service to) the evaluative premises in clients’ syllogism
chains, is likely to be more helpful to clients in the long run to make lasting
changes. For example, in the present case, it would be incumbent on a
logic-based CBT therapist to help the client inspect Emotional Rule 1 in
Syllogism Chain 2; that is, challenge the client to justify it.

Perfectionistic Demands in Negative Emotion Syllogism Chains

In in the present case, it can be potentially edifying to query the client why
not being able to hold the marriage together (even if true) would make the
client “the world’s biggest loser.”

Table 2.2 Reportative Speech Act Fallacies

Type of Report Definition Example

Oversimplifying Overgeneralizing, false “Nobody likes me.”

bifurcations, and “Either I get this job or
stereotyping. I will end up flipping fries
for the rest of my life.”
“All men are after just one thing.”
Distorting Making predictions about “If I commit to a relationship, it
Probabilities the future that are not almost definitely won’t work
probable relative to out, just like what happened with
available evidence. my brother’s relationship.”
Blind Conjecture Advancing explanations, “I probably got into that car
causal judgments, and accident because the devil is out
contrary-to-fact claims to get me.”
about the world based on “Right after I said I never get into
fear, guilt, superstition, car accidents I got into one. I
magical thinking, should have kept my
fanaticism, or other anti- mouth shut.”
scientific grounds. “If I didn’t wear that red dress, he
wouldn’t have raped me.”
28 Logic-Based Cognitive-Behavioral Approach

Box 2.1 Practice

Therapist (T)–Client (C) Exchange

Challenging the Client’s Emotional Rule

In the below part of their session, the therapist helps the client identify his
justification for his emotional rule:

T: You are telling yourself that, if you failed to make your marriage
work then you’re the world’s biggest loser. But why would that
make you this big failure?
C: Marriage is something very important to me; and if I wasn’t able
to get that right!
T: So, you think that your marriage was something very special?
You wouldn’t be as upset with yourself if it were something less
important to you?
C: Right, I don’t care if I screw up on small things.
T: So, this idea of yours about not messing up on things that are
important to you, is this just a preference, or is it a demand you are
making on yourself? In other words, are you telling yourself that
you must not mess up on things important to you?
C: It’s definitely a demand.

Clearly, if not messing up on things important to the client were a mere pre-
ference, then messing up on something important to him like his marriage would
likely not have led him to use such emotively strong terms (“The world’s
biggest loser”) to globally damn himself. As demonstrated in Part 3 of this book,
what often drives linguistic acts such as self- and other-damnation, and cata-
strophizing, is a further higher-tiered speech act that makes a perfectionistic demand.
For example, the client may embrace a further emotional rule that de-
mands that he must never mess up at things important to him. As illustrated
in the expansion of the client’s negative syllogism chain, the client bases his
catastrophizing on such a perfectionistic demand, and (ultimately) uses the
latter demand to disavow his capacity to go on with his life:

Syllogism Chain 3

(Emotional Rule 1) I must never mess up at things important

to me such as my marriage.
(Inference Rule) If I must never mess up at things important to me
such as my marriage, then if I failed to make my marriage work, then
I’m the world’s biggest loser.5
 Capacity Disavowals in Syllogism Chains 29
(Emotional Rule 2/Conclusion 1) Therefore, if I failed to make
my marriage work then I’m the world’s biggest loser.
(Report 1) If my wife divorced me then I failed to make my
marriage work.
(Conclusion 2/Emotional Rule 3) Therefore, if my wife divorced me
then I’m the world’s biggest loser.
(Report 2) My wife divorced me.
(Conclusion 3) Therefore, I’m the world’s biggest loser.
(Disavowal Rule) If I’m the world’s biggest loser, then I can’t go on with
my life (try to find someone else, explore new possibilities as a single
person, etc.).
(Conclusion 4) Therefore, I can’t go on with my life.

It now becomes clearer why the client finds the unwanted divorce to be so
self-denigrating as to refuse to go on with his life. He has associated the di-
vorce with a relentless and unforgiving painful feeling of inadequacy arising
from the perceived violation of an internalized demand. It is the latter feeling
that feeds his declared incapacity to move on, making him feel powerless over
his future, an aura of futility about his capacity to make constructive change
going forward. This is the explanation, and the plot indeed thickens when one
“looks under the hood” to see what is going on neurologically in the client’s
cranium.6 Nevertheless, an explanation is not a justification; and it is the latter
that a logic-based approach to CBT emphasizes as a therapeutic intervention.

Box 2.2 Practice

How to Present Syllogism Chains to Clients

The purpose of helping the client formulate his emotional reasoning is to help
him see how he is justifying his linguistic acts within a syllogism chain so that he
can determine if these acts are truly justifiable. Syllogism chains such as that in
Syllogism Chain 3 can be quite complex because they are multitiered and the
inference rules needed to demonstrate formal validity may exceed practicality.
Therefore, a useful rule of thumb for therapists to follow in reflecting back clients’
syllogism chains is to do so in a concise way. Here is how the therapist might
present the above complex syllogism chain to the client:

First you use “must never” to demand that you not mess up at
things important to you such as your marriage. Then, you
conjecture (suppose, guess) that you messed up your marriage by
“failing to make it work.” From these premises you damn yourself
by deducing that you are “the world’s biggest loser.” Finally,
because you damn yourself as “the world’s biggest loser,” you
refuse to try to go on with your life by concluding you can’t.
30 Logic-Based Cognitive-Behavioral Approach
Notice how this presentation tells a concise logic-based story about the client’s
syllogism chain:

1. It identifies the logical progression of speeh acts: Achievement

Perfectionism → Blind Conjecture → Self-Damnation →
Disavowal using a behavioral disavowal.
2. It identifies the language used to perform each of these acts (“must,”
“the world’s biggest loser,” “…failing to make the marriage
work,” and “can’t”).
3. It is concise.

In reflecting back clients’ syllogism chains by following the above three

guidelines, I have found that clients tend to grasp the flow of their syllogism
chains quite well.

Once the client comprehends his emotional reasoning chain, next is to

help the client look carefully at the linguistic acts in the chain to see if they
are truly justified (rational).

Refutation
If not being able to “make the marriage work” makes the client “the biggest
loser in the world,” then is the client prepared to rate, the same way, other
similarly divorced men he knows? And what evidence does the client even
have for thinking that the failure of the marriage was due to him, or him
exclusively? And importantly, why must the client never mess up on im-
portant things such as his marriage?
Indeed, since Conclusion 4 rests on Emotional Rule 1 in Syllogism
Chain 3, helping the client to see that this rule is unjustified or irrational can
help the client also see that his disavowal of his capacity to stop damning
himself for the divorce is also unjustified or irrational. Moreover, providing
a refutation of other premises in Chain 3 from which his disavowal follows
can reinforce its groundlessness. Here, by refutation is meant using the methods
of logic and science to show that linguistic acts (including both reports and evaluations)
are unjustified.

Types of Refutation
In my clinical experience, a refutation tends to be most effective when the
client herself arrives at it. This can be facilitated Socratically when the
therapist asks questions that can elicit a refutation from the client.
There are generally three different types of questions that can be raised,
ones that probe for (1) lack of empirical evidence to support a premise; (2)
 Capacity Disavowals in Syllogism Chains 31
logical inconsistencies; and (3) self-defeating consequences of accepting the
premise:

Empirical Refutation
In the case of the divorced client, asking the following set of questions can
potentially help the client to see that the demand in Emotional Rule 1, as
provided in Syllogism Chain 3, is unrealistic:

• Where does this “must” come from?

• Is there a law of nature necessitating that you never mess up at things important
to you?
• Are such strong preferences of others always satisfied? If not, why must
yours?

Asking the following question can potentially elicit empirical evidence that
helps the client expose an inductive fallacy that refutes Report 1 in
Syllogism Chain 3:

• What other explanations can you think of that might also account for why your
marriage didn’t work out?

The latter question looks for alternative hypotheses that can explain the
marriage not working out. This can lead the client to consider that he may
not have enough evidence to accept his favored hypothesis over competing
hypotheses. This can help to expose an inductive fallacy in the client’s
reasoning.7

Logical Refutation
The following question can help show that the act of self-damning in
Emotional Rule 3 is inconsistent with other evaluations the client would make:

• Do you know anyone else in your same situation whom you nevertheless hold in
high regard?

Pragmatic Refutation
The following question can help the client to refute Emotional Rule 1 by
showing that messing up on something important, even one’s marriage, can
potentially have some positive aspects too:

• Can your divorce, even though unfortunate, provide a learning experience that
you can use constructively going forward?
32 Logic-Based Cognitive-Behavioral Approach

Box 2.3 Practice

Therapist (T)–Client (C) Exchange

Refuting Clients’ Irrational Speech Acts

In the below exchange, the therapist helps the client to refute his demand
for perfection and blind conjecture (as performed in Syllogism Chain 3):

T: Let’s take a look at your demand that you must never mess up at
things important to you like your marriage. Is there some sort of
law of nature that says this?
C: No, not really; but it is important to me.
T: So you don’t want to mess up at these things.
C: That’s right, I don’t want to.
T: So, you are saying that you don’t want to mess up at these things
so you must never mess up at them?
C: Yes, that’s right.
T: But is there any kind of law of nature that says that people
always get what they want?
C: No, I suppose not.
T: Right, because you didn’t get what you want when your wife
divorced you. Do you know other people who don’t always get
what they want?
C: Yes, I suppose everyone.
T: Right again! So, is it reasonable to demand that you always get
what you want, namely that you never mess up at things that are
important to you?
C: No, it really isn’t. I see that now.
T: Let’s also take a look at your claim that you failed to make your marriage
work. It sounds like you are saying that you caused the breakup.
C: Yes, it’s my fault.
T: So, you are saying that if you had been different in certain ways,
your marriage would not have been broken up?
C: Yes, I wasn’t always in a good mood, and stuff. I could have
been more romantic, spent more time.
T: So, you are making a scientific claim here but what evidence do you
have that changing these things would have made any difference?
C: Well, maybe she would have felt different then.
T: Yes, maybe, but maybe not. Can you think of any other possible
explanations for why your wife divorced you?
C: Maybe we just grew apart. That’s what she claims.
T: Maybe she’s right!
C: Maybe.
 Capacity Disavowals in Syllogism Chains 33
T: But, let’s suppose for a minute that you did cause the breakup.
Does that make you “the world’s biggest loser”?
C: Maybe not the biggest loser, but a pretty big one!
T: Do you know anyone else you respect whose spouse divorced
them because they were not very good at being a partner?
C: Yes, I do, my friend, Jack.
T: Tell me about Jack.
C: He’s a biology professor. He does cancer research. He works in
the lab and was hardly ever around. I guess his wife just got
lonely and left him.
T: Is he a big loser?
C: No, he’s a really cool guy.
T: So how can you say that you are a big loser because you caused
your breakup and Jack isn’t? Do you have double standard, one
for Jack and another for yourself?
C: Yes, I see that now.
T: Very good!

Table 2.3 summarizes each type of refutation.

Directly Refuting a Capacity Disavowal

Such modes of refutation can be used synergistically to help the client see
that he is deducing his “I can’t” from irrational premises. However, another
Table 2.3 Types of Refutation

Type of Explanation Example

Refutation

Empirical Disconfirms reportative Do you know people who were divorced

premises by showing possible
empirical evidence against
filing a report, or lack of
adequate evidence for filing it.
Pragmatic Provides a practical reason for Can your divorce, even though
not performing a speech act
included in an emotional rule
or conclusion.
Logical Looks for inconsistencies in an
emotional rule or conclusion
with other evaluations the
client may be making; or
involves a non-sequitur.
like you, and it wasn’t their fault?
Are there other possible explanations for
the breakup?
unfortunate, provide a learning
experience that you can use
constructively going forward?
Is damning yourself like this serving any
useful purpose? Does it have any
negative consequences?
Can you think of others whom you
respect who nevertheless mess up on
their marriages?
If other people’s demands to not mess up
are not always satisfied, why must yours?
Because you prefer something, does that
mean it must be?
34 Logic-Based Cognitive-Behavioral Approach
approach is to refute the capacity disavowal directly instead of attempting to
refute the premises from which it is deduced8:
What evidence do you have that you lack the capacity to go on with
your life; for example, make a concerted effort to meet someone new,
say by enlisting in a dating service?
Here, it is useful to draw the distinction between “I can’t” on the one hand,
and “I won’t” or “I choose not to,” on the other.

• Is it that you can’t or just won’t?

The point is to help the client take responsibility for choosing not to
make an effort.
Other useful philosophical questions to ask include:
• Do you have free will or are your actions beyond your control?
The latter question attempts to elicit a logical refutation by uncovering
a contradiction in the client’s belief system.
• What is the value of not even trying to move on with your life? Does it help you
find someone else, make you feel better, or otherwise improve your life?
The latter question attempts to elicit a pragmatic refutation of the
client’s not making an effort to go on with his life.
• Do you know anyone else who was divorced and was able to stop damning
himself and turn his life around?
The latter question attempts to elicit an empirical refutation of the
client’s disavowal of his capacity to stop damning himself.
• Have you ever felt like you couldn’t do something but then did it anyway?
This question also attempts to provide an empirical refutation that
feeling like you can’t does not necessarily mean you can’t.

Box 2.4 Practice

Therapist (T)–Client (C) Exchange

Directly Refuting a Client’s Capacity Disavowal

In the below exchange, the therapist attempts to directly refute the client’s
capacity disavowal:

T: You said you can’t “go on with your life.” What are you doing
now with your life?
C: I still go to work; otherwise mostly just stay in my apartment,
keep to myself; cry a lot.
T: Do you have any close friends you speak to?
 Capacity Disavowals in Syllogism Chains 35
C: My friend, George, calls me occasionally. He wants to set me up
with this woman, Jenny, he knows. He says she would be a
good match for me.
T: What did you tell George?
C: I told him no. I just don’t have it in me to meet anyone else. I
feel like such a loser. How could I ever make it work with
anyone else, anyway. I just can’t.
T: So you feel like you can’t?
C: Yes, that’s right.
T: Have you ever felt like you couldn’t do something and then
managed to do it anyway?
C: [Pause] I think so. I used to be afraid to fly. But I overcame it
because the last job I had required it.
T: So, just because you feel like you can’t does not necessarily
mean you can’t?
C: Yes, I suppose that’s true.
T: Do you believe you have free will?
C: Yes, I do.
T: So, if you agree that you have free will, can you choose to go out
with Jenny?
C: I suppose. Yes, I can.
T: So, you’re choosing not to go out with her?
C: Yes.
T: So, it’s not that you can’t; but rather that you won’t?
C: I see what you mean. I can, but I just don’t want to. But I guess
I could still make myself go out with her even though I really
don’t feel like it.
T: Excellent!

Refutation alone is not sufficient for overcoming irrational or self-

defeating negative emotion syllogism chains, however. Thus, the tendency
to disavow one’s capacity to make constructive changes may still persist
even if the client cognitively appreciates the irrationality of her premises. In
such a state of cognitive dissonance9 the client may still feel like “the world’s
biggest loser,” while appreciating, on a cognitive level, that she is being
irrational. The next step is to work toward overcoming this negative po-
larity by changing the neural circuits that keep the client in such a painful
state of conflict. This is possible by helping the client to embrace a
counteractive positive valence polarity. Chapter 3 accordingly introduces a
virtue-oriented approach for this purpose, and Chapter 4, in turn, shows how
to implement it through cognitive-behavioral assignments.
36 Logic-Based Cognitive-Behavioral Approach
Notes
1 The latter obstruction can occur in the case where the second syllogism diverts at-
tention from resolving the emotional problem created by the first syllogism. As
discussed in Chapter 5, this complication arises in the case where the first syllogism is
a catastrophic syllogism about taking risks and the second is one that rejects risk-
taking, thereby buying temporary relief from anxiety without addressing the un-
derlying problem, i.e., the tendency to catastrophize about taking risks.
2 This alignment of the rating of an intentional object with an interoceptive feeling is
discussed in greater detail in Chapter 5.
3 See below discussion on refutation.
4 See, for example, the classic discussion on the different types of inductive inferences
in Copi and Cohen (2019).
5 Formally, this inference rule is necessary to validate the inference to the conclusion. It
has been grayed out here because challenging such an inference rule rarely serves a
practical purpose. However, as discussed in Chapter 5, inference rules in general track
the flow of clients’ images and interoceptive feelings and present a kind of map of
neurological wiring. See Chapter 5 for further elaboration.
6 Such an inspection is undertaken in Chapter 5.
7 See above chart on “Reportative Speech Act Fallacies.”
8 As shown in Part 3 of this book, these interventions are not mutually exclusive and
may both be usefully employed.
9 See discussion on cognitive dissonance in Chapter 6.

References
Austin, J.L. (1975). How to do things with words (2nd ed.). Harvard University Press.
Copi, I., & Cohen, C. (2019). Introduction to logic (15th ed.). Routledge.
Lumen (n.d.). Structure and function of the brain. https://courses.lumenlearning.com/
boundless-psychology/chapter/structure-and-function-of-the-brain/
Ochsner, K.N., Ray, R.R., Hughes, B., McRae, K., Cooper, J.C., Weber, J., Gabrieli,
J.D.E., & Gross, J.J. (2009). Bottom-up and top-down processes in emotion gen-
eration common and distinct neural mechanisms. Psychological Science, 20(11),
1322–1331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858766/
Sartre, J.P. (2007). Existentialism is a humanism. Carol Macomber (Trans.). Yale
University Press.
Searle, J.R. (1969). Speech acts. Cambridge University Press.
3 Guiding Virtues and Their
Uplifting Philosophies

Chapter 2 discussed the process of refutation of clients’ irrational or self-

defeating speech acts as performed within negative emotion syllogism
chains. Refutation is useful because it shows clients precisely why clients’
dispositions to engage in these linguistic acts are indeed irrational or self-
defeating. Thereby, it sets the stage for clients to choose positive goals or
“guiding virtues” toward which to strive to counteract the latter disposi-
tions. For example, a pragmatic refutation of a risk-avoidant disavowal
points to its self-defeating nature. Thus, as an antidote, a risk-avoidant
client may strive to be more courageous instead refusing to accept respon-
sibility for taking reasonable risks. In this manner, refutations can seamlessly
lead to embracing counteractive guiding virtues.

Guiding Virtues
Since there are five categories of “I can’t” (behavioral, emotional, im-
pulsive, volitional, and cognitive), there are five corresponding groups of
guiding virtues to overcome the different types of “I can’t” in each cate-
gory. These “guiding virtues” include Decisiveness, Perseverance, Patience,
Temperance, Tolerance, Continence, and Serenity. Table 3.1 identifies the
counteractive guiding virtue/s for each category and provides a definition
of each virtue.
Table 3.2, in turn, identifies the guiding virtue/s for overcoming each of
the respective types of capacity disavowal.
As broached in Chapter 2, it is often the case that “I can’t” is deduced
from the “must” of demanding perfection. In other words, if “I must” (in
the sense of being absolutely necessary), then I am, of necessity, dispossessed
of my freedom to do otherwise. (For example, “I must always get the
approval of others”; therefore, “I can’t help but seek it.”) So, in relin-
quishing my “I must” I can gain my freedom, because my “I can’t” is based
on it. As such, the Guiding Virtues of the different varieties of demanding
perfection can also be useful for helping to replace one’s “I can’t” with a
positive goal.
38 Logic-Based Cognitive-Behavioral Approach

Table 3.1 Guiding Virtue/s for Each Category of Capacity Disavowal

Capacity Disavowal Counteractive Definition of Guiding Virtue

Category Guiding Virtue

Behavioral Decisiveness Realistic trust in one’s ability to accomplish

the goals one sets; and preparedness to
take rational risks to accomplish these
goals under less-than-ideal conditions.
Perseverance Tenacious persistence, within rational
limits, in striving for reasonable goals
with keen awareness that such tenacity
can be key to accomplishing them.
Patience Willpower to sacrifice short-term, fleeting
pleasures for more long-term, lasting
ones, with appreciation that good things
often involve hard work and overcoming
obstacles.
Emotional Temperance Taking responsibility for, and exercising
control over one’s emotions without
making excuses, and without first having
to overcome irrational emotional
tendencies.
Volitional Tolerance Willpower to entertain and accept
alternative perspectives, or ways of doing
things, even if one does not agree with
them, without over- or under-reacting.
Impulsive Continence Willpower to constrain physical desires,
neither over- nor under-doing them.
Cognitive Serenity (Peace Allowing thoughts to freely enter and exit
of Mind) conscious awareness without
catastrophic, damning, or demanding
speech acts in conceiving, pondering, or
dismissing them.

Table 3.2 Guiding Virtue/s for Overcoming Each Type of Capacity Disavowal

Type of I Can’t Category Guiding Virtue/s

1. Risk-avoidant Behavioral Decisiveness

2. Low-frustrative Patience, Perseverance
3. Dependent Decisiveness
4. Blame-based Emotional Temperance
5. Phobic Impulsive Countenance
6. Hyper-egoic Volitional Tolerance
7. Obsessive Cognitive Serenity

Table 3.3 identifies key guiding virtues for overcoming various types of
demanding perfection that may arise in emotional rules in syllogism chains
from which clients deduce self-destructive capacity disavowals (Cohen, 2007).
 Guiding Virtues and Uplifting Philosophies 39
Table 3.3 Key Guiding Virtues for Each Type of Demanding Perfection

Guiding Virtue Description

1. Courage • Confronting adversity without under- or

overestimating the danger. It means fearing
things to the extent that it is reasonable to
fear them and, in the face of danger, acting
according to the merits of the situation.
2. Unconditional Acceptance of • Self Unconditional, self-acceptance based on
a deep philosophical understanding of
human worth and dignity.
• Others Consistently extends this profound
respect for unconditional human worth and
dignity to other human beings
• The World Unconditional acceptance of the
world as a whole even if one finds some parts
of it undesirable.
• Life Acceptance of one’s life as possessing
worth and meaning despite the inevitability
of problems of living.
3. Authenticity • Autonomously and freely living according to
one’s own creative lights as opposed to
losing oneself on a bandwagon of social
conformity.
4. Prudence • A grasp of what is in one’s power and what is
not, including an appreciation of what things
in one’s power are worth attaining; along
with the skill to deliberate well about means
to attaining them.
5. Empathy • Transcending one’s own ego-centered universe
by connecting (cognitively, emotionally, and
spiritually) with the subjectivity of others.

In addition, reportative fallacies can also be overcome by refuting them

and adopting guiding virtues appropriate to them. Table 3.4 includes guiding
virtues for overcoming the three classes of reportative fallacies discussed in
Chapter 2 (Cohen, 2007).
The above guiding virtues—Objectivity, Foresightedness, and Being
Scientific—can help clients to refute premises inside a syllogism chain based
on demanding perfection. For example, a client who demands that she
always be successful (Achievement Perfectionism) may be deducing that
she can’t ever do anything right by hastily generalizing from not having
been successful at a job interview. In such a case, a logic-based therapist can
help the client to be more objective by helping her to avoid overgeneralizing
(“You say you can’t do anything right. Is this true? Can you list some things
that you have done ‘right’?”).
Such reportative guiding virtues along with the other aforementioned
guiding virtues provide a rich, mutually supportive repository of aspirational
40 Logic-Based Cognitive-Behavioral Approach
Table 3.4 Guiding Virtues for Each Type of Reportative Fallacy

Reportative Fallacy Guiding Virtue Definition of Guiding Virtue

1. Oversimplifying • Objectivity Realistic, perceptive, open-

2. Distorting Probabilities
3. Blind Conjecture
minded, and unbiased
judgment in practical matters
including equitable and
sympathetic judgment of
others in contrast to
stereotypical and prejudicial
judgment.
• Foresightedness Making generalizations and
predictions that are probable
relative to available evidence.
• Being Scientific Reliance on confirmatory
evidence in creating
explanatory hypotheses,
making causal judgments and
avoiding mere speculation.

goals that can be useful in helping clients to set themselves free from self-
stultifying syllogism chains terminating in “I can’t.” In particular, Table 3.5
aligns specific guiding virtues with specific types of demanding perfection
(Cohen, 2019) and the latter to specific types of capacity disavowals. For
example, a client who exhibits a risk-avoidant “I can’t” may be demanding
outcome certainty, which can be overcome by working cognitively and
behaviorally toward attaining Foresightedness in assessing rational risks and
then summoning Courage to undertake them.
It is remarkable that guiding virtues tend to be mutually supportive so
that other virtues beside the ones listed for a given capacity disavowal may
also be constructively applied in overcoming it. For example, it can take
objectivity to be empathetic (without objectivity, the tendency toward
prejudgment can destroy the prospects of being empathetic). Further, as
presented in Part 3 of this book, the types of demanding perfection listed
here have been commonly associated with the types of capacity disavowal
to which they have been aligned in Table 3.5. Other permutations of
alignment between the different types of capacity disavowals, demanding
perfection, and guiding virtues are also possible, however.

Guiding Virtues as Habits

In his profoundly important classic work on virtue, well ahead of its time,
Aristotle (1941) states,

[B]y doing the acts that we do in our transactions with other men
we become just or unjust, and by doing the acts that we do in the
presence of danger, and being habituated to feel fear or confidence, we
 Guiding Virtues and Uplifting Philosophies 41
Table 3.5 Alignment of Capacity Disavowals with Their Respective Types of Demanding
Perfection and the Latter with Their Respective Counteractive Guiding Virtues

If a Client Exhibits This Look for This Type of And Counteract with This Guiding
Type of Capacity Demanding Virtue/s:
Disavowal: Perfectiona:

1. Risk-avoidant Outcome Certainty • Courage, Foresightedness

2. Low-frustrative Hedonic • Prudence
3. Blame-inducedb Existential • Courage
• Unconditional World Acceptance
Treatment • Unconditional Other Acceptance
4. Phobic Impulsivec • Courage
• Foresightedness
5. Hyper-egoic Epistemic • Empathy
• Courage
• Unconditional Other Acceptance
6. Dependentd Approval • Courage
• Authenticity
Performance • Unconditional Self-Acceptance
7. Obsessivee Moral certainty • Unconditional Self-Acceptance
Existential certainty • Unconditional Life Acceptance.

a See Table 1.1 in Chapter 1 for definitions of each of these types of perfectionism.
b There are two types of blame-based disavowals identified in this book: existential and treatment.
See Chapter 9.
c In cases of specific phobias, there is an aversive (fear) impulse arising from the amygdala. This is not
a cognitive demand; however, the fear impulse generates a cognitive response of catastrophizing.
For details see Chapter 10, which addresses phobic disavowals.
d There are two types of demanding perfection involved in dependent disavowals: approval and
performance. See Chapter 12.
e There are two types of obsessive disavowals identified in this book: moral certainty and
existential certainty. See Chapter 13.

become brave or cowardly. The same is true of appetites and feelings of

anger; some men become temperate and good-tempered, others self-
indulgent and irascible, by behaving in one way or the other in the
appropriate circumstances. Thus, in one word, states of character arise
out of like activities. This is why the activities we exhibit must be of a
certain kind; it is because the states of character correspond to the
differences between these. It makes no small difference, then, whether
we form habits of one kind or of another from our very youth; it makes
a very great difference, or rather all the difference. (bk.2, ch.1)

In this passage, Aristotle anticipated the behavioral aspect of CBT, the idea
that constructive change, no less negative change, is a result of habits
formed through practice, that is, repeatedly doing the same thing. Indeed,
according to Aristotle, a virtue is itself a habit of a special sort, namely, one
whereby one is inclined to avoid extremes and to exercise moderation in
making choices and acting. For example, a courageous individual neither
42 Logic-Based Cognitive-Behavioral Approach
acts foolishly nor cowardly in the face of danger but instead makes a rational
judgment about danger and acts accordingly. Moreover, such “means” or
points of moderation, states Aristotle (1941), are “relative to us,” (bk.2,
ch.6) meaning that one must make rational judgments relative to the si-
tuation. So, what may be courageous in one context may well be foolish in
another context—say where one risks one’s life unnecessarily with no
reasonable prospect of success. Thus, such habituation is quite complex in
its nature. It involves filing accurate reports, relative to particular situations,
about what conduces to virtuous ends, and then acting according to in-
ternalized rules prescribing the virtuous conduct. Such cognitive-behavioral
activity requires application of linguistic and logical skill sets honed through
practical experience. As is made evident in Part 2 of this book, the human
brain is equipped to develop such complex habits but can also falter when,
instead of rational rules guiding the deliberative process, there are instead
irrational ones of the sort discussed earlier (complex series of speech acts of
catastrophizing, demanding perfection, damning, etc.).

Behavioral Syllogisms of Virtuous Conduct

On the latter Aristotelian model, the rational, deliberative process involved
in virtuous conduct consists of behavioral (action-prescribing) syllogisms in
which a rule prescribes virtuous (or proscribes unvirtuous) action. A report
premise then files a rational judgment under the rule. From which, one
deduces an actionable conclusion aligned with the rule and judgment in the
context in question. For example,

Virtue-Based, Behavioral Syllogism A

(Rule) Don’t cave to short-term pleasures at the expense of long-

term, lasting ones.
(Report) This would give me short-term pleasure but is likely to
cause me considerable pain in the long-run.
(Conclusion) Therefore, don’t do this.

Or
Virtue-Based Behavioral Syllogism B

(Rule) Assume (reasonable) risks to seek valued ends.

(Report) This could probably help me obtain what I really want, and
if I don’t succeed I could always try something else.
(Conclusion) Therefore, do this.

While Virtue-Based, Behavioral Syllogism A can help build Perseverance in

clients who are low-frustrative, Syllogism B can help build Decisiveness in
clients who are risk-avoidant. The client, in the former case, will, initially,
 Guiding Virtues and Uplifting Philosophies 43
be inclined toward immediate gratification, and, in the latter case, inclined
toward not taking even rational risks.
The goal is then to reverse these tendencies; the short-term hedonic client
building willpower to forgo immediate pleasure for the sake of long-term, lasting
pleasure; the risk-avoidant client building willpower to take rational risks to get
what she wants. In each case, this constructive change is achieved by internalizing
and following the respective syllogism (Cohen, 2013). This change involves
cognitive, behavioral, and emotional realignment linked to turning on certain
neurological circuits in the brain and turning off others. Such “internalized”
change requires habituation through practice, both cognitively and behaviorally.1
This process involves both concrete thinking and abstract thinking. The
former is accomplished by the reportative premise while the latter is ac-
complished by the virtuous rule. Reportative premises rely on reportative
virtues such as Foresightedness (“This is likely to cause me considerable pain
in the long-run.”) and Scientific Thinking (“If I don’t succeed, I could al-
ways try something else”). Rule premises prescribe virtuous actions in ac-
cordance with the definition of the virtue. For example, being decisive means
being prepared to take rational risks to accomplish one’s goals, so its virtuous
rule prescribes the latter conduct. And, having the willpower to sacrifice
short-term pleasure for the sake of more long-term, lasting pleasure is what
being patient means, so its virtuous rule prescribes the said conduct.

The Role of Uplifting Philosophies in Supporting

Behavioral Rules
Such behavioral rules can themselves be justified (or interpreted) by en-
listing philosophical world views espoused by great thinkers throughout
history. Consider again, for example, the rule, “Assume (reasonable) risks to
seek valued ends,” which defines the guiding virtue of Decisiveness.
Philosophically, we may ask why taking any kind of risks in seeking one’s
goals is justifiable? Clinically, I have found that, to ponder such philoso-
phical questions with the client, can be a powerful tool in helping to realize
deeper purpose and meaning in life; to gain, or regain, sight of the pro-
verbial forest for the trees; that is, the abstract life goals, aspirations, values,
or meanings obscured by the humdrum details of everyday life. And this
realization can have remarkable potential to inspire the client to make
positive life changes, in striving for the counteracting guiding virtues.
Such philosophical “guiding lights” are as many and sundry as there are
human perspectives about what really matters in life. For instance, the deci-
siveness rule (to be prepared to assume reasonable risks to seek valued ends) can
be justified secularly, from an existential perspective, to inspire decisiveness.
“In life, a man commits himself, draws his own portrait and there is nothing
but that portrait” states existential philosopher, Jean-Paul Sartre, in his famous
article, “Existentialism is a Humanism” (Sartre, 2007, p. 33). Only through
one’s actions, admonishes Sartre, can one define oneself as someone, for “a man
44 Logic-Based Cognitive-Behavioral Approach
is nothing hut a series of enterprises, and that he is the sum, organization, and
aggregate of the relations that constitute such enterprises” (Sartre, 2007, p. 38).
So, merely having “dreams, expectations, and hopes only serve to define a
man as a broken dream, aborted hopes, and futile expectations; in other words,
they define him negatively, not positively” (p. 38). “First I must commit
myself,” admonishes Sartre, and then act on it (p. 36).
Here, such abstract, philosophical thinking can be used to bolster the ideal of
Decisiveness, infuse it with vitality, and inspire overcoming the fear that keeps
one from defining oneself positively instead of negatively as disappointed dreams,
hopes, or expectations. Indeed, the human ability to frame such abstract con-
ceptions is what separates the human brain from other species of animals. It is this
ability that has the incredible propensity to fuel forward-moving, positive change.
There are some important caveats, however. First, clients should un-
derstand that guiding virtues such as Decisiveness, Continence, Tolerance,
and the others are ideals and are never fully actualized. In other words, it is
impossible, or almost impossible, to be perfect, so to demand perfection
would be self-defeating. For example, demanding that one never make
mistakes tends to generate self-damnation (instead of Unconditional Self-
Acceptance) and risk-avoidance (instead of Decisiveness). Nevertheless, the
inability to be perfect can be framed as an exciting life journey in which one
can strive to become better and better, with no end to how improved one
can become. As philosopher William James once remarked, “freedom in a
world already perfect could only mean freedom to be worse, and who could
be so insane as to wish that?” (James, 1955, p. 85).
Second, a philosophical world view should not be forced upon a client.
Instead, it should resonate with her if it is to be internalize and applied
toward making constructive changes (Cohen, 2017). For example, a very
religious person may not be at ease with a secular or anti-religious per-
spective. Even if the view itself is not irreligious but is espoused by an
author who rejects the client’s faith, this could place the worldview in an
unfavorable light for the client. For example, as is well known, Sartre was
an atheist. In such case, an uplifting philosophy from a religious thinker
would be more appropriate, such as one from Soren Kiekegaard, a religious
existentialist who emphasized Decisiveness in life choices.
Like Sartre, Kierkegaard (2007) warned against failing to act: “How
wretched and miserable it is to find in a person many good intentions but few
good deeds,” for “there is danger of losing your decisiveness; of going
through life without courage and fading away in death” (p. 4). However,
unlike Sartre, Kierkegaard provided a religious justification for aspiring to
become more decisive. To those afraid to take reasonable risks, he advised,

Therefore, dare to renew your decision. It will lift you up again to have
trust in God. For God is a spirit of power and love and self-control, and
it is before God and for him that every decision is to be made. Dare to
act on the good that lies buried within your heart. Confess your
 Guiding Virtues and Uplifting Philosophies 45
decision and do not go ashamed with downcast eyes as if you were
treading on forbidden ground. If you are ashamed of your own
imperfections, then cast your eyes down before God, not man. Better
yet, in weakness decide and go forth! (p. 8)

Such philosophical prose can be potent aspirational medicine for a religious

person, whose self-doubts (being “ashamed of one’s own imperfections”)
have kept her from taking risks.
In any event, the philosophy needs to capture a world view that resonates
with the client, not the therapist. Philosophies are at the core of an in-
dividual’s identity. Much like an optician who grinds a pair of lenses to
accommodate the eyes of a patient, imposing another’s preferred philo-
sophy on a client may only obscure (and frustrate) the client’s vision.
This is not to say that every world view is ipso facto acceptable. A
worldview that encourages damnation of self, others, or the world; or one
that promotes catastrophizing is not acceptable. For example, a white na-
tionalist worldview, which damns others on racial grounds, would be
unacceptable on the theory of CBT presented here because it would
support self-destructive acts of other-damnation, intolerance, and egotism.2

Cognitive Dissonance
Still, it is one thing to pay lip service to a philosophy and quite another to
embrace it cognitively, behaviorally, and emotionally. Typically, clients are
in cognitive dissonance before they achieve the latter. This is a state in
which the client’s chain of self-defeating emotional syllogisms conflicts with
her virtue-based syllogism chain (Cohen, 2017). For instance, consider the
following two syllogisms:

Negative Emotion Syllogism Chain

(Emotional Rule 1) I must never do anything if I’m not certain it

won’t harm someone I love.
(Conclusion 1/Emotional Rule 2) Therefore, if I’m not certain my
children (whom I love) won’t be (emotionally) harmed if I go back
to work, I’d be a horrible mother if I go back to work.
(Report 1) I’m not certain they won’t be harmed if I go back to work.
(Conclusion 2) Therefore, I’d be a horrible mother if I go back to work.
(Conclusion 2) Therefore, I can’t do it!

Virtue-Based Behavioral Syllogism Chain

(Uplifting Philosophy) First I should commit myself and then act on

my commitment—or else define myself negatively through my
inaction [Sartre]
46 Logic-Based Cognitive-Behavioral Approach
(Rule 1/Conclusion 1) Therefore, [assuming I want to define myself
positively] I should commit myself to taking (reasonable) risks and act
on them to get what I truly want out of my life.
(Report 1) Going back to work would probably help me get what I
truly want out of my life, and I have no evidence it would harm my
children, and may even make me a better role model for them.
(Conclusion 2) Therefore, I should commit myself to going back to
work, and just do it!

Clearly, the uplifting philosophy of Sartre infuses the above virtue-based

syllogism chain with vitality and spirit that carries through to its life-
affirming conclusion. In shifting attention to the previous negative emotion
syllogism chain, the conclusion pushes in the opposite direction. Such at-
tention shifting, back and forth, between the negative and positive polarities
of these two evaluative processes, preempts meaningful change. Further,
the habituation of the negative emotion chain keeps this client in a per-
petual state of inactivity and lack of commitment. The first syllogism chain
therefore drives the client’s inertia unless there is extinction of this self-
defeating, negative tendency and, instead, habituation toward the positive
polarity of the second syllogism chain through cognitive-behavioral work.
This requires creating a cognitive-behavioral plan to guide the process of
constructive change. Chapter 4 discusses key elements of such a plan.

Notes
1 See in this book Part 2 for the neurological correlates of such habituation.
2 In such a case, success of therapy would depend on helping the client to refute such
self-defeating speech acts, adopt a corrective guiding virtue, and adopt a philosophy
that actually supports the latter virtue.

References
Aristotle. (1941). Nicomachean ethics. In R. McKeon (Ed.), The basic works of Aristotle.
Random House.
Cohen, E.D. (2007). The new rational therapy: Thinking your way to serenity, success, and
profound happiness. Rowman & Littlefield.
Cohen, E.D. (2013). Logic-based therapy and its virtues. In E.D. Cohen & S. Zinaich
(Eds.), Philosophy, counseling, and psychotherapy. Cambridge Scholars Publishers.
Cohen, E.D. (2017). Logic-based therapy and everyday emotions. Lexington Books.
Cohen, E.D. (2019). Making peace with imperfection: Discover your perfectionism type, end the
cycle of criticism, and embrace self-acceptance. Impact Publishers, Inc.
James, W. (1955). Some metaphysical problems pragmatically considered. In R.B. Perry
(Ed.), William James: Pragmatism. Meridian Books.
Kiekegaard, S. (2007). Dare to decide. In C.E. Moore (Ed.), Provocations. Plough
Publishing House. https://onlinechristianlibrary.com/wpcontent/uploads/2019/05/
kierkegaard_provocations.pdf
Sartre, J.P. (2007). Existentialism is a humanism. Carol Macomber (Trans.). Yale
University Press.
4 Applying Philosophies in a
Cognitive-Behavioral Plan

The purpose of a plan of action is to give clients the opportunity to reverse

the negative polarity that keeps them disposed toward self-defeating cog-
nition, behavior, and emotion; so that they become, instead, disposed to-
ward their counteractive guiding virtues. Such habituation, as the
Aristotelian model makes clear, requires practice. This practice consists in
cognitive and behavioral assignments.

Philosophical (Cognitive) Reframing Assignments

Philosophical (cognitive) reframing, as used in the present approach, is a
process in which a positive philosophy and a guiding virtue it supports is used to
replace a self-destructive negative emotion syllogism chain with a positive, life-
affirming one. This process consists of three steps:

1. Identifying one’s self-destructive speech acts within one’s syllogism

chain,
2. Refuting the self-destructive speech acts in the chain, and
3. Enlisting one’s uplifting philosophy (or set of philosophies) to justify
pursuing the counteractive guiding virtue.

In Vivo Practice
The above three activities can be practiced as emotionally challenging events
arise in the course of daily living. For example, suppose that during the
workweek after the last therapy session, the client’s boss criticized him in
front of his officemates about a mistake he made on a spreadsheet. The
client could use this experience as an opportunity to practice self-talk
(speaking to oneself, silently) to key into his chain of speech acts as the
outrage begins to swell up inside him:

What am I telling myself to work myself up like this? Oh yes, there I go

demanding that I not be treated badly, then damning my boss as a son-of-
a-bitch for how he treated me, and then telling myself how I can’t control
48 Logic-Based Cognitive-Behavioral Approach
my outrage. But where is it written that I must never be treated poorly?
And does this really make my boss a son-of-a-bitch? What he did was
inappropriate; he could have taken me aside; but that doesn’t exactly
make him the worst boss on earth; his act sucked but that doesn’t mean he
sucks; and I can definitely use this as an opportunity to exercise
Temperance by reminding myself about what Sartre says,1 that we
are responsible for our passions and that it is just a copout to say we can’t
control them. I can even feel my anger subsiding as I speak to myself !

Notice that in the above instance of self-talk, the client’s formulation of a

syllogism chain is condensed to the main inferences without the necessity of
formulating all premises needed to formally validate the inference: “I
demand that I not be treated badly, then damn my boss as a son-of-a-bitch
for how he treated me, and then tell myself how I can’t control my outrage.”
Such “ordinary language arguments” generally suffice for clients to identify
the sequence of self-destructive speech acts within their syllogism chains.

Interoceptive Imagery2
This intervention is a form of “rational-emotive imagery” invented by
psychologist Maxie Maultsby and developed by Albert Ellis (Thorburn,
2015). The version presented and applied in LBT emphasizes intentional
shifting from a negative set of images, especially an interoceptive felt need, to a
positive set of images comprised of a guiding virtue and its uplifting
philosophy.
First, the client is asked to mentally replay or imagine a negative experience.
Second, once in the latter state, he is asked to key into the interoceptive
feeling of “must” creating the disturbed state of consciousness. Third, he is
asked to shift his intentional focus to the positive imagery raised by the
uplifting, abstract language of his guiding virtue and its uplifting philosophy.
So, in the aftermath of the office incident, the client might imagine
himself back in this situation, where there he is, being criticized by his boss
in front of his officemates. Once in this state, the client lets himself feel the
outrage he experienced at the time the event occurred. Indeed, the brain
can rerun the interoceptive feelings that were originally experienced. While
replaying the original emotional state in consciousness, the client keys into
the feeling behind his demand, a felt need not to be treated so poorly. The
client then shifts his intentional focus to his guiding virtue and its uplifting
philosophy, allowing himself to experience the positive valence arising
from this intentional shift. The client, in turn, experiences relief from the
negative valence of the first experience.
This exercise can be quite effective in demonstrating to the client his
inherent power over his negative feelings; and, with practice, tends to
reverse the negative polarity of the original imagery by associating it instead
with the positivity of the counteractive virtue and its uplifting philosophy.
 Philosophies in Cognitive-Behavioral Plan 49

Box 4.1 Practice

Therapist (T)–Client (C) Exchange

Conducting Interoceptive Imagery
Therapists can take clients through a dyad of interoceptive imagery experiences,
and once they know how it works, can also practice it on their own when the
therapist thinks the client is ready to practice it effectively. Following is an
example of such a session:

T: Tell yourself what you told yourself when you felt outraged
about how your boss treated you. And let me know when you
are there. Take as much time as you need.
C: [Pause] Okay … I’m there now.
T: How are you feeling?
C: I’m really feeling pissed. Everyone is silent and just staring at me
as he sounds off about the mistake on that spreadsheet and how
mistakes like this could cost us huge sums of revenue.
T: What are you telling yourself to piss yourself off ?
C: I’m thinking what a son-of-a-bitch my boss is for treating me
like this in front of everyone.
T: Is this a preference or a demand?
C: No, I’m demanding it! This is definitely a “must” that he not
put me through this.
T: Do you feel this “must,” you feel a need not to be treated
like this?
C: Yes, I can feel it.
T: Now think about the guiding virtue we discussed, Temperance.
C: Okay, I’m thinking about it. I can actually see the word spelled
out in my mind like a neon sign. Kind of like a light in the
darkness.
T: I like that metaphor! How can you get closer to that light?
Think of your uplifting philosophy.
C: Sartre says that we’re responsible for our passions, that denying
out freedom is just making excuses.
T: Are you feeling this freedom and responsibility, this power to let
go of your excuses; to let go of your demand?
C: I can feel it; I’m letting go now. Letting them float away.
T: Tell me how you are feeling now.
C: I’m feeling a sense of relief; a kind of peacefulness. Much more
relaxed!
T: Excellent!
50 Logic-Based Cognitive-Behavioral Approach

Ongoing Life Issues

In cases of ongoing states of affairs, for example, the divorce case discussed
earlier, the client can continue to practice working it through each time he
thinks about the divorce and begins to feel distraught. Again, this would
involve following the progression of speech acts climaxing in the capacity
disavowal, refuting these acts, and reflecting on the philosophy/ies he has
adopted to promote his guiding virtue/s.

Shame Attacking Exercises

Another practice exercise is where the therapist asks the client to engage in
some innocuous form of behavior that the client thinks would likely draw
negative attention of others. For clients who tend to demand that they get
the approval, or at least not the disapproval of others, and therefore assess
their self-worth based on what others think of them, shame attacking ex-
ercises can be particularly helpful.

Box 4.2 Practice

Sample Shame Attacking Exercises

Some examples of shame attacking exercises therapists can suggest include
these (Yankura, & Dryden, 1994):

• Asking for a gross of condoms at a pharmacy counter, and then

requesting a discount because one uses so many.
• Loudly announcing the stops on the subway (without fleeing the
car one happens to be in).
• Stopping a stranger on the street and saying, “Excuse me, I’ve
just gotten out of the loony bin. Can you tell me what year it is?”
• Walking a banana down a crowed city street.

While doing the exercise, the client identifies his speech acts, refutes
them, and replaces them with an uplifting philosophy:

Okay, I have placed this demand on myself not to do anything stupid

that made a fool of myself, and that if I did, I would be a fool. So, I
really couldn’t stand doing anything like that. But here I am, speaking
to a waiter in a restaurant, a perfect stranger, about the last time we
played tennis, and I know she thinks I’m insane. But does it really
matter what she thinks of me? I can do this, after all! I have just proved
 Philosophies in Cognitive-Behavioral Plan 51
that I can be authentic, a creator of my own values, not merely
someone who does what’s expected.3

Risk-Taking Exercises
In this type of exercise, a risk-avoidant client picks something relatively safe
to do that he nevertheless has anxiety about doing.

Box 4.3 Practice

Sample Risk-Taking Exercises

Some examples of risk-taking exercises therapists could use include the
following:

• Sending back one’s food in a restaurant and ordering something

different;
• Making an online purchase with a credit card;
• Washing off silverware instead of putting it through the
dishwasher;
• Singing happy birthday twice while washing one’s hands instead
of one more round for good measure;
• Eating in “The Greasy Spoon Inn”; or
• Walking under a ladder.

Indeed, the activity chosen for this exercise is very subjective since what
feels uncomfortable to one risk-avoidant client may not seem so to another.
As in shame attacking exercises, while engaging in the risk-taking exercise,
the client works through the anxiety he is experiencing.

Box 4.4 Practice

Applying a Philosophy in a Risk-Taking Exercise

Albert Camus (2005)stated, “Courage in all its power and grandeur raises
you above yourself.” The below client self-talk illustrates application of this
uplifting philosophy to do a risk-taking exercise:

Silverware has to be perfectly clean before I eat from it; so, it

would be disgusting if I ate from a dirty spoon. So, I just can’t do
it. But nothing is perfectly clean, not even my mouth where the
spoon would go; and is it really disgusting or am I just making
myself disgusted. My guiding virtue is Courage, which means
52 Logic-Based Cognitive-Behavioral Approach
being afraid to the extent it is reasonable to be afraid, and my
philosophy of Courage tells me to improve myself through acts
of Courage. Well here it goes, into the old hatch!

Tackling Major Life Challenges

Clients’ constructive changes occur gradually through practice of the sorts
discussed above. These activities can be practiced in the context of everyday
life, from how one interacts with the cashier at a local grocery store to
performance at work or school. It is progressive change over time. At some
juncture, however, the client may be ready to tackle a more difficult
challenge. This could be a major life decision. For example, a risk-avoidant
client apprehensive about accepting a job promotion she has waited a long
time for, can practice identifying and refuting her self-defeating speech acts
within the syllogism chain, refuting them, and reframing in terms of a
philosophy toward a guiding virtue.

Box 4.5 Practice

Applying a Philosophy to a Major Life Decision

Existential philosopher, PaulTillich (1952), in The Courage to Be,
stated, “The drive for security, perfection, and certitude … becomes
biologically destructive if the risk of insecurity, imperfection, and uncertainty
is avoided.” According to Tillich, “Courage always involves a risk,” but it is
the only way of affirming oneself. Courage, he says, is “the act of the
individual self in taking the anxiety of nonbeing [losing one’s Authenticity]
upon itself by affirming itself…” This uplifting philosophy is illustrated in the
below client self-talk:

I’m feeling really anxious about taking the plunge. So, what am I
telling myself to create my anxiety when I really want so badly to
have this promotion? I have to play it safe, and not take any risks.
If I don’t play it safe, then it’s possible something horrible could
happen like I mess up and prove myself to be a big failure. So,
that’s why I’m telling myself I can’t go through with it. But wait
a minute, what if I did mess up? Would that be so bad? I could
always get my old job back or get the same job somewhere else,
which would suck but not like it would kill me. And there I go,
berating myself. If I turned out not to be a good fit for the job, it
would not mean I was a “big failure.” We all screw up at one
thing or another, even very competent people. It will take
Courage, I know. But that’s my guiding virtue and even though
 Philosophies in Cognitive-Behavioral Plan 53
I’d prefer to be certain about being successful at my new job, it’s
self-destructive to avoid taking risks because that’s the only way
of affirming who I am. If I never take risks, then who am I
anyway!

In so reframing, the client frees herself to act on her

philosophy—in this case to exercise Courage through the self-
affirmation of accepting a promotion.

Positive Reinforcement
Albert Ellis often counseled his clients to reward themselves with something
they enjoy such as a dessert or something they like to do. This association of
the constructive action with something pleasurable is supposed to set the
foundation for overcoming cognitive dissonance and making progress to-
ward positive, permanent change. Such an assignment aimed at reinforcing
the favorable behavior is based on operant conditioning; and it can be useful
when appropriately applied (Kim, 2020; Center for Substance Abuse
Treatment, 1999). However, there are neuropsychological processes that
make the intrinsic reward of completing one’s goal to be itself reinforcing;
and there is some evidence that the externalized reward can interfere with
the intrinsic reward (Murayamaa et al., 2010). The nature of the brain’s
reward system that builds solid habits will be examined further in Chapter 5.

Meditation
Buddhist philosophy, coupled with meditative practice, has also been
shown to be effective in reducing emotional stress, including anxiety and
depression (American Psychological Association (APA), 2019; Kabat-Zinn
et al., n.d.).
The central idea derives from the First Noble Truth of Buddhism:

Birth is suffering, aging is suffering, sickness is suffering, dissociation

from the loved is suffering, not to get what one wants is suffering: in
short the five categories affected by clinging are suffering.
(Buddhanet, n.d.)

Succinctly stated, people upset themselves by unrealistically “clinging” to

such things, that is, by demanding that things outside human control not
happen, such as aging, death, and loss. Thus, one way of “letting go” of
such demands is to meditate.
Meditation, however, comes in different forms, the most prominent of
which is mindfulness meditation in which there is nonjudgmental observing of
an intentional object. For instance, in this sort of meditation, one focuses on
54 Logic-Based Cognitive-Behavioral Approach
one’s breathing while gently keeping other thoughts and value judgments
from disrupting the focused, momentary attention.
Philosopher Mike W. Martin also speaks of what he calls “virtue-
mindfulness” In this sense of “value-based” mindfulness, one allows oneself
“to be morally and spiritually awake.” This sense of “mindfulness,” he says,
was embraced by Henry David Thoreau when he went to Walden Woods
to live and commune with the majesty of nature (Martin, 2020, p. 63).
The latter value-based sense of “mindfulness” is also a sense that appears
to apply to interoceptive imagery discussed above, in which the client
mindfully attends to the positively valent imagery of her virtues and up-
lifting philosophies and feels “morally and spiritually awake.” However, to
avoid confounding the latter value-based sense of mindfulness with the
more commonplace sense of non-judgmental mindfulness, in this book, I
refer to the virtue-based variant as interoceptive imagery and use the term
“mindfulness” exclusively in connection with the nonjudgmental form.

Box 4.6 Practice

Training in Mindfulness Meditation

One training program that is available online free is that based on one
developed by Jon Kabat-Zinn at the University of Massachusetts
Medical School (Palouse Mindfulness, n.d.). This is an eight-week
program that can help clients learn how to incorporate mindfulness
into their daily lives. Clients can even receive a certificate with
completion of the course.

In contrast to mindfulness mediation, value-based variants may utilize

cognitive techniques such as reappraisal or reframing. One such class de-
rived from Buddhism includes a form of compassion-based mediation called,
“loving-kindness meditation,” which seeks to cultivate unconditional ac-
ceptance of self, others, and (eventually) the world. As emphasized in this
book, these are fundamental guiding virtues for overcoming the disposition
to engage in self-destructive, speech acts of damnation. Accordingly,
meditative practice of this sort may be especially applicable to problems
involving such self-destructive tendencies, for example hyper-egoic dis-
avowals (see Chapter 11) and dependent disavowals (see Chapter 12). In the
latter type of meditation, one keeps one’s focus on the target, while silently
repeating some kindness such as “may you be happy” or “may you be free
from suffering.” Some application may also include imagery such as vi-
sualizing the target or imagining light emanating from one’s heart toward
others. Targets generally begin with easier ones and gradually progress to
harder ones, and eventually to all beings (Zeng et al., 2015).
 Philosophies in Cognitive-Behavioral Plan 55
Philosophical Bibliotherapy
For clients able and willing to read the works of great philosophers,
assigning these texts, or rather edited selections or excerpts from them, as
bibliotherapy can provide a useful homework assignment. However, the
mode of delivery of the uplifting philosophy need not come from a phi-
losophical text as bibliotherapy. It can also be in the form of a play. For
example, the play, Nausea, by Sartre (2017) portrays the same philosophical
idea (that human beings define themselves through their actions) in a literary
format, which can similarly inspire Decisiveness as a guiding virtue.
Literary forms such as movies can also do the same. For example, the
movie, “42” (2013), about Jackie Robinson, the first African American
baseball player in the Major League, can inspire the ideals of Decisiveness,
Perseverance, and Courage in some clients who may be risk-avoidant or
dependent. Inasmuch as there is an incredibly rich database of movies now
readily available in digital format, such resources can be assigned as bib-
liotherapy as appropriate.
The same is true for music, which can also capture philosophical world
views. For example, classic hip-hop artists such as Digital Planets have
embedded philosophical themes into their lyrics as in “Pacifics,” which
embeds Sartre’s philosophy:
Vibing off the jams of the crews on Sugarhill
Lay around and think ain’t nothing to do
Checking out some Fromm, some Sartre, Camus
Mingus’ Ah Um, damn Roach can drum (SongLyrics, n.d.)

“Nothing to do?” Then “check out” Sartre (as well as social psychologist
Eric Fromm and existential novelist Albert Camus) who can give you a
more enlightened idea of why “Laying around” is not a good idea.
Again, the selection of an uplifting philosophy to ground a virtuous rule
is a personal choice and, therefore, should not be subverted by a therapist’s
own bias. This is also true of the mode of delivery in assigning bib-
liotherapy. Thus, a therapist’s preference or non-preference for hip-hop is
irrelevant. What matters is whether the philosophy, as well as its mode of
delivery, (1) resonates with the client, (2) justifies the virtuous rule in
question, and (3) does not itself commit any speech acts that subverts the
very point of therapy. Within these broad parameters, numerous, diverse
philosophies are possible across cultures (from East to West), demographics,
race, ethnicity, religion, gender, and sexual orientation.

Other Bibliotherapy
In addition to philosophical bibliotherapy, informational bibliotherapy can
also be useful since the reportative premises of clients’ emotional reasoning
56 Logic-Based Cognitive-Behavioral Approach
and virtue-based reasoning make factual claims. For example, a client in-
clined toward self-damnation may intend to turn down a job offer because
she believes she is unqualified, whereas further information about the
nature of the work could prove useful in objectively assessing her job
qualifications.

Worksheets
Self-help as well as CBT workbooks that contain worksheets for clients to
work through can be useful. The companion workbook (Cohen, 2022) to
this book contains a chapter for each of the capacity disavowals addressed in
Part 3 of this book, and can, accordingly, guide clients in doing the ex-
ercises included in its respective cognitive-behavioral plan.

Further Philosophical Resources

Uplifting philosophies can be found in many and sundry places in the annals
of human thought. One challenge is to point these ideas toward specific
guiding virtues and to cast them in language that promotes positive affect.
There have been few systematic attempts to organize philosophical ideas
around the specific virtues. One such tool is my book, The New Rational
Therapy: Thinking Your Way to Serenity, Success, and Profound Happiness. It is
a systematic catalog of uplifting philosophies crystalized into positive lan-
guage, keyed to specific guiding virtues (Cohen, 2007).
A further book, focusing on Unconditional Positive Regard, is Albert
Ellis’s The Myth of Self-Esteem: How Rational Emotive Behavior Therapy Can
Change Your Life Forever (Ellis, 2005). This book examines ideas of different
philosophers, from existentialists such as Sartre, Kiekegaard, and Nietzsche
to Buber, Lao Tsu, and Jesus of Nazareth. While the book tends to be
critical of many philosophers it inspects, it also offers a rich selection of ideas
potentially useful for promoting Unconditional Self-Acceptance. I would
recommend this book as a resource for Logic-Based Therapists looking for
uplifting philosophies to keep on tap.

Cognitive-Behavioral Interventions
The above types of cognitive-behavioral interventions are broad classes that
can be fine-tuned to particular capacity disavowals or cognitive-behavioral
problems to which they are applied. They are also not the only exercises
that could be assigned to clients for these purposes. However, they re-
present a core set that can be rationally expanded. For example, therapists
can usefully include role-play (Wolfe, n.d.) as well as journaling.
In the end, the primary goal of cognitive-behavioral intervention is to
help clients reverse the polarity of their negative-emotion syllogism chains,
by replacing the latter with positive, philosophical, virtue-oriented
 Philosophies in Cognitive-Behavioral Plan 57
syllogism chains. The next part of this book turns to the underlying neu-
rological mechanisms that appear to support application of cognitive-
behavioral interventions such as the ones described here.

Notes
1 “The existentialist does not believe in the power of passion. He will never regard a
grand passion as a destructive torrent upon which a man is swept into certain actions
as by fate, and which, therefore, is an excuse for them. He thinks that man is re-
sponsible for his passion” (Sartre, 1985).
2 The term “interoceptive” refers to interoceptive feelings. The latter are feelings of the
internal state of the body, including motivational feelings and feelings of necessity
generated by somatosensory structures in the brain. See Chapter 5 for more details.
3 Friedrich Nietzsche (2010), spoke, “Behold the believers of all beliefs! Whom do they
hate most? Him who breaketh up their tables of values, the breaker, the law-
breaker—he, however, is the creator.”

References
American Psychological Association (APA). (October 30, 2019). Mindfulness medita-
tion: A research-proven way to reduce stress. https://www.apa.org/topics/
mindfulness-meditation
Buddhanet. (n.d.). The first noble truth. http://www.buddhanet.net/4noble4.htm
Camus, J.P. (2005). The Spirit of St. Francis de Sales. Retrieved from
www.gutenberg.org/cache/epub/9184/pg9184-images.html
Center for Substance Abuse Treatment. (1999). Brief cognitive-behavioral therapy (ch.
4). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64948/
Cohen, E.D. (2007). The new rational therapy: Thinking your way to serenity, success, and
profound happiness. Rowman Littlefield. 42 (2013). Warner Bros. Trailer. https://
www.youtube.com/watch?v=H69szHCElcE
Cohen, E.D. (2022). Cognitive-behavior therapy for those who say they can’t: A workbook for
overcoming your self-defeating thoughts. Routledge.
Ellis, A. (2005). The myth of self‐esteem: How rational emotive behavior therapy can change your
life forever. Prometheus Books.
Kabat-Zinn, J. Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K.E., Pbert, Ph L.,
Lenderking, W.R., & Santorelli, S.F. (n.d.). Effectiveness of mindfulness training for an-
xiety. https://mbsrtraining.com/effectiveness-of-a-meditation-based-stress-reduction-
program-in-the-treatment-of-anxiety-disorders-jon-kabat-zinn-ph-d/
Kim, J. (January, 2020). How to get your desired behaviour using operant conditioning.
Positive Psychology. https://positivepsychology.com/operant-conditioning-reinforcement/
Martin, M.W. (2020). Mindfulness in good lives. Lexington Books.
Murayamaa, K., Matsumotob, M., Izumab, K., & Matsumotob, K. (2010). Neural basis of the
undermining effect of monetary reward on intrinsic motivation. Proceedings of the National
Academy of Sciences, 107(49), 20911–20916. pnas201013305 20911.20916.
Nietzsche, F. (2010). Thus Spake Zarathustra. Thomas Common (Trans.). Retrieved
from https://www.gutenberg.org/files/1998/1998.txt
Palouse Mindfulness. (n.d.). Online Mindfulness-Based Stress Reduction (MBSR).
Online MBSR/Mindfulness (Free) (palousemindfulness.com).
Sartre, J.P. (1985). Existentialism and human emotions. Philosophical Library.
58 Logic-Based Cognitive-Behavioral Approach
Sartre, J.P. (2017). Nausea. Ishi Press.
SongLyrics. (n.d.). Digable planets – Pacifics lyrics. http://www.songlyrics.com/
digable-planets/pacifics-lyrics/
Thorburn, R.W. (April 15, 2015). Rational emotive imagery. ellisREBT. Retrieved
from https://www.ellisrebt.co.uk/rational-emotive-imagery/
Tillich, P. (1952). The courage to be. Yale University Press. https://antilogicalism.com/
wp-content/uploads/2017/07/the-courage-to-be.pdf
Wolfe, J. (n.d.). REBT in Action: 4-Video Series. Video 1. Retrieved from https://
www.psychotherapy.net/video/rebt
Yankura, J. & Dryden, W. (1994). Albert Ellis. Sage.
Zeng, X., Chiu, C.P.K., Wang, R., Oei, T.P.S., & Leung, F.Y.K. (2015). The effect of
loving-kindness meditation on positive emotions: A meta-analytic review. Frontiers in
Psychology, 6, 1693. https://doi.org/10.3389/fpsyg.2015.01693
Part II

Neurological Correlates
5 Neuropsychology of a Logic-
Based Therapy

One exciting upshot of a logic-based approach to CBT is the potential for

contemporary neuropsychology to provide empirical confirmation by de-
monstrating the functionality of specific brain regions responsible for
emotional reasoning, that is, the evaluative syllogisms involved in the ac-
tivity of emoting. Indeed, some emerging research in neuropsychology
now points to a deductive understanding of the process occurring during an
emotion (Goel & Dolan, 2003). In particular, it points to a logical model in
terms of premises and conclusion instead of a causal model in terms of
events, beliefs, and consequences. Accordingly, the working hypothesis
here is that an emotion is a logic-based evaluative process that tracks
neurological activity in the prefrontal cortices of the brain and related areas,
including physiological changes in other parts of the body. Thus, according
to neuropsychologist Antonio Damasio, “an emotion is the combination of
a mental evaluative process,” occurring on the prefrontal cortices of the brain
(such as the ventromedial prefrontal cortex) “with dispositional responses to
that process mostly toward the body proper, resulting in an emotional body
state…” (Damasio, 1994, p. 139). As discussed in this chapter, the afore-
mentioned “mental evaluative process” appears to include emotional rea-
soning that can be represented in the form of an evaluative syllogism chain,
which performs speech acts interactive with the body proper.
Not all emotions are created equal, however. For example, fear of a bear
in one’s midst is largely a pre-wired “fight or flight” response to danger. In
such cases, one automatically tends to react first and think second. In
contrast, negative emotions such as anxiety are more complex, because they
involve judgments about future danger and evaluations of the danger, and
therefore have considerable cognitive input.1 This distinction tracks two
affective networks, one that is largely dependent on the cerebral cortex; the
other that is largely or primarily dependent on subcortical “limbic” activ-
ities (those of the amygdala, hippocampus, hypothalamus, etc.) (Bechara,
2005). Unfortunately, these two systems do not always work synergistically,
which, as discussed later, creates conflicts.
62 Neurological Correlates
The Human Brain’s Deductive System for Emotional
Reasoning
The hypothesis advanced here is that deductive inferences in emotional
reasoning proceed in terms of a flow of associated images including feelings.
Indeed, there is evidence to suggest that certain right hemispheric regions
of the brain supply formal rules such as modus ponens for processing such
content (Parsons & Osherson, 2001).
As discussed in Chapter 1, the primary syllogism of emotional reasoning
proceeds according to modus ponens. Roughly, the brain process that
follows the latter inference rule may be conceptualized as follows. An image
A has been associated with an interoceptive feeling B, thereby “wiring in” a
neural inference rule whereby if A then B. So, when an individual has an
intentional object C (perceives or imagines a certain event, person, object,
or other) which she associates with A, she then experiences B. For example,
in the case of a negative emotion, if the person has come to associate the
image of being in the presence of strangers (A) with a feeling of trepidation
(B), then imagining herself delivering a public speech (C) triggers the
feeling of trepidation (B).
Recent fMRI studies suggest that the prefrontal cortex, particularly the
ventromedial prefrontal cortex (VMPFC), plays a major role in regulating as
well as generating negative emotions (Hiser & Koenigs, 2018). There is also
evidence that, when individuals make deductions from practical syllogisms,
the VMPFC is engaged. For instance, Goel and Dolan (2003) used func-
tional magnetic resonance imaging (fMRI) to study activation of the
VMPFC of 19 participants while they examined 60 emotionally charged
syllogisms and 60 emotionally neutral syllogisms for their validity. When
participants engaged in deductive activity with syllogisms with emotional
content (ones that used language such as “murderous,” “criminals,” “per-
verse,” “not innocent,” “pimps,” “handicapped,” “not smart,” “rapists,”
and “expendable”) there was increased activation in the VMPFC and
suppression of activation in the dorsolateral prefrontal cortex (DLPFC).
The converse relationship between these brain regions occurred when the
participants engaged in deductive activity with neutral syllogisms (for ex-
ample, “elephants,” “mammals,” “mules,” and “grocers”).
According to Goel and Dolan, this reciprocal engagement “provides
evidence for a dynamic neural system for reasoning, the configuration of
which is strongly influenced by emotional saliency” (Goel & Dolan, 2003,
p. 2314). Further, as suggested in this chapter, the negative correlation
between DLPFC and VMPFC suggests synergistic roles of these two pre-
frontal cortices in a dynamic system of reasoning integrating both neutral
(reportative) and emotional (evaluative) reasoning in controlling negative
emotions as well as physical desires (Koenigs & Grafman, 2009). This
regulatory system, on all accounts, also has projection to subcortical regions,
notably the amygdala.
 Neuropsychology of a Logic-Based Therapy 63
The Role of the Ventromedial Prefrontal Cortex in
Mental Disorders: Implications for a Logic-Based Model
The VMPFC maintains bidirectional neural pathways to the amygdala
(Ghashghaei et al., 2007), which tracks fear in response to perceived en-
vironmental dangers as well as physical desires (such as food, sex, money,
and other rewards) (Fernando et al., 2013). There is also evidence that
hypoactivity in the VMPFC leads to disinhibited amygdala activity, causing
mood and anxiety disorders (Motzkin et al., 2015; Hare et al., 2009).
However, according to Hiser and Koenigs (2018), the latter disinhibition
model is inconsistent with a wider body of evidence. “It has long been
established,” they contend, “that humans with VMPFC damage do not
exhibit increases in negative affect, such as fear, anxiety, or guilt, following
the acquisition of their lesions (as would be predicted by the inhibition
model).” Instead such individuals “may exhibit blunted affect and… re-
duced susceptibility to depression and posttraumatic stress disorder” (Hiser
& Koenigs, 2018, p. 640). This suggests that the VMPFC itself plays a major
role in the generation of negative emotions involved in mental illness.
This does not discount that a disinhibited amygdala can itself cause be-
havioral and emotional problems. Indeed, as discussed below, this can
happen in cases of overindulgence of physical desires where there is poor
self-control (insufficient VMPFC control over, or acquiescence with the
amygdala signal), or in approach-avoidance conflicts where a positive goal
signal from the VMPFC conflicts with a negative signal from the amygdala.
Nevertheless, the research by Goel and Dolan (2003) tracking evaluative,
syllogistic activity in the VMPFC, taken with the hypothesis that the
VMPFC itself plays a major role in the generation of negative emotions
involved in mental illness, supports the hypothesis proposed here:

A chain of evaluative syllogisms in the VMPFC can track negative emotions

such as anxiety, guilt, anger, and depression.

For example, according to the proffered hypothesis, activity in the (right2)

VMPFC generated by a catastrophic practical syllogism can potentially raise
the level of activity in the amygdala and engage the hypothalamic axis
(pituitary and adrenal glands) and sympathetic nervous system, raising the
level of unnecessary stress, and creating self-destructive, negative emotions.
Corroboratively, in one study, high levels of intolerance to uncertainty
(as measured by comparing it with broader anxiety indicators such as the
State-Trait Anxiety Inventory) were associated with increased activity in
the VMPFC and amygdala during extinction learning (Morriss et al., 2015).
On the proposed hypothesis, the study participants may have harbored
evaluative syllogism chains with speech acts such as deduction of cata-
strophizing from demanding certainty, with risk-avoidant disavowal;
thereby resisting extinction learning.
64 Neurological Correlates
The Parameters of Human Control: The Role of the
Dorsolateral Prefrontal Cortex
A key component in the proposed logic-based model is the DLPFC. The
latter is associated with cognitive functions, such as working memory, in-
tentions, goal-directed action, abstract reasoning, and attention. However,
several fMRI studies suggest that these “DLPFC-mediated cognitive control func-
tions” are also recruited by the VMPFC in regulating negative emotion through
reappraisal/suppression strategies (Lévesque et al., 2003). Much as the VMPFC
serves to regulate the amygdala to control irrational impulses, the DLPFC
serves to regulate the evaluative cognitions in the VMPFC that drive ne-
gative emotions. As discussed below, without input from the DLPFC, the
VMPFC would not have the capacity to rationally regulate the amygdala,
or at least would not perform this function efficiently.

Exercising Discretion
As Aristotle (1941) keenly perceived, rational, evaluative reasoning is
context-dependent. It involves choosing “the mean relative to us,” that is,
taking into consideration the situation in which a choice is being made
(bk.2, ch.6). What has maximum value in one context may have little or no
(positive) value in another context. Telling the truth may be the most
prudent response in most contexts but not in all contexts, for example,
when being truthful will get you or others killed. So, making value deci-
sions is a complex reasoning activity that requires the exercise of discretion.
DLPFC activation appears to track such discretion. In one study, human
participants were tasked with choosing between stimuli whose value (based
on a set of criteria given to the participants in advance) varied from one
context to another. A control group was also tasked with choosing between
stimuli whose value did not vary according to context. fMRI imaging
revealed that the DLPFC had increased activation in the cases in which
participants exercised discretion in contrast to the control group (Saraiva
and Marshall, 2015).
In another fMRI study, 22 participants made binary choices between
visual stimuli with attributes of shape, color, and pattern associated with
monetary values with the goal of determining maximum monetary reward.
Context changes involved integrating a second attribute with a default
shape valuation. Activity in participants’ DLPFC increased when context
changed (Rudorf & Hare, 2014).

Reappraising a Situation
The DLPFC also appears to be involved in reappraisal such as in moral
contexts. In one study, participants were presented with a war scenario
involving a crying baby who was endangering the lives of many others
 Neuropsychology of a Logic-Based Therapy 65
hiding from the enemy. Participants monitored by fMRI scans were asked
to decide if it would be morally acceptable to smother their own baby in
this situation. Participants who considered such a response to be appropriate
had greater activation of their DLPFC than participants who considered this
inappropriate regardless of costs. Further studies corroborate these findings
(Tei et al., 2017; Tassy et al., 2011).

Exercising Volitional Self-Control

There is also evidence that the DLPFC is more active in controlling desires
in individuals with greater self-control. For instance, in another study
participants who exercised greater self-control in avoiding unhealthy foods
had increased activation of their DLPFC and decreased activation of their
VMPFC while the converse was true for participants with poorer self-
control.
In one study, two hypotheses were proposed, and confirmed, about the
neurobiology of self-control:

(i) Goal-directed decisions have their basis in a common value signal

encoded in the VMPFC, and
(ii) Exercising self-control involves the modulation of this value signal by
the DLPFC.

This study used fMRI imaging to monitor brain activity of dieters engaged
in decisions about food consumption. VMPFC activity correlated with goal
values in both self-controllers and non-self-controllers. It correlated with
both taste and health in self-controllers but only taste in non-self-
controllers. Activity in the DLPFC increased when participants exercised
self-control, especially in successfully exercising it, and decreased in the
VMPFC (Hare et al., 2009; Rudorf & Hare, 2014).

Box 5.2 Practice

Boosting Clients’ Self-Control

A practical upshot of the role of the DLPFC in modulating the

VMPFC is that a program of CBT that addresses strengthening the
DLPFC to modulate VMPFC signals can boost clients’ self-control,
such as in the case of low-frustrative clients. The section on the
“Neurological Access of Control” in this chapter provides a logic-
based model for understanding how this modulation process works,
and thus what techniques may be effective.
66 Neurological Correlates

The Neurological Axis of Control: A Logic-Based Model

As mentioned earlier, activation of the DLPFC has been identified in in-
dividuals who engage in neutral deductive reasoning, that is, deductive
reasoning that is primarily reportative, not evaluative. Further, the DLPFC
appears to play a major role in making inductive inferences, that is, acquiring
rules (hypotheses, generalizations, and causal relations) from observations
stored in its working memory (Crescentini et al., 2011). This capacity of the
DLPFC for inductive inference together with its capacity for reportative
deductive inferences provides support for a logic-based model of how the
DLPFC communicates with the VMPFC to increase discretion, moral
flexibility, and self-control.
For instance, the DLPFC may acquire the rule that eating foods high in
saturated fat contributes to high cholesterol by inferring it from the testi-
mony of physicians along with other healthcare sources (media, books,
etc.). When this inductive rule is combined with an inductive report ac-
quired by reading the candy wrapper (or other informational sources), these
reportative premises can then become the basis for a reportative syllogism
such as this one:

(Inductive Rule) Eating foods high in saturated fat can contribute to

high cholesterol.
(Inductive Report) This candy is high in saturated fat.
(Conclusion) Eating this candy can contribute to high cholesterol.

The DLPFC stores the above conclusion in its working memory (Barbey
et al., 2013; Manes et al., 2002). The VMPFC then receives this report
from the DLPFC,3 and utilizes it in an evaluative syllogism such as this one:

(Major Premise Rule) If eating this candy can contribute to high

cholesterol, then it’s bad for me.
(Report from DLPFC) Eating this candy can contribute to high cholesterol.
(Conclusion) Eating this candy is bad for me.

The above Major Premise Rule is constructed by linking high cholesterol

with being “bad for me.” The ability of the VMPFC to trigger feelings
associated with particular sets of facts has been confirmed by Damasio,
Bechara et al. (2000). When a decision is being made that involves some
factual aspects of a previous situation, the VMPFC triggers feelings or
sensory images, associated with those facts. Patterns of these images trig-
gered by the VMPFC are stored in somatosensory structures such as the
insula, and somatosensory and anterior cingulate cortices.
For example, the report from the DLPFC that eating this candy can
contribute to high cholesterol, can, in turn, trigger a “bad” or negative
 Neuropsychology of a Logic-Based Therapy 67
feeling associated with the previously stored fact that high cholesterol can
lead to heart attacks. Hence, given Damasio’s hypothesis, the decision to
rate or evaluate high-cholesterol foods as “bad for me” in the Major
Premise largely appears to be a function of the prior “bad” (negative)
feeling or “somatic markers” associated with high cholesterol.4 “[W]hen
the somatosensory image which defines a certain emotional response is
juxtaposed to the images which describe a related scenario of future out-
come, and which triggered the emotional response via the ventromedial
linkage, the somatosensory pattern marks the scenario as good or bad” (Bechara
et al., 2000, p. 297, my italics). The VMPFC then adds the report that
eating this candy can contribute to high cholesterol and, in turn, deduces the
badness of eating it.
The VMPFC can then direct the amygdala not to eat this candy. This is
because the conclusion, “Eating this candy is bad for me” is not merely a
report. It is an evaluative speech act that condemns eating it. From a neurological
perspective this means that it can “turn off the amygdala switch” (deactivate it),
thereby regulating its response. This capacity of the VMPFC to suppress the
amygdala has been confirmed by functional imaging studies (Motzkin et al.,
2015; Morriss et al., 2015).

Conflict Between the Amygdala and VMPFC

However, this “top-down” command from the VMPFC may not always be
sufficient to “switch off” impulses directed from the amygdala (Motzkin
et al., 2015). So, an individual may “know better” but still eat this candy. In
such cases, the amygdala impulse overwhelms the command issued by the
VMPFC.5

The Role of the Striatum in Behavioral Responses

Impulses generated by the amygdala are a function of its roles in storing
and retrieving pleasant or painful feelings arising from prior sensory ex-
periences, for example, tasting a candy bar.6 When subsequent sensory
experiences ensue that are associated with the previous experiences, for
example, seeing this candy, the amygdala triggers the associated feeling. In
the case of a pleasurable association, the amygdala sends signals to the
striatum (primarily to the ventral part), which is a network of subcortical basal
ganglia associated with reward that translates motivational signals into action. If
the VMPFC is unable to suppress the amygdala signal, the striatum
translates it into action, for example, eating the unhealthy candy (Cho
et al., 2013).
In cases where an unpleasant experience is triggered, the amygdala may
react by sending a message to the hypothalamus, which engages the sym-
pathetic nervous system to prepare for “fight or flight.” It can also signal the
striatum to modulate a behavioral response such as avoidance or escape to
68 Neurological Correlates
cope with the stress (Fareria & Tottenhamb, 2016). This reaction, however,
can be unrealistic and excessive and, if the VMPFC is not able to suppress
the amygdala signal, it can lead to intense, self-defeating anxiety.

Approach-Avoidance Conflict
The striatum also receives goal-directed signals from the prefrontal cortex,
largely the VMPFC. If the amygdala sends a conflicting signal to the striatum,
for example it associates the VMPFC goal with danger, the individual may
experience an approach-avoidance conflict. Such states of conflict have been implicated
in anxiety disorders such as generalized anxiety disorder, social anxiety disorder
(SAD), panic disorder, specific phobia, and posttraumatic stress disorder (PTSD).
According to Aupperle and Paulus (2010), “inherent in the notion of an
anxiety disorder is conflict between approach-related drives (e.g., to seek
positive social interactions, to leave the house) and avoidance-related drives
(e.g., to prevent being humiliated or having a panic attack).”Aupperle 2010

Box 5.3 Practice

Using CBT Interventions to Address Conflicts

CBT as well as pharmacological treatments have been shown to be

effective in decreasing amygdala activation (Aupperle & Paulus,
2010). In the case of CBT, this appears to be the result of using
cognitive-behavioral interventions such as those discussed in Chapter 4
that help the medial prefrontal cortex negotiate and reconcile the
conflicting signals.

Building Virtuous Habits to Overcome Approach-Avoidance Conflicts

The role of cultivating habits that support virtuous conduct (Courage,
Decisiveness, Unconditional Positive Regard, Authenticity, etc.) is of
paramount importance in overcoming such approach-avoidance conflicts
and producing more permanent brain changes. The striatum appears to play
a significant role in shaping behavioral habits through input from the
prefrontal cortex, especially the infralimbic cortex, a region of the VMPFC
involved in the modulation of fear (Lipton et al., 2019). In adapting goal-
driven behavior to context, habits that support virtuous activity (such as
finding the Aristotelian “mean” between extreme behavioral responses)
“are likely to also rely on corticostriatal circuits that use contextual in-
formation to shape behavior” (Graybiel & Grafton, 2015). This probably
includes input from the DLPFC, which records such information in
working memory. Midbrain dopamine neurons form a complex network of
 Neuropsychology of a Logic-Based Therapy 69
connectivity with the ventral and dorsal regions of the striatum, which are
active in reinforcing learning, thus contributing to the development of habits
(Darvas & Palmiter, 2009; Haber, 2011). Development of virtuous habits
appear to require practice, both cognitively and behaviorally (Wood & Rünger,
2016), which can, in turn, help to suppress or defeat self-destructive
amygdala impulses.

Box 5.4 Practice

Setting Behavioral Goals

Positive reinforcement of desirable actions is essential to helping

clients overcome approach-avoidance conflicts and create permanent
cortico-striatal circuit changes that build virtuous habits. The dopa-
mine that is naturally released when a client accomplishes a desired goal
is itself positively reinforcing; so, setting behavioral goals, even if small
ones, and achieving them, can be instrumental in building intrinsic
motivation (wanting to perform virtuous acts for their own sake), and,
therefore, in building virtuous habits (Lee & Reeve, 2017).

Neuropsychology of Syllogism Chains

It would be an oversimplification to locate the exclusive root of affective
and anxiety disorders in the VMPFC’s inability to suppress strong
amygdala impulses and to be overwhelmed by them. As discussed above,
this can be the case in self-control and approach-avoidance situations;
however, this does not capture the manner that the VMPFC can itself
generate self-destructive amygdala impulses. As mentioned earlier, the VMPFC
not only can regulate negative emotions; it can also cause them (Hiser &
Koenigs, 2018). This is possible when it engages in self-destructive speech
acts such as catastrophizing.
Unfortunately, syllogisms with self-destructive speech acts can interface with
other syllogisms to create further dysfunction. As examined in Chapter 1, the
terminus of such self-defeating syllogism chains is often a capacity disavowal,
which disavows one’s freedom to control one’s behavior, emotions, volitions,
impulses, or cognitions. Syllogism chains terminating with capacity disavowals
often drive intense emotions such as anxiety, anger, depression, and guilt; and
self-defeating behavior such as avoidance of positive life changes.
For example, in the below syllogism, the client stifles his own freedom
and fails to take responsibility for his capacity to control his behavior:

1. I must be certain about future outcomes (such as not messing up).

70 Neurological Correlates
2. If I must be certain I won’t mess up, then if I could forget my lines if I
perform in the play, then I could make a damn fool of myself.
3. Therefore, if I could forget my lines if I perform in the play, then I
could make a damn fool of myself.
4. But, if I performed in the play, I could forget my lines.
5. Therefore, I could make a damn fool of myself.
6. If I could make a damn fool of myself, then I can’t perform in the play.
7. Therefore, I can’t perform in the play.

In the above chain, the grayed-out statements (with bullets) serve as inference
rules that validate the chain of inferences. As discussed below, while these
rules track the connections between people’s thoughts (images and feel-
ings), people do not ordinarily consciously formulate these rules as they
think (that is, process images and feelings).

The Phenomenological Level

Looking at the inference from 1 and 4 to 5 from a phenomenological
perspective, it looks like this:

• In (1) the client is disposed to experience an interoceptive feeling of

need to be certain about future outcomes; and to express it as a demand
for certainty using language such as “I must” or “I need” to be certain.
• In (4) the client imagines himself forgetting his lines, which activates
the dispositional felt need to be certain in (1); that is, brings it to
awareness. The client, in turn, experiences a feeling of uncertainty arising
from the inconsistency between the image of forgetting his lines and the
felt need for certainty, which feels threating.
• In (5), the client expresses this threatening feeling using the words,
“make a damn fool of myself,” which generates a further self-referential,
negative feeling.

Here, (4) is conditional, iffy, and uncertain. After all, the client does not
have to perform in the play, so he could avoid the risk of messing up. But
what if he did decide to perform? How does he know he would not be
walking into the lion’s den, only to turn himself into a “damn fool”? This
could happen, so the client does not know for sure.
At this juncture, notice how the client has succeeded in making himself
anxious about the possibility of performing (“if I perform…”). It is a familiar
sort of emotional reasoning that many people carry out with little or no
inspection of the premises and inferences underlying the anxiety.
 Neuropsychology of a Logic-Based Therapy 71
The Neurological Level
However, there is a less explored account of how the client has succeeded
in making himself anxious, which takes place “under the hood” on a
neurological level. Given the preceding discussion of the neuropsychology of
the logic-based theory of CBT, the following picture emerges about what
happens when the client reasons from (1) to (5):

i. In premise (1), the client’s VMPFC is disposed to trigger an

interoceptive felt need for certainty in a somatosensory structure if
the client imagines a possible situation of messing up; this felt need,
having originally arisen from the activity of the amygdala in coping
with conditions of uncertainty (Mushtaq et al., 2011). The client’s
VMPFC is disposed to conceptualize this felt need in terms of language
such as “must” or “need” and relate these terms to the “I” as in “I must
be certain” and thus to make a demand to be certain about future
outcomes (Binder & Desai, 2011; Jiang, 2018).
ii. In premise 4, the client’s VMPFC, with input from his DLPFC,7 forms
an image of forgetting his lines while performing in the play, which is
associated with a negative interoceptive feeling from similar past
experiences. The VMPFC, responsive to the latter image, in turn,
activates the dispositional felt need in (1) and the evaluative image
demanding certainty that the negative outcome in question not
happen. The client’s DLPFC, in turn, compares the image of
forgetting his lines to the latter evaluative image demanding
certainty. The client’s VMPFC, in turn, triggers a threatening
interoceptive feeling of uncertainty (confusion) responsive to the
inconsistency between the evaluative image demanding certainty and
the image of forgetting the lines.8 The client’s DLPFC, in turn, focuses
attention on the image of this negative, conflicting state for purposes of
resolving the confusion.
iii. In (5), the client’s VMPFC reacts to the confusion by keying the
threating interoceptive feelings of uncertainty/confusion to negative
language, “damn fool,” which it uses, within the evaluative image of
forgetting the lines, to damn himself.
iv. These speech acts, in turn, activate the client’s amygdala, which, in
turn, transmits a “danger” signal to his hypothalamus and striatum,
which, in turn, activates other parts of his body in preparation for
“fight or flight.”
v. The client experiences anxiety about the prospect of performing in the
play, comprised of the above cognitive imagery, associated feelings, and
sensations of bodily change brought about by his amygdala (e.g.,
pounding heart, lump in throat, lightheadedness, and nervous
weakness).
72 Neurological Correlates
Notice that, in (1), the VMPFC dispositionally triggers an interoceptive
motivational feeling, that is, a felt need, which appears to be stored else-
where in a somatosensory structure as a pattern (Bechara et al., 2000). One
possibility is that this pattern is stored in the insular cortex, which is asso-
ciated with generation of conscious, reflective motivational feelings
(Namkung et al., 2017; Tyng et al., 2017). This motivational feeling of
necessity appears to be modulated by the prefrontal cortex (a “reflective
system”) even though it appears to have originated from the amygdala (an
“impulsive system”). “[W]hile the amygdala is considered as an impulsive
system, the insula is regarded as a reflective one. Taken together, beyond
being the center of interoception, the anterior insula stands at a ‘hub’
position to regulate the introduction of subjective feelings into cognitive
and motivational processes” (Namkung et al., 2017, p. 204, my italics;
Nummenmaa et al., 2018). Further evidence suggests that the anterior (as
well as mid) cingulate cortex is consistently activated in motivational
feelings (Craig, 2008; Kawabata & Zeki, 2008). The hypothesis advanced here
is thus that the reflective motivational signal processed through the anterior insula and
cingulate cortex creates a conscious motivational feeling that undergirds the demand.

Box 5.5 Practice

Using the Subjectivity of Perfectionistic Demands to Refute Them

On the hypothesis presented here, perfectionistic demands are rooted

in subjective feeling states, and therefore have no independent
existence outside the client’s mind. From a practical standpoint,
providing this explanation to the client can help a CBT therapist
bolster the refutation of perfectionistic demands for perfection. While
these demands may feel like they have objective authority, they are
instead based on conscious, subjective motivational feelings processed
by somatosensory centers in the brain. A major goal of therapy is thus
to help the client change the neural circuits that feed this self-
defeating motivational feeling through cognitive-behavioral inter-
ventions such as those discussed in Chapter 4.

In premise 4 the DLPFC (likely in conjunction with other prefrontal re-

gions such as the anterior cingulate cortex (Porcaro et al., 2014) modulates
reality assessment by comparing (Morris et al., 2014) imagery and reacting
to the conflict between the demand for certainty that performing in the
play work out, and the possibility of it not working out. As discussed below
(under neurology of refutation), the brain appears to have prewired cir-
cuitry for detecting contradictions (Asp, 2012).
 Neuropsychology of a Logic-Based Therapy 73
Mason and Just (2011) have pointed to a “coherence monitoring system”
comprised of (bilateral) DLPFC.9 Confirmatively, the DLPFC is involved
in updating information to predict outcomes and thus helps to facilitate
threat detection (Wever et al., 2015). Further, it also appears to play a
significant role in human decision-making under conditions of uncertainty.
(Yang et al., 2017). Moreover, it also appears to play an attentional role in
modulating pain awareness (Lorenz et al., 2003). Thus, it may also play an
attentional role in modulating awareness of the feeling of uncertainty.
Further, the conflict between the demand for certainty and the possibility
itself leads to VMPFC triggering of a negative interoceptive feeling of con-
fusion (Tyng et al., 2017). This effect, in turn, makes goal conflicts salient and
motivates goal-directed behavior to resolve the conflict and avoid its recur-
rence (Inzlicht et al, 2015). In the case of risk-avoidant clients, this resolution is
the less-than-optimal tendency to forego the risk, however.
From a Freudian psychodynamic perspective, such conflicts arise from
superego perfectionistic demands in conflict with ego reality perception.
From this perspective, the threatened feeling arising from the conflict lies in
the failure of the ego to reconcile the conflict (unless the superego gives up
its perfectionism). Neurologically, this conflict arises from perfectionistic
demand-driven, negative emotion syllogism chains generated by the
VMPFC (the superego) in conflict with reality reports furnished by the
dorsolateral prefrontal cortex (the ego), leading to activation of somato-
sensory structures (such as the insula) and the amygdala-hypothalamus-
pituitary axis (the id). Thus Freud’s concept of internal conflict between
ego, superego, and id may generally align on a neurological level with the
logic-based theory developed here (Cohen, 2020).
In conclusion 5, the associated negative, interoceptive feelings are en-
coded in language associated with strongly negative valences (“damn fool”)
to self-damn. Some studies confirm that “people who used more affect
words, relative to cognitive words, showed greater activation in somato-
sensory areas during emotion” (Saxbe et al., 2013, p. 810). As discussed
below, this suggests that the language clients use to express their feelings
may affect the way they feel. What is more, the valence of words, including
“threat words” such as “damn fool” and “horrible” have been shown to
bilaterally activate the amygdala (Isenberg et al., 1999).
The reflective system of images and feelings accordingly activates an
impulsive system that involves the activation of the amygdala and the hy-
pothalamic axis, which, in turn, produces a second set of physical sensations
such as those arising from cardio-pulmonary and neuro-muscular changes
(Bechara, 2005).

Some Implications of the Logic-Based Theory

Quite remarkably, notice that in the neurological picture of what transpires
when the client makes himself anxious about the possibility of performing,
74 Neurological Correlates
his reasoning coalesces with his anxiety. It is not possible to identify the
reasoning as the cause of the anxiety because the reasoning is itself part of
the process of anxiety. Anxiety and other emotions on the view presented here
consist of neurological processes in which emotional reasoning figures as an essential
component. Thus, causal accounts of how a dysfunctional belief system can
cause anxiety are, strictly speaking, misleading. True, there are internal
causal relations as one part of the affective neural circuitry excites another
part; however, the process is seamless in the sense that one step builds on
another. For example, notice that in step v above, the anxiety includes
cognitive imagery, associated feelings, and sensations of bodily change,
which were each added in preceding successive steps of the reasoning
process.
A further upshot is that, from a neurophenomenological perspective, a
syllogism chain is essentially a sequence of associated images and interoceptive feelings.
For instance, when the VMPFC associates image A with image B, and image
B with image C, it then associates image A with image C. Hence, when a
person “deduces” a conclusion from a set of premises, she associates one set of
images/feelings with another. This is an insight, now confirmed by neu-
roscience, from the annals of philosophical speculation. “When any phae-
nomena are constantly and invariably conjoined together,” wrote
eighteenth-century British philosopher David Hume, “they acquire such a
connexion in the imagination, that it passes from one to the other, without
any doubt or hesitation” (Hume, 2012, pt. 3, sec. 1). Hume was indeed
correct when he submitted that human reasoning proceeds in terms of images
in “the imagination.” He was also correct when he pointed to the diversity of
feelings that arise during emotional experiences. “There is something very
inexplicable in this variation of our feelings,” Hume said, “but it is what we
have experience of with regard to all our passions and sentiments” (Hume,
2012, pt. 3, sec. 5). Add to this that some images are not passive reports but
instead play out in the imagination as acts of catastrophizing, damning, and
demanding; and the goal of an enlightened logic-based CBT is to change the
self-destructive, associative bonds between the images embedded in the
premises and conclusions of clients’ reasoning.
The above account also sheds light on the nature of emotive language.
How is it that terms can have negative and positive “emotive force”? The
hypothesis advanced here, based on the referenced neuroscience,10 is that
human beings have formed certain generic terms in ordinary language to reflect and
express sets of negative interoceptive feelings, and they have formed others to reflect
and express positive ones. Thus the term, “horrible” is associated with a set of
negative interoceptive feelings (feelings of “horror”), which permits it to
reflect and express strongly negatively perceived interoceptive feelings.;
while the term “wonderful” is associated with a set of positive interoceptive
feelings. In contrast, neutral terms such as “tree” may have autobiographical
associations. For example, an environmentalist may have come to associate
 Neuropsychology of a Logic-Based Therapy 75
this term with a set of positive interoceptive feelings to reflect positive
experiences out in the wilderness.
Well before there was empirical evidence from neuroscience, Albert
Ellis, who was largely influenced by Albert Korzybski’s General Semantics
Theory (Ellis, 2001), made the emotive power of words a cornerstone of his
approach to CBT. The key idea here is to be selective about the terms one
uses. Thus, to characterize the image of forgetting one’s lines in terms of
“damn fool” and “horrible” (in iii above) can sustain and amplify the ne-
gative valence of the associated negative feelings. In fact, one study has
confirmed the correlation between the use of both positive and negative
“affect words” (such as “happy,” “inspiring,” “crying,” “abandon,” and
“cruel”) with increased activity in interoceptive cortices (including insular
and anterior cingulate cortices) (Saxbe et al., 2013).
The latter correlation between emotional language and somatosensory
cortical activity supports the hypothesis that use of more tempered emotional
language can induce the VMPFC to trigger distinct, less intense interoceptive
feelings. For example, use of words such as “unfortunate” or “too bad,” in-
stead of “damn fool” or “horrible,” to characterize the image of forgetting
one’s lines may trigger somatosensory structures to produce less uncomfortable
interoceptive feelings, thereby helping to reduce emotional stress.
Further, it appears that inference rules that validate a chain of inferences in
emotional reasoning (such as the statements grayed out in the preceding example)
track the neural pathways that connect images and interoceptive feelings. An upshot
of the latter is that cognitive-behavioral change requires changing the
neural pathways tracked by inference rules in evaluative syllogism chains.
As discussed in Chapter 6, this means creating new inference rules that track
neural pathways that carry positive emotions.

Neuropsychology of Capacity Disavowals

So far, in the above neurological description of anxiety about public per-
formance, the client has managed to trip neurological circuits that generate
a mix of interoceptive feelings of anxiety through commission of a series of
logically connected speech acts. However, there is more to this story; in
particular, how the client can also manage to “turn off” (or “turn down”)
these circuits through a capacity disavowal using the term, “I can’t.”
The deduction of the “I can’t” in conclusion (7) from premise (5) provides
a sort of coping mechanism to deal with the performance anxiety. Unfortunately,
while potentially helpful in other cases where the danger is realistic, it is self-
defeating in the present case. This is because, in telling himself “I can’t,” the
client is not allowing himself to satisfy his rational interest in performing. In
general, such risk-avoidant disavowals (see Chapter 7) foreclose the possibility
of making constructive changes in one’s life and, instead of helping a person to
deal with the anxiety of risk-taking, it can help to temporarily reduce it, while
preventing the person from working through the underlying problem (such as
76 Neurological Correlates
the tendency to self-damn or catastrophize), and thereby achieving a more
permanent reduction in anxiety.
Neurologically, the following picture emerges in deducing (7) from (5):

vi. In conclusion 7, the client’s VMPFC generates the image of forgetting

his lines concurrently with experiencing the associated feelings and
bodily sensations, including the conflicted feeling of confusion arising
from the felt need for certainty and the image of forgetting the lines. In
this context, where reality seems and feels incoherent (it is impossible to
satisfy the demand for certainty when the future is uncertain), the
VMPFC triggers a further interoceptive feeling of powerlessness, and applies
the words, “I can’t” to disavow the capacity to perform in the play.
vii. The client’s VMPFC then encodes the latter capacity disavowal into a
signal to “turn off” the client’s amygdala switch.
viii. Upon receipt of this “coast is clear” message from the VMPFC to the
amygdala, cognitive imagery, associated feelings, and bodily sensations
begin to simmer down.

In step vi, a conflict arising from the client’s felt need for certainty (expressed
linguistically in a demand for certainty) and the feeling of uncertainty arising
from a DLPFC reality assessment (expressed linguistically in a report) is re-
solved through generation of a feeling of powerlessness (verbally expressed
through a disavowal of freedom and responsibility). Through the speech act
disavowing his freedom and responsibility, the client effectively fulfills his
own prophecy by making himself powerless. After all, he could have ques-
tioned his demand for certainty, self-damning image, and disavowal. He
could have refused to use language such as “must,” “damn fool,” and “can’t,”
or their equivalent, to perform the latter series of speech acts. The client is
part of a culture of language users that to a significant extent construct their
own realities that feed somatosensory “markers” or feelings of necessity,
danger, and powerlessness (Cromby, 2004). However, the client is also
capable of speaking alternative languages; thereby adopting different per-
spectives, and thereby feeling freer, less fearful, and more self-efficacious.
Consistent with the current state of neural science, a logic-based theory
of CBT recognizes the capacity of human beings to reframe emotional
reasoning in their VMPFC, for instance, by giving up their catastrophic
speech acts imbedded in their syllogism chains and replacing them with
more self-enriching ones. Building such rational habits by changing prior
irrational tendencies stored in the striatum requires concerted cognitive-
behavioral work. However, the human brain has a considerable amount of
neuroplasticity, and CBT has had considerable success in facilitating such
constructive neurological change (Aupperle & Paulus, 2010; Månsson et al.,
2016; Queirazza et al., 2019).
 Neuropsychology of a Logic-Based Therapy 77
The CBT method of refutation (or “disputation”) figures importantly in
promoting such change, and neuroscience is beginning to identify the
mechanisms by which the different types of refutation work.

Neurology of Refutation
One study has found that patients with focal damage to their VMPFC can lead
to a “doubt deficit” according to which evidence against believing something
is discounted, suggesting that the VMPFC plays a major role in assessing
information for its credulity. According to the hypothesis embraced by the
researchers as originally advanced by Asp et al. (2012), human beings are
predisposed to believe or accept information unless the VMPFC “tags” it as
false. The VMPFC performs the latter function by triggering an interoceptive
feeling of doubt which is, in turn, associated with the information.

According to this “False Tagging Theory,”

when meaningful information, such as a novel proposition, is normally

assessed, a negative somatic signal marks any discrepancies in the
comparison of existing mental information to the new proposition. If
there is a conflict, a negative state is induced, and for propositions that are
falsified, the negative marker is apposed to the propositional information,
and a record of this apposition is stored in the prefrontal cortex. (Asp,
2012, pp. 32–33)

As such, human beings possess a “doubt circuit” for processing the credulity
of propositional information. This means that clients are disposed toward a
refutation process unless they have brain lesions precluding this functional
disposition. It also appears that this process has subprocesses for assessing the
credibility of different types of doubtful information. Specifically, it appears
that the brain possesses circuitry for processing logical contradictions. This
circuitry appears to include regions of the posterior VMPFC (Brodmann
area 32), among other related prefrontal regions (Porcaro et al., 2014).
As discussed in Chapter 1, there are three general forms of refutation: logical,
empirical, and pragmatic. Logical refutation consists essentially in identifying a
contradiction. For example, a logical refutation of the emotional rule, “If I
made a mistake, I am an unworthy person,” would be to show that the client,
who embraces this rule, also considers others to be worthy persons who made
similar mistakes. Formally, the refutation deduces the contradiction that the
client is both worthy and not worthy, which is flagged as contradictory by the
posterior VMPFC in conjunction with related circuits, which, in turn, tags the
rule as false and triggers an appropriate interoceptive feeling.
Empirical refutation uses inductive logic to disconfirm empirical reports.
As discussed earlier in this chapter, the DLPFC plays a major role in in-
ductive reasoning and may therefore figure importantly in empirical
78 Neurological Correlates
refutation (Goel & Dolan, 2004). For example, suppose a client hypothe-
sizes that she didn’t get a certain job because she is overweight. A refutation
may proceed by eliciting relevant information from the client stored in
DLPFC memory. For instance, this information might include a job de-
scription saying that a bachelor’s degree is preferred, a qualification the
client lacks. The client’s DLPFC may then track the inference to possibly
not having gotten the job due to qualifications. Such information may, in
turn, be recruited by the client’s VMPFC, which compares the client’s
hypothesis with the existing information, identifies the discrepancy, and
triggers a negative interoceptive feeling of doubt.
Consistent with the logic-based hypothesis proposed in this book, a
pragmatic refutation appears to involve production of a self-defeating
negative syllogism syllogism chain in the posterior VMPFC as an
antecedent to generating a negative, non-epistemic interoceptive
feeling. By “non-epistemic” I mean this feeling is not associated with
the veracity of a proposition but rather with the practical consequences
of believing it. For example, a client may be helped to see that his
syllogism chain deducing self-damnation defeats his achievement goals
by creating needless stress. The client’s VMPFC may, in turn, trigger a
negative interoceptive feeling associated with nonachievement rather
than epistemic doubt or incredulity.
The human propensity to process the three modalities of refutation
confirms the use of refutation as a step toward overcoming self-defeating
negative emotion syllogism chains. The next chapter inquires into the
human neurological potential to generate positive emotions to replace such
self-defeating negative emotions through the introduction of guiding vir-
tues with uplifting philosophical interpretations.

Notes
1 Damasio calls the first more primitive emotions, “primary emotions,” and the latter
more “evolved” emotions, “secondary emotions” (Damasio, 1994, pp. 131–143).
2 The role of the right VMPFC in shaping negative emotions is discussed below.
3 When the DLPFC is processing this information, it has increased activity while the
VMPFC has less activity. When the VMPFC receives this information from the
DLPFC and processes it, there is then less activity in the latter and increased activity
in the former, thus accounting for the negative correlation between these two
cortical regions.
4 Bechara et al. back up the claim that bodily feelings or “bioregulatory signals” are a
major guide in making advantageous decisions by pointing to lesion studies in which
patients with VMPFC lesions are incapable of making such decisions. See also
Damasio (1994).
5 Such conflict should not be confused with cognitive dissonance, which I reserve for
conflict between two cortically generated syllogism chains rather than between one
such chain and the amygdala. See Chapter 3.
6 Such feelings are distinct from those produced in somatosensory structures. See
Bechara (2005).
 Neuropsychology of a Logic-Based Therapy 79
7 Such possible outcomes of alternative actions may be generated by the DLPFC. “…
the dorsolateral prefrontal cortex may be important for generating potential re-
sponses and their expected outcomes” (Shuren & Grafman, 2002, p. 918).
8 “[W]hen presented with situations in which a decision is required, individuals
generate possible responses and the probable outcomes of those responses and recall
their prior experiences in similar situations. The VPC [ventromedial prefrontal
cortex] performs the latter function by activating a link between factual knowledge
about the situation and the type of bioregulatory state (including the emotional state)
associated with that situation based on the individual's past experiences. When a
person faces a situation similar to one previously experienced, relevant facts are
generated, and the VPC activates linkages to reconstruct a previously learned
factual-emotional set” (Shuren & Grafman, 2002, p. 918).
9 Some studies suggest a role for the DLPFC in resolving but not also detecting in-
consistencies (Helder et al., 2017).
10 See especially Damasio (1994), including his chapter on feelings.

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6 Neuropsychology of Guiding
Virtues and Their Philosophies

As discussed in Chapter 4 and confirmed in Chapter 5, the refutation of a

premise in a negative emotion syllogism chain sets a preparatory condition
for construction of a counteractive virtue-based syllogism chain. In a similar
manner in which negative emotion syllogism chains track negative emo-
tions, such positive (virtue-based) syllogism chains track positive emotions.
Examples include joy, interest, contentment, love, gratitude, hope, pride,
amusement, inspiration, and awe, among others. These emotions are
conscious responses to internal and external stimuli characterized by plea-
sant feelings, facial/body expressions, evaluations, behavioral plans, and
activation states, particularly of the VMPFC and DLPFC (Yin, 2019).
The guiding virtues are, in turn, associated with positive emotions. For
example, a proud person tends to experience pride; a hopeful person tends
to experience hope; and highly motivated person tends to feel inspired.
However, while positive emotions include feelings that have positive va-
lences (a pleasant somatosensory feeling), these feelings are not the same
thing as positive emotions, which are cognitive-behavioral habits or dispositions.
Still, those who are virtuous take pleasure in their virtuous dispositions (as
well as in the virtuous dispositions of others). This is an ancient insight. “A
man is not a good man at all,” said Aristotle, “who feels no pleasure in noble
actions, just as no one would call that man just who does not feel pleasure in
acting justly… and similarly in the case of the other virtues which might be
enumerated: and if this be so, then the actions in accordance with virtue must
be in themselves pleasurable” (Aristotle, 1941, bk.1, Ch.8).
There is now neurological evidence to back up Aristotle’s claim. In one
fMRI study, participants were given statements to read and asked to imagine the
scenarios they depicted. The participants were then asked to assess each of these
scenarios for their degree of praiseworthiness/blameworthiness. Judgments of
praiseworthiness relative to neutral scenarios were found to produce greater
activity in the DLPFC and the orbital frontal lobe, a region consisting largely of
the VMPFC involved in processing emotions (Takahashi et al., 2008).
It appears that each of these brain regions may also play a functional role in
positive emotions. According to Yang et al. (2018), the VMPFC may be a
“hub” through which positive emotion signals influence cognitive
 Guiding Virtues and Their Philosophies 85
regulation pathways to the amygdala while the DLPFC maintains and
contributes “goal-relevant information” to this regulatory process (p. 257).
Further, the VMPFC may provide “real-time” positive appraisals of the
stressor, inasmuch as its activation appears to be correlated with more
positive thoughts about the stressor (p. 264).
To the latter point, Doré et al. (2017) conducted an fMRI study in which
participants were shown negative images and were asked to “think about the
depicted situations by focusing on potential positive aspects or outcomes”
(p. 237). The researchers found that successful positive reappraisal tracked in-
creased activity in brain areas involved in reward assessment including the ventral
striatum and VMPFC. In addition, positive reappraisal enhanced positive con-
nectivity between VMPFC and amygdala, and individual differences in en-
hanced connectivity between VMPFC and amygdala, ventral striatum,
dorsomedial prefrontal cortex and DLPFC predicted a greater positive reappraisal
success score (combined score for each participant in successfully lowering ne-
gative affect and raising positive affect as calculated from participant responses).
According to the researchers, “these outcomes provide the neural basis for the
ability to create positive meaning from negative experiences” (p. 235).

Cognitive Dissonance
This neurological plot thickens with several meta-analyses that distinguish
more specific subregions of the VMPFC involved in positive versus negative
emotion; that is, a more anterior region of the VMPFC associated with positive
emotion and a more posterior region associated with negative emotion (Hiser &
Koenigs, 2018; Myers-Schulz & Koenigs, 2012). This regional localization of
valence creates an interesting picture of what goes on “under the hood”
when a human being experiences cognitive dissonance, that is, the conflict
between two behavioral syllogism chains reaching inconsistent conclusions.
One subregion of the VMPFC, the more posterior region, is hypothesized to
encode a stress signal to the amygdala; the other, the more anterior subregion,
the opposite signal.
The goal of logic-based therapy (LBT) is thus to help the client increase
positive (virtue-based) controls by building firm positive habits with the
ventral striatum in behavioral alignment with the positive reasoning. Given the
respective roles that both VMPFC and DLPFC play in emotional reasoning,
the hypothesis advanced here is thus that the capacity to increase positive emotions in the
anterior VMPFC and reduce negative emotions in the posterior VMPFC through
positive reappraisal is a function of constructing syllogism chains based on guiding virtues.
For example, consider again the below syllogism (from Chapter 5):

Negative Emotion Syllogism Chain A (Posterior VMPFC)

1. If I performed in the play, I could forget my lines.
2. Therefore, I could make a damn fool of myself.
3. Therefore, I can’t perform in the play
86 Neurological Correlates
Instead, I could reframe my reasoning along the following lines:

Positive Emotion Syllogism Chain B (Anterior VMPFC)

1. If I performed in the play, I could find exciting new ways to express
myself.
2. Therefore, I could live a more fulfilling life.
3. Therefore, I should do it!

In turn, the above (positive) syllogism can activate regions of the brain
(VMPFC, amygdala, ventral striatum, dorsomedial prefrontal cortex, and
DLPFC) to potentially reduce negative and increase positive affect.
According to the model proposed here, the VMPFC is activated during
the stressor, which, in the present example, is the anxiety generated in
Syllogism Chain A in conflict with Syllogism Chain B. While such conflict
is itself unpleasant, Yang et al. (2018) maintain that the process of reframing
activated in the VMPFC during this stressful period, predicts greater likelihood
of increased positive emotions and decreased negative emotions in the recovery period,
that is, the period after the stressor is removed (when the cognitive dissonance is
resolved). This is a strong argument for working with clients to reframe their
thinking, that is, to construct virtue-based behavioral syllogisms to coun-
teract the syllogisms that support negative emotions.

Box 6.1 Practice

Basic Strategy for Promoting Positive Neurological Change

Logic-based CBT therapists can facilitate positive emotions that
militate against the salience of posterior VMPFC negative emotions
(depression, anxiety, etc.) through construction of anterior VMPFC
virtue-based behavioral syllogisms chains, which can promote long-
term change by reversing negative polarity of existing neural circuits.

Uplifting Philosophies
In Chapter 3, I mentioned that, clinically, I have found that helping clients
to explore the more abstract philosophical meanings or world views un-
derlying life choices can have remarkable potential to inspire positive life
changes. Accordingly, LBT adds an additional level of support to virtue-
based behavioral syllogism chains that includes a life-affirming philosophy
with which the client resonates. In fact, there now appears to be a neu-
ropsychological basis for incorporating this higher level of abstraction.
First, philosophical language tends to be abstract as compared to more
concrete terms. Whereas concrete words, such as “tree,” depend on sensory
experiences, abstract words, such as “life,” depend on linguistic information.
 Guiding Virtues and Their Philosophies 87
Thus, abstract terms have different meanings across different contexts (for
example, “life” may refer to plants in one context, humans in another) while
the meanings of concrete words tend to be stable across contexts. Further,
abstract words tend to co-occur in particular linguistic contexts as parts of
larger concepts, such as “the meaning of life” in contrast to concrete terms
which appear to be largely related by their similarity to one another (for
example, “tree” and “bush”) (Hoffman, 2016). Thus, abstract terms tend to
be processed differently than concrete words by the brain.
In particular, recent fMRI studies have shown that areas of the rostral anterior
cingulate, a region of the VMPFC involved in emotion processing, is activated in
processing abstract words, as a function of their association with positive or negative
feelings. In one study, an analysis of more than 1,400 English words showed that
“abstract words, in general, receive higher ratings for affective associations (both
valence and arousal) than concrete words, supporting the view that engagement of
emotional processing is generally required for processing abstract words” (Vigliocco et al.,
2014, p. 1767, my italics; Hoffman, 2016).
This evidence suggests that the abstract language of “uplifting” philoso-
phical theories (e.g., “freedom” and “commitment”), as parts of broader lin-
guistic structures (e.g., “freedom to commit”) as well as the words that
reference the guiding virtues themselves (“courage,” “respect,” “decisive-
ness,” etc.) have efficacy to stimulate positive hedonic associations. Thus, there
is neurological evidence to suggest that a steady regime of reflecting on phi-
losophical ideas cast largely in positive, abstract language gleaned from various
media (including music, literature, and film) may help to avoid emotional stress
and reduce negative experiences.

Box 6.2 Practice

Therapist (T)–Client (C) Exchange

Facilitating Clients’ Uplifting Language
Therapists can facilitate client’s formulation of uplifting philosophies by helping
them choose abstract language associated with positive feelings. For example:

T: Can you think of a positive word or phrase to describe what

Sartre meant when he said people define themselves through
their actions?1
C: Yes, does he mean that people are free to decide who they want
to become?
T: Excellent! So, you should exercise your freedom to pursue your
life goals.
C: Yes, that’s it!
88 Neurological Correlates
Second, abstract philosophical ideas as well the virtues they support
appear to add a vitalizing spiritual dimension to the empowerment of LBT.
Spirituality involves a sense of connection to a transcendent purpose or
meaning to one’s life (Miller, n.d.). Thus, the epiphany one has when one
connects with abstract ideas on the nature of reality and truth can be such a
“higher order” experience. While religious experience can be a form of
spiritual experience, it is not the only kind. Meditation can provide an-
other; but so too can philosophical contemplation. In fact, there is evidence
that such experience can activate a “pre-established neural circuit” im-
plicating dorsolateral prefrontal, dorsomedial frontal, and medial parietal
cortices (Mohandas, 2008).
Some studies have also linked spiritual experiences to positive emo-
tions. In one study, two “self-transcendent” positive emotions were in-
vestigated: elevation and admiration. The first is an emotional response to
perceiving good deeds or acts of gratitude or charity. The second is an
emotional response to talent or skill. Participants viewed videos that were
calculated to arouse these emotions, as compared to a control group that
viewed humorous videos. In addition, participants’ perception of two
“basic beliefs” were examined: (1) Life is meaningful and (2) people are
good. It was found that these beliefs mediated increased spirituality in the
experimental group. That is, the positive emotions in question were
linked to greater acceptance of the two “basic beliefs,” which, in turn,
was linked to increased spirituality. One possible interpretation of these
results is that these beliefs, essentially abstract “uplifting” philosophies,
provided basic premises in a virtue-based syllogism chain, which, as such,
increased spirituality. In any event, the study suggests that philosophical
ideas may be intimately linked to positive emotions and spirituality (Van
Cappellen et al., 2013).
Third, insofar as abstract philosophical ideas are linked to positive emotions,
they may also possess the capacity to “broaden and build” one’s emotional and
intellectual resources. According to Fredrickson (2004),

by broadening an individual’s momentary thought-action repertoire—

whether through play, exploration or similar activities—positive emotions
promote discovery of novel and creative actions, ideas and social bonds,
which in turn build that individual’s personal resources; ranging from
physical and intellectual resources, to social and psychological resources.
Importantly, these resources function as reserves that can be drawn on later
to improve the odds of successful coping and survival. (p. 1367)

Further, in contrast to concrete words, which tend to perceptually de-

scribe details of situations, abstract philosophical theories can provide a
broader view of life and reality so as not to lose the proverbially forest for
the trees.
 Guiding Virtues and Their Philosophies 89
Neuropsychology of Meditative Practice
Buddhist philosophy, as discussed in Chapter 4, provides a salient mode of
philosophy that can be especially uplifting when practiced through medi-
tation. There is now an abundance of empirical data confirming that
meditation works to relieve negative emotions including anxiety and de-
pression, and (in some cases) increase positive ones (Khoury et al., 2013;
American Psychological Association (APA) 2019; Psychiatry & Behavioral
Health Learning Network, 2019; Graser & Stangier, 2018).

Mindfulness
As discussed in Chapter 4, one very popular sort of mediation is mind-
fulness. The latter involves two related but distinct factors: (1) focused at-
tention and (2) awareness. As attention shifts, so does focused awareness.
While there is general awareness of what passes in and out of consciousness,
in mindfulness awareness is focused on a particular experience (such as one’s
breathing) that occurs in the present, with sustained attention in this focus
(Valim et al., 2019).
In mindfulness, one shifts focus away from oneself to something else such
as one’s breathing. While one continues to be nonjudgmentally aware of all
else, this shift in awareness means that one ceases to evaluate all else in
relation to oneself. “I am a bad person,” “I screwed up,” “I must get others’
approval,” “What am I going to do if it all hits the fan?” All such evaluations
in relation to oneself are suspended, which facilitates letting go of these
thoughts. Here and now, just thoughts, they can gently be pushed aside.
Such thoughts playing out in the imagination as acts of demanding, cata-
strophizing, self-damning, etc. streaming in a syllogism chain generated by
one’s posterior VMPFC are depersonalized while one focuses attention on a
non-self-referential object (Tang & Tang, 2013; D’Argembeau, 2013; Tang
et al., 2015).
There is also substantial fMRI evidence that the DLPFC, which is as-
sociated with attention shifting and maintenance, is active during mind-
fulness meditation. This is explicable because the latter meditation practice,
as mentioned, involves focused attention (Taren et al., 2017; Hiroki et al.,
2014). As such, mindfulness meditation may succeed in focusing awareness
away from “neutralized” speech acts in syllogism chains that would
otherwise (without mindfulness) produce painful emotional experiences
(Kirk et al., 2014). In this way, the VMPFC and DLPFC can work sy-
nergistically to provide a peaceful state of awareness.
90 Neurological Correlates

Box 6.3 Practice

Use of Mindfulness to Increase Cognitive Control

In one study, participants first took a three-day residential retreat
version of the eight-week Mindfulness-Based Stress Reduction
(MBSR) program (Palouse Mindfulness, n.d.).
The study concluded that brief mindfulness training such as the
aforementioned increases functional connectivity between the DLPFC
and dorsal and ventral corticolimbic circuits involved in cognitive
control (Taren et al., 2017). This enhanced functional connectivity can
thus manifest itself in strengthening clients’ capacity for attentional
focusing, a cognitive skill at the root of successive meditative practice,
but also in making and implementing decisions (Nihonsugi et al., 2015).
Hence, clients with impulsivity and procrastination issues may also
benefit from mindfulness meditation (Morris, 2017).

Compassion-Based Meditation
As discussed in Chapter 4, a further kind of Buddhist meditation based on
the generation of positive ideas is compassion-based meditation. This
consists of a group of Buddhist meditation that “proposes to the practitioner
to cultivate unconditional kindness for oneself and for others.” As a result,
this sort of meditation “amplifies and cultivates positive valence emotions”
(Valim et al., 2019, p. 2). In fact, there is some evidence that this type of
meditation may be even more efficacious than mindfulness in decreasing
negative emotions and generating positive ones (Valim et al., 2019).
Inasmuch as compassion-based meditation is essentially a form of positive,
cognitive reappraisal or reframing, this may not be surprising, since there is
already neuropsychological evidence that such cognitive interventions can
enhance the circuits that increase positive emotions and reduce negative
ones (Doré et al., 2017). Moreover, as discussed previously in this chapter,
the fact that such meditative approaches use abstract words with positive
valence can also explain their potential to increase positive emotions.

Theory and Application

This and the previous chapter have provided some key neurological cor-
relates of major components of the logic-based variant of rational-emotive
behavioral therapy introduced in Part 1 of this book. It has accordingly
provided neuropsychological evidence that

1. People upset themselves by deducing self-defeating conclusions from

irrational speech acts.
 Guiding Virtues and Their Philosophies 91
2. This process consists of evaluative syllogisms that track the flow of
associated images, interoceptive feelings, and other bodily sensations
generated by cortical, somatosensory, and limbic structures.
3. This process uses “threat” language to conceptualize and amplify these
negative feelings, especially language used to perform irrational speech
acts such as demanding perfection, catastrophizing, damnation, and
capacity disavowal; and,
4. Cognitive-behavioral interventions can manage these neuropsycho-
logical changes, especially interventions that use philosophical, virtue-
based reframing.

The next part of this book (Part 3) applies this theoretical and scientific
study to reversing the negative valence polarity of diverse forms of capacity
disavowals by which clients keep themselves prisoners in self-perpetuated
states of felt powerlessness. Regaining freedom and autonomy from such
self-oppression, through the uplifting nature of positive valence imagery
and practice, is hence a primary focus.

Note
1 See Chapter 3 for a discussion of Sartre’s idea that people define themselves through
their actions.

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Part III

Overcoming Common
Types of Capacity
Disavowal
7 Risk-Avoidant Capacity
Disavowals

A risk-avoidant capacity disavowal is a behavioral disavowal that ob-

structs one’s freedom to take reasonable risks. Syllogism chains con-
taining such disavowals typically contain demanding certainty about
outcomes of one’s actions (outcome certainty) and catastrophizing, from
which the disavowal is deduced. These chains appear to be associated
with anxiety disorders including Generalized Anxiety Disorder (GAD)
and Obsessive-Compulsive Disorder (OCD) (Gentes & Ruscio, 2011).
As mentioned in in, this anxiety involves increased VMPFC and
amygdala activity (Morriss et al., 2015).

Types of Actions Risk-Avoidant Clients Avoid

Risk-avoidant clients may disavow doing such things as these:

• Actions that open oneself up to being rejected or negatively judged by

others
• Activities that include the possibility of making a serious mistake (for
instance, on an important work assignment)
• Life decisions to end unfulfilling employment or relationships (for
instance, seeking a college degree to train for a new line of work,
getting a divorce)
• Activities in which you can lose something of value (money,
friendship, a job)
• Commitments that may not work (such as starting an intimate
relationship, getting married or engaged)
• Activities having a relatively small risk of dying or being seriously
injured (such as air travel, or driving a motor vehicle)
• Putting oneself in situations where others could possibly betray you, or
otherwise not do their part
• New or unchartered territory (such as changing jobs, learning to play a
musical instrument, or taking dancing lessons)
98 Overcoming Common Capacity Disavowal
The Role of Uncertainty in Risk-Avoidance
As discussed in Chapter 2, capacity disavowals are typically nested in syllo-
gism chains that have at their highest tier, an emotional rule that demands
perfection. When these syllogism chains track anxiety, they are associated
with high levels of intolerance to uncertainty (Morriss et al., 2015) un-
certainty. The anxiety of risk-avoidant clients is always in response to “What
if such-and-such happens?” where the questionable event is associated with a
feeling of uncertainty about an outcome. The latter feeling has been linked to
increased insula activation during the experience of uncertainty (Sarinopoulos
et al., 2009), which “can be interpreted as the brain making predictions about
how one is going to feel in response to a possible outcome” (Wever et al.,
2015). This “prediction” appears to involve “simulation,” that is, imagining a
possible, future outcome, typically one associated with a negative valence of
how one would feel in the imagined situation (Anderson et al., 2019).
Risk-avoidant clients often attempt to cope with uncertainty by avoiding
it. While avoidance (by decreeing that one can’t do the act in question)
temporarily relieves the negative interoceptive feelings associated with the
anxiety, it also preempts constructive behavioral change. The client is thus
disempowered and accepts the status quo, even though it may be incon-
sistent with the client’s goals or aspirations. Because life consists of an
ongoing stream of risk-taking, the anxiety may abate temporarily only to
arise again subsequently, Further, the feeling of disempowerment itself takes
its toll emotionally and may be comorbid with depression (American
Psychiatric Association, 2013, p. 674).

Risk-Avoidant Syllogism Chains

The syllogism chain generating anxiety in risk-avoidant clients schemati-
cally looks like this:

Demanding Certainty about Outcomes → Catastrophizing (can

include Self or Existential-Damnation) → Risk-avoidant Disavowal

For example, a risk-avoidant client with anxiety about committing to mar-

riage may defeat his own happiness by sabotaging a relationship he wants to
maintain. The client’s evaluative syllogism chain might look like this1:

1. I must be certain about future outcomes.

2. But it’s possible for it not to work if I marry her.
3. Therefore, marrying her could be a horrible mistake.
4. Therefore, I can’t do it.

Phenomenologically, the client, in the above case, makes the following

imaginative chain of associations and speech acts (Kropf et al., 2019):
 Risk-Avoidant Capacity Disavowals 99
• In (1), the client dispositionally harbors a strong, reflective motivational
feeling,2 a felt need to be certain about the outcome of future actions
before undertaking them. This feeling of need has been reinforced by
negative, past experiences of risk-taking under conditions of
uncertainty. It is dispositionally expressed using the language of
necessity, such as “must” or “need” (Nummenmaa et al., 2018).
• In (2), the client imagines a state in which he marries and the marriage
does not work, which activates his dispositional felt need to be certain
about future outcomes (in this case, that the marriage works out), along
with it linguistic expression as a demand for certainty. The client, in
turn, focuses attention on the incompatibility of this demand with the
image in which he marries and the marriage does not work, which
triggers an emotionally threatening feeling of uncertainty.
• In (3), thus feeling threatened by committing to marriage, the client, in
turn, catastrophize about it by thinking it could be a “horrible mistake.”
• Finally, in (4), the catastrophic use of “horrible mistake” makes the
image of the marriage not working feel even worse; while the felt need
to be certain, in conflict with the feeling of uncertainty, and the
pulsations of unpleasant, physical sensations oscillate in the client’s
consciousness. Steeped in this painful consciousness of contradictoriness
(“I must be certain but that’s just not possible”), it feels impossible to
commit to marriage. Responsive to this feeling of powerlessness over doing
the impossible, the client uses the words, “I can’t” to disavow his capacity to
commit to marriage.

As discussed in Chapter 5, such series of images and feelings arise from

activity in prefrontal and somatosensory cortices, which signal subcortical
structures such as the amygdala to generate the client’s anxiety. In the case
of premise 1, there is an interoceptive feeling triggered by the ventromedial
prefrontal cortex (VMPFC)—a motivational feeling for certainty—which,
in turn, steers the linguistic demand for certainty that the marriage
(“must”) work.
It is remarkable that, in (1), the client is merely disposed to feel the need
for certainty and disposed to express this feeling as a demand using the
language of necessity (“must” or “need”). Neither this dispositional feeling
nor its linguistic expression is activated until the client imagines, in (2), a
state that is incompatible with it. As such, it may be appropriate to call
premise 1 a presupposition of the syllogism chain. From a neurological
perspective, this means that the dispositional, interoceptive felt need in (1)
is activated later in the chain, in (2), by the VMPFC when the client
imagines a state incompatible with it. As discussed later in this chapter,
when the primary syllogism is expanded to include its upper tier that
contains premise 1, this presupposition is exposed—that is, the need for
certainty is both felt and linguistically expressed.
100 Overcoming Common Capacity Disavowal
This interoceptive felt need for certainty, which undergirds the demand for
certainty, is merely a subjective feeling generated by the insula (Namkung
et al., 2017). Because it is a subjective feeling state existing in the client’s
brain, it has no independent epistemic status. As pointed out in Chapter 5,
this can be important for subsequent purposes of refuting the demand.
More generally, according to the hypothesis advanced in this book, the
entire syllogism chain is comprised of linguistically expressed, phenomenal
associations of images and feelings. On a functional, neurological analysis, in
(3) the VMPFC signals the amygdala, which, in turn, activates the hy-
pothalamic axis. On the other hand, the conclusion in (4), which tracks
increased activity in the VMPFC and decreased activity in the amygdala,
signals the latter to stand down. So, the client avoids sustaining his anxiety
at the expense of not committing to the marriage.
From a clinical perspective, being able to track the flow of underlying
images and associated feelings generated by the aforementioned neural
processes can be a powerful tool for helping the client construct his
emotional reasoning, identify their linguistic expression, and to refute, and
replace them. The remainder of this chapter shows how the six steps of
logic-based CBT can be applied to such change.

Step 1: Formulating the Primary Syllogism Using O + R

At this inception stage, the therapist’s posture is largely person-centered,
that is, exemplifying the guiding virtues of unconditional client acceptance,
authenticity, and empathy. Indeed, while such posture is not likely in itself
to promote constructive change, it is well confirmed that it can encourage
the client to self-disclose, which is necessary if the CBT therapist is to
facilitate the client’s formulation of his emotional reasoning. The latter is
the main purpose of Step 1.
This involves first identifying the primary syllogism from which the “I
can’t” is deduced in a complex chain. As discussed in Chapter 1, this in-
volves finding the client’s intentional object (O) and rating (R) and utilizing
modus ponens to formulate the syllogism.

Box 7.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism
In the below part of their session the therapist helps the client find O & R
to construct the primary syllogism:

T: So, tell me about what brings you here today.

C: It’s about my relationship with my girlfriend.
 Risk-Avoidant Capacity Disavowals 101
T: Is there a problem you would like to discuss?
C: Well, it’s not really a problem with the relationship; actually,
that’s going really well.
T: So, tell me more.
C: She wants to get married, and not sure, well about what to do.
T: What is your concern?
C: I really do love her, and I think she loves me, but what if it
doesn’t work?
T: So, you are having some anxiety about the possibility of the
marriage not working out if you marry her?
C: Yes, that’s right.
T: I see. What if the marriage doesn’t work after you get married?
On a scale of 0 to 10, how bad would you rate it?
C: I’d give it a 9 or 10.
T: That’s pretty bad; near or about the worst thing that could happen?
C: Yes, it would be a horrible mistake if it didn’t work!
T: So, it sounds like you are thinking that if you marry your
girlfriend then it might not work; and if that could happen, then
it could be a horrible mistake. So, if you marry her, you could
be making a horrible mistake. Is that your reasoning?
C: Yes, exactly.

Thus, in the present example, the client’s primary syllogism is along the
following lines:

Syllogism Chain A

1. (Rule) If the marriage might not work if I marry my girlfriend (O),

then marrying her could be a horrible mistake (R).
2. (Report) It might not work if I marry my girlfriend (O).
3. (Conclusion) Therefore, marrying my girlfriend could be a
horrible mistake (R).

As noted in Chapter 1, anxiety is a future-oriented emotion, so it’s in-

tentional object (O) expressed in the reportative premise is always about a
possible future event; in the present case, “It might not work if I marry my
girlfriend.” O is also a conditional (“….if I marry my girlfriend”), which
reflects the contingent nature of anxiety reasoning, and the consequent is
uncertain (it might not work). This “what-if” quality of O, and the un-
certainty of its consequent, is associated with increased activity in areas of
the brain that track anxiety, including the VMPFC, amygdala, and anterior
insula (Grupe & Nitschke, 2013).
102 Overcoming Common Capacity Disavowal
Step 2: Expanding the Syllogism Chain
Once the primary syllogism is formulated, the client can begin to inspect his
premises. Syllogism chains have both top and bottom tiers, so a complete
inspection of premises requires expanding the chain from both ends. The
approach recommended here is beginning in the middle of the chain by
first formulating the primary syllogism; second, formulating the higher tier
syllogism/s that justify the rule premise of the primary syllogism; and third,
formulating the lower tier syllogism/s that follow from the conclusion of
the primary syllogism.3 Usually, the highest tier in the chain contains a
perfectionist demand, while the lower tier usually contains a conclusion
with “I can’t” (or equivalent language). Because the latter “I can’t” dis-
avowal is deduced from the higher order premises, expanding the chain
from the middle to the top tier before expanding it to the lower tier is
preferable, as this fully exposes the chain of inferences upon which the
disavowal ultimately rests.

Expanding the Chain to the Top: Exposing the Demand for Certainty
Expanding the syllogism to its top proceeds by questioning the rule premise
of the primary syllogism. Because this premise is an inference rule, it is
usually suppressed, that is, assumed rather than explicitly stated or thought;
however, once made explicit, as shown in Syllogism A (above), it becomes
possible for the client to look for its underlying justification. This justifi-
catory process, in turn, generates a further, higher-order syllogism tier that
often contains a perfectionistic demand. In calling this tier “higher order,” I
mean that the rule premise of the primary syllogism is deduced from it.
In the present case, the following syllogism chain emerges:

Syllogism Chain B

1. (Rule 1) I must be certain the marriage will work.

2. (Rule 2) If I must be certain the marriage will work, then if it
might not work, then marrying her could be a horrible mistake.
3. (Conclusion/Rule 3) Therefore, if the marriage might not
work if I marry my girlfriend (O), then marrying her could
be a horrible mistake (R).
4. (Report) It might not work if I marry my girlfriend (O).
5. (Conclusion) Therefore, marrying my girlfriend could be a
horrible mistake (R).

In Syllogism Chain B, above, Rule 1 makes a perfectionistic demand for

certainty. In conjunction with Rule 2, it entails Rule 3, which is the major
premise of the primary syllogism. Rule 2 provides an inference rule that
validates the inference from (1) to (3). It is grayed out here because the
 Risk-Avoidant Capacity Disavowals 103
therapist does not directly challenge it, and therefore need not formulate it
in stating back the client’s reasoning. It’s utility appears to be in showing the
linkage between the speech acts—demanding perfection and catastro-
phizing; and, on a phenomenological level, in mapping the linkage be-
tween the images and feelings that are sequentially associated—feeling of
uncertainty, motivational feeling steering the “must,” the negative image of
the marriage not working out, feeling of confusion generated from the
contradiction, and its associated dysphoria matched to “horrible mistake.”

Box 7.2 Practice

Therapist (T)–Client (C) Exchange

Exposing the Demand for Certainty
In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing a demand for certainty:

T: Let’s look at this premise of yours that, if the marriage might not
work, it could be a horrible mistake. Why would it be a
“horrible mistake”? You said it would be a 9 or 10 on the bad
scale, but why would it be that big of a mistake?
C: Would you want to go through a failed marriage?
T: No, I would prefer not. If you married and it failed, would it be
the failed marriage that would be “horrible”; or would it be
your decision to get married that would be a “horrible mistake”?
C: It would be the decision. I think I could eventually get over the
marriage not working out; but why put myself through it in the
first place!
T: Would you think less of yourself if the marriage didn’t work?
C: No, I wouldn’t hate myself or anything like that. It’s just that it
would have been entirely avoidable, and I would have
unnecessarily put myself in the situation of being in a failed
marriage. Better off just not getting married!
T: It sounds like you are concerned about the uncertainty of the
marriage working out?
C: Yes, it’s the uncertainty.
T: You need to be sure it will work before making a commitment?
C: Yes.
T: So, your reasoning seems to be that, because you need to be
certain the marriage will work, if it might not work, it could be
a horrible mistake.
C: Yes, that’s it.
104 Overcoming Common Capacity Disavowal
Catastrophizing by Self- or Existential Damnation
In Rule 3 of Syllogism B the client catastrophizes about the possibility of the
marriage not working out. In some cases, risk-avoidant clients may cata-
strophize by including self-damning outcomes, for example, “If my marriage
could fail, I could turn out to be a colossal failure.” The client may demand
certainty that he not fail, and catastrophize about the possibility of proving
himself a failure if the marriage failed; and then disavow his capacity to
commit to marriage because it could make him a “colossal failure.” Thus, it is
helpful for CBT therapist to check to see if the client is inclined to negatively
rate himself. (“Would you think less of yourself if the marriage didn’t work?”)
I say inclined to negatively rate himself. This is because in risk-avoidant
reasoning the client imagines himself as a failure and thus within the ima-
gination damns himself. Since the damning act has not actually yet oc-
curred, it is not quite accurate to say the client has damned himself. Yet, the
imagination is a royal cue to one’s actual habits or dispositions. As discussed
in Chapter 5, habituation involves goal-oriented communication of the
VMPFC with the ventral striatum. This communication proceeds in terms
of images and interoceptive feelings, and these same brain regions are active in
both reality and imagination, so imagination is a lot like reality.4 This close
relationship between reality and imagination also suggests that working on
one’s imagination can be a dynamic mechanism to affect positive cognitive-
behavioral change (Neuroscience News, 2018).
In other cases, a risk-avoidant client may base his catastrophic thinking
on existential damnation, that is, the idea that if he fails at something then
his entire life is worthless or meaningless. (“If I marry and it doesn’t work,
then my whole life could be totally destroyed.”) A client is not necessarily
self-damning if she believes her entire life is worthless. She may believe she
is a worthy person who has had very bad luck. CBT therapists with risk-
avoidant clients may therefore find it useful to confirm that their clients are
not catastrophizing by engaging in either existential-or self-damnation.

Expanding the Syllogism Chain to the Bottom: Deducing the

Risk-Avoidant Capacity Disavowal
The anxiety generated through the mental streaming of images and asso-
ciated interoceptive feelings tracked in Syllogism Chain B, may lead to an
“I can’t” disavowal. Thus, from the conclusion of the primary syllogism,
the client may deduce the risk-avoidant “I can’t”:

Syllogism Chain C

1. (Rule 1) I must be certain the marriage will work.

2. (Rule 2) If I must be certain the marriage will work, then if it
might not work, then marrying her could be a horrible mistake.
 Risk-Avoidant Capacity Disavowals 105
3. (Conclusion 1/Rule 3) Therefore, if the marriage might not work
if I marry my girlfriend (O), then marrying her could be a horrible
mistake (R).
4. (Report) It might not work if I marry my girlfriend (O).
5. (Conclusion 2) Therefore, marrying my girlfriend could be
a horrible mistake (R).
6. (Risk-avoidant Rule) If marrying my girlfriend could be a horrible
mistake, then I can’t do it.
7. (Conclusion 3) Therefore, I can’t do it.

Box 7.3 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness
In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal:

T: Has your thinking held you back from committing to your

girlfriend?
C: Yes, when she brings up the subject of marriage, I become very
uncomfortable and ask if we can discuss this another day. I know
she’s losing patience with me. I am afraid I might lose her the
way I did my last girlfriend when she tried to get serious.
T: When you are thinking about how marrying her could be a
horrible mistake, how does this feel?
C: I feel like it’s going to mess things up.
T: You feel threatened by it?
C: Yes, like it could destroy what I have now.
T: And if you knew for sure that this wouldn’t happen, you’d be
okay with it?
C: Yes, I would.
T: But you don’t know this for sure.
C: No, I don’t.
T: So it’s the uncertainty that feels threatening. On the one hand,
you feel like you need to know if the marriage will work, but
you know that you can’t know this.
C: Yes, that’s right.
T: Let’s see if you can get yourself to feel like this now. Imagine you
are deciding right now whether or not to make the commitment
to marry your girlfriend. Let me know when you are there.
C: [Pause] Okay, I’m there.
T: How are you feeling?
C: Afraid.
106 Overcoming Common Capacity Disavowal
T: Of what might happen?
C: Yeah, I really need to know.
T: Do you feel this need inside you?
C: Yes, I actually do feel it.
T: And the uncertainty? Is that a feeling too?
C: Yes, like not having any control over what’s going to happen.
T: So you feel powerless over what might happen?
C: Yes! I always get to this point and then tell myself that I just
can’t do it.
T: It sounds like you are stuck in this contradiction. You tell
yourself you need to know for sure if the marriage will work
before committing to it, but since you can’t know this for sure,
you feel stuck?
C: Yes, I do feel stuck. I feel so helpless.
T: So, you tell yourself you can’t.
C: Yes, I do.
T: You are “can’tstipating yourself.” You hold onto your “can’t,”
and refuse to excrete it because you feel like you can’t.
C: [Laugh]. Yes, that’s right.

The “I can’t” in Conclusion 3 in Syllogism Chain C arises from a feeling

of powerlessness, generated by the conflict between the intensely negative
somatosensory (insular) felt need driving the “must” [be] “certain” and the
feeling of uncertainty arising from the possibility of the marriage not
working. Here, phenomenologically, playing out in the imagination si-
multaneously, is an absolute, non-negotiable felt need for certainty and the
painful “horror” that what must not happen might well happen. All this,
while Conclusion 2 of Syllogism Chain C arouses the sleeping giant (the
amygdala) to add fuel to the fire (engagement of the hypothalamic axis,
prompting physiological changes and their sensations that coalesce with the
aforementioned feelings and imagery).
So, in deducing the “I can’t” in Conclusion 3 the client finds respite
from the discomfort of this intense anxiety by deciding not to take the risk.
This is a disempowering (temporary) “fix” to an ongoing problem, how-
ever. The next step is to refute the “I can’t,” thereby unleashing the client’s
freedom to take rational risks.

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
As discussed in Chapter 1, refutation of “I can’t” disavowals can proceed in
two different ways: directly or by way of refuting the premises from which
it is deduced. Because the anxiety as described is a function of the premises
 Risk-Avoidant Capacity Disavowals 107
from which it is deduced, it is not generally a good idea to try to refute the
“I can’t” directly before addressing these. Once these premises are shown to
be irrational, the flow of imagery and feelings behind the anxiety can be
disrupted by changing the imagery and dissociating their disempowering
feelings and negative, linguistic performances.

Indirect Refutation
In particular, inasmuch as the client’s catastrophizing is deduced from his
demand for certainty, it is generally an effective strategy to challenge and to
help the client refute the demand for certainty, thereby eliminating the
client’s root basis for catastrophizing.
Empirical refutation of the “must” can proceed by challenging the client
to provide the basis for it. “Where is it written that you must be certain
about marriage before committing to it?” “Can anyone be certain about
anything in the material universe?”
Pragmatic refutation can identify an absurd practical consequence. “If you
waited to be certain, you would never do anything, not even cross the street!”
Logical refutation can tease out a contradiction. “You report to work
regularly even though your job is not 100% secure,” “You drive a car or
take public transportation that is not 100% safe.”
Helping the client to key into the interoceptive feelings he is having
when he demands certainty can also be useful as support for the refutation
because it makes clear that the basis of the demand is a motivational feeling
that has no objective epistemic status.
Not unremarkably, a client may admit that there is not 100% certainty in
the material universe but still insist that that some things are more certain
than others. This reflective posture is progress because it provides an op-
portunity for the therapist to explore with the client rational risk-taking
instead of demanding certainty before acting.

Box 7.4 Practice

Therapist (T)–Client (C) Exchange

Refuting the Demand for Certainty
In the below part of their session, the therapist helps the client refute his
demand for certainty:

T: Okay, I understand why you feel like you can’t go through with
the marriage. But this is because you think you must be certain
that the marriage will work, and because it is possible it won’t
work, you feel threatened by marriage and use the threat words,
“horrible mistake.” So you feel like you can’t take a chance on
108 Overcoming Common Capacity Disavowal
the marriage, even though you said you love your girlfriend, and
she loves you, and would marry her if you felt you could. Is this
a correct summary or have I gotten anything wrong?
C: No, that sounds about right.
T: Okay great, so let’s take a look at this premise of yours that you
need to be certain the marriage will work. Why is that you must
be certain about your marriage working, while so many other
people don’t insist on this and get married?
C: Yeah, and a lot of them end up getting divorced!
T: That’s true, but a lot of them don’t; but regardless of whether
the marriage works, they still get married. If there was some sort
of “law of nature” that said they “must” be certain, wouldn’t
they have not gotten married in the first place?
C: I suppose so. I don’t think there’s a law of nature that says this.
T: Okay, good, so where does this demand you are making on
yourself come from?
C: I don’t know; I guess I am telling myself that I have to be certain.
T: That’s right. You feel like you must be certain?
C: Yeah, I do.
T: This is a feeling that you have. When you imagine your
marriage not working out you feel threatened by the
uncertainty of not knowing. And then you feel like you must
know for sure this won’t happen?
C: Yes, exactly.
T: But these are just subjective feelings. The people who get married
may or may not have the same feelings, and still they just get
married anyway.
C: Yes, they do.
T: Anyway, suppose you get married and it doesn’t work. You said
yourself you would eventually get over it. So why do you think
it could be a “horrible mistake”?
C: Well maybe it wouldn’t be “horrible,” just a pain in the butt.
T: Yes, that’s true. But isn’t that how we learn things. We do
things and then chalk it up to life experiences?
C: I suppose that’s true. If I don’t take any chances, I won’t really
do anything.
T: Excellent! If you had to be certain about anything you wouldn’t
even go out of your house because you can’t be certain
something inconvenient or unfortunate won’t happen.
C: Yeah, this makes sense to me now. It’s kind of dumb to require
that I be certain about anything before doing it. But this is a life
commitment; it’s not just any old thing. It’s an important decision.
T: Yes, true. But if you had to be certain, you wouldn’t make any
important decisions. Are there any other important decisions
you have made?
 Risk-Avoidant Capacity Disavowals 109
C: Yes, of course. I decided to go to therapy.
T: Very good!

Direct Refutation
In direct refutation, the therapist helps the client to refute the “I can’t”
disavowal instead of the premises from which it is deduced. Here the therapist
challenges the client to consider the evidence for claiming to lack the capacity
to take rational risks, and to accept his freedom and responsibility for
choosing not to. “Is it that you can’t marry your girlfriend or that you choose
not to?” “Are you like a machine that is programmed to never marry and
therefore lack the capacity to do otherwise?” “What makes you different
from others who have demonstrated the capacity to make commitments?”
“You admit that others can commit to marriage, so why can’t you?”

Box 7.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Risk-Avoidant Disavowal
In the below part of their session the therapist helps the client refute the
capacity disavowal that keeps him from making a commitment:

T: So, let’s look again at this refusal of yours to make a

commitment to your girlfriend. You said you can’t go
through with it. Now that you see that you don’t have to be
certain the marriage will work, do you still think you can’t do it?
C: It is still going to be hard for me.
T: You still feel like you can’t, like you are powerless?
C: Yes, I still have that feeling.
T: I understand. Does that mean it’s not a choice? Do you have the
capacity to decide to marry your girlfriend? Do you have the
free will?
C: Yes, of course, I do.
T: But when you said you couldn’t go through with it, were you
not denying that you had the free will?
C: Yes, I guess I was, but I now see that I can. It’s just going to be hard.
T: Because you still have this feeling?
C: Yes.
T: So, the other people we talked about who decided to get
married also had free will?
110 Overcoming Common Capacity Disavowal
C: Yes, they did, and I suppose that if they could do it, so can I.
Maybe they were can’tstipating themselves too, but they still
made a commitment.
T: Excellent!

Step 4: Identifying the Guiding Virtues

Refutation of the self-defeating speech acts in risk-avoidant syllogism chains
sets the antecedent for constructive change. If demanding certainty and
catastrophizing are irrational and self-defeating, what would be more ra-
tional? The counseling goal here is to replace client dispositions toward
these speech acts—along with their negative interoceptive feelings and self-
destructive behavior—with positive, constructive dispositions or habits.
As discussed in Chapter 5, human beings are innately goal-directed.
Cortical-striatal circuits work synergistically with midbrain dopamine
neuron networks to reinforce attainment of goals. Virtues are goal-driven,
reinforced dispositions associated with positive emotions. These goals en-
gage rational mechanisms of cognitive and emotional control, and therefore
serve as antidotes to the self-destructive habits propelled by demanding
certainty and catastrophizing in risk-avoidant clients.
The guiding virtue of risk-avoidant “I can’t” disavowals is Decisiveness.
In working to become more decisive, striatal connections that support these
dispositions (cognitively, behaviorally, and emotionally) can be strength-
ened, and prior connections that stem self-defeating anxiety, extinguished.
Inasmuch as risk-avoidant disavowing is deduced from demanding cer-
tainty and catastrophizing, guiding virtues that counteract these dispositions
are also indicated. These virtues include Courage and Foresightedness.
Courage can help clients to accept responsibility for denying their freedom
to choose; and it can help them to act decisively.
Foresightedness can help clients to assess rational risks to avoid over- and
under-reacting to danger, and thus to take reasonable risks. The probability
of an outcome is relative to evidence, not to one’s aversion to the outcome.
Hence, the client’s negative feelings about (feeling threatened by) the
possibility of the marriage not working is not itself relevant to the calcu-
lation of the probability of this outcome. “The marriage probably won’t
work” is irrational if based on the fear of it not working out.
“If it can go wrong it will,” so-called “Murphy’s Law” is an irrational way to
avoid risk-taking. It is irrational because many things that can go wrong don’t.
Clients who use such false ideas to rationalize their irrational tendencies may be
challenged to relinquish them, and to substitute instead rational inductive criteria.
Rational predictions are based on representative samples. That is, “the
sample must have a sufficient number of cases and must be sufficiently
diverse to make it representative of the class being used to ground the
 Risk-Avoidant Capacity Disavowals 111
prediction” (Cohen, 2009, p. 169). Thus, the divorce rate may vary across
different populations relative to occupation, age, sexual orientation, geo-
graphy, religion, political affiliation, education level, and number of times
married, among other things. According to some studies, the probability of
a first marriage lasting for at least 20 years is 65% for men with a college
degree; while for men with a high school diploma or less it is 50%
(Zuckerman, 2020). Actuaries have about a 17% chance of getting divorced
while flight attendants have about a 53% chance (Leadem, 2017).
Paradoxically, 75% of marriages may end in divorce due to lack of
commitment (Shaw, 2019). So, clients who can overcome their risk-
avoidance to commitment may effectively increase the probability of their
marriages working out. In the end, such statistics cannot make the decision
for the client who is left to decide what risk is worth undertaking to attain the
desired outcome. Human beings natively possess the value-based decision-
making capacity to accomplish this task (Brosch & Sander, 2013).
Unfortunately, this ability is impeded by logico-linguistic tendencies that lead
to risk-avoidant “I can’t” disavowals. The goal of therapy is not to decide for
the risk-avoidant client but rather to help such clients overcome these irra-
tional tendencies, and to build rational decision-making habits, instead.

Box 7.6 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues
In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming risk-avoidant disavowals.
T: Our goal now is to help you overcome these self-defeating
habits of yours to demand certainty, catastrophize, and then refuse
to accept your freedom to do things that involve risk-taking. This
will involve working on a new set of positive goals to counter
these negative ones. It will involve changing the hot-running
negative feelings and emotions you have toward taking risks. I
mean the ones that are presently active and making you feel
disempowered. This will require replacing these feelings and
emotions with positive, constructive ones. But it will take a
commitment from you to work toward these new goals. The
reward is that putting in the work can be extremely liberating!

C: What goals are these?

T: Instead of demanding perfection and then catastrophizing when
you aren’t certain, you can work on building virtuous habits of
Courage and Foresightedness.
112 Overcoming Common Capacity Disavowal
C: Okay, so not being so afraid and figuring things out in advance?
T: Right. Courage is a habit of rationally controlling your fear of
taking risks. It does not mean taking risks not likely to produce
the outcomes you want. It means not being afraid to go after
things you really want when you have a good chance of getting
them. Foresightedness, in turn, is a habit of basing calculation of
risk on the evidence, not on exaggerating risk based on fear.
C: I think I can work on this.
T: Great! There is another related virtue too, Decisiveness. This
virtue can back up Courage. It means you have realistic
confidence in your ability to accomplish things; so instead of
procrastinating, you have the courage and foresightedness to
come to a reasonable conclusion and act on it.
C: This makes sense to me. Actually, it sounds kind of exciting!

Step 5: Finding an Uplifting Philosophy

As discussed in Chapter 6, abstract, positive language such as “Courage,”
“Foresightedness,” “Decisiveness” is associated with positive interoceptive feel-
ings. As such, setting the guiding virtues as aspirational goals can itself feel in-
spiring. This is also true in the case of philosophical language, which can be
“uplifting,” especially when used to justify the guiding virtues. In the case of risk-
avoidant clients, providing philosophical world views that inspire Courage,
Foresightedness, and Decisiveness can provide a counterweight to the negative
feelings associated with the imagery involved in risk-avoidant anxiety.
As discussed in Chapter 3, the acceptability of a philosophical worldview is
not dictated by the CBT therapist. This is because the view needs to resonate
with the client to be efficacious in promoting a guiding virtue. Accordingly,
the philosophies provided here for risk-avoidant clients are only possible
suggestions. Thus, they may work for some clients but not for others. As
discussed in Chapter 4, there are many media sources from which philoso-
phies can be derived (literary works, movies, musical lyrics, etc.), so they
need not be gleaned from the works of great philosophers directly.

Philosophies of Courage
These uplifting philosophies inspire the use of reason and knowledge rather
than “blind emotion” to make judgments about taking risk.

Moderation Through Use of Reason

I have found that many clients resonate well with Aristotle’s counsel to
exercise moderation in confronting risk. This may be because it does not make
 Risk-Avoidant Capacity Disavowals 113
unconditional demands on clients. “Courage is moderation,” Aristotle
states, “with respect to feelings of fear and confidence.” As such, “the
courageous man regulates both his feeling and his action according to the
merits of each case and as reason bids him” (Aristotle, 1941, bk. 3, ch. 7). This
means it can sometimes be okay to be afraid, or not confident, about taking
certain risks. So, the client is not being counseled to never be afraid, which is
as daunting as it is unreasonable. The uplifting terms “Golden Mean.”
For risk-avoidant clients, the key is not to panic, but to exercise cog-
nitive control instead by looking at the context or situation. As discussed in
Chapter 5, humans are innately wired to engage in cognitive control. The
DLPFC provides contextual input to the VMPFC to place context-
appropriate signals to the amygdala in sounding the danger alarm. So,
Aristotle counsels the client to think through the situation rationally first and
react second; and, as it is sometimes positively expressed, follow the “Golden
Mean” instead of going to extremes.

Knowledge as an Antidote to Fear

American philosopher Ralph Waldo Emerson provides an uplifting way of
expressing the idea of forethought in confronting risk aversion. In his essay
entitled, “Courage,” he says, “Knowledge is the antidote to fear.” He
amplifies on this philosophy by stating that, whether one is a child or a
soldier,

each surmounts the fear as fast as he precisely understands the peril and
learns the means of resistance. Each is liable to panic, which is, exactly,
the terror of ignorance surrendered to the imagination. Knowledge is
the encourager, knowledge that takes fear out of the heart, knowledge
and use, which is knowledge in practice. They can conquer who
believe they can. … (Emerson, 1904)

There are at least two useful interpretations of “Knowledge is the antidote

to fear” that can be gleaned from this brief passage.
First, the more one learns about a situation, the more one is positioned to
address any risks. Unfortunately, risk-avoidant clients tend to shy away
from risks before they even “understand the peril” and how best to address
it without surrendering their goals. “Knowledge is an antidote to fear” thus
means that acquisition and deployment of relevant knowledge can help one ra-
tionally assess risks, reduce them, and, thereby, feel less threatened by them. So,
knowing that successful marriages involve reciprocity rather than self-
centeredness can provide the client with direction that could reduce the
risks of the marriage going awry.
Second, the idea of panic being “the terror of ignorance surrendered to
the imagination” succinctly captures the imaginative state of risk-avoidant
clients, which processes images associated with negative interoceptive
114 Overcoming Common Capacity Disavowal
feelings keyed to the language of “terror.” On the other hand, “those who
believe they can,” says Emerson, have the capacity to “conquer” such
“terror of ignorance surrendered to the imagination.” So here is the up-
lifting idea of positive thinking (“Yes I can”) combined with an enlightened
imagination free of the “terror of ignorance.”
Third is the related idea that “knowledge is the encourager.” In the case
of risk-avoidant clients, relevant knowledge, or insight, can help the client
reframe the risk as an opportunity for constructive change, and thus to inspire and
excite. For example, the client could reframe marriage as an opportunity to
achieve a goal not possible outside a committed relationship, such as an
intimate, unified bond of love based on trust, empathetic understanding,
and mutual caring. Here, the abstract, positive language in terms of which
such imaginative reframing occurs (“unified bond of love,” “mutual
caring,” etc.) can help to replace the client’s negative interoceptive feelings
(associated with the image of a “failing” marriage) with positive feelings.

Philosophies of Foresightedness
These philosophies, which take a scientific approach, change the focus
from the demand for certainty to the more realistic goal of increasing prob-
ability.

Probability and Reasonableness

Among outstanding twentieth-century contributors to this approach5 is
Bertrand Russell, who made abundantly clear that “predictions about the
future are probable relative to the facts as known.” “The most we can
hope,” he declared, “is that the oftener things are found together, the more
probable it becomes that they will be found together another time…”
(Russell, 1972, pp. 65–66). Here, the idea that the future necessarily re-
sembles the past and can therefore be known with certainty, based on past
experience, is deconstructed and reframed in terms of the idea of probability.
While we can sometime quantify the latter, the probability of a statement is
essentially the reasonableness of believe it. So, the conceptual shift is from
certainty to reasonableness. Terms such as “reasonable” and “probable”
have positive affective valences and provide constructive surrogates for
clients who demand certainty. So, in embracing the virtue of
Foresightedness, a risk avoidant client is engaging in a conceptual shift from
the language of “must” and “certain” to that of “probable” and “reason-
able.” This conceptual shift also carries with it the realization that what is
probable or reasonable is not necessarily true. This means that embracing a
philosophy of Foresightedness can help risk-avoidant clients come to terms
with the idea that they can be on firm epistemic grounds in acting on their
beliefs even if they subsequently turn out to be mistaken. This can have
much to do with self-reproach, for one is not to blame when one acts on a
 Risk-Avoidant Capacity Disavowals 115
reasonable belief that turns out to be mistaken. This is, indeed, a core part
of what it means to be human, so risk-avoidant clients can let go of a
superhuman, God-like demand for omniscience about the future.
These philosophies help clients to overcome self-destructive procrasti-
nation by inspiring action.

Existentialism
As discussed in Chapter 3, existential philosophies such as that of Jean-Paul
Sartre are useful for the latter purpose. One can define oneself positively only
through one’s actions, according to this view (Sartre, 2007). “I could have,
would have, or should have” does not fulfill a person, that is, accomplish
one’s hopes and dreams.
Indeed, existential philosophies stress that part of the “human condition”
is uncertainty, that is, the universal set of conditions that constrain human
existence (Sartre, 2007, p. 41). We have no choice but to act amid un-
certainty. “Whenever we desire something, there are always elements of
probability,” Sartre admonishes. “If I am counting on a visit from a friend,
who is traveling by train or trolley, then I assume that the train will arrive
on time, or that the trolley will not derail. I operate within a realm of
possibilities….” To be decisive means to act under such conditions of
uncertainty. This is part of the meaning of being decisive. For “no God or
greater design can bend the world and its possibilities to my will.” On the
other hand, in choosing not to act, one has also made a choice (Sartre, 2007,
p. 44). The denial of one’s freedom and responsibility to act, or not to act,
under conditions of uncertainty is therefore to lie to oneself.
The uplifting news is that, accepting this freedom and responsibility
holds the potential for human happiness, for, in the end, things will be
much what one decides they are (Sartre, 2007, p. 34). It is how one feels that
counts (Sartre, 2007, p. 32). So, within this sphere of subjectivity, calling an
action, or possible action, a “horrible mistake” is also a decision. It could
also be a growth experience, a valuable life lesson, or a new beginning. As
such, once the client accepts his freedom and responsibility, positive possi-
bilities are limited only by his imagination, and interpretation of outcomes.

Pragmatism
The basic idea of pragmatism is that true beliefs are ones that work when they
are acted on. So, one does not know what one is not prepared to act on.
According to American pragmatist William James, “Our errors are surely
not such awfully solemn things. In a world where we are so certain to incur
them in spite of all our caution, a certain lightness of heart seems healthier
than this excessive nervousness on their behalf” (James, 1912, ch. 7).
According to James, what is certain in this world of ours is that we will err at
some point regardless of the precautions we take. As such, James recommends
116 Overcoming Common Capacity Disavowal
reframing the way mistakes are imagined. Rather than catastrophizing about
them, one can instead reframe them as part of living and thus with “a certain
lightness of heart.” Here, reframing in positive terms of “a certain lightness of
heart” and “healthier” shifts attention away from the negativity of images
associated with making mistakes and makes acting feel better.
James further counsels, “It is only by risking our persons from one hour
to another that we live at all. And often enough our faith beforehand in an
uncertified result is the only thing that makes the result come true.” For
example, James writes,

Suppose, for instance, that you are climbing a mountain, and have
worked yourself into a position from which the only escape is by a
terrible leap. Have faith that you can successfully make it, and your feet
are nerved to its accomplishment. But mistrust yourself, and launching
yourself in a moment of despair, you roll in the abyss. (ch. 4)

So, the client who lacks faith that his marriage will work may himself bring
it about that it does not. “You make one or the other of two possible
universes true by your trust or mistrust—both universes having been only
maybes, in this particular, before you contributed your act.” Here, the
Jamesian antidote to the risk-avoidant “I can’t,” is thus having “faith” and
“trust,” two words backed by feelings that inspire success.

Box 7.7 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy
In the below part of their session, the therapist helps the client to find a
philosophy and to try it out through use of interoceptive imagery.

T: So, how can you change the way you think to become more
Courageous, Foresighted, and Decisive? Let’s take Courage first.
How do you think a courageous person looks at life?
C: I suppose such people aren’t afraid to make commitments.
T: Just any commitments?
C: No, I mean ones that are important.
T: Any examples?
C: Yes, sure. Not being afraid to speak up when they think it’s
right. Being level-headed, not someone who wastes their time
on trivial things but knows the value of things and is willing to
take risks when it really matters.
T: Excellent! The ancient philosopher Aristotle shared a similar
view. He said courageous people don’t go to extremes like
 Risk-Avoidant Capacity Disavowals 117
feeling too afraid or too confident. He said courage involves a
sort of “Golden Mean.” Some things are worth the risk, other
things aren’t. When something is worth the risk, then you take
it; otherwise not.
C: You mean like spending my life with the woman I love instead
of being afraid of trying?
T: Yes! Not afraid to go for it if this is really what you want.
C: It is what I really want, so I wish I could get over this fear.
T: Okay, let’s try the imagery we tried earlier. Get yourself to feel
that fear of the uncertainty and that need to be certain. Let me
know when you are there.
C: [Pause] Okay, I’m there.
T: Do you feel afraid and disempowered?
C: Yes, I’m feeling it, helpless, almost desperate!
T: Okay, now image having the courage to be with the one you
love, following the “Golden Mean,” no longer being too afraid.
C: I’m imagining it.
T: How are you feeling now?
C: I feel much better. Like I have power over my life; so cool how
this makes me feel better!
T: Yes, it really is cool how much control we can have over how
we feel.

Step 6: Constructing a Plan to Apply the Philosophies

Because the uplifting philosophies clients adopt are their philosophies, cli-
ents can feel good about applying them to overcome their risk-avoidance.
The goal of such “philosophical practice” is to reverse the polarity of the
cognitive dissonance between the risk-avoidant syllogism chain (Syllogism
Chain C above) and virtue-based ones. For example, one virtue-based
syllogism might be:

(Rule 1) I should seek knowledge as an antidote to my fear.

(Report 1) I fear my marriage might not work.
(Conclusion 1/Rule 2) So, as an antidote to my fear, I should seek
knowledge that can help me attain a marriage that works.
(Report 2) Bibliotherapy that provides information on successful
marriages could help.
(Conclusion 2) So, I should seek information on successful marriages.

Effectively, the philosophical wisdom in question (Rule 1) carries with it a

prescription for overcoming the self-destructive anxiety that prevents the client
from making a commitment (Conclusion 1). As such, the CBT therapist can
118 Overcoming Common Capacity Disavowal
help facilitate the client’s selection of pertinent literature on successful mar-
riages (Report 2). This could include philosophical and self-help literature that
promotes reframing of negative emotional reasoning, but it could also include
factual and statistical information, for example the statistic mentioned earlier,
that 75% of divorces are due to lack of commitment.
Construction of a virtue-based syllogism chain such as the above one
may proceed seamlessly by posing three related questions, the answers to
which comprise the content of the virtue-based chain.6

Three Questions to Pose to Clients

More generally, I have found these questions useful in helping clients to
develop potent cognitive-behavioral plans:

1. In what ways has your risk-avoidant thinking, actions, and emotions

negatively impacted your life, or the lives of others?
2. What changes would your uplifting philosophies prescribe?
3. How are you to make these constructive changes?

The first question provides reportative information such as that contained

in Report 1 above. It helps the client to reflect on the problematic nature of
her risk-avoidant tendency, which may (and typically does) loom wider
than the presenting problem. For example, the client’s reticence to make
commitments may have negatively manifested itself in multiple life con-
texts, from work-related contexts to social ones. It may have diminished the
quality of the client’s life by alienating others; consuming large expanses of
time spent ruminating; avoiding social interaction; holding the client back
professionally; and adversely affecting the client’s moods.
One useful way of eliciting specific information from the client is to ask
the client what things she tends to do when she feels the anxiety of risk-avoidant
thinking. Does she withdraw (become uncharacteristically quiet, unsociable,
go to bed), displace on others, engage in self-defeating or regrettable be-
havior, become moody or whiny, etc.?

Box 7.8 Practice

Therapist (T)–Client (C) Exchange

Introducing the Idea of a Cognitive-Behavioral Plan

T: In the below part of their session, the therapist helps the client to gain an
understanding of what an action plan will involve, and to identify some
of the negative consequences of his risk-avoidant disavowal. Are you
 Risk-Avoidant Capacity Disavowals 119
okay with setting up a plan to apply your philosophies, and
work on your guiding virtues? This will take work on your part.
C: What kind of work?
T: You will have practice assignments to do. Some of them will use
imagery like we used before, only you would practice it on your
own too. Others will involve behavioral assignments, doing
certain things. You may have some bibliotherapy, which means
being given things to read or thinking about. You will have
some worksheets to work through. All of this will involve
cognitively and behaviorally working towards overcoming your
risk-avoiding habits and replacing them with ones that will
make you more courageous, foresighted, and decisive.
C: Yes, I’m willing to do these things.
T: That’s great to hear! Why are you willing to put in all this work?
C: Because it can help me not to be so afraid, right?
T: Right. So, to be clear, tell me about how your being afraid to
take risks has affected the quality of your life?
C: Well, obviously with my girlfriend. I want to commit and keep
telling myself “I can’t.” I now realize I really can, but still don’t
feel like I could actually go through with it, I mean propose
to her.
T: Very good! Any other ways this reluctance to take risks has
affected your life?
C: Yes, I have not done many things I would like to have done in
other areas of my life, like professionally. I could open my own
retail business but have worked in this department store for the past
five years. I’m a department manager and all, but I could take what
I have learned and open my own business if I had the nerve.
T: That’s useful information. When you feel anxious about making
decisions, what sort of things do you tend to do? I mean, for
example, do you act grumpy, ruminate, avoid social contact?
C: Yeah, I ruminate a lot, and I really lose patients with others, and
try not to talk to customers when I’m at work. Kind of into
myself when I feel like this.
T: So, it sounds like your risk-taking anxiety issue has also affected
you in some ways socially as well as individually?
C: Yes, that’s true.

The second question, in turn, draws conclusions from the information

gleaned from the first question in conjunction with the uplifting philo-
sophy. It tracks Conclusion 1 in the above virtue-based syllogism. It thus
gives the client an opportunity to reflect on how living by her philosophical
lights could positively change her life for the better.
120 Overcoming Common Capacity Disavowal

Box 7.9 Practice

Therapist (T)–Client (C) Exchange

How Can the Philosophy Help?
In the below part of their session, the therapist challenges the client to
consider what changes his new philosophy might suggest.

T: Do you think the guiding virtues and their philosophies could

help with these things?
C: I think they might.
T: How?
C: Well, Aristotle’s idea of the “Golden Mean” could help me have
more courage when its stupid to be afraid. It could help me,
maybe, to propose to my girlfriend; and maybe even finally get
up enough courage to start my own retail business.
T: And what about the time you spend ruminating, losing your
patience, and trying to avoid customers? What do you think
Aristotle would tell you to do differently?
C: I suppose he would say, instead of getting so hung up on being
afraid, I should just go about my business and stop worrying so
much and let myself alone. I really don’t have to be so afraid.
That’s just some feeling I have in my head, anyway.
T: Excellent!

Finally, the third question tracks information such as that contained in

Report 2 above. It provides the client with the opportunity to identify the
means toward which to make or aspire to make the prescribed positive
changes. It is here where a cognitive-behavioral plan is directed toward
making these constructive changes. Here is also where appropriate cognitive-
behavioral assignments are provided for the client to undertake.

Box 7.10 Practice

Therapist (T)–Client (C) Exchange

Applying the Philosophy
In the below part of their session, the therapist gives the client an
opportunity to reflect on how to make the suggested changes.
 Risk-Avoidant Capacity Disavowals 121
T: Based on what you are saying, what sort of assignments do you
think might be helpful?
C: I suppose instead of ruminating about things, not talking to
customers and stuff, I can tell myself to cut it out.
T: That’s a great idea! When you catch yourself demanding
certainty, catastrophizing about not having it, and telling
yourself you can’t do things, you can think about how this
demand is irrational and self-defeating; you can focus on your
guiding virtues and their philosophies instead; and then you can
just go about your business.
C: Yes, I can work on that!
T: Excellent!

The remainder of this chapter discusses some (although not all) useful
cognitive-behavioral assignments for risk-avoidant clients.

Some Cognitive-Behavioral Assignments for Risk-Avoidant Clients

Risk-Taking Exercises
Because long-standing dispositions toward risk-avoidant thinking, feeling,
and acting have been wired into the client’s neural circuitry, such con-
structive change takes considerable practice. It is most likely a cumulative,
effortful process over time that builds the stamina to overcome the latter
logico-evaluative dispositions and promote advancement toward the client’s
guiding virtues of Courage, Foresightedness, and Decisiveness. Cognitive
dissonance is an important milestone because it means that the client is aware
of her self-destructive dispositions and has developed the wherewithal to
oppose them with guiding virtues and uplifting philosophies.
Risk-avoidant assignments figure importantly in this thrust toward
overcoming these ingrained dispositions. Such assignments consist of prac-
tice taking relatively benign risks in the context of ordinary life. Thus, the
risk-avoidant client may be asked to think of something that she has been
disposed against doing notwithstanding the relatively benign risk. For ex-
ample, playing the slot machines for a few dollars may have no deleterious
consequences for a client who can afford to lose this relatively small amount
of money. So, an assignment to gamble a few dollars may work as a risk-
taking assignment if the client is disposed against taking the risk. In this case,
the client might invest and reinvest any possible winnings until all the money
has been lost, which is the likely consequence. In so doing, the client can
exhibit Courage because it may be reasonable not to fear a loss of such small
consequence. As part of the assignment, the client would also be asked to
examine her negative emotion syllogism chain, refute its speech acts, and
focus instead on her guiding virtues and their uplifting philosophies.
122 Overcoming Common Capacity Disavowal

Box 7.11 Practice

Therapist (T)–Client (C) Exchange

Practicing Cognitive-Behavioral Skills in a Risk-Taking Exercise
In the below, the client examines his risk-avoidant reasoning, identifies his
irrational speech acts, disputes them, and applies his uplifting philosophy to a
risk-taking exercise.

There I go, demanding certainty; and then reminding myself I

would be taking big risks with my money; so, it’s a really dumb
thing to do (After all, even a few bucks doesn’t grow on trees!);
which means, “I can’t do it!” But wait a minute; being certain is
not part of life because everything has some risk. And it’s only a
few dollars I’m risking and won’t break me. So why is it “a really
dumb thing to do”? Being so afraid to gamble away a few bucks
is really going to an extreme. In this situation, it’s actually
reasonable not to be afraid. Isn’t this what it means to be
courageous? Isn’t this the “Golden Mean”? I can do this! I
might even have some fun!

Interoceptive Imagery
In such exercises, the client practices imagining a situation about which he
is experiencing risk-avoidant anxiety, and then uses cognitive reframing to
overcome the anxiety. In the form illustrated earlier in this chapter in the
practice section on “Embracing an Uplifting Philosophy,” the client takes
the following sequential steps:
• First, the client imagines a situation that is risk-avoidant for her and gets
herself to feel the anxiety associated with the situation in question.
• Second, once experiencing the anxiety, the client focuses on her felt
need for certainty and her feeling of uncertainty.
• Third, the client shifts imagery to an uplifting philosophy promotive of
Courage, Foresightedness, or Decisiveness.

The goal of this methodology is thus to reverse the polarity of the “hot” and
“cold” running emotions, by associating the imagery that previously evoked
anxiety with the positive philosophy and its guiding virtue. Its effectiveness is
largely a function of how well the philosophy resonates with the client, and
the positive valence of the abstract language used to express it.
 Risk-Avoidant Capacity Disavowals 123

Box 7.12 Practice

Practicing Interoceptive Imagery with a Risk-Avoidant Client

A Case Example

In one session, I asked a client who demanded outcome certainty

to imagine himself messing up in front of his father and to focus
on his felt need to be certain he would not mess up. The client
was asked to use the image of a human being as an “end in itself,”
a being whose value is unconditional, as his uplifting philosophy
to defeat the negative imagery. This philosophy did not work
very well for this particular client. After the client, a devout
Catholic, changed his philosophy to one by his favorite
philosopher, Saint Thomas Aquinas, that “Grace builds on
nature,” the client returned to the imagery exercise using this
philosophy, and it successfully helped him shift from a negative
self-downing emotion to a positive self-affirming one. The felt
need to be certain he wouldn’t mess up seemed to evaporate
because his uplifting philosophy gave him permission to be
imperfect with the Grace of God.

Systematic Tackling of Major Behavioral Challenges

At some juncture, the client may be ready to tackle a more difficult chal-
lenge. For example, the client contemplating committing to marriage may
have done imagery exercises attempting to work through his “hot-
running,” self-destructive emotional reasoning, and performed other
commitment exercises (for example, making an on-the-job commitment).
However, the client may not have proposed marriage. Inasmuch as such a
commitment has been an ongoing problem for the client (for example, he
has gone through years of protracted relationships without committing to
them, subsequently ending them when they become “too serious”), the
behavioral assignment now rises to a the level of a major life decision.
In proceeding, the client is counseled to practice the cognitive-
behavioral processes of keeping in touch with the logico-linguistic chain of
self-defeating acts that propel the client’s risk-avoidant anxiety; their re-
futations (especially the demand for certainty); and the guiding virtues and
their uplifting philosophies that motivate positive change.
In the end, it is important for the client to be ready to accept the chal-
lenge. It is not a good idea for the therapist to force, intimidate, or
otherwise manipulate the client into making the life change in question.
124 Overcoming Common Capacity Disavowal
This is likely to backfire as the end-goal is to increase the client’s freedom
by liberating him from his oppressive “I can’t.” However, in manipulating
the client to act, the client substitutes one form of oppression for another.

Worksheets
CBT Workbooks that contain worksheets for clients to work through can
be useful. The companion workbook to this book contains a chapter de-
voted to risk-avoidant disavows that can help clients systematically practice
the rational-emotive behavioral activities discussed above.

Bibliotherapy
Bibliotherapy useful for risk-avoidant clients might address the nature and
value of (rational) risk-taking, the aspirational, abstract (but still accessible)
philosophical side of Courage, Foresightedness, and Decisiveness. It could
also include self-help materials, as mentioned.
Movies that illustrate and inspire courage in overcoming life obstacles tend
to be especially useful in creating positive somatosensory associations. This is
a popular media theme and there are numerous movies readily available
(Largo, 2014). For instance, the client who demands certainty about com-
mitting to marriage might view an uplifting movie about the power of love
and commitment such as is illustrated in the true story, Loving (Nichols,
2016) about an interracial couple in the 1950s South who marry despite
racially oppressive cohabitation laws that test the couple’s commitment.
Uplifting philosophical ideas about Courage (Courage quotes, n.d.),
Foresightedness (Foresight quotes, n.d.), and Decisiveness (Decisiveness
quotes, n.d.) are bountiful on websites with famous quotes, which can
sometimes be profound enough to promote positive images that counteract
self-destructive syllogism chains.
The New Rational Therapy (Cohen, 2006) provides a collection of up-
lifting philosophical antidotes to self-destructive speech acts, including
demanding perfection and catastrophizing. These philosophies, derived
from the ideas of Western as well as Eastern philosophers, have been
condensed into an accessible, uplifting form.
There is a plethora of books on informal logic that contain accessible
discussions of inductive logic useful in introducing clients to rational
standards for making probabilistic inferences. Chapter 2 of Caution: Faulty
Thinking Can Be Harmful to Your Happiness, can provide a user-friendly
approach to helping clients identify inductive fallacies in the reportative
premises of their syllogism chains (Cohen, 2013).

Notes
1 Inference rules necessary to validate each link in the syllogism chain have been
eliminated. Inference rules can be useful to formulate when the therapist wants to
 Risk-Avoidant Capacity Disavowals 125
challenge them. As discussed below, this can be helpful for purposes of challenging
the major premise rule of the primary syllogism.
2 See Chapter 5 for a discussion of reflective motivational feelings.
3 In cases in which the reportative premise of the primary syllogism is in question, it is
also important for the therapist to investigate the inductive evidence that justifies it.
This, however, can be done in the refutation stage utilizing an empirical refutation.
4 This does not mean that there are not differences in brain function during reality
assessment and imagination. For instance, there appears to be a dysfunction in regions
such as the dorsolateral prefrontal cortex in reality monitoring in patients with
schizophrenia (Garrison et al., 2017).
5 Here I would be remiss not to include John Stuart Mill, who, in his A System of Logic,
made important contributions to the science of inductive logic. Regarding predictive
inductions, he stated, “Two things resemble each other in one or more respects; a
certain proposition is true of the one; therefore it is true of the other…. [I]t is clear
[however], that every dissimilarity which can be proved between them furnishes a
counter-probability of the same nature on the other side” (Mill, 2009, ch. 20, sec. 2).
6 In my clinical experience, I have not ordinarily found it necessary to explicitly for-
mulate this syllogism chain, because clients generally deduce the conclusions on their
own once they answer the aforementioned questions.

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8 Low-Frustrative Capacity
Disavowals

A low-frustrative capacity disavowal is a behavioral disavowal that creates

and sustains low frustration tolerance (LFT), that is, the felt incapacity to
“stand” or “tolerate” frustration in performing goal-directed behavior
successful completion of which is perceived to be difficult, challenging, or
otherwise unpleasant. The low-frustrative individual thus tends to avoid or
give up on tasks that are not immediately gratifying. As a result, the in-
dividual does not make progressive change and tends to remain in her
“comfort” zone, without expanding her range of activities or encounters.
The client may thus present with a history of choosing short-term pleasures
at the expense of more lasting ones that require perseverance and foregoing
immediate gratification.
Low-frustrative syllogism chains tend to contain speech acts of de-
manding perfection and catastrophizing, from which the low-frustrative
disavowal is deduced. Low-frustrative clients make a hedonic demand for
immediate gratification and deduce catastrophizing when their efforts are
frustrated. In turn, these clients conclude that they can’t stand or tolerate
things that present obstacles to immediate gratification, and either try to
avoid them or give up on them prematurely. Instead, they tend to substitute
things that offer short-term satisfaction (drugs, sex, purchasing things).

Emotional Problems Arising from Low-Frustration

Tolerance
These clients tend to experience intense frustration about accomplishing life
goals when accomplishing them conflicts with obtaining immediate grati-
fication. They also tend to experience anxiety because of the uncertainty
surrounding what to do when their desired goals run amuck of immediate
gratification. They may also experience depression due to not having
achieved long-term goals that bring more lasting pleasures. Further, they
may experience anger when the actions of other persons are preventing their
immediate gratification.
The feeling of frustration experienced by clients with low frustration
tolerance is an interoceptive feeling that appears to be generated by the
128 Overcoming Common Capacity Disavowal
insula (Bierzynska et al., 2016). The negative emotion of frustration is dis-
tinct from the feeling of frustration since the emotion also includes related
cognitive changes (described below in the section on Low-Frustrative
Syllogism Chains) as well as behavioral changes—avoidance of things that
preclude immediate gratification.
The term “low-frustration tolerance” (LFT) itself refers to the negative
habit or disposition to experience the emotion of frustration. Thus, people
with low-frustration tolerance are disposed to demand immediate gratifi-
cation and when they can’t get it, they feel frustrated, which leads them to
catastrophize about it; and then to disavow their ability to stand it, which,
in turn, leads them to avoid the things that are inconsistent with immediate
gratification, even when they are likely to lead to long-term gratification.
One view is that LFT originates in the amygdala, which seeks immediate
gratification (Bechara, 2005). This view appears to be consistent with the
hypothesis advanced here, that the Ventromedial Prefrontal Cortex (VMPFC),
interactive with somatosensory structures, undergird the speech act of de-
manding immediate gratification. The latter brain regions have both input and
output capacity, and the VMPFC both receives and sends signals to the
amygdala. In (statistically) normal cases, the VMPFC, in synergy with the
dorsolateral prefrontal cortex (DLPFC), exercises control over the amygdala’s
short-term pleasure drive, keeping frustration at manageable levels. However,
in cases of LFT, the VMPFC and somatosensory structures create a cognitive
or “reflective” demand for immediate gratification (not just a physical, “im-
pulsive” desire from the amygdala). The latter demand, in turn, linguistically
generates catastrophizing, thereby sending destress signals back to the amygdala,
adding further fuel to the fire. In other words, in cases of LFT, the VMPFC
cooperates with, rather than opposes the amygdala by turning the amygdala
impulse for immediate gratification into an absolutistic, inflexible demand for
it. This has important implications for treatment because it portends the need
for cognitive reframing to address the cognitive dysfunction (the linguistic de-
mand) (Magen et al., 2014).

Types of Situations Low-Frustrative Clients Tend

to Avoid
Low-frustrative clients may disavow their capacity for such things as:

• Activities perceived to be stressful such as rigorous work schedules or

routines
• Goal-directed activities that require lengthy courses of study or training
such as law and medicine
• Domestic chores that are not “fun”
• Activities that require regular practice such as learning a musical
instrument
 Low-Frustrative Capacity Disavowals 129
• Activities that might not “come easy,” or which seem challenging or
difficult, for example, mathematics
• Encounters or associations with people they “can’t stand”
• Exams or assignments that require careful preparation or research
• Relationships with significant others that become problematic (for
example, illness or financial challenges)
• Attempting to correct or improve things at which they have made
mistakes or failed

Low-Frustrative Syllogism Chains

Schematically, low-frustrative syllogism chains look like this:

Hedonic Demand for Perfection → Catastrophizing → Low-

Frustrative Disavowal

For example, a low-frustrative client with anxiety about going back to

school to earn a degree may defeat his own purpose by demanding im-
mediate gratification. The client’s evaluative syllogism chain might look
like this:

1. I must get what I want immediately (fast).

2. But it would take me two years of study just to get my AS degree.
3. Therefore, for me, it would be like being in hell for two years.
4. Therefore, I just couldn’t stand it!

Phenomenologically, the following imaginative chain of associations and

speech acts tracks the above syllogism chain:

• In (1) the client dispositionally harbors a felt need to experience immediate

gratification rather than to endure the frustration of having to wait; this
feeling having been reinforced by negative, past experience such as
psychological trauma (Green, 1983) stemming from child abuse, or
oppositely, of having regularly received immediate gratification without
having learned to postpone immediate gratification (Ballinger, n.d.). This
felt need for immediate gratification is dispositionally expressed using the
language of necessity, such as “must” or “need.”
• In (2), the client imagines a state in which she postpones immediate
gratification for two years by pursuing an AS degree, which activates her
dispositional felt need for immediate gratification and its linguistic
expression as a demand. The client, in turn, focuses attention on the
incompatibility of this demand for immediate gratification and the image
of having to wait for two years, which triggers an emotionally painful
feeling of frustration.
130 Overcoming Common Capacity Disavowal
• In (3), feeling this frustration, the client catastrophizes about it by
imagining the wait in terms of “like being in hell for two years.”
• Finally, in (4), the catastrophic use of the negative language, “being in
hell for two years” makes the image of waiting feel even worse; while
the felt need/demand for immediate gratification, in conflict with the
frustrating/catastrophic image of having to wait, and the pulsations of
unpleasant, physical sensations oscillate in the client’s consciousness.
Steeped in this consciousness of painful conflict (“I must have
immediately what I cannot”), it feels impossible to postpone
immediate gratification. Responsive to this feeling of powerlessness to
circumvent the hellish wait to satisfy the felt need for immediate gratification, the
client uses the words, “I couldn’t stand it” to disavow her capacity to wait.

This series of images and interoceptive feelings plays out while the neu-
rological processes described in Chapter 5 play out in parallel succession
beneath the skin. In premise 1, the dispositional felt need undergirds the
speech act of demanding immediate gratification, which is activated and
becomes a basis of comparison in premise 2; which, in turn, generates a
conflicted consciousness, wherein a perfectionistic demand for immediate
gratification is juxtaposed to the reality of having to postpone immediate
gratification for two years in order to accomplish a life-goal (obtaining a
college degree). It is this conflicted consciousness that creates the inter-
oceptive feeling of impossibility (and hence that of powerlessness) in
conclusion 4. It is also what feels so frustrating, which, in turn, leads to the
speech act of catastrophizing in conclusion (3), which, together with the
feeling of impossibility/powerlessness, leads to the speech act of disavowal
in conclusion 4.
Understanding such successive progressions and interplay of images and
feelings as expressed through clients’ syllogism chains is a powerful clinical
tool for keying into the clients’ affective as well as cognitive world. In this
world, the dichotomy between reason (logic) and emotion evaporates as
streams of images and associated feelings coalesce with language in logical
succession to express emotions.
Ironically, it is the fact that human beings are logical creatures capable of
keying into inconsistencies or contradictions that creates the problem; for
without a consciousness of irreconcilable conflict in attaining her educative
goal, the low-frustrative client could simply proceed with the degree. At the
same time, it is this painful conflict that holds her back, and frightens her off,
so to speak—with help from limbic signals from the lower forebrain.
In the case of low-frustrative clients, the way to ease the confused
consciousness and open up the doors to a more deeply fulfilling life, with
more possibilities to freely explore, is to overcome the dispositional demand
for immediate gratification in premise 1, and replace it with a virtuous rule
that promotes positive, life-affirming emotions. The six-step counseling
process for accomplishing this follows.
 Low-Frustrative Capacity Disavowals 131
Step 1: Formulating the Primary Syllogism Using O & R
As discussed in Chapters 1 and 7, this involves finding the client’s inten-
tional object (O) and rating (R) to formulate the syllogism.

Box 8.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism
In the below part of their session the therapist helps the client find O & R
to construct the primary syllogism.

C: I am very unhappy with my life.

T: Tell me more about that.
C: At this point in my life I always thought I’d have a good job, but
it’s just not happening.
T: What do you mean by a “good job”?
C: One that’s fulfilling. I am a salesperson in a women’s clothing
store. It’s really easy work and no pressure or anything, and I
really get along with my boss; but it’s not fulfilling.
T: What kind of work would you find fulfilling?
C: I would love to be an RN, but I only have a high-school
diploma. I would need at least an associate’s degree, and that
would take me two years to complete!
T: So, why don’t you go for your degree to become an RN if that’s
what you want?
C: I don’t think I could stand it. It would be like being in hell for
two years!
T: It sounds like you feel very frustrated.
C: Yes, very frustrated!
T: I can understand how you would be. Is this your reasoning? If it
takes you two years to get your degree, it will be like being in
hell for two years. But that’s just how long it will take; so it will
be like hell for two years if you decide to go for the degree.
C: Yes, like being in hell!

In the present example, the client’s primary syllogism would be along the
following lines:
132 Overcoming Common Capacity Disavowal
Syllogism Chain A

1. (Rule) If it takes me two years to get my AS degree (O) then it will

be like being in hell for two years (R).
2. (Report) It will take me two years to get my AS degree (if I decide
to pursue the degree) (O).
3. (Conclusion) Therefore, it will be like being in hell for two years if
I decide to pursue the degree (R).

Inasmuch as the client confronts the uncertainty of whether or not to

pursue the AS degree, her future is uncertain. As discussed in Chapter 7,
this “what-if” quality of the client’s intentional object can also create an-
xiety. On the one hand, pursuing the degree means putting herself in a
“hell-like” state of withheld gratification for two entire years; on the other
hand, taking the “easy” way out, she may never get the degree and may
never reap the rewards of advancing her career. So the client has created a
dilemma for herself. With low-frustrative clients, the demand for im-
mediate gratification tends to dictate the outcome, which is “taking the easy
way out.” So, it is important for the therapist to help expose the latter
demand and challenge the client to inspect it.

Step 2: Expanding the Syllogism Chain

To this end, the rule premise of the primary syllogism can be questioned to
expose the premises from which it is deduced: “Why will it be like being in
hell for two years if it takes you that long to get your degree?”

Box 8.2 Practice

Therapist (T)–Client (C) Exchange

Exposing the Demand for Immediate Gratification
In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing a demand for immediate gratification.

T: So, let’s take a look at this premise of yours that, if it takes you
two years to get your degree, it will be like being in hell for two
years. Why would that be?
C: Two years is a big chunk out of my life to wait just to get an
associate’s degree.
T: What if you could get it immediately, or at least without waiting
very long, and wouldn’t have to wait, say not more than a few
weeks? Would you do it then?
C: Yes, sure. I just wouldn’t have the patience to wait for two
years. But that’s not going to happen. It takes two whole years!
 Low-Frustrative Capacity Disavowals 133
T: So when you imagine waiting for two years, does it feel like you
need to get it faster? Can you feel this need, kind of like a gut feeling?
C: Yes, I can feel it.
T: Like you must get it fast, not have to wait so long?
C: Yes, that’s exactly right!
T: So, let’s get clear on your reasoning. You must get what you
want fast, but you would have to wait two years; so, for you, it
would be like being in hell for two years.
C: Yes, that pretty much sums it up!

In the present case, the client’s syllogism chain is expanded upward as follows:

Syllogism Chain B

1. (Rule 1) I must get what I want immediately (fast).

2. (Rule 2) If I must get what I want immediately, then if it takes me
two years to get my AS degree then it will be like being in hell for
two years.
3. (Rule 3/Conclusion 1) Therefore, if it takes me two years of
study just to get my AS degree (O), then it will be like being
in hell for two years (R).
4. (Report) It will take me two years of study just to get my AS
degree (if I decide to pursue the degree) (O).
5. (Conclusion 2) Therefore, it will be like being in hell for two years
if I decide to pursue the degree (R).

In Syllogism Chain B, Rule 1 makes a perfectionistic demand for im-

mediate gratification, which in conjunction with grayed out inference
Rule 2, entails Rule 3, the major premise of the primary syllogism.
The conclusion of the primary syllogism can also be expanded down-
ward to the low-frustrative disavowal, “I couldn’t stand it.”

Box 8.3 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness
In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: You also said you did not think you could stand the two-
year wait.
134 Overcoming Common Capacity Disavowal
C: Right, I don’t think I could.
T: Do you think or feel like you couldn’t?
C: Both.
T: Okay good. So, you are thinking you couldn’t. But, when you
imagine this “hellish” wait, you also have this feeling of
disempowerment, like would be impossible for you to do?
C: Yes, exactly. I also feel like I couldn’t do it.
T: You feel you couldn’t and so you think it too?
C: Yes, but in thinking it, it makes me feel it even more.
T: Kind of a vicious circle. When you tell yourself you can’t, you
make yourself feel even more like you can’t?
C: That’s right.
T: And that’s why you haven’t even tried?
C: Yep!
T: We call this “low frustration tolerance,” or LFT for short. Are
you willing to work on overcoming it?
C: Yes, I think so.

This downward expansion is represented in Syllogism Chain C.

Syllogism Chain C

1. (Rule 1) I must get what I want immediately (fast).

2. (Rule 2) If I must get what I want immediately, then if it takes me
two years to get my AS degree then it will be like being in hell for
two years.
3. (Rule 3/Conclusion 1) Therefore, if it takes me two years of study
just to get my AS degree (O) then it will be like being in hell for
two years (R).
4. (Report) It will take me two years of study just to get my AS
degree (if I decide to pursue the degree) (O).
5. (Conclusion 2) Therefore, it will be like being in hell for
two years if I decide to pursue the degree (R).
6. (Low-Frustrative Rule 4) If it’s like being in hell for two years,
then I couldn’t stand it.
7. (Conclusion 3) Therefore, I couldn’t stand it.

In Syllogism Chain C, the low-frustrative disavowal (Conclusion 3) is

deduced from Conclusion 2 in conjunction with grayed-out Low-
Frustrative Rule 4. The latter rule tracks the flow of images and feelings
from Conclusion 2 to the low-frustrative disavowal in Conclusion 3. In
phenomenological terms, this inference tracks the intense feeling of frus-
tration matched to the negative language of “like being in hell for two
 Low-Frustrative Capacity Disavowals 135
years” associated with the image of waiting two years, which collides with
the felt need/demand for immediate gratification, to generate a feeling of
impossibility/powerlessness to “stand” the wait. Such that when the client
performs the speech act of disavowing the power to stand it—by pro-
nouncing, “I couldn’t stand it,” this act only intensifies the felt dis-
empowerment/impossibility, and, therewith, any motivation to even try.

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
Indirect Refutation proceeds by refuting the “must” at the top of chain,
namely Rule 1 in Syllogism Chain C. As mentioned earlier, the felt need for
immediate gratification and its translation into the speech act of demanding
immediate gratification does not happen until after the client engages in
imagery associated with “frustrating” immediate gratification; in the present
case, imagining postponing immediate gratification for two years.
Once the client becomes aware of how she has been presupposing this
premise in the stated manner, clients generally have little difficulty in ad-
mitting its power over their emotional and behavioral lives. They also tend
to see how, when they imagine foregoing immediate gratification, they
linguistically express their felt need for it as a demand. Insofar as this de-
mand is at the top of the hierarchy its refutation unroots the self-defeating
speech acts deduced from it, namely catastrophizing and the low-frustrative
disavowal. A pragmatic refutation of this premise is generally a useful way
to expose its unrealistic character. “If people always had to have immediate
gratification, then we would never achieve anything that takes time to
attain. This means we would never have great works of art, scientific
breakthroughs, and most things in human civilization that we pre-
sently have.”

Box 8.4 Practice

Therapist (T)–Client (C) Exchange

Refuting the Demand for Immediate Gratification
In the below part of their session, the therapist helps the client refute his
demand for immediate gratification.

T: You said before that you are telling yourself that you must get
what you want fast. But is there anything worthwhile that cannot
be gotten fast?
C: Yes, having a child. It takes 9 months. I always wanted to have
kids but, well didn’t think I could go through it.
136 Overcoming Common Capacity Disavowal
T: So, what if all women always had to get what they wanted right
away, fast?
C: Then no one would go through a pregnancy and have kids.
T: So, the human race would die out!
C: Yes, I get your point. But it’s not everyone, it’s me. Other
people have more patience than I do.
T: And is this because they don’t demand that they get what they
want right away? And, if they made the same demand as you,
then they too would not have patience?
C: Yes, that sounds right. It’s this demand to get what I want fast
that seems to be messing me up. I get it!

Direct refutation of the low-frustrative “I can’t” might proceed by a logical

refutation along the lines of asking why so many other individuals could
“stand” going for degrees that take much longer than two years; or asking, if
he still couldn’t stand it if his life or the lives of loved ones depended on it. Or
direct refutation might proceed by an empirical refutation such as asking for
evidence to prove that he “can’t stand it” instead of just that he would prefer
not. In any event, once the indirect refutation of the demand for immediate
gratification succeeds, the direct refutation of the capacity disavowal has a
greater likelihood of succeeding inasmuch as the basis for performing this
speech act in the first place would have already be relinquished. However,
while the refutation sets the stage for permanent constructive change, it does
not itself suffice for such change as the hot, emotional polarity would, at this
juncture in the therapeutic process, still be toward demanding immediate
gratification. The goal is to feel one can “stand it,” not just think it.

Box 8.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Low-Frustrative Disavowal
In the below part of their session, the therapist helps the client refute the
capacity disavowal that keeps him from making a commitment.

T: So, let’s talk about your conclusion that you couldn’t stand to
wait two years to get your associate’s degree. Now that you see
you don’t always need to get what you want right away do you
still think you couldn’t stand to wait?
C: Maybe not, but it sure feels like it.
T: I understand. But that’s just a subjective feeling. Have you ever
done anything you felt you couldn’t do?
 Low-Frustrative Capacity Disavowals 137
C: Yes, when I was a little girl, I didn’t think I could go to
overnight camp, but my mom made me go, and I ended up
loving it.
T: Very good. So, you can do things you don’t feel like you can do.
C: Yes, I suppose I can. But she forced me to go. I had no choice.
T: True. Nevertheless, the issue is not whether you had a choice
but rather whether you had the capacity to go to overnight
camp, and obviously you did, even though you felt like you
couldn’t.
C: I see your point.
T: So, when you say you couldn’t stand going to school for two
years, your feeling that you couldn’t do it is not really evidence
that you couldn’t do it; because you just proved you can do
things you don’t feel like you can do.
C: Yes, my feeling doesn’t prove I couldn’t do it.
T: So, do you have any evidence?
C: No, I don’t. Just that feeling, which doesn’t really mean I
couldn’t do it.

Step 4: Identifying the Guiding Virtues

This is where the guiding virtues become paramount; for they foster positive
emotions that have the power to reverse the negative polarity. In the case of
low-frustrative clients, the guiding virtues of the low-frustrative disavowal are
Patience and Perseverance; and the guiding virtue of the hedonic demand for
immediate gratification is Prudence. Hence, clients with LFT can reverse their
negative polarity with Prudence, Patience, and Perseverance.
As defined in Chapter 3, Prudence involves awareness of what is in one’s
power and what is not, with particular regard to knowing what things in
one’s power are worth attaining, the means to attain them, and the ability
to think rationally about applying those means. This involves a shift from
short-term hedonism (seeking immediate gratification regardless of the
consequence) to long-term hedonism (foregoing immediate gratification to
attain more permanent satisfactions in the long run).
Patience refers to the positive habit or disposition (“virtue”) of willpower to
forego short-term pleasures for long-term ones (see also Chapter 3). So, in
contrast to LFT, which entails short-term hedonism—the disposition to seek
immediate, fleeting pleasures, Patience entails long-term hedonism—the
tendency to seek pleasures that persist in the long run. Patient individuals do
not demand immediate gratification but instead have rational philosophies
about life that enable them to experience less frustration when they do not
get what they want immediately.
138 Overcoming Common Capacity Disavowal
Individuals who have Perseverance do not give up or become discouraged
prematurely when things are challenging or difficult. However, such in-
dividuals also appreciate the rational limits of persistence and do not persist in
unattainable goals, or ones not worth the costs of pursuing. As such, individuals
who have Perseverance also manifest Prudence in deliberating about what
goals to pursue in the first place, how to pursue them, and just how long.
The words “Prudence,” “Patience,” and “Perseverance” themselves
have a positive valence; that is, speaking these words aloud or to oneself
tends to evoke positive interoceptive feelings. This is of paramount im-
portant for low-frustrative clients because association with such positive
feelings can help reverse the association that not getting immediate grati-
fication has with feeling frustrated.

Box 8.6 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues
In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming low-frustrative disavowals.

T: So, it looks like you are experiencing a lot of negative feelings

when you are not able to get what you want right away. I’m
talking about that need you feel to get what you want right
away, and the frustration you feel when you don’t get it; and
that powerlessness you feel to stand things in order to achieve
long-term goals such as going to school for a degree. On the one
hand, you have these feelings; on the other, you express these
feelings by telling yourself things like you must get what you
want fast; it would be like being in hell if you didn’t; and you
couldn’t stand it if you had to wait for something. As you have
seen, these things you are telling yourself are self-defeating
because you end up not getting really what you want in the long
run. And the negative feelings you experience are just subjective
feelings that contribute to your unhappiness by making you feel
bad and lead to telling yourself things that get in the way of your
long-term happiness such as a career as an RN.
C: This is great. I really get this! But what can I do to feel better,
and get out of this funk?
T: The approach I take is to adopt a new set of positive goals,
which I call “guiding virtues.” These virtues involve positive
emotions that can counteract your old emotions, including your
negative feelings.
 Low-Frustrative Capacity Disavowals 139
C: This is very interesting. Can you tell me more about these
guiding virtues?
T: Sure. The guiding virtues that would be appropriate in your case
are Prudence, Patience, and Perseverance.
C: They all start with a “P”! What’s Prudence?
T: Being prudent means being practically wise. You don’t sell
yourself short about what you can accomplish. You don’t get
sidetracked by going after immediate satisfactions that only lead
to long-term dissatisfaction. You have a handle on the means to
accomplish the things that are truly good for you.
C: That’s really neat. I think I know what having Patience means:
not getting frustrated too fast, right?
T: Right, it means having the willpower to forego short-term
satisfactions for long-term ones.
C: And Perseverance means not quitting, right?
T: Well, yes, but if you’re prudent then you’ll see that some things
might be worth quitting while others are worth sticking with.
So, Perseverance also has its rational limits.
C: I like that idea, not being pigheaded.
T: Right. These virtues are ideals. What this means is that you can
never be perfect at them. No one is perfectly prudent, patient,
or perseverant. So, there really is no limit to how much better
you can get at them. So, having these virtues doesn’t mean you
will never screw up. Even very prudent people make mistakes,
and we can learn from these mistakes. No demands for
perfection here because that’s not realistic.
C: I really like this!
T: Excellent!

Step 5: Finding an Uplifting Philosophy

Philosophical theories that can help clients reverse such negative polarity abound
in classical philosophical literature. These philosophies have also found their way
into popular culture—movies, novels, etc. I have provided some potentially
useful ones here, however it is again important to emphasize that what may be
uplifting for one client may not be for another; and philosophical outlooks are
not likely to work for clients unless they resonate well with clients.

Philosophies of Prudence
These uplifting philosophies inspire clients to use rational reflection on
making decisions about what ends to pursue. While they do not tell a client
140 Overcoming Common Capacity Disavowal
what to pursue, they militate against caving to irrational desires for im-
mediate gratification and thus can be useful in promoting constructive
change in low-frustrative clients.

Sober Reasoning, Not Immediate Gratification

I have found the philosophy of long-term hedonism embraced by ancient
Greek philosopher Epicurus to be useful for low-frustrative clients. It is
popularly thought that he advocated a licentious lifestyle, the seeking of
excessive pleasures. However, this is far from the truth, and in fact just the
opposite is true. From Epicurus’ perspective, choosing pleasures based on a
demand for immediate gratification would be self-defeating, leading to
more pain than pleasure in the long run. Instead, he proposed a dis-
criminating life in which one prudently chooses what pleasures to pursue.
Prudence, Epicurus said, is more “precious” than any other virtue because
all the rest depend on it. The pleasant life, he said, is not even possible
without Prudence.
By pleasure, Epicurus meant “the absence of pain in the body and of
trouble in the soul.” And, by Prudence he meant, “sober reasoning,
searching out the grounds of every choice and avoidance, and banishing
those beliefs through which the greatest disturbances take possession of the
soul” (Epicurus, n.d.). Here, “sober reasoning” is the antidote to LFT, and
the gateway to pleasure in the sense defined. The demand for immediate
gratification thus emerges as an affliction “through which the greatest
disturbances take possession of the soul.”
The idea of pleasure as “the absence of pain in the body and trouble in
the soul” can be a useful definition for low-frustrative clients to adopt
because their greatest obstacle to pleasure is the frustration they suffer when
they are unable to obtain immediate gratification. There is also evidence
that pain and pleasure may exist on a continuum so that “the absence of
pain” is itself pleasant relative to a painful state (Leknes & Tracey, 2008).
Epicurus’ reference to “pain in the body” (physical pain) and “trouble in
the soul” (emotional pain) in defining pleasure also has evidentiary credence
(Fogel, 2012). It appears that the same areas of the brain reactive in one are
reactive in the other, so speaking about avoidance of both as parts of the
definition of pleasure also makes sense. Low-frustrative clients can thus
view avoidance of emotional pain much the way they probably already
view avoidance of physical pain. In seeking pleasure, these clients may be
constructively counseled to avoid the pain of LFT no less than they would
the pain of a physical injury.

The Hedonic Calculus

Nineteenth-century British philosopher Jeremy Bentham is well known for
his idea that pleasure can be quantified. According to Bentham, the more
 Low-Frustrative Capacity Disavowals 141
pleasure one can amass, the better. At first sight, this sounds like he might
embrace an indiscriminate take on what pleasures to pursue. However, this
would be inaccurate because Bentham held that there are rational criteria to
determine which pleasures to pursue.
First, he said, a pleasure seeker should consider the intensity, duration
(how long it lasts), propinquity (how much time one has to wait to get it),
and certainty (likelihood) of the pleasure. However, he went on to em-
phasize two other criteria, namely the fecundity and purity of the pleasure.
By “fecundity” he meant the chances that the pleasure would be followed
by further pleasures. By “purity” he meant the chances that the pleasure
would not be followed by pains (Bentham, 1789).
What this suggests is that, in demanding that they obtain immediate
gratification, low-frustrative clients forget about whether the immediate
pleasures they obtain will have fecundity (produce other pleasures) and
purity (will not lead to pains). Unfortunately, low-frustrative clients may
tend to consider the first four of Bentham’s standards. For example, sexual
pleasures are very intense forms of pleasure and there are indiscriminate and
relatively quick ways to find someone with whom to have sex. However,
the sexual escapade may well end with contracting a sexually transmitted
disease, which can produce “pain in the body” as well as “trouble in the
soul.” So it is only prudent for low-frustrative clients to take seriously
Bentham’s standards of fecundity and purity.

Buddhism: Compassion for Others

One fundamental aspect of Buddhism is its theory of “nonself,” according
to which the source of suffering is clinging to the “I” that desires things for
oneself. This philosophy maintains that the concept of self as a concrete
substance behind these desires is illusory (Shiah, 2016). Rather, the self is a
stream of consciousness, a set of mental phenomena held together by causal
relations. On this view, in giving up the idea of the desiring self, one’s
suffering is no longer a higher priority than that of others, as all suffering is
just suffering, and its elimination wherever it occurs is equally as compel-
ling. According to eighth-century Indian Buddhist monk, Shantideva,
“Without exception, no sufferings belong to anyone. They are to be
warded off simply because they are suffering. Why is any limitation put on
this?” (Bodhicaryāvatāra, 1995). Thus, a prudent person does not become
immersed in the delusion of the desiring self but rather works compassio-
nately to help reduce the suffering in the world.
As discussed below, the idea of cosmic interconnectedness of all beings,
and thus the defocusing of the notion of the desiring self, can be a useful
part of a compassionate meditative approach aimed at helping the low-
frustrative client to transcend her self-centered felt need/demand for
immediate gratification.
142 Overcoming Common Capacity Disavowal
Philosophies of Patience
These philosophies emphasize willpower, that is, exercise of control over
feelings of frustration about perceived obstacles to goal-directed behavior.
While experience of some frustration is a normal part of human adaptation
when a desire or preference is obstructed, low-frustrative clients experience
more intense, more frequent, and more easily triggered frustration due to a
demand for immediate gratification in conflict with a catastrophized image
of not obtaining it; and thus feelings of impossibility and powerlessness
generated by this conflict, leading to low-frustrative disavowals. As such,
philosophies of patience in the context of CBT seek to dismantle the
dysfunctional demand and the low-frustrative disavowal deduced from it.
They do this by empowering clients to affirm their freedom and autonomy
to stand up to life challenges to their goal-directed behavior.

Stoicism
One very important contribution of ancient philosophy to clinical psy-
chology, in particular to REBT as developed by Albert Ellis, is the phi-
losophy of Stoicism, especially its analysis of the range of human control:
making clear the things over which we have control, and the things over
which we do not. According to Stoic philosopher Epictetus,

There are things which are within our power, and there are things
which are beyond our power. Within our power are opinion, aim,
desire, aversion, and, in one word, whatever affairs are our own.
Beyond our power are body, property, reputation, office, and, in one
word, whatever are not properly our own affairs. (Epictetus, 1948,
ch. 1)

Epictetus (1948) goes on to say that “the things within our power are by
nature free, unrestricted, unhindered; but those beyond our power are
weak, dependent, restricted, alien” (ch. 1). As such, if you confuse these
things and take what is not in your power as something that is, then “you
will be hindered, you will lament, you will be disturbed, you will find fault
both with gods and men” (ch. 1) On the other hand if you do not confuse
these two categories of things and take only what is in your power as your
own, then “no one will ever compel you, no one will restrict you; you will
find fault with no one, you will accuse no one, you will do nothing against
your will; no one will hurt you, you will not have an enemy, nor will you
suffer any harm” (ch. 1).
Unfortunately, low-frustrative clients tend to confuse what is in their
power with what is not by discounting that their desires and aversions,
thoughts, feelings, and actions are “their own.” Thus, the client who states,
“I couldn’t stand it” in disavowing her freedom to take a two year course of
 Low-Frustrative Capacity Disavowals 143
study confuses two distinct categories of things by discounting control over
her own ability to act (as well as think and feel), and thereby hinders and
disturbs herself needlessly, and ends up lamenting the lost opportunity.
Low-frustrative clients may therefore be admonished to keep this dis-
tinction in mind before they cave to feelings of powerlessness and pro-
nounce those inhibitory words, “I can’t stand it” because these feeling are
themselves in their control. As long as the client continues to tell herself she
“can’t” is as long as she continues to sustain this destructive feeling of loss of
control. Here, the key is to shift language to the more uplifting language of
Stoicism: I can because this is “my own” and is therefore, “by nature free,
unrestricted, unhindered.” Such words have within themselves incredible
power to change the negative valence sustained by a low-frustrative dis-
avowal to a positive one. This power can be confirmed through inter-
oceptive imagery in which the client imagines and then replaces her
frustrating image with that of being “free, unrestricted, and unhindered” in
what is “her own.”

Letting the “Mud” Settle: Use of Metaphor in Eastern Philosophy

In the Tao Te Ching, ancient Chinese philosopher and founder of Taoism,
Lao Tzu (n.d.), is credited for having said,

Do you have the patience to wait

till your mud settles and the water is clear?
Can you remain unmoving
till the right action arises by itself? (ch. 15)

This prose also appears to have been adapted by contemporary Buddhists

(Bodhipaksa, n.d.) to tell a story about Buddha, who, while journeying,
asked an impatient disciple to fetch some drinking water for him. When
the disciple went to the lake, some oxen were crossing it and the water
became muddy and unsuitable for drinking. The disciple returned and
told Buddha that the water was too dirty to drink. After about a half an
hour, Buddha again asked the disciple to go to the lake and fetch drinking
water for him. Again, the disciple returned and informed the Buddha that
the water was muddy. Buddha said nothing and soon asked the disciple to
go once again to fetch drinking water. The disciple was furious but felt
obliged to return to fetch the water. This time the water was clear, so he
collected some water and returned with it. “What have you done to clean
the water?” asked Buddha. The disciple was confused by the question.
Buddha explained,

You waited and let it be. Therefore, the mud settled on its own and
now the water is clear. Your mind is like that too! When it’s muddy,
you have to let it be. Give it some time. Don’t be impatient. On the
144 Overcoming Common Capacity Disavowal
contrary, be patient. It’ll reach a balance on its own. You don’t have to
make any effort to calm it down. Everything will pass on its own as
long as you don’t hold on to it. (Soulful Arogya, 2016)

The use of storytelling to ease stress has been a staple of Eastern philosophy.
Metaphor is a powerful component of this tradition, and also a useful
mechanism for convey uplifting messages. Here, the clear, uplifting message
is that Patience can be the vehicle of constructive change. The act of
waiting rather than giving in to the frustration of not getting what one
wants immediately can be more rewarding in the end. The idea of “letting
go” rather than trying to “hold on” is an integral part of the Buddhist
tradition. The proverbial mud (frustration) will settle (calm down) on its
own without giving up and looking elsewhere for immediate gratification
only to become ensconced once again in the mud.

Philosophies of Perseverance
These philosophies support Patience by inspiring perseverance when things
seem challenging or difficult by reframing such perceptions in a positive
light.

Overcoming Obstacles through Zestful Vigor

In Engaging in Bodhisattva Behavior, Shantideva, cited earlier, has bequeathed
a large number of uplifting aphorisms on Perseverance. I have assembled
some below and have italicized the positive language that can support
positive feelings and emotions (Shantideva, 2005):

• “What’s joyful perseverance? It’s zestful vigor for being constructive. Its
opposing factors are explained as lethargy, clinging to what’s negative
(or petty), and, from being discouraged, disparaging oneself.”
• “Discouraged and having given up effort, will there be liberation due
to feeling bankrupt, or what? But by strengthening my effort through having
my pride, even huge things will have difficulty triumphing (over me).”
• “I shall triumph over everything and nothing shall triumph over me! …”
• “… the supporting forces for fulfilling the aims of limited beings are strong
intention, steadfastness, delight, and letting go. Strong intention is
developed from the dread of suffering and by reflecting on its benefits.”
• “Uprooting opposing factors like that, I shall strive then to further my
zestful vigor with the forces of strong intention, having pride, delight, and letting
go, also readily accepting and taking control.”

Shantideva’s connection of Perseverance with joyfulness (“joyful perse-

verance”) is clearly calculated to arouse positive emotions as means to
 Low-Frustrative Capacity Disavowals 145
overcoming the inertia of negative emotions (“clinging to what’s nega-
tive”); lack of energy or enthusiasm (“lethargy”); and underestimating one’s
own capacity (“disparaging oneself”). To the contrary, in having a positive
outlook (“pride”), one can triumph over “even huge things.” With this
positive, life affirming outlook, I can therefore “triumph over everything
and nothing shall triumph over me!”
Shantideva uses the words, “strong intention, steadfastness, delight, and
letting go” to sum up the key factors underlying Perseverance. He says that
“strong intentions” arise from the “dread of suffering” and by “reflecting on
its benefits.” The main idea here is that the negative polarity of an image
that evokes the feeling of frustration and is then “dreaded”—catastrophized
(for example, having to wait two years to get a degree), can be reversed to a
positive polarity by reframing it in terms of its benefits (for example, ad-
vancing one’s career goals). This philosophy can, accordingly, be applied
through interoceptive imagery in which the client imagines the “dreaded”
image and then imagines its positive aspects along with the arousal of po-
sitive feelings.
As mentioned previously, the idea of “letting go” is a central idea in
Buddhist philosophy. Here, “letting go” means ceasing to catastrophize
about the frustrations of living. Inasmuch as they are part of reality, de-
manding that they be banished from existence only generates further
frustration. Hence, the goal in Buddhism is to embrace them as part of the
ontological fabric. By such “letting go,” there can be an increased sense of
freedom. This freedom is coextensive with giving up one’s demands for
perfection. Paradoxically, “accepting and taking control” does not portend
overcoming such cosmic features; it means embracing them, with “joyful
perseverance.”

Failure as a Stimulus and Guide to Success

In demanding immediate success, low-frustrative individuals tend to give
up when they do not at first succeed, since failure does not bring immediate
gratification. Because the image of failing is associated with a catastrophized
feeling of frustration, low-frustrative clients may be especially disposed to
give up on difficult or challenging activities since such activities may not
only not provide immediate gratification but may also end in failure. This
outlook on failing is unfortunate because it blinds the client to the possi-
bility of learning from her mistakes.
In this regard, American Pragmatist and philosopher of education, John
Dewey has provided a way to reframe the image of failing in a positive
light. According to Dewey,

Nothing shows the trained thinker better than the use he makes of his
errors and mistakes. What merely annoys and discourages a person not
146 Overcoming Common Capacity Disavowal
accustomed to thinking, or what starts him out on a new course of
aimless attack by mere cut-and-try methods, is a stimulus and a guide to
the trained inquirer. (Dewey, 1986, p. 206)

Failing at something, Dewey maintains, gives her useful information about

“what modifications should be introduced in the hypothesis upon which he
has been operating” (p. 206). As a result, this information can be used in the
next attempt to resolve the challenge. As such, the line between failure and
success is no longer perceived in stark contrast, but rather as a continuum
where failure is part of the price of success.

Enjoying the Journey: The Pleasure Is in the Activity or Pursuit

In fact, the ancient Greek philosophers believed that it is the activity of
attempting to resolve a challenge that affords the most desirable form of
pleasure. According to Aristotle, “What is pleasant is the activity of the
present, the hope of the future, the memory of the past; but most pleasant is
that which depends on activity, and similarly this is most lovable” (Aristotle,
1941, bk. 9, ch. 7). This way of thinking is likely to be missed by low-
frustrative clients who may tend to perceive goals in terms of what is
produced through an activity, but not the activity itself. Thus, the low-
frustrative client who is confronted with withholding immediate gratifi-
cation to work toward long-term pleasure may not fully appreciate the
pleasure to be gained in the activity itself of working toward the goal. The
client who is frustrated by having to wait two years to get a degree may not
consider the pleasure in working toward the degree and may place all the
value in the degree itself. This narrow perspective may fail to consider other
pleasures one may have on route such as forging new relations with in-
structors and other students, having gratifying learning experiences, and
engaging in spirited class discussions. CBT therapists may thus help such
clients to broaden the range of possible pleasant experiences by encouraging
them to “enjoy the journey” (the activities involved in pursuing a long-
term external goal), and not just the destination (the attainment of the goal
itself).
In fact, there is evidence that dopamine levels in the brain increase during
the activities involved in pursuing goals, which can make the pursuit itself
feel good (Wax, 2020). Further, long-term, complex goals such as gaining a
college degree can be divided into smaller subgoals such as getting a good
grade on an exam or participating in a class discussion. As a result, each
goal-directed mini pursuit within the broader context of pursuing the long-
term, complex goal broadens the range of possible pleasurable experiences,
which can, in turn, alleviate frustration for the low-frustrative client
(Ryback, 2016).
 Low-Frustrative Capacity Disavowals 147

Box 8.7 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy
In the below part of their session, the therapist helps the client to find a
philosophy and to try it out through use of interoceptive imagery.

T: Each of these virtues can be interpreted differently depending on

your personal philosophy or world view. For example, some
people look at things more religiously, others not so much.
Some people look at things from a more global perspective
(what’s good for the world), others more individualistically (the
good of certain people). What approach you take is up to you.
The important thing is that you feel comfortable with it. So,
from your own point of view, how do you think you could
become more a more prudent person?
C: I’m really not very religious, but I like to think of myself as a
spiritual person. I really enjoy helping people. It gives me a feeling
of purpose, but I easily get discouraged, like in going for my RN.
T: This is very helpful. The Buddhist tradition emphasizes
compassion for others as a way of helping to reduce the
amount of suffering in the world. It teaches that the route to
happiness is to give up the preoccupation with satisfying your
own immediate desires. On this way of thinking, being prudent
means focusing on compassionate caring of others.
C: I have heard about Buddhism but never looked into it. I like this
idea, getting mind off my demand to satisfy myself and my own
frustration, and think about what I can do to help others.
T: Very good! This would fit with going for your RN degree. You
can think of it as a way you can start on a journey to help others.
C: That’s what I wanted to do in the first place but I didn’t realize
until now how I was putting myself first.
T: Right, putting getting things fast above your long-term goal of
helping others.
C: Yes, exactly.

Step 6: Constructing a Plan to Apply the Philosophies

In this step, the client applies her uplifting philosophies to overcome her
negative emotion syllogism chains and make progress toward her guiding
148 Overcoming Common Capacity Disavowal
virtues. As discussed in Chapter 7, this involves asking clients three related
questions calculated to elicit the virtue-based syllogism chains that prescribe
a behavioral plan.

Question 1: In what ways has low-frustration tolerance negatively

impacted your life, or the lives of others?

This would generally include the different ways in which low-frustrative

clients have held themselves back such as career goals and interpersonal
relationships.1 It may also include the negative impact on business associ-
ates, domestic partners, and others with whom their lives have crossed.

Question 2: What changes would your uplifting philosophies prescribe?

Box 8.8 Practice

Therapist (T)–Client (C) Exchange

Introducing the Idea of a Cognitive-Behavioral Plan
In the below part of their session, the therapist helps the client to gain an
understanding of what an action plan will involve, and to identify some of the
negative consequences of his low-frustrative disavowal.

T: The next step is to put together a plan for applying your

philosophy. I mean changes you are prepared to make based on
it. Are you willing to do this?
C: Yes, and very excited about it too!
T: Great! So, to get a sense of where to focus our efforts, can you tell
me in what ways your LFT has negatively affected you or others?
C: Well, obviously not going for my associate’s degree. And, as I
mentioned, I haven’t had any kids. I had a boyfriend who
wanted to get serious with me, but he wanted kids. I told him
that wasn’t going to happen. He found someone else, and now
has two kids.
T: I see. Does it affect your everyday life in any ways?
C: Yeah, I think so. I avoid things that are hard to do. I took
ballroom dancing and I am not a natural. It was really difficult for
me to learn the steps, so I quit. It’s like that with a lot of things. I
try them and when they don’t work right away, I bug out.
T: Such as?
C: I tried computer dating. The first guy I met was married. That
did it for me. I just didn’t have the patience to try again. I guess
that was my demand to get what I want quick, right?
 Low-Frustrative Capacity Disavowals 149
For example, John Dewey’s philosophy of perseverance that says failure is
“a stimulus and a guide to the trained inquirer” would advise a low-
frustrative client who has failed a college course to learn from her mistakes;
for example, not having studied carefully enough, to retake the course with
the intention to better prepare for exams.

Question 3: How are you to make these constructive changes?

Box 8.9 Practice

Therapist (T)–Client (C) Exchange

How Can the Philosophy Help?
In the below part of their session, the therapist challenges the client to
consider what changes his new philosophy might suggest.

T: Yes, sounds like it. So, what would your Buddhist philosophy
tell you to do differently?
C: I guess it would tell me to stop demanding that I satisfy my
desire to get things fast, to have more patience. Too focused on
myself. I suppose I could have listened to the guy about why he
was dating when he was married. He seemed very unhappy, but
instead I called him some things I don’t care to repeat. I could
have tried to learn the dance steps even if it took some time.
Eventually I would have learned them. I suppose I was again just
too into myself and not enough into just learning the steps.

However, it is one thing to have the intention to study more judiciously, and
quite another to do it. Thus, studying may feel very frustrating indeed for the
client since it conflicts with this demand; and she may thus catastrophically
tell herself she “can’t stand” to put in the necessary effort. As such, the
cognitive-behavioral plan would need to include assignments that help the
client change the latter negative valence polarity to a positive, constructive
one. The following assignments offer some suggestions.

Box 8.10 Practice

Therapist (T)–Client (C) Exchange

Applying the Philosophy
150 Overcoming Common Capacity Disavowal
In the below part of their session, the therapist gives the client an
opportunity to reflect on how to make the suggested changes.

T: You’re doing an excellent job applying the Buddhist philosophy!

Now you know the sort of changes you want to make. So, we
need to determine how to make them. This will involve your
working cognitively and behaviorally to change the negative
feelings you get when you are confronted with things that take
Patience, Perseverance, and Prudence. So, our goal would be to
come up with a set of exercises that will help you begin to develop
these virtues by practicing them. Are you prepared to put in this
work? It would actually involve a lifetime commitment because, as
mentioned, virtues are always in a state of improvement, and the
skills you will be cultivating will always require work.
C: Yes, very much!

Cognitive-Behavioral Assignments for Low-Frustrative Clients

Interoceptive Imagery
As discussed earlier in this chapter, practicing replacing images associated with
the feeling of frustration with images associated with positive feelings can be
useful in changing the negative polarity. Uplifting philosophies that contain
words and images with positive valences are especially useful for this purpose.
For example, the client can bring herself to feel the frustration generated by the
image of postponing immediate gratification in conflict with the felt need for it,
and then reflect on Lao Tzu’s image of the mud gently settling until the water
becomes crystal clear; and thus “letting go” of the frustration as the water clears.
Or, she can use Epictetus’ positive image of being “free, unrestricted, and
unhindered” by her own feelings.

Box 8.11 Practice

Therapist (T)–Client (C) Exchange

Practicing Interoceptive Imagery
In the below part of their session, the therapist takes the client through an
interoceptive feeling exercise and shows the client how she has the power to
change how she feels inside.

T: Great! One exercise you can do involves imagery that evokes

feelings. It can be helpful, but it raises some unpleasant feelings.
 Low-Frustrative Capacity Disavowals 151
Are you willing to try it?
C: Yes, I am.
T: Want to try it now?
C: Yes, please.
T: Okay, imagine yourself enrolled in the associate’s degree
program and it’s going to take two years. And get yourself to
feel that “like being in hell” feeling you get when you imagine
it. Let me know when you are feeling it.
C: [Pause] Okay I’m feeling it now.
T: Tell me how you are feeling.
C: Like I need to get this over with, but I can’t and I feel like, well
maybe it feels more like being in purgatory than hell!
T: Okay, now imagine you are a nurse helping to reduce the
suffering in the world. Let yourself feel your deep compassion
for their suffering, and joy in the relief of patients you have
helped.
C: I’m imaging it. I feel a sense of inner peace. It feels good!
T: Excellent! So, when you start to feel like you’re “in purgatory”
or “hell” or another negative-feeling state, you can reverse the
polarity of your negative feelings by practicing your imagery.
C: Yes, this really helps!

Mindfulness Meditation
I recommend this form of meditation for low-frustrative clients because of
its apparent association with self-transcendence, that is, the ability to non-
judgmentally observe the self as a transitory experience, rather than as a
static “I” with which one identifies (Hölzel et al., 2011). This detached,
nonevaluative experience of self can be helpful for low-frustrative clients
because the “I” is the source of the demand for immediate gratification; for
it is this static “I” that must be satisfied. In detaching from this “I” one can
“let go” of the demand by effectively transcending oneself. The low-
frustrative client can thus become an impartial observer rather than a par-
ticipant in the thrust toward immediate gratification.
Self-report findings of individuals trained in mindfulness mediation have
indicated change in perception of self in alignment with such self-transcendence
(Ibid). There is also neurological evidence. For example, according to the au-
thors of one fMRI study of individuals who underwent mindfulness meditation
training, there was “a shift away from both the VMPFC and the amygdala,
toward more lateral prefrontal regions [in particular, the DLPFC] supporting a
more self-detached and objective analysis of interoceptive (insula) and ex-
teroceptive (somatosensory cortex) sensory events, rather than their affective or
152 Overcoming Common Capacity Disavowal
subjective self-referential value” (Farb et al. 2007). Given such incredible power
of the human brain, through mindfulness practice, to non-self-referentially and
non-judgmentally experience the somatosensory flow of feelings that generate
speech acts of demanding and catastrophizing, low-frustrative clients can
thereby attain a state of consciousness undisturbed by these self-destructive
speech acts and their underlying negative feelings.

Box 8.12 Practice

Assigning Clients Mindfulness Training

As discussed in Chapter 4, one potentially helpful mindfulness
training program that therapists could recommend to their low-
frustrative clients is the one based on the approach developed by
Kabat-Zinn (Palouse Mindfulness, n.d.). It is accessible online and is at
the time of this writing available free of charge.

Compassion Meditation
This form of meditation can also be helpful for low-frustrative clients be-
cause it emphasizes (Shiah, 2016) interconnectedness rather than in-
dividuality and self-centeredness. Indeed, the concept of compassion itself
connotes interconnectedness, which carries a positive valence. This medi-
tative defocusing from consciousness of personal desires and their expres-
sion as demands for immediate gratification generates positive feelings of
“loving kindness” directed to all beings; universally connected in a state of
selflessness that sets the stage for cultivation of positive emotions, which
counteract the negative self-serving ones. In contrast to mindfulness
meditation, this form involves reframing in terms of images and words
associated with positive feelings. For example, images and verbal expres-
sions in terms such as “harmony,” “unity,” “boundless unity,” “love,”
“awesomeness,” “kindness,” and other terms of “interconnectedness” can
arouse corresponding feelings with positive valances. For low-frustrative
clients, the goal is liberation from the tyranny of a demand for self-
gratification and its correlative disavowal of freedom and responsibility.

Box 8.13 Practice

Therapist (T)–Client (C) Exchange

Practicing Loving Kindness Meditation
 Low-Frustrative Capacity Disavowals 153
In the below part of their session, the therapist guides the client through a
loving kindness mediative experience.

T: Another exercise you can try is a type of mediation known as

compassion mediation. Like mindfulness mediation, it can help
to divert your attention from your felt need and demand for
getting things right away or fast. This is based on the Buddhist
philosophy you have adopted. It involves concentrating your
attention on the interconnectedness of all human beings, and,
really, all reality. You can focus your attention on a particular
person or even an object, and let yourself feel your
interconnection, you with it, and it with you; and how you
are bound up in unity with it and everything else in the cosmos.
C: This is an awesome way of thinking about everything.
T: “Awesome,” that’s a great word to use! What other positive
words come to mind when you think of this cosmic
interconnectedness? For example, I think of “loving kindness.”
C: “Peace,” “harmony,” “love,” “caring,” “unity.”
T: Excellent! One suggestion is to practice this when you feel
frustrated by something. So, you would then meditate on your
interconnectedness with the object of your frustration and all
else with “peace,” “harmony,” “love,” “caring,” and “unity.”
What do you think?
C: I’m definitely willing to try it.
T: Want to try it now?
C: Yes, sure!
T: Okay, great. Do you have something you are frustrated about
that you want to mediate on?
C: Yes, I have a friend who calls me every day and talks and talks
and I want to get off the phone, but she keeps going on and on.
I get soooooo frustrated and haven’t been very nice to her.
T: So, imagine that she is on the phone with you and you want to
get off right now and she won’t stop talking.
C: Okay, I’m imagining it, and feeling that frustration!
T: Now focus on your interconnectedness, this awesome cosmic unity with
her, her with you, and with all else in the cosmos. Affirm the
solidarity, peace, loving kindness, and caring in this interconnected whole.
C: [Pause] I am focusing. I feel like a weight is being lifted off my
shoulders. I feel this relief, this freedom.
T: Excellent! If you start to get distracted by other thoughts, just gently
refocus your attention on this awesome unity you are experiencing.
C: Okay, I am still focusing, still feeling this lightness.
154 Overcoming Common Capacity Disavowal
In Vivo Practice
This is an important activity for building a connection with the guiding virtues and
their uplifting philosophies because it can afford abundant occasions for practice. It
has two related parts: a cognitive component and a behavioral component.
Clients with LFT typically confront challenges daily, making the daily
life arena grist for practice. The cognitive part of this exercise consists of
contextually identifying the demand for immediate gratification, the de-
duction of catastrophizing, and the “I can’t stand it” disavowal that leads to
avoidance of frustrating activities. It proceeds to refutation of these self-
destructive speech acts (especially the demand), identification of their
guiding virtues, and reflection on their respective uplifting philosophies.
The behavioral part then consists of the client acting in accordance with the
latter philosophies. “What would Shantideva tell me to do in this case? I will
do it even though it’s not pleasant!” Clients can accordingly discuss their
progress with their therapists in the follow-up session.

Box 8.14 Practice

In Vivo Philosophical Reframing

In the below self-talk, the client uses his uplifting philosophy to work on
cultivating Patience in the context of a life issue.

C: That customer just made a mess of the jeans on the display table and
all the sizes are out of order. Now my boss is telling me to fix it. And
there I go thinking it will take me forever to straighten it out again!
I’m demanding that I not have to take the time to sort through these
jeans again, and then catastrophizing about having to do it, and then
telling myself I couldn’t stand it. I am now coming within inches of
telling my boss to take this job and shove it. But really, where is it
written than a salesperson like me in a women’s clothing store must
have customers satisfy my demand for short-term satisfaction. It’s
actually a good thing that customers are shopping here; otherwise I
wouldn’t even have this job. And, of course, I can stand it if they
mess up the display. They do it all the time and putting things back
in order is part of what I get paid to do. This is a good opportunity
for me to practice having patience. My philosophy of patience is to
wait until the mud settles, which means letting go of this demand of
mine, letting it settle until the water is clear. So, instead of doing
something rash like telling off my boss, I can just chill while
straightening things out. That way I will keep my job!
 Low-Frustrative Capacity Disavowals 155
Systematic Tackling of Major Life Challenges
Working cognitively and behaviorally through the latter assignments, low-
frustrative clients can gradually build the skills necessary to confront major life
goals, especially ones that require a long-term commitment such as seeking a
degree. As discussed previously, such goals can often constructively be ap-
proached by reframing them in terms of subgoals. Thus, taking one subgoal at
a time, the client can focus on managing each successive step in the pro-
gression toward the (central) goal without overwhelming herself with the
magnitude of the entire commitment. Here, embracing the uplifting
Aristotelian philosophy of taking pleasure in the activities involved in life
pursuits, can be helpful in promoting a positive affective valence.

Note
1 See also, in this chapter, the list of types of situations low-frustrative clients tend to avoid.

References
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low-frustration-tolerance-1-reason-behind-daily-homework-battles/
Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist
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dept.wofford.edu/neuroscience/neuroseminar/pdffall2008/a9.pdf
Bentham, J. (1789). An introduction to the principles of morals and legislation. Retrieved from
http://www.self.gutenberg.org/
Bierzynska, M., Bielecki, M., Marchewka, A., Debowska, W., Duszyk, A., Zajkowski,
W., Falkiewicz, M., Nowicka, A., Strelau, J., & Kossut, M. (2016). Effect of frus-
tration on brain activation pattern in subjects with different temperament. Frontiers in
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Bodhicaryāvatāra. (1995). K. Crosby & A. Skilton (Trans.). Oxford: Oxford University Press.
Bodhipaksa. (n.d.). Fake Buddha quotes. Retrieved from “If you let cloudy water settle
it will become clear. If you let your upset mind settle, your course will also become
clear” – Fake Buddha Quotes.
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the educative process. In J.A. Boydston (Ed.), The later works, 1925–1953, 8.
Southern Illinois University Press.
Epictetus. (1948). The Enchiridion. T.W. Higgins (Trans.). Liberal Arts Press. Retrieved
from https://www.gutenberg.org/files/45109/45109-h/45109-h.htm
Epicurus. (n.d.). Letter to Menoeceus. R.D. Hicks (Trans). Retrieved from http://
classics.mit.edu/Epicurus/menoec.html
Farb, N.A., Segal, Z.V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson,
A.K. (2007). Attending to the present: Mindfulness meditation reveals distinct neural
modes of self-reference. Social Cognitive and Affective Neuroscience, 2(4), 313–322.
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Fogel, A. (April 19, 2012). Emotional and physical pain activate similar brain regions
where does emotion hurt in the body? Psychology Today. https://www.
psychologytoday.com/us/blog/body-sense/201204/emotional-and-physical-pain-
activate-similar-brain-regions
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(2011). How does mindfulness meditation work? Proposing mechanisms of action
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of-setting-goals.html
9 Blame-Based Capacity
Disavowals

A blame-based capacity disavowal is an emotional disavowal in which

clients sustain negative affect by blaming the way they feel on external objects
(people, events, etc.), which, in turn, keeps them in a constant state of
emotional stress. Clients with blame-based capacity disavowals deny their
capacity to control their feelings, typically concluding, “I can’t help/stop
the way I feel.” Intense feelings of anger, sadness, and hopelessness are
commonly perceived to be beyond the client’gs control.
Clients with blame-based anger disavowals typically demand that they be
treated fairly, while clients with the depressive form typically demand that
bad things not happen to them or their loved ones. Clients with either of
these forms of disavowal tend to be in a perpetual state of stress because it is
inevitable in everyday life that a they will encounter unfair treatment and/
or bad things happening to them.
Neuropsychologically, the perceived loss of control in clients with
blame-based capacity disavowals is distinct from that in impulsive clients. In
the latter, the client experiences a physical desire originating in the
amygdala, for instance, a sexual desire. In the former, the client experiences
a reflective (cognitive) feeling of need that drives the disavowal. In other
words, the problem is a result of negative speech acts in the upper forebrain
(prefrontal cortex), in contrast to physical desires in the lower forebrain
(amygdala/limbic system); and, therefore, the therapeutic intervention is
cognitive reframing in terms of language associated with positive emotions.
Clients with blame-based capacity disavowals typically confuse the in-
tentional objects of their feelings with the causes of these feelings. They
may think that the feeling of anger toward a certain person is ipso facto
caused by the person toward which they feel anger; whereas the cause of the
angry feeling is not the intentional object (the physical person). Instead, the
feeling is part of a stream of associated images, feelings, and speech acts
comprising a syllogism chain. Because clients can reverse the negative
polarities of these phenomenal-linguistic chains through cognitive-
behavioral activities (such as reframing, interoceptive imagery, and beha-
vioral exercises), the client’s blame-based capacity disavowal of the capacity
to control the angry feeling is false-to-fact and irrational. The same can also
158 Overcoming Common Capacity Disavowal
be said, mutatis mutandis, about the causal etiology of feelings of sadness,
hopelessness, and depression.

Blame-Based Syllogism Chains

Syllogism chains with blame-based capacity disavowals tend to involve
speech acts of treatment or existential perfectionism, catastrophizing, and
damnation, from which the blame-based “I can’t” disavowal is deduced. In
clients with blame-based anger disavowals, the latter disavowal is deduced
from a treatment demand (for instance, the demand to be treated fairly); in
clients with blame-based depression disavowals, it is deduced from an ex-
istential demand (for instance, the demand that bad things not happen to
oneself or one’s loved ones).
In syllogism chains with blame-based capacity disavowals, a felt need is
dispositionally triggered when the client perceives his having been mistreated
(in the case of anger) or something bad having happened (in the case of de-
pression). The client then focuses on the disparity between the felt need and
the reality; catastrophizes about it; feels threatened by the reality (the mis-
treatment or mishap); tends to damn the person (in case of anger), or the world
at large (in case of depression); and then disavows capacity to control his
feelings. In this process, the client deflects (causal) responsibility for the painful,
threatening affect away from himself through the damning speech act, as-
signing causal responsibility to its intentional object (the person or the event),
and thus judges the affect to be outside his control and entirely in the hands of
someone or something else. The language of responsibility deflection in clients
with blame-based capacity disavowals is diffuse and may include such language
as “aggravates me”; “upsets me”; “makes me angry”; “pisses me off”; “de-
presses me”; “makes me (feel) miserable”; and “makes me (emotionally) sick.”
Schematically, syllogism chains with blame-based capacity disavowals
look like this:

Treatment/Existential Demand for Perfection → Catastrophizing →

Others/Global Damnation → Blame-Based Capacity Disavowal

Anger Chains
A client with blame-based anger may exhibit the following syllogism chain:

1. Others should never treat me unfairly.

2. But you falsely accused me of lying to you.
3. Therefore, the way you treated me was so reprehensible and
inexcusable.
4. Therefore, you are a horrible person to have treated me like this.
5. Therefore, I just can’t help being so angry at you.
 Blame-Based Capacity Disavowals 159
Phenomenologically, the following imaginative chain of associations and
speech acts tracks the above syllogism chain:

• In (1), the client dispositionally harbors a deontological feeling of

wrongfulness or unfairness associated with certain ways of being treated,
which he calls “unfair” (Cropanzano et al., 2017).1
• In (2), the client recalls an image of a particular individual falsely
accusing the client of lying to him, which activates the client’s
dispositional feeling of unfairness associated with being treated
unfairly; which, in turn, engages the client’s linguistic demand not to
be so treated. The client, in turn, focuses attention on the incompatibility
of this demand and the image of being falsely accused, which triggers a
feeling of anger intentionally focused on the accuser.
• In (3), feeling this anger, the client catastrophizes about it by imagining
being falsely accused in terms of its being “so reprehensible and
inexcusable.” This language, in turn, amplifies the interoceptive feeling
of unfairness, and its threatening character (Seto & Nakao, 2017).
• In (4), the client’s intense, felt anger toward the accuser leads the client
to use the words, “horrible person” to damn the person. This damning
of the person further amplifies and directs the client’s anger toward the
person.
• Finally, in (5), the client imagines the person as having the power over
his intense anger, which leads him to feel powerless over controlling his
anger, which, in turn, leads him to use the words “I just can’t help
feeling so angry at you.”

The above series of images and interoceptive feelings for anger tracking its
syllogism chain is the phenomenal manifestation of parallel neurological
processes akin to those described in Chapter 5. The dispositional feeling of
unfairness or wrongfulness in premise 1 is triggered in premise 2 by the
ventromedial prefrontal cortex in response to an image associated with this
interoceptive feeling. Focus on the image evoking this feeling is modulated
by the dorsolateral prefrontal cortex (DLPFC). The client’s recall in premise
(2) is also modulated by the DLPFC, which utilizes working memory to
keep the client in touch with the actual occurrence of the event in question in
contrast to merely imagining something (Garrison et al., 2017). The right
anterior insula is associated with the feeling of unfairness generated in (2)
and amplified in (3).2 The insula has also been found to be bilaterally active
in both sadness (see below depression chain) and anger (Damasio
et al., 2000).
In the above stream of associations, the inference from (4) to (5) involves
a confusion by the client of the intentional object of his feeling of anger
(i.e., the person who falsely accuses him) with the cause of the anger. The
person in question does something that the client negatively reacts to,
which leads the client to think that it is the person who holds the power
160 Overcoming Common Capacity Disavowal
over him, whereas the anger itself is a chain of associations and speech acts
the client makes with respect to images and feelings. So, it is reasonable to say
that the client causes his own anger. Indeed, intentional objects of feelings
may not even exist, for example, feeling angry about something that never
actually happened. In such a case of a nonexistent intentional object, it
would be absurd to suppose that the anger was caused by the object that
does not even exist. It is therefore helpful for clients to understand that the
intentional objects of their feelings are not the causes of them.
Unfortunately, clients with blame-based anger disavowals tend to bolster
this confusion with disempowering language such as “made me angry” and
“pissed me off ” reflecting the idea that the cause of the anger is the person
thought by the client to have done something wrong.
The damnation of the person in (4) conditions the attentional shift to
this person as cause of the client’s anger in (5), wherein the client ima-
gines himself as powerless over the anger caused in him by this “horrible
person.”
It is also remarkable that not all anger chains necessarily advance from
catastrophizing to damnation as in the above inference from (3) to (4).
However, in clients with blame-based anger disavowals, this progression
to damnation of another appears to be commonplace, probably because
the disavowal of the capacity to control one’s anger is often a function of
shifting (causal) blame from oneself to the person to whom one directs
one’s anger. The act of damning this person thus sets the stage for the
disavowal by focusing attention clearly on the individual as the
“culprit.”
It is further important to note that the strongest kinds of anger (such as
rage) generally arise when the client damns the doer, not just the deed. For
instance, an individual who experiences road rage typically damns the other
driver rather than merely how he or she is driving (“You rotten SOB, I’ll
get you for that”). Thus, the anger likely to be imagined to be beyond one’s
control is that which damns the doer rather than the deed.

Depression Chains
A client with blame-based depression may exhibit the following syllogism
chain:

1. Bad things must never happen to me.

2. But I got laid off due to the pandemic.
3. Therefore, what happened to me was horrible.
4. Therefore, the world is a terrible place.
5. Therefore, I just can’t help feeling depressed.

Phenomenologically, the following imaginative chain of associations and

speech acts tracks the above syllogism chain:
 Blame-Based Capacity Disavowals 161
• In (1), the client dispositionally harbors a felt need for bad things not to
happen to him. The word “bad things” itself is dispositionally
associated with events in the client’s life that are, in turn, associated
with an interoceptive feeling of dread. The felt need itself is associated
with language of necessity such as “must” or “need.”
• In (2), the client recalls an image of his being laid off due to the
COVID-19 pandemic, which activates the client’s dispositional felt
need for bad things not to happen to him, along with the feeling of
dread associated with such things happening to him; and the linguistic
expression of the felt need as a demand. The client, in turn, focuses
attention on the incompatibility of this demand and the image of being
laid off, which triggers a feeling of sadness.
• In (3), feeling this sadness, the client catastrophizes about it by imagining
being laid off in terms of its being “horrible.” This language, in turn,
amplifies the interoceptive feeling of sadness and its distressful character
(Seto & Nakao, 2017).
• In (4), the client’s intense sadness leads the client to use the words,
“terrible place” with reference to the world at large. This further
amplifies and directs the client’s sadness to the world at large, thereby
generating a feeling of hopelessness (Beck et al., 2003).
• Finally, in (5), the client’s hopelessness leads him to feel powerless over
the world and over his own feeling of hopelessness, which, in turn,
leads him to conclude, “I just can’t help feeling depressed.”

Notice how the client’s sadness in (4) is amplified by global damnation,

which generates an enveloping feeling of hopelessness, which is the core
feeling of depression. The depressed client, in turn, imagines himself stripped
of all internal controls, the “terrible” world having sucked away his capacity
to feel anything except the hollow residual of meaningless existence.
In one phenomenological investigation, Beck et al. (2003) collected
descriptions of hopelessness from in-depth interviews with eight individuals
who had experienced hopelessness. The authors then compiled this data
into the following description of the feeling of hopelessness:

Hopelessness is like being on a path and coming to a primeval

swampland, turning around and finding that the path has vanished.
You don’t know how you got here. There is nothing but the
swampland, frightening and boggy with hidden patches of quicksand.
Sounds are menacing, nonsensical; you feel lost and at the hands of a
merciless universe. You feel terribly alone although you can see
people in the distance going about life and seemingly feeling okay. …
You wonder what you have done to deserve this, ashamed for being
in this place. You try to make sense of it all—what does it
mean?—yet, it seems so pointless with no way out. You may even
wonder why not just give up and sink into the abyss and be done with
162 Overcoming Common Capacity Disavowal
it because nothing else seems possible. Every step takes effort, feels
heavy, goes nowhere but here.

Here, this all-enveloping sense of doom is described metaphorically—in

terms of negative terms such as “swampland” and “patches of
quicksand”—to convey the sense of being “in the hands of a merciless
universe.” Paradoxically, for the client with blame-based depression, this
desolate feeling of impotence or powerlessness is self-fulfilling because it
gives rise to the feeling of impossibility to feel anything but itself. And if it
feels impossible to feel any other way than impotent over one’s feelings,
then that is just how one will continue to feel. As such, phenomen-
ologically, the client with blame-based depression experiences a state of
being trapped inside his own feeling of powerlessness. It is self-sustaining,
and unmitigated because this meta-feeling of powerlessness over feeling
powerless feeds upon itself.
Phenomenologically, the terrible state of the world causes the feeling of
powerlessness. The client is but a passive recipient of this feeling; so, the
client is impotent in stopping it. This meta-feeling of impotence in turn
gives rise to the blame-based capacity disavowal, “I can’t help feeling de-
pressed.” The feeling of depression is itself essentially this feeling of pow-
erlessness, which is viciously self-proliferating. The more the client attends
to his meta-feeling of powerlessness over controlling his feeling of pow-
erlessness, the more he confirms—and sustains—the powerlessness he feels
over controlling this feeling.
At its root, this vicious cycle is ultimately sustained by the client’s perfec-
tionistic felt need and its linguistic expression. In the case of clients with blame-
based depression, as well as anger, the path to creating, or restoring, a positive
sense of interoceptive efficacy is therefore to overcome the client’s dispositional
existential or treatment demand and replace it with a virtuous rule that pro-
motes positive emotions. The next part of this chapter shows how to use the
six-step counseling process (see introduction) to accomplish this goal.

Step 1: Formulating the Primary Syllogism Using O & R

As discussed in previous chapters, this involves finding the client’s inten-
tional object (O) and rating (R) to formulate the client’s primary syllogism.
In the present example of blame-based depression, the client’s primary
syllogism would be along the following lines:

Syllogism Chain A

1. (Rule) If I got laid off due to the pandemic (O), then what
happened to me was horrible (R).
2. (Report) I got laid off due to the pandemic (O).
3. (Conclusion) Therefore, what happened to me was horrible (R).
 Blame-Based Capacity Disavowals 163
In this case, the report is not just imagined; it is recalled as a veridical per-
ception of reality. This is an important feature of the reportative act in
depression in contrast to that in anxiety, which is conditional and predictive
of a future possibly that has not yet occurred. For example, in the cases of
risk-aversive and low-frustrative clients, the reportative act in the primary
syllogism is an imagined future possibility.
The inference rule is then the bridge that provides for the valid inference
to the conclusion. This rule premise is important to formulate for purposes
of expanding the syllogism upward to its higher tier.

Box 9.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism
In the below part of their session the therapist helps the client find O & R
to construct the primary syllogism.

C: I’ve been very depressed lately.

T: Tell me about that.
C: Two weeks ago, I was laid off from my job. It wasn’t that I did
anything wrong; it’s just that the company is letting a lot of
employees go because of the pandemic. My manager told me
that there was just not enough work to justify keeping me.
T: So, you’re feeling depressed about having been laid off?
C: Yes, it’s been really hard. I need money to pay the rent. Just
when I thought things were going well, this had to happen!
T: So you’re telling yourself that, what happened is very bad?
C: Yes! It’s a horrible thing, especially at a time like this!
T: I understand. So, you are telling yourself that, getting laid off
during a pandemic is a horrible thing; so, since this happened to
you, it’s horrible?
C: Yes, that’s exactly what I’m telling myself!

Step 2: Expanding the Syllogism Chain

So formulated, the therapist can proceed to question the rule premise in
order to expose the premises from which it is deduced: “Why is it ‘horrible’
to get laid off in a pandemic?”
Pending the client’s response to this question, the syllogism may be
expanded upwards as follows.
164 Overcoming Common Capacity Disavowal
Syllogism Chain B

1. (Rule 1) Bad things must never happen to me.

2. (Rule 2) If bad things must never happen to me, then if I got laid
off in the pandemic, then what happened to me was horrible.
3. (Rule 3/Conclusion 1) Therefore, if I got laid off in the
pandemic, then what happened to me was horrible.
4. (Report) I got laid off in the pandemic.
5. (Conclusion 2) Therefore, what happened to me was horrible.

In Syllogism Chain B, above, Rule 1 makes a perfectionistic existential

demand about the world, which in conjunction with grayed-out inference
Rule 2, entails Rule 3, the major premise of the primary syllogism.

Box 9.2 Practice

Therapist (T)–Client (C) Exchange

Exposing the Existential Demand

In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing a perfectionistic existential
demand.

T: Why is getting laid off during this pandemic horrible?

C: I told you I need to pay my rent. I don’t have a job.
T: Is it any worse because it’s during a pandemic?
C: Yes, it’s like the pandemic was bad enough; now I don’t even
have a job. Things like this are not supposed to happen!
T: Not “supposed to happen”? Can you explain what you mean?
C: I know they happen, and not just to me, but it blows my mind;
it’s hard for me to even imagine I would end up like this!
T: So, you feel like something like this must never have happened
to you?
C: Yes.
T: Okay, is this your reasoning? Bad things like getting laid off in a
pandemic must never happen to you; therefore, since this did
happen to you, it’s horrible?
C: Yes, really horrible!

The conclusion of the primary syllogism can then be expanded down-

ward as illustrated below.
 Blame-Based Capacity Disavowals 165
Syllogism Chain C

1. (Rule 1) Bad things must never happen to me.

2. (Rule 2) If bad things must never happen to me then if I got laid
off in the pandemic, then what happened to me was horrible.
3. (Rule 3/Conclusion 1) Therefore, if I got laid off in the pandemic,
then what happened to me was horrible.
4. (Report) I got laid off in the pandemic.
5. (Conclusion 2) Therefore, what happened to me was horrible.
6. (Rule 4) If what happened to me was horrible, then the world is a
terrible place.
7. (Conclusion 3) Therefore, the world is a terrible place.
8. (Rule 5) If the world is a terrible place, then I just can’t help
feeling depressed.
9. (Conclusion 4) Therefore, I just can’t help feeling depressed.

Box 9.3 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness
In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: Okay, so what if getting laid off in the pandemic is as horrible as

you say? Aren’t there other worthwhile things you can still do?
C: I suppose so; but I don’t really feel like anything is worthwhile
anymore now that this has happened. A world where such a
horrible thing can happen to me is really a terrible place. I mean
how could this happen? What did I do to deserve this!
T: So, since what happened to you was horrible, the world itself is a
terrible place?
C: Yes, that’s right.
T: I can understand why you feel depressed. Sounds like you feel
hopeless.
C: That’s exactly what I feel, like why even bother!
T: Like you are powerless?
C: Yes, I feel so powerless!
T: Are you powerless over the way you feel?
C: Yes, I can’t help feeling so powerless.
T: Kind of a vicious cycle. Feeling powerless over your feeling of
powerlessness?
C: I didn’t think of it like that, but yes, that’s just how I do feel,
powerless over feeling powerless.
166 Overcoming Common Capacity Disavowal
T: And it’s the terrible state of the world that makes you feel
like this?
C: Right. It makes me depressed.
T: So, it sounds like you are saying this feeling of powerlessness is
what you mean by feeling depressed?
C: Yep; like this world has got me down, and I have absolutely no
control over what happens to me in it!

In the above two-tiered expansion downward, the client deduces global

damnation from Conclusion 2 in conjunction with the grayed-out in-
ference rule, Rule 4. This, in turn, sets the stage for the expansion
downward to the second tier that contains the blame-based capacity dis-
avowal (Conclusion 4).
The latter two deductions track the flow of associated images and inter-
oceptive feelings from the feeling of sadness amplified by catastrophizing the
image of being laid off in the pandemic as “horrible.” This amplification is
further amplified in the flow of images and feelings to the speech act of damning
the entire world as “a terrible place,” which triggers the feeling of hopelessness as
metaphorically described above. This feeling leads the client to disclaim any
(causal) responsibility for how he feels, instead feeling ensconced in impotence.
This feeling of impotence or powerlessness is then expressed in Conclusion 4 as
“I just can’t help feeling depressed.” The practical consequences of this con-
clusion is thus to perpetuate the depressed feeling of powerlessness over such a
“horrible” turn of events in a “terrible” world, along with it cognitive-
behavioral aspects—such as decreased interest or pleasure in activities previously
evoking interest or pleasure, lethargy, and reduced capacity to think clearly or
concentrate (American Psychiatric Association, 2013, pp. 160–161).

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
Indirect refutation of the blame-based depression disavowal in Conclusion
4 proceeds by refuting the demand in Premise 1, which supports the entire
chain. Empirical justification proceeds by showing that the demand that bad
things never happen to the client has no basis in verifiable fact but is instead
merely a subjective feeling in the client’s mind. Logical refutation proceeds
by helping the client to see that the premise that bad things “must never
happen” is inconsistent with other beliefs the client holds namely that bad
things do, in fact, happen to him and to others. Pragmatic justification
proceeds by helping the client to see that his demand is self-defeating,
fostering painful feelings that serve to diminish his capacity to think clearly
about constructive approaches to dealing with his job loss.
 Blame-Based Capacity Disavowals 167

Box 9.4 Practice

Therapist (T)–Client (C) Exchange

Refuting the Existential Demand
In the below part of their session, the therapist helps the client refute his
existential demand.

T: Let’s take a look at the demand you are making that bad things
like getting laid off during a pandemic not happen to you? Can
you tell me where you get that from? Is there any law of nature
that says you must not have bad things like this happen to you?
C: No, but that’s just the way I feel.
T: Right, but that’s a subjective feeling. Did you ever have feelings
that had no basis in reality?
C: I suppose everyone does. Like when you feel lucky at the crap
table and end up losing your shirt!
T: Very good!
C: Yeah, but aren’t some feelings based on reality? Like when you
feel hungry? If you don’t eat, you can starve to death.
T: True. But there is evidence that feeling hungry can give valuable
information about the state of a person’s body. Is there any evidence
that feeling a need for bad things not to happen proves they won’t?
C: No, just the opposite. Shit happens!
T: Yes, it does. So, you are setting yourself up for feeling let down
when you demand that it not happen.
C: I see that. I have been demanding something that’s unrealistic
and then working myself up over it when something goes
wrong, like losing my job, and this pandemic.
T: Right. Things don’t always go the way we would prefer. But
does that mean the world is a terrible place?
C: I suppose not. Things don’t always have to go the way I want. I
can still find some things to be happy about I suppose, like I’m
still alive and healthy!
T: Excellent!

Direct refutation proceeds by challenging the client’s feelings of im-

potence and impossibility to control his feelings, which ground the blame-
based depression disavowal in Conclusion 4. “Does feeling like you can’t do
something mean that you really can’t do it?” “Have you ever felt a certain
way but acted differently anyway?” “Have you ever felt hopelessly de-
pressed and then got involved in a meaningful activity and began to feel
168 Overcoming Common Capacity Disavowal
differently?” Here, the strongest direct refutation is to help the client de-
monstrate that he can feel differently. One way is to engage in positive be-
havioral activity that distracts from the negative feelings; another is to
engage in cognitive reframing through positive imagery. Both active re-
futational approaches are discussed later in this chapter.3

Box 9.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Capacity Disavowal
In the below part of their session the therapist helps the client refute the
blame-based capacity disavowal that keeps him from making a commitment.

T: So, do you still think it’s the world that’s making you feel so
hopeless, or is it what you are telling yourself about the world? I
mean, suppose you didn’t tell yourself that what happened to
you was “horrible,” and, therefore, the world is a “terrible
place”? Would you still feel so powerless and hopeless if you
didn’t tell yourself these things?
C: I could stop saying those things; but I suppose that’s just how I feel!
T: Have you ever felt hopeless and powerless like this before and
were then able to feel better?
C: Yup, when my father died five years ago; it was like howling at
the wind. I felt so helpless.
T: That empty, desolate feeling that such a horrible thing must not
happen; and yet it did happen, and there’s nothing whatsoever
you can do to bring your father back.
C: Yes, exactly!
T: So, did you get through it?
C: It’s still painful when I think about it, but I have been able to
move on with my life.
T: But you thought at the time that you couldn’t stop feeling
this way?
C: Yes, so you are saying that, if I could stop feeling depressed after
my dad died, then I should be able to stop feeling like this now.
T: Yes, very good!
C: I get what you’re saying, but it took me about a year to stop
torturing myself.
T: I understand. Still, even though it felt impossible to stop
grieving, or feeling depressed, you eventually managed to do it.
C: Yes, I get it.
 Blame-Based Capacity Disavowals 169
Step 4: Identifying the Guiding Virtues
The guiding virtues that can help to promote such counteractive refutations
and reverse the negative polarity of the feelings of powerlessness and im-
possibility are Courage; Unconditional Other, or World Acceptance; and
Temperance. Courage counteracts catastrophizing while Unconditional
Other Acceptance counteracts damnation of others in the case of blame-
based anger disavowals, while Unconditional World Acceptance counteracts
global damnation in the case of blame-based depression disavowals. These
virtues have this counteractive power because they tend to counteract dis-
positional treatment and existential demands. Temperance, in turn, can di-
rectly counteracts the dependent capacity disavowal.
Thus, a person with Courage does not ordinarily demand that the world
not bring harm to him or his loved ones because he is realistic about what
he can expect from the world and therefore does not catastrophize about
it thereby creating unnecessary fearfulness. Likewise, a person with
Unconditional World Acceptance realistically accepts the world as it is, along
with its inherent flaws, and therefore does not demand that it be perfect, and,
as such, devoid of bad things happening to him or others. Similarly, people
with Unconditional Other Acceptance accept other humans as imperfect
beings and therefore do not demand that others always treat them fairly.
People with Temperance accept responsibility for their feelings and
therefore do not disavow their capacity to control their feelings. Such in-
dividuals do not make excuses for their feelings by using self-destructive,
responsibility-denying language such as “I can’t help my feelings” or “They
make me angry” or “It depresses me.” Such individuals are also cognitive-
behaviorally disposed toward self-control, and therefore do not ordinarily
experience contrary irrational feelings (for example, intense anger), which
they must make a special effort to control. Instead, they do not experience
such feelings in the first place.
Of course, these are ideals, and human beings, even ones that have good
measures of Temperance, Courage, and Unconditional Other and World
Acceptance do indeed sometimes become irrationally disturbed. So, it is an
ongoing, life pursuit to work toward attaining these virtues, realizing that
there is always room for positive growth.

Box 9.6 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues
In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming blame-based capacity disavowals.
170 Overcoming Common Capacity Disavowal
C: I can understand how I am telling myself things to depress
myself; but I’m not sure I can just stop telling myself these things
and not feel depressed.
T: I understand. The next step in the process of overcoming these
irrational things you are telling yourself is to set some positive
goals that can help you feel better.
C: What goals are you referring to?
T: I’m talking about Courage, Unconditional World Acceptance,
and Temperance. I mean, instead of catastrophizing about bad
things happening, you can work on being courageous in
dealing with the negative things that happen. Also, instead of
damning the world when something bad happens, you can
work toward being more accepting of the world; so that you
can let yourself off the roller coaster ride of making yourself
feel like a helpless victim when things go wrong. And, by
“Temperance” I mean working on self-control so that you
stop your vicious cycle of feeling powerless over feeling
powerless. Are you open to attempting to work on these
things?
C: Yes, I’ll try, but don’t know if it will do any good.
T: That’s okay. At this point, what’s important is to give it your
best shot.
C: I will definitely do that.
T: This is not about being perfect; it’s about attempting to do
better. None of us are perfect because we are all human. But we
can keep at it and over time make progress, even though
sometimes we may take two steps backwards to take three steps
forward. That’s the way constructive change usually happens,
gradually.
C: I feel relieved now that you said that.
T: Because you don’t have to be perfect?
C: Yes.
T: Then this is itself progress!

Step 5: Finding an Uplifting Philosophy

Building these virtues involves cognitive as well as behavioral changes that
can be supported through cognitive reframing in terms of uplifting (posi-
tive) philosophies appropriate to their cultivation. These philosophies can
foster positive emotions instrumental in reversing the negative polarity of
feelings of unfairness, intense anger, sadness, hopelessness, and the felt need
to be treated fairly or not have bad things happening.
 Blame-Based Capacity Disavowals 171
Philosophies of Courage
In the context of working with clients with blame-based capacity dis-
avowals, these philosophies help clients to manage or avoid distressful or
threatening feelings about misfortune or mistreatment by putting their
gravity into perspective so as not to over- (or under-) react.

Reframe Misfortune as an Opportunity to Grow Stronger

German existentialist, Friedrich Nietzsche reframes misfortunate and mis-
treatment as opportunities to grow stronger. Opposing the status quo,
which preached pity for sufferers, Nietzsche (1909), in his work entitled,
Beyond Good and Evil, proclaims:

We opposite ones, however, who have opened our eye and conscience
to the question how and where the plant “man” has hitherto grown
most vigorously, believe that this has always taken place under the
opposite conditions, that for this end the dangerousness of his situation
had to be increased enormously, his inventive faculty and dissembling
power (his “spirit”) had to develop into subtlety and daring under long
oppression and compulsion, and his Will to Life had to be increased to
the unconditioned Will to Power—we believe that severity, violence,
slavery, danger in the street and in the heart, secrecy, stoicism,
tempter’s art and devilry of every kind,—that everything wicked,
terrible, tyrannical, predatory, and serpentine in man, serves as well for
the elevation of the human species as its opposite (Sec. 44, p. 59).

In this highly emotive prose, Nietzsche reverses the negative valence of

terms such as “wicked,” “terrible,” “tyrannical,” predatory,” and “ser-
pentine,” turning unwelcome conditions ordinarily characterized in terms
of them, into opportunities to increase one’s “subtlety,” “daring,” “in-
ventive faculty,” and “Will to Live,” turning the latter into the “un-
conditional Will to Power.” In other words, these purportedly negative
conditions provide the conditions for becoming more self-reliant, less
vulnerable, freer, courageous, and creative.
This does not mean that a person should put herself in danger for its own
sake. It rather means that, when confronted with such situations, they can be
reframed in a positive way as providing an opportunity for “spiritual” growth.
Thus, the client who is faced with the loss of a job might take the op-
portunity to go back to school to acquire marketable skills that could in-
crease his prosperity in the long run. This does indeed provide an
opportunity to exercise Courage, overcoming his self-destructive feelings of
sadness, distress, and hopelessness, and instead experiencing the uplifting,
positive feelings associated with exercising courage and “power” over his
life to promote constructive change.
172 Overcoming Common Capacity Disavowal
In the case of the client who feels threatened by having been treated
unfairly and who experiences anger, if not rage, at his accuser, he can re-
frame this situation as an opportunity to exercise power over his situation
and his feelings, by tactfully dealing with the situation, thus freeing himself
from the self-generated negative valence of demanding fair treatment and
catastrophizing about not receiving it.

Philosophies of Other and World Acceptance

These philosophies, in the context of working with clients with blame-
based capacity disavowals, involve helping clients to overcome damnation
of others and the world by reversing the negative affective valence ex-
pressed and amplified by these speech acts, to positive affect associated with
a sense of being at peace with others and the world at large.

Speaking “I Thou” to Others

Austrian-Israeli philosopher, Martin Buber distinguishes between “I-It”
and “I-Thou” relationships that we can have with intentional objects of
consciousness. In the former relationship, one perceives the external object
(person or thing) as an “It” to be used for this or that purpose. In this
relationship to the external world, the object is viewed instrumentally, not
as something of value in itself but rather for what good it can serve. For
example, to I-It a tree means to see it as something that provides shade from
the damaging rays of the sun. Likewise, to I-It a person is to see the person
as instrumental to something one may want. Thus, the pizza delivery man is
seen as someone who is delivering dinner, and whose value rests squarely in
delivering a hot and cheesy pie.
In contrast, to I-Thou the pizza delivery man is to see him as a whole, not
dissected into functional parts. Even more, it is to transcend one’s own
separateness in time and space from him to experience a sense of unity with
this person, who is then no longer “pizza delivery man”; for the latter
would engender an It. Instead, there is coalescent unity, bound up with all
else in the universe. Buber eloquently expresses the idea:

If I face a human being as my Thou, and say the primary word I-Thou
to him, he is not a thing among things, and does not consist of things.

This human being is not He or She, bounded from every other He and
She, a specific point in space and time within the net of the world; nor
is he a nature able to be experienced and described, a loose bundle of
named qualities. But with no neighbour, and whole in himself, he is
Thou and fills the heavens. This does not mean that nothing exists
except himself. But all else lives in his light. (Buber, 1937, p. 8)
 Blame-Based Capacity Disavowals 173
In cultivating the capacity to enter into such a relationship with others, the
client can transcend the critical, negative linguistic activity involved in
scrutinizing a person for malfeasance and comparing it to a perfectionistic
demand to be treated fairly. The latter form of functional “I-It” relationship
prevents the client from seeing the negatively assessed individual as a Thou
through the formation of a gestalt with a positive valence. Buber’s philosophy
of I-Thou relationships can, accordingly, help a client to avoid the demand
and the negative comparative analysis in favor of an uplifting positive feeling.
Practiced regularly, the client can then develop the cognitive-behavioral
disposition or habit to treat the other with unconditional acceptance.
Practicably, pronouncing another as “Thou” may be accomplished in a
here and now compassion-based, meditative process, focusing one’s at-
tention on the image of the other while pronouncing this person “Thou.”
According to Buber (1937), this activity of imaging is one of inclusiveness
(Scott et al., 2009); that is, imagining oneself in the other and the other in
oneself; mutuality and resonance, not dissection and separateness. This
image of another called “Thou” can thus be a spiritually uplifting, unifying
one, potentiating the capacity to feel positive feelings about the other, and
abstracting from the dissection of the other into parts—into an “It”—and
then ruminating about what one finds to be unacceptable in the other.

What Is True of the Part Is Not Necessarily True of the Whole

Seventeen-century German philosopher and mathematician, Gottfried
Leibnitz, made use of this principle to show that the existence of evil in the
world does not mean that the world itself is evil. Indeed, Leibnitz (1996)
proclaimed, God made “the best possible … universe” (p. 383). Yet he asks,
how can this be true when there is evil in the world,

for one cannot deny that there is in the world physical evil (that is,
suffering) and moral evil (that is, crime) and even that physical evil is
not always distributed here on earth according to the proportion of
moral evil, as it seems that justice demands. There remains, then, this
question of natural theology, how a sole Principle, all-good, all-wise
and all-powerful, has been able to admit evil, and especially to permit
sin, and how it could resolve to make the wicked often happy and the
good unhappy? (p. 98)

This is a question that many clients with blame-based depression ponder,

which tends only to increase the negative valence of their catastrophizing.
Leibnitz uses the aforementioned principle to resolve this quandary:

[T]he best course is not always that one which tends towards avoiding
evil, since it is possible that the evil may be accompanied by a greater
good. For example, the general of an army will prefer a great victory
174 Overcoming Common Capacity Disavowal
with a slight wound to a state of affairs without wound and without
victory. … imperfection in the part may be required for a greater
perfection in the whole. (p. 378)

Thus, a world in which human beings have free will is a better one than one
in which they don’t, notwithstanding that this allows for the possibility of
moral evil; and a world that allows for suffering also allows for heroic feats to
overcome this suffering. Danger can bring about suffering but it also allows
for Courage; a world without disease would be one in which there would be
no opportunity to exercise scientific thought and creativity to find cures. So,
a world with such evils, in contrast to one without them, may be the “best
possible universe.” In this manner, the client with blame-based depression
who feels overwhelmed by hopelessness can seek comfort in believing that
the evil befalling him does not make the world a bad place but, quite the
contrary, may provide the opportunity to build character through virtuous
actions, and find new meaning in confronting life challenges.

Philosophies of Temperance
These uplifting philosophies help clients to accept responsibility for their
feelings, rather than blaming them on external objects or events, and to use
language that conveys this capacity.

You Make Yourself Angry

This goes to the heart of the ancient tradition of Stoicism, which holds that
human beings are the authors of their own emotional disturbances by the
judgments they make about the events in the world. Thus, according to
Epictetus (1758),

Men are disturbed, not by things, but by the principles and notions
which they form concerning things. … When therefore we are
hindered, or disturbed, or grieved, let us never attribute it to others,
but to ourselves; that is, to our own principles. (sec. 5)

Thus, laying blame on others for one’s anger is irrational. Epictetus con-
tinues,

An uninstructed person will lay the fault of his own bad condition
upon others. Someone just starting instruction will lay the fault on
himself. Someone who is perfectly instructed will place blame neither
on others nor on himself. (sec. 5)

Here, the idea of “placing blame” on others or oneself means damning the
person--self or others. According to Epictetus, however, the casting of such
 Blame-Based Capacity Disavowals 175
blame is irrational because it is not the person (oneself or another) who is at
fault but rather one’s negative judgment about another. So it makes sense to
damn one’s judgment, not oneself or the other.
Ancient Roman Stoic Marcus Aurelius (1862) develops an uplifting
philosophy to remediate this propensity of clients with blame-based anger
disavowals to blame others for their anger:

[I]t is not men’s acts which disturb us, for those acts have their
foundation in men’s ruling principles, but it is our own opinions which
disturb us. Take away these opinions then, and resolve to dismiss thy
judgement about an act as if it were something grievous, and thy anger
is gone. How then shall I take away these opinions? By reflecting that
no wrongful act of another brings shame on thee: for unless that which
is shameful is alone bad, thou also must of necessity do many things
wrong, and become a robber and everything else. (bk. 11)

A key point to be gleaned from the above passage is that the wrongful acts
of others do not reflect negatively on the one who is wronged. However,
in damning the other and thereby losing one’s temper, one acts in a manner
that reflects poorly on one’s own capacity for self-constraint. On the other
hand, in keeping one’s composure, one turns the occasion into an op-
portunity to build Temperance, which is a positive gain. As such, for the
client with blame-based anger, the antidote to the damning of others is to
seize the opportunity to exercise emotional constraint and thus take strides
toward the cultivation of Temperance. “There I go again, blaming this
person for my anger when I don’t have to demand that I be treated fairly in
the first place, and then damn the person for not doing so. Here’s my op-
portunity to build character by remaining calm!”
This does not mean that the maltreatment needs to go unaddressed.
Rational responses include explaining why the action was wrongful or even
taking legal action in serious cases. However, from the Stoic perspective,
the client can be encouraged to remain temperate and thus seize the op-
portunity to turn the misdeed of another into a triumph of character.

You Also Make Yourself Depressed

The Stoic logic applies as well to blame-based depression in which one
demands that bad things not happen and then, seeing that some such
thing has happened, catastrophizes about it, and then damns the world.
The Stoic admonishes one to cherish one’s peace of mind above the
mundane affairs of life that, as a matter of course, need not comport to
one’s preferences or expectations.
This peace of mind, the Stoics admonish, can be destroyed through one’s
own refusal to accept the transitory nature of both good and bad things,
which come and go, and are beyond one’s capacity to control. Aurelius
176 Overcoming Common Capacity Disavowal
(1862) uses the metaphor of “leaves” that are produced in the spring, and
then scattered on the ground and blown here and there by the wind.
Unfortunately, he says, while “brief existence is common to all things,”
many of us “avoid and pursue all things as if they would be eternal” (bk.
10). This perfectionistic demand that what is inherently transitory last
forever sets oneself up for unhappiness. It does so by leading one to cata-
strophize about the losses and misfortunes of human existence, and then,
especially in the cases of substantial misfortunates such as the client who gets
laid off in the pandemic, to damn the universe.
Epictetus (1758) offers a behavioral approach to overcome this dis-
position toward self-defeating speech acts, and to move, instead, toward
greater acceptance of the world notwithstanding its imperfections.
“Begin therefore from little things,” he counsels. “Is a little oil spilt? A
little wine stolen? Say to yourself, ‘This is the price paid for equanimity,
for tranquility, and nothing is to be had for nothing’” (sec. 12). As such,
the client can build up his willpower to tackle the larger misfortunates.
Like a weightlifter, beginning with the heavier weights is not likely to
bear fruit; but, by starting with the smaller weights, one can eventually
work up to lifting the much heavier ones.

Box 9.7 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy
In the below part of their session, the therapist helps the client to find a
philosophy and to try it out through use of interoceptive imagery.

C: So, what do I need to do to become more courageous and the

other things you mentioned?
T: The first step is to get clear about your own philosophies about
what makes a person courageous, unconditionally world
accepting, and temperate. By a philosophy, I mean an
uplifting way of thinking that inspires you to be more
virtuous in confronting your challenges. Different people have
different ways of looking at things philosophically, so it should
be something that you really feel committed to.
C: Is it okay if it comes from the Bible?
T: Of course, if that works for you.
C: I’m thinking of 2 Timothy 1:7, “For God has not given us a spirit
of fear and timidity, but of power, love, and self-discipline.”
T: Yes, I can see how this could be very uplifting: “power, love,
and self-discipline.” That nicely sums things up!
 Blame-Based Capacity Disavowals 177
C: Yep.
T: Let’s try this out. Get yourself to feel this sense of powerlessness
over what happens to you and let yourself feel this powerlessness
over controlling this feeling. Imagine, the pandemic is raging,
no job in sight, and no promise about what’s going to come of
you. Let yourself feel this desolation and let me know when you
are there.
C: I’m feeling it.
T: Okay, now say to yourself in your mind “For God has not given
us a spirit of fear and timidity, but of power, love, and self-
discipline.” And repeat to yourself, “Power, love, and self-
discipline.” “Power, love, and self-discipline.”
C: Okay.
T: [momentary pause] How are you feeling now?
C: I have this incredible feeling of power, like I am infused with
this positive energy He has given me. It feels amazing!
T: Excellent! This is a philosophy you can use to help increase
Courage. And since these guiding virtues are all connected, it
sounds like it may also help to increase Temperance and
Unconditional World Acceptance in confronting your current
life challenges.
C: I love it!
T: Great! Next step is to set up a plan for you to put your
philosophy to work. This is a structured set of exercises that will
help you work on developing your guiding virtues.

Step 6: Constructing a Plan to Apply the Philosophies

As discussed in previous chapters, this step involves asking clients three
related questions calculated to elicit the virtue-based syllogism chains
that prescribe a cognitive-behavioral plan.

Question 1: In What Ways Has Not Controlling Your Feelings

Negatively Impacted Your Life, or the Lives of Others?
In cases of blame-based anger, clients tend to have difficulty getting along
with others and may act aggressively when they perceive themselves to be
treated unfairly, only to later regret the manner in which they have man-
aged the situation. In blame-based depression, clients tend to withdraw
from activities they previously enjoyed. In severe cases they may satisfy the
diagnostic criteria for Major Depressive Disorder (American Psychiatric
Association, 2013, 160–161). This may include suicidal ideation.
178 Overcoming Common Capacity Disavowal
Question 2: What Changes Would Your Uplifting Philosophies Prescribe?
In the case of blame-based anger, clients’ responses may include improving
relationships; avoiding self-defeating aggression they regret after the fact;
and making rational assessments about handling situations in which they
believe they have been mistreated. In the case of blame-based depression,
clients’ responses may include regaining a sense of purpose in life, enjoy-
ment of things previously enjoyed, and, broadly, an affirmation of living in
an imperfect world.

Question 3: How Are You to Make These Constructive Changes?

CBT therapists accordingly can work with the client to create a plan of
action that promotes the client’s stated goals.

Box 9.8 Practice

Therapist (T)–Client (C) Exchange

Setting up a Cognitive-Behavioral Plan
In the below part of their session, the therapist discusses the three
aforementioned questions with the client to set up a cognitive behavioral plan.

T: Since the plan we develop for you will work on changing the
way you react to life situations when you feel depressed, tell me
more about how it has affected your life.
C: Well, I haven’t been doing much of anything. I spend a lot of
time sleeping. I have been socially distancing, so I don’t have
much social contact. I keep to myself, go out occasionally to get
groceries, and basically stay in.
T: Are you in contact with any friends or relatives?
C: I speak to my friends on the phone; sometimes we have Face
Time; but I’m not very sociable, I know. I still speak with my
ex; she calls me every few weeks, but I usually get into
arguments and hang up.
T: What do you think Paul in 2 Timothy would tell you about the
way you are living now?
C: I think he would say that I am being afraid and timid, and that
God has given me power, love, and self-discipline, which I
should be using.
T: Very good!
C: I can be more sociable, friendly, more loving and supportive of
my friends, and even my ex. They are also living through this
pandemic, so I can be kinder and more considerate of what they
 Blame-Based Capacity Disavowals 179
are going through too. I can try not to feel so down; maybe
figure out what to do about my job situation, if I can get up
enough courage to try.
T: Excellent! Our plan will aim at helping you work toward these
goals.

Cognitive Behavioral Assignments for Clients with Blame-Based

Capacity Disavowals
The below exercises are suggestions for creating such a plan for clients with
blame-based depression and anger.

Compassion-Based Meditation
Insofar as blame-based anger focuses negatively on a person perceived to be
the cause of one’s anger, this form of meditation can be useful in reversing
this negative polarity because it focuses on positive imagery related to the
person in question. As mentioned, the Buberian activity of pronouncing
this other individual as “Thou” can be a way of building spiritual unity with
the other by reimagining her as bound up with oneself and the rest of the
universe. Here, the goal is to dissolve the gap between oneself and the
other, for the client to feel this connectedness, not just imagine it. In fact,
there is substantial evidence that compassion-based meditation has neural
correlates associated with such feelings as empathy and forgiveness, parti-
cularly insula, cingulate cortex (Lutz et al., 2008), and precuneus
(Lieberman & Pfeifer, 2005).
The inclusiveness captured by the “I-Thou” relationship has been has
considered key to dissolving obstructive barriers between clients and
therapists in the counseling relationship (Martin, 2017). Thus, the
cognitive-behavioral assignment here is for clients with blame-based
anger to practice this important element of the counseling relationship in
relating to others outside the counseling relationship.
Makransky (2019) describes this Buberian meditative process as entering
into an “inclusive mode” by first recalling a loving or caring moment and
allowing oneself to feel the energy of this caring moment in the here and
now; and then, focusing on another person, allowing the energy of this felt
caring to flow to another person, “sensing the other as a subject, a whole
life and fuller person beyond superficial impressions and judgments, pos-
sessed of great worth and potential.”
Makransky also suggests beginning with individuals about whom one
already cares, and eventually working up to individuals whom one dislikes.
Accordingly, the therapist may suggest that the client begin with a loved
180 Overcoming Common Capacity Disavowal
one, then proceed to others whom she may like; then to others whom she
may neither like nor dislike, such as a recent acquaintance; and eventually
applying the process to a person she perceive to make her angry.
Another approach that incorporates self-compassion is offered by Kristen
Neff and Roos Vonk (Neff & Vonk, 2009). According to Neff and Vonk,
“Anger often arises when people feel insulted or humiliated…. Self-
compassion appears to lessen the need to defend one’s ego because it makes it
easier to admit mistakes and personal shortcomings” (p. 39). Self-compassion
has three components, according to Neff and Vonk: “treating oneself with
kindness, recognizing one’s shared humanity, and being mindful when
considering negative aspects of oneself” (p. 23). When these conditions are
satisfied, one becomes less self-defensive, less likely to criticize or damn
oneself, more keenly aware of one’s own imperfections, and more likely to
realize that all human beings, oneself included, are by their nature imperfect.
Consequently, meditation aiming at building self-compassion can lessen one’s
tendency to become intensely angry at others. For clients with blame-based
anger, this suggests a heightened sense of control over one’s anger, and thus
less likelihood of making blame-based capacity disavowals.
There is, in fact, also empirical data to suggest that self-compassion as part
of a meditative process can be a useful part of CBT interventions among
depressed clients (Stefan 2019). Kristin Neff (n.d.-a) has provided a useful
video that therapists can use to help their clients undertake compassion-
based meditation aimed at self-compassion. This process appears to be
useful for dealing with anger as well as depression.
According to Neff (n.d.-a), this process may begin with loving kindness
toward another for whom one has strong positive, unequivocal feelings
such as a close friend or beloved relative, or even a pet, someone with
whom one feels safe; then imagining this individual in one’s presence,
sensing the way the individual looks and sounds; allowing oneself to feel the
feeling of loving kindness one feels toward this individual; then sending
positive wishes for wellbeing to this individual by silently repeating the
statements, “May you be safe,” “May you be peaceful,” “May you be
healthy,” and “May you live with ease and well-being.” Perhaps this person
is going through a difficult time; in which case one may add “as possible” to
the end of each statement.
Then one extends these positive wishes by including oneself in the loving
kindness circle, silently repeating the same message to oneself; then
broadening the scope of well-wishing to include other human beings
whom one may not know very well; then to every human being; then
further broadening the scope to include plants and animals, and finally to
the world at large. At each successive stage, the client uses the same positive
language to express her compassion and positive wishes, culminating with
“wishing well the world and everything in it.”
Such positive wishes are aspirations, not demands for the world to be
perfect. The client therefore affirms the suffering in the world, sending her
 Blame-Based Capacity Disavowals 181
well wishes to those who suffer, including herself; wishing the world and
every creature in it the very best possible.

Box 9.9 Practice

Practicing Loving-Kindness Meditation

The video narrated by Kristen Neff (n.d.-a) is 20 minutes and
offers guiding directions that clients can follow and practice on their
own. She also offers a series of related videos accessible on the
Internet that may also be used in a client’s cognitive-behavioral plan
(Neff, n.d.-b).

Phenomenologically, the client who engages in such compassion-based

meditations are effectively working on changing the valence polarity of the
person she believes is producing her anger. This shift in polarity, together
with the Stoic insight that the client is herself in control of her own
emotions, which are a function of her own judgments (speech acts), can
provide a powerful activity for helping clients with blame-based anger or
depression to overcome their blame-based capacity disavowals.
Neurologically, as a result of engaging regularly in loving kindness
meditation, changes in the ventral striatum reinforced by receipt of dopa-
mine through its network of dopamine receptors, can be hypothesized to
help build dispositional reduction in intensity of negative affect (anger or
depression), making it easier for the client to control angry feelings.
Linguistically, the client can begin to overcome the tendency to damn
others (in the case of anger) or to damn the universe (in the case of de-
pression), by building unconditional other and world acceptance, thereby
weakening the tendency to make destructive and unrealistic existential and
treatment demands.

Interoceptive Imagery
Another mechanism that can help to support the aforementioned phe-
nomenological, neurological, and linguistic changes is the regular use of
interoceptive imagery using the uplifting philosophies themselves to help
reverse the negative polarity arising in cases of blame-based anger and
depression.
Aurelius’ philosophy that, “no wrongful act of another brings shame on
thee” can provide an uplifting, empowering image to help build
Temperance and overcome the perfectionistic demand for fair treatment.
Thus, the therapist can instruct the client to get himself to feel the need for
fair treatment and allow himself to feel the conflict arising between the
182 Overcoming Common Capacity Disavowal
blunt recall of being unfairly accused of lying. In this negative state, the
therapist can then ask the client to silently say, “No wrongful act of another
brings shame on thee,” letting himself feel the liberating power of this
image; then asking the client to describe his experience in shifting from the
first negative feeling to the second positive one.
Other potentially beneficial imagery might include:

• Aurelius’ image of leaves falling slowly from the tree and blowing
away, hence metaphorically conveying the transitory nature of things,
hence the unreality of the felt need that bad things not happen; and the
sense of freedom arising from letting the felt need “blow away.”
• The positive imagery evoked by the Nietzschean philosophy of using
suffering to grow stronger, along with its positive language—building
“subtlety,” “daring,” “inventive faculty,” and “unconditional Will to
Power”—and the uplifting sense of power to turn a negative situation
into a positive one.
• Leibnitz’s image of misfortune fading into the background of “the best
possible universe,” giving meaning and purpose to the misfortune by
setting the antecedents for a world that allows for courageous actions
in the face of misfortune, and countless other praiseworthy
possibilities—and the sense of optimism arising from such positive
imagery.

The intended goal here is to help the client build up new associations with
the images representing the uplifting philosophies, instead of negative
ones associated with the felt perfectionistic need and its irreconcilable
conflict with perceived reality. A good test of whether a philosophy is
suitable for a client is if it succeeds in reversing the negative polarity of the
former negative image to the latter positive one. In some cases, where a
client is unable to feel better—experience a sense of relief, freedom,
optimism, etc.—by switching to the philosophical imagery, I have re-
addressed step 5 with the client before proceeding to step 6. Importantly,
the six steps of a logico-linguistic approach to CBT presented here are
fluid and dynamic, not rigid and inflexible. As such, they can be revisited
if necessary.
Inasmuch as interoceptive imagery and compassion-based meditation are
both phenomenological in character and involve image shifting, they can
work synergistically on building new image/feeling associations and
overcoming old ones. In the case of blame-based anger, these new asso-
ciations aim at reversing the negative valence of the imagery surrounding
the perceived cause of anger (typically the person “at whom” the client is
angry). In the case of blame-based depression, the new images aim at re-
versing the negative valence of the images surrounding the event about
which the client catastrophizes.
 Blame-Based Capacity Disavowals 183

Box 9.10 Practice

Practicing Interoceptive Imagery

The client with blame-based depression who was laid off from his
job can utilize his philosophy extracted from 2 Timothy to shift from
the negative polarity of feeling powerless to a positive interoceptive
feeling. This was illustrated above in the Practice section on
“Embracing an Uplifting Philosophy.” The client would then
practice this exercise until the association with the positive feeling
comes to be associated with the imagery of losing his job in the
pandemic.

In Vivo Practice
Inasmuch as blame-based anger tends to be a persistent occurrence in the
everyday life of a client who makes blame-based anger disavowals, it lends
itself well to in vivo practice. For everyday situations that raise the problem,
the client can accordingly work on identifying her emotional reasoning;
identifying its irrational speech acts; refuting them; identifying the guiding
virtues of the latter; embracing an uplifting philosophy; and putting it into
practice. The faulty speech acts, their refutations, and their guiding virtues
are likely to be consistently the same since blame-based capacity disavowals
typically follow the same cognitive-emotive flow of images and feelings.4
In this kaleidoscope of ever-emerging perceptions of impropriety among
imperfect human beings, practicing compassion-based meditation and in-
teroceptive imagery can be a useful component of in vitro practice. For
there is synergy in working cognitively, affective, linguistically, and beha-
viorally on everyday life occasions where one may feel mistreated by
someone else and experience what feels like anger impossible to quell.
As earlier mentioned, distraction can also be a useful adjunct to over-
coming blame-based capacity disavowals because it serves as a strong mode
of refutation. If the client can go about life without feeling the negative
feelings in question (ones of anger or depression), then she has ipso facto
demonstrated that she does indeed have the power to control her feelings.
The familiar phase “Fake it till you make it” has neurological correlates.
Human beings appear to be capable of “tricking” their brains by acting in
ways other than they feel. Because their actions may be associated with an
alternative, more positive set of interoceptive feelings, the ventromedial
prefrontal cortex may generate this alternative set. For example, smiling
when one feels down can actually help to reverse the antecedent negative
polarity (Riggio, 2012).
184 Overcoming Common Capacity Disavowal
Tackling Major Problems
Clients with blame-based depression who confront major challenges in
their lives, such as the case of the client who was laid off, can use the
occasion to make constructive behavioral changes. These changes can re-
quire courage to act, not allowing oneself to be overwhelmed by feelings of
hopelessness. For example, the client who loses his job in a pandemic may
decide to go back to school to learn new employable skills, apply the skills
he already has in a different way, or get temporary work until the job
market improves. The client can build the willpower to take such a step
forward by working on the other items in the behavioral plan; but at some
juncture, such action is inevitable if working through the depression is to
happen. The guiding virtues are paramount here—Courage, Temperance,
and Unconditional World Acceptance. These virtues provide the guiding
light (the motivation) out of the depths of depression; and the uplifting
philosophies are the nautical maps (cognitive insights with positive valence)
to navigate the sea of life, in all its splendor and surprise, toward the guiding
light. The action plan is then the vessel (means) to transport clients toward
these more peaceful waters.

Bibliotherapy
Movies can often be a useful component of a plan for overcoming blame-
based anger and depression. In the latter case, movies that depict courage in
triumphing over adversity can be useful for such clients. For example, one
movie that has such potential is the film, Lorenzo’s Oil, about a child with
Adrenoleukodystrophy (ALD), an autosomal, neurogenerative disease, and
the dedication of his parents in finding a cure (Miller, 1992). The
Nietzschean philosophy of suffering is laid plainly before the viewer,
showing how out of adversity can arise great things, in this case a discovery
for a disease that had the potential to save other children suffering from the
same disease. Leibnitz’s reminder that what is true of the part is not ne-
cessarily true of the whole also emerges as a theme to remind those with
global damnation that the world may still be the best possible one, not-
withstanding the hardship the family confronted.
One movie that resonates well with the idea of loving kindness in re-
sponse to injustice of others is the 2014 historical drama, Selma, about
Martin Luther King’s struggle to gain voting rights for African Americans
(DuVernay, 2014). King’s response to injustice was not rage but instead
agape (love), channeled into peaceful protest. In Buberian terms, instead of
seeing the oppressors as “It” he proposed seeing them as “Thou.”
According to King, “Agape does not begin by discriminating between
worthy and unworthy people. To the contrary, “It begins by loving others
for their sakes” and it “makes no distinction between a friend and enemy; it
is directed toward both” (King Center, n.d.). Amid great suffering and
 Blame-Based Capacity Disavowals 185
inequity, King’s message of love and peace was shown to prevail in
President Lyndon Johnson’s passage of the Voting Rights Act of 1965. The
film thus shows how the injustice perpetrated by others can successfully be
defeated with love instead of anger and aggression. In this manner, as
bibliotherapy, the film may help to inspire relinquishing the unrealistic
demand not to be treated unfairly and working toward unconditional ac-
ceptance of others, instead.
One book that is likely to strike a positive chord with some if not many
clients is the Art of Happiness: A Handbook for Living, by the Dalai Lama and
psychiatrist, Howard C. Cutler. This book consists largely of accounts that
Cutler had with the Dalai Lama about the challenges of living. The chapters
on suffer and the human potential to mitigate the degree that one suffers in
life by applying Buddhist philosophy can be a potentially useful bib-
liotherapeutic source for clients who make perfectionistic existential de-
mands and, as a result, drive themselves into depression. The chapters on
compassion, loving kindness, and empathy for others can also be potentially
useful for clients who demand fairness and justice from others and, as a
result, harbor self-destructive anger for others.
It is important to emphasize that bibliotherapy, like the philosophies
they exemplify, needs to resonate with the client if they are to be
“uplifting”—that is, efficacious in helping to reverse negative valence po-
larities. This means that one size does not necessarily fit all. For example, a
film or novel that is religion-oriented, or appeals to a particular religious
domination, may work for a religious client or a client with the same re-
ligious orientation, but it may not be appropriate for a more secular client
or a client with a different religious orientation.
The same applies to other types of media used as bibliotherapy. For
example, some clients may have the aptitude and interest to read primary
sources in philosophy and literature while others may not. So, giving a
client Buber’s I and Thou to read may be a reasonable choice for clients with
a strong aptitude to read complex philosophical works, but not for other
clients who may not have the same aptitude or interests (Buber, 1937).

Notes
1 Chapter 1 discusses deontological feelings.
2 “Offers judged as unfair elicited activity both in participants’ brain ‘cognitive’ areas
(e.g., the dorsolateral PFC), as well as in the ‘emotional’ areas, such as the anterior
insulae (and in particular the right insula). Of interest here, this region showed higher
activity on rejected unfair offers compared with fair offers, thereby suggesting, once
again, a key role for emotional involvement in judgements of what is fair and what is
not” (Cropanzano et al., 2017, 739).
3 See the section on “Cognitive-Behavioral Assignments for Clients with Blame-Based
Capacity Disavowals.”
4 This is not necessarily the case, however. For instance, while I have found damnation
of others to be common component of blame-based anger, I have also had clients
186 Overcoming Common Capacity Disavowal
whose anger was focused more on the deed than the doer. Such a case would
therefore not include the part of the syllogism chain in which the client damns the
perceived perpetrator of the perceived misdeed.

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of relating to oneself. Journal of Personality, 77(1), 23–50. https://doi.org/10.1111/j.14
67-6494.2008.00537.x
Nietzsche, F. (1909) Beyond good and evil. H. Zimmern (Trans.). In O. Levy (Ed.), The
Complete Works of Fredrich Nietzsche. Macmillan, Vol. 12. https://archive.org/details/
beyondgoodevilpr1909niet/page/n19/mode/2up
Riggio, R.E. (June 25, 2012). There’s magic in your smile: How smiling affects your
brain. Psychology Today. https://www.psychologytoday.com/us/blog/cutting-edge-
leadership/201206/there-s-magic-in-your-smile
Scott, J.G., Scott, R.G., Miller, W.L., Stange, K.C., & Crabtree, B.F. (2009). Healing
relationships and the existential philosophy of Martin Buber. Philosophy, Ethics, and
Humanities in Medicine, 4(11), 1–9. https://doi.org/10.1186/1747-5341-4-11
Seto, H. & Nakao, M. (2017). Relationships between catastrophic thought, bodily
sensations and physical symptoms. BioPsychoSocial Medicine, 11, 28. https://doi.org/1
0.1186/s13030-017-0110-z
Stefan, S.I. & Hofmann, S.G. (2019). Integrating metta into cbt: how loving kindness
and compassion meditation can enhance cbt for treating anxiety and depression.
Clinical Psychology in Europe, 1(3), 1–15. https://doi.org/10.32872/cpe.v1i3.32941
10 Phobic Capacity Disavowals

Phobic capacity disavowals are impulsive disavowals, which means essentially

that they are generated by the amygdala. Other common forms include
drug, alcohol, and food disavowals (Bechara, 2005).
Phobias involve an intense, irrational fear of an intentional object, and
refusal to accept freedom and responsibility to control this fear. In contrast
to rational fear, phobic fears are unrealistic and involve miscalculations of
probability of danger, especially death. As philosopher Samuel L. Hart
describes, “[t]he fear felt in a threatening situation is invaluable. The ad-
justive value of emotions decreases with their reality incongruence … [and]
instead of making thought abide by the threatening situation, force it to
dwell on imaginary situations” (Hart, 1972, p. 41).
The intentional objects of phobias may include specific objects such as
spiders, dogs, blood, certain foods, and needles; or situations such as flying,
being alone, being in crowed spaces, being in the dark, riding in a car,
being away from home, dying, and being touched. They may also include
social situations such as meeting or speaking to strangers or being observed
by others. Clients who have specific or social phobias may circumscribe
their lives around them. For example, a client with a phobia about flying
may turn down desirable employment that involves some travel; or refuse
to vacation abroad despite a strong desire to do so.
Neurologically, phobic disavowals appear to involve bottom-up emotion
generation where the amygdala is activated by the sight of the object in
question, which signals the ventromedial prefrontal (VMPFC) and soma-
tosensory cortices such as cingulate and insular cortices (Hermann et al.,
2009). However, there also appears to be a top-down, reciprocal response
from the VMPFC,1 which, in turn, can amplify through negative cognitive
processing of the alarm signal sent from the amygdala. This interactivity
between upper and lower forebrain activity appears to provide the neu-
rological correlates of the reaction, and its sustenance barring successful
cognitive-behavioral interventions. Such interventions can succeed by
extinguishing the disposition to respond with fear modulated by the ventral
striatum (Pohlack et al., 2012). Recalling the object of the phobia can also
 Phobic Capacity Disavowals 189
generate the somatosensory fear. In such cases, the VMPFC appears to
trigger this feeling.2
Cognitively, phobias are related to catastrophizing based on over-
estimating the probability of serious physical harm or death from the feared
object. They may be comorbid with other anxiety and mood disorders
including generalized anxiety disorder, panic disorder, and depression
(Witthauer et al., 2016; Merikangas & Angst, 1995). The example provided
below of agoraphobia shows the manner in which panic disorder can come
to be a comorbid factor in a phobia.

Phobic Disavowal Syllogism Chains

Schematically, the syllogism chain of speech acts associated with the cog-
nitive (upper hindbrain) aspect of phobias tends to be along the following
lines:

Distorting Probabilities → Catastrophizing → Phobic Disavowal

(“I can’t help being so afraid”).

For example, a client with agoraphobia might exhibit a syllogism chain that
looks like this:

1. If I have a panic attack I will suffocate to death.

2. But I could have a panic attack if I go shopping at the mall.
3. Therefore, it would be a terrible mistake to go.
4. Therefore, I can’t go shopping at the mall.

Phenomenologically, the following imaginative chain of associations and

speech acts tracks the above syllogism chain:

• In (1), the client dispositionally harbors a negative image of having a

panic attack, gasping for air, and suffocating to death associated with a
feeling of mortal danger.
• In (2), the client imagines a state in which she goes shopping at the mall
which activates her dispositional negative image of having a panic
attack, gasping for air, and suffocating to death, which triggers the
associated feeling of mortal danger.
• In (3), the client, in turn, amplifies this fearful feeling further by
catastrophizing about it—calling it a “terrible mistake.”
• Finally, in (4), the amplified feeling of mortal danger, comingles with
somatic sensations of throbbing heartbeat, muscle contraction, and
imagery of suffocating, playing out simultaneously in the client’s
consciousness. In this painful state, the client feels powerlessness over
this mortal fear of going shopping at the mall, and uses the words, “I
can’t” to disavow her capacity to do so.
190 Overcoming Capacity Disavowal
The dispositional negative image of having a panic attack, gasping for air,
and suffocating to death in (1) has likely been reinforced by a negative, past
traumatic experience of having had a panic attack, perhaps occurring while
the client was shopping at the mall or somewhere elsewhere the client
associates with mall shopping. In turn, the imagery of having a panic attack and
the associated interoceptive feeling of mortal danger in (2) appears to be the bottom-up
contribution of the amygdala, which identifies emotional experience (Phelps,
2004) and (in concert with the hippocampus) modulates storage (McGaugh
et al., 1996) in the medial temporal lobe (Ritchey et al., 2008). This feeling
of mortal danger is then retrieved or “recalled” by the VMPFC3 via so-
matosensory structures such as the insula (Bechara et al., 2000), which has
bidirectional interconnections with the hippocampus as well as the amyg-
dala (Zonjy et al., 2014), when a “thought” (image) associated with it is
entertained such as a friend asking the client to go shopping with her to
the mall.
In (3), the client’s use of catastrophic language application, in response to
the recalled negatively valent experience, amplifies its intensity. This highly
negative output activates the amygdala, which, in turn, activates the hy-
pothalamic–pituitary–adrenal axis, which then generates the bodily feelings
in (4) associated with this elevated body state—increased heart rate, re-
spiration, etc.
On the above hypothesis about neurological processing in phobias, there
is a reciprocal synergy between bottom-up and top-down networks
whereby the process begins (bottom-up) and ends (top-down) with the
amygdala. From a CBT standpoint, this suggests the utility of cognitive
reframing of the amygdala-generated, stored output when recalled and
processed by the VMPFC as a syllogism chain (that is, stream of associated
images and feelings).
In this process, the dispositional image of suffocating to death from a
panic attack sustains the client’s phobia against going to the mall to shop
since the latter going to the mall is associated with the former imagery, from
which the client deduces catastrophizing and, in turn, her phobic dis-
avowal. Accordingly, cognitive behavioral intervention would consist in
overcoming the dispositional image and replacing it with more realistic,
reassuring imagery about mall shopping.
In contrast to the other disavowals discussed in previous chapters, pho-
bias are modulated by the amygdala’s impulsive response to danger. In the
case of risk-aversive, low-frustrative, and blame-based disavowals, the
motivational feeling that generates the disavowal arises from a cognitive desire
in the form of a felt need expressed linguistically as a demand (“I must be
certain,” “I must get what I want immediately,” “Others must never treat
me unfairly,” “Bad things must never happen”). These desires or motiva-
tional feelings appear to be products of the “reflective system” (Bechara,
2005), especially the VMPFC. In the case of phobias, the feeling of mortal
 Phobic Capacity Disavowals 191
danger appears to be an impulse encoded by the amygdala performing its
survival function, albeit in a dysfunctional manner.
In the latter case, the VMPFC is “hijacked” by this impulse, which, in
turn, amplifies the actual danger by distorting probabilities and then cata-
strophizing about them. Cognitive intervention accordingly addresses
helping the client regain rational control of her cerebral function by re-
interpreting the distorted probabilities and substituting a feeling of em-
powerment for that of mortal danger. The next part of this chapter shows
how this may be accomplished using the six-step logic-based methodology.

Step 1: Formulating the Primary Syllogism Using O & R

Applying the O & R formula, the client’s primary syllogism would be as
follows.

Syllogism Chain A
(Rule) If I could have a panic attack if I go shopping at the mall, then it
would be a terrible mistake if I go.
(Report) If I go shopping at the mall, I could have a panic attack.
(Conclusion) Therefore, it would be a terrible mistake if I go shopping
at the mall.

The reportative act in the above syllogism is an imagined, conditional (“If I

go … then …”) event that predicts a negative future outcome of going
shopping at the mall, namely, experiencing another panic attack. In this
way, it resembles the reportative acts of risk-aversive clients who imagine
conditional, future, negative possibilities and suffer anxiety about them.
This is not surprising because phobias are anxiety disorders and the structure
of emotional reasoning of anxiety is future oriented, conditional, and
predicts negative outcomes.
The rule in Syllogism A in turn associates the image of having a panic
attack at the mall with being “a terrible mistake,” and the conclusion ac-
cordingly deduces its being “a terrible mistake” if the client goes shopping
at the mall.

Box 10.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism
In the below part of their session the therapist helps the client find O & R to
construct the primary syllogism.
192 Overcoming Capacity Disavowal
T: So what do you think could happen if you go shopping at
the mall?
C: I could have another panic attack.
T: On a scale of 0 to 10, how bad would it be if that happened? I
want you to answer this by imagining yourself having a panic
attack.
C: [Pause] Okay, it would be like a 10.
T: You mean the worst possible thing that could happen?
C: Ah, yes! I am starting to feel like I’m going to get one just
thinking about it!
T: And it’s that bad?
C: Yes, that bad.
T: So, not a good idea to go to the mall?
C: It would be a terrible mistake!
T: So, what you’re saying is that if you go shopping at the mall, you
could have a panic attack; and if that happened, it would be a
terrible mistake; so that’s why you think it would be a terrible
mistake to go shopping at the mall.
C: That’s right.

Step 2: Expanding the Syllogism Chain

The therapist can then expand the client’s syllogism chain upward by
questioning the rule premise. “So, what if there is a possibility that you
might have a panic attack? Why would that make it a ‘terrible mistake’ even
if you had one?”
In cases of phobic disavowals clients almost invariably rest the latter in-
ference rule on a predictive judgment about coming to serious physical
harm, quite often lethal harm. In the latter case, the syllogism might be
expanded upwards along these lines.

Syllogism Chain B
(Rule 1) If I could suffocate to death if I go shopping at the
mall, then it would be a terrible mistake if I go.
(Report 1) if I could have a panic attack if I go shopping at the
mall, then I could suffocate to death.
(Rule 2/Conclusion 1) Therefore, if I could have a panic attack
if I go shopping at the mall, then it would be a terrible mistake
if I go.
(Report 2) If I go shopping at the mall, I could have a panic attack.
 Phobic Capacity Disavowals 193
(Conclusion 2) Therefore, it would be a terrible mistake if I go
shopping at the mall.

Box 10.2 Practice

Therapist (T)–Client (C) Exchange

Identifying the Source of the Catastrophizing
In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing the source of his catastrophizing.

T: Okay, let’s look at this premise of yours that if you could have a
panic attack it would be a terrible mistake to go shopping at
the mall.
C: Why wouldn’t it be if that happened!
T: Tell me why you think so.
C: I couldn’t breathe! I felt like I was suffocating to death. I
thought I was going to die.
T: So, you think you could suffocate to death, if you go again?
C: Yes, as I told you, I couldn’t breathe!
T: And if you have a panic attack you could suffocate to death?
C: Yes.
T: And if you could suffocate to death it would be a terrible
mistake to go?
C: No duh!
T: So, that’s why, if you could have a panic attack, it would be a
terrible mistake?
C: Yes! I could die.
T: I see.

In Syllogism Chain B, above, Rule 1 provides the inference rule that tracks
the flow of images and feelings, in particular, the feeling of mortal danger
that lead to the speech act of catastrophizing. In conjunction with Report 1,
this rule implies the major premise of the client’s primary syllogism.
The conclusion of the primary syllogism, however, can then be ex-
panded downward as illustrated below.

Syllogism Chain C
(Rule 1) If I could suffocate to death if I go shopping at the mall, then
it would be a terrible mistake.
194 Overcoming Capacity Disavowal
(Report 1) if I could have a panic attack if I go shopping at the mall,
then I could suffocate to death.
(Rule 2/Conclusion 1) Therefore, if I could have a panic attack if I go
shopping at the mall, then it would be a terrible mistake.
(Report 2) If I go shopping at the mall, I could have a panic attack.
(Conclusion 2/Rule 3) Therefore, it would be a terrible mistake
if I go shopping at the mall.
(Disavowal Rule) If it would be a terrible mistake if I go shopping at
the mall, then I can’t do it.4
(Conclusion 3) Therefore, I can’t go shopping at the mall.

Box 10.3 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness
In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: So I understand why you think it would be a terrible mistake if

you go shopping at the mall. But what if you go shopping
anyway?
C: No, I can’t do that!
T: You’re afraid?
C: Very afraid!
T: You feel so afraid that you feel you can’t go shopping at the mall?
C: Yeah.
T: So, the feeling is so strong that you feel powerless over it?
C: Yes, that’s right.

The deduction from Rule 3 (in conjunction with the Disavowal Rule) to the
disavowal in Conclusion 3 tracks the imagery of experiencing another panic
attack associated with the interoceptive feeling of mortal danger that is further
amplified by the act of catastrophizing in Rule 3 and, in turn, generating the
feeling of powerlessness driving the linguistic expression of the “I can’t”
disavowal in Conclusion 3. The practical implication is the client feels in-
capable of going shopping at the mall, and therefore keeps herself from
engaging in this activity. Unfortunately, because such a process of relin-
quishing freedom and responsibility is progressive, it tends to be generalized
to other activities. In extreme cases, this can lead to refusal to even leave the
house, which may become the client’s “only safe place.” Thus, therapeutic
 Phobic Capacity Disavowals 195
intervention sooner rather than later is a good idea inasmuch as the web of
syllogism chains generated by the aforementioned bottom-up/top-bottom
neurological process can expand exponentially to include more and more
aspects of the client’s life until she has severely disabled herself.

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
Indirect refutation of the client’s disavowal can proceed by refuting Rule 1
and Report 1 of Syllogism Chain C. In the case of Report 1, an empirical
refutation is a strong mode of refutation since this rule makes an empirical
claim. Granted it is possible that the client could suffocate to death if she has
a panic attack. However, it is also possible that the client could suffocate to
death drinking a glass of water. The question is therefore how probable such
a possibility is. So, the therapist can challenge the client to provide evidence
to show that there is a significant chance of suffocating to death, that is, a
degree of probability that makes it reasonable to be concerned. And here is
where the client is likely to fall short of a rational basis for concern. “Did
you suffocate to death the last time you had a panic attack, or the time
before that?” Obviously not!
Insofar as Report 1 is refuted, Rule 1 loses its significance inasmuch as its
antecedent is not likely to happen anyway. However, harboring this pre-
mise can still be problematic for the client even if it is not problematic in
the present context. For what if there was a significant possibility of suf-
focating to death? Then it would not suffice to say, “Don’t worry, you’re
not going to die from it.” Indeed, living portends risks; and clients who
have phobias tend to blow risks out of proportion and then catastrophize
about them. So, there are two, not just one, potential phobia drivers that
create a vicious cycle; for, as soon as the client speculates about the possible
risks, the catastrophic thoughts kick in and make those risks feel even
greater. Thus, it is not sound therapy to refute the probability distortion
without also refuting the catastrophizing.

Box 10.4 Practice

Therapist (T)–Client (C) Exchange

Refuting the Catastrophizing
In the below part of their session, the therapist helps the client refute his
catastrophizing as well as its source, namely the probability of suffocating to death.

T: Let’s take a more careful look at your premises. You are so

intensely afraid that you tell yourself you can’t go shopping at
196 Overcoming Capacity Disavowal
the mall. This is because you believe that if you suffocated to
death it would be horrible mistake. And you think that you
could suffocate to death if you had a panic attack while at the
mall. But what’s the probability that you will suffocate to death?
C: I sure felt like I was going to die when it happened.
T: But you didn’t die, did you?
C: No, but I could have.
T: You could have suffocated the last time you drank a glass of
water or slept with a pillow?
C: Maybe, but I couldn’t breathe.
T: You felt like you couldn’t breathe but clearly you did breathe.
C: That’s true.
T: A lot of people get panic attacks. Do you have any evidence that
some, if any, died from their panic attacks?
C: No, I don’t.
T: As a matter of fact, there just isn’t any such evidence. But even if
there is a chance you could suffocate to death, is it helpful to
catastrophize about it?
C: I suppose panicking about having a panic attack is kind of stupid.
T: Right, you would be better off just calmly considering whether
you wanted to take the risk.
C: And then maybe I wouldn’t terrorize myself.
T: Right, it’s self-defeating. In order to protect yourself from
having a panic attack you frighten the daylights out of yourself!
C: I agree, that’s not helping any.
T: Very good!

Here, a pragmatic refutation is useful. “Instead of catastrophizing, is it not

more helpful to calmly assess the risks and make a reasonable decision based on
this assessment? Isn’t the latter approach more likely to avoid needless stress?”
A direct refutation of the “I can’t” disavowal regarding shopping at the
mall can take the form of a logical refutation. “If you really can’t go shopping
at the mall, then how is it that you have gone so many other times before? Is
it rather that you don’t choose to go? And if it’s a choice then you can if you so
choose. And even if you feel like you can’t, does that really mean you truly
can’t? Have you ever felt a certain way but acted contrary to that feeling?”

Box 10.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Phobic Disavowal
 Phobic Capacity Disavowals 197
In the below part of their session the therapist helps the client refute the
capacity disavowal that keeps him a prisoner of irrational fear.

T: So it sounds like you are working yourself up so that you feel

powerless. But just because you feel like you can’t go shopping
at the mall, does that truly mean you can’t? I mean, do people
ever do things even though they feel like they can’t? Did you
ever do something you thought you couldn’t do?
C: Oh yes. I told myself I couldn’t get through biochemistry, and I
got a C in it.
T: And you felt like you couldn’t do this, but you did?
C: Yes, that’s right.
T: So maybe you can go shopping at the mall?
C: Maybe, if I can get over feeling so damn afraid of having a panic
attack.
T: Then, that’s what we will work on.
C: Okay, I am willing to try.
T: Excellent!

Step 4: Identifying the Guiding Virtues

The guiding virtues that can help to promote such counteractive refutations
and reverse the negative polarity of feeling powerlessness are Foresightedness,
Courage, and Continence. Foresightedness can help overcome probability
distortion; Courage, catastrophizing; and Continence, the “I can’t” disavowal.
Having Foresight means tending to make rational probability assessments
rather than distorted claims such as the likelihood of suffocating to death
from a panic attack. Having Courage means tending to act on the basis of
such rational assessments, rather than going to one extreme or the
other—too afraid and not afraid enough. Continence directly counteracts
“I can’t.” It means tending to exercise willpower, keeping the phobic
impulse from “hijacking” her rational self-determination, that is, freely and
responsibly making rational decisions, and acting on them.

Box 10.6 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues
In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming low-frustrative disavowals.
198 Overcoming Capacity Disavowal
T: So, to work on overcoming your fear, let’s set some positive
goals, which can guide you away from the irrational premises we
talked about. We can call them “guiding virtues” because they
can build character by strengthening some of your natural
capacities, and in this way help you to live more happily.
C: Such as? What natural capacities?
T: Humans have the capacity to make rational judgments about the
future based on past experience; but many of us get caught off in
fear and don’t use this capacity to their advantage. So, instead of
exaggerating the chances of dying of a panic attack you can
work on having greater Foresight. By Foresightedness I mean
the habit of basing your judgments about the future on the
evidence of the past, not on fear. So, evidence needs to drive
your fear, not the other way around. That’s one of the things
that helps humans to deal satisfactorily with life.
C: I get it. Being afraid only when there’s a good reason to be.
T: Right! And, instead of catastrophizing about things, you can also
work on Courage.
C: Get up the courage to go to the mall?

T: Precisely. And exercising willpower to decide freely instead of

being constrained by feeling powerless. This is sometimes called
Continence.

C: That sounds good. I hope I can do it.

T: Being hopeful is also good!

Step 5: Finding an Uplifting Philosophy

As discussed in prior chapters, guiding virtues, are habits cultivated through
practice and exercise. The latter involves making cognitive and behavioral
changes through cognitive reframing utilizing positive philosophies to re-
verse the negative polarity of imagery associated with mortal danger.

Philosophies of Foresightedness
These uplifting philosophies perform the latter function by helping clients
to cultivate a more realistic appraisal of probabilities. In the context of
treating phobic clients, the goal of these philosophies is to encourage and
inspire belief on evidence, not on blind fear. While the former promotes
truth, the latter leads to falsehood.
 Phobic Capacity Disavowals 199
The Pragmatic Theory of Truth
The pragmatic theory of truth, which looks for the “cash value” of
believing—or not believing, holds that truth lead to satisfaction, while false
beliefs lead to the opposite. According to its pragmatist philosopher William
James,

Pragmatism asks its usual question. “Grant an idea or belief to be true,”

it says, “what concrete difference will its being true make in any one’s
actual life? … What, in short, is the truth’s cash-value in experiential
terms?” The moment pragmatism asks this question, it sees the answer:
TRUE IDEAS ARE THOSE THAT WE CAN ASSIMILATE,
VALIDATE, CORROBORATE, AND VERIFY. FALSE IDEAS
ARE THOSE THAT WE CANNOT. That is the practical difference
it makes to us to have true ideas… Any idea that helps us to deal,
whether practically or intellectually, with either the reality or its
belongings, that doesn’t entangle our progress in frustrations, that
FITS, in fact, and adapts our life to the reality’s whole setting, will
agree sufficiently to meet the requirement. It will be true of that reality.
(James, 2013, my bolding)

So, phobic beliefs are false because they frustrate us and prevent us from
dealing satisfactorily with reality. From this pragmatic perspective, looking
at the client’s phobic belief that she will die from a panic attack, it becomes
evident that such a belief is false because it does not permit her to deal
satisfactorily with reality. The true belief is, instead, one that she can “as-
similate, validate, corroborate, and verify.” This means that her past ex-
perience of not having died of suffocation from past panic attacks can be
used to expose the falsehood of her belief because it demonstrates clearly
that her belief cannot be confirmed. It cannot be “assimilated” because it
runs up against her experience and is inconsistent with it; it cannot be
corroborated because she survived her previous panic attack, along with
countless others who have had panic attacks.
This theory of truth thus gives the client a lift toward Foresightedness
inasmuch as it inspires the client to look for such validation, and to discount
blind fear in favor of truth.

The Duty to Seek the Truth

Seizing on truth’s alignment with past experience, English mathematician,
W. K. Clifford (1886), proclaims that every human being has a human duty to
question all that we believe and to believe only on sufficient evidence. For, “every
time we let ourselves believe for unworthy reasons, we weaken our powers
of self-control, of doubting, of judicially and fairly weighing evidence”
(p. 4). As a result, we develop habits of believing falsely. However, not only
200 Overcoming Capacity Disavowal
are such bad habits detrimental to the welfare of the individual who cul-
tivates them; they are also dangerous for other human beings with whom
the individual speaks. “Habitual want of care about what I believe leads to
habitual want of care in others about the truth of what is told to me” (p. 5).
So, if the client believes that she will probably die if she has another panic
attack, without having adequate evidence for this belief, she serves as a poor
role model for others with whom she interacts—her children, family,
friends, and peers, among others. “Men speak the truth to one another
when each reveres the truth in his own mind and in the other’s mind; but
how shall my friend revere the truth in my mind when I myself am careless
about it….” (p. 5) As such, the client, along with all human beings, shares a
duty to believe on sufficient evidence. Clifford eloquently sums up:

Belief, that sacred faculty which prompts the decisions of our will, and
knits into harmonious working all the compacted energies of our
being, is ours not for ourselves, but for humanity. It is rightly used on
truths which have been established by long experience and waiting toil,
and which have stood in the fierce light of free and fearless
questioning. (p. 3)

With this positive, abstract phrase, “Standing in the fierce light of free and
fearless questioning,” Clifford offers clients with phobic disavowals a
powerful linguistic lift toward Foresightedness, relinquishing her patently
unverifiable claim about the lethal nature of her panic attacks.

Philosophies of Courage
In the context of phobic disavowals, these uplifting philosophies involve
seeking moderation between two extremes, that of catastrophizing about
having another panic attack, and that of doing nothing to address one’s
panic attacks. Going to the former extreme, means ruminating about
imagery associated with a feeling of mortal danger and telling oneself how
awful, horrible, or terrible it would be to do anything that might bring on a
panic attack; thus, curtailing one’s freedom and autonomy to engage in a
palpably safe activity such as shopping at the mall. Going to the latter ex-
treme means denying that one has a problem in the first place, rationalizing
the phobia, and making excuses about not going to the mall (“I was just too
tired to go”). In the case of either extreme, the client perpetuates the
dysfunction, and reinforces the self-defeating fear.

Death Is Nothing Terrible Anyway

Because catastrophizing death cognitively amplifies and sustains the phobic
response, the Stoic view of death can provide a potentially useful philo-
sophical antidote to it. Epictetus (1948) admonishes,
 Phobic Capacity Disavowals 201
Men are disturbed not by things, but by the views which they take of
things. Thus death is nothing terrible, else it would have appeared so to
Socrates. But the terror consists in our notion of death, that it is terrible.
When, therefore, we are hindered or disturbed, or grieved, let us never
impute it to others, but to ourselves—that is, to our own views. (ch. 5)

So, in telling herself that, it would be a terrible mistake to go mall shopping,

if she could die from a panic attack (see Syllogism C, Rule 1, above), the
client is creating her own “terror.” She does this, according to Epictetus,
through her own judgment about death. Thus the idea here is for the client
to exercise her freedom to relinquish this judgment. “I am driving myself
crazy by first telling myself I am going to die of a panic attack if I go
shopping, and then telling myself how horrible that would be. I can instead
stop telling myself these things in the first place and stop terrorizing myself.”

Death May Be a Good Thing

In the dialog, The Apology, written by ancient Greek philosopher, Plato,
Socrates defends himself in court against charges of corrupting the youth of
Athens, for which he has been sentenced to death. Confronted by death, far
from catastrophizing about it, he rejects the belief that death is an evil, and
instead reframes it as possibly a good thing. He says,

Let us reflect in another way, and we shall see that there is great reason
to hope that death is a good; for one of two things—either death is a
state of nothingness and utter unconsciousness, or, as men say, there is a
change and migration of the soul from this world to another. Now if
you suppose that there is no consciousness, but a sleep like the sleep of
him who is undisturbed even by dreams, death will be an unspeakable
gain. … But if death is the journey to another place, and there, as men
say, all the dead abide, what good, O my friends and judges, can be
greater than this? (Plato, 2020, 40d)

For the client who believes in a hereafter, physical death is a prelude to a

new life in which one is reunited with loved ones; and for the client who
does not believe in a hereafter, death is a peaceful eternal night’s sleep.
On either reframe, there is reason to hope for something positive; thus,
providing new positive images for reversing the negative polarity of the
former ones.

Death Is Nothing to the Living or the Dead

Ancient hedonist philosopher Epicurus provides a further reframing of death,
not as either a good or evil, but instead, nothing to the living. He admonishes,
202 Overcoming Capacity Disavowal
Accustom yourself to believe that death is nothing to us, for good and
evil imply awareness, and death is the privation of all awareness;
therefore a right understanding that death is nothing to us makes the
mortality of life enjoyable, not by adding to life an unlimited time, but
by taking away the yearning after immortality. For life has no terror; for
those who thoroughly apprehend that there are no terrors for them in
ceasing to live. (Epicurus, n.d.)

On this view, the image of death as something terrible creates unnecessary

anxiety in living and undermines one’s happiness. However, by reframing
the state of being dead as neither good nor evil—because such valuation
assumes awareness, which is absent in death—the client can relieve this
anxiety and thus enjoy life more fully. Indeed, on this reframe, catastro-
phizing about death by rating it “the most awful of evils,” is irrational since,
“it is nothing, then, either to the living or to the dead, for with the living it
is not and the dead exist no longer.” So, the phobic client who magnifies
the risk of dying of a panic attack, and then catastrophizes about it can take
solace in the image of dying from a panic attack being not only unlikely,
but also nothing to the living or to the dead.

Philosophies of Continence
These philosophies providing uplifting images for overcoming self-
destructive physical impulses such as life-restrictive phobias. They em-
phasize accepting one’s freedom to control such irrational impulses as
phobias, and to act accordingly.

Yoga’s Transcendence of Fear

According to the Yoga Sutras of the ancient Indian sage Pantanjali (2011),
fear arises as a result of being absorbed in the material world and one’s
psychical responses to it. “The causes of suffering are not seeing things as they
are, the sense of ‘I,’ attachment, aversion, and clinging to life” (sutra 3). Thus,
in this state a person is preoccupied with her own fears, desires, feelings,
sensations, and, by implication, their linguistic expression. Caught up in this
kaleidoscope of changing images and feelings, one can readily mistake “that
which is impermanent, impure, distressing, or empty of self [Soul] for per-
manence, purity, happiness, and self [Soul]” (sutra 5).
According to this classical Hindu philosophy, transcending such “hindrances”
is attained through increased awareness of their true nature—“impermanent,”
“impure,” “distressing,” and “empty.” Attainment of this “pure awareness” is
the ultimate goal of this approach, which can be undertaken through meditative
practice.
It is stated, “Focusing with perfect discipline on the ‘tortoise channel,’ one
cultivates steadiness” (sutra 32). The “tortoise channel” refers to the chest
 Phobic Capacity Disavowals 203
cavity within which the heart beats rapidly when one is afraid. Quite accu-
rately, the hypothalamic-pituitary access speeds up cardiorespiratory functions
and the rapid heartbeat is felt in the chest when a person experiences fear.
Focusing nonjudgmental attention (“with perfect discipline”) on the
heartbeat helps the person to cultivate self-control (“steadfastness”). The
goal here is “pure awareness” of the feeling, not its interpretation or eva-
luation. The latter can mislead the client into thinking she is about to die
and can thus lead to catastrophizing. The former does not mislead but
instead liberates one from the turbulent sea of sensations. Once liberated,
the client can then reframe the phenomenal world (experiential world) as
providing an opportunity to graduate to such a higher state of conscious-
ness, free from such turmoil. One metaphor Pantanjali uses to capture this
state of “pure awareness” is that of a “luminous mind,” which raises the
image of a bright light shining through to consciousness from the phe-
nomenal world, enlightening it to the true nature of reality (Chapple, n.d.).
Attainment of the latter peace of mind requires practice, however. “Both
practice and non-reaction are required to still the patterning of con-
sciousness.” And the purpose of “Yoga is to still the patterning of con-
sciousness.” Through such practice in “stilling” the turbulent states of
consciousness, the client can come to see through the thin veneer of false
danger signals, to see them as “impermanent, impure, and empty” residuals
of suffering that obscure one’s true being, and to shift from such negative
linguistic polarity to that of the uplifting language of “liberation,” “pure
awareness,” and “luminous mind.”
Charles Johnston (2010), Sanskrit scholar and Indian philosophy scholar,
eloquently expresses the mediative state involved in such “pure awareness”:

…First, the beam of perceiving consciousness is focused on a certain

region or subject, through the effort of attention. Then this attending
consciousness is held on its object. Third, there is the ardent will to
know its meaning, to illumine it with comprehending thought. Fourth,
all personal bias—all desire merely to indorse a previous opinion and so
prove oneself right, and all desire for personal profit or gratification
must be quite put away. There must be a purely disinterested love of
truth for its own sake. Thus is the perceiving consciousness made void,
as it were, of all personality or sense of separateness. The personal
limitation stands aside and lets the All-consciousness come to bear upon
the problem. The Oversoul bends its ray upon the object, and
illumines it with pure light. (bk. 3, ch. 3)

Here, the idea of “pure light” illuminating the mind is a metaphor for a
“purely disinterested love of truth for its own sake.” This identification of
light with such “love” is again an uplifting metaphor. The light fills the mind
with love, and all the personal distractions (including one’s fear) are voided.
One is infused with the “Oversoul,” that is, the universal light of truth.
204 Overcoming Capacity Disavowal
Human Beings Unlike Other Animals Have the Power of Rational Choice
According to Aristotle (1941), to be continent means to have irrational
impulses while still having the self-control not to act on them. This means
that one may feel afraid to do something but still be able to do it, not-
withstanding the feeling of fear.
Moreover, “the incontinent man acts with appetite, but not with choice;
while the continent man on the contrary acts with choice, but not with
appetite” (bk. 3, ch. 2). According to Aristotle, this means that the con-
tinent person, unlike the incontinent person, engages in a rational, delib-
erative process about the means to the end sought. Thus, the continent
client may have an irrational impulse to avoid mall shopping for fear of
having a panic attack, however come to the conclusion that being able to
lead a successful life requires that she do things that will promote her social
and emotional wellbeing. On the other hand, allowing herself to cave to
her fear will disempower her and may eventually progress to fear of leaving
her house if she does not stand up to her fear.
Here, Aristotle’s antidote to a phobic impulse is to act contrary to it by
using one’s rational deliberative ability. For him, this is what separates
animals from human beings, since “choice is not common to irrational
creatures … but appetite and anger are” (bk. 3, ch. 2). Whereas animals do
not possess the deliberative powers to choose to act one way or another
notwithstanding their appetites, human beings do have such power. Thus,
surrendering this capacity and caving to the appetite is contrary to human
nature itself. Viewed in this light, it is a mark of one’s humanness to make a
choice and act on it despite the irrational pulse. “I am a rational being with
the capacity to exercise deliberative power over my animal impulses such as
my fear. This is what makes me special among other creatures in nature.”

Freedom and Responsibility, Not Bad Faith

Jean-Paul Sartre (2007) famously remarked,

Existentialists do not believe in the power of passion. They will never

regard a grand passion as a devastating torrent that inevitably compels
man to perform certain acts, which, therefore, is an excuse. They think
that man is responsible for his own passion. (29)

In this succinct statement, Sartre provides a potent lift for a client who seeks
refuge in her fear as a deterministic excuse for not venturing out into the
world to define herself through are actions. The chief idea is that the
perceived “I can’t” is really a choice, not the result of an invisible cause that
forcibly forecloses freedom and responsibility to act.
The feeling of powerlessness arising out of visceral feelings and images
elevated by the client to the level of a catastrophe is still just a feeling, not
 Phobic Capacity Disavowals 205
(ordinarily) a brain lesion that destroys the capacity to act. So, Sartre is quite
correct that the “I can’t” disavowal of capacity to act is “bad faith”
(pp. 47–48), that is, simply lying to oneself. The lift comes from realizing
that one is, as Sartre would say, “condemned to be free.” In this combi-
nation of “condemned” with “freedom” lies a jarring affective polarity that
has potential to disrobe the feeling of powerlessness:

We are left alone, and without excuse. That is what I mean when I say
that man is condemned to be free. Condemned, because he did not
create himself, yet nonetheless free, because once cast into the world,
he is responsible for everything he does. (p. 29)

The paradoxical combination of abstractions in “condemned to be free,”

side-by-side with “liberty” and “responsible for everything” conjures a
feeling of uneasiness with the feeling of powerlessness, and thus gives rise to
a somatosensory sense of power at odds with powerlessness. This is Sartre’s
existential “kick in the pants” for the phobic client who chooses to be
sidelined by “existential angst,” particularly about dying of a panic attack.

Box 10.7 Practice

Therapist (T)–Client (C) Exchange

Embracing Some Uplifting Philosophies
In the below part of their session, the therapist helps the client to find several
philosophies she can use in overcoming her phobic disavowal.

T: These guiding virtues—Courage, Foresightedness, and

Continence—can be looked at differently depending on
your world view. For example, some people are religious
and see Courage from the perspective of devotion to God.
C: I think of myself as a spiritual person, but I am not into religion,
at least not organized religion where you go to a house of
worship and pray.
T: Okay, so how do you look at what it means to be courageous?
Since you are concerned about dying, how do you look at death?
What does it mean to be courageous in confronting death?
C: I suppose, not being afraid so afraid of dying so that it prevents
you from living.
T: Very good! So how can you look at death, so you aren’t too
afraid to live, or to live well?
C: I think it would mean looking at death more rationally rather
than being so afraid to die.
206 Overcoming Capacity Disavowal
T: What would be a more rational way of thinking about death?
C: I’m not sure, maybe seeing it as a part of a process, and so not
really terrible.
T: The ancient Greek philosopher, Epicurus, said that death is
nothing to the living or the dead, because when you’re alive
death is not there and when you’re dead you’re no longer alive.
So, either way, it’s not terrible to the living or the dead.
C: I get that. Yeah, that makes sense to me. I like that!
T: Great! So, you can use this to work on Courage in facing your
panic attacks. And, as we said, in any event, the likelihood of
dying from a panic attack is not backed by evidence. So how can
you become more Foresighted about confronting possibilities?
Do you have any worldview on that?
C: I guess to pay attention to the facts more.
T: Why should you do that?
C: Well, because they you won’t do things, or not do them, that
you’ll be sorry about later.
T: There’s a philosopher by the name William James who would
agree with you. He said that the facts, or true ideas, are ones that
have “cash-value in experiential terms.” He means that if you have
a true idea it will work for you; but if you have a false idea, you will
run into trouble because it will conflict with other facts. So, in the
end, if you tend to believe false ideas then you will be an unhappy
camper, and more likely to be happier by believing true ones.
C: Yeah, like thinking that panic attacks cause you to suffocate to
death. That’s been causing me a lot of headaches!
T: Yes, great insight!
C: I see how this can be helpful, looking at things different can
make you feel better.
T: Exactly! So how can you look at this feeling of being powerless
in a different way that can make you feel, and do better?
C: That’s a good question! I don’t know, maybe just do it anyway?
Stop making excuses!
T: Yes, that’s what so-called “existentialists” say to do. These are
philosophers and psychologists who stress exercising your
freedom and taking responsibility for your decisions, even
your inaction. One of them, Jean-Paul Sartre, tells everyone
that they are “condemned to be free,” by which he means that
no matter what we do, or don’t do, it’s our choice and we bear
the responsibility. And when you tell yourself “I can’t” you are
just lying to yourself, living in what he calls, “bad faith”; and so
you have this power over your fears, whether or not you choose
to exercise it. And it’s always your choice. You have the power!
And it’s always your choice whether or not you exercise it.
That’s what he means “condemned to be free.”
 Phobic Capacity Disavowals 207
C: It makes me a bit nervous, but sort of in a good way. Like
lighting a fire under me, getting me to do something sensible. I
can see this. Yeah, I like this too.
T: Excellent! You said before that you consider yourself a spiritual
person. Can you tell me about that?
C: Yes, I believe that there is something bigger than myself;
something more powerful and in some ways truer than my
own thinking about things. Why?
T: Well, I was thinking about the classical Hindu perspective on
reality. Have you heard of Yoga?
C: Of course. You meditate sitting down, I think. I don’t know
much about it, though. Can you tell me something about it?
T: Sure, I’m thinking about the idea that the material world we live
in creates a lot of turbulence in our minds. There’s the ups and
down of living, and people work themselves up needlessly very
often, and nothing really changes anyway. Well, the idea is to
use this world as a kind of looking glass into something greater
than it. It helps you heighten your awareness of the way things
really are. So, you feel afraid, and by thinking about your fear,
you come to see that it really is a kind of illusion and it gets you
to think more about what is real.
C: That’s sort of like what we have been doing in our counseling
sessions.
T: Yes! You are starting to gain greater awareness about the true
nature of panic attacks, the fear of death, and death itself. This
can help you to feel a greater connectedness with reality, what
the Yogis call a “luminous mind,” one where the light of truth,
and the love of truth enlightens you and lifts up your spirit.
C: Very neat! I think this may already be helping!
T: Wonderful!

Step 6: Constructing a Plan to Apply the Philosophies

Here is where the client has an opportunity to put her uplifting philoso-
phies into action, first with coming to terms with the negative impact of her
phobic disavowal.

Question 1: In What Ways Has Your Phobia Negatively Impacted

Your Life and/or the Lives of Others?
Restricted activities are obviously a common consequence. In cases of
agoraphobia with panic disorder these restrictions tend to expand to further
208 Overcoming Capacity Disavowal
areas of life (Baumgold, 1977). They can affect social and working re-
lationships by virtue of such avoidance. The result tends to be dysphoria.
Clients with specific phobias are also at risk of developing other anxiety
disorders, depressive disorders, bipolar disorders, and substance abuse dis-
orders (American Psychiatric Association, 2013, p. 202).

Question 2: What Changes Would Your Uplifting Philosophies

Prescribe?
Reasonable responses would include replacing the feeling of powerlessness
with affirmative feelings of power and control; exercising rational decision-
making; attaining skill in calming down amygdala impulses; being more
realistic about probabilities; reframing the idea of death in a non-
catastrophic way; and pushing yourself to act notwithstanding your fear.

Question 3: How Are You to Make These Constructive Changes?

Here is where the therapist and client can work together to assemble a
cognitive-behavioral plan that can help the client work toward the afore-
mentioned changes.

Box 10.8 Practice

Therapist (T)–Client (C) Exchange

Setting up a Cognitive-Behavioral Plan

T: So maybe we can use the ideas we talked about, the different

ways of looking at things, to build a plan action. I mean some
things you can do to overcome your fear and become more
courageous, foresighted, and continent.
C: Yes, actually I’m excited about this!
T: Great! Let’s start with thinking about the ways your fear of
going shopping at the mall has impacted your life, or the lives of
your friends, family, coworkers, or other people in your life.
This way, we can get a handle on the things we can work on
changing. How does this sound?
C: Yes, sure.
T: So how has this fear impacted your life?
C: I have found myself lying to my friends when they want to hang
out and shop at the mall. I had always liked to try on clothes
before buying them so I can get a good fit; but now I just order
stuff online, and keep things that I never would have purchased
in the first place, just so I don’t have to ship them back, which is
 Phobic Capacity Disavowals 209
a pain in the neck. I also always enjoyed the mall. There are
some nice restaurants I used to eat in; and now I don’t get to eat
in those places. I have less friends now because some of them
have gotten tired my excuses; and in this town, most of the
entertainment and stuff is in the mall; so I can see why they are
frustrated with me; I am frustrated with myself!
T: I see! So, we can definitely put together a plan that can help you
work on these issues. But it will take work on your part. I mean it
will involve working on changing your thinking in the ways we
talked about in relation to you fear; and it will involve making
behavioral changes too. Are you willing to put in the work?
C: Yes, I am willing to try!
T: Excellent!

Cognitive Behavioral Assignments for Clients with Phobic Disavowals

The following exercises are some potentially useful suggestions for assem-
bling the cognitive-behavioral plan.

Cognitive Reframing Exercises

Clients with phobias who persist in their catastrophic speech activities are
not likely to make constructive changes. As discussed, in phobias the ex-
aggerated fear impulse generated by the amygdala is amplified by cata-
strophizing, whereas the opposite is needed to subdue the impulse. This is
where philosophical reframing comes into the picture. Instead of rehearsing
the negatively valent images of suffocating to death at the mall, and cata-
strophizing about it (“How terrible, horrible, and awful!”), the goal is to
reframe with images that move toward greater Courage. The various re-
frames of death discussed previously provide ways of building such new
images. “If I die of a panic attack, it will be like an uninterrupted, peaceful,
eternal night’s sleep, so why the terror?” In this manner, the client can
work on extinguishing the association of the negative images of suffocating
to death with going mall shopping (for example).
The client can use Sartre’s idea of being “condemned to be free” to
counteract the association of mall shopping with the feeling of powerlessness
by imaging mall shopping and then entertaining the latter language along
with “liberation,” “freedom,” and “responsibility.” Here, imagining the
negatively valent image along with such positive language can help to reverse
the negative polarity of the former image (Knuppenberg & Fredericks, 2021).
The client can rehearse Clifford’s idea of a duty to question things rather than
dogmatically accepting them without adequate evidence while reflecting on
the groundless image of dying from a panic attack.
210 Overcoming Capacity Disavowal
The client can reflect on the human capacity to make rational choices by
deliberating about means to ends and acting according to those choices rather
than being ruled by a slavish compulsion to act on impulse. This is an im-
portant segue into actually practicing acting on such rational deliberation.

Systematic Exposure
Behavioral change is essential in overcoming phobias. Systematic exposure
means gradually working up to the actions that are the intentional objects of
the fear. Thus, for example, the client might start by watching a video of
shoppers at a mall; then perhaps driving by the mall; parking in the parking
lot; walking up to the mall entrance; going in the entrance and walking
back out; increasing gradually the time spent in the mall.
In these activities, the client rehearses the cognitive framing exercises
discussed above. The goal is to bring cognitive appreciation into alignment
with emotional appreciation of the safety of going shopping at the mall.
It is possible that the client has a panic attack in this process; however, the
client will have worked cognitively on the imagery associated with the panic
attack and worked to extinguishing the negative association as discussed
above. In so doing, the client is poised to work through the panic attack.

Mindfulness: Yoga Meditation

Mindfulness meditation is also a useful component of a phobia action plan
because it can teach the client how to tune out the catastrophic acts that
give the phobia legs. The key is that one does not evaluate or rate the
psychic phenomenon; one only becomes aware of it. In Yoga meditation,
this involves practicing this “nonreactive” watching of the fear, that is,
perceiving the feeling in the chest cavity (and throat) without catastro-
phizing about it.

Box 10.9 Practice

Practicing Yoga Meditation

I have found Moon and Rock (2018), the “Guided Meditation for
Releasing Fear and Anxiety,” to be useful for working through fear
using Yoga meditation. The client with a phobic disavowal might
make it part of her action plan package.
This video artfully uses the metaphorical image of an opening in the
head through which the pure light of love (“pure awareness”) flows in
while the black smoke of fear floats away through the same opening.
 Phobic Capacity Disavowals 211
Bibliotherapy
One self-help book on overcoming phobias that I would recommend is
Phobia Relief: From Fear to Freedom by Kalliope Barlis (2016). Based on
neurolinguistics, it contains pointed exercises that may be useful for helping
clients with phobias to practice interoceptive imagery to reverse the negative
valence of images and associated feelings that lead to phobic disavowals.
Another self-help book in this area is When Panic Attacks: A New Drug-
Free Therapy to Beat Chronic Shyness, Anxiety and Phobias by David Burns
(2010). This book, which is based on the CBT approach of Aaron Beck
(1979), is especially tuned in to reportative speech acts such as over-
generalizing, bifurcating, and distorting probabilities.
An excellent Rational-Emotive Behavior Therapy self-help book that
tops off Burns’ treatment of reportative speech acts with forms of perfec-
tionistic demands and the self-destructive speech acts deducible from them,
is How To Control Your Anxiety Before It Controls You by Albert Ellis (2016).
This book contains an expansive set of interventions for dealing with an-
xiety, including phobias.
A film that provides a particularly potentially uplifting valence for clients
with phobic disavowals is Pontiac Moon directed by Peter Medak (1994).
This film, starring Ted Danson and Mary Steenburger, tells the tale about a
journey in 1969 undertaken by a father, Washington Bellamy (Ted
Danson), and his son, in a vintage 1949 Pontiac with an odometer reading
of 237,081. The journey is to the Spires of Moon National Park, exactly
1776 miles away, which would put 238,857 miles on the car, the same
amount of miles from Earth to the moon. Washington plans the trip in
tandem with the Appollo 11 moon launch so that he and his son would
arrive at the same time the moon landing occurs. The kicker is that
Danson’s wife (Mary Seenburger) suffers from agoraphobia and has not
been out of the house for seven years. The trip draws her out of the house.
Mustering up the Courage, she follows her two loved ones in a car that can
turn into a boat. The story proceeds, metaphorically associating the
monumental triumph of this brave woman with the triumph of stepping
foot on the moon. The uplifting themes of love and triumph coupled with
the idea of reaching for the moon, gives this movie a special magical,
uplifting character that would auger well for clients who have phobias,
especially, but not exclusively, agoraphobia.

Notes
1 “The common recruitment of PFC [prefrontal cortex] highlights that top-down and
bottom-up processes may be coactive in many circumstances, and that any task may
only partially disentangle them” (Ochsner et al., 2009).
2 “The VMPC, by contrast, is involved in inducing somatic states from secondary in-
ducers, or entities generated by the recall of a personal or hypothesized emotional
event” (Gupta et al., 2011).
212 Overcoming Capacity Disavowal
3 “The amygdala is involved in inducing these somatic states from primary inducers, or
stimuli/entities that are innate or highly learned to be pleasurable or aversive (e.g.,
snakes; monetary reward or punishment). The VMPC, by contrast, is involved in
inducing somatic states from secondary inducers, or entities generated by the recall of a
personal or hypothesized emotional event” (Gupta et al., 2011).
4 The Disavowal Rule is grayed-out here because it is the catastrophizing in Rule 3
that would be challenged by the therapist, not this inference rule.

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11 Hyper-Egoic Capacity
Disavowals

Hyper-egoic capacity disavowals are volitional disavowals in which clients

disavow the capacity to tolerate situations in which others disagree with
them and/or the people themselves who disagree with them. These dis-
avowals are associated with intense anger when the client encounters such
situations. Clients who engage such disavowals tend to have difficulty
maintaining satisfying relationships in their personal, working, and social
lives.
Hyper-egoic disavowals proceed from top-down control in contrast to
impulsive disavowals such as phobias, which originate with activation of the
amygdala (see Chapter 10). Hyper-egoic disavowals originate with activa-
tion of the prefrontal cortex and are therefore outputs from dysfunctional
speech activities related to cognitive processing of exteroceptive stimuli.
More precisely, I submit that this type of disavowal proceeds from a
perfectionistic epistemology according to which the client perceives himself
to be the arbiter of reality. That is, the client demands that truth, or reality,
correspond to his beliefs rather than accepting that his beliefs are true when
they correspond to reality, and false when they do not. In this way, the
client defies the very commonsensical “correspondence theory of truth”
succinctly articulated by Aristotle over two thousand years ago. “To say of
what is that it is not, or of what is not that it is, is false,” said Aristotle
(1909), “while to say of what is that it is, and of what is not that it is not, is
true” (Metaphysics, 1011b25). Oppositely, the hyper-egoic client takes the
truth to be what the client says it is, not whether it agrees with an objective
(intersubjective) criterion of reality (Cohen, 2017).
In the extreme, the client satisfies the diagnostic criteria of narcissistic
personality disorder (NPD). According to the American Psychiatric
Association (2013), Diagnostic and Statistical Manual (American Psychiatric
Association), NPD is “a pervasive pattern of grandiosity (in fantasy or be-
havior), need for admiration, and lack of empathy.” The client with NPD
manifests grandiosity by autocratically demanding obedience by others, and
special treatment or recognition. Such individuals may display delusions of
grandeur, imagining themselves as having “unlimited success, power,
brilliance, beauty or ideal love” (pp. 669–670).
 Hyper-Egoic Capacity Disavowals 215
This contrasts the habitual liar who assesses truth as correspondence to
reality but nevertheless attempts to deceive others about it. Instead, the
hyper-egoic client demands reality into existence as the scriptural God did
in the story of creation (“Let there be light”) and then issues the demand
(“Commandment”) that others accept it without question.
Phenomenologically, human beings experience the external world
through their own subjectivity and process reality through the set of images
and feelings that they have acquired throughout their lives. So, it is un-
derstandable that human beings harbor a predisposition or bias toward their
own view of reality. Unfortunately, the hyper-egoic client, as understood
here, fails to compensate for this predisposition by attempting to understand
the alternative perspectives of others and to tolerate them, notwithstanding
that they may differ or contradict their own. Here, the capacity to ex-
perience empathy for others can play a crucial role in transcending one’s
own subjectivity to recognize the legitimacy of others’ subjectivity.

Hyper-Egoic Syllogism Chains

The syllogism chains of hyper-egoic clients begin with the aforementioned
demand that reality agree with their own beliefs, and, more generally speaking,
to their own preferences, judgments, desires, values, and expectations.
Schematically, such chains proceed as follows:

Demanding Reality → Catastrophizing about disagreement from

others/damning others who disagree → Hyper-egoic Disavowal

As suggested above, there are two different versions of the syllogism

chain—one involving catastrophizing, the other damnation. Less schema-
tically, the first proceeds along the following lines.

Version A
1. It must be true if I say so.
2. But you are questioning my judgment.
3. Therefore, this is awful.
4. Therefore, I can’t stand it.

For example, the client may believe that the Republican Party is the best
political ideology because it is less likely to increase taxes to support social
programs such as reducing poverty and helping underprivileged and min-
ority groups. The client may believe that everyone has an equal shot at the
pie, and it is the underprivileged person’s own fault that she is impoverished
and it is not the client’s charge to “bail her out” with his “hard-earned”
money. The client accordingly may demand that reality be just as he be-
lieves it to be, and that, therefore, others believe it too, unquestionably. So,
216 Overcoming Capacity Disavowal Types
when a socially conscious Democrat disagrees with the hyper-egoic client,
he catastrophizes about it and then tells himself he can’t stand being chal-
lenged about what he demands be true. For, from the client’s perspective,
his view is the true one since it is the one he accepts (it makes the most sense
to him) and that, therefore, it is an awful thing that the socially conscious
Democrat has the audacity to “falsely” challenge his political belief.
Often, hyper-egoic clients tend to hold a version of the above argument
that is directed personally against the individual who challenges or disagrees
with the client’s belief. Accordingly, this second version of the syllogism
chain looks like the following:

Version B
1. It must be true if I say so.
2. But you are questioning my judgment.
3. Therefore, you are a horrible person.
4. Therefore, I can’t stand you.

In Version B of the syllogism chain, the client attacks and damns the person
(premise 3), not simply the act of disagreeing or challenging him. “That
Democrat is a stupid jerk.” Based on my observations, this version appears
to be the most prominent form of hyper-egoic disavowal and tends also to
generate the most intense anger. However, the two versions of the syllo-
gism chain are not mutually exclusive; and, while a client who harbors the
former (the version that catastrophizes about being challenged) may not also
harbor the latter (the version that damns the person who makes the chal-
lenge), the client who harbors the latter tends to also harbor the former. As such,
overcoming hyper-egoic disavowals often requires working on overcoming
both catastrophizing and damnation of others.
Phenomenologically, the syllogism chains presented in Versions A and B
track the following flow of feelings and images:

• In (1), the client dispositionally harbors a felt need to always be correct,

which is linguistically expressed in terms of an epistemic demand that
reality match his own judgment (“It’s true because I say so”).
• In (2), the client perceives another person questioning his judgment,
which activates the felt need to always be correct in (1). The client, in
turn, focuses attention on the incompatibility of this felt need/demand
and the image of being questioned, which, in turn, activates a self-
defensive feeling of being threatened by the person questioning the
client’s judgment (MacKay, 2019).
• In (3), feeling threatened, the client catastrophizes about it by calling it
“awful” and/or attacks the person by calling him a “horrible person.”
These speech acts, singularly or in combination, amplify the feeling of
being threatened, to produce a feeling of intense anger.
 Hyper-Egoic Capacity Disavowals 217
• In (4), the feeling of intense anger triggers a feeling of powerlessness to
tolerate the person’s act of questioning the client’s judgment, or the
person himself. The client, in turn, expresses this feeling of
powerlessness or intolerance by using the words “I can’t stand it” in
the former case, and “I can’t stand you” in the latter case.

The perfectionistic demand in (1) represents a sort of lusting or craving for

power over reality itself, which in the extreme can lead to bazaar beliefs in
capacities and talents that are non-existent. Like other cravings or felt needs
discussed in this book, the client construes any perceived attempt to subvert
it as a threat, which forms the basis of speech acts of catastrophizing and
damnation of others. This is where the prefrontal cortex signals the
amygdala to prepare the body for fight or flight. This means that hyper-
egoic clients can become aggressive, including physically aggressive
(Öngen, 2010).
The phenomenological picture painted here is of a client who is, in a
way, addicted to exercising power over reality, and sees any attempt to
interfere with this exercise of power as something or someone to be
stopped (Ross, n.d.). This picture may suggest a sense of low self-esteem
about which the client is in denial. However, the problem may be less
about low self-esteem and more about a dysfunctional sense of high self-
esteem, what has sometimes been termed high but “fragile” self-esteem
(Kernis et al., 2008). This is high self-esteem that is concomitant with a
tendency to become self-defensive about it. The model here suggests that
such self-defensiveness arises out of a perfectionistic epistemic demand that
reality conform to one’s own subjectivity, and the perception of any ex-
ternal factors that contradict this demand as threats to be defended against.
This does not discount the possibility that the client may harbor feelings of
inadequacy he is attempting to get rid of. This may be true in some cases while
not necessarily in all cases. Further, this possibility is not inconsistent with the
model proposed here. Thus, it is possible that the client dispositionally harbors
a painful feeling of inadequacy associated with a felt need to get rid of this
feeling by always being correct, which is linguistically expressed in terms of a
demand that reality match his own judgment. However, clients who fit this
description are not disposed to degrade themselves or question their own self-
worth. As such, cognitive-behavioral interventions that attempt to help the
client to stop engaging in self-damnation is not likely to be effective as it tends
to be in cases of clients with low self-esteem. Thus, it is, in my estimation, not
in general clinically advisable to treat hyper-egoic clients as clients suffering
from low self-esteem.
Based on the model presented here, cognitive interventions best proceed
by focusing largely (although not exclusively) on dismantling the epistemic
demand that supports the syllogism chain terminating in the hyper-egoic
disavowal. This involves, first, the explication of the emotional reasoning
comprising this chain.
218 Overcoming Capacity Disavowal Types
Step 1: Formulating the Primary Syllogism Using O & R
Applying the O & R formula, the client’s primary syllogism would proceed
as follows.

Syllogism Chain A
(Rule) If you question my judgment, it’s awful.
(Report) You are questioning my judgment.
(Conclusion) Therefore, it’s awful.1

The Report in Syllogism Chain A focuses the client’s attention on the conflict
between what the client says or believes and what his critic says or believes,
while the Rule validates the catastrophizing deduced in the conclusion. Thus,
this Rule, once identified, is grist for probing by the therapist. Why, indeed, is
it awful for the client to have his judgment questioned?

Box 11.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism

In the below part of their session, the therapist helps the client find O & R to
construct the primary syllogism.

C: My former wife said that I was emotionally abusive. There was

something mentally wrong with her. She was half my
intelligence and yet she told me I didn’t understand the needs
of a woman. What she needed was a “lobotomy!”
T: Why did she say you were emotionally abusive?
C: She accused me of being a dictator. How crazy is that! She was
the dictator, like a dumb one from a banana republic!
T: Can you give me an example?
C: Like when we had a fight about wearing masks during the
pandemic. She wanted me to wear one when I went out
because she said that I could get the virus and infect her and our
kid. That’s such bullshit. Masks don’t even work; and who did
she think she was, telling me to wear one of those things that a
bunch of left-wing sickos came up with to oppress my
constitutional rights.
T: So, you and your wife disagreed about whether masks were
effective in reducing the transmission of the COVID-19 virus?
C: You better believe it.
 Hyper-Egoic Capacity Disavowals 219
T: And if you had shared her belief that masks work, you would
have been okay with wearing one?
C: I suppose so. But that’s just some crazy conspiracy theory.
T: On a scale of 1 to 10, where 10 is the worst possible thing, how
bad was it when your ex-wife disagreed with you like this?
T: It was at least a 10!
C: Sounds like you got extremely angry when she questioned your
judgment.
T: Well, no duh! I am a thousand times smarter than her. She has a
stupid bachelor’s degree in art history. What kind of dumb
asshole would get a degree in art history, anyway? She couldn’t
even find a job in it. I have an MBA and I’m a corporate
executive. I’m not used to being told what to do. I give the
orders because I’m smart. And I’m supposed to listen to her?
T: I think I understand your thinking. You are saying that if your
ex-wife questioned your judgment, like in the case of the
effectiveness of masks, it’s really awful, at least a 10 on the bad
scale. And since she questioned you like this, what she did was
really awful. Is this your reasoning?
C: And what if it is? What are you going to do with it? Show me
how I’m wrong and she’s right? Are you also some kind of
quack or conspiracy theorist too?
T: My goal has been to help you clarify your thinking so you can
examine it. Is this okay with you?
C: I didn’t really need your help. But, just so long as you don’t try
to tell me how wrong I was and how right that crazy bitch was.
T: I’m not going to tell you how wrong you were about the
effectiveness of masks, and how right your ex-wife was. Is that okay?
C: I suppose so.

Step 2: Expanding the Syllogism Chain

Response to the latter question permits exposure of the epistemic demand that
grounds the edifice for deducing the hyper-egoic disavowal. This premise
along with its inference rule (Rule 2) is illustrated in Syllogism Chain B.

Syllogism Chain B
(Rule 1) It must be true if I say so.
(Rule 2) If it must be true if I say so, then if you question my
judgment, it’s awful.
(Rule 3/Conclusion 1) Therefore, if you question my judg-
ment, it’s awful.
220 Overcoming Capacity Disavowal Types
(Report) You are questioning my judgment.
(Conclusion 2) Therefore, it’s awful.

Box 11.2 Practice

Therapist (T)–Client (C) Exchange

Identifying the Source of the Catastrophizing

In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing the source of his catastrophizing.

T: So, why do you think that, if your ex-wife questioned your

judgment, then it’s so awful, at least a 10 on the bad scale?
C: I think I already told you why!
T: You said you give the orders because you’re smart. Sounds like
you’re saying that when you say something then it’s right.
Otherwise you just won’t say it.
C: That’s right. I don’t mince words. If I have something to say, I
say it and I know what I’m talking about when I talk. Not like
some mealy-mouthed moron like my ex-wife.
T: Okay, I get it. So it’s awful if someone else such as your wife
questions your judgment because you if you say something, it
has to be right.
C: That’s what I said. Yes!
T: Okay, I think we’re getting somewhere.
C: Oh yeah? Where are we getting? Tell me something I don’t
already know.
T: How do you feel when you are in this situation. Imagine your
ex-wife is disagreeing with you about the effectiveness of masks
and asking you to wear one. Get yourself to feel the way you did
when you were in this situation; and let me know when you are
there.
C: Who the hell is she feeding me this bullshit!
T: She is saying something that flatly contradicts what you are
saying. You feel what you are saying must be right; and she’s
contradicting it?
C: It feels….
T: Threatening?
C: It feels like I need to stop her.
T: From contradicting you?
C: It’s such a crock of bullshit. She’s out of line. She has to stop!
 Hyper-Egoic Capacity Disavowals 221
Here, with explication of the epistemic demand in Rule 1, the conflict with
the reportative act in the Report is made explicit, thereby eliminating the
wonderment surrounding how being questioned by another about one’s beliefs
can be grounds for catastrophizing. It is because the client has anointed himself
a sort of god-like figure with the superhuman power to decide by fiat what
reality is for others. Within this framework, it is quite explainable why the
client catastrophizes about being questioned. However, explanation is not the
same as justification as discussed below in the section on refutation.
Phenomenologically, the client’s image of being questioned runs up
against his felt need for reality to be as he says it is. This produces the further
feeling of being threatened, which is expressed in catastrophic terms
(“awful”), which in turn sets off the amygdala to activate the hypothalamus-
pituitary axis. The latter then becomes the basis for the hyper-egoic dis-
avowal in the downward expansion of the syllogism chain as shown in
Syllogism Chain C.

Syllogism Chain C
(Rule 1) It must be true if I say so.
(Rule 2) If it must be true if I say so, then if you question my
judgment, it’s awful.
(Rule 3/Conclusion 1) Therefore, if you question my judgment, it’s
awful.
(Report) You are questioning my judgment.
(Conclusion 2) Therefore, it’s awful.
(Disavowal Rule) If it’s awful then I can’t stand it.
(Conclusion 3) Therefore, I can’t stand it.

Box 11.3 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness

In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: So this feeling you get when you feel like she has to stop
contradicting you; it sounds like it feels overwhelming to you;
like it’s impossible to tolerate it if she doesn’t stop.
C: That’s how it feels. And now you’re going to tell me that I’m
wrong to feel that way? I knew you were trying to set me up! But
that’s not going to happen because I am two steps ahead of you!
222 Overcoming Capacity Disavowal Types
T: No, I’m not going to tell you that you are wrong to feel the way
you do. Feelings are not right or wrong. But feelings can be
negative or positive, and the negative ones can be painful and
can lead us to say and do things we may later regret.
C: I am not apologizing for anything.
T: I am not asking you to.

In Syllogism Chain C, the client deduces the hyper-egoic disavowal from

the catastrophizing in Conclusion 2 in conjunction with the inference rule
in the Disavowal Rule. Phenomenologically, this inference proceeds when
the anger generated by the catastrophizing in Conclusion 2 triggers the
feeling of powerlessness over exercising constraint. This is behaviorally
significant because a client so disposed to feel powerless in controlling
himself can act in physically and emotionally abusive ways that are likely to
create serious problems not only for the client but for others with whom he
interacts. As such, it is important for the CBT therapist to defuse the client’s
disposition toward hyper-egoic disavowal. This can be initiated first by
identifying the self-defeating speech acts in the client’s syllogism chain, and
second, through both indirect and direct refutation of the client’s hyper-
egoic disavowal.

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
In reference to Syllogism Chain C, the client harbors a perfectionistic
and “magical” sense of empowerment in the epistemic demand framed in
Rule 1. From this demand, the client deduces Catastrophizing in
Conclusion 2; and from the latter the client deduces the hyper-egoic dis-
avowal in Conclusion 3. Insofar as Conclusion 3 rests on Rule 1, indirect
refutation proceeds by refuting Rule 1, the epistemic demand; and direct
refutation proceeds by refuting Conclusion 3, the hyper-egoic disavowal.
In the case of an indirect refutation of the epistemic demand in Rule 1, the
CBT therapist can help the client to perform a pragmatic refutation. It is
important that the client feels impowered in this process since he is likely to
resist the process if he imagines that the therapist is attempting to question
his judgment. So, working cognitively and behaviorally with this client
population can be challenging indeed.
I suggest pragmatic refutation because other types of refutation are likely
to meet with resistance. For example, the client believes he is possessed of
extraordinary talents and capacities. Thus, looking for inconsistencies be-
tween his beliefs about himself and others is not likely to impress the client.
Similarly, pointing to empirical evidence that reality is not shaped by the
client’s demands is not likely to work because the client is already disposed
 Hyper-Egoic Capacity Disavowals 223
to deny evidence that contradicts his own beliefs. However, pragmatic
refutations may be least likely to step on the client’s epistemic toes by of-
fering the client new avenues for exercising realistic control over reality.
Along such pragmatic lines, the therapist can ask the client how his negative
(cognitive and behavioral) responses to others who question his judgment have
affected his interpersonal relationships. The client may thus have an oppor-
tunity to reflect on the self-defeating implications of his demand that his
judgment be the final verdict on reality, including what is right, good, and
preferable for others. “I don’t get along with most people.” “I was divorced
twice,” “I have been charged with domestic battery and spent some time in
prison.” “The few friends I have only use me.” “As an instructor, I get the
worst student evaluations in my department.” Such potential responses can
help build a strong case for making constructive cognitive and behavioral
changes, including the way he processes and handles conflict with others.

Box 11.4 Practice

Therapist (T)–Client (C) Exchange

Refuting the Catastrophizing

In the below part of their session, the therapist helps the client refute his
catastrophizing utilizing a pragmatic approach that appeals tothe client’sbest interest.

T: It sounds like it’s very stressful for you when others such as your
ex-wife question your judgment. Do you encounter similar
stress in other situations, for example, in your work as a
corporate executive?
C: All the time. Some guys don’t know how to follow orders. I am
trying to run a business, not a babysitting service. If they don’t
do what they’re told, then they need to get out. But it is stressful
dealing with them. I’ll give you that.
T: So, what if you could do your job as well as you do now, and
get along with others in your business and personal life better
than you do now; but without the stress; without those
threatening feelings; and feeling like you can’t stand or put up
with others?
C: The only way that would happen is if others stopped acting like
assholes. But that’s not going to happen.
T: I think there may be another way.
C: How is that?
T: Well, your demand to be right all the time, where you tell
yourself you need to be right; that seems to be creating a lot of
224 Overcoming Capacity Disavowal Types
your stress, since you feel threatened by what others say when
they disagree with you. If you gave up this demand, you could
get rid of the stress.
C: So, what are you saying? Let the assholes be assholes?
T: Well, if you could get rid of a lot of the stress created by this felt
need, would it not be worth giving it up? Aren’t you interested
in doing what’s in your best interest?
C: How do I know that’s in my best interest?
T: Does upsetting yourself like this serve any other interest of
yours?
C: Letting them know they’re fools.
T: But that’s just what alienates them, and makes it more difficult
for you to get along with them, isn’t it?
C: Maybe.

Direct refutation of the hyper-egoic disavowal might usefully proceed by

encouraging the client to demonstrate its falsehood by exercising self-
control. “You say you can’t stand it when others challenge your views, but
why not prove yourself wrong by just letting them say what they think and
simply respectfully disagree without personally attacking them.” Logical
refutation might also work in the direct refutation. For the therapist can ask
the client if he ever managed to politely let others voice their criticisms of
him without losing control. If the client confirms, then he has satisfactorily
proven that feeling powerless to “stand” something does not necessarily
mean lacking the capacity to do so.

Box 11.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Hyper-egoic Disavowal

In the below part of their session, the therapist helps the client refute the
capacity disavowal that keeps him a prisoner of irrational fear.

T: You said before that it feels impossible for you to stand it when
others disagree with you. So, here’s your chance to prove that
you can stand it by letting others say what they want.
C: I know that.
T: Because it’s just a feeling. Have you ever let anybody disagree
with you before?
 Hyper-Egoic Capacity Disavowals 225
C: The CEO. He can be an asshole, too. Someday, he will work
for me.
T: So if you can let your CEO disagree with you, you can let
others do it too; which proves that just because you feel like you
can’t, doesn’t mean you really can’t.
C: I know that, too.

Step 4: Identifying the Guiding Virtues

The guiding virtues that can help to promote the above indirect and direct
refutations and reverse the negative polarity associated with others’ dis-
agreement, are Empathy, Courage, Unconditional Other Acceptance, and
Tolerance. Empathy can help to counteract the client’s epistemic demand
(“It’s true if I say so”); Courage, the catastrophizing (“It’s awful”);
Unconditional Other Acceptance, the damning of others who disagree
with the client (“You are a stupid jerk”); and Tolerance, the hyper-egoic
disavowal itself (“I can’t stand it” or “I can’t stand you”).

Box 11.6 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues

In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming hyper-egoic disavowals.

T: No doubt, you already know this, it can take courage to let others
freely disagree with you; and it can be helpful to try to see things
from others’ perspective, to try to empathize with them, even if
you don’t agree with their views in the end. It can also be
helpful to stop thinking of and calling others “assholes” and
“fools” because as soon as you even think of others that way,
you generate anger toward them, which just makes it harder to
control yourself and to avoid the stress arising from the conflict.
This means trying to accept others unconditionally, not on the basis
of whether they agree or disagree with you. I know this can be
hard, it takes having tolerance for others’ views, which means
controlling your anger when others disagree with you.
C: I have remarkable capacity for self-control so this should not be
very difficult for me. How about you? What do you have to
226 Overcoming Capacity Disavowal Types
work on? I’d like to be a fly on the wall when you lose your
temper and call your wife an asshole.
T: None of us are perfect; and can all stand to make improvements.
That’s actually an important point. These virtues I’m talking
about—Courage, Unconditional Other Acceptance, Empathy,
and Tolerance—are ideals to aim at. We can all get better at
them, but we’ll never be perfect.
C: I think I could master it.
T: So, you are willing to work on them?
C: Why not, if this can get rid of all the stress, and deal with these,
these “people” better, then yes.
T: That’s great, but since nobody’s perfect, you are not likely to get
rid of all of the stress.
C: We’ll see about that.

Empathy
Empathy involves connecting cognitively and emotionally with the sub-
jectivity of another person. This requires an attentional shift from a self-
interested state of consciousness to one where the person experiences the
imagery the other person (the cognitive aspect) as well as feeling the way the
other person is feeling (the emotional or affective aspect). So, phenomen-
ologically, there are two aspects of the experience of empathy, the cognitive
and the affective, where the latter accounts for the negative valence of the
former. Neurologically ( Jankowiak-Siuda & Zajkowski, 2013; Shamay-
Tsoory, 2011), the cognitive network that mediates empathy includes the
ventromedial prefrontal cortex (VMPFC) while the affective network includes
the right anterior insula and the anterior cingulate cortex. It has been hy-
pothesized that Narcissistic Personality Disorder (NPD) involves a dysfunction
in the shared emotional system, in particular, in the right anterior insula (Ibid).
Lesion studies have also confirmed this hypothesis (Gu et al., 2012).
This may suggest that clients who satisfy the DSM5 criteria for diagnosis of
NPD (and perhaps also subclinical cases) are incapable of empathy. However,
being incapable and being unwilling to show empathy are two different things
(Lamia, 2020), and some studies suggest that empathy can be trained in nar-
cissistic clients (Hepper et al., 2014b). In one study, clients with high levels of
narcissism watched a video about domestic violence. One group was asked to
image how the victim was feeling as though they were in the victim’s situation,
while the other group was not given any instructions. The group given no
instructions showed little empathy for the victim whereas the group given the
instructions demonstrated empathy comallegory to a control group of parti-
cipants without narcissism. The study suggests that clients with hyper-egoic
 Hyper-Egoic Capacity Disavowals 227
disavowals have potential to cultivate empathy if they practice or make a special
effort to do so. This motivation might come in the form of giving the client a
self-interested reason such as career advancement, avoiding a divorce, or
performing better in social contexts (Markman, 2014). Thus, while non-
narcissistic clients may be disposed to share feelings with others who suffer,
narcissistic clients may need to make a special effort and to practice in order to
become better at it. This is not to say that those with brain lesions in the
anterior insula are similarly capable of developing this capacity.
Cultivation of a habit of Empathy, which is what I mean by the guiding
virtue, need not be off limits to clients with hyper-egoic disavowals. But even
if such clients in the extreme have severe limitations due to neurological
dysfunction in their affective system (the right anterior insula, apparently), such
clients may still have the capacity to develop understanding of others’ per-
spectives, so-called “cognitive empathy” or “theory of mind,” which do not
necessarily involve shared feelings (Stietz et al., 2019; Singer & Lamm, 2009).
As such, cognitive-behavioral interventions aimed at cultivating empathy may
still be indicated even in the case of clients with incapacity for shared feelings.

Courage
On the model proposed here, cultivation of Courage in clients with hyper-
egoic disavowals means giving up their preconception that they have the
power to demand reality. This involves a major conceptual shift where the
client comes to accept and feel secure about not having this magical power.
From an empathetic perspective, this can be a very substantial challenge for a
client with a fragile sense of self-esteem. So, the therapist should be cognizant
of the anxiety likely to arise in making such a conceptual shift and the resistance
the client may have to this change. As discussed below, the adoption of an
uplifting philosophy set is important to overcoming the tendency to cata-
strophize about perceived threats to the client’s demand to control reality.
Moreover, such Courage appears to be a precondition of cultivating Empathy
because, for such clients, it may take some measure of Empathy to even
imagine reality from any other perspective other than their own.

Unconditional Other Acceptance

This virtue involves accepting others without negatively judging them.
This means avoiding the use of pejorative language to rate their entire
persons. This does not proscribe assessing the actions of others, but again
this includes not catastrophizing about such actions. It means accepting
cognitively and affectively that a person is not a bad person if they disagree
with the client’s preferences, beliefs, desires, values, or expectations. This
virtue is also linked to Empathy since the latter promotes seeing things from
another’s perspective rather than judging them. Indeed, it is impossible to
empathize with someone if one is damning them.
228 Overcoming Capacity Disavowal Types
Unconditional Other Acceptance may also be supported by other
emotions such compassion. Having compassion for another is distinct from
having empathy. While Empathy involves sharing the suffering of others,
“compassion, on the other hand, is conceived as a feeling of concern for
another person’s suffering which is accompanied by the motivation to help”
(Singer & Klimecki, 2014, R875). In contrast with Empathy, compassion
activates the ventral striatum, which is associated with action, in this case,
the motivation to help (Singer & Klimecki, 2014).
Accordingly, meditative activity such as compassion mediation may be
useful for promoting Unconditional Other Acceptance by helping to build
brain connections associated with compassion. As such, I suggest (below)
including compassion meditation as part of the behavioral plan of clients
with hyper-egoic disavowals.

Tolerance
Tolerance is a social, or moral, virtue involving recognition of the (moral
and legal) rights of others to have different perspectives about reality, in-
cluding different political, social, personal, ethical, and aesthetic beliefs,
preferences, and expectations (Witenberg, 2014). Ideally, a tolerant person
does not first get angry or feel threatened by the views of others when they
conflict with one’s own, and, then control these negative feelings. Instead,
she is disposed not to feel threatened or get angry in the first place. This is,
indeed, the aspirational goal, or guiding virtue of Tolerance. In any event,
tolerance implies willpower to control anger and feelings of being threa-
tened, and to permit others’ free expression of alternative perspectives.
As in all cases of building guiding virtues, the therapist should encourage
the client not to demand that she perfectly actualizes the virtue, which
would be to substitute one form of perfectionism for another. Emphasizing
this with hyper-egoic clients is especially important since they are already
disposed to make perfectionistic demands about reality.
Tolerance is supported by Unconditional Other Acceptance inasmuch as
clients who unconditionally accept others are also likely to tolerate their
alternative perspectives. Similarly, Empathy supports Tolerance since clients
who can empathize with others are open to understanding others’ diverse
outlooks and are therefore likely to tolerate them.
Importantly, having tolerance for others’ perspectives does not mean that
the client must agree with these perspectives. It rather means that the client
recognizes that others also have the personal autonomy and right of self-
determination to form their own perspectives even if these perspectives do
not agree with the client’s own perspectives.

Step 5: Finding an Uplifting Philosophy

These virtues collectively support clients’ personal autonomy without
violating the personal autonomy of others. Uplifting philosophies that
 Hyper-Egoic Capacity Disavowals 229
support this overarching goal can promote improved interpersonal re-
lationships and more satisfactory life encounters. Such philosophies are
diverse, but only a subset of them are likely to fit the world views of clients
who are hyper-egoic. Thus, CBT therapists should exercise caution not to
impose ideas that may fit liberal democratic philosophies but conflict with a
more circumscribed, self-interested perspective embraced by hyper-egoic
clients. Philosophies likely to resonate with this client population are likely
to be largely pragmatic, and appeal to enlightened self-interest, rather than
nonutilitarian and altruistic. The goal is not to transmute the client’s value
system but instead to help the client utilize his own values to give up his
self-defeating demand about reality.

Philosophies of Empathy
These philosophies, in the current context, emphasize building trust in
relationships inasmuch as the latter can be useful to improving interpersonal
relationships.

Carl Rogers’s Concept of Empathy

According to Rogers (1974), “the way of being with a person which is
termed empathic has several facets.” He states,

It means entering the private perceptual world of the other and

becoming thoroughly at home in it. It involves being sensitive,
moment to moment, to the changing felt meanings which flow in
this other person; to the fear or rage or tenderness or confusion or
whatever that he or she is experiencing. It means temporarily living in
his life, moving about in it delicately, without making judgments,
sensing meanings of which he is scarcely aware but not trying to
uncover feelings of which he is totally unaware since this would be too
threatening. It includes communicating your sensings of his world as
you look with fresh and unfrightened eyes at elements of which he is
fearful. It means frequently checking with him as to the accuracy of
your sensings and being guided by his responses. You are a confident
companion to him in his world. By pointing to the possible meanings
in the flow of his experiencing you help him to focus on this useful
type of referent; to experience his meanings more fully and to move
forward in his or her experiencing.2

The importance of this definition of empathy lies in its phenomenological

import. Meanings are captured by words, but their referents are “felt” or
experienced. Hence, for the client to know what another person means, it
is necessary to “enter the private perceptual world of the other.”
230 Overcoming Capacity Disavowal Types
For the client who is hyper-egoic, this requires a special effort, but as
discussed above, it is still possible. The client thus learns to look outside his
own subjectivity, to affirm that others have a subjective world. This pro-
vides the client an opportunity to practice suspending his judgment, or
prejudgment, to build trust in the other by demonstrating that he can
understand the other’s flow of felt meanings.
In this communicative process, the client shifts attention away from
demanding reality because the goal is comprehending and reflecting back,
nonjudgmentally, the flow of felt meanings the other person is experien-
cing. It is not about “objective reality,” or who is right and who is wrong.
It is not about defending against criticism. The other person may feel dif-
ferently than the client. But this is the client’s opportunity to enter the
other’s subjective world to see his perspective from “the inside” rather than
from an external point of view.
To the degree that the client can resonate with the client’s subjective
world, “temporarily living in his life, moving about in it delicately, without
making judgments, sensing meanings of which he is scarcely aware of the
client,” the client can experience solidarity with the other, rather than
seeing her as a threat to be stopped. From a pragmatic, self-interested
perspective, this is constructive change. The client gains the trust of the
other, becomes more self-disclosing, and thus less likely to undermine his
self-interest.
There is, however, a distinction between “emotion contagion,” on the one
hand, and Empathy on the other (Singer & Klimecki, 2014). Clients who are
being taught how to build Empathy, can and should understand that there are
two extremes to avoid. The first is getting too close to the subjective world of
the client to be of much use in communicating the client’s felt meanings. The
other is being too distant to appreciate these meanings.
One way in which one can get too close to the client’s subjective world
is to allow one’s own felt meanings to become intwined with those of the
other. This can happen when one lives vicariously through the other or
engage in countertransference. You associate the person’s situation with
your own unfinished business and therefore lose the other’s perspective.
Avoidance of this extreme led Carl Rogers (1989) to famously characterize
empathy as “to sense the client’s world as if it were your own, but without
ever losing the ‘as if ’ quality” (p. 284).
Another way to get to close is to see the other’s subjective world as a
threat to your own. This is the main concern in the case of clients with
hyper-egoic disavowals. Thus, clients should be instructed to focus on the
other’s subjective world, and to temporarily bracket their own.
The other extreme, that of not getting close enough to the subjective
world of the other, is another concern for the client population in question.
The client should be encouraged to let down his guard temporarily in order
to enter the other’s subjective world. Otherwise, empathetic resonance is
not likely to be attained.
 Hyper-Egoic Capacity Disavowals 231
Busting Your Gut to See the Truth in What the Other Is Saying
One useful approach to avoiding the latter extreme of being too far removed
from the other’s subjective world, is introduced by feminist thinkers Mary
Belenky, Nancy Goldberger, Blythe Clinchy, and Jill Tarule (Clinchy, 1996).
They distinguish two ways of knowing, separate versus connected knowing. The
first involves coming at the other’s views with doubt and incredulity. This way
of knowing is associated with analytic philosophy. The idea is to find holes in
what the other is saying in order to discover the truth. A classic example of this
approach, from the annals of the history of philosophy, is Rene Descartes’
famous attempt to prove the existence of the external world by systematically
doubting everything he could conceivably doubt until he could find some-
thing he could not doubt (“I think therefore I am”) and then using this in-
dubitable truth to construct the rest of what we know about the external world
(Descartes, 1901, med. 2, ch. 6).
Indeed, the client with hyper-egoic disavowals is likely to be comfortable
with this approach. However, it does not support empathy, because it is
difficult if not impossible to resonate with the other’s subjective world
when one is focusing one’s attention on trying to find holes in it. So, while
the client may be encouraged to apply this approach after he has explored
the other’s subjective world, it is self-defeating to use it for purposes of
empathizing with the other.3
In contrast, the second approach, connected knowing, involves temporarily
trying one’s best to see the truth in what the other is saying. Here the client
is instructed to temporarily suspend his doubt and incredulity (along with
his feeling of being threatened by what the other is saying) to attempt to
believe the other. This can allow the client to connect with the subjective
world of the other rather than separate or detach from it. Indeed, the client is
likely to find this challenging, however, the CBT therapist can support the
client in the endeavor by emphasizing the practical value of being able to
empathize with others—again, appealing to the client’s self-interest in being
able to get along better with others.

Philosophies of Courage
In the context of working with clients with hyper-egoic disavowals, these
philosophies aim at helping the client to realize that it is not catastrophic to
inhabit a world in which he does not have the power to fashion reality
according to his own images and feelings; that, like other imperfect human
beings, his judgment may be flawed, or at odds with others who share the
same imperfections.

Plato’s Allegory of the Cave

In this famous allegory by Plato (1961), cave dwellers have spent their lives
chained inside a cave having the capacity to see only the shadows of objects
232 Overcoming Capacity Disavowal Types
being projected on a cave wall. Conversant all their lives about these
shadows, and the order in which they appear, all these prisoners are certain
that they are conversant about reality. However, when one of them is
forcibly released and dragged unwillingly up the ascent into the world
outside the cave, his vision is dazzled by the light and it takes some time
before he is able to look up at the sky by day and eventually to look directly
at the sun.
The value of this allegory lies in the power of its metaphor to help us
realize that one’s own images and feelings are not necessarily the most real,
and that it can take the firm arm of another to lead us up the ascent so that
we too can eventually see the light of the sun, the metaphorical symbol of
reality or truth.
In the finale of the allegory, the enlightened and liberated former cave
dweller goes back down into the cave to enlighten his former peers about
the world outside the cave but is received by them with contempt, as
someone whose vision had been corrupted by his ascent, and if they could
get their hands on him, they would surely kill him.
So, with whom does the client wish to align himself, the enlightened and
liberated former cave dweller or the prisoners who would try to kill the
latter? The question can be a jarring wake-up call, for one imprisoned by
unwillingness, to look beyond one’s own circle of ideas; to muster up
Courage to venture outside this proverbial cave of ignorance.
This need not (and should not) be a plea to the client to seek knowledge
for its own sake. Still very few of us are content to live in ignorance when
the truth can set us free, opening our eyes to things that could make life so
much more fulfilling. But it can take Courage to entertain the perspectives
of others who may have been to places and seen things of which we
ourselves may know so little.

Doing What You Really Want Can Take Courage

In The Fountainhead, a novel by Ayn Rand (1971), Peter Keating, an ar-
chitect, is led by a desire for power and prestige as a means to gain self-
esteem. But in his quest for the latter, he gives up the one thing he ever
wanted, to marry Catherine (Katie) Halsey. When their paths unexpected
cross, Peter (rhetorically) asks Katie why people are taught to regard doing
what one wants as “easy and evil” and instead to be disciplined and re-
strained in going after these things. He then states,

It’s the hardest thing in the world—to do what we want. And it takes
the greatest kind of courage. I mean, what we really want. As I wanted
to marry you. Not as I want to sleep with some woman or get drunk or
get my name in the papers. Those things—they’re not even
desires—they’re things people do to escape from desires—because it’s
such a big responsibility, really to want something. (p. 533)
 Hyper-Egoic Capacity Disavowals 233
Applying the above idea of Courage, the client who is hyper-egoic may
profit from considering what he “really wants”; power and control over
reality and thus over what others think, or to have close human relation-
ships bound by solidarity, friendship, intimacy and love? These latter things,
the client sacrifices in order to try to control what others think. But what
does it matter in the end when one fails to get what one truly wants?
In the novel, Peter ends up an empty vessel, a shell of whom he truly
hoped to become. Courage, here, meant looking more deeply into what
one “really wants,” and pushing oneself to get it. Inasmuch as this lesson
appeals to “enlightened” self-interest, in the spirt of Rand’s philosophy of
selfishness as a virtue (Rand, 1992), it may provide an uplifting philosophy
for the client disposed toward hyper-egoic disavowals.

Philosophies of Unconditional Other Acceptance

These philosophies, in the context of working with clients with hyper-
egoic tendencies, involve pragmatic justifications for maintaining respectful
relationships with others.

Do Not Do to Others What You Would Not Want Others to Do to You

This negative form of the so-called “Golden Rule,” has both self-interested
as well as other-regarding bases for compliance. In the sixteenth century,
British philosopher Thomas Hobbes (1651) put a self-interested twist on
the latter by suggesting that, unless you respect others, they will be moti-
vated to take revenge and thereby harm you. According to Hobbes, this
precept sums up the “Laws of Nature,” which are articles of rational self-
interest that tell us, “a man is forbidden to do, that, which is destructive of
his life, or takes away the means of preserving the same; and to omit, that,
by which he thinks it may be best preserved” (ch. 14). Along these lines, he
admonishes all of us that, “Injustice, Ingratitude, Arrogance, Pride,
Iniquity, Personal Bias, and the rest, can never be made lawful. For it can
never be that War shall preserve life, and Peace destroy it” (ch. 15). So, for
peace sake, Hobbes urges everyone to put aside their personal attacks and
other forms of degradation to treat others as they would have others
treat them.
Granted, Hobbes’ idea of self-interest, as the basis of respect for others, is
far from the idea of “turning the other cheek” since Hobbes tells us that no
one can take away our right to defend ourselves against the onslaught of
aggressors. However, Hobbes invites the client to imagine that others are as
intolerant of him as he is of them (refusing to permit disagreement), and
then ask himself if he would be prepared to tolerate having his own right of
free expression foreclosed by others. Indeed, the likely answer to the latter
question would be no.
234 Overcoming Capacity Disavowal Types
Self-Love Involves Loving Others
Social psychologist, Erich Fromm (1955) provides a philosophical per-
spective on love for oneself that has potential to help the client transcend a
form of tunneled vision regarding love that prevents his adjustment in the
world. “Narcissism,” says Fromm, is the “opposite pole to objectivity,
reason, and love.” To truly love oneself, one must love others. Absorbed in
his “own inner processes,” the client misconceives reality, part of which is
what the love of oneself even means:

If I can say, “I love you,” I say, “I love in you all of humanity, all that is
alive; I love in you also myself.” Self-love, in this sense, is the opposite
of selfishness. The latter is actually a greedy concern with oneself which
springs from and compensates for the lack of genuine love for oneself.
(pp. 37–38)

So, love for oneself involves relatedness to all, not just one person to the
exclusion of everyone else. The latter breeds alienation and dependence,
not unity and independence.
“Productive” (genuine) love implies “care, responsibility, respect, and
knowledge.” In respecting a person, one looks at him “objectively and not
distorted by wishes and fears” (p. 38). Without such love implying respect,
one can become ensconced in this a “distorted” painful sense of reality,
forfeiting the opportunity to find happiness.
Unconditional Other Acceptance implies such respect. As such, thera-
pists can work with clients who are hyper-egoic to make the effort to
transcend their narrow, self-interest to embrace others, not fear them.

Philosophies of Tolerance
These philosophies in the context of working with clients with hyper-egoic
disavowals involve uplifting ideas that provide rational, self-interested
reasons for not attempting to censor or stop others from expressing their
alternative perspectives on reality. They inspire the exercising of willpower
for such purposes.

Permitting Alternative Perspectives Is a Winning Strategy

This philosophical approach to tolerance is ardently defended by the British
philosopher, John Stuart Mill (1859), in his famous treatise, On Liberty.
According to Mill,

the peculiar evil of silencing the expression of an opinion is, that it is

robbing the human race; posterity as well as the existing generation;
those who dissent from the opinion, still more than those who hold it.
If the opinion is right, they are deprived of the opportunity of
 Hyper-Egoic Capacity Disavowals 235
exchanging error for truth: if wrong, they lose, what is almost as great a
benefit, the clearer perception and livelier impression of truth,
produced by its collision with error. (ch. 2)

While the client who is hyper-egoic may not care about “robbing the
human race,” he does care about “robbing” himself of a “great benefit.”
The benefit in question is either learning valuable information from another
who disagrees with him, maybe even life-saving information, or else
gaining a “clearer” and “livelier” perception of the truth by seeing his
opinion against the backdrop of falsehood. Either way, in permitting others
to disagree, the client, no less than the dissenter or humankind itself, is a
greater gainer than if he simply silenced the alternative perspective.
Accordingly, reframing the image of permitting others to disagree, in
terms of “great benefit” and “clearer” and “livelier” perception of truth,
can associate this image with a positive interoceptive feeling. This positive
polarity can, in turn, help overcome the negative polarity of such imagery
generated by the client’s felt need (and demand) for reality (or truth) to be
what the client says it is.

Not Recognizing Others Is a Lonely Existence

Being trapped in your own subjectivity, able to know only your own
images, is a lonely existence. There is no one else to learn from; no one to
give you hope when you are lost, no one to help you out of a difficult
situation. If you are on the wrong track there is no one to set you straight
because you are the only source of information, value, and hope. Indeed,
you are the source of what is right or wrong.
Philosophers have long written about the problem of solipsism, the
theory that you can only know what resides in the confines of your own
subjective states, so that other minds, and even a physical world outside
your own circle of ideas is beyond human knowledge. Skeptics such as
David Hume (1777) have concluded that such extramental reality cannot be
proven. But even this ultimate skeptic concluded that as a human being,
not a philosopher, to live a satisfactorily life, he must set aside his skeptical
beliefs and accept that there is a physical world out there that provides a
practical source of knowledge and truth. “Be a philosopher,” he said, “but,
amidst all your philosophy, be still a man” (sec. 1). If a Mack truck were
heading one’s way down a speedway, then philosophizing about the ex-
istence of an external world would obviously be the wrong approach.
Instead, for the sake of survival itself, none of us are in any realistic position
to doubt the existence of a physical world that operates independently of
our own epistemic demands. This appears to be why our limbic systems
operates first, before our reflective systems, to get us out of harm’s way.
In contrast, “rationalist” philosopher Rene Descartes (1901), mentioned
earlier, was not comfortable resting his belief in an external reality on
236 Overcoming Capacity Disavowal Types
practicality, and as such tried to prove the existence of the external world.
Starting with indubitable knowledge of his own existence as revealed
through his own thinking, he attempted to deduce everything else in the
world, including physical objects and other minds. He does this by realizing
that he has a tendency to believe in an external world. However, he also has
a “clear and distinct” idea of God as a benevolent being who would not
deceive him about the existence of the external world. “For as He has given
me … a very strong inclination to believe that those ideas [of sensible
things] arise from corporeal objects, I do not see how He could be vin-
dicated from the charge of deceit, if in truth they proceeded from any other
source, or were produced by other causes than corporeal things: and ac-
cordingly it must be concluded, that corporeal objects exist” (med. 6, ch.
10). In so doing, he sought to save himself from the solitary solipsistic
universe where only he and his subjectivity exist.
In contrast to Descartes, seventeenth-century British philosopher John
Locke (1690) takes an empirical approach to escaping the solipsistic position
by arguing that there exist external objects, ideas of which are received
through sense perception; which set the basis for (probable) knowledge
about the external world. These physical things cause images in us which
either represent qualities actually existing in the external substance (“pri-
mary qualities” such as size, shape, number, motion/rest, and solidity) or
which are subjective images that exist in our minds but not in the sub-
stances themselves (“secondary qualities” such as taste, color, odor, sound,
and temperature). Yet, even in the latter case, it is by virtue of a certain
configuration of primary qualities of physical objects (read molecular
structure) that we sensibly perceive particular subjective sensations of taste,
color, odor, sound, or temperature (bk. 2, ch. 8).
According to Locke, we can also have indirect (probable) knowledge of
other minds because we can sensibly perceive the behavior of other human
bodies, which resembles our own behavior when we are in certain mental
states.
So, for Locke, there is an objective reality outside our own control. We
are therefore not alone in the world; for there are objective sources of
knowledge and truth that are independent of our own preferences, believes,
values, or expectations.
In contrast to Locke, seventeenth-century philosopher Bishop George
Berkeley (2003) takes an “idealistic” approach to escaping the solipsistic
position, by arguing that the physical world consists entirely of images in
our mind (their being or existence is perception). According to Berkeley,
some of these images are objective while others are subjective. In the case of
objective images, God imprints them into our minds, whereas purely
subjective images are strictly the products of our own finite minds. Whereas
the former images are predictable and regular, following laws of nature that
God has established to guide our lives, the latter are dreams, delusions, or
hallucinations that are only in our minds, neither in the minds of other
 Hyper-Egoic Capacity Disavowals 237
human beings, nor in the infinite mind of God. So, Berkeley too sought
to rest objective knowledge and truth ultimately in another being,
namely God.
If the client who tends to make hyper-egoic disavowals believes in God,
then he may be comfortable with a philosophy like Berkeley’s that could
help him to break out of his solipsistic position to recognize that he alone is
not the source of reality; that there is an objective reality beyond his own
fiat to which he as well as other human beings can be privy; a reality that
God has given to all human beings, not just the client, to guide their lives.
He can also realize that he is not God who possesses the awesome power to
determine reality for all others, but is instead himself a creature of God
who, like all other humans, is subject to the natural laws imposed on all
finite minds by God.
Or, the client who believes in God could subscribe to Descartes’ ap-
proach by placing his trust in God not to deceive him about objective
reality beyond his own epistemic demands. And, if the client is not espe-
cially moved by the appeal to God, he can rest his acceptance of external
reality on Locke’s empiricism, or Hume’s pragmatism.
In acceding to objective reality by adopting a classical epistemology such
as the ones described above, the client can thereby work toward giving up
the self-defeating theory of truth according to which reality is whatever the
client says it is. This, in turn, can open the door to listening to others, who
may be closer to the truth than he, and thus to being more tolerant and
respectful of alternative perspectives.
The motivation for the client to break out of the solipsistic position by
embracing the views of others and reality beyond his own magical demands
is escape from the loneliness of epistemic isolation. The client is devoid of
friendship, intimacy, and the deep interconnectedness of others, cogni-
tively, emotionally, and behaviorally. This leads to a profound sense of
loneliness (Science of Us, 2016), a void that no amount of reality manip-
ulation and power over others can fill. According to H. S. Erlich (1998),

Whether alone or not, the narcissistic person has actually immunized

himself to the experience of loneliness: his entire makeup is a defense
against the experience of needfulness and loneliness. At the same time,
however, there is an underlying, implicit, and not fully spelled out
assumption that, such intense efforts at self-containment and self-
sufficiency notwithstanding, the narcissist actually craves relatedness,
love, and closeness—no less, and perhaps even more so, than
others. (p. 145)

This hole in relatedness can begin to be filled if the client takes steps toward
relinquishing his self-absorbed, self-isolating, epistemic demand and re-
places it with an uplifting philosophy of epistemic relatedness such as one of
the traditional epistemic philosophies suggested above.
238 Overcoming Capacity Disavowal Types

Box 11.7 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy

In the below part of their session, the therapist helps the client to find a
philosophy to overcome his hyper-egoic disavowal.

T: I am happy to hear you’re on board with working on the

guiding virtues. There are different approaches to looking at
these virtues. Let’s start with the virtue of Tolerance. When you
exclude everyone else’s views, the only ones left are your own.
It means that no one else except you have a grasp of reality
unless they happen to agree with you.
C: That’s about right.
T: Do you ever feel somewhat alone in this universe, being the
only true source of knowledge.
C: It’s true that it’s a curse having a higher intellect than others.
T: So, you do feel lonely?
C: At times, like it would be nice to take a break and rely on others;
but I have to keep constantly checking them so that they don’t
get it wrong.
T: You mean think differently than you?
C: Badly, at least most of the time.
T: What if you embraced a theory of truth that was not so
demanding and lonely? Would that work for you?
C: I don’t know what you mean.
T: Do you believe there is an external world out there beyond your
own subjectivity? I mean you have certain ideas, images,
feelings, and sensations. But do they correspond to anything
else outside your own mind?
C: You mean, if the tree falls in the forest, and no one’s there, does
it really exist? That’s an asinine question. The answer is yes!
T: Okay, fair enough. So not everything you say is necessarily true.
For example, you might feel like you’re incapable of tolerating
other people’s disagreement with you; but that doesn’t mean you
really can’t; because what seems true to you may not really be true.
C: Okay, so where are you going with this?
T: It means that you might not always be correct; and others might
sometimes be, because there is an objective reality beyond your
own ideas, feelings, and sensations.
C: So, yeah. I might be mistaken sometimes, but hardly ever.
T: And others might not be.
 Hyper-Egoic Capacity Disavowals 239
C: So, what of it?
T: It means you are not really alone, after all, because other people can
count too. You can reframe your view in terms of being partners in
the search for truth; it’s not just you alone on the journey.
C: So, this is how I’m supposed to be more tolerant of others?
T: Does this work for you? If it works, for you, yes; if not, then no.
C: Maybe it works for me. In a way, it feels like there’s less pressure on
me. Like a backup system, or a co-pilot. I suppose I can do that, so
long as this co-pilot has a brain, and is not like my ex-wife.
T: Sounds like progress. The next step is to practice your new
philosophy by applying it to your life.

Step 6: Constructing a Plan to Apply the Philosophies

Inasmuch as the foregoing uplifting philosophies provide (rationally) self-
interested bases for giving up the latter theory of truth, clients who are
hyper-egoic may find them appealing as motivation for making con-
structive changes in their interpersonal relations. This potential exists if
these clients can first comprehend, rather than rationalize, the self-defeating
nature of their ways of dealing with disagreement. Thus, it is prudent for
therapists to ask their clients to reflect on how they may have contributed
to defeating their own purposes.

Question 1: In What Ways Has Your Disposition to Reject the

Alternative Perspectives of Others Negatively Impacted Your Life?
Negative consequences often include being excluded by others in mean-
ingful activities—for example, social events and work projects; strained
working relationships; failed interpersonal relations such as divorce; poor
decision-making in business (O’Reilly et al., 2018); and incarceration for
commission of crimes (Hepper et al., 2014a). Fortunately, clients who
come to therapy on their own (as distinct from clients who are remanded to
therapy) tend to have some realization that their ways of dealing with others
are not working; but they are most often not aware of the nature of their
emotional reasoning and how it is impacting negatively on their lives.

Question 2: What Changes Would Your Uplifting Philosophies

Prescribe?
In asking this question, therapists afford clients an opportunity to reflect on
how reframing their reasoning in terms of their philosophies could point to
240 Overcoming Capacity Disavowal Types
constructive changes they could make. Reasonable responses might include
expending a greater effort to get along with others such as avoiding personal
attacks and displays of anger or aggression; letting others express their views;
trying harder to see others’ alternative perspectives; taking responsibility for
mistakes, prudentially, ethically, or legally (instead of blaming others);
avoiding boasts about being smarter or better than everyone else, or making
groundless, grandiose claims; and building enduring and meaningful in-
terpersonal relationships.

Question 3: How Are You to Make These Constructive Changes?

Below, I have assembled some recommendations for assembling a plan of
action to help the client work toward such changes.

Cognitive-Behavioral Assignments for Clients with Hyper-Egoic

Disavowals
The primary goal in these assignments is to assist the client in relinquishing the
epistemic demand to control reality, from which the client deduces catastro-
phizing, damning others, and the hyper-egoic disavowal. Phenomenologically,
this means helping the client to change the negative valence associated with the
image of others disagreeing to a feeling of tolerability and mature posturing
toward veneration for the subjectivity of others in the quest for truth. This is an
uplifting and liberating sense that one is not trapped in one’s own subjectivity,
lonely and destitute of support in this quest. It lies in no longer feeling the
necessity of being right, as linguistically expressed in an epistemic demand to be
the arbiter of reality, “If I say so, it’s true.” It also lies in seeing the subjectivity
of others, not as a threat to one’s own happiness, but, to the contrary, as an
integral part of it.
In working with clients with hyper-egoic disavowals, especially those
with clinically diagnosable Narcissistic Personality Disorder, it is important
for the therapist to avoid taking personally the tendency of such individuals
toward personal attacks and attempts to humiliate her. Such behavior is part
of the intolerance issue to be addressed through therapy. It is also important
to realize that the client’s progress toward his guiding virtues is often slow,
and, as in all other client populations, always incomplete, and a work in
progress.

In Vivo Cognitive Reframing

The client can usefully practice refuting his epistemic demand when he
catches himself attempting to control reality in the context of everyday life. As
mentioned earlier, this can be done using pragmatic refutation. “Here I go
again; defeating my own purposes by alienating everyone in the office.”
 Hyper-Egoic Capacity Disavowals 241
The client can be on the lookout for his acts of catastrophizing and
damning others when he imagines or perceives others to disagree with him.
He can effectively work on pragmatic refutations here too. “If others dis-
agree is it really so terrible? It’s not going to kill me! And they might even
like me better if I stop calling them fools!”
Similarly, the client can work in vivo on direct refutation of the hyper-
egoic disavowal. “I feel like I can’t stand it; but I am going to show I can
stand it by simply letting the others say what they think even if I disagree.”
Keeping before him, his goals of becoming more empathetic, un-
conditionally accepting of others, courageous, and tolerant, the client can
key these goals with the uplifting philosophies he has embraced and reflect
on them. “So, I have just proved I can be tolerant of others’ views by letting
them speak their minds without shutting them down! I feel like Descartes
must have felt when he came to the conclusion that there’s a world out
there beyond his own thoughts.”
“I listened to my wife’s criticisms and didn’t lose my cool or curse her
out like I usually do. I’m starting to get more courageous, more un-
conditionally accepting of her. She really seemed pleased with me when I
didn’t put her down. I suppose that’s what I really want anyway. I don’t
want to end up an empty shell, like Peter in the Fountainhead!”

Interoceptive Imagery
The client can also usefully practice keying into the felt need to control
reality and then shift his imagery to an uplifting philosophy. For example,
the client can first imagine another person disagreeing with him; key into
the felt need to stop the disagreement; and experience the threatening
feeling generated by the latter colliding with the former. Applying Plato’s
uplifting philosophy of Courage, the client can then shift from this painful
feeling and image to the positive image of courageously looking up at the
sun; freeing himself from the shackles of closemindedness; and basking in
the light of truth.

Empathizing
As mentioned, it likely will take a special effort on the part of the client
who tends toward hyper-egoic disavowals to empathize with others. Here,
the client is encouraged to practice regularly empathizing with the other,
“temporarily living in his life, moving about in it delicately, without
making judgments,” as Carl Rogers describes.
For example, when others speak to the client about their personal
matters, the client may have tended to change the subject, disregard others’
thoughts and feelings, or negatively judge them. Instead, the client may be
instructed to push himself to suspend judgment, listen to what the client is
saying; try his best to see the truth in it; and attempt to capture the felt
242 Overcoming Capacity Disavowal Types
meanings the other is attempting to convey. While this is not likely to
“come naturally” to the client, these skills can increase the more effort is
expended on a regular basis to cultivate them. The therapist can also
helpfully reinforce the client’s efforts with positive reinforcement when
appropriate (“You did an excellent job”), also emphasizing that the work he
is doing has strong potential to improve his interpersonal relationships.

Compassion-Based Meditation
This sort of meditation may help narcissists to focus more on others and less
focused on themselves to exclusion of others. Fromm’s distinction between
selfishness and self-love appears to be the basis, with effort to move closer to
the latter and thus further from the former. This melds with the Eastern
idea of unity and inclusiveness with others, states of being that are essential
for improving interpersonal relationships (Brahmana, 2017).
In this meditative practice, the client repeats phrases such as “May you be
safe”; “May you be peaceful”; “May you be healthy”; and “May you live
with ease and well-being”; sending these wishes to a special person; to
oneself; to others; and eventually to the world of living beings. The re-
peated phrases can also be altered to resonate best with the client, but the
goal is to send loving kindness to others, including oneself.4 Thus, it is not
intended to exclude oneself from wishes of loving kindness; however, such
self-compassion is not to be confused with narrow self-interest to the ex-
clusion of others. In fact, its very essence is inclusiveness and unity
(Neff, 2011).

Box 11.8 Practice

Practicing Loving-Kindness Meditation

In the following Internet post, a self-confessed narcissist who practices loving

kindness meditation describes his experience.

What happens? Well, it’s supposed to build empathy and

compassion. I just call it “a way of softening the guard around
the heart”. … I’ve been doing this regularly now (as in daily) in
the mornings, and sporadically throughout the day for about
3 weeks. I can honestly say it has impacted me. Don’t ask me
how, and it’s subtle, but it just kind of works. I won’t bore you
with the details, but I’ve noticed a kindness and willingness to be
nicer to people just for the SAKE of it. It kind of sneaks up on
you. ([bag_of_stan], n.d.)
 Hyper-Egoic Capacity Disavowals 243
Regular practice is key. As discussed in Chapter 9, this regularity is
necessary to reinforce brain changes in the ventral striatum, the part of the
brain associated with habituation.
Unfortunately, there is a dearth of research on the effectiveness of loving
kindness meditation in cases of clients with narcissistic tendencies.
Notwithstanding, my observations have been that, while it may prove
unhelpful in extreme cases (and narcissism appears to exist on a continuum)
it can be useful in some cases. In contrast, there appears to be some evi-
dence that mindfulness meditation may not be useful and may possibly
exacerbate the tendency toward self-absorption in the client population in
question (Young, 2017).

Bibliotherapy
In general, literature that focuses on rational self-interest may prove to be
the most useful for this client population. Author Ayn Rand, mentioned
earlier, has written several books that may resonate with the clients in
question. In addition to her well-known novels such as the Fountainhead
and Atlas Shrugged (Rand, 1971, 2005), she also edited a collection of essays
titled The Virtue of Selfishness, in which she interprets the concept of
“selfishness” as rational self-interest, and aligns it with such virtues as
honesty and justice (Rand, 1992).
John Stuart Mill’s treatise On Liberty is a powerful defense of accepting
others’ right to self-expression even if one disagrees (Mill, 1859). It can be
interpreted from a perspective of rational self-interest, meaning one is a
greater gainer by tolerating others’ freedom of expression, so it should
resonate with clients who are hyper-egoic.
The Matrix, the original film directed by Lana and Lilly Wachowski
(1999), starring Keanu Reeves, provides a science fiction depiction of
Plato’s Allegory of the Cave in which prisoners are held captive in a virtual
world by intelligent machines. One prisoner, Neo (played by Keanu
Reeves), confronted with the choice between learning the truth or con-
tinuing with his present life, courageously chooses the latter course. In the
end, the struggle it unleashes sets him free.
This film may provide a useful segue into Socratically exploring the nature of
reality with the client, particularly the idea that attaining truth requires opening
one’s mind to alternative possibilities, even realities that may not be pleasant or
congenial; and that refusal to accept the freedom to do so can keep a person
prisoner in his own deceptive subjectivity, and stifle his prospects for happiness.
There are indeed many films that deal with the value of interpersonal
relationships in the attainment of human happiness, and how self-
absorption can squander the opportunity. One especially uplifting film on
this theme is the 2007 drama, The Ultimate Gift, which provides a portrayal
of a young man who is self-absorbed, wealthy, and clueless about what is
truly missing from his life in his quest for happiness (Sajbel, 2007). It takes
244 Overcoming Capacity Disavowal Types
the “ultimate gift” given to him by his grandfather in his last will and
testament to help him find out that self-love and the love of others are
intertwined, as Fromm (1955) admonishes, and that money or other ex-
ternal goods are not the royal route to happiness. What is especially striking
about this film is the manner in which it builds to the moment where this
lonely and disillusioned traveler of life realizes that what is missing, what he
“really wants,” is friendship based, not narrow self-interest, but instead on
mutuality and love. This film has potential to spark meaningful self-
reflection with clients who are hyper-egoic.

Notes
1 This formulation depicts catastrophizing. As mentioned previously, the client may
also damn the critic as well as catastrophize about the act of questioning him. To
illustrate the latter syllogism chain containing damnation of others instead of cata-
strophizing, simply substitute “You are a stupid jerk” for “it’s awful.”
2 Transcription from Rogers (1974) video.
3 After the client explores the subjective world of another person with whom he disagrees,
he can then proceed to try to refute what the other says by using logical argument aimed
at exposing holes in the other’s judgment. This is quite consistent because empathy does
not require that, in the end, the client actually comes to agree with his critics.
4 For further details of how to conduct such meditation, see the discussion of
compassion-based meditation, this book, Chapter 9, and the loving-kindness medi-
tation video by Neff (n.d.).

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12 Dependent Capacity
Disavowals

Dependent capacity disavowals are cognitive disavowals in which the client

in a dysfunctional, codependent relationship disavows her capacity to make
her own decisions or manage her own life affairs without being told what to
do by the other partner. Relationships of this nature may include emo-
tional, physical, or sexual abuse.
Clients who make such disavowals tend to be self-deprecating and de-
pendent on the approval of others to feel worthy. On the other hand, when
they are judged negatively by others, they experience strong negative
feelings about themselves. Consequently, these clients tend to seek out
partners who are domineering, so that they tend to be led by the “strong
arm” of another. As such, the relationship is co-dependent and dysfunc-
tional, where the stronger partner exercises excessive control over the
weaker partner, and the weaker partner is overdependent on the stronger
partner for direction. Unless the client receives therapy, she may predictably
leave one dysfunctional relationship only to forge similarly dysfunctional
future relationships. In the extreme, the client satisfies the diagnostic criteria
for Dependent Personality Disorder (American Psychiatric Association,
2013, p. 725). This client population experiences anxiety related to ex-
ercising independent judgment.
The dependent client demands the approval (or reassurance) of others
and may seek out this approval by blindly conforming to what others are
doing (Cohen, 2015). In demanding approval, such clients can be highly
susceptible to unhealthy activities, including taking harmful drugs and other
risk-taking activities (Yiğitoğlu & Keskin, 2019).

Dependent Disavowal Syllogism Chains

The syllogism chain supporting dependent disavowals starts with the befor-
ementioned demand for approval, and can be schematically exhibited as follows:

Demanding approval → Demanding perfect performance → Distorting

probabilities → Self-Damning → Disavowing capacity to exercise
autonomous judgment
248 Overcoming Capacity Disavowal Types
The main premises (minus inference rules) of the syllogism chain proceed as
follows:

1. I must have another’s approval.

2. Therefore, I must not mess up.
3. But I’ll mess up if I make this decision on my own.
4. Therefore, if I make this decision on my own, I’ll make a fool of
myself.
5. Therefore, I can’t make this decision on my own.

In the above, the deduction to (2) from (1) is validated by the inference rule
that I can get others’ approval only if I do not mess up. Therefore, the
“must” in (2) is an instrumental “must”; that is, it stipulates a means-end
relationship between not messing up and attaining the approval of others.
Because there is always the possibility of messing up in the future, the
connection between these two premises is an ongoing source of anxiety for
the client. In (3) the client predicts messing up; and in (4) deduces making
herself into a fool for having screwed up. As such, the client, imagining
herself a fool, concludes in (5) that she is incapable of successfully exercising
her own judgment. Accordingly, she paints herself into the corner of either
not doing anything at all or seeking out help from others. This can be a
domestic partner, a group of peers, coworkers, or others whom she believes
could save her from messing up.
Typically, there is a primary target (individual or individuals) from whom
the client seeks approval and upon whom the client has come to depend.
The possibility of negative judgment from this individual/s is the source of
most of her anxiety about messing up (“What would she say if he found
out?”). The client is thus motivated to try to please this individual and may
go to extremes in attempting to do so. Unfortunately, the quest to get the
approval of this individual is endless and fraught with anxiety each step
along the way. Consequently, the client is enslaved by a self-defeating,
perfectionistic demand for approval that is never quite satisfied in the
present and always subject to future abridgment.
Neurologically, there is evidence that Cluster C Personality Disorders
such as Avoidant Personality Disorder and Dependent Personality Disorder
involve activation of the amygdala in response to a disorder-relevant sti-
mulus. There is also medial prefrontal cortex activity as well as anterior
cingulate cortex and insula activation (Boehme et al., 2014). While there
does not appear to be extensive neuropsychological research on Dependent
Personality Disorder per se, it may be reasonably hypothesized that the
anxiety response in the latter closely tracks brain activity in anxiety dis-
orders such as Social Personality Disorder (Boehme et al., 2014). If so, then
it is reasonable to hypothesize that the ventromedial prefrontal cortex is
active in triggering interoceptive feelings processed in the insular and
anterior cingulate cortices; and in messaging the amygdala to process the
 Dependent Capacity Disavowals 249
threat. On this hypothesis, dependent disavowals involve top-down neural
processing.
Phenomenologically, this neural process appears to proceed along the
following lines:

• In (1), the client is disposed to have a felt need for approval associated
with images of others, particularly the primary target/s of her
dependence (expressible linguistically as a demand for approval).
• In (2), the client is disposed to have a felt need not to mess up, which is
associated with the interoceptive felt need for approval in (1).
• In (3), the client imagines herself making a particular decision on her
own and messing up, which, in turn, triggers the dispositional felt need
in (2), which, in turn, triggers the associated dispositional felt need in
(1). The client then compares her image of making the decision and
messing up with the latter felt need, which triggers a distressing feeling.
• In (4), the client linguistically expresses the latter feeling in self-damning
terms (“I’m a fool”), which amplifies and transmutes it into a feeling of
unworthiness.
• In (5), experiencing this feeling of unworthiness, while imagining
herself messing up and the target’s disapproving, she feels powerless to
make the decision on her own, and linguistically expresses this sense of
powerlessness using the “I can’t” disavowal.

Neural correlates of the feeling of unworthiness appear to include the dor-

somedial prefrontal cortex (DMPFC), precuneus, posterior superior tem-
poral sulcus (PSTS), and temporal parietal junction (TPJ). The precuneus
appears to be part of the brain’s “mentalizing system” or ability to key into
what others are thinking, which “serves as a gateway for translating the
subjective interpretation of reputation into state self-esteem” (Kawamichi
et al., 2018; Cavanna & Trimble, 2006). The STS and DMPFC also appear
to be part of the latter system (Isoda & Noritake, 2013). A reduction in the
feeling of self-worth also appear to be associated with increased activity in
bilateral anterior insula and dorsal anterior cingulate cortex, which corre-
lates with self-reports of distress about being rejected by others (Eisenberger
et al., 2011).
Given the top-down model presented above, cognitive interventions
involve helping the client to refute and replace the demand for approval,
which sustains the feeling of worthiness and hence the sense of power-
lessness that manifests in terms of the dependent disavowal. The steps in this
process are provided in the remainder of this chapter.

Step 1: Formulating the Primary Syllogism Using O & R

An example of a dependent client’s primary syllogism is provided below,
along with dialogic illustration of how to help the client construct it.
250 Overcoming Capacity Disavowal Types
Syllogism Chain A
(Rule) If I mess up if I make this decision on my own, then I’ll make a
fool of myself.
(Report) I will mess up if I make this decision on my own.
(Conclusion) Therefore, if I make this decision on my own, I’ll make a
fool of myself.

In Syllogism Chain A, the client deduces the conclusion from the Rule and
Report. The Rule serves to validate the inference. The Report makes a
prediction about what will happen if she attempts to exercise her own
judgment. From these premises the client deduces the dependent
disavowal.

Box 12.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism
In the below part of their session, the therapist helps the client find O & R to
construct the primary syllogism.

C: I can’t make decisions.

T: Why do you say that?
C: I suppose you can say, well, I’m afraid to make them.
T: Tell me about that.
C: Like the time I booked a surprise vacation for my husband in the
mountains. I planned it for weeks, and thought how happy it
would make him; and what a fiasco. The cabin was infested with
bed bugs; we both got eaten alive. Never again!
T: Okay, I see. You’re afraid things won’t turn out the way you
intended.
C: Yes.
T: So what if things don’t turn out as you intended? So, your
vacation was a bust. What of it?
C: I just make such a fool of myself. My husband was really
disgusted with me. And I don’t blame him. That’s, well, that’s
just me.
T: So, you are saying that, if you make your own decisions you’ll
mess up; and if that happens you’ll make a fool of yourself ? So,
if you make your own decisions, you’ll make a fool of
yourself ? Is this your reasoning?
C: Yes, that’s it.
 Dependent Capacity Disavowals 251
Inasmuch as the Report in Syllogism A is an empirical claim, it requires
evidence. That the client considers herself a fool is not an empirical claim.
The latter is her self-rating, a value judgment, which is not deducible from
empirical evidence alone without the introduction of a self-defeating
evaluative premise that messing up in the past makes one a fool. Nor is
there a calculus to compute how many times an individual must make
mistakes before they are officially a “fool.” The latter concept implies total
and irredeemable worthlessness, which is a fiction generated by use of
vacuous, self-destructive language without a referent. The logico-linguistic
approach developed in this book emphasizes the centrality of identifying
clients’ self-defeating negative language contributing to clients’ mental
health issues and replacing it with uplifting language, especially that of the
guiding virtues and supportive uplifting philosophies.

Step 2: Expanding the Syllogism Chain

In the case of clients with dependent disavowals, negative self-rating language
(such as “I’m a fool”) is frequently deduced from higher order premises
expressed in demanding language (such as “must”). Syllogism Chain B
below illustrates expansion upward of Chain A to expose this demand.

Syllogism Chain B
(Rule 1) I must not mess up.
(Rule 2) If I must not mess up, then if I mess up if I make this decision
on my own, then I’ll make a fool of myself.
(Rule 3/Conclusion 1) Therefore, if I mess up if I make this
decision on my own, then I’ll make a fool of myself.
(Report) I will mess up if I make this decision on my own.
(Conclusion 2) Therefore, if I make this decision on my own, I’ll make
a fool of myself.

Box 12.2 Practice

Therapist (T)–Client (C) Exchange

Exposing an Upper Tier Performance Demand
In the below part of their session, the therapist helps the client identify an upper
tier of the syllogism chain containing a perfectionistic performance demand.

T: Okay, so let’s take a look at this premise of yours, that if you

mess up, you’ll make a fool of yourself. How do you feel when
you think about “messing up” like when your vacation didn’t
252 Overcoming Capacity Disavowal Types
turn out the way you wanted it to? Let yourself feel the way you
felt when this happened.
C: Okay.
T: How does it feel?
C: Terrible!
T: Does it feel more like, “Well it would have been better if it
didn’t happen,” or more like, “Oh no! It must not happen!”?
C: Definitely more like it must not happen.
T: So, you feel this need not to mess up?
C: Yes. I do feel it.
T: So, it sounds like you’re demanding that you not mess up; telling
yourself that you must not mess up?
C: Yes, that is what I tell myself a lot of times.
T: And if you do what you feel you must not do, namely mess up,
then you’re a fool?
C: Yes, 100%.

In Syllogism Chain B, the client deduces the major premise rule of

Syllogism Chain A from the inference rule, Rule 2 (grayed out), in con-
junction with the demand made in Rule 1. As mentioned earlier, the latter
perfectionistic performance demand is deduced from a higher demand that
it is supposed (by the client) to promote. This higher-order level of de-
duction is illustrated in Syllogism Chain C below.

Syllogism Chain C
(Rule 1) I must have another’s approval.
(Rule 2) If I must have another’s approval, then I must not
mess up.
(Rule 3/Conclusion 1) I must not mess up.
(Rule 4) If I must not mess up, then if I mess up if I make this decision
on my own, then I’ll make a fool of myself.
(Rule 5/Conclusion 2) Therefore, if I mess up if I make this decision
on my own, then I’ll make a fool of myself.
(Report) I will mess up if I make this decision on my own.
(Conclusion 3) Therefore, if I make this decision on my own, I’ll make
a fool of myself.
 Dependent Capacity Disavowals 253

Box 12.3 Practice

Therapist (T)–Client (C) Exchange

Exposing the Demand for Approval
In the below part of their session, the therapist helps the client identify the
demand for approval upon which her dependent disavowal ultimately rests.

T: But why are you demanding that you not mess up in the first
place? Like when your vacation didn’t go according to plans.
C: If you saw the look on my husband’s face, you would
know why!
T: You said your husband was “disgusted” with you.
C: He didn’t say it but, believe me, he was. I let him down! I
should have read the reviews before booking it. Almost all of
them said “Bedbugs! Stay away!”
T: You “let him down,” meaning he was disappointed in you? You
didn’t get his approval?
C: Yes, that’s right.
T: Do you feel like you need his approval?
C: Yes, I do.
T: So, you feel like you need your husband’s approval and tell
yourself you must not mess up so you can get his approval? Is
this your reasoning?
C: Yes, exactly.
T: Do you ever try to get other people’s approval too?
C: Yes, I’m like that with my friends, and even people I don’t
know. But my husband is my rock. He is always there for me.
T: To tell you what to do?
C: Right.

Syllogism Chain C displays the higher-tier demand from which the

demand for perfect performance (Rule 3) is deduced. This higher-tier
demand, as provided in Rule 1, demands approval from the client’s
target. The latter demand tends to be the source of the client’s disavowal
of the freedom and responsibility to make her own decisions and live
according to her own lights. Because the demand for perfect perfor-
mance is deduced for the demand for approval, it is the latter demand,
rather than the former demand, that is the main focus of cognitive and
behavioral interventions with the client population in question. This
does not mean that the demand for perfect performance does not deserve
254 Overcoming Capacity Disavowal Types
to be addressed in its own right. It is to say that its persuasiveness (felt
need) ordinarily derives from the demand for approval with respect to
clients with dependent disavowals.
Notice that I have not grayed out the inference rule, Rule 2, in Syllogism
Chain C. This is because it can be useful to challenge the premises upon which
it rests. For instance, the (attempted) justification of this rule in Syllogism Chain
C⁎ is commonplace.

Syllogism Chain C⁎
(Rule 1) If the other will think me a fool (if I mess up) then I must not
mess up (if I must have another’s approval).
(Report) If I mess up, then the other will think me a fool.
(Rule 2/Conclusion) Therefore, If I must have another’s approval,
then I must not mess up.

Box 12.4 Practice

Therapist (T)–Client (C) Exchange

Identifying the Dependent Client’s Self-Doubts
In the below part of their session, the therapist helps the client see how she is
defining her self-worth in terms of others’ approval.

T: So, you play it safe by having your husband—or others—tell

you what to do so you don’t mess up and lose their
approval. But what do you think they would think if you
messed up?
C: They would think I’m a fool.
T: So, people will think you’re a fool if you mess up; and then you
won’t get their approval, which you tell yourself you need. Is
that it?
C: Yes, that’s it.
T: So, it’s largely about what people might think of you. You’re
afraid to make your own decisions because you’re afraid of what
others might think of you if you mess up.
C: I didn’t think of it like that before, but yes, that’s right.

The report in Syllogism Chain C⁎ is itself an empirical claim that reveals the
primary reason why the client thinks she will not gain the other’s approval
if she screws up. The client is afraid of what the other will think of her if she
 Dependent Capacity Disavowals 255
messes up. It is about appearance. Typically, the dependent client is dis-
posed to think of herself in global negative terms (“fool,” “loser,” “failure,”
or other globally damning term). But she nevertheless does not want her
target to think of her in this negative light. So, she may expend large
amounts of energy trying to satisfy the target, while at the same time being
afraid to exercise self-judgment. As such, she places herself passively at the
mercy of others, hoping that she will not destroy the potential to gain some
semblance of self-worth through the approval of another. Sadly, in the very
quest to ground her self-worth on this approval, she undermines the very
possibility of self-respect.
Rule 1 in Syllogism Chain C⁎, “If the other will think me a fool, then I
must not mess up,” is clearly problematic. The problem with the latter rule
is that it bases self-worth on what another thinks. This portends a highly
unstable sense of self-worth that comes and goes with the acceptance of
others. It is a proverbially roller-coaster ride that ends only when the client
relinquishes her demand for approval from others as the grounds of her
dependent disavowal, and hence of her ongoing state of reliance on others.
The deductive chain from which the latter disavowal is ultimately de-
duced is displayed in Syllogism Chain D.

Syllogism Chain D
(Rule 1) I must have another’s approval.
(Rule 2) If I must have another’s approval, then I must not mess up.
(Rule 3/Conclusion 1) I must not mess up.
(Rule 4) If I must not mess up, then if I mess up if I make this decision
on my own, then I’ll make a fool of myself.
(Rule 5/Conclusion 2) Therefore, if I mess up if I make this decision
on my own, then I’ll make a fool of myself.
(Report) I will mess up if I make this decision on my own.
(Rule 6/Conclusion 3) Therefore, if I make this decision on my
own, I’ll make a fool of myself.
(Disavowal Rule) If I’ll make a fool of myself if I make this decision on
my own, then I can’t make this decision on my own.
(Conclusion 4) Therefore, I can’t make this decision on
my own.

Box 12.5 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness
256 Overcoming Capacity Disavowal Types
In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: So now I think I understand why you tell yourself you can’t

make decisions. You tell yourself that you’ll make a fool of
yourself, because you’ll mess up, and won’t get the approval you
demand. You imagine yourself messing up, feeling like a fool,
and not getting the approval you feel you need to be a worthy
person. When you think of yourself in such negative terms like
“fool” that make you feel even more powerless to make a
decision without being told what to do. Does this resonate with
you or am I leaving anything out?
C: No, I think this is right. But I really don’t know how to change.
T: Well, that’s because you’re still demanding approval. So,
imagining not getting this approval makes you feel unworthy,
which makes you feel powerless to change.

In the inference from Rule 6 in Syllogism Chain D to Conclusion 4, the

client seals her fate to be at the mercy of others. It is here where the client’s
feeling of unworthiness amplified by pejorative self-rating terms such as
“fool” (“loser,” “failure,” or similar self-damning language) leads to the
sense of powerlessness to exercise self-judgment, and hence to disavow her
capacity to exercise her freedom and responsibility for shaping her own life.
Helping the client to make constructive change toward this fundamental
goal of therapy begins with the recognition of the emotional reasoning that
sustains her dependent status, and proceeds with the refutation of its most
destructive premise, the demand for approval.

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
Dependent clients, like all of us, have probably had occasions when they
did things on their own without approval from others. Indeed, few, if any
adults, are totally dependent on others. So, one indirect refutational ap-
proach, a logical refutation, is to demonstrate to the client that she does not
need the approval of others to accomplish a goal. “Did you ever do any-
thing on your own without seeking the approval of others?” If the answer
to this question is in the affirmative, then the therapist can point out that
this would not have been possible if the client needed to have another’s
approval.
A further approach, an empirical refutation, is to challenge the client to
consider what evidence she has thinking she must have the approval of
another. “Where is it written that you must have the other’s approval?”
 Dependent Capacity Disavowals 257
Typically, clients do not have an answer to this question and will admit it is
nowhere written that they must have this approval. Indeed, the client feels a
need for the approval, upon which she bases her self-worth, but this is
merely a subjective feeling, not an objective fact about the external world.
As mentioned, the client identifies her self-worth with such approval.
Accordingly, a logical refutation can proceed by helping the client to see
the inconsistency in how she assesses her own self-worth and how she
assesses others. “Do you know anyone else whom you consider to be a
worthy person? Does this person gain her self-worth by getting the ap-
proval of others?” If the answer to the latter question is no, then the client
succeeds in exposing the double standard by which she assesses herself and
others.

Box 12.6 Practice

Therapist (T)–Client (C) Exchange

Refuting the Demand for Approval
In the below part of their session, the therapist helps the client refute her
demand for approval.

C: So, how then can I change?

T: By giving up your demand for approval. Do you have an
evidence that you need the approval of your husband or anyone
else? Did you read somewhere that you need it?
C: No, but, like you said, I feel like I need to have it.
T: But that’s just a feeling inside you. Did you ever feel like you
needed something and nevertheless did without it?
C: Yes, of course. When I was younger, I felt like I needed to
marry Brad Pitt. But that never happened! And it never will!
T: So, if you can do without Brad Pitt, why can’t you do without
getting your husband’s approval before you make decisions?
C: Funny, but maybe so!
T: Do you know anyone whom you admire whether or not others
approve of him, or her?
C: Yes, I always admired my high-school biology teacher. The
students hated her and would mock her, but she was a good person.
T: So, the worth of a person does not depend on whether others
approve of them?
C: No, I suppose not.
T: So why do you base your self-worth on whether you get others’
approval?
258 Overcoming Capacity Disavowal Types
C: I see your point! I can still have worth even if I don’t get
someone else’s approval.
T: And did you ever accomplish a goal that you were proud of
without first getting someone else’s approval?
C: Yes, I did. I saved a stray puppy that was about to run onto the
highway. Everyone told me to let it go, but I refused. I gave it to
animal rescue, and it was adopted.
T: Wonderful! So, you don’t need the approval of anyone else to
make your own decisions and accomplish great things, after all!
C: It’s true; that’s right!

Direct refutation of the client’s dependent disavowal can proceed by

helping the client to realize that she is confusing “can’t” with “won’t.”
“What evidence do you have that you “can’t” decide on your own? All you
can prove is that you have not decided on your own. But that is consistent
with your simply not wanting to decide on your own because you are afraid
of messing up.”
Direct refutation can also proceed by having the client disprove the
“can’t” by actually deciding something on her own. Indeed, this is the
strongest refutation because it proves that the feeling of impossibility is just
a subjective feeling, and not a fact about what she is capable of doing.
Further, raising the question, “Have you ever done anything you felt you
couldn’t do?” can also be a useful way for the therapist to help the client
realize that feeling like she can’t do something does not mean she can’t.

Box 12.7 Practice

Therapist (T)–Client (C) Exchange

Refuting the Dependent Disavowal
In the below part of their session, the therapist helps the client refute the
capacity disavowal that keeps her in a disabling state of anxiety.

T: You said you can’t make decisions, but you already have shown
that you can. So when you said “can’t” did you really
mean “won’t”?
C: Well, maybe in some cases that’s true, but not in all cases.
T: Give me an example.
C: I don’t think I can make a decision that could hurt someone
else, like a medical decision.
T: So you feel like you can’t make these decisions on your own?
 Dependent Capacity Disavowals 259
C: Yes, I feel like I can’t, just thinking about it.
T: But that just means you have anxiety about making such
decisions, not that you really can’t make them.
C: Yes, a lot of anxiety. So, what’s the difference if I say, “can’t”
or “won’t”?
T: When you say “can’t” you renounce your freedom and
responsibility. When you say, “won’t” you imply you have a
choice, and you are choosing not to make the decision. You are
responsible for the decision because you were free to do
otherwise.
C: Very scary, but I see what you mean. I’m just afraid, but that
doesn’t mean I can’t.

Step 4: Identifying the Guiding Virtues

The guiding virtues that support the above-mentioned refutations
include Decisiveness, Courage, Authenticity, and Unconditional Self-
Acceptance. Decisiveness can counteract the dependent disavowal itself,
by disposing the client to act contrary to it; Authenticity counteracts the
demand for approval by disposing the client to live by her own lights
rather than seeking the approval of others as the basis for action.
Unconditional Self-Acceptance disposes the client against self-damnation
(“I’m a fool”); and Courage disposes the client against over- and under-
reacting to misjudgments (“messing up”) or other potential threats to
one’s self-esteem.
These virtues tend to be mutually reinforcing and form an interlocking
network. In particular, Unconditional Self-Acceptance supports Authenticity
by helping the client to feel comfortable with acting on her own values,
goals, and considered judgments rather than seeking to conform to the va-
lues, goals, or expectations of others. As such, in the context of discussing
uplifting philosophies for overcoming dependent disavowals, it makes sense
to group together philosophies of Unconditional Self-Acceptance and
Authenticity since a philosophy that supports the former can also support
the latter.
Similarly, it makes sense to speak of philosophies of Decisiveness and
Courage. In Chapter 3, Decisiveness was defined as “Realistic trust in one’s
ability to accomplish the goals one sets; and preparedness to take rational
risks to accomplish these goals under less-than-ideal conditions.” Courage
accordingly supports the willpower to take rational risks in exercising one’s
own judgment. Hence, in the following sections on uplifting philosophies,
the associated virtues are grouped accordingly.
260 Overcoming Capacity Disavowal Types

Box 12.8 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues
In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming dependent disavowals.

T: Yes, it can be “scary,” to make decisions that can have

significant consequences; so it can take Courage. This means
that we can work on increasing your Courage. We call this a
“guiding virtue” because it can give you a positive goal to aim
at. No human is 100% courageous. But we all can work towards
developing more Courage. Does that sound reasonable to you?
C: Yes, it does. Maybe, I’m too afraid.
T: Great! There are some other guiding virtues we can add. One is
Decisiveness. This means not procrastinating, making up your
mind, and acting in a timely way.
C: I could use some of that. I put things off big time.
T: Because you are afraid to act?
C: Yes.
T: The good news is that Courage and Decisiveness can work
together. If you increase your Courage, you can overcome the
fear and become more decisive too.
C: I see that. Less afraid, more courageous, and then more decisive.
T: And there’s also another two mutually supporting guiding
virtues you can work toward. They are Unconditional Self-
Acceptance and Authenticity. The first means that you accept
yourself regardless of whether you get the approval of
others. The second means you live the way you want, not the
way others want.
C: I wish I could be more like this. But how?

Step 5: Finding an Uplifting Philosophy

The above four guiding virtues set positive goals for dependent clients in
cultivating autonomous living within the social constraints of human ex-
istence. As the sixteenth-century British poet, John Donne, famously stated,
“No man is an island,” as there is a healthy range of dependence essential to
human flourishing. So uplifting philosophies that aim at helping dependent
clients to overcome their dependent disavowals address such a healthy range
 Dependent Capacity Disavowals 261
of independence. This would include forging interpersonal relationships
that involve mutually supportive roles in the workplace and in personal and
social spheres while promoting the opportunity to exercise freedom and
responsibility for one’s own life decisions (for example, being a devoted
employee but not a slave to one’s employer; being a loyal partner, while
maintaining a private sphere of interests and values that mark one out as a
separate, co-equal person).

Philosophies of Unconditional Self-Acceptance and Authenticity

These philosophies can help a dependent client feel and be herself rather than
attempting to derive her self-worth through the approval of others. As
discussed previously, the latter dependent posture of self-rating portends an
unstable and self-defeating state of being. In contrast, the philosophies
sampled in what follows can help the dependent client change the negative
polarity she experiences in relating to herself to a positive, affirmative sense
of self; and thus to defeat the dependent disavowal that undermines her
relating to others as an autonomous person.

Treat Yourself as an “End in Itself” and Not as a “Mere Means”

These are the terms the eighteenth-century German philosopher,
Immanuel Kant, used to admonish human beings to treat themselves (as
well as others) as persons (“ends in themselves”) and not as objects (“mere
means”). By a “person” Kant mean a “rational being,” that is, as a being
who has free will and can therefore act independently or autonomously.
This is in contrast to a mere object which does not have free will and
cannot act independently or autonomously but is instead determined by the
wills of persons or physical forces acting on them (Kant, 1964, p. 96).
Persons, Kant says, have worth in themselves, intrinsically, and not as
instruments that can be used for this or that purpose. An object such as a
pen can be used for writing, and its entire worth is a function of this
purpose. If the pen runs out of ink then it ceases to have worth and it can be
discarded. In contrast, the value of a person is not a function of a particular
use, such that if the person ceases to have this use (for example, the capacity
to earn a wage), she becomes worthless. Instead, the value of a person
cannot be added or subtracted from the person regardless of her utility.
In Kantian terms, the dependent client treats herself like an object whose
value is a function of her ability to gain and sustain the approval of another,
such that this value is subtracted or added with this approval. However, on
the contrary, the client is not an object. She is a person whose value is
independent of the approval of others. Persons are “not merely subjective
ends [the objects of the desires of others] whose existence has a worth for us
as an effect of our action, but objective ends, that is, things whose existence
is an end in itself; an end moreover for which no other can be substituted”
262 Overcoming Capacity Disavowal Types
(Kant, 1964, p. 96, my italics). She is therefore special, irreplaceable, non-
objectifiable, and intrinsically worthy regardless of whether she screws up
or loses the approval of others.
I have found Kant’s image of self-worth to be valuable in producing a
positive valent experience in some clients, as confirmed by their self-
reports. Insofar as this sense of worthiness boosts state self-esteem (the
experience of self-esteem), it may produce brain changes conducive to
building a habit of Unconditional Self-Acceptance (or “trait self-esteem”).
Neurologically, the experience appears to increase activity in the subgenual
ACC (Brodmann area 25, a part of the ventromedial prefrontal cortex) and
the ventral striatum, which is associated with reward processing and re-
inforcement of goal-directed behavior (Eisenberger et al., 2011).

Be the Creator of Your Own Values

“The Noble kind of man,” said German existentialist Friedrich Nietzsche,
experiences himself as a person who determines value and does not need to
have other people’s approval … He understands himself as something
which in general first confers honour on things, as someone who creates
values” (Nietzsche, 1954, Chapter 9, sec. 260, p. 579). This philosophy can
potentially reverse the dependent client’s image of herself as a passive re-
cipient of others’ values to that of an active agent in the determination or
creation of values. It may thus be a potent way of counteracting the client’s
feeling of impossibility or powerlessness to make her own decisions and to
live according to her own lights.
This image is one of being “Noble,” and having the power to “confer
honor on things” and “create value.” This positive abstract language can
replace the language of “fool” (“loser,” “failure,” etc.) the client has come
to associate herself with, and thus help to change the negative polarity of
the image of herself to that of a positive source of power and control over
her life.
This may well be why so many have been captivated by the aphorisms of
Nietzsche; for his writings thematically combat conventional ideas of
conformity and mindless obedience to the status quo. While trans-
valuational images such as those conjured up by Beyond Good and Evil (the
work from which the above quote is sited) can potentially have positive
uplifting value for dependent clients, who suffer from passivity, unasser-
tiveness, and disempowerment, they may also be contraindicated for other
client populations. Notoriously, Adolf Hitler appears to have misused
Nietzsche’s writings to support his sociopathy (Bedard, 2018). This un-
derscores that some philosophies may not be therapeutically indicated and
could have countertherapeutic effects for certain client populations. For
example, Nietzsche’s philosophy would seem not to be appropriate for
hyper-egoic clients since it may reinforce the dysfunction rather than help
to reduce it.
 Dependent Capacity Disavowals 263
Have Compassion for Yourself
Beating oneself up by negatively rating oneself, calling oneself pejorative
names, is not the route to self-acceptance. On the contrary, according to
Buddhist, Kristin Neff, the royal route to the latter is self-compassion. The
latter she defines in terms of three conditions: (1) “self-kindness, that we be
gentle and understanding with ourselves rather than harshly critical and
judgmental”; (2) “common humanity, feeling connected with others in the
experience of life rather than feeling isolated and alienated by our suffering”;
(3) “mindfulness—that we hold our experience in balanced awareness, rather
than ignoring our pain or exaggerating it” (Neff, 2011).
According to Neff, all three of these conditions are essential to becoming
self-compassionate. The latter is also to be distinguished from high self-
esteem. The former involves mindful understanding and loving kindness
toward oneself. In contrast, high self-esteem involves self-rating (Neff,
2011). This means it does not involve Unconditional Self-Acceptance,
which is a constant; it does not increase, or decrease based on another’s
approval or disapproval, one’s success or failure, or other contingent life
event or experience. Indeed, for the dependent client, the flip side of high
self-esteem is low self-esteem since the former can quickly turn into the
latter the moment someone withdraws approval, or one is unsuccessful.
Further, Neff suggests that an empirically confirmed way to promote these
conditions in us is through compassion-based mediation such as loving kindness
meditation (Neff, 2011). Indeed, as discussed in Chapter 6, there is now neu-
rological evidence that confirms this ancient Buddhist wisdom. fMRI studies
have shown that seasoned compassion-based meditators have decreased activity
in the amygdala when viewing negative images (Spoon, 2018; Lutz et al., 2004).

Philosophies of Decisiveness and Courage

These philosophies aim to overcome the inertia in exercising independent
judgment in choosing and living one’s own life. Dependent clients experience
anxiety about messing up, and therefore seek out others to tell them what to
do. Philosophies of Decisiveness can help reverse the negative valence asso-
ciated with the exercise of independent judgment by associating it with po-
sitive images of “freedom,” “responsibility,” “self-fulfillment,” “proactivity,”
and “progress” (or related linguistic expressions). Philosophies of Courage, in
turn, help to bolster this positive association by counteracting the negativity of
messing up with positive images of “success” through the exercise of “rational”
judgment based on “evidence” and “probability” (or related expressions).

Reinvent Yourself as a Self-Reliant Person

As discussed in previous chapters (see Chapters 37, and 10), existentialists
such as Jean-Paul Sartre can provide uplifting philosophies to encourage
264 Overcoming Capacity Disavowal Types
action instead of passivity. The core idea germane for dependent clients is
the idea Sartre expresses by the phrase, “Existence precedes essence,”
meaning that human beings are self-defining beings (Sartre, 2007,
pp. 20–21). The dependent client has in these terms freely painted herself in
a corner by defining herself in terms of others views of her and not in terms
of her own values, goals, and interests. On this view, the client has both the
freedom and responsibility to redefine herself in terms of the latter self-
referential ideas by acting on them. This means making and acting on
decisions according to these personal lights.
This involves overcoming the feeling of impossibility that pilots her
dependent disavowal. It means coming to appreciate that when she says, “I
can’t” what she really means is “I won’t” or “I feel like I can’t.” It then
means casting aside this “bad faith” (see Chapter 10) to act, and hence to
define herself as an independent self. Here, the client is presented with the
uplifting idea that she is not bound by her previous self, but can reinvent
herself as a self-reliant person, or as Kant would say, as an “end in herself.”
This is encouraging because dependent clients tend to fatalistically believe
their “essence” is cast in stone and that their futures must be replicate their
past. This appears to be why they tend to seek out other people on whom
to depend when they fall out of current relationships. The dependent client
can escape this vicious cycle with the existential medicine of reframing her
fatalistic image of herself in terms of a new image of freedom and re-
sponsibility to be (become) whom she chooses.

Follow Your Own Lights as Though They Were Laws

Stoic philosophy can also be a useful aid to the dependent client in building
the courage to be self-reliant; to act according to her own considered
judgments and values and not to be intimidated by what others might say or
think of her. According to Epictetus, this is possible by reframing one’s own
convictions as “inviolate laws” by which one is bound. “Whatever rules
you have adopted,” instructs Epictetus, “abide by them as laws, and as if
you would be impious to transgress them; and do not regard what anyone
says of you, for this, after all, is no concern of yours.” Otherwise, he says,
you will “add procrastination to procrastination, purpose to purpose, and
fix day after day in which you will attend to yourself” and accomplish
nothing on your own (Epictetus, 1948, sec. 50).
This does not mean that a person must be perfect and never mess up.
Even Socrates was not perfect and had to learn by progressive installments
of self-improvement. But you will not begin the process of self-
improvement, Epictetus admonishes, until you get over the fear of being
judged negatively by others, and instead “think yourself worthy of living as
a man grown up and a proficient” (Epictetus, 1948, sec. 50).
Thus, following this ancient wisdom, the dependent client can speak to
herself with a clear, unequivocal voice: “I am a worthy, albeit imperfect
 Dependent Capacity Disavowals 265
person, an adult, who has within me the power to act by my own lights. As
such, I do not need someone else to tell me what to do. I will accordingly
let my own judgment be a law unto myself, without allowing fear of what
others may think of me to deter me!”

Don’t Be a “Willing Slave”

In his treatise on The Subjection of Women, John Stuart Mill (1869), a century
ahead of his time, stated,

Men do not want solely the obedience of women, they want their
sentiments. All men, except the most brutish, desire to have, in the
woman most nearly connected with them, not a forced slave but a
willing one, not a slave merely, but a favourite. They have therefore
put everything in practice to enslave their minds. The masters of all
other slaves rely, for maintaining obedience, on fear; either fear of
themselves, or religious fears. The masters of women wanted more
than simple obedience, and they turned the whole force of education
to affect their purpose. All women are brought up from the very
earliest years in the belief that their ideal of character is the very
opposite to that of men; not self-will, and government by self-control,
but submission, and yielding to the control of others. All the moralities
tell them that it is the duty of women, and all the current
sentimentalities that it is their nature, to live for others; to make
complete abnegation of themselves, and to have no life but in their
affections. And by their affections are meant the only ones they are
allowed to have—those to the men with whom they are connected, or
to the children who constitute an additional and indefeasible tie
between them and a man. (pp. 26–27)

In this passage, Mill has described the plight of many dependent female
clients today. These are women who perceive their purpose in life as one of
servitude to a man. These women believe that they are nothing without a
man to direct them and give meaning to their life. It is what French feminist
philosopher, Simon de Beauvoir (2000), in the twentieth century, called
“dependent love.” Such a woman without a man by her side, she said, is “a
scattered bouquet” (p. 138).
While the socially sanctioned sexism of which Mill speaks has substantially
dried up in many contemporary social quarters, it has unfortunately not been
fully eradicated, and remains to insidiously shape the minds of at least a subset
of women, even in progressive industrialized societies. As Mill astutely
perceives, such women are not mere slaves, in physical bondage; they are
instead willing slaves. Even more, it feels impossible for them to do otherwise
but define their self-worth in terms of serving their masters.
266 Overcoming Capacity Disavowal Types
For such clients, Mill’s characterization of this form of mental oppression
can be an epiphany. It works by virtue of its potential to reverse the positive
polarity of the sense of self-worth the client intermittently gains by getting
the other’s approval—in being his “favorite.” The stark analogical term,
“willing slave,” can indelibly taint this conditional sense of worthiness; it
puts it in a light the client may never have before imagined; one that can be
jolting. In one case, after a client read the paragraph from Mill cited above
(which I had given her to read as bibliotherapy), she looked me squarely in
the eyes and said, “No more willing slave.” At that moment, it was clear to
me that the language of Mill’s prose had shattered the thin veneer of her
false sense of security. True to this prediction, the client moved forward by
divorcing her husband (who was both physically and emotionally abusive),
went back to school to earn a degree; and the last time I spoke with her, she
told me she was still rereading and underscoring passages in Mill’s Subjection
of Women.

Reframe Loss of Self-Esteem as an Impermanent State of Consciousness, Not

Damage to an Underlying Self
According to Buddhist teachings, there is another reason why the depen-
dent client’s search for self-esteem may be flawed. It is because the self is,
itself, illusory. For, according to Buddhist doctrine, there is no permanent
“self” (or “soul”) that underlies states of consciousness. We pass in and out
of states of consciousness—desires, thoughts, perceptions, sensations, feel-
ings, memories—and when they are gone there is no residue called the
“self.” This is part of the all-encompassing Buddhist idea that reality is
impermanent, and that clinging to things that are impermanent is what
causes needless suffering. Liberation from such suffering comes with ac-
ceptance. Thus, in the Buddhist text, Samyutta Nikāya [Connected
Discourses], it is stated, “Any kind of consciousness whatsoever, whether
past, future, or present, internal or external, gross or subtle, inferior or
superior, far or near—one sees all consciousness as it really is with correct
wisdom thus: ‘This is not mine, this I am not, this is not my self’” (Bodhi,
2000, p. 223). Clinging to the self as though it were something permanent
beyond the impermanence of consciousness itself leads to needless
suffering—painful states of consciousness.
This Buddhist doctrine of “non-self” can have a liberating application to
the case of the dependent client. This client feels threatened by the image of
messing up. It feels like the self will be harmed. However, because the self is
illusory, that is, there is no underlying thing called the self, it can’t be
harmed. There is just a flow of images and feelings. The brain constructs
self-consciousness or awareness through the activity of several brain regions
such as the insular cortex, anterior cingulate cortex, and the VMPFC
(D’Argembeau, 2013; Riehl, 2012). However, from the Buddhist per-
spective, there is no self that orchestrates these brain activities.
 Dependent Capacity Disavowals 267
Since there is no self, fear of harm to self, that is, loss of self-esteem, as a
result of messing up and not getting the approval of others, is irrational, and
the source of unnecessary pain. To lose self-esteem does not portend da-
mage to a (non-existent) self; it is simply to add another set of images and
feelings that are impermanent and can be overcome by realizing what they
truly are—transient states of unnecessary consciousness. As such, for the
dependent client, having Courage means realizing that loss of self-esteem is
just a state of consciousness that can be overcome by allowing these ne-
gative images and feelings to pass away, instead of hanging on to them.

Exercise Your Positive Freedom

In his classic essay on “Two Concepts of Liberty,” British philosopher Isaiah
Berlin distinguishes between negative and positive liberty. I am free in the
negative sense, he says, “to the degree to which no human being interferes
with my activity.” So, I am free to vote in this sense if no one prevents me
from casting my ballot. On the other hand, I am not free in this negative
sense when, in a totalitarian state, the government interferes with my vote,
say by blocking my entrance to the voting precinct. However, even if free in
the negative sense, I still may be unfree in the positive sense, which, he says,

derives from the desire on the part of the individual to be his own master.
I wish my life and my decisions to depend on myself… I wish to be…self-
directed and not directed by…other men as if I were an inanimate object,
an animal, a slave incapable of…conceiving purposes and realising them.
… I wish above all to be conscious of myself as a thinking, willing, active
being whose choices are his own, bearing responsibility for his acts, and
able to explain them by reference to his own ideas and purposes. I feel free
in proportion as I know this to be true, and enslaved in proportion as the
facts make me realise that it is not true. (Berlin, 1958, p. 14)

So, the person who is free to vote (in the negative sense) is not free (in the
positive sense) if she simply votes the way someone else told her she should
vote. Exercising positive freedom not only means making one’s decisions
based on one’s own reasons; it also means acting on these reasons. So ne-
gative freedom (not being prevented from acting on one’s own decisions) is
a precondition of positive freedom, but it does not substitute for it.
Dependent clients can thus benefit from distinguishing between these two
senses of freedom. The client may think she is free because she is not phy-
sically constrained, shackled, or bound, and can move about freely.
Nevertheless, in her dependent state, she may still not feel free insofar as she
realizes that she does not act according to her own ideas and purposes. This is
the feeling of impossibility or disempowerment that fuels her disavowal of her
freedom and responsibility to make her own decisions. The way to reverse this
negative polarity, on Berlin’s view, is to work toward positive freedom, which
268 Overcoming Capacity Disavowal Types
allows the client to feel free. This requires practicing making her own decisions
and gaining this positive feeling of freedom until it becomes a habit or dis-
position. And the latter habit is precisely what it means to be decisive.

Box 12.9 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy
In the below part of their session, the therapist helps the client to find a
philosophy to overcome her dependent disavowal.

T: Well, this is where you get a chance to put your own ways of
looking at the world to work. You see, different people look at
the guiding virtues differently. They have different philosophies
of life, what we call “uplifting philosophies.” For example, with
regard to Decisiveness, some people believe that everyone has
free will and that they are just lying to themselves when they
tell themselves they “can’t” make decisions. What is your
philosophy? C: I’m not sure. I think that’s kind of unfair,
though. It’s really hard for me. I mean, I don’t think I’m lying to
myself. It’s just very hard for me.
T: Sounds like Buddhism might work for you as a philosophy of
Unconditional Self-Acceptance. It emphasizes having compassion
for yourself instead of negatively judging yourself. So, your self-
worth does not change, even if you make a mistake or have a
hard time deciding. Does this philosophy resonate with you?
C: Yes, it does. I’m not very nice to myself. I always tell myself how
I’m such a fool when I mess up; and even when I just don’t know
what to do! Then I look for someone to tell me what to do so I
don’t screw up and look stupid. I suppose I really could stand to
have more compassion for myself. But how do I do that!?
T: There’s a type of meditation called loving-kindness meditation.
Did you ever hear of it?
C: No, I haven’t.
T: It involves wishing yourself, as well as others, loving kindness. I
can recommend an audio recording to get you started (Neff,
n.d.-b).
C: Can this really work?
T: Yes, as part of a broader plan of action.
C: Okay, I’ll try it!
 Dependent Capacity Disavowals 269

Step 6: Constructing a Plan to Apply the Philosophies

The philosophies provided in Step 5 suggest ways therapists can help their
dependent clients reverse the negative polarity created by their demand for
approval and the performance demand deduced from it. The goal in this is
to help the client feel more self-sufficient. This shift can occur through a
combination of behavioral and cognitive reframing activities that apply
these philosophies by both directing constructive behavioral change and
shaping cognitive reframing. By reflecting on the manner in which clients’
current dependent disposition has adversely affected their lives, they are
more likely to grasp the sort of cognitive and behavioral changes that may
help them overcome their current dependent state and make progress to-
ward their guiding virtues. Hence:

Question 1: In What Ways Has Your Disposition to Depend on

Others to Tell You What to Do, to the Exclusion of Making Your
Decisions or Life Choices Negatively Impacted Your Life?
Quite commonly, dependent clients focus on the void in their personal
fulfillment. On the one hand, they have strived to feel better about
themselves; but, on the other, their attempt to gain favor with others has
never seemed to fill this void, even when they have succeeded in attaining
the approval of others. The feeling of powerlessness, a sense of being adrift
at the sea of life, at the mercy of whatever direction the wind might blow;
this is how one client once described it. Even when the client is not alone;
for example, a woman with a man by her side; she is an appendage, a
servant attempting to curry favor; not a person in her own right. As
mentioned earlier, it is a sense of bondage, a form of “willing
slavery”—even though the desire to serve feels more like compulsion than
willful submission.
Dependent clients often express desires to advance their own
interests—career, education, etc.—but are not incentivized to do so. They
fear failure; they may be discouraged by significant others; or they lack
independent financial means. Some, who are in abusive relationships, may
vacillate between expressing a strong desire to get out of the relationship,
on the one hand, and on the other, blaming themselves for the abusive
treatment (“I could have tried harder”) or making excuses for the perpe-
trator (“He’s really a good man,” “He provides for me”).

Question 2: What Changes Would Your Uplifting Philosophies

Prescribe?
Raising this question entrenches change in images that feel liberating rather
than self-stultifying. Insofar as the philosophies in question resonate with
270 Overcoming Capacity Disavowal Types
the client’s own values, considered judgments, interests, and goals, they can
help to revitalize these personal perspectives (associate them with strong
positive valence); and, therefore, to muster counteractive force against the
feeling of disempowerment driving the client’s disavowal to live by her
own lights.
Importantly, this process of moving toward constructive change re-
inforces the client’s own values, fostering autonomy. It is not supposed to
attempt to replace the client’s values or considered judgments. The latter
would simply be a continuation of what had created her dependency in the
first place. The therapeutic goal is client liberation, not merely another
instance of subjection. Accordingly, the therapist can work with the client
to construct a plan of action aimed at promoting independent judgment
according to her own values and considered judgments.

Question 3: How Are You to Make These Constructive Changes?

Below are some suggestions for constructing a plan of action intended to
support such client liberation.

Cognitive-Behavioral Assignments for Clients with Dependent Disavowals

Cognitive assignments have as their goal reinforcement of the process of
helping the client practice identifying the irrational speech acts under-
girding her self-defeating, negative emotions (especially, her anxiety about
exercising independent judgment), refuting these acts, identifying their
guiding virtues, and embracing uplifting philosophies that help the client to
think and feel more liberated. Behavioral assignments involve practicing
behavior that aligns with and reinforces these cognitive reframes. The ul-
timate aim is to help the client to overcome the self-stultifying feeling of
impossibility or disempowerment that prevents her from exercising her
own independent judgment in living by reversing the latter’s negative
polarity; and, accordingly, to become more courageous, unconditionally
self-regarding, decisive, and authentic in confronting the everyday chal-
lenges of living.

In Vivo Cognitive Reframing and Acting on It

Everyday living offers many occasions for independent judgment and ac-
tion. Most clients are already reasonably comfortable with routine
actions—driving their child to school, preparing meals, performing job-
related tasks that are pro forma or regular; since these things are already
sanctioned and such that not performing them would arouse disapproval
from others. However, some things are less standard, more controversial,
and more likely to arouse disapproval if they are not carried out without a
hitch. For example, the client may be invited to attend an overnight
 Dependent Capacity Disavowals 271
conference; organize a social event; or her interest may be peaked by a
course offered at the local community college. While these may be at-
tractive to her, she may fear that going off course and doing something
outside the range of standard activities could negatively affect her ability to
carry out her usual routine. As such, she may feel anxiety about committing
to such things, and her first inclination may be to ask her significant other
what to do; or to procrastinate, thereby making her decision by indecision
(time passes and the opportunity is foreclosed). Here, however, is where
there is ample opportunity for the client to practice making cognitive-
behavioral changes by first keying into her emotional reasoning; identifying
her irrational demands for approval and performance, and her self-
damnation; refuting these speech acts; and embracing her guiding virtues by
reflecting on her uplifting philosophies.

Box 12.10 Practice

Practicing In Vivo Cognitive Reframing

Below, the client cognitively reframes a situation arising in her life about
which she is beginning feel anxiety.

There I go feeling this need for approval, and then telling myself
I better talk to him first; like I’m a child and need his permission;
and then feeling this fear of messing up and telling myself how I
better not mess up; so telling myself what I loser I’d be if I didn’t
do the right thing; and feeling so helpless and needy. But I don’t
really need his approval. That’s just that feeling I get that makes
me afraid to mess up; I’m a person, not some object that’s
controlled by others. I can accept myself unconditionally, not just
when I get his approval. I have the power in me to make my
own decisions. I can do this even if I feel like I can’t. I can be
decisive and courageous. I am going to make my own decision
for a change and do what I really want. This is the authentic me!

Such cognitive reframing sets the stage for the final step in the process,
the exercise of willpower to perform the act in question—not just making
the decision but also acting on it. Thus, a client may go through the
cognitive process, but nevertheless not act on it. This is not uncommon, so
the cognitive-behavioral therapist who works successfully with dependent
clients is prepared to exercise patience but is also persistent in encouraging the
client to act on her decisions.
272 Overcoming Capacity Disavowal Types
Shame Attacking Exercises
These exercises can be helpful for clients with dependent disavowals in-
asmuch as they are motivated by the felt need for approval. Reversal of the
negative polarity attached to not getting the approval of others can be
increased by actually staging events where the client gets the disapproval of
others. In these exercises, the therapist counsels the client to deliberately
create an event in which others will disapprove of her. The client is free to
choose the event; however, it would be one where others are likely to
negatively judge her. It would also be an event in which the potentially
disapproving person/s is such that the client feels a need that he approve or
at least not disapprove of her. For example, the client might stage spilling a
pitcher of cherry punch all over her white blouse at a dinner engagement
and refuse to attempt any damage control while remaining at the event for
the remainder of the event. During this time, the client can quietly work
through her self-destructive acts of demanding, self-damning, and dis-
avowing utilizing an appropriate uplifting philosophy (“My worth and
dignity is a constant because I am a person, not an object; so it really does
not matter whether others are negatively judging me”).

Rational-Emotive Imagery
The dependent client can also helpfully imagine such potentially compro-
mising situations without necessarily being in them, and then work through
a cognitive reframing process (Thorburn, 2015). This activity may be a
useful preliminary to actual events. For example, the client can imagine
herself spilling the punch pitcher all over herself before actually going
through with the shame attack exercise.
However, it is not advisable to substitute the rational-emotive imagery
exercise for the behavioral exercise because the ultimate goal is to change
behavior as well as cognition, which appears to be less likely without the
behavioral exercise. As discussed in Chapter 5, activation of the ventral
striatum is important in building behavioral dispositions or habits.
However, while there is evidence that imagining past events can activate
the ventral striatum (Bulganin & Wittmann, 2015; Reddan et al., 2018), it
is not clear that imagining something that has not yet happened also has the
same effect. Thus, imagining a “shameful” event, without having actually
gone through it, may not have the same potential for building behavioral
dispositions as would actually having gone through the behavioral exercise.
Nevertheless, there is substantial overlap between the brain changes that
occur in imagination and those that occur during an actual encounter
(University of Colorado at Boulder, 2018). As such, practicing rational-
emotive imagery prior to as well as after engaging in a shame attacking
exercise may be a rational approach to overcoming dependent disavowals
and building behavioral dispositions conducive to the guiding virtues.
 Dependent Capacity Disavowals 273
Compassion-Based (Loving Kindness) Meditation to Build Self-Compassion
As discussed in Step 5, building self-compassion can be a useful way to
increase Unconditional Self-Acceptance. Loving kindness meditation is one
constructive way to accomplish the latter goal. The nature of this medi-
tative approach is described in Chapter 11.
As defined by Kristin Neff,1 there are three conditions self-compassion:
“self-kindness,” “common humanity,” and “mindfulness” (Neff, 2011).
These conditions are mutually supportive. According to Buddhism, a
person cannot have compassion for himself if she does not have compassion
for others. If she is disconnected and isolated from others, alone in her
suffering, she is not likely to attain the balance between overreacting and
underreacting necessary for having self-compassion. Instead, she is more
likely to exaggerate her own suffering, consequently tormenting herself
rather than being kind to herself. This is why loving kindness meditation
requires directing loving kindness to others as well as oneself. The love that
one extends to oneself is thus a shared love, a love that binds all humanity
and indeed all living things into a unified community. Having self-
compassion means that one does not feel alone in the universe but instead
feels comforted by unity with a whole that is greater than (and distinct
from) the sum of its parts.
Unfortunately, the dependent client seeks to purchase her self-worth by
gaining the approval or acceptance of others. In this effort, she forfeits the
opportunity to connect with others in a healthy manner, seeing that we are
all imperfect beings who suffer loss, sickness, aging, and death. Thus,
compassion for all is equally due. The other is no more important than
oneself, and conversely. The client’s self-worth is no more contingent on
what others think than is the worth of others contingent on what she
thinks. There is coequality, coalescing in oneness. For the dependent client,
loving kindness meditation can help to deliver this message of unity, re-
versing the negative, vicious cycle stemming from demanding approval of
others in order feel worthy; and instead keying into the positive polarity of
feeling coequally unified and loved.
Kristin Neff has also assembled a set of exercises that dependent clients
may find useful in working on building Unconditional Self-Acceptance.
These exercises can be freely accessed online (Neff, n.d.-a).

Mindfulness Meditation
In Step 5 (this chapter), I introduced an uplifting philosophy to “Reframe
loss of self-esteem as an impermanent state of consciousness, not damage to
an underlying self.” This philosophy can be applied by shifting attention
away from the self and preoccupation with self-esteem, to observing
nonjudgmentally one’s stream of consciousness. Accordingly, mindfulness
meditation can provide a useful way to achieve this goal (see Chapter 4). In
274 Overcoming Capacity Disavowal Types
this manner, the dependent client can practice moving away from her
preoccupation with feeling threatened by her loss of self-esteem through
messing up and losing the approval of others. For in mindfulness medita-
tion, messing up is a state of consciousness that passes, not a scar on the
extramental substratum of self that persists even after the state of con-
sciousness is gone. Inasmuch as mindfulness meditation focuses on a par-
ticular object of consciousness, such as breathing, the client can gently push
such negative states away. Practicing this skill can be useful in helping the
dependent client give up self-defeating rumination on negative images of
losing self-esteem and the felt need to gain others’ approval.

Bibliotherapy
As mentioned earlier, John Stuart Mill’s Subjection of Women contains some
powerful language, such as “willing slave,” that can help reverse the un-
stable feeling of self-esteem that depends on the approval of others (Mill,
1869). The paragraph I have cited in this chapter from the latter work can
itself serve as an edited selection for a dependent client in an oppressive
dependent relationship to read and ponder.
For such clients who have a literary penchant, I would also recommend The
Second Sex by Simone de Beauvoir (2000), also previously referenced. This
book eloquently evokes the images and feelings behind dependent clients who
cling to the sexist idea that a woman needs a man. De Beauvoir’s ideas can also
be applied to heterosexual men as well as gay men who make similar demands,
thereby immersing themselves in dysfunctional relationships.
Dramatic portrayals of the dysfunctional and oppressive nature of gender
roles are also bountiful. One especially uplifting example is Mona Lisa Smiles,
starring Julia Roberts and Kirsten Dunst, and directed by Mike Newell
(2003). The film is set in the 1950s at an all-women’s school (Wellesley
College) where the students accept that their education is but a precursor to
becoming a wife and mother. Exposed to a free-spirited instructor (Julia
Roberts) who represents an authentic, unconditionally self-accepting role
model, the women are inspired to look at their potential for independent
living in a new light. This film may be useful especially for dependent fe-
male clients who have contemplated a career or return to school, but who
have been deterred by fear of failure and how others might judge them.
For dependent clients, building authentic love with their partners can also
be an important goal. The little book titled, Growing in Love: 21 Ways to
Become Less Dependent & More Authentic, by James Leonard Park (1998),
which is available free online, briefly discusses 21 ideas that “dependent
personalities” may have about love and contrasts them with ideas that stem
from Authenticity in love. For example:

We have developed basically independent lives.

We are whole within ourselves individually.
 Dependent Capacity Disavowals 275
And from this independent wholeness,
we can come together for meaningful times of sharing. (sec. 1)

These ideas can provide uplifting images that may be quite serviceable for
dependent clients to adopt to offset the negative polarity generated by their
dysfunctional acts of demanding, self-damning, and disavowing.
A classic work that succinctly addresses cultivating a loving relationship
founded on mutuality, as described above, is The Art of Love by Eric Fromm
(2006). In this small, accessible book, Fromm speaks of love as an art, which
like other arts, requires practice. At its core, “mature love,” he says, “is a
union underlying the condition of preserving one’s integrity, one’s in-
dividuality … In love, the paradox occurs that two beings become one and
yet remain two” (p. 19).2 This Eastern theme goes well with the Buddhistic
underpinnings of loving-kindness meditation and may provide a useful
adjunct to such meditative practice for the dependent client.

Notes
1 See “Have Compassion for Yourself” above.
2 See also the discussion of Fromm’s view on love, this book, .

References
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85_17
13 Obsessive Capacity Disavowals

Obsessive capacity disavowals are a form of cognitive disavowal that in-

volves a sense of powerlessness in controlling negatively valent thoughts or
images that enter the client’s conscious awareness. In extreme, this is the
obsessive component of obsessive-compulsive disorder (OCD). The client
feels powerless in getting the distressing thoughts out of his mind. There is
an overwhelming sense of unrealistic danger surrounding the thoughts; for
example, that the image of stabbing someone means that the client is really
going to perform the act. Consequently, obsessive disavowals may be as-
sociated with considerable anxiety.
Obsessive disavowals often involve responses such as rituals or other
actions to try to get rid of the obsession. A ritual may take the form of overt
behavior or a cognitive activity. For example, a client may engage in some
palpably meaningless activity such as counting to ward off “bad thoughts.”
A responsive action may involve checking the door numerous times to
make certain it is really locked.
Neurologically, such disavowals appear to involve top-down control
where the ventromedial prefrontal cortex (VMPFC) is self-referentially
hyperactive and hyperactivates striatal and amygdala axes, thus creating
high levels of anxiety or stress (Apergis-Schoute et al., 2018; Rus et al.,
2016). Further, in individuals with OCD, there is evidence of reduced
functional connectivity between the dorsolateral prefrontal cortex
(DLPFC) and the orbitofrontal cortex, a part of the VMPFC. Inasmuch
as the DLPFC provides inductive input to the VMPFC that enables it to
make rational assessments of danger, it is remarkable that there is a di-
minished connectivity between these two functional components of
emotional control in such individuals. Further, the dorsolateral pre-
frontal cortex plays a role in shifting attention; so it’s lack of connectivity
may indicate a deficit in attention-shifting in individuals with OCD
(Bechara, 2005).
Cognitively, this form of disavowal tends to be based on a perfectionistic
demand for moral or existential certainty, that is, the (linguistic) act of
demanding that one be certain that one will not perform, or be subjected to
morally or existentially unacceptable things (Cohen, 2019).
 Obsessive Capacity Disavowals 279
Morally unacceptable things clients may obsess about are actions that the
client imagines himself performing which transgress the client’s en-
culturated or personal moral values. Existentially unacceptable things clients
may obsess about include unwanted events. The morally/existentially un-
acceptable acts/events about which obsessive clients obsess are imagined
actions engaged in by the client or things that happen to the client or his loved
ones. That is, they are self-referential or entail such reference.
Examples of morally unacceptable actions that clients with obsessive
disavowals may imagine and obsess about include

• harming or killing a loved one

• killing a pedestrian while driving
• doing something “sinful” (violative of one’s religion)
• committing suicide by overdosing on a drug
• destroying someone else’s property
• engaging in inappropriate sex acts
• screaming profanities in the presence of others, and
• contaminating others with a disease.

Obsessive clients who obsess about performing morally unacceptable actions

often fear the possibility that they might act out the actions they imagine, for
example, having sex with a child; and demand certainty that they not do so.
Examples of existentially unacceptable events that clients with obsessive
disavowals may obsess about include

• contracting a serious disease

• something bad happening to a loved one
• eating or drinking something that is contaminated
• things being messy or out of order, and
• having forgotten to turn off the stove (even though one checked it
several times).

Existentially obsessive clients tend to demand certainty that such events not
happening. The events in question tend to be things that can happen. Thus,
clients’ thinking is not delusional. It is rather the lack of certainty that the
event in question won’t happen that is the client’s focus.
Existentially obsessive clients tend to perceive the intentional objects of their
obsessions as existential threats with the potential to seriously diminish the
quality of their entire lives or kill them. For example, a client obsessed about
having eaten a tainted food may imagine and obsess about becoming deathly ill.

Obsessive Disavowal Syllogism Chains

These chains can accordingly be divided into two general kinds: (1) moral and
(2) existential disavowal syllogism chains. Each is described below, in its turn:
280 Overcoming Capacity Disavowal Types
Morally Obsessive Disavowal Syllogism Chains
Syllogism chains of morally obsessive disavowals can be schematically re-
presented as follows:

Demanding moral certainty about not doing something immoral →

Self-Damning about not having it → Disavowing capacity to stop
ruminating about it.

The flow of premises of a morally obsessive disavowal syllogism chain, ex-

cluding inference rules, proceed as follows:

1. I must be certain I won’t do anything (seriously) morally unacceptable.

2. But I have this image of doing something morally unacceptable.
3. Therefore, it’s not certain I won’t actually do it.
4. Therefore, this could mean I’m a horrible person.
5. Therefore, I can’t stop thinking about it.

In this progression of premises to conclusions, the client demands in (1) that

he have moral certainty, and then in (2), seeing that he harbors an image of
doing something morally unacceptable, he deduces in (3) that it’s not
certain that he won’t actually do it (for why would he have such an image
in his head if he did not intend to do it!). From (3) he then deduces in (4)
that it could make him a horrible person to have imagined something so
horrible and yet lack certainty he would not do it. From (4), the client then
deduces disavowing his capacity to stop ruminating about the image.
Because the client feels uncertain about whether this image portends an
underly potential to actually perform the action, he feels compelled to keep
checking it by revisiting it over and over again, ad nauseam. He “can’t” get
it out of his mind because he has self-doubt that he is such a “horrible
person” who can and/or will really do it.
Phenomenologically, the following flow of images and feelings tracks the
above premises in their turn:

• In (1), the client is disposed to feel the need for certainty that he won’t do
anything seriously immoral, which he is disposed to linguistically express
as a demand for certainty in terms of “must” or related term of necessity.
• In (2), the client has an image of his doing something he associates with
a strong negative feeling of moral disapprobation.
• In (3), the image feels “real” and evokes a feeling of moral uncertainty
about his capacity to really perform the forbidden action. This image
and associated feeling of uncertainty triggers the dispositional felt need
for certainty in (1), which he compares to his current image and
associated feeling of uncertainty. This comparison, in turn, feels
threatening to the client.
 Obsessive Capacity Disavowals 281
• In (4), while imagining himself performing the forbidden act, feeling
this threat and its uncertainty, the client feels (viscerally) disgusted, and,
in turn, experiences a feeling of self-doubt. The client expresses the feeling
of disgust using the term “horrible person” to damn himself, and the
proviso, “could,” to express the self-doubt.
• In (5), feeling disgusted by the compromising image of himself, yet still
experiencing the feeling of moral uncertainty about his capacity to
actually perform the “horrible” act, and consequent self-doubt about
being a “horrible person,” the client ruminates about the image,
repeatedly checking it; feeling compelled to keep going over and over it
to resolve the moral uncertainty and cleanse the tainted image of himself.

As described above, the image of performing the forbidden act, say stabbing
someone, feels “real.” It is a sense that what is going on in consciousness is
also really happening. Indeed, the brain processes that occur in the ima-
gination bear similarity to the processes that occur during a veridical ex-
perience (University of Colorado at Boulder, 2018; Reddan et al., 2018),
which can account for the vividness of imagination. In the case of obses-
sions, the barrier between reality and fiction feels very thin, however not so
thin that it crosses over to reality. The client is thus not convinced it’s real.
On the one hand, there is the gut feeling of disgust intentionally focused
on himself through a linguistic act of self-damnation, and apparently also a
guilty feeling as though he could or would perform the act.1 On the other
hand, there is uncertainty that he could or would actually engage in the act
in question, and therefore that he is truly a “horrible person.” Yet he is not
convinced otherwise. This feels threatening alongside the felt need for
moral certainty and self-doubt.
Thus, the ruminative cycle or “looping” is a checking activity in which
the client feels uncertain about whether he is truly capable of committing
the act depicted in his imagination. Because his self-image hangs in the
balance—whether or not he is indeed a “horrible person”—he feels like he
“can’t” stop checking it for a resolution. Unfortunately, the cycle repeats
over and over again, ad nauseam, without any resolution.
In some cases, a client may be distressed by merely having the “impure”
thought. In such cases the client may not feel uncertain about whether he
will actually perform the forbidden act. Instead, he may be uncertain about
whether he is truly a bad person (“I had this thought, so am I a bad
person?”). In this case, the client may feel compelled to ruminate about the
thought in order to check it to see if having this thought really does make
him a bad person.
In any event, the ruminative process is largely influenced by self-
evaluation, that is, the potential, negative rating of oneself. This is confirmed
by hyperactivity in the VMPC in obsessive clients, as previously discussed.
This is because the VMPFC appears to play an active role in self-evaluation.
“By assigning personal value to self-related contents, the VMPFC may play
282 Overcoming Capacity Disavowal Types
an important role in the construction, stabilization, and modification of self-
representations, and ultimately in guiding our choices and decisions”
D’Argembeau, 2013, p. 1). For instance, the image of oneself as a “horrible
person” and the subsequent feeling of disgust it evokes appears to be
modulated by the VMPFC. Accordingly, from a psychotherapeutic per-
spective, neuropsychological investigations into what cognitive-behavioral
interventions affect positive changes in the way the VMPFC processes self-
representation may prove useful in treating obsessive disavowals and other
disorders involving self-rating. In particular, there is evidence that mind-
fulness meditation attenuates self-referential processing and strengthens other-
regarding referential processing (Shi & He, 2020). From a neurological
perspective, this appears to involve a shift from ventromedial to dorsomedial
prefrontal activity, inasmuch as there is evidence that the VMPFC processes
self-referential consciousness whereas the dorsolateral prefrontal cortex
(DLPFC) processes conscious states referencing others (Wagner et al., 2012).

Existentially Obsessive Disavowal Syllogism Chains

Syllogism chains of existentially obsessive disavowals can mutatis mutandis be
schematically represented as follows:

Demanding existential certainty → Existentially damning about not

having it → Disavowing capacity to stop ruminating about it.

The flow of premises of a existentially obsessive disavowal syllogism chain,

excluding inference rules, proceed as follows:

1. I must be certain bad things won’t happen to me or others whom

I love.
2. But I have this image of something bad happening to me.
3. Therefore, I am not certain it won’t really happen.
4. Therefore, it’s horrible this could really happen to me.
5. Therefore, I can’t stop thinking about it.

In such existentially obsessive syllogism chains the client has life-damning ra-
ther than self-damning doubts. Whereas the latter expresses a feeling of self-
disgust or unworthiness, the former is an all-consuming feeling that one’s
whole life is on the line, a potential “horrific” degradation or demise of one’s
existence due to a life-impairing event, potentially even death itself.
Phenomenologically, the thrust of negative evaluation and negative so-
matosensory valence is in the speech act of life-damning catastrophizing in
premise (4) along with the feeling of uncertainty it also tracks. Thus, in (5),
there is the threatening feeling of potential “horror” unresolved. “Will it
really happen!?” As such, the client feels compelled to keep recycling the
image of the “horrible” event happening, a destabilizing feeling of helplessness
 Obsessive Capacity Disavowals 283
to stop, spurred by feeling uncertain about this possibility; and, accordingly,
continually looping as the client keeps checking in vain for a resolution.
In both moral and existentially obsessive disavowals, as presented here, the
dysfunction is rooted in the demand for certainty in the first premise. Thus,
cognitive interventions may successfully dismantle the disavowal that is
(ultimately) deduced from this demand by helping the client to give up this
demand. The therapist can do this only if she helps the client to expose it,
and to appreciate how it is generating his obsessive disavowal. The latter
can be accomplished by first helping the client to construct his obsessive
syllogism chain. Below, this process is described and illustrated.

Step 1: Formulating the Primary Syllogism Using O & R

The primary syllogism in the obsessive chain is constructed from an inten-
tional object (O) in which the client reports the self-disturbing image and its
uncertainty. The rating (R) is then the negative evaluation of O in cata-
strophic terms. Syllogism A provides an example of a morally obsessive syl-
logism chain. As mentioned above, the structure of an existential syllogism
chain is similar except that it contains life-damning instead of self-damning.

Syllogism Chain A
(Rule) If I’m not certain I won’t actually stab my fiancé to death then it
could mean I’m a horrible person.
(Report) I’m not certain I won’t actually stab her to death.
(Conclusion) Therefore, this could mean I’m a be a horrible person.

Box 13.1 Practice

Therapist (T)–Client (C) Exchange

Identifying the Primary Syllogism

In the below part of their session, the therapist helps the client find O & R to
construct the primary syllogism.

C: I keep imagining stabbing my fiancé with a steak knife. I’m

holding the knife and it’s dripping with her blood, and she’s
laying on the kitchen floor in front of me dead but with her eyes
wide open staring at me! I love my fiancé so much! How can I
keep imagining doing such a horrible thing! I feels so real, like I
might do it, but it’s so damn crazy!
T: You feel like you might do it?
284 Overcoming Capacity Disavowal Types
C: Yeah, when I imagine it, and it’s driving me crazy.
T: You said “might.”
C: Yes, and that’s the thing. I’m not certain I won’t do it.
T: And that’s upsetting to you?
C: Yes, I love her so much. How could I have such doubts?
T: And what do you think it mean if you have such doubts?
C: I’m this horrible person!
T: So you think, since you’re not certain you won’t do such a thing,
it means you’re a “horrible person”?
C: Not exactly, it could mean this. Maybe I wouldn’t do it; but I
have to be sure!
T: So, you think, since you’re not certain you won’t do such a
thing, it means you could be a horrible person?
C: Yes, exactly.

In Syllogism Chain A, the client is distressed by not being certain he won’t

stab his fiancé to death (Report). From this Report in conjunction with the
given Rule, he deduces that he could be a horrible person. There is here the
underlying feeling of self-disgust triggered by uncertainty about the capacity
to commit such an act. This is not a settled matter for the client, however.
He could be a horrible person. It is this self-doubt that keeps the client in
limbo, recycling the feeling, and sustaining the morally obsessive disavowal.

Step 2: Expanding the Syllogism Chain

Once the premises of the primary syllogism are exposed, the therapist is in a
position to explore these premises.

Box 13.2 Practice

Therapist (T)–Client (C) Exchange

Keying into the Feeling of Uncertainty

In the below part of their session, the therapist helps the client identify the
source of his reportative premise, a feeling of uncertainty.

T: Let’s take a look at this premise of yours that you’re not certain
you won’t do it. Do you have a feeling that leads you to say this?
C: Yes, when I’m imagining doing it, it feels like, well, like I’m not
certain I won’t really do it.
 Obsessive Capacity Disavowals 285
T: So, in imagining yourself doing it, it feels so real that you aren’t
certain you won’t really do it.
C: Yep.

The source of the uncertainty expressed in the Report in Syllogism

Chain A is a feeling of uncertainty the client is experiencing, which he ex-
presses as an epistemic judgment about uncertainty. This feeling of un-
certainty is itself triggered by the vividness of the imagery. It is not quite
real, but it is “real enough” to create self-doubt. Neurologically, the
VMPFC has strong connections with the ventral striatum (Gusnard et al.,
2001), which is a locus of purposive action (Kim et al., 2009; Gow, n.d.).
This can explain why there is also a phenomenological sense of con-
nectedness with actually doing what one imagines doing. But, of course,
human beings also have the ability to distinguish between reality and
imagination and do not do everything they imagine themselves doing.
Further, it may be that the client imagines doing such a thing in the first
place because he finds it so reprehensible; for, it has been my observation that,
it is not uncommon for obsessive individuals to imagine the things they find
most reprehensible. So, the mere fact that the client harbors such an image
does not mean he would really carry out the act in question. Still, it is the
client’s demand for certainty that makes the Report in Syllogism Chain A feel so
disturbing to the client. Syllogism Chain B makes this point clear.

Syllogism Chain B
(Rule 1) I must be certain I won’t do anything (seriously)
morally unacceptable.
(Rule 2) If I must be certain I won’t do anything morally unacceptable,
then this could mean I’m a horrible person if I’m not certain I won’t
stab my fiancé to death.
(Rule 3/Conclusion 1) Therefore, if I am not certain I won’t
actually stab my fiancé to death then it could mean I’m a
horrible person.
(Report) I’m not certain I won’t actually stab her to death.
(Conclusion 2) Therefore, this could mean I’m a horrible person.

Box 13.3 Practice

Therapist (T)–Client (C) Exchange

Exposing the Demand for Moral Certainty

286 Overcoming Capacity Disavowal Types
In the below part of their session, the therapist helps the client identify an
upper tier of the syllogism chain containing a demand for moral certainty.

T: So, why do you think that if you’re uncertain that you won’t do
it, then it could mean you’re a horrible person? Why does being
uncertain mean this?
C: It’s bad enough that I have these thoughts; but if I actually went
through with it, that would definitely make me a horrible person!
T: But you don’t know for sure that you could really do it.
C: That’s why it means I could be a horrible person. Maybe I
am. When I imagine doing it, I just don’t know!
T: So, are you saying you have to be certain you wouldn’t do such
a thing; otherwise, you could be a horrible person?
C: Yes, that’s what I’m saying. I must be certain!
T: I see. Are you willing to try to imagine these images that are
disturbing you? This can help us to see what your thinking
looks like.
C: Yes, okay.
T: Okay, very good. Imagine you just stabbed your fiancé and
you’re standing over her with the knife dripping with her blood;
and she’s there on the floor, eyes wide open.
C: I am imagining it now!
T: Do you feel a need to be certain you won’t really do this?
C: Yes, it’s so horrible! I feel … I feel I need to know for sure I
won’t do this!
T: Is this feeling what makes you say you must be certain, to demand
certainty of yourself?
C: Yes!
T: But you don’t feel certain you won’t do it?
C: No, I’m just not sure.
T: So, you feel the need to be certain but you’re not. How does
this feel?
C: Horrible! I feel horrible! I feel I’m horrible!
T: So, it feels threatening to you as person?
C: I feel disgusting!
T: So, you must be certain, and since you’re not, you could be this
horrible person?
C: Yes!

In Syllogism Chain B, from his demand for moral certainty in Rule 1,

together with Rule 2 (grayed out), the client deduces the inference rule
linking his moral uncertainty about stabbing his fiancé to damning himself
 Obsessive Capacity Disavowals 287
(Rule 3/Conclusion). Thus, the client’s provisional self-damning stems
from his demand for moral certainty juxtaposed with his uncertainty as
expressed in the Report. Here, the underlying feelings—a felt need for
certainty versus a feeling of uncertainty—collide in consciousness and
trigger the feeling of self-disgust or loaving that drives a feeling of self-
doubt and provisional speech act of self-damning in Conclusion 2.
This act of self-damning, in turn, provides the premise from which the
client deduces his morally obsessive disavowal, as shown in Syllogism Chain C.

Syllogism Chain C
(Rule 1) I must be certain I won’t do anything (seriously) morally
unacceptable.
(Rule 2) If I must be certain I won’t do anything morally unacceptable,
then it could mean I’m a horrible person if I’m not certain I won’t stab
my fiancé to death.
(Rule 3/Conclusion 1) Therefore, if I am not certain I won’t actually
stab my fiancé to death then this could mean I’m a horrible person.
(Report) I’m not certain I won’t actually stab her to death.
(Conclusion 2) Therefore, this could mean I’m a horrible person.
(Disavowal Rule) If it could mean I’m a horrible person, then I can’t
stop thinking about it.
(Conclusion 3) Therefore, I can’t stop thinking about it.

Box 13.4 Practice

Therapist (T)–Client (C) Exchange

Identifying the Feeling of Powerlessness

In the below part of their session, the therapist helps the client identify the
feeling of powerlessness that drives the capacity disavowal.

T: Okay, I think we have some clarity about your reasoning.

C: Now I can’t stop thinking about it!
T: You keep running the image of stabbing your fiancée in
your mind?
C: Yes.
T: You’re still uncertain you won’t do it?
C: Yes. I’m uncertain.
T: And this could mean you’re a horrible person?
C: Yes!
T: So you keep checking it out because you’re not sure?
288 Overcoming Capacity Disavowal Types
C: Yes! That’s it! This feeling of like “could I really be such a
horrible person!? I’m really not sure but I need to be,” so I keep
going over it.
T: And, because you have this feeling of uncertainty, and, on the
other hand, this felt need to know for sure, it feels like you can’t
let it go until you make sure?
C: Exactly, I can’t stop thinking about it until I know for sure.

In Syllogism Chain C, the morally obsessive disavowal in Conclusion 3 is

deduced from the self-doubting expressed in Conclusion 2 taken in con-
junction with the Disavowal Rule. In Conclusion 3, experiencing moral
uncertainty and self-doubt, the client feels compelled to keep ruminating about it
trying to resolve the self-doubt. The speech act of saying “I can’t” both ex-
presses this internal compulsion and reinforces it. Escape from this compulsion
begins with indirect and direct refutation of this self-stultifying “I can’t.”

Step 3: Identifying and Refuting Self-Defeating Speech

Acts in the Chain
Both morally and existentially obsessive clients demand certainty in a world
in which there is no certainty. Moreover, such clients tend to have other
anxiety issues including panic disorder, social anxiety disorder, and gen-
eralized anxiety disorder (American Psychiatric Association, 2013, p. 242).
Thus, merely telling a client to distract herself because the images, feelings,
and urges they may be experiencing are “just thoughts,” is not likely to be
adequate. Unless the client confronts the reality that there is no guarantee
that bad things won’t happen or that, as an imperfect being, he won’t do
bad things, it is unlikely that the client will work through his tendency to
obsess over the thoughts he has.
So, an empirical refutation that goes to the source of the problem,
namely, the demand for moral or existential certainty, can be a constructive
approach. “Where is it written that you must be certain bad things won’t
happen to you or your loved ones, or that you will never do bad things?”
Once such perfectionistic demands for certainty are relinquished, such
intentional objects lose their threatening character.
Morally obsessive clients tend to berate themselves when they think they
have the capacity to do bad things; have had bad thoughts; or are not
certain they will not act on them. So, one potentially useful approach is to
challenge these clients to find a single person who has not done anything
bad; has not had bad thoughts; or is not certain they would not act on their
thoughts. “If having bad thoughts that you were not certain you would not
act on meant you were a bad person, then we’d all be bad!”
 Obsessive Capacity Disavowals 289
Pragmatic refutations can also be helpful. In the case of existentially
obsessive clients, this involves helping these clients to see that cata-
strophizing about bad things ruining their lives itself ruins their pro-
spects for happiness. “When you catastrophize about being
contaminated whenever you dine out, do you not defeat your purpose
in dining out in the first place, namely having a relaxing, enjoyable
evening?”

Box 13.5 Practice

Therapist (T)–Client (C) Exchange

Refuting the Demand for Moral Certainty

In the below part of their session, the therapist helps the client refute his
demand for moral certainty, first using an empirical approach, and second,
using a pragmatic approach.

T: You said it’s your felt need for certainty that leads you to
demand certainty that you won’t do such a thing. This feeling
might explain why you are demanding certainty, but does it
justify it? Is it a good reason to think you must have certainty? Do
you have evidence for thinking this?
C: I suppose not.
T: So, it’s just a subjective feeling?
C: I think so.
T: Can subjective feelings ever be misleading?
C: Oh yeah, a lot of times.
T: Any examples?
C: Like when as a kid I was afraid of monsters.
T: Very good! And here we have another kind of “monster” for
which there’s no evidence.
C: Yep!
T: And is demanding certainty making you feel better?
C: No, it’s making me feel worse!
T: So, in running the images over and over in your mind, it doesn’t
give you certainty?
C: No, it doesn’t. Just makes me feel worse!
T: A vicious cycle.
C: Yes, it’s driving me crazy!
T: So what good does it do to demand certainty?
C: It doesn’t do any good. Just makes things worse!
290 Overcoming Capacity Disavowal Types
Direct refutation of the obsessive disavowal can take a logical approach.
“Have you ever been able to stop obsessing over a thought?” Commonly,
obsessive clients have had such experiences. “So, if you could do it then,
why not now?”
Direct refutation of “I can’t” can also proceed by asking the client to key
into his feeling of compulsion. “Have you ever done something you didn’t
feel like doing? Of course, you have. So, feeling like you can’t does not prove
you really can’t.”

Box 13.6 Practice

Therapist (T)–Client (C) Exchange

Refuting the Capacity Disavowal

In the below part of their session, the therapist helps the client refute his
morally obsessive disavowal using a logical refutation.

T: You said you can’t stop thinking about this image, that it feels
like you need to keep going over it, checking it.
C: And, it’s driving me crazy! I feel so helpless, like I’m stuck.
T: Have you ever felt like you couldn’t do something before, but
did it anyway?
C: Let me think. [Pause] Yes, I gave up smoking. I felt like I
couldn’t quit. But I stopped two years ago when I was diagnosed
with coronary artery disease and the doctor told me to stop
smoking or it would kill me.
T: And that bit of professional advice got you to give it up?
C: Yep, stopped me in my tracks!
T: So even though you felt like you couldn’t stop, you did anyway.
C: Yes.
T: So, just because you feel like you can’t doesn’t necessarily mean
you really can’t?
C: Yes, I suppose so.
T: So why do you think you can’t stop ruminating if you could stop
smoking?
C: I suppose there’s really no reason to think I can’t stop the
thought. Maybe I can beat this!
T: Very good!
C: So how can I stop?
 Obsessive Capacity Disavowals 291
Step 4: Identifying the Guiding Virtues
Key guiding virtues that support the abovementioned refutations include
Serenity (Peace of Mind), Unconditional Self-Acceptance, and Unconditional
Life Acceptance.
In the context of obsessive disavowals, Serenity involves the disposition
to allow thoughts (images and feelings) to freely pass through conscious
awareness without scrutinizing them and demanding moral certainty.
Serene individuals are not self-indulgent; focus more on others than on
themselves; and tend to have positive feelings toward others. This does not
mean they have unrealistic, pie-in-the-sky outlooks on life, however. To
the contrary, they are comfortable with probability rather than certainty;
the human inability to control everything; the fact that not everything can
always be neat and tidy; that bad things can and do (inevitably) happen, and
that all human beings, including themselves, make mistakes and do not
always do the right thing.
Unconditional Self-Acceptance supports and is supported by Serenity by
virtue of allowing self-doubts to enter and exit consciousness without
damning oneself or feeling compelled to ruminate about them. Individuals
who are unconditionally self-accepting distinguish between the goodness
(or badness) of the deed and that of the doer. Hence, they do not condemn
themselves for their own misdeeds. Still, they tend to feel regret when they
act inappropriately and are willing to admit to themselves, as well as to
others, when they so act. They may doubt the rectitude of their actions but
not of themselves.
Finally, Unconditional Life Acceptance means being disposed to accept
one’s life as possessing worth and meaning despite the inevitability of bad
things that happen. It involves the ability to separate the worthwhileness of
living from negative events, realizing that what may be true of one aspect of
one’s life need not be true of the whole. It portends a positive, life affirming
outlook and willingness to rationally address problems as they arise in living.

Box 13.7 Practice

Therapist (T)–Client (C) Exchange

Introducing the Guiding Virtues

In the below part of their session, the therapist acquaints the client with the
guiding virtues for overcoming his morally obsessive disavowals.

T: As you have seen, there are certain things you do, namely
demand certainty that you not do bad things; and damn yourself
when you think you will, and then hold this over yourself as a
292 Overcoming Capacity Disavowal Types
threat when you’re not certain. As you have also seen, your
demand arises from a felt need for certainty; and your self-
damning arises from self-doubts generated by realizing that you
aren’t certain you wouldn’t do the bad things you imagine. So,
the main goal is to get rid of these negative feelings and replace
them with positive ones.
C: How can we do that?
T: This is where “guiding virtues” come in. These are positive
goals associated with positive feelings. In calling them virtues, I
mean that they are character traits that you can build up through
practice. So, it’s going to take a lot of practice on your part.
C: Tell me more about these guiding virtues.
T: Some of these virtues can be especially useful in counteracting
the negative feelings. There are three of them that could prove
helpful in your case.
C: What are they?
T: One is Serenity, which is Peace of Mind that allows you to let
negative images, feelings, memories, and so forth pass out of
consciousness freely. That’s exactly what you aren’t doing when
you demand certainty. Another is Unconditional Self-
Acceptance. This involves accepting yourself, whether or not
you think you will or might do bad things. And, again, this is
exactly what you don’t do in having self-doubts and thinking of
yourself as a “horrible person.” These virtues are ideals, which
means that you will never be perfectly unconditionally self-
accepting or serene. There will always be room for
improvement, so this is a life pursuit; not just something you
will completely master in a few months of counseling. So, are
you willing to work?
C: Yes, I will try my best.
T: Excellent!

Step 5: Finding an Uplifting Philosophy

The above three virtues provide positive goals for obsessive clients in their
quest to overcome their obsessive disavowals. There are a diverse lot of
uplifting philosophies that can serve to interpret each of these goals. The ones
suggested below are grouped according to whether the obsession is moral or
existential. However, the philosophies offered here are only possible sug-
gestions; and it is ill-advised to assume that a philosophy that is uplifting for
one morally obsessive client will be so for another; or that a philosophy that is
uplifting for one existentially obsessive client will be so for another.
 Obsessive Capacity Disavowals 293
Philosophies for Morally Obsessive Clients
These philosophies aim at avoiding self-evaluation and the demand for
moral certainty, while cultivating Unconditional Self-Acceptance and
Serenity. Below are some suggestions.

Stop Clinging to the Idea of a Self

As discussed in Chapter 12, Buddhism holds that the self is illusory.
Grasping for things that are impermanent as though they were permanent,
leads to the illusion that there is something permanent underlying the flux
of images and feelings that flow through consciousness.
According to Buddhist monk, Thich Nhat Hanh (1998),

The idea of self is the hidden idea that there is something called “self,”
“me,” or “mine.” It’s an idea that “I,” “me,” exist, and that there are
things belonging to “me.” “Me” and “mine.”

However, he admonishes, this idea of a self is “the center of all our

grasping, of all our imagining, of all our wrong perceptions” (Hanh, 1998).
If there is no underlying self about which to make demands, then there is
no point to self-damning when this illusory self falls short. There is, of
course, constructive change that can be sought for the future because true
nature of reality is, in fact, change. New images and feelings can replace
previous ones as the flow of consciousness continues.
So, the point is to let go of the self, stop clinging to it and making
demands about something that does not exist in the first place; for,

“Those who are not bound to the internal formations of grasping and attachment
no longer imagine and cling to the idea of a self,” they don’t cling, they don’t
imagine, they don’t compare, they don’t calculate that there is a self. …
(Hanh, 1998)

So, the morally obsessive client imagines a self, and falsely believes he has
one. This leads him to demand that this “I” be moral and that it be certain it
is moral. Unfortunately, comparing what is demanded with what is
real—the impermanence of reality—leads to more grasping, tenaciously
clinging to the self and its entourage of possessions while this grasping and
attachment leads to great suffering. “People have a hard time letting go of
their suffering out of fear of the unknown,” states Hahn. “They prefer
suffering that is familiar” (Rasheta, 2016).
As such, in the act of demanding moral certainty to avoid suffering, the
obsessive client creates his own familiar brand of suffering and basks in it by
tormenting himself—ruminating, savoring the unsavory stench of his self-
demonization.
294 Overcoming Capacity Disavowal Types
The philosophical antidote from the Buddhist is thus to stop the
grasping and attachment. Release this negative energy (valence) of
grasping and attachment to the self. Mindfulness meditation is the true
path to accomplishing this goal, according to Buddhism. It has this po-
tential because it can train the VMPFC to “break free of negative thought
loops and to orient itself in an object of focus in the present moment”
(Hampton, 2017).

Be Your Own Best Friend

The morally obsessive client tortures himself; he treats himself in a way he
would never treat his best friend by subjecting himself to a painful, re-
lentless consciousness when he could be doing something productive and
meaningful with his time.
Ancient Greek philosopher Aristotle presents this uplifting philosophy in
his classic discussion of the nature of friendship. He states,

For men say that one ought to love best one’s best friend, and a man’s
best friend is one who wishes well to the object of his wish for his sake,
even if no one is to know of it; and these attributes are found most of
all in a man’s attitude towards himself, and so are all the other attributes
by which a friend is defined … All the proverbs too agree with this,
e.g., “a single soul,” and “what friends have is common property,” and
“friendship is equality,” and “charity begins at home”; for all these
marks will be found most in a man’s relation to himself; he is his own
best friend and ought to love himself best.
(Aristotle, 1941, bk. 9, ch. 8)

Unfortunately, the obsessive client taunts himself by imagining doing things

that he finds repugnant, and then flaunting it before himself over and over
again, attempting to gain moral certainty that he truly would not do such a
thing despite his imagining doing it. This is far from being a friend to
oneself. Thus, Aristotle’s antidote is to resolve to be one’s own best friend.
The mechanism of constructive change in this context appears to be the
positive polarity of the linguistic formulation, “Be your own best friend,” in
juxtaposition to the self-disturbing, self-doubtful imagine of such an act as
stabbing one’s fiancé to death. Aristotle would explain this process in terms
of overcoming a habit by which one has become incontinent; and he states
that, “those who are incontinent through habituation are more curable than
those in whom incontinence is innate” (Aristotle, 1941, bk. 7, ch. 10).
Thus, to the extent that the obsessive client is habituated to ruminate,
Aristotle would concur that the client is capable of working toward be-
coming his own best friend instead of demoralizing and tormenting himself.
My own clinical observations suggest that this philosophy of “Being your
 Obsessive Capacity Disavowals 295
own best friend,” so expressed, may resonate well with a sizable number of
clients with self-damning tendencies.

Treat Yourself as an “End in Itself”

I have also found Kant’s philosophy of treating oneself as an “end in itself,”
not as a “mere means,” to be useful with such clients. As discussed in
Chapter 12, this means to see one’s worth and dignity as a constant. So, for
an obsessive client who sees his self-worth as hanging in the balance, de-
pending on whether he has the capacity to engage in morally unacceptable
conduct, this philosophy tells him to stop confusing objects with persons
(Kant, 1964).
This means that the client may focus on the worthiness of his actions, not
himself (“I am a worthy person even if I do something bad”) (Ellis, 2001,
p. 47). It also means that the unconditionally self-accepting client does not
rate himself using degrading, negative language such as “horrible person.”
Instead, he may imagine himself acting in morally unacceptable ways, de-
nounce such behavior (should he so act), and continue to accept himself as a
person with inalienable worth despite his capacity for misdeeds.
As such, the unconditionally self-respecting client would not feel the need
to ruminate about what a bad person he could be. On the Kantian phi-
losophy, the client’s value as a person would remain intact whether, or not,
he performs the forbidden act.

Philosophies for Existentially Obsessive Clients

Such philosophies aim at avoiding life-evaluation and the demand for ex-
istential certainty, while cultivating guiding virtues of Unconditional Life
Acceptance and Serenity. Below are some suggestions.

Be Religious: Have Faith and Openness to Truth

The Buddhist philosopher Alan Watts effectively defined faith as the op-
posite of demanding certainty. He said, “faith is a state of openness or
trust.” To have faith means “to let go, and become open to truth, whatever
it might turn out to be” (Watts, 2015). The key idea here is that demanding
certainty forecloses trust in what can happen. It is like saying “I don’t trust
anything or anyone, including my own ability to deal with what may
happen.” According to Watts, this is anti-religious; for being religious does
not mean being closed to the future but rather open to the truth.
So, the obsessive client who demands existential certainty has no faith to
deal with whatever happens to him. From a Western perspective, this is also
to turn a blind eye on God who is All Loving and Good. In clinging to
certainty as the route to knowledge, he surrenders trust in God, and lives in
a state of persistent anxiety about the future, ruminating about the “horror
296 Overcoming Capacity Disavowal Types
of horrors” that may befall him, checking over and over again, ad nauseam,
until he can get what he will never have: certainty. Unfortunately, in
craving certainty, the obsessive client surrenders his faith.

Be Optimistic Despite Inevitability of Tragedy

Austrian existentialist and Holocaust survivor, Viktor Frankl, speaks of “a
tragic optimism,” by which he means “one is, and remains, optimistic in
spite of the ‘tragic triad,’” that is, “those conditions of human existence
which may be circumscribed by (1) pain; (2) guilt; and (3) death” (Frankl,
1984, p. 161). Other existentialists such as Sartre have similarly spoken of
“the human condition” (Sartre, 2007, p. 42); that is, universal aspects of
human existence with which all human beings must reckon.
Frankl asks, “How is it possible to say yes to life in spite of all that?” And
his answer lies in the human potential for “(1) turning suffering into a
human achievement and accomplishment; (2) deriving from guilt the op-
portunity to change oneself for the better; and (3) deriving from life’s
transitoriness an incentive to take responsible action” (Frankl, 1984,
pp. 161–162).
One can accomplish these things, Frankl instructs, when one finds a
purpose, a reason, a meaning. “Once an individual’s search for a meaning
is successful, it not only makes him happy but also gives him the capability
to cope with suffering” (Frankl, 1984, p. 163). Frankl is clear that there is
not simply one abstract “meaning of life” that fits all human beings or
even a single human being under all situations. Rather, by “finding a
meaning” he means finding a particular purpose, goal, or reason in a
particular situation of adversity that enables a person to successfully cope
with the situation.
He gives an example of an elderly patient who came to see him who had
survived the death of his beloved wife and was experiencing depression.
Frankl asked his patient how his wife would have felt had he died first, to
which the patient responded that she would have suffered severely. Frankl
responded by pointing out that he had spared her this suffering by surviving
her. Thus, the patient found meaning in this tragedy, specifically the
meaning of sacrifice (Frankl, 1984, p. 135).
So Unconditional Life Acceptance means, on Frankl’s interpretation, a
disposition to be optimistic in spite of the inevitability of tragedy (pain,
guilt, and death) founded on the human capacity to find personal meanings
in concrete situations of adversity that enables one to reframe such situa-
tions in constructive ways, learn from them, and take responsibility by
making positive life changes.
For the obsessive client, the positive polarity of such a philosophy of
optimism in coping with the inevitability of tragedy, through construction
of positive meanings, can help the client reverse the negative polarity arising
from the client’s demand for existential certainty. Instead of futilely
 Obsessive Capacity Disavowals 297
struggling to escape tragedy (by ruminating on its possibility), the client can
affirm life by embracing his capacity to find new purposes and meanings in
confronting them.

Box 13.8 Practice

Therapist (T)–Client (C) Exchange

Embracing an Uplifting Philosophy

In the below part of their session, the therapist helps the client to find a
philosophy and to try it out through use of interoceptive imagery:

C: So how can I develop these virtues?

T: Actually, how you go about it is largely up to you. It depends on
what would make you, as an individual, feel serene instead of
compulsive, and self-accepting instead of self-doubting. It’s really
about keying into your own interpretations or “philosophies” of
Serenity and Unconditional Self-Acceptance. For example, a
Buddhist might interpret these virtues differently than say, a
Christian. So, the first thing is to get a handle on your own views
since what is uplifting or positive for one person might not be for
another. Remember, we want these virtues to counteract the
negativity of your feelings of uncertainty and self-doubt.
C: I’m a Christian. I was raised in a very strict household and went to
church every Sunday. I believe that God has a plan for each of us.
T: Okay, very good. So, maybe we can look at a philosophical
view that sees the virtues from a Christian perspective.
C: Sounds good to me.
T: So, does God love all of us equally, according to your faith?
C: Oh yes, and his mercy shines down on all of his creation. As
creatures of the Divine Being, we are all blessed.
T: So that includes you too, right?
C: Of course!
T: So your worth as a creature of God does not change. God will
love you no matter what you do?
C: Oh yes, that’s a major part of my faith.
T: So when you think of God and his love for you, how does that
make you feel?
C: It feels really good!
T: So, let’s try some imagery again. Imagine stabbing your fiancé
to death again; and let yourself feel those negative
feelings—the feeling of uncertainty clashing with your need
298 Overcoming Capacity Disavowal Types
for certainty that you won’t do such a thing. Let me know
when you are there.
C: [Pause] Okay, I am imagining it; and I’m feeling like shit too!
T: Okay, now focus instead on God’s love for you as one of his
creatures; how he loves you no matter what, regardless of what
you do; his love shines down upon you.
C: I am focusing.
T: How are you feeling now?
C: I’m feeling much better, like a weight has been lifted off my
shoulders; like I’m free of this tremendous weight.
T: Wonderful! That’s what Serenity feels like, and your Christian
philosophy of Serenity is working for you!

Step 6: Constructing a Plan to Apply the Philosophies

The philosophies in Step 5 point to some potentially useful approaches to
provide a lift toward the obsessive client’s guiding virtues. These philoso-
phies can, in turn, be applied by the client through development of a
cognitive-behavioral plan. The following questions may be posed to the
client to direct development of the plan.

Question 1: In What Ways Has Your Disposition to Demand Moral/

Existential Certainty Negatively Impacted Your Life?
Often, obsessive clients point to the time they spend each day ruminating
about the images they have. They also point to the distress they
experience—self-doubts in the case of moral obsessiveness, and life-doubts in
the case of existential obsessiveness. They may avoid activities they used to
enjoy, for example, dining out to avoid anxiety about getting sick. These
clients may also disclose their frustrations in attempting to ignore the images
or get rid of them with other thoughts or actions (American Psychiatric
Association, 2013, pp. 237–238). They may change their lifestyles and careers
to fit their obsessions; for example, choose an occupation they can do alone
so they can perform their rituals. Their obsessions may lead them to stay
home and avoid other people, thus adversely affecting their social lives.

Question 2: What Changes Would Your Uplifting Philosophies Prescribe?

Effective philosophies for obsessive clients would help these clients overcome
the latter unwanted cognitive, affective, and behavioral consequences by
helping them to change the negative valence associated with their ruminative
images so that they no longer feel threatened by them. The goal is not to
 Obsessive Capacity Disavowals 299
assure clients that their anxiety is irrational because the probability of their
doing certain bad things or having certain bad things happen is extremely
low. This is a proverbial “Band Aid” since the problem lies in the demand for
certainty, not in the empirical fact of whether a particular intentional object is
probable. The goal is thus to help the client to overcome this self-disturbing
demand and the self- or life- degrading evaluations that are deduced from it.

Question 3: How Are You to Make These Constructive Changes?

The following set of cognitive-behavioral activities comprises a suggested
plan of action for working through obsessive disavowals.

Cognitive-Behavioral Assignments for Clients with Obsessive Disavowals

Cognitive assignment seeks to help the client identify the speech acts that
drive the disavowal, namely the demand for moral certainty in the case of
morally obsessive disavowals, and existential certainty in the case of ex-
istentially obsessive disavowals, and the damning act (self-damning and
life-damning, respectively) deduced from the demand. Unless the client
appreciates the genesis of his obsessive disavowal, it is not likely he will be
able to overcome it. These exercises further help the client to practice
refuting these acts, identify their respective guiding virtues, and embrace
uplifting philosophies that promote these virtues. The behavioral compo-
nent of these exercises is then to engage in behavioral activities that build
new cortico-striatal connections and solidify new constructive habits or
dispositions, in particular ones that tolerate, even welcome uncertainty,
moral and existential imperfection, and freedom from the crippling feelings
of helplessness and compulsion that pervade obsessive disavowals.

Exposure and Response Prevention

The basic process (Beyond OCD, n.d.), combined with CBT, involves
helping the client to identify potential triggers of the obsessive thinking,
gradually exposing the client to the triggers, and working cognitively and
behaviorally to neutralize the obsession and response.
Where there is a ritualistic response (Exploring Your Mind, 2019) or
bodily activity, “response prevention” involves having the client imagine the
threatening image without going through the ritual; for example, counting or
foot tapping.
This may address the response (or “compulsion”) but it does not get at
the core of the obsession that leads to the response. The cognitive inter-
vention is aimed at helping the client practice overcoming the demand for
certainty that generates the deductive series of imagines and feelings that
comprise the obsessive disavowal syllogism chain. This involves the process
briefly outlined above where the client keys into the felt need for certainty,
300 Overcoming Capacity Disavowal Types
and his linguistic demand for certainty; the conflict between the latter
demand and the uncertainty of the imagined, existential or moral threat; the
damning speech act arising from the latter threat; it’s refutation; the guiding
virtues that counteract the threat; and the latter’s uplifting philosophy. The
goal is thus to reverse the negative polarity generated by the demand for
certainty; allowing the client to freely imagine the image in question
without feeling the compulsion and helplessness that sustain the obsessive
disavowal.

Behavioral Assignments to Apply the Uplifting Philosophy

Not engaging in a ritual response or some other activity triggered by an
obsession is one form of behavioral assignment, which clients can practice
on their own as well as in the counseling room. Another is not engaging in
the obsessive thinking altogether. So, as a follow-up to the above cognitive
exercise, instead of ruminating about the disturbing image, the client can do
something constructive. This is the behavioral upshot of what an uplifting
philosophy may prescribe. For example, Frankl would admonish the client
to find a meaning to act on instead of ruminating about a tragedy or
possible tragedy. “Okay, I am going to die and don’t know exactly when,
but I don’t need to sit here for hours and ruminate about it. Instead, I can
see this uncertainty in the universe as a wakeup call to get off my rump and
do something constructive with my life.” In this manner, the client ad-
dresses the demand for certainty by reframing uncertainty in a positive light
to work on reversing the former’s negative polarity while also working on
making behavioral changes.

Interoceptive Imagery
In this activity, the client intentionally gets himself to feel the existential or
moral need for certainty and the subsequent conflict between the latter need
and the feeling of uncertainty surrounding the image in question. The client
then shifts from the latter negative experience to the uplifting philosophy,
allowing himself to feel the positive valence of the latter. The client thus
practices neutralizing the negative polarity of the perfectionistic demand by
associating the image in question with the polarity of his uplifting philosophy.
“This too is impermanent and shall pass.” Or “I am a person, an ‘end in itself,’
whose worth is unconditional.” Or “I am my own best friend.” The client is asked
to focus on the words (such as those italicized) and imagery evoked by the
abstract philosophy and to let himself feel the Serenity (peace of mind) it
brings. If the client truly resonates with the philosophy, it can change the
initial negativity to positivity. If not, the therapist can help the client find a
more suitable philosophy. (The ones provided in this chapter are just some
suggestions.)
 Obsessive Capacity Disavowals 301
Meditative Practice
Mindfulness meditation can be useful for clients who tend to be self-
damning, such as morally obsessive clients. As mentioned earlier, there is
evidence that mindfulness meditation attenuates self-referential processing
as processed through the VMPFC and strengthens other-regarding refer-
ential processing (Shi & He, 2020). Morally obsessive clients are focused on
negative self-referential images; so refocusing their attention on others ra-
ther than themselves can be helpful. In addition to mindful meditation,
such clients may also benefit from compassion-based meditation such as
loving-kindness meditation because it focuses on positive valent imagery
toward oneself as well as others (Neff, n.d.). Chapter 12 discusses this type
of meditation in greater detail with respect to building Unconditional Self-
Acceptance.
Existentially obsessive clients who ruminate about self-harm may benefit
from mindfulness meditation since it shifts attention away from self-referential
processing, However, all existentially obsessive clients may benefit from
mindfulness mediation because it helps build skill in non-evaluatively assessing
the intentional objects in consciousness, which can help reduce their dis-
position toward existential damning (D’Argembeau, 2013).

Bibliotherapy
In her online blog, “Tiny Buddha,” Lori Deschene (n.d.) offers some tips
on dealing with uncertainty that she has gleaned from Buddhism. These
include:

1. Replace expectations with plans

2. Become a feeling observer.
3. Prepare for different possibilities.
4. Get confident about your coping and adapting skills.
5. Utilize stress reduction techniques preemptively.
6. Focus on what you can control.
7. Practice mindfulness.

Written in a very accessible style and filled with everyday examples, this
blog article is a brief but informative read for clients who suffer from ob-
session because it keys into ways that can help such clients overcome its
source: the demand for certainty.
Viktor Frankl’s classic, Man’s Search for Meaning, referenced earlier, is an
accessible and very uplifting development of Frankl’s philosophy expressed in
the form of the psychotherapy he called, “Logo Therapy” (Frankl, 1984, p. 9).
The book starts off with a chapter discussing Frankl’s time spent in a Nazi
concentration camp during the Third Reich. Using his own experience as a
telling example, he vividly illustrates how one, even in such dire straights, can
302 Overcoming Capacity Disavowal Types
cope with tragedy by “finding meaning.” I would especially recommend it for
existentially obsessive clients.
One book that eloquently embodies Frankl’s search for meaning is
Tuesdays with Morrie by Mitch Albom (2002), recounting the author’s
weekly visits with his former professor, Morrie Schwartz, a Brandeis
University sociology professor dying from ALS (Lou Gehrig’s Disease).
Subjects broached include fear of aging, fear of death, the suffering of
others, regrets, and a host of other life issues about which existentially
obsessive individuals often ruminate.
The peaceful manner in which Morrie confronts his own demise pro-
vides a poignant example of Serenity attained by letting go of the demand
for existential certainty and confronting life, and death, as it is, not as it must
be. The fear of death, Morrie admonishes, forecloses opportunity. On the
other hand, “[t]o know you’re going to die, and to be prepared for it at any
time…. you can actually be more involved in your life while you’re living”
(p. 81). This brief and accessible book can provide clients suffering from
existential disavowals one potentially uplifting and empowering example of
what to emulate in seeking Unconditional Life Acceptance and Serenity.
Capturing the essence of Albert Ellis’ classic use of language to paint
emotively active images, his lecture on Unconditionally Accepting Yourself and
Others, available as an audio recording, provides an overview of what it means
to unconditionally accept oneself as well as others (Ellis, 2005).2 I highly re-
commend it for clients who suffer from morally obsessive disavowals as well as
other disavowals such as dependent disavowals that involve self-damning.
Finally, but clearly not exhaustive of potentially useful bibliotherapeutic
resources for obsessive disavowals, my book, Making Peace with Imperfection:
Discover your Perfectionism Type, End the Cycle of Criticism, and Embrace Self-
Acceptance, contains chapters on “Moral Perfectionism,” “Existential
Perfectionism,” and “Certainty Perfectionism” (Cohen, 2019). The book
also contains a Perfectionism Inventory the client can take at the beginning
of the book and can then read the specific chapters that address his per-
fectionism types. There are also exercises the client can complete.

Notes
1 Neural correlates of such “deontological guilt” appear to be the medial cortex and
somatosensory structures, notably insula and anterior cingulate (Basile et al., 2011).
2 A portion of this recording is also presently accessible online as a free video (Ellis, 2013).

References
Albom, M. (2002). Tuesdays with Morrie: An old man, a young man, and life’s greatest lesson.
Broadway Books.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental dis-
orders, 5th ed., Washington, D.C.: American Psychiatric Association. https://
doi.org/10.1176/appi.books.9780890425596
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Apergis-Schoute, A., Bijleveld, B., Gillan, C., Fineberg, N., Sahakian, B., & Robbins,
T. (2018). Hyperconnectivity of the ventromedial prefrontal cortex in obsessive-
compulsive disorder. Brain and Neuroscience Advances, 2, 1–10. https://doi.org/10.11
77/2398212818808710
Aristotle (1941). Nicomachean ethics. In R. McKeon (Ed.), The Basic Works of Aristotle.
Random House.
Basile, B., Mancini, F., Macaluso, E., Caltagirone, C., Rrackowiak, R.S.J., & Bozzali, M.
(2011). Deontological and altruistic guilt: Evidence for distinct neurobiological substrates.
Human Brain Mapping, 32(2), 229–239. https://doi.org/10.1002/hbm.21009
Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist
drugs: A neurocognitive perspective. Nature Neuroscience, 8(11), 1458–1463. https://
dept.wofford.edu/neuroscience/neuroseminar/pdffall2008/a9.pdf
Beyond OCD (n.d.). Cognitive behavior therapy. Retrieved from https://
beyondocd.org/information-for-college-students/cognitive-behavior-therapy
Cohen, E.D. (2019). Making peace with imperfection: Discover your perfectionism type, end the
cycle of criticism, and embrace self-acceptance. Impact Publishers.
D’Argembeau, A. (2013). On the role of the ventromedial prefrontal cortex in self-
processing: The valuation hypothesis. Frontiers in Human Neuroscience, 7, 372. https://
doi.org/10.3389/fnhum.2013.00372
Deschene, L. (n.d.). 7 Ways to deal with uncertainty so you can be happier and less anxious.
Tiny Buddha. tinybuddha.com.
Ellis, A. (2001). Feeling better, getting better, staying better: Profound self-help therapy for your
emotions. Impact Publishers.
Ellis, A. (2005). Unconditionally accepting yourself and others. Audiotape. Albert Ellis Institute.
https://store.albertellis.org/products/unconditionally-accepting-yourself-and-others
Ellis, A. (2013). Unconditionally accepting yourself. REBT Info / REBT Training. Online Video.
Retrieved from https://rebtinfo.com/dr-ellis-on-unconditional-self-acceptance-video/
Exploring Your Mind. (November 16, 2019). OCD with hidden rituals. Retrieved
from https://exploringyourmind.com/ocd-with-hidden-rituals/
Frankl, V. (1984). Man’s search for meaning. Simon & Schuster.
Gow, R.V. (n.d.) Reward processes and the role of the ventral striatum. Retrieved from
http://drrachelvgow.com/neuroscience-nutrition/structural-and-functional-
neuroimaging-in-adhd/ventral-striatum-and-role-in-reward-processes/
Gusnard, D.A., Akbudak, E., Shulman, G.L., & Raichle, M.E. (2001). Medial prefrontal
cortex and self-referential mental activity: Relation to a default mode of brain
function. Proceedings of the National Academy of Sciences, 98(7) 4259–4264. https://
doi.org/10.1073/pnas.071043098
Hampton, D. (April 23, 2017). Retrieved from https://thebestbrainpossible.com/
science-confirms-mindfulness-is-powerful-brain-medicine/Mindfulness is powerful
medicine for your brain The Best Possible Brain
Hanh, T.N. (March 15, 1998). Sutra on the middleway. A Buddhist library. Retrieved
from Dharma Talk given by Thich Nhat Hanh on March 15 (http://
abuddhistlibrary.com).
Kant, I. (1964). Groundwork of the metaphysics of morals. H.J. Paton (Trans.). Harper
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Kim, H., Sul, J.H., Huh, N., Lee, D., & Jung, M.W. (2009). Role of striatum in
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https://self-compassion.org/guided-self-compassion-meditations-mp3-2/
Rasheta, N. (November 22, 2016). 31 – The fear of uncertainty. [Transcript of Podcast].
Secular Buddhism Podcast. Retrieved from https://secularbuddhism.com/the-fear-
of-uncertainty/
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Functional and structural connectivity of the amygdala in obsessive-compulsive dis-
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strengthening other-referential processing. Mindfulness, 11, 599–605. https://
doi.org/10.1007/s12671-019-01271-y
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person knowledge in the medial prefrontal cortex. Wiley Interdisciplinary Reviews.
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Watts, A. (May 27, 2015). Alan Watts on faith and belief. Daily Zen. Retrieved from
https://www.thedailyzen.org/2015/05/27/alan-watts-on-faith-and-belief/
14 Key Hypotheses of a
Logic-Based Therapy

Emerging from the study conducted in this book, are at least 14 inter-
connected neurophenomenological, logico-linguistic hypotheses. This
network of mutually supportive hypotheses is subsumed below under the
following headings: (1) Speech Acts, (2) Syllogism Chains, (3) Types of
Interoceptive Feeling, (4) Prefrontal Cortex “Hijack,” and (5) Positive
Habits. Collectively, they support the logic-based, philosophical, and
virtue-oriented approach taken in this book to helping clients overcome
self-imposed, tyrannical disavowals of personal freedom and responsibility.

Speech Acts
1. Human beings are not passive recipients of their emotions. Instead,
emotions are activities they perform, the core of which are series of
associated speech acts. In the case of negative emotions, this may include
demanding perfection, catastrophizing, damnation, and capacity
disavowals, which correlate with neurological activities—activation
of certain emotional centers in the brain.
2. Speech acts, both negative and positive, use evaluative language (for
example, “world’s biggest loser” or “wonderful person”) that express
interoceptive feelings, amplify the (positive or negative) valence of
these feelings, and evoke further feelings (for example, feeling
unworthy or feeling admiration).
3. Such feelings are “conceptualized” through linguistic (semantic)
processing occurring largely (but not entirely) via activation of the
ventromedial prefrontal cortex (VMPFC) (Binder & Desai, 2011;
Jiang, 2018); thereby, these feelings acquire sense and reference. This
includes assignment of intentional objects (Husserl, 2001). For
example, by calling oneself “a loser,” a negative feeling arising from
the image of having failed, becomes self-deprecating.
4. When these linguistic acts are performed (quietly to oneself or to
others), they can affect the way a person responds, cognitively,
emotively, and behaviorally.
306 Overcoming Capacity Disavowal
Syllogism Chains
5. Such speech acts are often connected with other speech acts in
syllogism chains that track a flow of associated images and
interoceptive feelings. For example, “I must be sure about something
before I do it, but I have some doubts about this; so, this could be a
terrible mistake; so, I just can’t do it.” On the phenomenal level, this
syllogism chain tracks a felt need to be certain about outcomes, which
is triggered by the image of not being certain about the outcome of a
particular act, which generates a threatened feeling conceptualized and
amplified by the words “terrible mistake,” which generates a further
feeling of incapacity to perform the act in question. On the
neurological level there is activation of the VMPFC which triggers
patterns of interoceptive feelings in somatosensory structures.
6. There are at least three profoundly important implications of the last
point:
a. Logical inferences (deductions) occurring during emotional
experience can be explained as a flow of associated images and
feelings; therefore,
b. cognition and affect (interoceptive feelings) cannot be separated
as they are processed by the brain in emotional experiences;
therefore,
c. sound cognitive-behavioral approaches are ipso facto locked into
taking account of client’s feelings.

Types of Interoceptive Feeling

7. Further, there are two systems of feelings, one generated by cortical
structures in the upper forebrain such as the VMPFC and
somatosensory structures such as the insula, somatosensory cortices,
and anterior cingulate cortex. The latter interoceptive feelings are
experienced in the flow of images and feelings tracked by syllogism
chains associated with negative emotions such as guilt, depression, and
anxiety.
8. In contrast, the second system originates in the lower forebrain and
consists of the amygdala, hypothalamus, and other limbic system structures
producing feelings associated with aversive stimuli such as fear, and
pleasant stimuli such as sexual feelings. This system is largely automatic.
9. Although the latter feelings originate in the activity of the subcortical
system (amygdala) in processing experiences involving aversive external
stimuli, neurological patterns of these feelings are formed in
somatosensory structures and triggered by the cortical system
(VMPFC) when recall of the original experience is evoked (Bechara,
2005; Cohen, 2020).
 Key Hypotheses of a Logic-Based Therapy 307
10. The upper forebrain system includes motivational feelings such as felt
needs associated with images related to certainty, getting things fast,
gaining the approval of others, being treated fairly, and being right
about things. These are the phenomenological correlates of
perfectionistic demands. Conflicts or inconsistencies arising between such
felt needs and perception of reality, as expressed in perfectionistic
demands and empirical reports in conflict with these demands, tend to
generate negative, self-destructive emotions such as anxiety and
depression (for example, as in the case of a felt need for approval in
conflict with rejection by a former lover). Accordingly, identifying
conflicts or inconsistencies between clients’ perfectionistic demands
and their perception of reality (in emotional reasoning) can often be
helpful in getting at the roots of self-destructive behavioral and
emotional disorders.

Prefrontal Cortex “Hijack”

11. This leads to a further point underscored here but not always discussed
in the literature. While the lower forebrain, particularly the amygdala,
can “hijack” (Goleman, 1997, p. 61) the upper forebrain, particularly
the VMPFC, as in cases of phobias and post-traumatic stress disorder
(PTSD) (Ford, 2012; Koenig & Grafman, 2009), prefrontal cortex
“hijack” is also possible, resulting in irrational and self-defeating
emotions. In this case, it is the prefrontal cortex that creates the
disfunction, not the amygdala. In this case, negative emotion syllogism
chains containing irrational speech acts (such as perfectionistic
demands, catastrophizing, damnation, and capacity disavowals) direct
self-destructive emotional responses. For example, in the case of
anxiety about not being certain something “horrible” won’t happen,
an existential demand for certainty may trigger self-defeating amygdala
activity, not conversely. Indeed, the connectivity between the
prefrontal cortex and the amygdala is a two-way street with traffic
(neural signals) running in both directions (Motzkin et al., 2015).

Guiding Virtues and Their Uplifting Philosophies

12. The power of abstract philosophical ideas and their capacity to bolster
and promote virtue has been underexplored in the literature. Some
approaches emphasize virtue without also identifying and refuting
irrational speech acts from which freedom-impairing capacity
disavowals are deduced (Seligman, 2013; Azar, 2011); whereas other
approaches concentrate on the empirical premises (reportative speech
acts) that help to steer emotions (Beck, 1979; Edelstein, 2020, 2017).
However, the logic-based, philosophical, virtue-oriented approach
advanced here recognizes the importance of systematically identifying
308 Overcoming Capacity Disavowal
and refuting the irrational chain of speech acts in clients’ negative
emotion syllogisms, while also helping clients build positive emotions
through introduction of virtues and their uplifting philosophies. The
hypothesis introduced here is thus that systematic integration of both
therapeutic aspects is efficacious in reversing the negative valence of
self-destructive emotional dispositions.
13. The capacity of guiding virtues and their philosophies to help produce
positive feelings and reverse the negative valence polarity of self-
defeating negative feelings appears to be at least partly due to their
abstract character, especially when they are expressed in “uplifting”
(positive) language.1 This is of no small consequence for a cognitive-
behavioral approach, which emphasizes reframing to address emotional
and behavioral problems. Thus, the possible inclination of some
therapists to avoid abstraction and philosophical ideas may be
counter to helping their clients build positive emotional dispositions
instead of negative ones.

Positive Habits
14. In fact, it appears that the ventral striatum, subcortical ganglia involved
in purposive behavior, can reinforce behavior associated with adaptive
reappraisal or reframing (McRae & Mauss, 2015; Bergland, 2015). This
can potentially aid in replacing old self-defeating habits with new,
constructive ones by using guiding virtues and their uplifting
philosophies. For example, a client who is risk-avoidant might
reframe risk-taking as a way of exercising Courage and as an
opportunity to define himself positively instead of as a disappointed
dream or hope (an existential philosophy embraced by Sartre (2007)).
Armed with such a philosophical perspective on Courage, the client
who confronts a life challenge, for example, ending a loveless marriage,
and embarking on a new life as a single person, the client may begin to
recast the negative valence polarity of the life change in terms of an
exciting opportunity for positive growth, as opposed to her present
stagnation. Inasmuch as such positive reframing is associated with
increases in activity in the ventral striatum, the client may become
more disposed to acting in accord with the guiding virtue and its
uplifting philosophy.

The Big Picture

The microscopic dissection of the moving parts of a psychotherapy always
runs the risk of losing the forest for the trees. So, it may be fitting to end this
study by looking globally at how these moving parts “hang together.”
On the logic-based, philosophical model based on the above 14 inter-
connected hypotheses, the therapeutic process may be compared
 Key Hypotheses of a Logic-Based Therapy 309
(metaphorically) to watching a conductor of an orchestra who signals to
different groups of musicians when to come in. In the sphere of psy-
chotherapy practice there are three levels of activity going on: logical/
linguistic, phenomenological, and neurological. These levels interface with
each other and knowing what is occurring at one level can help the
therapist to know what is happening on another level. Like a seasoned
listener and appreciator of music, the seasoned therapist knows what to look
for and how each piece fits with the rest of the composition.
To give you a general idea of what I mean, let me close with a case of a
client I recently met in an online session. This client reported that he was
experiencing a feeling of nostalgia for playing his guitar, which, as a former
musician, he had sidelined for other activities in his life.
He experienced anxiety about playing his guitar, he said, because there
would never be enough time to get the full experience of becoming
emersed in his music. “How does it feel when you think you won’t have
enough time to get the full immersive experience?” I asked. I had a hunch
he would tell me that he felt like he was being deprived of something he
hungered for; and this was just what he told me. There was a felt need that
wasn’t being rewarded. Here was that contradiction between reality and this
perfectionistic demand that arose from this interoceptive motivational
feeling.
His guiding virtue was Serenity in an imperfect universe; that is, Peace of
Mind, notwithstanding there not being enough time to achieve perfect, or
near-perfect uninterrupted immersion without having to tend to practical
realities.
Just as this client and I were probing for a philosophical stance on the
latter virtue with which he resonated, his toddler son toddled in; and, just at
that moment, the client became aware that there is a sort of music that
permeates the universe and that he was attempting to bracket off his love
for music from the beautiful continuum of reality.
Accordingly, we did interoceptive imagery where he got himself to feel
the need for absolute immersion without time constraints and then to shift
his consciousness to his philosophy of “Music in the universe and the
universe in the music” (the potentially uplifting words I used to reflect back
what he was describing). Not surprisingly, he then felt a sense of relief from
the painful felt need for perfect immersion.
It was clear that we had found a way for the client to experience the
music of life, including (but not exclusively) by playing his guitar. Instead of
avoiding doing what he loved, his behavioral plan included playing his
guitar while reframing his experience as part of a continuum of music in the
world.
The experience was edifying for the client, and I couldn’t help but think I
had been watching a masterful conductor (God? Nature? the World Soul?)
conducting a logico-linguistic, neurophenomenological symphony, and
helping my client to see the beauty in the motion of its harmonious parts.
310 Overcoming Capacity Disavowal
It has been this incredibly rich blending of moving elements in an ap-
proach that includes a comprehensive vista of many (I dare not say all) of
these elements, which I have attempted to convey in this book: a hybrid of
philosophy (East and West), virtue theory, phenomenology, logic, lin-
guistics, psychology, neuroscience; amalgamated into one systematic whole.

Note
1 See Chapter 6.

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Index
Note: Italicized page numbers refer to figures, bold page numbers refer to tables
ABC theory 15–16
agoraphobia 189
Albom, Mitch 302
allegory of the cave 231–2, 243
alternative perspectives 234–5, 239–44
amygdala 24, 62, 67–9, 307
anger 1, 4, 16, 21, 23, 69; blame-based
157–60, 162, 169, 170, 172,
174–5, 177–85; chains 158–60;
and damning speech acts 13;
definition of 17; and hyper-egoic
disavowals 214, 216–17, 222, 225,
240; intense 214, 216–17;
intentional objects 16; from low-
frustration tolerance 127; and
post-temporal catastrophizing 14;
and rational choice 204; role of
ventromedial prefrontal cortex
63; and tolerance 228;
see also anxiety; depression; grief;
guilt; shame
anxiety 1, 23, 51, 61, 69, 71, 74–6, 306,
307; and death 202; definition of
17; and dependent disavowals
247–8, 258, 263, 270, 270–1;
disorders 63, 68, 97, 189, 191,
209; indicators 63; low-frustrative
127, 129, 132; and obsessive
disavowals 278, 288, 295, 298–9;
and phobias 189, 191; and
positive emotions 86; reducing
53, 89; reportative act in 163;
risk-avoidant 98–101, 104,
106–7, 112, 118, 119, 122–3;
role of ventromedial prefrontal
cortex 63; see also anger;
depression; grief; guilt; shame
The Apology (Plato) 201
approach-avoidance conflict 68–9
Aristotle 3, 40–2, 64, 84, 113, 146, 204,
214, 294
Art of Happiness: A Handbook for Living
(Dalai Lama and Cutler) 185
The Art of Love (Fromm) 275
Asp, E.W. 77
Atlas Shugged (Rand) 243
attention-shifting 46
Aupperle, R.L. 68
Aurelius 181–2
Austin, J.L. 11
authenticity 39, 261–3
avoidant personality disorder 248
bad faith 204–5
Barlis, Kalliope 211
Beck, Aaron 211
behavior disavowal 38
behavioral goals 69
behavioral response 67–8
behavioral syllogism 42–3
Belenky, Mary 231
Bentham, Jeremy 141
Berkeley, George 236–7
Berlin, Isaiah 267
Beyond Good and Evil (Nietzsche) 262
bibliotherapy 55–6, 124, 184–5, 211,
243–4, 274–5, 301–2
blame-based capacity disavowal 25, 157–86;
anger chains 158–60; applying the
philosophies 177–84; bibliotherapy

184–5; cognitive-behavioral
assignments for 179–84; cognitive-
behavioral plan 178–9; compassion-
based meditation for 179–81;
depression chains 160–2; and
existential demand 164; existential
demand 167; and feeling of
powerlessness 165–6; guiding
virtues for 169–70; interoceptive
imagery 181–3; overview 157–8;
primary syllogism 162–3; refutation
of 168; self-defeating speech acts
166–8; syllogism chains 158;
tackling major problems 184;
uplifting philosophies for 170–8; in
vivo practice 183
blind conjecture 27, 40
bottom-up control 23
Buddha 143
Buddhism 53–4, 141–2, 145, 266
Burns, David 211
Camus, Albert 3, 55
capacity disavowals 1–2; blame-based
157–86; categories 38; dependent
247–75; of freedom 23–6; hyper-
egoic 214–44; low-frustrative
127–55; neuropsychology of
75–7; obsessive 278–302; phobic
188–211; refuting 33–4; risk-
avoidant 97–124; rule 25; six-step
intervention for 7; in syllogism
chains 23–36; types of 25
catastrophizing 193; in hyper-egoic
capacity disavowal 220; in phobic
capacity disavowal 193; post-
temporal 14; pre-temporal 14;
refuting 195–6, 223–4; in risk-
avoidant capacity disavowal 104;
speech acts 14
Caution: Faulty Thinking Can Be Harmful
to Your Happiness (Cohen) 124
certainty, demand for 102–3
cingulate cortex 188
clients, primary syllogism of 18–21
Clifford, W.K. 199–200
Clinchy, Blythe 231
cluster C personality disorder 248
cognition: and disavowals 23–4; in logic-
based therapy 4; in rational-
emotive behavior therapy 272; in
speech acts 306
cognitive behavior therapy (CBT) 1, 4;
Index 313
logic-based 26–7; therapists
6, 26–7
cognitive control 24
cognitive disavowal 38
cognitive dissonance 45–6, 85–8
cognitive dysfunctions 23–4
cognitive empathy 227
cognitive processing: logico-linguistic
level 5; neurological level 5;
phenomenological level 5
cognitive reframing: dependent capacity
disavowals 270–1; hyper-egoic
capacity disavowal 240–1; phobic
capacity disavowal 209–10
cognitive-behavioral habits 84
cognitive-behavioral interventions 56–7
cognitive-behavioral plan 47–57; for low-
frustrative capacity disavowal
148–9; meditation 53–4;
philosophical (cognitive)
reframing 47–53; philosophical
bibliotherapy 55–6; for phobic
capacity disavowal 207–9; positive
reinforcement 53; for risk-
avoidant capacity disavowal
118–19; worksheets 56
Cohen, E.D. 56, 124, 302
coherence monitoring system 72–3
common humanity 263, 273
compassion meditation 90, 152–3
compassion-based meditation 54, 179–81,
242–3, 273
connected knowing 231
continence 38, 44, 202–5; freedom
204–5; rational choice 204;
responsibility 204–5;
transcendence of fear 202–3
control: discretion 64; neurological axis of
66–7; parameters of 64–5;
reappraisal 64–5; self-control 65
coping mechanisms 75
correspondence theory of truth 214
courage 5–6, 39; allegory of the cave
231–2; and death 200–2; doing
what one really wants as 232–3;
following own lights as laws 264;
for hyper-egoic capacity
disavowal 227; knowledge as
antidote to fear 113–14; loss of
self-esteem as impermanent state
of consciousness 257; moderation
through use of reason 112–13;
philosophies of 112–14, 231–3,
314 Index
263–7; positive freedom 267;
refusal of women to be willing
slaves 265–6; reinvention as a
self-reliant person 263–4, 264
Cutler, Howard C. 185
Dalai Lama 185
Damasio, Antonio 61
Danson, Ted 211
De Beauvoir, Simone 274
death: as a good thing 201; as nothing to
the living or the dead 201–2; stoic
view of 200–1
decisiveness 38, 43–4; following own
lights as laws 264; loss of self-
esteem as impermanent state of
consciousness 267; philosophies of
263–7; positive freedom 267;
refusal of women to be willing
slaves 265–6; reinvention as a self-
reliant person 263–4, 264
deductive reasoning 18
deontological feelings 13, 185
dependent capacity disavowal 25
dependent capacity disavowals 247–75;
applying the philosophies 269–75;
bibliotherapy for 274–5; cognitive-
behavioral assignments for 270–5;
compassion-based meditation for
273; definition of 247; demand for
approval in 253; feeling of
powerlessness in 255–6; guiding
virtues for 259–60; in vivo cognitive
reframing 270–1; mindfulness
meditation for 273–4; overview
247; primary syllogism 249–50;
rational-emotive imagery for 272;
refutation of 258–9; self-defeating
speech acts in 256–8; self-doubts in
254; shame attacking exercises for
272; syllogism chains 247–56;
uplifting philosophies for 260–8;
upper tier performance demand
in 251–2
dependent personality disorder 247, 248
depression 1, 23, 69, 306, 307; ABC
theory 16; blame-based 158,
160–2, 166, 167, 169, 173–5,
178–85; chains 160–2; definition
of 17; and intentionality of
emotions 16; and low-frustration
tolerance 127; and phobias 189;
and positive emotions 86; and
post-temporal catastrophizing 14;
reducing 53, 89; reportative act in
163; and risk avoidance 98; role
of ventromedial prefrontal cortex
63; see also anger; anxiety; grief;
guilt; shame
depression chains 160–2
Descartes, Rene 235–6
Dewey, John 145–6
Diagnostic and Statistical Manual 214
Digital Planet (hip-hop group) 55
direct refutation 109
disavowals 1–2; blame-based 157–86;
categories 38; dependent 247–75;
of freedom 23–6; hyper-egoic
214–44; low-frustrative 127–55;
neuropsychology of 75–7;
obsessive 278–302; phobic
188–211; refuting 33–4; risk-
avoidant 97–124; rule 25; six-step
intervention for 7; in syllogism
chains 23–36; types of 25
discretion 64
disempowering languages 23
dispositions 84
distorting probabilities 27, 40
divorce 16
Dolan, R.J. 62, 63
Donne, John 260
dorsolateral prefrontal cortex (DLPFC)
62–3, 64–5, 78, 84–6, 128,
159, 278
dorsomedial prefrontal cortex
(DMPFC) 249
Dunst, Kirsten 274
ego 73
Ellis, Albert 1, 6, 11, 15–16, 53, 56, 142,
211, 302
Emerson, Ralph Waldo 113–14
emotion contagion 230
emotional disavowal 38
emotional pain 140
emotional reasoning, deductive system
for 62
emotions: as complex linguistic activities
17–18; definition of 61;
intentionality of 16
emotive potency 1
empathy 39, 229–31; cognitive 227; for
hyper-egoic capacity disavowal
226–7, 241–2; separate versus
connected knowing 231

empirical evidence 26
empirical refutation 31, 33
Engaging in Bodhisattva Behavior
(Shantideva) 144–5
Epictetus 3, 142, 200–1, 264
Epicurus 140, 201–2, 206
Erlich, H.S. 237
evaluative reasoning 18
evaluative syllogism 21, 23
existential damnation 13, 14, 104
existential demand 164, 167
existentialism 206
existentially obsessive disavowals: faith
295–6; openness to truth 295–6;
optimism despite inevitability of
tragedy 296–7; syllogism chains of
282–3; uplifting philosophies for
295–6; see also morally obsessive
disavowals
failure 145–6
false tagging theory 77
fear 63; knowledge as antidote to 113–14;
transcendence of 202–3
fecundity 141
feelings, in logic-based therapy 4
foresightedness 114–15, 198–200;
pragmatism 199; truth-seeking
199–200
42 (film) 55
The Fountainhead (Rand) 232–3, 243
Frankl, Viktor 296–7, 301
Fredrickson, B.I. 88
freedom 23–6, 204–5; disavowals of
freedom 23–6
Freud, Sigmund 15
Fromm, Eric 55, 234, 244, 275
frustrations 127–8
functional magnetic resonance imaging
(fMRI) 1, 62, 64, 84, 87, 89–90
general semantics theory 75
generalized anxiety disorder (GAD)
68, 97
global damnation 13, 14
goal-setting 69
God 236–7
Goel, V. 62, 63
golden mean 113
Golden Rule 233–4
grief: definition of 17; see also anger;
anxiety; depression; guilt; shame
Index 315
Growing in Love: 21 Ways to Become Less
Dependent & More Authentic
(Park) 274–5
Guided Meditation for Releasing Fear and
Anxiety (Moon and Rock) 210
guiding virtues 5, 37–46; behavioral rules
43–5; behavioral syllogism 42–3;
for blame-based capacity
disavowal 169–70; for capacity
disavowal categories 38; cognitive
dissonance 45–6, 85–8;
definitions of 38; for dependent
capacity disavowals 259–60; for
each type of demanding
perfection 39; for each type of
reportative fallacy 40; as habits
40–2; for hyper-egoic capacity
disavowal 225–8; identifying
110–12; introducing 111–12; in
logic-based therapy 307–8; of
low-frustrative capacity
disavowal 138–9; mindfulness
89–90; neuropsychology of
84–91; neuropsychology of
meditative practice 89–90; for
obsessive capacity disavowals
291–2; for overcoming each type
of capacity disavowal 38;
overview 37–46; for phobic
capacity disavowal 197–8; and
risk-avoidant capacity disavowal
110–12; theory and application
90–1; uplifting philosophies
43–6, 86–8
guilt 1, 16, 23, 69; definition of 17; and
interoceptive feelings 306; in
morally obsessive capacity
disavowals 281; and tragic
optimism 296; and ventromedial
prefrontal cortex 63; see also anger;
depression; grief; shame
habits, positive 308
Halsey, Catherine 232–3
Harper, R.A. 12
hedonism 137, 140
Heiddeger, Martin 3
Hitler, Adolf 262
Hobbes, Thomas 233
How To Control Your Anxiety Before It
Controls You (Ellis) 211
Hume, David 74, 235
316 Index
hyper-egoic capacity disavowal 25,
214–44; alternative perspectives
239–44; applying the philosophies
239–44; bibliotherapy for 243–4;
catastrophizing in 220; cognitive-
behavioral assignments for 240–3;
compassion-based meditation
242–3; definition of 214;
empathizing 241–2; expanding
downward 221–2; guiding virtues
for 225–8; interoceptive imagery
241; in vivo cognitive reframing
240–1; and narcissistic personality
disorder 214; overview 214–15;
primary syllogism 218–19;
refuting 224–5; self-defeating
speech acts in 222–4; syllogism
chains 215–17; uplifting
philosophies for 228–39
“I can’t” 23–6, 37
“I must” 37
id 73
idea of self 293–4
illocutionary force 23–6
immediate gratification 140–2
impulsive disavowal 38
impulsive dysfunctions 23
inductive judgments 26
inference 18
inference rules 70
informational bibliotherapy 55–6
instant gratification 132–3
insula 73
insular cortex 188
intentional objects 16, 100–1, 157, 188
interoceptive feelings 1, 12, 306–7
interoceptive imagery 48–9, 54, 122–3,
150–1, 181–3, 241, 300
James, William 44, 199
Johnston, Charles 203
Just, M.A. 72
Kant, Immanuel 261
Keating, Peter 232–3
Kierkegaard, Søren 3, 44
knowledge 113–14; connected 231; of
other minds 236; separate 231
Korzybski, Albert 75
Lao Tzu 143
Laws of Nature 233
Leibnitz, Gottfried 182
lethargy 145
letting go 145
linguistic rules 18
Locke, John 236
logical refutation 31, 33
logic-based therapy (LBT) 3; big picture
308–10; cognition in 4; feelings in 4;
guiding virtues and uplifting
philosophies in 307–8; implications
of 73–5; key hypotheses f 305–10;
neuropsychology of 60–78; positive
habits in 308; prefrontal cortex
hijack 307; and speech acts 305; and
syllogism chains 306; and types of
interoceptive feeling 306–7
low-frustration tolerance (LFT) 128, 139
low-frustrative capacity disavowal 25,
127–55, 139–47; applying the
philosophies 148–50; cognitive-
behavioral assignments for 150–5;
cognitive-behavioral plan 148–9;
definition of 127; emotional
problems in 127–8; feeling of
powerlessness 133–4; guiding
virtues for 138–9; and instant
gratification 132–3; interoceptive
imagery 150–1; in vivo practice
154–5; mindfulness meditation
151–2; overview 127; primary
syllogism 131–2; refuting 136–7;
self-defeating speech acts 135–6;
syllogism chains 129–35; types of
situations avoided by
clients 128–9
luminous mind 207
major premise rule 66
Making Peace with Imperfection (Cohen) 302
Makransky, J. 179–80
Man’s Search for Meaning (Frankl) 302
Martin, Mike W. 53–4
Mason, R.A. 72
Matrix (film) 243
Medak, Peter 211
meditation 53–4; compassion 54, 152–3;
compassion-based 90, 179–81,
242–3, 273; mindfulness 151–2,
210, 273–4, 294, 301
metaphors 143–4
Mill, John Stuart 234–5, 243, 265–6, 274
mindfulness 89–90, 263, 273
mindfulness meditation 53–4, 151–2, 210,
273–4, 294, 301

misery 12
moderation 112–13
modus ponens rule 18
Mona Lisa Smiles (film) 274
mood disorders 63
moral certainty, demand for 285–6,
289, 298
morally obsessive disavowals: being one's
own best friend 294–5; idea of self
293–4; syllogism chains of 280–2;
treating oneself as an end in itself
295; uplifting philosophies for
293–5; see also existentially
obsessive disavowals
motivational feelings 57, 72, 125,
190, 307
movies 55
must-demands 12
The Myth of Self-Esteem (Ellis) 56
narcissism 234
narcissistic personality disorder (NPD)
214, 226
Nausea (Sartre) 55
Neff, Kristin 262–3, 273
negative emotion syllogism chain 23–30,
85; disavowals of freedom 23–6;
perfectionistic demands in 27–30;
reportative fallacies in 26–7
negative emotions, and perseverance 145
Ness, Kristen 18
A New Guide to Rational Living (Ellis and
Harper) 12
The New Rational Therapy (Cohen)
56, 124
Newell, Mike 274
Nietzsche, Friedrich W. 3, 5–6,
181–2, 262
non-self, doctrine of 266
obsessive capacity disavowals 25, 278–302;
applying the philosophies 298–302;
behavioral assignments for 300;
bibliotherapy for 301–2; cognitive-
behavioral assignments for 299–301;
definition of 278; demand for moral
certainty in 285–6, 289, 298;
existentially 282–3; existentially
unacceptable events in 279;
exposure and response prevention
for 299; feeling of powerlessness in
287–8; feeling of uncertainty in
284–5; guiding virtues for 291–2;
Index 317
interoceptive imagery for 300;
mindfulness meditation for 301;
morally 280–2; morally
unacceptable actions in 279;
overcoming capacity disavowal
types 300; overview 278–9;
primary syllogism 283–4; refutation
of 290; self-defeating speech acts in
288–90; syllogism chains 279–88;
uplifting philosophies for 292–8
obsessive-compulsive disorder (OCD)
97, 278
On Liberty (Mill) 234–5, 243
optimism 296–7
oversimplifying 27, 40
oversoul 203
“Pacifics” (song) 55
pain 140
panic disorder 68
Pantanjali 202–3
Park, James Leonard 274–5
patience 38, 138, 142–4; metaphors
143–4; stoicism 142–3
Paulus, M.P. 68
peace of mind 38
perfectionistic demands 72
perseverance 38, 138, 144–6; failure as
stimulus 145–6; joyful 144–5;
pleasure in activity or pursuit 146;
zestful vigor in 144–5
person-centered orientation 6–7
philosophical (cognitive) reframing
47–53; interoceptive imagery
48–9; ongoing life issues 50; risk-
taking exercises 51–2; shame
attacking exercises 50–1; tackling
major life challenges 52–3; in vivo
practice 47–8
philosophical bibliotherapy 55
Phobia Relief: From Fear to Freedom
(Barlis) 211
phobias 24, 68
phobic capacity disavowal 25; applying
the philosophies 207–8;
bibliotherapy for 211;
catastrophizing in 193, 195–6;
cognitive reframing exercises for
209–10; cognitive-behavioral
assignments for 209–11;
cognitive-behavioral plan 207–9;
definition of 188; feeling of
powerlessness in 194; guiding
318 Index
virtues for 197–8; intentional
objects 188; mindfulness
meditation 210; primary
syllogism 191; refuting 196–7;
self-defeating speech acts in
195–6; syllogism chains 189–91;
systematic exposure for 210;
uplifting philosophies for
198–207
phobic capacity disavowals 188–211;
overview 188–9
physical pain 140
Plato 3, 5, 201, 231–2
pleasure 140–1
Pontiac Moon (film) 211
positive emotions 84; and perseverance
145; self-transcendent 88;
syllogism chains 86
positive freedom 267
positive habits 308
positive reinforcement 53
posterior superior temporal sulcus
(PSTS) 249
post-temporal catastrophizing 14
post-traumatic stress syndrome
(PTSD) 68
powerlessness, feeling of 133–4, 165–6,
194, 204–5, 255–6, 287–8
practical syllogism 21
pragmatic refutation 31, 33
pragmatism 115–16, 199
precuneus 249
prefrontal cortex 307
pre-temporal catastrophizing 14
pride 145
primary syllogism 18–21, 100–1, 131–2,
162–3, 191–2, 218–19,
249–51, 283–4
probability 114–15
prudence 39, 138, 140–2; and Buddhism
141–2; sober reasoning 140
psychoanalysis 15
purity 141
Rand, Ayn 232–3, 243
rating 100–1
rational choice 204
rational-emotive behavior therapy
(REBT) 1, 3, 11, 142, 211
rational-emotive imagery 272
reappraisal 64–5
reason 112–13
Reason and Emotion in Psychotherapy
(Ellis) 11
reasonableness 114–15
Reeves, Keanu 243
refutation 30–5; of blame-based capacity
disavowal 168; of capacity
disavowals 33–4; of
catastrophizing 195–6, 223–4; of
clients' irrational speech acts 31,
33; of demand for approval
257–8; of demand for certainty
107–9; of demand for moral
certainty 289; direct 109;
empirical 31, 33; of existential
demands 167; logical 31, 33; of
low-frustrative capacity
disavowal 136–7; neurology of
77–8; of obsessive capacity
disavowals 290; of phobic
disavowal 196–7; pragmatic 31,
33; types of 30–1, 33
reportative fallacies 26–7
reportative speech act fallacies 27
reportative syllogism 19
responsibility 204–5
risk taking 51–2
risk-avoidant capacity disavowal 25, 75,
97–124; applying the philosophies
117–21; bibliotherapy for 124;
catastrophizing by self- or
existential damnation 104;
cognitive-behavioral assignments
for 121–4; cognitive-behavioral
plan 118–19; deducing 104–6;
definition of 97; and demand for
certainty 102–3; and guiding
virtues 110–12; intentional
objects 100–1; interoceptive
imagery for 122–3; primary
syllogism 100–1; refuting
109–10; risk-taking exercises for
121–2; role of uncertainty in 98;
self-defeating speech acts
106–10; syllogism chains
98–106; systematic tackling of
behavioral challenges 123–4;
types of actions 86; uplifting
philosophies 112–17;
worksheets 124
risk-taking exercises 121–2
Roberts, Julia 274
Robinson. Jackie 55

Rogers, Carl 229–31
rostral anterior cingulate 87
Samyutta Nikaya (Connected Discourses) 266
Sartre, Jean Paul 3, 5, 44, 55, 115, 204,
206, 263
The Second Sex (De Beauvoir) 274
self, idea of 293–4
self reliance 263–4
self-compassion 273
self-control 65
self-damnation 13, 14, 25, 104
self-defeating speech acts 106–10, 135–6,
195–6, 222–4, 256–8, 288–90
self-disturbing speech acts 11–15
self-esteem 266–7
selfishness 233
self-kindness 262–3, 273
self-rating 263
self-transcendence 151
separate knowing 231
serenity 38
sexual pleasure 141
shame: attacking 50–1, 272; definition of
17; uplifting philosophies for 34,
175, 181–2; see also anger; anxiety;
depression; grief; guilt
Shantideva 141, 144–5
should-demands 12
sober reasoning 140
social anxiety disorder (SAD) 68
social personality disorder 248
Socrates 201, 264
somatic markers 67
speech acts 1; catastrophizing 14; damning
14; of demanding perfection 13;
irrational 32–3; and logic-based
therapy 305; of self-damnation
13; self-defeating 106–10, 135–6,
166–8, 195–6, 222–4, 256–8,
288–90; self-disturbing 11–15
State-Trait Anxiety Inventory 63
Steenburger, Mary 211
Stoic philosophy 3
striatum 67–8
The Subjection of Women (Mill) 265–6, 274
superego 73
syllogism 18–21; behavioral 42–3; chains
23–36, 69–75; evaluative 21, 23;
negative emotion 23–30; practical
21; primary 18–21, 100–1, 131–2,
162–3, 191–2, 218–19, 249–51,
Index 319
283–4; refutation 30–5;
reportative 21
syllogism chains: blame-based 158;
dependent capacity disavowals
247–9; of existentially obsessive
disavowals 282–3; expanding
251–6, 284–8; expanding
downward 104–6, 134–5, 163–4,
193–5; expanding upward 102–3,
133–4, 163–4, 192–3; hyper-
egoic capacity disavowal 215–17;
and logic-based therapy 306; low-
frustrative capacity disavowal
129–35; of morally obsessive
disavowals 280–2; neurological
level 71; neuropsychology of
69–75; obsessive capacity
disavowal 279–88;
phenomenological level 70;
phobic capacity disavowal
189–91; risk-avoidant capacity
disavowal 98–106
Tao Te Ching 142
Taoism 143
Tarule, Jill 231
temperance 38
temporal parietal junction (TPJ) 249
theory of mind 227
therapist-client relationships 6–7
Thich Nhat Hanh 293
Thoreau, Henry David 54
tolerance 38, 44, 228; alternative
perspectives 234–5; philosophies
of 234–7; recognizing
others 235–7
top-down control 24
tortoise channel 202–3
tragedy, inevitability of 296–7
tragic optimism 296–7
truth 199–200; openness to 295–6
Tuesdays with Morrie (Albom) 302
The Ultimate Gift (film) 243–4
uncertainty 98; feeling of 284–5
unconditional acceptance 56
unconditional life acceptance 296
unconditional other acceptance 227–8;
negative form of Golden Rule
233–4; philosophies of 233–4;
self-love 234
unconditional positive regard 56
320 Index
unconditional self-acceptance 39, 44,
261–3; compassion for oneself
262–3; creating own values 262;
philosophies of 261–3; treating
oneself as an end in itself 261–2
uplifting philosophies: applying 117–21; for
blame-based capacity disavowal
170–8; continence 202–5; courage
112–14, 200–2, 227, 231–3, 263–7;
decisiveness 263–7; for dependent
capacity disavowals 260–8;
embracing 116–17; empathy 226–7,
229–31; existentialism 115; for
existentially obsessive clients 295–6;
foresightedness 114–15, 198–200;
for hyper-egoic capacity disavowal
228–39; in logic-based therapy
307–8; for low-frustrative capacity
disavowal 139–47; for morally
obsessive clients 293–5; for
obsessive capacity disavowals
292–8; patience 142–4;
perseverance 144–6; pragmatism
115–16; prudence 140–2; for risk-
avoidant capacity disavowal
112–17; tolerance 228;
unconditional other acceptance
227–8; unconditional self-
acceptance and authenticity 261–3;
uplifting 147
value-based mindfulness 54
ventromedial cortex 24
ventromedial prefrontal cortex (VMPFC)
62, 64–5, 67–9, 71–3, 76–8, 84–7,
99–100, 128, 188, 190–1, 226–7,
263, 278
The Virtue of Selfishness (Rand) 243
virtue-mindfulness 54
volitional capacity 24
volitional disavowal 38
Vonk, Roos 18
Wachowski, Lana 243
Wachowski, Lily 243
Watts, Alan 295
When Panic Attacks (Burns) 211
willpower 24
worksheets 56, 124
Yang, X. 84, 86
yoga 202–3, 207