2009 - A Behavior-Analytic Account of Cognitive Bias in Clinical Populations - Wray, Freund, Dougher

8/13/2019 2009 - A Behavior-Analytic Account of Cognitive Bias in Clinical Populations - Wray, Freund, Dougher

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A Behavior-Analytic Account of Cognitive Bias inClinical Populations

Alisha M. Wray, Rachel A. Freund, and Michael J. Dougher

University of New Mexico

Cognitive bias refers to a well-established finding that individuals who suffer from certainclinical problems (e.g., depression, anxiety, posttraumatic stress disorder, substance abuse, etc.)selectively attend to, remember, and interpret events relevant to their condition. Although abody of literature exists that has tried to examine this phenomenon, most existing explanationsare mentalistic and mediational. In this paper we offer a behavior-analytic account of cognitivebias, its development, and how it may contribute to maintenance of clinical problems. Thisaccount is based on establishing operations or motivating events, verbal processes, andrelational responding. Clinical and future research implications are also discussed.

Key words: cognitive bias, mood congruence, depression, establishing operations, motivatingoperations, verbal processes

It is well established that certainclinical populations selectively attendto, remember, and interpret events inways that are congruent with theirdisorder (e.g., Weingartner, Miller, &Murphy, 1977; Williams, Mathews,& McLeod, 1996). This phenomenonis generally referred to as cognitivebias (McNally, 1995). Selective atten-

tion, selective memory, attributionalbiases, and dysfunctional attitudesare examples of cognitive bias andare characteristic of a range ofdisorders including depression (e.g.,Blaney, 1986), posttraumatic stressdisorder (e.g., Kaspi, McNally, &Nader, 1995; McNally, Lasko, &Macklin, 1995), obsessive compulsivedisorder (e.g., Foa & McNally, 1986),panic disorder (e.g., Becker, Rinck, &

Margraf, 1994), specific and socialphobias (e.g., Burgess, Jones, Ro-bertson, Radcliffe, & Emerson,1981), anxiety (McNally, 1995), sub-stance abuse (e.g. Franken, Rosso, &

Honk, 2003), bulimia nervosa (Meyeret al., 2005), and body dysmorphicdisorder (Buhlmann, McNally, Wil-helm, & Florin, 2002).

Given the cognitive orientation ofthe researchers interested in cognitivebias, it is not surprising that existingconceptual accounts are mediationaland rely on various postulated cog-

nitive processes and hypotheticalcognitive constructs (Beck, 1967;Beck, Rush, Shaw, & Emery, 1979;Bower, 1981). As such, they do notprovide a conceptual account thatspecifies the environmental determi-nants or the critical functional rela-tions that are imperative for theprediction and control of the phe-nomenon. Because cognitive bias is aubiquitous phenomenon and is rele-vant to a number of clinical disor-ders, it is important to provide suchan account. The purpose of thepresent paper is to offer a conceptu-alization that relies primarily on twointerdependent behavioral proces-ses: motivating operations (Michael,1982, 1993, 2000) and the function-altering processes involved in stimu-lus equivalence (e.g., Sidman, 1994;Sidman, Willson-Morris, & Kirk,1986) and derived relational re-

sponding (Hayes, Barnes-Holmes, &Roche, 2001). Before addressing therole of these behavioral processes incognitive bias, we will present the

This paper was partially supported by agrant funded by the Student ResourcesAllocation Committee of the Graduate andProfessional Student Association at the Uni-versity of New Mexico.

Correspondence should be directed to

Alisha M. Wray, at the University of NewMexico Psychology Department, 1 Universityof New Mexico MSC03 2220, Albuquerque,New Mexico 87131 (e-mail: [email protected]).

The Behavior Analyst 2009, 32, 2949 No. 1 (Spring)

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empirical evidence for the phenome-non.

COGNITIVE BIAS IN

CLINICAL DISORDERS

Cognitive bias has been studiedusing a variety of cognitive tasks,almost all of which assess the relativesalience of different classes of stimuli.For example, after exposure to labo-ratory procedures designed to inducea sad mood, individuals may beasked to study a list of words thatcontains pleasant, neutral, and sadwords. If the individual recalls moresad words after the mood-inductionprocedure than pleasant or neutralwords, he or she is said to have acognitive bias for the sad words.

Cognitive bias has been studiedacross a range of clinical disorders;however, it has been most extensivelystudied in individuals with depres-sion. The content or topography ofthe cognitive biases may vary amongclinical disorders, but the empiricalfindings as well as the functional

relations presented in this paper holdacross clinical disorders (Burgess etal., 1981; Foa et al., 2003; Foa &McNally, 1986; MacLeod & Ruther-ford, 1992; Mathews & MacLeod,1985; McNally, Kaspi, Riemann, &Zeitlin, 1990; Mogg, Mathews, Bird,& Macgregor-Morris, 1990; Rinck,Reinecke, Ellwart, Heuer, & Becker,2005; Watts, McKenna, Sharrock, &Trezise, 1986; Williams et al., 1996).

Thus, only the data on cognitive biasin depression will be presented.

Cognitive Bias in Depression

Cognitive bias has been investigat-ed most extensively in clinical andlaboratory studies of depression. Se-lective attention, biased memory, andpreference for negative events andinformation are major symptoms ofdepression (e.g., Beck et al., 1979;

Blaney, 1986; Bradley, Lee, & Mogg,1997; Ellis & Ashbrook, 1989; Roth& Rehm, 1980; Williams et al., 1996).The emotional Stroop task is com-

monly used to measure the personalimportance of various stimuli (e.g.,Watts et al., 1986; Williams et al.). Inthis task, participants are presentedwith a series of colored words varying

in emotional content (e.g., sad, bag)and are required to name as fast asthey can the color of each wordrather than the actual word. Reactiontime is the dependent variable, and itis assumed that the more emotionallyrelevant the words, the more difficultthe task will be, as measured bylonger response latencies. The emo-tional Stroop procedure has beenused with individuals with depres-

sion, who tend to respond slower tothe color of depression-related wordsthan to neutral words (Gotlib &McCann, 1984). Similar effects havealso been found for depression-relat-ed words with nondepressed individ-uals after sadness and other negativemoods had been induced experimen-tally (Gilboa & Gotlib, 1997).

The majority of cognitive biasresearch in depression has focused

on selective memory. Studies usingdepressed participants have shownmood-congruent memory effects,meaning that participants recalledmore material when the valence ofthe material matched their currentmood than when the material wasinconsistent with their mood. Forexample, using a repeated measuresdesign to examine the relation be-tween their diurnal depression cycleand autobiographical memories, D.M. Clark and Teasdale (1982) report-ed that individuals with depressionrecalled more negative memoriesduring the time of day when theyreported being more depressed andmore pleasant memories when theywere less depressed. This pattern ofmood congruence has been replicatedacross several clinical studies (seeBlaney, 1986, for a review). In addi-tion, mood-congruent effects were

reported in a study that examinedthe effects of dysphoria on sentencecreation and free-recall tasks (Hertel& El-Messidi, 2006). These findings

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suggest that individuals with depres-sion show memory bias effects acrossa range of memory-assessment pro-cedures.

These clinical findings are consis-

tent with the results of laboratorystudies that have examined the rela-tion between mood and cognitivebias. Laboratory studies often usemood-induction procedures to alterparticipants moods. A full review ofmood-induction procedures is be-yond the scope of this paper, butmost involve the presentation ofwritten statements, pictures, or music(alone or in combination) that are

intended to induce a particular moodor make participants feel a partic-ular way. Using mood-induction pro-cedures, mood-congruent memoryeffects have been replicated manytimes. For example, in free-recallsituations, individuals in negativemood conditions report significant-ly more negative autobiographicalmemories than individuals in neutralor positive mood conditions (Bower,

1981; Natale & Hantas, 1982; Teas-dale & Fogarty, 1979; Teasdale &Taylor, 1981; Teasdale, Taylor, &Fogarty, 1980). In contrast, individ-uals in positive mood conditionsrecall more pleasant memories. Inaddition, individuals induced into apositive mood not only describedevents and people in more positiveterms than negative terms but theyalso use more positive descriptionsthan individuals in a negative mood(Bower). Furthermore, several stud-ies have found that experimentallyinduced mood states affect perfor-mance on word-recall tasks, such thatsad words are more frequently re-called when subjects are in a sadmood, and positively valenced wordsare more frequently recalled whensubjects are in a positive mood(Bower; Ellis & Ashbrook, 1989;Teasdale & Russell, 1983). Further-

more, it has been shown that therelation between memory contentand mood is symmetrical (Baker &Gutterfreund, 1993; Van der Does,

2002). That is, asking subjects torecall sad memories induces sadmoods. Taken together, these find-ings suggest that individuals tend torecall events that are congruent with

their prevailing mood state.Although some studies have failed

to find mood-congruent memoryeffects, these failures have been attri-buted to procedural variables, includ-ing the use of nonclinical popula-tions (Blaney, 1986; Hasher, Rose,Zacks, Sanft, & Doren, 1985), tasksrequiring low cognitive demand(Challis & Krane, 1988; Ellis, 1985;Ellis & Ashbrook, 1989; Ellis, Thom-

as, McFarland, & Lane, 1985), andtasks with low personal relevance(Bower & Forgas, 2000). Altogether,mood-congruent recall effects appearto be a robust finding.

Cognitive bias has also been re-peatedly demonstrated with cognitivephenomena other than memory. Forexample, several studies that mea-sured thoughts and attitudes duringboth clinical and experimentally in-

duced depressed mood have shownthat negative thoughts increase infrequency when in a depressed moodand decrease when in a positive orneutral mood (Bodenhausen, Shep-pard, & Kramer, 1994; Gotlib, Le-winsohn, Seeley, Rohde, & Redner,1993; Hollon, Kendall, & Lumry,1986; Miranda & Persons, 1988).Also, individuals with depressiontend to describe themselves in nega-tive ways (Hill & Dutton, 1989) andpredict that, in general, they willattain less success and more failurethan nondepressed individuals (e.g.,Buchwald, 1977; Gotlib, 1981, 1983).Sheppard and Teasdale (2000) re-ported that depressed participantsagreed more readily (i.e., emittedfaster response latencies) with dys-functional attitude statements andless readily (i.e., emitted slower re-sponse latencies) with functional at-

titude statements compared to con-trols.

Other variables shown to vary asfunction of mood include self-efficacy

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ratings, task persistence, and self-critical or self-blaming attributions.For example, participants in a sadmood-induction condition reportedsignificantly lower estimates of effi-

cacy than subjects in a joyful moodcondition (Kavanagh & Bower,1985). In addition, individuals in apositive mood condition persistedlonger on anagram tasks than indi-viduals in a negative mood condition(Kavanagh & Bower).

Both clinically depressed individu-als and those in laboratory-induceddepressed moods demonstrate self-critical attribution styles (Coyne &

Gotlib, 1983; Follette & Jacobson,1987; Forgas, Bower, & Moylan,1990; Raps, Peterson, Reinhard,Abramson, & Seligman, 1982; Stiens-meier-Pelster, 1989). For example,individuals with higher levels ofdepression and comorbid diagnosesendorse a more self-deprecating andblaming attributional style for eventswith negative outcomes (Barnett &Gotlib, 1988; Fresco, Alloy, & Reilly-

Harrington, 2006; Gotlib et al., 1993;Morrison, Waller, & Lawson, 2006;Raps et al.; Stiensmeier-Pelster) whileat the same time attributing positiveoutcomes to external events (Forgaset al.; Fresco et al.; Persons & Rao,1985). This is in contrast to the self-enhancing attribution style of indi-viduals in positive moods. Nonde-pressed participants and participantsin neutral or positive mood condi-tions attributed negative outcomes toexternal causes that are infrequent(Forgas et al.; Forgas & Locke, 2005;Fresco et al.; Gotlib et al.) andattributed positive outcomes to theirpersonal contribution, which theydescribed as occurring regularly andin many contexts (Follette & Jacob-son; Forgas et al.; Forgas & Locke;Fresco et al.; Peterson, Villanova, &Raps, 1985). In effect, positive moodcorrelates with self-enhancement,

whereas depressed mood correlateswith self-criticism.

Cognitive bias in social infor-mation processing has also been

demonstrated with individuals withdepression. Gotlib, Krasnoperova,Yue, and Joormann (2004) reportedthat depressed participants differen-tially attend to sad faces when given a

series of pairs of faces depictingvarious emotions. Social informationprocessing biases have been paral-leled in laboratory-induced moods(for reviews, see Bower, 1981, 1991;Bower & Forgas, 2000). For instance,individuals in a happy mood condi-tion gave more positive descriptionsof their friends, whereas participantsin an angry mood condition gavemore negative descriptions. Similarly,

positive mood was associated withincreased attention (e.g., in a story,they spent more time reading thesecharacteristics) to positive aspects ofa stranger, whereas sad mood wasassociated with increased attention tothe strangers negative aspects (For-gas, 1992; Forgas & Bower, 1987).These studies also showed that happyand sad participants looked longer atpictures of several common scenes that

contained mood-congruent content.That is, happy participants lookedlonger at happy pictures (e.g., wed-dings), and sad participants lookedlonger at sad pictures (e.g., funerals)(Kelly, 1982). There was also a differ-ence in participants reports of howthey planned to spend their time inthe coming days. Participants in adepressed mood reported a plan tospend more time in solitary andserious activities, whereas happy par-ticipants reported a plan to spend timeengaging in enjoyable and light-heart-ed activities.

In addition, several studies haveshown that depressives differentiallyseek negative social feedback andtend to remember and believe nega-tive feedback more than positivefeedback (Giesler, Josephs, & Swann,1996; Joiner, 1995; Joiner, Katz, &Lew, 1997; Katz, Beach, & Ander-

son, 1996; Ritz & Stein, 1995; Scha-fer, Wickrama, & Keith, 1996;Swann, Griffin, Predmore, & Gaines,1987; Swann & Read, 1981a, 1981b;



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Swann, Stein-Seroussi, & Giesler,1992). For example, Giesler et al.found that when roommates wereasked to list each others positive andnegative characteristics, 82% of those

diagnosed as depressed later chose tohear the negative comments listed bytheir roommates, in contrast to 25%of the nondepressed participants.Moreover, Swann, De La Ronde,and Hixon (1994) reported thatdepressed participants actually preferintimate relationships that are char-acterized by negative feedback. Tak-en together, these findings suggestthat individuals in a depressed mood

not only selectively attend to negativesocial information but they may alsobe more comfortable in situationsthat provide such information.

Interestingly, cognitive bias seemsto covary with the intensity ofdepression (e.g., Beck, 1967; Beck etal., 1979; Rush, Weissenburger, &Eaves, 1986; Weingartner et al.,1977). Although laboratory-basedmood-induction studies have not

consistently shown a relation betweennegative mood intensity and mood-congruence effects (Blaney, 1986), theclinical depression literature suggestsotherwise. For instance, measures ofcognitive bias used in depressionstudies are positively correlated withsymptom severity and course (Rushet al.). The association betweensymptom severity and degree ofcognitive bias indicates that cognitivebias may play a role in the mainte-nance of clinical problems.

There are data that suggest thatcognitive styles play a role in themaintenance of mood, despite con-tradictory environmental input (Bar-nett & Gotlib, 1988; Coyne & Gotlib,1983; Teasdale, 1983). Clinical prob-lems often remain long after theinitial precipitating event, which sug-gests the involvement of cognitive orverbal processes. For example, rumi-

nation about current and past de-pressing experiences can maintaindepression even in the absence ofcurrent negative environmental input

(Fennell, Teasdale, Jones, & Damle,1987). Bower and Forgas (2000)reported that depending on the typeof cognitive strategies employed,mood and mood disorders can not

only be exacerbated but can also beameliorated.

CONCEPTUAL ACCOUNTS OF

COGNITIVE BIAS

Cognitive Accounts

A thorough discussion of cognitivetheories of cognitive bias is beyondthe scope of this paper, but thisapproach typically can be summa-

rized by one of the two followingpositions. The first position positsthat beliefs, automatic thoughts, dys-functional attitudes, attributions, andschemas cause depressed mood (e.g.,Beck, 1967; Beck et al., 1979; D. A.Clark, Beck, & Alford, 1999; Ingram,Miranda, & Segal, 1998; Persons &Miranda, 1992). Also suggested bythese theories is that negative cogni-tive styles establish vulnerability to

subsequent depression.Much empirical work has investi-gated these assertions, and the abun-dance of evidence does not supportcognition as causal in mood disorders(Barnett & Gotlib, 1988; Coyne &Gotlib, 1983; Hammen, Marks, de-Mayo, & Mayol, 1985; Lewinsohn,Steinmetz, Larson, & Franklin,1981). Negative cognition appears tobe a concomitant and consequence ofmood rather than an antecedent,indicating that mood may be primary(Barnett & Gotlib; Coyne & Gotlib;Hammen et al.; Lewinsohn et al.).For example, it has been shown thatattribution styles did not differamong remitted depressives and nev-er-depressed controls (Barnett & Got-lib). Longitudinal observations haverevealed that as depression scoresdecreased, reported number of irra-tional beliefs also decreased (Persons

& Rao, 1985), although dysfunction-al attitudes have been shown topersist with recent clinical remission(Rush et al., 1986). It is difficult to

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discern the etiological relevance ofthis latter effect, however, becauseprior episodes of depression maychange ones cognitive behavior, per-haps affecting (increasing) the relative

baseline of ones dysfunctional atti-tudes.

Within prospective, longitudinalanalysisthe best approach for de-termining the etiological significanceof cognitioncognitive styles havenot predicted the onset of depressionor the future vulnerability to depres-sion. For example, Lewinsohn et al.(1981) found that depressive cogni-tive style was absent before the first

episode of depression. Results foradolescents further suggest that anegative cognitive pattern is absentbefore the onset of the first episode ofdepression, and that the negativecognitive style is in effect only duringthe depressed mood (Gotlib et al.,1993). Taken together, the datasuggest that cognition may not al-ways precede the onset of mooddisorders; rather, mood disorders

may be the result of some othercausal variable.The second position is that basic

emotion nodes that are biologicallywired into the brain become activatedwhen in a sad mood, which in turnactivates other nodes (e.g., physio-logical arousal, events, facial expres-sions, etc.) in the network, whichdetermine what events, labels, ap-praisals, and behaviors are accessible(Bower, 1981, 1991). These cognitivepatterns are proposed as the primarycause of depression, whereas emo-tional factors are seen as secondary.When a negative emotion is activat-ed, so are the memories, labels, andactions associated with it, so that iswhat is accessible and apparent.Although this account is compellingin some ways, and later versions of itstate that the emotion nodes areactivated by environmental events, it

is explicitly stated that the concern isnot with situational antecedents butspecifically with the behavioral andcognitive consequences that are the

result of emotional states. This theoryfails to appeal to environmentalcontingencies in the development ofthese networks because the assump-tion is that the structure exists and is

activated analogously to an electricalnetwork. Because the theory fails todescribe how this develops or howchanges to this network might affectassociations among these variousnodes, it remains, from a behavioralperspective, an inadequate explana-tion of how cognition might causemood disorders.

To summarize, current cognitiveformulations do not adequately ac-

count for the majority of the data.Although they may account for thecontribution of negative cognitions tothe maintenance of depression, thesetheories do not explain the reductionin negative cognition to normal levelsduring remission, nor do they ac-count for the absence of dysfunction-al cognitive styles before onset of thefirst episode of depression. Also, theidea that negative schemas (latent or

otherwise) function to produce de-pression or vulnerability to depres-sion has been disputed in the cogni-tive literature. Finally, these theoriesdo not explain how maladaptivecognitive behavior patterns emerge.

Ultimately, explanations that givecausal status to cognitions are relyingon responseresponse relations, and,as is the case with most mediationalaccounts, the relevant behavioralprocesses, environmental determi-nants, and functional relations thataccount for the cognitions are notspecified. Questions therefore remainconcerning the behavioral principlesand processes that underlie cognitivebias and their functional relation tothe other behavioral components of amood disorder. However, cognitivetheoreticians and researchers haveidentified a clinically important phe-nomenon, because the role of cogni-

tive bias in the maintenance ofclinical problems cannot be disputed.Given the prevalence of cognitivebias in a wide range of clinical



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disorders and its potential role intheir maintenance and treatment, it isclearly not epiphenomenal. Thus, abehavioral account of cognitive biasis important.

A Behavior-Analytic Conceptualizationof Cognitive Bias

As stated earlier, our main purposein this paper is to offer a behavior-analytic account of cognitive bias,especially as it occurs in clinicalcontexts. Distilling the literature al-ready presented, cognitive bias can bedefined as the selective attention,recall, or interpretation of environ-mental and private events. It isgenerally studied in relation to emo-tional states, like depression or anx-iety, and is proposed to explain thosestates or result from them. We takethe position here that although cog-nitive bias is characteristic of certainemotional states or clinical disordersand may influence other behavior, itneither causes nor is caused by it.Rather, a thoroughgoing account

must specify the antecedent eventsthat produce emotional states thatalso evoke certain overt and covertbehavioral repertoires, including thoseverbal repertoires commonly referredto as cognition. Thus, cognitive biasand associated emotional states resultfrom certain environmental eventsand relevant behavioral processes.Particularly relevant in our view aremotivating operations (Michael,

1982, 1993) and verbal processes(e.g., Hayes et al., 2001; Sidman,1994; Sidman et al., 1986; Skinner,1957).

Motivating Operations

As described by Michael (1982,1993, 2000), motivating operationsaffect all three components of rele-vant contingencies of reinforcementand punishment. Accordingly, they

differentially potentiate relevant con-sequences and increase the probabil-ity of behaviors that in the past havebeen effective in obtaining potenti-

ated reinforcers or escaping or avoid-ing potentiated punishers. Over theyears, a number of different termshave been used to identify variablesthat serve these functions (e.g.,setting

factors, Kantor, 1959; setting events,Bijou & Baer, 1961; potentiating vari-ables, Goldiamond, 1983; and estab-lishing operations, Michael, 1982,1993, 2000; for a review, see Leig-land, 1984). Motivating operationsnow seems to be the most com-monly used term (Friman & Haw-kins, 2006; Laraway, Snycerski, Mi-chael, & Poling, 2003) and will beused here.

Food deprivation is an example ofa motivating operation. For food-deprived organisms, food is potenti-ated as a reinforcer, food-seekingbehavior increases in probability,and stimuli that have been discrimi-native for food reinforcement differ-entially gain control and salience.Food deprivation also abolishes ordepotentiates non-food-related con-tingencies in that non-food-related

consequences become relatively lessreinforcing, behavior associated withthese consequences decreases in rela-tive frequency, and relevant discrim-inative stimuli become relatively lesscontrolling and salient. In our view,the effects of motivating operationson stimulus control are most relevantto the current discussion of cognitivebias.

The effects of motivating operationson stimulus control. A less technicaland more conventional way of sayingthat motivating operations differen-tially affect the stimulus controlexerted by relevant discriminativestimuli is to say that we selectivelyattend to stimuli that are relevant tospecific motivating operations. Whenwe are food deprived, for example,we selectively attend to food-relatedstimuli, and this includes food- relat-ed stimuli that are not present in the

immediate environment. For exam-ple, we may begin to recall (remem-ber) the locations of places wherefood can be or has been obtained,

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and we might even interpret ambig-uous stimuli as being food related.This phenomenon has been calledmotivated perception, and was illus-trated by Skinners description of his

use of the device he called the verbalsummator (Rutherford, 2003; Skin-ner, 1936, 1953). Recall that theverbal summator was a device thatgenerated a short series of repeatingmeaningless sounds that individualswere asked to listen to and interpret.Individuals frequently reported hear-ing words or phrases relevant to theircurrent emotional or motivationalstates. Skinner suggested that the

device could be used to assess indi-viduals complexes, and there wereattempts to formalize the use of theverbal summator as a projectivetechnique (see Rutherford).

Although motivating operationsare said to enhance the controlexerted by relevant discriminativestimuli, the effects of motivatingoperations extend to stimuli whosecontrol has been acquired by means

other than differential reinforce-ment. Stimuli whose control is ac-quired through physical or semanticgeneralization, instruction, abstrac-tion (Catania, 2007a, 2007b), equiv-alence, or other derived stimulus rela-tions would be similarly affected. Forexample, through stimulus general-ization, a thirsty child may respondappropriately to a novel cup that isphysically similar to a cup fromwhich he or she previously drank.The child may also reach for a waterbottle after being instructed that theycan be used for drinking, or may, inthe right context, ask for a tazaafter learning that it is the Spanishequivalent of the English wordcup. These examples illustrate thecrucial point that motivating opera-tions affect controlling stimuli re-gardless of the process by which theyacquired stimulus control over rele-

vant operants.With respect to cognitive bias,

especially in clinical contexts, wecan see that real-world events that

produce anxiety and depression (e.g.,trauma, punishment, loss of rein-forcement, criticism, etc.; Dougher& Hackbert, 1994) as well as labora-tory-based mood-induction proce-

dures can function as motivatingoperations. More specifically, theseevents elicit emotional reactions, butthey also differentially potentiaterelevant contingencies of reinforce-ment, thereby enhancing the stimuluscontrol and salience of relevant dis-criminative stimuli.

Implicit in the concept of enhancedstimulus control is a differentialincrease in the probability of the

operants they occasion and a differ-ential decrease in the probability ofoperants occasioned by other, depo-tentiated stimuli. In a sense, then,motivating operations restrict bothenvironments and repertoires. Thatis, there is an increase in the proba-bility of all behavior relevant to thecontingencies potentiated by a par-ticular motivating operation, includ-ing private respondents and operants,

and a decrease in the probability ofoperants relevant to most othercontingencies. As an example, con-sider an individual who has recentlyexperienced the unwanted break-upof a relationship. The loss of rein-forcement certainly elicits strongemotional responses, but it alsoserves to enhance the stimulus con-trol exerted by the range of stimuliassociated with that failed relation-ship, increases the probability ofrelationship-related repertoires, anddifferentially potentiates the reinforc-ing value of repairing the relationshipand getting back together. For exam-ple, the individual may differentiallyattend to the perfume of his or herloved one on a stranger, mistakenlysee the loved one in places they usedto frequent, have recurrent thoughtsof good times, and obsessively replayevents that led to the break-up.

The extent to which contingenciesare affected varies as a function ofindividual learning history. Thus, anidiographic functional analysis is



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necessary to determine what contin-gencies are differentially potentiated(Kanter, Busch, Weeks, & Landes,2008). For example, after a break-up,some individuals may prioritize re-

placing the lost intimacy and mayavoid work and other activities thatwere once reinforcing. For others, theprospect of becoming involved inanother potentially punishing inti-mate relationship can become highlyaversive, while other activities (e.g.,work, substance use, sleep, eating)may become highly potentiated.Likewise, for some individuals, stim-uli associated with the terminated

relationship may elicit strong emo-tional reactions and selective memo-ries and may evoke behavior that isintended to either mend the termi-nated relationship or find a replace-ment. For others, these stimuli mayevoke behaviors intended to avoidreminders of the terminated relation-ship and opportunities to begin newones. In addition, these stimuli mayevoke verbal repertoires that include

self-recrimination, blaming, and ru-mination in an attempt to understandor analyze the reasons for the break-up and to generate new rules that areintended to govern future relation-ships.

To summarize, when we experiencethe aversive effects of a failure orloss, we may come under the differ-ential control of many stimuli thatare affectively or semantically relatedto that event. This includes privatestimuli, such as the verbal behavioror stimuli involved in trying to makesense of the loss and avoiding futurefailures. In a failure or loss situation,a range of contingencies is affectedsuch that previously reinforcing con-sequences become associated withaversive stimulation, and are there-fore more likely to be avoided. Thiscreates a situation in which a limitedrange of stimuli acquires increasing

control over behavior, resulting in anarrowed or restricted behavioralrepertoire. Interestingly, this restrict-ed range of potentiated contingencies

is characteristic of many clinicalproblems, especially anxiety and de-pression (Hayes et al., 2001; Wilson& Murrell, 2004), and is also adefining characteristic of cognitive

bias (i.e., stimulus selectivity, inflex-ible cognitive patterns, and a limitedrange of emotional states).

Appeal to external motivatingevents may explain momentary in-stances of cognitive bias or differen-tial stimulus control, but in individ-uals with clinical disorders, cognitivebias is often more pervasive and longlasting. The world is perceived, re-called, and interpreted in ways that

can serve to self-perpetuate cognitivebias, the restricted repertoires andassociated affect that characterizeclinical disorders. Individuals withclinical disorders tend to generatebiased rules or narratives about theworld and themselves, and those rulesare continuously validated via biasedor potentiated perceptions, recollec-tions, and interpretations. Becausegenerating coherent narratives about

environmental events and their rela-tion to behavior may be reinforcing,individuals may be motivated toactively search for or selectivelyattend to events and apparent rela-tions that are consistent with thosenarratives or explanations (Hayes etal., 2001; Pyszczynski & Greenberg,1987; Rothbaum, Weisz, & Snyder,1982; Swann, 1983, 1987). In thatway cognitive bias can be self-perpet-

uating, but that self-perpetuatingprocess seems to be dependent onthe verbal behavior that is character-istic of these disorders. We turn nowto a more detailed consideration ofthe role of verbal processes in cogni-tive bias.

The Role of Verbal Processes

Hayes et al. (2001) and Hayes,Strosahl, and Wilson (1999) have

argued that once humans acquirelanguage, verbal processes becomedominant and pervasive and greatlyinfluence the way in which we per-

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ceive and respond to internal andexternal stimuli. Whether this state-ment is true awaits further empiricalevidence, but it seems clear that, atleast for language-able humans,

many clinically important behaviors(as well as those relevant to cognitivebias) are accompanied by a stream ofverbal behavior (naming, categoriz-ing, comparing, interpreting, evaluat-ing, etc.) that can and often doesmediate the functions of those events(Hayes, Gifford, & Hayes, 1998; Ju &Hayes, 2008; Michael, 1982; Skinner,1957). Although we take the positionhere that verbal behavior has impor-

tant functional-altering effects andthat a full account of complex verbalbehavior must include an account ofthese effects, we fully acknowledgethat mediating verbal behavior isitself ultimately the result of rein-forcement contingencies (e.g., Hayeset al., 2001; Schlinger & Blakely,1987).

Self-talk. Perhaps the most rele-vant verbal behavior for a conceptual

analysis of cognitive bias is when thespeaker and the listener are the sameindividual; this has been commonlyreferred to as self-talk. Self-state-ments can function similarly to ex-ternal motivating operations andmay be thought of as verbal motivat-ing events. The inner dialogue evokedby a particular environmental eventis a function of an individualshistory, but the function-alteringeffects can be significant. Returningto the example of an individual goingthrough the unwanted termination ofa valued relationship, the ensuingself-talk may be characterized byself-blame, criticism, and attemptsto create a coherent explanation. Thisself-talk itself may function as averbal motivating operation not onlyin its ability to elicit more depressedaffect but also in terms of its effectson relevant reinforcement contingen-

cies and restricted stimulus control.Mistakes and transgressions made inthe relationship and previous rela-tionship failures are easily recalled, as

are other instances of failure in otherdomains (e.g., as a parent, employee,or friend). In an effort to make senseof the failed relationship, the individ-ual may generate an explanation that

selectively incorporates his or herperceived weaknesses and faults andarrives at a self-condemning conclu-sion.

The tendency to generate a coher-ent narrative or make sense of eventsin ones life has been observed by anumber of researchers and given avariety of names, including forming aself-narrative (Gergen & Gergen,1988; Pennebaker & Seagal, 1999),

making or finding meaning (Janoff-Bulman & Frieze, 1983), posttrau-matic growth (Calhoun & Tedeschi,2000; Tedeschi & Calhoun, 2003),developing a sense of coherence(Antonovsky, 1979) story telling(Zettle, 2007), and making sense orreason giving (Hayes et al., 1999,2001). This may be particularly so forevents that elicit or evoke emotions(Schachter & Singer, 1962). Swann

(1983, 1987) asserts that cognitivebias in depression may be due to thecomfort that is found in a consistentself-narrative. Making sense has beenproposed by Hayes et al. (2001) toreduce arousal associated with uncer-tainty. In fact, Hayes et al. (1999)assert that making sense can bereinforcing to such a degree that itbecomes entirely pervasive and inef-fective in solving psychological prob-lems.

A preliminary laboratory study inan ongoing series of studies by Wray,Dougher, and Bullard (2008) ex-plored whether making sense is rein-forcing. The study compared partic-ipants preference for a solvablecomputer task with response-contin-gent feedback to a formally similarbut unsolvable task, on which equalor greater amounts of positive feed-back were presented independent of

the participants performance. Themajority of participants preferred thesolvable task when equal amounts ofpositive feedback were presented, and



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half of the participants preferred thesolvable task even when greateramounts of positive feedback wereprovided for the unsolvable task.

A common form of self-talk that

maintains negative mood states andcognitive bias despite temporal dis-tance from the initial motivatingoperation is rumination. Rumination,which is particularly common indepression, is frequently defined asintrusive and recurrent thought thatis often self-focused on the symp-toms, causes, and consequences ofthe negative affect (e.g., Martin & Tes-ser, 1996; Nolen-Hoeksema, 1991).

Nolen-Hoeksema asserted that rumi-nation may allow individuals to focusinwardly and evaluate their problems.From a behavior-analytic perspec-tive, rumination is viewed as verbalbehavior that serves a variety offunctions such as reducing uncertain-ty and arousal associated with theuncertainty (Hayes et al., 2001),avoiding more distressing thoughts(Behar, Zuellig, & Borkovec, 2005),

or avoiding aversive emotions (Hayeset al., 2001; Kanter et al., 2008).Because private events, includingself-statements, are often experiencedas aversive, individuals may try toavoid them.

Although rumination may be anattempt to ultimately reduce aversiveprivate events, it is often only tem-porarily effective and typically in-creases in frequency over time. Infact, Nolen-Hoeksema (1991) assertsthat a ruminative response style mayexplain why some individuals becomeclinically depressed after an aversiveevent and others do not. Ruminationis a behavior that produces verbalstimuli that function to evoke nega-tive affective states and aversiveprivate events (e.g., memories) thatserve to exacerbate, rather thanameliorate, these events. Studiesshow that experimentally induced

rumination increases depressed moodand overgeneralized negative memo-ries (e.g., Park, Goodyer, & Teasdale,2004). Reciprocally, mood may in-

crease the likelihood of certain typesof self-talk such that the moredepressed an individual is, the morenegative self-statements he or shemakes.

Stimulus equivalence and derivedrelational responding. Self-talk canserve a motivative function andthereby perpetuate cognitive bias,but the processes by which verbalstimuli acquire this or any functionneed to be explained. Once relationalresponding is established, verbalstimuli acquire functions throughtheir participation in equivalencerelations with other verbal and non-

verbal events. In general, once equiv-alence relations are establishedamong a set or class of topographi-cally distinct stimuli, a function ac-quired by one member of the set willtransfer to the others (e.g., Dougher,Augustson, Markham, Greenway, &Wulfert, 1994). In this way, verbalstimuli acquire many of the psycho-logical effects of nonverbal stimuli.This is why, as Friman, Hayes, and

Wilson (1998) describe, reporting apast painful event can be painful initself.

Equivalence is only one kind ofstimulus relation (see Hayes et al.,2001, for a detailed theory of stimu-lus relations and relational respond-ing), and it has been demonstratedthat stimulus functions can be trans-formed in line with a number of otherrelations such as opposition, differ-ence, beforeafter, and less than/greater than (Dymond & Barnes,1995, 1996; Green, Stromer, & Mac-kay, 1993; OHora & Barnes-Holmes,2001; OHora, Roche, Barnes-Holmes,& Smeets, 2002; Roche & Barnes,1996, 1997; Roche, Barnes-Holmes,Smeets, Barnes-Holmes, & McGeady,2000; Steele & Hayes, 1991; Whelan& Barnes-Holmes, 2004; Whelan,Barnes-Holmes, & Dymond, 2006).For example, using college students

as participants, Dougher, Hamilton,Fink, and Harrington (2007) firsttrained arbitrary relations amongthree equally sized visual stimuli, A,

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B, and C, so that A was responded toas smaller than B, and B was respond-ed to as smaller than C. Then partic-ipants were trained to press the spacebar on a keyboard at a steady rate in

the presence of the B stimulus. Once asteady rate of bar pressing wasachieved, the A and C stimuli werepresented alone without additionalinstructions. All of the participantspressed the bar at a slower rate to theA stimulus and at a faster rate to the Cstimulus than to the B stimulus. Afterthat, the B stimulus was paired withmild electric shock six times in aclassical conditioning arrangement,

with skin conductance responses serv-ing as the dependent variable. Whenthe A and C stimuli were thenpresented in extinction, most of theparticipants showed a smaller skinconductance response to the A stimu-lus and a larger response to the Cstimulus than to the B stimulus.Interestingly, because of the originalrelational training, the C stimulus,which had no previous association

with shock, elicited a larger fearresponse than the stimulus that hadbeen directly paired with shock. Thesedata suggest that relational traininginfluences the way in which individu-als respond to stimuli with which theymay have had no direct experience,and that individuals may imposefunctional relations on novel eventsas a result of their learned or derivedrelations with familiar stimuli.

One relation often imposed onstimuli that is particularly relevantto cognitive bias is causality. Al-though causality has not been wellinvestigated as a stimulus relation, itis clear that individuals readily im-pose and derive causal relationsamong events. For example, Petersonand Seligman (1984) asked partici-pants to describe the two worstevents they had experienced withinthe last year, and the only instruc-

tions provided were to keep thedescription within a specified wordlimit. Results indicated that partici-pants spontaneously offered causal

explanations without any promptingto do so. However, the types ofexplanations tend to vary as a func-tion of individual learning historyand affective states. For example,

when depressed individuals explainan aversive event, they assignedcausality to self-deficiencies (e.g.,My partner left me because I amunlovable). These maladaptive caus-al explanations have repeatedly beendemonstrated to correlatewith clinicalproblems (Barnett & Gotlib, 1988;Fresco et al., 2006; Gotlib et al., 1993;Morrison et al., 2006; Raps et al.,1982; Stiensmeier-Pelster, 1989).

Motivating Operations AffectSelf-Relations

Relational frame theory assertsthat relational responding is a func-tional operant that is abstracted andcomes under contextual control(Hayes et al., 2001, p. 29). If so, thenrelating should be a function of all ofthe variables that affect operantresponding. There is evidence tosuggest that relational respondingcan be brought under both anteced-ent stimulus control (e.g., Dymond &Barnes, 1995; Green et al., 1993;Wulfert & Hayes, 1988) and conse-quential control (Whelan & Barnes-Holmes, 2004; Whelan et al., 2006;Wilson & Hayes, 1996), but particu-larly relevant to our discussion ofcognitive bias is the effect motivatingoperations might have on relational

responding.A recent within-subject experiment

by Freund (2007) offers preliminaryevidence for the effects of a motivat-ing operation on self-relational re-sponding. Nondepressed college stu-dents (as measured by self-report onthe Beck Depression InventoryII)were exposed to several practice trialson a version of the Implicit Relation-al Assessment Procedure (IRAP;

Barnes-Holmes et al., 2006) computertask. The procedure requires partici-pants to push a key corresponding totrue or false as quickly but accurately



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as possible to a set of true (love isgood) or false (love is bad)statements under two different in-struction conditions. In one condi-tion, participants were instructed to

respond in a way that is consistentwith what they believe, and in theother, to respond in a way that isinconsistent. Thus, in the consistentinstruction condition, participantswould respond true to love isgood and false to love is bad.In the inconsistent condition, theywould respond false to love isgood and true to love is bad. Inthis study, practice trials involved

responding true or false to self-statements such as I am sitting, Iam standing, I am a student, andI am a doctor. The operatingassumption of the procedure is thatparticipants will respond faster underconsistent instructions than underinconsistent instructions, and thatthe difference in reaction times re-veals the participants implicit rela-tions among the elements in the

statements.Once participants had achievedstability on the IRAP practice trials,they were given a set of self-referencetrials that included statements like Iam happy, I am sad, I amaccepted, and I am rejected andwere asked to select true or falseunder consistent and inconsistentinstruction conditions. Overall, par-ticipants more quickly endorsed pos-itive self-statements as true and neg-ative statements as false in baseline(i.e., during neutral or positivemood). After negative mood-induc-tion procedures that consisted ofreading a story of personal failure inan academic setting while listening toa piece of sad music, participantsreported their mood on a moodchecklist and were then reexposed tothe self-reference IRAP. Nine of 15participants reported a shift in mood,

and subsequently responded faster tonegative self-statements and slower topositive self-statements than they didin baseline. Thus, for most partici-

pants, the mood-induction proce-dures altered their self-descriptionsor the relation between themselvesand the positive and negative descrip-tors. Based on these preliminary

data, if mood-induction procedurescan be considered motivating opera-tions, then motivating operations canalter self-relations.

To summarize, the behavioral phe-nomena that fall under the generalrubric of cognitive bias are ubiqui-tous and are not restricted to clinicalpopulations. The events we attend to,remember, and interpret are con-trolled by potentiated consequences

and contingencies of reinforcement.In the present paper, we see cognitivebias as the product of motivatingoperations and verbal processes, es-pecially arbitrary relational respond-ing and the resulting transformationof functions. However, cognitive biasis particularly conspicuous in clinicalcontexts and contributes to the de-velopment and maintenance of clini-cal disorders.

CLINICAL IMPLICATIONS

The present account of cognitivebias suggests some implications fortreatment of mood disorders. Forinstance, individuals may need tocontact alternative motivating op-erations that will potentiate non-depressive contingencies followinga motivating operation that evokesdepressive contingencies. Some liter-ature in support of this idea indicatesthat negative mood motivates peopleto actively seek out motivating oper-ations to reverse the mood state andits effect (Sakaki, 2006; Siemer,2005). Seeking out mood-incongru-ent activities is sometimes referred toas mood management, and has beenseen in people who are depressed aswell as those who are temporarilyinduced into mood states (Bower &

Forgas, 2000; Swinkels & Giuliano,1995). People deliberately search forstrategies to repair their mood, andsome methods used to reduce or

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reverse mood states are more effec-tive than others. For example, peoplewho experience negative mood mayuse drugs or alcohol to alleviate theirdistress. This tends to be effective in

the short term for reducing negativeemotions, but it is ineffective as along-term strategy.

Clinically depressed individuals ap-pear to use less effective strategies torepair their mood than nondepressedindividuals do. These individualsoften use coping strategies, likeavoidance and rumination, that en-hance and maintain the negativemood. For example, depressed and

formerly depressed participants re-ported using less adaptive strategies,like thought suppression, in responseto unpleasant thoughts compared toparticipants who were never de-pressed (Rude & McCarthy, 2003).Depressives also paid less attention toand had less clarity about theirfeelings, and reported a relativeunwillingness to disclose their feelingscompared to nondepressed individu-

als (Rude & McCarthy). It seems thatthese less effective strategies, whichare often characterized by avoidanceof aversive private events, are poten-tially self-perpetuating in that theydecrease the probability of contactingcurrently depotentiated but potential-ly reinforcing contingencies. For thisreason, interventions that are intend-ed to establish or potentiate nonde-pressive contingencies should be acomponent of therapy.

The motivating operations thatpotentiate mood-shifting contingen-cies can come from external sources(e.g., an experimenters request, anevent, therapeutic intervention) orself-talk (e.g., self-statements via con-ditioning and transformation of func-tion). Studies have shown that briefdistraction improved a temporarysad mood, whereas self-focused ru-mination worsened participants sad

mood (Bower & Forgas, 2000; Sie-mer, 2005). Additionally, it appearsthat focusing attention away fromself-related stimuli and toward other-

related stimuli during a dysphoricmood may improve mood (Hertel &El-Messidi, 2006). Comparable ef-fects were demonstrated in a seriesof three mood-induction experiments

by Van Dillen and Koole (2007).These authors reported that perform-ing a math task during a negativemood reduced this mood. In otherwords, simply interacting with anondepressive contingency while innegative mood can significantly alterthe mood.

Based on this analysis, treatmentinterventions such as behavioral acti-vation, exposure, self-monitoring,

cognitive restructuring, mindfulness,and acceptance are likely to beeffective in decreasing depressionbecause they expose clients to moti-vating events that potentiate alterna-tive behaviors, consequences, andsalience of discriminative stimuli.Behavioral activation, exposure, andself-monitoring (Korotitsch & Gray,1999) contribute to client contactwith increased environmental events,

and cognitive restructuring, mindful-ness, and acceptance work to changecognitive behavior or its function(Allen, Chambers, & Knight, 2006;Hayes & Wilson, 2003; Teasdale,1999; Teasdale et al., 2002). Thesemethods increase contact with alter-native motivating operations whileexpanding ones overt and privatebehavioral repertoires.

Thus, distraction may be useful if itserves to contact other mood-incon-gruent motivating events that allowindividuals to continue the pursuit ofgoals and values. However, thisaccount (and writings of others, e.g.,Hayes et al., 1999, 2001) suggests thatattempts to reduce unwanted privateexperiences, for the sole purpose ofreducing aversive affective states,may be unsuccessful because of thefunction-altering effects of verbalstimuli. Findings on the paradoxical

effects of thought suppression withnegative thoughts (Wegner, Schnei-der, Carter, & White, 1987) furthersuggest that treatments that highlight



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distraction and suppression as inte-gral components may not be effec-tive, and at worst, may be iatrogenic.As an individual attempts to suppressunwanted thoughts, the attempts will

inevitably fail at times (Wegner,1994). As this happens, if the indi-vidual is in a negative mood, thestimuli that are being used as distrac-tion from the aversive thoughts andaffective state may acquire similaraversive functions via relational re-sponding.

Behavior-analytic therapies, suchas acceptance and commitment ther-apy (ACT; Hayes et al., 1999) or

behavior activation therapy (BAT;Martell, Addis, & Jacobson, 2001),that take a different approach tounwanted private experiences offergreat promise in the treatment ofdisorders that are characterized bycognitive bias. For example, ACTtherapists focus on altering clientsresponses to their private events andverbal behavior in an attempt tofacilitate defusion and acceptance,

and BAT therapists focus on increas-ing engagement with reinforcing mo-tivating operations and rely primarilyon the secondary effects of increasedreinforcement to alter clients moodsand cognition or self-directed verbalbehavior. Likewise, incorporating apsychoeducational component intoexisting treatments about the effectsof mood on cognition might be usefulin facilitating acceptance, defusion,or mindfulness of unwanted privateevents. All of these strategies mayserve to alter the aversive functions ofthe unwanted experiences via expo-sure rather than to exacerbate theavoidance repertoires that maintainthe clinical problem. Regardless ofwhether and how behavioral ac-counts of clinically relevant phenom-ena are integrated into specific ther-apies, it is important that thesephenomena be understood.

Our conceptual analysis is basedon established behavioral principles,but it is ultimately an interpretation.Although there is direct empirical

evidence to support some of ourinterpretations, a good deal moreresearch is necessary to fill in theempirical gaps. One major difficultyin conducting research of this type

with normal adults is the fact thatthey come to the laboratory withcomplex histories and well-developedverbal repertoires. That is, the reper-toires of interest are already devel-oped, and it is, therefore, difficult togain experimental control over therange of relevant variables. Still,behavior-analytic studies of complexhuman behavior can be informativedespite the lack of precise experimen-

tal control, and these basic findingsare critical to move clinical behavioranalysis forward.

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