Emotional Arousal in Cognitive Theory

Aaron T. Beck, M.D.

June 2002

I am often asked about the role of emotion in cognitive therapy. Emotional arousal is to
honor the life and work of an essential part of what we do. For example, we induce anxiety in
our panic patients so that they can then reprocess their cognitions with the minimal induced
panic that they feel during the sessions. We also have a variety of methods for producing
anxiety in patients with GAD. In short, if we are going to change cognitions, we need to have
hot cognitions and that involves emotional arousal. I have found, however, that in the case of
depression the hot cognitions are there all along. Depressed patients are continually in a
state of arousal and, as they discuss troubling topics during the session, their arousal becomes
greater and that then provides a strong base for cognitive restructuring.
I believe that a certain degree of flexibility in encouraging the patient to express their
emotions is important. It is conducive to rapport and facilitates patients perceptions of their
therapist as involved and concerned. I also have strong theoretical reason for encouraging
emotional expression, as follows. (1) The expression of emotion has certain meanings to the
patient, for example, I cant be all bad if he listens sympathetically, or Its okay to have these
negative emotions. Or, (2) the interaction taking place can provide an experiential form of
reframing (similar to what Franz Alexander termed The Corrective Emotional Experience).
Much of the impact of therapy can be related to the Spontaneous deactivation of the
dysfunctional beliefs.

Originally published in Cognitive Therapy Today Volume 7, Issue 2. June 2002.