It's the Thought That Counts: The Role of Intentions and Meta-Awareness in Cognitive Therapy

It is usually assumed that cognitive therapy helps patients to reassess the validity of the content of their thinking, resulting in thoughts which are more realistic and less negative, thereby alleviating emotional distress. This paper proposes that negative cognitions may be dysfunctional, not only in terms of inaccurate propositional content, but also through fostering unhelpful or maladaptive intentions. Some benefits of cognitive therapy may result from helping patients to give up unhelpful intentions or adopt novel intentions in situations where they are experiencing distress. The process of adopting new intentions is facilitated by development of awareness of thoughts as mental events, here called meta-awareness. The effects of different components of cognitive therapy on intentions and on meta-awareness are described. Making intentional effects explicit clarifies the process of action of cognitive therapy, and may facilitate clinical practice, empirical investigation and training.