Cognitive therapy and serious mental illness. An interacting cognitive subsystems approach

The increasing application of Cognitive Therapy to the more enduring forms of psychopathology represented by the DSM-IV 'Axis II Disorders' has led to the piecemeal development of the discipline, and the incorporation of appr oaches from other therapeutic modalities, and from wider sources, such as B uddhist meditation. The present paper proposed the development of the Cogni tive rationale, using as a foundation the research-based insights provided by Teasdale's 'Interacting Cognitive Subsystem' model (Teasdale and Barnard , 1993). By emphasizing the close relationship between the emotional (impli cational) subsystem and states of bodily arousal, this restores aversive ar ousal states to a central place ill the understanding of psychopathology, a nd clinical practice. The role of threatening information about the self re ceived through early relationships in leading to chronic aversive arousal s tates, whether high arousal as in anxiety, or low, as in depression, in Axi s II disorders, is considered. The implications of the tension between this aversive information and the basic human endeavour of constructing the sel f are discussed, and a clinical example is used to illustrate the therapeut ic approaches suggested by this perspective. Copyright (C) 1999 John Wiley & Sons, Ltd.