Elsevier

Clinical Psychology Review

Volume 28, Issue 8, December 2008, Pages 1297-1309
Clinical Psychology Review

Dissonance induction and reduction: A possible principle and connectionist mechanism for why therapies are effective

https://doi.org/10.1016/j.cpr.2008.06.003Get rights and content

Abstract

Several empirically supported treatments for depression are currently available with little understanding of either principles or mechanisms that are responsible for their effectiveness. This article reviews existing principles and finds that they contain little mechanism information. A connectionist mechanism used to explain why systematic desensitization and response prevention are effective in treating anxiety disorders is reviewed and generalized to understand why empirically supported treatments of depression work. This mechanism suggests a dissonance induction followed by reduction principle that can guide clinical practice. Application is extended to learned helplessness and rumination because they are associated with depression. Implications for clinical practice are provided. Limitations are identified and discussed.

Section snippets

Principles

Castonguay and Beutler (2006) suggested guidelines for identifying empirically supported principles of psychotherapy. They defined therapeutic principles as, “the conditions under which a concept (participant, relationship quality, or intervention) will be effective.” (p. 6). Empirically supported principles were divided into three main categories: participant factors (characteristics of both therapist and patient), relationship factors (attributes of the therapeutic relationship that are

Mechanisms

Kazdin (2007) defined mechanism as, “the basis for the effect, i.e., the processes or events that are responsible for the change; the reasons why change occurred or how change came about.” (p. 3). Mechanism information entails a causal sequence of events leading to change. Unfortunately, it appears that while the field of clinical psychology can confidently assert that empirically supported therapies create change, there is little published information about how these changes occur (cf. Kazdin,

A connectionist mechanism for anxiety treatment

The network of a phobic person before treatment can be understood to function as follows. The top stimulus row pertains to anxiety-related stimuli. Their activation is processed down through the connections diagramed by the solid lines to the nodes in the second layer as described in the previous section, which, like the O in the S-O-R model is where anxiety-related cognitions and emotions are located/processed. More than two such nodes are clearly required but are not illustrated for

Validation issues

The section more fully addresses the question “How valid is the dissonance induction/reduction principle? Mathematics is a deductive system that enables one to prove the truth/validity of a conclusion. Science is an inductive system that empirically supports hypotheses based on consistency between expectation and observation. No amount of evidence can prove the validity of a hypothesis because subsequent data can falsify it at any future time. This is why we speak of empirically supported

Dissonance reduction

Cognitive dissonance is a deeply rooted well supported explanatory social psychological principle Inspired by Lewin's field-theoretical approach (Lewin, 1936), Heider (1958) applied the principle of consonance to interpersonal relationships between two persons and an attitude object which could be another person, a topic of conversation, or an event in the form of POX diagrams where P = person, O = other person, and X = attitude object. The lines connecting the three vertices of the resulting

Dissonance induction and reduction explains EST's for depression

The purpose of this section is to apply the dissonance induction/reduction principle to EST's for depression including behavior therapy (BT), cognitive therapy (CT), and interpersonal psychotherapy (IPT; Nathan & Gorman, 2002). Though each modality differs in its underlying assumptions regarding the etiology and maintenance of depression and therapeutic emphases, we shall argue that cognitive dissonance induction and reduction is a commonly shared principle, not only in terms of symptom

Biases, learned helplessness and rumination

Cognitive dissonance theory can also help explain a number of empirical findings related to information processing patterns among depressed individuals such as depressive realism (Dobson and Franche, 1989, Moore and Fresco, 2007), learned helplessness theory and its variations (Abramson et al., 1989, Abramson et al., 1978, Seligman and Maier, 1967, Sideridis, 2005), and the finding that ruminative thinking is involved in the maintenance of depressive symptoms (Lyubomirsky and Nolen-Hoeksema,

Limitations

We now identify and discuss six limitations to the dissonance induction/reduction principle presented above. First, the dissonance induction/reduction principle does not fully explain why some therapists succeed more than others who report using the same techniques. Some therapists may be more effective at inducing dissonance and facilitating its reduction than other therapists. Two therapists implementing what they believe to be the same therapies may in fact not be duplicating therapeutic

Implications for clinical practice

The main point we want to emphasize is that effective clinicians, regardless of their theoretical orientation, probably implement the dissonance induction/reduction principle, which we have argued changes the way their clients to think, feel, and behave because it causes their brain network to process information differently. Three positive expectations result from this view. First, we expect that clinicians can become more effective by consciously using the dissonance induction/reduction

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