Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
Research ArticlePractice

Part 7. Pathogenic beliefs

Greg Dubord
Canadian Family Physician June 2011, 57 (6) 689;
Greg Dubord
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: greg.dubord@cbt.ca
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

To the list of common pathogens—like bacteria, viruses, and fungi—we must add another: cognitions. I define a pathogenic belief—or cognogen for short—as a belief that contributes to psychological or physical pathology.

Cognopathology

Each distinct psychopathology has fairly characteristic upstream cognogens. Cognitive specificity refers to causative links between specific cognogens and their specific psychopathologies. Here are some examples:

COGNOGEN*COGNOTYPEPSYCHOPATHOLOGY
I can’t cope with attacks away from homeAgoraphobogenicAgoraphobia
I can never be too thinAnorexogenicAnorexia nervosa
It’s hopelessDepressogenicDepression
I can’t copeAnxiogenicGeneralized anxiety disorder
I can’t cope at all if I don’t sleep wellInsomnogenicInsomnia
A panic attack could kill mePanicogenicPanic disorder
I must push away these intrusive imagesObsessogenicObsessive compulsive disorder
All dogs are very dangerousPhobogenicSimple phobia
If people knew me, they’d reject meSociophobogenicSocial anxiety disorder
I’m a burden to everyoneSuicidogenicSuicidality
  • ↵* Most patients with a given diagnosis have more than 1 cognogen.

  • Identifying cognogens

    The 3 basic methods for identifying cognogens are listening, asking, and guessing.

    Listening

    Pt: I’ve gotta make up for lost time. (Manicogenic cognogen)

    Pt: I’m the fattest and ugliest ever. (Body dysmorphogenic cognogen)

    Pt: There’s no such thing as too many tests. (Hypochondrogenic cognogen)

    Asking

    Dr: What was going through your mind before you picked up the razor?

    Pt: I was scared the empty feeling would never end. (Borderline personality disorder cognogen)

    Dr: What were you thinking before you punched him?

    Pt: Doc, life is dog-eat-dog …. You’ve gotta hit them or they’ll hit you. (Antisocial cognogen)

    Dr: What were you thinking just before you used?

    Pt: A little bit can’t hurt. (Substance abuse cognogen)

    Guessing (“empathic conjectures”)

    Dr: [To the truant child] Billy, are you worried you’ll never make friends at your new school? (School-refusal cognogen)

    Dr: [To the angry patient] Were you feeling you had to settle the score right there and then? (Intermittent explosive disorder cognogen)

    Dr: [To the tearful widow] Jan, are you frightened that you’ll never find happiness again now that Pete is gone? (Complicated grief cognogen)

    These methods are admittedly inexact. Unfortunately, precision in assessing almost every posited mediator of psychopathology remains a serious challenge for psychiatry. Biological approaches are, if anything, blinder than cognitive approaches, with no tools whatsoever for measuring putative mediators in the clinical setting—FPs continue to await psychiatry’s neurotransmitter laboratory tests.

    Tips

    1. In the real world it is neither practical nor desirable to treat all cognogens. Some are of low pathogenicity, and the severity of symptoms must be the guide.

    2. Efforts to identify the most virulent cognogen are to be encouraged—to a point. In many cases the sweetest spot is simply not knowable—“close enough” will do.

    3. Cognogens rarely work alone. If you’ve identified one, odds are its brother, uncle, and second cousin are lurking around, and they should be treated as well.

    4. Although cognogens are often treated with “cognitive restructuring tools” (ie, persuasion), in many situations other interventions (eg, medications) are preferred.

    5. The extent to which one charts cognogens varies with the context. Although orthodox cognitive behavioural therapy necessitates compulsive documentation, if you predict only 5 to 6 loosely structured 20-minute sessions over a few months, much rougher documentation (eg, half a dozen cognogens recorded) is more appropriate. If the “therapy” is likely only a single session (eg, for noncompliance), then any cognogen documentation might be a relatively poor use of resources.

    The cognogen concept opens the door to more effective mental health interventions. Cognogen assessment should be a part of many clinical encounters.

    Acknowledgments

    I thank the following CBT South America participants for their helpful critique of this paper: Drs Fred Archibald, Kathleen Cadenhead, Vivian Chow, Greg Cully, Peter Innes, and Angela MacArthur.

    Footnotes

    • Next month: Cognitive illusions

    • Copyright© the College of Family Physicians of Canada
    PreviousNext
    Back to top

    In this issue

    Canadian Family Physician: 57 (6)
    Canadian Family Physician
    Vol. 57, Issue 6
    1 Jun 2011
    • Table of Contents
    • About the Cover
    • Index by author
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Part 7. Pathogenic beliefs
    (Your Name) has sent you a message from The College of Family Physicians of Canada
    (Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Part 7. Pathogenic beliefs
    Greg Dubord
    Canadian Family Physician Jun 2011, 57 (6) 689;

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Respond to this article
    Share
    Part 7. Pathogenic beliefs
    Greg Dubord
    Canadian Family Physician Jun 2011, 57 (6) 689;
    Reddit logo Twitter logo Facebook logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Cognopathology
      • Identifying cognogens
      • Tips
      • Acknowledgments
      • Footnotes
    • eLetters
    • Info & Metrics
    • PDF

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Cited By...

    • No citing articles found.
    • Google Scholar

    More in this TOC Section

    Practice

    • Managing type 2 diabetes in primary care during COVID-19
    • Effectiveness of dermoscopy in skin cancer diagnosis
    • Spontaneous pneumothorax in children
    Show more Practice

    Cognitive Behavioural Therapy Series

    • Part 6. The CUE question
    • Part 5. The mood pie
    Show more Cognitive Behavioural Therapy Series

    Praxis

    • Part 6. The CUE question
    • Part 5. The mood pie
    • Rapid recommendations
    Show more Praxis

    Similar Articles

    Navigate

    • Home
    • Current Issue
    • Archive
    • Collections - English
    • Collections - Française

    For Authors

    • Authors and Reviewers
    • Submit a Manuscript
    • Permissions
    • Terms of Use

    General Information

    • About CFP
    • About the CFPC
    • Advertisers
    • Careers & Locums
    • Editorial Advisory Board
    • Subscribers

    Journal Services

    • Email Alerts
    • Twitter
    • LinkedIn
    • Instagram
    • RSS Feeds

    Copyright © 2023 by The College of Family Physicians of Canada

    Powered by HighWire