Part 7. Pathogenic beliefs

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:

Identifying cognogens

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

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.