by Jan M.A. de Vries, PhD
The cross-fertilisation between psychology and psychotherapy depends to a large degree on principles described best by ‘memetics’ (Dawkins, 1989) the study of self-replication of units of culture or ‘memes’. Memes can be ideas, theories, models and principles but also gossip, stories, religion, fashion, songs, etc. They spread in the world in the way viruses replicate and move from host to host. For theoretical knowledge this means that it will spread if people talk and write about it and in today’s world if it is on the radio, television, and the Internet. Some ideas are fertile, reproduce shamelessly and flood the popular arena, while other ones seem to be more modest and do not make it outside of their specialist area. Some emerge and die down quickly, while others show great resilience and longevity. What makes ideas and principles effective ‘memes’ is not always clear, but applicability, simplicity, and ease of communication most likely play a role.
The flow between scholarly knowledge and popular knowledge is affected by these mechanisms and so is the flow between fields like psychology and psychotherapy. Although many aspects of psychology have become an active and recognised ingredient in psychotherapeutic practice and the other way around, others have somehow not been able to jump across. Cognitive dissonance is such a principle. It has never made a big impact outside of social psychology. It has never fully entered the common domain. And only recently has it started to make inroads in psychotherapy. This is not because of lack of applicability or inherent incompatibility but probably because the meme of the theory has not been communicated effectively enough. In this article I hope to contribute to redressing this issue. I will argue that dissonance theory provides an excellent model for understanding essential aspects of psychotherapy and furthermore that it may aid our understanding of processes of inner conflict, change, and resistance to change.
Cognitive dissonance theory
Cognitive dissonance theory (or simply dissonance theory) was first introduced by Leon Festinger (1957). He described dissonance as the unpleasant tension arising from holding two or more inconsistent cognitions at the same time. The arising discomfort motivates efforts to reduce the inconsistency. This can be done by adapting thoughts, trying to bring perceptions and beliefs closer together, or if behaviours are involved altering them to be in line with beliefs and values. The musical terminology is no coincidence and relates dissonance to inner ‘disharmony’ and consonance to ‘harmony’. The theory caused quite a stir when it was first introduced, because contrary to the prevailing paradigm of the time – behaviourism – it predicted that we can be motivated more strongly by the urge to reduce inner discord than by external reinforcement and punishment (Festinger and Carlsmith, 1959). Since then the theory has been widely researched of which a recent overview can be found in Cooper (2007). Dissonance has been demonstrated to bring about attitude change and behavioural change, and the aversive character of the accompanying discomfort and related sympathetic activation have also been supported empirically (Cooper, Zanna and Taves, 1978). Dissonance theory has been subject to intense debate and has undergone a series of transformations of which Aronson’s (1968, 1992) conception is probably of most interest to psychotherapists. He suggests that dissonance is felt most strongly if our behaviours or decisions violate beliefs about the self, our sense of identity, our sense of competence, and being morally good.
“At the very heart of dissonance theory, where it makes its strongest predictions, we are not dealing with just any two cognitions; rather we are usually dealing with the self concept and cognitions about some behaviour. If dissonance exists, it is because the individual’s behaviour is inconsistent with his self-concept.”
Aronson (1968: 23)
Dissonance theory and theories of psychotherapy
We don’t have to think too hard to see the parallel with Rogers’ work. What is dissonance for Aronson and caused by inner conflict involving self-related beliefs is ‘incongruence’ in Rogers (1961) perspective and rooted in a conflicted relationship between what he calls the real self and the ideal self, the ‘I am’ and the ‘I should’. And the similarity does not stop here. Studies on dissonance have demonstrated that the reduction of dissonance can be achieved through justification processes, such as external attribution, trivialisation, misinterpretation, and distortion as well as shifts in attention (Cooper, 2007). The last two aspects are also highlighted in Ewen’s (2003) description of Rogers’ perspective on incongruence:
“Experiences that serve as a threatening reminder of the incongruence between the self-concept and the organismic experience are likely to be defended against by distorting them (or less frequently) by blocking them from consciousness.” Ewen (2003: 202)
In a similar vein dissonance theory can be related to Freud’s (1924) outline of the structure of personality and inner conflict. In Freudian theory it is the interactions between ‘id’, ‘ego’, and ‘superego’ that lead to such conflict, in particular the clashes between strategic behaviour initiated by the ego and disapproval of our conscience i.e. the superego. The resulting discomfort and internal turmoil are identical to what can be inferred from cognitive dissonance theory when we engage in behaviour that we consider morally wrong. Furthermore, what is conceived as ‘defenses’ in psychoanalytical theory translates seamlessly into ‘efforts to reduce or prevent dissonance.’ Festinger (1957: 235) was aware of the specific parallel between his theory and Freud’s (1946) perspectives on cognitive distortion, but other than that few authors have further explored this relationship. Chow (2001) is an exception. His emphasis on the accumulation of unresolved dissonance over time is akin to psychodynamic principles of how neuroses develop. It is a pity that his paper lacks the theoretical clarity to justify further comments here.
We may have expected the main proponents of cognitive therapy to acknowledge the existence of the principle of cognitive dissonance, but neither Beck (for instance Beck, 2008; Alford & Beck, 1997) nor Ellis (1977, 1999) refers to Festinger’s work where it would seem appropriate. For instance when Ellis (1999, p. 158) emphasises the role of ‘cognitive disputing’ in rational emotive behaviour therapy it is almost as if he leaves a blank in the explanation of its impact, to avoid having to call on dissonance processes. It is similarly bewildering how Aaron Beck does not seem to have seen the obvious connection between ‘cognitive reactivity’ – negative attitudes about the self (Beck, 2008, p. 971) and dissonance or the role of dissonance in bringing about cognitive change. Tryon and Misurell (2008) put it as follows:
“Both the cognitive and behavioral components in Beck’s system serve as dissonance induction procedures, [..] We suggest that actions of the cognitive therapist create dissonance between the patient’s newly acquired cognitions and their current behavioural patterns.”
Tryon & Misurell (2008: 1304)
Notwithstanding the lack of acknowledgment of the potential of cognitive dissonance in the writings of eminent authors on psychotherapy, the theory has seen a variety of recent applications to mental health issues, such as the treatment of eating disorders (Mitchell, Mazzeo, Rausch & Cooke, 2007), smoking (Levinson, Campo, Gascoigne, Jolly, Zakharyan & Tran 2007), trauma response in victims of political violence (De Vries & De Paor, 2005), and conflicting values and job tasks of mental health care workers (Taylor & Bentley, 2005). In particular, evidence for the effectiveness of a cognitive dissonance based treatment of anorexia and bulimia is accumulating (Shaw & Stice, 2008; Krysanski, 2006; Stice, Marti, Shaw & O’Neill, 2008; Mitchell et al., 2007). In these programmes clients are asked to engage in counter attitudinal verbal, written, and behavioural exercises in which they criticise the ‘thin-ideal’. The outcomes demonstrate that if participants made counter attitudinal statements without coercion, they ended up changing their attitude in the direction of the statement they made. This approach is based on findings by several researchers (Cooper, 2007) and inspired by Festinger and Carlsmith’s (1959) seminal study. In light of this it is worth to take some time and see in what ways dissonance theory may be taken into account by psychotherapists and presented to their clients as a way of understanding psychotherapy processes.
As I reported in a previous article for Inside Out (De Vries, 2007) inner conflict as a source of mental health problems can be addressed in a meaningful way with cognitive dissonance theory. The article focussed on the inner conflicts experienced by ex-combatants in the conflict in Northern Ireland and emphasised the problems they had justifying their activities. The violent acts they had committed were inconsistent with perspectives of themselves as morally good and only through justifying those acts as having taken place as part of a war in which they were ‘right’ about what they were doing, could they reduce the resulting dissonance. The new situation of ‘peace’ brought about new perspectives. Reflection on the conflict in this new light, not surprisingly, brought about new evaluations of the use of violence. Justifications in support of violence were often weakened in the process and thus their dissonance resurfaced. The implications of this were considerable and it was suggested that depression in ex-combatants may be partly due to mental suffering rooted in cognitive dissonance (De Vries & De Paor, 2005). In general, it is hypothesised that mental health can be impacted by long term inner conflict originating from any irreversible act that is highly dissonant with the belief that one is good, competent, or consistent. Resulting emotions like remorse, intense regret, shame, or guilt are likely to be indicators of dissonance discomfort and may alert psychotherapists to these inner conflicts
Resistance to Change
In turn mental health problems may have irreversible effects on the lives of those who suffer from them and this may interfere with recovery. For instance if a client’s depression has led to divorce and a family breakup this may not only exacerbate the depression, but also create a situation in which the inner conflict around being responsible for the marital breakup is at stake. Dissonance theory would predict that such a client may have difficulty ‘giving up’ the depression, because in doing so would lose an important justification to reduce the blame for the breakup. Paradoxically, the way towards recovery may lead to new dissonance for which a return to being depressed would be a solution. The dissonance generated by a thought like ‘if I could have recovered earlier I could have saved my marriage, or my career, etc.’ may be such that it is in fact preferable to live with a modicum of depression to keep supporting the justification for such losses.
Dissonance theory also provides an important rationale for why simple suggestions are unlikely to work in the situation described above. For instance, if one were to suggest to this client that physical exercise is a good way of regulating mood and the client finds out that it works, he may be confronted with the disconcerting thought that if it is that simple, could he not have thought of that himself, recovered earlier and saved his marriage? In line with Aronson’s (1992) perspective on dissonance this is likely to generate considerable dissonance: the client will feel very stupid! To avoid this, it is not unthinkable that the client my resist or sabotage the effects, for instance by not really trying or by exercising too hard and acquiring an injury that prevents further efforts. The logical conclusion is that to facilitate change in such cases, it may be important to ensure that interventions are presented in ways that convince them that it is not something they could have easily come up with themselves. It would seem that in such cases recovery needs to come with clear signs that it could not have happened earlier.
We may have stumbled here on an alternative rationale for why unusual therapies such as eye movement desensitisation and reprocessing (EMDR), hypnosis, or magnetic therapy (Bretelau, 2008) may work. Even if there were no active element in the intervention it could provide the client with an excuse to allow change that they might otherwise have been resistant to. This perspective is inspired by Totman (1979) who used an analogous line of reasoning in arguing that dissonance theory can be used to explain the placebo effect in medical interventions.
After the early stages of a developing mental health issue a process takes place in the person whereby problematic behaviours, emotions, and cognitions generally become aligned. This can essentially be perceived as a process of dissonance reduction. Becoming depressed, affected by anxiety, or another problem initially clashes with the perception of the self as competent. However as the problems persist it is likely that the evidence for the originally competent self no longer holds. This means to accept a self that is no longer competent. Reduction in self-esteem will go hand in hand with this. Receiving a psychiatric diagnosis often serves as a defining moment in reaching this new status quo. Cognitive Behaviour therapy aims to challenge and change the thoughts, emotions, and behaviours that maintain this state. In particular initiating behaviours in the client that are inconsistent with the mental health problems, may provide powerful evidence against this state and thus motivate change. For example, doing something fun challenges a depressed state and doing something brave is inconsistent with anxiety. Corsini (1979) claimed that by making bets with his anxious clients, he was able to cajole them into doing something fear provoking and consequently find out that their fear would extinguish. In cognitive dissonance terms his aim can be described as generating dissonance with the prevailing state of anxiety and unless his clients found alternative explanations or justifications for their bravery, their proneness to anxiety could decrease to reduce the inconsistency between the anxiety and the brave behaviour.
Cooper (2007) sums up the empirical research on the conditions that need to be met for inconsistent behaviour to produce dissonance. Three of them have consequences for behaviour therapy: (a) the decision to exhibit the behaviour has to be made in freedom; (b) the person has to be committed to the behaviour; and (c) the consequences need to be foreseeable (p. 73). If we apply these principles for example to the use of exposure therapy for social phobia, it would be predicted that to attend a party would only be dissonant with the phobia if the decision to do so was made without explicit pressure from the therapist (Was the bet perceived as pressure or not?), the person was committed to make the best of attending the party, and the effects of attending would be foreseeable i.e. an eventual reduction in social anxiety. Corsini’s and any other behaviour therapist’s success may be contingent upon meeting these conditions. It is beyond the scope of this article, but it would be an interesting exercise to evaluate other therapeutic interventions along these lines.
Cognitive dissonance as a heuristic in psychotherapy
This short article does not pretend to provide a comprehensive statement on the use of dissonance theory within psychotherapy. The intention has been to relate the concept to existing perspectives like humanistic-, cognitive-, and behaviour therapy, and provide some ideas for its application to the understanding of inner conflict, change, and resistance to change. I have attempted to demonstrate that dissonance theory operates at a fundamental level of mental processing that can be incorporated in models of psychotherapy. It is more than just introducing alternative terminology. Cognitive dissonance theory has a sound theoretical basis, well defined properties, and its predictions are supported by rigorous research (Cooper, 2007). This is more than can be said about a variety of models developed exclusively within psychotherapy. The clarity of the theory also suggests the possibility of using it as a means to communicate with clients and provide a heuristic for understanding their own cognitive functioning. It is hoped that this article has presented some food for thought and will be instrumental in the further transmission of the ‘cognitive dissonance meme’.
Jan M.A de Vries is psychology lecturer and subject leader in the School of Nursing and Midwifery in Trinity College Dublin. He has lectured in psychology in Europe and the USA and published widely. He also set up and coordinated a programme for victims and ex-combatants involved in the troubles in Northern Ireland at the Glencree Centre for Reconciliation in Co. Wicklow. He leads a research programme on Cognitive Dissonance in TCD.
Alford, B. A. and Beck, A. T. (1997) The Integrative Power of Cognitive Therapy. New York and London: Guildford Press.
Aronson, E. (1968) ‘Dissonance theory: progress and problems,’ in R.P. Abelson, E. Aronson, W. J. McGuire, T. M. Newcomb, M. J. Rosenberg and P. H. Tannenbaum (eds), Theories of Cognitive Consistency: A Sourcebook. Chicago, IL: Rand McNally.
Aronson, E. (1992) ‘The Return of the Repressed: Dissonance Theory Makes a Comeback.’ Psychological Enquiry, 3, 4, 303-311.
Beck, A. T. (2008) ‘The Evolution of the Cognitive Model of Depression and Its Neurobiological Correlates.’ American Journal of Psychiatry, 165, 969-977.
Bretelau, L. (2008) ‘Repetitive Transcranial Magnetic Stimulation (rTMS) in Combination with Escitalopram in Patients with Treatment-Resistant Major Depression. A Double-Blind, Randomised, Sham-Controlled Trial.’ Pharmacopsychiatry, 41, 2, 41-47.
Chow, P. (2001) ‘The Psychometric Properties of the Cognitive Dissonance Test.’ Education, 122, 1, 45-49.
Cooper, J. (2007) Cognitive Dissonance: Fifty Years of a Classic Theory. London: Sage.
Cooper, J., Zanna, M. P. and Taves, P. (1978) ‘Arousal as a necessary condition for attitude change following induced compliance.’ Journal of Experimental Social Psychology, 36, 1101-1106.
Corsini, R. J. (1979) ‘The betting technique.’ Individual Psychology, 16, 5-11.
Dawkins, R. (1989) The Selfish Gene (new edition). New York: Oxford University Press.
De Vries, J. M. A. and De Paor, J. (2005) ‘Healing and Reconciliation in the L.I.V.E. Program in Ireland.’ Peace and Change: A Journal of Peace Research, 30, 3, 329-358.
De Vries, J. M. A. (2007) ‘Cognitive Dissonance in Victims of Political Violence.’ Inside Out; The Journal for the Irish Association of Humanistic and Integrative Psychotherapy, 52, 65-70.
Ellis, A. (1977) Reason and emotion in psychotherapy: The rational-emotive approach. New York: Julian Press.
Ellis, A. (1999) ‘Why Rational-Emotive Therapy to Rational Emotive Behavior Therapy?’ Psychotherapy, 36, 2, 154-159.
Ewen, R. B. (2003) An Introduction to Theories of Personality (6th Ed). Mahwah, NJ: Lawrence Erlbaum and Associates.
Festinger, L. (1957) A theory of cognitive dissonance. Palo Alto, CA: Stanford University Press.
Festinger, L. and Carlsmith, J. M. (1959) ‘Cognitive Consequences of forced compliance.’ Journal of Abnormal and Social Psychology, 58, 203-210.
Freud, S. (1924) A general introduction to psychoanalysis. New York: Boni & Liveright.
Freud, S. (1946) Collected papers, Vol. III. London: Hogarth Press.
Krysanski, V. L. (2006) ‘Investigation of a cognitive dissonance intervention versus a psychoeducational placebo control: Testing the effectiveness of prevention programming for eating disorders.’ Dissertation Abstracts International: Section B: The Sciences and Engineering, 67, 6B, 3456.
Levinson, A. H., Campo, S., Gascoigne, J., Jolly, O., Zakharyan, A. and Tran, Z. V. (2007) ‘Smoking, but not smokers: Identity among students who smoke cigarettes.’ Nicotine and Tobacco Research, 9, 8, 845-852.
Mitchell, K. S., Mazzeo, S. E., Rausch, S. M. and Cooke, K. L. (2007). ‘Innovative Interventions for Disordered Eating: Evaluation Dissonance-Based and Yoga Interventions.’ International Journal of Eating Disorders, 40, 2, 120-128.
Rogers, C. R. (1961) On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin.
Shaw, H. and Stice, E. (2007) ‘A dissonance-based intervention for the prevention of eating disorders and obesity’ in C.W. Le Croy and J. E. Mann (eds) Handbook of prevention and intervention programs for adolescent girls. Hoboken, NJ: John Wiley and Sons.
Stice, E., Marti, N., Shaw, H., and O’Neill, K. (2008) ‘General and Program-Specific Moderators of Two Eating Disorder Prevention Programs.’ International Journal of Eating Disorders, 41, 7, 611-617.
Taylor M. F., Bentley, K. J. (2005) ‘Professional Dissonance: Colliding Values and Job Tasks in Mental Health Practice.’ Community Mental Health Journal, 41, 4, 469-480.
Totman, R. G. (1976) ‘Cognitive Dissonance and the Placebo Response.’ European Journal of Social Psychology, 5, 119-125.
Tryon, W. W. and Misurell, J. R. (2008) ‘Dissonance induction and reduction: A possible principle and connectionist mechanism for why therapies are effective.’ Clinical Psychology Review, 28, 8, 1297-1309.