We have all observed the rapid transformation of an individual from sitting in a corner with a towel over the head and uncommunicative, to an animated, joyful state, when participating in a stimulating activity, such as a birthday party or a talent show. In the card-sorting experiment, the individuals move through a series of intermediate steps of card-sorting, culminating when the individuals reach their goals. Prior to the experiment, the individuals scored at least one standard deviation below normal on neurocognitive tests. At baseline, they showed negative self-concept, dysfunctional attitudes, and dysphoria. After reaching the goal, the individuals improve significantly in self-concept, defeatist attitudes, and mood. In addition, on a subsequent card-sorting task, the individuals showed a significant improvement over the baseline performance. It should be noted that in the experiment, the individuals were not only guided to success, but received a good deal of support, plus reinforcement from the experimenter. The control group, incidentally, which did not have guided success or the experimenter’s support, did not show improvement on any of these tests.
The experiment demonstrated, of course, what we have all observed clinically: successful experience accompanied by the positive collaboration, with a coach, changed the self-concept from negative to positive, reduced the defeatist attitudes, and improved the mood. These intrinsic changes represent the key to clinical improvement (it is also shown in the clinical trial). It should also be noted that the significant improvement, over baseline, on the final card-sorting task, indicates the positive responsivity of the neurocognitive test to positive experiences.
Formulation: As the cognitive organization shifts from the regressive level/mode to the adaptive mode, there is a similar shift in the content of the appraisals. In the regressive mode, there is a damping down of the view of the self, the outside world, and the future. Specifically, the individuals see themselves as inferior, inadequate and unlovable and the outside world as inimical. Unlike depressives, however, the view of the future is not hopeless; the individuals have a more or less complacent or apathetic view of the future. Since they have given up their psychosocial or other goals, they do not expect to be disappointed and they do not think in terms of an unpleasant future.
An aspect of the adaptive mode is particularly gratifying: when in this mode, the individuals are rational: They can carry on various activities that demand reason and logic: participate in a conversation, playing chess, shop for the cooking or nature clubs. A humanistic/idealistic way of looking at this is, the delusions, hallucinations, erratic behaviors, occasional irrational thinking, representing the regressive mode, conceal the normal personality; when the adaptive mode is activated, the individuals’ beliefs, emotions, and behaviors are normal. As I have pointed out previously, our job is to develop strategies to activate the individuals’ goals and values, to enable them to stay in the adaptive mode.