This chapter identifies the neurological correlates of the logic-based theory of cognitive-behavior therapy advanced in this book. Against the commonly assumed hypothesis that negative emotions such as anxiety and depression are generated by “bottom-up” (amygdala) control over the executive brain (prefrontal cortex), it provides evidence that the opposite is often the case. More specifically, it advances the hypothesis that, in such cases, a chain of evaluative syllogisms encoded by the ventromedial prefrontal cortex (VMPFC) tracks negative emotions. In turn, the chapter provides further evidence that these negative emotion syllogism chains involve a flow of associated images and interoceptive feelings (internal bodily feelings) generated by the VMPFC and other somatosensory structures such as insula, cingulate cortex, and somatosensory cortices.
The chapter shows how speech acts such as demanding perfection, catastrophizing, damnation, and capacity disavowals key such interoceptive feelings and images to evaluative language (for example, “horrible person”) that conceptualizes the feeling (for instance, makes it self-referential). It also shows how motivational feelings of felt need, which modulate perfectionistic demands, often conflict with reality reports, generating a threatening feeling of confusion (“I must be perfect but I’m not”), which, in turn, drives catastrophizing, damnation, and capacity disavowals. The chapter further shows how certain regions of the prefrontal cortex such as the dorsolateral prefrontal cortex can provide counteractive balances to offset negative emotions.