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Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings

Ariel s. winn.

1 Assistant Professor of Pediatrics, Harvard Medical School

2 Associate Program Director for the Boston Combined Residency Program, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital

Lisa DelSignore

3 Assistant Professor in Pediatrics, Tufts University School of Medicine

4 Assistant Professor, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center

Carolyn Marcus

5 Instructor in Pediatrics, Harvard Medical School

Laura Chiel

6 Chief Resident, Boston Combined Residency Program, Boston Medical Center

Eli Freiman

7 Chief Resident, Boston Combined Residency Program, Boston Children's Hospital

Diane Stafford

8 Clinical Professor of Pediatrics, Stanford University School of Medicine

9 Associate Program Director, Pediatric Endocrinology Fellowship, Lucile Packard Children's Hospital Stanford

Lori Newman

10 Director of Professional Development, Department of Medical Education, Boston Children's Hospital

Associated Data

B. Introduction Slides.pptx

C. Spaced Retrieval Practice Facilitator Guide.docx

D. Interleaving Facilitator Guide and Handout.docx

E. Elaboration Facilitator Guide and Handout.docx

F. Generation Facilitator Guide and Handout.docx

G. Reflection Facilitator Guide and Handout.docx

H. Commitment-to-Change Initial Form.docx

I. Commitment-to-Change Follow-up Form.docx

All appendices are peer reviewed as integral parts of the Original Publication.

Introduction

Cognitive learning strategies are strategies that improve a learner's ability to process information more deeply, transfer and apply information to new situations, and result in enhanced and better-retained learning.

We developed an interactive workshop for a national conference of pediatric educators to teach five cognitive learning strategies. The specific strategies were (1) spaced retrieval practice, (2) interleaving, (3) elaboration, (4) generation, and (5) reflection. Each strategy was taught using an active learning exercise. We evaluated the effectiveness of the workshop through a commitment-to-change exercise in which we asked participants to commit to making a change in their teaching as it related to the workshop and then queried them 6 weeks later about their implementation successes and barriers.

Of the 161 participants registered for the workshop, 52 completed the voluntary workshop evaluation. All 52 participants committed to making a change in their teaching as a result of the workshop. Of those 52 participants, 24 completed the 6-week follow-up survey. Eighty-two percent of those respondents ( n = 18) reported implementing a change based on the workshop, with 77% of respondents implementing a change that they had committed to directly after the workshop and 55% implementing a change that they had not originally committed to at the end of the workshop.

This workshop successfully led to behavioral change in the teaching of cognitive learning strategies. We anticipate that this will lead to improved learning among the trainees whom participants teach.

Educational Objectives

By the end of this interactive workshop, learners will be able to:

• 1. Identify and describe five cognitive learning strategies.
• 2. Identify clinical teaching opportunities to apply cognitive learning strategies.
• 3. Implement different cognitive learning strategies in various clinical teaching settings.

Medical researchers project that the collective body of medical information will double every 73 days by 2020. 1 It is incumbent on medical schools and clinical training programs to help students and trainees learn to absorb, organize, store, and retrieve this vast amount of information. Historically, students and trainees have been taught using passive learning strategies, such as rereading, highlighting, and cramming, along with attending lectures, conferences, or grand rounds as inactive participants. These passive learning strategies can be effective for short-term information recall, leading to the illusion of knowledge mastery, but are rarely effective in producing sustained learning. 2 – 7

In contrast, there is emerging literature, popularized by the book Make It Stick: The Science of Successful Learning , 4 indicating that applying cognitive learning strategies in active learning environments can help achieve more productive and sustained learning. 4 – 9 Cognitive learning strategies are strategies that improve a learner's ability to process information more deeply, transfer and apply information to new situations, and result in enhanced and better-retained learning. 6 , 10 – 11 These learning strategies engage learners in activities in which they are responsible for performing tasks while thinking about what they are learning and why they have reached particular solutions. 4 – 9 , 12 – 14 There is solid evidence that routine integration of these strategies coupled with daily active learning practice results in higher-order and sustained learning outcomes. 15 – 18

Although some medical educators have started to adopt active learning practices in the classroom setting, including the integration of problem-based learning, team-based learning, and flipped classroom models, 12 , 19 – 22 many faculty have not received instruction on cognitive learning strategies. 12 As more students enter medical school with exposure to cognitive learning strategies from their undergraduate college experiences, they will expect to engage in active learning using these strategies. Moreover, learners have increasingly begun to accept that delayed gratification and desirable difficulty lead to sustained retention of newly acquired knowledge and skills. 4 , 23 – 25 Health professional students should therefore expect their faculty to be well trained in cognitive learning strategies.

In this workshop, participants learn the theory behind five specific evidence-based cognitive learning strategies. We identified these five strategies, after an extensive search of the literature, as valuable, practical, and easy to adopt within one's own teaching practice while greatly improving learning and retention of information. The five cognitive learning strategies addressed in this workshop include spaced retrieval practice, interleaving, elaboration, generation, and reflection 2 , 4 , 6 , 8 , 9 , 12 (see Appendix A for definitions). Participants apply these cognitive learning strategies using concrete examples (both clinical and nonclinical) and engage in active group discussion and authentic practice. To encourage behavior change, participants then determine how to integrate these cognitive learning strategies into their current clinical teaching settings. This workshop provides a platform for health care professional educators to gain an understanding of five evidence-based cognitive learning strategies, apply these strategies, and then determine ways to incorporate cognitive learning into their teaching to promote knowledge gain, retention, and learner satisfaction. This workshop contributes to and enhances the existing literature on cognitive learning strategies, as it allows participants to practice each strategy and then determine practical ways they can incorporate the strategies when teaching in their own medical field or clinical discipline. Other workshops have focused primarily on questions, small-group discussions, or role-play as a way of teaching other active learning strategies based in cognitive learning theory. 26 – 30 We know of no other source that provides this comprehensive educational experience.

Session Description and Implementation

We planned and presented this 90-minute workshop for the 2018 annual national meeting of the Association of Pediatric Program Directors (APPD). This workshop was adapted from a similar half-day retreat that we originally constructed for the Boston Children's Hospital Academy for Teaching and Educational Innovation and Scholarship, an interprofessional academy inclusive of self-identified clinician-educators (trainees, faculty, and health care professional staff) from all pediatric departments at Boston Children's Hospital.

A total of 161 participants registered for the APPD workshop. Registration information collected by the APPD organization showed that participants included pediatric residents, chief residents, and fellows, as well as junior and senior attending faculty members. No specific prerequisite knowledge of active learning or cognitive learning strategies was required. Our workshop was facilitated according to the outline and time line in the Table .

Facilitators of our session included attending physician educators, nonphysician medical educators, and chief residents (although we recognize that residents, fellows, or other health care professionals could also facilitate this session). All facilitators were well versed with the book Make It Stick: The Science of Successful Learning . 4 Prior to the session, we suggested that each facilitator learn about the cognitive learning strategy he or she was responsible for presenting, either through the relevant sections of the book or through other relevant materials of the facilitator's choosing. Although we had more than five facilitators available to present the workshop, two facilitators could reasonably present the session in its entirety.

The first 5 minutes of the workshop involved a brief introduction to the session's organization, goals, and objectives and to each of the facilitators (name, educational role, and hospital/program affiliation). One facilitator then gave a 15-minute interactive didactic presentation ( Appendix B ) that reviewed the differences between passive and active learning strategies, how active learning strategies promote learning for mastery, and how active learning strategies derive from cognitive learning theories. The presentation also included an overview of the specific cognitive learning strategies that would be practiced in small groups during the workshop.

The workshop then segued into the small-group sessions that focused on active practice of the five cognitive learning strategies over a 50-minute time frame. Participants were seated accordingly at five round tables. A limited number of chairs were assigned to each round table to encourage smaller group sizes. Groups were divided randomly, based on where participants chose to sit for the introductory portion of the workshop.

Facilitators were assigned to teach one cognitive learning strategy and rotated to each of the five tables while participants remained stationary. The facilitators were responsible for conducting a 10-minute session at each table based on their assigned strategy. Each 10-minute session was structured as follows:

• • The facilitator briefly reviewed the strategy and presented what was known about it based on educational and cognitive psychology literature (2 minutes).
• • The group engaged in an interactive activity to practice using the strategy and experience how it enhanced learning (5 minutes).
• • The group brainstormed suggestions on how the strategy could be applied to teaching in their clinical practice settings (3 minutes).

Each of the cognitive learning strategy activities the facilitators modeled is included in Appendices C - G . Participants were also given a cognitive learning strategy worksheet on which to take notes during the small-group sessions (first page of Appendix A ). Please note that for programs in which only two facilitators are available, we suggest dividing the room in half, having one facilitator present two strategies and the other facilitator present three strategies, then switching. We have found that learning from multiple presenters enlivens the activities and discussions and reduces cognitive load.

After the small-group activity concluded, all participants reconvened as a large group to reflect on the session and pose questions to the facilitators for 15 minutes. Five of the seven facilitators made up the panel, whereas the additional two facilitators walked around the audience with microphones and stimulated discussion among the large group. Participants were encouraged to share experiences, questions, and challenges related to applying these cognitive learning strategies in actual clinical teaching settings. (For programs with two facilitators, we suggest one large-group discussion.) The last 5 minutes of the workshop were reserved for a short wrap-up session during which participants were encouraged to complete the commitment-to-change assessment form ( Appendix H ). They were informed that they would receive an email follow-up from the facilitators in 6 weeks to inquire if they had implemented any changes to their teaching practices based on what was learned during the workshop.

Evaluation Strategy

Our evaluation strategy was based on the commitment-to-change framework 31 first introduced in 1982 by Purkis. 32 The framework measures behavioral change by asking attendants of an educational session to commit to a behavioral change. The framework then keeps track of the attendants to understand their success in the implementation of the behavioral change and identifies any barriers to successful implementation. At the end of our workshop, we asked participants to voluntarily complete our commitment-to-change assessment tool ( Appendix H ). Six weeks after the workshop, we emailed the participants who completed the assessment tool. In the email, we included a scanned copy of their initial commitment-to-change form and asked them to complete an online assessment about their implementation successes and barriers ( Appendix I ). We sent reminders at 1- and 2-week intervals.

Of the 161 people registered for our workshop, 24 (14.9%) identified as residency program directors, 13 (8.1%) identified as fellowship program directors, 48 (29.8%) identified as associate residency program directors, five (3.1%) identified as associate fellowship program directors, 41 (25.5%) identified as chief or former chief residents, 10 (6.2%) identified as residents, three (1.9%) identified as hospitalists, five (3.1%) identified as coordinators, and 12 (7.4%) identified as other. We were unable to collect further data on the participants who attended the workshop and suspect that a small portion of those who registered did not attend and that a small percentage of attendants did not preregister.

Of those who attended the workshop, 52 completed our voluntary commitment-to-change form ( Appendix H ) at the end of the workshop. One hundred percent of respondents reported they were planning to make a change in their teaching as a result of participating in the workshop. Two of the authors (Laura Chiel and Eli Freiman) reviewed the responses to question 2 separately and categorized the responses into the five cognitive learning strategies—spaced retrieval practice, interleaving, elaboration, generation, and reflection—and other (if unrelated or unclear relationship to a specific learning strategy). The two authors agreed on 96% of the forms. For the two forms without agreement, a third author (Lisa DelSignore) offered her categorization and prompted discussion, allowing them to reach 100% consensus. Eight respondents listed changes that corresponded to more than one cognitive learning strategy. The categorizations of these responses are listed in Figure 1 . The most frequent cognitive learning strategies cited were interleaving and reflection.

Percentage of respondents committing to each of the five cognitive learning strategies at the end of the workshop. Other refers to committed-to changes unrelated to the five cognitive learning strategies.

Forty-eight of 52 respondents wrote their email addresses on the initial form ( Appendix H ) and were therefore able to participate in the follow-up survey. Twenty-two of these 48 participants completed the follow-up survey ( Appendix I ), corresponding to a 46% response rate. Eighty-two percent of respondents ( n = 18) reported implementing a change based on the workshop. Seventy-seven percent of respondents ( n = 17) reported implementing one of the changes they had committed to at the end of the workshop. Fifty-five percent of respondents ( n = 12) implemented a change related to the workshop that they had not committed to at the end of the workshop. Fourteen percent of respondents ( n = 3) said that they had not yet implemented a change. Two of the authors (Laura Chiel and Eli Freiman) again reviewed the responses to question 3 separately and categorized the responses into the five cognitive learning strategies—spaced retrieval practice, interleaving, elaboration, generation, and reflection—and other. The two authors agreed on 100% of the forms. Six respondents listed changes that corresponded to more than one cognitive learning strategy. The categorizations of these responses are shown in Figure 2 . Three respondents did not implement any change based on the workshop. When asked about barriers to implementing change, two responded that they were not currently involved in any teaching, and one stated an intention to implement the change.

Percentage of respondents committing to each of the five cognitive learning strategies at the end of the workshop compared to percentage of respondents who implemented each of the five cognitive learning strategies at their home institutions. Other refers to committed-to changes unrelated to the five cognitive learning strategies.

We designed a faculty development workshop to teach pediatric educators five principles of cognitive learning strategies and found that participants were able to incorporate these learning strategies into their teaching as a result of the workshop. Our evaluation strategy was based on Purkis’ commitment-to-change framework. 32 The evaluation aligned with the third level of Kirkpatrick's evaluation model—learner behavior—in that the evaluation took place posttraining, when participants had returned to their own institutions, and determined the extent to which participants implemented or transferred what they learned during the training session. 33 Using the commitment-to-change evaluation strategy provided solid evidence that participants gained knowledge and skills from the workshop and applied that learning to their own training programs. Those who did not implement a change reported that they either were not involved in teaching or still planned on implementing the change, without foreseeable barriers.

At the end of the workshop, participants were more committed to using interleaving and reflection than the other strategies. Interestingly, back at their home institutions, participants put all five strategies to use, suggesting that generation, elaboration, and reflection were easier to implement than participants had initially thought. In addition, more than half of the respondents reported implementing a change that they had not committed to during the workshop.

We have been able to reflect on the design and implementation of the workshop. Each activity was purposefully focused on a nonmedical topic, drawn from everyday life, allowing for presentation of the workshop across clinical disciplines and professions. Using nonmedical topics also ensured that medical information did not distract from the workshop. However, during each exercise, we brainstormed with the group how the strategy could be applied to clinical teaching. This sparked rich conversations as participants generated examples that related to their clinical settings. Participants also shared concerns about anticipated challenges and solutions to using the strategies. On further reflection, we realized that brainstorming implementation strategies could benefit from more time in future sessions. We also noted that all facilitators for the academy retreat and APPD workshop were physicians or involved in medical education. Given that these five cognitive learning strategies can be generalized to all health care professionals, it may be appropriate to have an interprofessional panel of facilitators, especially for audiences drawing from multiple professions. Inviting facilitators from varied health care professions routinely leads to the discovery of common teaching challenges and sharing of optimal solutions.

We believe that it is ideal to have five facilitators available to lead the workshop to allow one facilitator to teach each of the five cognitive learning strategies. We found that the variety of having five people rotate to each of the small groups increased the participants’ interest and eagerness to learn all of the strategies. This configuration may present challenges for those trying to replicate the workshop, as not all educational programs may have this number of available facilitators. One solution to increase the number of presenters is to include residents or fellows as facilitators, as the strategies apply to all levels of learners, regardless of rank or seniority.

The evaluation strategy we used has limitations. Only a small portion of participants participated in the commitment-to-change activity. It is possible that those who participated were more likely to incorporate change into their teaching practices than those who did not participate. Furthermore, the outcomes were self-reported, and it is possible that participants over- or underestimated their incorporation of new teaching skills.

It is our hope that educators who gain an understanding of and experience with cognitive learning strategies through our structured workshop approach will implement these strategies when they teach their learners and when they train other educators. In this way, we hope to provide tools to confront the challenge of learning and retaining vast amounts of information so that it can be recalled quickly and applied appropriately in the delivery of optimal patient care.

A. Handouts.docx

Acknowledgments

Drs. Winn and DelSignore are co-primary authors of this publication.

Disclosures

None to report.

Funding/Support

Prior presentations.

DelSignore L, Winn A, Marcus C, et al. Applying cognitive learning theories to “make learning stick” in the clinical teaching setting. Presented at: Association of Pediatric Program Directors (APPD) Spring Meeting; March 21, 2018; Atlanta, GA.

Ethical Approval

Reported as not applicable.

Decision Making: a Theoretical Review

• Regular Article
• Published: 15 November 2021
• Volume 56 , pages 609–629, ( 2022 )

Cite this article

• Matteo Morelli 1 ,
• Maria Casagrande   ORCID: orcid.org/0000-0002-4430-3367 2 &
• Giuseppe Forte 1 , 3  

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Decision-making is a crucial skill that has a central role in everyday life and is necessary for adaptation to the environment and autonomy. It is the ability to choose between two or more options, and it has been studied through several theoretical approaches and by different disciplines. In this overview article, we contend a theoretical review regarding most theorizing and research on decision-making. Specifically, we focused on different levels of analyses, including different theoretical approaches and neuropsychological aspects. Moreover, common methodological measures adopted to study decision-making were reported. This theoretical review emphasizes multiple levels of analysis and aims to summarize evidence regarding this fundamental human process. Although several aspects of the field are reported, more features of decision-making process remain uncertain and need to be clarified. Further experimental studies are necessary for understanding this process better and for integrating and refining the existing theories.

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OPINION article

Psychological construction as a theoretical principle for guiding cognitive-behavioral treatments.

• Department of Psychology, University of Oradea, Oradea, Romania

Cognitive behavior therapies (CBT) are considered the benchmark for evidence-based psychological treatments for psychological disorders ( David et al., 2018 ). CBT treatments work and are well-known because they constantly update with new scientific research encompassing the theory, models, and their real-life applications ( Ingram et al., 2019 ). The integration of psychopathology research into the development of CBT models and practices is the current standard for enhancing their scientific plausibility ( Hayes and Hofmann, 2018 ). Although CBT is characterized by a strong integration of science, it considers emotion and cognition as essential entities that exist as natural kinds and that we can identify, assess, and change in order to improve people's lives. In other words, it is based on an essentialist assumption regarding conscious psychological states. Recent research suggests a different perspective, claiming that psychological categories are not “essential” phenomena, but observer-dependent constructed entities ( Barrett, 2009 ; Gündem et al., 2022 ).

In this article, I argue that (1) psychological essentialism is one core assumption in CBT theories and models; (2) psychological essentialism has been recently challenged by a “psychological construction approach” of psychological states ( Barrett, 2009 ); and (3) a “psychological construction approach” brings significant changes to the practice of CBT.

Psychological essentialism and the “essence” of psychological states in CBT

Essentialism suggests that categories we encounter, such as dogs, trees, or birds, have an underlying essence or existence that causally determines what they are ( Brick et al., 2022 ; Neufeld, 2022 ). Psychological essentialism is the hypothesis that psychological categories (emotions, cognitions, and behaviors) are natural kinds rather than social constructions ( Barrett, 2009 ; Brick et al., 2022 ). They have an essence that determines their characteristics and what they are ( Brick et al., 2022 ; Neufeld, 2022 ). They are distinct (emotion is separate from cognition) and homogenous (types of emotion share more attributes between them than with types of cognition) categories with sharp boundaries ( Neufeld, 2022 ). For instance, feeling sad is a conscious psychological state that is caused by having an emotion. Emotions such as sadness exist as natural kinds. When we feel sad, we experience the reality of the emotion of sadness. Feeling sad is an attribute of sadness. Low arousal, body feelings, avoidant action tendencies, and sad thoughts are accompanying features of sadness, determined by its essence, which is emotion. It is distinct from cognition and behavior. It has distinct brain bases and causal relationships. Thus, we try to recognize, discover, and study emotions.

There are two major arguments that suggest CBT is founded on a psychological essentialist assumption. The first major argument for the psychological essentialism of CBT is the fact that CBT considers perception, cognition, emotion, and behavior as distinct entities that are discovered based on assessments of their manifestations. Based on the assessment of their attributes, the therapists identify and discover which cognitions, behaviors, and emotions are involved in patients' problems ( Westbrook et al., 2007 ). Both therapists and patients should not confuse emotion, behavior, and cognition. Emotion, behavior, and cognition have distinct attributes that reflect their essence ( Neufeld, 2022 ). When patients “mistakenly” say, “I feel like a failure,” the therapists have to correct patients to recognize it is a thought, not an emotion, and to help them realize they are confounding feelings with cognitions. Thus, CBT bears heavily on “faculty” psychology and the essentialist assumption that emotion, cognition, and behavior are distinct, homogenous entities with clear boundaries that exists as natural kinds and can be discovered ( Neufeld, 2022 ). The second major argument for the psychological essentialism of CBT is the ABC model of cognitive causation in CBT. The ABC model asserts that emotions (C) are not caused by A (negative events), but by beliefs or cognition (B) ( Westbrook et al., 2007 ). One entity, cognition, causes another entity, emotion, or behavior. Thus, the ABC model relies on the essentialist assumption that these entities are natural kinds that interact based on mechanistic causation ( Barrett, 2009 ). A natural kind (“cognition”) causes another natural kind (“emotion”) ( Barrett, 2009 ). All these descriptions of the CBT principles suggest a strong essentialist foundation for CBT.

The psychological construction approach

Recently, increasing research from affective neuroscience supports the idea that psychological states we know (emotion, cognition, and behavior) are not natural kinds, but conceptual constructions reflecting how we explain what the internal and external sensations stand for given prior experience (see Gündem et al., 2022 for reviews of the evidence). Perception is the mental states humans have when they understand what the external sensations stand for based on prior experience ( Barrett, 2009 ). Cognition refers to the mental state during the process of replaying past experiences in the brain ( Barrett, 2009 ). Emotion refers to mental states when individuals comprehend the meaning of internal bodily experiences ( Barrett, 2009 ). In short, mental states are ad-hoc conceptualizations of internal and/or external sensations based on simulations of what those sensations stand for given prior experience ( Barrett, 2009 ). Although there are many differences brought in by the psychological construction approach regarding mental states ( Barrett, 2009 ), here I describe two of them in relation to psychological treatments: the constructed and “recipe-like” nature of mental states and the probabilistic causation. First, psychological essentialism considers conscious mental states as natural kinds (entities with distinct brain bases, features, and mechanisms that control them) ( Barrett, 2009 ). The psychological construction approach negates this view and considers psychological states to be composite “recipe-like” constructions made up of basic ingredients such as concepts, core affect, behavioral repertoire, prior experience, and internal and external sensations ( Barrett, 2009 ). Therefore, the conceptualization and the type of ingredients recruited for its composition determine how a psychological state will change. When we change depressed feelings, distorted emotional concepts and unhelpful ingredients will be of interest. Second, psychological essentialism advances mechanistic psychological causation ( Barrett, 2009 ). A causes B. If we activate or develop an entity A, then we will change another entity B. Instead, the psychological construction approach advanced a probabilistic, not mechanistic causality relationship ( Barrett, 2009 ). The occurrence of cognition does not directly cause emotion. Rather, the presence of a specific cognition increases the likelihood of a constructed state of cognition transitioning into a specific constructed state of emotion ( Barrett, 2009 ). Believing that failing at an exam is awful (B) does not directly cause a feeling of anxiety but increases the probability that the psychological state we have will transform into a state of anxiety (C) rather than just fear.

Previous proposals focused on the clinical implications of a psychological construction approach based on brain-based mechanisms such as dysfunctions of energy regulation in mental disorders ( Shaffer et al., 2022 ). Here, I outlined several consequences of applying the psychological construction approach as a principle for changing mental states through the talking methods of CBT.

Implications for CBT formulation

Formulation is the process by which we describe the psychological mechanisms that underlie psychological issues and the ways through which we modify them ( David et al., 2018 ). From the psychological construction approach, understanding the patients' emotional problems will require understanding why the patients construct the psychological state they have into dysfunctional feelings of depression and not into functional feelings of sadness. During this process, the therapists will try to find which are the emotional concepts of the individual and which are the ingredients, or “psychological primitives,” of their depressed feelings (i.e., conceptual granularity, prior experience, core affect, behavioral repertories). Then, they will try to find the prior states that increased the probability of having depressed feelings (i.e., beliefs) and the mechanisms that control the frequent construction of their state as depressed feelings (i.e., context, attention). As the therapists explain the relationship between B and C, they will follow a probabilistic causation approach. For instance, instead of teaching the client that his beliefs that the exam is awful cause his feelings of anxiety, based on a psychological construction approach, the therapist will say, “You understand that as long as you believe that failing the exam is awful, you will probably feel anxiety and not concern.”

Implications for CBT practice

Although traditional CBT treats cognition, behavior, and emotion as distinct entities, at a closer look at the practice of CBT, we may find several precursors of the psychological construction approach. For instance, in the mainstream practice, therapists who follow a behavioral tradition often conceptualize cognition as a behavior and instead of cognitive interventions, to change cognition, they use behavioral interventions. Consequently, rather than employing cognitive restructuring, the therapists alter cognition by changing the environmental cues that initiate cognition (e.g., refraining from remaining in bed if that is the place where negative thinking occurs more frequently), and substituting it with an alternative cognition (e.g., rather than believing “I am useless,” the patients may be asked to recall instances of successful performance, what to change and that one failure does not define us) that has comparable consequences (e.g., motivating and giving importance to the problems).

Treating cognition as a behavior resembles the psychological construction approach.

However, the mainstream approach views cognition as behavior or belief, influenced by different theories on how cognition is understood (cognitivist vs. behaviorism), rather than being the same psychological state differently constructed by the individual as cognition or behavior. The psychological construction approach suggests that the same psychological state may be cognition, behavior, or emotion, depending on how it is constructed by the individual and on its “ingredients.” Thus, changing a cognition as a behavior is not something that follows the theoretical orientation of the therapist, but something that follows how the individual constructs that psychological state. From the psychological construction approach, when patients say I keep thinking “I am useless,” they are referring to a behavior. Probably, this psychological state is predominantly under the control of what is known as behavioral mechanisms (e.g., reinforcement). The client's statement, “I believe I am useless,” might indicate a different construction that the patients have engaged in, that of belief. Then, the intervention will focus on the analysis of confirmatory and dis-confirmatory information to change beliefs. Nonetheless, the individuals may construct the psychological state as something they feel—“I feel I am useless.” In this case, changing the psychological state as a feeling by validating, expressing, and processing the feeling may be more appropriate. As individuals may construct their mental state as different psychological states, depending on the type of construction (emotion, cognition, behavior), we may find some control mechanisms to be more often involved than others. Although early applications of multiple change strategies for the same mental state indicates possible benefits, scientific research may clarify which strategy or combination of strategies and in which condition would be more efficient for a particular individual. Furthermore, the intervention should consider the principles related to the ingredients or “recipe-like” composition of psychological states. When we target changing a psychological state (distorted appraisals) that may transform into dysfunctional feelings, the affective ingredients become the focus of treatment ( Tiba, 2010 ; Tiba and Manea, 2018 ). For instance, the cognitive satiation procedure is one good illustration of changing the affective ingredients of negative thoughts and reducing their emotional impact. For this purpose, the therapist may introduce a semantic satiation method: “One way to reduce the affective load of the thought “I am useless” is to use semantic satiation. In this exercise, we must repeat the expression “I am useless” more than 40 times until we load the thought with a phonetic rather than affective composition.”

Summary and outlook

A psychological construction approach brings important changes to how we deliver evidence-based psychological treatments: (1) understanding emotion, cognitive states, and behavior as different constructions of conscious psychological states; (2) changing psychological states is done by changing the general and specific control mechanisms involved in the specific unfolding of those states; (3) changing the ingredients involved in psychological states is a way of changing the relation between “thoughts” and “feelings.” As these principles may be viewed as super-ordinate principles guiding the models of psychological treatments, they can be integrated into the metacognitive principles of the CBT models. Given the enrichment of CBT interventions, the psychological construction approach has the potential to bring significant advancements to CBT treatment.

Author contributions

AT: Writing—original draft, Writing—review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The funding for publication of the article was provided by the University of Oradea. This work was supported by a grant of the Ministry of Research, Innovation and Digitization, CNCS - UEFISCDI, project number PN-III-P1-1.1-TE-2021-1090, within PNCDI III.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: psychological construction, cognitive behavior therapy (CBT), essentialism, emotional disorders, constructed mind

Citation: Tiba AI (2024) Psychological construction as a theoretical principle for guiding cognitive-behavioral treatments. Front. Psychol. 15:1363819. doi: 10.3389/fpsyg.2024.1363819

Received: 31 December 2023; Accepted: 07 March 2024; Published: 19 March 2024.

Reviewed by:

Copyright © 2024 Tiba. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Alexandru I. Tiba, alexandrutiba@gmail.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Article Contents

I. cognition, knowledge, and understanding, ii. learning from literature: the evidence, iii. conclusion.

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On Studying the Cognitive Value of Literature

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JUKKA MIKKONEN, On Studying the Cognitive Value of Literature, The Journal of Aesthetics and Art Criticism , Volume 73, Issue 3, July 2015, Pages 273–282, https://doi.org/10.1111/jaac.12172

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The debate on the cognitive value of literature is undergoing a change. On the one hand, several philosophers recommend an epistemological move from “knowledge” to “understanding” in describing the cognitive benefits of literature. On the other hand, skeptics call for methodological discussion and demand evidence for the claim that readers actually learn from literature. These two ideas, the notion of understanding and the demand for evidence, seem initially inconsistent, for the notion of understanding implies that the cognitive benefits of literature are ultimately nonverbal and thus inarticulate. In this article, I defend both the move from knowledge to understanding and the demand for evidence. After proposing that the cognitive value of literature is best construed in terms of enhancing the reader's understanding, I argue that the place to look for evidence for the cognitive benefits of literature is not the laboratory but the practice of literature.

In the 1940s, Dorothy Walsh remarked that “the arts have customarily been regarded as a source of intellectual nourishment” and artworks “have been accepted as vehicles of insight, revelation, and enlarged comprehension.” 1 The “cognitivist” view that artworks, and literary works in particular, could provide their audiences significant knowledge and insight concerning matters of human interest has indeed been popular in philosophical aesthetics in the analytic tradition. Nevertheless, the opposite view has also had wide support. Skeptics have insisted that literary works do not furnish their readers with new knowledge, at least that of propositional kind, and that the works do not therefore have genuine cognitive value. According to these “anticognitivist” views, science and other knowledge‐seeking practices are the proper source of knowledge, and literature can merely offer an illusion of truth.

In this article, I discuss two intertwined issues in the recent literature and cognition debate. In the first part, I explore the benefits of “neo‐cognitivism,” suggesting that the concept of understanding outperforms the concept of knowledge in describing the various cognitive values associated with literature: the insights, viewpoints, and attitudes—the “enlarged comprehension”—that people are believed to gain from literature. 2 In the second part, I examine certain important factors that have been paid too little attention in the debate: the evidence that cognitivist theories provide for their claims and the methods used in studying learning from literature. I show that the question of evidence is complicated when it comes to neo‐cognitivism that is based on an unorthodox epistemological notion, namely, that of “understanding.” The problem is that because neo‐cognitivism describes the cognitive value of literature in terms of advancing the reader's understanding, it is very difficult to find articulations of those benefits, for the concept implies that they are ultimately nonverbal; yet, the neo‐cognitivist has to provide some evidence for his or her claims in order to avoid the dogmatic position that Hilary Putnam calls a “religion of literature.” 3 After studying different conceptions of justification implicit in the debate, I propose that the place to look for evidence for the cognitive benefits of literature is not psychological studies, which the naturalist‐minded skeptic favors, but the practice of literature and the study of it.

Although “cognition” in the general scientific sense refers to a wide variety of mental processes from language comprehension to problem solving, in analytic philosophy of literature it is customarily identified with the communication of knowledge and acquisition of true beliefs, cognitive value thus being narrowly epistemic value. 4 On the other hand, cognitivists have been rather reluctant to give elaborate definitions of their key concepts, such as ‘truth’ and ‘knowledge’—not to mention concepts, such as ‘vision’ or ‘insight.’ In the discussion, truth , for instance, is commonly understood in a pretheoretical sense, or to cover both truth as correspondence and truth as coherence. 5 As for knowledge , in turn, it has been proposed that there are three sorts of knowledge that literary works can afford: first, knowledge that, or propositional knowledge; second, knowledge how, or skills; and third—deriving from the second kind of knowledge—experiential knowledge.

Anticognitivists have presented a wide variety of arguments against the idea that literary works could make genuine, substantial contributions to knowledge. While there might be several plausible ways to support the traditional cognitivist view that literary works may provide their readers propositional and/or nonpropositional knowledge, the standard concepts of truth and knowledge certainly appear too narrow in comprehensively capturing the assumed cognitive benefits of literature. Moreover, in identifying the cognitive value of literature with truth and knowledge, literature is made subordinate to informative discourses and practices that constitutively seek knowledge. The question of the cognitive significance of literature is ultimately about the distinctive cognitive value of literature, not about literature's ability to mimic informative discourses or employ devices used in science and philosophy, such as thought experiments. Therefore, many cognitivists have been eager to find alternative epistemic notions in describing the cognitive value of literature.

During the recent decades, several philosophers have argued that the cognitive value of literature is not primarily in the works supplying new knowledge to readers but operating on the knowledge that readers already possess. These views may be called neo‐cognitivist theories . They state, roughly put, that the cognitive value of literature lies in the works “advancing” or “clarifying” readers’ understanding of things they already know, “enhancing” or “enriching” their existing knowledge, “entrenching” their ways of thinking, or helping them to “acknowledge” things, to see concepts contextualized in “concrete forms of human engagement.” 6 In addition to “deepening” readers’ knowledge, neo‐cognitivists see literary works capable of training readers’ cognitive skills , to make them psychologically more sensitive, for instance.

The basic idea behind neo‐cognitivism is compelling, and numerous philosophers are broadly sympathetic to the intuition. However, not only does the notion of “understanding” have different meanings for different neo‐cognitivists but also the concept is customarily described in a self‐consciously metaphorical way; not many philosophers have systematically explored it from an epistemological point of view. Indeed, Catherine Z. Elgin is among those few who have pursued the idea of art in the “advancement of understanding.” 7 Following Nelson Goodman, Elgin gives the concept of understanding a high priority. She claims that understanding should be a central epistemological concern, as the concept is needed to explain, for instance, why knowledge is valuable. 8 In Elgin's view, understanding differs from belief as it is about subject matters rather than individual propositions: we understand facts but also actions, techniques, pictures, and the like. 9 Further, understanding is holistic , as it covers the whole phenomenon and cannot be broken into bits. 10 Understanding may also be nonverbal , as in a mechanic's understanding of carburetors. 11 In addition, whereas one either knows or does not know a given fact, understanding comes in degrees : a professor and a student share many scientific beliefs, but they give them different significance. 12 In general, Elgin conceives understanding as a cognitive faculty that includes “the collection of abilities to inquire and invent, discriminate and discover, connect and clarify, order and organize, adopt, test, reject.” 13 She maintains that “perception, recognition, classification, and pattern detection” are all cognitive activities. 14 For her, the advancement of understanding is, among other things, conceptual reorganization that manifests in a person's ability to form insightful questions. 15

Applied to art, the idea of the advancement of understanding maintains that artworks may develop readers’ perception, provide them new perspectives to familiar things, help them acknowledge previously unnoticed relations between concepts, and offer them new categories for classifying objects. 16 In a nutshell, neo‐cognitivism holds that a reader (or viewer) needs to employ his or her concepts in order to comprehend an artwork and that precisely this conceptual rehearsal leaves its trace on the reader's (or viewer's) conceptual apparatus. In Elgin's example, the comparison of Michelangelo's Pietà and Picasso's Guernica , which both portray a woman holding her dead child—helps us to understand the difference between “incalculable sorrow” ( Pietà ) and “unmitigated grief” ( Guernica ); by comparing these paintings, we come to recognize that “grief … is grittier; it is tinged with anger. Sorrow … is smooth.” 17

The neo‐cognitivist's move from knowledge to understanding captures many familiar aspects in our encounter with literary works, and there is much in the position that makes it appealing. For example, our inability to draw “messages” out of literary works becomes a cognitive benefit of literature: rather than providing answers, literary works provoke questions and prompt us to explore solutions for them. This aspect is interesting as we attribute literary value to bewilderment and perplexity that characterize literary experience. Because of their complexity, literary works often escape our attempts to formulate theses out of their content; yet, we sense that the works are getting at something very important. Moreover, in preferring understanding to true beliefs we can attach cognitive value to false views that literary works express or convey and in comprehending—yet not accepting— distorted , for example, immoral, viewpoints. 18 In reading literature, we do not learn what the real world is like; rather, we come to learn what it looks like for a depressed person, for example. 19 Neo‐cognitivism could even account the cognitive value of propagandistic works, as the works, false (or mythological) by design, help us to understand persuasion and human psychology, for instance. Also, the procedural epistemology behind neo‐cognitivism, that is, the view that literary works trigger cognitive processes and that understanding comes in degrees, is intuitively absorbing. It could be used in explaining, from a cognitive point of view, why people return to works they consider important and why they render the works’ content differently in different times. The notion of degrees would also explain why people who differ in their literary competence get different views out of literary works.

The anticognitivist is not, however, satisfied with the neo‐cognitivist's ideas about conceptual reorganization and procedurality. Instead, the anticognitivist may claim that in explaining the cognitive benefits of literature in terms of “enhancing understanding,” the neo‐cognitivist merely “resorts to metaphors” or even takes a “full‐blown obscurantist position.” 20 The anticognitivist could also remark that “understanding” is already a disputable epistemological concept. Nevertheless, were the anticognitivist to consider the neo‐cognitivist's epistemological explanations descriptive enough, there is still the question of justification. Peter Lamarque wisely asks,

How is this “illumination” or “enhanced” understanding manifested? Would we expect that those immersed in the great works of literature understand people and the world better than those who are not so well read? Yet there seems no evidence that such readers are especially knowledgeable about human traits, as are psychologists or social scientists or even philosophers. 21

However, the parties of the debate are not in agreement about what counts as evidence of such changes. A look at different notions of justification is thus in place.

ii.A. The Armchair

Appeals to intuition as evidence have traditionally been central in analytic philosophy. In the philosophy of literature, the philosopher often illuminates her conception of “the” reader and the perlocutionary effect of a given work by describing her personal experience with the work; others are expected to react to the work the way the intuitive reader does. Moreover, it is a widely held belief in the philosophy of literature that interpretations can be, at least partly, normative : a philosopher can support her theoretical claims by showing that the interpretation she proposes is possible, rewarding, and better than its rivals. When it comes to the cognitive value of literature, it is thought that the philosopher's task is to show, by pointing to particular works, what kind of things readers can learn from literature and help others to see those features. The anticognitivist may, however, consider this way of justification insufficient and state that she has not herself recognized any conceptual change as a result of reading the work. She may claim that in reading the work she is simply offered a perspective toward the fictional content of the work. Because of these differing intuitions, both parties are eager to extend their claims as to describe how general readers react to fictional works.

A growing number of philosophers are dissatisfied with the traditional armchair approach. Gregory Currie argues that cognitivists’ claims of the educative function of the works “are all empirical claims with no self‐validating power” and that the educative function “cannot be known in advance of seeing what sorts of behavioural changes exposure to the narrative in question leads to.” 22

Currie's demand for empirical evidence points to a blind spot in the discussion. Nonetheless, one has to be careful in interpreting the cognitivist's claims. To begin with, there are roughly two different, although partly intertwined, philosophical projects interested in literature: first, the project that seeks to use literary works in philosophical enquiry and which has been prominent especially in moral philosophy and, second, the project that aims to explain the cognitive benefits of literature in general. Of these, the former project does not attempt to describe the practice of literature and cannot thus be accused for the lack of empirical evidence. Moreover, it is not always clear whether a philosopher's claims in the second project are descriptive or normative; “empirical” claims about general readers may be simply rhetorical. As for their normativity, one may of course ask if an epistemologically oriented philosopher is a good guide to literary interpretation. Notwithstanding, cognitivists have to a great extent ignored the reader and the actual effect the works might have.

ii.B. The Laboratory

In recent years, many philosophers have been eager to look at the sciences in order to advance the debate on literature and cognition. According to the naturalistic approach, promoted by philosophers such as Currie, philosophers should in the first place turn their eyes to psychological studies on actual readers. Because “we,” that is, human beings, have similar imaginative capacities and structure of the mind, together with certain shared cultural beliefs and attitudes, “we” are claimed to respond to fictional works basically the same way. 23 The study of these naturalistic tendencies is believed to shed light on philosophical issues.

At the same time, there has been a growing interest in the cognitive and emotive effects of literary narratives in psychology and neurosciences. The results of recent empirical psychological studies are diverse and controversial, and it is open to dispute what they can be said to show. To mention some examples, studies have attempted to show that readers really gain information from fictional narratives; that readers’ act of “transporting” themselves into the story affects their actual beliefs; that fictional narratives make long‐term changes in readers’ actual beliefs; that fictional stories foster empathy and emotional perception and allow people to experience and understand emotions more clearly than in real life; that reading fiction helps people to predict human behavior or understand life in terms of human intentions; that the understanding of characters in fictional narratives parallels the comprehension of peers in the actual world; and that reading literary fiction leads to improved performance on affective and cognitive theory of mind. 24

Despite that many psychological studies seem to support the cognitivist position, their explanatory potential in the philosophy of literature is not obvious. While psychologists themselves are often cautious in their conclusions, philosophers and literary scholars have tended to accept the alleged results at their face value. Not enough attention has been given to methodological matters such as: Were the narratives presented for the subjects literary narratives or artificial narratives devised especially for experimental purposes? Were the subjects given full literary works or just excerpts? How was the material introduced to the subjects? What sort of instructions they were given? How did the study eliminate the other possible cognition‐enhancing factors, such as reading nonfiction?

Indeed, many studies in empirical psychology seem to pose more questions than answers for a philosopher. For instance, in a recent study that gained much transdisciplinary interest, psychologists David Comer Kidd and Emanuele Castano measured the cognitive and affective effects of reading excerpts of different kinds of narratives by showing their subjects computer‐generated pictures of facially expressed emotions and asking the subjects to infer the character's thoughts and emotions from “minimal linguistic and visual cues.” 25 As the effects of reading excerpts of literary works were measured using fictional scenarios, one might argue that the study did not measure actual effects—or “real life responses”—of reading literary works proper. Currie thinks that while it may be true that the experiments so far conducted do not “target the conditions philosophers consider most conducive to literary education,” such as sensitive subjects and highly valued literary works, that may be known only by taking interest in the empirical work. 26 Indeed, Currie argues that philosophers should keep themselves aware of the state of the evidence and frame their hypotheses in ways that suggest how the tests may be carried out. Furthermore, he proposes that philosophical theories of epistemic value of literature—how we might learn from literature—are still needed in order to provide explanatory options for psychological work. 27

One might wonder whether cooperation between experimental psychologists and literary scholars might be the best way to gather evidence that would be experimentally rigorous and yet sensitive to the reading of literature. In fact, during the recent decades many literary scholars have been eager to apply the tools of experimental psychology and cognitive science to the interpretation of literary narratives. 28 In cognitive poetics, literary interpretation is studied using psychological concepts, such as schema and script . According to schema theory, the interpretation of human experience is an automatic process, an act of identification, in which the subject organizes experiential information using his or her existing cognitive frameworks or concepts ( schemas ), such as gender roles, and structure of actions performed in repeated situations ( scripts ), such as visiting a grocery store. 29

Literary scholars have, however, debated whether the interpretation of literary works could be reduced to the reader's act of employing her existing schemas. Those who support the fashionable idea of “unnatural narratives” have argued that many literary works, especially those of innovative sort, “defy, flaunt, mock, play, and experiment with some (or all) of these core assumptions about narrative.” 30 Literary works often twist readers’ “natural,” everyday schemas, perhaps creating new conceptions. 31 As the literary scholar Jan Alber sees it, “some literary texts not only rely on but also aggressively challenge the mind's fundamental sense‐making capabilities.” 32 Already in free indirect discourse, the origin of fictional thoughts—whether they belong to the experiencing or the narrating mind—is often unclear. From the cognitivist's point of view, the focus on narrative might also be questionable, for literary works might have cognitive value that cannot be reduced to their narrativity.

What is more worrisome is that in using cognitive psychological concepts, literary scholars and philosophers outsource the epistemology of literature to psychology and submit to natural scientific notion of knowledge, which manifests itself, for instance, in the quasi‐physical notion of event applied in cognitive narratology. Indeed, the empirical psychological study and the neo‐cognitivist's position seem utterly incompatible. The acquisition of knowledge from literature or short‐term improvements in perception might perhaps be (to some extent) scientifically studied, but as Putnam remarks, what the (neo‐)cognitivist is after is “a rival kind of knowledge, and hence inaccessible to scientific testing.” 33 The neo‐cognitivist notion of understanding seems closer to a hermeneutic phenomenological conception of knowledge, or knowledge of a person's comprehensive experience of the world. If we construe understanding from the point of view of the reader's phenomenological experience of the work, it is difficult to see how the actual cognitive benefits of literature could ever be quantified and measured. How could we test, for instance, how literature helps us to see the significance of things or gives meaning to our experiences or helps us to make our lifeworld? Such things can be evaluated only from the perspective of the subject , who gives the work a meaning, not outside him or her. The enhanced understanding gained by reading fictional literature is akin to happiness, marital satisfaction, or a mechanic's comprehension of carburetors in that it can be conceived only from inside. 34

Reading literature is not a natural activity, a stimulus–response mechanism, whose effects could be measured as one can measure how a human eye reacts to light. Instead, as has often been emphasized, literary works are cultural artifacts whose interpretation requires skills and knowledge, such as knowledge of literary conventions and history. The neo‐cognitivist's conception of understanding and the idea of reading as a cultural activity does not, however, remove the cognitivist's burden of proof; rather, it invites a look at literary interpretation as performed by professional readers.

ii.C. The Practice of Criticism

Peter Lamarque and Stein Haugom Olsen suggest that were literature to have cognitive value, we would expect to find evidence for it from the practice of criticism. As they see it, the proper “literary” way of reading is to be found from the core of criticism, literary analysis in particular. Lamarque and Olsen themselves think that the lack of debate on literary truths in criticism implies that truth is not a literary value. 35 In the neo‐cognitivist approach, in turn, criticism is a true treasure chamber. Critical analyses of how a given work challenges the reader's conceptual thinking, questions her standard conceptions, and provides her new categories, for instance, give valuable evidence—and insight—for the neo‐cognitivist. Indeed, even standard literary histories describe what sort of cognitive functions literary works have been given in different periods and literary genres. According to Jesse Matz,

The novel inherited by the moderns … seemed essentially traditional—slow, staid, set, and so unable to match the flux, the bewilderment, the excitement that now defined modern life. Therefore the moderns tried to “make it new” by trading the novel's regular forms for experimental forms of flux, perplexity, openness, skepticism, freedom, and horror. They replaced omniscience with fixed or fallible perspectives, broke their chapters into fragments, made sex explicit, and dissolved their sentences into the streams and flows of interior psychic life. 36

Of great importance are, of course, critical descriptions of particular literary works. Robin Feuer Miller says that, in The Brothers Karamazov , Dostoyevsky asks us to contemplate “great questions,” such as the problem of evil and the overcoming of grief felt at the loss of a child. 37 For Malcolm V. Jones, the novel “echoes and develops some of the most ancient paradoxes and preoccupations of humanity” and is capable of “plumbing and illuminating the depths of the human soul.” 38 In reading the work, we are invited to perform conceptual enquiries, for we “find ourselves drawn from our focus on the murder story to questions of moral responsibility and guilt, complicity and collusion.” 39 Moreover, this contemplating does not limit to the reading of the work, as “its characters and the dramatic events in which they participate continue to agitate the memory long after the book has been put down.” 40

Now, critics have the literary competence required in analyzing the cognitive content of the work and paraphrasing it. They describe in detail how literary works express and explore the abstract themes they are about. Nonetheless, in critical analysis, the cognitive function of literature is commonly approached in terms of implicit readers . Two questions emerge: first, do literary works genuinely contribute to actual readers’ thought (the perlocutionary effect) and, second, do critics and general readers approach literary works for same purposes, for example, for philosophical insights conveyed by a work? Noël Carroll, for one, claims that philosophers have not paid enough attention to the common reader but “often build their theories in response to certain epistemological constraints that have little to do with the actual reception of art.” 41 After pointing the way to “the actual reception of art,” Carroll however reverts to his armchair view of the general interests of “typical consumers of art and literature.” 42 However, the question of actual reception needs to be explored.

ii.D. The Practice of Literature

In debating the cognitive value of literature, cognitivists and their opponents tend to disagree about what the “common reader” looks for in literature. Eileen John, for one, thinks that readers frequently take a philosophical, that is, conceptual analytical, attitude to certain kinds of literary works. 43 Lamarque objects to John's claim by saying that readers seldom have “‘cognitive’ expectations,” for they “are not commonly motivated to read such works by the thought that they will learn something.” 44 Lamarque states that conceptual clarification rather “looks like a contingent by‐product of reading.” 45 Is it? The aprioristic debate quickly arrives at a dead end. Moreover, speculations about typical literary responses seem futile, as there is information concerning common readers, the consumptors of literature.

In addition to the practice of academic literary analysis that provides us information about how professional readers approach literary works, there are literary studies on reception as performed by general readers. Some of these studies are explicitly after the question of how texts change the minds and lives of actual readers. 46 Reception studies carried out in literary studies cover various approaches from reception history to sociological studies of contemporary audiences and even social psychology; the studies may, for example, examine critical response or employ interviews in qualitatively studying actual readers.

For instance, literary historical studies on the reception of particular works illustrate how the works have been approached and understood in different times. Such studies are important in showing, for example, that for the readers of The Brothers Karamazov , “cognitive expectations” have always been central. 47 Interestingly, certain recent studies of contemporary audiences suggest that while people report to read fictional literature primarily for pleasure, that is, entertainment and relaxation, the cognitive factor, their motive to gain knowledge or enlightenment from reading, is also significant. 48 What makes literary reception studies important for the neo‐cognitivist is that they examine the reading of actual and complete literary works in the actual setting: the literary practice. Nonetheless, sociological literary studies, for instance, might not deeply capture the insights that people think they have gained from literature. As suggested earlier, the neo‐cognitivism view of understanding calls for a subject's point of view.

In addition to the two promising sources of evidence (or aspects to it), critical analysis and literary reception studies, evidence for the neo‐cognitivist might be found from readers’ descriptions of their literary experiences, especially as expressed in nonfictional writings that traditionally link to literature and emphasize one's influences and attitudes to life: essay and autobiography. For example, in his memoirs, the philosopher Georg Henrik von Wright describes one of his intellectual awakenings:

In my solitary walks in Buenos Aires [in 1968] my mind was occupied with disturbances in Paris and other parts of the world. I came to deeply realize Dostoyevsky's story about the Grand Inquisitor. I felt as if I understood the profound, tragic meaning of life and history: if a man should carry out his natural capabilities to do good, he has to have a freedom to do evil. One capability requires another. The powers of self‐preservation and self‐annihilation keep each other in balance in the man. I mention this episode, because it gave me the attitude that still determines my thinking. It is not objective knowledge, but a way, though not the only way, to contemplate life. 49

Von Wright's statement is impressive, but many philosophers and literary theorists alike suspect references to actual readers because of the assumed idiosyncrasy of the responses. Of course, our knowledge of readers’ actual responses to literary works does not solve any philosophical debates. Of course, studies of literary reception are more or less contingent, as they deal with particular literary cultures, particular works, and particular readers. Of course, reception studies require interpretation and critical consideration as for their aims, concepts, methods, and results. Nevertheless, one's looking at descriptions of personal literary experiences and literary reception studies can shed light on the values that people look for in literature and hopefully give an insight of what people think they have gained from reading the works. Do they look for “insight, revelation, and enlarged comprehension” in reading literature, and do they report to come to see things, such as the difference between “incalculable sorrow” and “unmitigated grief”? At least von Wright did; in his later life, he wrote several philosophical essays on the insights he had drawn from Dostoyevsky and other authors.

I agree with those who are skeptical about the cognitive value of literature in that the cognitivist has to support his or her claims about the cognitive value of literature with evidence stronger than mere reference to the textual features of the works. At the same time I am afraid that there is no direct way to such evidence. As for its methodology, philosophy of literature is perhaps best considered in a pluralistic fashion. It needs a metacritical element in order to understand what it is to approach a literary work as an artwork. If the enhancement of understanding is an important literary phenomenon, one will find evidence for it from the practice of criticism. Nevertheless, academic literary analysis is theory driven and does not represent all the values that general readers search for in literature; nor does critical analysis examine the perlocutionary effects of the works. It is thus important for a philosophical survey to also have a constraint from the actual practice of literature. While the reception of literature can be studied from various viewpoints, I propose that a philosopher would benefit most from looking at literary historical and sociological reception studies conducted by literary scholars, for such studies are acquainted in theories of reading and examine the actual practice of literature. Finally, in understanding in what ways literary works actually advance one's understanding and affect one's thought, we need the subject's, the reader's, point of view, to which documents such as essays and autobiographies provide one route.

What is the place for the philosophy of literature, then? It is in the overall analysis of the phenomenon of literature. As for studying the cognitive benefits of literature, there are philosophical issues, such as the notion of “cognitive benefit” and the relation between aesthetic and cognitive values in literature. Even if the results of empirical studies of literary reception were to be univocal and prove that fictional literature has cognitive benefits, the fact that people learn from literature is not much of a discovery. After all, various sorts of things may “enhance our understanding,” and yet we hesitate to call these things, such as gossiping about one's neighbor, cognitive practices. 50 A philosophical theory would need to account the distinctive features of literary cognition, that is, how literary works provide heightened perception in a unique way, as works of literature. Critics’ descriptions of literary works’ cognitive content are often metaphorical, especially when the works provide new viewpoints or violate the commonplace, and the “plumbing and illuminating the depths of the human soul” calls for epistemological scrutiny.

The notion of “cognitive value” in literary aesthetics also requires reexamination. One thing is, as I have proposed, the move from knowledge to understanding, which seems fascinating but requires much more theoretical exploration. The other is the demand for the cognitive payoff of literature, which, in turn, seems too strict. Anticognitivists often imply that in order to be cognitively valuable, learning from literature should be equal to that of learning scientific facts. Obviously this is partly due to cognitivists’ grandiose claims of the beneficial effects of literature and their eagerness to place art on a par with science. Perhaps we need new analogues. For example, the reading of nonfiction, such as essays, biographies, and journals, hardly offers readers revolutionary changes in worldview or insights that stay with them for the rest of their lives—things anticognitivists regularly consider to be in the heart of “cognitive value.” More often, learning from nonfiction assumedly amounts to slight changes in the reader's understanding of things. Perhaps even the readers of self‐help guides soon forget the informative content of the works, not to mention acting upon that information, although the guides are written and read in order to (completely) change one's life. Presumably a large part of the “cognitive content” of both nonfiction and fiction is in the works inspiring one in one's journey.

Many will object that the neo‐cognitivist notion of understanding makes the cognitive outcome of literature too contingent. What is it that we learn in literature? Does a given work enhance our understanding in a certain way, say, under the perspective of authorial control, or is it that literature influences more than educates us? Von Wright, for instance, speaks of his impression and suggests that the insight he has gained from The Brothers Karamazov has a subjective and affective dimension. Does this lead to a position we have to avoid? Do we have to stick to the rather questionable idea of “objective meaning” of a literary work and maintain that the cognitive content of a literary work is fixed and will be automatically grasped in the act of reading? Indeed, the turn from knowledge to understanding implies a difficult move from text to experience. Clearly, a great deal of theoretical work is needed to properly establish such moves, but the road seems worth taking.

Dorothy Walsh, “The Cognitive Content of Art,” Philosophical Review 52 (1943): 433–451, at p. 433.

The term ‘neo‐cognitivism’ is adopted from John Gibson, “Cognitivism and the Arts,” Philosophy Compass 3 (2008): 573–589.

Hilary Putnam, “Literature, Science, and Reflection,” in Meaning and the Moral Sciences (London: Routledge and Kegan Paul, 1978), pp. 83–94, at p. 89.

For traditional notions of the cognitive value of literature, see, for example, Monroe C. Beardsley, Aesthetics: Problems in the Philosophy of Criticism , 2nd edition (Indianapolis: Hackett, 1981), p. 426, and M. J. Sirridge, “Truth from Fiction?” Philosophy and Phenomenological Research 35 (1975): 453–471, at p. 453.

Actually, there may even be several conceptions of truth underlying a single theory of literary truth. See Peter Lamarque, The Philosophy of Literature (Oxford: Blackwell, 2009), at pp. 225–227.

Respectively, Catherine Z. Elgin, “Understanding: Art and Science,” Synthese 95 (1993): 13–68; Noël Carroll, “Art, Narrative, and Moral Understanding,” in Aesthetics and Ethics: Essays at the Intersection , ed. Jerrold Levinson (Cambridge University Press, 1998), pp. 126–160; Gordon Graham, Philosophy of the Arts: An Introduction to Aesthetics , 2nd edition (London: Routledge, 2000); Eileen John, “Reading Fiction and Conceptual Knowledge: Philosophical Thought in Literary Context,” The Journal of Aesthetics and Art Criticism 56 (1998): 331–348; and John Gibson, Fiction and the Weave of Life (Oxford University Press, 2007), pp. 111, 116.

Elgin derives the idea of preferring the “advancement of understanding” to formation of belief from Nelson Goodman, who also prefers ‘rightness’ to ‘truth.’ See Nelson Goodman, Ways of Worldmaking (Indianapolis: Hackett, 1978), at pp. 22, 109–110.

Catherine Z. Elgin, “Understanding and the Facts,” Philosophical Studies 132 (2007): 33–42; see also Catherine Z. Elgin, “From Knowledge to Understanding,” in Epistemology Futures , ed. Stephen Hetherington (Oxford: Clarendon Press, 2006), pp. 199–215.

Catherine Z. Elgin, Considered Judgment (Princeton University Press, 1996), p. 123.

Catherine Z. Elgin, “Understanding's Tethers,” in Epistemology: Contexts, Values, Disagreement , eds. Christoph Jäger and Winfried Löffler (Frankfurt: Ontos Verlag, 2012), pp. 131–146, at pp. 131–132.

Elgin, “Understanding: Art and Science,” p. 14.

Elgin, “Understanding and the Facts,” p. 36; see also Catherine Z. Elgin, “Is Understanding Factive?” in Epistemic Value , eds. Adrian Haddock, Alan Millar, and Duncan Pritchard (Oxford University Press, 2009), pp. 322–330, at p. 325.

Nelson Goodman and Catherine Z. Elgin, Reconceptions in Philosophy and Other Arts and Sciences (London: Routledge, 1988), p. 161.

Catherine Z. Elgin, “Reorienting Aesthetics, Reconceiving Cognition,” The Journal of Aesthetics and Art Criticism 58 (2000): 219–225, at p. 219.

See Catherine Z. Elgin, “Art in the Advancement of Understanding,” American Philosophical Quarterly 39 (2002): 1–12.

See Elgin, “Art in the Advancement of Understanding.” For a variation of this view, see David Novitz, Knowledge, Fiction, and Imagination (Temple University Press, 1987), pp. 119–120.

Elgin, “Understanding: Art and Science,” p. 23.

Here, see Catherine Z. Elgin, “True Enough,” Philosophical Issues 14 (2004): 113–131.

See Putnam, “Literature, Science, and Reflection,” pp. 89–90.

Peter Lamarque, “Learning from Literature,” The Dalhousie Review 77 (1997): 7–21, at pp. 19–20; and Putnam, “Literature, Science, and Reflection,” p. 89. (On metaphors, see also Jerome Stolnitz, Aesthetics and Philosophy of Art Criticism: A Critical Introduction [Boston: Houghton Mifflin, 1960], pp. 305–306; and Jerome Stolnitz, “On the Cognitive Triviality of Art,” British Journal of Aesthetics 32 [1992]: 191–200, at pp. 191–193, 196.)

Lamarque, “Learning from Literature,” p. 20.

Gregory Currie, “On Getting Out of the Armchair to Do Aesthetics,” in Philosophical Methodology: The Armchair or the Laboratory? ed. Matthew C. Haug (New York: Routledge, 2013), pp. 435–448, at pp. 446 and 447. For criticism of the lack of evidence in literary theory, see also Colin Martindale, “Empirical Questions Deserve Empirical Answers,” Philosophy and Literature 20 (1996): 347–361, and Richard A. Posner, “Against Ethical Criticism,” Philosophy and Literature 21 (1997): 1–27, at pp. 9–10.

See Gregory Currie, Narratives and Narrators: A Philosophy of Stories (Oxford University Press, 2010), pp. 111–112, 116.

Respectively, see, for example, Elizabeth J. Marsh, Michelle L. Meade, and Henry L. Roediger III, “Learning Facts from Fiction,” Journal of Memory and Language 49 (2003): 519–536; Melanie C. Green and Timothy C. Brock, “The Role of Transportation in the Persuasiveness of Public Narratives,” Journal of Personality and Social Psychology 79 (2000): 701–721; Markus Appel and Tobias Richter, “Persuasive Effects of Fictional Narratives Increase Over Time,” Media Psychology 10 (2007): 113–134; Dan R. Johnson, “Transportation into a Story Increases Empathy, Prosocial Behavior, and Perceptual Bias toward Fearful Expressions,” Personality and Individual Differences 52 (2012): 150–155; P. Matthijs Bal and Martijn Veltkamp, “How Does Fiction Reading Influence Empathy? An Experimental Investigation on the Role of Emotional Transportation,” PLoS One 8 (2013): doi: 10.1371/journal.pone.0055341; Keith Oatley, “Why Fiction May Be Twice as True as Fact: Fiction as Cognitive and Emotional Simulation,” Review of General Psychology 3 (1999): 101–117; Richard J. Gerrig and David N. Rapp, “Psychological Processes Underlying Literary Impact,” Poetics Today 25 (2004): 265–281; Raymond A. Mar and Keith Oatley, “The Function of Fiction Is the Abstraction and Simulation of Social Experience,” Perspectives on Psychological Science 3 (2008): 173–192; Raymond A. Mar, Keith Oatley, Jacob Hirsh, Jennifer dela Paz, and Jordan B. Peterson, “Bookworms versus Nerds: Exposure to Fiction versus Non‐Fiction, Divergent Associations with Social Ability, and the Simulation of Fictional Social Worlds,” Journal of Research in Personality 40 (2006): 694–712; Raymond A. Mar, Keith Oatley, and Jordan B. Peterson, “Exploring the Link between Reading Fiction and Empathy: Ruling Out Individual Differences and Examining Outcomes,” Communications 34 (2009): 407–428; David Comer Kidd and Emanuele Castano, “Reading Literary Fiction Improves Theory of Mind,” Science 342 (2013): 377–380.

Kidd and Castano, “Reading Literary Fiction Improves Theory of Mind,” p. 379.

Currie, “On Getting Out of the Armchair to Do Aesthetics,” p. 444.

Gregory Currie, “Methods in the Philosophy of Literature and Film,” in The Oxford Handbook of Philosophical Methodology , eds. Herman Cappelen, John Hawthorne, and Tamar Szabó Gendler (Oxford University Press, forthcoming).

For theories of literary interpretation that rely on cognitive psychology and cognitive science for literary interpretation, see, for example, David Herman, Storytelling and the Sciences of Mind (MIT Press, 2013); Lisa Zunshine, Why We Read Fiction (The Ohio State University Press, 2006); Alan Palmer, Fictional Minds (University of Nebraska Press, 2004); and Richard J. Gerrig, Experiencing Narrative Worlds: On the Psychological Activities of Reading (Yale University Press, 1993).

For an illustration of—and doubt in—explaining interpretation in terms of schemas and scripts, see, for example, Richard J. Gerrig and Giovanna Egidi, “Cognitive Psychological Foundations of Narrative Experiences,” in Narrative Theory and the Cognitive Sciences , ed. David Herman (Stanford: CSLI Publications, 2003), pp. 33–55, at pp. 40–41.

Jan Alber, Stefan Iversen, Henrik Skov Nielsen, and Brian Richardson, “Unnatural Narratives, Unnatural Narratology: Beyond Mimetic Models,” Narrative 18 (2010): 113–136, at p. 114.

See, for example, Jan Alber, Stefan Iversen, Henrik Skov Nielsen, and Brian Richardson, “What Is Unnatural about Unnatural Narratology? A Response to Monika Fludernik,” Narrative 20 (2012): 371–382.

Jan Alber, “Impossible Storyworlds—and What to Do with Them,” Storyworlds: a Journal of Narrative Studies 1 (2009): 79–96, at p. 80.

Putnam, “Literature, Science, and Reflection,” p. 89; emphasis in original.

For an illuminating philosophical inquiry on the advancement of a mechanic's experiential understanding of engines, see Matthew B. Crawford, Shop Class as Soulcraft: An Inquiry into the Value of Work (New York: Penguin, 2009).

Peter Lamarque and Stein Haugom Olsen, Truth, Fiction, and Literature: A Philosophical Perspective (Oxford University Press, 1997), pp. 332–333. Some philosophers have, however, argued that critics do explicate implicit theses in literary works and that it is the task of general readers to evaluate the theses. See Peter Kivy, Philosophies of Arts: An Essay in Differences (Cambridge University Press, 1997), pp. 122, 125; see also Noël Carroll, On Criticism (New York and London: Routledge, 2009), p. 56. Some others have argued that certain critical terms, such as “profundity” or “psychological plausibility,” have a conceptual connection with truthfulness; see M. W. Rowe, “Lamarque and Olsen on Literature and Truth,” Philosophical Quarterly 47 (1997): 322–341, at p. 336, and Gregory Currie, “Literature and Truthfulness,” in Rationis Defensor: Essays in Honour of Colin Cheyne , ed. James Maclaurin (Dordrecht, the Netherlands: Springer, 2012), pp. 23–31, at pp. 28–30.

Jesse Matz, “The Novel,” in A Companion to Modernist Literature and Culture , ed. David Bradshaw and Kevin J. H. Dettmar (Malden, MA: Blackwell, 2006), 215–226, at p. 215.

Robin Feuer Miller, The Brothers Karamazov: Worlds of the Novel (Yale University Press, 2008), pp. 5 and ix.

Malcolm V. Jones, Introduction to The Brothers Karamazov (New York: Knopf, 1992), pp. i–xiv, at pp. i, ii.

Jones, “Introduction,” p. iv.

Jones, “Introduction,” p. i.

Noël Carroll, “The Wheel of Virtue: Art, Literature, and Moral Knowledge,” The Journal of Aesthetics and Art Criticism 60 (2002): 3–26, at p. 15; see also Peter Kivy, “On the Banality of Literary Truths,” Philosophic Exchange 28 (1997): 17–27, at pp. 20–21.

Carroll, “The Wheel of Virtue,” p. 15.

John, “Reading Fiction and Conceptual Knowledge,” p. 331.

Lamarque, The Philosophy of Literature , p. 254.

Lamarque, The Philosophy of Literature , p. 250.

See Jonathan Rose, “Rereading the English Common Reader: A Preface to a History of Audiences,” Journal of the History of Ideas 53 (1992): 47–70.

See, for example, Julian W. Connolly's account of critics’ and common readers’ (early) responses to the work, including the reactions of Nietzsche, Zweig, Hesse, Freud, and Mann, in Julian W. Connolly, Dostoevsky's The Brothers Karamazov (London and New York: Bloomsbury, 2013), chap. 5.

For a detailed review of some such studies, see Anders Pettersson, The Concept of Literary Application: Readers’ Analogies from Text to Life (New York: Palgrave Macmillan, 2012), pp. 171–180.

Georg Henrik von Wright, Mitt liv som jag minns det ([“My Life as I Remember it”] Stockholm: Söderström, 2001), p. 267. Author's translation.

See Lamarque, The Philosophy of Literature , p. 248.

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