Imagine this: You are taking a final exam in school and, afterward, realize that you got an answer to one question wrong. You immediately think, Well, I must have failed the exam based on that one wrong answer. This is not an uncommon response to this type of situation, and it is an example of all-or-nothing thinking, which is one of multiple negative thought patterns we commonly experience. But what does this have to do with cognitive restructuring?
Some of us experience negative thoughts on a somewhat frequent basis and are not truly aware of just how much these thoughts impact our daily lives. So, how do we change these thought patterns? One way that is often used in Cognitive Behavioral Therapy (CBT) is Cognitive Restructuring.
What Is Cognitive Restructuring?
Cognitive Restructuring is a therapeutic step-based process that guides you through how to identify negative thought patterns (which are referred to as cognitive distortions), assess your behavioral responses, challenge these distortions in thinking, and develop healthier and more accurate alternative thought patterns. Most of us have negative thoughts. But they are not truly cognitive distortions unless they are persistent.
Here’s another scenario: A good friend of yours forgets your birthday, and you casually remind them of it the next day. Your friend profusely apologizes and says, in a very serious tone, I am the worst friend ever. This is something you have heard them say many times before, and you have told them they are not the worst friend. This is an example of cognitive distortion. This type of thinking is what cognitive restructuring pinpoints and seeks to change through a series of steps which start with exploring and identifying emotions and/or behaviors.
Cognitive Restructuring Treatment
A therapist will generally start out by having their client focus on identifying their negative emotions and/or behaviors. Therapists might ask questions about what feelings occur in life’s most difficult moments and/or what types of behaviors are triggered in alarm situations. An alarm situation could be feeling anxious and experiencing heart palpitations before going out for drinks with a friend. There is also feeling depressed when you are spending the evening alone at home because your friend had other plans.
In order to understand why negative and intrusive thoughts and feelings occur in these triggering alarm situations, therapists often follow a step-by-step process for cognitive restructuring. This starts with educating clients on what cognitive distortions are and how these distortions impact clients’ moods and behaviors.
3 Major Steps: How Does Cognitive Restructuring Work?
Steps in cognitive restructuring typically are as follows:
1. Psychoeducation of Clients
Generally, many therapists start off by discussing what cognitive restructuring is and what its goals are with clients. They also inform their clients of what cognitive distortions are, provide a few relevant examples, and explain how these negative thought and behavior patterns hold such a powerful sway over people’s lives.
Therapists will sometimes have printed lists of common cognitive distortions for their clients to read through. They will then enter into a discussion of whether these types of thoughts seem realistic or irrational to their clients. Some therapists might ask their clients to circle or place check marks next to the alarm situations they have previously experienced.
The common cognitive distortions list will usually include examples of:
- Magnification and minimization;
- Personalizing everything;
- Magical thinking;
- Emotional reasoning;
- Jumping to conclusions;
- Should statements;
- Disqualification of the positive;
- All-or-nothing thinking.
2. Becoming More Mindful of Cognitive Distortions and Recording Responses
The second step in the cognitive restructuring process is for a client to become more aware of the negative thoughts and associated behaviors when they occur. Asking What led me to feel/think/act this way? helps trace the triggers for cognitive distortions. Knowing the warning signs to be cognizant of is crucial in restructuring thought and behavior patterns.
For example, you feel anxious about going out with your friend to a new bar in town. So you realize that your anxiety stems from going to an unfamiliar place. When you recognize what is triggering your anxiety, you then record your thoughts and feelings. Thought recording is a core component of cognitive restructuring and is a way to assess thoughts, emotions, behaviors, and more positive alternative responses.
3. Questioning, Decatastrophisizing, and Evaluating
Socratic questioning (such as Is this thought I am having realistic?) helps individuals assess whether or not there is evidence for the type of thought they are having. Are these thoughts habitual or misinterpreted? Decatastrophisizing gets people to think about what’s the worst that could actually happen and helps minimize anxious responses to potential alarm situations.
These what if questions get people to think about how situations might realistically play out versus how they catastrophize them in their minds. This leads to an evaluation of these thoughts where therapists have their clients judge their own thoughts based on the evidence they have gathered. The final verdict should come in the form of a realistic thought.
Does Cognitive Restructuring Really Work?
Specialists have intensively studied and therapeutically used cognitive restructuring for decades.
- Studies have shown it to be effective in reducing many types of cognitive distortions, including test-taking anxiety and negative self-perceptions of female athletes.
- Therapists use cognitive restructuring as an alternative to exposure treatment. This is even though studies find that both types of treatment can be effective for different people with various diagnoses.
- The long-term impact of cognitive restructuring is difficult to empirically measure. But many clients (and therapists, who tend to use cognitive restructuring themselves) see lasting improvements in how they think, feel, and behaviorally respond to alarm situations.
Cognitive restructuring isn’t an exact science. But it is a CBT process that, for many people, is effective in changing cognitive distortions into accurate thoughts. So therapists widely use it as a means to continue even after the treatment ends.
Targeting triggers and assessing the rationality of our thoughts can lead us to successful thinking.
The images are from depositphotos.com.